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Q4’08
Earnings Call
            February 24, 2009
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
This document includes certain financial measures including 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 our Q4’08 quarterly earnings release
issued on February 24, 2009.




   2                                                                                                                                           2
Trevor Fetter
      President &
Chief Executive Officer
Favorable operating trends
             1.2% admissions growth (2008 versus 2007, same-hospital)
             0.1% decline in outpatient visits (2008 versus 2007, same-hospital)
             4th consecutive quarter of paying admissions growth (Q1’08-Q4’08, same-hospital)
 Volumes
                0.1% growth in paying admissions (Q4’08 versus Q4’07, same-hospital)
             3rd consecutive quarter of paying outpatient visit growth (same-hospital)
                0.9% increase in paying outpatient visits (Q4’08 versus Q4’07, same-hospital)




             6.6% increase in commercial managed care revenues (same-hospital)
Commercial
 Managed          Commercial managed care admissions declined 3.0% (Q4’08 versus Q4’07, same-hospital)
  Care
                  Commercial outpatient visits declined 0.2% (Q4’08 versus Q4’07, same-hospital)


             11.4% increase in adjusted EBITDA (2008 versus 2007)
Adjusted
             27.6% increase in Q4 adjusted EBITDA, increased $43 million (Q4’08 versus Q407)
EBITDA
                  9.1% adjusted EBITDA margin (Q4’08)



             Cash consumption reduced by 55% (2008 versus 2007)
Free Cash
                  $239mm cash use in 2008, versus $535mm in 2007
   Flow

 4
Two-year volume trends remain positive
                     . . . even with Q4’08 softening
                (same-hospital)

                     4.0%
                                                                                                                      Paying O/P Visits (1)
                                                                               Paying Admits (1)
                     2.0%                                                                                                     Total Admits
Annual Growth




                     0.0%
                        Q306        Q406        Q107        Q207        Q307        Q407        Q108        Q208    Q308    Q408

                                                                                                       O/P Visits
                     -2.0%



                     -4.0%



                     -6.0%



                     -8.0%




                             (1) Paying volumes are defined as total volumes less charity and uninsured volumes.

            5
Progress in critical areas

                        Significant contribution to volume growth
       PRP


     Outpatient         Volumes have stabilized
      Volumes



                         Volume growth directed to most
        TGI              attractive service lines




                        Quality investments enhanced hospitals’
                          value propositions
       C2Q                     COE designations from commercial payers
                               P4P



6
Quality differentiates Tenet’s value
    C2Q                proposition
                                  CMS Hospital Compare Data(1)
    95%
                                                                                                                                93.8%
                                                                                                                        93.2%
                                                              SCIP(2) measures added
    93%                                                                                                         92.2%
                                                                                                        91.2%
                                                                                                90.8%
                                                                                        90.4%
    91%                                                         89.7%
                                                                                   89.6%
                                                                                                                   90.3%
                                                   88.8%                88.5%
    89%
                                                                                                        89.3%
                                           87.2%
                                                                                                88.6%
                                                                                        88.0%
    87%
                                                                                87.0%
                                  84.7%
                                                               86.7% 86.2%
    85%                                               85.9%

                                             84.7%
                          82.8%
    83%                                                                                             Tenet
                  81.5%              83.3%
                                                                                                    National Average
          80.5%            82.3%
    81%
                     81.1%

    79%   80.0%


    77%

    75%
          Q1       Q2  Q3           Q4       Q1       Q2  Q3            Q4       Q1     Q2  Q3           Q4     Q1 2008
                                                                                                                    Q2          Q3
                    2005                               2006                              2007

            (1) Measures are for 4 trailing quarters. Data reflects latest available.
7           (2) Surgical Care Improvement Project (Infection Control).
Non-Financial Performance Metrics

                        All-time high on CMS measures
    Clinical Quality    Internal metrics evidence continued advances
                          Evidence-based medicine protocols
                          Infection rates
                          Compliance with admissions standards




      Employee         Total employee turnover improved by 20%
     Satisfaction      Virtually no voluntary hospital CEO turnover




8
Physician and patient satisfaction scores
    continue to strengthen


       2.9% increase in physician satisfaction (2008 versus 2007)
          Physician satisfaction increased from 72% to 81% (Oct ’05 versus Q4’08)



       1.1% increase in patient satisfaction (2008 versus 2007)




