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.
Adjusted EBITDA for the quarter was $3.17 billion as compared to $2.94 billion in the prior year. As noted in our release, in the first quarter of this year, we recorded an increase in revenues of $145 million related to resolving certain disputed claims with a commercial payer that covered a six-year period. In the prior year quarter, we recorded an additional $244 million of revenues and $90 million of expenses that related to the Texas Directed Payment Program for an earlier period.
I will also note, as it relates to prior year comparisons, we still were experiencing high-level of COVID volumes in the first quarter of 2022. COVID admissions accounted for 9.7% of admissions last year compared to about 3% this year. In addition, in the prior year quarter, we recognized approximately $190 million of COVID-related support payments versus about $30 million in this year's first quarter.
Sam highlighted our positive volume metrics in the quarter and this was coupled with good payer mix and case-mix trends. Same-facility managed care and other admissions grew 4.2% during the quarter when compared to the prior year, and non-COVID managed care admissions grew 11.3% versus the prior year. Non-COVID case mix improved just under 1% as compared to both prior year and sequentially from the fourth quarter. This contributed to a non-COVID inpatient revenue per admission increasing 2.2% as compared to the first quarter of last year.
We remain pleased with our team's management of operating costs, even with the backdrop of higher inflation. Our consolidated adjusted EBITDA margin was 20.3% in the quarter.
Labor cost as a percentage of revenue improved both sequentially and when compared to the prior year, and our supply costs continue to trend favorably as well. We have discussed previously other operating expenses have been subject to some inflationary cost pressures and increased approximately 20 basis points as a percentage of revenue when compared to the prior year.
So let me speak to some cash flow and capital allocation metrics, as they remain a key part of our long-term growth and value-creation strategies.
Our cash flow from operations increased $458 million in the quarter from $1.35 billion in the prior year to $1.8 billion this year. Capital spending was just under $1.2 billion. We paid $175 million in dividends and repurchased just under $850 million of our stock during the quarter. Our debt-to-adjusted EBITDA leverage ratio remains near the low end of our stated leverage 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 $62.5 billion and $64.5 billion. We expect net income attributable to HCA Healthcare to range between $4.75 billion and $5.16 billion. We expect full-year adjusted EBITDA to range between $12.1 billion and $12.7 billion. And we expect full-year diluted earnings per share to range between $17.25 and $18.55. And lastly, we expect capital spending to approximate $4.6 billion during the year.
I will mention that our updated capital spending guidance is based on opportunities we believe exist to continue to invest growth agenda, and it also considers some land acquisitions we are planning for future development. In addition, we are seeing some inflationary increases in construction costs that we factored into our guidance as well.
Finally, I will mention, in early April, we closed on a transaction to increase our ownership interest in the Valesco joint venture with Envision. We will consolidate this venture, beginning in the second quarter and expect the venture will generate approximately $1 billion of annual revenues with no material impact to adjusted EBITDA.
So with that, I'll turn the call over to Frank, and we'll open it up for Q&A. We look forward to your questions.