Addus Homecare Corp (ADUS) 2023 Q3 法說會逐字稿

Good day, and welcome to the Addus HomeCare's Third Quarter 2023 Earnings Call.

美好的一天，歡迎參加 Addus HomeCare 的 2023 年第三季財報電話會議。

(Operator Instructions)

（操作員說明）

Please note this event is being recorded. I would now like to turn the conference over to Ms. Dru Anderson. Please go ahead, ma'am.

請注意此事件正在被記錄。現在我想把會議交給德魯·安德森女士。請繼續，女士。

Thank you. Good morning, and welcome to the Addus HomeCare Corporation Third Quarter 2023 Earnings Conference Call. Today's call is being recorded. 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.

謝謝。早安，歡迎參加 Addus HomeCare Corporation 2023 年第三季財報電話會議。今天的通話正在錄音。如果今天的電話會議討論了任何非公認會計原則財務指標，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原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 third 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.

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 年第三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。本公司不承擔更新任何前瞻性陳述的義務，無論是由於新資訊、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 Third Quarter 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 third quarter results in more detail. Following our comments, the 3 of us would be happy to respond to any questions.

謝謝你，德魯。早上好，歡迎參加我們的 2023 年第三季財報電話會議。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。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三季的業績。根據我們的評論，我們三個人很樂意回答任何問題。

Before I turn to the discussion of our results, I want to take a moment and bring you up to date on the status of the CMS proposed Medicaid Access Rule. At this time, CMS continues to review the more than 2,000 comments submitted to the proposal before issuing a final rule. The comments submitted to CMS, including those from a broad array of state Medicaid agencies, overwhelmingly called for the administration to rescind the part of the proposed rule requiring that 80% of the Medicaid payment providers go to direct caregiver wages.

在開始討論我們的結果之前，我想花點時間向您介紹 CMS 提議的醫療補助准入規則的最新狀態。目前，CMS 仍在審查提交給該提案的 2,000 多條評論，然後發布最終規則。提交給 CMS 的評論，包括來自眾多州醫療補助機構的評論，絕大多數呼籲政府廢除擬議規則中要求 80% 的醫療補助支付提供者直接支付護理人員工資的部分。

States, along with others who submitted comments to the proposed rule, generally cite both the inherent challenges to a one-size-fits-all approach and the lack of data to support the likelihood of the 80% mandate increasing access to care for Medicaid beneficiaries as the reasons for the call to rescind it. Similar calls to rescind the 80% mandates are coming from Congress, including in the House Energy and Commerce Health subcommittee hearing held on Wednesday of last week.

各州以及其他對擬議規則提出評論的人普遍指出，一刀切的方法存在固有的挑戰，而且缺乏數據來支持 80% 的授權增加醫療補助受益人獲得護理的機會的可能性作為呼籲撤銷它的理由。國會也發出了類似的要求撤銷 80% 授權的呼籲，包括在上週三舉行的眾議院能源和商業健康小組委員會聽證會上。

Based on the feedback we have received from industry sources, we believe the final rule may be published sometime late in the first quarter or early part of the second quarter of 2024. While the volume and substance of the comment letters may have an impact on the final rule, we do not currently have visibility as to whether the proposed rule will be materially changed. We do, however, expect that if the rule is finalized as proposed, it would most likely be subject to a legal challenge on one or more states.

根據我們從行業消息來源收到的反饋，我們認為最終規則可能會在 2024 年第一季末或第二季度初發布。雖然評論信的數量和內容可能會對最終規則，我們目前無法確定擬議規則是否會發生重大變化。然而，我們確實預計，如果該規則按提議最終確定，它很可能會受到一個或多個州的法律挑戰。

It is important to remind you that there are many unknowns around the proposed rule and its ultimate impact on our operations even if it were to be implemented as proposed and withstand legal challenge. Among these unknowns, we do not know when a final rule will be issued, and therefore, when the proposed full year implementation period will begin or if the proposed implementation period might be extended for a longer period of time. Our team will continue to be active on this issue as we attempt to affect changes to any final rule.

需要提醒您的是，即使提議的規則按照提議實施並經受法律挑戰，其對我們營運的最終影響仍存在許多未知因素。在這些未知因素中，我們不知道最終規則何時發布，因此，擬議的全年實施期何時開始，或者擬議的實施期是否可能延長更長的時間。我們的團隊將繼續積極解決這個問題，並嘗試影響任何最終規則的變更。

Yesterday, we announced our results for the third quarter of 2023. These results highlight continued strong financial performance by Addus. This performance would not be possible without the hard work and dedication of all our employees as they continue to provide quality care to our clients and patients in the home. I want to say thank you to each member of our team, your efforts are appreciated.

昨天，我們公佈了 2023 年第三季的業績。這些業績凸顯了 Addus 持續強勁的財務業績。如果沒有我們所有員工的辛勤工作和奉獻精神，這一成績是不可能實現的，因為他們繼續為我們的客戶和在家中的患者提供優質的護理。我想對我們團隊的每一位成員表示感謝，感謝你們的努力。

As we announced, our total revenue for the third quarter of 2023 was $270.7 million, an increase of 12.6% as compared to $240.5 million for the third quarter of 2022. This revenue growth resulted in adjusted earnings per share of $1.15 as compared to adjusted earnings per share for the third quarter of 2022 of $0.94, an increase of 22.3%. Our adjusted EBITDA of $30.9 million was an increase of 20% over the third quarter of 2022.

正如我們所宣布的，我們2023 年第三季的總收入為2.707 億美元，比2022 年第三季的2.405 億美元增長12.6%。這一收入增長導致調整後每股收益比調整後每股收益增加1.15 美元2022年第三季每股收益為0.94美元，成長22.3%。我們的調整後 EBITDA 為 3,090 萬美元，比 2022 年第三季成長 20%。

During the third quarter of 2023, we continued to see strong cash flow from operations as our states and other payers have continued to pay in a timely manner. This strong cash flow, along with continued management of our balance sheet has allowed us to reduce our debt while maintaining a cash balance of approximately $80 million at the end of the quarter.

2023 年第三季度，我們繼續看到強勁的營運現金流，因為我們的州和其他付款人繼續及時付款。強勁的現金流以及對資產負債表的持續管理使我們能夠減少債務，同時在季度末保持約 8000 萬美元的現金餘額。

Our low leverage gives us the financial flexibility to be opportunistic as we anticipate seeing additional acquisition opportunities coming to market over the next several quarters. It remains our plans to use our financial capacity to acquire strategic operations that align with our overall growth strategy of offering all 3 levels of home-based care in our markets.

