Addus Homecare Corp (ADUS) 2023 Q2 法說會逐字稿

Good day, and welcome to the Addus HomeCare's Second Quarter 2023 Earnings Conference Call. (Operator Instructions) Please note that this event is being recorded.

美好的一天，歡迎參加 Addus HomeCare 2023 年第二季財報電話會議。 （操作員說明）請注意，該事件正在被記錄。

I would now like to turn the conference over to Dru Anderson. Please go ahead.

我現在想把會議交給德魯·安德森。請繼續。

Thank you. Good morning, and welcome to the Addus HomeCare Corporation Second Quarter 2023 Earnings Conference Call. Today's call is being recorded. To the extent any non-GAAP financial measure is discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP by going to the company's website and reviewing yesterday's news release.

謝謝。早安，歡迎參加 Addus HomeCare Corporation 2023 年第二季財報電話會議。今天的通話正在錄音。如果在今天的電話會議中討論了任何非公認會計準則財務指標，您還可以透過造訪公司網站並查看昨天的新聞稿，找到該指標與根據公認會計準則計算的最直接可比較財務指標的調節表。

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.

本次電話會議也可能包含 1995 年《私人證券訴訟改革法案》含義內的前瞻性聲明，包括有關 Addus 2023 年及以後預期季度和年度財務業績的聲明等。為此目的，本次電話會議期間所做的任何非歷史事實陳述的陳述都可能被視為前瞻性陳述。在不限制前述內容的情況下，對預測、估計、目標、計劃、信念、期望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 in its second quarter 2023 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. 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.

特此提醒您，這些陳述可能會受到 Addus 向美國證券交易委員會提交的文件及其 2023 年第二季新聞稿中所述的重要因素的影響。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。本公司不承擔因新資訊、未來事件或其他原因而更新任何前瞻性陳述的義務。我現在想將電話轉給公司董事長兼執行長德克·艾利森先生。請繼續，先生。

Thank you, Dru. Good morning, and welcome to our 2023 second quarter earnings call. With me today are Brian Poff, our Chief Financial Officer; and Brad Bickham, our President and Chief Operating Officer.

謝謝你，德魯。早上好，歡迎參加我們的 2023 年第二季財報電話會議。今天和我在一起的有我們的財務長 Brian Poff；以及我們的總裁兼營運長 Brad Bickham。

As we do on each of our earnings call, I'll begin with a few overall comments, and then Brian will discuss the second quarter results in more detail. Following our comments, the 3 of us will be happy to respond to any questions. Before I turn to discussion to our results, I want to take a moment and update you on events related to the CMS proposed rule for Medicaid services. As you know, in early May of this year, the Health and Human Services Department introduced the proposed rule titled, assuring access to Medicaid services. While we have previously stated our agreement with the goal of broadening coverage and expanding the caregiver workforce, we question the specific approach, proposed and (inaudible) concept or caregiver wages as there are inherent challenges in setting a one-size-fits-all minimum percentage.

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，然後布萊恩將更詳細地討論第二季的業績。根據我們的評論，我們三人將很樂意回答任何問題。在討論我們的結果之前，我想花點時間向您介紹與 CMS 醫療補助服務擬議規則相關的最新事件。如您所知，今年 5 月初，衛生與公共服務部提出了題為「確保獲得醫療補助服務」的擬議規則。雖然我們之前已表示同意擴大覆蓋範圍和擴大護理人員隊伍的目標，但我們對具體方法、提議和（聽不清）概念或護理人員工資提出質疑，因為設定一刀切的最低工資存在固有的挑戰百分比。

This is due to the wide variance among state waiver programs, which directly impacts the administration burden required to provide home and community-based services in individual state. We also believe that many providers, especially small local providers and those operating in states with larger rural populations may be unable to continue providing care due to the significant administrative burden from related costs required to provide quality, regulatory compliance, home and community-based services. These challenges, if not properly considered and addressed, may have the opposite effect intended by the proposed rule by inadvertently reducing access to services, particularly in rural areas. We recently submitted our comment letter for this proposed Medicaid Access rule. We also participated in the development of comment letters from our various trade associations. Overall, over 2,000 comments were submitted to CMS, including comments from 31 states.

這是由於各州豁免計劃之間存在巨大差異，這直接影響了各州提供家庭和社區服務所需的管理負擔。我們還認為，許多提供者，特別是小型當地提供者以及在農村人口較多的州運營的提供者可能無法繼續提供護理，因為提供品質、合規性、家庭和社區服務所需的相關成本帶來龐大的行政負擔。這些挑戰如果沒有適當考慮和解決，可能會無意中減少獲得服務的機會，從而產生擬議規則的相反效果，特別是在農村地區。我們最近提交了針對這項擬議的醫療補助准入規則的評論信。我們也參與了各行業協會意見信的製定。總共向 CMS 提交了 2,000 多條評論，其中包括來自 31 個州的評論。

From our review of the CMS database, comments related to the 80% threshold proposal were significantly opposed. Many other comments shared observations consistent with ours, including the difficulty in implementing a one-size-fits-all approach, the lack of evidence or data to support the 80% proposal and the potential to negatively impact Medicaid (inaudible) states, including California and Washington as well as the National Association of Medicaid Directors express serious concerns our opposition to the 80% minimum threshold.

從我們對 CMS 資料庫的審查來看，與 80% 閾值提案相關的評論遭到了強烈反對。許多其他評論分享了與我們一致的觀察結果，包括實施一刀切的方法的困難、缺乏支持 80% 提案的證據或數據以及對醫療補助（聽不清）州（包括加利福尼亞州）產生負面影響的可能性華盛頓州以及全國醫療補助董事協會對我們反對80% 的最低門檻表示嚴重關切。

Among the comments filed were letters from several law firms representing either providers, trade associations or states strongly asserting that Congress did not provide the health of human services department, a legal authority to mandate this specific proposed 80% threshold rule on state and that's the setting up any national press based on a limited or no data is arbitrary and therefore, in balance.

在提交的評論中，有幾家代表供應商、行業協會或各州的律師事務所發出的信件，強烈主張國會沒有提供公共服務部門的健康信息，該部門是一個法定機構，可以對各州強制執行這一具體提議的80% 閾值規則，這就是設定任何基於有限數據或沒有數據的國家新聞報道都是任意的，因此是平衡的。

On July 21, Addus participated in a listening session with the CMS administrator, other CMS staff and several home-based care trade associations. These associations verbally (inaudible) selective concerns regarding the proposed rule and presented alternative approaches primarily focused on increasing Medicaid rates to help alleviate the workforce prices. As of now, advocacy and education to Congress and others will continue. However, no (inaudible) of action will occur until CMS issues a final rule. Once the final rule is published, if it includes an 80% or similar threshold, we expect legal challenges to be initiated.

7 月 21 日，Addus 參加了 CMS 管理員、其他 CMS 工作人員和幾個家庭護理行業協會的聆聽會議。這些協會口頭（聽不清楚）選擇性地關注擬議的規則，並提出了主要側重於提高醫療補助費率以幫助緩解勞動力價格的替代方法。截至目前，對國會和其他方面的宣傳和教育將繼續進行。然而，在 CMS 發布最終規則之前，不會採取任何行動（聽不清楚）。一旦最終規則發布，如果它包含 80% 或類似的閾值，我們預計將發起法律挑戰。

While we do not know the outcome of all of our actions, we are encouraged by the volume of comments from many diverse parties the vast majority of which express significant concern with any minimum wage percentage threshold. In summary, (inaudible) volume and (inaudible) of the comment letters may have an impact on the final rule and the final rule that implemented is likely to be subject to legal talent. It is important to note and emphasize that there are many unknowns around the proposed rule and its long-term impact on our operations even if it were to be implemented as proposed and withstand legal challenges.

雖然我們不知道我們所有行動的結果，但我們對來自不同各方的大量評論感到鼓舞，其中絕大多數對任何最低工資百分比閾值表示嚴重關切。總之，（聽不清楚）評論信的數量和（聽不清楚）可能會對最終規則產生影響，而最終實施的規則可能會受到法律人才的影響。值得注意並強調的是，即使提議的規則要按提議實施並經受住法律挑戰，其對我們運營的長期影響仍存在許多未知因素。

Among these, we do not know when a final rule will be issued, and therefore, when the 4-year implementation period would begin or if the implementation period might be extended for a longer time frame. In addition, we would explore operational changes to manage our business to minimize the potential impact of any final rule. The rule as proposed also does not cover parts of our personal care services. We currently estimate that over 20% of our existing PCS revenue would not be covered by the proposed rule.

