Tenet Healthcare thinks outside the hospital

The revealing number in Tenet Healthcare’s 2025 accounts is 24. That is roughly the percentage of revenue supplied by its ambulatory surgery business. Beside it sits another number: 44, that business’s approximate share of adjusted EBITDA. A quarter of the sales, nearly half of this measure of earnings. Suddenly, a company associated with hospital corridors looks different. The interesting question becomes where an operation takes place, and who owns the room.

The building changes the business

Tenet operates hospitals, outpatient facilities and physician practices. Its United Surgical Partners International subsidiary, USPI, runs a network of surgery centers and surgical hospitals. Conifer Health Solutions supplies the administrative plumbing: patient access, coding, billing, collections and support for value-based care. Patients encounter the first two businesses as places to receive treatment. Hospitals, physician groups and employers can buy the third as a service.

Here is the useful distinction. A hospital must organize itself around many kinds of need, including emergencies. An ambulatory surgery center concentrates on scheduled procedures for patients who can leave without an overnight hospital admission. USPI’s specialties include orthopedics, gastroenterology, ophthalmology and ENT. That narrower assignment can support a different operating model. It also puts boundaries around which patients and procedures belong there.

The shift has a long runway behind it. Tenet began as National Medical Enterprises, acquiring four California hospitals in 1969. Its founders were Richard Eamer, Leonard Cohen and John Bedrosian. The company became Tenet in 1995, after acquiring American Medical International. Twenty years later, taking a majority stake in USPI changed the possibilities: growth could come from assembling surgery partnerships as well as adding hospitals.

The doctor is also an owner

USPI’s arrangement has an important human detail. The surgeon may also be a business partner. In a two-way venture, physicians and USPI share ownership. In a three-way venture, a health system joins them. USPI says partnership decisions are reached through consensus, with physicians involved in matters such as staffing and financial distributions. Its operating support is intended to give doctors more room to concentrate on surgery.

That structure helps explain what Tenet offers beyond capital. A center needs scheduling, staffing, supplies, contracting and financial administration. An individual practice may not want to build all of that alone. USPI offers an established operating organization while keeping physicians inside the ownership arrangement. Its website reports more than two million procedures annually and approximately 6,000 physician partners. The network is large; the local relationships still matter.

The surgeon may also be a business partner.An ownership detail with operating consequences.

For someone studying the company, there is a catch. Shared ownership means shared economics. USPI’s reported earnings include amounts attributable to other owners. In 2025, ambulatory adjusted EBITDA was $2.026 billion; after the company’s deduction for noncontrolling interests, the figure was $1.221 billion. The larger number describes the segment. It is not all available to Tenet’s shareholders.

The bill for changing direction

The expansion required substantial money. In November 2021, Tenet announced approximately $1.2 billion for SurgCenter Development’s interests in 92 surgery centers and related services. The word “interests” matters: SurgCenter often owned minority stakes. Tenet also proposed spending up to another $250 million to acquire portions of physician ownership. Alongside the purchase came a five-year development agreement, with a minimum target of 50 additional centers.

Capital moved the other way, too. Tenet sold 14 hospitals in 2024 for approximately $4.8 billion. Put those transactions together and the strategy becomes visible: reconsider which facilities belong in the portfolio, then put money behind selected services and partnerships. HCA, Surgery Partners, SCA Health and local nonprofit systems offer competing routes to care. Tenet’s particular combination is hospitals, an extensive surgical partnership network and an administrative services business.

This was no uninterrupted march toward a better model. In 2017, losses, debt and investor pressure had put strategic alternatives, including a possible sale, under discussion. Those pressures help explain the demand for change, although they do not establish a single moment when management changed its mind. Today’s chairman and CEO, Saum Sutaria, joined in 2019 after nearly two decades at McKinsey. His background combines medicine and economics.

Conifer is changing as well. A January 2026 agreement calls for CommonSpirit Health to pay Tenet $1.9 billion over three years, while Conifer pays $540 million to redeem CommonSpirit’s 23.8% stake. Conifer will support CommonSpirit through the end of 2026. The two payment directions matter: this is an ownership change and a contract conclusion, with separate financial effects. For a reader trying to understand Tenet, it is another reminder to examine the underlying arrangements before treating a headline transaction value as the whole story.

A margin is not a medical outcome

The earlier failure was more serious than an awkward portfolio. In 2016, Tenet and subsidiaries agreed to pay more than $513 million to resolve criminal charges and civil claims involving illegal referral payments. Two subsidiaries agreed to plead guilty. Any account of operating discipline needs that history beside it. Financial efficiency cannot stand in for lawful referrals, patient safety or clinical quality.

Even the current growth numbers need inspection. In the second quarter of 2026, USPI’s same-facility surgical revenue rose 5%, while cases fell 1.2%. Revenue per case increased 6.3%, which Tenet attributed to higher acuity and favorable service mix. More revenue did not mean more operations. Reimbursement, staffing costs and the types of procedures performed can all change the outcome.

What travels beyond healthcare

The transferable idea is specialization with shared ownership: define a repeatable job, build support around it and give important participants a stake. It depends on suitable patients, reliable clinicians, workable payment rates and partners willing to cooperate. A center built for scheduled surgery cannot simply absorb emergency or complex inpatient needs. Tenet’s September 2026 announcement of a new Nacogdoches campus, including emergency and rehabilitation services, makes that distinction concrete.

For patients, the practical task is local. Use Tenet’s facility finder to locate services, then check the specific facility, clinician and insurance network. For a planned procedure, ask about the complete expected bill and follow-up arrangements. Tenet’s transformation makes location a business question. For the person receiving care, it remains a question about getting the right treatment in a place equipped to provide it.