9
Current macroeconomic challenges

     Unemployment
       Some of 2008’s commercially insured patients may
       become part of 2009’s uninsured
         Migrate from best-paying to worst-paying status

     Declining household income and wealth
       Risk of collection rate deterioration
       Declining utilization of healthcare services

     Rising credit costs and declining credit availability


10
Solid metrics despite economic environment
(same-hospital, Q4’08 versus Q4’07)




      0.1% increase in paying admissions

      0.9% increase in paying outpatient visits

      2.5% increase in managed care admissions

      3.0% decline in commercial managed care admissions

      2.3% increase in commercial admissions in TGI service lines

      Pricing increase remain solid

      0.8% increase in controllable operating expenses

      110 basis point increase in bad debt expense

     170 basis point increase in adjusted EBITDA margin

11
2009 Outlook
     Unusually complex array of uncertainties
       Volume growth
       Payer and patient mix
       Bad debt expense
     Adjusted EBITDA outlook: $735 – $800 million
       Flat to up 9.3% versus 2008
     Capex economies available to support interim
     free cash flow objectives




12
Stephen L. Newman, M.D.
    Chief Operating Officer
Percentage change in commercial admissions in seven TGI
                          service lines(1) exceeds percentage change in non-TGI
TGI                       commercial admissions
                          (same hospital)

                    14%
                    12%
                    10%
                    8%
     Y-o-Y Change




                    6%
                    4%
                    2%
                    0%
                           Q1       Q2        Q3      Q4       Q1       Q2         Q3       Q4      Q1       Q2        Q3      Q4
                    -2%
                    -4%
                                           2006                                 2007                                2008
                    -6%

                           Q1’ 06   Q2’ 06   Q3’ 06   Q4’ 06   Q1’ 07   Q2, 07    Q3, 07   Q4, 07   Q1’ 08   Q2’ 08   Q3’ 08   Q4’ 08

TGI Growth (%)              (7.2)   (4.3)     (6.8)   (4.2)    (4.2)    (1.4)      3.4      2.0      5.8      6.0      (1.2)    2.3

Non-TGI Growth (%)          (3.6)   (6.2)     (5.4)   (2.7)    (2.2)    (0.9)     (1.6)    (2.8)    (6.5)    (4.0)     (4.1)   (4.6)

Delta (%)                   (3.6)    1.9      (1.4)   (1.5)    (2.0)    (0.5)      5.0      4.8      12.3     10.0     2.9      6.9

Total Growth (%)            (4.4)   (5.8)     (5.7)   (3.0)    (2.7)    (1.0)     (0.4)    (1.8)    (3.8)    (1.7)     (3.4)   (3.0)


       (1) Includes: general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart and orthopedic surgery.
  14
Percentage change in paying admissions in seven TGI
                          service lines(1) exceeds percentage in non-TGI paying
TGI
                          admissions
                          (same hospital)
                    6%

                    5%

                    4%
     Y-o-Y Growth




                    3%

                    2%

                    1%

                    0%
                            Q1        Q2        Q3      Q4        Q1       Q2          Q3       Q4       Q1      Q2        Q3       Q4
                                             2006                                  2007                                2008
                    -1%

                             Q1’ 06   Q2’ 06   Q3’ 06   Q4’ 06   Q1’ 07   Q2, 07     Q3, 07   Q4, 07   Q1’ 08   Q2’ 08    Q3’ 08   Q4’ 08

TGI Growth (%)               (1.7)    (1.1)     (4.1)   (1.2)    (1.8)    (3.3)      (0.5)     1.6      3.5      6.5       5.1      2.5

Non-TGI Growth (%)           (3.7)    (3.2)     (3.8)   (1.0)    (1.6)    (1.7)      (0.9)    (0.5)     0.5      1.0       1.2     (0.5)

Delta (%)                     2.0      2.1      (0.3)   (0.2)    (0.2)    (1.6)       0.4      2.1      3.0      5.5       3.9      3.0

Total Growth (%)             (3.3)    (2.8)     (3.9)   (1.1)    (1.7)    (2.0)      (0.8)    (0.1)     1.1      2.2       2.0      0.1



        (1) Includes: general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart and orthopedic surgery.
15
17.0% net growth in active physicians
                PRP
                              since Jan 1, 2007
                                                                                                                %
                                                                                                         or 9.0
                                                                                                   1,122
                                                                                             th of
                                                                                      t Grow
                                                                                   Ne
                                                846 or 7.3%
                                      Growth of
                                  Net

