Kelvin A. Baggett, M.D., M.P.H., M.B.A.SVP, Clinical Operations & Chief Medical Officer

December 10, 2012

Clinical Operations

Forward-looking Statements

Certain statements contained in this presentation constitute “forward-looking statements” within the meaning of Section 27A of the Securities Act of1933 and Section 21E of the Securities Exchange Act of 1934. Such forward-looking statements are based on management's current expectationsand involve known and unknown risks, uncertainties and other factors that may cause the Company’s actual results to be materially different fromthose expressed or implied by such forward-looking statements. Such factors include, among others, the following: the passage of heath carereform legislation and the enactment of additional federal and state health care reform; other changes in federal, state and local laws andregulations affecting the health care industry; general economic and business conditions, both nationally and regionally; demographic changes;changes in, or the failure to comply with, laws and governmental regulations; the ability to enter into managed care provider arrangements onacceptable terms; changes in Medicare and Medicaid payments or reimbursement; liability and other claims asserted against the Company;competition, including the Company’s ability to attract patients to its hospitals; technological and pharmaceutical improvements that increase thecost of providing, or reduce the demand for, health care; changes in business strategy or development plans; the ability to attract and retainqualified personnel, including physicians, nurses and other health care professionals, and the impact on the Company’s labor expenses resultingfrom a shortage of nurses or other health care professionals; the significant indebtedness of the Company; the Company's ability to integrate newbusinesses with its existing operations; the availability and terms of capital to fund the expansion of the Company's business, including theacquisition of additional facilities; the creditworthiness of counterparties to the Company’s business transactions; adverse fluctuations in interestrates and other risks related to interest rate swaps or any other hedging activities the Company undertakes; the ability to continue to expand andrealize earnings contributions from the revenue cycle management, health care information management, capitation management, and patientcommunications services businesses under our Conifer Health Solutions (“Conifer”) subsidiary by marketing these services to third party hospitalsand other health care-related entities; and its ability to identify and execute on measures designed to save or control costs or streamline operations.Such factors also include the positive and negative effects of health reform legislation on reimbursement and utilization and the future designs ofprovider networks and insurance plans, including pricing, provider participation, coverage and co-pays and deductibles, all of which containsignificant uncertainty, and for which multiple models exist which may differ materially from the company's expectations. Certain additional risksand uncertainties are discussed in the Company’s filings with the Securities and Exchange Commission, including the Company’s annual report onForm 10-K and quarterly reports on Form 10-Q. The information contained in this presentation is as of November 7, 2012. The Companyspecifically disclaims any obligation 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 presentation includes certain financial measures such as Adjusted EBITDA, which are not calculated in accordance with generally acceptedaccounting 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 andrelated GAAP measures can be found in the Company’s third quarter earnings release issued on November 7, 2012.

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Overview

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• Highlight of External Factors and Internal Focus

• Tenet’s Quality Agenda 1.0 vs. 2.0

• Delivering Results

• Looking to 2014 and Beyond

• Key Takeaways

• Open Discussion and Q&A

Driven by private and public payer-led initiatives to contain costs and improve quality, three trends have emerged:

We believe these trends will continue

The Changing Environment of Healthcare

Reimbursement focused on value 

Renewed focus on safety and the prevention of hospital‐acquired conditions and preventable readmissions; and 

Greater alignment of providers of care through clinical integration models like accountable care organizations. 

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Our Strategy is Clear

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Differentiate our hospitals through superior quality and

service, growing our business by providing greater value to

customers

Align physicians more closely with our facilities in order to

improve quality and efficiency

Control cost through our Medicare Performance Initiative and other initiatives designed to increase the efficiency and cost-effectiveness of care provided to

our patients

Acquire acute care hospitals to strengthen our markets or as opportunities emerge in new

markets

Grow Conifer Health Solutions both in number of customers and

services we offer to third-party health care providers

Grow our outpatient footprint through acquisitions to develop new channels for our hospitals

and patients

Tenet’s Strategy is to:

Commitment to Quality – Key Strategic Initiative

• Focused on Core Process Measures Performance• Early adopter of these proxy measures for associated outcomes• Continue to exceed the national average

• Dedicated to creating industry leading ED and OR throughput times

Center of Excellence Designations by Managed Care

• Strategy to differentiate Tenet hospitals• Anticipation of narrow networks/steering

Measuring Satisfaction of Patients and Physicians

• Absence of industry comparative benchmarking • Relationship between satisfaction and engagement unclear

