Acadia Healthcare Company Inc (ACHC) 2025 Q2 法說會逐字稿

Good day, and welcome to Acadia Healthcare's second quarter Of 2025 earnings call. (Operator Instructions) Also, please be aware that today's call is being recorded.

大家好，歡迎參加 Acadia Healthcare 2025 年第二季財報電話會議。（操作員指示）另外，請注意，今天的通話正在錄音。

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

現在我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 second quarter 2025 financial results. This press release can be found in the Investor Relations section of acadiahealthcare.com website. Here with me today to discuss the results are Chris Hunter, Chief Executive Officer; and Heather Dixon, Chief Financial Officer.

謝謝，早安。昨天收盤後，我們發布了一份新聞稿，宣布了 2025 年第二季的財務表現。此新聞稿可在 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有執行長克里斯·亨特 (Chris Hunter) 和財務長希瑟·迪克森 (Heather Dixon)。

To the extent any non-GAAP financial measure is discussed on today's call, 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.

如果在今天的電話會議上討論了任何非 GAAP 財務指標，您也可以在我們網站上發布的新聞稿中找到該指標與根據 GAAP 計算的最直接可比較財務指標的對帳。

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 2025 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 second 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》所定義的前瞻性陳述，其中包括有關 Acadia 2025 年及以後預期季度和年度財務表現的陳述。這些聲明可能會受到 Acadia 向美國證券交易委員會提交的文件以及公司第二季新聞稿中列出的重要因素的影響。因此，實際營運和結果可能與前瞻性陳述中討論的結果有重大差異。

At this time, I would like to turn the conference call over to Chris.

現在，我想將電話會議交給克里斯。

Thank you, Patrick, and good morning, everyone. Thank you for being with us for Acadia's second quarter 2025 conference call. We're pleased with our progress to date in 2025 as we continue to execute our strategy in line with our growth objectives. We reported solid top line growth with total revenue of $869.2 million, up 9.2% over the second quarter last year, while adjusted EBITDA was $201.8 million, a 7.5% increase over the same period a year ago.

謝謝你，派崔克，大家早安。感謝您參加 Acadia 2025 年第二季電話會議。我們將繼續按照成長目標執行策略，對 2025 年迄今的進展感到滿意。我們報告了穩健的營收成長，總營收為 8.692 億美元，比去年第二季成長 9.2%，調整後的 EBITDA 為 2.018 億美元，比去年同期成長 7.5%。

I would like to speak for a moment about the recently passed One Big Beautiful Bill Act. We believe the provisions of the bill are manageable over the coming years particularly due to the carve-outs from work requirements and the extended time line for implementing changes to the supplemental payment provisions of the Medicaid program.

我想談談最近通過的「一項偉大的美麗法案」。我們相信，該法案的條款在未來幾年內是可控的，特別是由於工作要求的豁免以及實施醫療補助計劃補充支付條款變更的延長時間表。

For the full year 2025, we expect gross revenue of approximately $230 million from existing state Medicaid supplemental programs. More than half of this revenue comes from states that may begin reducing these payments starting in fiscal 2028 if proposed changes to the programs are implemented. If these changes occur, we also anticipate that a portion of the revenue loss would be offset by a reduction in the provider taxes we pay in those states.

到 2025 年全年，我們預計現有州醫療補助補充計畫的總收入約為 2.3 億美元。如果擬議的計劃變更得以實施，超過一半的收入來自各州，這些州可能會從 2028 財年開始減少這些付款。如果發生這些變化，我們也預計部分收入損失將透過減少我們在這些州支付的提供者稅來抵消。

Regarding the Medicaid work requirements included in the legislation, we do not expect a material impact on our operations as these begin to be phased in next year. This is largely due to exemptions for the populations we serve, including individuals with chronic substance use disorders and those with serious and complex medical conditions.

關於立法中包含的醫療補助工作要求，我們預計這些要求明年將開始分階段實施，不會對我們的營運產生重大影響。這主要是因為我們服務的人群享有豁免，包括患有慢性物質使用障礙的個人和患有嚴重複雜疾病的個人。

At Acadia, we remain committed to delivering essential care to underserved and vulnerable populations. We will continue to prioritize partnerships with payers and state agencies that recognize the long-term cost savings of integrating mental and physical health care and the importance of addressing behavioral health needs nationwide.

在阿卡迪亞，我們始終致力於為服務不足和弱勢群體提供基本護理。我們將繼續優先與付款人和國家機構建立合作夥伴關係，這些機構認識到整合心理和身體保健的長期成本節約以及解決全國行為健康需求的重要性。

On that note, we're pleased to share that the state of Tennessee has approved a new Directed Payment Program, underscoring the critical role behavioral health services play in supporting community well-being. This approval marks a meaningful step in the broader national movement to invest in behavioral health programs that are vital to expanding access, improving outcomes and meeting the growing demand for behavioral health services across the country.

關於這一點，我們很高興地告訴大家，田納西州已經批准了一項新的定向支付計劃，強調了行為健康服務在支持社區福祉方面發揮的關鍵作用。此項批准標誌著全國範圍內投資行為健康計畫的廣泛運動邁出了有意義的一步，這些計畫對於擴大獲取途徑、改善結果和滿足全國範圍內日益增長的行為健康服務需求至關重要。

Turning to development activity. For the second quarter, we added 101 beds to existing facilities, bringing the total to 191 beds added to existing facilities for the first half of 2025. Including the 288 beds from newly constructed facilities, we have added a total of 479 beds to date in 2025. Our new facility construction projects have also progressed nicely. We are extremely proud to be a preferred partner to many premier names in health care who want to integrate behavioral health into their system with a shared purpose of improving both mental and physical outcomes for more patients.

轉向開發活動。第二季度，我們在現有設施中增加了 101 張床位，使 2025 年上半年現有設施中增加的床位總數達到 191 張。包括新建設施的 288 張床位在內，到 2025 年我們總共增加了 479 張床位。我們的新設施建設項目也進展順利。我們非常自豪能夠成為許多醫療保健領域頂尖公司的首選合作夥伴，他們希望將行為健康融入他們的體系，共同致力於改善更多患者的身心健康。

Over the past two months, we have completed construction of three new facilities in conjunction with our joint venture partners. This includes our second facility with Geisinger located in their headquarters city of Danville, Pennsylvania, which opened earlier this month. Two other joint venture facilities have completed construction and are scheduled to open later this year. Acadia also added four new comprehensive treatment centers, or CTCs, for opioid use disorder, extending our market reach to 174 CTCs across 33 states. We have now added 11 CTCs to date in 2025.

在過去的兩個月裡，我們與合資夥伴共同完成了三座新設施的建造。其中包括我們與 Geisinger 合作的第二家工廠，位於其總部所在地賓夕法尼亞州丹維爾，該工廠於本月初開業。另外兩家合資工廠已經完工，計劃於今年稍後投入營運。Acadia 也增加了四個新的鴉片類藥物使用障礙綜合治療中心（CTC），將我們的市場範圍擴大到 33 個州的 174 個 CTC。截至 2025 年，我們已新增 11 個 CTC。

Moving to volumes. In the second quarter, same-facility patient days increased by 1.8%, which was slightly below our expectations. We saw strong performance in our specialty and CTC lines of business, with same facility growth in the mid-single digits for each, consistent with our expectations. As we have discussed previously, our same-facility results continue to be impacted by a handful of underperforming facilities. While performance at the majority of these facilities was generally in line with our expectations, we did observe a deterioration in performance at 1 facility, which continues to face particularly strong local market pressures which we are closely monitoring.

移至卷。第二季度，同一醫療機構的患者天數增加了 1.8%，略低於我們的預期。我們的專業業務和 CTC 業務表現強勁，相同設施的成長率均達到中等個位數，符合我們的預期。正如我們之前所討論的，我們的同類設施業績繼續受到少數表現不佳的設施的影響。雖然大多數工廠的業績總體符合我們的預期，但我們確實觀察到 1 家工廠的業績出現下滑，該工廠繼續面臨著特別強勁的本地市場壓力，我們對此正密切關注。

More broadly, volumes in our acute care business came in slightly below expectations. While demand across the majority of our business remains robust, health care is inherently local, and we experienced pockets of weakness in volumes in certain acute care markets with higher Medicaid exposure. We believe this pressure on Medicaid volumes is consistent with what peers experienced during the second quarter.

