Addus Homecare Corp (ADUS) 2022 Q4 法說會逐字稿

Good day, and welcome to the Addus HomeCare Fourth Quarter and Year-End 2022 Earnings Conference Call. (Operator Instructions) Please note, this event is being recorded. I would now like to turn the conference over to Dru Anderson. Please go ahead.

美好的一天，歡迎來到 Addus HomeCare 第四季度和 2022 年年底收益電話會議。 （操作員說明）請注意，正在記錄此事件。我現在想將會議轉交給 Dru Anderson。請繼續。

Thank you. Good morning, and welcome to the Addus HomeCare Corporation Fourth Quarter and Year-End 2022 Earnings Conference Call. Today's call is being recorded.

謝謝。早上好，歡迎來到 Addus HomeCare Corporation 2022 年第四季度和年終收益電話會議。今天的通話正在錄音中。

To the extent that any non-GAAP financial measure is discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP by going to the company's website and reviewing yesterday's news release.

如果今天的電話會議中討論了任何非 GAAP 財務指標，您還可以通過訪問公司網站並查看昨天的新聞稿，找到該指標與根據 GAAP 計算的最直接可比財務指標的對賬。

This conference call may also contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements, among others, regarding Addus' expected quarterly and annual financial performance for 2023 or beyond. For this purpose, any statements made during this call that are not statements of historical fact may be deemed to be forward-looking statements. Without limiting the foregoing, discussions of forecasts, estimates, targets, plans, beliefs, expectations and the like are intended to identify forward-looking statements.

本次電話會議還可能包含 1995 年《私人證券訴訟改革法案》含義內的前瞻性陳述，其中包括關於 Addus 2023 年或以後預期季度和年度財務業績的陳述。為此，本次電話會議期間作出的任何非歷史事實陳述均可被視為前瞻性陳述。在不限制前述規定的情況下，對預測、估計、目標、計劃、信念、預期等的討論旨在識別前瞻性陳述。

You are hereby cautioned that these statements may be affected by important factors, among others, set forth in Addus' filings with the Securities and Exchange Commission and its fourth quarter 2022 news release. Consequently, actual operations and results may differ materially from the results discussed in the forward-looking statements. The company undertakes no obligation to update any forward-looking statements, whether as a result of new information, future events or otherwise.

特此提醒您，這些聲明可能會受到 Addus 向美國證券交易委員會提交的文件及其 2022 年第四季度新聞稿中規定的重要因素的影響。因此，實際運營和結果可能與前瞻性陳述中討論的結果存在重大差異。公司不承擔更新任何前瞻性陳述的義務，無論是由於新信息、未來事件或其他原因。

I would now like to turn the call over to the company's Chairman and Chief Executive Officer, Mr. Dirk Allison. Please go ahead, sir.

我現在想將電話轉交給公司董事長兼首席執行官德克艾利森先生。請繼續，先生。

Thank you, Dru. Good morning, and welcome to our 2022 fourth quarter and year-end earnings call. With me today are Brian Poff, our Chief Financial Officer; and Brad Bickham, our President and Chief Operating Officer. As we do on each of our earnings calls, I will begin with a few overall comments, and then Brian will discuss the fourth quarter results in more detail. Following our comments, the 3 of us would be happy to respond to your questions.

謝謝你，德魯。早上好，歡迎來到我們的 2022 年第四季度和年終財報電話會議。今天和我在一起的是我們的首席財務官 Brian Poff；和我們的總裁兼首席運營官 Brad Bickham。正如我們在每次財報電話會議上所做的那樣，我將首先發表一些總體評論，然後布賴恩將更詳細地討論第四季度的業績。根據我們的評論，我們 3 個人很樂意回答您的問題。

I first want to say thank you to all the employees at Addus HomeCare for their efforts this past year. While it's exciting to know that we had a great year financially, it is more important to know we provide care to approximately 66,000 clients and patients in 2022. I am very proud of our team's hard work in making sure we are able to meet the home care needs of all these deserving people. Meeting our mission each day will continue to lead to ongoing growth for Addus.

我首先要感謝 Addus HomeCare 的所有員工在過去一年中所做的努力。雖然很高興知道我們在財務上度過了美好的一年，但更重要的是要知道我們在 2022 年為大約 66,000 名客戶和患者提供了護理。我為我們團隊的辛勤工作感到非常自豪，以確保我們能夠與家人見面所有這些應得的人的護理需求。每天完成我們的使命將繼續為 Addus 帶來持續增長。

Yesterday, we announced our financial results for the fourth quarter and full year 2022, and I'm extremely proud of our operating performance. Our team grew revenue 10% to $247.1 million for the fourth quarter of 2022 as compared to $224.6 million for the fourth quarter of 2021. This resulted in adjusted earnings per share of $1.11 as compared to an adjusted earnings per share for the fourth quarter of 2021 of $0.97, an increase of 14.4%. We also exceeded $28 million in adjusted EBITDA.

昨天，我們公佈了第四季度和 2022 年全年的財務業績，我對我們的經營業績感到非常自豪。我們的團隊在 2022 年第四季度的收入增長了 10%，達到 2.471 億美元，而 2021 年第四季度為 2.246 億美元。與 2021 年第四季度的調整後每股收益相比，這導致調整後每股收益為 1.11 美元0.97 美元，增長 14.4%。我們的調整後 EBITDA 也超過了 2800 萬美元。

For the full year of 2022, our revenue was $951.1 million with an adjusted EBITDA of $101.5 million or 10.7% of revenue. Our team was able to achieve these full year results despite the first 2 months of 2022 being negatively impacted by the Omicron wave. During 2022, we continue to see strong cash flow from operations as our states and other payers have worked -- pay providers like Addus in a timely manner. This strong cash flow has allowed us to maintain a net leverage position of less than 1x adjusted EBITDA, giving us the financial flexibility to continue to implement our strategy even as the cost of debt has increased.

2022 年全年，我們的收入為 9.511 億美元，調整後的 EBITDA 為 1.015 億美元，佔收入的 10.7%。儘管 2022 年前 2 個月受到 Omicron 浪潮的負面影響，我們的團隊仍能夠實現這些全年業績。在 2022 年期間，隨著我們各州和其他付款人的努力，我們繼續看到來自運營的強勁現金流——及時向 Addus 等提供商付款。這種強勁的現金流使我們能夠保持低於 1 倍調整後 EBITDA 的淨槓桿頭寸，從而使我們在財務上具有靈活性，即使在債務成本增加的情況下也能繼續實施我們的戰略。

As has been the case for us over the last few quarters, the labor environment continues to improve. During the fourth quarter of 2022, we experienced improved hiring in our Personal Care segment with hires per business day increasing approximately 10% as compared to the fourth quarter of 2021. We are also seeing this improved hiring trend continue in January and February of this year with hires per business day running ahead of our fourth quarter of 2022 performance.

正如我們過去幾個季度的情況一樣，勞動環境繼續改善。在 2022 年第四季度，我們的個人護理部門的招聘情況有所改善，與 2021 年第四季度相比，每個工作日的招聘人數增加了約 10%。我們還看到，這種招聘趨勢在今年 1 月和 2 月仍在繼續每個工作日的招聘人數超過我們 2022 年第四季度的業績。

A part of our improved hiring results have been due to the recent investment we made in a candidate tracking system, which allows us to better engage with potential employees as well as shortening the time between application and higher. We are continuing to roll out this system to all of our sites, a process that should be completed in 2023.

我們改善招聘結果的部分原因是我們最近對候選人跟踪系統進行了投資，這使我們能夠更好地與潛在員工互動，並縮短申請和更高職位之間的時間。我們將繼續將該系統推廣到我們所有的站點，該過程應在 2023 年完成。

Hiring in our Clinical segment has been more challenging than in our Personal Care segment, However, we began to see our clinical hiring pick up in the third quarter and continue through the fourth quarter of 2022, particularly in our hospice segment. This, along with the incremental improvement in our clinical turnover has started to relieve some of the staffing challenges we faced in the first half of 2022 in our clinical segment. There are some geographic areas where both clinical hiring and wage pressures continue, but the overall hiring environment has certainly improved, and we expect this trend to continue in 2023.

在我們的臨床部門招聘比在我們的個人護理部門更具挑戰性，但是，我們開始看到我們的臨床招聘在第三季度開始增加並持續到 2022 年第四季度，特別是在我們的臨終關懷部門。這一點，以及我們臨床營業額的逐步改善，已經開始緩解我們在 2022 年上半年在臨床部門面臨的一些人員配置挑戰。在某些地區，臨床招聘和工資壓力仍在繼續，但整體招聘環境肯定有所改善，我們預計這一趨勢將在 2023 年繼續。

As has been announced, the COVID-19 public health emergency will end on May 11, 2023. With the ending of the emergency declaration, the enhanced federal Medicaid match that states have been receiving from the federal government will gradually phase out. The full 6.2% in extra federal funding will last through March 31, 2023. This match will then decrease to 5% for the second quarter, 2.5% for the third quarter of this year and 1.5% for the fourth quarter of 2023. Even with the reduced funding to state Medicaid plans, we believe the states in which we operate are in a much stronger financial position than before the pandemic.

