瑞信美股医疗设施行业医疗设施行业2018年Q4总结医院结果表现强劲2019年展望向好20193721

DISCLOSUREAPPENDIXATTHEBACKOFTHISREPORTCONTAINSIMPORTANTDISCLOSURES,ANALYSTCERTIFICATIONS,LEGALENTITYDISCLOSUREANDTHESTATUSOFNON-USANALYSTS.USDisclosure:CreditSuissedoesandseekstodobusinesswithcompaniescoveredinitsresearchreports.Asaresult,investorsshouldbeawarethattheFirmmayhaveaconflictofinterestthatcouldaffecttheobjectivityofthisreport.Investorsshouldconsiderthisreportasonlyasinglefactorinmakingtheirinvestmentdecision.7March2019Americas/UnitedStatesEquityResearchHealthcareFacilitiesHealth[e-mail]@credit-suisse.comCalebHarris,[e-mail]@credit-suisse.comQ4Recap:HospitalResultsStrongDespiteFluComp;2019OutlooksSkewPositively■SolidQ4RelativetoExpectationsforAllFourCoveredHospitalCompanies:Eachofthepublichospitalcompaniesthatwecover(CYH,HCA,THC,andUHS)reportedEBITDAaheadofconsensusexpectations.Thetoplinewasalsoaheadofexpectationsforeachofthefourhospitalcompanies.Streetexpectationsaheadofthequarterwerereasonablerelativetothetoughflucompvs.4Q18.■VolumesFairlyStableasHCAContinuestoOutperform;PricingRemainsSolid:Forthefourthquarterof2018,thehospitalgroupreportedSSinpatientadmissionsgrowthof0.4%,onaverage.ThisrepresentsanincreaseintheY/Ygrowthrateof50bpssequentiallyandadecreaseof70bpsY/Y.Thefluhadsomenegimpacton4Q18relativeto4Q17(sincetheprioryearfluseasonwasmuchstronger).UHS’sgrowthrateimprovedthemostsequentially(increaseof200bpsto2.9%).CYH’sgrowthrateimprovedby180bpssequentially,butwasstillnegative(-0.5%).ThehospitalgroupreportedaY/Yincreaseinnetrevenueperadjustedadmissionof2.5%,onaverage,inthefourthquarterof2018.ThisrepresentsadecreaseintheY/Ygrowthrateof180bpssequentiallyandanincreaseof40bpsrelativeto4Q17.ExcludingTHC,allhospitaloperatorswithinourcoveragesawincreasesinY/Ypricinggrowthvs.4Q17.However,THC’sY/Ypricinggrowthwasup5.4%Y/YafteradjustingfortheCAproviderfeerevenues(vs.-0.6%reported).■2019Expectations/CommentaryVarybyCompany:Thehospitalcompaniesgenerallyexpectlow-single-digitpricinggrowthin2019(similartoslightlylowerrelativeto2018).Onvolumes,THCandCYHgenerallyexpectflatSSadjustedadmissions,whileUHSandHCAexpectlow-single-digitgrowthinSSadjustedadmissions.HCAofferedastrongEBITDAoutlookof$9.35-9.75bln,whichimplies4.5-9.0%growthY/Y.Thisincludes2-3%SSvolumegrowthand2-3%SSpricinggrowth.UHSprovidedEBITDAguidanceof$1.826-$1.909bln(3.6-8.4%growth).Thisoutlookassumesthattheacutebusinessperformswell(6-7%coreEBITDAgrowthatthemidpoint),butthatbehavioralhealthcoreEBITDAisrelativelyflat(up3-3.5%onanall-inbasis).THC’sEBITDAoutlookof$2.65-2.75blnwasaheadofexpectationsandassumescontinuedstrongperformancefromConiferandtheAmbulatorysegment.Finally,CYH’sEBITDAguidancewasapositivesurpriseat$1.625-1.725bln.CYH’soperationshaveimproved,andCYHbelievesitwillcompleteitsdivestitureprogramin2H19.■UpdatingUHSModel:OurUHSTPisnow$152(prev$150).Our2019EBITDAestimateis$1.869bln(previously$1.831bln).RiskstoourratingandPTincludeanyslowdowninvolumesandpricingtrends.7March2019HealthcareFacilities2TableofcontentsSummaryof4Q18Results3Company-by-Company4Q18Recap4CommunityHealthSystems.....................................................................................4HCAHoldings...........................................................................................................4TenetHealthcare......................................................................................................5UniversalHealthServices........................................................................................7PricePerformance&Valuation9Industry–KeyOperatingStatistics11SameFacilityAdmissions......................................................................................11SameFacilityAdjustedAdmissions.......................................................................11SameFacilityPricing..............................................................................................11MarginAnalysis......................................................................................................12ExpenseAnalysis...................................................................................................12LaborExpenses12SupplyExpenses13OtherOperatingExpenses13FinancialStrength/Leverage..................................................................................13UniversalHealthServices(UHS)157March2019HealthcareFacilities3Summaryof4Q18ResultsAllfourpublichospitalcompanieswithinourcoveragepostedEBITDAresultsaheadofconsensusexpectationsfor4Q18.ThemajorhospitalcompaniesreportedSSinpatientadmissionsgrowthof+0.4%Y/Y(adecreaseof70bpsY/Yandanincreaseof50bpssequentially).However,thedispersionofadmissionsgrowthacrossthevariouscompanieswasfairlywide.UHSreportedanincreaseinSSadmissionsof2.9%,andHCAreportedanincreaseof1.9%.THCreportedadecreaseof2.7%,whileCYHreportedadecreaseof0.5%.HCAandUHS(themosturban-concentratedproviders)continuetooutperformtheirpeersonthisme