HCA Healthcare reported adjusted Q4 earnings per share of $8.01, a 28.8% increase year over year and well above consensus estimates. Total revenue rose 6.7% to $19.51 billion, driven by a 2.5% increase in equivalent admissions and a 2.9% rise in revenue per equivalent admission. Same-facility admissions climbed 2.4%, reflecting continued demand for both inpatient and outpatient services. Adjusted EBITDA expanded 10.8% to $4.11 billion, lifting margins to 21.1% from 20.3% a year earlier.

The company authorized a $10 billion share buyback program, representing roughly 9% of the current market capitalization. Management expects the repurchase to reduce share count meaningfully over the next two years, enhancing earnings per share and driving a free cash flow yield of approximately 6%. Since the start of the program, HCA has returned over $15 billion to shareholders through buybacks and dividends.

HCA issued 2026 guidance projecting adjusted earnings per share between $29.10 and $31.50, exceeding the analyst consensus of $27.70. Revenue is forecasted at $76.5 billion to $80.0 billion, topping prior estimates of $75.74 billion. The outlook assumes continued admission growth, further improvement in pricing trends and efficiency initiatives that should drive mid-single-digit operating margin expansion.

Shares have surged over 40% in the past year, reflecting aggressive buybacks and steady margin gains. HCA now trades at roughly 16 times estimated earnings, a level that leaves limited upside if operating margin benefits peak. Potential policy headwinds from changes to Medicaid reimbursement and Affordable Care Act subsidies could exert pressure on volume and revenue mix. Investors should monitor upcoming regulatory developments and any signs of margin compression.