Universal Health Services Inc (UHS) May 12, 2026 Conference Transcript

With Universal Health Services presenting today, we have Darren Larrick, who's the VP of Investor Relations. I don't know, did you want to say anything before we start or should we jump right into Q&A? All right. Well, then, I guess there were a lot of pieces, moving pieces with Q1. You think about California staffing and STPs and weather and flu and ACA. So, like, I think everyone's trying to do their own math about what core growth was in Q1. Can you kind of give us your thoughts on what? Core growth-wise in Q1?

I think I've heard that question before. Well, Kevin, great to see you and be at the conference with you and the team. Good to see you yesterday. We had the opportunity to visit one of our facilities in the Las Vegas market, and hopefully you got a good flavor for that. We've got a really impressive group out here. So, yeah, so to your question, Kevin, I think when you step back from the first quarter, what we started with was, I think first, the quarter was in line with our expectations, and there were a number of known headwinds that we had when we issued our guidance with the fourth quarter results. First quarter, same-store results in our acute care business, revenues were up about 8%, and same-store revenue growth in our behavioral was up about 7%. You know, we've commented that there's a bit of a stronger contribution from pricing, you know, and we had some seasonal factors that impacted our volume in the quarter. However, I think if you think about those seasonal factors, primarily weaker flu on the acute care side, and then a little bit of weather disruption on the behavioral side, and excluding some of those factors, I think we were right in the 2% range from a volume perspective in both segments. Pricing growth in the quarter included core growth. You know, we put that at around 3%, and the benefit of, you know, funding from some of the Medicaid supplemental programs that were approved last year, we had a $133 million year-over-year increase in those payments. So, you know, given all the... Sort of focus on the increase in those Medicaid supplemental payments. We've been getting this question a lot, you know, what was the core growth? And I think just to sort of give you the headline, we would put it at around down 20 million or so, so down around 3%. And, you know, that math exercise, you know, essentially is we had a $15 million headwind related to the exchanges that we, you know, it was part of our guidance that we reaffirmed. We had about a $30 million impact split between behavioral and acute on the seasonal factors related to flu and respiratory. We had about a five million dollar... Impact for the readiness for the California staffing regulation that begins in June. And then on a non-same store basis, we have a number of de novo hospitals, and there was about a $15 million non-core. A type of headwind in the first quarter on that. So, you know, put all those things together, it kind of adds up to about a $20 million or down roughly 3% number. And, you know, obviously, we expect that to improve over the balance of the year.

Can you help us bridge then how that goes for Q1 for the rest of the year?

Yeah, so I think there's really four components to that. So, you know, clearly when your volumes have, you know, some pressure, as we saw in the first quarter, you lose some operating leverage. And we do expect volumes to improve as we, you know, look at the rest of the year, reaffirm the 2% to 3% zone that, you know, we think we can achieve. Part of that is we have a bit of new capacity coming online and acute. We've got about 2% of new capacity growth coming online. Some of that you'll see in the second quarter, but certainly in the second half of the year, so as that capacity gets absorbed, you'll see some benefit there. So operating leverage between both segments. The second piece is we've talked a lot about the investments that we've made in behavioral in terms of headcount, and really those investments were made to better accommodate the demand that we're seeing and be able to grow our volumes a bit better. And so in behavioral, we expect there to be somewhat of a moderation in headcount growth in 26. Headcount grew about 4%. In 25, against 1% volume growth, we expect headcount growth to be more closely in line with volume growth this year, so closer to that 2% level. It stepped down in the first quarter. It was about 2.5% or so headcount growth in Q1. And, you know, as we kind of move down into the 2% range, I think that will contribute some positivity to the P&L. And then two more things, Kevin, I would say, you know, we don't talk a lot about our health plan. We've got a, you know, pretty high-performing, high-quality health plan in the state of Nevada, particularly in northern Nevada. We achieved four stars, so we went from three and a half to four stars. So that should be about a $25 million tailwind for the year. And we had been losing a little bit of money last year, make some money, and that's a positive. And then, you know, look, we have talked a lot about our Cedar Hill. The DeNovo Hospital, we've got $50 million built into our guidance of improvement, so we lost $50 million in startup losses last year. We expect to achieve break-even for the full year. Some gradual improvement as we move through the year should also help the underlying. That does enter our same-store group in the second quarter.

