Hospital operator HCA Healthcare (NYSE: HCA) fell short of the markets revenue expectations in Q4 CY2025, but sales rose 6.7% year on year to $19.51 billion. The company’s full-year revenue guidance of $78.25 billion at the midpoint came in 1.1% below analysts’ estimates. Its GAAP profit of $8.14 per share was 9.2% above analysts’ consensus estimates.
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HCA Healthcare (HCA) Q4 CY2025 Highlights:
- Revenue: $19.51 billion vs analyst estimates of $19.71 billion (6.7% year-on-year growth, 1% miss)
- EPS (GAAP): $8.14 vs analyst estimates of $7.46 (9.2% beat)
- Adjusted EBITDA: $4.11 billion vs analyst estimates of $4.04 billion (21.1% margin, 1.9% beat)
- EPS (GAAP) guidance for the upcoming financial year 2026 is $30.30 at the midpoint, beating analyst estimates by 1.9%
- EBITDA guidance for the upcoming financial year 2026 is $16 billion at the midpoint, above analyst estimates of $15.82 billion
- Operating Margin: 16.6%, up from 13.5% in the same quarter last year
- Free Cash Flow Margin: 4.5%, down from 7% in the same quarter last year
- Market Capitalization: $107.8 billion
"We finished 2025 with strong performance consistent with previous quarters. Our investments in network expansion, workforce development, and advancing clinical capabilities further strengthened the HCA Healthcare system. I want to thank our colleagues for their outstanding work, their dedication to our patients, and their unyielding commitment to our mission," said Sam Hazen, Chief Executive Officer of HCA Healthcare.
Company Overview
With roots dating back to 1968 and a network spanning 20 states, HCA Healthcare (NYSE: HCA) operates a network of 190 hospitals and 150+ outpatient facilities providing a full range of medical services across the US and England.
Revenue Growth
A company’s long-term performance is an indicator of its overall quality. Any business can put up a good quarter or two, but many enduring ones grow for years. Over the last five years, HCA Healthcare grew its sales at a decent 8% compounded annual growth rate. Its growth was slightly above the average healthcare company and shows its offerings resonate with customers.
We at StockStory place the most emphasis on long-term growth, but within healthcare, a half-decade historical view may miss recent innovations or disruptive industry trends. HCA Healthcare’s annualized revenue growth of 7.9% over the last two years aligns with its five-year trend, suggesting its demand was stable. 
This quarter, HCA Healthcare’s revenue grew by 6.7% year on year to $19.51 billion, missing Wall Street’s estimates.
Looking ahead, sell-side analysts expect revenue to grow 4.7% over the next 12 months, a deceleration versus the last two years. This projection is underwhelming and implies its products and services will face some demand challenges. At least the company is tracking well in other measures of financial health.
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Operating Margin
Operating margin is one of the best measures of profitability because it tells us how much money a company takes home after subtracting all core expenses, like marketing and R&D.
HCA Healthcare has managed its cost base well over the last five years. It demonstrated solid profitability for a healthcare business, producing an average operating margin of 17.2%.
Analyzing the trend in its profitability, HCA Healthcare’s operating margin decreased by 6.2 percentage points over the last five years, but it rose by 1.1 percentage points on a two-year basis. We like HCA Healthcare and hope it can right the ship.
In Q4, HCA Healthcare generated an operating margin profit margin of 16.6%, up 3.1 percentage points year on year. This increase was a welcome development and shows it was more efficient.
Earnings Per Share
Revenue trends explain a company’s historical growth, but the long-term change in earnings per share (EPS) points to the profitability of that growth – for example, a company could inflate its sales through excessive spending on advertising and promotions.
HCA Healthcare’s EPS grew at an astounding 21% compounded annual growth rate over the last five years, higher than its 8% annualized revenue growth. However, this alone doesn’t tell us much about its business quality because its operating margin didn’t improve.
Diving into HCA Healthcare’s quality of earnings can give us a better understanding of its performance. A five-year view shows that HCA Healthcare has repurchased its stock, shrinking its share count by 33.2%. This tells us its EPS outperformed its revenue not because of increased operational efficiency but financial engineering, as buybacks boost per share earnings. 
In Q4, HCA Healthcare reported EPS of $8.14, up from $5.63 in the same quarter last year. This print beat analysts’ estimates by 9.2%. Over the next 12 months, Wall Street expects HCA Healthcare’s full-year EPS of $28.38 to grow 6.1%.
Key Takeaways from HCA Healthcare’s Q4 Results
It was encouraging to see HCA Healthcare beat analysts’ full-year EPS guidance expectations this quarter. We were also glad its EPS outperformed Wall Street’s estimates. On the other hand, its revenue slightly missed and its full-year revenue guidance fell slightly short of Wall Street’s estimates. Overall, this was a weaker quarter. The stock remained flat at $471.25 immediately after reporting.
So should you invest in HCA Healthcare right now? We think that the latest quarter is only one piece of the longer-term business quality puzzle. Quality, when combined with valuation, can help determine if the stock is a buy. We cover that in our actionable full research report which you can read here (it’s free).
