Tenet Healthcare will cut about 1,300 jobs as part of an initiative to save $150 million on annual operating expenses. The Dallas-based hospital operator also expects to report a net loss from continuing operations of approximately $366 million in third quarter.

Tenet announced its preliminary financial results for the three months ending Sept. 30 early Friday. The current executive chairman and CEO, Ronald Rittenmeyer, said the changes will help to "drive organic growth, expand margins, and better support our hospitals and other facilities in delivering higher levels of quality and patient satisfaction."

It is unclear where the jobs eliminated are located. Tenet has over 8,000 employees in North Texas and a total of about 130,000 at facilities across the U.S. and the United Kingdom.

Feeling the pressure

The announcement comes nearly a week before Tenet was set to release its quarterly earnings. It follows a series of blows for the embattled hospital chain, including continued financial losses, a $514 million legal payout, board shakeups and the exit of longtime CEO Trevor Fetter.

Other investor-owned hospitals, like HCA Holdings and Community Health Systems, have also faced headwinds that have made business a challenge in recent years, analysts say.

The hospital chains set high expectations for patient volumes as millions of Americans gained health insurance under the Affordable Care Act, and as aging baby boomers began to need care.

They consolidated and grew portfolios. They expanded into areas where demand might be highest. Tenet made major investments in ambulatory centers across several U.S. markets.

But those brick-and-mortar investments didn’t translate into revenue.

On Friday, Tenet said that both adjusted admissions and net patient revenue were down more than 2 percent from the same period last year. Those types of declines have been a major frustration for investors who have been applying pressure and turning up the heat.

In August, there were hints at a proxy fight as two Tenet board members abruptly resigned, citing irreconcilable differences with the company, whose stock price has tumbled 60 percent over the past five years. Earlier this week, Fetter officially stepped down as the company’s leader.

Rittenmeyer will fill the void while Tenet continues its search for a permanent replacement. In the announcement Friday, he said the company is "moving quickly and decisively" to improve financial results.

'A difficult calculus'

As hospital leaders focused on growth and expansion, they may have downplayed key issues that are now catching up to them in the numbers, said John Morrow, a managing director for Franklin Trust Ratings, who focuses on hospital performance and health-care analytics.

He noted, for example, that Obamacare never reached its anticipated 50 million enrollment goal. More Americans ended up on high-deductible health insurance plans, which can lead patients to forgo care or be unable to pay. And all of this happened as advances in technology have kept people healthier for longer — and thus, out of the hospital.

Growing volume in the health-care industry is “a difficult calculus,” Morrow said. “The entire industry is facing headwinds and it’s leading to a brittle market. And they are under shareholder pressure to reduce debt.”

The Tenet announcement attributed at least $30 million of the expected third-quarter miss to losses associated with hurricanes Harvey and Irma. An additional $10 million of Tenet’s loss was attributed to lower-than-anticipated revenue from the Texas and Florida Medicaid programs.

Tenet said it has begun the implementation of an enterprise-wide cost reduction initiative, which includes the renegotiation of contracts with suppliers and vendors. Those changes, added to the job cuts, are expected to cut annual operating expenses by $150 million, the company said.

But Morrow anticipates Tenet would have to “substantially increase” the number of planned layoffs to reach the goal and remain a profitable and competitive hospital system.