                                                                               Class of 2008
Active physicians




                                                                                                       (946)
                                  Class of 2007
                                                                                        2,068 (2)
                                                       (898)
                                         1,744(1)

                                                                                                                       13,571
                                                                      12,449
                                                                                                                       Active
                          11,603
                                                                      Active                                           (12/31/08)
                          Active                                      (12/31/07)
                          (1/1/07)



                                                2007                                                2008

                    (1)   Includes 166 physicians with existing privileges at other Tenet hospitals, primarily in El Paso
                    (2)   Includes 103 physicians with existing privileges at other Tenet hospitals, primarily in El Paso
   16
Physician Relationship Program:
PRP              Volume Growth from the “Class of 2007”

Class of 2007’s referral volume during 2008:
     45,000 admissions, or 26 admissions per each of the Class of 2007’s
     1,744 physicians(1)
     275,000 outpatient visits, or 158 per “Class of 2007” physician

Class of 2008 referral volume is ramping faster than the
Class of 2007 at a comparable point in the Tenet relationship
     Strong referral volume from the Class of 2008 provides compelling
     evidence of our enhanced capabilities in PRP targeting for physician
     recruitment and redirection.




     (1) Includes 166 physicians with existing privileges at another Tenet hospital, primarily in El Paso.

17
Biggs C. Porter
Chief Financial Officer
2008 Adjusted EBITDA

$732mm – up $75mm, or 11.4%, over 2007’s $657mm
Overcame loss of $54mm in Medicaid funding in Georgia, Florida, and
North Carolina
     Normalized for loss of this Medicaid funding, operating improvement was:
        $129mm increase in adjusted EBITDA, excluding $54mm loss of
        Medicaid funding
        19.6% normalized growth, 2008 compared to 2007




19
Q4’08 Highlights
              4.9% increase in net operating revenues (same-hospital)
Revenues      6.6% increase in commercial managed care revenues (same-hospital)
                  Commercial managed care admissions declined 3.0% (same-hospital)
                  Commercial outpatient visits declined 0.2% (same-hospital)


             0.8% increase in controllable costs per adjusted patient day (same-hospital)
Operating    0.8% increase in SW&B expense per adjusted patient day (same-hospital)
Efficiency   50% decline in malpractice expense
                  21% decline in malpractice expense (2008 versus 2007)



              7.5% bad debt ratio, improved from 7.6% in Q3’08
                   5.9% decline in uninsured admissions (same-hospital, Q4’08 versus Q4’07)
Bad Debt          10.8% decline in uninsured outpatient visits (same-hospital, Q4’08 versus Q4’07)
             37% of dollars collected at front-end of patient contact,
                  up from 29% in Q4’07
             Collection rates (total) declined to 33 percent from
                  combined uninsured and balance-after
                   Q3’08 collection rate of 33%
                   Q4’07 collection rate of 35%



             $507mm cash at 12/31/08
 Cash

 20
Note Exchange Offer (1)

     $1.6 billion in near-term maturities
            $1.0B on 12/01/11 - $915mm, or 91%, elected to participate (1)
            $0.6B on 6/01/12 - $484mm, or 81%, elected to participate (1)
     New maturities:
            $700mm maturing 5/01/15
            $700mm maturing 5/01/18
     $170mm to $190mm(2) anticipated gain on retirement of existing notes
            Corresponding discount on the new notes will be amortized as interest expense over the term of the
            notes
     2009 interest payments and interest expense:
            $22mm expected increase in 2009 cash interest payments;
            $36mm expected increase in 2009 cash interest expense (interest expense excluding discount
            amortization)
            $50mm-$60mm expected increase in 2009 reported interest expense
     Annualized interest payments and interest expense:
            $43mm cash interest payments
            $60mm-$70mm total interest expense

     (1)   Based on bonds tendered as of early tender date (2/18/09).
     (2)   Actual gain will be based on market prices.


