Addus Homecare Corp (ADUS) 2023 Q4 法說會逐字稿

Good morning, everyone, and welcome to the Addus Homecare's fourth quarter and year end 2023 earnings conference call. (Operator Instructions) Also note, today's event is being recorded. And at this time, I'd like to turn the floor over to Dru Anderson and please go ahead.

大家早安，歡迎參加 Addus Homecare 的第四季和 2023 年底財報電話會議。（操作員說明）另請注意，今天的事件正在被記錄。現在，我想把發言權交給 Dru Anderson，請繼續。

Thank you. Good morning, and welcome to the Atos HomeCare Corporation Fourth Quarter and 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, 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 Atos expected quarterly and annual financial performance for 2024 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. You are hereby cautioned that these statements may be affected by important factors, among others, set forth in Avnet's filings with the Securities and Exchange Commission and in its fourth quarter 2023 news release and 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.

謝謝。早安，歡迎參加 Atos HomeCare Corporation 第四季和 2023 年財報電話會議。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（本次電話會議）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也可能包含 1995 年《私人證券訴訟改革法案》含義內的前瞻性陳述，包括有關 Atos 2024 年或以後預期季度和年度財務業績的陳述等。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。特此提醒您，這些陳述可能會受到安富利向美國證券交易委員會提交的文件及其2023 年第四季度新聞稿中所述的重要因素的影響，因此，實際運營和結果可能與所討論的結果存在重大差異在前瞻性陳述中。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。

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 fourth 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 quarterly calls, I will begin with a few overall comments, and then Brian will discuss the fourth-quarter results in more detail following our comments, the three of us would be happy to respond to any questions.

謝謝 Dru，早安，歡迎參加我們的 2023 年第四季財報電話會議。今天與我在一起的有我們的財務長 Brian Poff 和我們的總裁兼營運長 Brad Bickham。正如我們在每次季度電話會議上所做的那樣，我將首先發表一些總體評論，然後布萊恩將在我們的評論之後更詳細地討論第四季度的業績，我們三個人將很樂意回答任何問題。

Yesterday we announced our results for the fourth quarter and full year of 2023. These results highlight another strong year of financial performance by Atos. This performance is made possible by the hard work and dedication of all of our employees as they continue to provide quality care to our clients and patients by helping to fulfill our mission of taking care of people in their homes. I am both amazed and thankful for all of them that our employees do for our company. As we announced yesterday, our total revenue for the fourth quarter of 2023 was 276.4 million, an increase of 11.9% as compared to 247.1 million for the fourth quarter of 2022. This revenue growth resulted in adjusted earnings per share of $1.32 as compared to adjusted earnings per share for the fourth quarter of 2023 of $1.11, an increase of 18.9%. Our adjusted EBITDA of 34 or $34.3 million was an increase of 21.3% over the fourth quarter of 2022. Our total revenue for 2023 was approximately 1.1 billion, an increase of 11.3% as compared to the 951.1 million for 2022. Revenue growth resulted in adjusted earnings per share of $4.58 as compared to adjusted earnings per share for 2022 of $3.73, an increase of 22.8%. Our adjusted EBITDA of 121 million was an increase of 19.3% over 2022.

昨天，我們公佈了 2023 年第四季和全年業績。這些結果突顯了 Atos 財務表現又一個強勁的一年。這項業績的實現得益於我們所有員工的辛勤工作和奉獻精神，他們透過幫助履行我們照顧家人的使命，繼續為我們的客戶和患者提供優質照護。我對我們的員工為公司所做的一切感到既驚訝又感激。正如我們昨天所宣布的，我們 2023 年第四季的總營收為 2.764 億美元，比 2022 年第四季的 2.471 億美元成長 11.9%。這一營收成長導致調整後每股收益為 1.32 美元，而 2023 年第四季調整後每股收益為 1.11 美元，成長 18.9%。我們的調整後 EBITDA 為 34，即 3,430 萬美元，比 2022 年第四季成長 21.3%。我們2023年的總營收約為11億美元，較2022年的9.511億美元成長11.3%。營收成長導致調整後每股收益為 4.58 美元，而 2022 年調整後每股收益為 3.73 美元，成長 22.8%。我們的調整後 EBITDA 為 1.21 億美元，比 2022 年成長 19.3%。

During 2023, we continued to experience strong cash flow from operations as our states and other payers have continued to pay in a timely manner. This allowed us to reduce our debt balance to approximately 126 million, inclusive of the funding of our acquisition of Tennessee quality care on August first, 2023, at year end, our cash balance was approximately 65 million, which together with 335 million of availability under our existing credit facility, continues to give 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 primary focus to use our financial capacity to acquire strategic operations. It align with our overall growth strategy of offering all three levels of home-based care and our personal care.

2023 年，我們的營運現金流繼續強勁，因為我們的州和其他付款人繼續及時付款。這使我們能夠將債務餘額減少至約1.26 億美元，其中包括我們於2023 年8 月1 日收購田納西州優質護理公司的資金，截至年底，我們的現金餘額約為6,500 萬美元，加上3.35 億美元的可用資金我們現有的信貸安排繼續為我們提供機會主義的財務靈活性，因為我們預計未來幾季市場將出現更多收購機會。利用我們的財務能力來收購策略業務​​仍然是我們的首要關注點。它符合我們提供所有三個層級的家庭護理和個人護理的整體成長策略。

Mark, let me provide you with some thoughts related to the Medicaid access proposed rule that was introduced last year. Many comments were submitted expressing concern toward the proposed 80% compensation requirement to be implemented by states within a four year period, a final rule concerning this issue was sent to the Office of Management and Budget on January 26 for their review and clearance. Based on this timing, we feel that the rule is on track to be finalized in April of this year. The contents of the final rule are unknown at this time and could be significantly different. And the proposed rule while we are unsure whether this rule will contain the 8% requirement, a different percentage requirement or ultimately be implemented, we would not be surprised to see the four year implementation period extended. We do believe that a key for personal care providers to be successful with any minimum requirement for direct wages. It's to have scale in each state in which they provide care. This will not only allow those providers to spread their costs over a larger revenue base, but also will provide more opportunity for meaningful patient advocacy within the state in which they operate.

馬克，讓我向您提供一些與去年推出的醫療補助准入提案規則相關的想法。許多評論對各州在四年內實施的 80% 補償要求表示擔憂，有關此問題的最終規則已於 1 月 26 日發送給管理和預算辦公室供其審查和批准。根據這個時間安排，我們認為該規則預計將在今年 4 月最終確定。最終規則的內容目前尚不清楚，並且可能會大不相同。擬議的規則雖然我們不確定該規則是否包含 8% 的要求、不同的百分比要求或最終實施，但如果看到四年的實施期延長，我們不會感到驚訝。我們確實相信，個人護理提供者成功的關鍵是直接工資的最低要求。在他們提供護理的每個州都有規模。這不僅使這些提供者能夠將成本分攤到更大的收入基礎上，而且還將為他們州內有意義的患者倡導提供更多機會。

As for Altace, we are currently in the process of looking at personal care opportunities, which would give us a larger presence in a number of our current states. We are also looking for opportunities where we can enter new states in a material way, personal cares and valuable service that is being provided to our elderly and disabled population. And we are optimistic that states will evolve their programs to be viable regardless of how this rule is finalized.

至於 Altace，我們目前正在尋找個人護理機會，這將使我們在當前的許多州擁有更大的影響力。我們也在尋找機會，以物質方式進入新的狀態，為我們的老年人和殘疾人提供個人護理和有價值的服務。我們樂觀地認為，無論該規則如何最終確定，各州都會發展其可行的計劃。

During the fourth quarter, we continued to experience solid results related to our ability to hire caregivers, especially in our Personal Care segments.

