2. Forward-Looking Statements
Certain statements contained in this presentation constitute forward-looking statements. Such forward-looking statements are based on
management's current expectations and involve known and unknown risks, uncertainties and other factors that may cause the
Company’s actual results to be materially different from those expressed or implied by such forward-looking statements. Such factors
include, among others, the following: general economic and business conditions, both nationally and regionally; industry capacity;
demographic changes; changes in, or the failure to comply with, laws and governmental regulations; the ability to enter into managed
care provider arrangements on acceptable terms; changes in Medicare and Medicaid payments or reimbursement, including those
resulting from a shift from traditional reimbursement to managed care plans; liability and other claims asserted against the Company;
competition, including the Company’s failure to attract patients to its hospitals; the loss of any significant customers; technological and
pharmaceutical improvements that increase the cost of providing, or reduce the demand for, health care; a shortage of raw materials, a
breakdown in the distribution process or other factors that may increase the Company’s cost of supplies; changes in business strategy
or development plans; the ability to attract and retain qualified personnel, including physicians, nurses and other health care
professionals, including the impact on the Company’s labor expenses resulting from a shortage of nurses or other health care
professionals; the significant indebtedness of the Company; the availability of suitable acquisition opportunities and the length of time it
takes to accomplish acquisitions; the Company's ability to integrate new businesses with its existing operations; and the availability and
terms of capital to fund the expansion of the Company's business, including the acquisition of additional facilities. Certain additional
risks and uncertainties are discussed in the Company’s filings with the Securities and Exchange Commission, including the Company’s
annual report on Form 10-K and quarterly reports on Form 10-Q.
Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to
achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in
underlying factors, new information, future events or otherwise.
Non-GAAP Information
During the Company’s quarterly earnings calls and in this presentation, management refers to certain financial measures and statistics,
including measures such as adjusted EBITDA, which are not calculated in accordance with Generally Accepted Accounting Principles
(GAAP). Management recommends that you focus on the GAAP numbers as the best indicator of financial performance. These
alternative measures are provided only as a supplement to aid in analysis of the Company.
Reconciliation between non-GAAP measures and related GAAP measures can be found in the press release issued on May 6, 2008,
and on the Company’s web site, www.tenethealth.com.
2
5. Key Strategies Proving Effective
2nd consecutive quarter of positive admissions growth (same-hospital)
Volumes 1.0% admissions growth (Q1’08 versus Q1’07, same-hospital)
0.8% admissions growth excluding flu
EBITDA EBITDA margin of 9.9%, up 120 basis points over Q1’07
Physician Continued growth of active medical staffs
Relations
Commercial payers recognizing Tenet’s progress in clinical quality
Pricing
Cost initiatives plus operating leverage improved unit costs
Costs
Growth in uninsured beginning to moderate
Bad Debt
Aggregate uninsured + charity admissions declined 1.2%
Commercial managed care admissions declined 3.7%
Commercial
Commercial outpatient visits declined 2.1%
Volumes
5
6. Performance metrics(1) (cont.)
Adjusted $239mm adjusted EBITDA
EBITDA
3.7% growth in admissions compared to April, ’07
April (2)
0.9% growth in commercial managed care admissions
Volumes
2.8% growth in outpatient visits
1.6% admissions growth
Y-T-D Volume
2.6% commercial admissions decline
Growth
1.3% growth in uninsured + charity
(through 4/30/08)
0.1% decline in outpatient visits
(1) Same-hospital
(2) April 2008 had one more weekday and one less weekend day than April 2007.
Weekdays generally produce stronger volumes than weekend days.