21
2009 Outlook – Adjusted EBITDA
                                                                                             2009                  2008
                                                                                            Outlook               Actual
     Admissions - growth (1)                                                   (%)           0.0 – 1.0               1.2
     Outpatient visits – growth (1)                                            (%)           0.0 – 1.0              (0.1)
     Net operating revenues – growth                                           (%)           4.0 – 6.0               6.1
     Net operating revenues                                                  ($Bil)          9.0 – 9.2               8.7
     Controllable operating expenses PAPD – Growth                             (%)           2.0 – 3.0               2.7
     Controllable operating expenses                                        ($Bil)           7.5 – 7.6               7.3
     Bad debt ratio                                                            (%)           8.3 – 9.3               7.3
     Bad debt expense                                                       ($mm)           750 – 850                632
     Adjusted EBITDA (2)                                                    ($mm)           735 – 800                732
     Depreciation and Amortization                                           ($mm)          400 – 420                373
     Interest Expense, Net                                                   ($mm)          450 – 470                402
     Loss from continuing operations before income taxes(2)                  ($mm)          (135) –(70)             (43)
     Net loss from cont. ops. (2009 normalized at 37.1% tax rate)(2)         ($mm)          (85) – (44)             (39)
     E.P.S. (2009 normalized at 37.1% tax rate, continuing operations)(2) ($)             (0.18) – (0.09)          (0.08)



      (1)    Same-hospital annual growth versus prior year
      (2)    Excludes impairments, restructuring charges, litigation costs, net gains (losses) on sales of investments,
               and net gain related to debt exchange
22
2009 Adjusted EBITDA Walk-Forward
        (Continuing operations)

                           ($mm)                                                                                                  Adjusted
                                                                                           Revenue                Cost
                  Line
                                                                                                                                  EBITDA
                   #

                   1      2008                                                                8,663              (7,931)              732
                   2      Volume – assuming constant mix (a)                                    61                 (37)                24
                   3                  – impact from adverse mix shift                          (37)                (6)                (43)
                   4      Pricing – Base Line Increase (b)                                     303                 (28)               275
                   5              - Managed Care (c)                                            43                  -                  43
                   6      Costs – Base Line Inflation (d)                                        -                (298)               (298)
                   7             - Cost Reduction Initiatives (e)                                -                 150                150
                   8      Bad Debt – impact of rate differential only (f)                        -                (110)               (110)
                   9      Other (g)                                                             57                 (30)                27
                   10     Total – Upper End of Adjusted EBITDA Range                          9,090              (8,290)               800
                   11     Allowance for Risk (h)                                                                                      (65)
                   12     Total – Lower End of Adjusted EBITDA Range                                                                  735
(a) Assumes admissions growth of 0.8% and outpatient visit growth of 0.5%, using 2008 average pricing. Margin assumption on incremental revenues 40%.
(b) Base line pricing increases of 3.5%. This assumption is before discrete initiatives valued in this analysis.
(c) Rate parity price increases in existing contracts and anticipated future increases plus $7mm from P4P payments.
(d) Inflation rate of 4.0% reflects normal merit increases, union contract adjustments, supply cost increases and other items before discrete initiatives valued
      in this analysis.
(e) Full year impact of cost initiatives initiated in late 2008; malpractice reductions; plus original $29mm in 2008’s estimates as previously disclosed
(f) Assumes 2009 bad debt ratio of approximately 8.5%, a 90 basis point increase over our Q4’07 bad debt ratio of 7.6%. Bad debt ratio was 7.3% in 2008.
(g) Includes impact of Sierra Providence East Medical Center (El Paso) and Coastal Carolina Hospital.
(h) Various risks including volume growth, volume mix, and bad debt create at least $65 million in uncertainties for 2009 performance.
                             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.

       23
Cash Initiatives and Divestitures
             ($mm)


      $129 . . . Cash generated in 2007
      $307 . . . Cash generated in 2008:
                       $144          Broadlane investment sale
                       $ 60          Redding insurance settlements (not included in earlier expectations)
                       $ 50          Hospital sales (San Dimas, Garden Grove, Encino & Tarzana )
                       $ 53          Other


      $245 . . . . . . . . USC sale (excluding working capital)
      $63 - $98 . . . . . Other in 2009
      $615 - $650 . . . Sub-total estimate for 2008 - 2009 time period (1)
      $140 - $180 . . . Estimate for MOBs in 2009 - 2010
                           (not included in 2009 year-end Cash and Cash Equivalents estimate of $450 to $550 on slide 25)


      $755 – $830 . . . Revised total estimate (1) (Initial estimate was $750 - $950)


(1)   Above estimates exclude $62 - $85 California wage and hour settlements, but these settlements are
      included in the year-end 2009 Outlook for cash.