我們的低槓桿率使我們能夠靈活地把握機會，因為我們預計未來幾季會有更多收購機會進入市場。我們仍然計劃利用我們的財務能力來收購與我們在市場上提供所有 3 個級別的家庭護理的整體成長策略相一致的策略業務。

During the third quarter, we continued to see an improving labor environment, especially as it pertains to our personal care segment. During the third quarter of 2023, we experienced solid personal care hiring with 84 hires per business day, up from 81 hires per business day in the second quarter of this year.

在第三季度，我們繼續看到勞動力環境不斷改善，特別是與我們的個人護理領域有關。 2023 年第三季度，我們的個人護理招募表現強勁，每個工作日招募 84 名員工，高於今年第二季度每個工作日 81 名員工。

In addition to our strong hiring numbers, we continue to see improvement in our starts per business day. While it's important to increase our hires, making sure these hires actually start caring for consumers is a key contributor in the past few quarters to our growth in personal care. Hiring in our clinical care segment has also improved, but does remain a challenge in our -- more challenging than in our personal care segment, with certain more difficult urban markets impacting our home health and hospice growth rates in those markets.

除了強勁的招募人數之外，我們還看到每個工作日的開工率不斷提高。雖然增加員工數量很重要，但確保這些員工真正開始關心消費者是過去幾季我們個人護理業務成長的關鍵因素。我們的臨床護理領域的招聘也有所改善，但仍然是一個挑戰——比我們的個人護理領域更具挑戰性，某些更困難的城市市場影響了我們在這些市場的家庭健康和臨終關懷增長率。

As we have in prior quarters, we continue to utilize the funding we received from the American Rescue Plan Act or ARPA. To date, we have received approximately $26 million, of which we have $8.3 million remaining to utilize. We anticipate receiving an additional $16 million in ARPA funding beginning in the fourth quarter of this year. These funds have been helpful with our caregiver recruitment and retention efforts to support the delivery of personal care services and should continue to help those efforts in the future as we deploy the remaining funds.

與前幾季一樣，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 2,600 萬美元，其中還有 830 萬美元可供使用。我們預計從今年第四季開始將額外獲得 1,600 萬美元的 ARPA 資金。這些資金有助於我們的護理人員招聘和保留工作，以支持提供個人護理服務，並且在我們部署剩餘資金時，應該在未來繼續幫助這些工作。

In addition to utilizing the ARPA funds for direct recruitment and retention of caregivers, we are also utilizing the funds to improve our caregivers experience through the implementation of enhanced caregiver training and the development of caregiver application that we believe will help our caregiver retention and overall service delivery.

除了利用ARPA 資金直接招募和保留護理人員外，我們還利用這些資金透過實施強化護理人員培訓和開發護理人員應用程式來改善我們的護理人員體驗，我們相信這將有助於我們的護理人員保留和整體服務送貨。

In our personal care segment, our services have largely continued to receive reimbursements for the majority of the states we operate in, with our most recent rate increase in our largest personal care market of Illinois effective in the second quarter. While we anticipate future reimbursement increases to enhance access to care and to help mitigate additional wage pressures, we will be negotiating with our union partners over the next few quarters in certain of our markets, to update aspects of our collective bargaining agreements.

在我們的個人護理領域，我們的服務基本上繼續在我們經營的大多數州獲得報銷，我們最大的個人護理市場伊利諾伊州的最新費率上調於第二季度生效。雖然我們預計未來報銷會增加，以增加獲得護理的機會並幫助減輕額外的工資壓力，但我們將在未來幾個季度與某些市場的工會合作夥伴進行談判，以更新我們集體談判協議的各個方面。

Given rising costs from inflation and certain onetime benefit enhancements, we expect we may see lower levels of margin contribution from the near-term rate increase in Illinois as we work to see that our caregivers are compensated appropriately in these markets. The impact of these negotiations may result in a slightly lower overall gross margin percentage in our personal care segment that we anticipate will be offset by volume increases in those markets.

考慮到通貨膨脹帶來的成本上升和某些一次性福利的提高，我們預計伊利諾伊州近期升息帶來的利潤貢獻水平可能會較低，因為我們努力確保我們的護理人員在這些市場上得到適當的補償。這些談判的影響可能會導致我們個人護理部門的整體毛利率略有下降，我們預計這將被這些市場銷售的成長所抵消。

We continue to await the release of the final rule on the home health rate for 2024. We are hopeful that CMS has listened to the extensive feedback received over the past few months that the proposed rate decrease is not adequately take into consideration the increase in wages and expenses home health providers have experienced over the past several years or the questionable methodology and assumption used by CMS in calculating the behavioral adjustment and budget neutrality aspects surrounding proposed rate cuts.

我們繼續等待 2024 年家庭健康費率最終規則的發布。我們希望 CMS 聽取了過去幾個月收到的廣泛反饋，即擬議的費率降低沒有充分考慮工資的增長家庭醫療保健提供者在過去幾年中經歷過的費用和費用，或CMS 在計算圍繞擬議降息的行為調整和預算中性方面所使用的可疑方法和假設。

While the home health rate cut is currently only a proposed rule, the hospice reimbursement rule was finalized during the third quarter with an overall rate increase of 3.1% effective October 1, 2023, which is an improvement over the original proposed hospice rate increase of 2.8%.

雖然家庭健康費率削減目前只是一項擬議規則，但臨終關懷報銷規則已在第三季最終確定，自2023 年10 月1 日起整體費率上漲3.1%，比最初提議的臨終關懷費率上漲2.8% 有所改善。 %。

We are cautiously optimistic that we will see some incremental improvement in the proposed home health rate reduction with the publication of the final home health rule in the coming days, which will more appropriately reflect our increased costs. However, as we stated before, we believe that these near-term traditional Medicare home health reimbursement pressures are likely to moderate over the next few years. And as such, we will continue to look for home health acquisition opportunities that are strategic to our overall growth.

我們謹慎樂觀地認為，隨著未來幾天最終家庭健康規則的發布，我們將看到擬議的家庭健康率降低有所逐步改善，這將更恰當地反映我們增加的成本。然而，正如我們之前所說，我們認為這些近期傳統醫療保險家庭健康報銷壓力可能會在未來幾年內緩解。因此，我們將繼續尋找對我們整體成長具有策略意義的家庭健康收購機會。

Now let me discuss our same-store revenue growth for the third quarter of 2023. For our personal care segment, our same-store revenue growth was 13.9% when compared to the third quarter of 2022. During the third quarter of 2023, we saw personal care same-store hours per business day grow 4.2% over the same period in 2022 and up slightly on a sequential quarterly basis. We are excited to see our various hiring and scheduling improvement initiatives taking hold and contributing to our strong sequential our growth over the past several quarters.