在第四季度，我們在僱用護理人員的能力方面繼續取得了紮實的成果，特別是在我們的個人護理領域。

During the fourth quarter of 2023, our personal care hiring was up 3.9% over the fourth quarter of last year at 80 hires per business day fee. Sequentially, our hires per day was slightly lower than the third quarter of this year, which was not unexpected due to the normal slowdown during the holiday season. In addition to our strong hiring numbers, we saw a 30 basis point improvement in our starts per business day as compared to the fourth quarter of 2022, as we have mentioned on previous calls, making sure that hires actually start caring for consumers has been a key contributor in the past few quarters to our growth in Personal Care has for our clinical segments. Hiring has continued to improve of what we experienced in previous quarter. As we have over the past couple of years, we continue to utilize the funding we receive from the American Rescue Plan Act or are to date, we have received approximately 28 million, of which we have $6 million remaining to utilize these funds have been helpful with our caregiver recruitment and retention efforts to support delivery of personal care services and should continue to help those efforts in the future as we deploy the remaining funds. In addition to utilizing the corporate funds for direct recruitment and retention of caregivers, we continued to utilize the funds to provide our caregivers, Eric, to improve our care neighbor's experience from the implementation of enhanced caregiver training and the continued development of a caregiver application that we believe will improve our retention and overall service delivery in our Personal Care segment, our services have continued to receive reimbursements support from the states in which we operate. We believe that states continue to see the value of personal care services we provide, especially with all the broader market disruption that has occurred across the country over the past three years in health care services, although some of the federal financial support to states have been reduced. We feel confident that personal care services continue to show true value to the state's various state Medicaid programs as well as our managed care partners. And we expect this work for our services to continue.

2023 年第四季度，我們的個人護理招聘比去年第四季度增長了 3.9%，每個工作日招聘 80 名員工。因此，我們的每日招聘人數略低於今年第三季度，由於假期期間的正常放緩，這並不令人意外。除了強勁的招聘人數之外，正如我們在之前的電話會議中提到的那樣，與2022 年第四季度相比，每個工作日的開工率提高了30 個基點，確保員工真正開始關心消費者一直是我們的首要任務過去幾季我們個人護理業務成長的主要貢獻者是我們的臨床細分市場。與上一季相比，招募情況持續改善。正如我們在過去幾年中所做的那樣，我們繼續利用從《美國救援計劃法案》獲得的資金，或者說迄今為止，我們已經收到了大約2800 萬美元，其中我們還剩下600 萬美元，這些資金的使用很有幫助我們的護理人員招募和保留工作旨在支持提供個人護理服務，並且在我們部署剩餘資金時應繼續幫助這些工作。除了利用公司資金直接招募和留住護理人員外，我們還繼續利用這些資金為我們的護理人員 Eric 提供服務，透過實施強化護理人員培訓和持續開發護理人員應用程式來改善我們的護理鄰居的體驗。我們相信，這將改善我們在個人護理領域的保留率和整體服務交付，我們的服務繼續獲得我們經營所在州的報銷支持。我們相信，各州繼續看到我們提供的個人護理服務的價值，特別是在過去三年來全國各地醫療保健服務領域發生了更廣泛的市場混亂的情況下，儘管對各州的一些聯邦財政支持已經被取消。減少。我們相信，個人護理服務將繼續為該州的各種州醫療補助計劃以及我們的管理式護理合作夥伴展現真正的價值。我們希望我們的服務能夠繼續進行這項工作。

As for our clinical segments, effective October first, 2023, Medicare hospice reimbursement was increased by approximately 3.1% on January 1st of this year, home health and Medicare reimbursement was increased by approximately 0.8%. Although this year's home-health rate increase was below what is required to recover ongoing operating increases, we believe that traditional Medicare home health reimbursement pressures are likely to moderate over the next few years. And we will continue to look for home health acquisition opportunities that are strategic to our overall growth.

至於我們的臨床部分，自 2023 年 10 月 1 日起，醫療保險臨終關懷報銷自今年 1 月 1 日起增加了約 3.1%，家庭健康和醫療保險報銷增加了約 0.8%。儘管今年的家庭健康費率增幅低於恢復持續營運成長所需的水平，但我們認為傳統醫療保險家庭健康報銷壓力在未來幾年可能會有所緩解。我們將繼續尋找對我們整體成長具有戰略意義的家庭健康收購機會。

Now let me discuss our same-store revenue growth for the fourth quarter of 2023. For our Personal Care segment, our same-store revenue growth was 11.2% when compared to the fourth quarter of 2022.

現在讓我討論一下 2023 年第四季我們的同店營收成長情況。對於我們的個人護理部門，與 2022 年第四季相比，我們的同店收入成長了 11.2%。

During the fourth quarter of 23, we saw Personal Care same-store hours per business day, grow 2.7% over the same period in 2022 and also increased on a sequential basis. Importantly, our Sandy bag, importantly, over 75% of our personal care space showed hourly volume growth over the same period in 2022. We are excited to see our investments in hiring and scheduling optimization initiatives, taking hold and contributing to our strong sequential Tower's growth over the past several QUARTERS.

23 年第四季度，我們看到個人護理每個工作日的同店營業時間較 2022 年同期增長 2.7%，環比也有所增長。重要的是，我們的 Sandy bag，重要的是，我們超過 75% 的個人護理空間在 2022 年同期顯示出每小時的銷售成長。我們很高興看到我們在招聘和調度優化計劃方面的投資，在過去幾季中為我們的塔樓連續強勁增長做出了貢獻。

Turning to our clinical operations, our hospice same-store revenue increased 3.5% when compared to the fourth quarter in 2022, while our same-store ADC was down 1% when compared to the same quarter last year. We did see a sequential quarterly increase in same-store admissions, 2.7, up 2.7% as of the end of the fourth quarter of 2023. Our hospice median length of stay was 28 days, exclusive of our journey care and our recently acquired Tennessee quality care operation. For comparison purposes, we have historically excluded our journey care operation as it has a higher proportion of shorter length of stay patients due to our inpatient units in the Chicago area. While median length of stay was lower than the third quarter, we were not surprised due to the expected seasonality from the holiday season. We are, however, encouraged by the steady sequential improvement in admissions volume in our hospice segment and anticipate those favorable trends continuing and it's 2024.

就我們的臨床業務而言，我們的臨終關懷同店營收與 2022 年第四季相比成長了 3.5%，而我們的同店 ADC 與去年同期相比下降了 1%。我們確實看到同店入場人數環比增長 2.7，截至 2023 年第四季末成長了 2.7%。我們的臨終關懷中心住院時間中位數為 28 天，不包括我們的旅程護理和我們最近收購的田納西州優質護理業務。出於比較目的，我們歷來排除了我們的旅程護理業務，因為我們的住院病房位於芝加哥地區，因此較短住院時間的患者比例較高。雖然中位數停留時間低於第三季度，但由於假期季節的預期季節性，我們並不感到驚訝。然而，我們對臨終關懷領域的入院量穩步連續改善感到鼓舞，並預計這些有利的趨勢將持續到 2024 年。

Our home health segment same-store revenue decreased 17.8% 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 has most home health providers have experience. We continue to be affected by the movement of Medicare beneficiaries from Medicare fee-for-service to Medicare Advantage. We are continuing to work with our Medicare Advantage payers to obtain higher per-visit rates as they work in parallel to transition to episodic or case rates. But this process takes time. In the meantime, we have limited certain admissions due to the lower contract rates. Even with this payer shift and the reimbursement pressures in home health, 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 service by allowing us to provide the full continuum of home-based care.

