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Investor Day 2004 HCA Jack O. Bovender Chairman & CEO.

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Presentation on theme: "Investor Day 2004 HCA Jack O. Bovender Chairman & CEO."— Presentation transcript:

1 Investor Day 2004 HCA Jack O. Bovender Chairman & CEO

2 Investor Day 2004 HCA 2 Health Care Market Outlook Strong U.S. Healthcare Expenditures ($ Billions) National Health Care Spending 1990 – 2010 National Health Care Expenditures as a Share of Total GDP 12.0% 13.4 % 13.3%14.8%15.4%15.9%16.4%17.1% Source: U.S. Centers for Medicare and Medicaid Services—National Health Expenditure Projections, 2003 Will the U.S. economy shift 2.3% of GDP to health care services over the next seven years?

3 Investor Day 2004 HCA 3 Source: AHA Annual Survey, 1980 - 2002 Outpatient Visits Inpatient Admissions Admissions (millions) Outpatient Visits (millions) Inpatient Admissions and Outpatient Visits 1980 - 2002

4 Investor Day 2004 HCA 4 HCA Annual Environmental Review Key Findings and Actions, October 2003 HCA’s core business strategy is sound. The Company’s focus will continue to be on market-leading positions in large, fast-growing urban communities. To compete more effectively in the outpatient area, the Company will establish a senior level operational unit focused on outpatient services. HCA anticipates making strategic acquisitions in outpatient services. (Marilyn Tavenner, President Outpatient Services, effective January 1, 2004) The Company intends to reduce capital expenditures from approximately $2 billion in 2003, to approximately $1.8 billion in 2004 (excluding acquisitions). HCA anticipates lowering its target ratio of debt-to-total capitalization from 55% to the low 50s by mid-to-late 2005.

5 Investor Day 2004 HCA 5 HCA Annual Environmental Review Key Findings and Actions, October 2003 The Company’s current $1.5 billion share repurchase program will be completed in a judicious manner, as dictated by market conditions. HCA’s Senior Management and Board of Directors are evaluating a change to the Company’s existing dividend policy and expected to announce any changes in the Company’s existing dividend policy in the first quarter of 2004. (New quarterly dividend of $0.13 per share to be paid June 1, 2004). The company has revised its long-term earnings per share growth target after 2004 (rebasing for outlier reductions and higher bad debts) from mid-teens to low-double digits.

6 Investor Day 2004 HCA 6 Strong Cash Flow Trends Provide Opportunities Net Cash Provided by Operating Activities Dollars in Millions Excluding settlements with government agencies and investigation related costs. New Dividend Policy Share Repurchase Program Capital Reinvestment BalanceSheet

7 Investor Day 2004 HCA 7 HCA Capital Expenditures 1,565 New Beds 54 Facilities with Surgery and/or ICU/CCU expansions Four New Facilities 378 Beds Open Heart, Imaging Cardiology, Oncology, etc. 37 ER Expansions 37 ER Expansions Distribution of Capital Dollars 2002 and Beyond Distribution of Capital Dollars 2002 and Beyond New Denver Facility Expansions Billions 2000 $1.2 2001 $1.4 2002 $1.7 2003 $1.8 2004E $1.8 Routine Patient Safety & Infrastructure New Facilities Expansions

8 Investor Day 2004 HCA 8 $7.3 Billion 244 Million Shares 38% of outstanding shares Average Price: $30.03 Opportunities Of Having Strong Cash Flow Share repurchase program $1.3B: 37.9M Shares 1997 1998 1999 2000 2001 2003 2002 YTD 2004 1 1: 2004 purchases through 5-6-042: Includes other activities affecting share balance (stock option exercises, restricted grants, and ESPP activity). $33.59/share $22.68/share $930M: 41M Shares $1.4B: 55.6M Shares $24.61/share $1.3B: 43.5M Shares $28.65/share $706M: 19.2M Shares $36.88/share $1.1B: 31.1M Shares $35.76/share $422M: 10.0M Shares $42.19/share 650M Shares 12/31/96 465M Shares 2 4/30/04 $282M: 6.2M Shares $45.53/share

9 Investor Day 2004 HCA 9 Our Commitment To… …Enhancing Shareholder Value …our Mission & Values …Ethics and Compliance …Diversity …Transparency of Earnings …the Care and Safety of Our Patients And above all else… …the Care and Improvement of Human Life …Reinvestment in Our Facilities

