The Ensign Group, Inc. (Nasdaq: ENSG) has traded in a roughly $118.73 to $194.00 52-week range, reflecting strength in healthcare services and acquisition-driven growth over the past year. The stock trend has been positive amid broad sector demand for non-acute care services, though broader healthcare and macro pressures, including reimbursement uncertainty, have weighed on sentiment.
Quarterly Results
For the quarter ended December 31, 2025, Ensign reported total revenue of $1.36 billion, up from $1.13 billion in the year-ago period. GAAP diluted earnings per share was $1.61, compared with $1.36 in Q4 2024. Adjusted EPS was $1.82 for the quarter. Revenue growth was driven by expanded occupancy at existing facilities and contributions from recent acquisitions.
The company’s Skilled Services segment, which represents the bulk of revenue, saw increased patient volume and higher medically complex cases, lifting service revenue year-over-year. Rental revenue from real estate operations also increased. Cost of services rose in line with volume growth, pressuring margins modestly, but operating leverage supported profit expansion.
Full-Year Performance
For the full year 2025, Ensign reported GAAP diluted EPS of $5.84, versus the prior year’s level, an increase of about 14%. Adjusted full-year EPS was $6.57. Annual revenue exceeded $5.05 billion, up from $4.26 billion in 2024, marking continued expansion driven by organic growth and acquisitions.
Liquidity remained solid with about $503.9 million in cash on hand and approximately $591.6 million of available credit capacity at year-end, providing capacity for operational needs and future acquisitions.
Guidance & Strategy
Ensign issued 2026 earnings guidance of $7.41 to $7.61 per share and revenue guidance of $5.77 billion to $5.84 billion. The midpoint suggests double-digit growth over 2025 results. Management reiterated its focus on expanding the company’s footprint through targeted acquisitions and improved operational performance at newly acquired facilities.
Sector & Macro Context
The healthcare services sector has broadly outperformed parts of the market, supported by demographic trends favoring post-acute and long-term care demand. However, macro headwinds such as labor cost inflation, regulatory reimbursement shifts, and ongoing Medicare/Medicaid policy uncertainty have weighed on margins for many healthcare service providers. These sector challenges accompany broader market volatility that has affected valuations in related equities.
Strengths & Weaknesses
Strengths:
- Robust year-over-year revenue and earnings growth, with expanded service volumes.
- Strong balance sheet and credit capacity support the acquisition strategy.
- Diversified operations across multiple states and facility types.
Weaknesses:
- Cost of services growth compressing operating margins.
- Dependence on Medicare/Medicaid reimbursement policies that may fluctuate.