(ACHC) 2022 Q4 法說會逐字稿

Good morning, and welcome to Acadia Healthcare's Fourth Quarter and Full Year 2022 Earnings Call. (Operator Instructions) Please note that this event is being recorded today. I would now like to turn the conference over to Gretchen Hommrich. Please go ahead, ma'am.

早上好，歡迎來到 Acadia Healthcare 的第四季度和 2022 年全年收益電話會議。 （操作員說明）請注意，今天正在記錄此事件。我現在想將會議轉交給 Gretchen Hommrich。請繼續，女士。

Good morning, and welcome to Acadia's Fourth Quarter 2022 Conference Call. I'm Gretchen Hommrich, Vice President of Investor Relations for Acadia. I'll first provide you with our safe harbor before turning the call over to our Chief Executive Officer, Chris Hunter.

早上好，歡迎來到阿卡迪亞 2022 年第四季度電話會議。我是 Acadia 投資者關係副總裁 Gretchen Hommrich。在將電話轉交給我們的首席執行官克里斯亨特之前，我將首先為您提供我們的安全港。

To the extent any non-GAAP financial measure is discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP on our website by viewing yesterday's news release under the Investors link.

如果在今天的電話會議中討論了任何非 GAAP 財務指標，您還可以通過查看投資者鏈接下昨天的新聞稿，在我們網站上找到該指標與根據 GAAP 計算的最直接可比財務指標的對賬。

This conference call may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements, among others, regarding Acadia's expected quarterly and annual financial performance for 2022 and beyond. You are hereby cautioned that these statements may be affected by the important factors, among others, set forth in Acadia's filings with the Securities and Exchange Commission and in the company's fourth quarter news release. And consequently, actual operations and results may differ materially from the results discussed in the forward-looking statements.

本次電話會議可能包含 1995 年《私人證券訴訟改革法案》含義內的前瞻性陳述，其中包括關於 Acadia 2022 年及以後預期季度和年度財務業績的陳述。特此提醒您，這些聲明可能受到重要因素的影響，其中包括阿卡迪亞向美國證券交易委員會提交的文件和公司第四季度新聞稿中規定的因素。因此，實際運營和結果可能與前瞻性陳述中討論的結果存在重大差異。

At this time, for opening remarks, I would like to turn the conference call over to our Chief Executive Officer, Chris Hunter.

此時，為了開場白，我想將電話會議轉交給我們的首席執行官克里斯亨特。

Thank you, Gretchen. Good morning, everyone, and thank you for being with us today for our fourth quarter 2022 conference call. I'm here today with Chief Financial Officer, David Duckworth; and other members of our executive management team. David and I will provide some remarks about our financial and operating performance for the fourth quarter of 2022 and guidance for 2023. Following our comments, we'll open the line for your questions.

謝謝你，格雷琴。大家早上好，感謝您今天與我們一起參加我們的 2022 年第四季度電話會議。我今天和首席財務官戴維·達克沃斯 (David Duckworth) 一起來到這裡。以及我們執行管理團隊的其他成員。大衛和我將就我們 2022 年第四季度的財務和運營業績以及 2023 年的指導意見發表一些評論。根據我們的評論，我們將開通您的問題熱線。

In December, we held our first ever Investor Day at Carnegie Hall in New York, and we're appreciative that so many of you joined us in person and through our webcast. It was a great event, and we appreciate your support. I'm pleased to say that our fourth quarter results and start to 2023 demonstrate that we're executing on the strategy we presented with favorable results across our key performance metrics.

12 月，我們在紐約卡內基音樂廳舉辦了有史以來的第一個投資者日，我們非常感謝你們中的許多人親自和通過我們的網絡廣播加入我們。這是一個很棒的活動，我們感謝您的支持。我很高興地說，我們第四季度的業績和 2023 年初的業績表明，我們正在執行我們提出的戰略，在我們的關鍵績效指標中取得了有利的結果。

Throughout the past year, we continued to see strong momentum in our business, reflecting robust demand for our behavioral health care services. We need to continue to commend our dedicated team of employees and clinicians across our operations who have worked tirelessly to meet the needs of those seeking treatment for mental health and substance use issues. Our strong results reflect our ability to effectively operate our 250 facilities across Acadia's network and serve our patients with safe quality care.

在過去的一年裡，我們的業務繼續保持強勁勢頭，反映出對我們的行為保健服務的強勁需求。我們需要繼續讚揚我們敬業的員工和臨床醫生團隊，他們在我們的運營中孜孜不倦地工作，以滿足那些尋求心理健康和物質使用問題治療的人的需求。我們的強勁業績反映了我們有能力在 Acadia 的網絡中有效運營我們的 250 個設施，並為我們的患者提供安全優質的護理。

During the fourth quarter, we continued to see positive trends in our business with an increase in our same facility revenue of 9.4% compared with the fourth quarter of 2021 including an increase in revenue per patient day of 5.2% and an increase in patient days of 4.0%. Our fourth quarter results marked a strong finish to 2022, and we believe set us up well for 2023.

在第四季度，我們繼續看到我們業務的積極趨勢，與 2021 年第四季度相比，我們的同一設施收入增長了 9.4%，其中每個患者日收入增長了 5.2%，患者日增長了4.0%。我們第四季度的業績標誌著 2022 年的強勁收官，我們相信我們為 2023 年做好了準備。

We are proud of our vitally important work to support expanding patient populations in order to make a positive difference in more communities. Acadia has created a strong foundation to build upon during a time of unprecedented demand for behavioral health care services.

我們為支持不斷擴大的患者群體以在更多社區中產生積極影響而開展的至關重要的工作感到自豪。在行為保健服務需求空前的時期，Acadia 奠定了堅實的基礎。

A recent 2022 study from Indiana University found that approximately 45% of patients who visit the emergency department for physical injuries and ailments also have mental health and substance use problems that are frequently overlooked. Acadia has established strong relationships with med surg hospitals across the country bringing our experience and expertise to markets where they are desperately needed.

印第安納大學最近一項 2022 年的研究發現，大約 45% 因身體受傷和疾病而到急診室就診的患者也有經常被忽視的心理健康和物質使用問題。 Acadia 與全國各地的外科醫院建立了牢固的關係，將我們的經驗和專業知識帶到急需它們的市場。

And fortunately, a greater social awareness of mental health issues and broader acceptance of treatment have made behavioral health care priority with medical professionals and government health care officials. Acadia is well-positioned to address this critical societal need as a leader in providing behavioral health care services across the care continuum.

幸運的是，社會對心理健康問題的認識越來越強，對治療的接受度越來越高，這使得行為保健成為醫療專業人員和政府保健官員的優先事項。作為在整個護理過程中提供行為保健服務的領導者，Acadia 有能力滿足這一關鍵的社會需求。

During the fourth quarter of 2022, we continued to advance our growth objectives across each of our service lines. As we've previously shared, we believe our 5 distinct growth pathways will enable the company to meet this demand and extend our market reach. I'll briefly update you on our accomplishments related to these 5 pathways during the fourth quarter. On the first pathway, facility expansions remains a primary driver of our growth as this pathway allows us to efficiently expand services in established markets by utilizing our existing infrastructure and experienced staff.

2022 年第四季度，我們繼續推進每條服務線的增長目標。正如我們之前分享的那樣，我們相信我們的 5 條不同的增長途徑將使公司能夠滿足這一需求並擴大我們的市場範圍。我將向您簡要介紹我們在第四季度與這 5 條途徑相關的成就。在第一個途徑中，設施擴建仍然是我們增長的主要驅動力，因為這條途徑使我們能夠利用我們現有的基礎設施和經驗豐富的員工有效地在成熟市場擴展服務。

We added 80 beds to our existing facilities during the fourth quarter, finishing the year with a strong second half performance with 212 bed additions and bringing our total number of bed additions to 290 for the year. Looking ahead, we expect to add approximately 300 beds through facility expansions in 2023. Importantly, many of the bed additions in 2023 will open in the first half of the year and are expected to contribute to an accelerating volume growth outlook for the company.

我們在第四季度為現有設施增加了 80 張床位，以強勁的下半年表現結束了這一年，增加了 212 張床位，使我們全年增加的床位總數達到 290 張。展望未來，我們預計 2023 年將通過設施擴建增加約 300 張床位。重要的是，2023 年新增的許多床位將在今年上半年開放，預計將有助於公司的銷量增長前景加速。

A second important growth pathway is to identify underserved markets for behavioral health care services and develop wholly owned de novo facilities that bridge this gap and help meet the critical community need.

