HCA Healthcare, Community Health Systems, Tenet Healthcare and Universal Health Services are among the largest for-profit health systems in the country. Each system has a unique backstory and commands an extensive network of facilities and physicians.
Here's how the systems compare in five key areas, including leadership, system size, key financial statistics, executive compensation and payer mix.
1. Leadership
HCA Healthcare (Nashville, Tenn.)
Sam Hazen was appointed CEO of HCA in January 2019 after serving as president and COO since 2016. Three other things to know:
- Mr. Hazen is a 40-year veteran of HCA, and has held various senior positions for the health system, including president of operations from 2011 to 2015.
- He also served as president of HCA's Western Group, which included all operations west of the Mississippi River and represented about 50 percent of the system's revenue.
- Mr. Hazen began his career in Humana's financial management specialist program in 1983 and has held CFO positions at hospitals in Georgia and Las Vegas.
Tenet Healthcare (Dallas)
Saum Sutaria, MD, was appointed CEO of Tenet in September 2021. He was also elected board chair on Aug. 10. Three other things to know:
- Dr. Sutaria previously served as president and COO of Tenet with responsibilities spanning the enterprise.
- He joined the for-profit system in 2019 after working for nearly two decades at McKinsey & Company. At McKinsey, Dr. Sutaria was a leader in the healthcare and private equity practices, advising clients on strategic, operational and financial matters.
- Dr. Sutaria previously held an associate clinical faculty appointment at the University of California at San Francisco, where he also engaged in postgraduate training with a focus in internal medicine and cardiology.
Community Health Systems (Franklin, Tenn.)
Tim Hingtgen was named CEO of CHS in January 2021 after serving as president and COO from September 2016 through December 2020. Three other things to know:
- Mr. Hingtgen, who also serves on the board, joined CHS as a vice president of operations in 2008. In January 2014, he was promoted to president of division IV operations, and in May 2016, he was promoted to executive vice president of operations.
- Before joining CHS, Mr. Hingtgen served as a CEO or COO of hospitals affiliated with UHS and Brentwood, Tenn.-based Province Healthcare.
- Mr. Hingtgen has a master's degree in business administration from the University of Nevada, Las Vegas.
Universal Health Services (King of Prussia, Pa.)
Marc Miller was named CEO of UHS in January 2021 and has served as president since 2009. Three other things to know:
- Mr. Miller is also a member of the UHS board, serving on the executive committee and the finance committee.
- He began his career at UHS in 1995 and has held multiple positions of increasing responsibility at hospitals and at the corporate office. Before stepping into executive leadership roles at, he held various operating roles at UHS acute care hospitals.
- Mr. Miller's prior executive roles include group director for the health system's acute care operations in Pennsylvania, South Carolina and Florida; Eastern region vice president of the acute care division; and senior vice president and co-head of the UHS acute care division.
2. System size
Tenet launched as a small operation in California. In May 1969, it acquired four hospitals along with some additional care sites and real estate for future hospital developments. Three other things to know:
- Tenet operates 61 acute care and specialty hospitals, about 110 other outpatient facilities, a network of employed physicians and a global business center in Manila, Philippines.
- United Surgical Partners International, Tenet's ambulatory arm, operates or has ownership interests in more than 465 ASCs — the most of any health system — and 24 surgical hospitals. It also operates Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients.
- Tenet has more than 100,000 employees and 6,000 physicians.
HCA was founded in 1968 by Thomas Frist Sr., MD, Thomas Frist Jr., MD, and Jack Massey. Dr. Frist Sr., who was the father of former U.S. Senate majority leader Bill Frist, built Park View Hospital in Nashville with a group of physicians. They wanted to manage and expand the hospital, eventually creating the hospital management company known as HCA. Three other things to know:
- HCA comprises 182 hospitals and more than 2,300 care sites in 20 states and the United Kingdom.
- The system's care sites include ASCs — of which it operates about 150 — freestanding ERs, urgent care centers, diagnostic and imaging centers, walk-in clinics and physician clinics.
- HCA has more than 270,000 employees, including 94,000 registered nurses and 38,000 active physicians
CHS was founded in 1985 when Thomas Chaney, former executive of Hospital Affiliates, Inc., and David Steffy and Richard Ragsdale, former HCA executives, spun off Republic Health Corp. to form Community Health Systems. The second hospital acquisition took place in January 1986. Three other things to know:
- CHS operates 77 acute care hospitals with about 13,000 beds and more than 1,000 care sites, across 15 states. Its healthcare portfolio includes physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ASCs.
- In 2014, CHS had approximately 200 hospitals. In 2016, CHS began refining its portfolio with the spinoff of Brentwood, Tenn.-based Quorum Health, which included 38 hospitals and its hospital management and consulting business. Over the next several years, CHS sold or closed dozens of hospitals.
- CHS has more than 90,000 employees and 20,000 physicians — employed and independent — serving on the medical staff of its hospitals.
UHS was founded in 1979 by Alan B. Miller, who currently serves as the system's executive chair. Eighteen months later, UHS owned four hospitals and had management contracts with two others. Three other things to know:
- UHS now operates 27 acute care hospitals, 331 behavioral health inpatient facilities, 22 freestanding emergency departments and nearly 40 outpatient facilities and ambulatory care centers in 39 states in the U.S., Washington, D.C., Puerto Rico and the United Kingdom.
- The for-profit system also offers health insurance plans through Prominence Health Plan, and manages a network of physicians through Independence Physician Management.