10 Investor Day 2004 HCA 10 The Genesis of the Bad Debt/Charity Care Issue 22.2% 23.5% 21.2% 22.2% 17.0% 19.2% 29.7% 23.5% 15.1% 15.4% 19.7% 16.7% 20.3% 15.4% 19.3% 15.9% 16.4% National Average: 15.2% 1 National Average: 15.2% 1 18.1% >20% Uninsured 15-20% Uninsured <15% Uninsured 25.6% 14.6% 22.8% HCA is in 14 of the 20 highest uninsured states, with 72% of its hospitals in those states HCA Weighted Average: 22.6% 2HCA Weighted Average: 22.6% 2 1: U.S. Census Bureau “Health Insurance Coverage in the United States: 2002”. 2: Kaiser Commission: Health Ins. Coverage of Nonelderly Adults 2001-2002. 13.1%

11 Investor Day 2004 HCA Bad Debt, Charity Care, and Accounts Receivable Management Milton Johnson Senior Vice President & Controller Joe Steakley Senior Vice President - Internal Audit Beverly Wallace President – Financial Services Group

12 Investor Day 2004 HCA Milton Johnson Senior Vice President & Controller 2

13 Investor Day 2004 HCA 13 Bad Debts & Charity Quarterly Trending Bad Debts & Charity $610 $786 $795 $837 $1B $0 $587 $567 $514 $491 Charity Bad Debts $912 Bad Debts/Net Revenue 3

14 Investor Day 2004 HCA 14 Origination of Bad Debt Expense Source of Bad Debt Expense 1 : Uninsured Patients 75-80% Co-Pay & Deductibles 20-25% 1. Management estimate for 12 month period ending 3/31/2004. 4

15 Investor Day 2004 HCA 15 Uninsured Volume Same Facility - Percent Change from Prior Year Source: QMIRS/CASEMIX. Same facility based on current same facility definition for all quarters. Uninsured Admissions 7.2% vs. PY 2.4% vs. PY 7.5% vs. PY 11.5% vs. PY 13.7% vs. PY Uninsured/Charity ER Visits 3.2% vs. PY 5.1% vs. PY 9.4% vs. PY 19.9% vs. PY 17.9% vs. PY (In Thousands) Two quarters of stabilization Three quarters of stabilization 5

16 Investor Day 2004 HCA 16 Uninsured/Charity Volume Same Facility - Percent of Total Uninsured/Charity Admissions (Percent of Total) Source: CASEMIX. Same facility based on current same facility definition for all quarters. Uninsured/Charity ER Visits 6

17 Investor Day 2004 HCA 17 Uninsured Revenues Consolidated - Percent Change from Prior Year Uninsured Net Revenue 20.1% vs. PY 32.3% vs. PY 38.4% vs. PY (In Millions) 1.6% vs. PY 3.2% vs. PY 7

18 Investor Day 2004 HCA 18 Uninsured Revenues Consolidated - Percent of Total Uninsured Net Revenue (Percent of Total) 8

19 Investor Day 2004 HCA 19 Self-Pay Accounts Receivable Balance Sheet Analysis 3/31/04 3/31/04 Total Self-Pay A/R$3,209 Approximately two-thirds Uninsured and one-third co-pay deductibles A/R Q1/03-Q1/04 Chg. Q1/03-Q1/04 Chg. Increase in Self-Pay A/R 1 $550 Approximately 75% of increase is from uninsured accounts and 25% from co-pay & deductibles. 1: Hospital Only 9

20 Investor Day 2004 HCA 20 Unreserved Self-Pay Accounts Receivable (Dollars in Millions) 2Q 033Q 034Q 031Q 04 Total Self-Pay A/R$2,721$2,867$3,000$3,209 Total Allowance for Doubtful Accounts2,3782,4942,6492,856 Net Unreserved Self-Pay A/R$343$373$351$353 10

21 Investor Day 2004 HCA 21 Accounts Receivable Indicators Cash Collections % Adj. Net Revenue / Days in A/R Cash Collections % Adjusted Net Revenue Days in Accounts Receivable 2002 20032004 11

22 Investor Day 2004 HCA 22 Change in Hospital Accounting Policy Bad Debts Move to reserving a percentage of Uninsured and Co- insurance accounts receivable, and unbilled uninsured revenue during the period. Each hospitals’ uncollectability percentage will be updated quarterly based on the hindsight analysis results. Aggregate uncollectability percentage will decrease due to inclusion of unbilled uninsured revenue in base. To be fully implemented in 2Q 2004 12