我們的家庭健康部門同店收入比2022 年同一季度下降了17.8%，因為我們繼續減少付款人的入院人數，而這些付款人目前沒有向我們報銷足夠的費率來支付我們的費用，這是大多數家庭健康提供者都有的經驗。我們繼續受到 Medicare 受益人從 Medicare 按服務收費轉向 Medicare Advantage 的影響。我們將繼續與我們的 Medicare Advantage 付款人合作，以獲得更高的每次就診費率，因為他們同時過渡到偶發費率或病例費率。但這個過程需要時間。同時，由於合約價格較低，我們限制了某些入場人數。即使面臨付款人的轉變以及家庭健康方面的報銷壓力，我們仍然對我們的家庭健康業務感到興奮，因為它補充了我們的個人護理服務，特別是在我們參與基於價值的合約模式和臨終關懷服務的情況下，允許我們提供全面連續的家庭護理。

As for our development efforts, we continue to focus on opportunities that help to further our strategy, especially as it relates to value-based care, obtaining much needed scale in our current Personal Care state, we are continuing to see small tuck-in acquisition opportunities, which offer us the ability to add to our service coverage in our current markets and with the expected time line for the publishing of the Medicaid access rule approaching, we are hopeful that we will start to see more personal care acquisition opportunities develop, which should help us to continue adding scale in our current markets.

至於我們的發展努力，我們繼續專注於有助於推進我們策略的機會，特別是當它與基於價值的護理相關時，在我們當前的個人護理狀態下獲得急需的規模，我們繼續看到小額收購機會，這使我們能夠擴大我們在當前市場的服務覆蓋範圍，並且隨著醫療補助准入規則發布的預期時間線的臨近，我們希望我們將開始看到更多的個人護理收購機會的發展，這應該有助於我們繼續擴大目前市場的規模。

As I mentioned earlier, we believe that the large providers of personal care services in St. We'll have a significant advantage to continue operating effectively at scale and expanding market share.

正如我之前提到的，我們相信聖威的大型個人護理服務提供者將擁有顯著的優勢，可以繼續大規模有效運作並擴大市場份額。

Our value-based care efforts.

我們基於價值的護理工作。

I noted last quarter, we had gathered data over time to be able to demonstrate material reductions in both emergency room visits as well as the percentage of patients readmitted to the hospital at various post-discharge intervals. In addition, as I noted, we have been able to help with the improvement of PD scores and the closure of care gaps relating to these patients. We continue to believe our success is due to our ability to provide both nonclinical personal care services to identify changes in condition and clinical resources as needed for specific skilled patient care interventions. We are now using this information as part of our conversations with various Medicare Advantage and commercial payers to demonstrate how Attis can be a part of providing quality, cost-effective care to their members that can reduce the overall medical loss ratio while simultaneously improving overall quality of care.

我在上個季度指出，隨著時間的推移，我們收集了數據，以便能夠證明急診室就診次數以及出院後不同時間間隔內重新入院的患者百分比明顯減少。此外，正如我所指出的，我們已經能夠幫助改善 PD 評分並縮小與這些患者相關的護理差距。我們仍然相信，我們的成功歸功於我們提供非臨床個人護理服務以識別病情變化的能力，以及根據特定熟練患者護理幹預措施所需的臨床資源的能力。我們現在使用這些資訊作為與各種 Medicare Advantage 和商業付款人對話的一部分，以展示 Attis 如何為其會員提供優質、具有成本效益的護理，從而降低整體醫療損失率，同時提高整體品質的照顧。

During the first quarter of 2024, we also began to use our new value-based care management system. We are excited about this technology as it will allow us to increase both the scale and efficiency of our value-based programs, which we believe is important as we continue to further develop these type relationships with our large payers.

2024 年第一季度，我們也開始使用新的基於價值的護理管理系統。我們對這項技術感到興奮，因為它將使我們能夠提高基於價值的計劃的規模和效率，我們認為這對於我們繼續進一步發展與大型付款人的此類關係非常重要。

Before I close my remarks, I want to once again say how proud I am 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 at home, which remains one of the safest and most cost-effective places to receive 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 both our dedicated caregivers and other employees who worked so incredibly hard, providing outstanding care and support to our clients, patients and their families.

在我結束演講之前，我想再次表示我對我們團隊的護理感到多麼自豪。他們正在為我們的老年和殘疾消費者和患者提供服務。毫無疑問，大多數客戶和患者希望在家中接受護理，這仍然是最安全、最具成本效益的接受護理的地方之一。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。我們理解並認識到，我們的營運和成長依賴於我們敬業的護理人員和其他辛勤工作的員工，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. At a set of very strong financial and operating performance for the fourth quarter, marking a strong finish to a record year. Our results were driven by robust demand for our services, led by 11.2% year over year organic growth in personal care services revenue well above our normal expected range of 3% to 5% for the year. Personal Care revenues were up 12.1% compared with the prior year, a record annual rate of growth for Altace. This impressive growth reflects both higher volumes as well as the benefit of ongoing rate support for our personal care services. Our fourth quarter results included a full three months of operations of Tennessee quality care, a provider of home health, hospice and private duty nursing services, which we acquired on August first 2023. The integration process has gone as expected, and we are excited about the opportunities to serve more patients in this strategically important market acquisitions remain an important part of our growth strategy, especially situations with a profile similar to tenancy quality care, where we have the ability to leverage our strong personal care presence and add clinical services. We are optimistic that we will see additional attractive acquisition opportunities in 2024 as we gain more clarity on pending reimbursement issues and other regulatory changes that could affect Altace in our industry we were pleased to see positive year-over-year trends in our hospice business during the fourth quarter with increases in revenue, average daily census length of stay patient days and revenue per patient day, inclusive of our Tennessee quality care acquisition. While we did see sequential growth in same-store admissions of 2.7% between the third quarter and fourth quarter, our ADC declined slightly between the quarters on a higher number of discharges. Same-store revenue for our home health services, which was 6.2% of our business, was down 17.8% from the same period a year ago. This volume trend reflects our strategy to intentionally limit admissions from payers with less favorable reimbursement rates. As we have seen a 500 basis point shift in our same-store episodic non episodic mix from the prior year. We continue to look for ways to more effectively balance our mix of episodic cases versus non episodic cases and are focused on opportunities to negotiate more favorable rates with certain payers. As Dirk noted, total net service revenues for the fourth quarter were $276.4 million. The revenue breakdown is as follows. Personal Care revenues were 204.5 million or 74% of revenue. Hospice care revenues were 54.7 million or 19.8% of revenue. Home Health revenues were $17.1 million or 6.2% of revenue. In addition to Tennessee quality care, these results include the operations of Apple home health, which we acquired in October of 2022 and is included in our same-store numbers for the first time.

謝謝你，德克，大家早安。第四季度的財務和營運業績非常強勁，標誌著創紀錄的一年的強勁收官。我們的業績得益於對服務的強勁需求，個人護理服務收入年增 11.2%，遠高於我們今年 3% 至 5% 的正常預期範圍。個人護理收入較上年增長 12.1%，創 Altace 創紀錄的年增長率。這一令人印象深刻的成長既反映了銷售量的增加，也反映了我們個人護理服務持續費率支援的好處。我們第四季度的業績包括田納西優質護理公司整整三個月的運營，該公司是一家家庭健康、臨終關懷和私人護理服務提供商，我們於 2023 年 8 月 1 日收購了該公司。整合過程按預期進行，我們很高興有機會在這項具有重要策略意義的市場收購中為更多患者提供服務，這仍然是我們成長策略的重要組成部分，特別是與租賃品質護理類似的情況，我們有能力利用我們強大的個人護理業務並增加臨床服務。我們樂觀地認為，隨著我們對懸而未決的報銷問題和可能影響我們行業Altace 的其他監管變化更加清晰，我們將在2024 年看到更多有吸引力的收購機會。我們很高興看到我們的臨終關懷業務較去年同期呈現正面的趨勢。第四季收入、平均每日人口普查住院病人天數和每個病人日的收入有所增加，包括我們在田納西州的優質照護收購。雖然我們確實看到第三季和第四季同店入場人數較上季增加了 2.7%，但由於出院數量增加，我們的 ADC 在兩季之間略有下降。家庭健康服務的同店收入占我們業務的 6.2%，較去年同期下降 17.8%。這一數量趨勢反映了我們有意限制報銷率不太優惠的付款人的入院策略。正如我們所看到的，我們的同店情境非情境組合較前一年發生了 500 個基點的變化。我們繼續尋找方法來更有效地平衡偶發性案件與非偶發性案件的組合，並專注於與某些付款人談判更優惠費率的機會。正如 Dirk 指出的那樣，第四季度的總淨服務收入為 2.764 億美元。收入明細如下。個人護理收入為 2.045 億美元，佔總收入的 74%。臨終關懷收入為 5,470 萬美元，佔收入的 19.8%。家庭健康收入為 1,710 萬美元，佔總收入的 6.2%。除了田納西州的優質照護之外，這些結果還包括我們於 2022 年 10 月收購的 Apple home health 的營運情況，該公司首次包含在我們的同店資料中。

