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Segment and Geographic Information
 12 Months Ended
Dec. 31, 2022
Segment Reporting [Abstract]  
Segment and Geographic Information
NOTE 13 — SEGMENT AND GEOGRAPHIC INFORMATION
We operate in one line of business, which is operating hospitals and related health care entities. At December 31, 2022, we operated in two geographically organized groups: the National and American Groups. Effective January 1, 2023, we reorganized our operations into three geographically organized groups: the National, American and Atlantic Groups. The National Group includes our hospitals located in Alaska, California, Idaho, Indiana, Kentucky, Nevada, New Hampshire, North Carolina, Tennessee, Utah and Virginia, the American Group includes our hospitals located in Colorado, Central Kansas, Louisiana and Texas, and the Atlantic Group includes our hospitals located in Florida, Georgia, Northern Kansas, Missouri and South Carolina. The hospitals we operate in England remain in the Corporate and other group.
Adjusted segment EBITDA is defined as income before depreciation and amortization, interest expense, losses and gains on sales of facilities, losses on retirement of debt, income taxes and net income attributable to noncontrolling interests. We use adjusted segment EBITDA as an analytical indicator for purposes of allocating resources to geographic areas and assessing their performance. Adjusted segment EBITDA is commonly used as an analytical indicator within the health care industry, and also serves as a measure of leverage capacity and debt service ability. Adjusted segment EBITDA should not be considered as a measure of financial performance under generally accepted accounting principles, and the items excluded from adjusted segment EBITDA are significant components in understanding and assessing financial performance. Because adjusted segment EBITDA is not a measurement determined in accordance with generally accepted accounting principles and is thus susceptible to varying calculations, adjusted segment EBITDA, as presented, may not be comparable to other similarly titled measures of other companies. The geographic distributions of our revenues, equity in earnings of affiliates, adjusted segment EBITDA, depreciation and amortization, assets and goodwill and other intangible assets are summarized in the following table (dollars in millions) and represent the operating segments under the January 1, 2023 reorganized segment structure:
 
     
                
      
                
      
                
  
    
For the Year Ended December 31,
  
    
    2022    
     
    2021    
     
    2020    
  
Revenues:
                           
National Group
   
$
16,767
 
   
$
16,329
 
   
$
14,428
 
Atlantic Group
   
 
19,324
 
   
 
19,098
 
   
 
16,199
 
American Group
   
 
20,858
 
   
 
19,636
 
   
 
17,479
 
Corporate and other
   
 
3,284
 
   
 
3,689
 
   
 
3,427
 
    
 
 
     
 
 
     
 
 
  
    
$
60,233
 
   
$
58,752
 
   
$
51,533
 
    
 
 
     
 
 
     
 
 
  
Equity in earnings of affiliates:
                           
National Group
   
$
(1
) 
   
$
(33
) 
   
$
(28
) 
Atlantic Group
   
 
(3
) 
   
 
(2
) 
   
 
(2
) 
American Group
   
 
(43
) 
   
 
(50
) 
   
 
(40
) 
Corporate and other
   
 
2
 
   
 
(28
) 
   
 
16
 
    
 
 
     
 
 
     
 
 
  
    
$
(45
) 
   
$
(113
) 
   
$
(54
) 
    
 
 
     
 
 
     
 
 
  
Adjusted segment EBITDA:
                           
National Group
   
$
3,616
 
   
$
4,202
 
   
$
3,243
 
Atlantic Group
   
 
3,881
 
   
 
4,218
 
   
 
3,405
 
American Group
   
 
5,102
 
   
 
4,836
 
   
 
4,061
 
Corporate and other
   
 
(532
) 
   
 
(612
) 
   
 
(672
) 
    
 
 
     
 
 
     
 
 
  
    
$
12,067
 
   
$
12,644
 
   
$
10,037
 
    
 
 
     
 
 
     
 
 
  
Depreciation and amortization:
                           
National Group
   
$
801
 
   
$
754
 
   
$
686
 
Atlantic Group
   
 
921
 
   
 
848
 
   
 
764
 
American Group
   
 
937
 
   
 
897
 
   
 
873
 
Corporate and other
   
 
310
 
   
 
354
 
   
 
398
 
    
 
 
     
 
 
     
 
 
  
    
$
2,969
 
   
$
2,853
 
   
$
2,721
 
    
 
 
     
 
 
     
 
 
  
 
 
     
                
      
                
      
                
  
    
For the Year Ended December 31,
  
    
    2022    
     
    2021    
     
    2020    
  
Adjusted segment EBITDA
   
$
12,067
 
   
$
12,644
 
   
$
10,037
 
Depreciation and amortization
   
 
2,969
 
   
 
2,853
 
   
 
2,721
 
Interest expense
   
 
1,741
 
   
 
1,566
 
   
 
1,584
 
Losses (gains) on sales of facilities
   
 
(1,301
) 
   
 
(1,620
) 
   
 
7
 
Losses on retirement of debt
   
 
78
 
   
 
12
 
   
 
295
 
    
 
 
     
 
 
     
 
 
  
Income before income taxes
   
$
8,580
 
   
$
9,833
 
   
$
5,430
 
    
 
 
     
 
 
     
 
 
  
 
     
                
      
                
      
                
  
    
December 31,
  
    
    2022    
     
    2021    
     
    2020    
  
Assets:
                           
National Group
   
$
11,793
 
   
$
11,236
 
   
$
10,605
 
Atlantic Group
   
 
15,092
 
   
 
13,944
 
   
 
11,909
 
American Group
   
 
17,934
 
   
 
17,224
 
   
 
16,082
 
Corporate and other
   
 
7,619
 
   
 
8,338
 
   
 
8,894
 
    
 
 
     
 
 
     
 
 
  
    
$
52,438
 
   
$
50,742
 
   
$
47,490
 
    
 
 
     
 
 
     
 
 
  
 

 
  
  National  
Group
 
 
Atlantic
Group
 
 
 American 
Group
 
 
Corporate
and Other
 
 
 Total
 
Goodwill and other intangible assets:
                                         
Balance at December 31, 2019
    $ 1,062     $ 1,366     $ 4,970     $ 871     $ 8,269  
Acquisitions
      29       9       27       279       344  
Foreign currency translation, amortization and other
      (2 )      —       (1 )      (32 )      (35 ) 
    
 
 
    
 
 
    
 
 
    
 
 
    
 
 
  
Balance at December 31, 2020
      1,089       1,375       4,996       1,118       8,578  
Acquisitions
      126       610       66       260       1,062  
Foreign currency translation, amortization and other
      (3 )      (15 )      —       (82 )      (100 ) 
    
 
 
    
 
 
    
 
 
    
 
 
    
 
 
  
Balance at December 31, 2021
      1,212       1,970       5,062       1,296       9,540  
Acquisitions
   
 
75
 
  
 
90
 
  
 
90
 
  
 
7
 
  
 
262
 
Foreign currency translation, amortization and other
   
 
(43
) 
  
 
(3
) 
  
 
—
 
  
 
(103
) 
  
 
(149
) 
    
 
 
    
 
 
    
 
 
    
 
 
    
 
 
  
Balance at December 31, 2022
   
$
1,244
 
  
$
2,057
 
  
$
5,152
 
  
$
1,200
 
  
$
9,653