All right, great. And then that 2% to 3% volume number that you guys outlined for both the acute and the behavioral, it sounds like you're saying you think Q1 was essentially 2% if you kind of adjust for blue in both of those numbers. How are you thinking about the fundamental demand of both of those businesses right now to get to that 2% to 3%?

Yeah, so, you know, I think first, it starts with the markets, right? We have, for a long time, you know, really gravitated, especially in our acute care division, when you look at our footprint, to markets with stronger than average population growth compared to the U.S., you know, overall strong demographics, and so those are, you know, key elements of the demand drivers in our business. So if you're in good markets and, you know, can grow at a higher rate because of the underlying trends in the market, we've also invested pretty heavily in our market. So I talked about some capacity that we're adding in both divisions, both acute and behavioral, but in particular on acute, we've got a number of big bed tower projects that, you know, will be coming online here in the second quarter. And then we're opening our 30th hospital this month in Florida on a really attractive market. That will be de novo, but worth mentioning just that hospital because it's in the Palm Beach Gardens, Jupiter area. And, you know, that will be embedded growth as we think about, you know, future years, just given the strength of that market. You know, and then I think the strategies that we employ, so alignment with our physicians, investments that we make in outpatient, all the things that, you know, really contribute to volume, I think. As it relates to the exchanges, the reduction in exchange volume that we've talked about is really more of a payer mix shift issue for us, the way we think about it, than it is a volume drag. We think a lot of those exchange members that are losing coverage or not paying their premiums ultimately show up at the hospital. Included in our $75 million exchange impact or headwind for this year is really the notion that the vast majority of those will convert to some form of uninsured as opposed to volumes. That's a lesser part of it. Kevin, on the behavioral side, you know, I think the last few quarters, we've exhibited much better, you know, momentum around volume. So the last four quarters, you've seen sequentially improving volume. We talked about in the first quarter, we reported 1.6% adjusted patient day growth. If weather was a little bit more widespread and the behavioral impact, that was about a 50 basis point impact overall, and so that would have gotten straight into that 2% range. I think for us, the two big drivers of volume and behavioral that we think will get us more deeply into the 2% to 3% range are going to be, again, investing in headcount, which we've done most of that in 2025. And then really focusing more aggressively on our outpatient strategy, which we're doing with some capital with the talk space acquisition. We can certainly cover that one, but also some things that we're doing from an internal perspective.

Can you talk a little bit about the behavioral investment? Because it sounds like you added 4% to labor force, but it sounds like the volumes hasn't been matching the 4%. Did you get what you wanted to out of that lift? And why is it only 2% necessary going forward if you did 4% last year?

Yeah, so I think if you look at the progression of our volume, we went from kind of... Negative in first quarter to exiting the year around one and a half percent. And so I would attribute some of that incremental progress to the investments that we made in headcount. So roughly 4% growth in headcount. There's obviously onboarding and training and things like that that go into bringing those folks on. And we exited the year, you know, as I said, around 3.5%, 4% headcount growth. And that stepped down a little bit closer to 2.5% in the quarter. So, you know, when we think about our ability to service the volume that we have, we have the capacity in many of our facilities. These from a bed perspective, we're operating in the kind of low 70% with our occupancy rates. And now it's really just about, you know, matching volume with staff and being able to get the operating leverage from that.

Okay. And then you mentioned the formal care act being more of a pair mix issue, but it seems like Q1 was a little bit lower than kind of what the annualized number would have implied it to be, which is kind of what a lot of the companies are saying right now. So, I mean, I think you indicated that it was going to ramp as the year goes on. So, I guess, A, what are you seeing there? But then, B, if it's ramping as the year goes on, does that mean 27 is a bigger annualized cut than 26? Or is it something about the seasonality of that business that should always be lower in Q1?