正如已經宣布的那樣，COVID-19 公共衛生緊急事件將於 2023 年 5 月 11 日結束。隨著緊急狀態聲明的結束，各州從聯邦政府那裡獲得的增強型聯邦醫療補助計劃將逐步取消。全部 6.2% 的額外聯邦資金將持續到 2023 年 3 月 31 日。此匹配將在第二季度降至 5%，今年第三季度降至 2.5%，2023 年第四季度降至 1.5%。即使由於州醫療補助計劃的資金減少，我們相信我們經營所在的州的財務狀況比大流行之前要好得多。

During our fourth quarter, the funding we received from the American Rescue Plan Act or ARPA has allowed us to begin increasing caregiver wages, pay sign-on and retention bonuses or provide onetime bonuses to current caregivers depending on the state program. Today, we have realized approximately $24 million, of which we still have $13.8 million to utilize over the next 12 months. These funds have been helpful with our recruitment efforts to support patient care and should continue to help our hiring and retention efforts in the future as we deploy our remaining funds. As for Illinois, our largest state of operation, on January 1 of this year, we received a $0.70 per hour statewide rate increase as expected. This rate increase covers the Chicago minimum wage increase we saw last July and allows us to raise wages elsewhere in Illinois.

在我們的第四季度，我們從美國救援計劃法案或 ARPA 獲得的資金使我們能夠開始增加護理人員的工資、支付簽約和保留獎金或根據州計劃向當前護理人員提供一次性獎金。今天，我們已經實現了大約 2400 萬美元，其中我們還有 1380 萬美元可以在未來 12 個月內使用。這些資金有助於我們支持患者護理的招聘工作，並且在我們部署剩餘資金時應該會繼續幫助我們在未來的招聘和留住工作。至於我們最大的運營州伊利諾伊州，今年 1 月 1 日，我們收到了預期的全州每小時 0.70 美元的加薪。這一漲幅涵蓋了我們去年 7 月看到的芝加哥最低工資漲幅，並使我們能夠提高伊利諾伊州其他地方的工資。

On December 30, 2022, the State of Illinois announced an additional increase of $1.26 per hour, which will be effective on March 1, 2023, subject to approval from CMS. Once approved, our Illinois state reimbursement rate will increase to $26.92. This increase will cover the upcoming July 1 minimum wage increase in Chicago and allow us to continue to raise wages for all our Illinois employees. We believe these increases should help us to continue the favorable hiring trends we have been seeing in our Personal Care segment.

2022 年 12 月 30 日，伊利諾伊州宣布額外增加每小時 1.26 美元，將於 2023 年 3 月 1 日生效，但須經 CMS 批准。一旦獲得批准，我們的伊利諾伊州報銷率將增加到 26.92 美元。這一增長將涵蓋芝加哥即將於 7 月 1 日上調的最低工資，並使我們能夠繼續提高伊利諾伊州所有員工的工資。我們相信這些增長應該有助於我們繼續保持我們在個人護理部門看到的有利招聘趨勢。

I also want to give a brief update on recent developments regarding our participation in the New York Consumer Directed or CDPAP program. On February 1 of this year, the Governor of New York issued her budget, which proposes to repeal the procurement process for fiscal intermediaries who participate in the CDPAP program, eliminating the reduction of providers, which would have occurred under this process.

我還想簡要介紹一下我們參與紐約消費者導向或 CDPAP 計劃的最新進展。今年 2 月 1 日，紐約州州長發布了她的預算案，其中提議廢除參與 CDPAP 計劃的財政中介機構的採購流程，消除供應商的減少，這將在該流程下發生。

This budget now proposes to make changes to the MLTC program with a goal of minimizing the number of providers in the state. We believe these proposals will allow Addus to continue providing services to our current clients while growing with payers whose reimbursement rates provide for an adequate financial return. The final budget for New York is due on April 1, 2023. Once that budget is published, we will be able to refine our growth plan for New York. As a reminder, we continue to operate as normal with our MLTC partners in the New York market with respect to the CDPAP program. As we receive further clarification on the state CDPAP rates, we will evaluate whether to increase our CDPAP admissions as appropriate.

該預算現在提議對 MLTC 計劃進行更改，目標是盡量減少該州的提供者數量。我們相信這些提議將使 Addus 能夠繼續為我們現有的客戶提供服務，同時與報銷率提供足夠財務回報的付款人一起成長。紐約的最終預算將於 2023 年 4 月 1 日到期。預算公佈後，我們將能夠完善紐約的增長計劃。提醒一下，我們繼續與我們在紐約市場的 MLTC 合作夥伴就 CDPAP 計劃正常運作。當我們收到有關各州 CDPAP 費率的進一步說明時，我們將評估是否適當增加我們的 CDPAP 錄取率。

Now let me discuss our same-store revenue growth for the fourth quarter of 2022. For our Personal Care segment, exclusive of the New York CDPAP and ARPA funds, our same-store revenue growth was 7.9% when compared to the fourth quarter of 2021. Over the past 3 years, a majority of our same-store growth in PCS came from rate increases from our states.

現在讓我討論一下我們 2022 年第四季度的同店收入增長。對於我們的個人護理部門，不包括紐約 CDPAP 和 ARPA 基金，與 2021 年第四季度相比，我們的同店收入增長了 7.9% . 在過去的 3 年裡，PCS 同店增長的大部分來自我們各州的利率增長。

With the disruption caused by the pandemic, hourly growth has been more difficult. Recently, we have started to see a resumption of growth in same-store hours. In the fourth quarter of 2022, we saw same-store hours excluding New York CDPAP, grew 2.6% over the same period in 2021 and 1.5% on a sequential quarterly basis. This mix of volume and rate growth is more consistent to our historical averages prior to the pandemic.

由於大流行造成的破壞，每小時的增長變得更加困難。最近，我們開始看到同店營業時間恢復增長。 2022 年第四季度，不包括紐約 CDPAP 在內的同店營業時間比 2021 年同期增長 2.6%，環比增長 1.5%。這種數量和增長率的組合更符合我們在大流行之前的歷史平均水平。

Turning to our clinical care operations. Our home health segment same-store revenue grew 8.3% over the same quarter in 2021, primarily as a result of our prioritizing episodic cases and declining non-episodic referrals due to the lower reimbursement rates. As we have seen, our non-episodic referral opportunities continue to increase, our managed care team has been working with our Medicare Advantage virtual payers to adjust our contract rates to a more appropriate level, which will allow us to accept more nonepisodic volume growth going forward.

轉向我們的臨床護理操作。我們的家庭保健部門同店收入比 2021 年同一季度增長了 8.3%，這主要是由於我們優先考慮偶發性病例，並且由於報銷率較低而導致非偶發性轉診減少。正如我們所看到的，我們的非偶發性轉診機會繼續增加，我們的管理式醫療團隊一直在與我們的 Medicare Advantage 虛擬付款人合作，將我們的合同費率調整到更合適的水平，這將使我們能夠接受更多的非偶發性數量增長向前。

Recently, we have started to see success in these efforts as we continue to discuss movement to episodic case rates for a longer-term solution. We are still in negotiations with a couple of our large payers and look forward to the completion of those discussions. Our operations team continues to work hard on both mix and staffing and home health to ensure we maximize the value of the services we provide. We remain excited about home health operation as it complements our personal care services, particularly where we participate in value-based contracting models.

最近，我們開始看到這些努力取得了成功，因為我們繼續討論為長期解決方案轉向偶發病例率。我們仍在與我們的幾個大付款人進行談判，並期待這些討論的完成。我們的運營團隊繼續在人員配置和家庭健康方面努力工作，以確保我們提供的服務價值最大化。我們仍然對家庭健康業務感到興奮，因為它補充了我們的個人護理服務，特別是在我們參與基於價值的合同模式的情況下。

Our hospice same-store revenue decreased 4.9% when compared to the fourth quarter in 2021 with a decrease of 0.9% in our average daily census as compared to the fourth quarter of 2021 as well as the resumption of Medicare sequestration. Our medium length of stay did improve to 27 days in the fourth quarter as compared to 22 days for the same period in 2021, but was down slightly from 28 days for our third quarter of 2022. While hospice continues to recover from the pandemic at a slower rate than we expected, we did see an increase in hospice admissions on a sequential basis, which is encouraging.

