Though surgical volumes were a sore spot for major for-profit health systems in the opening half of 2026, executives said this week they are optimistic those service lines will stay afloat for the remainder of 2026 and beyond.
In fireside chats hosted this week at the Wells Fargo Healthcare Conference, executives acknowledged that demand for surgeries, and elective surgeries in particular, have had a rough go this year.
Broadly, they painted the trend as a result of coverage reductions stemming from health insurance exchange disenrollments, increased price consciousness among those who do still have coverage and, to a lesser extent, early impacts from the administration’s phase-out of the Medicare inpatient-only list.
“It's possible that the consumer sentiment thing could ease a little bit as people get to their deductibles and find that in the fourth quarter they actually now is a good time to do it,” HCA CEO Sam Hazen mused while breaking down the trends. “We'll have to see.”
In Q2, HCA’s same-facility inpatient and outpatient surgeries declined 2.3% and 3.4% year over year, respectively.
At Universal Health Services (UHS), overall surgical volumes dipped 0.8% in Q2, “and that was actually an improvement over the prior period, you know,” Chief Financial Officer Steve Filton said during a separate talk.
Though UHS didn’t see “any significant issues” in regard to the slowdown related to elective versus non-elective procedures, Community Health Systems (CHS) had specifically called out a multi-quarter dip in electives among commercially insured patients and has similarly attributed the softness to broader consumer confidence declines. Chief Financial Officer Jason Johnson, in a Wednesday session, reaffirmed that characterization (while stressing that consumers’ pullback wasn’t tied to any changes to CHS’ procedure payment policies).
Tenet Health reported a 0.7% year-over-year decline in hospital surgeries for the second quarter and a 0.8% drop across six months. Even within its ambulatory segment, United Surgical Partners International (USPI), same-facility surgical cases declined 1.2% for the second quarter and 0.6% for the half.
CEO Saum Sutaria, M.D., said during the company’s earnings call that the elective surgery weakness was mostly felt among its hospitals and in states hardest hit by the exchange disenrollments, but that outpatient elective surgeries at both its hospitals and its ambulatory surgical centers “were actually quite strong.”
Following an earnings season where many of organizations revised their full-year guidance, executives said they’re expecting surgical demand to follow the trajectory set in the first half. UHS’ Filton, for instance, said that the “little lighter” surgical volumes have been backed into the 50-basis-point reduction in overall volume growth projections in its acute care business. HCA’s update also assumes that surgical volumes and overall demand “remain about the same,” and does not include a rebound in surgeries, executives said.
Still, executives took time to highlight bright spots in their surgical results and affirmed their views of longer-term headwinds for demand.
CHS, unlike Tenet and UHS, did see some acuity decline among its surgical volumes, but highlighted a year-over-year surgical volume increase in June and expectations to see “continued improvement there, particularly [in] the fourth quarter.”
More broadly, the executives outlined strategic investments in outpatient capacity, including ambulatory surgical centers, that they say will meet rising demand due to the inpatient-only list phase-out and consumers’ general cost concerns.
Johnson described expansion of CHS’ ambulatory footprint as a “top priority” for the company and highlighted four ambulatory surgical center acquisitions and openings its notched so far this year.
Hazen said that in 2026 “we will have acquired roughly a billion dollars worth of new facilities, mainly outpatient facilities, where we have added to our networks,” pickups that included ambulatory surgical centers alongside other settings like urgent cares. He added that most of the company’s recent acquisition opportunities have presented themselves in the outpatient space, “and we’ll continue to invest in those.”
Tenet, by far the most heavily weighted toward ambulatory surgery capacity with USPI’s more than 550 locations, has no plans to slow down investments in either side of its business as the policy landscape bends in its favor.
“In an industry where so much of the recent regulatory activity has not been overtly favorable to the broader sector, having half of our business where virtually everything that comes out from a regulatory perspective is a tailwind, or a benefit to the business, or will help grow and diversify the business over time—it’s terrific, right?” Sutaria said. “I think that’s very much helpful to us.”