HCA Healthcare, Inc. (HCA) Earnings Call Transcript & Summary

Hello, everybody. I'm A.J. Rice, the health care services analyst at UBS. And we're really happy to have up next to HCA Healthcare. We've got Chris Wyatt, SVP and Controller, and we've got Frank Morgan, VP of Investor Relations. I really appreciate you guys doing it again this year for us.

We're about 11 months into the year. What would you say are some of the positives that have developed as the year has gone, particularly if they were surprises, be interesting. And then there are particular areas of challenge that you would call out?

First of all, good to be here, A.J. Thank you. Very pleased with the company's performance this year so far. I think 1 item that we would highlight that has been even a little better than expectation certainly is volume for the company. We came into the year thinking we would be a little above our historical assumption of 2% to 3%. We said 3% to 4%. We're running about 5% on adjusted admissions this year. So volumes have been very strong, and we think it's a combination of the markets that we're in, very good demographics and growth in those markets. We think it's a function of how we execute in our markets and the way our teams are performing, the capital that we're spending and then to some extent, a good coverage environment as well. We think it's all contributed to the solid volume growth. We think it has been broad-based across our markets and across the various service lines. So that's been a real positive. On the -- anything on the downside, we knew coming into the year, physician costs were a challenge, but we're very pleased about how those have moderated. This year, as you look, we've seen the growth rate come down each quarter. And so very pleased from a physician cost standpoint. Then we got the curveball of the hurricanes in the fourth -- in the third quarter, excuse me, with Helene and Milton, and that was probably the biggest surprise on the downside so far this year.

Okay. And your preliminary comments about next year, you seem to be thinking that the volume strength will probably continue. What's giving you confidence there? I know exchanges have been a part of that, but it sounds like you're being a little more cautious on exchange growth next year, but what's underpinning your thoughts there?

So on our third quarter call, we talked -- when we gave some perspectives on 2025, we talked about volume being, we think, in that 3% to 4% growth range. And a few factors behind that one. You mentioned the exchanges. While we don't think we'll see the sizable enrollment growth we saw in '24, we still think it could be solid in maybe the 8% to 10% range as it relates to enrollment growth on the exchanges. We think Medicaid will moderate. We're down roughly 8% on equivalent admissions this year. So that moderates. And then maybe a little bit of lift over the average for the company on the Medicare side as well. But that's what gives us some level of confidence at this distance and we think we'll be above our 2% to 3% kind of historical assumption on volume next year.

Okay. Great. On -- one thing you mentioned in your comments, it was a little surprise there was obviously the hurricanes, dealing with that. Maybe just to remind people what you've said third quarter, fourth quarter impact and then how should we think about it? I think there was a little confusion on the third quarter call about the jump forward and how much of that you'll recover when you'll recover it and so forth.

Sure. So on the hurricanes, we sized about a $50 million impact in the third quarter and then $200 million to $300 million in the fourth quarter is what we think is the ongoing effect. And just to remind everyone, North Carolina, we have some impacts there, we think manageable, but we see a longer duration to the impact in North Carolina. And then we had 1 hospital in our Tampa area that we had to close, and we're working to reopen and anticipate that will happen by the end of the year. And so that's what yields that $200 million to $300 million. As we look forward into '25, at least the way we're thinking about it at this distance right now is we'll continue to see some ongoing effects in North Carolina, and you may see a year-over-year decline in our earnings related to that market specifically. On the facility in Tampa, we expect it to be open by the end of the year. So you see some year-over-year benefit there that we think right now probably washes between the two. It is how we're thinking about it right now in terms of the hurricane ongoing effect into 2025.

So not to be too granular about it, but it's $50 million in the third and then $200 million to $300 million in the fourth. Do you get that -- most of that back right away in the early part of the year? Or are you sort of gradually rebuild to it?

Yes. What I would say is, again, I think that North Carolina will see a year-over-year decline because we had 9 months of -- almost 9 months of normal operations and really 1 quarter impacted. We'll see a pickup in West Florida because we won't presumably have a quarter where the hospital is closed. And so we just see that basically being kind of a net neutral year-over-year between those 2 is how we're thinking about it.

And when you think about other moving parts this year, one has been the two-midnight rule and there's been a lot of debate about how much that's helping admissions and so forth. I think you guys sized it at about 0.5% contributor to the overall admissions growth. Is that having -- is that meaningful enough to be having an impact on your revenue per case? I would assume that these are lower revenue per case dynamics. And have we seen the full impact of that so that it's not a further tailwind in '25? Or will it be a further tailwind in '25, you think?

