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SEGMENT INFORMATION
6 Months Ended
Jun. 30, 2022
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
Our business consists of our Hospital Operations segment, our Ambulatory Care segment and our Conifer segment. The factors for determining the reportable segments include the manner in which management evaluates operating performance combined with the nature of the individual business activities.

Our Hospital Operations segment is comprised of acute care and specialty hospitals, imaging centers, ancillary outpatient facilities, micro‑hospitals and physician practices. At June 30, 2022, our subsidiaries operated 60 hospitals serving primarily urban and suburban communities in nine states. On April 1, 2021, we transferred 24 imaging centers from our Ambulatory Care segment to our Hospital Operations segment. The total assets associated with the imaging centers transferred to our Hospital Operations segment constituted less than 1% of our consolidated total assets at March 31, 2021. Also in April 2021, we completed the sale of the majority of the urgent care centers then held by our Hospital Operations segment to an unaffiliated urgent care provider. In addition, we completed the sale of five Miami‑area hospitals and certain related operations in August 2021. In April 2022, we completed the sale of a Hospital Operations segment micro-hospital.

Our Ambulatory Care segment is comprised of the operations of USPI. At June 30, 2022, USPI had interests in 410 ambulatory surgery centers (261 consolidated) and 24 surgical hospitals (eight consolidated) in 34 states. In April 2021, we completed the sale of 40 urgent care centers then held by our Ambulatory Care segment to an unaffiliated urgent care provider and, as noted above, transferred 24 imaging centers from our Ambulatory Care segment to our Hospital Operations segment. Effective June 30, 2022, we purchased all of the shares previously held by Baylor in USPI for $406 million, which increased
our ownership interest in USPI’s voting shares from 95% to 100%. See Note 13 for additional information about this transaction.

Our Conifer segment provides revenue cycle management and value‑based care services to hospitals, health systems, physician practices, employers and other clients. At June 30, 2022, Conifer provided services to approximately 660 Tenet and non‑Tenet hospitals and other clients nationwide. Conifer provides revenue management, administrative services and various other services to Tenet hospitals. We believe the pricing terms for these services are commercially reasonable and consistent with estimated third‑party terms. At June 30, 2022, we owned approximately 76% of Conifer Health Solutions, LLC, which is Conifer’s principal subsidiary.

The following tables include amounts for each of our reportable segments and the reconciling items necessary to agree to amounts reported in the accompanying Condensed Consolidated Balance Sheets and Condensed Consolidated Statements of Operations, as applicable:
June 30, 2022December 31, 2021
Assets:  
Hospital Operations$16,111 $17,173 
Ambulatory Care9,600 9,473 
Conifer910 933 
Total $26,621 $27,579 
Three Months Ended
June 30,
Six Months Ended
June 30,
2022202120222021
Capital expenditures:    
Hospital Operations$130 $90 $262 $200 
Ambulatory Care19 27 40 35 
Conifer
Total $152 $122 $307 $243 
Net operating revenues:
Hospital Operations total prior to inter-segment eliminations$3,645 $4,095 $7,443 $8,042 
Ambulatory Care771 664 1,509 1,310 
Conifer
Tenet111 124 226 246 
Other clients222 195 431 383 
Total Conifer revenues333 319 657 629 
Inter-segment eliminations(111)(124)(226)(246)
Total $4,638 $4,954 $9,383 $9,735 
Equity in earnings of unconsolidated affiliates:
Hospital Operations$$$$
Ambulatory Care52 49 94 87 
Total $54 $54 $100 $96 
Adjusted EBITDA:    
Hospital Operations$431 $449 $945 $883 
Ambulatory Care319 295 601 552 
Conifer93 90 185 176 
Total $843 $834 $1,731 $1,611 
Depreciation and amortization:    
Hospital Operations$179 $188 $346 $378 
Ambulatory Care28 23 55 48 
Conifer10 18 19 
Total $216 $221 $419 $445 
Three Months Ended
June 30,
Six Months Ended
June 30,
2022202120222021
Adjusted EBITDA$843 $834 $1,731 $1,611 
Depreciation and amortization(216)(221)(419)(445)
Impairment and restructuring charges, and acquisition-related costs(57)(20)(73)(40)
Litigation and investigation costs(18)(22)(38)(35)
Interest expense(222)(235)(449)(475)
Loss from early extinguishment of debt(66)(31)(109)(54)
Other non-operating income (expense), net— (1)— 
Net gains on sales, consolidation and deconsolidation of facilities15 — 15 
Income from continuing operations, before income taxes$265 $319 $643 $586