Acadia Healthcare Company Inc (ACHC) 2024 Q3 法說會逐字稿

Good day, and welcome to Acadia Healthcare's third-quarter of 2024 earnings call.

美好的一天，歡迎參加 Acadia Healthcare 的 2024 年第三季財報電話會議。

(Operator Instructions) Also please be aware that today's call is being recorded.

（操作員說明）也請注意，今天的通話正在錄音。

I would now like to turn the call over to Patrick Feeley, Head of Investor Relations. Please go ahead.

我現在想將電話轉給投資者關係主管 Patrick Feeley。請繼續。

Thank you. And good morning, yesterday after the market closed, we issued a press release announcing our third-quarter 2024 financial results. This press release can be found in the investor relations section of the acadiahealthcare.com website. Here with me today to discuss the results are Chris Hunter, Chief Executive Officer; Heather Dixon, Chief Financial Officer. To the extent any non-GAAP financial measure is discussed in today's call.

謝謝。早安，昨天收盤後，我們發布了新聞稿，宣布 2024 年第三季財務業績。本新聞稿可在 acadiahealthcare.com 網站的投資者關係部分找到。今天與我一起討論結果的是執行長克里斯·亨特 (Chris Hunter)；希瑟‧迪克森，財務長。在今天的電話會議中討論了任何非公認會計準則財務指標。

You will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP. In the press release that is posted on our website as well as the 10-Q filed yesterday afternoon.

您還會發現該指標與根據 GAAP 計算的最直接可比較的財務指標的調整表。在我們網站上發布的新聞稿以及昨天下午提交的 10-Q 中。

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 2024 and beyond, 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 third-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，包括有關 Acadia 2024 年及以後的預期季度和年度財務業績的陳述等，這些陳述可能受到以下重要因素的影響阿卡迪亞向美國證券交易委員會提交的文件以及該公司第三季度的新聞稿中都有提及，因此，實際營運和結果可能與前瞻性聲明中討論的結果存在重大差異。

At this time. I'd like to turn the call over to Chris.

此時。我想把電話轉給克里斯。

Thank you, Patrick and good morning everyone. Thank you for being with us for Acadia's third-quarter, 2024 conference call.

謝謝你，派崔克，大家早安。感謝您參加阿卡迪亞 2024 年第三季電話會議。

We have a lot to cover today, but I want to begin with our results and key highlights of the quarter. I'll then provide a broader update on our quality standards here at Acadia, followed by a legal update. I will close with the discussion of how we drive outcomes for the vulnerable populations we serve and how we are expanding access to high quality care for a patient population that so desperately needs it.

今天我們有很多內容要介紹，但我想從我們的業績和本季的主要亮點開始。然後，我將提供有關阿卡迪亞品質標準的更廣泛的更新，然後是法律更新。最後，我將討論我們如何為我們服務的弱勢群體帶來成果，以及我們如何為迫切需要的患者群體擴大獲得高品質照護的機會。

During the third-quarter, we reported strong results with total revenue of $816 million, representing growth of 8.7% over the third-quarter of 2023, driven by both rate improvement and patient day growth.

在第三季度，我們報告了強勁的業績，總收入為 8.16 億美元，較 2023 年第三季度增長 8.7%，這得益於費率改善和患者日數增長。

This top line growth combined with solid operating leverage led to adjusted EBITDA growth of 10.5% over the same quarter last year.

這一營收成長加上穩健的營運槓桿，導致調整後 EBITDA 較去年同期成長 10.5%。

Underlying labor costs continue to trend favorably. And our initiatives around recruitment retention and engagement have helped attract and maintain talent.

基本勞動成本持續呈有利趨勢。我們圍繞招募留任和參與的措施有助於吸引和留住人才。

We've also made consistent progress against our bed growth targets. We were on pace to complete construction on approximately 1,200 beds this year including nearly 700 beds in the fourth-quarter. From several new wholly owned and joint venture facilities. This includes hospitals and partnerships with Henry Ford Health in Detroit and Inner Mountain Health in Denver, Colorado, as well as a new acute care novo facility in Madison, Wisconsin that was completed earlier this month.

我們在床位成長目標方面也取得了持續進展。今年我們預計將完成約 1,200 個床位的建設，其中第四季將完成近 700 個床位。來自幾個新的獨資和合資工廠。其中包括與底特律亨利福特健康中心和科羅拉多州丹佛內山健康中心的醫院和合作夥伴關係，以及本月早些時候在威斯康辛州麥迪遜市竣工的一個新的急診中心。

We're also on track to add over 400 beds to our existing facilities for the year including over 300 expected in the fourth-quarter.

今年我們還計劃在現有設施中增加 400 多個床位，其中預計第四季將增加 300 多個床位。

With that, I'd like to take this opportunity to remind you about our ongoing commitment to quality safety and compliance. At Acadia, our mission is to provide compassionate care that improves lives, inspires hope and elevates communities. And when you consider the patient populations, we serve in behavioral health and addiction treatment.

藉此，我想藉此機會提醒您我們對品質安全和合規性的持續承諾。在阿卡迪亞，我們的使命是提供富有同情心的護理，以改善生活、激發希望和提升社區水平。當你考慮到患者群體時，我們提供行為健康和成癮治療服務。

They are truly amongst our nation's most acute at risk and underserved. We play an incredibly important role in supporting these patients. And we take that role seriously with respect to recent and accurate media reports about the care at our behavioral health facilities. We want to share more about how our facilities operate and how we aim not only to meet but exceed the standards that regulation requires.

他們確實是我們國家面臨最嚴重風險且未充分服務的族群之一。我們在支持這些患者方面發揮著極其重要的作用。我們認真對待這個角色，尊重最近有關我們行為健康機構護理的準確媒體報道。我們希望更多地分享我們的設施如何運作，以及我們如何滿足並超越監管要求的標準。

First, I want to be clear, medical necessity drives patient care decisions at Acadia. These decisions are made by licensed providers and adhere to all associated legal requirements.

首先，我想明確的是，醫療必要性推動了阿卡迪亞的病患照護決策。這些決定由獲得許可的提供者做出，並遵守所有相關的法律要求。

The allegation that Acadia systematically holds patients longer than medically necessary is false and goes directly against everything we do and stand for when it comes to patient care, if you've not already done. So I would encourage you to read our response at quality.acadiahealthcare.com, which importantly includes data that shows the average length of stay across Acadia's hospitals is in fact, in line with the industry average and below those in government and non-profit run facilities.

關於阿卡迪亞系統性地拘留患者時間超過醫療必要時間的指控是錯誤的，並且直接違背了我們在患者護理方面所做的一切和所代表的一切（如果您還沒有這樣做的話）。因此，我鼓勵您閱讀我們在quality.acadiahealthcare.com上的回复，其中重要的數據顯示阿卡迪亞醫院的平均住院時間實際上與行業平均水平一致，低於政府和非營利組織的平均住院時間設施。

Behavioral health is complex, but it is clear that the need has never been greater for high quality behavioral health care. Given the severe mental health crisis that our nation faces, it is estimated that more than one in five Americans live with a mental illness and one in three Americans with serious mental illness are still receiving no treatment, yet, the United States has 40% fewer psychiatric beds per capita than comparable countries. It's a disease that impacts every family in our country and every day, our 23,500 Acadia employees help fulfill our mission to provide compassionate care that improves the lives of patients and their families.

行為健康很複雜，但很明顯，對高品質行為健康護理的需求從未如此強烈。鑑於我們國家面臨嚴重的精神健康危機，據估計，超過五分之一的美國人患有精神疾病，三分之一的患有嚴重精神疾病的美國人仍未接受治療，但美國的這一比例減少了40%人均精神科床位數高於可比較國家。這種疾病影響著我們國家的每個家庭，我們的 23,500 名阿卡迪亞員工每天都在幫助履行我們的使命，提供富有同情心的護理，改善患者及其家人的生活。

We operate in one of the most highly regulated and supervised subsectors of health care. Our facilities, clinicians and practices are routinely subject to oversight and inspection by various agencies to ensure compliance with regulatory requirements including but not limited to robust CMS guidelines on all aspects of patient care, documentation and billing.

我們在醫療保健領域監管和監督最嚴格的行業之一開展業務。我們的設施、臨床醫生和實踐經常受到各個機構的監督和檢查，以確保遵守監管要求，包括但不限於關於患者護理、文件和計費各個方面的強大 CMS 指南。

To give you just a sense of the oversight of our facilities consider that over the past five years, our acute psychiatric hospitals have been subject to routine inspections and surveys by independent third parties and government agencies such as the joint commission CMS and various state agencies. An average of roughly five times per hospital per year.

為了讓您了解我們設施的監督情況，請考慮在過去五年中，我們的急性精神病院一直接受獨立第三方和政府機構（例如聯合委員會 CMS 和各個國家機構）的例行檢查和調查。每家醫院每年平均約五次。

Like other well run provider organizations, these hospitals are routinely subject to third party audits including chart reviews both as part of routine regulatory reviews and part of our own internal compliance programs.

與其他運作良好的提供者組織一樣，這些醫院定期接受第三方審計，包括圖表審查，這既是例行監管審查的一部分，也是我們自己的內部合規計畫的一部分。

They are also routinely subject to oversight from third party payers with utilization management efforts taking place before during and after patient stays.

他們也經常受到第三方付款人的監督，在病人住院前後進行利用管理工作。

This oversight ranges from payers own clinicians rounding with local providers within our facilities to retroactive chart reviews and payer audits.

這種監督的範圍從付款人自己的臨床醫生與我們設施內的當地提供者進行交流，到追溯圖表審查和付款人審計。

I want to stress that this type of oversight is important to help ensure that patients receive the best care available.

