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Text: A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare is included in today's release.
With the effects of the pandemic moderating in the second quarter, we experienced a strong rebound in demand for our services.
COVID admissions in the quarter were down to 3% of total, as compared to 10% in the first quarter.
Volumes across all categories grew significantly compared to last year.
And notably, we grew inpatient admissions and outpatient surgeries over 2019.
The growth was supported by an improved payer mix, which resulted from an increase in commercial volumes.
On a year-over-year basis, revenues grew 30% to $14.4 billion.
Inpatient revenues increased 20%, driven by a 17.5% admission growth.
Outpatient revenues grew an impressive 59%, reflecting the resurgence in outpatient demand across most categories.
To highlight a few areas, outpatient surgeries were up 53%, emergency room visits grew 40%, cardiology procedures increased 41%, and urgent care visits were up 82%.
Compared to 2019, overall inpatient admissions grew almost 3% with commercial admissions growing 8%.
Outpatient surgeries grew approximately 3.5%.
Emergency room visits were only down 5.5% with the month of June basically flat.
Acuity, however, in our emergency rooms was up, with moderate growth in the most acute categories.
We were able to leverage the increased revenue into higher margins.
Adjusted EBITDA margin improved compared to last year, excluding the government stimulus income and sequentially in comparison to the first quarter.
Diluted earnings per share, excluding losses and gains on sales of facilities and losses on retirement of debt, increased 35% to $4.37.
As noted in our release, earnings per share in the second quarter of 2020 included a $1.73 per diluted share benefit from government stimulus income.
This benefit was reversed in the third quarter of 2020 as a result of the decision we made to return our entire share of provider relief funds from the CARES Act.
Once again, our teams delivered on our operating agenda.
As we look to the rest of the year, we have raised our annual guidance to reflect the performance of the company over the first half of the year and the belief that the current levels of demand should prolong over the remainder of the year.
We continue to invest aggressively in our strategic plan, which revolves around building greater clinical capabilities to serve our communities while also developing more comprehensive enterprise resources to support caregivers and differentiate our local networks.
We believe this operating model will continue to create value for our patients, deliver market share growth, and produce solid returns for our shareholders.
I will discuss our cash flow and capital allocation activity during the quarter, then review our updated 2021 guidance.
As a result of the strong operating performance in the quarter, our cash flow from operations was 2.25 billion, as compared to 8.7 billion in the second quarter of 2020.
In the prior-year period, cash flow from operations was positively impacted by approximately 5.8 billion due to CARES Act receipts.
And this year, we had approximately 850 million more income tax payments in the quarter than the prior year due to the deferral of our second-quarter 2020 estimated tax payments.
Capital spending for the quarter was 842 million, and we have approximately 3.8 billion of approved capital in the pipeline that is scheduled to come online between now and the end of 2023.
We completed just under 2.3 billion of share repurchases during the quarter.
We have approximately 5 billion remaining on our authorization.
And consistent with our year-end discussion, we are planning on completing the majority of this in 2021, subject to market conditions.
Our debt to adjusted EBITDA leverage was 2.65 times, and we had approximately 5.6 billion of available liquidity at the end of the quarter.
During the quarter, we closed on the acquisition of Meadows Regional Hospital in Vidalia, Georgia.
We also closed on the Brookdale Home Health and Hospice transaction as of July 1st, 2021.
We have a number of other development transactions in our pipeline to expand our regional delivery networks, including over 15 surgery center additions through both de novo development and acquisitions, as well as a number of urgent care and physician practice acquisitions.
We also anticipate the closing of our previously announced facility divestitures in Georgia later this quarter, and we plan to use the proceeds from this transaction for other capital allocation purposes.
We expect full-year adjusted EBITDA to range between 12.1 billion and 12.5 billion.
We expect full-year diluted earnings per share to range between $16.30 and $17.10 per share.
And our capital spending target remains at approximately 3.7 billion.
As Sam mentioned, our revised guidance considers the strong results in the first half of the year and our belief in the company's ability to continue this performance for the remainder of the year.
If you could give instructions to the callers on the queue.

user
sees fy earnings per share $16.30 to $17.10.

assistant