與 2021 年第四季度相比，我們的臨終關懷同店收入下降了 4.9%，與 2021 年第四季度相比，我們的平均每日人口普查下降了 0.9%，同時恢復了 Medicare 扣押。與 2021 年同期的 22 天相比，第四季度我們的中等住院時間確實增加到了 27 天，但略低於 2022 年第三季度的 28 天。雖然臨終關懷繼續從大流行中恢復速度比我們預期的要慢，但我們確實看到臨終關懷入院人數連續增加，這令人鼓舞。

Our hospice ADC increased to 32.3% for the fourth quarter of 2022 as compared to an ADC of 2,635 for the fourth quarter of 2021, inclusive of the ADC attributable to our JourneyCare acquisition which closed on February 1, 2022. As for our ongoing development efforts, we continue to look at potential acquisitions that meet our strategic criteria. Our deal flow continues to consist primarily of a number of smaller acquisition opportunities mainly in our personal care and home health segments.

我們的臨終關懷 ADC 在 2022 年第四季度增加到 32.3%，而 2021 年第四季度的 ADC 為 2,635，其中包括我們於 2022 年 2 月 1 日完成的 JourneyCare 收購所產生的 ADC。至於我們正在進行的開發工作，我們繼續尋找符合我們戰略標準的潛在收購。我們的交易流程繼續主要包括一些較小的收購機會，主要集中在我們的個人護理和家庭健康領域。

While we have a desire to look at larger assets, deals of size have been slower to come to market, especially with the near-term reimbursement rate challenges for home health. We expect to see larger home health opportunities in the coming months as the market understands the reimbursement rates coming from CMS. In the meantime, we have been reducing our debt with our strong cash flow. Going forward, our disciplined balance sheet would allow us the financial flexibility to take advantage of any larger strategic opportunity that may present themselves.

雖然我們希望看到更大的資產，但規模交易進入市場的速度較慢，尤其是在家庭健康的近期報銷率面臨挑戰的情況下。隨著市場了解 CMS 的報銷率，我們預計在未來幾個月內會看到更大的家庭健康機會。與此同時，我們一直在以強勁的現金流減少債務。展望未來，我們紀律嚴明的資產負債表將使我們具有財務靈活性，以利用可能出現的任何更大的戰略機會。

As for our value-based care efforts, we are continuing to see positive results from our various value-based care contracts. We have now entered into 5 value-based contracts in 3 states, covering 4,800 clients. These contracts are focused on helping our clients avoid unnecessary emergency room visits and hospital admissions as well as readmissions at various time frames following a hospital discharge. In addition, we are also working on improving Addus benchmarks.

至於我們基於價值的護理工作，我們繼續從我們的各種基於價值的護理合同中看到積極的結果。我們現在已經在 3 個州簽訂了 5 份基於價值的合同，涵蓋 4,800 名客戶。這些合同的重點是幫助我們的客戶避免不必要的急診室就診和住院，以及在出院後的不同時間段內再次入院。此外，我們還致力於改進 Addus 基準測試。

To date, our outcomes data has shown our ability to help reduce costs while improving quality benchmarks. We are currently working on additional value-based opportunities for 2023. Value-based care continues to be a revenue growth opportunity, which we expect to grow to a more meaningful amount over the next few years.

迄今為止，我們的成果數據表明我們有能力在提高質量基準的同時幫助降低成本。我們目前正在為 2023 年尋找更多基於價值的機會。基於價值的護理仍然是一個收入增長機會，我們預計在未來幾年內會增長到更有意義的數量。

I'm so proud of our team for the care they are providing to our elderly and disabled consumers and patients. The home remains one of the safest and most cost-effective places to receive care and is also the place for most elderly individuals and their families prefer to be. We believe the heightened awareness of the value of home-based care is favorable for our industry and will be a growth opportunity for our company. We understand and appreciate that our operations and growth are dependent on our dedicated caregivers who worked so incredibly hard providing outstanding care and support to our consumers, patients and their family.

我為我們的團隊為我們的老年和殘疾消費者和患者提供的護理感到自豪。家仍然是最安全和最具成本效益的接受護理的地方之一，也是大多數老年人及其家人更願意去的地方。我們相信，提高對家庭護理價值的認識有利於我們的行業，並將成為我們公司的增長機會。我們理解並讚賞我們的運營和增長依賴於我們敬業的護理人員，他們非常努力地工作，為我們的消費者、患者及其家人提供出色的護理和支持。

With that, let me turn the call over to Brian.

有了這個，讓我把電話轉給布賴恩。

Thank you, Dirk, and good morning, everyone. Addus had a strong financial and operating performance for the fourth quarter, capping off another record year of profitable growth. Our results reflect strong demand for our services, led by organic growth in personal care services, well above our normal expected range of 3% to 5%, along with solid same-store growth in our home health segment.

謝謝你，德克，大家早上好。 Addus 第四季度的財務和運營表現強勁，實現了又一個創紀錄的盈利增長年度。我們的業績反映了對我們服務的強勁需求，個人護理服務的有機增長遠高於我們 3% 至 5% 的正常預期範圍，同時我們的家庭保健部門的同店增長穩健。

In addition to our organic growth, we benefited from our acquired operations in home health, Armada Home Health and Summit Home Health added in 2021 and Apple Home Healthcare, which we closed at the beginning of the fourth quarter of 2022. Our hospice business has continued to slowly recover from the pandemic with a return to our pre-COVID median length of stay range in the upper 20s. Our hospice results also include the acquisition of JourneyCare, which closed in February 2022.

除了我們的有機增長外，我們還受益於我們收購的家庭健康業務、2021 年新增的 Armada Home Health 和 Summit Home Health，以及我們在 2022 年第四季度初關閉的 Apple Home Healthcare。我們的臨終關懷業務仍在繼續慢慢地從大流行中恢復過來，回到我們在 COVID 之前的 20 多歲的逗留時間中位數範圍。我們的臨終關懷成果還包括對 JourneyCare 的收購，該收購於 2022 年 2 月完成。

As Dirk noted, total net service revenues for the fourth quarter were $247.1 million. The revenue breakdown is as follows: Personal Care revenues were $183.4 million or 74.2% of revenue, Hospice care revenues were $50.6 million or 20.5% of revenue, and home health revenues were $13.1 million or 5.3% of revenue.

正如德克指出的那樣，第四季度的總淨服務收入為 2.471 億美元。收入明細如下：個人護理收入為 1.834 億美元，佔收入的 74.2%，臨終關懷收入為 5060 萬美元，佔收入的 20.5%，家庭保健收入為 1310 萬美元，佔收入的 5.3%。

We have continued to actively pursue acquisition opportunities that meet our criteria and complement our organic growth. In 2022, we added approximately $65 million of annualized revenue with the acquisitions of JourneyCare and Apple Home Healthcare. We continue to evaluate and pursue other acquisition opportunities and believe we will see a more favorable market environment later this year as sellers, particularly in brokered processes, have been slower than expected in coming to market. In part due to significant Medicare reimbursement uncertainty through October of last year for home health services.

我們繼續積極尋求符合我們標準並補充我們有機增長的收購機會。 2022 年，我們通過收購 JourneyCare 和 Apple Home Healthcare 增加了約 6500 萬美元的年收入。我們將繼續評估和尋求其他收購機會，並相信我們將在今年晚些時候看到一個更有利的市場環境，因為賣家，特別是在經紀流程中，進入市場的速度比預期的要慢。部分原因是截至去年 10 月，家庭保健服務的 Medicare 報銷存在重大不確定性。

The final announcement of late 2022 on reimbursement changes for home health has provided more clarity and should lead to opportunities for future acquisitions in skilled home health, although we continue to monitor developments regarding future reimbursement changes and related impacts. Most importantly, we are well capitalized to continue to pursue our acquisition strategy as opportunities arise.

2022 年底關於家庭健康報銷變更的最終公告提供了更多的清晰度，應該會為未來收購熟練的家庭健康帶來機會，儘管我們將繼續監測有關未來報銷變更和相關影響的進展。最重要的是，我們擁有充足的資本，可以在機會出現時繼續推行我們的收購戰略。

Other financial results for the fourth quarter of 2022 include the following: our gross margin percentage was 31.9% compared with 32.4% for the fourth quarter of 2021. While we benefited from our annual hospice rate adjustment on October 1, 2022, our results reflect the negative impact of the July 1, 2022, minimum wage increase in Chicago, one of our largest personal care markets for which we did not receive a corresponding reimbursement increase.

2022 年第四季度的其他財務業績包括：我們的毛利率為 31.9%，而 2021 年第四季度為 32.4%。雖然我們受益於 2022 年 10 月 1 日的年度臨終關懷費率調整，但我們的結果反映了2022 年 7 月 1 日芝加哥最低工資上漲的負面影響，我們最大的個人護理市場之一，我們沒有收到相應的報銷增長。

Effective January 1, 2023, we did receive a statewide reimbursement increase in Illinois, which will offset the Chicago minimum wage increase. With another recently announced statewide increase to be effective on March 1, 2023, pending CMS approval. We anticipate our gross margin in the first quarter to be negatively impacted sequentially by approximately 120 basis points from the annual reset on payroll taxes and our annual merit increases, which are effective on March 1.

