How HCA Healthcare’s ‘Conservative’ Covid Strategy Reaped Dividends

Under the leadership of CEO Sam Hazen, the 54-year-old company recorded higher revenue and profits in 2021 than before the pandemic.

By Katie Jennings


Sam Hazen has dealt with his fair share of natural and man-made disasters. Floods. Tornadoes. Mass shootings. As the CEO of HCA Healthcare, which operates 182 hospitals across 20 states and the U.K., he’s in the business of handling regional crises. In January 2020, the Nashville, Tennessee-based company had its emergency preparedness team start investigating news of an undetermined virus out of China. “A pandemic, to be perfectly candid, was my worst nightmare,” says Hazen, 61. “Because I knew it would have an implication for the company largely and really be an at-scale event.”

By mid-March, as the first state lockdown orders went into effect, Hazen and HCA’s executive team zeroed in on two key priorities: “We’ve got to figure out a way to protect our people, that’s our employees. And then we’ve got to find a way to protect the organization,” he says. “If we can do both of those, then we would be in a position to take care of patients and take care of the community.”

It’s been a bumpy two years for many of the nation’s hospitals. The Covid-19 pandemic filled intensive care units with severely ill, ventilated patients, but operating rooms and outpatient clinics went dark. The shutdown of elective procedures, like knee replacements and cataract surgeries, saw hospital surgical volume drop nearly 50% in spring 2020, costing U.S. hospitals between $16.3 to $17.7 billion per month in revenue, according to one analysis. A federal bailout in the form of provider relief grants and paycheck protection loans, which now total around $278 billion, helped stem the tide of hospital closures that had started before the pandemic. Forty-six hospitals closed in fiscal year 2019, according to the Medicare Payment Advisory Commission. That shrunk to 25 closures in 2020 and 10 in 2021.

While other hospital systems relied on federal cash to limit the red ink and keep the lights on, HCA not only survived the pandemic but thrived. The company, which has 283,000 employees, recorded higher revenue and profits in 2021 than before it all began in 2019. In 2021, HCA reported $7 billion

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