第二個重要的增長途徑是確定行為保健服務服務不足的市場，並開發全資的從頭開始的設施，以彌合這一差距並幫助滿足關鍵的社區需求。

In 2022, we opened a 60-bed Children's Hospital. It's the first stage of our Montrose Behavioral Health Hospital operations in Chicago. We look forward to increasing the pace of our de novos from opening 1 per year to 2 per year in 2023 as we're on track to open our 101-bed Montrose adult hospital, an outpatient facility in our 80-bed facility, Coachella Valley Behavioral Health in Indio, California later this year.

2022 年，我們開設了一家擁有 60 個床位的兒童醫院。這是我們在芝加哥的蒙特羅斯行為健康醫院運營的第一階段。我們期待著在 2023 年加快從頭開業的步伐，從每年 1 家增加到每年 2 家，因為我們有望開設擁有 101 個床位的 Montrose 成人醫院，這是我們擁有 80 個床位的 Coachella Valley 醫院的門診設施今年晚些時候加利福尼亞州印第奧的行為健康。

We're excited to announce a new de novo facility that is slated to open in 2024. This 100-bed acute care behavioral health hospital will serve the residence of Mesa, Arizona and surrounding communities. [Agave] Ridge Behavioral Hospital will offer a full continuum of inpatient behavioral health care services for adult, older adult, adolescent and child patients. Our groundbreaking is scheduled for next week. We will continue to pursue additional de novo opportunities in other underserved markets with a goal to develop and open acute and specialty facilities in 2024 and beyond. We also continued to expand our network of comprehensive treatment center facilities, or CTCs, specifically designed to meet the growing and critical need for addiction treatment, especially for patients dealing with opioid use disorder.

我們很高興地宣布一個新的設施將於 2024 年開放。這家擁有 100 個床位的急症護理行為健康醫院將為亞利桑那州梅薩和周邊社區的居民提供服務。 [龍舌蘭] Ridge 行為醫院將為成人、老年人、青少年和兒童患者提供完整的住院行為健康護理服務。我們的奠基儀式定於下週舉行。我們將繼續在其他服務不足的市場尋求更多從頭開始的機會，目標是在 2024 年及以後開發和開設急症和專業設施。我們還繼續擴大我們的綜合治療中心設施或 CTC 網絡，專門設計用於滿足日益增長的成癮治療需求，特別是對治療阿片類藥物使用障礙的患者。

During the fourth quarter, we opened 3 new de novo CTCs in Florida and Delaware, bringing our total to 7 new CTCs for the year, which exceeded our goal of at least 6 CTCs. As the opioid crisis has continued to escalate across the country, we believe Acadia's CTC facilities play a vital role in the communities they serve with programs that combine behavioral therapy and medication to treat opioid use disorders. Each CTC provides a range of comprehensive substance use treatment support services that include medical, counseling, vocational, educational and other treatment services to help our patients progress. We will continue to expand our CTC network and service offerings to meet this essential need with an objective of adding 6 CTCs in the year ahead.

第四季度，我們在佛羅里達州和特拉華州開設了 3 個新的 CTC，使我們全年的 CTC 總數達到 7 個，超過了我們至少 6 個 CTC 的目標。隨著阿片類藥物危機在全國范圍內持續升級，我們相信阿卡迪亞的 CTC 設施在他們服務的社區中發揮著至關重要的作用，這些項目結合了行為療法和藥物治療阿片類藥物使用障礙。每個 CTC 都提供一系列全面的藥物濫用治療支持服務，包括醫療、諮詢、職業、教育和其他治療服務，以幫助我們的患者取得進步。我們將繼續擴展我們的 CTC 網絡和服務產品以滿足這一基本需求，目標是在來年增加 6 個 CTC。

Our third attractive growth pathway is forming strategic partnerships with leading health systems across the country. We've been fortunate to establish strong relationships with leading national health care providers and premier health care systems who want to expand behavioral health care treatment options in their respective communities.

我們的第三個有吸引力的增長途徑是與全國領先的衛生系統建立戰略夥伴關係。我們很幸運能夠與領先的國家醫療保健提供者和頂級醫療保健系統建立牢固的關係，他們希望在各自的社區中擴大行為醫療保健治療選擇。

We bring the clinical expertise and experience they need to deliver high-quality care while we have an opportunity to leverage the provider's market presence and establish relationships in the community. In the second half of 2022, we were pleased to open 2 new facilities. The first facility was a 90-bed facility with our joint venture partner, Covenant Health in Knoxville, Tennessee in August; and the second facility was Maple Heights Behavioral Health, a 120-bed facility, which was opened in December with our partner, Lutheran Health Network in Fort Wayne, Indiana.

我們帶來他們提供高質量護理所需的臨床專業知識和經驗，同時我們有機會利用供應商的市場影響力並在社區中建立關係。 2022 年下半年，我們很高興開設了 2 個新設施。第一個設施是與我們的合資夥伴 Covenant Health 於 8 月在田納西州諾克斯維爾建立的一個擁有 90 個床位的設施；第二個設施是 Maple Heights Behavioral Health，這是一個擁有 120 個床位的設施，於 12 月與我們的合作夥伴印第安納州韋恩堡的 Lutheran Health Network 一起開放。

Acadia now has 19 joint venture facilities in various stages of development with 9 facilities opened and 10 facilities expected to open over the next several years, including 2 in 2023. We remain encouraged by the strong continued interest from potential partners in our JV pipeline.

Acadia 現在擁有 19 個處於不同開發階段的合資設施，其中 9 個設施已開放，10 個設施預計將在未來幾年開放，其中 2 個將在 2023 年開放。潛在合作夥伴對我們的合資管道的強烈持續興趣令我們感到鼓舞。

For our fourth growth pathway, we have maintained a very disciplined focus on M&A opportunities and continue to look for selective acquisitions that complement our growth strategy and are incremental to our financial objectives. During the fourth quarter, we acquired 4 CTCs from Georgia-based brand-new start treatment centers located in separate suburbs of the Atlanta metropolitan area, extending Acadia's CTC network to 151 locations at the end of 2022.

對於我們的第四條增長路徑，我們一直非常嚴格地關注併購機會，並繼續尋找有選擇性的收購來補充我們的增長戰略，並增加我們的財務目標。在第四季度，我們從位於亞特蘭大都會區不同郊區的佐治亞州全新啟動治療中心收購了 4 個 CTC，到 2022 年底將 Acadia 的 CTC 網絡擴展到 151 個地點。

We remain focused on selectively identifying attractive M&A opportunities that are complementary to our existing geographic footprint and portfolio of service offerings. We are fortunate to have a strong balance sheet that provides the flexibility to pursue acquisitions as well as make the necessary investments to support our other strategic growth pathways.

我們仍然專注於有選擇地確定有吸引力的併購機會，這些機會與我們現有的地理足跡和服務產品組合相輔相成。我們很幸運擁有強大的資產負債表，可以靈活地進行收購以及進行必要的投資以支持我們的其他戰略增長途徑。

For our fifth and final growth pathway, we remain focused on extending the continuum of care across our facilities and identifying additional ways to support patients. For example, we are continuing to strengthen our mid-level acuity programming, which we most often use to step down our patients after residential treatment. Since 2019, we have added over 50 PHP and IOP programs, including 5 in Q4 2022 alone. We are also continuing to advance our cross referral program, including by launching system improvements in Q4, which make it easier for our nurses and clinicians to identify cross-referral opportunities and facilitate the referral process itself.

對於我們的第五個也是最後一個增長途徑，我們仍然專注於在我們的設施中擴展護理的連續性，並確定支持患者的其他方法。例如，我們正在繼續加強我們的中級敏銳度計劃，我們最常使用它來讓我們的患者在住院治療後下台。自 2019 年以來，我們已經添加了 50 多個 PHP 和 IOP 程序，其中僅 2022 年第四季度就有 5 個。我們還在繼續推進我們的交叉轉介計劃，包括在第四季度啟動系統改進，這使我們的護士和臨床醫生更容易識別交叉轉介機會並促進轉介過程本身。

Finally, we continue to fill in service line gaps in our markets. Our previously mentioned acquisition of 4 CTCs in the Atlanta area, for example, complements our existing acute specialty, PHP and IOP service lines in that market. In conclusion, we are well-positioned to maintain our strong growth trajectory and meet our development targets for the year, which are adding approximately 670 beds in 2023 through approximately 300-bed additions to existing facilities, opening 2 inpatient de novo facilities, 2 facilities with JV partners with more JV announcements to come and opening at least 6 CTC locations.

最後，我們繼續填補我們市場中的服務線空白。例如，我們之前提到的在亞特蘭大地區收購 4 個 CTC，補充了我們在該市場現有的急性專業、PHP 和 IOP 服務線。總之，我們有能力保持我們強勁的增長軌跡並實現我們今年的發展目標，即通過在現有設施中增加約 300 張床位，在 2023 年增加約 670 張床位，開設 2 個新住院設施，2 個設施與 JV 合作夥伴一起發布更多 JV 公告，並開設至少 6 個 CTC 地點。

We're working hard to deliver on our 24 -- our 2024 and 2025 growth targets as well as strengthening the foundation that these new facilities will become a part of. As Acadia continues to lead and grow, we are committed to creating and implementing best-in-class IT solutions that will further enhance the delivery of care and support the patients we serve.