其中，我們不知道最終規則何時發布，因此4年的實施期何時開始，或實施期是否會延長更長的時間。此外，我們將探索營運變革來管理我們的業務，以盡量減少任何最終規則的潛在影響。擬議的規則也不涵蓋我們的部分個人護理服務。我們目前估計超過 20% 的現有 PCS 收入不會受到擬議規則的覆蓋。

Now let me turn to the quarterly financial results. Yesterday, we announced our results for the second quarter of 2023. These results indicated continued strong financial performance by Addus. I want to thank our team for providing quality care to our clients and patients in the home while allowing us to deliver these consistent financial results. For the second quarter of 2023, our total revenue was $260 million, an increase of 9.7% as compared to $236.9 million for the second quarter of 2022. This revenue growth resulted in an adjusted earnings per share of $1.07 as compared to adjusted earnings per share for the second quarter of 2022 of $0.91, an increase of 17.6%. Our adjusted EBITDA of $28.3 million was an increase of 12.7% over the second quarter of 2022. During the second quarter 2023, we continue to see strong cash flow from operations as our states and other payers have continued to pay in a timely manner.

現在讓我談談季度財務表現。昨天，我們公佈了 2023 年第二季的業績。這些結果表明 Addus 的財務表現持續強勁。我要感謝我們的團隊為我們的客戶和患者提供優質的居家護理，同時使我們能夠實現這些一致的財務表現。 2023 年第二季度，我們的總收入為2.6 億美元，比2022 年第二季度的2.369 億美元增長9.7%。與調整後每股收益相比，這一收入增長導致調整後每股收益為1.07美元2022 年第二季為 0.91 美元，成長 17.6%。我們的調整後 EBITDA 為 2830 萬美元，比 2022 年第二季度增長 12.7%。在 2023 年第二季度，我們繼續看到來自營運的強勁現金流，因為我們的州和其他付款人繼續及時付款。

This strong cash flow, along with conservative management of our balance sheet, has allowed us to maintain a net leverage position of less than 1x adjusted EBITDA, continuing to give us financial flexibility, which should enable us to be opportunistic as we anticipate seeing transactions come to the market over the next 2 quarters. While our goal is to use our financial capacity to acquire strategic operations that align with our overall growth strategy, we will continue to be diligent with the use of our capture. As has been the case over the last few quarters, the overall labor environment continues to improve.

這種強勁的現金流，加上對資產負債表的保守管理，使我們能夠將淨槓桿頭寸維持在調整後EBITDA 的1 倍以下，繼續為我們提供財務靈活性，這將使我們能夠在預期交易到來時抓住機會未來2季推向市場。雖然我們的目標是利用我們的財務能力來收購與我們整體成長策略一致的策略業務，但我們將繼續勤勉地利用我們的捕獲能力。與過去幾季的情況一樣，整體用工環境持續改善。

During the second quarter of 2023, we continued to experience solid hiring in our Personal Care segment with 81 hires per business day. Our new candidate management and tracking system, which now has been fully implemented across all of our service lines has allowed us to better engage with potential employees shortening the time between application and higher by approximately 10 days, finding ways to continue reducing the time frame between application and the first client visit is an area we will continue to focus on to help us meet our growth targets.

2023 年第二季度，我們的個人護理部門持續保持強勁的招募勢頭，每個工作日招募 81 名員工。我們新的候選人管理和追蹤系統現已在我們所有的服務線中全面實施，使我們能夠更好地與潛在員工互動，將申請與批准之間的時間縮短約10 天，並找到繼續縮短申請與批准之間的時間範圍的方法申請和首次客戶拜訪是我們將繼續關注的領域，以幫助我們實現成長目標。

Hiring in our Clinical segment continues to be more challenging than in our Personal Care segment, although we have seen modest improvement as compared to this time in 2022. While hiring in our clinical segment continues to improve overall, there are certain markets that have been more difficult and have impacted our growth rate in those markets. During the second quarter, we continued to utilize the funding we received from the American Rescue Plan Act or ARPA. To date, we have received approximately $25 million, of which we still have $10.6 million remaining to use over the next few quarters. As is previously mentioned, these funds have been helpful with our recruitment and retention efforts to support patient care and should continue to help those efforts in the future as we deploy the remaining funds. As for Illinois, our largest state of operation on April 1 of this year, we received an increase of $1.26 per hour. As a result, our Illinois state reimbursement rate is now $26.92 per hour.

儘管與2022 年相比，我們的臨床部門的招聘工作有所改善，但我們的臨床部門的招聘仍然比個人護理部門更具挑戰性。雖然我們的臨床部門的招聘總體上繼續改善，但某些市場的招聘情況比個人護理部門的招聘情況要好得多。困難並影響了我們在這些市場的成長率。第二季度，我們繼續利用從美國救援計畫法案 (ARPA) 獲得的資金。迄今為止，我們已收到約 2,500 萬美元，其中仍有 1,060 萬美元可供未來幾季使用。如前所述，這些資金有助於我們的招募和保留工作，以支持患者護理，並且在我們部署剩餘資金時，未來應該繼續幫助這些工作。至於伊利諾伊州，我們今年 4 月 1 日運營的最大州，我們每小時增加了 1.26 美元。因此，我們伊利諾伊州的報銷費率為每小時 26.92 美元。

This increase covers the July 1, 2023 minimum wage increase in Chicago and allows us to continue to raise wages for all of our Illinois caregivers. We are pleased to see strong support from the state as the most recent approved budget calls for an increase of $1.15 per hour and our reimbursement rate effective January 1, 2024. One additional issue I'd like to discuss is (inaudible) rate decrease for home health that CMS recently released. We are very disappointed that CMS continues to propose rates for this important level of home care that does not take into consideration the increase in wages and expenses our industry has experienced.

此次上漲涵蓋了芝加哥 2023 年 7 月 1 日最低工資的上漲，並使我們能夠繼續提高所有伊利諾伊州護理人員的薪資。我們很高興看到來自州政府的大力支持，因為最近批准的預算要求每小時增加1.15 美元，並且我們的報銷費率將於2024 年1 月1 日生效。我想討論的另一個問題是（聽不清楚）費率降低CMS最近發布的家庭健康。我們非常失望的是，CMS 繼續為這一重要級別的家庭護理提出費率，而沒有考慮到我們行業經歷的工資和費用的增長。

While home health has only seen a proposed rate, Hospice recently saw a slight improvement in the final rates in the coming year, so we are hopeful that the final home health rate when published will more appropriately reflect our increased cost. However, we believe that these reimbursement pressures are likely to moderate over the next few years. And as such, we will continue to look for acquisition opportunities that are strategic to our overall growth. Now let me discuss our same-store revenue growth for the second quarter of 2023.

雖然家庭健康只看到了建議的費率，但臨終關懷中心最近發現來年的最終費率略有改善，因此我們希望最終的家庭健康費率在發佈時能夠更恰當地反映我們增加的成本。然而，我們認為這些報銷壓力在未來幾年可能會減輕。因此，我們將繼續尋找對我們整體成長具有策略意義的收購機會。現在讓我討論一下 2023 年第二季我們的同店營收成長情況。

For our Personal Care segment, our same-store revenue growth was 12.6% when compared to the second quarter 2022. During the second quarter of 2023, we saw Personal Care same-store hours per business day grew 3.85 over the same period in 2022 and 1.2% on a sequential quarter basis. We are excited to see our various hiring and scheduling (inaudible) beginning to take hold and contribute to sequential power growth over the past several quarters.

對於我們的個人護理部門，與2022 年第二季度相比，我們的同店收入增長了12.6%。在2023 年第二季度，我們發現個人護理每個工作日的同店營業時間比2022 年同期增長了3.85 小時，季增 1.2%。我們很高興看到我們的各種招聘和調度（聽不清楚）開始紮根並為過去幾季的電力連續成長做出貢獻。

Turning to our clinical operations. Our home health segment same-store revenue decreased 10.9% over the same quarter in 2023 as we continued to reduce admissions from payers that do not currently reimburse us adequate rates to cover our costs. While we did see lower admissions primarily due to intentionally limiting admissions from these nonstrategic (inaudible) our gross margin improved, as did our mix of episodic volume and overall profitability. While we have limited certain admissions due to contract rates, our managed care team continues to work with our Medicare Advantage and commercial payers to adjust our contract rates to a more appropriate level, which will allow us to selectively accept more non-episodic volume going forward.