Other financial results for the fourth quarter of 2023 include the following. Our gross margin percentage was 33.4% compared with 31.9% for the fourth quarter of 2022 and a sequential improvement compared to 32% for the third quarter of 2023. As expected, the addition of the Tennessee quality care operations created a higher overall proportion of clinical services and had a resulting positive impact on gross margin. We also benefited from the 3.1% annual hospice rate increase effective October first, 2023 exclusive of the retroactive positive impact from collective bargaining negotiations.

2023 年第四季的其他財務表現包括以下內容。我們的毛利率為 33.4%，而 2022 年第四季為 31.9%，與 2023 年第三季的 32% 相比，季比有所改善。正如預期的那樣，田納西州優質護理業務的增加創造了更高的臨床服務總體比例，並對毛利率產生了積極影響。我們也受惠於 2023 年 10 月 1 日起生效的年度臨終關懷率成長 3.1%，不包括集體談判談判的追溯性正面影響。

Our gross margin percentage was 33% for the fourth quarter of 2023, an increase of 100 basis points sequentially and slightly above expectations as we continue to experience strong cash flows, particularly in our Personal Care segment, we have benefited from a lower implicit price concession requirement and saw this impact us positively in the fourth quarter, which contributed to our higher gross margin. For the first quarter of 2024, we expect our gross margin percentage to be negatively impacted by our annual merit increases and the normal annual reset of payroll taxes as well as the expected compression we previously discussed from certain collective bargaining negotiations. Cumulatively, we expect these items to contribute a decline sequentially of approximately 140 basis points compared to the fourth quarter of 2023. Additionally, we anticipate our implicit price concessions to return to a more normal level in the first quarter, resulting in an additional 30 basis points of compression from the fourth quarter of 2023.

2023 年第四季我們的毛利率為 33%，季增 100 個基點，略高於預期，因為我們繼續經歷強勁的現金流，特別是在個人護理領域，我們受益於較低的隱性價格優惠要求，並在第四季度對我們產生了積極影響，從而提高了我們的毛利率。對於 2024 年第一季度，我們預計我們的毛利率百分比將受到年度績效成長、工資稅正常年度重置以及我們先前在某些集體談判談判中討論的預期壓縮的負面影響。與 2023 年第四季相比，我們預計這些專案累積將導致環比下降約 140 個基點。此外，我們預計我們的隱性價格優惠將在第一季恢復到更正常的水平，從而導致比 2023 年第四季額外壓縮 30 個基點。

G&a expense was 22% of revenue, consistent with 22% of revenue for the fourth quarter a year ago, but declined sequentially from 22.3% in the third quarter of 2023. Adjusted G&A expense for the fourth quarter of 2023 was 21%, up slightly from 20.4% in the same period of the prior year. The Company's adjusted EBITDA increased to 34.3 million compared with $28.2 million a year ago, an increase of 21.6%. Adjusted EBITDA margin was 12.4% compared with 11.4% for the fourth quarter of 2022 and an increase sequentially from 11.4% in the third quarter of 2023, primarily as a result of the expansion in our gross margin percentage. Adjusted net income per diluted share was $1.32 compared with $1.11 for the fourth quarter of 2022. The adjusted per-share results for the fourth quarter of 2023 exclude the following the retroactive impact of collective bargaining collective bargaining negotiations of $0.07 acquisition expenses of $0.07 and non-cash stock-based compensation expense of $0.12. Adjusted per share results for the fourth quarter of 2020 to exclude the following acquisition expenses of $0.06 restructure and other nonrecurring costs of $0.01 and non-cash stock-based compensation expense of $0.13. Our effective tax rate for the fourth quarter of 2023 was 22.8%, in line with our expectations for calendar 2024. We currently expect our tax rate to be in the mid 20% range. Dsos were 39.1 days at the end of the fourth quarter of 2023 compared with 41.5 days at the end of the third quarter of 2023 as we have continued to experience consistent cash collections from the majority of our payers. Our DSOs for the Illinois Department of Ag for the fourth quarter were 49.5 days compared with 41.8 days at the end of the third quarter of 2023. Our cash flows were very strong throughout 2023 with our fourth quarter net cash provided by operations at $30 million for the year, net cash provided by operations was $119.8 million, exclusive of 7.6 million in urban net spending. As of the end of the fourth quarter, we still have approximately $6 million in our funds outstanding to be utilized as of December 31st, 2023, the company had cash of 64.8 million with capacity and availability under our revolver of $470,000,335.6 million, respectively. With our strong cash flow, we have continued to pay down debt in 2023 and reduced our revolver balance by an additional $40 million in the fourth quarter net of borrowings to fund our acquisitions during the year, we still lowered our revolver balance by $8.5 million from the end of 2022, we continue to have the financial flexibility to invest in our business and pursue our strategic growth initiatives, including acquisitions. As we mentioned, we will continue to selectively pursue strategic acquisitions in 2024, dependent on market conditions. At the same time, we will also continue to diligently manage our net leverage ratio, which is currently well under one times. Net of cash on hand with another record year in 2023. We look forward to our future opportunities and ability to increase shareholder value.

一般及行政費用佔營收的 22%，與去年第四季佔營收的 22% 一致，但較 2023 年第三季的 22.3% 有所下降。2023 年第四季調整後一般管理費用為 21%，略高於去年同期的 20.4%。公司調整後的 EBITDA 增至 3,430 萬美元，較上年同期的 2,820 萬美元成長 21.6%。調整後 EBITDA 利潤率為 12.4%，而 2022 年第四季為 11.4%，比 2023 年第三季的 11.4% 有所增加，這主要是由於我們毛利率百分比的擴大。調整後攤薄每股淨利為 1.32 美元，而 2022 年第四季為 1.11 美元。2023 年第四季調整後每股業績不包括集體談判 0.07 美元的集體談判的追溯影響，收購費用為 0.07 美元，非現金股票補償費用為 0.12 美元。調整後的 2020 年第四季每股業績不包括以下 0.06 美元的重組收購費用和 0.01 美元的其他非經常性費用以及 0.13 美元的非現金股票補償費用。我們 2023 年第四季的有效稅率為 22.8%，與我們對 2024 年的預期一致。我們目前預計稅率在 20% 左右。2023 年第四季末的 Dsos 為 39.1 天，而 2023 年第三季末為 41.5 天，因為我們繼續從大多數付款人處獲得一致的現金收款。我們第四季伊利諾州農業部的 DSO 為 49.5 天，而 2023 年第三季末為 41.8 天。2023 年，我們的現金流非常強勁，第四季度營運提供的淨現金為 3,000 萬美元，營運提供的淨現金為 1.198 億美元，不包括 760 萬美元的城市淨支出。截至第四季末，截至2023 年12 月31 日，我們仍有約600 萬美元的未償還資金可供使用，公司擁有現金6,480 萬美元，我們的循環資金容量和可用資金分別為470,000,335.6 百萬美元。憑藉強勁的現金流，我們在2023 年繼續償還債務，並在第四季度將我們的循環餘額額外減少了4000 萬美元（扣除當年為收購提供資金的借款），我們仍將循環餘額從2023 年減少了850 萬美元。到 2022 年底，我們將繼續擁有財務靈活性來投資我們的業務並實施包括收購在內的策略成長計畫。正如我們所提到的，我們將根據市場狀況，在 2024 年繼續選擇性地進行策略性收購。同時，我們也將繼續努力管理淨槓桿率，目前淨槓桿率遠低於一倍。扣除手頭現金後，2023 年將再創歷史新高。我們期待未來的機會和能力來增加股東價值。

