HCA ( HCA) said it was growing more skeptical about its ability to collect money from its uninsured hospital patients, and lowered its first-quarter earnings guidance Wednesday as a result.

The company predicted first-quarter earnings of 69 cents a share, well short of its previous guidance and the Thomson First Call analyst consensus of 76 cents a share. The shares sold off $3.60, or 8.4%, to $39 on the Instinet premarket session.

The company expects first-quarter revenue to rise 12.6% to $5.9 billion, slightly higher than the analyst consensus forecast. Same-facility revenue rose about 8.7% in the first quarter from a year ago.

HCA expects to put up a provision for doubtful accounts of $694 million in the first quarter, which comes out to about 11.7% of revenue, compared with a similar provision of $428 million, or 8.1% of revenue, last year. The decision to make the higher reserve came after a review showed continued deterioration in the collectability of uninsured accounts, which partially reflected a surge in uninsured volume at its hospitals in the quarter.

HCA said uninsured emergency room visits rose 18% in the first quarter from a year ago, and rose 26% in March alone. Uninsured admissions rose 14% in the first quarter from a year ago and 19% in March. The company said its health-care facilities provided $218 million of charity care and discounts to the uninsured in the quarter, up from $182 million in the first quarter of 2003.

The company lowered full-year earnings guidance to $2.60-$2.70 a share, down from old guidance of $2.85-$2.95 a share. Analysts surveyed by Thomson First Call were forecasting earnings of $2.87 a share.

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