轉向我們的臨床操作。我們的家庭健康部門同店收入比 2023 年同季度下降了 10.9%，因為我們繼續減少目前未向我們報銷足夠費率來支付費用的付款人的入院人數。雖然我們確實看到入場人數減少，主要是由於有意限制這些非戰略性（聽不清）的入場人數，但我們的毛利率有所改善，我們的劇集數量和整體盈利能力的組合也有所改善。雖然我們因合約費率而限制了某些入院人數，但我們的管理式醫療團隊繼續與我們的Medicare Advantage 和商業付款人合作，將我們的合約費率調整到更合適的水平，這將使我們能夠選擇性地接受未來更多的非偶發性治療量。

In addition to renegotiating rate, our operations team continues to work on improving both face mix and staffing and home health to ensure we maximize the value of the services we provide. We remain excited about our home health operation as it complements our personal care services, particularly where we participate in value-based contracting model. Our hospice same-store revenue decreased 1.1% when compared to the second quarter in 2022. However, excluding the impact of sequestration, our hospice same-store revenue growth was basically flat year-over-year. While our hospice segment is continuing to take longer to recover from the difficult period during and after the pandemic, it is encouraging to see sequential growth in our ADC as compared to the first quarter of 2023.

除了重新協商費率之外，我們的營運團隊還繼續努力改善面孔組合、人員配置和家庭健康，以確保我們最大限度地發揮所提供服務的價值。我們對我們的家庭健康業務仍然感到興奮，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約模式的情況下。與 2022 年第二季相比，我們的臨終關懷同店營收下降了 1.1%。不過，排除扣押的影響，我們的臨終關懷同店營收同比增長基本持平。儘管我們的臨終關懷部門仍需要更長的時間才能從大流行期間和之後的困難時期中恢復，但與 2023 年第一季相比，我們的 ADC 連續成長令人鼓舞。

During the second quarter, we started to see an increasing length of stay from patients coming from skilled nursing facility referral. As of the end of the quarter, our hospice medium length of stay was 29 days exclusive of our Journey Care operations, which historically has a higher proportion of short-stay patients. We believe this is a trend towards a more typical length of stay from those referral sources, primarily due to the expiration of certain provisions implemented as part of the public health emergency declaration, which ended on May 11. This morning, we announced we closed on our Tennessee Quality Care acquisition, a provider of home health, hospice and private duty nursing service.

在第二季度，我們開始看到來自熟練護理機構轉診的患者的住院時間越來越長。截至本季末，我們的臨終關懷中心住院時間為 29 天，不包括我們的 Journey Care 業務，該業務歷來短期住院患者比例較高。我們認為，從這些轉診來源來看，這是一種更典型的停留時間的趨勢，主要是因為作為公共衛生緊急聲明的一部分實施的某些規定已到期，該聲明於5 月11 日結束。今天早上，我們宣布我們關閉我們收購了田納西州的 Quality Care，這是一家家庭健康、臨終關懷和私人護理服務提供者。

Tennessee quality care serves as an average (inaudible) center of approximately 1,800 patients through 17 locations, covering a service area of over 50 counties in Tennessee and generating approximately $40 million in annualized revenue. This is a very strategic acquisition for Addus as it allows us to offer all 3 levels of home-based care in an attractive market as well as being a significant (inaudible) state. With this transaction, we will also be able to expand our home health and hospice services into 9 additional counties as we look ahead a number of locations in the future. We are excited about the potential of this new operation and look forward to working with our new team members.

田納西州優質護理中心平均（聽不清楚）擁有 17 個地點的約 1,800 名患者，涵蓋田納西州 50 多個縣的服務區域，年收入約為 4,000 萬美元。對於 Addus 來說，這是一次非常具有戰略意義的收購，因為它使我們能夠在一個有吸引力的市場以及一個重要（聽不清楚）的州提供所有 3 個級別的家庭護理。透過這項交易，我們還將能夠將我們的家庭健康和臨終關懷服務擴展到另外 9 個縣，同時我們展望未來的許多地點。我們對這項新業務的潛力感到興奮，並期待與我們的新團隊成員合作。

Over the past few quarters, we have discussed our strategic focus around potential acquisition opportunities in both personal care services and home health care. With the announcement of the proposed Medicaid access rule from CMS, we have become far more selective in relation to potential acquisitions in the personal care service line. While we continue to believe strongly in our strategy of caring home health care and hospice with personal care services, we believe it is prudent to focus our PCS efforts primarily towards modifying this proposed rule. However, we will remain focused in development efforts in the BCS space, if any highly strategic acquisition opportunities emerge.

在過去的幾個季度中，我們圍繞個人護理服務和家庭醫療保健領域的潛在收購機會討論了我們的策略重點。隨著 CMS 宣布擬議的醫療補助准入規則，我們在個人護理服務領域的潛在收購方面變得更加挑剔。雖然我們仍然堅信我們透過個人照護服務提供居家醫療保健和臨終關懷的策略，但我們認為，謹慎的做法是將我們的 PCS 工作主要集中在修改這項擬議規則上。然而，如果出現任何高度策略性的收購機會，我們將繼續專注於 BCS 領域的開發工作。

As for our value-based care efforts, we are continuing to see positive initial results from our various contracts and hope to have outcome data to share by the end of the year. While we are pleased with the current status of our value-based efforts, we are still in the early stages of our goal to have this segment grow into a more significant part of our long-term business. However, we continue to see a great deal of interest from payers wanting to work with us on these type arrangements. We are continuing to invest in value-based strategies and related technology resources in 2023, which we believe will help give us an opportunity to accelerate our revenue growth in this part of our operations. With the addition of our most recent acquisition of Tennessee Quality Care, we now have 3 (inaudible) all 3 levels of care. We believe this coverage positions us well to continue to add value-based contracts in these markets.

至於我們基於價值的護理工作，我們繼續從各種合約中看到積極的初步成果，並希望在年底前分享成果數據。雖然我們對基於價值的努力的現狀感到滿意，但我們仍處於使該細分市場成為我們長期業務更重要部分的目標的早期階段。然而，我們仍然看到付款人對這些類型的安排表現出極大的興趣，並希望與我們合作。 2023年，我們將繼續投資基於價值的策略和相關技術資源，我們相信這將有助於我們有機會加速這部分業務的收入成長。加上我們最近收購的 Tennessee Quality Care，我們現在擁有 3 個（聽不清楚）所有 3 個等級的護理。我們相信，這種覆蓋範圍使我們能夠繼續在這些市場上增加基於價值的合約。

As I say each quarter, I am so proud of our team for the care they are providing to our elderly and disabled consumers and patients. There is no question that the majority of clients and patients want to receive care in the home, which remains one of the safest and most cost effective received (inaudible). 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 for buying outstanding care and support to our clients, patients and their family. With that, let me turn the call over to Brian.

正如我每季所說的那樣，我為我們的團隊為老年和殘疾消費者和患者提供的護理感到非常自豪。毫無疑問，大多數客戶和患者都希望在家中接受護理，這仍然是最安全、最具成本效益的護理方式之一（聽不清楚）。我們相信，人們對家庭護理價值的認識提高有利於我們的行業，也將成為我們公司的成長機會。我們理解並感謝我們的營運和成長依賴我們敬業的護理人員，他們非常努力地為我們的客戶、患者及其家人提供卓越的護理和支援。接下來，讓我把電話轉給布萊恩。

Thank you, Dirk, and good morning, everyone. Addus had a strong financial and operating performance for the second quarter of 2023, continuing our solid performance through the first half of the year. Our Personal Care results reflect robust demand for our services at a favorable rate environment, led by a very strong 12.6% year-over-year organic revenue growth for the quarter, well above our normal expected range of 3% to 5%. We are very pleased with the momentum in the core Personal Care segment with an 11.7% revenue increase for the year-to-date period over the prior year. As expected, we received our second statewide increase of the year in Illinois our largest personal care market on April 1. This increase is in addition to our January 1, 2023 increase in the state.

謝謝你，德克，大家早安。 Addus 2023 年第二季的財務和營運表現強勁，延續了上半年的穩健表現。我們的個人護理表現反映了在有利的利率環境下對我們服務的強勁需求，本季有機收入年增 12.6%，遠高於我們 3% 至 5% 的正常預期範圍。我們對核心個人護理業務的發展勢頭感到非常滿意，今年迄今的收入比前一年增長了 11.7%。正如預期的那樣，我們於4 月1 日在伊利諾伊州最大的個人護理市場迎來了今年第二次全州範圍內的漲價。此次漲價是在該州於2023 年1 月1 日漲價的基礎上進行的。

Additionally, we received a retroactive reimbursement increase in New York, which was largely focused on our consumer-directed business and has brought our margins in this program more in line with our other programs in the state. As a result, we have resumed taking new clients into our consumer direct program and therefore, are no longer excluding those results from our same-store revenues.