我想強調的是，這種監督對於幫助確保患者獲得最好的照護非常重要。

The work we do matters and our clinicians often must make difficult critical decisions about life saving care on a daily basis. We also believe it is important not to perpetuate myths that psychiatric care is ineffective or even harmful at Acadia clinicians follow industry standard, clinically driven admission and discharge criteria and we hold ourselves to an incredibly high standard.

我們所做的工作很重要，我們的臨床醫生經常必須每天就挽救生命的照護做出艱難的關鍵決定。我們也認為，重要的是不要讓阿卡迪亞的精神科護理無效甚至有害的神話長期存在。自己。

With that, I'll provide a brief legal update. As we disclosed last month in September, we received a voluntary request for information from the US Attorney's Office for the southern district of New York, as well as a subpoena from the US district court for the western district of Missouri related to admissions length of stay and billing practices.

接下來，我將提供簡短的法律更新。正如我們上個月在 9 月披露的那樣，我們收到了紐約南區美國檢察官辦公室自願提供資訊的請求，以及美國密蘇裡州西區地區法院發出的與入學停留時間有關的傳票和計費慣例。

On the same day, one of our acute care hospitals also received a subpoena from the western district of Missouri regarding similar subject matter.

同一天，我們的急診醫院也收到了來自密蘇裡州西部地區的類似主題的傳票。

Since that time, the southern district of New York has withdrawn its request. Furthermore, the Department of Justice which issued the original subpoenas' from the western district of Missouri has since withdrawn both of those subpoenas and is permitting the company to produce documents and information on a voluntary basis.

此後，紐約南區撤回了請求。此外，從密蘇裡州西部地區發出原始傳票的司法部已撤回這兩張傳票，並允許該公司在自願的基礎上提供文件和資訊。

As the organization within the federal government tasks with law enforcement, the Department of Justice is leading and coordinating efforts on behalf of multiple federal agencies and departments investigating similar matters, any of which may make their own request.

作為聯邦政府內負責執法的組織，司法部正在代表多個聯邦機構和部門領導和協調調查類似事項的工作，其中任何一個機構和部門都可以提出自己的要求。

The company recently received a subpoena from the SEC requesting similar information and it's reasonable to assume that we could receive additional requests for information from other federal agencies in the future. As long as the investigation is ongoing.

該公司最近收到了 SEC 的傳票，要求提供類似訊息，並且可以合理地假設我們將來可能會收到其他聯邦機構的更多資訊請求。只要調查仍在進行。

We are fully engaged and we will continue to work through this process. We believe strongly that quality care is foundational to everything we do. This is not new, we believe that quality compliance and safety not only are important from a patient experience and regulatory standpoint, but also are simply good business practices in the best interest of all stakeholders.

我們全力投入並將繼續完成這一過程。我們堅信優質照護是我們所做一切的基礎。這並不新鮮，我們相信品質合規性和安全性不僅從病患體驗和監管的角度來看很重要，而且也是符合所有利害關係人最大利益的良好商業實踐。

I'd like to share some updates on our quality focus and efforts since I joined the company back in 2022.

我想分享自 2022 年加入公司以來我們對品質的關注和努力的一些最新情況。

For those who may have covered us for a while, you will recall that in 2022, we committed to spending approximately $100 million in incremental technology investments to enhance patient and staff safety, as well as augment care coordination.

對於那些可能已經關注我們一段時間的人來說，您會記得，到 2022 年，我們承諾花費約 1 億美元進行增量技術投資，以增強患者和員工的安全，並加強護理協調。

As a result, our acute care hospitals today employ wearable remote patient monitoring systems to make sure we're doing the best job we can of keeping patients safe.

因此，我們的急診醫院如今採用可穿戴式遠距病患監護系統，以確保我們盡最大努力保護病患安全。

Similarly, our hospitals have implemented wearable safety technology for staff that enables expedited response times and mitigation of adverse events. We've also implemented software solutions that provide real time tracking and oversight on clinical and quality operations at our facilities including compliance with regulatory requirements.

同樣，我們的醫院為員工實施了可穿戴安全技術，可以加快回應時間並減少不良事件。我們還實施了軟體解決方案，可以對我們設施的臨床和品質運營進行即時追蹤和監督，包括遵守監管要求。

You will also recall that psychiatric facilities were specifically excluded from the 2009 High Tech Act which provided billions in funding to hospitals and physicians for the implementation of electronic health records.

您還會記得，精神病院被明確排除在 2009 年《高科技法案》之外，該法案為醫院和醫生提供了數十億美元的資金用於實施電子健康記錄。

As a result, the prevalence of EMRS in psychiatric facilities has lagged other parts of the health care industry, at Acadia, we found that unacceptable. And over the past two years have been implementing electronic medical records across our acute hospitals. This is enabling our clinicians to spend more time doing what they do best, focusing on patient care while enhancing our ability to leverage data and analytics, as well as enabling our providers efficient access to care information to provide the very best in care.

因此，精神科設施中 EMRS 的盛行率落後於醫療保健產業的其他部分，在阿卡迪亞，我們發現這是不可接受的。在過去的兩年裡，我們一直在急診醫院實施電子病歷。這使我們的臨床醫生能夠花更多時間做他們最擅長的事情，專注於患者護理，同時增強我們利用數據和分析的能力，並使我們的提供者能夠有效訪問護理信息，以提供最好的護理。

Part of our quality reviews include an executive committee review, a peer review and a review by the joint commission of patient charts. All of which are facilitated on a much more granular and simplified basis with EMRs in place, to highlight a few other areas of focus. Two years ago, we separated quality and compliance into two distinct specialized teams.

我們的部分品質審查包括執行委員會審查、同儕審查和病患病歷聯合委員會的審查。所有這些都透過電子病歷的實施在更精細和簡化的基礎上得到促進，以突出其他一些重點領域。兩年前，我們將品質和合規性分成兩個不同的專業團隊。

Our Chief Medical Officer and Chief Quality Officer provide direct oversight on patient safety, clinical quality and regulatory compliance initiatives. While our Chief Compliance Officer provides direct oversight of our corporate compliance program including ongoing chart audits to ensure accurate documentation, coding and billing.

我們的首席醫療官和首席品質官對病患安全、臨床品質和監管合規措施進行直接監督。我們的首席合規官對我們的公司合規計畫進行直接監督，包括持續的圖表審計，以確保準確的文件、編碼和計費。

Over the past two years, we have also implemented quality dashboards across our hospitals and last year implemented monthly quality reviews to hold leaders accountable for quality.

在過去的兩年裡，我們還在整個醫院實施了品質儀表板，並在去年實施了每月品質審查，以讓領導者對品質負責。

These efforts are resulting in better care, better outcomes and better lives for our patients. In 2023, for instance, 81% of our patients who responded to follow up surveys including involuntarily admitted, respondents reported feeling hopeful as a result of the care they received in our hospitals and our payer partners have seen these results in their members as well. Many of our facilities have received center of excellence designation from some of the largest payers in the market.

這些努力為我們的患者帶來了更好的照護、更好的結果和更好的生活。例如，到2023 年，我們的81% 的患者在接受包括非自願入院在內的後續調查後表示，他們對在我們醫院接受的護理感到充滿希望，而我們的付款合作夥伴也在其會員身上看到了這些結果。我們的許多設施已獲得市場上一些最大付款人的卓越中心稱號。

I'd like to conclude by speaking briefly about our ongoing commitment to expanding access to life saving treatment.

最後，我想簡要地談談我們對擴大挽救生命治療的持續承諾。

As I noted, there remains a significant unmet need for behavioral health care services in our country. Behavioral health related deaths in the United States remain at or near all-time highs. According to the CTC, 49,000 Americans died of suicide in 2022.

正如我所指出的，我國對行為健康照護服務的需求仍然存在巨大的未滿足的需求。美國與行為健康相關的死亡人數仍處於或接近歷史最高水準。據 CTC 稱，2022 年有 49,000 名美國人死於自殺。

During that same year, more than 100,000 Americans died due to drug overdose deaths. Meanwhile, the inpatient psychiatric industry remains fragmented and under bedded. A result of decades of underfunding and underinvestment that has exacerbated the supply demand imbalance, notably based on standard clinical benchmarks, it's estimated that approximately 75,000 additional beds are required across the country to meet estimated needs. And according to Samson, nearly 30 million Americans with mental illness receive no mental health treatment.

同年，超過 10 萬美國人因藥物過量死亡。同時，住院精神科產業仍支離破碎且基礎薄弱。由於幾十年來資金不足和投資不足加劇了供需失衡，特別是根據標準臨床基準，估計全國需要約 75,000 個額外床位才能滿足估計需求。據薩姆森稱，近 3,000 萬名患有精神疾病的美國人沒有接受心理健康治療。

Put simply the need for behavioral health care in this country is increasing while the number of available beds has been decreasing, creating a broadening gap in leaving those patients who need the most care unable to get it.

簡而言之，這個國家對行為健康照護的需求正在增加，而可用床位的數量卻在減少，造成了越來越大的差距，導致那些最需要照護的患者無法獲得照護。

So to meet that need, Acadia is in the process of investing billions of dollars to expand access over the next several years, including the expected construction of over 2000 beds over the next two years, this continues to be an attractive use of capital and we expect new bed capacity will help drive accelerating volume growth in 2025 and beyond, we remain committed to investing to expand access to the high quality behavioral care that is so desperately needed in this country.

因此，為了滿足這一需求，阿卡迪亞正在投資數十億美元以擴大未來幾年的覆蓋範圍，包括預計在未來兩年內將建造2000 多個床位，這仍然是一種有吸引力的資本用途，我們預計新床位容量將有助於推動 2025 年及以後的床位數量加速增長，但我們仍然致力於投資，以擴大獲得該國迫切需要的高品質行為護理的機會。

Finally, and has always been the case. We also cannot indefinitely fund facilities if there is not a path to viability or strong patient utilization, that would be an irresponsible use of resources that could be deployed where more acutely needed. Therefore, as we've done historically, from time to time, we will take action to deploy resources or close facilities.