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

我們今天早上準備的評論到此結束，感謝您與我們在一起。我現在請接線生接通您的問題電話。

Ladies and gentlemen, at this time, we'll begin the question-and-answer session. (Operator Instructions)

女士們、先生們，現在我們開始問答環節。（操作員說明）

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

Thank you. Good morning and thanks for taking the questions. So it gets up first maybe on the on the quarter results. And I guess as it relates to our 24, which you don't give specific outlook, but just to get a sense of Q4, margins were above 12%. We clearly outperformed here and up 100 basis points year over year. So I guess you outlined a couple of different things, I guess on the bad debt benefit, seems like you don't assume it's going to persist. But I guess outside of that, how much of this margin improvement is sustainable? And when we think about 24, as a fully honest, when you talk about Q1 being a weaker quarter, especially sequentially, as we think about the full year is 11.4 I guess that you reported in '23 years as your adjusted EBITDA margin. Is that a good starting point for for the full year '24? How should we think about the full year. Thank you.

謝謝。早上好，感謝您提出問題。因此，它可能首先出現在季度業績上。我猜想，因為它與我們的 24 季度相關，您沒有給出具體的前景，但只是為了了解第四季度的情況，利潤率高於 12%。我們的表現明顯優於大盤，較去年同期上漲 100 個基點。所以我想你概述了一些不同的事情，我想關於壞帳福利，似乎你不認為它會持續下去。但我想除此之外，利潤率的改善有多少是可持續的？當我們考慮24 時，作為一個完全誠實的人，當您談論第一季度是一個較弱的季度時，尤其是連續的，因為我們認為全年是11.4，我猜您在23 年中報告了調整後的EBITDA 利潤率。這是 24 年全年的良好起點嗎？我們應該如何思考全年。謝謝。

Could you add, I think, obviously give a little bit of color on expectations sequentially from Q4 to Q1. You're right on just typical seasonality with payroll taxes and merits. We typically see our lowest margin in Q1. We typically see that kind of ease through the year. I think we would expect to see that again in 2024. But I think with not not expecting, I guess for the same cadence of rate increases on the personal care side in 24 that we've seen, but we expect margins to be fairly consistent. But I think part of the wildcard there is how successful we are at acquisitions with that mix of the clinical business continues to creep up. That's obviously going to be beneficial overall to margins. But otherwise, we would expect this to be a fairly standard year in 20 or.

我認為，您能否補充一下，顯然對從第四季度到第一季的預期進行了一些說明。您對典型的季節性工資稅和優點是正確的。我們通常會在第一季看到最低的利潤率。我們通常會在這一年中看到這種輕鬆的情況。我認為我們預計 2024 年會再次看到這種情況。但我認為，並非沒有預期，我想個人護理的利率上漲節奏與我們所看到的 24 年相同，但我們預計利潤率將相當一致。但我認為，部分不確定因素是，隨著臨床業務的不斷成長，我們在收購方面取得了多大的成功。這顯然總體上有利於利潤率。但除此之外，我們預計今年將是 20 世紀相當標準的一年。

Thank you. And I guess follow-up to that, when it comes to the rate increases in personal care on the pivot to talk about the rate increase you're expecting in January 1, any other states with rate increases? And I guess on what average rate increase, excluding Illinois, do you do expect, you know, for the year and going forward?

謝謝。我想接下來，當談到個人護理費率上漲時，請談談您預計 1 月 1 日加息的情況，還有其他州加息嗎？我猜想，除了伊利諾伊州，您預計今年和未來的平均利率會上漲多少？

Yes, I think currently right now, we don't see any other material rate increases from states that are currently scheduled. I think as we move through the year, obviously, that's always and subject to change. We did recently receive notice. We're going to get another rate increase in our VA program, which is the federally funded program that will impact us in a few of our markets, but nothing else really probably sits a note.

是的，我認為目前，我們沒有看到當前計劃的各州有任何其他材料費率上漲。我認為，隨著時間的推移，顯然，這種情況總是會改變。我們最近確實收到了通知。我們的 VA 計劃將再次加息，這是一項聯邦政府資助的計劃，將對我們的一些市場產生影響，但其他任何事情都可能沒有什麼意義。

I think one of the things that we have said for a number of years is we wanted to get back. So where when you look at our Personal Care, our growth rate, you add about half to two thirds in volume and the rest in price increases. And while during the pandemic, we saw that shift and mainly get price increases as far as our growth, we have seen that start to revert back to normal. So for 2024, we expect that to be the case about a third of our growth will be through rate increases, 50% to two-thirds of our growth should be through volume increase.

我認為我們多年來所說的一件事就是我們想回來。因此，當你觀察我們的個人護理產品的成長率時，你會發現銷售量增加了大約一半到三分之二，其餘的則增加了價格。雖然在大流行期間，我們看到了這種轉變，隨著我們的成長，價格主要上漲，但我們已經看到這種情況開始恢復正常。因此，到 2024 年，我們預計大約三分之一的成長將透過利率上調實現，50% 至三分之二的成長應透過銷售成長實現。

And I guess to that end since you mentioned it that, so is it fair to assume in your kind of 3% to 5% organic growth for personal credit you have been talking about in the past. Is that a fair assumption for '24?

我想，既然你提到了這一點，那麼假設你過去一直在談論的個人信用有機增長 3% 到 5% 是否公平。對於 24 世紀來說，這是一個合理的假設嗎？

Yea. Obviously, get another rate increase in Illinois. We talked about some of the margin profile that previously but now expect a lot of pass through. But it is I saw a nice rate increase, one of our largest markets. But I think our expectation this year 2023, we were obviously over double digits. All you're not expecting to see that same rate in 24, but would expect to be toward the top end of that three to five, if not slightly above for '24.

是的。顯然，伊利諾伊州再次升息。我們討論了一些以前但現在預計會大量傳遞的保證金概況。但我看到了我們最大的市場之一的良好利率增長。但我認為我們對 2023 年的預期顯然超過了兩位數。您預計不會在 24 年看到相同的比率，但預計會接近這三到五個的頂端，如果不是略高於 24 年的話。

And if I may just squeeze a very last one on the cash flow following up very strongly in Q4 and the year. So I guess if you adjust for the for the RP funds saw utilization, so it's almost like a hundred percent EBITDA conversion into the full year. So how should we think about this cash flow conversion going forward? Is that sustainable or how should we think about operating cash flow for '24 and going forward? Thank you.

如果我可以在第四季度和今年非常強勁地跟進現金流上最後一個。因此，我想如果您根據 RP 資金的利用率進行調整，幾乎就像全年 EBITDA 轉換為 100%。那我們該如何看待未來的現金流轉換呢？這是可持續的嗎？或者我們應該如何考慮 24 世紀及未來的營運現金流？謝謝。

It's not going to be at that 100% rate. We got some very positive working capital tailwind. I think on our cash flow in 23, we wouldn't expect that obviously, that's not sustainable long term, but I think we've talked about our cash flow conversion in the past. Have been you have 75% to 80% of kind of adjusted EBITDA, which I think is pretty consistent expectation for '24.

