The Ledger

Three of the country’s biggest for-profit hospital chains took the same investor conference stage this week and told three different stories about 2026. Speaking at the Wells Fargo 21st Annual Healthcare Conference on September 9, 2026, HCA Healthcare Chief Executive Officer Sam Hazen said elective surgical volumes fell 6 percent in the first half of 2026, roughly three times the pace of decline HCA saw in the first half of 2025, driven mainly by Affordable Care Act (ACA) exchange enrollees losing coverage and going uninsured rather than shifting to other insurance, plus cost-conscious patients delaying procedures and, to a lesser extent, early effects of the Centers for Medicare and Medicaid Services’ (CMS) phase-out of the Medicare inpatient-only list; Hazen said he is not assuming a rebound before the fourth quarter, when patients typically resume delayed procedures after meeting annual deductibles. Tenet Healthcare, whose earnings increasingly come from ambulatory surgery centers (ASCs) rather than hospital beds, told the same conference it was raising full-year guidance, crediting a higher-acuity, ASC-heavy procedure mix for insulating it from the exchange-driven falloff hitting more inpatient-dependent peers. Community Health Systems, a smaller and more financially stretched for-profit operator, went the opposite direction, trimming its full-year outlook and describing a mixed picture of improving volumes in some markets offset by softer commercial demand, more uninsured visits and slower payer payments, with executives saying several headwinds will likely persist into 2027. Confidence: Medium-High on the company-specific figures and guidance changes, drawn from executives’ own remarks at a public investor conference as reported by trade press; Medium on the framing that ASC and acuity mix explains the divergence between Tenet and Community Health Systems, since that inference comes from conference coverage rather than either company’s own attribution. Sources: Almost all of HCA’s ACA patients are going uninsured. Here’s how that affected Q2, Healthcare Dive, As elective surgical volumes drag in 2026, health system execs say solid demand is still in sight, Fierce Healthcare, Tenet Healthcare at Wells Fargo conference: high-acuity push deepens, Investing.com, Community Health Systems at Wells Fargo conference: guidance trimmed, Investing.com.

A Dallas-based landlord and a Wall Street asset manager just placed a fresh bet that outpatient surgery keeps growing, in the same week hospital executives described patients and procedures moving that direction. Lincoln Property Company and PGIM, the real estate investment arm of Prudential Financial, announced September 10, 2026 that they acquired the Surgery Center of Gilbert, a 13,957-square-foot, five-operating-room ambulatory surgery center in Mesa, Arizona, operated under a long-term lease by a partnership of Banner Health, Atlas Healthcare Partners and physician surgical partners; terms were not disclosed. The purchase is the latest move in a dedicated healthcare real estate partnership Lincoln and PGIM launched in December 2025 to scale investment in outpatient medical buildings, following their March 2026 purchase of the St. Joseph Medical Pavilion in Denver. PGIM Real Estate’s Soultana Reigle said the firm sees “compelling opportunities in medical outpatient real estate, supported by the long-term shift of care into lower-cost, more accessible settings.” Confidence: High on the transaction facts, drawn from the companies’ own announcement; deal value was not disclosed. Sources: Lincoln and PGIM Expand Outpatient Medical Portfolio with Banner-Anchored Phoenix Acquisition, Real Estate Daily News.

A Seattle-area Catholic nonprofit hospital system is cutting virtual-care jobs for the second time in three months, and its own leadership is naming state budget policy as the reason. Virginia Mason Franciscan Health filed a Worker Adjustment and Retraining Notification (WARN) notice on September 9, 2026 eliminating 24 virtual-care positions, with layoffs beginning November 10; the cut follows a June round that eliminated 116 virtual-care jobs at the same system. Interim president Chad Melton said the system “continues to face significant financial challenges due to recent state budget cuts and increased taxes, in addition to mounting pressures from rising labor costs, growing supply expenses, increasing claim denials, and persistent underpayment from government programs,” tying the layoffs directly to Washington state’s fiscal environment rather than treating them as an isolated telehealth retrenchment. Confidence: High. This run reviewed the WARN filing coverage and the system’s own statement as quoted directly by trade press. Sources: Virginia Mason Franciscan Health to cut virtual care jobs, Becker’s Hospital Review, Virginia Mason Franciscan Health layoffs to hit 116 employees, Modern Healthcare.

CVS Health used the same investor conference to argue its 2026 turnaround is holding, even as its own executives said Medicare Advantage medical costs still are not cooperating. CVS raised its full-year 2026 adjusted earnings-per-share guidance to a range of 7.90 to 8.10 dollars in its second-quarter earnings release in early August 2026, up 60 cents from its prior range, crediting improved execution at Aetna, its pharmacy business and its Oak Street Health primary-care unit. At the September 9 Wells Fargo conference, Aetna President Steven Nelson said the insurer is running roughly 2,000 initiatives to manage medical costs and is seeing “some pockets of favorability” in Medicare Advantage, but that overall cost trend remains elevated and the company is not assuming a meaningful trend improvement in its planning; executives separately flagged 2027 as another year of headwinds before margins return to target levels. Confidence: Medium. The guidance figures are drawn from CVS’s own earnings release; the conference commentary relies on trade-press summary of remarks this run did not independently transcribe. Sources: CVS Health Corporation Reports Strong Second Quarter 2026 Results and Raises Full-Year 2026 Guidance, CVS Health Investor Relations, CVS Health Corporation (CVS) Presents at Wells Fargo 21st Annual Healthcare Conference Transcript, Seeking Alpha.

THE DEAL SHEET

This run’s scan of FTC and DOJ merger actions and state transaction-review dockets found no new healthcare antitrust complaints or consent decrees in the last 24 to 48 hours; the MultiPlan/Claritev out-of-network repricing multidistrict litigation (MDL 3121) remains in discovery with no ruling since its August 22 case management conference. A frontier check on medical office building dealmaking, a Ledger branch not touched in the last three issues, surfaced today’s Lincoln Property Company/PGIM transaction covered above. A parallel check on post-acute and senior-housing consolidation found First Atlantic Healthcare’s pending 275 million dollar sale of 18 Maine skilled nursing and assisted-living facilities to Eagle Arc Acquisitions and Links Healthcare Group, announced September 1, 2026, still awaiting state approval with no new dated development inside this run’s 24-to-48-hour window. An open-ended scan surfaced no additional transaction beyond the items covered above.