最後，而且一直都是如此。如果沒有可行的途徑或無法有效利用患者，我們也不能無限期地為設施提供資金，這將是對資源的不負責任的使用，而這些資源可以部署在更急需的地方。因此，正如我們歷史上所做的那樣，我們會不時採取行動部署資源或關閉設施。

During the third-quarter, we made the decision to close two subscale satellite programs in one of our markets that together comprised 104 beds.

第三季度，我們決定關閉其中一個市場的兩個小型衛星項目，這兩個項目共有 104 個床位。

With that, I'd like to turn the call over to Heather, to discuss our financial results for the quarter and forward guidance.

因此，我想將電話轉給希瑟，討論我們本季的財務表現和前瞻性指引。

Thanks Chris, and good morning, everyone. For the third-quarter, we reported $816 million in revenue representing an increase of 8.7% over the third-quarter of last year. Same facility revenue grew 8.6% compared with the third-quarter of 2023, which included patient day growth of 4.7% and an increase in revenue per patient day of 3.6% revenue per patient day, excluding the CTC business, which as you will recall does not have associated patient days increased 4.9%.

謝謝克里斯，大家早安。第三季度，我們的營收為 8.16 億美元，比去年第三季成長 8.7%。與 2023 年第三季相比，同一設施收入增長了 8.6%，其中患者日增長 4.7%，每個患者日收入增長 3.6%，不包括 CTC 業務（您可能還記得這一點）無相關患者的天數增加了4.9%。

Adjusted EBITDA for the third-quarter of 2024 increased 10.5% over the prior year to $194.3 million excluding income from provider relief funds in the third-quarter of 2023.

2024 年第三季調整後 EBITDA 比上年成長 10.5%，達到 1.943 億美元，不包括 2023 年第三季提供者救濟基金的營收。

Adjusted EBITDA margin was 23.8% compared with 23.4% for the same quarter. Last year, an expansion of 40 basis points on a same facility basis adjusted EBITDA margin increased 100 basis points over the prior year's quarter to 29.7% excluding the income from the provider relief fund. Last year adjusted income attributable to Acadia

調整後 EBITDA 利潤率為 23.8%，而同一季度為 23.4%。去年，在相同設施基礎上擴大了 40 個基點，調整後的 EBITDA 利潤率比去年同期增加了 100 個基點，達到 29.7%（不包括提供者救濟基金的收入）。去年調整後歸屬於阿卡迪亞的收入

Stockholders per diluted share was $0.91 for both the current and prior year period excluding the income from the provider release fund in the third-quarter of 2023.

本期及去年同期攤薄後每股股東為 0.91 美元，不包括 2023 年第三季提供者釋放基金的收入。

Consistent with previous periods. Adjustments to income for the third-quarter of 2024, include transaction legal and other costs and loss on impairment.

與前幾期一致。2024 年第三季收入調整包括交易法律成本和其他成本以及減損損失。

Maintaining a strong financial position remains a top priority for Acadia, providing the flexibility to make strategic investments that are in line with our disciplined capital allocation strategy and support our continued growth. As of September 30, 2024, we had $82.1 million in cash and cash equivalents and $321.5 million available under our $600 million revolving credit facility with a net leverage ratio of approximately 2.5 times.

保持強勁的財務狀況仍然是阿卡迪亞的首要任務，提供靈活性來進行符合我們嚴格的資本配置策略的策略性投資，並支持我們的持續成長。截至 2024 年 9 月 30 日，我們擁有 8,210 萬美元的現金和現金等價物，以及 6 億美元循環信貸額度下的 3.215 億美元可用資金，淨槓桿率約為 2.5 倍。

Moving on to our outlook for 2024. As noted in our press release, we have updated our previously announced guidance for the year which includes revenue in the range of $3.15 billion to $3.165 billion adjusted EBITDA in the range of $725 million to $735 million and adjusted earnings per diluted share in the range of $3.35 to $3.45.

繼續我們對 2024 年的展望。正如我們在新聞稿中所指出的，我們更新了先前宣布的今年指引，其中包括收入在31.5 億美元至31.65 億美元之間，調整後EBITDA 在7.25 億美元至7.35 億美元之間，調整後每股攤薄收益在3.35 美元至 3.45 美元。

As we discussed on the second quarter earnings call coming into the back half of the year. We expect same facility patient day growth to accelerate into the mid-single digit range. As you saw in our results, we achieved that in the third-quarter with same facility patient day growth of 4.7% an acceleration of 230 basis points over the first half of the year.

正如我們在今年下半年的第二季財報電話會議上所討論的。我們預計同一設施的患者日數成長將加速至中個位數範圍。正如您在我們的業績中看到的那樣，我們在第三季度實現了這一目標，同一設施的患者日增長率為 4.7%，比上半年加速了 230 個基點。

While volume growth in September remained above 5%. We have experienced lower volume growth than expected in October, with same facility patient day growth of approximately 3% for the month, which we believe is a result of the recent headlines and reporting in the media that Chris addressed at the top of the call as such. Our revised guidance reflects expected fourth quarter year over year, same facility volume growth of approximately 3% to 4% which is 200 basis points to 300 basis points below our previous expectations for the quarter.

而9月份成交量成長仍維持在5%以上。我們 10 月的銷量成長低於預期，當月同一設施的患者日增長率約為 3%，我們認為這是最近的頭條新聞和媒體報道的結果，克里斯在電話會議的開頭提到：這樣的。我們修訂後的指引反映了預計第四季度將年增約 3% 至 4%，比我們先前對該季度的預期低 200 至 300 個基點。

We do expect this headwind to be transitory in nature, however, and as we have been doing for some time now we continue to engage with our referral sources and our local communities to ensure that we are addressing any concerns as they arise. This change in our volume growth outlook for the fourth quarter resulted in a $20 million to $30 million impact to our revenue guidance and a $10 million to $15 million impact to our EBITDA outlook.

然而，我們確實預期這種逆風本質上是暫時的，正如我們一段時間以來所做的那樣，我們將繼續與我們的推薦來源和當地社區接觸，以確保我們能夠解決出現的任何問題。我們第四季銷售成長前景的這項變更對我們的營收指引產生了 2,000 萬至 3,000 萬美元的影響，並對我們的 EBITDA 前景產生了 1,000 萬至 1,500 萬美元的影響。

Of note, updated EBITDA guidance reflects the expectation that we will not make material reductions to the cost structure in response to the anticipated lower volume growth in the fourth-quarter. As we do believe this recent disruption to be temporary.

值得注意的是，更新後的 EBITDA 指引反映了這樣的預期：我們不會因為第四季預期銷售成長放緩而大幅削減成本結構。因為我們確實相信最近的破壞是暫時的。

Therefore, we do not view the anticipated $10 million to $15 million reduction to fourth quarter EBITDA as reflective of the potential run rate impact should lower than expected volumes persist longer than we anticipate. We will of course reduce facility level costs accordingly.

因此，我們並不認為第四季度 EBITDA 預期減少 1000 萬至 1500 萬美元反映了潛在的運行率影響，如果低於預期的銷售持續時間比我們預期的要長。我們當然會相應地降低設施水平成本。

Beyond these near time, near term headwinds, we are also highly confident in the future for Arcadia as we are on the cusp of a significant acceleration and capacity expansion. As Chris noted we have a large pipeline of over 2000 beds under construction. This includes approximately 1,000 beds expected to open over the next few months which represents an expansion of our inpatient capacity of nearly 9%.

除了這些近期的不利因素之外，我們對阿卡迪亞的未來也充滿信心，因為我們正處於顯著加速和產能擴張的風口浪尖。正如 Chris 指出的那樣，我們正在建造一條包含 2000 多個床位的大型管道。其中包括預計在未來幾個月內開放的約 1,000 張床位，這意味著我們的住院容量將擴大近 9%。

We've also been able to accelerate certain construction projects ahead of schedule. And as a result, we expect to deliver multiple new facilities in the first-half of 2025. You will see this reflected in our guidance revision for expansion capital expenditures.

我們也能夠提前加速某些建設項目。因此，我們預計將在 2025 年上半年交付多個新設施。您將在我們的擴張資本支出指南修訂中看到這一點。

Additionally, as Chris noted, our revised guidance reflects the exit of two subscale satellite programs in one of our markets during the third-quarter. Prior full year guidance contemplated approximately $17 million of revenue contribution and approximately $1 million of EBITDA contribution from these programs in the second half of the year.

此外，正如克里斯指出的那樣，我們修訂後的指導反映了第三季度我們一個市場中兩個小型衛星計畫的退出。先前的全年指引預計這些計畫在下半年將帶來約 1,700 萬美元的收入貢獻和約 100 萬美元的 EBITDA 貢獻。

Finally, as a reminder, 2024 guidance excludes any contribution from the Tennessee supplemental payment program payments which we expect will be retroactive to July 1, 2024, upon program approval and implementation.

最後，提醒一下，2024 年指引不包括田納西州補充支付計畫付款的任何繳款，我們預計該計畫將在計畫批准和實施後追溯至 2024 年 7 月 1 日。

The company's guidance also does not include the impact of any future acquisitions, divestitures, transaction, legal and other costs or non-recurring legal settlement expense.

該公司的指引也不包括任何未來收購、剝離、交易、法律和其他成本或非經常性法律和解費用的影響。

With that operator, we are ready to open the call for questions.

透過該接線員，我們準備好開始提問。

We will now begin the question-and-answer session to ask a question. (Operator Instructions)

我們現在將開始問答環節來提出問題。（操作員說明）

AJ Rice, UBS.