不會達到 100% 的比率。我們得到了一些非常積極的營運資金推動。我認為就我們 23 年的現金流而言，我們顯然不會期望，這從長遠來看是不可持續的，但我認為我們過去已經討論過我們的現金流轉換。調整後的 EBITDA 達到 75% 到 80%，我認為這與 24 年的預期相當一致。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Thanks. Good morning. Appreciate, Dirk, all the comments you gave us. Just on the final rule and I thought that your tone maybe sounds a little more positive as we're getting closer to the final rule here in terms of and maybe some potential flexibilities that will be included in the final rule on and then just tone around deploying continuing to deploy capital into the personal care market sort of as we move past this final rule first, I wanted to get a sense of whether that, that's accurate. And then I thought it might be helpful if you just wanted to talk about.

謝謝。早安.感謝德克，您給我們的所有評論。就最終規則而言，我認為您的語氣可能聽起來更積極一些，因為我們越來越接近最終規則，也許一些潛在的靈活性將包含在最終規則中，然後只是調整語氣當我們首先超越這個最終規則時，我想了解這是否準確。然後我想如果你只是想談談的話可能會有所幫助。

Well, when you see the final rule, maybe what would be some of the key changes specifically that you'll be looking for that you would view as sort of a milestones that would keep you confident and deploying capital for the long term in the personal care market.

好吧，當你看到最終規則時，也許你會特別尋找一些關鍵的變化，你會認為這些變化是一種里程碑，可以讓你保持信心，並在個人領域長期部署資本。護理市場。

Yes, Scott, thanks. We are more positive about the Medicaid access rule. We think there's been a number of comments I'm from various stakeholders, including a number of the states, a number of which we mentioned to you before were democratic states that are close to the Biden administration. I think the thing that we all understand about the Biden administration is they're very supportive of the personal care industry, and they want to make sure that our elderly and disabled population have greater access to care and not less care and so as we continue to work through the comments of the rule and look at our own situation of how we would operate it, that if the rule at various aspects are put in, we become very, very bullish on the fact that this industry is going to continue to grow. It is going to be one that we believe will be supported by the states, we believe state programs will look at any final rule.

是的，斯科特，謝謝。我們對醫療補助准入規則更加積極。我們認為我收到了來自不同利益相關者的一些評論，包括一些州，其中我們之前向大家提到過一些是與拜登政府關係密切的民主州。我認為我們對拜登政府的了解是，他們非常支持個人護理行業，他們希望確保我們的老年人和殘疾人士獲得更多的護理機會，而不是更少的護理，因此，隨著我們繼續仔細研究一下規則的評論，看看我們自己的情況，我們將如何操作它，如果各個方面的規則都出台了，我們會變得非常非常看好這個行業將繼續增長。我們相信這將得到各州的支持，我們相信各州的計劃將考慮任何最終規則。

And again, realizing that just because of final rules published, I mean that will never get in there will be legal challenges and other things that will go through. But as we prepare going forward, we're doing things such as creating more efficient ways of scheduling. We're putting dollars into our ability to take some of the cost out of scheduling and to be more effective in our cost bases. So that whatever structure that comes through, Atos will be one of the survivors of the industry and will grow as we did as you kind of saw through the situation in Illinois when when that percent was put in and larger providers were able to operate very effectively and gain market share through the period.

再次，我意識到，僅僅因為最終規則的發布，我的意思是，永遠不會出現法律挑戰和其他將要經歷的事情。但當我們準備繼續前進時，我們正在做一些事情，例如創建更有效的調度方式。我們正在投入大量資金來提高我們的能力，以減少日程安排中的部分成本，並提高我們的成本基礎的效率。因此，無論採用何種結構，Atos 都將成為該行業的倖存者之一，並將像我們一樣成長，就像您看到伊利諾伊州的情況一樣，當這個百分比被投入時，更大的供應商能夠非常有效地運作並在此期間獲得市場份額。

So for us, we're doing things alone, investments into scheduling investments into recruitment and retain each our value-based investments. And then also we're really focused now on the both the backfill acquisition opportunities we're seeing, as well as some of the larger opportunities we expect to see, which could take us into new markets for Altace, but in such a manner that would start in a material way because we believe a large providers. As I stated in our script, we believe the large providers are going to have a tremendous benefit in the personal care side as this rule is rule, is that ever put into place.

因此，對我們來說，我們正在單獨做事，投資安排投資招聘並保留我們每項基於價值的投資。然後，我們現在真正關注的是我們看到的回填收購機會，以及我們期望看到的一些更大的機會，這可能會帶我們進入 Altace 的新市場，但以這樣的方式將以物質方式開始，因為我們相信大型供應商。正如我在腳本中所說，我們相信大型提供者將在個人護理方面獲得巨大的利益，因為這條規則就是規則，無論是否實施。

Okay, got it. And just as my follow-up, just on the business. Just would be curious if you wanted to maybe drill a little bit into how you're thinking about hospice segment margins for 2024 on you obviously had the rate increase effective in for one arm. So maybe how you're thinking about sort of that rate again, start maybe how you're thinking about cost per visit for hospice and how and then with some of the volume trends, how you think that could translate into a into margins for US hospital? Do you think this could be a year for margin expansion in hospice, are you targeting trying to hold margins relatively constant?

好，知道了。正如我的後續行動，只是關於業務。如果您想深入了解您對 2024 年臨終關懷部門利潤率的看法，我會很好奇，因為顯然您的一隻手臂的費率增加是有效的。因此，也許您如何再次考慮該費率，首先您可能如何考慮臨終關懷的每次就診成本，以及如何考慮一些數量趨勢，您認為這可能會轉化為美國的利潤率醫院？您認為今年可能是臨終關懷產業利潤率擴張的一年嗎？您的目標是保持利潤率相對穩定嗎？

Yes, Scott, I can take the first part on the margins, and I'll let Brad talk a little bit about just some of the volume expectations, but I think it obviously was a 3.1% increase. Our typical merit is probably around that 3% range. Obviously, wages are 100% of our cost basis. So yes, there's probably a little bit of pull through there, but I think our expectation overall is not really see no material margin expansion in hospice. But to maintain maybe a little bit like a sort of a bolt ArelNet. Brad talk a little bit about kind of volume expectations for this year.

是的，斯科特，我可以在邊緣部分討論第一部分，我會讓布拉德談談一些銷量預期，但我認為這顯然是 3.1% 的增長。我們的典型優點可能在 3% 左右。顯然，工資是我們成本基礎的 100%。所以，是的，可能會有一點拉動，但我認為我們的整體預期並不是真正看到臨終關懷領域沒有實質的利潤擴張。但維護 ArelNet 可能有點像螺栓。布拉德（Brad）談到了今年的銷量預期。

Yes, Scott, on the volume side, we if you look at our year-over-year results, we were essentially kind of flattish on the volume side. Having said a lot of that was due to some we had pretty heavy discharges in Q4. We expect, you know, with the strong admission volumes that we've seen over the past couple of quarters that will start translating into some ADC growth. I think we're kind of looking in that 5% to 7% revenue growth for the hospice segment.

是的，斯科特，在銷量方面，如果你看看我們的同比業績，我們在銷量方面基本上持平。話雖如此，其中許多原因是我們在第四季的排放量相當大。您知道，我們預計，隨著過去幾季我們看到的強勁入場量，這將開始轉化為 ADC 的成長。我認為我們希望臨終關懷領域的收入能成長 5% 到 7%。

Okay, got it. So sounds -- at the top end of that, Brad, pretty evenly split between rate and rate and volumes for a with a 3% rate increase?