Clinical Quality: Quality Agenda 1.0Process Focused

6

80.0

81.1

82.8

84.7

87.2

88.8

89.7

88.5

89.690.4

90.891.2

92.2

93.193.8

94.4 94.795.1

95.796.2

96.697.0 97.2 97.5

98.0 98.2 98.3 98.5 98.598.5

80.581.5

82.3

83.3

84.7

85.986.7

86.287.0

88.088.6

89.3

90.3

91.3

92.2

93.2 93.594.1

94.695.0 95.3 95.5 95.7 96.0

96.6 96.9 97.197.5

77

79

81

83

85

87

89

91

93

95

97

99

Q20

4-Q

105

Q30

4-Q

205

Q40

4-Q

305

Q10

5-Q

405

Q20

5-Q

106

Q30

5-Q

206

Q40

5-Q

306

Q10

6-Q

406

Q20

6-Q

107

Q30

6-Q

207

Q40

6-Q

307

Q10

7-Q

407

Q20

7-Q

108

Q30

7-Q

208

Q40

7-Q

308

Q10

8-Q

408

Q20

8-Q

109

Q30

8-Q

209

Q40

8-Q

309

Q10

9-Q

409

Q20

9-Q

110

Q30

9-Q

210

Q40

9-Q

310

Q11

0-Q

410

Q21

0-Q

111

Q31

0-Q

211

Q41

0-Q

311

Q11

1-Q

411

Q21

1-Q

112

Q31

1-Q

212

Tenet %

National Average %

CMS Hospital Compare- Core Measures Tenet Trend vs. National Average

Note: 1. Source Data: CMS Hospital Compare website.

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166

202

260

306 305 308

2007 2008 2009 2010 2011 2012

Tenet Quality Is Recognized By Insurers

Centers of Excellence and Other Quality Designations for Tenet Hospitals and Service Lines

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Refreshed Commitment to Quality

Reduction of Health Care Associated InfectionsElimination of Never EventsService measurement and improvement targeted at gaining engagement and loyaltyGeneration of internal evidence using tools and dataOutcomes improvement incorporating functionality, mortality, morbidity and management metrics

Standards and Standardization

Reduction of non-value added care variabilityImproved clinical infrastructure and competencyYearly agenda setting for local governing boardsService line evaluation and approval that improves likelihood of program success and return on investmentExternal work to harmonize metrics

Engaged in Driving BusinessPursuit of certifications that differentiate care environments Marketing of performance and recognitions that create a competitive advantageJoint Operating Committees with selected managed care clinical leadersEmployer engagement to garner large contracts

Clinical Operations: Quality Agenda 2.0Improving Outcomes, Driving Value

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Clinical Operations

Delivering improved outcomes at a lower total cost of care or reducing costs while maintaining the current level of outcomes

Value = Outcomes AchievedCost to Deliver those Outcomes

Safety – First doing no harm

Care Variability and Quality - Care that is consistent with the latest evidence, science or demonstrated best practices

Service – Person centered care, delivered with dignity, respect and desired engagement of the patient and their families

Key Components:Key Components:

Care setting / Level of care

Intensity of services

Resource utilization

Throughput, turn around time and cycle times

Risk Mitigation (Compliance and Malpractice)

Patient Outcomes

Cost

Patie

nt B

asel

ine

Hea

lth S

tatu

s

Defining Value

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Clinical Operational Performance Improvement Objectives Framework

Healthcare Associated Infections (HAIs)

Healthcare Associated Infections (HAIs)

Hospital Acquired Conditions (HACs)Hospital Acquired Conditions (HACs)

Elective DeliveriesElective Deliveries

Patient  FallsPatient  Falls

Never EventsNever Events

Venous Thromboembolism

Venous Thromboembolism

Blood Product  UtilizationBlood Product  Utilization

Preventable ReadmissionsPreventable Readmissions

Patient MortalityPatient Mortality

Medication ErrorsMedication Errors

Cardiac  Care AppropriatenessCardiac  Care 

Appropriateness

Stroke CareStroke Care

Diabetes  CareDiabetes  Care

Heart Failure ManagementHeart Failure Management

Telemetry CareTelemetry Care

Ventilator ManagementVentilator Management

Antibiotic AdministrationAntibiotic Administration

Core Process MeasuresCore Process Measures

Sepsis CareSepsis Care

Perinatal CarePerinatal Care

Patient SatisfactionPatient Satisfaction

Employee EngagementEmployee Engagement

Physician SatisfactionPhysician Satisfaction

Clinical Leadership Turnover

Clinical Leadership Turnover

Physician Leadership Engagement

Physician Leadership Engagement

Nursing RetentionNursing Retention

Nursing EducationNursing Education

Turn‐around‐time (TAT)Turn‐around‐time (TAT)

ED ThroughputED Throughput

Supply UtilizationSupply Utilization

Formulary Standardization

Formulary Standardization

Imaging EfficiencyImaging Efficiency

Lab OrderingLab Ordering

Physician Preference Items

Physician Preference Items

Clinical WorkflowClinical Workflow

Resource ConsumptionResource Consumption

Business ContinuityBusiness Continuity

Categories

Performance Areas

Unifying Purpose

Safest, high quality, most efficient provider of health care services.