更廣泛地說，我們的急性護理業務量略低於預期。雖然我們大部分業務的需求仍然強勁，但醫療保健本質上是地方性的，並且在某些醫療補助暴露較高的急性護理市場中，我們的業務量出現了疲軟的跡象。我們認為，醫療補助額度面臨的壓力與同業在第二季所經歷的情況一致。

Medicaid volumes at our acute care hospitals were down slightly on a year-over-year basis in the second quarter, while commercial and Medicare volumes increased by 9% and 8%, respectively.

我們急診醫院的醫療補助量在第二季度同比略有下降，而商業和醫療保險量分別增加了 9% 和 8%。

Before turning the call over to Heather, I want to talk about our quality initiatives. As we extend our market reach in 2025, patient safety and quality patient care are central to our mission, and we continue to focus on quality across our operations, leveraging technology and utilizing data to reduce medication errors, improve care coordination, support quality and ensure the consistent delivery of evidence-based care and support strong clinical outcomes.

在將電話轉給 Heather 之前，我想談談我們的優質舉措。隨著我們在 2025 年擴大市場範圍，患者安全和優質的患者護理是我們使命的核心，我們將繼續關注整個運營的質量，利用技術和數據來減少用藥錯誤，改善護理協調，支持質量並確保持續提供循證護理並支持強大的臨床結果。

We believe Acadia has led the industry in adopting the latest technology and evidence-based practices. Our facilities are licensed, accredited and regularly inspected to uphold high regulatory and quality standards, including rigorous requirements for employee training and patient safety.

我們相信阿卡迪亞在採用最新技術和循證實踐方面處於行業領先地位。我們的設施經過許可、認證並定期接受檢查，以遵守高監管和品質標準，包括對員工培訓和病人安全的嚴格要求。

We have remote 24/7 patient monitoring devices in Acadia's acute facilities, which enhance patient safety and provide critical documentation of patient care and outcomes and ensure more consistent care protocols across our facilities. Our hospital staff and clinicians are also provided with wearable safety devices that enable expedited responses and mitigation of adverse events.

我們在阿卡迪亞的急診設施中配備了全天候遠端病人監控設備，這提高了病人的安全性，提供了病人護理和結果的關鍵記錄，並確保我們整個設施的護理方案更加一致。我們還為醫院工作人員和臨床醫生配備了可穿戴安全設備，以便快速回應並減輕不良事件。

We have implemented robust analytics through an integrated quality dashboard that provides real-time visibility into over 50 distinct safety, patient experience and regulatory compliance-related key performance indicators, providing facility leadership with real-time insight into operational effectiveness across our hospitals. Our operators use this data on a daily, weekly and monthly cadence to drive our continuous quality improvement efforts at the bedside and throughout our facilities.

我們透過整合品質儀表板實現了強大的分析功能，可即時查看 50 多個不同的安全性、病患體驗和法規遵循相關的關鍵績效指標，為設施領導層提供對我們整個醫院營運效率的即時洞察。我們的操作員每天、每周和每月使用這些數據來推動我們在床邊和整個設施的持續品質改進工作。

Our ability to harness this data and accurately measure outcomes is an important advantage in negotiating with payers who are focused on value-based care. We will continue to invest in technology to strengthen our core capabilities and support a strong culture of accountability for quality.

我們利用這些數據並準確衡量結果的能力是與專注於基於價值的護理的付款人進行談判的重要優勢。我們將繼續投資技術以加強我們的核心能力並支持強大的品質責任文化。

Our Corporate Quality and Safety Committee conducts quarterly performance reviews that help us maintain consistency in clinical practice across our operations. And our Corporate Compliance Committee conducts quarterly reviews to ensure compliance with our internal code of conduct. Importantly, our quality initiatives investments in the latest technology tools and evidence-based protocols support the work of our employees and clinicians.

我們的企業品質和安全委員會每季進行一次績效評估，以幫助我們在整個營運過程中保持臨床實踐的一致性。我們的公司合規委員會每季進行審查，以確保遵守我們的內部行為準則。重要的是，我們對最新技術工具和循證協議的品質計劃投資支持了我們的員工和臨床醫生的工作。

Working together with our facility operators has helped us attract skilled practitioners and maintain talent in a competitive labor market. We are experiencing more favorable labor trends in 2025, supported by our initiatives centered around more centralized facility level recruitment, retention and employee engagement and a strong focus on extensive training in our local markets. We commend our approximately 25,000 dedicated employees for an outstanding job in providing quality, compassionate care for the patients and families who seek our care.

與我們的設施營運商合作幫助我們吸引熟練的從業者並在競爭激烈的勞動力市場中留住人才。2025 年，我們將經歷更有利的勞動力趨勢，這得益於我們以更加集中的設施級招聘、保留和員工參與度為中心的舉措，以及對當地市場的廣泛培訓的高度重視。我們讚揚我們大約 25,000 名敬業的員工，他們出色地為尋求我們護理的患者和家屬提供了優質、富有同情心的護理。

Lastly, I'd like to take a moment to recognize Heather Dixon, who will be stepping down from her role as Chief Financial Officer later this month. Over the last two years, Heather has been instrumental in strengthening our financial foundation and advancing our growth strategy. Her leadership, insights and unwavering commitment have left a lasting impact on our organization. On behalf of the Board of Directors, the executive leadership team and all of us at Acadia, we extend our sincere gratitude to Heather and wish her continued success in her next chapter.

最後，我想花點時間感謝 Heather Dixon，她將於本月稍後辭去財務長一職。在過去的兩年裡，希瑟在加強我們的財務基礎和推進我們的成長策略方面發揮了重要作用。她的領導力、洞察力和堅定不移的承諾給我們的組織留下了持久的影響。我謹代表董事會、執行領導團隊和阿卡迪亞全體員工向 Heather 表示誠摯的感謝，並祝福她在新的篇章中繼續取得成功。

As we begin the search for a permanent successor, I'm pleased to announce that Tim Sides, currently Senior Vice President of Operations Finance, will assume the role of Interim CFO. Tim brings extensive experience and deep operational expertise, and we are confident in his ability to ensure a seamless transition and continued financial stewardship.

當我們開始尋找永久繼任者時，我很高興地宣布，現任營運財務高級副總裁 Tim Sides 將擔任臨時財務長。蒂姆擁有豐富的經驗和深厚的營運專業知識，我們相信他有能力確保順利過渡和持續的財務管理。

With that, I would now like to turn the call over to Heather to discuss our financial results for the quarter.

現在，我想將電話轉給 Heather，討論一下我們本季的財務表現。

Thanks, Chris, and good morning, everyone. We reported $869.2 million in revenue for the quarter, representing a 9.2% increase over the second quarter of last year. Adjusted EBITDA for the second quarter of 2025 was $201.8 million, reflecting an adjusted EBITDA margin of 23.2%. Same-facility revenue grew 9.5% year-over-year, including a 7.5% increase in revenue per patient day and 1.8% growth in patient days. On a same-facility basis, adjusted EBITDA was $256 million, and adjusted EBITDA margin was 30.1% in the second quarter of this year.

謝謝，克里斯，大家早安。我們報告本季營收為 8.692 億美元，比去年第二季成長 9.2%。2025 年第二季調整後 EBITDA 為 2.018 億美元，調整後 EBITDA 利潤率為 23.2%。同店營收年增 9.5%，其中每位患者每日收入成長 7.5%，患者每日數量成長 1.8%。以相同設施計算，今年第二季調整後的 EBITDA 為 2.56 億美元，調整後的 EBITDA 利潤率為 30.1%。

During the second quarter, the Tennessee Supplemental Payment Program was approved. As a result, we recognized a favorable pretax benefit of $51.8 million in the quarter, of which $28.5 million related to the fiscal year 2024 and $11 million related to the first quarter of 2025, with $12.3 million related to the second quarter of 2025. This compares to $8.6 million in net supplemental payments from the state recognized in the second quarter of 2024.

第二季度，田納西州補充支付計畫獲得批准。因此，我們在本季確認了 5,180 萬美元的稅前收益，其中 2,850 萬美元與 2024 財年有關，1,100 萬美元與 2025 年第一季有關，1,230 萬美元與 2025 年第二季有關。相較之下，2024 年第二季州政府確認的淨補充支付為 860 萬美元。

Also included in our second quarter results were start-up losses of $14.2 million related to recently opened facilities compared to $4.6 million in the second quarter of 2024.

我們第二季的業績還包括與最近開設的設施相關的 1,420 萬美元的啟動損失，而 2024 年第二季為 460 萬美元。

Looking at the balance sheet. Maintaining a strong financial position remains a top priority, providing us with sufficient capital to make strategic investments in our business. As of June 30, we had $131.4 million in cash and cash equivalents and $828 million available under our $1 billion revolving credit facility.

