(Reuters) - Tenet Healthcare Corp THC.N slashed its full-year forecasts and reported a bigger-than-expected quarterly loss as the U.S. hospital operator struggled with fewer patient admissions, sending its shares down about 11 percent after the bell.

The company reported fewer patient visits in the quarter, continuing an industry-wide trend reported by rivals, including the largest hospital operator HCA Healthcare Inc HCA.N which said last month that its results were challenged by a softer growth in patient numbers.

Tenet’s adjusted admissions on a same-hospital basis, which include patients who stay in the hospital overnight and those treated on an outpatient basis, fell 1.4 percent in the second quarter ended June 30.

“We are not surprised by these results and view the admissions growth headwinds facing the hospital sector as longer-term issues that will not be solved in the coming quarters,” Piper Jaffray analyst Sarah James said in a client note on Monday.

Hospital operators’ stocks have been volatile due to uncertainty surrounding the fate of former President Barack Obama’s signature healthcare law, formally known as the Affordable Care Act, which benefited the hospitals as the law expanded insurance coverage.

Tenet forecast full-year adjusted earnings per share from continuing operations between 69 cents to 99 cents, from its previous forecast of $1.05 to $1.30.

The company also lowered its full-year revenue forecast to a range of $19.1 billion to $19.4 billion, from $19.7 billion to $20.1 billion.

The hospital operator said on Monday its full-year outlook will be impacted by the sale of its Houston-based assets announced last quarter, lower patient volumes and lower-than-expected revenue from its Conifer unit.

Tenet, which had long-term debt of about $15 billion as of June 30, has been implementing cost-cutting programs, focused on raising hospital segment margins to turn its business around.

Earlier this month, the hospital operator completed divestment of three of its Houston-based hospitals to HCA Holdings.

Net loss attributable to the company’s shareholders widened to $55 million, or 55 cents per share, in the second quarter, from $46 million, or 46 cents per share, a year earlier.

Excluding items, the company lost 17 cents per share, compared with analysts’ average estimate of a loss of 16 cents, according to Thomson Reuters I/B/E/S.

Net operating revenue fell 1.4 percent to $4.80 billion, missing estimates of $4.90 billion.

Shares of the Dallas-based company were down 11.2 percent at $14.90 in after-hours trading on Monday.