Clinical Variability & Quality

ServiceOperational EfficiencySafety

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Supporting reporting of publicly required data

Participating in relevant external registries

Aggregating, analyzing and distributing data

Identifying and sharing best practices

Establishing internal collaboratives

Providing support and expertise for sustainable clinical operational improvement

How We are Working Together to Increase Value

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Driving Outcomes – Patient Safety

Patient Safety Improvement ProcessPatient Safety Performance Improvement Initiatives:Rapid Response• Process quickly determines if the

risk exposure extends beyond a single site

• Reduces cycle time to identify and address cause

• Centralized mechanism to capture and share best practices

Does it require a safety flash memo?

Do we send a detailed safety alert?

Serious Reportable Patient Safety Events: Decreasing Events and Continuously Learning

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Oct

ober

4th

–29

th

All Tenet facilities sequestered all NECC products

Inventory Assessment of all Facilities for NECC and Ameridose Products

Daily communication with all hospitals

Incident Command Center Deployed and Patient Hotline Activated

Customized Facility FAQs and Patient Letters

All Patient Notification Letters Mailed

Monitoring system and patient screening exams implemented

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Business Risk:October 2012 Meningitis Outbreak

Daily CEO Updates

Communication with FDA and State Depts. Of Health

Incident Command Center

Engaged Conifer for response call center and patient letters

46%Ventilator Associated 

Pneumonias reduced by 46%

Demonstrable Results

Patient Safety Initiatives since 2011 have resulted in significant improvements in key areas:

57%Retained Foreign Objects 

reduced by 57%

Falls with Injury 

reduced by 41%

41% 64%Vascular Catheter‐Associated Infection     

reduced by 64%

36%Pressure Ulcer Stages III & IV  reduced by 36%

31%Catheter Associated Urinary Tract 

Infection          reduced by 31%

The above rates are per 1000 device days and patient days.

The above rates are per 1000 patient discharges.

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CMS Readmission Reduction Program initiated a penalty for avoidable readmissions beginning October 2012, with an initial associated penalty of 1% of total base operating DRG as a withhold.

Avoiding Potential Readmissions

Created a task force in Q4 2009

Distributed best practices in Q1 2010 

To increase accountability, we included readmissions in our incentive plans starting in 2010 

Incorporated predictive tools in 2011 

Initiated pilots with external and post acute care vendors in 2011

Actio

n

ResultsOnly 2 Tenet hospitals received the maximum penalty of 1%.Acute Myocardial Infarction and Pneumonia Readmissions continue to be better than the national average and continue to improve

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Tenet HIT Roadmap 

The Enabling Role of Technology: HIT

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Phase 1 ‐ EHRs

• Core clinicals• 26 completed as of 10/2012 

Phase 2 ‐ CPOE

• 26 completed as of 10/2012

• Satisfied CMS HIT targeted incentives

Targeted Completion: 2014Targeted Completion: 2014

Advances in health information technology continue to improve care and help us to better inform clinical processes.

Health Information Technology (HIT)

Clinical Apparatus

Driving Value – Future Measures

• Stroke is the 4th leading cause of death.  About 795,000 Americans each year suffer a new or recurrent stroke. 

• 41 Tenet hospitals participate in the American Heart Association‐Get With The Guidelines program.

• St Louis University Hospital created and leads the Mid‐American Stroke Network, which includes 45 regional hospitals.

Stroke 

• Readmissions measures will now include all unplanned readmissions for all conditions hospital‐wide, as well as total knee / total hip arthroplasty complication and 30‐day readmission.

• Systems are being developed to address these measures, including predictive analytics tools which have been beta tested in 2012 and are in implementation phases.

New Readmissions Measures

• Estimates range from 300,000 to 600,000 people are affected  by VTE each year in the United States

• VTE is the 2nd most common cause of excess length of stay due to complication after surgery 

• Since 2009, we have had a system wide focus that includes process redesign, practices and policies

• Results: 96% compliance with VTE policies and practices

Venous Thromboembolism  (VTE)

Beginning January 2013, Tenet hospitals will be required to submit VTE and Stroke Measure data to CMS. Failure to submit this data will result in a loss of 2% of the Annual Payment Update (APU) in 2014.What have we done to prepare and focus on improvement?

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QUESTIONS?

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