In addition, we may reference during today's call measures such as EBITDA, adjusted EBITDA, adjusted EBITDA net of NCI, and adjusted net income attributable to UHS, which are non-GAAP financial measures. Adjusted EBITDA net of NCI increased 10%, and adjusted EPS increased 20% as compared to the fourth quarter of 2024. For the full year 2025, revenue growth was 10%, adjusted EBITDA net of NCI increased 15%, and adjusted EPS increased 31%. Our fourth quarter and full-year performance were highlighted in particular by continued strong expense management in acute care, sequential volume improvements in behavioral health, solid pricing across both segments, and significant share repurchase activity.
We strengthened our growth agenda with the addition of new inpatient capacity, while also intensifying our focus in the outpatient arena through the addition of new service locations across both segments. In our behavioral segment, we've taken a disciplined approach to new bed capacity during 2025, as we devoted more resources to accelerate our outpatient behavioral strategy. From a technology perspective, we've deployed AI and advanced technologies in 2 primary domains within our business: in our operations to impact quality and patient experience, and in our administrative operations to increase efficiency. On the administrative side, we enhanced our acute care revenue cycle operations by deploying AI-based solutions to improve documentation and streamline our claims appeals process.
Over the next several quarters, we will be rolling out process improvements and new technologies in our behavioral health revenue cycle operations. I'll now turn the call over to Steve Filton for more details on the quarter and our financial outlook for 2026. I will highlight a few financial and operational trends and outline our 2026 financial guidance before opening the call up to questions. Acute care same-facility revenue per adjusted admission increased by 5.4% during the fourth quarter of 2025.
| Metric | Period | Current guidance |
|---|---|---|
| Revenue (FY2026) | Full year 2026 | $18.4B-$18.8B (6%-8% growth) |
| Adjusted EBITDA net of NCI (FY2026) | Full year 2026 | $2.64B-$2.79B (2%-8% growth) |
| Adjusted EPS (FY2026) | Full year 2026 | $22.64-$24.52 (4%-13% growth) |
| Same-facility volume growth, both segments | Full year 2026 | 2%-3% (Q1 likely below range on winter storms) |
| Capital expenditures (FY2026) | Full year 2026 | $950M-$1.1B |
| Health insurance exchange pre-tax impact | Full year 2026 | ~$75M adverse; exchange volumes assumed down 25%-30% |
| California behavioral staffing regulation impact | FY2026 / ongoing | ~$35M adverse in 2026; ~$30M ongoing annually thereafter |
| Medicaid supplemental payments net benefit | Full year 2026 | $1.36B (up ~$23M vs 2025; includes new Nevada program) |
| Acute pricing growth assumption | Full year 2026 | 3%-4% |
| Behavioral pricing growth assumption | Full year 2026 | 2%-3% |
| Core consolidated growth | Full year 2026 | ~5% |
| Share repurchase target | Full year 2026 | $800M-$900M range at a minimum |
| Metric | YoY | Note |
|---|---|---|
| Revenue (Q4) | +9% | Growth across both segments; +10% for full-year 2025 |
| Adjusted EBITDA net of NCI (Q4) | +10% | Expense management and pricing; +15% for full-year 2025 |
| Adjusted EPS (Q4) | +20% | EBITDA growth plus significant share repurchase; +31% full-year 2025 |
| Acute same-facility net revenues (Q4) | +6.9% | Pricing and acuity; +5.2% excluding insurance subsidiary |
| Acute same-facility segment EBITDA (Q4) | +10.4% | Revenue growth plus reduced contract labor and strong supply chain management |
| Acute revenue per adjusted admission (Q4) | +5.4% | Steady acuity increase |
| Behavioral same-facility net revenues (Q4) | +7.2% | 5.6% revenue per adjusted patient day and 1.5% patient day growth |
| Behavioral same-facility segment EBITDA (Q4) | +6.9% | Revenue growth partly offset by headcount investment in constrained markets |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Outpatient behavioral strategy | Operated ~100 outpatient access points, building Thousand Branches step-in model | Now 119 outpatient behavioral locations (10 new Thousand Branches centers in 2025), on track for at least 10 more in 2026; outpatient ~10% of behavioral revenue | — |
| AI and technology adoption | Early administrative and revenue-cycle deployments plus post-discharge follow-up | Fully rolled out agentic AI for post-discharge care; 2026 focus on behavioral patient-safety tech and behavioral revenue-cycle AI, partnering with Hippocratic AI | — |
| Medicaid supplemental payments (DPP) | 2025 net benefit ~$1.3B; D.C. program recognized in Q3 | 2026 net benefit projected at $1.36B including a newly approved Nevada program; Florida (~$45M-$50M) still pending, California more uncertain | — |
| DPP durability / OB3 legislation | Reductions begin 2028, ramping to $420M-$470M by 2032 | Reimbursement intact through 2027; outpatient growth (more commercial mix) positioned as a natural hedge against 2028+ reductions | — |
| Behavioral volume recovery | Volumes muted by staffing scarcity; sub-2% growth | 2025 headcount investment (3.5%-4% FTE growth) gives confidence in reaching the 2%-3% patient day target in 2026 | — |
| Capital allocation and leverage | Active buybacks with leverage at low end of 2x-3x target | Leverage at multi-year lows; intends to keep flexibility for M&A rather than lever down further, continuing aggressive buybacks | — |