Adapthealth Corp (AHCO) 2024 Q3 法說會逐字稿

Good day, everyone, and welcome to today's AdaptHealth Third Quarter 2024 Earnings Release. (Operator Instructions)

大家好，歡迎閱讀今天的 AdaptHealth 2024 年第三季財報發布。（操作員說明）

Today's speakers will be Suzanne Foster, Chief Executive Officer of AdaptHealth; and Jason Clemens, Chief Financial Officer of AdaptHealth.

今天的演講者是 AdaptHealth 執行長 Suzanne Foster；和 AdaptHealth 財務長傑森·克萊門斯 (Jason Clemens)。

Before we begin, I'd like to remind everyone that statements included in this conference call and in the press release issued today may constitute forward-looking statements within the meaning of Private Securities Litigation Reform Act. These statements include, but are not limited to, comments regarding financial results for 2024 and beyond. Actual results could differ materially from those projected in forward-looking statements. Because of a number of risk factors and uncertainties, which are discussed at length in the company's annual and quarterly SEC filings. AdaptHealth Corp has no obligation to update the information provided on this call to reflect such subsequent events.

在開始之前，我想提醒大家，本次電話會議和今天發布的新聞稿中的陳述可能構成《私人證券訴訟改革法》含義內的前瞻性陳述。這些聲明包括但不限於 2024 年及以後財務表現的評論。實際結果可能與前瞻性陳述中預測的結果有重大差異。由於存在許多風險因素和不確定性，這些風險因素和不確定性在該公司向 SEC 提交的年度和季度文件中進行了詳細討論。AdaptHealth Corp 沒有義務更新本次電話會議中提供的資訊以反映此類後續事件。

Additionally, on this morning's call, the company will reference certain financial measures such as EBITDA, adjusted EBITDA, adjusted EBITDA margin and free cash flow, all of which are non-GAAP financial measures. You can find more information about these non-GAAP measures in the presentation materials accompanying today's call, which are posted on the Company's website. This morning's call is being recorded and a replay of the call will be available later today.

此外，在今天早上的電話會議上，該公司將參考某些財務指標，例如 EBITDA、調整後 EBITDA、調整後 EBITDA 利潤率和自由現金流，所有這些都是非 GAAP 財務指標。您可以在今天電話會議隨附的演示材料中找到有關這些非公認會計準則措施的更多信息，這些材料發佈在公司網站上。今天早上的通話正在錄音，今天晚些時候將提供通話重播。

I am now pleased to introduce the Chief Executive Officer of AdaptHealth, Suzanne Foster.

現在我很高興介紹 AdaptHealth 執行長蘇珊娜·福斯特 (Suzanne Foster)。

Thank you, and good morning, everyone. Thank you for attending our third quarter earnings call. Before we start, I want to acknowledge the extraordinary efforts our team displayed during the recent weather events in the Southeast.

謝謝大家，大家早安。感謝您參加我們的第三季財報電話會議。在開始之前，我要感謝我們的團隊在東南部最近的天氣事件中所表現出的非凡努力。

Prior to the storms, we contacted more than 40,000 patients from the impacted areas to confirm they had the medical equipment they needed before the severe weather moved in. In advance of the storm, we made sure to deliver oxygen where needed. As a result, there were no material service interruptions. I want to thank the team again for their exceptional performance.

在暴風雨發生前，我們聯繫了受影響地區的 40,000 多名患者，以確認他們在惡劣天氣到來之前擁有所需的醫療設備。在風暴來臨之前，我們確保在需要的地方提供氧氣。因此，沒有發生重大服務中斷。我要再次感謝團隊的出色表現。

Now turning to Q3 results. We are pleased to report another consistent quarter. With results in line with our expectations for revenue, adjusted EBITDA, and free cash flow. Compared to the previous year, revenue was flat with our two larger products, sleep and respiratory, delivering growth that offset a decline in diabetes. Sleep increased 3.5% respiratory was strong, increasing 8.6% while diabetes decreased 11.8%.

