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Text: The table providing supplemental information on adjusted EBITDA and reconciling to net income attributable -- attributable to HCA Healthcare Inc. is included in today's release.
As the COVID-19 pandemic continues to surge, we started the year with strong financial results in the first quarter.
The results were driven by better-than-expected revenue growth and improved operating margins.
Revenues grew over $1.1 billion, or 8.7% as compared to the prior year.
This growth was generated by highly acute inpatient volumes, better payer mix, and a rebound in surgical and outpatient volumes in March.
Generally speaking, March trends are continuing into April.
Inpatient revenues increased by 12%.
The acuity within our inpatient business was higher as reflected in both the case mix index, which increased 7% and length of stay which grew by 6%.
Additionally, commercial admits inside of our domestic operations represented 29% of total admits, compared to 26.5% last year.
The commercial payer mix has been consistently around this level for the past four quarters.
These two factors combined explain the 17% increase in inpatient revenue per admissions.
The total -- the total admits were down 4.2% year over year.
In comparison to 2019, admits were down approximately 3%, which was -- which was in line with our expectations.
In the quarter, we treated almost 50,000 COVID-19 inpatients, which represented 10% of total admissions.
Throughout the quarter, the percentage of COVID-19 admits to total admits declined.
January with 17%, February was 8%, and March was down to almost 5%.
Outpatient revenues increased 4.7% as compared to the prior year.
This result is better performance than the previous two quarters in which outpatient revenue was down approximately 5%.
Outpatient revenues declined in January and February, consistent with that trend.
But March, which had one additional weekday this year, increased by 30% as outpatient surgery and other procedures recovered strongly.
Same facility outpatient surgery volumes grew 2.3% as compared to last year.
As compared to 2019, they declined 3%.
E.R. visits declined 18%.
This decrease is generally consistent with the trends we experienced in the previous two quarters.
visits were down 19% compared to 2019.
Our teams continue to focus and deliver on our operating agenda.
The adjusted EBITDA margin for the company grew on a year-over-year basis and was consistent on a sequential basis with the prior quarter.
Diluted earnings per share, excluding losses and gains on sales as well as losses on debt retirement, increase 78% to $4.14.
During the quarter, we announced the definitive agreement to acquire a majority stake in the home health and hospitals business of Brookdale Senior Living.
This business provides us with a large platform that complements our local provider systems.
It will expand the services we offer across our networks and provide us with more enterprise capabilities to coordinate care for our patients and improve their experiences.
Additionally, we believe the home will become a more important setting for healthcare in the future with continuing growth and demand.
We anticipate this transaction will close in the third quarter and we look forward to our new partnership with Brookdale.
Also during the quarter, we opened two new hospitals.
One in Denver and one in Orlando.
Each of these hospitals will strengthen our system offerings in these communities.
In the second quarter, we expect to close on the acquisitions of two small hospitals both of which complement our networks in Nashville and Savannah.
And lastly, we continue to invest broadly across our networks to improve convenience, access, and value for patients by developing more outpatient facilities.
The pipeline for development and acquisition in this category remains strong.
As we look to the rest of the year, we have increased our annual guidance to reflect the first quarter's performance and better perspective on important macro factors.
Mainly, governmental reimbursement and economic outlooks for our markets including uninsured assumptions.
Bill will provide more details on our guidance in his comments.
The first corps is yet another period where the disciplined operating culture and strong execution by our teams were on display.
We could not have performed at this level without their unwavering commitment to our patients and the communities we serve.
As we continue to resource and execute on our strategic agenda, we will remain true to our mission of improving lives and delivering on the responsibilities we have to all our stakeholders.
Sam spoke to many of our operating metrics and results so I will discuss our cash flow and capital allocation activity during the quarter and then review our updated 2021 guidance.
As a result of the strong operating performance in the quarter, our cash flow from operations was $1.99 billion, as compared to $1.375 billion in the first quarter of 2020.
Capital spending for the quarter was $654 million and we completed just over $1.5 billion of share repurchases during the quarter.
We have approximately $7.3 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 2.85 times and we had approximately $5.6 billion of available liquidity at the end of the quarter.
We expect revenue to range between $54 billion and $55.5 billion.
We expect full-year EBITDA to range between $10.85 billion and $11.35 billion.
We expect full-year diluted earnings per share to range between $13.30 and $14.30.
And our capital spending target remains at approximately $3.7 billion.
Our revised guidance considers the strong results in the first quarter, and also considers the extension of the public health emergency and the deferral of sequestration reductions through the end of the year.
In summary, we recognize some uncertainties remain as we go through the balance of the year, but we are confident in the company's ability to manage through various business cycles and we are well-positioned to continue to invest capital to capture growth opportunities and execute on acquisition opportunities if they become available.
Please remind everyone to limit their questions to one so that we may keep trying and get in the queue as possible.

user
q1 earnings per share $4.14.
sees fy earnings per share $13.30 to $14.30.
qtrly same facility admissions declined 4.2 percent and same facility equivalent admissions declined 6.5 percent.
sees 2021 revenues $54.0 to $55.5 billion.

assistant