自 2023 年 1 月 1 日起，我們確實收到了伊利諾伊州全州範圍內的報銷增加，這將抵消芝加哥最低工資的增加。最近宣布的另一項全州範圍內的增加將於 2023 年 3 月 1 日生效，等待 CMS 批准。我們預計，自 3 月 1 日生效的工資稅年度重置和我們的年度業績增長以來，我們第一季度的毛利率將受到大約 120 個基點的負面影響。

These decreases will be offset slightly by the positive impact from our January 1 rate increase in Illinois, although we expect to see some minor compression from the March 1 Illinois increase. As we anticipate our gross margin contribution after wage negotiations and increases to paid time off and mileage rates from this rate increase to be in the low 20% range where our normal Illinois Personal Care gross margin is typically in the mid-20% range. Overall, we expect our gross margin sequentially to decline by approximately 100 to 110 basis points from the fourth quarter of 2022 to the first quarter of 2023.

這些下降將被我們 1 月 1 日在伊利諾伊州加息的積極影響略微抵消，儘管我們預計 3 月 1 日伊利諾伊州加息會帶來一些小幅壓縮。正如我們預計在工資談判後我們的毛利率貢獻以及帶薪休假和里程率的增加將在 20% 的低範圍內，而我們正常的伊利諾伊州個人護理毛利率通常在 20% 的中間範圍內。總體而言，我們預計從 2022 年第四季度到 2023 年第一季度，我們的毛利率將下降約 100 至 110 個基點。

G&A expense was 22.1% of revenue, consistent with the same percentage in the fourth quarter a year ago, but lower sequentially from 22.5% in the third quarter of 2022. Adjusted G&A expense was 20.4% for the fourth quarter of 2022, an increase over the prior year of 20.1%, but lower sequentially from 20.6% in the third quarter.

G&A 費用佔收入的 22.1%，與去年第四季度的比例一致，但低於 2022 年第三季度的 22.5%。2022 年第四季度調整後的 G&A 費用為 20.4%，增幅超過上年同期為 20.1%，但低於第三季度的 20.6%。

The company's adjusted EBITDA increased to $28.2 million compared to $26.7 million a year ago. Adjusted EBITDA margin in the fourth quarter was 11.4% compared with 11.9% for the same period last year. While we expected to see some margin compression in 2022, primarily due to wage pressures, we were pleased to have exceeded 11% in adjusted EBITDA margin for the first time this year. Looking ahead, while we continue to operate in a dynamic environment, we expect to see stabilization in our adjusted EBITDA margin in 2023.

公司調整後的 EBITDA 增至 2820 萬美元，而一年前為 2670 萬美元。第四季度調整後的 EBITDA 利潤率為 11.4%，而去年同期為 11.9%。雖然我們預計 2022 年利潤率會有所壓縮，這主要是由於工資壓力，但我們很高興今年調整後的 EBITDA 利潤率首次超過 11%。展望未來，雖然我們繼續在充滿活力的環境中運營，但我們預計 2023 年調整後的 EBITDA 利潤率將趨於穩定。

Adjusted net income per diluted share was $1.11, compared with $0.97 for the fourth quarter of 2021. The adjusted per share results for the fourth quarter of 2022 exclude the following: acquisition and de novo expenses of $0.06; restructure and other nonrecurring costs of $0.01; and noncash stock-based compensation expense of $0.13. The adjusted per share results for the fourth quarter of 2021 exclude the following: the favorable impact of the retroactive Illinois rate increase net of $0.05; acquisition and novo expenses of $0.09; restructure and other nonrecurring costs of $0.01; and noncash stock-based compensation expense of $0.11.

調整後的攤薄後每股淨收益為 1.11 美元，而 2021 年第四季度為 0.97 美元。2022 年第四季度調整後的每股收益不包括以下各項：收購和從頭開始的費用 0.06 美元； 0.01 美元的重組和其他非經常性成本；和 0.13 美元的非現金股票補償費用。調整後的 2021 年第四季度每股收益不包括以下內容：伊利諾伊州追溯加息 0.05 美元的有利影響；收購和 novo 費用為 0.09 美元； 0.01 美元的重組和其他非經常性成本；和 0.11 美元的非現金股票補償費用。

Our effective tax rate for the fourth quarter of 2022 was 19.2% and benefited from several discrete credits during the quarter as well as continued strong work opportunity tax credits. For calendar year 2023, we expect our tax rate to be in the mid-20% range.

我們 2022 年第四季度的有效稅率為 19.2%，受益於本季度的幾項離散信貸以及持續強勁的工作機會稅收抵免。對於 2023 日曆年，我們預計我們的稅率將在 20% 的中間範圍內。

DSOs were 45.1 days at the end of the fourth quarter of 2022 compared with 46.2 days at the end of the third quarter of 2022. We have experienced consistent cash collections for most of our payers and expect to see this trend continue. Our DSOs for the Illinois Department of Aging for the fourth quarter were 41.5 days compared with 35.4 days at the end of the third quarter this year.

2022 年第四季度末 DSO 為 45.1 天，而 2022 年第三季度末為 46.2 天。我們的大多數付款人都經歷了一致的現金催收，預計這一趨勢將繼續下去。我們在第四季度為伊利諾伊州老齡化部門提供的 DSO 為 41.5 天，而今年第三季度末為 35.4 天。

Our fourth quarter net cash provided by operations was $24.3 million. During the quarter, we made the final repayment installment on our fee roll tax deferral in 2020 under the Cares Act of $4.1 million and also had a net utilization of ARPA funds of $4.2 million. Exclusive of these payments, our cash flow from operations would have been $32.6 million during the fourth quarter.

我們第四季度運營提供的淨現金為 2430 萬美元。在本季度，我們根據《關愛法案》在 2020 年支付了 410 萬美元的費用滾動稅延期的最後還款分期付款，並且 ARPA 資金的淨使用額為 420 萬美元。排除這些付款，我們第四季度的運營現金流為 3260 萬美元。

For the full year 2022, our cash flow from operations was $105.1 million, inclusive of a positive net impact from government stimulus advances of $8.7 million. We also benefited from a positive impact of working capital changes of approximately $19 million in 2022, primarily due to our strong accounts receivable collections. As of December 31, 2022, the company had cash of $80 million and bank debt of $134.9 million with capacity and availability under our revolver of $380.2 million and $237.2 million, respectively.

2022 年全年，我們的運營現金流為 1.051 億美元，其中包括 870 萬美元的政府刺激預付款的積極淨影響。我們還受益於 2022 年約 1900 萬美元的營運資金變化的積極影響，這主要是由於我們強勁的應收賬款回收。截至 2022 年 12 月 31 日，公司擁有現金 8000 萬美元和銀行債務 1.349 億美元，我們循環貸款下的產能和可用性分別為 3.802 億美元和 2.372 億美元。

We have continued to focus on debt repayment in the face of rising interest rates. And as a result of our strong cash flow, we're able to reduce our revolver balance by a net $90 million in 2022. To date, in 2023, we have continued this focus and have further reduced our revolver balance by another $13.5 million.

面對利率上升，我們繼續關注債務償還。由於我們強勁的現金流，我們能夠在 2022 年將循環餘額淨減少 9000 萬美元。迄今為止，在 2023 年，我們繼續關注這一重點，並將循環餘額進一步減少 1350 萬美元。

We have a capital structure that supports our growth initiatives and acquisition strategy as previously noted, we expect to be active in the M&A market this year. At the same time, we will continue to diligently manage our net leverage ratio, which is currently well under 1x net of cash on hand.

如前所述，我們的資本結構支持我們的增長計劃和收購戰略，我們預計今年將活躍於併購市場。與此同時，我們將繼續努力管理我們的淨槓桿率，該比率目前遠低於手頭現金淨額的 1 倍。

This concludes our prepared comments this morning, and we would like to thank you for being with us. I'll now ask the operator to please open the line for your questions.

今天早上我們準備好的評論到此結束，我們要感謝您與我們在一起。我現在請接線員打開您的問題熱線。

(Operator Instructions) The first question today comes from Scott Fidel with Stephens.

（操作員說明）今天的第一個問題來自斯科特菲德爾和斯蒂芬斯。

First question, just appreciate the commentary just around the 2 Illinois rate increases and then the impacts on gross margins. Might be helpful just if you want to -- if you could just give us what you would view the overall annualized revenue impact of those 2 Illinois rate increases in aggregate, obviously, that would, I guess, sort of annualize out more in the second quarter. And then just an update as well on sort of how the blended rates look across your other markets in Personal Care outside of Illinois for 2023?