Yeah, no, I appreciate that question. So, yeah, so. Exchange, health insurance exchange volumes, the observed trend in the first quarter was down 5%, and what

we really did

in the quarter was we had a $15 million impact in the first quarter, and more than half of that was an additional reserve that we took, Which really kind of takes into account this idea that our fully loaded exchange volumes will ultimately be down closer to 11% to 12% after we see kind of who pays premiums and who doesn't and the effectuation rate of those individuals that we serve that may not even have coverage at the end of the day. So that's really what that impact was. And we did make the comment. That the impact would steepen a little bit as we move through the year. And so there's a few things that go into that, you know, first. We did have, in 2025, we had a little bit of a buildup of our exchange volumes, so ended in the second half higher than what we were in the first half, so the expectation is that the year-over-year reduction in exchange volumes as a result will be a little bit steeper. But I think we also built in the idea that there's some shift in metal tier. So some of the behavior may change in terms of utilization. Certainly the out-of-pockets and some of the uncollectibles were in that $75 million number that we expect to build throughout the year. So I think it's a little early to... You know, say for sure exactly how the rest of the year plays out. We'll probably know more in the second quarter. I think it's fair to say there's probably a little bit of a headwind as we think about 27, just given the dynamic that we had a higher, you know, exchange mix last year, and then the decline is a little bit bigger. I don't think it'll be that much, you know, that material as we think about 27.

Okay, and when we think about the... Florida SDPs, you guys put out an AK, I guess, last week, right, with a 25 approval, but we don't have the 26 approval. Can you just go through kind of where we are and all of that right now?

Yeah, so, you know, certainly a lot of questions in the Florida program now for several months. A lot of providers obviously have exposure to that market. And, you know, we were, I think, pleased to see the approval. It shows that even in this current administration, there's recognition that these Medicaid supplemental payments are part of the broader funding mechanism for providers and hospitals. In many states, you know, Medicaid base rates are underfunded. And so that's why these programs were designed. And, you know, we think they aren't going away there. They'll continue to be there. There's obviously some things that legislation last year that will change that a little bit in the future. As it relates to Florida. So we did note in our 10Q filing last week that the program was approved, and it relates to the fiscal 25 program, so October 1 of 24 to September 30 of 25. The incremental benefit that we expect relative to the previous program would be $100 million of incremental supplemental benefit, and we'll record that in our second quarter coming up here. The 26 program has not been approved. We fully expect it to be approved. It's just, you know, it's lagging the 25 approval. It remains to be seen if it'll be approved in the same way, the same structure. And so we don't have an estimate on that yet. And at this point, you know, the 25 is the known amount.

Is there a nuance that would make you think that it would be potentially noticeably different? Than the 25?

No, I think it's really just a reticence to, you know, provide an estimate on that program until it's approved and the structure is fully known. But, you know, I think our general expectation is that it will be approved, you know, at some point this year. And, you know, from a sizing perspective, likely to be similar in size to the 25 program that was just approved, but we'll have to wait for those details. Okay.

And then, you know, a number of companies have talked about, you know, major cross-cutting initiatives because of... You know, whether it's SDP cuts in the future or maybe more in the near term, kind of Medicaid pressure on enrollment, exchange pressure on profitability. What are you guys doing, if anything, to kind of like adjust and react to those funding pressures?

Yeah. So, you know, I think the – so first of all, I would say we're always working on those things internally, and I think our teams have done a really good job on the cost side. In acute care, we've done a lot to improve productivity, and I think there's still a lot of opportunity there, not just this year, but as we think about, you know, into the future. So what does that mean? You know, driving, improvements in length of stay and throughput in our hospitals, both on the inpatient and through the emergency departments. So, you know, real opportunity there in behavioral. You know, we've talked to you a little bit about this, but we made, you know, a big investment over the last couple of years in improving our RCM on the acute care side and, you know, have yielded some real results from that initiative really over the last, you know, four to six quarters on the acute side. We're going through that same process on the behavioral side. I think that'll be a bit more of a 27 tailwind for us as we think about revenue cycle improvements and behavioral. Those are real opportunities for us. I'm thinking about next year. And then, you know, I think the other piece of this, and it's, you know, not necessarily cost related, but I think relevant to UHS as a company, we've opened a lot of hospitals in recent years. You're at one of our newer ones here in the market. We opened that hospital with 150 beds. We're staffing it to 120, but you heard from local folks that, you know, we've got plans in place to, you know, continue to grow as that market continues to grow in the southeast part of Las Vegas and West Henderson. And we've got De Novo Hospitals, one that will be opening this month. That will be embedded growth, you know, as we think about 27 and 28. We've got a facility in Washington, D.C. that's had some gradual improvement, more to go there, but that's embedded growth as we think about the opportunity to. Uh, you know, to really get some earnings growth out of some of those newer facilities. We have two de novo hospitals on the behavioral side that will, um, one just opened and one they'll be opening in the third quarter. Um, so again, you know, lots of opportunities we think about, um, new facility and expansion.