6
9. USC Sale
Price Sale price = Book value at closing
Book
$311 million (3/31/08)
Value
Approx $25mm in 2007, excluding corporate
EBITDA
overhead and unusual or non-recurring items
Capital
Normal annual capital expenditures approx. $10mm
Expenditures
9
11. Physician Relationship Program (“PRP”)
13,158 calls logged on 6,764 physicians in Q1’08
5.7% admissions increase from these 6,764
physicians:
Best quarterly performance since PRP launch
497 PRP calls on unaffiliated physicians
11
12. Active Physician Staff Continues to Grow
178 net additions to active physician staff in Q1’08
10.3% net growth in active physician staff since 1/1/07
12
13. New PRP Enhancements
Increased numbers of staff becoming involved
Expanded training curriculum
Customized education program for hospital-based
recruiters
13
15. TGI – Commercial admissions growth in TGI
service lines(1) significantly exceeds total
commercial admissions growth
2% TGI Service lines – commercial admissions only (1)
1% Total commercial admissions
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Down
Y-o-Y Growth
-1%
1.2%
-2%
-3%
-4%
-5%
-6%
-7%
2006 2007 2008
(1)
Data represents commercial admissions growth in 8 service lines which are typically emphasized by TGI:
general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart, orthopedic surgery,
and Cath/EP.
15
16. Commercial admissions decline confined to a
small number of hospitals
3 hospitals responsible for more than half the Q1’08 commercial
admissions decline of 1,520 admissions
April: no loss of aggregate commercial admissions in these 3
hospitals
16
17. Florida’s volume resurgence continues
1.1% aggregate admission growth in Q1’08
Reducing outmigration
Regionalizing selected services
17.7% growth (14 cases) in commercial open heart
procedures
17
18. April volumes were strong (1)
3.7% total admissions growth
1.6% Y-T-D admissions growth through April 30
All 5 regions saw positive growth in April
0.9% growth in commercial managed care
admissions
2.8% growth in outpatient visits
(1)
April 2008 versus April 2007. April 2008 had one more weekday and one fewer weekend
days than April 2007. The company typically experiences stronger volumes on week days
than on weekends.
18
19. Pricing enhancements
Recently signed commercial contracts made key
contribution
Progress towards closing pricing gap relative to
competitors
Memorandum of understanding with Independence
Blue Cross in Philadelphia
Includes incremental payments for Quality
19
20. Cost structure continues to improve
Productivity:
1.2% improvement in FTEs per adjusted patient day
10.7% decline in contract labor expense per adjusted
patient day
18% reduction in registered nurse turnover
Supply costs:
Limited to a 3.9% increase per adjusted patient day
Much of supply cost increase due to 1.2% increase in
orthopedic, neurosurgical and general surgery procedures
20
24. Solid pricing gains(1)
6.0% growth in net inpatient revenue per admission
8.6% growth in net outpatient revenue per visit
5.5% increase in net patient revenue per adjusted
admission
Recently signed commercial contracts support pricing trend
Signed contracts cover approximately:
84% of commercial rates for 2008
68% for 2009
(1) Same-hospital
24
25. Cost Containment
Controllable Expenses(1) per Adjusted Patient Day
8%
6.5
6.3
6%
Y-o-Y Growth
5.1 5.1
4.8
4.3 4.2
4% 3.6
2.6
2%
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2008
2007
(1) Same-hospital controllable expenses defined as SWB, supplies, and other operating expenses.
25
28. Medical Office Building (“MOB”) Proposed Sale
34 MOBs in package
Jones Lang LaSalle is Tenet broker
2.4 million square feet net rentable space
MOBs located at 21 of our hospitals
MOBs located in 7 states
28
29. 2008 Outlook Revisions
. . . pricing strength offsets slower outpatient
volume growth
Prior Revised
(2/26/08) (5/6/08)
Admissions - growth (1) (%) 1-2 no change
Outpatient visits – growth (1) (%) 2–3 1-2
Net inpatient revenue per admit - growth (1) (%) not provided 3.5 – 4.25
Net outpatient revenue per visit – growth (1) (%) not provided 4.5 - 5.25
Pricing – base line growth (%) 3.2 3.4
Pricing – managed care increment ($mm) 36 47
Net revenue ($ bil) 9.3 – 9.4 no change
Bad debt ratio (%) 6.5 - 7.0 no change
Controllable operating expenses PAPD – Growth (1) (%) 3.0 – 3.5 no change
EBITDA ($mm) 775 - 850 no change
Adjusted cash flow from operations ($mm) 400 - 500 no change
Capital expenditures ($mm) 600 - 650 no change
(2)
Cash balance at 12/31/08 ($mm) 200 - 300 no change
(1) Same-hospital growth from 2007 to 2008
(2) Excludes potential proceeds from initiatives to raise $400-600mm, USC sale, and other non-operating items
29
30. 2008 Adjusted EBITDA Outlook Revisions
2008 (2/26/08) 2008 - REVISED
($ millions) Revenue Cost EBITDA Revenue Cost EBITDA
Prior year 8,852 (8,151) 8,852 (8,151)
701 701
Cost Report Adjustments (40) - (40) (40) - (40)
Georgia/ Florida Medicaid (60) - (60) (56) - (56)
Volume (1) 193 (116) 77 167 (106) 61
Pricing – Base Line Increase (2) 280 (18) 262 291 (18) 273
Managed Care (3) 36 - 36 47 - 47
Other Initiatives (4) 51 (18) 33 51 (18) 33
Costs – Base Line Inflation (5) - (261) (261) - (271) (271)
Cost Reduction Initiatives (6) - 100 100 - 100 100
Other (7) 88 (86) 2 88 (86) 2
9,400 (8,550) 9,400 (8,550)
Total (8) 850 850
(1) Annual admissions growth of 1.5 percent, outpatient visit growth of 1.5 percent using 2007’s average pricing with 40 percent margin assumption on incremental
revenues.