第一個問題，請欣賞關於伊利諾伊州兩次加息的評論，然後是對毛利率的影響。如果你願意的話可能會有幫助——如果你能告訴我們你會如何看待伊利諾伊州這兩次加息對總體年化收入的影響，顯然，我想，那會在第二個中產生更多的年化收益四分之一。然後再更新一下 2023 年伊利諾伊州以外的其他個人護理市場的混合費率情況如何？

Yes, Scott. I'll talk about the January 1 increase first. So based on kind of current volumes in Illinois, that's going to result in approximately right around $12 million in annualized revenue. So obviously, coming in January 1, you'll see a full quarter impact of that in Q1. The March 1 rate increase, which is a little larger per hour, is going to be probably between $17 million and $18 million kind of based on current volumes in Illinois, obviously, getting 1 month of impact of that in Q1, but you'll see the full impact of that as that rolls through Q2.

是的，斯科特。我會先談談 1 月 1 日的增長。因此，根據伊利諾伊州目前的產量，這將產生大約 1200 萬美元的年收入。很明顯，從 1 月 1 日開始，您將在第一季度看到它的整個季度影響。 3 月 1 日的漲幅，每小時漲幅略大，根據伊利諾伊州目前的交易量，漲幅可能在 1700 萬美元到 1800 萬美元之間，顯然，第一季度會受到 1 個月的影響，但你會在第二季度滾動時看到它的全部影響。

Outside of that, I think we've seen a couple of other markets that we're going to see rate increases for I think South Carolina, which is one of our smaller markets has come through with a rate increase early this year. Probably not going to see the same level of rate increases across the board. We've seen in the last couple of years. But I think overall, I'm still seeing some support in some other areas as well.

除此之外，我認為我們已經看到其他幾個市場我們將看到南卡羅來納州的加息，我認為南卡羅來納州是我們較小的市場之一，今年早些時候已經加息。可能不會看到全面的相同水平的利率增長。我們在過去幾年中看到了。但我認為總的來說，我仍然在其他一些領域看到了一些支持。

Okay. Got it. And then a follow-up question. Just wanted to follow up on Dirk's commentary just on I guess, sort of the updated framing around the M&A pipeline? And Brian, I know you mentioned as well sort of maybe picking up middle later this year. I'm assuming is that sort of implying wanting -- the market wanting to also get visibility into at least the proposed 2024 rates for home health in Medicare, just given some of the uncertainty around some of the proposals that CMS had talked about for next year as well. And that would be the first part.

好的。知道了。然後是後續問題。只是想跟進 Dirk 的評論，我猜是關於併購管道的更新框架？布賴恩，我知道你也提到過今年晚些時候可能會中等。我假設這是一種暗示——市場希望至少了解 2024 年 Medicare 家庭健康的擬議費率，只是考慮到 CMS 下一步討論的一些提議的一些不確定性年也是如此。這將是第一部分。

And then the second part, I guess, if you wanted to just sort of update us on your prioritization list between home health, personal care, hospice in terms of how you're prioritizing M&A in the pipeline here?

然後是第二部分，我想，如果你想就你如何在管道中對併購進行優先排序，向我們更新你在家庭健康、個人護理、臨終關懷之間的優先列表？

Yes, Scott, I do think the question of what's going to happen with the home health rates long term is still somewhat to be answered. I mean, obviously, last year, there was a period of time where we didn't know a whole lot based on what had been announced by CMS as to what the actual rule is going to be by the time it came through. We still have a little bit of that going forward, as you know, trying to figure out exactly what the rates are going to be.

是的，斯科特，我確實認為家庭健康率長期會發生什麼的問題仍有待回答。我的意思是，很明顯，去年有一段時間，根據 CMS 宣布的內容，我們對實際規則通過時的實際情況知之甚少。如您所知，我們還有一些前進的方向，試圖弄清楚利率到底是多少。

And I think the real question lies in what sellers and the purchasers are thinking. I don't know that all sellers today have come to the place where they have factored in that there might be future limitations on the rate increase. And so their expectations for price may be still a little high. I think from us as purchasers and others in the industry, we're trying to be very careful and strategic as to what we pay for deals until we truly understand the ruling. So I think that has affected some of the -- as Brian said, some of the larger broker deals that we may see, particularly around in the home health market.

我認為真正的問題在於賣家和買家在想什麼。我不知道今天所有的賣家都已經考慮到未來加息可能會受到限制。所以他們對價格的預期可能還是有點高。我認為，從我們作為採購商和業內其他人的角度來看，在我們真正理解裁決之前，我們正在努力對交易支付的費用保持謹慎和戰略性。所以我認為這已經影響了一些 - 正如布賴恩所說，我們可能會看到一些較大的經紀交易，特別是在家庭健康市場。

Going forward, the prioritization really continues to be quite consistent from what we've been telling you for the last few quarters. Our prioritization as far as where we will use our acquisition dollars will be really around personal care as well as home health.

展望未來，優先順序與我們在過去幾個季度中告訴您的內容確實繼續保持一致。就我們將在何處使用我們的收購資金而言，我們的優先順序將真正圍繞個人護理和家庭健康。

At this point in time, we're probably not as focused on hospice as we have been in the past. We think we have a nice operation around the hospice coverage around our personal care market. So we're really trying to grow home health. And we're really also continuing to look for those strategic opportunities to grow personal care, either strengthening the states in which we currently operate are potentially entering into new states where we would like to go. So that will be our focus that you'll see over the next few quarters in 2023.

在這個時候，我們可能不像過去那樣專注於臨終關懷。我們認為我們在個人護理市場的臨終關懷覆蓋方面做得很好。所以我們真的在努力發展家庭健康。而且我們真的也在繼續尋找那些發展個人護理的戰略機會，要么加強我們目前經營的州，要么有可能進入我們想去的新州。因此，這將是我們在 2023 年接下來的幾個季度中看到的重點。

The next question comes from Tao Qiu with Stifel.

下一個問題來自 Stifel 的陶秋。

Could you talk about any shift in discharge rate or referral sources that may have impacted this quarter on the hospice side? And since you mentioned the positive hiring trend, which contributed to the 6.6% quarter-on-quarter growth in the admissions there. Should we expect a relatively strong sequential gain in ADC in the first quarter this year?

您能否談談可能影響本季度臨終關懷方面的出院率或轉診來源的任何變化？既然你提到了積極的招聘趨勢，這導致那裡的入學人數環比增長 6.6%。我們是否應該期待今年第一季度 ADC 的環比增長相對強勁？

And additionally, JourneyCare, I know it has played a major part last year. And when compared to your $50 million annual revenue expectation, should we expect any upside in terms of the continued ramping up of performance there?

此外，JourneyCare，我知道它在去年發揮了重要作用。與您 5000 萬美元的年收入預期相比，我們是否應該期待在那裡的業績持續增長方面有任何好處？

Yes, happy to take those questions. First, when you look at the just kind of mix from an admission and discharge rates, we haven't -- what we have seen is certainly some improvement in our median length of stay year-over-year. We're kind of back to that upper 20s where we were pre-pandemic. We did see a 1-day slide sequentially. I think the one area where we're still seeing an opportunity for improvement is when you look at nursing home, discharge length of stay and median length of stay, those still haven't recovered.

是的，很高興回答這些問題。首先，當你從入院率和出院率來看只是一種組合時，我們沒有——我們看到的肯定是我們的住院時間中位數同比有所改善。我們有點回到大流行前的 20 多歲。我們確實連續看到了 1 天的幻燈片。我認為我們仍然看到改進機會的一個領域是當你看療養院、出院住院時間和中位住院時間時，那些仍然沒有恢復。

So we're tending to get those patients later in the cycle. And I think some of that may resolve itself with the ending of the public health emergency and some of the special rules around SNFs and related to skilling patients that you did not have to have the prior 3-day hospitalization that was previous pre-pandemic.

因此，我們傾向於在周期的後期接收這些患者。我認為其中一些問題可能會隨著公共衛生緊急事件的結束以及圍繞 SNF 的一些特殊規則以及與技能患者相關的一些特殊規則而自行解決，你不必在大流行前進行為期 3 天的住院治療。

So I think there's certainly some opportunities there. When you look at from the standpoint of what does Q1 look like. We certainly have added a lot of staff. So that's very helpful to help with the growth aspects. But I still think you're going to see a little bit of a bumpiness in hospice in probably the first half of the year and more of the growth is going to come through in the second half of the year. And part of it is related to what I just said, related to expiration of the -- some of the allowances under the PHE.

所以我認為那里肯定有一些機會。當您從 Q1 的角度來看時。我們當然增加了很多員工。所以這對幫助增長方面非常有幫助。但我仍然認為，你可能會在今年上半年看到臨終關懷方面的一些顛簸，而更多的增長將在今年下半年實現。其中一部分與我剛才所說的有關，與 PHE 下的一些津貼到期有關。

With respect to JourneyCare, we've fully integrated JourneyCare into our processes, our systems, I think it's just poised for some growth. But again, they still have some of the same issues that you see for I think they're going to be kind of challenging in the first couple of quarters related to some of the -- can we get more nursing home business. And particularly, can we get patients that come on service a little earlier out of those facilities.

