William B. Rutherford
Executive Vice President and Chief Financial Officer at HCA Healthcare
Great. Thank you, Sam, and good morning, everyone.
I will provide some additional comments on our performance for the quarter. Consolidated net revenue increased 8.3% to $16.21 billion from $14.97 billion in the prior year period, which was just driven by 4.5% growth in equivalent admissions and 3.6% increase in revenue per equivalent admissions. Same facility revenues grew 7.9%. As Sam mentioned in his comments, the Valesco joint venture had a negative impact of approximately $100 million on the company's adjusted EBITDA in the quarter as well on a year-to-date basis.
A portion of the third quarter results was due to a revising our revenue estimates from the second quarter as we began to see claims being paid. This result was not what we were expecting, as we are experiencing revenue shortfalls compared to what we originally modeled. The Valesco operating results had a negative impact of adjusted EBITDA margins of approximately 80 basis points in the quarter, and 40 basis points on a year-to-date basis.
Going forward, we anticipate the loss from this venture to approximate $50 million a quarter. We are working diligently on multiple efforts to address these results, including making program adjustments where necessary, deploying efforts to reduce the cost structure and working with payers for more appropriate reimbursement. As we have discussed previously, we have seen subsidy request increase from contracted hospital-based providers. Professional fee expense for contracted providers have grown approximately 20% on a year-to-date basis, although we are encouraged, the rate of growth of these payments slowed in the third quarter as compared to the second quarter. In addition to the mitigation strategies discussed above, we continue to assess other operational adjustments within our cost resiliency programs to help offset some of the impact from these issues.
Let me speak to some cash flow and capital allocation metrics. Our cash flow from operations was $2.48 billion in the quarter. Capital spending was $1.15 billion. We paid about $160 million in dividends and repurchased $1.14 billion of our stock during the quarter. Our debt-to-adjusted EBITDA leverage ratio remains near the low end of our stated range of 3 times to 4 times.
As noted in our release this morning, we are updating our full-year 2023 guidance as follows. We expect revenues to range between $63.5 billion and $64.5 billion. We expect net income attributable to HCA Healthcare to range between $4.94 billion and $5.13 billion. We expect adjusted EBITDA to range between $12.3 billion and $12.6 billion, and diluted earnings per share to range between $17.80 and $18.50. We expect capital spending to approximately $4.7 billion for the year.
Before we open it up for questions, I'd like to provide some commentary on our year-to-date performance. We believe our core business metrics remain solid. Year-to-date, our same facility admissions have grown 3.3%. Equivalent admissions have grown by 5.1%. Non-COVID admissions have grown 7.5% over prior year on a year-to-date basis. Same facility ER visits have grown 5.7%. Inpatient surgeries have grown 2.3%, and outpatient surgeries are up 3.1%, all on a year-to-date basis. These volume metrics have outpaced our original expectations going into the year.
Our payer mix trends remained favorable. Same facility managed care admissions increasing 5.3%, and Medicare admissions increasing 4.3% on a year-to-date basis. Medicaid and uninsured admissions are slightly down from the prior year on a year-to-date basis. Our case mix index has held and increased slightly over prior year, and our same facility revenues have increased 6.4% on a year-to-date basis.
Our same facility labor cost and supply costs are below prior year as a percentage of revenue. Through a focused and diligent effort, our operating teams have done an incredible job of addressing the contract labor pressures we had last year. On a year-to-date basis, our contract labor expense is down 18% or over $300 million from the prior year. We have confidence that a similar focus and diligent effort will help address the current physician cost pressures over time.
Lastly, when we look at our current adjusted EBITDA guidance for 2023, we think there were several notable items to consider. We discussed in our year-end call in January, COVID support payments, the out-of-period Texas Waiver payment, and the 340B impact from 2022, which all totaled approximately $500 million. And when you consider the $145 million payer settlement we recorded in the first quarter of this year, as we take all that into account, we are pleased with the growth rate we've been able to achieve. In addition, our diluted earnings per share, excluding losses on sale of facilities and losses on retirement of debt has grown 7.2% year-to-date. So, I wanted to take a moment to put this quarter in some perspective.
So with that, we look forward to your questions. And I'll turn the call over to Frank to open it up.