現在轉向第三季的結果。我們很高興地報告另一個穩定的季度。結果符合我們對收入、調整後 EBITDA 和自由現金流的預期。與前一年相比，我們的兩個較大產品（睡眠和呼吸）的收入持平，帶來的成長抵消了糖尿病的下降。睡眠增加3.5%，呼吸強健，增加8.6%，而糖尿病則減少11.8%。

Rounding out the numbers, which Jason will cover more in depth, we delivered an improvement in adjusted EBITDA margin and had a positive quarter for free cash flow. We completed the non-core asset sale we announced last quarter, refinanced our senior secured credit facility and, paid down another $50 million of debt. As a result, we are now committing to delevering further with a new multi-year target set at 2.5 times net leverage.

傑森將更深入地介紹這些數字，我們調整後的 EBITDA 利潤率有所改善，並且自由現金流呈現正成長。我們完成了上季宣布的非核心資產出售，為我們的優先擔保信貸安排再融資，並償還了另外 5,000 萬美元的債務。因此，我們現在承諾進一步去槓桿化，將新的多年目標設定為 2.5 倍淨槓桿率。

Over the past quarter, our focus has been on establishing a One Adapt approach to operating this business, which means rolling out standard work, new operating structures, and identifying growth opportunities. Let's start with sleep. According to the American Academy of Sleep Medicine, there are approximately 30 million adults in the US living with obstructive sleep apnea, but only 20% have been diagnosed.

在過去的季度中，我們的重點是建立 One Adapt 方法來運營該業務，這意味著推出標準工作、新的營運結構並識別成長機會。我們先從睡眠開始吧。根據美國睡眠醫學會的數據，美國約有 3,000 萬成年人患有阻塞性睡眠呼吸中止症，但只有 20% 被診斷出來。

This market is large and it is growing rapidly, partly because of increased awareness of OSA and the negative health implications by going untreated. As detection technology evolves, we believe more people will be prompted to seek treatment for OSA with many of those patients seeking CPAP therapy.

這個市場很大且正在快速成長，部分原因是人們對 OSA 的認識不斷提高以及不治療對健康造成的負面影響。隨著檢測技術的發展，我們相信將會有更多的人尋求 OSA 治療，其中許多患者正在尋求 CPAP 治療。

There are reasons AdaptHealth is the number one market leader in sleep. It's because our respiratory therapists and sleep coaches provide best-in-class adherence programs, and our resupply team delivers a highly reliable and convenient experience to more than 1.6 million patients.

AdaptHealth 成為睡眠領域中第一市場領導者是有原因的。這是因為我們的呼吸治療師和睡眠教練提供一流的依從性計劃，並且我們的補給團隊為超過 160 萬患者提供高度可靠和便捷的體驗。

The opportunity for growth in sleep is to increase new patient conversion rates. Right now, approximately 75% of the referrals we receive are fulfilled. We are working on opportunities to improve this conversion rate by introducing a new self-scheduling feature in myAPP, thereby eliminating the need to reach the patient by phone, and standardizing workflow processes to eliminate the back-and-forth of getting services for new patients approved.

睡眠成長的機會是提高新患者的轉換率。目前，我們收到的推薦大約有 75% 得到了滿足。我們正在尋找機會提高這種轉換率，方法是在 myAPP 中引入新的自我安排功能，從而消除透過電話聯繫患者的需要，並標準化工作流程，以消除為新患者獲取服務的來回過程得到正式認可的。

Turning to respiratory, based on data from the American Lung Association, we know that more than 35 million people in the US are living with chronic lung disease like asthma and COPD. Supporting these patients requires a commitment to excellence, which we have. Our clinical coordination team is unique in the market, in that, we have multiple levels of respiratory therapist care.

說到呼吸系統，根據美國肺臟協會的數據，我們知道美國有超過 3500 萬人患有哮喘和慢性阻塞性肺病等慢性肺病。支持這些患者需要我們對卓越的承諾。我們的臨床協調團隊在市場上是獨一無二的，因為我們擁有多層次的呼吸治療師護理。

As a result, we deliver strong clinical outcomes designed to help lower hospital readmission rates. It is this level of clinical support that differentiates us in results in growth. To maintain our position as the number one market leader in this area, we are focused on optimizing our workflows and exploring opportunities to expand our product portfolio to better help patients living at home with respiratory conditions.

因此，我們提供了強有力的臨床成果，旨在幫助降低再入院率。正是這種程度的臨床支持使我們在成長方面與眾不同。為了保持我們在該領域第一市場領導者的地位，我們專注於優化我們的工作流程並探索擴大我們產品組合的機會，以更好地幫助患有呼吸系統疾病的在家患者。

Our sleep and respiratory product lines currently make up the majority of our revenue and we expect continued solid performance in these areas. We must, however, fix our performance and execution issues that we have in diabetes, which currently represents 17% of revenue.