23 Investor Day 2004 HCA Joe Steakley Senior Vice President - Internal Audit 13

24 Investor Day 2004 HCA 24 Scope of Quarterly Hindsight Project Hindsight now performed quarterly Over 2,000 hours per quarter to complete Each Hindsight Project: –Test approx. 130 hospitals Sample comprising 90-95% of the Company’s Hospital billed patient A/R and Net Revenue –The resulting Day Metric applied to 163 hospitals –Remaining 27 of 190 Hospitals: HealthONE – 6 Recent Acquisitions/New Facilities – 13 International – 8 14

25 Investor Day 2004 HCA 25 Hindsight Theory: Best Predictor of Current Allowance is Past Results January 31, January 31, 2003 2004 15

26 Investor Day 2004 HCA 26 1/31/03 - Hindsight Date A/R > 1 yr Bad Debt & Charity Write-Offs 2/1/03 1/31/04 Collected or Contractual Recoveries Source: 134 hindsight hospitals reviewed 1Q 2004 16

27 Investor Day 2004 HCA 27 Hindsight Allowance Calculation Write-Offs (BD & Charity) as of 1/31/03 A/R(A) $ 1,641 Less: 3-year Avg. Recovery Percent5.8% (95) Equals: Net Write-Offs (BD & Charity)(B) $ 1,546 A/R > 1 year at 1/31/04 $ 656 Times: 3-year Avg. Uncollectible Percent 79.3% Estimated Uncollectible A/R > 1 year(C) $ 520 Hindsight Allowance at 1/31/03 $ 2,066 (B+C) (in millions) Source: 134 hindsight hospitals reviewed 1Q 2004. 17

28 Investor Day 2004 HCA 28 Conversion of Hindsight Allowance to a Day Metric 1/31/03 A/R Agings for a sample size of 134 Hospitals Allocation of $2,066 million Days Over 150$ 1,645 100% 121-150291 100%120 91-12037113034.92%(10.48) 0-902,931 Total$ 5,238$ 2,066109.52 Hindsight Allow. expressed as a Day Metric = 110 days Hindsight Allow. as a Percent of 1/31/03 Total A/R =39.4% Hindsight Allow. as a Percent of 1/31/03 Self Pay A/R = 89.4% 18

29 Investor Day 2004 HCA 29 Roll Forward of 110 Day Metric to 3/31/04 Consolidated A/R Agings to Determine the Recommended Allowance 3/31/04 A/R Agings for all Hospitals Apply Allocation Percents Recom. Allow. Over 150$2,202 100% 34.92% $ 2,202 121-150358 91-120429150 0-903,452 Total$ 6,441$ 2,710 Recommended Allowance based on a 110-day Day Metric = $2,710 Recommended Allowance based on 89.4% of 3/31/04 Self Pay A/R = $2,701 19

30 Investor Day 2004 HCA 30 Recorded Allowance as a % of Self Pay A/R 20

31 Investor Day 2004 HCA 31 1Q 2004 Allowance Adjustment Recommended Allowance Based on Day Metric ($2,710 adjusted for specific hospital deviations) $ 2,685 Adjustments to Allowance: - Business Trends (HS% Applied to Self Pay A/R) 42 - Charity (Incremental Increase in Charity w/o’s below the Day Metric) (26) Adjusted Recommended Allowance $ 2,701 Allowance as a % of Self Pay A/R 89.4% (in millions) 21

32 Investor Day 2004 HCA 32 New Hospital Allowance Methodology Self Pay A/R: Self Pay A/R with no Insurance Due + Self Pay A/R with Insurance Due (Co-Pays & Deductibles) $ 2,975 Plus: A/R in Charity 47 Equals: Total Self Pay A/R $ 3,022 Times: Hindsight as a Percent of Self Pay A/R (Based on Quarterly Hindsight) : 89.4 % Needed Allowance for Doubtful Accounts $ 2,701 22 (in millions)

33 Investor Day 2004 HCA Beverly Wallace President – Financial Services Group 23

34 Investor Day 2004 HCA 34 Uninsured admissions are relatively small… opportunities exist for non-emergent admissions Medicare103,820Medicare103,820Uninsured13,31374%Uninsured13,31374% Managed/ Medicaid 92,869 92,869 Emergency 210,002 52%Emergency 210,002 52% Non-Emergency Non-Emergency 193,662 48% Non-Emergency Non-Emergency 193,662 48% Admissions 403,664  2.5%Admissions Medicare62,554Medicare62,554Uninsured 4,631 4,63126%Uninsured 26% Managed/ Medicaid 126,477 126,477 52% 48% 74% 26% Net % Change 1Q03-04         1 st Quarter 2004 – Eastern & Western Groups 24