查看資產負債表。保持強勁的財務狀況仍然是我們的首要任務，這為我們提供足夠的資金對我們的業務進行策略性投資。截至 6 月 30 日，我們擁有 1.314 億美元的現金和現金等價物，以及 10 億美元循環信貸額度下的 8.28 億美元可用資金。

Moving on to our outlook for 2025. Based on our results through the first half of the year, we are updating our adjusted EBITDA range for the full year to $675 million to $700 million. This is primarily due to lower expected volume growth and higher start-up costs, partially offset by an increase in anticipated supplemental payments. For modeling purposes, we expect our Q3 adjusted EBITDA to be modestly above Q4, which is in line with typical seasonality.

接下來展望 2025 年。根據我們今年上半年的業績，我們將全年調整後的 EBITDA 範圍更新為 6.75 億美元至 7 億美元。這主要是由於預期銷售成長較低和啟動成本較高，但預期補充付款的增加部分抵消了這一影響。出於建模目的，我們預計第三季調整後的 EBITDA 將略高於第四季度，這與典型的季節性相符。

For the full year, we now expect same-facility volume growth in the range of 2% to 3% compared to the prior expectation of low to mid-single digits. Start-up losses are expected to be approximately $60 million to $65 million for the full year. The $10 million increase relative to our prior guidance is due to new facility construction running ahead of schedule.

就全年而言，我們現在預計同設施銷售成長率將在 2% 至 3% 之間，而先前預期的成長率為低至中等個位數。預計全年啟動損失約 6,000 萬至 6,500 萬美元。與我們之前的指導相比，增加 1000 萬美元是由於新設施建設提前完成。

For the full year, we now expect to add between 950 and 1,000 total beds compared to our previously expected range of 800 to 1,000 beds. We now expect net Medicaid supplementals to increase by $30 million to $40 million in 2025 as compared to the prior year, including a $40 million to $45 million recurring benefit from the recently approved Tennessee program.

就全年而言，我們預計新增床位數量為 950 至 1,000 張，而先前預期的新增床位數量為 800 至 1,000 張。我們現在預計，到 2025 年，醫療補助淨補助將比上一年增加 3,000 萬至 4,000 萬美元，其中包括最近批准的田納西州計劃帶來的 4,000 萬至 4,500 萬美元的經常性福利。

With that, we're ready to open the call for questions.

好了，我們現在可以開始提問了。

(Operator Instructions)

（操作員指示）

A.J. Rice with UBS.

瑞銀的 A.J. Rice。

Just maybe drill down a little bit on your comment about Medicaid, maybe expand a little bit on exactly what you're seeing? Is it an issue with getting you get the patients in, but they are not approving the length of stay you think they should approve? Or are they not referring the patients over? And is this something specific to Acadia or do you think this is happening across the board? And maybe then, where are those patients going, I guess?

也許您可以深入探討一下您對醫療補助的評論，也許可以詳細說明您所看到的具體情況？讓病人入院有問題嗎？但是他們不批准您認為他們應該批准的住院時間？還是他們沒有把病人轉診過來？這是阿卡迪亞獨有的現象嗎？還是您認為這種情況很普遍？那麼，我想，那些病人可能要去哪裡呢？

Yes, A.J., this is Chris. Thanks for the question. The primary driver of volume coming in below our expectations really was the weaker Medicaid volumes in our acute care business, which is what you're asking about. I'd say a couple of things. I think we believe this reflects some of the evolving utilization patterns among managed Medicaid plans, which are navigating elevated cost pressures across the board. And it appears these dynamics are having some impact on admissions trends across our inpatient services, including behavioral health.

是的，A.J.，這是克里斯。謝謝你的提問。導致交易量低於我們預期的主要原因實際上是我們的急性護理業務中醫療補助交易量較弱，這正是您所問的。我想說幾件事。我認為我們認為這反映了管理醫療補助計劃中一些不斷變化的利用模式，這些計劃正在全面應對不斷上升的成本壓力。看來這些動態對我們的住院服務（包括行為健康）的入院趨勢產生了一定的影響。

There's always a natural tension between providers and payers. And I think we remain confident that the high acuity populations we serve and the strong outcomes we're able to deliver are critical to long-term care cost efficiency as well as network adequacy, and we continue to engage constructively with our partners there on access and outcomes. And so we'll continue to proactively work with our payer partners to that regard.

提供者和付款人之間總是存在著天然的緊張關係。我認為我們仍然相信，我們所服務的高敏感度人群和我們能夠提供的良好結果對於長期護理成本效率和網絡充分性至關重要，並且我們將繼續在獲取和結果方面與我們的合作夥伴進行建設性接觸。因此，我們將繼續積極與我們的付款合作夥伴進行這方面的合作。

Okay. On the start-up costs that you're incurring, I think you upped the number for this year by about $10 million, if I have this right. Is that accelerating programs that were going to come in next year, and therefore, hopefully, that helps the year-to-year trend? Or is it -- it's taking longer, the ramp in the new facilities is slower than you had anticipated, and that's contributing to a step-up in start-up costs?

好的。關於您承擔的啟動成本，如果我沒記錯的話，我認為您今年的啟動成本增加了約 1000 萬美元。這是否會加速明年即將推出的項目，從而有望幫助推動逐年成長的趨勢？還是——花費的時間更長，新設施的建設速度比您預期的要慢，這導致啟動成本增加？

Hi A.J., this is Heather. It's actually a little bit different. So the $10 million in incremental start-up losses is reflective of an accelerated opening pace. So during the year, we have been experiencing some opportunities to open the beds a little more quickly than what we had anticipated. And that means that we are experiencing those incremental start-up costs earlier in the year than what we would have previously anticipated. So that's really what's driving it.

你好，A.J.，我是 Heather。事實上，情況有一點不同。因此，1000 萬美元的增量啟動損失反映了開業速度的加快。因此，在這一年中，我們遇到了一些機會，可以比我們預期的更快地開放床位。這意味著我們在今年早些時候經歷的這些增量啟動成本比我們之前預期的要早。這才是真正的驅動因素。

What that means, though, is it's effectively a pull forward from 2026. So you would expect to see 2026 start-up losses decline even more than we had originally anticipated.

但這實際上意味著它從 2026 年開始向前推進。因此，您可以預期 2026 年初創企業虧損的下降幅度將比我們原先預期的還要大。

Okay. Thanks a lot.

好的。多謝。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

So Chris, you and I have talked in the past about free cash flow outlook. And is there an opportunity in '26 to kind of pull forward your free cash flow positive outlook? And if so, maybe you could elaborate on that.

克里斯，你和我過去曾談論過自由現金流前景。那麼，26 年是否有機會提前實現自由現金流的正面前景？如果是這樣，也許您可以詳細說明一下。

Yeah. Thanks for the question, John. We have previously guided to being free cash flow positive at the end of 2026. I think a couple of points I would make. First of all, the beds that we have built recently, we just believe are going to continue to pay dividends for years to come as they ramp up, and we continue to be really excited about those.

是的。謝謝你的提問，約翰。我們先前曾預測到 2026 年底自由現金流將為正值。我想提出幾點。首先，我們相信，隨著我們最近建造的床位數量的增加，它們將在未來幾年繼續帶來回報，我們對此感到非常興奮。

I think as most know, we built and licensed 776 beds last year. And we expect to build up to 1,000 beds this year, and we continue to be on track there. However, given the environment and more specifically, the policy environment, with the amount of uncertainty created by the recently passed Big Beautiful Bill, we're going to absolutely take a harder look and are taking a harder look at capital spending in our pipeline of projects. So we have the opportunity to take a pause on some of our expansion capital spending.

我想大多數人都知道，我們去年建造並許可了 776 張床位。我們預計今年將建造多達 1,000 張床位，並且我們將繼續按計劃進行。然而，考慮到環境，更具體地說是政策環境，以及最近通過的《大美麗法案》造成的不確定性，我們絕對會更加認真地審視並更加認真地審視我們項目中的資本支出。因此，我們有機會暫停部分擴張資本支出。

This would, of course, enable us to unlock more of the underlying free cash flow of the business at a faster pace. And I'd also add that it would have the added benefit of enabling us to unlock more near-term EBITDA. Start-up costs would decline at a faster pace. And at the same time, we still have the multiyear benefit of a significant number of ramping beds that we have assembled over the past few years that are coming online.