現在讓我討論一下我們2023 年第三季的同店營收成長。對於我們的個人照護部門，與2022 年第三季相比，我們的同店營收成長了13.9%。在2023 年第三季度，我們看到個人護理品每個工作日同店營業時間較 2022 年同期成長 4.2%，較上季略有上升。我們很高興看到我們的各種招募和日程安排改進措施得到落實，並為我們過去幾季的強勁連續成長做出了貢獻。

Turning to clinical operations. our hospice same-store revenue increased 3.1% when compared to the third quarter in 2022. While our same-store ADC was basically flat when compared to the third quarter of 2022, we did see an increase in same-store ADC of 1% over last quarter.

轉向臨床操作。與2022 年第三季相比，我們的臨終關懷同店營收成長了3.1%。雖然我們的同店ADC 與2022 年第三季相比基本上持平，但我們確實看到同店ADC 比2022 年第三季成長了1%。上個季度。

During the third quarter, we continued to see an increasing length of stay from patients residing in skilled nursing facilities as we anticipated following the end of the public health emergency.

在第三季度，正如我們在公共衛生緊急情況結束後所預期的那樣，我們繼續看到居住在熟練護理機構的患者的住院時間不斷增加。

As of the end of the third quarter, our hospice medium length of stay was 32 days, exclusive of our Journey Care and recently acquired Tennessee Quality Care operations.

截至第三季末，我們的臨終關懷中心住院時間為 32 天，不包括我們的 Journey Care 和最近收購的田納西州 Quality Care 業務。

For comparison purposes, we have historically excluded our Journey Care operations as it has a higher proportion of shorter length of stay patients due to our inpatient units in the Chicago area. We continue to be encouraged by the steady sequential improvement in admissions and census volumes in our hospice segment and anticipate those favorable trends continuing into the fourth quarter.

出於比較目的，我們歷來排除了 Journey Care 業務，因為我們的住院部位於芝加哥地區，因此短期住院患者的比例較高。我們繼續對臨終關懷部門的入院率和人口普查量的穩步連續改善感到鼓舞，並預計這些有利的趨勢將持續到第四季度。

Our home health segment same-store revenue decreased 8.8% over the same quarter in 2022 as we continued to reduce admissions from payers that do not currently reimburse us adequate rates to cover our cost. While we did see lower admissions primarily due to intentionally limiting admissions from these nonstrategic Medicare Advantage plans, we did see a sequential increase in home health volume of 5.5% as a result of some incremental contract pricing success and improvements in clinical staffing.

我們的家庭健康部門同店收入比 2022 年同一季度下降了 8.8%，因為我們繼續減少目前未向我們報銷足夠費率以支付我們費用的付款人的入院人數。雖然我們確實看到入院人數減少主要是由於有意限制這些非策略性Medicare Advantage 計劃的入院人數，但由於一些增量合約定價的成功和臨床人員配備的改善，我們確實看到家庭保健數量連續增加了5.5%。

While we have limited certain admissions due to contract rates, we have seen an increase in our overall episodic admission rate going from 46% in the third quarter of 2022 to a rate of 56% in the third quarter of 2023. With the improvement in episodic admission rate, we have seen an increase in our home health gross margin to 36.2% in our third quarter of this year compared to 23.2% in the third quarter of 2022.

雖然我們因合約費率而限制了某些入場人數，但我們發現整體的情境入場率從 2022 年第三季的 46% 上升到 2023 年第三季的 56%。隨著入院率的提高，我們的家庭健康毛利率在今年第三季成長至36.2%，而2022 年第三季為23.2%。

We remain excited about our home health operation as it complements both our personal care services, particularly where we participate in value-based contracting models and our hospice services by allowing us to provide the full continuum of home-based clinical care.

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和我們的臨終關懷服務的情況下，使我們能夠提供完整的家庭臨床護理連續性。

Over the past few months, we have continued to see limited strategic opportunities in both personal care and home health due to the reimbursement uncertainty that exists in each of these segments. As we have more clarity around these particular issues, we believe that we will start to see increasing acquisition opportunities in these segments that will meet our strategic objectives.

在過去的幾個月裡，由於個人護理和家庭健康領域都存在報銷不確定性，我們繼續看到這些領域的策略機會有限。隨著我們對這些特定問題的了解更加清晰，我們相信我們將開始看到這些領域越來越多的收購機會，從而實現我們的策略目標。

We are extremely pleased with our Tennessee Quality Care acquisition, which has strengthened our overall operations in the state of Tennessee. This is an example of the type of acquisition that fits squarely within our strategy of providing all 3 levels of home care and building density in strategically important states.

我們對田納西州 Quality Care 的收購感到非常滿意，這加強了我們在田納西州的整體業務。這是一種收購類型的例子，完全符合我們在具有戰略意義的州提供所有 3 個級別的家庭護理和建築密度的策略。

As for our value-based care efforts, we have been telling you for the past several quarters that we are gathering data to improve our effectiveness at helping to reduce the overall cost of care for members of our payers that participate in our various value-based care programs. We now have results in most -- in our most mature value-based agreements, and we have been able to demonstrate a material reduction in both emergency room visits as well as a percentage of patients which were readmitted to the hospital at both 30- and 90-day intervals.

至於我們基於價值的護理工作，我們在過去幾個季度一直告訴您，我們正在收集數據，以提高我們的效率，幫助降低參與我們各種基於價值的付款人成員的總體護理成本。護理計劃。現在，我們在大多數最成熟的基於價值的協議中都取得了成果，並且我們已經能夠證明急診室就診次數以及 30 歲和 30 歲時重新入院的患者比例均大幅減少。90 天的間隔。

In addition, we've been able to help with the improvement of HEDIS scores and the closure of care gaps relating to these patients. We believe our success is due to our ability to provide both nonclinical personal care services to identify changes and conditions and clinical resources as needed for specific skilled patient care interventions.

此外，我們還能夠協助提高 HEDIS 評分並縮小與這些患者相關的護理差距。我們相信，我們的成功歸功於我們能夠提供非臨床個人護理服務來識別變化和狀況，以及根據特定熟練患者護理幹預措施所需的臨床資源。

We continue to invest in value-based strategies and related technology resources. These investments should give us an opportunity during the next couple of years to accelerate our revenue growth from this part of our operation as we increase the scale of our value-based programs. We will be using this information as part of our conversations with various Medicare Advantage payers showing them how Addus can be a part of providing cost-effective care to their members that can significantly reduce the overall medical loss ratio and improve the overall quality of care received by members participating in our programs.