35 Investor Day 2004 HCA 35 ER has the highest volume of uninsured… requires intervention Medicare103,820Medicare103,820Uninsured 13,313 13,313Uninsured Managed/ Medicaid 92,869 92,869 Admitted 210,002Admitted ER Visits 1,025,639 ER Visits 1,025,639 ER Visits 1,235,641  2.3% ER Visits 1,235,641  2.3% Medicare109,235Medicare109,235Uninsured 231,436 231,43695%Uninsured 95% Managed/ Medicaid 684,968 684,968 17%83% 5% 95% Net % Change 1Q03-04         1 st Quarter 2004 – Eastern & Western Groups 25

36 Investor Day 2004 HCA 36 Net Income Improvement Opportunity Similar Between Co-Pay/Deductible and Uninsured Accounts Co-pay & Deductibles Bad Debt Charity/Uninsured Bad Debt $600 Million $2.4 Billion 25-30% $600-720 Million Cost to HCA Cost to Charge Ratio “Full Absorption” 2003 (Carried at Net) (Carried at Gross) 26

37 Investor Day 2004 HCA 37 75-80% Uninsured Patients “How System is Accessed” “How System is Accessed” 20-25% Co-Pay & Deductibles Origination of Bad Debt Expense  1Q 01 vs. 1Q 04 front- end collections  93%, end collections  93%, percent collected  53%, percent collected  53%, co-pays/deductibles co-pays/deductibles  25%  25%  Intensify collections at discharge and post discharge and post discharge discharge  Minimum front-end deposit requirements deposit requirements 27

38 Investor Day 2004 HCA 38 Bad Debt Action Plan 75-80% Uninsured Patients  Screen all potential non-emergent patients by qualified medical personnel  Once stabilized or deemed non-emergent, proceed with collection effort  Mandatory ER case management  Patient Financial Management Committee  In-house case management  Concurrent financial counseling  Standard discharge process  Executive Management approval must be obtained  Minimum deposit standards  Enhanced front-end collection goals  Follow-up care criteria established. 28

39 Investor Day 2004 HCA 39 Net Revenue Impact Underpayment Recoveries / Overturned Denials 29

40 Investor Day 2004 HCA 40 Cost to Collect Black line indicates Baseline cost 30

41 Investor Day 2004 HCA 41 Focused Area of Opportunities 1.Improve front-end collections (co-pay/deductibles) 2.Simplify charity process 3.Case management (ER & Inpatient) 4.Non-emergent screening (ER & Inpatient) 31

42 Investor Day 2004 HCA 42

43 Investor Day 2004 HCA Richard M. Bracken President & Chief Operating Officer

44 Investor Day 2004 HCA 44 1.Patient Volumes 2.Outpatient Services 3.Managed Care Pricing 4.Labor Management 5.Kansas City 2

45 Investor Day 2004 HCA 45 199920002001200220032004 1,463 +2.7% 1,499 +2.8% 1,508 +2.7% 1,568 +2.5% 1,581 +0.6% Same Facility – Admissions in Thousands Admissions (000’s) – %  from PY Admissions Q1 2004…Inpatient Volumes Improved From Recent Trends Admissions (000’s) Percent Change from Prior Year Admissions (000’s) 3

46 Investor Day 2004 HCA 46 Admissions growth rates vary by market Admissions Change Admissions % Change (1,500) (1,000) (500) - 500 1,000 1,500 2,000 2,500 -15% -10%-5%0%5%10%15% Total Admissions Determine Bubble Size Top 15 Markets in Admission s Growth +11,860/ +5.9% vs. PY Top 15 Markets in Admission s Growth +11,860/ +5.9% vs. PY Bottom 15 Markets in Admission s Growth -2,773/ -2.6% vs. PY Bottom 15 Markets in Admission s Growth -2,773/ -2.6% vs. PY Average Chg. +2.5% 1 Volume Variance by Market – 1 st Quarter – Same Market Houston -2.6% So. Cal -5.6% Indiana -12.3% Far West Una. -3.2% Treasure Coast -2.4% Switzerland -6.4% Las Vegas -0.8% Dallas/ Ft. Worth +5.6% TampaBay +3.1% Austin +6.1% El Paso +9.7% Ft. Myers +5.9% San Antonio +3.1% No. VA -3.9% N. Cent. Fla. +5.2% Jacksonville +4.5% San Jose +3.9% Panhandle +2.7% N. Monroe -11.0% Mid America -5.2% Columbus +1.6% S.Carolina 0.1% Rio Grande +12.8% NW Ga. +12.9% Mid. GA +0.3% Cent. La. -1.4% Corpus Christi -1.7% Nashville +14.9% Denver 2 +6.1% Richmond +4.9% 1: Same Facility 2: Denver is a non- consolidating JV Market 4

