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Bear Stearns/Sept. 2004HCA Vic Campbell Senior Vice President Larry Kloess CEO, Centennial Hospital Mark Kimbrough VP, Investor Relations
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Bear Stearns/Sept. 2004HCA 2 This presentation contains forward-looking statements based on current management expectations. Those forward-looking statements include all statements other than those made solely with respect to historical fact. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those expressed in any forward-looking statements. These factors include, but are not limited to (i) increases in the amount and risk of collectability of uninsured accounts and deductibles and co-pay amounts for insured accounts, (ii) the ability to achieve operating and financial targets and achieve expected levels of patient volumes and control the costs of providing services, (iii) the highly competitive nature of the health care business, (iv) the efforts of insurers, health care providers and others to contain health care costs, (v) possible changes in the Medicare and Medicaid programs that may impact reimbursements to health care providers and insurers, (vi) the ability to attract and retain qualified management and personnel, including affiliated physicians, nurses and medical support personnel, (vii) potential liabilities and other claims that may be asserted against the Company, (viii) fluctuations in the market value of the Company’s common stock, (ix) the impact of the Company’s charity care and self-pay discounting policy changes, (x) changes in accounting practices, (xi) changes in general economic conditions, (xii) future divestitures which may result in charges, (xiii) changes in revenue mix and the ability to enter into and renew managed care provider arrangements on acceptable terms, (xiv) the availability and terms of capital to fund the expansion of the Company’s business, (xv) changes in business strategy or development plans, (xvi) delays in receiving payments for services provided, (xvii) the possible enactment of Federal or state health care reform, (xviii) the outcome of pending and any future tax audits and litigation associated with the Company’s tax positions, (xix) the outcome of the Company’s continuing efforts to monitor, maintain and comply with appropriate laws, regulations, policies and procedures and the Company’s corporate integrity agreement with the government, (xx) changes in Federal, state or local regulations affecting the health care industry, (xxi) the ability to successfully integrate the operations of Health Midwest, (xxii) the ability to develop and implement the payroll and human resources information system within the expected time and cost projections and, upon implementation, to realize the expected benefits and efficiencies, and (xxiii) other risk factors detailed in the Company’s filings with the SEC. Many of the factors that will determine the Company’s future results are beyond the ability of the Company to control or predict. In light of the significant uncertainties inherent in the forward-looking statements contained herein, readers should not place undue reliance on forward-looking statements, which reflect management’s views only as of the date hereof. The Company undertakes no obligation to revise or update any forward- looking statements, or to make any other forward-looking statements, whether as a result of new information, future events or otherwise. All references to “Company” and “HCA” as used throughout this document refer to HCA Inc. and its affiliates.
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Bear Stearns/Sept. 2004HCA 3 HCA is located in 16 of 20 Fastest Growing Large US Cities Switzerland U.K. % % % % % % Compared to the National Average of 4.5% Las Vegas +22% Las Vegas +22% Southern California +9% Southern California +9% Denver +9% Denver +9% Dade +8% Dade +8% Nashville +8% Nashville +8% Panhandle +10% Panhandle +10% Tampa Bay +8% Tampa Bay +8% Dallas/Ft. Worth +12% Dallas/Ft. Worth +12% Austin +18% Austin +18% Richmond +8% Richmond +8% Palm Beach +11% Palm Beach +11% Houston +10% Houston +10% Kansas City +5% Kansas City +5% Percent Growth in Market Population 2000-2005 Generally 25-40% Market Share 40% of facilities in Texas & Florida Generally 25-40% Market Share 40% of facilities in Texas & Florida
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Bear Stearns/Sept. 2004HCA 4 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 $1.65 Routine Patient Safety & Infrastructure New Facilities Expansions
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Bear Stearns/Sept. 2004HCA 5 Source: AHA Annual Survey, 1980 - 2002 Outpatient Visits Inpatient Admissions Admissions (millions) Outpatient Visits (millions) Inpatient Admissions and Outpatient Visits 1980 - 2002
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Bear Stearns/Sept. 2004HCA 6 Socio-Demographics—Age Wave Driving Healthcare Utilization 2000200120022003200420052006200720082009201020112012201320142015 95 100 105 110 115 120 125 Acute Care Utilization Index (2003=100) Baby Boomer Impact Accelerates 1.58% CAGR 2003-2012 121 119 117 115 113 112 110 108 106 105 103 102 100 98 97 96 1.7% 1.6% 1.5% 1.6% 1.5% 1.6% 1.5% 1.4% 1.56% 3-Year CAGR 1.59% 3-Year CAGR 1.58% 3-Year CAGR 1.62% 3-Year CAGR
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Bear Stearns/Sept. 2004HCA 7 HCA Admission Trends 2001 to 2Q 2004 Same Facility HCA Market Competitors 15.4% * HCA Growing Medicare Market Share Growth in Medicare Admissions 1998-2001 HCA Growing Medicare Market Share Growth in Medicare Admissions 1998-2001 * 2Q includes same-market admissions