我們的睡眠和呼吸產品線目前占我們收入的大部分，我們預計這些領域將繼續保持穩健的表現。然而，我們必須解決糖尿病領域的績效和執行問題，目前糖尿病領域佔收入的 17%。

Following last quarter's results, I turned my attention to our diabetes product line and found the outlook was much worse than I thought after my first two months. The reality is the market is growing, our competitors are growing and we are not. We acted immediately by dismissing several members of the diabetes leadership team and through a series of diagnostic reviews, we uncovered systemic operational issues that we need to fix.

繼上個季度的業績之後，我將注意力轉向了我們的糖尿病產品線，發現前兩個月的前景比我想像的要糟糕得多。現實是市場在成長，我們的競爭對手在成長，但我們沒有。我們立即採取行動，解雇了糖尿病領導團隊的幾名成員，並通過一系列診斷審查，發現了需要解決的系統性營運問題。

We have taken swift actions to turn this around. First, we appointed a new leadership team; one, a former CEO of an AdaptHealth acquisition with a background in delivering exceptional service in sleep and home medical supplies; and we brought in a seasoned sales leader with experience in diabetes. Second, we integrated the resupply of our diabetes products into our sleep resupply center of excellence to leverage its leadership, replicate processes, and increase performance.

我們已迅速採取行動扭轉這一局面。一是任命了新的領導班子；其中一位是 AdaptHealth 收購公司的前首席執行官，擁有在睡眠和家庭醫療用品領域提供卓越服務的背景；我們也聘請了一位在糖尿病領域經驗豐富的銷售主管。其次，我們將糖尿病產品的補給整合到睡眠補給卓越中心，以利用其領導力、複製流程並提高績效。

Third, we know that acquiring new CGM patients and being able to timely service them is the single most important thing we need to do. Notwithstanding a dynamic market environment, executing here is within our control. And we are taking the necessary actions to improve across the Board.

第三，我們知道，獲得新的 CGM 患者並能夠及時為他們提供服務是我們需要做的最重要的事情。儘管市場環境瞬息萬變，但這裡的執行仍在我們的掌控之中。我們正在採取必要的行動來全面改進。

Our diabetes improvement efforts are now underway, yet we expect that it will take us a few quarters to demonstrate results. Therefore, we are guiding the balance of the year down based on what we learned and to provide an appropriate amount of time for our actions to have an impact.

我們的糖尿病改善工作正在進行中，但我們預計需要幾個季度才能展示結果。因此，我們根據我們所學到的知識來指導今年的剩餘時間，並為我們的行動產生影響提供適當的時間。

Unlocking growth in diabetes is an imperative. The American Diabetes Association reports that more than 38 million Americans have diabetes with almost 100 million being pre-diabetic. If we put all these numbers in perspective, there are more than 100 million potential patients for AdaptHealth to serve in the United States. Today, we proudly serve 4.2 million patients a year. In simplest terms, growth is about providing exceptional service to the increasing number of patients that need our support.

釋放糖尿病的成長勢在必行。美國糖尿病協會報告稱，超過 3,800 萬美國人患有糖尿病，其中近 1 億人處於糖尿病前期。如果我們正確看待所有這些數字，AdaptHealth 在美國有超過 1 億的潛在患者可以服務。如今，我們每年為 420 萬名患者提供服務，對此我們深感自豪。簡而言之，成長就是為越來越多需要我們支持的患者提供卓越的服務。

Another topic I would like to update you on is the progress we are making on the technology front. Last quarter, I mentioned that we were doing a few low-cost experiments with AI and automation. I am happy to report that this is moving quickly. And we have moved from inception to production. The mission was to use AI to deal with the massive amount of incoming unstructured data we receive, which is an ongoing healthcare challenge.

我想向您介紹的另一個主題是我們在技術方面的進展。上個季度，我提到我們正在利用人工智慧和自動化進行一些低成本實驗。我很高興地報告，這一切進展很快。我們已經從開始階段轉向生產階段。我們的使命是使用人工智慧來處理我們收到的大量傳入的非結構化數據，這是一個持續的醫療保健挑戰。

With the way things are done, we receive more than 5 million pages of faxes every month and we rely on a combination of people and technology to get the information in those faxes into the correct workflow. In a matter of weeks, we successfully automated parts of the workflow and our new automated process enabled by AI has proven to be 99.6% accurate compared to 89% with our legacy process. This was the first step to prove we can do so with accuracy.