47 Investor Day 2004 HCA 47 Volume Variance by Market – 1 st Quarter – Same Market Total Admissions Determine Bubble Size Average Chg. +2.5% 1 - 500 1,000 1,500 2,000 2,500 3,000 0% Admissions Change 2%4%6%8%10%12%14%16%18% Admissions % Change N. Cent. Fla. +5.2% TampaBay +3.1% Dallas/ Ft. Worth +5.6% Nashville+14.9% Rio Grande +12.8% NW Ga. +12.9% El Paso +9.7% Austin +6.1% Ft. Myers +5.9% San Antonio +3.1% Panhandle +2.7% San Jose +3.9% Jacksonville +4.5% Denver 2 +6.1% Richmond+4.9% Top 15 Markets in Admission s Growth +11,860/ +5.9% vs. PY Top 15 Markets in Admission s Growth +11,860/ +5.9% vs. PY Q1 2004…Top 15 Markets Performing Above Company Average Top 15 Markets represent 49% of Total Company Admissions 1: Same Facility 2: Denver is a non- consolidating JV Market 5

48 Investor Day 2004 HCA 48 (900) (800) (700) (600) (500) (400) (300) (200) (100) - 100 200 -14%-12%-10%-8%-6%-4%-2%0%2%4% Average Chg. +2.5% 1 Bottom 15 Markets in Admissions Growth -2,773/ -2.6% vs. PY Bottom 15 Markets in Admissions Growth -2,773/ -2.6% vs. PY Cent. La. -1.4% Houston -2.6% So. Cal -5.6% Switzerland -6.4% N. Monroe -11.0% Indiana -12.3% Mid America -5.2% No. VA -3.9% Far West Una. -3.2% Corpus Christi -1.7% S.Carolina 0.1% Mid. GA +0.3% Columbus +1.6% Las Vegas -0.8% Treasure Coast -2.4% Admissions Change Admissions % Change Volume Variance by Market – 1Q 04 vs. PY – Same Facility Q1 2004…Bottom 15 Markets Performing Below Company Average Bottom 15 Markets represent 25% of Total Company Admissions Total Admissions Determine Bubble Size 1: Same Facility 6

49 Investor Day 2004 HCA 49 Q1 2004…“Big Earners” Had Strong Admissions Growth Top 15 Earnings markets (69% of Company’s earnings 1 ) grew +3.5% 2. (Company Avg.: 2.5%) 1: Includes Denver – A non-consolidating JV Market 2: Same facility – Q1 04 vs. Prior Year Dallas/ Ft. Worth Tampa Bay Houston Richmond Nashville San Antonio U.K. S. Carolina Panhandle Dade Utah Jacksonville N. Cent. Fla. Las Vegas Denver 7

50 Investor Day 2004 HCA 50 Capital Placed in Service by Year (Dollars in Millions) Western$208$228$249$532$439$586 Eastern$341$145$427$691$434$143 Total HCA$549$373$676$1,223$873$729 2003 projects typically approved 24-30 months ago Design & Permits Construction In Service 9 mo. 18 mo. Approved Average Timeframe 8

51 Investor Day 2004 HCA 51 1 st Quarter Admissions Change 1 st Quarter Admissions % Change (1,500) (1,000) (500) - 500 1,000 1,500 2,000 2,500 -15% -10%-5%0%5%10%15% Total Admissions Determine Bubble Size Same Market $970M in Major Projects completed in 16 Markets Capital Investment Strategy Supports Improved Admissions Growth TampaBay+3.1% Dallas/Ft. Worth +5.6% N. Cent. Fla. +5.2% Jacksonville +4.5% S. Carolina +0.1% Austin +6.1% El Paso 9.7% So. Cal. -5.6% Panhandle +2.7% Palm Beach +0.9% Reston +0.5% Richmond +4.9% Wesley+3.3% Denver 2 +6.1% Nashville +14.9% Rio Grande +12.8% Markets with Major Project Completions 2Q03-4Q03 Average Chg. +2.5% 1 1: Same Facility 2: Denver is a non- consolidating JV Market 9