I think for 2025, the regulation went into play at the beginning of the year. And so we think we'll largely have anniversaried it by the time we get to the end of the year. So I don't see a lot of additional impact into 2025 as it relates to two-midnight rule. You're right. It probably does have some effect on revenue per case, a little bit of effect on acuity, but it's not something that is significant for us to call out in any company level trends as it relates to those measures.

And of course, we're a week after the election. So -- we're getting a lot of questions on election, so I have to throw a few your away. The main focus seems to be on the public exchanges. And how much the companies, the hospitals have benefited from public exchanges and what were to happen if in '26 the enhanced subsidies go away? Do you want to just maybe level set people on how much volume you get from the exchanges, how that's trended? And if you have any early thoughts on enhanced subsidies and their impact?

Yes. I'll make a few comments. First, on the volume side, we've said that the exchanges represent roughly 7% of our admissions as a company. How we're thinking about the subsidies -- or excuse me, the premium tax credits. Overall, as you noted, they do expire at the end of 2025. I'll say there's a lot to play out politically over the next year. And we'll have to see what happens with exactly what plays out politically. With the Republican, what looks like trifecta here, one could think it may be challenging around extending those subsidies. But I think it's important to keep in mind that we have 21 million enrollees on the exchanges. And there's a significant number of enrollees in states that have not expanded Medicaid. And so in red states. And so One of the things that is important on our list is advocacy efforts through various coalitions to make sure there is an awareness of the number of enrollees that would face premium increases if those tax credits sunset at the end of 2025. So we'll be working hard on that front. I think if they do go away, we'll have to go through a set of considerations around who remains on the exchanges. For those that don't, we're -- what coverage does it migrate to? And then at what pace does it migrate? How quickly might somebody move away from the exchanges. And so as we have better line of sight into exactly what's going to happen and play out politically with the enhanced premium tax credits over the next year, we'll be in a better position to score that, but that's really our thinking and set of considerations around that right now.

And I mean I guess one thought is people might trade down from silver to bronze that has several implications on the one hand, what kind of -- would that change your rates that you get for -- I don't think there is a change in rates if someone moves between metal tiers. And then -- but then there's also the issue of they might have more of the patient responsibility co-pays that they would have to take on. We're all going to quickly become experts on the exchanges, but I don't even know, some of the companies I've asked said, look, we haven't even gotten into that level of detail. And that's fine if that's your answer, but at least I want to throw it out and see if you guys had any reaction to -- if one of the solutions is people trading down in metal tiers, does that mitigate in your mind some of the exposure?

Well, I'd just say, A.J., I think you've highlighted one of the complexities and things we'll have to think about, again, if the premiums increase, would people be incentivized to trade down, as you said, and move to a different tier. I don't know exactly how to think about or score that at this point in time. But that's one of the variables at play, certainly, that people have had this coverage for a number of years now that we've been operating since 2021 in the enhanced premium tax credit environment. They've gotten used to the coverage. And so they may well want to retain that coverage even if it is at a different benefit level. So we'll have to see that speculation right now but seems like a realistic possibility.

I mean the older population, certainly, the people who use more health care would have a lot of incentive to try to figure out a way to keep that if it cost them an extra $100 a month, maybe they do it for a while, maybe they do it for the first year, but certainly, the people that use health care are going to be the ones that try to keep it and maintain it the most.

Yes. And at the risk of -- I have Frank sitting over there, so he can't kick me and reach this far. But it's just the questions -- we're getting so many questions on this. I'm going to try 2 more things here. On the -- so it's 7% of admissions, I think the assumption is that the revenue per case that you're getting on exchange is more like commercial, so it's probably higher than average. I don't know if that's true or not because I'm sure the Medicare population is pretty high acuity. But is there any way to size the revenue exposure? Is that more like 10%? Would that be a good guess or?

What we've said is the revenue is roughly 8% to 9% of revenue for the company. In terms of the rate per case, I mean, it's not a commercial rate, but it is -- we've said roughly our second best paying payer, but it's not at the level of a commercial payer.

Okay. Okay. That's great. Well, we also are getting asked, and this is even probably harder to even get your arms around, but the possibility of tariffs. And so people go immediately to hospital supply chain and supply chain across the entire health care space. Have you guys looked at the percentage of your supplies that are being sourced internationally versus U.S.? And where is that concentrated if you do that. Do you have any sense of that in order of magnitude?