我們正在努力實現我們的 24 - 我們的 2024 年和 2025 年增長目標，並加強這些新設施將成為其中一部分的基礎。隨著 Acadia 繼續領先和發展，我們致力於創建和實施一流的 IT 解決方案，這將進一步加強護理的提供並支持我們所服務的患者。

As we discussed at our Investor Day, investments in technology will be a key area of focus for Acadia in 2023 and beyond. We are accelerating investments where we can strengthen our capabilities and lead the industry forward by leveraging technology to increase access to care, improve the delivery of care and ultimately support clinical integration and operational efficiencies.

正如我們在投資者日討論的那樣，技術投資將成為 Acadia 在 2023 年及以後的重點關注領域。我們正在加速投資，通過利用技術增加獲得護理的機會、改善護理的提供並最終支持臨床整合和運營效率，我們可以加強我們的能力並引領行業向前發展。

Initially, the areas where we expect to make short-term investments include enhancing our infrastructure which involves improving all of Acadia's technology capabilities across our network. A top priority is centered around electronic medical records. Today, we have manual paper-based processes across most of the company and the potential for electronic medical records is a significant opportunity for not only Acadia, but also the industry. As we migrate to electronic records, there are significant benefits from both a clinical and financial perspective. We are focused on technology investments across 5 main categories. The first is that we'll be able to better support our medical teams with respect to patient safety and compliance. Second, we believe these investments will enhance the overall patient experience. Third, we expect improvement in employee satisfaction, which will support recruiting and retention.

最初，我們希望進行短期投資的領域包括加強我們的基礎設施，這涉及提高我們網絡中 Acadia 的所有技術能力。首要任務是圍繞電子病歷。今天，我們在公司的大部分地方都有基於紙質的手動流程，電子病歷的潛力不僅對阿卡迪亞而且對整個行業都是一個重要的機會。隨著我們遷移到電子記錄，從臨床和財務角度來看都有很大的好處。我們專注於 5 個主要類別的技術投資。首先是我們將能夠在患者安全和合規性方面更好地支持我們的醫療團隊。其次，我們相信這些投資將提升整體患者體驗。第三，我們期望提高員工滿意度，這將支持招聘和保留。

Fourth, the additional data and analytics capabilities will also help us engage with payers as we are better able to support value-based care and identify operational efficiencies. And finally, we believe these disciplined investments will drive revenue and margin improvement opportunities for the company over time.

第四，額外的數據和分析能力也將幫助我們與付款人互動，因為我們能夠更好地支持基於價值的護理並確定運營效率。最後，我們相信這些有紀律的投資將隨著時間的推移為公司帶來收入和利潤率提高的機會。

As we communicated in December at our Investor Day, we expect to allocate approximately $35 million to $45 million in IT investments in the coming year of which $15 million to $25 million is incremental to our historical investment. We will continue to evaluate the value derived from these investments and believe that over the 4-year period from 2023 to 2026, that we could see a total of $75 million to $125 million in dedicated IT incremental capital expenditures.

正如我們在 12 月的投資者日所傳達的那樣，我們預計在來年分配大約 3500 萬至 4500 萬美元的 IT 投資，其中 1500 萬至 2500 萬美元是我們歷史投資的增量。我們將繼續評估從這些投資中獲得的價值，並相信在 2023 年至 2026 年的 4 年期間，我們可以看到總計 7500 萬至 1.25 億美元的專用 IT 增量資本支出。

We are highly encouraged by the value that this will provide for Acadia as we lead the industry forward in leveraging technology to improve the delivery of care. As we also noted in December, we had planned to add key leadership for this important initiative. And we're pleased to add that Laura Groschen joined Acadia as the company's new Chief Information Officer in early January. Laura joins Acadia with over 25 years of experience driving strategic transformation at large health care and consumer-focused IT organizations. She most recently served as the business unit CIO of Medtronic, the $30 billion global health care solutions company, where she led a team supporting information and technology for 20 operating units in global business functions across Medtronic's locations in 150 countries.

我們對這將為 Acadia 提供的價值感到非常鼓舞，因為我們在利用技術改善醫療服務方面引領行業向前發展。正如我們在 12 月也指出的那樣，我們計劃為這一重要舉措增加關鍵領導。我們很高興地補充說，Laura Groschen 於 1 月初加入 Acadia，擔任公司新任首席信息官。勞拉 (Laura) 加入阿卡迪亞 (Acadia)，擁有超過 25 年在大型醫療保健和以消費者為中心的 IT 組織推動戰略轉型的經驗。最近，她擔任市值 300 億美元的全球醫療保健解決方案公司美敦力 (Medtronic) 的業務部門首席信息官，領導一個團隊為美敦力 (Medtronic) 在 150 個國家/地區的全球業務職能部門的 20 個運營部門提供信息和技術支持。

As Acadia CIO, Laura will shape and advance our IT strategy as an integral part of our digital transformation and she will drive continued digital transformation across Acadia's scaled behavioral health capabilities. I also want to reinforce our commitment to quality across our operations. As we continue to extend our market reach, safe and quality care remains the top priority for the patients who seek our help I'm pleased to announce that we recently added Dr. Navdeep Kang to our management team as our new Chief Quality Officer for inpatient services.

作為 Acadia 的首席信息官，Laura 將塑造和推進我們的 IT 戰略，作為我們數字化轉型的一個組成部分，她將推動 Acadia 規模化的行為健康能力的持續數字化轉型。我還想加強我們對整個運營質量的承諾。隨著我們繼續擴大我們的市場範圍，安全和優質的護理仍然是尋求我們幫助的患者的首要任務服務。

In this role, Nav will work closely with our Chief Medical Officer, Dr. Mike Genovese and will be responsible for ensuring patient safety and superior quality of care by improving delivery of clinical services in our inpatient facilities. Nav will lead our initiative to provide a robust proactive culture of quality and excellence supported by processes and systems designed to prevent any issue and when necessary, quickly respond to any adverse events. Nav is a clinical psychologist and brings extensive experience in addiction treatment and behavioral health.

在此職位上，Nav 將與我們的首席醫療官 Mike Genovese 博士密切合作，並將負責通過改善我們住院設施的臨床服務交付來確保患者安全和優質的護理。 Nav 將領導我們的倡議，以提供強大的積極主動的質量和卓越文化，並由旨在防止任何問題並在必要時快速響應任何不良事件的流程和系統提供支持。 Nav 是一名臨床心理學家，在成癮治療和行為健康方面擁有豐富的經驗。

So as we look to the year ahead, we remain focused on increasing our pace of growth and capitalizing on expansion across our service lines. At the same time, we'll look for ways to improve upon the delivery of care we provide and strengthen our capabilities with the right technology investments in differentiated services that drive improved clinical outcomes.

因此，展望未來一年，我們將繼續專注於加快增長步伐並利用我們服務線的擴張。與此同時，我們將尋找方法來改進我們提供的護理服務，並通過對差異化服務的正確技術投資來加強我們的能力，從而推動改善臨床結果。

Across our network of 250 facilities, we have a shared mission to provide high-quality behavioral health care services and we look forward to the opportunities ahead for Acadia in 2023 and beyond. At this time, I will now turn the call over to David Duckworth to discuss our financial results for the quarter and 2023 guidance.

在我們由 250 個設施組成的網絡中，我們的共同使命是提供高質量的行為保健服務，我們期待著阿卡迪亞在 2023 年及以後的機遇。此時，我將把電話轉給大衛達克沃斯，討論我們本季度的財務業績和 2023 年的指導意見。

Thanks, Chris, and good morning. Looking at the fourth quarter, we delivered strong financial and operating results as we successfully delivered on our key performance metrics, demonstrating consistent execution of our strategy.

謝謝，克里斯，早上好。展望第四季度，我們成功實現了關鍵績效指標，取得了強勁的財務和運營業績，證明了我們戰略的一貫執行。

Revenue for the fourth quarter of 2022 increased 13.8% to $675.3 million compared with $593.5 million for the fourth quarter of 2021. Our revenue growth includes an increase in same facility revenue of 9.4%. For the fourth quarter, our adjusted EBITDA was $150.9 million and adjusted income attributable to Acadia stockholders per diluted share was $0.74, which includes income of $5.2 million related to the provider relief fund also related to the American rescue plan payments.