52 Investor Day 2004 HCA 52 Q1 2004…Some Rebound In Inpatient Surgeries Inpatient Surgeries 199920002001200220032004 Same Facility – Surgeries in Thousands Inpatient Surgeries - % Change from Prior Year 444 +2.2% 462 +3.5% 471 +3.6% 514 +2.8% 514 -0.2% Inpatient Surgeries Percent Change from Prior Year Inpatient Surgeries (000’s) 10

53 Investor Day 2004 HCA 53 2001 200220032004 HOSPITAL BASED ASC BASED Hospital Based Same Facility Q1 2004…Outpatient trends show slight recovery ASC Based 207,135 -3.2% 217,887 +4.0% 233,475 +2.1% 554,969 -0.5% 574,153 +1.5% 539,501 -5.1% +1.0% 1 st Qtr. +3.5% 1 st Qtr. Outpatient Surgeries 11

54 Investor Day 2004 HCA 54 Q1 2004…Outpatient trends show slight recovery 2001 200220032004 HOSPITAL BASED ASC BASED -3.2% +4.0% +2.1% -0.5% +1.5% -5.1% ASC Based Hospital Based Same Facility – Percent Change from Prior Year Outpatient Surgeries - % Change from Prior Year Outpatient Surgeries 12

55 Investor Day 2004 HCA 55 Outpatient Diagnostic Services CT Scan MRI Cardiac Cath 200220032004 13 Same Facility – Percent Change from Prior Year

56 Investor Day 2004 HCA 56 1.Despite improved Q1, too soon to declare recovery 2.Admission growth rates vary widely by market 3.Hospitals comprising majority of revenue base (58% of Revenues) performing better than Company averages (Excluding Houston) 4.Uninsured had modest impact on patient growth rates in Q1 5.Capital investment strategy supports improved admissions growth 6.Surgical trends improved Q1 04 HCA Patient Volume – Key Observations 14

57 Investor Day 2004 HCA 57 Outpatient Services 15

58 Investor Day 2004 HCA 58 9.4% 37.2% OutpatientEROutpatientER Outpatient Services comprised of three business lines 12.5% Hospital Based FreestandingFreestanding Outpatient Diagnostic Services Outpatient  Imaging  Cardiology  Oncology  Orthopedics  Neurology  Imaging  Cardiology  Oncology  Orthopedics  Neurology Hospital Based Outpatient Surgeries 15.3% ASC Based 70% 30% 2003 % of HCA Net Revenue As a % of Outpatient Surgeries 16

59 Investor Day 2004 HCA 59 Delivered in Two Distinct Locations 17 9.4% 37.2% OutpatientEROutpatientER 12.5% Hospital Based FreestandingFreestanding Outpatient Diagnostic Services Outpatient  Imaging  Cardiology  Oncology  Orthopedics  Neurology  Imaging  Cardiology  Oncology  Orthopedics  Neurology Hospital Based Outpatient Surgeries 15.3% ASC Based 70% 30% 2003 % of HCA Net Revenue As a %of Outpatient Surgeries Hospital Based Service/convenience strategy i.e.: improved access, dedicated parking, shortened registration process and extended hours of scheduling.Service/convenience strategy i.e.: improved access, dedicated parking, shortened registration process and extended hours of scheduling. Physician service/preference strategy i.e.: same day appointments, rapid report turn around, block OR scheduling, integrated patient scheduling, and on-line clinical reports.Physician service/preference strategy i.e.: same day appointments, rapid report turn around, block OR scheduling, integrated patient scheduling, and on-line clinical reports. Competitive managed care pricingCompetitive managed care pricing