我們持續投資基於價值的策略和相關技術資源。隨著我們擴大基於價值的計劃的規模，這些投資應該讓我們有機會在未來幾年內加速這部分業務的收入成長。我們將使用這些資訊作為與各種 Medicare Advantage 付款人對話的一部分，向他們展示 Addus 如何參與為其會員提供具有成本效益的護理，從而顯著降低總體醫療損失率並提高所接受護理的整體品質由參與我們計劃的會員提供。

With the recent addition of Tennessee Quality Care, we now have 3 states where we can offer all 3 levels of home care. We believe this coverage positions us well to continue to expand and add our value-based contracts in these markets.

隨著最近田納西州優質護理中心的加入，我們現在有 3 個州可以提供所有 3 個級別的家庭護理。我們相信，這一覆蓋範圍使我們能夠繼續在這些市場上擴大和增加基於價值的合約。

As I say each quarter, I'm so proud of our team for the care they are providing to our elderly and disabled consumers and patients. There's no question that the majority of clients and patients want to receive care in their homes which remains one of the safest and most cost-effective places to receive this care. We believe the heightened awareness of the value of home-based care is favorable for our industry and will continue to 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 clients, patients and their families.

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，而家中仍然是接受這種護理的最安全、最具成本效益的地方之一。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，並將繼續成為我們公司的成長機會。我們理解並讚賞我們的營運和成長依賴於我們敬業的護理人員，他們非常努力地為我們的客戶、患者及其家人提供出色的護理和支援。

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

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 third quarter, reflecting the continued momentum in our business in 2023. Our results were driven by robust demand for our services, highlighted by 13.9% year-over-year organic growth in personal care services, well above our normal expected range of 3% to 5%.

謝謝你，德克，大家早安。 Addus 第三季的財務和營運業績強勁，反映出我們業務在 2023 年的持續成長勢頭。我們的業績是由對我們服務的強勁需求推動的，其中個人護理服務同比有機增長 13.9%，遠高於我們3% 至5% 的正常預期範圍。

For the year-to-date period, personal care revenue is up 12.5% compared with the same period last year. In addition to the volume growth, we benefited from the statewide rate increases in Illinois, our largest personal care market that were effective January 1 and April 1 of this year.

今年迄今，個人護理收入較去年同期成長12.5%。除了銷售成長之外，我們還受益於伊利諾伊州全州範圍內的費率上漲，該市場是我們最大的個人護理市場，於今年 1 月 1 日和 4 月 1 日生效。

Our third quarter results included 2 months of operations of Tennessee Quality Care, a provider of home health, hospice and private duty nursing, which we acquired on August 1, 2023. We are pleased with the integration process to date and look forward to the additional growth opportunities this acquisition offers in an attractive market.

我們的第三季業績包括Tennessee Quality Care 的2 個月運營，該公司是我們於2023 年8 月1 日收購的家庭健康、臨終關懷和私人護理服務提供者。我們對迄今為止的整合過程感到滿意，並期待更多此次收購在一個有吸引力的市場中提供了成長機會。

Acquisitions remain an important area of focus for Addus, with the market somewhat tempered pending proposed rule changes for reimbursement and program structures. We continue to be selective in assessing and pursuing strategic opportunities in the interim. We were pleased to see continued improvement in our hospice business in the third quarter with positive sequential trends in same-store revenue, average daily census, length of stay and patient days with same-store revenues up 3.1% over the prior year.

收購仍然是 Addus 關注的重要領域，市場在等待報銷和計劃結構擬議規則變更之前有所緩和。在此期間，我們將繼續選擇性地評估和尋求策略機會。我們很高興看到第三季我們的臨終關懷業務持續改善，同店收入、平均每日人口普查、住院時間和患者天數均呈現積極的連續趨勢，同店收入比上年增長 3.1%。

We have begun to see the early impact from the expiration of the public health emergency, which we expected to lead to an increase in our skilled nursing facility hospice length of stay. The overall results for our hospice business also include the addition of the Tennessee Quality Care operations.

我們已經開始看到公共衛生緊急狀態結束的早期影響，我們預計這將導致我們熟練的護理機構臨終關懷的住院時間增加。我們臨終關懷業務的整體表現還包括田納西州優質護理業務的增加。

Same-store revenue for our home health services was down 8.8% from the same period a year ago, as we have intentionally limited admissions from payers with less favorable rates and continue to look for ways to more effectively balance our mix of episodic versus nonepisodic cases. These strategies have affected our volumes on a short-term basis but have resulted in improved profitability for home health. We are continuing to negotiate more favorable rates with certain payers that we anticipate will help drive higher patient volumes and saw sequential increases in admissions and total volume for second quarter of 2023.

我們的家庭健康服務的同店收入較去年同期下降了 8.8%，因為我們有意限制費率較低的付款人的入院服務，並繼續尋找方法來更有效地平衡偶發性病例與非偶發性病例的組合。這些策略在短期內影響了我們的銷售量，但提高了家庭健康的獲利能力。我們正在繼續與某些付款人協商更優惠的費率，我們預計這將有助於推動更高的患者數量，並看到 2023 年第二季度的入院人數和總數連續增加。

Our home health results include the Tennessee Quality Care acquisition as well as Apple Home Health, which we acquired on October 1, 2022. As Dirk noted, total net service revenues for the third quarter were $270.7 million. The revenue breakdown is as follows: Personal Care revenues were $201.9 million or 74.6% of revenue, Hospice care revenues were $53.1 million or 19.6% of revenue and home health revenues were $15.7 million or 5.8% of revenue.

我們的家庭健康業績包括對 Tennessee Quality Care 的收購以及我們於 2022 年 10 月 1 日收購的 Apple Home Health。正如 Dirk 指出的那樣，第三季度的總淨服務收入為 2.707 億美元。收入明細如下：個人照護收入為 2.019 億美元，佔收入的 74.6%；臨終關懷收入為 5,310 萬美元，佔收入的 19.6%；家庭健康收入為 1,570 萬美元，佔收入的 5.8%。

Other financial results for the third quarter of 2023 include the following: Our gross margin percentage was 32% compared with 31.3% for the third quarter of 2022 and a sequential improvement of 30 basis points compared to 31.7% for the second quarter of 2023. As expected, the addition of the Tennessee Quality Care operations and a higher mix of clinical services had a positive impact on gross margin.

2023 年第三季的其他財務表現包括： 我們的毛利率為 32%，而 2022 年第三季為 31.3%，與 2023 年第二季的 31.7% 相比，環比提高了 30 個基點。如預期的那樣，田納西州優質護理業務的增加和更高的臨床服務組合對毛利率產生了積極影響。

With the most recent reimbursement increase in Illinois, we were not negatively affected by the annual July 1 minimum wage increase in Chicago as we expected, as we had previously adjusted our wage scales.