2022 年第四季度的收入增長 13.8% 至 6.753 億美元，而 2021 年第四季度為 5.935 億美元。我們的收入增長包括同一設施收入增長 9.4%。第四季度，我們調整後的 EBITDA 為 1.509 億美元，調整後歸屬於 Acadia 股東的每股攤薄收益為 0.74 美元，其中包括與供應商救濟基金相關的 520 萬美元收入，也與美國救援計劃付款有關。

Adjusted -- adjustments to income for the fourth quarter of 2022 include transaction-related expenses and the related income tax effect. The company also recorded an unfavorable adjustment of $5.9 million or $0.05 per diluted share to its self-insured professional and general liability reserves relating to the settlement or expected settlement of certain prior year claims relating primarily to the 2017 to 2018 period.

調整後——2022 年第四季度收入調整包括交易相關費用和相關所得稅影響。該公司還對其自保專業和一般責任準備金進行了 590 萬美元或稀釋後每股 0.05 美元的不利調整，這些準備金與主要與 2017 年至 2018 年期間相關的某些上年度索賠的結算或預期結算有關。

The estimated accrual for professional and general liabilities is based on historical claims, prior settlements and judgments and other factors and actuarial assumptions. While we could see volatility in this reserve due to our self-insured retention level of $5 million, we view this fourth quarter adjustment as a nonrecurring item relating to unique facts and circumstances for certain claims in that 2017 to 2018 period.

專業和一般負債的估計應計費用是基於歷史索賠、先前的結算和判斷以及其他因素和精算假設。雖然由於我們的自保保留水平為 500 萬美元，我們可能會看到該準備金的波動，但我們將第四季度的調整視為與 2017 年至 2018 年期間某些索賠的獨特事實和情況相關的非經常性項目。

From a cost management perspective, we were pleased with our execution throughout 2022. While we saw higher wage inflation in 2022, including approximately 8% base wage inflation for the fourth quarter, we believe it's important to remain proactive in our pay and our volume and reimbursement growth have remained strong. While base wage inflation is expected to remain higher in the 7% to 8% range in the first half of 2023, we are seeing positive recent hiring trends and we also saw an 8% sequential reduction in premium pay from the third quarter to the fourth quarter of 2022.

從成本管理的角度來看，我們對整個 2022 年的執行情況感到滿意。雖然我們看到 2022 年的工資通脹率更高，包括第四季度基本工資通脹率約為 8%，但我們認為在我們的薪酬和數量上保持積極主動很重要報銷增長保持強勁。雖然預計 2023 年上半年基本工資通脹率將保持在 7% 至 8% 的較高水平，但我們看到近期的積極招聘趨勢，我們還看到第三季度至第四季度的保費連續下降 8% 2022 年季度。

Maintaining a strong financial position will remain a top priority for 2023, providing us the flexibility and capital to support our growth strategy and future investments. As of December 31, 2022, the company had $97.6 million in cash and cash equivalents and $525 million available under its $600 million revolving credit facility with a net leverage ratio of approximately 2.1x.

保持穩健的財務狀況仍將是 2023 年的首要任務，為我們提供靈活性和資本來支持我們的增長戰略和未來投資。截至 2022 年 12 月 31 日，該公司擁有 9760 萬美元的現金和現金等價物，其 6 億美元的循環信貸額度下有 5.25 億美元可用，淨槓桿率約為 2.1 倍。

During the fourth quarter, the company completed its repayment of amounts received pursuant to the Medicare Accelerated and Advanced Payment Program under the CARES Act. Of the $45.2 million of advanced payments received in 2020, the company repaid a total of $25.1 million in 2021 and paid the remaining $20.1 million in 2022, including $1.2 million in the fourth quarter of 2022.

在第四季度，公司根據 CARES 法案完成了根據 Medicare 加速和預付款計劃收到的款項的償還。在 2020 年收到的 4520 萬美元預付款中，公司在 2021 年共償還了 2510 萬美元，並在 2022 年支付了剩餘的 2010 萬美元，其中包括 2022 年第四季度支付的 120 萬美元。

Moving on to our guidance. As noted in our press release, we narrowed our previously issued guidance for 2023 as follows: revenue in a range of $2.82 billion to $2.88 billion, adjusted EBITDA in a range of $635 million to $675 million, adjusted earnings per diluted share in a range of $3.10 to $3.40, interest expense in a range of $80 million to $85 million, a tax rate in the range of 25% to 26%, depreciation and amortization expense in a range of $125 million to $135 million, stock compensation expense in a range of $30 million to $35 million, operating cash flow in a range of $450 million to $500 million, expansion capital expenditures in a range of $350 million to $400 million, maintenance capital expenditures in a range of $40 million to $50 million and IT capital expenditures in a range of $35 million to $45 million.

繼續我們的指導。正如我們的新聞稿所述，我們將之前發布的 2023 年指引縮小如下：收入在 28.2 億美元至 28.8 億美元之間，調整後的 EBITDA 在 6.35 億美元至 6.75 億美元之間，調整後的攤薄後每股收益在3.10 至 3.40 美元，利息支出在 8000 萬至 8500 萬美元之間，稅率在 25% 至 26% 之間，折舊和攤銷費用在 1.25 億美元至 1.35 億美元之間，股票補償費用在3000 萬到 3500 萬美元，運營現金流在 4.5 億到 5 億美元之間，擴張資本支出在 3.5 億到 4 億美元之間，維護資本支出在 4000 萬到 5000 萬美元之間，IT 資本支出在範圍在 3500 萬美元到 4500 萬美元之間。

We also established financial guidance for the first quarter of 2023, including revenue in a range of $690 million to $700 million, adjusted EBITDA in a range of $145 million to $150 million and adjusted earnings per diluted share in a range of $0.70 to $0.74. The company's guidance does not include the impact of any future acquisitions, divestitures, transaction-related expenses or the recognition of any additional provider relief fund income. With that, Joe, we are ready to open the call for questions.

我們還制定了 2023 年第一季度的財務指引，包括 6.9 億美元至 7 億美元的收入、1.45 億美元至 1.5 億美元的調整後 EBITDA 以及 0.70 美元至 0.74 美元的調整後每股攤薄收益。公司的指引不包括任何未來收購、資產剝離、交易相關費用或確認任何額外供應商救濟基金收入的影響。有了這個，喬，我們準備好開始提問了。

(Operator Instructions) And our first question will come from A.J. Rice with Credit Suisse.

（操作員說明）我們的第一個問題將來自 A.J.瑞士信貸的大米。

I know -- at the Investor Day and then in your comments today, you've talked about a little bit about the potential acquisition pipeline that's out there for you. I wondered if you'd expand a little more on what you're seeing. It seems like there's a lot of JV and potential acquisition opportunities coming out of pandemic. Is that still there? And then is there any opportunity you think this year, as you look out for larger deals, are there any of those potentially out there?

我知道——在投資者日，然後在你今天的評論中，你已經談到了一些關於你的潛在收購渠道的問題。我想知道你是否會進一步擴展你所看到的內容。大流行病似乎帶來了很多合資企業和潛在的收購機會。那還在嗎？然後你認為今年有沒有機會，當你尋找更大的交易時，有沒有可能存在的機會？

Yes. Thanks, A.J. This is Chris, and I'll start. We continue to feel very optimistic about the M&A pipeline, which is clearly one of our important growth levers for 2023. I would say that we have done extensive work in looking at the underbedded markets and really targeting the MSAs where we believe we have the most upside potential over time.

是的。謝謝，A.J.我是克里斯，我要開始了。我們繼續對併購管道感到非常樂觀，這顯然是我們 2023 年的重要增長槓桿之一。我想說的是，我們在研究基礎市場方面做了大量工作，並真正瞄準了我們認為我們擁有最多的 MSA隨著時間的推移，上升潛力。

So we have -- we're always looking to find ways to optimally deploy capital, whether that is doing more JVs, doing de novos, clearly looking at M&A. And right now, we feel very good about the pipeline that we have on the M&A front. And I feel also that we have some confidence that valuations are slightly softening as we're heading here into the new year.

所以我們 - 我們一直在尋找優化資本配置的方法，無論是做更多的合資企業，從頭開始，還是清楚地關注併購。現在，我們對併購方面的渠道感到非常滿意。而且我還覺得，隨著我們進入新的一年，我們對估值略有走軟有信心。

I would say to your question on the JV front, we also feel very strong about the pipeline there. Our existing JV announcements are expected to take us from our current acute states of 21 plus Puerto Rico into 3 additional states: Colorado, Minnesota and North Carolina. And then the pipeline of near-term deals on the JV front are expected to take us into 2 additional states. And I think really just strengthen our geographic footprint overall. So we feel very good about the pipeline that's building in these MSAs on the JV front, certainly with de novos and definitely with M&A as well.