60 Investor Day 2004 HCA 60 Delivered in Two Distinct Locations 18 9.4% 37.2% OutpatientEROutpatientER 12.5% Hospital Based FreestandingFreestanding Outpatient Diagnostic Services Outpatient  Imaging  Cardiology  Oncology  Orthopedics  Neurology  Imaging  Cardiology  Oncology  Orthopedics  Neurology Hospital Based Outpatient Surgeries 15.3% ASC Based 70% 30% 2003 % of HCA Net Revenue As a %of Outpatient Surgeries Freestanding Surgery Centers (ASCs) 76 Centers Operational 11 new centers coming on line over next 12 months 8 additional projects in various stages of development (12-18 month horizon) 25 other projects currently under review * * * Dedicated division based development teams (increase pipeline)Dedicated division based development teams (increase pipeline) Recruiting surgical specialties (offer ownership opportunities as a component of recruitment package)Recruiting surgical specialties (offer ownership opportunities as a component of recruitment package) Adding capacity to existing ASCsAdding capacity to existing ASCs Modifying equity model/re-syndication as appropriateModifying equity model/re-syndication as appropriate Reserving space in new MOBs for outpatient unitsReserving space in new MOBs for outpatient units

61 Investor Day 2004 HCA 61 Delivered in Two Distinct Locations 19 9.4% 37.2% OutpatientEROutpatientER 12.5% Hospital Based FreestandingFreestanding Outpatient Diagnostic Services Outpatient  Imaging  Cardiology  Oncology  Orthopedics  Neurology  Imaging  Cardiology  Oncology  Orthopedics  Neurology Hospital Based Outpatient Surgeries 15.3% ASC Based 70% 30% 2003 % of HCA Net Revenue As a %of Outpatient Surgeries Freestanding Imaging Centers 10-15 sites in planning and expected to come on line over the next 12 months 16 sites under review or with letters of intent for acquisition / joint venture * * * * * * Investing capital in freestanding imaging, cardiac cath and radiation oncology centers (includes ownership opportunities for physicians)Investing capital in freestanding imaging, cardiac cath and radiation oncology centers (includes ownership opportunities for physicians) “Acquisition strategy” more likely in mature markets such as Florida and Texas“Acquisition strategy” more likely in mature markets such as Florida and Texas “Build strategy” more likely in less mature markets such as Colorado, Virginia, Georgia, and South Carolina“Build strategy” more likely in less mature markets such as Colorado, Virginia, Georgia, and South Carolina Developing full-service models (oncology, cardiology, orthopedics) as opposed to single modality centers (minimizes risk due to reimbursement changes or exclusion from contracts)Developing full-service models (oncology, cardiology, orthopedics) as opposed to single modality centers (minimizes risk due to reimbursement changes or exclusion from contracts)

62 Investor Day 2004 HCA 62 Managed Care Pricing 20

63 Investor Day 2004 HCA 63 2004 Managed Care Contracting 2005 Contract Pricing Timeline* 6,844 Facility Level Active Contracts *Anticipated Completion Dates Pre-2004 1Q042Q043Q044Q04 83% of 2004 and 42% of 2005 contracts completed. 2005 Cumulative42%55%75%95%35%100% 11.1% 9.9% Net Revenue per Adjusted Admission Managed Care & Other Discounted 21

64 Investor Day 2004 HCA 64 Operating Expenses 22

65 Investor Day 2004 HCA 65 2001200220032004 7.0%9.4%7.4% 6.4%6.7%6.5% Same Facility – Percent Change from Prior Year Bad Debt Impact on Operating Expenses per Adjusted Admission Operating Expenses/AA – Percent Change from Prior Year Operating Expense/AA Operating Expense/AA (Adj. For Bad Debt) 23

66 Investor Day 2004 HCA 66 Labor costs: Favorable Trends Continue Increasing Labor Rate 20012002 20032004 9.6% 8.3% 5.7% 6.5% 5.1% 4.7% SW&B/AA % Change Wage Rate % Change Same Facility Utilization of Premium Contract Labor SW&B % of Net 39.4% 39.2% 38.5% 24

67 Investor Day 2004 HCA 67 Controlling premium labor 15% vs. Q1 15% vs. Q1 $41/APD$28/APD $35/APD $24/APD (2 nd Qtr. Actual)(3 rd Qtr. Actual)(4 th Qtr. Actual) $32/APD $22/APD 25% vs. Q1 25% vs. Q1 33% vs. Q1 33% vs. Q1 29% vs. ‘03 Q1 29% vs. ‘03 Q1 (1 st Qtr. Actual) * Eastern and Western Consolidated Operations Per Adjusted Patient Day As a Percent of Salaries Nursing Total Ops.* Actual Consolidated Contract Labor Contract Labor/APD 25