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Bear Stearns/Sept. 2004HCA 8 Volume Variance by Market – June YTD (3,000) -20% El Paso +4.9% Total Admissions Determine Bubble Size Houston-2.7% So. Cal -7.5% Indy-12.5% Las Vegas +3.3% 1 Dade+2.5% S.Carolina-2.0% Treas. Coast -2.9% West VA -1.8% Cent. La. -2.0% Far West Una. -3.4% Orlando Orlando -0.7% -0.7% Mid. Ga -1.4% North VA -2.5% Delta Una. -8.3% Swiss-5.4% MidAmer Una. -3.1% Denver 2 +2.7% Tampa Bay +3.2% Nashville 1 +13.0% Brownsville/Valley+13.0% Jacksonville+7.4% Atlanta+9.0% Chattanooga+8.6% NW Ga. +11.3% Austin+5.1% D/FW +3.0% Panhandle+4.6% Oklahoma-1.8% Lafayette+6.0% Admissions % Change (2,000) (1,000) - 1,000 2,000 3,000 4,000 5,000 -15%-10%-5%0%5%10%15%20% Admissions Change 2: Denver is a non-consolidating JV Market Top 15 Markets in Admissions Growth +18,367/ +5.2% Top 15 Markets in Admissions Growth +18,367/ +5.2% Bottom 15 Markets in Admissions Growth -6,787/ -3.2% Bottom 15 Markets in Admissions Growth -6,787/ -3.2% +1.5% same facility +1.9% same market 1: Same Market Inpatient Admissions Growth Continues to Vary Widely by Market June YTD – Same Market
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Bear Stearns/Sept. 2004HCA 9 Inpatient Surgery Trends Improving 2001 to 2 nd Quarter 2004 - Same Facility 1: Includes Kansas City facilities. 1 1 11
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Bear Stearns/Sept. 2004HCA 10 9.4% 37.2% OutpatientEROutpatientER Enhanced Outpatient Services Focus 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 O/P Comprised of Three Business Lines
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Bear Stearns/Sept. 2004HCA 11 2004 Managed Care Contracting 2005 Contract Pricing Timeline* 6,844 Facility Level Active Contracts *Anticipated Completion Dates Pre-2004 1Q042Q043Q044Q04 83% of 2004 and 50% of 2005 contracts completed. 2005 Cumulative42%55%75%95%35%100% 15.0% 10.5% 11.4% 13.0% 13.3% 9.6% 7.0% 7.3% 11.1% 9.2% 0% 16% 1Q 022Q 023Q 024Q 021Q 032Q 033Q 034Q 031Q 042Q 04 11.1% 9.9% Net Revenue per Adjusted Admission Managed Care & Other Discounted 11
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Bear Stearns/Sept. 2004HCA 12 Medicare Reimbursement Improves Oct. 1, 2004 with Outlier Threshold Change and Full Market Basket Update Medicare outlier threshold of $16,350 (Oct ‘00), $21,025 (Oct ‘01), $33,560 (Oct ‘02), $30,150 (Oct ‘03) and $25,800 (Oct ’04) Law changed for 2003 to base outlier cost-to-charge ratio on latest “filed” cost reports versus latest “settled” cost reports. Dollars in Millions $284 5.1% $218 3.7% $60 2.0% Medicare Outlier Payments % of O/L Payments to Total Medicare $240 4.7% 6 months
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Bear Stearns/Sept. 2004HCA 13 Labor Cost * Eastern and Western Consolidated Operations 15% vs. Q103 15% vs. Q103 25% vs. Q103 25% vs. Q103 33% vs. Q103 33% vs. Q103 29% vs. Q103 29% vs. Q103 29% vs. Q103 29% vs. Q103 2001 +6.5%+5.1% +4.7% +4.5% JUNE YTD Wage Rate Same Facility - % Change from PY 200220032004 1Q 01 2Q 01 3Q 01 4Q 01 1Q 02 2Q 02 3Q 02 4Q 02 1Q 03 2Q 03 3Q 03 4Q 03 1Q 04 2Q 04 Total Operations* Nursing Contract Labor Reduction $/Adj. Patient Day 1: Includes Kansas City facilities. 1
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Bear Stearns/Sept. 2004HCA 14 2001200220032004 7.0%9.4%7.4% 6.4%6.7%6.5% 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) Same Facility – Percent Change from Prior Year
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Bear Stearns/Sept. 2004HCA 15 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%
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Bear Stearns/Sept. 2004HCA 16 Bad Debts & Charity Quarterly Trending Bad Debts $610 $786 $795 $837 $1B $0 $587 $567 $514 $491 Charity Bad Debts $912 $893 BD % of Net Revenue BD % of Net Revenue Bad Debts & Charity 14%
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Bear Stearns/Sept. 2004HCA 17 HCA Reduces Malpractice Reserves by $59 Million in 2Q 2004 17 HCA Large Claims Declining
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Bear Stearns/Sept. 2004HCA 18 HCA is Investing Significantly in Programs for Patient Safety and Improved Patient Outcomes E MAR: Medication Error Prevention E POM: Physician Order Entry 100% Participation in CMS Quality Reporting Initiative Member of NQF and Leapfrog Cardiovascular, OB and Emergency Department Initiatives
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Bear Stearns/Sept. 2004HCA 19 Accounts Receivable Indicators Cash Collections % Adj. Net Revenue / Days in A/R 2002 20032004 Cash Collections % Adjusted Net Revenue Days in Accounts Receivable
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Bear Stearns/Sept. 2004HCA 20 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 $250mm annually Share Repurchase Program $7.5B in 8 years Capital Reinvestment $1.65B in 2004 Balance Sheet 55% @ 6/30/04 Debt-to-debt and total equity ratio
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Bear Stearns/Sept. 2004HCA 21 Employee Satisfaction at Record Levels Employee Satisfaction (Gallup Score) Employee Turnover Nurse Turnover Turnover Rate Satisfaction Score 21
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Bear Stearns/Sept. 2004HCA 22 A prudent financial strategy that provides for a strong balance sheet and return of cash to shareholders through share repurchase and/or dividends Excellent Investment Opportunities Strong Cash Flows Excellent Long-Term Earnings Growth Outlook Great Assets In Summary We Have….
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