當然，這將使我們能夠以更快的速度釋放更多業務的潛在自由現金流。我還要補充一點，它還有一個額外的好處，就是讓我們能夠獲得更多近期的 EBITDA。啟動成本將會以更快的速度下降。同時，我們仍可享受過去幾年組裝的大量即將投入使用的斜坡床的多年收益。

And so we're in the process of looking at all this now. I think to give you a granular example, we've identified two facilities in our pipeline that we have hit the pause button on, and that will save us over $100 million in CapEx over the next couple of years. We're still going through the process and we expect to have more to say over the next few months. But to your question, we do think that there is opportunity to accelerate our path to becoming free cash flow positive as a result.

所以我們現在正在研究這一切。我想給你一個具體的例子，我們已經確定了管道中的兩個設施，我們已經按下了暫停按鈕，這將在未來幾年內為我們節省超過 1 億美元的資本支出。我們仍在進行這一過程，預計在接下來的幾個月裡會有更多消息公佈。但對於您的問題，我們確實認為有機會加速實現自由現金流為正的進程。

Great. And just my follow-up is going back to A.J.'s question on Medicaid. So a couple of things there. So are you seeing a difference between nonmanaged Medicaid and Medicaid in terms of admissions? And do you have a stat -- like is there some stat that says, okay, we're -- we can quantify the [now] rates or prior auth rates that are elevated by x amount? I'm just kind of curious -- or do you think part of this would be the fact that the Medicaid population continues to shrink with redetermination 2.0? So I'm just trying to get a sense, is it a smaller population? Or can you really point to something that says, yes, they're just making it -- that they've stepped up the prior offer, they're just making it harder to get referrals?

偉大的。我的後續問題是回到 A.J. 關於醫療補助的問題。這裡有幾件事。那麼，您是否認為非管理型醫療補助和醫療補助在入院方面有差異？您是否有一個統計數據 - 例如是否有一些統計數據表明，好吧，我們 - 我們可以量化 [現在] 利率或先前授權利率，這些利率提高了 x 量？我只是有點好奇——或者您認為部分原因是隨著重新確定 2.0，醫療補助人口繼續減少？所以我只是想了解一下，人口是不是變少了？或者你真的可以指出一些東西來表明，是的，他們只是在這樣做——他們已經提高了先前的報價，他們只是讓獲得推薦變得更加困難？

Yes. John, I would not call anything out with respect to managed Medicaid plans and the difference, and I just don't think that there are any statistics right now that we -- I mean, it's something that we're going to continue to look at, but there is nothing right now that we would pinpoint on that front.

是的。約翰，我不會對管理式醫療補助計劃及其差異提出任何質疑，我只是認為現在還沒有任何統計數據可以讓我們——我的意思是，我們會繼續關注這個問題，但目前我們還沒有任何可以明確指出這一點的數據。

Okay. Thank you.

好的。謝謝。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

How much did the underperforming facilities drag on your same-store patient days within the quarter? And then you've called out $20 million of losses on those underperforming facilities. Has that changed at all? Would you expect that to normalize by the fourth quarter? Or those -- could those go lower or higher?

在本季內，表現不佳的設施對您同店病患就診天數造成了多大的拖累？然後你又指出這些表現不佳的設施造成了 2,000 萬美元的損失。情況有改變嗎？您預計這種情況到第四季會恢復正常嗎？或者那些——那些會變得更低或更高嗎？

Yes. Thanks for the question, Whit. This is Chris. I'll take it. I think I'd step back and just remind everyone that our 2025 guidance assumed a roughly $20 million EBITDA headwind for the full year from this group of underperforming facilities that we called out back during the fourth quarter. And these facilities have performed overall in line with our expectations.

是的。謝謝你的提問，惠特。這是克里斯。我要買它。我想我應該退一步提醒大家，我們的 2025 年指導方針假設全年這組表現不佳的設施將帶來約 2000 萬美元的 EBITDA 逆風，這些設施是我們在第四季度召回的。這些設施的整體表現符合我們的預期。

On a year-over-year basis, they did have a negative impact on our same-facility patient volume growth of about 80 basis points in the second quarter. So we expect to begin to comp over this headwind, the volumes in the fourth quarter of this year.

與去年同期相比，它們確實對我們第二季度同一設施的患者數量增長產生了約 80 個基點的負面影響。因此，我們預計今年第四季的銷售將開始克服這一不利因素。

A couple of things: I think the underperformance of facilities has tended to be correlated to more intense local media coverage. I referenced that in the prepared remarks within a facility's local market rather than any news at the national level.

有幾件事：我認為設施表現不佳往往與當地媒體的更密集報導有關。我在設施本地市場的準備好的評論中提到了這一點，而不是在國家層面的任何新聞中。

And I'd also say it's just difficult for us to put an estimate on the timing of the turnaround of the small group of facilities. We, therefore, believe it is prudent to take a more conservative approach when we set the guidance. But we're continuing to work through these every day. And I think that hopefully answers your question.

而且我還想說，我們很難估計一小部分設施的恢復時間。因此，我們認為在製定指導時採取更保守的方法是謹慎的。但我們每天都在繼續努力解決這些問題。我認為這有望回答你的問題。

Maybe I'll just add one more piece in from a numbers perspective with -- we had called out, we thought it would be a drag of around $20 million for the full year. We are seeing that be about $3 million worse than what we had originally anticipated. And that is attributable to the one facility that Chris has called out, which we are clearly watching very, very closely.

也許我只是想從數字的角度再補充一點——我們曾說過，我們認為這將拖累全年約 2000 萬美元的損失。我們發現這比我們最初預期的損失約為 300 萬美元。這要歸功於克里斯提到的一個設施，我們顯然正在非常密切地關注它。

Okay. And then maybe just on the guidance for the full year, Heather. Just any bridge or framework that you can provide for us to think about first half to second half to give us some confidence in the achievability of the full year, maybe comment on the net supplemental funding increases in the second half in malpractice?

好的。然後也許只是關於全年的指導，希瑟。您能否提供任何橋樑或框架，讓我們思考上半年到下半年的情況，讓我們對全年的可實現性有信心，也許可以評論一下下半年瀆職行為的淨補充資金增加情況？

Yes. Let me take those in turn. I'll say a couple of things on the bridge from a guidance perspective. if you look at the different pieces that are really driving the change that we made, I'd start with the start-up losses that I talked about. So that's about an incremental $10 million. And that, of course, is due to the faster bed opening pace that we just talked about. Those are offset by our incremental supplemental payments.

是的。讓我依序討論這些。我將從指導的角度講幾件事。如果你看看真正推動我們所做改變的不同部分，我會從我談到的啟動損失開始。因此這大約是 1000 萬美元的增量。當然，這是由於我們剛才談到的床鋪打開速度更快所致。這些都被我們的增量補充付款所抵消。

We now expect supplemental payments to be about $25 million to $30 million better than what we previously expected. You recall, we previously expected for supplemental payments to be flat to up $15 million on a net basis year-over-year, and we now expect that to be $30 million to $40 million of a tailwind for the full year.

我們現在預計補充付款將比我們之前預期的多出約 2500 萬至 3000 萬美元。您還記得，我們​​之前預計補充支付將與去年同期持平或淨增加 1500 萬美元，而現在我們預計全年補充支付將達到 3000 萬至 4000 萬美元。

Those -- that's offset by the volume that Chris has been talking about. The remainder of the change in our guidance would be related specifically to those softer volumes, and we think that's around the $30 million drag for the year. So those are the moving pieces.

這些——被克里斯一直在談論的音量所抵消。我們指引中其餘的變化將與這些較弱的交易量具體相關，我們認為這將為今年帶來約 3,000 萬美元的拖累。這些就是移動的部分。

If you -- I mean the second part of your question, you asked about -- what's -- how we ramp from the first half to the second half and what gives us confidence, I'll talk about a couple of things. If you think about the second half and what will be coming through, the first is our normal rate updates. You'll recall that those disproportionately happen in the second half of the year.

如果你——我的意思是你問題的第二部分，你問的是——我們如何從上半年過渡到下半年，以及是什麼給了我們信心，我會談幾件事。如果您考慮下半年以及將會發生什麼，首先是我們的正常利率更新。你會記得，這些情況通常發生在下半年。

And then the second thing I would point to is the supplemental payments again. Excluding Tennessee, we also expect higher supplemental payments in the second half of the year compared to the first from various other state increases that we're seeing.

然後我要指出的第二件事是補充付款。除田納西州外，我們也預計今年下半年其他各州的補充支付額將高於上半年。

And then finally, from a volume perspective, we'll be seeing a growing contribution from the new beds that we have added as we move throughout the year. There are two pieces to that. I'd say particularly related to our 2023 cohort of de novos, those have now been in place for long enough that we're seeing some really good contribution from those, and particularly as we move into the second half of the year, just given the timing of the openings for 2023.