AJ 賴斯，瑞銀集團。

Hi, everybody, and thanks for all the comments. Obviously, as you're seeing this sort of deceleration and growth, I know 3% still decent growth in volumes. But obviously you're expecting more is that, can you give us? I know this is pretty granular, but obviously, the question is in light of the media dynamic. Did you take a step down and then it seems like it's stabilized or has it subsequently deteriorated as you progress through the first part of the fourth quarter? And it's still trying to figure out where the bottom would be. And is it concentrated in certain markets where maybe the New York Times had focused its article on and subsequent inquiries or is it more broad based than that? Then I may have one more follow up?

大家好，感謝所有的評論。顯然，正如你所看到的這種減速和增長，我知道 3% 的銷量增長仍然不錯。但顯然你更期待的是，你能給我們嗎？我知道這很具體，但顯然，這個問題是根據媒體動態提出的。你是否有所退步，然後隨著第四季度前半部分的進展，情況似乎已經穩定下來，或者隨後惡化了？它仍在試圖找出底部在哪裡。它是否集中在《紐約時報》可能將其文章和後續調查重點關注的某些市場，或者它的基礎是否比這更廣泛？那我可以再跟進一次嗎？

Okay. Thanks, AJ, thanks for the question. I'll start with your, your question about sort of the, the, the step down and what we saw, we, we did see that step down beginning at the start of October and we saw that run pretty consistently throughout the month of October.

好的。謝謝，AJ，謝謝你的提問。我將從你的問題開始，關於降級以及我們所看到的情況，我們確實看到從十月初開始降級，並且我們看到整個十月的降級情況非常一致。

So to answer your question, we didn't see a continued decline throughout the month, we saw, you know, relatively stable volumes for the month of October in regards to your question about sort of any concentration or, or where we saw this, you know, we do, as I mentioned, expect that that the recent news coverage and the news of the investigation has had some moderating effect on the growth. But it's early days, we see this is as largely temporary and we've been working with our partners to sort of identify any specific questions that they have.

因此，為了回答你的問題，我們整個月沒有看到持續下降，我們看到，你知道，關於你關於某種集中度的問題，或者我們在哪裡看到這一點，我們看到，你知道，十月份的交易量相對穩定，你知道，正如我所提到的，我們確實預計最近的新聞報導和調查消息對成長產生了一定的調節作用。但現在還處於早期階段，我們認為這在很大程度上是暫時的，我們一直在與我們的合作夥伴合作，以確定他們遇到的任何特定問題。

Okay. And maybe just you've obviously got a number of JV discussions in the pipeline, some that have been announced and you've also worked hard to get your recruitment of clinicians. There. Are you seeing any impact in either of those areas from the news articles and the inquiries?

好的。也許您顯然已經進行了許多合資企業討論，其中一些已經宣布，並且您也努力招募臨床醫生。那裡。您是否從新聞文章和調查中看到了這些領域的任何影響？

Yeah AJ, this is Chris. Thanks for the question, you know, I would say on the JV pipeline front, we continue to just have a really robust pipeline as you would expect. You know, we have given that we have 21 JV partners, those that have been with us for some time and you remember that we actually have multiple facilities with many of these partners that we're talking about adding additional facilities to, you know, our pipeline looks good. I think they're, you know, further down in the pipeline.

是的，AJ，這是克里斯。謝謝你提出的問題，你知道，我想說，在合資企業管道方面，我們繼續擁有一個真正強大的管道，正如你所期望的那樣。你知道，我們已經給了21 個合資合作夥伴，這些合作夥伴已經與我們合作了一段時間，你還記得我們實際上與其中許多合作夥伴擁有多個設施，我們正在談論向其中添加額外的設施，你知道，我們的管道看起來不錯。我認為他們，你知道，正在醞釀中。

Clearly, there are questions that come up across the board and I think that's the case with employees as well, but I think we have done a really good job as a company this year continuing to talk about all the investments that we're making on the technology front. Continuing to work hard on our employee engagement and we've actually been very encouraged by our ability to continue to attract and retain talent.

顯然，存在一些全面的問題，我認為員工也是如此，但我認為今年作為一家公司，我們做得非常好，繼續談論我們正在進行的所有投資技術前沿。我們持續努力提高員工敬業度，實際上我們對持續吸引和留住人才的能力感到非常鼓舞。

Okay. Thanks a lot.

好的。多謝。

Whit Mayo, Leerink Partners.

惠特·梅奧，Leerink 合夥人。

Yeah, thanks. Appreciate the comments. I was just hoping maybe to if you guys could maybe provide a little bit more color as to you know, your preliminary thoughts around 2025. I heard Tennessee CTC comments Chris mentioned, I think accelerating growth with the bet editions is a feather into the business. Anything to share, just headwinds tail winds and maybe any preliminary thoughts around the startup costs that you might have in '25. Thanks.

是的，謝謝。感謝您的評論。我只是希望你們能在 2025 年左右提供更多的信息，你們的初步想法。我聽到田納西州 CTC 的評論克里斯提到，我認為透過投注版本加速成長是該行業的一大優勢。有什麼可以分享的，只是逆風順風，也許還有關於 25 年啟動成本的任何初步想法。謝謝。

I would, I'll take that. So I'll, I'll maybe talk about a few different categories here, but let me start with, with volume and then I'll move on to, you know, rate and then, you know, finally your question about start-up costs and the impact of the bed additions. So of course, you know, we're not going to give guidance today. It's, it's an early for that. We'll give that sort of in another few months. So I won't attempt to size this, but I'm going to give you some, some of my thoughts.

我願意，我會接受的。所以我可能會在這裡討論幾個不同的類別，但讓我從音量開始，然後我會繼續，你知道，評分，然後，你知道，最後你關於開始的問題-成本上升以及床位增加的影響。當然，你知道，我們今天不會提供指導。確實，現在還為時過早。我們將在接下來的幾個月內提供此類內容。所以我不會嘗試去衡量這個問題，但我會給你一些我的想法。

So what I would say is, you know, going back to the first quarter in regards to the volume, we talked about an expectation of volume improvement over the course of the year. And that's what we've seen. Volume growth improved throughout the second-quarter and then into the third-quarter. As you can see, we were back in the mid-single digit volume growth range and we exited the quarter in September above the 5% same store volume growth rate.

所以我想說的是，你知道，回到第一季的銷量，我們討論了全年銷售改善的預期。這就是我們所看到的。銷量成長在整個第二季度有所改善，然後進入第三季度。正如您所看到的，我們的銷售成長回到了中個位數成長區間，並且在 9 月結束時，同店銷售成長率高於 5%。

So that continued acceleration that we expected that we saw coming through and while that growth stayed above 5% in September, you know, as I just discussed in the prepared remarks, we've seen some moderation to that volume growth in October. And, you know, again, we believe that's a result of the headlines in the reporting. But, but we are seeing October run at around 3% and that's about 200 basis points to 300 basis points below where we would have expected to be.

因此，我們預計我們看到了持續的加速，雖然 9 月份的成長保持在 5% 以上，但正如我剛剛在準備好的評論中討論的那樣，我們看到 10 月份的銷量增長有所放緩。而且，你知道，我們再次相信這是報告中頭條新聞的結果。但是，我們預計 10 月的成長率約為 3%，比我們預期的水平低約 200 到 300 個基點。

You know, as we mentioned, we think that's temporary. So as we look forward to 2025 we, we, we don't know the exact timing, but certainly we would look to be back on track throughout the year, but we'll need to wait and see where we exit at the end of the year.

你知道，正如我們所提到的，我們認為這是暫時的。因此，當我們展望 2025 年時，我們不知道確切的時間，但我們肯定希望全年都能回到正軌，但我們需要等待，看看年底我們會在哪裡退出。

And then of course, you know, don't forget, as you know, as we know from a volume perspective, we expect to benefit from the continued ramp up of beds that we added over the last several quarters to continue to come through those new beds that are expecting to contribute to, you know, come contribute and come online in the coming quarters will continue to ramp and they'll continue to contribute to the growth over the course of 2025.

當然，你知道，不要忘記，正如你所知，從數量的角度來看，我們預計將從過去幾個季度增加的床位數量的持續增加中受益，以繼續克服這些困難。貢獻並上線的新床位將繼續增加，並將繼續為2025 年的成長做出貢獻。

So, the volume that, we expect will come back based on what we're seeing now and then combined with the volume from the incremental beds, from a rate perspective, you know, we continue to feel really good as you know, the states are continuing to just invest in psychiatric care, which has, you know, long suffered from the lack of investment and the conversations with our payers continue to be positive.

因此，我們預計的產量將根據我們現在所看到的情況而恢復，然後與增量床的數量相結合，從費率的角度來看，我們繼續感覺非常好，正如您所知，各州我們將繼續投資於精神科護理，您知道，精神科護理長期以來一直受到缺乏投資的困擾，並且與我們的付款人的對話仍然是積極的。

Tennessee is the latest state that's on the path to improving reimbursement and we're very optimistic that we'll see that that net benefit next year. Once the programs approved, there are other states that we think may follow. But the timing of those are a little less clear than the timing indications we have for Tennessee.

田納西州是最新一個正在改善報銷的州，我們非常樂觀地認為明年將看到淨收益。一旦這些計劃獲得批准，我們認為其他州可能會效仿。但這些時間安排不如我們為田納西州提供的時間安排那麼明確。

And then as always is, in the case of the timing of supplemental payments can be uncertain. For example, we expect Tennessee will be retroactive to July 1. So there's likely going to be some sort of an out of period benefit associated with that and we'll call that out once it's approved, but we just have to continue to wait and see on the timing.

與往常一樣，補充付款的時間可能是不確定的。例如，我們預計田納西州將追溯至 7 月 1 日。因此，可能會出現某種與此相關的期外福利，一旦獲得批准，我們就會宣布這一點，但我們只需要繼續等待，看看時機。

So overall, as we said, in the past, we continue to expect rates to normalize back to the low mid-single digit range at some point in the future. But it doesn't seem like we're going to see that happen in the short term.