我會說你在合資方面的問題，我們也對那裡的管道感到非常強烈。我們現有的合資公司公告預計將使我們從目前的 21 個緊急狀態加上波多黎各進入另外 3 個狀態：科羅拉多州、明尼蘇達州和北卡羅來納州。然後，合資企業方面的近期交易管道預計會將我們帶入另外兩個州。而且我認為真的只是加強了我們的整體地理足跡。因此，我們對在 JV 方面的這些 MSA 中構建的管道感到非常滿意，當然是從頭開始，當然也包括併購。

Okay. Great. And maybe my follow-up. Obviously, the 9.4% revenue increase is a robust number. I wonder if you could give us a little flavor for -- across the individual segments. Was that a consistent rate of growth? Or was there much variation across your key business loans?

好的。偉大的。也許我的後續行動。顯然，9.4% 的收入增長是一個強勁的數字。我想知道你是否可以給我們一些關於各個細分市場的味道。這是一個穩定的增長率嗎？還是您的主要商業貸款之間存在很大差異？

Yes, A.J., we were pleased with the same-facility revenue performance in the quarter, which included another strong quarter of revenue per day growth and our strongest quarter of the year from a volume perspective. And as we look at that by service line, we saw incredibly strong performance, demand, volume, pricing, really across all of the service lines, but we would highlight acute specialty and the CTC business all saw a very strong quarter. RTC also performed well, very stable. Of course, there are fewer investments going into that service line, but the facilities we have had a very good 2022 and fourth quarter, but acute specialty and CTC really led the charge in terms of revenue growth for the quarter.

是的，A.J.，我們對本季度同一設施的收入表現感到滿意，其中包括另一個強勁的每日收入增長季度，以及從數量角度來看，我們今年最強勁的季度。當我們按服務線來看時，我們看到所有服務線的表現、需求、數量、定價都非常強勁，但我們要強調急性專業和 CTC 業務都看到了非常強勁的季度。 RTC也表現不錯，很穩定。當然，進入該服務線的投資較少，但我們在 2022 年和第四季度的設施非常好，但 acute specialty 和 CTC 在本季度的收入增長方面確實領先。

And I would just add for '23, we really continue to expect strong patient day growth of 4% to 6% for the year. And I would say that the volume is supported by 3 things. The first is just our strong demand that continues. The second would be the important capacity additions that we've seen and that we just discussed in the second half of '22 that will continue into early '23. And then the third is just the improved performance that we're starting to see from optimizing our marketing and admissions processes. So it's early in the year. But so far into the quarter, we're seeing record census and patient day growth that we really think at the higher end of the 4% to 6% that we're projecting for the year.

我只想補充說，對於 23 年，我們確實繼續預計今年患者日增長率將強勁增長 4% 至 6%。我會說音量由 3 個東西支持。首先是我們持續的強勁需求。第二個是我們已經看到的重要容量增加，我們剛剛在 22 年下半年討論過，這將持續到 23 年初。然後第三個就是我們開始從優化營銷和招生流程中看到的改進性能。所以今年年初。但到目前為止，進入本季度，我們看到創紀錄的人口普查和患者日增長，我們真的認為在我們今年預測的 4% 到 6% 的較高端。

And our next question will come from Whit Mayo with SVB Securities.

我們的下一個問題將來自 SVB 證券公司的 Whit Mayo。

Maybe for David or actually more for Chris. When you guys look at the capital that you're deploying, have you changed at all or refined how you measure returns on capital? I'm just wondering how the returns have changed on these deals and what your minimum hurdle rates are today? And it might just be more helpful to frame from like a cohort perspective how capital returns are tracking?

也許是為了大衛，或者實際上更多是為了克里斯。當你們審視你們正在部署的資本時，你們有沒有改變或完善你們衡量資本回報率的方式？我只是想知道這些交易的回報如何變化，以及你們今天的最低門檻是多少？從同類群組的角度來構建資本回報如何追踪可能會更有幫助？

We always refine how we think about allocating capital across our growth pathways, across our service lines and haven't necessarily changed how we think about our targets. Certainly, like a lot of companies would say our weighted average cost of capital and the cost of debt has increased slightly. But from our perspective, we've always built in kind of a higher threshold that we target in our transactions, such that we haven't had to significantly change how we think about that capital allocation. We continue to think that our existing facility expansions are our most attractive opportunity.

我們總是改進我們對在我們的增長路徑、我們的服務線中分配資本的思考方式，並且不一定改變我們對目標的思考方式。當然，就像很多公司會說的那樣，我們的加權平均資本成本和債務成本略有增加。但從我們的角度來看，我們總是在交易中設定一個更高的門檻，這樣我們就不必顯著改變我們對資本配置的看法。我們仍然認為我們現有的設施擴建是我們最具吸引力的機會。

And then as we think about de novos and as we think about joint ventures and even M&A opportunities, we have a deal-specific analysis that we look at. But across those growth pathways, we're still seeing good opportunities that exceed the hurdles that we have in place across a number of different metrics. IRR. We look at ROIC. We look at our EBITDA multiple, not only at the time that we make an investment. But over the course of the investment as we hope to grow earnings, whether that's an M&A deal or a de novo or a joint venture facility. So no major changes, of course, as we projected out in December. There are many joint venture projects that we think will be tremendous for the company that we're working hard to bring online and bring good EBITDA growth for the company at strong returns. But we think all pathways will have activity that is going to be attractive.

然後當我們考慮從頭開始，當我們考慮合資企業甚至併購機會時，我們會進行特定交易的分析。但在這些增長路徑中，我們仍然看到了超越我們在許多不同指標上設置的障礙的好機會。內部收益率。我們看看 ROIC。我們不僅在進行投資時查看 EBITDA 倍數。但在我們希望增加收益的投資過程中，無論是併購交易還是從頭開始還是合資企業。因此，當然，正如我們在 12 月預測的那樣，沒有重大變化。我們認為有許多合資項目對我們正在努力實現的公司來說將是巨大的，並以強勁的回報為公司帶來良好的 EBITDA 增長。但我們認為所有途徑都會有具有吸引力的活動。

We get the question a lot around redeterminations. And I presume that most of your Medicaid is in the adolescent population and many of those that would lose traditional Medicaid coverage may just flip into chip. It might just be helpful to hear some of the work that you guys have done internally and how you might be thinking about how that plays out over the course of 2023.

我們經常遇到關於重新確定的問題。而且我認為您的大部分醫療補助都在青少年人群中，而許多將失去傳統醫療補助覆蓋範圍的人可能會陷入困境。聽聽你們在內部所做的一些工作，以及你們如何考慮這些工作在 2023 年的表現可能會有所幫助。

Yes, Whit, we've been focused on this topic as it's certainly been out there and now is, I guess, closer to being implemented across the different states than it was as we thought about the potential of it happening over the course of last year. But we've had a lot of time to plan. As we've talked about previously, we really view mental health coverage as essential and think that many states and payers would intend to continue to provide coverage. But of course, we want to help all of our Medicaid patients navigate what that means for them, whether it's an administrative process that they go through to reenroll in their Medicaid plans or find some other product.

是的，惠特，我們一直專注於這個話題，因為它肯定已經存在了，我猜，現在比我們考慮它在上一個過程中發生的可能性更接近於在不同的州實施年。但是我們有很多時間來計劃。正如我們之前所說，我們確實認為心理健康保險是必不可少的，並且認為許多州和付款人會打算繼續提供保險。但是，當然，我們希望幫助我們所有的醫療補助患者了解這對他們意味著什麼，無論是他們重新註冊他們的醫療補助計劃還是尋找其他產品所經歷的行政程序。

Our focus has been on educating our patients our facilities, our operations leaders, our revenue cycle leaders have done a tremendous job, just planning for that and communicating what to expect as we move into the second quarter. We'll continue to monitor the potential impact. Of course, there are patient populations, as you mentioned, the child and adolescent population that I think is less likely to have a disruption and will have a longer period of time where they can stay enrolled in Medicaid. But we want to help all of our patients just navigate what it means for their coverage through the year, and the team has done a nice job preparing.

我們的重點一直是教育我們的患者、我們的設施、我們的運營領導者、我們的收入周期領導者已經做了巨大的工作，只是為此做計劃並傳達我們進入第二季度時的預期。我們將繼續監測潛在影響。當然，正如您提到的那樣，有一些患者群體，我認為兒童和青少年群體不太可能受到干擾，並且他們可以在更長的時間內繼續參加醫療補助計劃。但我們希望幫助我們所有的患者了解這對他們全年的保險意味著什麼，並且團隊已經做了很好的準備工作。

Our next question will come from Kevin Fischbeck with Bank of America.