  24
2009 Cash Walk Forward                          ($mm)
                                                                                      High
                                                                        Low
2009 EBITDA                                                             735           800
Add Back: Stock Compensation Charges                                     20            25
Changes in Cash from Operating Assets and Liabilities                   (115)         (70)
Interest Payments                                                       (400)         (440)
Adjusted Net Cash Provided by Operating Activities – Cont. Ops.         240           315
Capital Expenditures – Cont. Ops.                                       (400)         (450)
Adjusted Free Cash Flow – Cont. Ops.                                    (160)         (135)
Income Tax Refunds                                                       15            25
Payments against Reserves for Restructuring Charges, Litigation Costs
                                                                        (190)         (170)
and Settlements
Net Cash Provided (Used In) Operating Activities from Disc. Ops.        (10)           10
Investing Activities, Reserve Fund, Divestitures and Other              308           343
Net Financing Activities                                                (20)          (30)
Net Increase (Decrease) in Cash and Cash Equivalents                    (57)           43
Cash and Cash Equivalents December 31, 2008                                     507
Cash and Cash Equivalents December 31, 2009                             450           550




 25

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tenet healthcare QuarterEndedDecember312008PowerPointPresentation

  • 1. Q4’08 Earnings Call February 24, 2009
  • 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 This document includes certain financial measures including 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 our Q4’08 quarterly earnings release issued on February 24, 2009. 2 2
  • 3. Trevor Fetter President & Chief Executive Officer
  • 4. Favorable operating trends 1.2% admissions growth (2008 versus 2007, same-hospital) 0.1% decline in outpatient visits (2008 versus 2007, same-hospital) 4th consecutive quarter of paying admissions growth (Q1’08-Q4’08, same-hospital) Volumes 0.1% growth in paying admissions (Q4’08 versus Q4’07, same-hospital) 3rd consecutive quarter of paying outpatient visit growth (same-hospital) 0.9% increase in paying outpatient visits (Q4’08 versus Q4’07, same-hospital) 6.6% increase in commercial managed care revenues (same-hospital) Commercial Managed Commercial managed care admissions declined 3.0% (Q4’08 versus Q4’07, same-hospital) Care Commercial outpatient visits declined 0.2% (Q4’08 versus Q4’07, same-hospital) 11.4% increase in adjusted EBITDA (2008 versus 2007) Adjusted 27.6% increase in Q4 adjusted EBITDA, increased $43 million (Q4’08 versus Q407) EBITDA 9.1% adjusted EBITDA margin (Q4’08) Cash consumption reduced by 55% (2008 versus 2007) Free Cash $239mm cash use in 2008, versus $535mm in 2007 Flow 4
  • 5. Two-year volume trends remain positive . . . even with Q4’08 softening (same-hospital) 4.0% Paying O/P Visits (1) Paying Admits (1) 2.0% Total Admits Annual Growth 0.0% Q306 Q406 Q107 Q207 Q307 Q407 Q108 Q208 Q308 Q408 O/P Visits -2.0% -4.0% -6.0% -8.0% (1) Paying volumes are defined as total volumes less charity and uninsured volumes. 5
  • 6. Progress in critical areas Significant contribution to volume growth PRP Outpatient Volumes have stabilized Volumes Volume growth directed to most TGI attractive service lines Quality investments enhanced hospitals’ value propositions C2Q COE designations from commercial payers P4P 6