此外，我們在紐約獲得了追溯性的報銷增加，這主要集中在我們以消費者為導向的業務，並使我們在該計劃中的利潤與我們在該州的其他計劃更加一致。因此，我們已恢復將新客戶納入我們的消費者直接計劃，因此不再將這些結果排除在我們的同店收入之外。

While our hospice business has been slower to recover to pre-pandemic levels, we experienced modest sequential improvement in several key metrics this quarter over the first quarter. Our average daily census, median length of stay and patient days all improved in the first quarter of the year with our median length of stay the highest we have seen since before the pandemic at 29 days. We expect to see further gradual improvement in our hospice business in the second half of this year with the expiration of the public health emergency expected to lead to an increase in our skilled nursing facility hospice length of stay. The Journey Care Hospice operations acquired effective February 2022, are included in our same-store revenues for the first time this quarter. Same-store revenue for our home health services declined 10.9% from the same period a year ago as we focus on appropriately balancing our mix of episodic versus nonepisodic cases to improve profitability. We are continuing our efforts to negotiate more favorable rates with certain of our payers and have limited emissions under some agreements in the interim.

儘管我們的臨終關懷業務恢復到疫情前水準的速度較慢，但本季我們的幾個關鍵指標較第一季略有連續改善。今年第一季度，我們的平均每日人口普查、中位住院時間和患者天數均有所改善，中位住院時間為大流行之前以來的最高水平，為 29 天。我們預計，隨著公共衛生緊急事件的結束，我們的臨終關懷業務將在今年下半年進一步逐步改善，預計將導致我們的熟練護理機構臨終關懷住院時間的增加。於 2022 年 2 月收購的 Journey Care 臨終關懷業務於本季首次納入我們的同店營收。我們的家庭健康服務的同店收入較去年同期下降了 10.9%，因為我們專注於適當平衡偶發性病例與非偶發性病例的組合，以提高盈利能力。我們正在繼續努力與某些付款人談判更優惠的費率，並在此期間根據一些協議限制排放。

Total net service revenues for the second quarter were $260 million. The revenue breakdown is as follows: Personal Care revenues were $198.3 million or 76.3% of revenue. Hospice care revenues were $50.2 million or 19.3% of revenue and home health revenues were $11.5 million or 4.4% of revenue. In addition to Journey Care, these results include the operations of Apple Home Health, which we acquired in October last year. As Dirk noted, we announced this morning that we completed our acquisition of Tennessee Quality Care, a provider of home health, hospice and private duty nursing services, which will complement our personal care services in the state. For 2023, we will continue to actively pursue acquisitions that meet our criteria and further our growth strategy. While the market environment for acquisition opportunities continues to be somewhat suppressed, we believe we will have a more favorable market environment as we gain more clarity around proposed rule changes in reimbursement and program structures.

第二季服務淨收入總額為 2.6 億美元。收入明細如下： 個人照護收入為 1.983 億美元，佔總收入的 76.3%。臨終關懷收入為 5,020 萬美元，佔收入的 19.3%，家庭健康收入為 1,150 萬美元，佔收入的 4.4%。除了 Journey Care 之外，這些業績還包括我們去年 10 月收購的 Apple Home Health 的營運情況。正如德克指出的那樣，我們今天早上宣布完成了對田納西州 Quality Care 的收購，該公司是一家家庭健康、臨終關懷和私人護理服務提供商，這將補充我們在該州的個人護理服務。 2023 年，我們將繼續積極尋求符合我們標準的收購，並進一步推動我們的成長策略。雖然收購機會的市場環境繼續受到一定程度的抑制，但我們相信，隨著我們對報銷和計劃結構的擬議規則變更更加清晰，我們將擁有更有利的市場環境。

Other financial results for the second quarter of 2023 include the following: Our gross margin percentage was 31.7%, a slight decrease compared with 31.9% for the second quarter of 2022, but an increase sequentially from 31.2% in the first quarter. With the most recent rate increase in Illinois, we will not experience the negative impact we have seen in the past 2 years from the July 1 increase to Chicago minimum wage as our wage rates have been adjusted statewide to be higher than this requirement.

2023 年第二季的其他財務表現包括： 我們的毛利率為 31.7%，較 2022 年第二季的 31.9% 略有下降，但較第一季的 31.2% 有所成長。隨著伊利諾伊州最近一次升息，我們不會經歷過去兩年從7 月1 日芝加哥最低工資上漲以來所看到的負面影響，因為我們的工資率已在全州範圍內調整為高於這一要求。

With our Tennessee Quality Care acquisition, we will see the positive impact on our gross margins of a higher mix of clinical services beginning in the third quarter and fully realized in the fourth quarter. G&A expense was 22.1% of revenue compared with 23.3% in the second quarter a year ago, reflecting the positive impact of leveraging our expenses as a percentage of our strong top line growth. Adjusted G&A expense for the second quarter of 2023 was 20.4%, a decrease from 21.3% from the same period in the prior year and a decline sequentially from 20.8% in the first quarter. The company's adjusted EBITDA increased to $28.3 million compared with $25.1 million a year ago.

透過收購 Tennessee Quality Care，我們將看到從第三季開始並在第四季度完全實現的更高組合的臨床服務對我們毛利率的正面影響。一般及行政費用佔收入的 22.1%，而去年第二季為 23.3%，反映出利用我們的支出佔收入強勁增長的百分比所產生的正面影響。 2023 年第二季調整後一般管理費用為 20.4%，較上年同期的 21.3% 有所下降，較第一季的 20.8% 環比下降。該公司調整後的 EBITDA 增至 2,830 萬美元，而一年前為 2,510 萬美元。

Adjusted EBITDA margin was 10.9% compared with 10.6% for the second quarter of 2022 and a 50 basis-point increase from 10.4% in the first quarter of 2023. Adjusted net income per diluted share was $1.07 compared with $0.91 for the second quarter of 2022. The adjusted per share results for the second quarter of 2023 excludes the following: The positive impact of the retroactive New York rate increase of $0.05, acquisition expenses of $0.08 and noncash stock-based compensation expense of $0.13. The adjusted per share results for the second quarter of 2022 exclude the following: acquisition and de novo expenses of $0.08 and noncash stock-based compensation expense of $0.13.

調整後EBITDA 利潤率為10.9%，相較於2022 年第二季的10.6%，比2023 年第一季的10.4% 成長50 個基點。調整後稀釋每股淨利為1.07 美元，而2022 年第二季度為0.91 美元2023 年第二季調整後每股業績不包括以下因素：紐約追溯性升息 0.05 美元、收購費用 0.08 美元以及非現金股票補償費用 0.13 美元的正面影響。 2022 年第二季調整後每股業績不包括以下內容：收購和從頭開始費用 0.08 美元，以及非現金股票補償費用 0.13 美元。

Our tax rate for the second quarter of 2023 was 23.8%, in line with our expectations. For calendar 2023, we continue to expect our tax rate to be in the mid-20% range. DSOs were 35. 6 days at the end of the second quarter of 2023 compared with 43.7 days at the end of the first quarter of 2023. We have continued to experience consistent cash collections for most of our payers and received a material payment from the Illinois Department of Aging immediately prior to quarter end.

我們2023年第二季的稅率為23.8%，符合我們的預期。對於 2023 年，我們繼續預計稅率將在 20% 的中間範圍內。 2023 年第二季末的 DSO 為 35. 6 天，而 2023 年第一季末為 43.7 天。我們繼續為大多數付款人提供一致的現金收款，並從伊利諾伊州收到了一筆實質付款老齡化部在季度末前夕。

As a result, DSOs for the Illinois Department of Aging for the second quarter were 22.3 days compared with 43.7 days at the end of the first quarter of 2023. While we are appreciative of the department's continued emphasis on keeping their provider payments current, we would anticipate our DSOs to return to more normal levels in the second half of the year. Our cash flows have continued to be very strong in 2023 with our second quarter net cash provided by operations of $41.6 million. Year-to-date, cash flows from operations are $63.8 million, exclusive of $3.4 million in ARPA net spending, well ahead of our expectations, primarily as a result of the accelerated cash collections we have experienced we have seen a $23.2 million positive impact from working capital changes year-to-date, which we would not anticipate to continue long term.