我們的下一個問題將來自美國銀行的 Kevin Fischbeck。

I just wanted to follow up on some of your labor comments because I think last quarter, you had talked about kind of 5% to 7% wage growth and it seems a little bit optimistic that you see some moderation in that number over time back to the 3% to 4% number. So I just want to get a little more color on kind of why it was so much higher in Q4 when most of the companies seem to be saying that they're seeing some progress on labor.

我只是想跟進你的一些勞工評論，因為我認為上個季度，你談到了 5% 到 7% 的工資增長，而且隨著時間的推移你看到這個數字有所放緩似乎有點樂觀3% 到 4% 的數字。因此，當大多數公司似乎都在說他們在勞動力方面取得了一些進展時，我只想了解一下為什麼在第四季度它會高得多。

Yes, Kevin, we did see 5% to 7% over the first 3 quarters of the year. The third quarter was around that 7% level. The fourth quarter, as we isolate just base wage inflation. We were around 8%, which we view as pretty similar to the 7% that we saw in the third quarter. We do want to remain proactive with our pay. So we're seeing an improved environment as we look at just our recruiting metrics as we look at our net new hires which improved throughout the fourth quarter and in January and the weekly data that we have for February. And so we're seeing some positive signs of improvement. We do have for the company our annual merit increase process that happens either in January for 2/3 of the company or in April for the other 1/3 of the company. And we want to remain committed to that and stay in the right place from a pay perspective across our markets.

是的，凱文，今年前三個季度我們確實看到了 5% 到 7%。第三季度大約是 7% 的水平。第四季度，我們只隔離基本工資通脹。我們大約是 8%，我們認為這與我們在第三季度看到的 7% 非常相似。我們確實希望在薪酬方面保持積極主動。因此，當我們查看整個第四季度和 1 月份的淨新員工人數以及我們 2 月份的每週數據時，我們看到了一個改善的環境，因為我們只查看我們的招聘指標。因此，我們看到了一些積極的改善跡象。我們確實為公司製定了年度加薪流程，該流程要么在 1 月對公司 2/3 的員工進行，要么在 4 月對公司其他 1/3 的員工進行。我們希望繼續致力於這一點，並從我們市場的薪酬角度來看保持在正確的位置。

So we have moved forward with that. And partially because of that, expect wage inflation to stay in that 7% to 8% range through the first half of this year. But with some of those positive metrics that we're seeing with the improvement that we mentioned in premium pay that we saw in the fourth quarter, we're seeing some positive signs. And I think as we look out at the second half of the year, we would see wage inflation and our outlook reflects wage inflation, dropping back down below the 5% level. We'll ultimately see if it returns to more of the 3% to 4% that the company saw for a number of years, and the industry saw for a number of years. But for now, second half of the year, we think we would moderate at that point to less than 5% on a base wage inflation. And then premium pay, we think, continues to improve throughout the year.

所以我們已經向前推進了。部分原因在於，預計今年上半年工資通脹將保持在 7% 至 8% 的範圍內。但是，隨著我們在第四季度看到的保費薪酬中提到的改善，我們看到了一些積極的指標，我們看到了一些積極的跡象。而且我認為，當我們展望下半年時，我們會看到工資通脹，我們的前景反映了工資通脹，回落至 5% 水平以下。我們最終會看到它是否會回到公司多年來看到的 3% 到 4% 的水平，以及行業多年來看到的水平。但就目前而言，即今年下半年，我們認為屆時我們會根據基本工資通脹率將通脹率降至 5% 以下。然後，我們認為，保費收入將在全年繼續提高。

Okay. I think last quarter, you kind of broke out some of the labor pressure from things like Center Point. Is there anything like that kind of skewing the metrics at all from ramp-up of newly opened facilities? And I guess has labor sourcing had all been a headwind to volume growth? Are you having a hard time staffing? Or is it just you can staff you just have to pay up for it?

好的。我認為上個季度，你有點像 Center Point 這樣的事情爆發了一些勞動力壓力。是否有任何類似的東西會從新開設的設施的升級中完全扭曲指標？我想勞動力外包一直是銷量增長的阻力嗎？您在招聘員工時遇到困難嗎？還是只是您可以僱用您只需要為此付出代價的員工？

I appreciate the question on the metrics. We would say, as you look at our labor metrics, including salaries, wages and benefits as a percentage of revenue, we did have a $4 million pickup that we recorded and highlighted in the fourth quarter of last year relating to the direct payment program in the state of Florida. And so that did lower our SWB metric by 30 basis points. And then, of course, depending on what metric you're looking at here in the fourth quarter of this year, if it's margin, it's impacted by the reserve adjustment that we highlighted. So we do have some adjustments that need to be made as you think about the year-over-year metrics given that. And within that, we would say our same facility group is performing very well. It's stable year-over-year and is seeing margin improvement year-over-year.

我很欣賞關於指標的問題。我們會說，當您查看我們的勞動力指標時，包括薪水、工資和福利佔收入的百分比，我們確實有 400 萬美元的回升，我們在去年第四季度記錄並強調了與直接支付計劃相關的佛羅里達州。因此，這確實將我們的 SWB 指標降低了 30 個基點。然後，當然，取決於你在今年第四季度在這裡看到的指標，如果是保證金，它會受到我們強調的準備金調整的影響。因此，鑑於此，當您考慮同比指標時，我們確實需要進行一些調整。其中，我們會說我們的同一個設施組表現非常好。它同比穩定，並且利潤率同比有所改善。

But there are 3 new facilities that we've opened in the second half of 2022. That do carry a much higher labor load as their volume and revenue ramps. So that did have an impact on both the SWB metric as well as our margin. CenterPoint perform well in the fourth quarter. We saw that just the team overseeing their integration, do a fantastic job throughout the year, bringing improvements to the performance of that acquisition. But it did also have an impact on our margin as -- from the acquired date and even in the fourth quarter, that business has a lower margin than the company average. So there's a few items like that, that did impact our labor metrics and some investments we've made at the corporate level which are having a positive impact on the company as we move into 2023 also are reflected in that SWB and in the margin.

但是我們在 2022 年下半年開設了 3 個新設施。隨著數量和收入的增加，這些設施確實帶來了更高的勞動力負擔。因此，這確實對 SWB 指標和我們的利潤產生了影響。 CenterPoint 在第四季度表現良好。我們看到，只有監督他們整合的團隊在全年都做得非常出色，從而改善了收購的績效。但它確實也對我們的利潤率產生了影響——從收購之日起，甚至在第四季度，該業務的利潤率都低於公司平均水平。所以有一些這樣的項目確實影響了我們的勞動力指標，我們在公司層面進行的一些投資在我們進入 2023 年時對公司產生了積極影響，這也反映在 SWB 和利潤率中。

Our next question will come from Andrew Mok with UBS.

我們的下一個問題將來自瑞銀集團的 Andrew Mok。

Chris, you mentioned some new investments and facility openings in your prepared remarks, but it wasn't entirely clear to me what changed versus the previous outlook. Can you help us better understand what specifically is driving the higher revenue outlook for 2023? And why that's causing a narrowing of the EBITDA range at this stage?

克里斯，你在準備好的發言中提到了一些新的投資和設施開放，但我並不完全清楚與之前的展望相比有什麼變化。您能否幫助我們更好地了解是什麼具體推動了 2023 年更高的收入前景？為什麼這會導致現階段 EBITDA 範圍縮小？

So Andrew, just to clarify, you're looking for more detail on the IT investments?

那麼安德魯，我想澄清一下，你正在尋找有關 IT 投資的更多細節嗎？

Just the 2023 revenue outlook versus the previous outlook you gave at the Investor Day. And why that's causing a narrowing of the EBITDA range at this stage?

僅將 2023 年收入前景與您在投資者日給出的先前前景進行對比。為什麼這會導致現階段 EBITDA 範圍縮小？

Yes. I mean, Andrew, we, of course, did provide initial guidance -- and this is David. We have provided initial guidance in December earlier than the company typically provides our guidance. And we did, as we updated that guidance in February, really viewed [de novo] range as a tightening of what we provided in December. I'll say since December, as we've gone through and finalized our budgeting process, as we've also seen trends through the fourth quarter and the start that we've had to Q1, we did increase our revenue outlook. And the key driver of that is that we see our volume accelerating. We talked about the 4% same facility volume growth for the fourth quarter now accelerating for 2023 to a range of 4% to 6%. And we are starting Q1 at the high end of that 4% to 6% range. So we're really pleased with the volume outlook, and it is slightly stronger than what we had projected in December, given some of those strong trends to start the year.

