Samuel N. Hazen - HCA Healthcare, Inc.
Management
I was going to say, we've got some assets I didn't know about. I thought I knew just about everything in HCA. So I think in South Florida, as I mentioned in a couple of calls ago, we still are seeing some pressure from our managed care providers in how they're classifying certain patients between observation and inpatient. And when I add the two together, we're actually up in South Florida. But unfortunately, for admissions, it doesn't count as an admission. We continue to work with our physicians and these managed care payers to make the right decisions on those status-ing, and we're improving that a little bit, but that's the driver in that particular market. In Houston; Houston, I don't know if you've seen it or not, but there's a lot of carnage in Houston with respect to system changes, leadership changes, and so forth. Houston is a difficult market because the economy has really suffered with oil prices and so forth. We've actually stabilized in Houston from a financial standpoint, but we have continued to see significant volume pressures, but it's been localized at a couple of our hospitals and not nearly as broad based as it was maybe a year or so ago. So that's the two markets that had the most pronounced weakness. As far as Medicare Advantage and Medicare business, that's generally consistent across the company. That's a natural phenomenon that's going on in the marketplace this year, just like it was going on last year. Our pricing continues to be very consistent between Medicare Advantage and traditional Medicare. We do see some of these status-ing issues from one market to the other, but overall we are very positive about what's going on with our Medicare growth. Now, I'll tell you, our Medicare business growing at 2.5% to 3%, or whatever that number was, is part of why our margins are down. People are asserting that our costs are up. It's really because the composition of our business is lower profitability on Medicare than it is commercial. And so as it grows, it puts a little bit of pressure on our margins, and that's part of the challenge that we had so far this year. But as that starts to stabilize and we start to see some recovery hopefully in our commercial book, we can recover that and get our margins back to where we want them to be. But we have a lot of markets that are growing. As I mentioned, North Florida, Tennessee, and Continental had great quarters. A handful of our other divisions grew around 1% or so. And then, we had a few that were down around 0.5 point to 1 point. So still a solid performance across the portfolio, a solid performance across the different service lines, and just a continued pattern of incremental growth organically in a marketplace that's cooled down a little bit. And we think, again, that's somewhat cyclical.