因此，伊利諾伊州老齡事務部第二季的 DSO 為 22.3 天，而 2023 年第一季末為 43.7 天。雖然我們讚賞該部門繼續強調保持供應商付款最新，但我們希望預計我們的DSO 將在今年下半年恢復到更正常的水平。 2023 年，我們的現金流持續強勁，第二季營運提供的淨現金為 4,160 萬美元。年初至今，營運現金流為 6,380 萬美元，不包括 ARPA 淨支出 340 萬美元，遠遠超出了我們的預期，這主要是由於我們經歷了現金回收加速的結果，我們看到了 2,320 萬美元的積極影響今年迄今為止，營運資本發生變化，我們預計這種情況不會長期持續。

At quarter end, we have $10.6 million in ARPA funding still available to be utilized. As of June 30, 2023, and prior to our borrowing related to the Finesse Quality Care Act, the company had cash of $84.2 million with capacity and availability under our revolver of $409.3 million and $319.9 million, respectively. With our strong cash flow, we have continued to pay down debt in 2023 and have reduced our revolver balance by $53.5 million since the beginning of the year with a $30 million reduction in the second quarter.

截至季末，我們仍有 1,060 萬美元的 ARPA 資金可供使用。截至 2023 年 6 月 30 日，在我們與《Finesse Quality Care Act》相關的借款之前，該公司擁有 8,420 萬美元的現金，我們的循環資金下的容量和可用性分別為 4.093 億美元和 3.199 億美元。憑藉強勁的現金流，我們在 2023 年繼續償還債務，自年初以來循環餘額減少了 5,350 萬美元，其中第二季減少了 3,000 萬美元。

We have a capital structure that supports our growth initiatives and acquisition strategy and as previously noted, we expect to remain active in the M&A market. At the same time, we will continue to diligently manage our net leverage ratio with the company debt-free at quarter end, net of cash on hand. This concludes our prepared comments this morning. We'd like to thank you for being with us. I'll now ask the operator to please open the line for your questions.

我們擁有支持我們的成長計劃和收購策略的資本結構，如前所述，我們預計將在併購市場保持活躍。同時，我們將繼續努力管理我們的淨槓桿率，使公司在季度末淨負債（扣除手頭現金）。我們今天早上準備好的評論到此結束。我們要感謝您與我們同在。我現在請接線生接通您的問題電話。

The first question today comes from Brian Tanquilut with Jefferies.

今天的第一個問題來自 Jefferies 的 Brian Tanquilut。

Dirk, I guess I'll start -- you mentioned that if the EMS rule is finalized as proposed, Addus would explore operational changes. So I know it's pretty early, but any details you can provide on what levers you can pull to offset any negative impact from that rule?

Dirk，我想我要開始了——你提到如果 EMS 規則按照提議最終確定，Addus 將探索營運變化。所以我知道現在還為時過早，但是您可以提供有關可以使用哪些槓桿來抵消該規則的任何負面影響的詳細資訊嗎？

Well, Brian, once we see what the rule (inaudible) final rule entails, there are things we can do, such as we'll look at states, which may be due to the rural (inaudible) ability to properly operate in that state, and we will potentially look at moving out of those states if necessary. We would hate -- we don't really want that to be the way the operations end up. But certainly, if the rule forces that, we will look at it. More importantly, what we really would do from an operational standpoint is really try to grow in the markets in which the rule works. We would try to accelerate both our M&A growth and our organic growth in those markets, really focused on the areas. The states that give us a high enough reimbursement rate to be able to pass along whatever percentage if there is a change in final rule, whatever that is to our caregivers.

好吧，布萊恩，一旦我們了解了規則（聽不清楚）最終規則的含義，我們就可以做一些事情，例如我們將研究各州，這可能是由於農村（聽不清楚）在該州正常運作的能力，如有必要，我們可能會考慮遷出這些州。我們會討厭——我們真的不希望這成為行動最終的結果。但當然，如果規則強制這樣做，我們會考慮它。更重要的是，從營運的角度來看，我們真正要做的是努力在規則發揮作用的市場中成長。我們將努力加速這些市場的併購成長和有機成長，真正專注於這些領域。這些州為我們提供了足夠高的報銷率，以便在最終規則發生變化時能夠傳遞任何百分比，無論這對我們的護理人員來說是什麼。

Let me make sure you understand -- I know you do, Brian, but I wanted stated publicly. And that is we want to make sure that we pay our caregivers (inaudible). That is absolutely critical for Addus and our caregivers (inaudible). But the way to do it in our mind is not for this stated minimum percentage. It's more through making sure that states are paying an adequate rate, and that is what the sites we would focus on in the future.

讓我確保你明白——我知道你明白，布萊恩，但我想公開聲明。也就是說，我們要確保向護理人員支付費用（聽不清楚）。這對阿杜斯和我們的護理人員來說絕對至關重要（聽不清楚）。但在我們看來，實現這一目標的方法並不是達到這個規定的最低百分比。更多的是透過確保各州支付足夠的費率，這就是我們未來關注的網站。

Understand that. Maybe as I think about kind of like your fill rate, right? And I know you've done a great job ramping up hiring on a daily basis. How are you thinking about the remaining opportunity to increase the fill rate, maybe get it back to pre-COVID levels? And what that would take and maybe kind of layering that -- I know your quarter-over-quarter hours are up north of 1%. So just trying to put that growth algorithm with the remaining opportunity is to drive growth over the next couple of quarters.

明白。也許正如我所想的那樣，就像你的填充率一樣，對嗎？我知道你們在每天增加招募方面做得非常出色。您如何看待剩下的機會來提高填充率，也許讓它回到新冠疫情前的水平？這需要什麼，也許是分層——我知道你每季的工作時間增加了 1% 以上。因此，只要嘗試將成長演算法與剩餘的機會結合起來，就能推動未來幾季的成長。

Brian, this is Brad. Yes, happy to discuss that. When we're looking at the fill rate, we have certainly seen some nice improvement over the past 12 months. We've probably increased a couple 200 to 300 basis points on the fill rate. A lot of that is focused on the improved hiring that we've seen over the past 12 months. The things that we're focused on are, frankly, in order to kind of get another couple of hundred basis points out of that number to get back up (inaudible) we were pre pandemic is. One, continue to focus on the hiring piece. But then also, when you look at our new candidate tracking system and the speed to hire getting those people on board and then also focusing on getting them to their first global (inaudible) because we still lose too many caregivers between honestly hiring and when they actually take a billable pace.

布萊恩，這是布萊德。是的，很高興討論這個問題。當我們觀察填充率時，我們確實看到了過去 12 個月的一些不錯的改善。我們可能將填充率提高了 200 到 300 個基點。其中很大一部分重點是我們在過去 12 個月中看到的招募情況的改善。坦白說，我們關注的事情是，為了從這個數字中再獲得幾百個基點，以恢復到大流行前的水平（聽不清楚）。一是繼續關注招募工作。但另一方面，當你看看我們新的候選人追蹤系統和招聘速度時，讓這些人加入，然後還專注於讓他們進入他們的第一個全球（聽不清楚），因為我們在誠實招聘和他們之間仍然失去了太多的護理人員實際上採取計費的步伐。

So really focused on accelerating that process, which also will improve turnover as well, which actually takes a little bit of the pressure off of the hiring. We've been really focused this year on getting back to the basics on the scheduling and the serving and assigning of caregivers. We've got some enhanced technology tools that we've added that help our schedulers, our service coordinators to make their job easier. So certainly seeing good progress on that. I still think that we have a couple of hundred basis points more opportunity there.

因此，我們真正專注於加速這一過程，這也將提高營業額，這實際上減輕了招聘的壓力。今年我們真正關注的是回到護理人員的日程安排、服務和分配的基礎知識。我們添加了一些增強的技術工具，可以幫助我們的調度員、服務協調員讓他們的工作更輕鬆。所以肯定會看到這方面取得了良好進展。我仍然認為我們在那裡還有幾百個基點的機會。

The next question comes from Scott Fidel with Stephens.

下一個問題來自斯科特·菲德爾和史蒂芬斯。

First just appreciate the color you gave us on the efforts on the (inaudible) HCBS rule. My first question though was just wanted to ask on the home health contracting environment. If you can just give us a little more details on how those recontracting efforts are going with those that lower tranche of payers. Is there any way that you can sort of quantify, I guess, what percentage of the MA payers would be in that insufficient reimbursement bucket and then also just wondering as you're bringing the Tennessee acquisition online, given the revenue mix is heavily weighted towards home health, how you would describe the (inaudible) contracts underneath that asset? And so against this backdrop of trying to be disciplined on your reimbursement with MA payers here.