因此，總體而言，正如我們過去所說，我們繼續預期利率將在未來某個時間點恢復正常至中個位數區間。但短期內我們似乎不會看到這種情況發生。

And then maybe finally I'll talk about startup costs. As you know, this year, we have embarked on a pretty significant step up in the investment and bed growth over multiple years. And I think as you all are aware, the startup cost is another factor that we need to think about for 2025. Just a reminder, we have over 2000 beds currently under construction and in total, we expect to complete construction on about 1,200 for the full year this year.

最後也許我會談談啟動成本。如您所知，今年，我們在多年來的投資和床位成長方面邁出了相當大的一步。我想大家都知道，啟動成本是 2025 年我們需要考慮的另一個因素。請注意，我們目前正在建造超過 2000 個床位，預計今年全年將完成約 1,200 個床位的建設。

And of course, we have a pipeline of the opportunities that we continue to see and then we'll backfill that construction pipeline and pull things in as soon as we can.

當然，我們有一系列我們繼續看到的機會，然後我們將回填該建設管道並儘快拉動東西。

The pace of bed additions this year is a material step up over the prior year versus the 500 to 600 beds that we've added over the last few years each.

與過去幾年我們每年增加 500 至 600 個床位相比，今年床位的增加速度比去年有了實質的進步。

Finally, as we discussed back in February, this year's bed editions were also disproportionately weighted towards the end of the year. If you'll recall, our initial guidance included start-up cost of around $20 million to $25 million in total, which was roughly flat relative to 2023 due to the back end loaded 2024 cadence. And as we've talked about previously, the start-up cost for the 2024 class of De Novos will mostly fall in 2025 due to the back end timing.

最後，正如我們在二月討論的那樣，今年的床品版本在年底時的權重也不成比例。如果你還記得的話，我們最初的指導包括總計約 2000 萬至 2500 萬美元的啟動成本，由於後端加載 2024 年的節奏，該成本與 2023 年大致持平。正如我們之前討論過的，由於後端時間安排，2024 年 De Novos 級的啟動成本將在 2025 年大部分下降。

So with the number of new beds being added this year, roughly doubling, that will result in a new step up in the starting costs beginning next year, particularly in the first part of the year, too early for us to provide numbers on that today with. But you know, in part, because that 2025 cadence and cost amount is going to depend on the timing of the openings of the bed additions and it's a little too early for us to have, have those specifics.

因此，隨著今年新床位數量的增加，大約增加一倍，這將導致明年開始的起始成本進一步上升，特別是在今年上半年，我們今天提供這方面的數字還為時過早和。但你知道，部分原因是 2025 年的節奏和成本金額將取決於床位增加的開放時間，而現在了解這些細節對我們來說還為時過早。

But you know, hopefully this at least gives you a framework of how to think about it. You know, of course, you know, we'll expect that those new beds will ramp towards breaking even over the course of next year. And by the end of 2025 we'd expect them to be contributing to the EBITDA growth. And by that point, we'll also be rolling them into the same facility bucket. So they would contribute to the same store volume growth as well.

但你知道，希望這至少為你提供了一個如何思考它的框架。當然，我們預計這些新床位將在明年達到收支平衡。到 2025 年底，我們預計它們將為 EBITDA 成長做出貢獻。到那時，我們也將把它們放入同一個設施桶中。因此，它們也將為同樣的商店銷售成長做出貢獻。

And then beyond 2025 we would expect start-up costs to level off if not, you know, outright decline. And at the same time, we would expect to have the continued benefit of those new cohorts of beds over the past several years ramping throughout that period.

然後，在 2025 年之後，我們預計啟動成本將趨於平穩，即使不是徹底下降。同時，我們預計將繼續受益於過去幾年中不斷增加的新床位。

But that was a lot with, I hope that answered your question. I gave you some.

但這是很多，我希望能回答你的問題。我給了你一些。

Yeah, not really. I mean, like 20 to 25 is what we have this year. I mean, you haven't a pretty good idea of timing factors as it relates to the opening of some of this and the 30, 35, 40, I mean, like any help within a range as to like what we could see.

是的，不是真的。我的意思是，今年我們有 20 到 25 個。我的意思是，你對時間因素不太了解，因為它與其中一些因素以及 30、35、40 的開放有關，我的意思是，就像我們能看到的範圍內的任何幫助一樣。

No, you know what III I appreciate the question. I think it's just too early for us to put a number on it. I would just, you know, point to the, to the factors and how the cohorts stack up with the beds sort of from last year this year and next year coming into confluence and then the timing of those beds that are back ended this year versus a more moderate pace next year?

不，你知道嗎 III 我很欣賞這個問題。我認為現在給出一個數字還為時過早。我只想指出這些因素，以及去年、今年和明年的床位如何疊加，然後是今年後端床位與床位的時間安排。

Okay. That's all I got. Thanks.

好的。這就是我所得到的。謝謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Hey, good morning. Chris maybe just circle back to the conversations you're having with the referral sources and your JV partners. I mean, obviously you have a lot of referral sources, right? So if you can walk us through what that looks like and so far, what's the feedback? And are you seeing any change in behavior for those referral sources at this point?

嘿，早安。克里斯也許只是回顧一下您與推薦來源和合資夥伴之間的對話。我的意思是，顯然你有很多推薦來源，對吧？那麼，如果您能向我們介紹一下到目前為止的情況，那麼回饋是什麼？此時您是否發現這些推薦來源的行為有任何改變？

Yeah. Thanks for the question, Brian. I mean, as you can imagine, I mean, we've been highly engaged with outreach to really multiple stakeholders. I mean, certainly, you know, key referral sources as well as JV partners for the last several months. You know, I would also say that we all know health care is local and with so many of these literally thousands of referral sources, you know, being on the ground across the country, you know, we've had to be even more deliberate about the outreach.

是的。謝謝你的提問，布萊恩。我的意思是，正如你可以想像的，我的意思是，我們一直在積極接觸真正的多個利害關係人。我的意思是，當然，你知道，過去幾個月的關鍵推薦來源以及合資夥伴。你知道，我還要說，我們都知道醫療保健是地方性的，而且有如此之多的數千個轉介來源，你知道，在全國各地，你知道，我們必須更加深思熟慮關於外展。

I think particularly to shore up any misunderstandings that sometimes have been, you know, the case due to the media reporting. And so, you know, we've been really consistent about emphasizing the quality of the care that we provide the investments that we're making in safety compliance quality over the last two years, which is nothing new.

我認為特別是為了消除有時因媒體報導而產生的誤解。因此，您知道，我們一直非常一致地強調過去兩年我們在安全合規品質方面進行的投資所提供的護理質量，這並不是什麼新鮮事。

We're just reaffirming that. And, you know, we placed a lot of emphasis on ensuring that our most important referral sources, understand these facts and understand where we believe the [rec], you know, the some of the media reporting has been inconsistent or inaccurate. And so, you know, and that that's with referral sources as well as JV partners.

我們只是重申這一點。而且，您知道，我們非常重視確保我們最重要的推薦來源，了解這些事實並了解我們認為 [rec] 的地方，您知道，一些媒體報導不一致或不準確。所以，你知道，這涉及推薦來源和合資夥伴。

You know, I would say when we sit down and we present them with the five key points from the recent release that I, you know, cited the website quality.acadiahealthcare.com, the setting the record straight. That's in our, that was in my prepared remarks.

你知道，我會說，當我們坐下來向他們展示最近發布的五個要點時，我引用了網站quality.acadiahealthcare.com，澄清了事實。這是我們的，這是我準備好的發言。

There's kind of five key points that we take them through that seem to be resonating. The first is that patient care decisions, including whether treatment is necessary and for how long are medical decisions that are made by licensed providers? The second is that the average length of stay at Acadia, acute hospitals is in line with national averages. The third is that independent, third parties make the initial determination that a patient requires hospitalization and evaluation.

我們向他們介紹了五個似乎引起共鳴的關鍵點。首先是病患照護決策，包括是否有必要進行治療以及由執照醫療服務提供者做出的醫療決策持續多久？第二是阿卡迪亞急診醫院的平均住院時間與全國平均一致。第三是獨立的第三方做出病人需要住院和評估的初步決定。

The fourth is that our hospitals are highly regulated and required to meet policies and standards set by federal state and local governments. And then finally, you know, it's widely recognized within the medical community that discharging psychiatric patients, particularly those that are a danger to themselves or others too early can result in catastrophic consequences. And I think, you know, these referral sources understand this and I think it resonates based on the feedback that we've continued to get.

第四，我們的醫院受到嚴格監管，並要求符合聯邦州和地方政府制定的政策和標準。最後，你知道，醫學界廣泛認識到，過早讓精神病患者出院，特別是那些對自己或他人有危險的患者，可能會導致災難性的後果。我認為，你知道，這些推薦來源理解這一點，我認為它會根據我們不斷收到的回饋產生共鳴。

You know, I think in the small percentage of cases where we have heard any concern, these really tend to be a little bit more correlated with intense local media coverage within that facility, local market, rather than, you know, any broader news at the national level. And so, you know, we've only been experiencing this as we've said in the prepared remarks over the past month. But I would just say based on the conversations that we're having, we do feel confident that we're having the right conversations with these referral partners.

你知道，我認為在我們聽到任何擔憂的一小部分案例中，這些實際上往往與該設施、當地市場內的當地媒體的密集報道更相關，而不是，你知道，任何更廣泛的新聞國家層面。所以，你知道，正如我們在過去一個月準備的演講中所說的那樣，我們才經歷過這種情況。但我只想說，根據我們正在進行的對話，我們確實有信心與這些推薦合作夥伴進行正確的對話。

We're trying to be intentional about getting in person when we can and then we have the right programs in place, you know, with these referral sources going forward as well as our JV partners. And I think any opportunity for us to meet in person and to have even greater touch points is something that we're just very focused on literally on a daily basis. So I hope that helps.