Well, the comments I'll make on tariffs, and obviously, it's early, we'll have to see what happens in terms of if any tariffs are enacted. One, we think in the near term, we're in a pretty good spot just based on our contracting and that the significant majority of our purchases are contracted through the end of 2025. So we think that provides us some protection on the tariff side. Beyond that, we're going to have to see what exactly is in the scope or certain things like medical supplies carved out of the tariffs. What countries will the tariffs apply to? Will it be across the board? Or will there be certain countries where we may have the ability to pivot some of our sourcing strategies. And then lastly, we've been able to navigate through a variety of supply chain challenges, whether it's disruptions from COVID or there have been tariffs in the past that we've been able to navigate. So that would be how we would approach it and think about it from this business. We certainly do have internationally sourced supplies that we'll have to think about, and we already are. But until we have some more clarity, it's hard to exactly size what the impact may be.

No, that makes sense. So maybe just stepping back and looking at the portfolio. I know in general, you're #1 or #2 in the markets -- the major markets in which you operate. Can you just maybe comment to the extent the pandemic, the post-pandemic environment, I think you kept investing capital pretty aggressively compared to peers. Where are you at in share? Do you feel like you've gained share? How easy is it to move the needle on share? What's your thought about that?

Well, if you go back to our Investor Day from last November, we talked about our market share journey, and we were about 27% market share. And then we had a target by the end of the decade to move that up a couple of percentage points. And we feel like we have the right strategies in place to do that. One of the things, again, that we talked about that flywheel of HCA where we build comprehensive networks with great enterprise capabilities and we attract physicians. We build comprehensive services. We build access points. We're operationally efficient, and we coordinate care. And we think if we can execute on all those, it will continue to give us the opportunity to grow in the various markets that we have. And so that is going to continue. It has been and will continue to be the focus. I don't know that there's anything magical or secret sauce there other than just the execution that we have on each one of those strategies, and we'll see how we're able to progress toward that target by the end of the decade.

I mean we may be at a point where interest rates are capping out, but they've been upward bound and a lot of nonprofit hospitals or their capital spending is driven by the ability to borrow in the tax-exempt financing market. So I just wondered on a relative basis as you've maintained your capital spending, is that -- have you seen other guys maybe less than what they've done? Or is it sort of hard to say at this point?

It's probably, A.J., market by market. I mean we definitely have well-funded competitors in the markets in which we operate. We think when we look at -- we anticipate spending $5 billion of capital this year, $6 billion of capital in the pipeline. We think those are the right -- at the right level to be able to compete and continue to grow our business. But we definitely have very well-funded competitors that are able to spend capital in our markets as well.

Bouncing around a little bit here. But the company has said, I think Sam has said this on one of the conference calls that with people moving from Medicaid to commercial coverage or to the exchanges, you might see a little bit of a seasonality shift where people meet their deductibles and all of a sudden in the back part of the year, especially in the fourth quarter, you might see an uptick. Has any of that played out yet? Or is it still sort of early to comment?

You're right. We've said that on a couple of calls now where we have a theory around the timing there as individuals maybe are more sensitive to co-pays and deductibles on the exchanges. We haven't necessarily seen that play out through the first 3 quarters of the year. I think we will -- certainly, we're going to know by the time we get through the fourth quarter, did it play out. It's still a theory that we have, but I think we'll have to report back to you on the fourth quarter and see if that ended up playing out. It's kind of in the year activity here.

The -- we've got a couple of dynamics on divestitures, acquisitions. Obviously, there's been some on of your peers among the public companies have seen nonprofit step up and pay pretty high prices for facilities. Alternatively, now we've got a change in administration that might be a little more lenient on the consolidation front. Any shifting landscape around the company's thoughts on acquisitions, divestitures and whether your thoughts about opportunities that might be available?

On the divestiture side, we have done a couple of one-off divestitures, sold a hospital in California here earlier in the year. But just like any healthy organization, we go through our portfolio on a regular basis and look for assets that are not performing or not strategic. But we don't have a strategy of divestiture and those generally seem to be one-off activities for us. On the acquisition front, I think what you said is notable around the change in administration, and it's been a little more challenging in the last few years to be able to execute transactions, at least on a larger scale. We certainly have been able to do some smaller acquisitions, what we call tuck-in to our markets, where we've been able to round out some complementary assets. And so we've done a number of those and would obviously continue to pursue those. And then we'll see with the new administration, does it open up any channels. We, of course, are always considering what may be out there and is there something that fits within our network and works and strategy at a reasonable price, and we'll continue to assess that.