首先感謝您為我們在（聽不清楚）HCBS 規則方面所做的努力所做的貢獻。我的第一個問題只是想問一下家庭健康承包環境。您能否向我們提供更多有關那些較低付款人的重新簽約工作進展的詳細資訊。我猜，有什麼方法可以量化 MA 付款人在報銷不足的情況下所佔的百分比，然後在將田納西州收購帶到網上時也想知道，考慮到收入組合嚴重偏向於家庭健康，您如何描述該資產下的（聽不清楚）合約？因此，在這種背景下，我們試圖對 MA 付款人的報銷進行紀律約束。

Yes, Scott, this is Brad. We have been really focused on, frankly, trying to get (inaudible)So when you look at the Medicare Advantage, really focusing on let's introduce the concept of getting to an episodic type reimbursement. But in the near term, less really focused on just getting those per visit rates up. And I think we've done a pretty good job of adjusting those rates in key markets, still have some work to do there, but it's really kind of market by market as to which payers that we're focused on.

是的，斯科特，這是布拉德。坦白說，我們一直非常專注於（聽不清楚）因此，當您查看醫療保險優勢時，真正專注於讓我們介紹獲得偶發性報銷的概念。但在短期內，人們不再真正專注於提高每次造訪率。我認為我們在調整關鍵市場的費率方面做得非常好，仍然有一些工作要做，但我們關注的付款人確實是逐個市場的。

When you look at the Tennessee quality care, they're contracting pretty -- a good mix, but I think there's opportunities from upside there for us. And so that's one of the things that are contracting, team will be focused on is working on those rates. They continue to work with the other payers to adjust not just trying to get the episodic, but also let's try to get the per visit rates up to where we can start taking on more of those referrals and continue to have the good operating margins or improved operating margins that we are currently showing.

當你看看田納西州的優質醫療服務時，你會發現他們的合約相當不錯——一個很好的組合，但我認為我們有上行的機會。因此，這是正在簽約的事情之一，團隊將重點關注的是製定這些費率。他們繼續與其他付款人合作進行調整，不僅試圖獲得偶發性的效果，而且讓我們嘗試將每次訪問率提高到我們可以開始接受更多推薦的水平，並繼續擁有良好的營業利潤率或提高我們目前顯示的營業利益率。

Okay. And then just my follow-up question would just be on sort of taking the improvement that you've had in personal care on the hours and maybe sort of giving us some visibility into how you're thinking about that continuing to trend out in the back half of the year and any seasonality that you maybe want to comment on and then separately, I guess just, Brian, maybe for you. Just on the Tennessee acquisition, maybe just sort of -- I know you talked about sort of starting to see some positive impact on margins in 3Q and then more fully realizing than in the 4Q. Any sort of, I guess, quantification you could give us add what the gross margin impact would be to sort of start out there from that acquisition in the third quarter? That's it for me.

好的。然後我的後續問題就是關於您在個人護理方面所取得的進步，也許可以讓我們了解您如何看待這種趨勢繼續在下半年以及您可能想評論的任何季節性，然後分別發表評論，我想布萊恩，也許適合您。就田納西州的收購而言，也許只是——我知道您談到在第三季度開始看到對利潤率的一些積極影響，然後比第四季度更充分地實現。我想，您可以給我們任何形式的量化，以補充從第三季的收購開始對毛利率的影響嗎？對我來說就是這樣。

Sure, Scott. I'll start with the BCS question first. I think we've talked about the last couple of quarters to see nice sequential growth in hours for business today. I think Q4 and Q1 was 1.9%. We saw that at 1.2% quarter-over-quarter this year. I think our expectation is (inaudible) probably more similar to what we've seen in this last quarter, around 1%, maybe give or take, over Q3, Q4. There's not a lot of seasonality really in PCS. I think typically where we see impact is more in the winter months where maybe you have some service delivery issues (inaudible) et cetera. Obviously, you're probably not going to see a lot of that. I mean in Q3 you might start to see some impact a little bit, end of the year (inaudible) colder holidays, et cetera, but it's going to be pretty minimal. So I wouldn't expect a lot of seasonality kind of in that trajectory. .

當然，斯科特。我先從 BCS 問題開始。我想我們已經討論過過去幾個季度的情況，今天的業務時間連續增長。我認為第四季和第一季是 1.9%。今年我們看到這一數字環比成長 1.2%。我認為我們的預期（聽不清楚）可能更類似於我們在上個季度看到的情況，大約 1%，可能在第三季、第四季有所變化。 PCS 中確實沒有太多季節性。我認為通常我們看到的影響更多是在冬季，那裡可能會遇到一些服務交付問題（聽不清楚）等等。顯然，您可能不會看到很多這樣的情況。我的意思是，在第三季度，您可能會開始看到一些影響，例如年底（聽不清楚）較冷的假期等，但影響很小。因此，我預計該軌跡不會有太多季節性。 。

I know the Tennessee quality care, just a couple of metrics that give you guys. I think we mentioned there are about $40 million in annualized revenue. It's a skilled business. So that gross margin profile is going to be in that mid- to upper 40% range. And I think we've talked about it before, the bottom line expectation to EBITDA (inaudible) in the more of that mid-teens as a percentage, so one thing I would just advise on as well with an acquisition this size, obviously, there's going to be some depreciation and amortization that will come into play with the intangibles we are borrowing for this acquisition. So with the most recent hike from the (inaudible) interest rate now is just a little over 7%. So we'll also be thinking about that from an interest expense perspective. But those are probably some good metrics, I think, from a modeling perspective.

我了解田納西州的優質護理，只是給你們提供了一些指標。我想我們提到過年化收入約 4000 萬美元。這是一門技術活。因此，毛利率將在 40% 的中上範圍內。我想我們之前已經討論過，EBITDA（聽不清楚）的底線預期百分比在十幾歲左右，所以對於這種規模的收購，我也想建議一件事，顯然，我們為這次收購借用的無形資產將會產生一些折舊和攤提。因此，最近一次（聽不清楚）利率的上調僅略高於 7%。因此，我們也會從利息支出的角度來考慮這一點。但我認為，從建模的角度來看，這些可能是一些很好的指標。

Next question comes from Ben Hendrix with RBC Capital Markets.

下一個問題來自加拿大皇家銀行資本市場的本‧亨德里克斯。

This is Mike Murray on for Ben. Can you give us a little bit more color on (inaudible) Same-store ADC declined 3.2%, driven by lower admissions with higher length of stay a partial offset. Are you still seeing pressure from referral sources? Is there an increase in competition in some of your markets? Any color would be helpful.

這是麥克·默里（Mike Murray）替補本。您能為我們提供更多關於（聽不清楚）的資訊嗎？同店 ADC 下降了 3.2%，這是由於入場人數減少和停留時間較長所部分抵消的。您是否仍面臨來自推薦來源的壓力？您的某些市場的競爭是否加劇？任何顏色都會有幫助。

Mike, it's Brad. We did see a kind of a drop on the admission front. What was encouraging is we start seeing that median length of stay increase, and as Dirk pointed out in his comments, primarily in the nursing facility, which we had anticipated with the expiration of certain provisions in the public health emergency. Frankly, we had kind of a slow May, the second half of June, and it continued in July, we've seen kind of a pickup in admission volume, which has corresponded into increased ADC. So we did have sequential growth, so we saw some recovery from Q1. I anticipate that we'll continue to see recovery into Q3 and into Q4, both on from an admission standpoint, but more importantly, on the ADC front.

麥克，是布拉德。我們確實看到入學人數有所下降。令人鼓舞的是，我們開始看到中位數住院時間增加，正如德克在評論中指出的那樣，主要是在護理機構，我們預計隨著公共衛生緊急情況下某些規定的到期，這種情況會出現。坦白說，我們在 5 月、6 月下半月經歷了一段緩慢的時期，並且在 7 月繼續，我們看到入場量有所回升，這與 ADC 的增加相對應。所以我們確實實現了連續成長，所以我們看到了第一季的一些復甦。我預計我們將繼續看到第三季和第四季的復甦，無論是從入場角度來看，但更重要的是從 ADC 方面來看。

Awesome. That's helpful. Just switching gears a little bit. You've seen some nice operating leverage on G&A in past quarters, but it still remains around 21%, 22% of revenue. How do you think about this line item longer term? Do you think you could get it back to pre-pandemic levels, which were, call it, 19%, 20%?

驚人的。這很有幫助。只需稍微切換一下齒輪即可。在過去的幾個季度中，您已經看到了 G&A 的一些不錯的營運槓桿，但它仍然保持在收入的 21%、22% 左右。從長遠來看，您如何看待該訂單項目？你認為你能把它恢復到大流行前的水平，即 19%、20% 嗎？

This is Brian. I think we're continuing to see leverage. So as our top line continues to grow, we (inaudible) saw that from Q1 into Q2 with kind of a decline in that percentage. So that would be our expectation. So a lot of those costs particularly on the corporate side (inaudible) we'll flex a little bit in the field on SG&A, but that's probably going to move more slowly than our revenue growth. So yes, we would anticipate over time as we continue to see our top line growth that we're going to get more leverage on G&A.

