HCA
#Thank you very much.
<UNK>, you want that one.
Obviously, we finished 2014 very strong, and we carried a lot of momentum into the first quarter of 2015.
You don't always know how that momentum is going to fare as you cross calendar, but given our really strong performance in the first quarter, felt really it was necessary to update our guidance.
The majority of the updated guidance came from the strong performance in the first quarter.
Clearly, our raise of almost $200 million of adjusted EBITDA factored in continuing momentum in the balance of the year, and so we think ---+ we really feel very confident in that revised guidance.
It's largely continuing to carry the momentum we saw in the fourth quarter of 2014, in the first quarter.
We're not revising our volume of [rate, that] guidance that we gave in February during our call.
At this point in time, I think we still need some more quarters to get into detail, but given the strength of the first quarter performance, we thought it was necessary to up our guidance.
In fact if we hadn't, and you applied to the guidance for the balance of the year, we'd be relatively flattish year over year.
We feel very confident with the momentum we've got right now, and that really is what led to the revised guidance we previously released.
I think it's both.
<UNK> mentioned it in some of his comments, it's really hard to dissect individual contribution, but I think the overall Company momentum contributed to that.
Clearly, I think increasing enrollment in Medicare, more in the Medicare Advantage as well, we're benefiting from.
But, kind of the other marketplace dynamics are in the Medicare payer class as well as in our other payer classes, so I think it's really a combination of a variety of factors that really go along with the volume drivers of our own core business.
This is <UNK>, let me just add.
We believe that Medicare business in general is not as economically dependent, obviously, as the commercial book, so the movement in Medicare is not going to be as pronounced as what we've seen on the commercial side of the equation.
So the aging of the baby boomers is going to continue to create opportunities for Medicare volume growth, and then gains in market share and program development and so forth are going to hopefully add additional volume opportunities for the company.
Ann, I thank you.
Thank you, <UNK>.
And let me just add one thing, there.
We do have certain markets, as I mentioned in my call today, where there are more pressing demand needs, and more pressing capital needs and so the Company will be focused on a handful of market share there.
We haven't finalized that plan specifically, yet, but we do see some opportunities specific to certain markets where there could be a little bit of an enhanced spend in those markets to really take advantage of the situation.
Thanks, A.
J.
<UNK> will take ---+
Let me try to cover some of those.
First, let me address kind of on the Texas waiver.
As we indicated at the end of last year, we planned on reducing our revenue recognition to the Texas waiver.
In the first quarter, we recognized about $77 million of waiver revenues in Texas, compared to about $112 million in the first quarter of 2014.
So it was down $35 million, which is really consistent with our expectations, and I think the items we talked about last year.
We understand the CMS inquiry in Texas is continuing.
We don't have anything new to report on there, and so we're still keeping our eye on it.
Clearly, a lot of discussion with various programs, whether they come under the form of provider tax, UPL, low-income pool, it's ---+ we understand that all of those are really [approved and funded] with CMS, either as a state plan amendment, or a [115] waiver program.
And there's differentiating characteristics, as you know.
The state plan amendments are not time-limited, and generally, the state does not have to be asked to be reapproved for those, unless it modifies its Medicaid program.
Then we've got the 1115 waiver programs, which are time-limited, and states must ask for reapproval, and those are the issues in both Texas and Florida.
The Florida [LIF] has had a lot of publication on there.
We receive about $75 million annually from the Florida LIF funding.
We think it's really early to talk about what might happen with these programs.
With Texas, we know we have a waiver that goes through [930] at [16].
All of these programs are extremely important for the safety net of the hospitals in those states and communities.
So we'll continue to keep our eye on what's going on between CMS and so forth.
You think ---+ if there's programs at risk, it's in those 115 waivers and those non-expansion states, and really that's Texas and Florida for us.
Kansas City ---+ or Kansas and Tennessee are others; those are really smaller programs on there.
So we're going to keep our eye on it and see where that flows, but we don't have anything new to report on Texas, and our revenue recognition is really in line with what we talked about last year, until we get some more clarity on that.
Thank you, A.
J.
Thanks, <UNK>.
We've got time for one more question.
Yes, we sure can, <UNK>.
I won't say it was ---+ hey, <UNK>, this is <UNK>.
I'm [not sure] about 40%, we were really well represented, I think, with all but a couple of markets in [first-year] reform.
We did see some out of network in year one.
As <UNK> mentioned, I think, the increase in exchange contracts that we saw in year two addressed some of those.
So I won't say it was material.
We were seeing some out-of-network business in the reform, and the exchange business, in year one.
In year two, in several of those markets, we've gotten into the contracts in there.
So I won't classify it as it was a material driver for us, but it was a factor.
All right, thank you.
Thanks, <UNK>.
Thank you, everyone, for being on the call.
Mark Kimbrough will be here all day to take any questions you have, and I thank you very much.