Do you have any sense that just the tough -- it's been particularly tough on the hospitals, the FTC has taken a view on that under the current administration? Do you have any sense that there are potential deals to be had that just people just didn't say -- said, "Hey, the FTC will never let that go through." and now that might open up or that remains to be seen?

Yes, I think it'd be speculative to say. I mean, again, we're certainly constantly looking and seeing what's available and what may be achievable. And like I said, there may be a different dynamic with the new administration, but I'd probably be speculating if I thought something specific was going to happen.

All right. Supplemental payments have been a big topic, and it's been a tailwind for the industry for the last year, 1.5 years. I know you guys have said a lot of your states have already put those in place. But Frank promised me that you guys would give us a disclosure on Tennessee and now that's done. But no. What is the latest about Tennessee? Any update on that?

As it relates to Tennessee, I mean, we're aware that they're advancing a new program, and we hear maybe at the end of the year or early next year in terms of timing for approval, but I don't have any specific information on Tennessee beyond that in terms of timing.

And there's a couple of big states that have had supplemental payment programs in place, Florida, California, maybe even Texas that have made some noise about potentially expanding those. Obviously, Florida would be a big one for you. Any update on anything you're hearing on those?

On supplemental payments, just broadly, I'll say, obviously, we've been pleased and think there's been needed growth in those programs over the last several years. Medicaid has been the most challenging payer, obviously, other than the uninsured. It still doesn't quite cover the cost of care, but the supplemental payments are getting us closer and we think very meaningful for providers and ensuring that Medicaid beneficiaries can get the health care they need. We're watching every state very closely and monitoring the activity. I don't have anything specific to comment on any certain state beyond what you asked me about Tennessee. We do think it was a positive earlier in the year where there was a regulation about states could go up to the average commercial rate in their various programs. I think that gives some headroom in some states that you've mentioned here. But I don't know specifically exactly how long it will take that to play out or when. But that is, I think, a very positive development that happened earlier in the year.

Yes. No, that's great. Just maybe what about managed care contracting? We've had a couple of years where it seemed to be there was a little catch-up for some of the labor pressures the industry experienced. Where are we at in absorbing that? Are we still have a little above trend rate updates? Or are we going to sort of normalize from here?

Yes. I think we're still very pleased with our managed care contracting. As we look out, we're about 80% contracted for next year and basically at rates where we have been running the last couple of years in terms of our contracting strategies. Also pleased in terms of just access to lives. I mean we have access to a significant majority of lives in most of the markets that we are in. And so we think those strategies have been good, both from achieving the pricing objectives, but then also making sure we have good access to lives in the markets in which we operate. So I think we're pleased in that regard.

At the risk of -- I know you just reported a couple of weeks ago, but that something may have changed. One of your peers had called out a little tougher environment for claims review, denials, et cetera. What's your perspective? I'm assuming it hasn't changed in the last few weeks, but I'll ask you about it anyway.

Yes, the -- first of all, we wouldn't give any intra-quarter perspective, but nothing would change from what you heard on the call that we work very closely with our payer partners to address denials, ensure we're paid appropriately for the care that we're given. There are some pockets where we feel like denials are higher than we would like them to be. And we work hard to try to rectify that situation. We put a lot of resources and focus because we want to be appropriately paid for the care that we deliver. And so that will continue to be something that we're certainly focused on.

It seems like when we hear the managed care companies comment on it, there seem particularly focused and somewhat surprised by the two-midnight rule. Have you seen particular scrutiny on that? Has that been something where there's been particular challenges to -- I mean they're saying that the hospitals have been better at figuring out what they do to qualify than they expected them to be for the inpatient admission side. But any thoughts?

Yes. I mean we've seen -- I think we've said publicly, our observation rates have gone down a little bit. And then the authorization denials that we were seeing historically have gone down. We still feel like they're higher than in our judgment, they ought to be, and that's one of the issues that we're trying to work through on the Medicare. On the MA two-midnight rule front, we're still early in the claims adjudication process. I mean it takes some number of months to work through a clean claim, you would know by now. But if there's any friction in the process, it takes some time to work through it. And so we're still a little bit early in terms of just kind of the adjudication under this new paradigm. So we'll see how it plays out. But we're certainly working closely with our payers to work through any issues.

