As we speak, but San Antonio is one of those markets where we have uniquely high occupancy. That market, for example, we run approximately 90% occupancy, and we think it’s better for us to open up new hospitals as opposed to keep adding on in every circumstance in that particular community. But we do own land in Austin, Texas for new hospitals, we own land in Dallas for new hospitals.We just recently purchased in the first quarter land for new hospitals in Las Vegas and Salt Lake City. We have land for new hospitals in a number of Florida markets. So that’s part of what you’re seeing in our capital spending, is that we are acquiring land for future network development. In addition to that, we have significantly advanced our outpatient facility development.
That doesn’t put too much pressure on our capital spending, but there are some elements of it that are in the increased guidance.And then finally, I think it’s important for everybody to understand, we are still in a situation where we have a lot of facilities that have high levels of occupancy. In the first quarter, the company ran approximately 73% to 74% occupancy in its inpatient facilities. And we need to have sufficient capacity as we build up our staffing over time. We need physical capacity to accommodate what we believe to be the demand for health care. So the projects are really mixed among those three things: land acquisitions for future hospital development; outpatient network development; and then relieving capacity constraints on the existing platform of facilities that we have today.Bill Rutherford And Josh, this is Bill.
I’ll add, we obviously can accommodate that increasing capital within the resources we’re generating and within our overall capital allocation philosophies that we have. And we also continue to see really strong returns on invested capital. So we have confidence that these investments will continue to generate growth for us into the future.Operator Your next question comes from the line of Brian Tanquilut from Jefferies. Your line is open.Brian Tanquilut Hey, good morning. Bill, maybe just a question on how we should be thinking about the moving pieces or considerations for the second quarter? I know you called out the envisioned contribution to revenue and then maybe the New Orleans Hospital. But anything that we should be thinking about just sequentially in year-over-year?
Thank you.Bill Rutherford Yes. Brian, nothing material. I mean, once we kind of anniversary the high COVID volume, which is principally first quarter, second quarter of last year, we began to see the start of normalization. Obviously, we’re coming off some continued high labor costs in the first quarter. We saw some improvement in the second quarter and obviously improvement as we went through the balance of the year. So I can’t say there’s anything material, I can call out, especially one quarter to the next. We typically wouldn’t do that. But for the balance of the year, now that we’ve got the majority of the high COVID behind us in terms of the year-over-year comparisons, things should begin to normalize for the most part.Operator Your next question comes from the line of Andrew Mok from UBS.
Your line is open.Andrew Mok Hi, good morning. You provided some breakeven metrics on Medicaid redeterminations in the past. Hoping you could provide an updated view on how you expect that to play out over the next 18 to 24 months? And what sort of impact that could have on near and intermediate-term operating results? Thanks.Bill Rutherford Yes. Thanks. I mean, obviously, this is an area we continue to pay attention to. We’ve got a fairly formalized approach inside of the company. We haven’t seen any impact yet as those redeterminations are just beginning to occur, but we are keeping very close to state plans. We’ve also made outreach to our Medicaid patients to help them look at alternative coverage in the event they find themselves displaced to Medicaid.
We continue to be encouraged with some of the third-party studies that we read that a relatively high percentage of those individuals potentially qualify for employer-sponsored coverage or through enhanced subsidies coverage within the health insurance marketplace.So we are staying very close to that. We are increasing our efforts to help people identify coverage that are available to them, trying to work with states and other community agencies where necessary to help people land coverage. So too early to be able to quantify what the impact of that may be. But ultimately, I believe when people can find coverage in the exchanges or through their employer. We wouldn’t really anticipate any material downside, and hopefully, there could be some upside benefit to that over the long run.Operator Your next question comes from the line of Scott Fidel from Stephens.
Your line is open.Scott Fidel Hi, thanks. Interested if you could talk about how you’re thinking about the sustainability of the surgical growth trends over the balance of the year, both in inpatient and outpatient. And interested if — was there any catch-up just as COVID really diminished in the first quarter? Or do you see those types of growth trends are sustainable over the course of the year?Bill Rutherford We’re looking — one, we’re pleased with the trends. It’s hard to parse exactly the contribution of that. I think overall, we’re pleased with the demand and the activity we see in the market. We continue to see — believe that we’re going to return to normal historical volume patterns. And if that does show itself, we should see continued growth in both inpatient and outpatient surgical volume.
We continue to invest in our outpatient footprint. That should help drive reasonable outpatient surgical growth. Our program development in the inpatient side should help continue to show good inpatient surgical growth as well. So we’ll just have to see that. I think, typically, we would see 1% to 2% type of surgical growth. And as the year goes on, hopefully, we’ll continue to see that.Sam Hazen Yes. And just to add to that, Bill. I think as we continue to increase our staffing capacity, it also affects our surgical capacity, because we do have instances we’re not able to open all of our operating rooms as sufficiently as we would prefer also. And so as our labor situation continues to get better, we think that will allow us to open up more surgical capacity, and we believe the demand in the market is still there.
So we’re encouraged by where we are with our surgical volumes, and we think we have some things that should prop it up, if you will, as we move through the year with our staffing agenda and our human resource strategies.Operator Your next question comes from the line of Lance Wilkes from Bernstein. Your line is open.Lance Wilkes Actually, that’s a perfect lead into my question. Could you talk a little bit about your outlook for staff growth? And in particular, obviously, you had the shift from temporary to permanent which has been great. Can you talk about how your staff has grown or maybe registered nurse staff or something like that over the last year? And then as you’re looking forward, are there any particular impediments to continued levels of growth?Sam Hazen Well, our total headcount was up around 2% when you look at this first quarter against last first quarter, And let me make sure that — actually, it’s more like 3% when you factor out the two lane divestiture.
So we’re up 3% quarter-over-quarter, which is obviously solid improvement in the market.As we’ve mentioned in the third quarter and the fourth quarter of last year, we were starting to see some momentum with our hiring, some momentum with our retention programs and so forth. And that’s carried through into the first quarter really well. I think our overall hiring was up 13% or something like that. But in the quarter compared to the running average, it was up 19% and that’s mostly in nursing. I don’t know that it will run that hot as we move through the rest of the year nor will we need it to run that hot as we move through the rest of the year.So our efforts with our recruitment, our efforts with retention will continue. We’re encouraged by other programs that we have to support our people and put them in the best position to succeed and deliver high-quality care.
