HCA Holdings has warned that first-quarter hospital earnings may be a bit of a downer.

The bellwether system, the nation’s largest investor-owned hospital company, disclosed Monday that it expect its first-quarter net income will decline slightly compared to last year’s and that earnings before interest, taxes, depreciation and amortization would be flat.

In the preview to its May 2 earnings release, Nashville-based HCA noted that its payer mix deteriorated slightly, with same-hospital Medicare admissions accounting for 48.1% of first-quarter admission compared to 47% in the year-ago period.

Meantime, managed care and exchange admissions fell to 27.4% from 28.6% in the year-earlier quarter ended Mar. 31.

EBITDA in the quarter is expected to be $2 billion on revenue of $10.62 billion compared with EBITDA of $2 billion on revenue of $10.26 billion in the year-ago period. Net income is expected to fall to $659 million in the quarter compared with $694 million in the first quarter of 2016.

Same-facility admissions and emergency-room visits across the 169-hospital system were up about 1% in the quarter, HCA said.

HCA flat EBITDA for the quarter interrupts a big winning streak at the company.

EBITDA in the fourth quarter was $2.21billion, an increase of 3.6% from the year-earlier. And full-year EBITDA was $8.2 billion compared with $7.9 billion in 2015.

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Dave Barkholz is Modern Healthcare’s Southern Bureau Chief stationed in Nashville. He covers hospitals, doctors, suppliers and governance across the Southeast. A winner of numerous national journalism awards, Barkholz started his career at Modern Healthcare in 1984 covering the investor-owned hospital companies. He spent the past 10 years in Detroit at Automotive News, a sister Crain publication.

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