Right. Labor has been a bright spot. I think you're now saying you're running about 2.5% to 3.5% year-over-year increases. I assume that, that would carry over into '25. Is that what's embedded in your early thoughts there? And I think your contract labor is about 4% of SWB. Is that sort of where you'd expect it to settle out? Or do you think there's more opportunity there?

So you're right. I mean we're very pleased with labor this year. I do think it's a bright spot, both in the 2.5% to 3.5% for kind of where we've been running on wage rates and then the contract labor declines that we've seen. I won't comment specific on specific assumptions for 2025 other than to say, I'll harken you back to the call where we -- Sam said, we think we'll have a relatively stable operating environment in 2025. And so that's what I would apply kind of broadly to just the cost environment next year. We are running about 4.5% of our SWB is contract labor, and we think that's a pretty good number for the company as well in terms of where we hope to run at least the rest of the year and continue hopeful stability into '25.

I know the HealthTrust ventures, we mainly talk about that from the supply GPO perspective, but one of the peer companies mentioned actually that they were using you guys to -- your nursing entity to provide them contract labor. And I didn't -- how -- is that a new initiative to start to push sort of external placements for your HealthTrust labor? I hadn't really heard that you were doing -- I know it was servicing your facilities, but I didn't know you were doing a lot of third party?

Yes, that's certainly the first focus is to make sure that, that organization is able to service the needs that HCA has. But then there are some opportunities to be able to help other organizations as well with staffing needs that they have. And so that is something that, that organization has been doing. But it is obviously making sure it's not compromising anything from HCA standpoint in terms of our staffing needs.

Is that relatively new? Or is that something you would have said you've done for a while?

We've been doing it for a number of years. I don't remember exactly how long, A.J., but it's been -- it's not brand new.

Okay. And then you mentioned in the prepared remarks about the professional fees. I think coming into the year, you had set up this Valesco Joint venture as being about $150 million loss for the year, $37 million or so a quarter. Where are you -- it sounds like you're performing sort of in line with that. I know it's not designed to be a big profit center for you sort of to get it closer to breakeven. What is -- what are the building blocks to improve the performance there? And where are you at putting those in place?

You're right. We're performing at or a little bit better than we expected on just the P&L of that entity specifically. It's not overly material to the company. I think the real value to Valesco, and Sam talked about this a little bit on the last call, is the platform that it creates for the organization, whether it's coordinating better clinical care and outcomes in our emergency room or hospital-based physicians, whether it's efficiency initiatives that we have on our emergency room operations or maybe even with our technology agenda as we roll out new approaches there. We think it's a really important platform that goes well beyond just the P&L specifically of the physicians we have. We have over 5,000 physicians inside of Valesco. So we'll obviously continue to try to improve the performance of that specific line as much as we can. But I just want to remind everybody, there's a significant value, we believe, just outside of the specific financial performance of that entity.

Okay. Maybe to flip over and talk for a little bit about the cash flow and capital deployment. Where -- maybe just again to level set, free cash flow or cash flow from operations this year, where do you roughly based on guidance, where will you guys be?

So we were at about $8 billion through the end of the third quarter. We had guided to $9.5 billion to $10 billion at the beginning of the year. We're probably more toward the upper side of that right now just based on the trajectory we're on. We'll see how the fourth quarter plays out, but in that zone of the $9.5 billion to $10 billion that we said at the beginning of the year in terms of cash flow. Very pleased at the cash flow production of the company.

Right. And so first priority is reinvesting in the business. Can you comment -- I mean, I know inpatient, outpatient, a lot of tugs there, where to spend money. Maybe give people a sense about the threshold returns you're looking at for the different investments that you do in the business. Why is that such a good use of your capital?

Sure. So this year, we're projecting we'll spend around $5 billion of CapEx. And we do look at both inpatient and outpatient opportunities. We don't have a set percentage target necessarily. I went back and looked over the last 5 years, we've been devoting 10% to 20% of our growth capital to outpatient and then the rest to inpatient; Obviously, inpatient is a more expensive proposition than the outpatient side, but that kind of gives you some sense of how much we're devoting. We still see really strong opportunities in both. Like I said, we've got a $6 billion pipeline of capital right now that's in process that is going to help address more access on the outpatient side through, say, for instance, freestanding emergency rooms, but then continuing to grow our service lines on the inpatient side that has been very important. Again, back to the Investor Day, one of the things that we highlighted is how we're growing high acuity services. As it relates to the hurdle rates that we have, I don't have something specific. Every project has to go through a pretty rigorous modeling process and vetting internally before we are comfortable moving it forward. And you have different returns on different projects. Sometimes you have to put some infrastructure in a hospital. You have to build a parking garage that doesn't necessarily have a return on it, but it's critical to being able to create access for patients on your campus. And so there's no one-size-fits-all hurdle rate for us. If you look at our return on invested capital, we're sitting at 18% to 19%. So that gives you some sense for kind of overall holistically how the company is performing, but there's not a specific number I'd quote you.

