It was a rough morning for Surgery Partners (SGRY). The company's stock hit a fresh 52-week low in Tuesday's premarket session after delivering a quarterly earnings report that fell short of expectations and setting a cautious tone for the year ahead.

Let's start with the numbers that got investors worried. For the fourth quarter, Surgery Partners reported adjusted earnings of 12 cents per share. That's less than half of what analysts were expecting—the consensus estimate was 30 cents. Revenue came in at $885 million, which was actually a bit better than the expected $866.47 million and represented a 2.4% increase from the same period last year.

Digging a little deeper, same-facility revenues—a key metric for a company that operates surgical centers—increased by 3.5%. That growth came from a 2.1% increase in revenue per case and a 1.3% increase in the number of cases. So, business is still growing, just not as profitably as hoped. The company's adjusted EBITDA was $156.9 million, down from $163.8 million a year ago. Cash flow from operations also dipped to $103.4 million from $111.4 million in the prior year's fourth quarter.

CEO Eric Evans didn't sugarcoat it. "Significant and unanticipated headwinds that culminated in fourth quarter results that did not meet our expectations," he said in the earnings release. But he tried to steer the focus toward the future: "Despite these challenging headwinds, demand for our services remains strong, and we remain optimistic on the structural tailwinds underpinning long-term ASC market growth."

That optimism, however, was paired with guidance for 2026 that left Wall Street wanting more. The company expects sales in the range of $3.35 billion to $3.45 billion for the fiscal year. The problem? Analysts were already looking for about $3.56 billion. So, the company's own forecast starts well below where the street thought it would be.

Evans outlined the plan to get back on track: "As we progress through 2026, we are proactively strengthening our performance by tightening execution and doubling down on our shift into higher-acuity procedures. We believe the company is well-positioned to capture momentum in the market through multiple initiatives, including continued organic growth, strategic M&A, and effective portfolio optimization."

In a move that might seem counterintuitive given the stock's plunge, the company recently announced a new share repurchase program. On February 26, it authorized buying back up to $200 million of its own stock. It's a signal of confidence from management, or at least a belief that the shares are undervalued, even if the market disagrees at the moment.

Speaking of the market's view, the technical picture isn't pretty. The stock is trading 8.5% below its 20-day simple moving average and 12.3% below its 100-day average—classic signs of a bearish trend. The Relative Strength Index (RSI) sits at 44.45, which is in neutral territory, but the MACD indicator is below its signal line, suggesting bearish pressure. For traders watching the charts, key resistance is seen at $13.50, with support down at $11.00.

The result of all this? Surgery Partners shares were down nearly 24% in premarket trading, changing hands around $12.08. That puts the stock at a new 52-week low, according to market data. It's a stark reminder that in healthcare services, even with strong underlying demand, execution and meeting quarterly targets matter a great deal to investors.