隨著伊利諾伊州最近一次報銷額的增加，我們並沒有像我們預期的那樣受到芝加哥每年 7 月 1 日最低工資增長的負面影響，因為我們之前已經調整了工資標準。

We do anticipate some additional gross margin expansion sequentially in the fourth quarter, both from the first full quarter of our Tennessee Quality Care clinical operations as well as our annual hospice rate increase which will be 3.1% effective October 1, 2023. The combined positive impact on our gross margin is expected to be approximately 60 basis points.

我們確實預計第四季度的毛利率將繼續出現一些額外的增長，無論是從田納西州優質護理臨床業務的第一個完整季度開始，還是從2023 年10 月1 日起，我們的年度臨終關懷費率將增加3.1%。綜合正面影響我們的毛利率預計約為 60 個基點。

Looking ahead to the first quarter of 2024, we will see the normal negative seasonal impacts from our annual merit increases and the reset of payroll taxes of approximately 80 basis points and as Dirk mentioned, may see some onetime slight compression on our margin percentages from our collective marketing negotiations.

展望 2024 年第一季度，我們將看到年度績效成長和工資稅重置約 80 個基點帶來的正常負面季節性影響，正如德克所提到的，我們的利潤率可能會暫時略有壓縮。集體行銷談判。

G&A expense was 22.3% of revenue, a decline from 22.6% in the third quarter a year ago, but up slightly from 22.1% sequentially in the second quarter, primarily as a result of our Tennessee Quality Care acquisition having a higher G&A profile.

一般及行政費用佔收入的22.3%，較去年第三季的22.6% 有所下降，但較第二季度的22.1% 略有上升，這主要是由於我們收購的田納西州Quality Care 具有較高的一般及行政費用。

Adjusted G&A expense for the third quarter of 2023 was 20.6%, essentially flat from the same period in the prior year and up slightly sequentially from 20.4% in the second quarter. With the first full quarter of Tennessee Quality Care and its higher G&A profile in the fourth quarter, we expect our adjusted SG&A percentage to remain relatively flat sequentially.

2023 年第三季調整後的一般管理費用為 20.6%，與去年同期基本持平，比第二季的 20.4% 略有上升。隨著田納西州優質護理的第一個完整季度及其第四季度一般管理費用的提高，我們預計調整後的一般管理費用百分比將與上一季保持相對持平。

The company's adjusted EBITDA increased to $30.9 million compared with $25.7 million a year ago. Adjusted EBITDA margin was 11.4% compared with 10.7% for the third quarter of 2022 and a 50 basis point increase from 10.9% in the second quarter of 2023.

該公司調整後的 EBITDA 增至 3,090 萬美元，而一年前為 2,570 萬美元。調整後 EBITDA 利潤率為 11.4%，較 2022 年第三季的 10.7% 成長，較 2023 年第二季的 10.9% 成長 50 個基點。

Adjusted net income per diluted share was $1.15 compared with $0.94 for the third quarter of 2022. The adjusted per share results for the third quarter of 2023 exclude the following: acquisition expenses of $0.08 and noncash stock-based compensation expense of $0.12. The adjusted per share results for the third quarter of 2022 exclude the following: acquisition expenses of $0.08, restructuring and other nonrecurring costs of $0.01, and noncash stock-based compensation expense of $0.14.

調整後每股攤薄淨利潤為 1.15 美元，而 2022 年第三季為 0.94 美元。2023 年第三季調整後每股業績不包括以下內容：收購費用 0.08 美元和非現金股票補償費用 0.12 美元。 2022 年第三季調整後每股業績不包括以下內容：收購費用 0.08 美元、重組和其他非經常性費用 0.01 美元以及非現金股票補償費用 0.14 美元。

Our tax rate for the third quarter of 2023 was 23.8% in alignment with our expectations. For the full year calendar 2023, we continue to expect our tax rate to be in the mid-20% range. DSOs were 41.5 days at the end of the third quarter of 2023 compared with 35.6 days at the end of the second quarter of 2023. While we have continued to experience consistent cash collections for most of our payers, we saw a more normal payment timing in the third quarter as anticipated.

我們 2023 年第三季的稅率為 23.8%，符合我們的預期。對於 2023 年全年，我們繼續預計稅率將在 20% 左右。 2023 年第三季末的 DSO 為 41.5 天，而 2023 年第二季末為 35.6 天。雖然我們繼續為大多數付款人提供一致的現金收款，但我們看到了更正常的付款時間第三季度如預期。

Our DSOs for the Illinois Department of Aging for the third quarter returned to a more typical level at 41.8 days compared with 22.3 days at the end of the second quarter of 2023.

我們的伊利諾伊州老齡化部門第三季的 DSO 恢復到更典型的水平，即 41.8 天，而 2023 年第二季末為 22.3 天。

Our cash flows have continued to be very strong in 2023 with our third quarter net cash provided by operations at $21.8 million. Year-to-date, net cash provided by operations was $87.6 million, exclusive of $5.5 million in ARPA net spending.

2023 年，我們的現金流持續強勁，第三季營運提供的淨現金為 2,180 萬美元。年初至今，營運提供的淨現金為 8,760 萬美元，不包括 ARPA 淨支出 550 萬美元。

As of the end of the third quarter, we still have approximately $8.3 million in ARPA funds outstanding to be utilized, and we expect to receive approximately $16 million in additional funding from the state of New Mexico beginning in the fourth quarter.

截至第三季末，我們仍有約 830 萬美元的 ARPA 資金待使用，預計從第四季開始，我們將從新墨西哥州獲得約 1,600 萬美元的額外資金。

As of September 30, 2023, the company had cash of $79.8 million and bank debt of $166.4 million with capacity and availability under our revolver of $450 million and $275.6 million, respectively.

截至 2023 年 9 月 30 日，該公司擁有 7,980 萬美元現金和 1.664 億美元銀行債務，我們的循環資金下的容量和可用性分別為 4.5 億美元和 2.756 億美元。

With our strong cash flow, we continue to prioritize debt repayment in the absence of acquisition activity. As a result, subsequent to our borrowing for the Tennessee Quality Care acquisition, we repaid $25 million on our revolver during the third quarter and have made additional payments of $25 million to date in the fourth quarter.