Okay. And then can you talk a little bit about AI? It's a hot topic nowadays. Everyone seems to be talking about, you know, what the opportunity is. Where do you guys see the opportunity for AI? And is there anything that people are talking about that you feel like you're getting ahead of their skis on at all as far as the opportunity?

Yeah, so, I mean, I think, so let's start maybe with the fundamental, you know, some industries are going to be disrupted in pretty significant ways, and some industries are, you know, going to benefit a great deal from AI or, you know, other advanced technologies. And I think I think our industry is certainly in the latter. And so we're early in that journey. I think what I would say a few things first. There's, um... A big focus internally on our AI governance process and, you know, making sure that we're making the decisions in a controlled way that we can scale them across our facilities and, you know, get the benefit, know what the KPIs are that we're measuring against. And so those decisions are made in, you know, I think a very controlled way. We've got a lot of projects that are in various stages of evaluation. I'd say, you know, a couple dozen are all in flight. Probably half of those are scaled or mostly deployed. And a lot of it, a lot of our start was on the revenue cycle side. We talked a lot about that, but in acute care, as we went through our process improvement, it was both process and technology improvement, and so from the standpoint of how we manage denials and how we do claims appeals, there's a lot of automation that we brought into that process with technology and AI being a big part of that, and we'll continue on that journey with behavioral. As I said, we were an early investor in Hippocratic AI, which is one of the leading AI companies in healthcare, and happy to partner with them in a number of projects. We have one solution that's fully deployed. We've talked a little bit about how all of our patients that are being discharged from the hospitals typically get a call from a nurse. We've been able to automate many of those calls with the Gentic AI through a post-discharge follow-up, so being able to verify with the patient they've got their prescriptions, they're following up on their DME or some of their post-acute care, et cetera. And there's... Few other projects with Hippocratic AI that, you know, we think will impact some other areas of the hospital. And then, you know, with respect to your question about what people might be missing, you know, I think this is going to be a more gradual process. I think we're, you know, we're kind of, we think this is a multi-year process. It should have, you know, some benefit to margin, but it's not going to show up overnight.

And then, actually, you mentioned on the behavioral side, doing some things on the claims denial side of things, similar to what you've done on the acute care side. Is there the same opportunity from a revenue capture perspective there, or did you start with acute because that was going to be a bigger opportunity, or is there a similar opportunity in both?

Yeah, so, I mean, I think we started with Acute. I think the opportunity there really was built around the fact that we have fully deployed our EHR across our acute care division. We're still in the implementation process and behavioral on that. And, you know, expect to see some of the similar types of process improvements on behavioral and some of the technology that we've deployed, particularly around claims, denials management, those types of things. You know, we think technology will play a big role in behavioral.

Okay. And then on behavioral, you've talked a lot about the shift to outpatient. You guys seem to be investing a lot of money into that side of the equation. Can you talk a little bit about why that's so interesting now and what the opportunity is for you?

Yeah, so I think behavioral, you know, just kind of at a high level, think about it as being, you know, roughly a little bit less than 10% of our total revenue in our behavioral business. And clearly, you know, the outpatient side of behavioral has grown a little bit more rapidly than the inpatient side. And so our focus, our investment, our strategies have been really, you know, designed around the opportunity that we see over the long term to participate in a bigger way on the outpatient side. You know, people are accessing mental health care services. The stigma attached to mental health has sort of, you know, come down as a society, and many people are comfortable kind of entering the mental health care system and kind of lower levels of care. And now we've got a full continuum of services to offer, from inpatients to some of the step-down levels of care that are adjacent or satellite to our hospital campuses. We're opening. Outpatient, freestanding outpatient clinics. We're making some investments there, and then we obviously, you know, we announced the Talkspace acquisition. We're really excited about that. That will be, you know, a virtual platform that really kind of fully closes out the, you know, the full continuum of services in outpatient.

