The biggest U.S. hospital company wants to take a tougher approach to collecting bills.
Executives at the company, HCA Healthcare, hope improving collections will help HCA compensate for enrollment cuts at Affordable Care Act public exchange plans.
Mike Marks, the chief financial officer at HCA, talked about the impact of the ACA exchange plan enrollment cuts Tuesday, during a conference call the company held to discuss results for the third quarter, which ended Sept. 30, with securities analysts.
Congress and the administration of President Donald Trump decided to let a temporary ACA exchange plan premium subsidy boost provided in response to the COVID-19 pandemic expire in 2026. Trump administration officials also changed the ACA exchange plan eligibility and application-checking rules.
The changes cut the number of admitted patients at HCA hospitals who had exchange plan coverage by 19% between the third quarter of 2025 and the latest quarter, Marks said.
The number of uninsured patients who were admitted increased by a similar amount.
Uninsured patients accounted for about 10.5% of all admissions in the latest quarter, up from 8.5% in the year-earlier quarter, Marks said.
The shift in the payer mix reduced HCA revenue by $400 million, Marks said. The revenue impact amounted to 2% of HCA’s total third-quarter revenue.
Marks said that, when compared with the year earlier quarter:
◆ Overall admissions increased 2.7%.
◆ Emergency room visits increased 5.1%.
◆ Admissions of patients with non-ACA-exchange plan commercial coverage increased 2.7%
Although more patients were uninsured and paid little or nothing, net revenue per unit of care provided to insured patients increased, Marks said.
“We continue to see rate growth across our payer categories,” Marks said.
Collections: HCA has an administrative services arm, Parallon, that helps HCA with billing and collections.
At Parallon, “we see continued strengthening of their abilities to collect our net revenues,” Marks said. “Their work to strengthen our abilities to deal with denials and other payments continues to improve.”
Improving “revenue integrity, and working to ensure that we collect revenue for the services we provide under the contracts that we operate under” is one of the top strategies for increasing HCA’s financial resilience, Marks said.
HCA streamed the call live online and posted a recording online.
What it means: Patients, employers and benefits advisors who hope that HCA hospitals will go easy on collections may be in for a surprise.
The earnings: HCA owns more than 200 hospitals, with more than 40,000 staffed beds, and it has about 60% more staffed beds than the second biggest hospital services provider, the U.S. Department of Veterans Affairs.
The company reported $1.8 billion in net income for the third quarter on $20 billion in revenue, compared with $1.9 billion in net income on $19 billion in revenue for the third quarter of 2025.