按照這種方式，我們每月收到超過 500 萬頁傳真，我們依靠人員和技術的結合將這些傳真中的資訊納入正確的工作流程。在短短幾週內，我們成功實現了部分工作流程的自動化，事實證明，由人工智慧支援的新自動化流程的準確率高達 99.6%，而舊流程的準確率僅為 89%。這是證明我們可以準確做到這一點的第一步。

We are optimistic about our ability to rapidly deploy this technology across our workflows in a way that is responsible. We see AI as a viable option for us to improve our performance, reliability, and efficiency.

我們對以負責任的方式在我們的工作流程中快速部署這項技術的能力感到樂觀。我們認為人工智慧是我們提高效能、可靠性和效率的可行選擇。

We are prioritizing use cases that will improve our ability to deliver exceptional service. I think it's good to note that due to improved operational rigor and successful cost management initiatives this past quarter, we were able to invest in people and technology while delivering improved bottom-line results.

我們正在優先考慮能夠提高我們提供卓越服務能力的用例。我認為值得注意的是，由於上個季度營運嚴謹性的提高和成本管理措施的成功，我們能夠在人員和技術方面進行投資，同時提供更好的底線結果。

In addition, this is the last quarter we will report results as a single segment. We are moving to a four-segment reporting structure that consists of sleep health, respiratory health, diabetes health, and wellness at home. This shift to segment reporting will allow for increased transparency and insight into our performance.

此外，這是我們將作為單一部門報告業績的最後一個季度。我們正在轉向四部分報告結構，包括睡眠健康、呼吸健康、糖尿病健康和家庭健康。這種向分部報告的轉變將提高透明度並深入了解我們的績效。

Most importantly, it will enable us to focus our resources and architect our growth in each segment. I continue to be optimistic about the road ahead. We have identified growth opportunities. We are assembling a high-performing team and investing in areas that allow us to serve even more patients in their homes. Our focus is on execution, and continuously improving every day.

最重要的是，它將使我們能夠集中資源並規劃我們在每個細分市場中的成長。我對未來的道路仍然保持樂觀。我們已經確定了成長機會。我們正在組建一支高績效團隊，並投資於能讓我們在家中為更多患者提供服務的領域。我們的重點是執行力，並且每天不斷改進。

And with that, I will turn it over to Jason.

這樣，我就把它交給傑森。

Thanks, Suzanne, and thanks to all for joining our call today.

謝謝蘇珊娜，也謝謝大家今天加入我們的電話會議。

For the third quarter of 2024, we delivered against our expectations for revenue, adjusted EBITDA, and free cash flow. We also made considerable progress in strengthening our financial position, disposing of non-core assets, refinancing our senior credit facility, and paying down debt.

2024 年第三季度，我們的營收、調整後 EBITDA 和自由現金流的表現超出了我們的預期。我們在加強財務狀況、處置非核心資產、優先信貸再融資和償還債務方面也取得了長足進展。

During the quarter, we completed the previously announced transaction to sell certain custom rehab assets to a third party. As a reminder, the annual revenue for these assets was about $30 million, so that comes out of our H&E revenue run-rate going forward. We continue to consider alternatives for a couple of similarly sized product categories that do not fit strategically into our core businesses.

在本季度，我們完成了先前宣布的交易，將某些客製化康復資產出售給第三方。提醒一下，這些資產的年收入約為 3000 萬美元，因此這是我們未來 H&E 收入運行率的結果。我們繼續考慮一些類似規模的產品類別的替代方案，這些產品類別在策略上不適合我們的核心業務。

In aggregate, they represent less than $100 million of annual revenue and we will provide updates as we make progress with those initiatives. Third quarter net revenue of $805.9 million was up 0.2% compared to the third quarter of 2023. Sleep revenue of $326.4 million increased 3.5% over the prior year, in line with our expectations as we faced a very-high comparable in 2023 due to record starts from fulfilling the backlog following a manufacturer recall.