(2) Base line pricing increases of 3.4 percent for 2008. These assumptions are before discrete initiatives valued in this analysis, and include certain assumptions on
adverse mix change
(3) Price increases in existing contracts and anticipated future increases.
(4) Full-year impact of 2007’s ED acuity capture effort and incremental adjustments to chargemaster.
(5) Inflation rate of 3.5 percent reflects normal merit increases, union contract adjustments and other items before discrete initiatives valued in this analysis.
(6) Full year impact of cost initiatives initiated in 2007.
(7) Includes impact of Sierra Providence East Medical Center (El Paso), Coastal Carolina Hospital, physician practices and other non-acute operations.
(8) Various risks including volume growth, volume mix, and bad debt create at least $75 million in uncertainties for 2008 performance, hence the adjusted EBITDA
outlook range from $775 mm to $850mm. 2009 uncertainties exceed those identified for 2008. This schedule is not intended to provide a series of spot
estimates or line item guidance. Other combinations of line item performance could produce the same, or higher, or lower results.
30
31. Illustrative, sample walk-forward path to
$1 billion adjusted EBITDA in 2009
2008 - REVISED 2009
($ millions) Revenue Cost EBITDA Revenue Cost EBITDA
Prior year 8,852 (8,151) 9,400 (8,500)
701 850
Cost Report Adjustments (40) - (40) - - -
Georgia/ Florida Medicaid (56) - (56) - - -
Volume (1) 167 (106) 61 151 (91) 60
Pricing – Base Line Increase (2) 291 (18) 273 312 (20) 292
Managed Care (3) 47 - 47 34 - 34
Other Initiatives (4) 51 (18) 33 - - -
Costs – Base Line Inflation (5) - (271) (271) - (286) (286)
Cost Reduction Initiatives (6) - 100 100 - 29 29
Other (7) 88 (86) 2 88 (67) 21
9,400 (8,550) 9,985 (8,985)
Total (8) 850 1,000
(1) Annual admissions growth of 1.5 percent, outpatient visit growth of 1.5 percent using 2007’s average pricing with 40 percent margin assumption on incremental
revenues.
(2) Base line pricing increases of 3.4 percent for 2008. These assumptions are before discrete initiatives valued in this analysis, and include certain assumptions on
adverse mix change
(3) Price increases in existing contracts and anticipated future increases.
(4) Full-year impact of 2007’s ED acuity capture effort and incremental adjustments to chargemaster.
(5) Inflation rate of 3.5 percent reflects normal merit increases, union contract adjustments and other items before discrete initiatives valued in this analysis.
(6) Full year impact of cost initiatives initiated in 2007.
(7) Includes impact of Sierra Providence East Medical Center (El Paso), Coastal Carolina Hospital, physician practices and other non-acute operations.
(8) Various risks including volume growth, volume mix, and bad debt create at least $75 million in uncertainties for 2008 performance, hence the adjusted EBITDA
outlook range from $775 mm to $850mm. 2009 uncertainties exceed those identified for 2008. This schedule is not intended to provide a series of spot
estimates or line item guidance. Other combinations of line item performance could produce the same or higher, or lower results.
31