我們會盡可能有意識地親自參與，然後我們會制定正確的計劃，你知道，這些推薦來源以及我們的合資夥伴都將繼續前進。我認為我們每天都會非常關注任何面對面見面並擁有更多接觸點的機會。所以我希望這會有所幫助。

Now, that helps. And then maybe Heather, you mentioned, you're prepared to mark that the volume impact and EBITDA like $10 million to $15 million. I think you cut the midpoint by $20 million. So just curious, what's the bridge there? And then how should we be thinking about, you know, the levers that you can pull if this volume weakness persists into 2025 like, you know, from a staffing or capacity perspective, how, how easy or what does that look like?

現在，這有幫助。然後，也許希瑟，您提到，您準備將銷售影響和 EBITDA 標記為 1000 萬至 1500 萬美元。我認為你將中點削減了 2000 萬美元。所以很好奇，那裡的橋是什麼？然後，如果銷售量疲軟持續到 2025 年，我們應該如何考慮可以採取哪些措施，例如從人員配置或產能的角度來看，如何、如何容易或是什麼樣子？

Yes, I'll take those in turn. So first, maybe just to give a little more clarity on sort of the revision to guidance. You are correct that certainly the largest driver was the volume trend that we saw. And just again to, to reiterate the numbers that we were looking at when we made the decision, you know, we exited September same store patient day growth over 5% which was a significant acceleration over the first-half of the year as we expected.

是的，我會依序處理這些。首先，也許只是為了更清楚地說明指南的修訂。你是對的，最大的驅動因素當然是我們看到的成交量趨勢。再次重申我們在做出決定時所考慮的數字，您知道，我們 9 月的同店患者日增長率超過 5%，正如我們預期的那樣，這比上半年顯著加速。

And originally, of course, we would have expected that to continue into Q4 as we accelerated on, on those even further whenever we exited. Or as we exit October, we are expecting around 3%. So a drop of 200 basis points to 300 basis points from our expectations. So that is what drove that $10 million to $15 million in EBITDA reduction for the balance of the year.

當然，最初我們預計隨著我們加速前進，這種情況會持續到第四季度，每當我們退出時，這種情況會進一步加劇。或者當我們退出 10 月時，我們預計約為 3%。因此，比我們的預期下降了 200 至 300 個基點。因此，這就是今年剩餘時間 EBITDA 減少 1,000 萬至 1,500 萬美元的原因。

What I would say is that on top of that, we had, you know, a couple of other things that were moving through out there, you know, there was a little bit of impact from the hurricane, just a couple of million dollars, although it did have some impact on the cadence of, of some of our construction projects. And then there was about a million as we mentioned in the prepared remarks related to the closing of those satellite facility beds during the quarter.

我想說的是，除此之外，我們還有其他事情正在發生，你知道，颶風造成了一些影響，只有幾百萬美元，儘管它確實對我們一些建設項目的節奏產生了一些影響。正如我們在與本季度關閉這些衛星設施床位相關的準備好的評論中提到的，大約有一百萬。

But that's really, what drove that maybe just to the second part of your question in regards to, to leverage, you know, we mentioned or I mentioned in the prepared remarks that, you know, the revenue guide was coming down related to that volume discussion by about $20 million to $30 million and the EBITDA relates to that was about $10 million to $15 million.

但這確實是推動問題第二部分的原因，關於槓桿作用，我們在準備好的評論中提到過，你知道，收入指南的下降與該數量有關討論金額約為2000 萬至3000 萬美元，而與之相關的EBITDA 約為1000 萬至1500 萬美元。

So that's a higher impact proportionately on EBITDA than on revenue for what you would normally expect to see from us. And that is, you know, certainly, the area where if this were to become a longer term impact. We would look to make you know, the appropriate revisions there to the cost structure.

因此，這對 EBITDA 的影響比例高於您通常期望從我們這裡看到的收入影響。當然，這就是會產生長期影響的領域。我們希望讓您知道成本結構的適當修改。

But as we mentioned, because we do feel this is temporary, we have not made some of those more significant changes to our cost structure and we remain ready to welcome those patients back at any time. So that would be I would say the biggest lever that we would call on to really focus on a sustained downturn.

但正如我們所提到的，因為我們確實認為這是暫時的，所以我們沒有對我們的成本結構做出一些更重大的改變，我們仍然準備好隨時歡迎這些患者回來。因此，我想說，這將是我們真正專注於持續衰退的最大槓桿。

All right, thank you.

好的，謝謝。

John Ransom, Raymond James.

約翰·蘭塞姆，雷蒙德·詹姆斯。

Hey, good morning. Just going back to this referral management issue. How much more work do you think you have to do to kind of carry the initial flurry of effect? And then how long are you giving yourself to where you would say? Okay, this, this just seems like we may have lost, you know, permanent 2%, 3% of our referrals. I'm just trying to get a sense of timing on this.

嘿，早安。回到這個推薦管理問題。您認為還需要做多少工作才能達到最初的效果？那你要花多久時間去實現你所說的目標？好吧，這，這看起來我們可能已經永久失去了 2%、3% 的推薦。我只是想了解這件事的時機。

Yeah, John, I would just say, I mean, this is something that we continue to work on every single day. It's just really difficult for us to put, you know, a time parameter on that. But, you know, I think we're having regular touch points. Of course, with all of these referral sources regularly, you know, we've continued to dial that up where it makes sense we've tried to meet in person.

是的，約翰，我只想說，我的意思是，這是我們每天都在繼續努力的事情。你知道，我們真的很難為此設定一個時間參數。但是，你知道，我認為我們有定期的接觸點。當然，由於定期有所有這些推薦來源，您知道，我們會繼續在有意義的地方進行聯繫，我們試圖親自會面。

Certainly where it makes sense even more frequently. But I just could not speculate on the timing as of right now. I would just say this hasn't just started this month. This has been something that we've been working on, you know, very consistently. And of course, in normal course, we're always talking to our referral partners regularly and that will continue.

當然，在更頻繁地有意義的地方。但我現在無法推測具體時間。我只想說這還不是這個月才開始的。你知道，這是我們一直在努力的事情。當然，在正常情況下，我們總是定期與我們的推薦合作夥伴交談，並且這種情況將會繼續下去。

Well, it's interesting. I mean, the original article was late August and then it took a month for this effect to be felt. So I guess there's a lag, right? I mean there was a 30 day lag before you saw it. The other question I had was I know you said before the VA was a bit of an air pocket. So maybe that was down to 300 bps. Has there been any additional pressure from that particular referral source given that they are also looking at you?

嗯，這很有趣。我的意思是，最初的文章是八月下旬，然後花了一個月的時間才感受到這種效果。所以我猜有一個滯後，對嗎？我的意思是，你看到它之前有 30 天的延遲。我的另一個問題是，我知道你之前說過，退伍軍人管理局有點像氣泡。所以可能會下降到 300 bps。鑑於他們也在關注您，是否有來自該特定推薦來源的任何額外壓力？

No, I mean, nothing that we would call out on the VA to answer your question?

不，我的意思是，我們不會要求 VA 來回答您的問題？

Okay, thank you.

好的，謝謝。

John. Maybe I'll just jump into the first part of your question and, and just remind you that that we did talk about what we think on a go forward basis. And I know it's, you know, as Chris mentioned too early for us to think about what that duration looks like because it's early days here. But just reminding you that, that we do not think that the Q4 reduction sort of that relative reduction for revenue and guidance is how you should think about the go forward run rate related to that for EBITDA, of course.

約翰.也許我會直接進入你問題的第一部分，並提醒你，我們確實討論了我們對未來的想法。我知道，你知道，正如克里斯提到的那樣，我們考慮這個持續時間是什麼樣的還為時過早，因為現在還處於早期階段。但只是提醒您，我們不認為第四季度收入和指導的相對減少是您應該如何考慮與 EBITDA 相關的前進運行率，當然。

Yeah, thank you.

是的，謝謝。

Christian Porter, Bank of America.

克里斯蒂安·波特，美國銀行。

Hi, this is Christian Porter on for Joanna. Thank you for taking our question. My first question was just wondering with the legal scrutiny that you guys are facing. Have you seen any impact to your hiring or retention or just ability to find people to staff your facilities? And then I have one follow up.

大家好，我是喬安娜的克里斯蒂安波特。感謝您提出我們的問題。我的第一個問題只是想知道你們所面臨的法律審查。您是否發現對您的招募或保留或只是為您的設施找到人員的能力產生了任何影響？然後我有一個跟進。

Yeah, thanks for the question. I would say overall, nothing material that I would call out. I think, you know, we're a company that continues to build capacity, as we said in the prepared remarks. Obviously, you know, a key factor is us continuing to attract talent in to fill these new facilities as well as to retain the existing, you know, ex excellent staff that we have.

是的，謝謝你的提問。總的來說，我想說，沒有什麼值得指出的。我認為，正如我們在準備好的發言中所說，我們是一家持續建立能力的公司。顯然，一個關鍵因素是我們持續吸引人才來填補這些新設施，並留住我們現有的、前優秀的員工。

You know, we do lean heavily on the extensive investments that we've made. Not only in these new facilities but also in technology EMRs remote patient monitoring patients, staff safety devices that really resonate with our employees. We also, you know, have just done yet another employee engagement survey and we take those results which we think really factor into our ability to attract and retain as well.

您知道，我們確實嚴重依賴我們所做的廣泛投資。不僅在這些新設施中，而且在電子病歷遠端病患監控技術、員工安全設備等方面也與我們的員工產生了真正的共鳴。您知道，我們也剛剛進行了另一項員工敬業度調查，我們認為這些結果確實影響了我們吸引和留住人才的能力。

So I would just say overall you know, it's, you know, normal course, we're certainly available for, you know, questions that periodically come up, you know, we're trying to be very communicative and transparent, you know, with our leadership and our staff and we'll continue to do that. But, you know, nothing else I would add on that front.