- UHS has about 94,000 employees —- 34,000 of whom operate at its acute care facilities and 55,000 of whom are focused on behavioral health. It also has 12 physician networks comprising more than 700 providers
The CEOs and CFOs of all four health systems saw compensation packages drop substantially in 2022, according to proxy statements filed with the Securities and Exchange Commission. CEOs of the four systems earned compensation packages of more than $43 million combined in 2022, down from a collective $65 million in 2021. CFOs earned more than $16 million combined last year, down from more than $27 million in 2021.
Note: Total compensation can include salary, bonuses, stock and option awards, change in pension value and nonqualified deferred compensation earnings and other compensation.
Samuel Hazen, CEO
2022: $14.6 million
2021: $20.6 million
2020: $30.4 million
Michael McAlevey, senior vice president and chief legal officer
2022: $6.5 million
2021: No data available
2020: No data available
William Rutherford, executive vice president and CFO
2022: $5.1 million
2021: $7.2 million
2020: $6.1 million
Ronald Rittenmeyer, former executive chair and CEO
2022: $24.3 million
2021: $18.7 million
2020: $16.7 million
Saum Sutaria, CEO
2022: $11 million
2021: $21 million
2020: $8.6 million
Dan Cancelmi, executive vice president and CFO
2022: $3.6 million
2021: $9.4 million
2020: $7.2 million
Tim Hingtgen, CEO
2022: $6.3 million
2021: $9.5 million
2020: $6.3 million
Wayne Smith, executive chair
2022: $6.2 million
2021: $8 million
2020: $9 million
Kevin Hammons, president and CFO
2022: $4.2 million
2021: $5.9 million
2020: $3.1 million
Marc Miller, CEO (appointed CEO in January 2021)
2022: $10.9 million
2021: $14 million
2020: $2.3 million
Alan Miller, executive chair
2022: $7.1 million
2021: $13.1 million
2020: $13.2 million
Steve Filton, executive vice president and CFO
2022: $3.3 million
2021: $4.8 million
2020: $1.7 million
4. Key financial statistics (Q2 2023)
HCA posted $1.19 billion in net income for the second quarter, 3.3 percent higher than the same period in 2022 ($1.16 billion). Two other second-quarter details:
- Operating income for the period totaled $1.81 billion compared with $1.76 billion during the second quarter of 2022.
- Revenues for the three-month period totaled $15.86 billion compared with $14.8 billion during the prior-year period. Expenses rose 7.6 percent to $14.05 billion with salaries and benefits up to $7.3 billion, a 7.1 percent year-over-year increase.
Tenet reported $123 million in net income on revenue of $5.1 billion. That compares with net income of $38 million on $4.6 billion of revenue in the same period last year. Two other second-quarter details:
- While revenues rose almost 10 percent to total $5.1 billion in the period, overall expenses also rose, resulting in the same operating margin of 11.9 percent for both the second quarters of 2023 and 2022.
- Salaries, wages and benefit expenses increased 7.5 percent year over year to almost $2.3 billion in the second quarter of 2023.
CHS reported a net loss of $38 million on revenue of $3.1 billion compared with a net loss of $326 million in the same period in 2022 on revenue of $2.9 billion. Two other second-quarter details:
- Operating income totaled $246 million for the second quarter on $3.1 billion revenues, an operating margin of 7.9 percent, compared with a $119 million gain on $2.9 billion of revenues in the second quarter of 2022.
- Salaries and benefits totaled $1.3 billion, up 3.2 percent year over year, but totaled 42.9 percent of revenues compared with 44.1 percent in the same period last year.
UHS reported net income of $179.4 million in the second quarter of 2023 on revenue of $3.5 billion versus $163.9 million in the same period in 2022 on revenue of $3.3 billion. Two other second-quarter details:
5. Payer mix
HCA
Payer mix by patient service revenues as of June 30:
Commercial: $15.5 billion (49.2 percent)
Medicare: $5.3 billion (16.9 percent)
Medicare Advantage: $5.1 billion (16.2 percent)
Managed Medicaid: $1.8 billion (5.7 percent)
Other: $1.6 billion (4.9 percent)
Medicaid: $1.5 billion (4.7 percent)
International: $752 million (2.4 percent)
Tenet
*Commercial includes Medicare Advantage and managed Medicaid
Payer mix by net patient service revenues as of June 30:
Commercial: $5.1 billion (70.6 percent)
Medicare: $1.2 billion (16.9 percent)
Medicaid: $544 million (7.6 percent)
Indemnity/other: $296 million (4.1 percent)
Uninsured: $60 million (0.8 percent)
Payer mix by admissions as of June 30:
Commercial: 67.1 percent
Medicare: 20.3 percent
Medicaid: 4.9 percent
Charity/uninsured: 4.4 percent
Indemnity/other: 3.3 percent
Payer mix by admissions as of June 30:
Commercial: 30 percent
Medicare Advantage: 25 percent
Medicare: 21 percent
Managed Medicaid: 13 percent
Uninsured: 7 percent
Medicaid: 4 percent
CHS
Payer mix by net operating revenues as of June 30:
Commercial: $3 billion (47.6 percent)
Medicare: $1.3 billion (20.5 percent)
Medicare Advantage: $1.1 billion (17.1 percent)
Medicaid: $872 million (14 percent)
Self-pay: $48 million (0.8 percent)
UHS
Payer mix by patient service revenues as of June 30:
Commercial: $2.1 billion (30 percent)
Managed Medicaid: $1.2 billion (17 percent)
Medicare: $815.8 million (12 percent)
Medicare Advantage: 849.7 million (12 percent)
Medicaid: $666.3 million (9 percent)
UK: $357.9 million (5 percent)
Other: 453.1 million (6 percent)