憑藉強勁的現金流，在沒有收購活動的情況下，我們將繼續優先償還債務。因此，在我們為田納西州 Quality Care 收購而藉款之後，我們在第三季度償還了 2500 萬美元的左輪手槍，並在第四季度迄今為止額外支付了 2500 萬美元。

Our year-to-date net borrowing on our revolver as of the end of the third quarter of 2023 was $31.5 million, inclusive of the acquisition of Tennessee Quality Care for approximately $106 million. We have a capital structure that supports our growth initiatives and acquisition strategy. And as previously noted, we continue to pursue selective acquisitions as market conditions evolve. At the same time, we will continue to focus on our debt repayment strategy and manage our net leverage ratio, which is currently well under 1x net of cash on hand.

截至 2023 年第三季末，我們的左輪手槍今年迄今的淨借款為 3,150 萬美元，其中包括以約 1.06 億美元收購田納西州 Quality Care。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，隨著市場狀況的變化，我們將繼續進行選擇性收購。同時，我們將繼續關注我們的債務償還策略並管理我們的淨槓桿率，目前該比率遠低於手頭現金淨額的1倍。

This concludes our prepared comments this morning, and we'd like to thank you for being with us.

我們今天早上準備的評論到此結束，我們要感謝您與我們在一起。

I'll now ask the operator to please open the line for your questions.

我現在請接線生接通您的問題電話。

(Operator Instructions)

（操作員說明）

And the first question will come from Scott Fidel with Stephens.

第一個問題將由斯科特·菲德爾和史蒂芬斯提出。

First question, just wanted to just ask about thinking about with the fourth quarter and recognizing that you don't provide formal guidance, but would be curious if you could give us some of your thinking on sort of directional trajectory of volumes across the 3 core business lines sequentially for the fourth quarter and any seasonality that you would think about also influencing that? And then also on the cash flow side, which has been very strong throughout the year, any working capital items that we should be thinking about when modeling 4Q cash flows.

第一個問題，只是想問一下對第四季度的思考，並認識到您沒有提供正式的指導，但我很好奇您能否就 3 個核心的交易量方向軌跡向我們提供一些想法第四季度的業務線順序以及您認為也會影響的任何季節性因素？然後，在全年都非常強勁的現金流方面，我們在對第四季度現金流進行建模時應該考慮的任何營運資本項目。

Yes, Scott, this is Brian. I think just looking ahead to Q4 on growth rates, obviously, we've been well ahead of our 3% to 5% this year in personal care, Illinois, 2 rate increases this year have definitely been beneficial. I think looking ahead to the fourth quarter, we still expect our growth rate in personal care to most likely be above that 3% to 5% range, maybe not quite to the level we've seen in the last couple of quarters with some of the comps to last year, but still a healthy growth rate on a same-store basis year-over-year for the fourth quarter.

是的，史考特，這是布萊恩。我認為，展望第四季度的成長率，顯然，我們在個人護理領域遠遠領先今年 3% 至 5%，伊利諾伊州，今年的 2 次升息肯定是有益的。我認為展望第四季度，我們仍然預計個人護理品的成長率很可能會高於 3% 至 5% 的範圍，也許還沒有達到我們在過去幾個季度看到的水平，其中一些與去年相比，但第四季同店年比仍保持健康成長。

I think in the clinical services, we've talked about we've seen some sequential improvement from Q2 into Q3. I think we would expect and anticipate to see continued positive momentum there. We do have a little bit of seasonality. I think just like (inaudible) when it comes around the holidays, particularly maybe in the hospice segment, but I think that's pretty typical. But I would say probably not overly material.

我認為在臨床服務中，我們已經討論過從第二季到第三季我們看到了一些連續的改善。我認為我們預計並預計會看到持續的積極勢頭。我們確實有一點季節性。我認為就像（聽不清楚）假期期間一樣，特別是在臨終關懷領域，但我認為這是非常典型的。但我想說可能不是太物質。

And then just on the question on the cash flow. I think nothing significant, I think, from a working cap perspective, I think our DSOs have been pretty stable. We talked last quarter about being a little artificially low. We came back a little more, so I think a normal range in Q3. I would expect that to be pretty consistent. So really nothing towards the end of the back part of this year. I think just thinking ahead a little bit, we get into the early part of next year, you sort of think about annual merits, compensation, things like that, that play a little bit of an impact some of your insurance on a prepaid basis, but again, probably nothing overly material there.

然後就是關於現金流的問題。我認為沒有什麼重要的，我認為，從工作上限的角度來看，我認為我們的 DSO 一直相當穩定。上個季度我們談到了人為壓低的情況。我們回來了一些，所以我認為第三季處於正常範圍。我希望這會非常一致。所以今年下半年確實沒有什麼。我認為提前考慮一下，我們進入明年初，你會考慮年度績效、薪酬等類似的事情，這會對你的預付保險產生一點影響，但同樣，可能沒有什麼過於實質性的內容。

Okay. And then just as a follow-up question, and I appreciate some of the visibility into thinking about gross margins in both the fourth quarter, in the first quarter. I thought it may be helpful just to the extent that you can, just relative to the specific dynamic that you called out around the renegotiation on the collective bargaining with the PCS workers and some effect that may have on gross margin.

好的。然後，作為一個後續問題，我很欣賞對第四季和第一季毛利率的一些思考。我認為這可能會在您能做到的範圍內有所幫助，只是相對於您圍繞與 PCS 工人進行集體談判的重新談判所提出的具體動態以及可能對毛利率產生的一些影響而言。

As we try to think about modeling that and I guess in particular sort of -- as we sort of step into next year and into the first quarter. I know you talked about like the 80 basis points of other factors, is there any type of, I guess, sort of range or framing that you can give us on how we should think about tackling the gross margin impact, I guess, for the PCS segment or on the consolidated basis from the, I guess, some of these revised wage agreements that you're working on?

當我們嘗試考慮建模時，我想特別是當我們進入明年和第一季時。我知道您談到了其他因素的 80 個基點，我想您是否可以向我們提供任何類型的範圍或框架，以說明我們應該如何考慮解決毛利率影響，我想，對於PCS 部門還是在綜合基礎上，我猜，您正在製定的一些修訂後的工資協議？

Yes, Scott. I think primarily, it's in Illinois. I think the rate increase we're getting on January 1. It isn't tied to any kind of step-up in minimum wage. There's no kind of offset wage scale per se that happens exactly at that time. So in our negotiations with them, and we'll be a little overcautious in exactly how detailed we get. But I think we expect to see some onetime, as Dirk mentioned, kind of benefit enhancements, so not necessarily hourly rates or wages. But some things that haven't been addressed through our negotiations in the past several years that we're taking an opportunity to address now.