是的。我的意思是，安德魯，我們當然提供了初步指導——這位是大衛。我們在 12 月提供了初步指導，早於公司通常提供我們的指導。當我們在 2 月份更新該指南時，我們確實將 [de novo] 範圍視為我們在 12 月份提供的範圍的收緊。我要說的是，自去年 12 月以來，我們已經完成並完成了預算編制過程，因為我們也看到了第四季度的趨勢以及我們必須從第一季度開始的趨勢，我們確實提高了收入預期。而其中的關鍵驅動因素是我們看到我們的交易量在加速增長。我們談到了第四季度 4% 的相同設施數量增長，現在到 2023 年將加速到 4% 到 6% 的範圍。我們在 4% 到 6% 範圍的高端開始第一季度。因此，我們對銷量前景非常滿意，考慮到年初的一些強勁趨勢，它比我們 12 月份的預測略強。

The EBITDA outlook we do believe that, that incremental volume drives incremental EBITDA as well. But our view is for now, given it's early in the year, we just tightened our EBITDA range but kept the midpoint where it was. And of course, things like wage inflation, have also been factored in just the updated view around that compared to projections that we had in December. Hopefully, that helps.

我們確實相信 EBITDA 前景，增加的數量也會推動增加的 EBITDA。但我們的觀點是，鑑於現在是今年年初，我們只是收緊了 EBITDA 範圍，但將中點保持在原來的水平。當然，與我們 12 月份的預測相比，工資通脹等因素也已被納入最新的觀點。希望這會有所幫助。

Got it. That's helpful. And then on the CapEx, I think it's been about 2 years in a row now where you've cut the growth CapEx about $85 million lower versus initial expectations with the step-up in growth CapEx (inaudible) this year. What's your confidence level in getting that completed this year?

知道了。這很有幫助。然後在資本支出方面，我認為現在已經連續 2 年了，隨著今年增長資本支出（聽不清）的增加，你已經將增長資本支出削減了大約 8500 萬美元，低於最初的預期。您對今年完成這項工作的信心如何？

Well, it's a good question because as we talked about throughout 2022, we have been looking forward to breaking ground across all of those new facilities that we've had in the pipeline just ready to start construction and work towards the opening of those new joint ventures and other facilities and didn't have as much visibility a year ago, as we talked about our CapEx guidance as we feel like we have today. There are a number of projects that have now broken ground. And at that point, we do have higher visibility and have a higher confidence level. And so we're expecting for that step-up to occur, and that's reflected in our guidance. And we'll continue to provide an update as to the timing of those projects.

好吧，這是一個很好的問題，因為正如我們在整個 2022 年所討論的那樣，我們一直期待著在我們準備中的所有這些新設施上破土動工，這些設施正準備開始建設，並致力於這些新聯合的開放風險投資和其他設施，並且在一年前沒有那麼多的知名度，因為我們談到了我們今天所擁有的資本支出指南。現在有許多項目已經破土動工。在這一點上，我們確實有更高的知名度和更高的信心水平。因此，我們期待這種升級發生，這反映在我們的指導中。我們將繼續提供有關這些項目時間安排的最新信息。

But we're glad to be at this moment where we feel like we have higher visibility because the opportunity we have to get those facilities open and bring them into the company, we think, is a key driver for our results 2, 3 years from now. So I'm not going to give you a percentage confidence level, but we do have much higher visibility today given that we've broken ground across many of those projects.

但我們很高興此刻我們覺得我們有更高的知名度，因為我們必須開放這些設施並將它們帶入公司的機會，我們認為，這是我們在 2、3 年後取得成果的關鍵驅動力現在。所以我不會給你一個百分比的信心水平，但我們今天確實有更高的知名度，因為我們已經在許多這些項目中破土動工。

Our next question will come from Gary Taylor with Cowen.

我們的下一個問題將來自 Gary Taylor 和 Cowen。

I had a question. I noticed in the release and you talked about this at Investor Day a little bit about the opportunity to add the intense outpatient programs at some of your IPF. So the question was how many of your IPF have all 3 also include partial hospitalization and the intense outpatient programs? And is there a way to sort of size the remaining revenue opportunity either per facility or just for the total company to build out those step-down programs across all the acute hospitals.

我有一個問題。我在新聞稿中註意到，您在投資者日談到了在您的一些 IPF 中增加密集門診計劃的機會。所以問題是您的 IPF 中有多少同時包含部分住院和密集門診計劃？有沒有一種方法可以對每個設施或整個公司的剩餘收入機會進行排序，以便在所有急症醫院建立這些降壓計劃。

Yes. Thanks, Gary, for the question. This is Chris. So I would say a majority of our acute facilities certainly have the opportunity for step-down programs, and that's something we haven't disclosed the exact number. Clearly, that is a focus of our clinical team led by our Chief Medical Officer, Mike Genovese, as we're trying to continue to -- we've added, obviously, that fifth growth pathway around PHP and IOP also looking to enhance the cross-referral opportunity within the company as well. But David, anything you would want to add on step-down programs?

是的。謝謝，加里，這個問題。這是克里斯。所以我想說我們的大多數急症設施肯定有機會進行降壓計劃，但我們還沒有透露確切的數字。顯然，這是由我們的首席醫療官 Mike Genovese 領導的臨床團隊的重點，因為我們正在努力繼續 - 顯然，我們已經添加了圍繞 PHP 和 IOP 的第五種增長途徑也希望增強公司內部的交叉推薦機會。但是大衛，你想在降壓計劃中添加什麼？

No. We have seen a number of new programs opened over the years. And our team has done a nice job really looking at where our patients are coming from, where we might be deflecting patients based on the level of care that's appropriate for them and where they might be stepping down and really using that to open new programs. And it also informs our de novo strategy just as we think about where we might have a service gap. So happy to bring on a number of new programs at our existing facilities, but it's also really being informed and useful as we think about the de novo growth and other opportunities where the company might need to add capacity.

沒有。多年來我們已經看到了許多新項目的開設。我們的團隊做得很好，真正了解了我們的患者來自哪裡，我們可能會根據適合他們的護理水平來轉移患者，以及他們可能會在哪些地方辭職並真正利用它來開設新項目。當我們考慮可能存在服務差距的地方時，它還會為我們的從頭戰略提供信息。很高興在我們現有的設施上開展一些新項目，但在我們考慮從頭增長和公司可能需要增加產能的其他機會時，它也確實得到了信息和幫助。

Could I just do a quick follow? Could you give us a sense of you have an IPF that doesn't have those 2 step-down programs. You have an IPF that has kind of mature step-down programs is the revenue differential? Is it 10% higher, 20% higher? Can you give us any sort of sense on what those step-down programs add to the facility profile?

我可以快速跟進嗎？您能否告訴我們您的 IPF 沒有這 2 個降壓程序？您的 IPF 具有某種成熟的降壓計劃，收入差異是什麼？是高出 10%，還是高出 20%？您能否就這些降壓計劃添加到設施概況中給我們任何意義？

We would probably be ballparking it right now. But I think that 10% range is probably about right, depending on the size of their program. In some cases, the facility could have a strong program that's not only stepped down. It's also capturing other patients in that market that may just need a different level of care. So it does vary by facility, but 10% may be the right estimate.

我們現在可能會把它放在一邊。但我認為 10% 的範圍可能是合適的，這取決於他們程序的大小。在某些情況下，該設施可能有一個強大的計劃，不僅會被取消。它還吸引了該市場中可能只需要不同級別護理的其他患者。所以它確實因設施而異，但 10% 可能是正確的估計。

Our next question will come from Pito Chickering with Deutsche Bank.

我們的下一個問題將來自德意志銀行的 Pito Chickering。

You've got Kieran Ryan on here for Pito. I was just wondering if you could maybe break out the SMB impact in 4Q from the onetime reserve adjustment? And then I have a quick follow-up after that.

你已經讓 Kieran Ryan 替 Pito 上場了。我只是想知道您是否可以從一次性準備金調整中分解出第四季度對 SMB 的影響？之後我會進行快速跟進。

Yes. The -- as we think about the SWB impact from the reserve adjustment, where that adjustment went on our P&L was actually in other operating expenses, which is where we have our interest expense. And so just thinking about it more from a margin perspective and other operating expenses that metric as a percentage of revenue for the fourth quarter was 13.9%. And without that reserve adjustment would have been 13.0%. So that's the impact that it had on that line item and had about a 0.9% impact on margin as well.

是的。 - 正如我們考慮準備金調整對 SWB 的影響，我們的 P&L 的調整實際上是在其他運營費用中，這是我們的利息費用。因此，從利潤率的角度更多地考慮它，其他運營費用佔第四季度收入的百分比為 13.9%。如果沒有準備金調整，則為 13.0%。這就是它對該訂單項的影響，對利潤率也有大約 0.9% 的影響。

That's helpful. And then just on the 2023 EBITDA outlook, could you just -- are you able to break out how much of the change there is due to discretionary investments and facility openings versus just the wage pressure, which seems to kind of hold in pretty high there in 4Q in the high single digits?