  • 7. Quality differentiates Tenet’s value C2Q proposition CMS Hospital Compare Data(1) 95% 93.8% 93.2% SCIP(2) measures added 93% 92.2% 91.2% 90.8% 90.4% 91% 89.7% 89.6% 90.3% 88.8% 88.5% 89% 89.3% 87.2% 88.6% 88.0% 87% 87.0% 84.7% 86.7% 86.2% 85% 85.9% 84.7% 82.8% 83% Tenet 81.5% 83.3% National Average 80.5% 82.3% 81% 81.1% 79% 80.0% 77% 75% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008 Q2 Q3 2005 2006 2007 (1) Measures are for 4 trailing quarters. Data reflects latest available. 7 (2) Surgical Care Improvement Project (Infection Control).
  • 8. Non-Financial Performance Metrics All-time high on CMS measures Clinical Quality Internal metrics evidence continued advances Evidence-based medicine protocols Infection rates Compliance with admissions standards Employee Total employee turnover improved by 20% Satisfaction Virtually no voluntary hospital CEO turnover 8
  • 9. Physician and patient satisfaction scores continue to strengthen 2.9% increase in physician satisfaction (2008 versus 2007) Physician satisfaction increased from 72% to 81% (Oct ’05 versus Q4’08) 1.1% increase in patient satisfaction (2008 versus 2007) 9
  • 10. Current macroeconomic challenges Unemployment Some of 2008’s commercially insured patients may become part of 2009’s uninsured Migrate from best-paying to worst-paying status Declining household income and wealth Risk of collection rate deterioration Declining utilization of healthcare services Rising credit costs and declining credit availability 10
  • 11. Solid metrics despite economic environment (same-hospital, Q4’08 versus Q4’07) 0.1% increase in paying admissions 0.9% increase in paying outpatient visits 2.5% increase in managed care admissions 3.0% decline in commercial managed care admissions 2.3% increase in commercial admissions in TGI service lines Pricing increase remain solid 0.8% increase in controllable operating expenses 110 basis point increase in bad debt expense 170 basis point increase in adjusted EBITDA margin 11
  • 12. 2009 Outlook Unusually complex array of uncertainties Volume growth Payer and patient mix Bad debt expense Adjusted EBITDA outlook: $735 – $800 million Flat to up 9.3% versus 2008 Capex economies available to support interim free cash flow objectives 12
  • 13. Stephen L. Newman, M.D. Chief Operating Officer
  • 14. Percentage change in commercial admissions in seven TGI service lines(1) exceeds percentage change in non-TGI TGI commercial admissions (same hospital) 14% 12% 10% 8% Y-o-Y Change 6% 4% 2% 0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 -2% -4% 2006 2007 2008 -6% Q1’ 06 Q2’ 06 Q3’ 06 Q4’ 06 Q1’ 07 Q2, 07 Q3, 07 Q4, 07 Q1’ 08 Q2’ 08 Q3’ 08 Q4’ 08 TGI Growth (%) (7.2) (4.3) (6.8) (4.2) (4.2) (1.4) 3.4 2.0 5.8 6.0 (1.2) 2.3 Non-TGI Growth (%) (3.6) (6.2) (5.4) (2.7) (2.2) (0.9) (1.6) (2.8) (6.5) (4.0) (4.1) (4.6) Delta (%) (3.6) 1.9 (1.4) (1.5) (2.0) (0.5) 5.0 4.8 12.3 10.0 2.9 6.9 Total Growth (%) (4.4) (5.8) (5.7) (3.0) (2.7) (1.0) (0.4) (1.8) (3.8) (1.7) (3.4) (3.0) (1) Includes: general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart and orthopedic surgery. 14
  • 15. Percentage change in paying admissions in seven TGI service lines(1) exceeds percentage in non-TGI paying TGI admissions (same hospital) 6% 5% 4% Y-o-Y Growth 3% 2% 1% 0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2006 2007 2008 -1% Q1’ 06 Q2’ 06 Q3’ 06 Q4’ 06 Q1’ 07 Q2, 07 Q3, 07 Q4, 07 Q1’ 08 Q2’ 08 Q3’ 08 Q4’ 08 TGI Growth (%) (1.7) (1.1) (4.1) (1.2) (1.8) (3.3) (0.5) 1.6 3.5 6.5 5.1 2.5 Non-TGI Growth (%) (3.7) (3.2) (3.8) (1.0) (1.6) (1.7) (0.9) (0.5) 0.5 1.0 1.2 (0.5) Delta (%) 2.0 2.1 (0.3) (0.2) (0.2) (1.6) 0.4 2.1 3.0 5.5 3.9 3.0 Total Growth (%) (3.3) (2.8) (3.9) (1.1) (1.7) (2.0) (0.8) (0.1) 1.1 2.2 2.0 0.1 (1) Includes: general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart and orthopedic surgery. 15