68 Investor Day 2004 HCA 68 …while employee satisfaction at record levels Employee Satisfaction (Gallup Score) Employee Turnover Nurse Turnover Turnover Rate Satisfaction Score 26

69 Investor Day 2004 HCA 6927 Supply costs driven by new technology 2001200220032004 7.3% 8.9%8.1% HCA Initiatives Fully Implemented Shared Services Model. Created GPO – now the 3rd largest group purchasing organization nationally. Division based procurement: limited the number of vendors for high volume implants. Supply Management Action Teams: hospital level program focused on supply utilization. HCA Initiatives Fully Implemented Shared Services Model. Created GPO – now the 3rd largest group purchasing organization nationally. Division based procurement: limited the number of vendors for high volume implants. Supply Management Action Teams: hospital level program focused on supply utilization. Technology Drivers Technology Drivers Coronary Stents Spinal Implants Orthopedic Implants Single Largest Driver of Supply Expense Same Facility % Change from PY Supplies/AA % Change from Prior Year

70 Investor Day 2004 HCA 70 Ethics and Compliance Program 19981999 2000 2001200220032004 Net Revenue Plan Managed Care Contracting Net Revenue Plan Managed Care Contracting Patient Safety Employer of Choice NEXT GENERATION Shared Services Leveraging our economies of scale and prior project experience into new clinical and best practice initiatives  Shared Services (Phase 2) Bad Debt ManagementBad Debt Management Centralized CodingCentralized Coding Teleradiology/PACsTeleradiology/PACs Centralized monitoring of patients (Digital ICU)Centralized monitoring of patients (Digital ICU) Centralized Lab & PharmacyCentralized Lab & Pharmacy Division based physician recruitmentDivision based physician recruitment Clinical Initiatives:Clinical Initiatives: ED efficiency/wait timeED efficiency/wait time OR utilizationOR utilization ICU effectivenessICU effectiveness Perinatal trainingPerinatal training Nosocomial InfectionsNosocomial Infections Sharpen the Organizational Agenda 28

71 Investor Day 2004 HCA 71 Market Update : Kansas City Financial Impact to HCA Market Summary & Highlights New management structure in place Admission run rate stabilizes & turns positive in first 12 months $71M in capital expenditures in 1 st year ($450M committed) Re-opened Trauma Services and Heart Program in Market Recruited 19 new physicians HCA Midwest Division Hospitals Acquired April 1, 2003 12 Hospitals (1 Mgmt. Contract) 2 ASCs IT Systems deployed Managed Care Contract renewal complete; ’04 average increase 9% Reduced Salaries & Wages $30M or 562 FTEs (190 were overhead & infrastructure) Won unionization attempt at Research Med Center (largest facility) 29

72 Investor Day 2004 HCA 72

73 Investor Day 2004 HCA Frank Houser, M.D. Corporate Medical Director & Senior Vice President, Quality

74 Investor Day 2004 HCA 74 Electronic Medication Administration Record (eMAR) Serious Preventable Adverse Drug Events occur in 2% of all hospital admissions and result in increased costs through extended length of stays, increased resource use, and greater malpractice costs. eMAR is proving very effective in reducing medication errors in HCA hospitals by at least one-third. eMAR is better patient care that saves money. 2

75 Investor Day 2004 HCA 75 Electronic Provider Order Management (ePOM) 34 hospitals have applied to pilot the ePOM software that our physicians helped develop with Meditech. Ten will be selected. The software will provide significant competitive advantage to our hospitals beginning in 2005. The combination of eMAR and ePOM will dramatically reduce Medication Errors and Preventable Adverse Drug Events in HCA hospitals. 3

76 Investor Day 2004 HCA 76 Data Source: HCA Data – CHOIS Nat’l Comparative Data - Solucient Quality Outcomes CABG: DRG 106, 107, or 109 4

77 Investor Day 2004 HCA 77 Cardiovascular HCA Cardiovascular Centers of Excellence internal recognition program developed in conjunction with our physician panel to begin in fourth quarter. 5

78 Investor Day 2004 HCA 78 Perinatal All 3,800 Labor and Delivery nurses in the HCA system are AHWONN certified in the interpretation of fetal monitoring. Better OB outcomes mean increased C- Sections, less VBACs, and less forceps and vacuum extractions. The frequency of OB malpractice claims at HCA have significantly decreased. Another competitive advantage for HCA hospitals. 6

79 Investor Day 2004 HCA 79 Acute Med/Surg without CV Surgery 7

80 Investor Day 2004 HCA


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