這很有幫助。然後就 2023 年的 EBITDA 前景而言，您能不能說出有多少變化是由於可自由支配的投資和設施開放而導致的變化，而僅僅是工資壓力，這似乎在那裡保持相當高的水平在 4Q 中高個位數？

Yes. I mean our expectation continues to be for those new facilities, which do carry some startup losses in the near-term but are an important driver of longer-term value creation and earnings growth for the company. But our expectation for 2023 is that those new facilities would still be in the $15 million to $20 million range in terms of where their start-up losses should run. That always depends on just the timing and number of new facilities that we have. But that $15 million to $20 million continues to be our estimate for annual start-up losses of our new facilities.

是的。我的意思是，我們仍然期望這些新設施在短期內確實會帶來一些啟動損失，但它們是公司長期價值創造和盈利增長的重要驅動力。但我們對 2023 年的預期是，這些新設施的啟動虧損仍將在 1500 萬至 2000 萬美元的範圍內。這始終取決於我們擁有的新設施的時間和數量。但這 1500 萬到 2000 萬美元仍然是我們對新設施年度啟動損失的估計。

And our next question will come from John Ransom with Raymond James.

我們的下一個問題將來自 John Ransom 和 Raymond James。

Just a couple on the reimbursement side. I have one and then a follow-up. So if we're looking at apples-to-apples, just pure rate 2023 over 2022, how should we think about just the pure rate updates affecting your revenue per day percentage growth?

報銷方面只有一對夫婦。我有一個，然後是一個跟進。因此，如果我們關注的是 2023 年比 2022 年的同類產品，那麼我們應該如何考慮影響您每天收入百分比增長的純利率更新？

Yes, John, we have a -- I'd say, compared to December, we have a more positive outlook around reimbursement. Of course, we always go in with expectations for rate increases in the mid-single-digit range. It's what we've seen throughout 2022. And based on inflation and other factors, I expect to see that for most of our payers going forward. But I want to remain cautious, just knowing we have a lot of different payers that we contract with. But as we have more recently just thought about what the year looks like from a revenue per day perspective, we are expecting, on average, 3% to 5%, but do feel like in the early part of the year, we have a higher level of visibility that we should sustain growth in the higher end of that range, so closer to that 5%.

是的，約翰，我們有一個 - 我會說，與 12 月相比，我們對報銷有更積極的前景。當然，我們總是對中等個位數範圍內的利率增長抱有期望。這就是我們在整個 2022 年所看到的情況。基於通貨膨脹和其他因素，我希望我們的大多數付款人都能看到這一點。但我想保持謹慎，只知道我們有很多不同的付款人與我們簽約。但正如我們最近剛剛從每天收入的角度考慮今年的情況，我們預計平均為 3% 至 5%，但確實感覺在今年年初，我們有更高的我們應該將增長維持在該範圍的較高端，接近 5%。

The reason for that is a lot of our contracting with Medicaid plans. Over 75% actually of our Medicaid revenue is contracted in the second half of the year, which means as we go through the first part of this year, we can see the rate increases that we received over the second half of the year that carry into the first half of this year. And then the focus is on renegotiating with those payers in advance of next year's contract date. So I do feel like we have higher visibility now. We saw a lot of success across our different facilities, markets and payers throughout 2022 and hope that, that continues in the mid-single-digit range and have visibility, we think that it will, through the first part of the year, a little more caution just built into the second part of the year where we may see it at the lower end, but we'll obviously stay focused on that. I think we still have opportunities just building some caution into our outlook for the later part of the year.

原因是我們與醫療補助計劃簽訂了很多合同。實際上，我們 75% 以上的醫療補助收入是在今年下半年收縮的，這意味著在今年上半年，我們可以看到我們在今年下半年收到的利率增長會延續到今年上半年。然後重點是在明年的合同日期之前與這些付款人重新談判。所以我確實覺得我們現在有更高的知名度。整個 2022 年，我們在不同的設施、市場和付款人中看到了很多成功，並希望繼續保持在中個位數範圍內並具有可見性，我們認為它會在今年上半年有一點今年下半年更加謹慎，我們可能會在低端看到它，但我們顯然會繼續關注這一點。我認為我們仍然有機會對今年下半年的前景保持謹慎。

And John, I would just add that to David's point, we have a very strong corporate managed care team that I think has continued to just build and enhance really good relationships with payers across the board and has for a number of years. We've chosen to invest in that team. And I think that really factors into some of the comments that David made. But we do want to be cautious about how all of this comes together and just the overall impact for the company in total.

約翰，我想補充一下大衛的觀點，我們有一個非常強大的企業管理式醫療團隊，我認為該團隊已經繼續與全面的付款人建立和加強真正良好的關係，並且已經持續了很多年。我們選擇投資於該團隊。我認為這確實影響了 David 發表的一些評論。但我們確實希望對所有這些如何結合在一起以及對公司的整體影響持謹慎態度。

And my follow-up is in theory, as you talk to your commercial and Medicaid partners about value-based kickers, use the baseball analogy, kind of where are you? And then just in theory, what would that look like for behavioral because we're not used to being very common in your world.

我的後續行動是理論上的，當你與你的商業和醫療補助合作夥伴談論基於價值的踢球者時，使用棒球類比，你在哪裡？然後從理論上講，這對於行為來說會是什麼樣子，因為我們不習慣在你們的世界裡很普遍。

Yes. So to use your baseball analogy, John, I would say we're approaching first [space], very early innings here. There -- we want to be in a position strategically, and we are doing so with these IT investments that we're prepared to move at the pace that the industry will move on behavioral health. It's one of the major reasons that we feel so strongly about getting all this infrastructure in place, making sure that we are able to capture data and that we can ultimately compete on the quality of the clinical outcomes that we're achieving relative to our competitors. But I think in terms of value-based programs. It depends on the payer. And we certainly are seeing some interest from payers here in the early stages that they are willing to provide us with some incentives.

是的。所以用你的棒球比喻，約翰，我會說我們正在接近第一個[空間]，這裡是非常早的幾局。在那裡——我們希望在戰略上處於有利地位，我們正在通過這些 IT 投資這樣做，我們準備按照行業在行為健康方面的步伐前進。這是我們強烈希望將所有這些基礎設施部署到位的主要原因之一，以確保我們能夠捕獲數據，並確保我們最終能夠在臨床結果的質量上與我們的競爭對手進行競爭.但我認為是基於價值的計劃。這取決於付款人。我們當然在早期階段看到付款人的一些興趣，他們願意為我們提供一些激勵措施。

Usually, it's around readmissions and successfully preventing readmissions, but there are other factors that will probably be added to that over time. But these contracts right now that we're seeing are just much more upside-only contracts. We are not seeing any contracts or any interest right now in downside risk or certainly any move to full capitation. So that's why I would say we're still approaching first space . And if we accelerate our pace here to second or third, we'll be ready given the investments that we're making, and that's how we want to position ourselves to move at that pace.

通常，它與再入院率和成功預防再入院率有關，但隨著時間的推移，可能還會添加其他因素。但我們現在看到的這些合約只是更多的上行合約。我們目前沒有看到任何合約或任何有下行風險的興趣，當然也沒有任何轉向全額支付的舉措。所以這就是為什麼我會說我們仍在接近第一空間。如果我們在這裡加快我們的步伐到第二或第三，我們將根據我們正在進行的投資做好準備，這就是我們希望以這種速度前進的方式。

So Chris, to be clear, baseball, you're supposed to talk about innings, you know on that basis, but that's okay. I get a second inning then, right?

所以克里斯，說清楚一點，棒球，你應該談論局數，你知道在那個基礎上，但這沒關係。然後我得到第二局，對吧？

Sure. I tried to give you both.

當然。我試著給你們兩個。

This concludes our question-and-answer session. I'd like to turn the conference back over to Chris Hunter for closing remarks.

我們的問答環節到此結束。我想將會議轉回給 Chris Hunter 作閉幕詞。

Well, thank you. Before we end the call, I just want to thank again our committed facility leaders, clinicians and approximately 23,000 dedicated employees across the country who have just continued to work tirelessly to meet the needs of patients in a safe and effective manner. I want to thank you all for being with us this morning and for your interest in Acadia. And if you have any additional questions today, please don't hesitate to contact us directly. Have a great day, everyone.

嗯，謝謝。在我們結束電話會議之前，我只想再次感謝我們敬業的設施領導、臨床醫生和全國約 23,000 名敬業的員工，他們剛剛繼續不懈地工作，以安全有效的方式滿足患者的需求。我要感謝大家今天早上和我們在一起，感謝你們對阿卡迪亞的關注。如果您今天有任何其他問題，請隨時直接與我們聯繫。祝大家有個美好的一天。

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect your lines.

會議現已結束。感謝您參加今天的演講。您現在可以斷開線路。