好，知道了。那麼聽起來 - 在最高端，布拉德，在利率和利率和數量之間相當平均地分配了 3% 的利率增長？

Yes, roughly.

是的，大約。

Okay. Thank you.

好的。謝謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Hey, good morning, guys, and congrats on the quarter of drip. Many as I think about your M&A philosophy, I understand obviously staying on the sidelines right now given the regulatory uncertainty but how are you thinking about if the rule comes out and the 80% rule goes through, is that the opportunity point given maybe distress or concerns among other players in the space or does that preclude you from getting more aggressive? And as you wait for finality on the rule, how do you think about that?

嘿，早安，夥計們，恭喜滴水季度。我對你們的併購理念的許多看法是，鑑於監管的不確定性，我顯然現在處於觀望狀態，但你們如何看待如果規則出台並且80% 規則得到通過，所給出的機會點可能是困境或該領域其他參與者的擔憂或是否會阻止您變得更加激進？當您等待規則最終確定時，您對此有何看法？

Yes, you know, I think once we have a final rule. We're of a size and a financial flexibility enough that we're going to operate, I think, very effectively in whatever rule comes through. So what we'll do we'll wait to see what the final rule is. We'll also have to understand the particular challenges that may occur at those rules. But once it comes out, we've started thinking through how do we grow our business in what particular markets there will be certain states that will be more advantageous for us to look to grow in. There may be some states that will have to wait and see what the various Medicaid programs and those state tried to do are things to do in response to any particular rule. So I think for us just the fact that we have a final rule, even though we know it will be challenged by various states, will allow us to then refine our strategy and continue with what we're doing.

是的，你知道，我想一旦我們制定了最終規則。我認為，我們的規模和財務靈活性足以讓我們能夠按照任何規則非常有效地運作。所以我們會做什麼，我們將拭​​目以待，看看最終的規則是什麼。我們也必須了解這些規則可能出現的特殊挑戰。但一旦它出來，我們就開始思考如何在哪些特定市場發展我們的業務，某些州將更有利於我們尋求發展。可能有些州必須等待，看看各種醫療補助計劃以及這些州試圖做的事情是針對任何特定規則而採取的行動。因此，我認為對我們來說，即使我們知道它會受到各州的挑戰，我們擁有最終規則這一事實將使我們能夠完善我們的策略並繼續我們正在做的事情。

And as I mentioned, we're already starting to do some of the things that we think will make us successful and whatever the rule is and that is investment in technology as it relates to scheduling, trying to take cost out of the base, ex the back office in our scheduling, looking at how we can more appropriately use the caregivers we have and give them more hours, which will help both with retaining them as well as recruitment costs for new folks. So we're pretty excited. Obviously, we would rather us be able to have a little more flexibility depending on the state in which you operate. We hope that's where the final rule goes, but we're prepared to operate in any manner in which it is finalized.

正如我所提到的，我們已經開始做一些我們認為將使我們成功的事情，無論規則是什麼，那就是對與調度相關的技術的投資，試圖從基礎中降低成本，例如我們的日程安排中包括後台辦公室，研究如何更適當地使用我們現有的護理人員並給他們更多的時間，這將有助於留住他們以及新員工的招募成本。所以我們非常興奮。顯然，我們希望能夠根據您所在的州擁有更多的靈活性。我們希望這就是最終規則，但我們準備好以任何最終確定的方式進行運作。

Appreciate it. And my one follow-up, as I think about your comments on value-based care and VM, trying to get to make inroads there, what does Addus need to do whether it's investment in capacity or investments in capabilities or expansion of service lines. I mean, what will you as a company need to do to gain traction? And really get the ball rolling there?

欣賞它。我的一個後續行動是，當我考慮您對基於價值的護理和VM 的評論時，試圖在這方面取得進展，Addus 需要做什麼，無論是對能力的投資，還是對能力的投資或服務線的擴展。我的意思是，作為一家公司，您需要做什麼才能獲得吸引力？並真正讓事情順利進行嗎？

Well, I think if you look at our value-based programs that we've been in several for a few years now, and we have collected a lot of favorable information that we believe will be useful in demonstrating value and to a managed Medicaid that has full risk, but then also potentially Medicare Advantage as well.

好吧，我想如果你看看我們幾年來一直在實施的基於價值的計劃，我們已經收集了很多有利的信息，我們相信這些信息將有助於展示價值和管理醫療補助具有完全風險，但也有潛在的醫療保險優勢。

I think Dirk alluded to it in his comments that we have recently implemented a new case management software that's going to allow us to scale that program. I think significantly It will also allow us to do some analytics that we haven't had access to the Board, I think will help to further improve the outcomes that we've already demonstrated. So I think there's a real opportunity there. You know, what we found is kind of interesting, as you know, is it really starts with personal care in the home and the information that we can collect from our caregivers regarding the clients that we're serving can really influence the outcomes. So we're very positive on where the value-based program is going, and we'll continue to invest in it.

我認為德克在他的評論中提到我們最近實施了一個新的案例管理軟體，這將使我們能夠擴展該計劃。我認為重要的是，它還將使我們能夠進行一些我們無法接觸到董事會的分析，我認為這將有助於進一步改善我們已經展示的結果。所以我認為那裡有一個真正的機會。您知道，我們的發現有點有趣，正如您所知，這實際上是從家庭中的個人護理開始的，而我們可以從護理人員那裡收集到的有關我們所服務的客戶的信息確實可以影響結果。因此，我們對基於價值的計劃的發展方向非常樂觀，我們將繼續對其進行投資。

Awesome. Thank you, guys.

驚人的。感謝你們。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hi, good morning. Just a couple of quick ones from me. I guess maybe, Brian, how do we think about the progression just quarter to quarter seasonality from these union negotiations maybe outside of the first quarter? I detail there and then it looks like billable hours per employee in PCS just continues to kind of steadily move up a little bit sequentially. I understand certain markets have caps on a lot of hours and things, but how do we think that may be progressing over the next one to two years?

早安.只是我的幾個快速的。我想，布萊恩，我們如何看待這些工會談判可能在第一季之外逐季季節性的進展？我在那裡詳細說明了，然後看起來 PCS 中每個員工的計費時間繼續穩定上升。我知道某些市場對很多時間和事情都有上限，但我們認為未來一到兩年這可能會取得怎樣的進展？

I'll take the first part. I'll let Brad talk about the hours for her caregiver, but a lot on the union side, I think really we've talked about the impact that's going to kind of come through with the Illinois rate increase. January first, we made some concessions there of enhanced benefit packages for those employees. So we're not expecting to see much of any real margin kind of pull through in Q1, but there's really no other seasonality once that's kind of in it. And there's no kind of adjustment in Q. two Q. three. So I wouldn't expect to see any other adjustments up or down kind of through the year, it should be whatever we kind of see in Q1, which we've kind of indicated what we think that will look like should be pretty static for the year yes.

我將採取第一部分。我會讓布拉德談論她的照顧者的工作時間，但在工會方面，我想我們確實已經討論了伊利諾伊州升息所帶來的影響。一月一日，我們做了一些讓步，為這些員工提供了增強的福利待遇。因此，我們預計第一季不會出現太多實際利潤率，但一旦發生這種情況，實際上就沒有其他季節性因素了。第二季和第三季沒有任何調整。因此，我預計今年不會出現任何其他向上或向下的調整，這應該是我們在第一季看到的情況，我們已經表明我們認為這應該是相當靜態的年份是的。

And then when you're looking at the hours piece, we have seen improvement in what we call our service percentage or fill rate. I know a lot of that is due I think to some of the initiatives that we've put in place this year to really refocus on scheduling clients and caregivers are we still have room to go as far as you'd alluded to kind of the cap, which is the authorized hours. We still have continue to have some up you there to improve those numbers.

