Steve G. Filton
Executive Vice President and Chief Financial Officer at Universal Health Services
Thank you, Mary. Good morning. Marc Miller is also joining us this morning. We welcome you to this review of Universal Health Services' results for the first quarter ended March 31, 2022.
During the conference call, we will be using words such as believes, expects, anticipates, estimates, and similar words that represent forecast projections and forward-looking statements. For anyone not familiar with the risks and uncertainties inherent in these forward-looking statements, I recommend a careful reading of this section on Risk Factors and Forward-Looking Statements and Risk Factors in our Form 10-K for the year ended December 31, 2021. We'd like to highlight just a couple of developments and business trends before opening the call up to questions.
As discussed in our press release last night, the company reported net income attributable to UHS per diluted share of $2.02 for the first quarter of 2022. After adjusting for the impact of the item reflected on the supplemental schedule as included with the press release, our adjusted net income attributable to UHS per diluted share was $2.15 for the quarter ended March 31, 2022.
During the first quarter of 2022, our operations continued to be impacted by the COVID-19 pandemic as well as pressures on staffing and wage rates. Specifically, a surge in patients with the Omicron variant of the virus, which began in December of 2021, tended to peak in most of our geographies in January of 2022. In our acute segment, we would note in general Omicron patients were less acutely ill than the COVID patients treated in previous surges, and thus displayed lower acuity. Meanwhile, amount of contract nursing hours used, and even more importantly, the rate we had to pay for those hours increased significantly in the first quarter, both on a sequential basis as well as a year-to-year -- and year-to-year comparison. Although in our Behavioral segment contract nursing cost did not increase quite as dramatically, our inability to fit all of our labor -- fill all of our labor vacancies had a notable limiting impact on our patient volumes and related revenues.
We do note that our results were benefited in the first quarter from approximately $12 million of revenues, net of related provider taxes from special Texas Medicaid reimbursements, which related to the last four months of 2021. Recognition of those revenues were deferred until formal government approvals was obtained.
Our first quarter also included approximately $15 million of startup losses incurred by recently opened de novo acute and behavioral health facilities and $6 million of losses related to temporarily closed bet at two behavioral health facilities, which were impacted by natural disasters. Those beds have since been reopened.
As disclosed in on last night's press release, our operating results for the first quarter of 2022 were unfavorably impacted by labor costs that were higher than anticipated and patient volumes at our behavioral health facilities that were lower than anticipated, due to the continued uncertainties related to the COVID-19 pandemic as well as cost escalations related to the nationwide shortage of nurses and other clinical staff. Although we're not changing our previously released 2022 operating results forecast at this time, we may make reductions to our forecast at a future date, if the unfavorable operating trends experienced during the first quarter of 2022 do not improve.
Our cash generated from operating activities was $445 million during the first quarter of 2022 as compared to $72 million during the same period in 2021. We note the first quarter 2021 cash generation reflected the repayment of the Medicare accelerated payments. We spent $200 million on capital expenditures during the first quarter of 2022. Our accounts receivable days outstanding decreased to 48 days during the first quarter of 2022 as compared to 50 days in the first quarter of 2021. Due to the large part to the continued repurchasing of our shares at March 31, 2022, our ratio of debt to total capitalization increased to 42% as compared to 35.7% at March 31, 2021.