最後，從數量的角度來看，隨著我們全年的發展，我們將看到新增床位的貢獻不斷增加。這其中有兩點。我想說的是，特別是與我們 2023 年的新員工隊伍有關，這些新員工已經存在很長時間了，我們看到了他們做出的一些非常好的貢獻，特別是當我們進入下半年時，考慮到 2023 年的開放時間。

And then also the recent bed expansions that we have added, remember, we've added almost 200 this year alone. And of course, those will begin and will continue to ramp for the second half of the year. So those are really the moving pieces from the first half to the second half. And I'll just remind you that we're also comping over the headwind from the underperforming facilities that began in the fourth quarter of last year.

此外，我們最近還增加了床位，記住，光是今年我們就增加了近 200 張。當然，這些措施將會在今年下半年開始，並將繼續推進。所以這些確實是從上半場到下半場的移動部分。我只是想提醒大家，我們也正在克服去年第四季開始的設施表現不佳所帶來的不利因素。

Sure. Thanks.

當然。謝謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特（Brian Tanquilut），傑富瑞集團。

Maybe just a question for us on fundamentals. Heather, as I think about wages or wage [fed] up, what, like 7%, 7.8% year-over-year. Obviously, volumes have been in the low single-digit range. Just curious what you're seeing on the wage front and just the labor expense line?

也許這只是一個關於基本面的問題。希瑟，我想到薪資或薪資上漲，大概是年增 7% 或 7.8%。顯然，交易量一直處於個位數的低點範圍內。只是好奇您在工資方面和勞動力費用方面看到了什麼？

Yeah. We're actually seeing some really good improvements and, frankly, consistency with some improvement on that line from a labor and wage front, we've seen a reduction in premium costs as well. And that's all very favorable that we're watching. We had -- of course, you'll recall that we had seen some pretty high watermarks a few years back from a labor perspective.

是的。我們實際上看到了一些非常好的改進，坦白說，與勞動力和工資方面的一些改進相一致，我們也看到了保費成本的降低。我們所看到的一切都非常有利。當然，你會記得，幾年前從勞工角度來看，我們已經看到了一些相當高的水位。

We've been managing that very closely and focused on it. We had reported previously that we were below the 5% mark whenever we were looking quarter-to-quarter. We've seen that come down even further. It's now roughly around the 3.5% range of what we saw for second quarter, and we see stability in that number.

我們一直在密切管理並關注此事。我們之前曾報告稱，無論何時，按季度來看，我們的成長率都低於 5%。我們看到這一數字進一步下降。現在它大約處於第二季度 3.5% 左右的水平，而且我們認為這個數字比較穩定。

Got it. And then my follow-up, Chris, as I look at the disclosures, it looks like you spent $54 million or so during the quarter in government investigations, air quotes. Curious, anything you can share with us in terms of are there settlement numbers included in that? And any progress you're seeing in terms of the discussions with the government to address these issues?

知道了。然後我的後續問題，克里斯，當我查看披露資訊時，看起來你在本季度在政府調查上花費了大約 5400 萬美元，空中報價。好奇的是，您可以與我們分享其中是否包含結算數字嗎？您認為與政府討論解決這些問題方面有什麼進展嗎？

Sure. Thanks for the question. A few things that I would point out. I think as we've previously communicated, we're committing to and have been committed to conducting a very thorough and independent review of our operations while continuing to work very cooperatively with the DOJ and the SEC. And while the pace of the government investigations and the related internal reviews that we're doing are going to naturally ebb and flow, much of the independent review and the cooperative engagement with the government has been performed in the first half of the year.

當然。謝謝你的提問。我想指出幾點。我認為，正如我們之前所傳達的那樣，我們承諾並一直致力於對我們的營運進行非常徹底和獨立的審查，同時繼續與司法部和證券交易委員會進行密切合作。雖然我們正在進行的政府調查和相關內部審查的步伐自然會有所起伏，但大部分獨立審查和與政府的合作都是在今年上半年進行的。

And so we can't predict how long this process will take or how much the investigation and engagement with the government was going to ultimately cost, but we do currently anticipate a reduction and the costs associated with the investigation over the second half of the year. And anything you'd add, Heather?

因此，我們無法預測這個過程需要多長時間，或者調查和與政府的接觸最終將花費多少，但我們目前預計今年下半年與調查相關的成本將會減少。還有什麼要補充的嗎，希瑟？

Yes. I would just pick up on the last part of your question there around whether there are any settlement costs in there? There are not. Those are just legal fees specifically related to the investigations and sort of the pieces that Chris just walked through. Any settlements on normal recurring litigation items or the cost of defending those items is included in our other operating expenses.

是的。我只想繼續回答你問題的最後一部分，其中是否有任何結算費用？沒有。這些只是與調查以及克里斯剛剛談到的部分有關的法律費用。任何針對正常重複訴訟項目的和解或辯護這些項目的費用都包含在我們的其他營運費用中。

Got it. Thank you.

知道了。謝謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Back to sort of the managed Medicaid question. A process perspective, if a patient shows up in the ER, how is managed Medicaid blocking them from getting admitted? Or are they just stuck in the ER until they stabilize? Or are they blocking patients coming from the court, schools or parents?

回到管理醫療補助的問題。從流程角度來看，如果病人出現在急診室，管理的醫療補助如何阻止他們入院？還是他們只能留在急診室直到病情穩定？還是他們阻止了來自法院、學校或家長的病人？

Yes. Pito, I would say it can completely depend. I mean there clearly can be authorization challenges that we can see on the front end where there are frequent approval, things that were streamlined before we have to go back and get multiple approvals. There can just be some general friction throughout the patient stay that we're dealing with as well. We continue to be very confident that we're going to be able to constructively work through this. I want to point that out, but that's what we're seeing.

是的。Pito，我想說這完全取決於。我的意思是，我們在前端顯然可以看到授權挑戰，因為前端需要頻繁批准，而以前我們必須回去獲得多次批准，而這些事情已經簡化了。在病人住院期間，我們也會遇到一些普遍的摩擦。我們仍然非常有信心，我們將能夠建設性地解決這個問題。我想指出這一點，但這就是我們所看到的。

Okay. Great. And then looking at your Medicaid population in acute specialty, CTC and residential, how do you think that the work requirements could impact each of those segments?

好的。偉大的。然後看看急性專科、CTC 和住宅中的醫療補助人口，您認為工作需求會如何影響每個部分？

Yeah. Thanks for the question. I would say that just generally, with work requirements, CMS is still in the process of writing the regulatory language there. But I think just the broader point for us is that we think that that all mental health and substance use treatments are going to be exempt from the Big Beautiful Bill's new copays that are going to apply. And that will directly have relevance to our patient population across the board.

是的。謝謝你的提問。我想說的是，一般來說，對於工作要求，CMS 仍然處於編寫監管語言的過程。但我認為，對我們來說，更廣泛的觀點是，我們認為所有心理健康和藥物使用治療都將免於適用《美麗大法案》的新共付額。這將與我們所有的患者群體直接相關。

I think there is still a little bit of work that's being done with respect to CMS and the language. I mean, I would call out that we believe that the significant majority of the populations will be exempt. But HHS also noted that from the work requirement provisions until '28 that if a state is making reasonable efforts to implement the rule, they can be exempted.

我認為在 CMS 和語言方面還有一些工作要做。我的意思是，我想說，我們相信絕大多數人口都會被豁免。但衛生與公眾服務部也指出，從工作要求條款到 28 年，如果一個州正在做出合理的努力來實施該規則，他們就可以獲得豁免。

So I would say it's hard to predict. There is a scenario that many or most states would delay as much as possible. I'd remember that states have had the option in the past of implementing work requirements at the state level, and only a small minority have actually pursued them as -- notably Missouri, which then quickly repealed its programs. But this is something that we're continuing to follow and feel like we're continuing to be well positioned with our patient population.

所以我認為這很難預測。有一種情況是，許多或大多數州都會盡可能地拖延。我記得過去各州可以選擇在州一級實施工作要求，但只有少數州真正實施了這些要求——尤其是密蘇裡州，該州隨後很快廢除了其計劃。但這是我們將繼續關注的事情，並且感覺我們在患者群體中繼續處於有利地位。

Thanks so much.

非常感謝。

Ben Hendrix, RBC.

本‧亨德里克斯 (Ben Hendrix)，加拿大皇家銀行。

And reiterate, congratulations and best of luck to Heather. Just thinking through the other smaller elements of the guidance -- of the bridge to guidance. I think that last quarter, you had called out about a $5 million headwind from closed facilities year-over-year and $10 million increase in professional liability fees. Just wanted to see if any of those elements, first of all, have changed?