關於 JourneyCare，我們已經將 JourneyCare 完全集成到我們的流程、我們的系統中，我認為它正準備實現一些增長。但同樣，他們仍然有一些與你看到的相同的問題，因為我認為他們在前幾個季度將面臨一些挑戰，這些問題與一些有關——我們能否獲得更多療養院業務。特別是，我們能否讓那些早點接受服務的患者離開這些設施。

Got you. And also, it sounds like you're going to get pretty strong rate growth in personal care services this year, and with the improved hiring trend when you return to a more normalized volume growth as well. So should we -- when we look at the organic growth profile, should we expect that you can sustain kind of the top end of that 3% to 5% growth? Or do you foresee yourself doing even higher than that?

明白了而且，聽起來今年個人護理服務的增長率會非常強勁，而且當您恢復到更正常的銷量增長時，招聘趨勢也會有所改善。那麼，當我們審視有機增長情況時，我們是否應該期望您能夠維持 3% 至 5% 增長的頂端？還是您預見自己會做得更好？

Well, I think you could certainly say that we are we're excited about the potential for growth this year in personal care, we would tend to believe that it could be to the upper end of that 3% to 5%. We're not ready to adjust that level. At this point in time, we want to see what continues to happen over this next year.

好吧，我想你當然可以說我們對今年個人護理的增長潛力感到興奮，我們傾向於認為它可能達到 3% 到 5% 的上限。我們還沒有準備好調整該水平。在這個時間點，我們想看看明年會繼續發生什麼。

I think the exciting part for us, as I mentioned in our comments was the fact that for the first time since the pandemic has occurred, we are starting to see over the last couple of quarters growth in personal care volume in the hours provided. And I think that's very exciting because that was a struggle that all the industry had for the last 2, 2.5 years. And now that we're able to hire more individuals are coming back on service, we're able to then put them to work, seeing this hourly growth and then put on top of that, just normalized rate impact, we believe that 2023 will be a nice year for us.

正如我在評論中提到的那樣，我認為對我們來說令人興奮的部分是，自大流行發生以來，我們在過去幾個季度中首次開始看到所提供的個人護理量有所增長。我認為這非常令人興奮，因為這是整個行業在過去 2、2.5 年中經歷的一場鬥爭。現在我們能夠僱用更多的人重新開始服務，我們能夠讓他們開始工作，看到這種每小時的增長，然後最重要的是，正常化的費率影響，我們相信 2023 年將會對我們來說是美好的一年。

Yes. And Tao real quick, I'll just piggyback a little bit on that. Just keep in mind, obviously, Q1 comps back to last year, impacted by the Omicron wave, I think, just across the board, we probably expect some pretty robust same-store numbers. But again, that impact last year compared to this year is going to be a big part of that difference. But with some of the rate increases we got, particularly with 2 rate increases this year from Illinois, which is our largest personal care market is definitely going to be helpful, I think, on the personal care side from a rate perspective.

是的。 Tao 真的很快，我會順便說一下。請記住，很明顯，第一季度受到 Omicron 浪潮的影響，我認為，從整體上看，我們可能會期待一些相當強勁的同店數字。但同樣，與今年相比，去年的影響將是造成這種差異的很大一部分。但是隨著我們獲得的一些加息，特別是今年從伊利諾伊州加息 2 次，我認為，從加息的角度來看，伊利諾伊州是我們最大的個人護理市場，這肯定會對個人護理方面有所幫助。

(Operator Instructions) The next question comes from Brian Tanquilut with Jefferies.

（操作員說明）下一個問題來自 Jefferies 的 Brian Tanquilut。

It's Taji on for Brian. Just a couple of questions for me this morning. So just going back to your discussion around contract negotiation for home health, right? So as you negotiate contract terms with Medicare Advantage payers, I'm curious what leverage points you're employing to successfully get those rates. And also, what does appetite look like from the payers to secure the value-based contracts like the case rate you had mentioned previously?

Brian 的任務是 Taji。今天早上只問我幾個問題。那麼回到你關於家庭健康合同談判的討論，對吧？因此，當您與 Medicare Advantage 付款人協商合同條款時，我很好奇您使用什麼槓桿點來成功獲得這些費率。而且，付款人對獲得基於價值的合同（如您之前提到的案例率）的興趣如何？

Yes. We've actually -- when you look at kind of from a leverage standpoint, I mean, these are the payers that are our largest payers on the home health side. They also tend to be in the markets where we have significant personal care presence as well. And so I think that is kind of a primary leverage point. These are also payers in certain instances where we have existing value-based arrangements or we're talking with them about adding value-based arrangements. So that's really kind of our leverage point when looking at can we get an episodic or case rates in place. I think there's still a lot of appetite from payers to explore value-based arrangements. I think we're starting to build a good track record around what we've accomplished. And so there's really no shortage of interest in those types of arrangements.

是的。實際上，當你從槓桿的角度來看時，我的意思是，這些支付者是我們在家庭健康方面最大的支付者。他們也傾向於進入我們也有大量個人護理產品的市場。所以我認為這是一個主要的槓桿點。在某些情況下，這些也是付款人，我們有現有的基於價值的安排，或者我們正在與他們討論增加基於價值的安排。因此，這確實是我們在研究能否獲得適當的偶發率或病例率時的槓桿點。我認為付款人仍然有很大興趣探索基於價值的安排。我認為我們開始圍繞我們所取得的成就建立良好的記錄。因此，人們對這些類型的安排確實不乏興趣。

I think it's really a matter of making sure that we have the wherewithal to do good with those projects. So you definitely don't want to stretch too far. So we're just making sure that we're building out some infrastructure relate it to value based, that should help us be able to take on more of those cases. And as Dirk alluded to in his comments, this is something that we think has a tremendous opportunity for us down the road, but it's going to take a little while to get there, make it meaningful from a revenue standpoint.

我認為這真的是一個確保我們有足夠的資金來做好這些項目的問題。所以你絕對不想伸展得太遠。因此，我們只是確保我們正在構建一些將其與基於價值相關聯的基礎架構，這應該有助於我們能夠處理更多此類案例。正如德克在他的評論中提到的那樣，我們認為這對我們來說是一個巨大的機會，但它需要一些時間才能到達那裡，從收入的角度來看讓它變得有意義。

Great. And then just one more follow-up. I think this is more so for Dirk. You had mentioned with the PHE, just the elimination of the enhanced federal Medicaid match. So what are the offsets that will create that stability, even though the enhanced federal Medicaid match programs ending in May, I think, Dirk, you had mentioned that in your commentary?

偉大的。然後再進行一次跟進。我認為德克更是如此。您在 PHE 中提到過，只是取消了增強的聯邦醫療補助計劃。那麼，即使增強的聯邦醫療補助計劃在 5 月結束，我認為德克，你在評論中提到過這一點，但會產生這種穩定性的補償是什麼？

Yes. This is Brad, actually. I think when you look at those -- the reduction in the match, I also think about redeterminations that were put on hold, which, again, we don't feel like we will have much, if any, impact from redeterminations on the Medicaid roles. Just when you look at the patient population that we serve, elderly fixed income chances of them being bumped out the roles is probably negligible.

是的。實際上，這是布拉德。我想當你看那些——比賽的減少時，我也想到了被擱置的重新決定，再一次，我們認為重新決定對醫療補助計劃的影響不會太大，如果有的話角色。只要看看我們服務的患者群體，固定收入的老年人被淘汰的可能性就可以忽略不計。

However, there are individuals that were added to Medicaid that may not qualify now. And I think that's in large case, why the match is being eliminated and lives being phased out as you see those redeterminations take place.

但是，有些加入 Medicaid 的個人現在可能不符合資格。而且我認為這在很大程度上是為什麼當你看到這些重新確定發生時比賽被淘汰並且生命被逐步淘汰的原因。

The next question comes from John Ransom with Raymond James.

下一個問題來自 John Ransom 和 Raymond James。

Dirk, I know it's a small piece of your business, but I'd be interested in your perspective on hospice, some of the cross currents we're seeing. Do you think this is a temporary thing? Or do you think something structural has differed in that marketplace?

德克，我知道這是你業務的一小部分，但我很想知道你對臨終關懷的看法，以及我們看到的一些分歧。你認為這是暫時的嗎？還是您認為該市場存在結構性差異？

Thanks, John. It seems there's been a little bit of change in the industry. I think you can see that in that all the providers of hospice over the last couple of quarters have had some struggles as far as growth. There's a question whether with the pandemic, there was a lot of increased elderly deaths that came through that period of time. And so the question is -- some of the indications are, if you look at the government data, the hospice has gone down a little bit over that time frame.