所以我只想說，總的來說，這是正常的過程，我們當然可以回答定期出現的問題，我們正在努力保持溝通和透明，你知道，與我們的領導層和員工一起，我們將繼續這樣做。但是，你知道，我不會在這方面添加任何其他內容。

All right. Thank you. And then my follow up question was you guys have mentioned that you guys are implementing people technology, clinical protocols and training just to make sure that quality is at its best. We were wondering how do you measure your results from these initiatives? So yeah, thank you.

好的。謝謝。然後我的後續問題是你們提到你們正在實施人員技術、臨床方案和培訓只是為了確保品質處於最佳狀態。我們想知道您如何衡量這些舉措的成果？所以是的，謝謝。

Yeah, I would say, I mean, this is something that we have invested in now for over two years with respect to the quality protocols that we put in place. So this isn't anything new. You know, I would say that, you know, again, as we, as I cited, it's not just one thing, it's not just the fact that we've, you know, put an EMR in place or that we've put patient monitoring in place.

是的，我想說，我的意思是，這是我們在製定品質協議方面已經投資了兩年多的事情。所以這不是什麼新鮮事。你知道，我會再說一遍，正如我們所引用的，這不僅僅是一件事，這不僅僅是我們已經，你知道，建立了電子病歷或我們已經建立了電子病歷的事實病人監護到位。

We've been really intentional on the quality front about literally putting entirely new all in one dashboards in place for our facilities that are, you know, providing all metrics that we're tracking routinely patient safety, staff training experience, patient experience incidents and observations, all of these things. And you know, we, we use this in a way to look at it. You know, our Chief Quality Officer, you know, also has done a phenomenal job of putting a heat map in place that we're holding our facilities accountable to.

我們在品質方面非常有意識地為我們的設施安裝了全新的一體化儀表板，您知道，這些儀表板提供了我們定期追蹤的病患安全、員工培訓經驗、病患體驗事件和觀察，所有這些事情。你知道，我們以某種方式來看待它。您知道，我們的首席品質長在製定熱圖方面也做出了出色的工作，我們要求我們的設施對此負責。

And we're also, we've implemented, you know, for the last several years, not just a monthly operating review, but a monthly quality review where we're holding our operators accountable for coming in and specifically talking about the advancements that they've made on the quality front.

你知道，在過去的幾年裡，我們不僅實施了每月的營運審查，而且還實施了每月的品質審查，我們讓我們的操作員負責進來，並具體討論以下方面的進步：他們在質量方面取得了進展。

You know, I think maybe the final thing I would point out is that we've also implemented the joint commissions AMP their software program at all of our acute facilities in the middle of this past year.

你知道，我想也許我要指出的最後一件事是，我們還在去年年中在我們所有的急性設施中實施了聯合委員會 AMP 的軟體程式。

And this is a cloud based solution that's produced by the joint commission that reflects all the up to date CMS standards and conditions that will modernize, you know, all of our quality assurance and performance improvement tactics.

這是一個基於雲端的解決方案，由聯合委員會制定，反映了所有最新的 CMS 標準和條件，您知道，這些標準和條件將使我們所有的品質保證和效能改進策略現代化。

So having that in place, this software ensures that our teams are auditing, that they're educating that they're monitoring clinical and operational practices that all coincide with the joint commission standards as well as the CMS conditions on participation.

因此，有了這些，該軟體可以確保我們的團隊進行審核，並教育他們正在監控符合聯合委員會標準以及 CMS 參與條件的臨床和操作實踐。

So just overall really modernizes our approach to survey preparedness to accreditation readiness. It puts us in a position where we're proactively looking for trouble spots across the portfolio and we're able to mobilize resource and proactive.

因此，總體而言，我們的調查準備和認證準備方法真正實現了現代化。它使我們能夠主動尋找整個產品組合中的問題點，並且能夠調動資源並採取積極主動。

We hold our operators accountable for quality standards and it's, you know, early days here because we literally have just implemented the software by the middle of the year. But we're very encouraged by just the cultural change. This will continue to enhance and manifest for the company.

我們讓操作員對品質標準負責，你知道，現在還處於早期階段，因為我們實際上剛剛在年中實施了該軟體。但我們對文化變革感到非常鼓舞。這將繼續增強並體現在公司身上。

Thank you.

謝謝。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Thank you very much. I was wondering if you could talk about the volume, softness in October. It sounds like most of that is referral related and acute related, but just wanted to see to what degree you're seeing RTC pressure as well or not. And then all any overall volume trends across the other segments as well.

非常感謝。我想知道你是否可以談談十月份的成交量和柔軟度。聽起來大部分都與轉診相關和急性相關，但只是想看看您在多大程度上也看到了 RTC 壓力。然後還有其他細分市場的所有總體銷售趨勢。

Yeah, thanks for the question. I'll take that. You know, we as we look at that volume pressure, you know, of course, we have done a lot of deep diving into the trends or looking for trends. What I would say is that as Chris mentioned, there's not a very specific outlier here in any one area or business line. As you mentioned, we do see a little more impact where some facilities have had a preponderance of local media focus as opposed to the national media focus.

是的，謝謝你的提問。我會接受的。你知道，當我們考慮成交量壓力時，你知道，我們當然已經深入研究了趨勢或尋找趨勢。我想說的是，正如克里斯所提到的，在任何一個領域或業務線中都不存在非常具體的異常值。正如您所提到的，我們確實看到一些設施受到當地媒體關注而不是國家媒體關注的影響更大。

But then more broadly, we've seen it, you know, relatively consistent throughout the month as I mentioned that, you know, sort of what we saw from a volume impact perspective, sort of started right at the beginning of the month and we saw it consistently at relatively the same level throughout the month.

但更廣泛地說，我們看到整個月相對一致，正如我所提到的，我們從數量影響的角度看到的情況，有點從本月初開始，我們整個月都保持在相對相同的水平。

Of course, there's always normal fluctuations as you go through the month. But, but really pretty consistent there. From a business line perspective, I'd say it was consistent, relatively speaking across acute and specialty. Both of those saw relatively the same impact specifically to your question on RTCs.

當然，每個月總會有正常的波動。但是，但是那裡確實非常一致。從業務線的角度來看，我想說，相對而言，在急性和專業領域，這是一致的。對於您關於 RTC 的問題，這兩者都產生了相對相同的影響。

You know, there were, you know, the normal fluctuation here and there. But you know what I would say about our RTC is that, you know, in a typical month. Very sadly, the total number of adolescents native care far outweighs the available beds across the board and our RTC facilities are typically operating at or near capacity throughout the year, of course, with normal variation. So, so that's sort of a view of, of what we saw and, and where we, where we looked into things, but, you know, it's pretty, pretty consistent across [acuant] specialty.

你知道，到處都有正常的波動。但你知道，關於我們的 RTC，我想說的是，在典型的月份中。非常遺憾的是，青少年本地護理的總數遠遠超過了可用床位的數量，我們的 RTC 設施通常全年都在滿負荷或接近滿負荷運行，當然，也有正常的變化。所以，這就是我們所看到的、我們在哪裡、我們在哪裡調查事物的一種觀點，但是，你知道，它在[敏銳的]專業中非常非常一致。

Appreciate that. Just as a follow up kind of same question for third-quarter on the revenue per patient day. 3.6 looks like that slowed a little bit from typical trends and maybe lower than you had expected. Just wanted to see kind of how that falls across the various segments and, and any observations you can offer there.

很欣賞這一點。正如第三季度每個患者日收入的後續問題一樣。 3.6 看起來與典型趨勢相比略有放緩，並且可能低於您的預期。只是想看看它是如何跨越各個細分市場的，以及您可以在那裡提供的任何觀察。

Yeah, sure, sure, good question. So for third-quarter, you know, what we saw coming through would have been, you know, impacted by the CTC portion that contributed to that. And if you recall, you know, CTC had a very strong year last year, sort of growing each quarter significantly. If you exclude the impact of CTC from Q3, it would have been 4.9% revenue per patient day growth. So that's probably a good way to look at that and, and hopefully answers your question.

是的，當然，當然，好問題。因此，對於第三季度，我們看到的結果將受到 CTC 部分的影響。如果你還記得的話，你就會知道，CTC 去年表現非常強勁，每季都有顯著成長。如果排除第三季 CTC 的影響，每位患者日收入將成長 4.9%。所以這可能是看待這個問題的好方法，並希望能回答您的問題。

Yes. Thank you very much.

是的。非常感謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey, good morning guys, looking at the referral sources on acute. Have you seen any channel of those referrals more impacted than others? Thinking about the ERS versus cores versus police schools or self-referrals?

嘿，早安，夥計們，正在查看急性上的推薦來源。您是否發現這些推薦管道比其他管道受到的影響更大？考慮一下 ERS ​​與核心、警察學校或自我推薦？

Yeah, there aren't any that I would pullout. So we're picking up an echo. I would say, you know, the hospitals and the EDS are always an area of focus, but you know, you've listed a number of them. I mean, there's so many are community based shelters, law enforcement. We, I mean, again, as we've said at the outset, we literally have thousands of referral sources.

是的，沒有任何我想拿出來的。所以我們收到了迴音。我想說，你知道，醫院和 EDS 始終是一個重點領域，但你知道，你已經列出了其中的一些。我的意思是，有很多社區庇護所和執法機構。我的意思是，正如我們一開始所說的，我們確實擁有數千個推薦來源。

So I wouldn't say that there are any specifically that we would call out. We continue to be even more intentional about reaching out to all of them and increasing the frequency of touch points.

所以我不會說我們會特別指出什麼。我們繼續更有意識地接觸所有人並增加接觸點的頻率。

Okay. And then looking at specialty. Was there any impact within any specific division within specialty versus the others to think of? You know, the guys should be thinking about that recovery because it's more of a consumer driven business versus the others. That's just more of a sort of, you know, a medical referral. Thank you.