再次向 Heather 表示祝賀並祝她好運。只需思考指導中的其他較小元素——指導的橋樑。我認為上個季度，您曾指出，關閉設施造成的不利影響去年比去年約 500 萬美元，專業責任費增加 1,000 萬美元。首先，我只是想看看這些元素是否有任何變化？

No. And thank you for the kind words, Ben. I appreciate it. There are not any changes to those other items. It's really just the few that I talked about.

不。謝謝你的善意，本。我很感激。其餘項目沒有任何變更。我實際上只談到了其中的幾個。

Okay. And then just following up a little bit on the headwind from the underperforming facilities. Can you talk a little bit about your strategic alternatives for addressing those facilities in the future? Specifically, how are you balancing your ability to address the referral headwinds that you're having there that may be press related versus potential for exit in those markets?

好的。然後稍微跟進一下表現不佳的設施所帶來的不利影響。您能否談談未來解決這些設施問題的策略選擇？具體來說，您如何平衡自己解決可能與媒體相關的建議阻力和退出這些市場的可能性的能力？

Yeah. Thanks for the question, Ben. I appreciate it. I would say several different things. First of all, we're constantly evaluating our portfolio. And as we go through the trade-offs, we've said in the past that we just won't hesitate to close underperforming facilities if we don't see a path to improvement. We have worked extensively in -- with so many of these facilities that have had media headwinds to be proactive in reaching out to referral partners and to be very deliberate in making that happen. And we've been doing that all year long, and we've seen real success in making that happen.

是的。謝謝你的提問，本。我很感激。我想說幾件不同的事情。首先，我們不斷評估我們的投資組合。當我們進行權衡時，我們過去曾說過，如果我們看不到改進的途徑，我們會毫不猶豫地關閉表現不佳的設施。我們與許多面臨媒體阻力的機構進行了廣泛的合作，積極主動地聯繫推薦合作夥伴，並非常謹慎地實現這一目標。我們一整年都在這樣做，並且取得了真正的成功。

But we do have 274 facilities. And as always the case, we're going to continue to routinely evaluate the portfolio. And when on a case-by-case basis, we find a situation that we can't indefinitely fund without a path to viability or strong utilization, then that would be a scenario that we would look at potentially closing a facility. We really believe that would be in a responsible use of resources that could be deployed where more acutely needed. And we're very focused on capital allocation and getting a maximum return on our capital for investors.

但我們確實有 274 個設施。與往常一樣，我們將繼續定期評估投資組合。當我們根據具體情況發現某種情況時，如果找不到可行性或高利用率的途徑，我們就無法無限期地為其提供資金，那麼在這種情況下，我們就會考慮關閉該設施。我們確實相信，這將是一種負責任的資源利用方式，可以部署到更急需的地方。我們非常注重資本配置，並為投資者獲得最大的資本回報。

So -- also, if we have a facility that doesn't fit in strategically, we want to have the flexibility to reevaluate the operation. That could mean an exit. It could mean we temporarily close it, we repurpose the facility to better fit strategically as well. But we're also going to continue to expand our bed capacity and open facilities across the portfolio that do make sense and have a continued strong return, and we're just monitoring that each and every day, including with our very respected JV partners.

因此，如果我們的設施在策略上不合適，我們希望能夠靈活地重新評估營運。這可能意味著退出。這可能意味著我們要暫時關閉它，重新利用該設施以更好地適應戰略。但我們也將繼續擴大我們的床位容量，並在整個投資組合中開放設施，這些設施確實有意義，並能持續帶來強勁的回報，我們每天都在監控這一點，包括與我們非常受尊敬的合資夥伴一起。

Great. Thank you.

偉大的。謝謝。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I'm still confused on the weaker Medicaid volumes. How are you able to isolate this as a payer issue versus broader Medicaid disenrollment or a pullback from the immigrant population? Is that just a working theory on your end? Or is there more concrete evidence to support that? And if this is a payer issue, why would this improve when the national Medicaid payers are well below margin targets and likely increasing utilization management near term?

我仍然對醫療補助金額減少感到困惑。您如何能將其作為付款人問題與更廣泛的醫療補助取消登記或移民人口減少問題區分開來？這只是你的一個工作理論嗎？或者有更具體的證據支持這一點？如果這是付款人的問題，那麼當國家醫療補助付款人的利潤率遠低於目標並且可能在短期內增加利用率管理時，為什麼情況會改善？

Yeah. I would just say, Andrew, that we're seeing different behavior by payer that we're continuing to monitor every single day. I wouldn't call anything out on the immigrant front. I mean, this is all very new that we're continuing to watch and monitor. I mean, it's -- what's not new is that there has always been a natural tension between payer and providers. And we're going to continue to monitor and work through that.

是的。我只想說，安德魯，我們看到付款人的行為有所不同，我們每天都在持續監控。我不會對移民問題發表任何言論。我的意思是，這一切都是全新的，我們將繼續觀察和監控。我的意思是，付款人和提供者之間一直存在著天然的緊張關係，這並不是什麼新鮮事。我們將繼續監測並努力解決這個問題。

Okay. And maybe just a follow-up on cash flow. I think your operating cash flow guidance was revised down $12 million for the year, which was in line with the EBITDA reduction. Can you remind us what's excluded from that number and what that number would look like on a reported basis?

好的。或許只是對現金流的追蹤。我認為您今年的經營現金流指導下調了 1200 萬美元，這與 EBITDA 的減少一致。您能否提醒我們這個數字不包含什麼以及報告的數字是什麼樣的？

So the cash flow -- the free cash flow obviously is looking at our operating cash flow. It then excludes sort of the usual items that would come about that are sort of the fundamental items like debt service and those types of things. But it also -- sort of in our case, the question that we have been going through on two things: one, CapEx; and then also non-recurring [legal] costs are excluded there as well.

因此，現金流——自由現金流顯然指的是我們的經營現金流。然後，它排除了通常會出現的一些基本項目，例如債務償還和諸如此類的事情。但就我們的情況而言，我們一直在討論的問題有兩個：一是資本支出；二是非經常性[法律]成本也被排除在外。

Got it. So that number needs to be adjusted down at least $100 million for the transaction costs, correct?

知道了。因此，該數字需要下調至少 1 億美元以彌補交易成本，對嗎？

So yeah, so there was roughly [$30 million in Q1 and then another $50 million] in Q2. So if you're looking at the full year, that's not a bad estimate, Andrew.

是的，第一季大約有 3000 萬美元，第二季又有 5000 萬美元。因此，如果你看的是全年情況，這不是一個糟糕的估計，安德魯。

Okay. Thank you.

好的。謝謝。

Matthew Gillmor, KeyBanc.

馬修‧吉爾摩 (Matthew Gillmor)，KeyBanc。

And best wishes to Heather as well. Following up on the acute volume pressures you called out for Medicaid. Is there anything you'd note in terms of how volumes progressed throughout the quarter and maybe even into July? Just curious if there was a cadence with respect to some of the pressures you're seeing on the Medicaid side.

也向 Heather 致以最良好的祝愿。追蹤您所呼籲的醫療補助的嚴重容量壓力。您是否注意到整個季度甚至 7 月份的交易量變化？我只是好奇，在醫療補助方面，您是否看到了一些壓力的節奏。

I'll let Chris answer that. But I'll just say thank you for the kind wishes, Matt. I appreciate it.

我讓克里斯來回答這個問題。但我只想說謝謝你的美好祝愿，馬特。我很感激。

I would say we started out the quarter with volumes running a little bit higher in the 3% range, and those came down and then have leveled out to between 1% and 2%, which we saw in the final month of June. So it was -- it started out, came down a little bit and then went back up and has leveled off.

我想說的是，本季初我們的交易量略高，在 3% 左右，然後下降，然後穩定在 1% 到 2% 之間，我們在 6 月的最後一個月看到了這一點。情況就是這樣——一開始，下降了一點，然後又回升並趨於平穩。

And then I wanted to see if you could provide some comments on the stronger commercial and Medicare volumes. I guess intuitively, it would seem like given the supply and demand dynamics, you can probably backfill some of the softer Medicaid volumes. But just kind of curious on the Medicare commercial trend, if there's anything in particular driving that? And is there a comment with respect to kind of backfilling that capacity as it becomes available?

然後我想看看您是否可以對更強勁的商業和醫療保險量提供一些評論。我想，從直覺上講，考慮到供需動態，似乎可以填補一些較軟的醫療補助額度。但我只是對醫療保險商業趨勢有點好奇，是否有任何特別的因素推動這個趨勢？對於在容量可用時如何填補這一問題，您有何評論？

The only thing that I would call out is just that our managed care team, I think, has done an excellent job of just continuing to secure commercial and Medicare contracts throughout the year. And over the past year, we obviously have a strong Medicaid concentration, but we've done a really good job of being deliberate about trying to diversify that and have been able to successfully contract across the board. So that's all I would call out.