When you start to go through budgets for next year, is there any particular area of capital spending, any theme that across the portfolio, a lot of people are wanting to invest in robots, whatever. I don't know what it is. Is there anything that you would call out there that you see bubbling up?

I don't think, A.J., anything different than what we've been executing historically. We -- again, we're going to continue to spend on our freestanding emergency room strategy. We've got 45 or 50 of those in our pipeline. We're going to continue to press our outpatient capacity. We have a couple of new hospitals; one that is about to open in San Antonio, one that's under construction in Florida as well. And so we'll assess some opportunities to do de novo facilities also. But I don't see anything -- at least right now, and let me be clear, we're not done with our planning process for 2025. We've got some work to do still, but nothing significantly to call out right now.

And I'm often asked about the metrics on occupancy and capacity are hard to assess. How would you characterize the portfolio? Do you have a lot of places where you're bumping up against capacity constraints or generally not?

Yes. Our occupancy overall, we're running in the low to mid-70% for a company. We report that on a public basis. As you can imagine, when you look underneath that, you've got assets that are running much higher and lower. And we do still -- again, that's part of that pipeline of capital that we still see several facilities that have capacity constraints that we need to go address and some are underway right now. Some are under evaluation right now. We go through a scoring process where we look at a variety of attributes to determine where are those facilities that have a high potential for us, but they're also running at high occupancy levels where we feel like we need to devote our capital dollars. And then we marry that with our local team's understanding of the markets and the dynamics and the competitive factors. And of course, in all that, too, we're trying to push our efficiency and throughput and length of stay. and make sure that we have gotten as efficient as we can be before we necessarily go spend capital. So there's a lot of factors that go into the mix, but we certainly underneath that average of low to mid-70% see opportunity to address capacity constraints that we have.

And we're seeing more broadly, I don't think you guys have talked about it, but I'll ask you about it. Hospitals coming out of the pandemic saying, "I want to really focus on my acute business. And to the extent I've had specialty units, rehab, psych, whatever, maybe I'll partner with somebody get out of that business directly. Maybe I'll keep my name on it, but I won't be the one running it day-to-day." I haven't seen you guys pursue that as much. Any -- what's your view on that whole dynamic?

Well, you're right. I mean from -- if you talk about rehab or behavioral or really any other service line, we have some partnerships that are long-standing in certain markets where we have partners in San Antonio or in Austin. It's very important, long-standing partnerships for us in the company. But we really haven't been down a strategy in any material way of doing anything joint venture on specific service lines outside of -- we've got one in women's imaging that's in Texas that is not overly material to the company, but we've done a little bit there. But beyond that, I don't have seen anything really to call out.

Got to, of course, ask you about using the capital for share repurchase, dividends, those type of things. I think you did $1.8 billion in the most recent quarter. I think it brings you to around $4.4 billion year-to-date. Talk about the pace of that. I mean, as the cash flow grows, will we see the buyback percentage allocated to buybacks grow? And where does dividend sort of sit in everyone's thinking?

Yes. So we've said we anticipate completing $6 billion of share repurchase this year, subject to market conditions, and we feel like we're on that path to do that for 2024. Beyond '24, it'd be premature for me to talk about capital allocation just yet. Beyond, I don't see it materially changing from -- we're going to continue to invest in CapEx. We'll continue to have some share repurchase, continue to pay a dividend. But we've got to work through our planning process, and of course, with our Board on sizing exactly how much we may devote in each one of those areas to 2025, but we see all of them continue to be important.

I sort of remember that it to be something you review in the spring. Is that right, the time frame? Or is there any particular time frame where you...

Well, we're going through our considerations now. We'll review it with our Board in the early part of next year, and then we'll give you and give everyone insight into it on our January call in terms of what we're expecting from a capital allocation standpoint.

All right. Well, once again, I really appreciate HCA Healthcare participating in the conference this year. Thanks to you all for making the track out here. And thanks, everyone, in the audience for sticking with us here. The next up in this room, I should probably give people that is, I believe, Natera. So anyway, thank you.