The hospital chain slid into red during the third quarter as more uninsured patients previously on Affordable Care Act plans sought out care and others deferred elective surgeries.

Executives at for-profit hospital chains have called out declining surgeries this quarter, saying that patients have been deferring procedures due to affordability concerns. The decrease has dampened earnings at CHS’ peers, including Universal Health Services.

While some hospital chains, like Tenet Healthcare, were able to weather the decline by funneling more patients to lucrative, high-acuity surgeries, CHS wasn’t able to capture those patients.

Although CHS saw a 2% year-over-year rise in same-store surgeries, the hospital chain saw fewer high-margin patients in elective orthopedic and general surgeries, according to CEO Kevin Hammons.

“Those are more elective-type procedures, and that's what's being deferred,” he said. “We believe this is a patient decision around care and being influenced by financial decisions.”

Patients getting surgeries with commercial insurance — which typically reimburses doctors the most — declined, leading to flat growth in same-store revenue per adjusted admission.

“There’s pent-up demand,” the CEO said. “Ultimately, we think that it comes back into the system because when you need a joint replacement, it’s not going to heal on its own.”

In addition to surgery challenges, CHS was pressured again by a rise in uninsured patients, which has battered for-profit hospital earnings this year . Executives across the sector have speculated that these uninsured patients are those who have been priced out of ACA plans following the expiration of enhanced subsidies last year.

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