我唯一要說的是，我認為我們的管理式醫療團隊在全年繼續確保商業和醫療保險合約方面做得非常出色。在過去的一年裡，我們顯然在醫療補助方面投入了大量精力，但我們在嘗試實現多元化方面做得非常好，並且能夠成功地簽訂全面的合約。這就是我要說的全部。

Got it. Thank you.

知道了。謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓 (Ryan Langston)，TD Cowen。

I guess, looking for any updates on the conversations with these referral sources at these underperforming facilities. I guess, are you making any progress there at all? And maybe just more broadly, like what are these referral sources looking for from you to maybe start ramping up those referrals again?

我想，正在尋找與這些表現不佳的設施的推薦來源對話的任何更新。我猜，你在那裡取得了任何進展嗎？也許更廣泛地說，這些推薦來源希望從您那裡得到什麼，以便可能再次開始增加這些推薦？

Yeah. No, thanks for the question. I would say it really depends. I think one of the things that we always do with our referral sources is we're very intentional about pointing out the acuity of the patients that we serve. And we're also very deliberate about bringing them into the facilities so that they can actually see the good work that we're doing every day.

是的。不，謝謝你的提問。我想說這確實取決於情況。我認為，我們始終對轉診來源採取的措施之一就是，我們非常有意地指出我們所服務的患者的病情敏銳度。我們也非常有意地將他們帶入設施，以便他們可以真正看到我們每天所做的工作。

We are very intentional about discussing the strong investments that we've made in quality, and we show them what we're doing with respect to patient monitoring, the staff safety devices we put in place, our EMRs, the way that we are monitoring quality through our Joint Commission and software. It's really important that they see not only the talk around quality, but how that's following -- how we're following through on that.

我們非常有意討論我們在品質方面所做的大量投資，並向他們展示我們在病患監測、我們安裝的員工安全設備、我們的電子病歷 (EMR) 以及我們透過聯合委員會和軟體監測品質的方式方面所做的工作。真正重要的是，他們不僅要看到有關品質的討論，還要看到我們如何貫徹這些討論。

And we've seen real success across the board. We're always trying to get them on site. But even when we're not, I think we've done a very good job of helping them translate the investments that we've made across the board in technology and quality into very strong results.

我們已經看到了全面真正的成功。我們總是試圖讓他們到達現場。但即使我們沒有做到這一點，我認為我們已經做得很好了，幫助他們將我們在技術和品質方面所做的全面投資轉化為非常強勁的成果。

I think the other thing I would point out is we have very strong patient satisfaction scores that we have been very intentional about measuring. And we're -- even with involuntary admissions, they continue to be very strong. So we certainly share those as they become available. And we also have been very intentional about sharing data with respect to patient outcomes.

我想指出的另一件事是，我們擁有非常高的患者滿意度評分，我們一直非常有意地進行衡量。而且我們 — — 即使有非自願入院的情況，他們的勢頭仍然非常強勁。因此，一旦有可用信息，我們一定會分享。我們也非常有意分享患者結果的數據。

Our patients getting better clinically as a result of our care, is the quality of their life improving. All of our data says that the outcomes have been very strong on that respect. And so we're sharing that patient experience, the patient outcomes, the data and getting them on site. And that has just proven to be very successful.

在我們的照護下，患者的臨床狀況得到改善，他們的生活品質得到改善。我們所有的數據都表明，這方面的結果非常強勁。因此，我們分享患者的體驗、患者的結果、數據並讓他們到現場。事實證明，這是非常成功的。

Great. And you mentioned sort of issues at one particular facility. I think you said local market pressure. Could you elaborate on exactly what that means? Is that pressure to that facility specifically or something kind of more broad based in that particular market?

偉大的。您提到了某個特定設施存在的問題。我認為您說的是當地市場壓力。能詳細說明一下這到底是什麼意思嗎？這種壓力是專門針對該設施的，還是針對該特定市場的更廣泛的壓力？

What I said in the prepared remarks was with respect to local media that goes back many years that has just proven to be problematic and has challenged us with respect to volumes. And as a result, our performance in that one singular facility.

我在準備好的演講中談到了當地媒體，這些媒體存在多年，但事實證明存在問題，並在數量上給我們帶來了挑戰。因此，我們在那個單一設施中的表現就很好。

Okay. Thanks.

好的。謝謝。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

So a couple of follow-ups. First, on the comments in the prepared remarks around the impact of the [reconciliation] bill and specifically the state Directed Payment Program. So you said more than half of the, I guess, $230 million benefit comes from states that you think may begin to reduce these spreads in fiscal '28. So just to clarify, you saying like more than half as in like not every state because these are the states where the rates under these programs are above Medicare? Is that the reason why you say more than half, not every state?

以下是一些後續問題。首先，關於準備好的評論中關於[和解]法案的影響以及特別是國家定向支付計劃的影響的評論。所以您說，我猜 2.3 億美元的收益中有一半以上來自您認為可能在 28 財年開始減少這些利差的州。所以只是為了澄清一下，您說的「超過一半」是指不是每個州都是如此，因為這些州的這些計劃的費率高於醫療保險？這就是您說超過一半而不是每個州的原因嗎？

That's exactly right.

完全正確。

And as it relates to those programs, the benefit from the Tennessee program is higher than you had expected in year-over-year. So is it essentially because the rates in that particular state under this program are moving up close to commercial rates?

就這些項目而言，田納西州計畫帶來的收益比您預期的要高。那麼，這是否主要是因為該計劃下該州的利率正在接近商業利率？

Yeah.

是的。

Okay. And how, I guess, another question, hopefully, yes or no answer. In terms of your volume outlook, and you mentioned that the comps will be easier in fourth quarter. So do you still expect mid-single digits growth in volumes in Q4 because of the easier comps?

好的。我想，這是另一個問題，希望答案是肯定或否定。就您的銷售展望而言，您提到第四季度的業績將會更容易。那麼，由於可比性更低，您是否仍預期第四季銷售將實現中等個位數成長？

I think that's a reasonable expectation for sure. We still expect that. We had previously said low to mid-single digits and growing to that mid-single digits in the second half of the year, particularly in Q4. We still believe that's true.

我認為這肯定是一個合理的期望。我們仍然期待這一點。我們之前曾說過，今年下半年，特別是第四季度，成長率將達到低到中等個位數。我們仍然相信這是真的。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great. You talked about perhaps taking a bit of a pause on capital spending on a couple of facilities. But maybe can you just help square up the step-up in the midpoint of bed additions this year against the lower CapEx guide? Maybe just said another way, has the CapEx allocation towards kind of bed additions changed, in your view?

偉大的。您談到也許會暫停對一些設施的資本支出。但是也許你可以幫助平衡今年床位增加中點與較低資本支出指南之間的差距？或許換句話說，您認為增加床位的資本支出分配是否改變了？

So it's a great question. So if I think about that in a couple of different pieces, we look at the CapEx for this year, certainly, we had a significant step up related to the significant number of beds that we're adding. What we are seeing is our ability to open some of those beds that we had anticipated earlier than what we had expected. So the CapEx, we expect will decline in the second half of 2025. We continue to expect that. And then we believe it will continue to decline even further as we move into 2026.

這是一個很好的問題。因此，如果我從幾個不同的角度來考慮這個問題，我們看看今年的資本支出，當然，我們在增加大量床位方面取得了顯著的成長。我們看到的是，我們能夠比預期更早開放一些我們預期的床位。因此，我們預計資本支出將在 2025 年下半年下降。我們繼續期待這一點。我們相信，到 2026 年，這一數字將繼續進一步下降。

So the small decrement that you see for the balance of the year is related to what Chris referred to, the pausing of a couple of those projects. Those are projects that are very early stage. So while it takes around two years to complete construction on a facility, the sort of the work in advance of that related to planning and design and some of those elements begins even earlier. And so it's really the elimination from 2025 of those types of costs related to where we will see a reduction in those related to where we're pausing.

因此，您看到的今年餘額的小幅下降與克里斯提到的幾個項目的暫停有關。這些項目都處於非常早期的階段。因此，雖然完成設施的建設大約需要兩年時間，但與規劃和設計相關的前期工作以及其中一些要素則開始得更早。因此，從 2025 年開始，我們將真正消除與我們暫停的地方相關的成本，並減少與我們暫停的地方相關的成本。

Okay. Got it. And maybe just as a follow-up. I know it's early to discuss 2026, but as we think about the '25 EBITDA jump-off point, would we just be excluding the '24 retro kind of fee supplemental payment and think about a kind of a $660 million EBITDA base to jump off for growth next year? Or are there any other puts and takes that might impact kind of where we should think about the jump off point for growth?

