Editor's note: This story has been updated with additional commentary from Universal Health Services' Q4 2025 earnings call.
Universal Health Services fell short of its volume goals in 2025, but expects capacity and workforce investments, along with ongoing cost management, to boost its numbers in the year to come.
The acute care and behavioral hospital operator said its net revenues rose 9.7% to $17.4 billion and its adjusted earnings per diluted share from 24.2% to $21.74 across 2025—with respective gains of about 7.1% and 8.5% forecast for 2026.
"We're pleased to share our positive growth outlook for 2026, which assumes core growth from our consolidated operations of approximately 5%, underpinned by the strength of our markets, continued expense management and ongoing efficiency opportunities," UHS Executive Vice President and Chief Financial Officer Steve Filton said during Thursday morning's earnings call.
The public for-profit shared the numbers Wednesday afternoon alongside its fourth-quarter performance, for which it reported a 9.1% year-over-year net revenue increase to $4.5 billion and $5.88 adjusted earnings per diluted share ($371.4 million adjusted net income attributed to UHS, $445.9 million as-reported net income attributed to UHS).
The quarter’s revenues were about in line with analysts’ consensus estimates but fell slightly below on earnings, per Zacks Investment Research. That performance and the 2026 guidance together proved a disappointment for investors, with the company's stock trading at about 11% below open as of noon Thursday.
Across the most recent quarter, UHS said its acute hospital business grew net revenues 9.4% to more than $2.5 billion and by 6.9% to nearly $2.4 billion for facilities owned during both periods.
Also on a same-facility basis, the health system saw flat adjusted admissions and a 0.7% decline in adjusted patient days. However, same-facility net revenue per adjusted admission rose 5.4%, and net revenue per adjusted patient day grew by 6.1%. Executives noted during the call that the quarter's volume stumble was caused in part by a "somewhat transitory" disruption in the Las Vegas market, and that same-facility volumes would have been about 1% higher without it.
Same-facility net revenues generated by acute care services grew by 6.9%, to nearly $2.4 billion, from the prior year’s fourth quarter. On a non-same-facility basis, net revenues grew 9.4% to more than $2.5 billion.
Speaking to growth within the segment, President and CEO Marc Miller highlighted for analysts new acute care hospitals the company has opened within the past two years. UHS has also "laid the groundwork for significant new acute care capacity to come online during 2026, with three inpatient expansions totaling 178 licensed beds in Florida, California and Nevada, and a state-of-the-art 156-bed de novo hospital in Palm Beach Gardens, Florida, that will open in the second quarter," Miller said.
Within the behavioral health business, net revenues increased 8.6% to above $1.9 billion for the quarter and by 7.2% to more than $1.8 billion on a same-store basis.
Quarterly adjusted admissions rose 1.8% and adjusted patient days by 1.5%, while revenue per adjusted admission rose by 5.3% and revenue per adjusted patient day by 5.6%, all on a same-store basis.
Miller also flagged two de novo behavioral health projects totaling 264 beds set to open in 2026, as well as plans to open 10 more outpatient branches in 2026.
Across the year and on a same-store basis, UHS’ acute care business saw increases across net revenues of 8.5%, adjusted admissions of 1.6%, adjusted patient days of 0.3%, revenue per adjusted admission of 5.4% and revenue per adjusted patient day of 6.8%. For the behavioral health facilities, same-store increases were 7.7% for revenues, 0.2% for adjusted admissions, 0.9% of adjusted patient days, 7.5% for revenue per adjusted admission and 6.8% for revenue per adjusted patient day.
UHS' 2026 forecast
The volumes on both sides of the business fell short of UHS' general goal of 2% to 3% growth per year. Rather, executives outlined efficiency and pricing gains as bright spots for the company's 2025, while also acknowledging there's room to improve in the months to come.
"In 2025, our operating costs were a little bit elevated by kind of an investment in headcount and hiring and filling vacant positions in markets where that has been a headwind, or an obstacle, to reaching our targeted volume growth," Filton said. "I think that headcount increases will clearly moderate in 2026 and leave us at a point where ... wage inflation and other operating cost inflation should not necessarily exceed the growth in revenue—which will allow for a margin expansion."
UHS' recent rollout of agentic AI to improve post-discharge care and reduce readmissions, as well as its broader strategic push to expand outpatient behavioral services, will also contribute to next year's margins, executives said.
As for the official forecast, UHS said it is projecting net revenues between $18.42 billion and $18.79 billion, adjusted EBITDA net of noncontrolling interests between $2.64 billion and $2.79 billion and earnings per diluted share between $22.64 and $24.52.
Baked into the forecast are same-facility volume growth between 2% to 3% for both sides of the business, as well as pricing increases of 3% to 4% for acute and 2% to 3% for behavioral. It also assumes a $75 million pre-tax earnings hit due to reductions in the Affordable Care Act exchanges, stemming from a 25% to 30% decline in exchange volumes where 10% to 20% of individuals will find other types of coverage.
UHS’ capital expenditures inched past $1 billion during 2025. In 2026, it outlined a range of $950 million to $1.1 billion.
King of Prussia, Pennsylvania-based UHS operates 29 inpatient acute care hospitals, 346 inpatient behavioral health facilities, 168 outpatient facilities and other ambulatory sites across 40 states and other regions.