謝謝，約翰。看來這個行業發生了一些變化。我想你可以看到，在過去幾個季度中，所有臨終關懷提供者在增長方面都遇到了一些困難。有一個問題，是否隨著大流行，在那段時間裡老年人死亡人數增加了很多。所以問題是——一些跡象表明，如果你看一下政府數據，臨終關懷在那個時間段內有所下降。

So while I don't believe and I don't think we as a team believe that's going to be a long-term change in the hospice environment. We do think there's some short-term impacts as those -- probably those early deaths of elderly patients that would have been on hospice as that kind of moves through when we get back to a more level operation as we consistently have seen [early] in the hospice environment.

因此，雖然我不相信，而且我認為我們作為一個團隊也不相信臨終關懷環境會發生長期變化。我們確實認為存在一些短期影響——可能是那些本應接受臨終關懷的老年患者的早期死亡，因為當我們回到更水平的操作時，我們一直在[早期]看到的那樣。臨終關懷環境。

So we're still excited about hospice. I want to make sure you understand that just because it's not a focus for our M&A at this point in time, that's largely because we already have about 20% of our revenue in hospice, and we really believe that to get the balance of home health and clinical services set on top of our personal care network is really the strategic way to move forward in the next year or 2.

所以我們仍然對臨終關懷感到興奮。我想確保你明白這只是因為它不是我們目前併購的重點，這主要是因為我們已經有大約 20% 的收入用於臨終關懷，我們真的相信要在家庭健康方面取得平衡建立在我們個人護理網絡之上的臨床服務確實是明年或兩年向前發展的戰略方式。

And so I mean, just a follow-up on that. Do you think length of stay are going to be any different in the future than they used to be? Is there more government scrutiny with (inaudible) and somethings like that? Or again, do you think this some of the struggles maybe your peers have had with shorter length of stay and getting bottleneck referrals? Do you think that's also temporary notwithstanding the demand issue, structural demand issue on the [COVID] mortality? Do you see anything with referral networks, length of stay, that kind of thing changing?

所以我的意思是，只是對此的後續行動。您認為未來的逗留時間會與過去有所不同嗎？是否有更多的政府審查（聽不清）和類似的東西？或者，您是否認為這可能是您的同齡人在較短的停留時間和獲得瓶頸推薦方面遇到的一些困難？儘管存在需求問題，[COVID] 死亡率方面的結構性需求問題，您是否認為這也是暫時的？您是否看到任何關於推薦網絡、停留時間等方面的變化？

Well, I think we saw during the pandemic that our length of stay was challenged. That was the industry probably due to what Brad mentioned earlier, and that is we were receiving the hospice patients that were coming on board over the last couple of years seem to have been later in their stage of -- in the hospice stage. So their length of stay, once we came on service tended to be shorter than what we had seen historically.

好吧，我認為我們在大流行期間看到我們的逗留時間受到了挑戰。這可能是由於布拉德之前提到的行業造成的，那就是我們正在接收過去幾年來的臨終關懷患者，這些患者似乎處於臨終關懷階段的後期。因此，一旦我們開始服役，他們的逗留時間往往比我們以往看到的要短。

The question will be, will we start to see that longer length of stay as the nursing homes, the SNFs get back to after the emergency is declared over. Will it get back to more of the normal approach that when we receive clients straight from a nursing home, the length of stay for those clients tended to be longer. If you look at the last couple of years, we've still received a lot of hospital hospice referrals and their length of stay has not changed a great deal, but those tend to be the shorter length of stay patients. So our belief is we will start to see that change over the next year or 2. But as to what point it really reverts back to a more normalized level, that's still a question for us.

問題是，我們是否會開始看到隨著療養院的停留時間更長，SNF 在宣布緊急情況結束後返回。當我們直接從療養院接待客戶時，這些客戶的逗留時間往往會更長，這是否會恢復到更多的正常方式。如果你看看過去幾年，我們仍然收到了很多醫院臨終關懷轉介，他們的住院時間沒有太大變化，但那些往往是住院時間較短的患者。因此，我們相信我們將在明年或兩年內開始看到這種變化。但至於它真正恢復到更正常化水平的時間點，這對我們來說仍然是一個問題。

(Operator Instructions) The next question comes from Matt Larew with William Blair.

（操作員說明）下一個問題來自 Matt Larew 和 William Blair。

I wanted to follow up on the comment about home health rates it's been on the Medicare Advantage side, been a theme for a number of the companies in the space and for years really in terms of getting adequate reimbursement. You referenced your leverage point around Personal Care. But just curious maybe what percentage of your book of business today, you feel on the MA side, you feel like you're getting adequate reimbursement, what's unique about the situation and how you're approaching payers today that might be different than 1 or 3 or 5 years ago?

我想跟進關於家庭健康費率的評論，它一直在 Medicare Advantage 方面，這一直是該領域許多公司的主題，多年來一直在獲得足夠的報銷方面。您提到了個人護理方面的槓桿點。但只是好奇今天您的業務簿中有多少百分比，您覺得在 MA 方面，您覺得您得到了足夠的報銷，這種情況有什麼獨特之處以及您今天如何接近付款人可能不同於 1 或3 或 5 年前？

Well, I think when you look at the MA business, we've had purposely kind of slow down some of the referral volume that we saw in Q4 and really to get the attention of some of the payers out there. We have found though, once we start having conversations with them they understand some of the challenges that we won, we haven't really revisited these rates in a while.

好吧，我認為當你看 MA 業務時，我們有意放慢了我們在第四季度看到的一些推薦量，並真正引起了一些付款人的注意。不過，我們發現，一旦我們開始與他們交談，他們就會了解我們贏得的一些挑戰，我們已經有一段時間沒有真正重新審視這些利率了。

We've had certainly some inflation around wages that need to be addressed. And if they want to have adequate coverage for their beneficiaries, they need to do something about the rates. So we've had some success. I think the way we're approaching is let's try to get some near-term wins, let's focus on if we're on a non-episodic let's get those non-episodic rates adjusted, right to where we're at in a position where we can start taking on those referrals, and they become profitable for us.

我們肯定有一些圍繞工資的通貨膨脹需要解決。如果他們想為他們的受益人提供足夠的保險，他們需要對費率採取一些措施。所以我們取得了一些成功。我認為我們正在接近的方式是讓我們嘗試獲得一些近期的勝利，讓我們專注於我們是否處於非偶發性讓我們調整那些非偶發性利率，就在我們所處的位置我們可以從哪裡開始接受這些推薦，他們會為我們帶來利潤。

And at the same time, let's look at the longer-term solution, which is honestly, we need to move towards an episodic type rate that is more comparable to Medicare fee-for-service. So we've had some good traction with the MA plans, both on the near-term solution, but then also on that longer-term solution in investigating and looking at episodic because I think they realized this isn't -- I think we're kind of reaching a point where if they want to have the coverage that they need, they're going to have to adjust rates.

同時，讓我們看看更長期的解決方案，老實說，我們需要朝著與 Medicare 按服務收費更具可比性的間歇式費率邁進。因此，我們對 MA 計劃有一些很好的吸引力，既有近期解決方案，也有調查和研究偶發事件的長期解決方案，因為我認為他們意識到這不是——我認為我們如果他們想要獲得所需的覆蓋範圍，他們將不得不調整費率。

Also, I think they're looking for we'd like to partner with people that we can look at potential value-based types of arrangements. So I think that bodes well for us, particularly where we have the personal care footprint that complements the home health footprint to be able to do something creative on the rate side.

此外，我認為他們正在尋找我們願意與我們可以研究潛在的基於價值的安排類型的人合作。所以我認為這對我們來說是個好兆頭，特別是在我們擁有個人護理足跡以補充家庭健康足蹟的情況下，能夠在利率方面做一些有創意的事情。

Okay. And then following up on some of the investments you made in terms of candidate tracking and both to engage the potential higher than decreased time to hire. Is there anything you can maybe quantify for us in terms of how that's improved the metrics you track on the hiring side? And then referenced rolling it out to all your sites in '23. So maybe where that roll out today? And what's kind of the course of rollout over '23, just so we could think about how that might continue to improve throughout the year.

好的。然後跟進您在候選人跟踪方面所做的一些投資，兩者都是為了吸引潛在的而不是減少招聘時間。就如何改進您在招聘方面跟踪的指標而言，您是否可以為我們量化？然後參考在 23 年將其推廣到您的所有網站。那麼也許今天推出的地方？ 23 年的推出過程是什麼樣的，這樣我們就可以考慮如何在全年繼續改進。

Yes. So on the candidate tracking system, we initiated it first with our clinical side, lower volume just to make sure we get kind of address any issues or bugs in the system. That was successful earlier this past year by about midyear. We then piloted at several of our personal care sites actually kind of split it out a couple of locations in each region. And I wanted to spend some time there because if you look at just volume of hiring that we do on the personal care side is significant.