這是布萊恩。我認為我們將繼續看到槓桿作用。因此，隨著我們的收入繼續增長，我們（聽不清楚）看到從第一季到第二季度，該百分比有所下降。這就是我們的期望。因此，其中許多成本，特別是在公司方面（聽不清楚），我們將在銷售、管理和管理方面稍微靈活一些，但這可能會比我們的收入增長慢。所以，是的，隨著時間的推移，隨著我們繼續看到我們的收入成長，我們預計我們將在一般管理費用上獲得更多的槓桿。

The next question comes from Matt Larew with William Blair.

下一個問題來自馬特·拉魯和威廉·布萊爾。

You gave us some metrics on hiring productivity. I'd be curious, just a little bit on the other side of that on the retention side, sort of improvement you've seen? And if there are technology tools that you can implement or evaluating to help drive that further.

您向我們提供了一些有關招募生產力的指標。我很好奇，在保留方面的另一面，您看到了某種改進嗎？是否有您可以實施或評估的技術工具來幫助進一步推動這一目標。

Yes, this is Brad. So when you look at our personal care hiring and you carve out family caregivers, so you look at kind of your traditional caregivers, we have seen nice improvement on the turnover rate, probably about to the tune (inaudible) 64% for Q1 of last year. We're down to 56%, which is again still ahead of industry standard. I think some of the things that we're looking at that I think have helped us on the turnover is, one, really working on caregiver engagement. Second, making sure that they have the hours that they want to work because we're still probably one of the biggest reasons that a caregiver leaves us is because they're not getting sufficient hours. So there's been a lot of focus on our part of trying to ascertain who wants more hours, what the schedules really looking at and putting some technology tools that help match that those additional hours they're looking for with clients that are available. So I think our IT team has done a great job of putting together some very helpful tool.

是的，這是布拉德。因此，當您查看我們的個人護理招聘並排除家庭護理人員時，您會看到傳統護理人員的種類，我們發現人員流動率有了很大的改善，可能接近去年第一季的64％（聽不清）年。我們降至 56%，仍領先於業界標準。我認為我們正在研究的一些對我們營業額有幫助的事情是，第一，真正致力於護理人員的參與。其次，確保他們有他們想要的工作時間，因為我們仍然可能是護理人員離開我們的最大原因之一，因為他們沒有得到足夠的工作時間。因此，我們非常注重確定誰想要更多的工作時間，日程安排真正考慮的是什麼，並使用一些技術工具來幫助將他們正在尋找的額外工作時間與可用的客戶相匹配。因此，我認為我們的 IT 團隊在整合一些非常有用的工具方面做得非常出色。

We're continuing to modify and work with those again, I think (inaudible) hire is important from -- to really kind of maximize our full rate. But honestly, it's really about making sure people are getting hours. In addition, we actually do conduct surveys with our caregivers. We just recently completed a round of surveys, got great response. Almost half of our caregivers responded. So you think about you get input from 14,000 caregivers, you learn a lot. But again, it's kind of interesting is hours, working -- getting enough hours is probably one of their key things, and that's what we're focused on.

我們正在繼續修改並再次與這些合作，我認為（聽不清楚）僱用很重要 - 真正最大限度地提高我們的全額率。但老實說，這實際上是為了確保人們有工作時間。此外，我們實際上也與我們的護理人員進行了調查。我們最近剛完成了一輪調查，並得到了很好的回應。幾乎一半的護理人員做出了回應。所以你想想你從 14,000 名護理人員那裡得到了意見，你學到了很多東西。但同樣，有趣的是工作時間——獲得足夠的工作時間可能是他們的關鍵事情之一，這也是我們關注的重點。

Okay. Understood. And then on M&A, you hope to sort (inaudible) side of that where you're focused from a PCS versus home health versus hospice perspective, but curious more on the supply side, what you all are seeing given some of the reimbursement dynamics that might be affecting potential sellers (inaudible) come to market as well as maybe general sense of your activity levels. Obviously, you just completed the Tennessee deal, but relative to historical, what you're seeing from an activity and pipeline perspective.

好的。明白了。然後在併購方面，您希望從 PCS 與家庭健康與臨終關懷的角度對您關注的（聽不清）方面進行排序，但對供應方面更感興趣，考慮到一些報銷動態，您都看到了什麼可能會影響進入市場的潛在賣家（聽不清楚）以及您的活動水平的整體感覺。顯然，您剛剛完成了田納西州的交易，但相對於歷史，您從活動和管道的角度看到了這一點。

Matt, this is Brian. I think on the supply side, I think we kind of mentioned in our comments, it's been slow. I think there are some opportunities out there. We're being pretty selective on the ones that we're looking at with some of the rule and reimbursement overhang. So we're being, I think, cautious on that front. But I would also say the environment has not kind of turned, is not what I call robust points. But there are still opportunities for us to look at. I think still from a priority standpoint, we still believe heavily in carrying skilled home health with our personal care, having hospice as an available alternative as well, but it really comes down to more strategic markets and pricing opportunities, I think, probably are driving us more on what our opportunities are that we're going to pay more attention to.

馬特，這是布萊恩。我認為在供應方面，我想我們在評論中提到過，它的速度很慢。我認為那裡有一些機會。我們對我們正在考慮的一些規則和報銷懸而未決的問題非常有選擇性。所以我認為我們在這方面保持謹慎。但我也想說，環境還沒轉變，不是我所說的穩健點。但仍有機會值得我們關注。我認為仍然從優先的角度來看，我們仍然堅信透過個人護理來提供熟練的家庭健康，也將臨終關懷作為一種可用的替代方案，但我認為這實際上取決於更具策略性的市場和定價機會，這可能正在推動我們更多地了解我們將更加關注哪些機會。

And let me add to what Brian has said, and that is we're facing challenges right now, as you know, in both personal care and home health as it relates to the (inaudible) rule changes or proposed rate reductions. Long term, we don't believe those should affect our strategy. We remain completely focused on our growth of all 3 levels of care in markets that allow us to appropriately deal with value-based care. One of the things we think these changes indicate is that you need to be larger as a company. So that when you sit across the table, certainly from Medicare Advantage payers, but others as needed that you have something that they need and that is size and quality of operation.

讓我補充一下布萊恩所說的，正如你所知，我們現在在個人護理和家庭健康方面面臨著挑戰​​，因為它與（聽不清楚）規則變化或擬議的費率降低有關。從長遠來看，我們認為這些不會影響我們的策略。我們仍然完全專注於市場中所有三個級別護理的成長，這使我們能夠適當地處理基於價值的護理。我們認為這些變化顯示的一件事是，作為一家公司，你需要擴大規模。因此，當您坐在桌子對面時，當然可以從 Medicare Advantage 付款人那裡獲得，但其他人也可以根據需要知道您擁有他們需要的東西，那就是營運規模和品質。

So while we are currently being more focused on our strategic model as to what we will look at, if something came up in either one of the segments of care that was extremely strategic, we're not going to let the proposed rules out there affect us long term. Now whether or not it affects the price that remains to be seen. I mean certainly, from our standpoint, we're going to negotiate it (inaudible) the fact that there are these challenges out there, but we're still focused on the long-term growth and profitability (inaudible).

因此，雖然我們目前更關注我們的策略模型，但如果任一護理領域出現了極具戰略意義的情況，我們不會讓擬議的規則影響我們長期來看。現在是否會影響價格還有待觀察。我的意思當然是，從我們的角度來看，我們將就存在這些挑戰的事實進行談判（聽不清楚），但我們仍然關注長期成長和獲利能力（聽不清楚）。

Okay. Understood. And just quickly one more on the time line for the Medicaid rule. I think in the past, you had mentioned you expected some uptake in the fall. I don't know, based on the quantity of comments and the listings that you had, if you have a different perspective, when that might come acknowledging (inaudible) uncertainty?

好的。明白了。醫療補助規則的時間表很快就又確定了。我想在過去，您曾提到您預計在秋季有所吸收。我不知道，根據您所擁有的評論和清單的數量，如果您有不同的觀點，那麼什麼時候可能會承認（聽不清楚）不確定性？

Yes. Well, I think when you (inaudible) proposed, there was a discussion around the fact that if you look historically, some of these things could be actually finalized within a few months of getting the final comments in. I think at the last conference call, (inaudible) we've made visits through the last quarter since then, our feeling is that, that's probably shifted and won't be finalized until sometime in 2024, especially if you think about it, when you receive so many comments and most of them are against the proposed change I think there's a lot of thought process going from a CMS perspective. So we're expecting something probably more in line with the first part to mid-part 2024.