好的。知道了。或許只是作為後續行動。我知道現在討論 2026 年還為時過早，但是當我們考慮 25 年 EBITDA 的起點時，我們是否會排除 24 年追溯費用補充支付，並考慮以 6.6 億美元的 EBITDA 基數作為明年增長的起點？或者是否有其他可能影響我們思考成長起點的因素？

So you're right, Jason. It's early to talk about 2026. So I don't want to try to even put any guidance out there, but let me give you a couple of points. First, we have high confidence in the accelerating growth that we're seeing, the success with the bed additions, our ability to pull some of those forward and open them even faster.

所以你是對的，傑森。現在談論 2026 年還為時過早。所以我不想嘗試提供任何指導，但讓我給你幾點。首先，我們對所看到的加速成長、床位增加的成功以及我們加快並更快開放其中一些床位的能力充滿信心。

I just want to make sure that I'm really clear in regards to your question on Tennessee. We walked through the numbers, and they're all laid out in the release. But for 2025, we now expect that the full year will include $40 million to $45 million of net impact from Tennessee, and that will be related to the in-year amounts. So said another way, we can expect somewhere in that range as a run rate on a go-forward basis. So I want to make sure that, that's clear that these are not a onetime payment. They were just a little lumpy.

我只是想確保我對您關於田納西州的問題有清楚的答案。我們仔細研究了這些數字，它們都列在了新聞稿中。但對於 2025 年，我們現在預計全年將包括來自田納西州的 4,000 萬至 4,500 萬美元的淨影響，這將與年內金額相關。換句話說，我們可以預期未來的運行率將處於該範圍內。所以我想確保，這些不是一次性付款。它們只是有點凹凸不平。

And then finally, I'll mention it again, I think it's worth mentioning again. The start-up costs will go down. We always knew that 2025 was going to be a very high watermark from a start-up cost perspective because of the significant number of beds we added in '24 and '25, and then to some element, at the end of '23 as well. So those, we will expect to step down. So I'll stop short of putting any other pieces out there or any numbers around it, but hopefully, that gives you a good idea of how to think about 2026.

最後，我會再次提及它，我認為它值得再次提及。啟動成本將會下降。我們一直都知道，從啟動成本的角度來看，2025 年的成本將非常高，因為我們在 24 年和 25 年增加了大量床位，並且在 23 年底也增加了一些床位。因此，我們希望這些人能夠下台。因此，我不會再提供任何其他資訊或相關數字，但希望這能讓您很好地了解如何考慮 2026 年。

Great. Thank you.

偉大的。謝謝。

Raj Kumar, Stephens.

拉吉·庫馬爾，史蒂芬斯。

Just kind of wanted to reflect on the supply and demand mismatch for higher acuity behavioral services that the company has called out, and hence, the development pipeline and comparing that again the same-store metrics. Maybe can you walk us through where are the gaps beyond just the Medicaid dynamic, just kind of relating to maybe labor, if there's competitive dynamics in your markets that you're seeing that are kind of causing the [non-handful] facilities that are not the previous call out is underperforming, maybe driving that near-term constraint?

只是想反映一下公司所呼籲的更高敏銳度行為服務的供需不匹配問題，以及因此而產生的開發管道，並再次與同店指標進行比較。也許您可以向我們介紹一下，除了醫療補助動態之外，還有哪些差距，可能只是與勞動力有關，如果您看到的市場競爭動態導致先前呼籲的[少數]設施表現不佳，也許是推動了短期限制？

Yeah. No, thank you for the question. I mean, clearly, health care is local, and it's -- every single one of these facilities is in an individual market that are different. And so each one of them, we have to consider that. I mean, there certainly can be situations where there are staffing challenges, and there could be headwinds, but I think we've done a really good job of trying to identify that. There's really nothing I would call out on that front.

是的。不，謝謝你的提問。我的意思是，顯然，醫療保健是地方性的，而且每個設施都位於不同的單獨市場。因此，我們必須考慮到每一個因素。我的意思是，肯定會存在人員配備方面的挑戰，也可能會遇到阻力，但我認為我們已經很好地識別了這些挑戰。關於這一點我實在沒有什麼好說的。

I think the demand is something that, as we've discussed in the prior question, reinforced that our referral sources in these markets are very important. And so we've tried to be very intentional of focusing there as well. So I think those are the major things that we would call out in addition to the things that I previously mentioned in terms of just reinforcing all the investments that we are continuing to make sure that we're treating -- we're caring for these patients appropriately.

我認為，正如我們在上一個問題中所討論的那樣，需求強調了我們在這些市場的推薦來源非常重要。因此，我們也非常有意識地將重點放在那裡。因此，我認為除了我之前提到的那些事情之外，我們還要呼籲的主要事情是加強我們將繼續進行的所有投資，以確保我們對這些患者進行適當的治療和護理。

We're treating them with strong clinical outcomes and that we have results that we can share not only with our referral partners, but also with payers. And I think we've done a very good job of doing that.

我們為他們提供了有效的臨床治療效果，這些結果不僅可以與我們的轉診合作夥伴分享，還可以與付款人分享。我認為我們在這方面做得非常好。

And then as my follow-up, looking at the growth pathways that you've laid out, just maybe an update on the PHP, IHP kind of penetration across your portfolio facilities? I know that was something that you'd previously highlight in terms of how many facilities that you're kind of adding those programs to, but maybe kind of any update in the quarter around that?

然後作為我的後續行動，看看您所列出的成長路徑，也許可以更新 PHP、IHP 在您的投資組合設施中的滲透情況？我知道您之前曾強調過，您將在多少個設施中添加這些程序，但本季是否會有相關的更新？

Yeah. What I would say on PHP, IOP is that we have always believed that, particularly with the strong acute book that we have, that there is a natural step down from our higher acuity patients to PHP and IOP settings. And we've tried to be very intentional about ensuring that, that happens on a very methodical basis.

是的。關於 PHP、IOP，我想說的是，我們始終相信，特別是憑藉我們強大的急性病記錄，從我們的高敏銳度患者到 PHP 和 IOP 設置，存在自然的下降趨勢。我們一直努力有意識地確保這一點，並有條不紊地進行。

I think we have taken some strong ground in enhancing those referral patterns and ensuring that across our book of business, we're always looking to step those patients down to Acadia facilities. That was not always the case. But this is a part of the business that we think has real growth potential over time and that we're continuing to address.

我認為我們在加強這些轉診模式方面已經取得了一些堅實的基礎，並確保在我們的業務範圍內，我們始終希望將這些患者轉診到阿卡迪亞醫療機構。情況並非總是如此。但我們認為，隨著時間的推移，這部分業務具有真正的成長潛力，我們將繼續解決這個問題。

We're not going to call out any specific metrics right now on that, but that's something that we will certainly be coming back and talking more about in the future because at the -- at its essence, there is such an opportunity for us to improve patient outcomes by having an appropriate step down in care. And so PHP will continue -- PHP and IOP will both continue to be an important part of our strategy.

我們現在不會就此提出任何具體的指標，但這是我們將來肯定會再次討論的問題，因為從本質上講，我們有機會透過適當降低護理水平來改善患者的治療效果。因此 PHP 將繼續下去——PHP 和 IOP 都將繼續成為我們策略的重要組成部分。

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。我想將會議交還給克里斯·亨特 (Chris Hunter) 做結束語。

Thank you. In closing, I just want to thank our committed facility leaders, clinicians and approximately 25,000 dedicated employees across the country who have continued to work tirelessly to meet the needs of our patients in a safe and effective manner.

謝謝。最後，我只想感謝我們敬業的機構領導、臨床醫生和全國約 25,000 名敬業的員工，他們一直不懈地努力以安全有效的方式滿足患者的需求。

As the leading pure-play behavioral health provider in the United States, we are proud the important work we're doing to address a critical societal need in our nation, and we remain focused on our purpose to lead care with light. Thank you all for being with us this morning and for your interest in Acadia. Have a great day.

作為美國領先的純行為健康服務提供者，我們為解決國家關鍵的社會需求所做的重要工作感到自豪，並且我們將繼續專注於引領光明醫療的目標。感謝大家今天上午與我們在一起並對阿卡迪亞的關注。祝你有美好的一天。

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。現在您可以斷開線路了。