Stephen Rusckowski
Chairman, Chief Executive Officer and President at Quest Diagnostics
Now turning to our results, we closed out 2021 with another record year of revenue, earnings, and cash from operations, our base business recovery throughout the year and we experienced strong demand for COVID-19 testing services. So for the full year 2021, total revenues grew by more than 14% to $10.8 billion. Earnings per share increased by nearly 49% on a reported basis to $15.55 and more than 27% on an adjusted basis to $14.24. Cash provided by operations increased by more than 11% to $2.2 billion. And for the fourth quarter, total revenues were $2.7 billion, a decrease of roughly 9% versus 2020, when COVID 19 volumes were certain. Earnings per share were $3.12 on a reported basis and $3.33 on an adjusted basis, both down approximately 26% versus the prior year.
So I'd like to share some perspective on the role of COVID-19 testing going forward. A lot of progress has been made in the battle against COVID-19, but we believe it isn't going away anytime soon. Our molecular volumes again this year strong with volumes peaking in January. Testing will continue to play an important part of managing COVID-19 and we believe that molecular testing remains the gold standard.
We continue to perform well throughout the surge, maintaining average turnaround times of two days or less for COVID molecular testing. We will continue to maintain appropriate testing capacities, and staffing levels for any additional service throughout this year, if they emerge. We also continue to believe there will be a bigger role for serology testing and how we measure COVID-19 protection going forward. Ultimately, we expect COVID-19 testing to eventually more flu-like and become a permanent part of our portfolio going forward.
Now turning to our base business. We continue to make progress executing our two-point strategy to accelerate growth and drive operational excellence. While we delivered 2% revenue growth, our base business from acquisitions again last year. In the fourth quarter, we acquired the assets of Labtech Diagnostics, a regional independent laboratory serving physicians and patients, primarily in South and North Carolina, Georgia, and Florida. This is the first full-service laboratory owned by Quest in South Carolina.
We also recently announced our acquisition of Pack Health, a patient engagement company that helps individuals adopt healthier behaviors to improve outcomes. This acquisition will bolster our extended pure capabilities. Now since 2012, we have completed more than 40 acquisitions including Outreach Laboratories, regional independent laboratories, and capability enhancing deals. And over the last four years, we've achieved our target of greater than the average of 2% revenue growth on our base business each year from acquisitions.
And then finally, all our M&A funnels remain strong. In 2021, we took full advantage of our strong health plan access, which is approximately 90% of all commercial insured advice in this country. We also made good progress working together with our plans to help companies and their employees save money by reducing denials and out-of-network linkage. Our clients also recognize the value of working with us and we have grown our health revenues faster than our overall revenue is the best level we've ever seen. Hospital health system revenues have grown more than 20% compared to 2019 levels excluding COVID-19 testing, driven largely by the strength of our professional laboratories services contract. Our performance in 2021 benefited from our two largest PLS contracts to date, Hackensack Meridian Health, and Memorial Hermann. Altogether, our PLS business without COVID-19 exceeded a record $500 million in annual revenue last year.
Hospitals have continuously pressure throughout the pandemic. Post pandemic, we believe the same will be true. We believe there will be a continued consolidation and ongoing challenges, for Quest, an opportunity to implement our flexible solutions that'll become more effective and productive. I think advanced diagnostics is critical for the future healthcare. We're building strong momentum in our key growth drivers, which include consumer and hereditary genetics, oncology, and pharma services. In 2021, these test categories accounted for several hundred million dollars of advanced diagnostics portfolio and they're growing more than 25% versus 2020, and nearly 33% versus 2019. We are investing aggressively in areas with potential for future differentiation to grow our advanced diagnostics value proposition including automatic test next-gen sequencing, bioinformatics, the salesforce, and customer service. We're leveraging our scale and expertise to give patients and fighters greater access to important innovations such as liquid biopsy and digital pathology.
Advanced diagnostics is one of the faster-growing areas of our portfolio. Our strategy and investments in this area will enable us to achieve high single-digit revenue growth going forward. And we're equally excited about the opportunities we see in our direct-to-consumer testing business. Revenues for Quest Direct services nearly doubled to more than $17 billion in 2021, driven by both the basis is probably the COVID-19 testing. We non-COVID consumer diagnostic market will experience double-digit growth over the next several years and we're on track to build the $250 million direct-to-consumer business by 2025. We're ramping up our investments in the business, launching a new and improved digital experience later this year, and we're also investing in an enhancements to the in-person customer experience at our patient service centers.
So we're off to a good start to 2022. We're building on our long-term relationships with Walmart by recently launching a consumer-initiated laboratory testing on walmart.com through our solution powered by Quest Direct and the MyQuest platform now has nearly 23 million users, up more than 3 billion in the past quarter.
We're very excited about our longer-term growth opportunities in advanced diagnostics and direct-to-consumer testing and our increasing investments in 2021, the strength in our business, and accelerate growth beyond the pandemic. These investments were made possible with the record cash in earnings we generated over the past few years.
Now, the second part of our two-point strategy is to drive operational excellence. We remain laser-focused on improving both operation quality and efficiency, which go hand to hand. In 2021, the Invigorate Program exceeded our goal of 3% productivity improvement. We made good progress last year in procurement supply savings as well as reducing health plan denials and improving patient collections at the time of service. While we faced modest inflationary wave pressures in 2021, on the supply cost side, we have more than offset any increases with cost savings from our suppliers. Historically, our Invigorate productivity savings have been met of any inflationary increases. Beyond that, we continue to drive additional productivity improvements with platform consolidation and greater use of automation and artificial intelligence.
Now, I'll turn to our salesforce. Excuse me. Now turning to our workforce, Quest employees are highly engaged, based on the results of our quarterly surveys. In a challenging labor market, we are focused and are still seeing improvements in engagement and retention. Our team has done a lot to create and start to work phase, and we continue to do everything we can to attract, recruit and retain talent.
We're entering 2022 in a strong position within the lab industry and more broadly throughout healthcare. Our base business is poised to build off the record revenues we achieved last year and we're investing to accelerate growth. We expect to see continued demand for COVID-19 testing services, albeit at lower levels than the last two years. The delay of the 2022 PAMA cuts announced last year was a good outcome for our industry and medicare beneficiaries. However, it will continue to be hard at work in 2022 with our trade association, and members of Congress with the goal of ours to get a permanent fix to PAMA.
We remain committed to our capital deployment strategy of returning the majority of our free cash flow to our shareholders. This morning, we raised our dividend for the 11th time since 2011. We expect to have more than $1 billion in cash available this year for M&A and share repurchases.
So putting it all together, our 2022 guidance reflects strong momentum and investment in our base business, balance with the a but expected decline in COVID-19 testing revenues. Before turning it over to Mark, I'd like to recognize and thank once again all of our employees who really have been the frontlines of the pandemic and continue to serve the healthcare needs of patients who depend on Quest every day.
Now Mark will provide more detail on our performance and our 2022 guidance. Mark?