是的。因此，在候選人跟踪系統上，我們首先從臨床方面啟動它，降低音量只是為了確保我們能夠解決系統中的任何問題或錯誤。去年早些時候，大約在年中，這是成功的。然後，我們在我們的幾個個人護理站點進行了試點，實際上將其分成了每個地區的幾個位置。我想在那里花一些時間，因為如果你只看我們在個人護理方面所做的招聘數量就很重要。

So we wanted to make sure that the system was working as planned. And so we've had those rollouts have been successful. We're now ready to take it to the rest of the personal care locations, which we'll do over the next probably 2 quarters to get all of the regions on the new candidate tracking system. It's pretty intuitive. It takes a little bit of training but pretty straightforward.

所以我們想確保系統按計劃運行。因此，我們已經成功推出了這些產品。我們現在準備將其帶到其他個人護理地點，我們將在接下來的兩個季度內完成這項工作，以使所有地區都進入新的候選人跟踪系統。這非常直觀。這需要一些培訓，但非常簡單。

But what we've seen is, one, increase in candidate flow to start with, but we've also seen that reduction from the time that someone submits an application to their actual hiring. And it's been -- depending on whether it's a clinical services or PCS, we've seen anywhere from 1 or 2 days savings to versus really on the PCS side, where we've seen probably 4 to 5 days acceleration of that process.

但是我們看到的是，第一，候選人流量開始增加，但我們也看到從某人提交申請到實際招聘的時間有所減少。而且它已經 - 根據它是臨床服務還是 PCS，我們已經看到從 1 到 2 天的任何地方節省到真正在 PCS 方面，我們已經看到該過程可能加速 4 到 5 天。

The next question comes from Joanna Gajuk with Bank of America.

下一個問題來自美國銀行的 Joanna Gajuk。

I'm sorry if you mentioned this earlier, but actually, I just want to follow-up on the last commentary did you give some stats in terms of your net hires in your personal care, how things are trending in Q4 and into Q1?

如果你之前提到過這個，我很抱歉，但實際上，我只是想跟進上一篇評論，你是否提供了一些關於個人護理淨僱員的統計數據，第四季度和第一季度的趨勢如何？

Yes. So if you look on the clinical side, we actually had a nice net hire. We added probably about 80 net hires on the clinical side, primarily on the hospice front, our hiring on PCS. Certainly, if you look year-over-year, it was, I think, about 10% greater than it was prior year, sequentially down a little bit. That's mainly because of the holiday season. You see some less slowness in Q4.

是的。所以如果你從臨床方面看，我們實際上有一個不錯的淨僱傭。我們在臨床方面增加了大約 80 名淨僱員，主要是在臨終關懷方面，我們在 PCS 上招聘。當然，如果你看與去年同期相比，我認為它比上一年增加了大約 10%，環比下降了一點。這主要是因為假期。你會看到第四季度的放緩程度有所減輕。

Good to see our January and February numbers look solid. So more in line kind of with the Q3 type number. So good hiring momentum on the personal care front. And again, as we said, the clinical hiring has certainly improved really since kind of midyear last year.

很高興看到我們的 1 月和 2 月數字看起來很穩固。所以更符合 Q3 型號。個人護理方面的招聘勢頭非常好。而且，正如我們所說，自去年年中以來，臨床招聘確實有所改善。

Okay. That's helpful. And I guess I'll say on the personal care, so you mentioned some positive trends there on rates, but also on the volumes, the hours per business to improve sequentially. As we think going forward about the following quarters. Is it fair to assume volumes in the normal situation should be growing sequentially over the quarter? Or is there some seasonality in the business?

好的。這很有幫助。我想我會說個人護理，所以你提到了一些關於費率的積極趨勢，但也提到了數量，每家企業的時間順序改善。正如我們對接下來幾個季度的思考。假設正常情況下的交易量應該在本季度連續增長是否公平？或者業務中是否存在季節性？

No. I mean I think there tends to be a little less seasonality related to personal care. I mean where you have seasonality primarily is if you have a depending kind of winter storms can affect it. A little slowness and it tends to be, frankly, in Q4 around December and the holidays. But we saw, in spite of that, some nice growth. So Q1, I think when we look at Q1, Q2, Q3 should be nice, steady growth with the hiring numbers that we're seeing.

不，我的意思是我認為與個人護理相關的季節性往往會少一些。我的意思是，你有季節性的地方主要是如果你有一種依賴的冬季風暴會影響它。有點慢，坦率地說，它往往是在 12 月左右和假期的第四季度。但儘管如此，我們還是看到了一些不錯的增長。所以第一季度，我認為當我們看第一季度、第二季度、第三季度時，我們看到的招聘數字應該是不錯的、穩定的增長。

Yes. Keep in mind, Joanna, just to piggyback on that a little bit. So in Personal Care, a lot of our markets, if we have missed visit things, we have the ability to make those up and reschedule those on different days. Again, that's market to market. So it's not always a guarantee, but we do have a little bit of flexibility if we run into some of those things. There's a little bit of ability to work around those in certain spots.

是的。請記住，喬安娜，只是為了稍微利用一下。因此，在個人護理領域，我們的很多市場，如果我們錯過了拜訪的事情，我們有能力彌補這些並在不同的日子重新安排。同樣，這是市場對市場。所以這並不總是保證，但如果我們遇到其中一些事情，我們確實有一點靈活性。在某些地方有一些解決這些問題的能力。

And I had a follow-up on the cash flow, which you mentioned it was very strong. You've included some of the maybe, call it, onetime type funding your receivable, it's not repeatable. But how should we think about operating cash flow for this year versus this $105 million? How much should we exclude kind of as a onetime not repeatable? And where would you think you could land for this year for cash flow?

我對現金流進行了跟進，你提到它非常強勁。你已經包括了一些可能，稱之為一次性類型的應收賬款資金，它是不可重複的。但是我們應該如何考慮今年的運營現金流與這 1.05 億美元的關係？我們應該排除多少一次性不可重複的東西？您認為今年可以在哪裡獲得現金流？

Yes. If you look at 2022, so it was $105 million, but if you kind of back out the net positive impact from the ARPA funds and then you back out kind of those working cap changes that I mentioned in my comments was around $19 million. So you back those out, that's $27 million, you probably would have been more in the $75 million-ish, $80 million range off of our EBITDA of over $100 million. So that's a pretty strong conversion rate still. So I think to expect something more in that range would be more probably opportunity for 2023.

是的。如果你看看 2022 年，它是 1.05 億美元，但如果你取消 ARPA 基金的淨積極影響，然後你取消我在評論中提到的那些工作上限變化，大約是 1900 萬美元。所以你支持這些，那是 2700 萬美元，你可能會在我們超過 1 億美元的 EBITDA 的 7500 萬美元左右，8000 萬美元範圍內。所以這仍然是一個相當高的轉化率。因此，我認為在 2023 年期望更多的東西更有可能是這個範圍內的機會。

I think '22, we're not going to continue to see $20 million in net working cap improvement even as we grow. That's probably more of a onetime thing. But that 75% conversion rate is probably something you should expect on a consistent basis.

我認為 22 年，即使我們在成長，我們也不會繼續看到 2000 萬美元的淨工作上限改善。這可能更像是一次性的事情。但 75% 的轉化率可能是您應該始終如一地期望的結果。

This is great. That's helpful. And the last one, a follow-up. So you were talking about working with the other home health -- sorry, on the rates, working with the Medicare Advantage plans. I don't remember, did you disclose, can you tell us what is your mix of Medicare fee-for-service versus the Medical Advantage previsit versus Medicare Advantage episodic type of contracts (inaudible) volumes like percent of visits.

這很棒。這很有幫助。最後一個，跟進。所以你在談論與其他家庭健康合作——抱歉，關於費率，與 Medicare Advantage 計劃合作。我不記得了，你有沒有透露，你能告訴我們你的 Medicare 按服務收費與 Medicare Advantage 預訪和 Medicare Advantage 情景類型的合同（聽不清）數量（如訪問百分比）的組合是什麼。

Yes. We haven't disclosed that in the past, but I mean we're probably a little over half of our businesses in Medicare are episodic and a little less than half is non-episodic. And again, we're working on that mix and certainly made some good progress in Q4 related to that.

是的。我們過去沒有透露過這一點，但我的意思是我們可能有一半多一點的醫療保險業務是偶發性的，不到一半是非偶發性的。再一次，我們正在研究這種組合，並且在第四季度取得了一些與此相關的良好進展。

This concludes our question-and-answer session. I would like to turn the conference back over to Dirk Allison for any closing remarks.

我們的問答環節到此結束。我想將會議轉回給 Dirk Allison，聽取任何閉幕詞。

Thank you, operator. I want to thank each of you today for your interest in Addus and for being part of our earnings call today, and we hope you have a great week. Thank you.

謝謝你，運營商。我今天要感謝你們每個人對 Addus 的興趣，並感謝你們今天參加我們的財報電話會議，我們希望你們度過愉快的一周。謝謝。

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

會議現已結束。感謝您參加今天的演講。您現在可以斷開連接。