The first quarter of 2026 brought plenty of opportunity for HCA Healthcare to stock up on outpatient facilities, with management saying Wednesday that the company does not expect any impending policy changes to dampen its appetite or opportunities for continued investment in access points.
During a session at the 2026 RBC Capital Markets Global Healthcare Conference, Chris Wyatt, senior vice president and controller for HCA, said the company spent about $260 million on acquisitions during the first quarter. These pickups were “primarily” freestanding emergency rooms and urgent care, followed by an ambulatory surgery center (ASC).
“We’re seeing more opportunity during the first quarter, … [and] we’ll continue to see opportunities probably a little bit more so on the outpatient side,” Wyatt said of HCA’s market share expansion progress. “It’s not that we don’t continue to look for inpatient opportunities—we did close two hospital acquisitions last year. So, we’ll continue to look for opportunities in that space, but outpatient seems to be what’s presenting itself just a little bit more right now.”
Wyatt’s comments this week flesh out those from CEO Sam Hazen during April’s earnings call, when the executive said the company was being “selective” but expects most of its dealmaking to come from the outpatient space. Both suggested that the company has some deals in the oven that it hopes to close before the year’s end, with Wyatt noting that urgent care and freestanding emergency rooms have made themselves more available.
“Now that’s not to say that [in] ASC there’s not opportunities, and we are doing some ASC acquisitions,” he said. “But you just look at the sheer volume of what we’ve done, it’s been more on the urgent care, freestanding emergency room side.”
HCA is the country’s largest for-profit health system, with 190 hospitals and around 2,500 ambulatory care sites. Across 2025, it grew revenues 7.1% to $75.6 billion and reported $6.8 billion of net income.
HCA has said that outpatient expansion—both acquisitions and de novo construction—is a priority over the next few years and a key destination for its billions of dollars in planned capital expenditures. The company, like several other major health systems, has said doing so would help strengthen its care networks within core markets, drawing new patients while helping offload some lower acuity volumes to less expensive sites of care.
Potential curveballs facing such a strategy could come from Washington, where policies like site neutrality and a planned phase-out of Medicare’s inpatient-only list could both impact payment rates. Wyatt acknowledged that HCA has an eye out for updates, particularly on site neutrality which “has been pretty limited so far” and not yet brought a significant impact on the company.
“It doesn’t change how we’re thinking about our capital deployment in any material way,” he said. “Right now, we’re going to continue to just build these outpatient networks and try to grow that. Fourteen sites of care, outpatient, [for] every one hospital—we’ve stated we’re trying to move that up toward 20.”
Wyatt’s other commentary during the event broadly covered familiar ground from the company’s earnings, in which HCA leadership acknowledged temporal interruptions to volumes during the beginning of Q1 but said that improving numbers in March suggest no issue in hitting the year’s 2% to 3% growth target. He again cautioned investors that the $150 million Q1 earnings hit from disruption within the health exchange is an estimate and likely to ramp up as the true impact of higher premiums, uninsurance and metal tier shifts make themselves known.
“Historically, the second quarter is when we’ve seen a bit of an uptick of patients that aren’t able to maintain their exchange coverage,” he explained. “We’ll see if that dynamic repeats itself. … I think the second quarter is going to be really important to see just how people are able to sustain their premiums.”
Elsewhere in policy land, Wyatt acknowledged CMS’ disclosure this week that it has approved nearly $8 billion of state-directed payments for Florida’s Medicaid program, which was “the amount that we expected.” The highly watched supplemental funds cover services delivered between Oct. 1, 2024, and Sept. 30, 2025.
The payments had not been included in HCA’s 2026 guidance, due to uncertainty, but are now being assessed and are expected to be recorded in the second quarter, Wyatt said.
Wyatt noted that the expectation of additional supplemental payments is part of why HCA expects it will broadly be able to weather the various funding cuts and policy changes of the One Big Beautiful Bill. Playing a factor is the company’s geographic footprint, where about 40% of its Medicaid revenue comes from expansion states where the impact will be greatest, he noted.
Among the tests it will have to navigate is the implementation of Medicaid work requirements set to take effect on Jan. 1, 2027. Wyatt said that “fortunately,” none of HCA’s states have opted to implement the requirements ahead of that deadline, but that the company is still keeping an eye on the systems they are preparing and planning its own efforts within the revenue cycle team to keep qualifying Medicaid patients covered.
“We think this is manageable for us, but we are certainly gearing up to help our patients as much as we possibly can through this work requirement transition, and historically, we have had a really strong track record of finding out if an admission is Medicare, Medicaid eligible and getting that worked out,” he said.