  • 16. 17.0% net growth in active physicians PRP since Jan 1, 2007 % or 9.0 1,122 th of t Grow Ne 846 or 7.3% Growth of Net Class of 2008 Active physicians (946) Class of 2007 2,068 (2) (898) 1,744(1) 13,571 12,449 Active 11,603 Active (12/31/08) Active (12/31/07) (1/1/07) 2007 2008 (1) Includes 166 physicians with existing privileges at other Tenet hospitals, primarily in El Paso (2) Includes 103 physicians with existing privileges at other Tenet hospitals, primarily in El Paso 16
  • 17. Physician Relationship Program: PRP Volume Growth from the “Class of 2007” Class of 2007’s referral volume during 2008: 45,000 admissions, or 26 admissions per each of the Class of 2007’s 1,744 physicians(1) 275,000 outpatient visits, or 158 per “Class of 2007” physician Class of 2008 referral volume is ramping faster than the Class of 2007 at a comparable point in the Tenet relationship Strong referral volume from the Class of 2008 provides compelling evidence of our enhanced capabilities in PRP targeting for physician recruitment and redirection. (1) Includes 166 physicians with existing privileges at another Tenet hospital, primarily in El Paso. 17
  • 18. Biggs C. Porter Chief Financial Officer
  • 19. 2008 Adjusted EBITDA $732mm – up $75mm, or 11.4%, over 2007’s $657mm Overcame loss of $54mm in Medicaid funding in Georgia, Florida, and North Carolina Normalized for loss of this Medicaid funding, operating improvement was: $129mm increase in adjusted EBITDA, excluding $54mm loss of Medicaid funding 19.6% normalized growth, 2008 compared to 2007 19
  • 20. Q4’08 Highlights 4.9% increase in net operating revenues (same-hospital) Revenues 6.6% increase in commercial managed care revenues (same-hospital) Commercial managed care admissions declined 3.0% (same-hospital) Commercial outpatient visits declined 0.2% (same-hospital) 0.8% increase in controllable costs per adjusted patient day (same-hospital) Operating 0.8% increase in SW&B expense per adjusted patient day (same-hospital) Efficiency 50% decline in malpractice expense 21% decline in malpractice expense (2008 versus 2007) 7.5% bad debt ratio, improved from 7.6% in Q3’08 5.9% decline in uninsured admissions (same-hospital, Q4’08 versus Q4’07) Bad Debt 10.8% decline in uninsured outpatient visits (same-hospital, Q4’08 versus Q4’07) 37% of dollars collected at front-end of patient contact, up from 29% in Q4’07 Collection rates (total) declined to 33 percent from combined uninsured and balance-after Q3’08 collection rate of 33% Q4’07 collection rate of 35% $507mm cash at 12/31/08 Cash 20
  • 21. Note Exchange Offer (1) $1.6 billion in near-term maturities $1.0B on 12/01/11 - $915mm, or 91%, elected to participate (1) $0.6B on 6/01/12 - $484mm, or 81%, elected to participate (1) New maturities: $700mm maturing 5/01/15 $700mm maturing 5/01/18 $170mm to $190mm(2) anticipated gain on retirement of existing notes Corresponding discount on the new notes will be amortized as interest expense over the term of the notes 2009 interest payments and interest expense: $22mm expected increase in 2009 cash interest payments; $36mm expected increase in 2009 cash interest expense (interest expense excluding discount amortization) $50mm-$60mm expected increase in 2009 reported interest expense Annualized interest payments and interest expense: $43mm cash interest payments $60mm-$70mm total interest expense (1) Based on bonds tendered as of early tender date (2/18/09). (2) Actual gain will be based on market prices. 21
  • 22. 2009 Outlook – Adjusted EBITDA 2009 2008 Outlook Actual Admissions - growth (1) (%) 0.0 – 1.0 1.2 Outpatient visits – growth (1) (%) 0.0 – 1.0 (0.1) Net operating revenues – growth (%) 4.0 – 6.0 6.1 Net operating revenues ($Bil) 9.0 – 9.2 8.7 Controllable operating expenses PAPD – Growth (%) 2.0 – 3.0 2.7 Controllable operating expenses ($Bil) 7.5 – 7.6 7.3 Bad debt ratio (%) 8.3 – 9.3 7.3 Bad debt expense ($mm) 750 – 850 632 Adjusted EBITDA (2) ($mm) 735 – 800 732 Depreciation and Amortization ($mm) 400 – 420 373 Interest Expense, Net ($mm) 450 – 470 402 Loss from continuing operations before income taxes(2) ($mm) (135) –(70) (43) Net loss from cont. ops. (2009 normalized at 37.1% tax rate)(2) ($mm) (85) – (44) (39) E.P.S. (2009 normalized at 37.1% tax rate, continuing operations)(2) ($) (0.18) – (0.09) (0.08) (1) Same-hospital annual growth versus prior year (2) Excludes impairments, restructuring charges, litigation costs, net gains (losses) on sales of investments, and net gain related to debt exchange 22