Is there a way to think about where outpatient can go if it's a little less than 10% of the behavioral? Like, it's an acute, outpatient's closer to half, you know? Like, is there, like, a... What do you think about that?

Yeah, well, I think the idea is that we do think that getting more deeply into the 2% to 3% range from a volume perspective, outpatient is going to be an even more important part of that equation. I don't know that we have a target around where that can go, but with Talkspace, just the base business, that would add. 300 or so basis points to the outpatient mix. And then we have a number of programs that we'll be developing alongside Talkspace that are really more revenue synergies to get at some of the step-down levels of care where people are coming out of our inpatient facilities and need the continuum of services. And some of them really just don't want to go back to the inpatient campus or satellite campus location. They want to have those services on a virtual basis. And now we'll be able to offer those higher levels of care on a virtual basis with the Talkspace platform.

Yeah, on the call, you talked a lot about how there were synergies between the two businesses. Do you view the synergies more as driving volume into Talkspace, kind of leveraging it as a post-op, or do you believe that Talkspace can drive volume into the inpatient side? Is it more one way than the other?

It's bidirectional, you know, but I would say the opportunity that we're going to really focus on heavily in kind of the early days of the integration will be in the, you know, the step down levels of care where we know that people need those levels of care inpatient, intensive outpatient services or, you know, the example that we've talked a lot about. And the opportunity to develop those on a virtual basis is something that we're excited to do with Talkspace. You know, there's other ways that I think Talkspace plays into our environment. On the residential side, where we have a lot of youth and adolescents, You know, having text-based therapy and some of the asynchronous types of therapy that Talkspace offers is going to be really appealing to that population and we'll be able to, you know, create a more sticky sort of post-discharge relationship with the patient so it's really becoming more about the lifetime value of the patient as we follow them in their journey.

Yeah, great. And then since you are in Las Vegas, a little about the Las Vegas market, I guess it's unusual to be hearing about Las Vegas being kind of a drag to the corporate. Like in Q4, it was down. Q1, it was better, but still a little bit below kind of the average. So like what's been going on in Vegas and how do you think about that rebounding over the rest of the year?

Yeah, so we were pleased to see that the first quarter volumes improved a little bit after being a little softer in the fourth quarter. So we were up about a one and a half percent or so in Vegas or in Nevada broadly and, you know, feel good about kind of the overall market. We've been here for a long, long time. We've got a big footprint, not just here, but also in the northern part of the state with Reno. You know, and, you know, I think as we heard yesterday in the hospital visit, you know, clearly tourism volumes were down, you know, kind of high single digits last year. That was maybe a little bit of a drag overall. But I think the good thing about what we're seeing in the market is unemployment is held steady. There are other, you know, there's better balance to the Vegas economy now. We've got a lot of sports teams and a lot of industry, particularly moving in, you know, the Henderson area where we have two hospitals. And so, you know, feel good about our prospects here, our footprint, our market share, our outpatient strategy. And in the northern part of the state, we've got this health plan that should exhibit, you know, some real improvement year over year as well.

All right, and maybe last question as we run out of time here, but can you just talk a little bit about your capital spending? Your leverage, it's pretty low relative to where the competitors are operating. Are there deals to be had? Should we be accepting free cash flow to be done on hospital deals, on adjacent deals like Talkspace, or should we think about repo as the capital deployment?

Yeah, so we've had a billion three under our share by back. And so I would start there because, you know, I think we made the comment in the first quarter earnings call that we'd be a little more aggressive in the second quarter and share buyback, just given, you know, the compelling value that we see in our own stock. We've got $800 million or so year mark for Talkspace, which we expect to close in the third quarter, and that's on track. And then we'll continue to invest in our markets, be opportunistic with share or purchase. And from an M&A perspective, in both segments, I think you'll see us continue to be opportunistic, particularly in the outpatient side. You know, in both, in both segments.

All right, great. I think that's all we have time for.

Thank you very much. Yeah, good to see you.