是的。好吧，我認為當你（聽不清楚）提議時，圍繞這樣一個事實進行了討論：如果你回顧歷史，其中一些事情實際上可能會在收到最終意見後的幾個月內最終確定。我認為在上次電話會議上，（聽不清楚）自那時以來，我們在上個季度進行了訪問，我們的感覺是，這可能會發生變化，直到2024 年的某個時候才會最終確定，特別是如果你考慮一下，當你收到如此多的評論和大多數評論時他們中的一些人反對擬議的變更，我認為從 CMS 的角度來看，有很多思考過程。因此，我們預期可能會出現與 2024 年第一部分到中期更一致的內容。

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。

So I guess, first, on the Tennessee acquisition, you mentioned the fact that the situation in terms of the payers, would you make this state as a target for value-based contracting. So when should we expect, I guess, for you guys to have a contract (inaudible) in the state, was it maybe the payer there was actually asking for you to add more services to kind of how you expect the situation in the state on that front evolved with this acquisition now closed.

所以我想，首先，在田納西州的收購中，您提到了付款人的情況，您是否會將這個州作為基於價值的合約的目標。因此，我想，我們應該期望您何時在該州簽訂合約（聽不清楚），是否可能是付款人實際上要求您添加更多服務，以達到您對該州情況的期望隨著此次收購的完成，這一戰線不斷發展。

Yes. I think on the value base, I mean, some of the payers that we work with outside of Tennessee are similar to the payers that are in Tennessee. Now it tends to be a different group of individuals that are overseeing those markets. But I think we'll at least be able to have an introduction pretty easily to start having those discussions around value-based I think that's something -- it's still not something we'd probably be jumping into in 3 months, but maybe towards the back half of integration within the first 12 months, we'll probably looking to get into value-based arrangement. But we'll start exploring those, frankly, now are engaging with payers to have some of those discussions as we work on some of the other rates that are with some of those managed care payers.

是的。我認為在價值基礎上，我的意思是，我們在田納西州以外合作的一些付款人與田納西州的付款人相似。現在，監管這些市場的往往是不同的個人群體。但我認為我們至少能夠很容易地進行介紹，開始圍繞基於價值的討論我認為這仍然不是我們在 3 個月內可能會跳入的內容，但也許朝著在前12 個月內整合的後半段，我們可能會尋求基於價值的安排。但坦白說，我們將開始探索這些問題，現在正在與付款人進行一些討論，同時我們正在與一些管理式醫療付款人一起制定其他一些費率。

Great. And if I may also follow-up on the fact at that this asset comes with a majority revenues being home health. So moving forward with the acquisition despite the weight cuts that are coming next year likely (inaudible) there could be more cuts going forward with the recruitment, so I guess, as we think about this business, home health segment, that is. With this, let's say, that the 2% rate that is finalized, maybe a little bit better than proposed. Would you expect to be able to grow EBITDA on a same-store basis, I guess, with these types of freight cuts?

偉大的。我還可以跟進這樣一個事實：這項資產的大部分收入來自家庭健康。因此，儘管明年可能會進行減重（聽不清楚），但繼續推進收購，隨著招聘的進行，可能還會有更多的削減，所以我想，當我們考慮這個業務時，即家庭健康領域。這樣一來，我們可以說，最終確定的 2% 的利率可能比提議的要好一些。我想，透過這些類型的運費削減，您是否期望能夠在同店基礎上增加 EBITDA？

Yes. I mean I think, Joanna, I can talk about the rate cuts, so I'll let Brad kind of talk about our growth opportunities with this acquisition. But I think already (inaudible) small segment for us today. The deals that we're looking at this one being a prime example. We've taken those potential (inaudible) over the next couple of years into consideration with our kind of long-term view on what we think our top line growth opportunity is there. We've modeled that in, and that flows through obviously to profitability for us and our expectation, and that's what we utilized in our pricing conversations with these targets.

是的。我的意思是，喬安娜，我想我可以談談降息，所以我會讓布拉德談談我們透過這次收購獲得的成長機會。但我認為今天對我們來說已經是（聽不清楚）一小部分了。我們正在研究的交易就是一個很好的例子。我們已經考慮了未來幾年的這些潛力（聽不清楚），以及我們對我們認為存在的頂線成長機會的長期看法。我們已經對此進行了建模，這顯然會影響我們的獲利能力和我們的期望，這就是我們在與這些目標的定價對話中所利用的內容。

So all part of our process, and we're aware of kind of the environment and take that into account. I think from this one, particularly (inaudible) of mentioned, there are opportunities to get into other counties. So I think we see some volume growth opportunities in the market, but I'll let Brad talk a little bit about that.

因此，我們流程的所有部分，我們都了解環境類型並考慮到這一點。我認為從這一點來看，特別是提到的（聽不清楚），有機會進入其他縣。因此，我認為我們在市場上看到了一些銷售成長的機會，但我會讓布拉德談談這一點。

Yes. So I think there certainly are some volume opportunities with potential de novos based on kind of where they are. I mean, they cover a large geography in Tennessee. I think there's some opportunities to move into some of the more urban markets. They're primarily kind of more rural focused. But also, I think to Brian's point, I mean, home health is a relatively small segment for us. So there's operational efficiencies that we gain by scaling up. And so I think that really went into our calculus about doing this deal and about the opportunities to get some same-store growth from a bottom line perspective as well as top line.

是的。因此，我認為肯定存在一些潛在的從頭開始的數量機會，這取決於它們所處的位置。我的意思是，它們覆蓋了田納西州的大片地區。我認為有一些機會進入一些更城市的市場。他們主要更關注農村地區。而且，我認為就布萊恩的觀點而言，我的意思是，家庭健康對我們來說是一個相對較小的部分。因此，我們透過擴大規模來提高營運效率。因此，我認為這確實是我們對進行這筆交易以及從底線和頂線角度獲得同店成長的機會進行的計算。

Appreciate it. And if I may, just a last question, I guess, more strategic and I know this just came out yesterday about CMMI announced a new voluntary demonstration, I guess, across all the states would have focused on dementia patients. So I don't know if something like this would be of interest to Addus, the material (inaudible) talks about targeting dual allergic population, but at the same time, to talk about us being open to Medicare certified providers. So I don't know if this is something that I guess makes Addus here well positioned given the kind of presence in both Medicaid, also Medicare home health.

欣賞它。如果可以的話，我想，最後一個問題更具戰略性，我知道昨天剛發布了 CMMI 宣布的一項新的自願示威活動，我想，所有州都將重點關注癡呆症患者。所以我不知道 Addus 是否會對這樣的事情感興趣，該材料（聽不清楚）談論了針對雙重過敏人群，但同時談論了我們對醫療保險認證的提供者持開放態度。所以我不知道這是否是我認為的，考慮到在醫療補助和醫療保險家庭健康中的存在，阿杜斯在這裡處於有利地位。

Yes, Joanna, this is Brad. Yes, very pleased with that announcement. It's certainly something that we're willing to explore. I think it really fits well into our strategy of having all 3 levels of care because it has a skilled component with the home health, but also has a personal care type component as well. Frankly, it's good to see CMS recognize that that's probably the population that honestly has the lack of services or a potential lack of services. Those are individuals that they can need home health, they can need personal care, they need hospice. But by the same token, (inaudible) when you look at hospice, you get a lot of criticism with somebody's on length of stay for a long period of time. And it's primarily those neurological disorders such as dementia. And I think this is really trying to kind of fill some of that gap and some of the pressure you have in trying to take care of those individuals in the right place. So very pleased with it, and I'm certainly looking forward to exploring it.

是的，喬安娜，這是布萊德。是的，對此公告非常滿意。這當然是我們願意探索的事情。我認為它確實非常適合我們提供所有 3 個級別的護理的策略，因為它具有家庭健康的熟練組成部分，而且還具有個人護理類型的組成部分。坦白說，很高興看到 CMS 認識到這可能是真正缺乏服務或潛在缺乏服務的人群。這些人可能需要家庭健康、個人照護、安寧療護。但出於同樣的原因，（聽不清楚）當你觀察臨終關懷時，你會因為某人長期住院的時間而受到很多批評。主要是癡呆症等神經系統疾病。我認為這確實是在試圖填補一些空白，以及在試圖在正確的地方照顧這些人時所面臨的一些壓力。我對此非常滿意，我當然期待著探索它。

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

我們的問答環節到此結束。我想將會議轉交德克艾利森先生發表閉幕詞。

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

謝謝你，接線生。我今天要感謝大家對 Addus 的興趣並參與我們的電話會議。希望您度過愉快的一周。

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。您現在可以斷開連線。