  • 23. 2009 Adjusted EBITDA Walk-Forward (Continuing operations) ($mm) Adjusted Revenue Cost Line EBITDA # 1 2008 8,663 (7,931) 732 2 Volume – assuming constant mix (a) 61 (37) 24 3 – impact from adverse mix shift (37) (6) (43) 4 Pricing – Base Line Increase (b) 303 (28) 275 5 - Managed Care (c) 43 - 43 6 Costs – Base Line Inflation (d) - (298) (298) 7 - Cost Reduction Initiatives (e) - 150 150 8 Bad Debt – impact of rate differential only (f) - (110) (110) 9 Other (g) 57 (30) 27 10 Total – Upper End of Adjusted EBITDA Range 9,090 (8,290) 800 11 Allowance for Risk (h) (65) 12 Total – Lower End of Adjusted EBITDA Range 735 (a) Assumes admissions growth of 0.8% and outpatient visit growth of 0.5%, using 2008 average pricing. Margin assumption on incremental revenues 40%. (b) Base line pricing increases of 3.5%. This assumption is before discrete initiatives valued in this analysis. (c) Rate parity price increases in existing contracts and anticipated future increases plus $7mm from P4P payments. (d) Inflation rate of 4.0% reflects normal merit increases, union contract adjustments, supply cost increases and other items before discrete initiatives valued in this analysis. (e) Full year impact of cost initiatives initiated in late 2008; malpractice reductions; plus original $29mm in 2008’s estimates as previously disclosed (f) Assumes 2009 bad debt ratio of approximately 8.5%, a 90 basis point increase over our Q4’07 bad debt ratio of 7.6%. Bad debt ratio was 7.3% in 2008. (g) Includes impact of Sierra Providence East Medical Center (El Paso) and Coastal Carolina Hospital. (h) Various risks including volume growth, volume mix, and bad debt create at least $65 million in uncertainties for 2009 performance. This schedule is not intended to provide a series of spot estimates or line item guidance. Other combinations of line item performance could produce the same or higher or lower results. 23
  • 24. Cash Initiatives and Divestitures ($mm) $129 . . . Cash generated in 2007 $307 . . . Cash generated in 2008: $144 Broadlane investment sale $ 60 Redding insurance settlements (not included in earlier expectations) $ 50 Hospital sales (San Dimas, Garden Grove, Encino & Tarzana ) $ 53 Other $245 . . . . . . . . USC sale (excluding working capital) $63 - $98 . . . . . Other in 2009 $615 - $650 . . . Sub-total estimate for 2008 - 2009 time period (1) $140 - $180 . . . Estimate for MOBs in 2009 - 2010 (not included in 2009 year-end Cash and Cash Equivalents estimate of $450 to $550 on slide 25) $755 – $830 . . . Revised total estimate (1) (Initial estimate was $750 - $950) (1) Above estimates exclude $62 - $85 California wage and hour settlements, but these settlements are included in the year-end 2009 Outlook for cash. 24
  • 25. 2009 Cash Walk Forward ($mm) High Low 2009 EBITDA 735 800 Add Back: Stock Compensation Charges 20 25 Changes in Cash from Operating Assets and Liabilities (115) (70) Interest Payments (400) (440) Adjusted Net Cash Provided by Operating Activities – Cont. Ops. 240 315 Capital Expenditures – Cont. Ops. (400) (450) Adjusted Free Cash Flow – Cont. Ops. (160) (135) Income Tax Refunds 15 25 Payments against Reserves for Restructuring Charges, Litigation Costs (190) (170) and Settlements Net Cash Provided (Used In) Operating Activities from Disc. Ops. (10) 10 Investing Activities, Reserve Fund, Divestitures and Other 308 343 Net Financing Activities (20) (30) Net Increase (Decrease) in Cash and Cash Equivalents (57) 43 Cash and Cash Equivalents December 31, 2008 507 Cash and Cash Equivalents December 31, 2009 450 550 25