好的。然後看專業。與其他領域相比，專業內的任何特定部門是否有任何影響？你知道，這些人應該考慮復甦，因為與其他業務相比，它更多的是消費者驅動的業務。你知道，這更像是一種醫療轉診。謝謝。

Yeah, I wouldn't say any really to call out there either. Pretty consistent.

是的，我也不會說任何真正的呼喚。相當一致。

Great. Thanks so much.

偉大的。非常感謝。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. I just wanted to follow up on the referrals in the areas where you are seeing pressure is the referral decision typically made at the organization or department level or is it select individuals within a department making decisions autonomously?

嗨，早安。我只是想跟進您所看到的壓力領域的推薦，推薦決策通常是在組織或部門層級做出的，還是部門內選定的個人自主做出決策？

And then secondly, I'm still struggling to recon this notion that the volume headwind is temporary with the fact that referral sources tend to be sticky. So, have you seen any evidence or early signs of recovering lost referrals? And if not, is there a push to open the door into new referrals to pack all these volumes? Just want to understand what's behind the temporary outlook? Thank you.

其次，我仍在努力重新認識這個觀點，即銷售逆風是暫時的，因為推薦來源往往具有黏性。那麼，您是否看到任何恢復遺失推薦的證據或早期跡象？如果沒有，是否有動力打開新推薦的大門來包裝所有這些卷？只是想了解暫時前景背後的原因是什麼？謝謝。

Yeah, thanks, Andrew. I would say that to answer your first question. These are decisions that are made by individuals. And I would say specifically, you know, there have been instances where there have been concerns that have been raised and we've mobilized leaders to, you know, move on the ground and to, you know, meet directly. And I think in many instances, we have been able to improve the referral situation, certainly to answer a lot of questions and to get those referral patterns back on track.

是的，謝謝，安德魯。我這麼說是為了回答你的第一個問題。這些是由個人做出的決定。我要具體說的是，你知道，在某些情況下，有人提出了擔憂，我們已經動員領導人實地行動，並直接會面。我認為在很多情況下，我們已經能夠改善推薦情況，當然可以回答很多問題並使這些建議模式回到正軌。

You know, there also have been, you know, some situations where it's just harder to get in front of that referral source. But I would say overall the strategies that we are putting in place, you know, this is a ground game, health care is local and we really like the approach that we're putting in place and we can continue to execute on that.

您知道，在某些情況下，很難找到推薦來源。但我想說的是，總的來說，我們正在實施的策略，你知道，這是一場地面遊戲，醫療保健是本地的，我們真的很喜歡我們正在實施的方法，我們可以繼續執行該方法。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Thank you. One clarification on your last response. It, it sounds like you're saying you have seen proof of concept where a face to face meeting had a positive impact on referral pattern after that meeting. Is that the right way to read that that in some cases you have seen the actual trend move after the meeting?

謝謝。對您上次回覆的一個澄清。聽起來您是說您已經看到了概念證明，其中面對面會議對會議後的推薦模式產生了積極影響。在某些情況下，您在會後看到了實際趨勢的變化，這是正確的解讀方式嗎？

Yeah, sure. I mean, I would again remind you that we have thousands of referral sources. We'd love to get in front of all of them face to face all the time that just isn't possible with so many. You know, I've personally been in front of you know, so many of our JV partners just over the course of the last few months, that's always preferred as opposed to doing a phone call or doing a video.

是的，當然。我的意思是，我想再次提醒您，我們有數千個推薦來源。我們很樂意一直面對面地與他們所有人面對面，但這對這麼多人來說是不可能的。你知道，我個人在過去幾個月裡一直在你面前，我們的許多合資夥伴都更喜歡這樣做，而不是打電話或拍影片。

But I think just overall the way that our operators function in the local market and again, health care being local is they try to get in front of these referral sources as frequently as we can. I just think that we have dialled up the expectation and asked them where possible to make that happen. But these are literally daily interactions that are already happening in normal course and you know, we'll continue to. So I hope that's helpful.

但我認為，總體而言，我們的營運商在當地市場的運作方式以及當地的醫療保健是他們試圖盡可能頻繁地接觸這些轉介來源。我只是認為我們已經提高了期望，並詢問他們如何可能實現這一目標。但這些實際上是日常互動，已經在正常過程中發生，你知道，我們將繼續這樣做。所以我希望這有幫助。

Got it, great. And then can you give us an idea of the normal patient day seasonality throughout Q4? Is October usually the high water mark or does it ramp through the year?

明白了，太好了。那麼您能否讓我們了解整個第四季的正常病患日季節性？十月通常是高水位線還是全年都會出現高峰？

Yeah, for fourth quarter, that's a great question. You are correct. October is normally the strongest month out of that quarter. The normal seasonality patterns that we see during fourth quarter are very specifically related to the holidays that occur throughout the end of November and through December. Typically speaking, you know, families that have an option or an alternative to, you know, bring someone home over the holiday period will do so. And so we typically see that impact in our volumes and we factor that in, we expect that yes, directly, October is the strongest month.

是的，對於第四季來說，這是一個很好的問題。你是對的。十月通常是該季度中最強勁的月份。我們在第四季看到的正常季節性模式與 11 月底和 12 月期間的假期有非常明確的關係。一般來說，如果家庭可以選擇或替代在假期期間帶某人回家，他們就會這樣做。因此，我們通常會看到這種對我們銷售的影響，並將其考慮在內，我們預計十月是最強勁的月份。

Matthew Gilmore, KeyBanc.

馬修·吉爾摩，KeyBanc。

Thanks. It's actually KeyBanc. Hey, I'll just keep it to one. I think Chris had mentioned that labor was trending favorably something you could provide some color in terms of wage inflation or, or turnover and just how that's been trending in the recent months.

謝謝。它實際上是KeyBanc。嘿，我就把它保留為一。我認為克里斯曾提到，勞動力的趨勢是有利的，你可以在薪資通膨或營業額方面提供一些色彩，以及最近幾個月的趨勢。

Yeah, sure. I'll take that, I'll jump in. So, you know, from a wage inflation perspective, you know, we have seen that continue to track favorably, you know, at the beginning of the year, we said we would anticipate for that to, to trend below 5%. And, and we have seen that continue to play out.

是的，當然。我會接受的，我會跳進去。所以，你知道，從薪資通膨的角度來看，你知道，我們已經看到薪資通膨持續保持良好勢頭，你知道，在今年年初，我們表示預期薪資通膨率將低於 5%。而且，我們已經看到這種情況繼續發生。

The highest watermark was the end of 2022 where it was up around 8%. So we've seen that moderate significantly and then for this year has held steady. And again, just to mention throughout the first nine months, we've seen it stay in that sort of sub 5% range and we would expect that to continue.

最高水位出現在 2022 年底，上漲了 8% 左右。因此，我們看到這種情況顯著放緩，然後今年保持穩定。再說一遍，在前 9 個月裡，我們看到它一直保持在 5% 以下的範圍內，我們預計這種情況會持續下去。

Got it. Thanks guys.

知道了。謝謝你們。

Raj Kumar, Stephens.

拉吉·庫馬爾，史蒂芬斯。

This is Raj on for Scott Forell. Thank you for taking the question. I just had one around, you know, one that we get particularly around desert hills and you know, relate to the tail of those cases with the six being settled earlier and then two kind of remaining just kind of any update on that.

我是拉吉（Raj），代表斯科特·福雷爾（Scott Forell）發言。感謝您提出問題。我剛剛遇到了一個，你知道，我們特別在沙漠丘陵周圍遇到的一個，你知道，與這些案件的尾部有關，其中六起案件已提前解決，然後剩下的兩起案件只是有關該案件的任何更新。

And then just another one on just the legal strategy kind of going further around like settlements versus contesting and you know, what actions Acadia has taken internally or externally to kind of counteract those.

然後是另一個關於法律策略的問題，例如和解與競爭，你知道，阿卡迪亞在內部或外部採取了哪些行動來抵消這些影響。

Yeah, thanks for the question. You know, I would start and just say, with your question on Desert Hills, we just can't comment on individual cases. But I would say, you know, we have and we will continue to disclose litigation matters that we view as material and all of our filings.

是的，謝謝你的提問。你知道，我首先要說的是，對於你關於沙漠山的問題，我們無法對個別案例發表評論。但我想說，你知道，我們已經並將繼續披露我們認為重要的訴訟事項和我們所有的文件。

We have bolstered our team on the legal front and, you know, I think we have, you know, also disclosed that we've hired Kirkland and Ellis as our outside counsel and for the, the broader, investigations and consulting with them very closely, but just, you know, with respect to ongoing investigations and cases, it's just very, we're very limited in what we can say publicly. And I would just leave it at that.

我們在法律方面加強了我們的團隊，你知道，我認為我們還透露，我們已聘請柯克蘭和埃利斯作為我們的外部顧問，並與他們進行更廣泛的調查和諮詢。對於正在進行的調查和案件，我們可以公開說的話非常有限。我就這樣吧。

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

我們的問答環節到此結束。我想將會議轉回克里斯·亨特 (Chris Hunter) 發表閉幕詞。

Thank you. In closing, I just want to again, thank our committed facility leaders, clinicians, and approximately 23,500 dedicated employees across the country who have continued to work tirelessly to meet the needs of our patients in a safe and effective manner. We are together doing incredibly important work for our patients across the country and remain committed to serving them with care, compassion and excellence.

謝謝。最後，我想再次感謝我們盡職盡責的機構領導、臨床醫生以及全國各地約 23,500 名敬業的員工，他們繼續不懈地工作，以安全有效的方式滿足患者的需求。我們正在共同為全國各地的患者開展極其重要的工作，並繼續致力於以關懷、同情和卓越的方式為他們提供服務。

Thank you all for being with us this morning and for your interest in Acadia.

感謝大家今天早上和我們在一起以及對阿卡迪亞的興趣。

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。現在您可以斷開線路。