是的，斯科特。我認為主要是在伊利諾伊州。我認為我們將在 1 月 1 日加息。它與最低工資的任何形式的提高無關。那時並沒有確切發生的補償工資規模本身。因此，在與他們的談判中，我們在細節上會有點過於謹慎。但我認為，正如德克所提到的，我們預計會看到一些一次性的福利增強，因此不一定是小時費率或工資。但有些問題在過去幾年的談判中尚未解決，現在我們正藉此機會解決。

So the way to think about, I think, going into next year, normally, we kind of see a rate increase. This is going to be the amount getting to be about a 4.2% increase on our current rate we would see kind of a normal margin pull-through. I think our expectation is we're not going to see that with this particular rate increase when we make some of these adjustments. Illinois is a decent part of our business. So we'll probably have a very slight impact on the margin rate, but not, I would say, overly material from a percentage basis, but probably a slight impact.

因此，我認為，進入明年，通常情況下，我們會看到利率上升。這將比我們目前的利率增加約 4.2%，我們將看到正常的利潤率拉升。我認為我們的預期是，當我們進行一些調整時，我們不會看到這種特殊的利率上升。伊利諾伊州是我們業務的重要組成部分。因此，我們可能會對保證金率產生非常輕微的影響，但我想說，從百分比來看，影響不會太大，但可能會產生輕微的影響。

The next question we have is from Ben Hendrix with RBC Capital Markets.

我們的下一個問題來自加拿大皇家銀行資本市場的 Ben Hendrix。

I appreciate the commentary about the PC hiring momentum. I was wondering if you could give us some -- your take on how retention has been trending, especially after the special Illinois rate increase that you saw or the extra Illinois rate increase you saw last year, if that's having an impact on retention. Then on the hospice side, the ADC up sequentially on a same-store basis. I'm wondering how that trended through the quarter and kind of what's giving you confidence in seeing some pickup in 4Q?

我很欣賞關於個人電腦招募勢頭的評論。我想知道您是否可以給我們一些關於保留率趨勢的看法，特別是在您看到伊利諾伊州特別加息或去年伊利諾伊州加息額外之後，這是否對保留率產生影響。然後在臨終關懷方面，ADC 在同店基礎上依次上升。我想知道整個季度的趨勢如何，是什麼讓您有信心在第四季度看到一些回升？

Ben, this is Brad. With respect to the PCS, just kind of looking at the turnover and retention rates there. We have seen continued improvement in our retention and our turnover rates on the PCS side. I think a lot of us, as we pointed out earlier, is a lot of the enhanced unemployment benefits ended last year, which certainly helped on the retention side and getting people to work. But then more importantly, I think as you point out, some of these rate enhancements have certainly helped keep people engaged to help with hiring numbers helped keep them -- I think we're doing a better job, honestly, of giving them more hours, as one of our focuses is we're doing a good job on the hiring front.

本，這是布拉德。就 PCS 而言，只需看看那裡的營業額和保留率。我們看到 PCS 方面的保留率和流動率持續改善。正如我們之前指出的，我認為我們許多人都受益於去年結束的增強型失業救濟金，這無疑有助於留住人們並讓人們工作。但更重要的是，我認為正如你所指出的，其中一些費率的提高肯定有助於保持人們的參與度，幫助招聘人數幫助留住他們——說實話，我認為我們在給他們更多的工作時間方面做得更好，因為我們的重點之一是我們在招募方面做得很好。

But what we really need to, I think, focus on this year and next is really maximizing our existing workforce because it's -- there's a lot of employees there that want more hours, and it's really a matter of matching those caregivers with open shifts, and that's where we're spending a lot of our efforts now and into next year is really focused on technology enhancements that would allow us to do a better job, which I think one helps us get cases started faster, as Dirk alluded to, but then more importantly, allows us to get more hours out of our existing workforce, which helps with the retention.

但我認為，今年和明年我們真正需要關注的是最大限度地利用我們現有的勞動力，因為那裡有很多員工想要更多的工作時間，這實際上是一個將這些護理人員與開放輪班相匹配的問題，這就是我們現在和明年投入大量精力的地方，真正專注於技術增強，這將使我們能夠做得更好，我認為這有助於我們更快地啟動案件，正如德克所提到的那樣，但更重要的是，這使我們能夠從現有員工中獲得更多工作時間，這有助於留住員工。

When you look at the hospice trends, we saw pretty good hospice numbers when you looked at July and particularly August, tailed off a little bit in September, but then picked up again in October. So I think we've got some good momentum on the hospice front.

當你觀察臨終關懷趨勢時，我們看到 7 月，特別是 8 月的臨終關懷數字相當不錯，在 9 月略有下降，但在 10 月再次回升。所以我認為我們在臨終關懷方面已經取得了一些良好的勢頭。

There's still some pockets where we had some challenges on the staffing side, primarily in some urban markets, like Chicago and Portland, Oregon. Those have improved. So I think that gives us some optimism heading into Q4, but as Brian pointed out, you typically have a little bit of seasonality around the holiday season, particularly with respect to hospice.

我們在人員配置方面仍然存在一些挑戰，主要是在一些城市市場，例如芝加哥和俄勒岡州波特蘭。這些都有所改善。因此，我認為這讓我們對第四季度感到樂觀，但正如布萊恩所指出的那樣，假期期間通常會有一些季節性，特別是在臨終關懷方面。

The next question will come from Joanna Gajuk with Bank of America.

下一個問題將由美國銀行的 Joanna Gajuk 提出。

So I guess maybe first I'll start with a follow-up question, and then I have my question. But on the follow-up, so just talking about the Illinois rate increase and how you expect a onetime, I guess, impact to gross margin because of the lower, I guess, flow through. But you also said in the prepared remarks, you expect to see some offsets from volume increases in the market. So could you talk about that a little bit more? Like when would you see those volume, I guess, increases materializing? Is it immediately? Or is it more of a comment over time?

所以我想也許首先我會從一個後續問題開始，然後我提出我的問題。但在後續行動中，只是談論伊利諾伊州的加息，以及我猜想，由於流量較低，您預計會對毛利率產生怎樣的影響。但您在準備好的發言中也表示，您預期市場成交量的成長會帶來一些抵銷。那你能多談談這個嗎？我猜你什麼時候會看到這些交易量增加？是立即嗎？或者隨著時間的推移，它更多的是一種評論？

Yes. Joanna, this is Brad. With respect to the volume, if you look at Illinois, and this kind of goes back to the previous question, we paid a pretty good rate in Illinois because of some of the rate increases that we've received from the state, which has been beneficial on caregiver recruitment and retention. So we've seen some really solid hours growth in Illinois. I think year-over-year, they're up by almost 6% on an hours basis. .