然後，當您查看小時數時，我們發現我們所謂的服務百分比或填充率有所改善。我知道這在很大程度上是由於我們今年採取的一些舉措，真正重新專注於安排客戶和護理人員，我們仍然有空間，就像您提到的那樣cap，即授權時間。我們仍然需要繼續請一些人來改善這些數字。

Got it. Thank you.

知道了。謝謝。

John Ransom, Raymond James.

約翰·蘭塞姆，雷蒙德·詹姆斯。

Hey, yes, good morning. On this small part of your business, but you have this relentless mix shift in payer mix from the home health business, some dark, do you think I mean, yes, the two of the big MA payers have are digesting acquisitions of home health or they're going to push some stuff, but do you think once they've digested these mergers and figure out how much they can allocate to their internal home health? Does that is there any sort of daylight in your opinion on the rate on rate relief? And then secondly, does it doesn't help to have personal care and hospice to trade when you have these discussions or should we just expect kind of this just continued relentless shift or keep going and the payers to kind of stick with a relatively low kind of per visit rate calculation?

嘿，是的，早安。在你業務的這一小部分，但你的家庭健康業務的支付者組合發生了這種無情的混合轉變，有些黑暗，你認為我的意思是，是的，兩個大的MA支付者正在消化家庭健康的收購或他們將推出一些東西，但你認為一旦他們消化了這些合併並弄清楚他們可以分配多少資金用於內部家庭健康？您對利率減免的利率有什麼看法嗎？其次，當你進行這些討論時，個人護理和臨終關懷是否對交易沒有幫助，或者我們是否應該期望這種持續不斷的轉變或繼續下去，而付款人會堅持相對較低的一種每次訪問率計算？

You know, I think they'll continue just for home health companies. I think they'll continue to be pressures as as the percent of Medicare beneficiaries move more toward Medicare Advantage and away from fee-for-service. I think we've seen that the last couple of years. I think the great thing for us. Remember home health, 6% of our business is not a business that when we look to what home health is for us. It's an important part of our business, but it really works with value-based care for us. It works to supplement what we do on our personal care side. So for us, we're able to set across in those markets where you have all three levels of care specifically as it relates even just to personal care and home health, we're able to use our personal care coverage across the state as leverage with our payers to help us drive rates to a more appropriate level, much more so than in those markets where if we just would have home health by itself.

你知道，我認為他們只會繼續為家庭健康公司服務。我認為，隨著醫療保險受益人的比例更多地轉向醫療保險優勢而不是按服務付費，他們將繼續面臨壓力。我想我們在過去幾年已經看到了這一點。我認為這對我們來說是一件很棒的事。請記住家庭健康，當我們專注於家庭健康對我們來說意味著什麼時，我們 6% 的業務並不是這樣的業務。這是我們業務的重要組成部分，但它確實為我們提供了基於價值的護理。它可以補充我們在個人護理方面所做的工作。因此，對我們來說，我們能夠在那些擁有所有三個級別的護理的市場中立足，特別是因為它甚至只涉及個人護理和家庭健康，我們能夠利用我們在全州的個人護理保險作為槓桿與我們的付款人一起幫助我們將費率提高到更合適的水平，比那些我們只擁有家庭健康的市場更有效。

So wildly why the big acquisitions by the big payer certainly going to continue to affect the market for a long period of time. It really doesn't affect us much at all just because of our locations and the size of our home health and what we really are focused on which is building our personal care business, our value-based care business and using clinical services on top of that, it helps supplement that particular growth.

為什麼大支付者的大規模收購肯定會在很長一段時間內繼續影響市場。它實際上對我們沒有太大影響，只是因為我們的位置和家庭健康的規模以及我們真正關注的是建立我們的個人護理業務、我們基於價值的護理業務以及在醫療保健之上使用臨床服務那，它有助於補充特定的成長。

Great. And then my follow-up and again, these are I recognize this is personal care. But do you all think that the the pandemic induced changes in hospice and also kind of the mortality that we lost for many seniors in 2021, 2022, but deep, do you think hospice will normalize and go back to its old growth rates? Or is there something also? Yes, structural there that just mean for them, maybe a less growthy business than it used to be?

偉大的。然後我再次跟進，這些是我認識到這是個人護理。但你們是否都認為這場大流行導致了臨終關懷的變化，以及我們在2021 年、2022 年失去的許多老年人的死亡率，但從本質上講，你們認為臨終關懷會正常化並回到原來的成長率嗎？或者也有什麼東西嗎？是的，那裡的結構性對他們來說意味著業務的成長速度可能不如以前？

Well, I do think there was a lot of structural changes that had that happened. The hospice during the pandemic, you had the accelerated data rates of the elderly population that normally would be your clients in hospice down the road. We have expected this to return to a more normalized level for the last couple of years. And we're still at times struggling just with some of the things that have occurred as far as trying to get back to that normal rate.

嗯，我確實認為這發生了很多結構性變化。在疫情期間的臨終關懷中心，老年族群的數據傳輸速度加快，他們通常是未來臨終關懷中心的客戶。我們預計這將在過去幾年中恢復到更正常化的水平。有時我們仍然在努力應對已經發生的一些事情，試圖恢復到正常水平。

But I will say this, I do believe it will get back. I believe hospice is a much needed service. And I think as we continue down the road you'll see that the admissions rate level out and become back more what we were expecting. I think you'll see that ADC growth start to grow see be a more consistent than what we've seen maybe the last couple of years. I mean, even in our business, as we've seen in our, we've struggled with things such as making sure we could hire enough caregivers. That's been a challenge the last couple of years, but we're starting to see on the hospice side of our business. It really start to level out a bit. I mean, we had 3.13 0.5% growth while our ADC was down a bit. As Brad mentioned on one of his questions, we had a extraordinary number of discharges in the fourth quarter above what we have seen historically in our company. And we don't expect that to continue. And once that comes back and we believe that hospice will get back to where it was prior to pandemic levels.

但我要說的是，我確實相信它會回來。我相信臨終關懷是一項非常需要的服務。我認為，隨著我們繼續前進，您會發現錄取率趨於平穩，並恢復到我們預期的水平。我想你會發現 ADC 的成長開始比我們過去幾年看到的更加一致。我的意思是，即使在我們的業務中，正如我們在我們的業務中所看到的那樣，我們也在努力解決諸如確保能夠僱用足夠的護理人員等問題。這在過去幾年中一直是一個挑戰，但我們開始看到我們業務的臨終關懷方面。它真的開始變得平穩了一些。我的意思是，我們的 ADC 略有下降，但成長了 3.13 0.5%。正如布拉德在他的一個問題中提到的那樣，我們第四季度的解僱人數超出了我們公司歷史上的水平。我們預計這種情況不會持續下去。一旦這種情況回來，我們相信臨終關懷將恢復到大流行之前的水平。

All right. Thanks so much.

好的。非常感謝。

Thank you, John.

謝謝你，約翰。

And ladies and gentlemen, in showing no additional questions, we'll be ending today's question-and-answer session, and I'd like to turn the floor back over to Dirk Allison for any closing remarks.

女士們先生們，在沒有提出任何其他問題的情況下，我們將結束今天的問答環節，我想將發言權轉回給德克·艾利森（Dirk Allison）發表結束語。

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

謝謝你，接線生。我們要感謝今天大家對 Addus 的興趣並參與本次電話會議，我們希望您有個愉快的一週。

And ladies and gentlemen, with that, we'll conclude today's conference call. We thank you for attending today's presentation. You may now disconnect your lines.

女士們、先生們，我們今天的電話會議就到此結束。我們感謝您參加今天的演講。現在您可以斷開線路。