是的。喬安娜，這是布萊德。就數量而言，如果你看看伊利諾伊州，這又回到了上一個問題，我們在伊利諾伊州支付了相當不錯的費率，因為我們從該州收到了一些費率上漲，這已經是有利於護理人員的招募和保留。因此，我們看到伊利諾伊州的工作時間確實出現了大幅成長。我認為，與去年同期相比，每小時增加了近 6%。 。

Even though we're not getting necessarily as much margin out of this -- the upcoming rate increase, I do anticipate that those volume increases should continue, which will give us more leverage off of our SG&A which I think when you talk about margin, really focused on the bottom line, it should have a negligible effect that we're seeing a little bit of not as much pull-through on this rate increase.

儘管我們不一定能從中獲得那麼多的利潤——即將到來的加息，但我確實預計這些數量的增長應該會繼續下去，這將使我們從SG&A中獲得更多的槓桿作用，我認為當你談論利潤時，真正關注的是利潤，它的影響應該可以忽略不計，因為我們看到這次升息沒有那麼大的拉動。

Okay. And my question around the margin comment there, so appreciate typically, this Q4 margins are higher. But then to your point, Q1 tends to be a lower margin quarter in a year. So I guess this year, I guess, tracking for the full year EBITDA margins, I'm talking about 11% and in change maybe 11.1% for the full year. So is that a good starting point when you think about the full year 2024, I understand you don't give specific guidance, but I guess in light of the commentary is around Q1, I think it will be helpful talking about also kind of fourth quarter period, how the margins could play out? And as you talk about that, I guess, any puts and takes in terms of the volumes and rates, obviously, volumes have been improving nicely in PCS, but it's very strong, right, and how you see this normalizing into next year?

好的。我的問題是關於利潤率評論的，所以通常要感謝的是，第四季度的利潤率更高。但就你的觀點而言，第一季往往是一年中利潤率較低的季度。所以我想今年，我想，追蹤全年 EBITDA 利潤率，我說的是 11%，全年的變動可能是 11.1%。那麼，當您考慮2024 年全年時，這是一個很好的起點嗎？我知道您沒有給出具體指導，但我想鑑於第一季左右的評論，我認為談論第四個也會有所幫助季度期間，利潤率如何發揮？當你談到這一點時，我想，就交易量和利率而言，任何看跌期權和賣出期權顯然，PCS 的交易量都在很好地改善，但它非常強勁，對吧，你如何看待這種正常化到明年？

Yes, Joanna, I think for 2023, I think we are trending toward finishing the full year above -- back above 11%, which is where we were a couple of years ago. I think we had talked about coming into this year, we expected our margins to remain somewhat stable compared to last year where we saw a lot of wage pressure. I think we've actually overperformed that a little bit this year, I think adding an acquisition like Tennessee Quality Care and Clinical is helpful with that as well. But I think our expectation looking forward to 2024 on a margin perspective is we would expect to again be back above 11% and stay in that range.

是的，喬安娜，我認為到 2023 年，我們的全年成長率將有可能回到 11% 以上，這是我們幾年前的水平。我想我們已經討論過今年的情況，我們預計我們的利潤率與去年相比會保持一定的穩定，去年我們看到了很大的工資壓力。我認為今年我們的表現實際上有點超出了預期，我認為增加像田納西州品質護理和臨床這樣的收購也有幫助。但我認為，從利潤率角度來看，我們對 2024 年的預期是，我們預計將再次回到 11% 以上並保持在該範圍內。

I think talking a little bit of piggybacking on Scott's earlier question about growth rates, I think our long-term growth rate in personal care 3% to 5%, I think we're still comfortable with and then getting to a 4-plus percent increase in Illinois just thinking about the top line, not necessarily the pull-through is very helpful in that regard going into next year. So I think we expect to be nicely into that range and maybe towards the top end of next year. And I think our clinical services, we anticipate we'd like to see those get back to our normal growth rates of kind of mid-single digits. So with that, again, that 11-plus percent bottom line margin expectation for next year.

我認為，談談斯科特之前關於增長率的問題，我認為我們個人護理領域的長期增長率為 3% 到 5%，我認為我們仍然對達到 4% 以上感到滿意伊利諾伊州的增長只是考慮收入，但不一定對明年的這方面拉動非常有幫助。所以我認為我們預計會很好地進入這個範圍，也許明年年底就會達到這個範圍。我認為我們的臨床服務預計我們希望看到這些服務恢復到中等個位數的正常成長率。因此，明年的底線利潤率預期將再次達到 11% 以上。

If I can just follow up on that. So I guess, sounds like you're talking about maybe higher end of the 3% to 5% for PCS. So how would you break it down the volumes versus rates? So I guess Illinois, you just mentioned 4% increase. And how are, I guess, the rest of the PCS markets trending when it comes to rate increases into next year?

如果我能跟進的話。所以我想，聽起來你所說的可能是 PCS 3% 到 5% 的高階。那麼，您如何將其分解為交易量與利率？所以我猜伊利諾伊州，你剛剛提到了 4% 的成長。我猜，在明年升息方面，其他 PCS 市場的趨勢如何？

Yes, I think Illinois obviously is going to be the most impactful one for us next year. So they're about 40% of our business in personal care. So at 4-plus percent, that's a good start on the 3% to 5% consolidated for the year. I think we've seen good rate support over the last couple of years from a lot of our markets. We've seen a lot of corresponding increases to offset some minimum wage step-up. We don't have many of those, I think, scheduled for next year. So I think our expectation is outside of Illinois, not probably a lot on the rate side next year. I think we are getting, as Brad mentioned, really good momentum and volume -- on the volume side. And we have an expectation that our markets will continue to grow both in number of clients, but also where we can maximize the fill rates from our authorizations. We're making some headway there. We have some opportunity there on the volume side, we believe.

是的，我認為伊利諾伊州顯然將成為明年對我們影響最大的州。因此，它們約占我們個人護理業務的 40%。因此，對於今年 3% 至 5% 的綜合成長率來說，4% 以上是一個好的開始。我認為過去幾年我們已經從許多市場看到了良好的利率支持。我們已經看到了許多相應的成長，以抵消一些最低工資的上漲。我認為，我們明年安排的活動並不多。因此，我認為我們的預期是在伊利諾伊州之外，明年的利率方面可能不會太多。我認為，正如布拉德所提到的，我們在數量方面獲得了非常好的勢頭和數量。我們預計我們的市場將在客戶數量方面繼續成長，而且我們可以最大限度地提高授權的填充率。我們正在這方面取得一些進展。我們相信，我們在數量方面有一些機會。

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

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。請繼續。

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

謝謝你，接線生。我要感謝您對 Addus 的興趣並參加我們今天的電話會議。我們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。