總的來說，它們的年收入不到 1 億美元，我們將在這些舉措取得進展時提供最新資訊。第三季淨收入為 8.059 億美元，較 2023 年第三季成長 0.2%。睡眠收入為 3.264 億美元，比上一年增長 3.5%，符合我們的預期，因為我們在 2023 年面臨著非常高的可比性，因為製造商召回後完成積壓訂單的開工創紀錄。

For perspective, over the past two years, sleep revenue grew $55.8 million against $270.6 million in the third quarter of 2022, representing 9.8% of compounded annual growth. Although CPAP starts to experience the typical sequential deceleration from Q2 as July and August vacation schedules impact sleep testing and referral activity, we were pleased to once again surpass 120,000 starts.

總體而言，過去兩年，睡眠收入成長了 5,580 萬美元，而 2022 年第三季為 2.706 億美元，佔複合年增長率的 9.8%。儘管由於 7 月和 8 月的假期安排影響睡眠測試和轉介活動，CPAP 從第二季度開始經歷典型的連續減速，但我們很高興再次超過 120,000 次啟動。

Sleep resupply census now stands at over 1.63 million patients, up another 29,000 from the previous quarter. Our CPAP survey indicated 15% of respondents were using GLP-1s to manage diabetes or weight loss, up from 12% last quarter. Now a year into our surveys, we are detecting a very slight uptick in CPAP adherence versus patients not indicating GLP-1 usage. So far, there is an immaterial difference in resupply ordering patterns.

睡眠補給普查顯示目前有超過 163 萬名患者，比上一季又增加了 29,000 名。我們的 CPAP 調查顯示，15% 的受訪者正在使用 GLP-1 來控製糖尿病或減肥，高於上季的 12%。現在我們的調查已經一年了，我們發現與未使用 GLP-1 的患者相比，CPAP 治療依從性略有上升。到目前為止，補給訂購模式之間存在著無關緊要的差異。

We will continue to monitor and report these trends as time goes on. Diabetes revenue of $141.1 million decreased 11.8% compared to the third quarter of 2023. Driven by lower CGM revenue. Before we get into those details, we were encouraged to see stabilization regarding insulin pumps and related supplies, representing $28.4 million of revenue for the quarter, about flat against the prior year. For CGMs, we've previously discussed reimbursement channel pressure as some payers shifted reimbursement policy to 100% pharmacy in 2024.

隨著時間的推移，我們將繼續監測和報告這些趨勢。糖尿病業務收入為 1.411 億美元，較 2023 年第三季下降 11.8%。受 CGM 收入下降的推動。在我們討論這些細節之前，我們很高興地看到胰島素幫浦和相關供應品的穩定，即本季收入 2840 萬美元，與前一年基本持平。對於 CGM，我們之前討論過由於一些付款人在 2024 年將報銷政策轉向 100% 藥房而帶來的報銷管道壓力。

That landscape has remained steady over the year, but as we lost access to members in a handful of markets in early 2024, we failed to overcome that headwind with new sales orders. We also shipped fewer recur orders than expected, impacted by the operational challenges Suzanne discussed. Respiratory revenue of $164 million increased 8.6% compared to the third quarter of 2023, led by oxygen exceeding our expectations.

這一情況在這一年中一直保持穩定，但由於我們在 2024 年初失去了少數市場的會員資格，我們未能透過新的銷售訂單克服這一阻力。受蘇珊討論的營運挑戰的影響，我們的重複訂單出貨量也低於預期。呼吸系統收入為 1.64 億美元，較 2023 年第三季成長 8.6%，其中氧氣收入超出了我們的預期。

For the first time in our history, our oxygen census surpassed 325,000 patients actively on service. Most patients on oxygen need to order tank refills periodically, and until recently, that has been a time-consuming process.

我們的氧氣普查歷史上首次超過了 325,000 名積極服務的患者。大多數吸氧患者需要定期訂購氧氣罐，直到最近，這還是一個耗時的過程。

During the quarter, 7.5% of our O2 patients order tank refills without having to interact with an Adapt customer service representative via new technology just launched in myAPP, as well as chatbot technology recently launched in our interactive voice response telephone systems.

本季度，我們 7.5% 的 O2 患者無需透過 myAPP 中剛推出的新技術以及我們互動式語音應答電話系統中最近推出的聊天機器人技術即可訂購氣瓶補充液，而無需與 Adapt 客戶服務代表互動。

This tech was launched in the second quarter with only 1.5% of O2 patients ordering through these platforms 90 days ago, so we are making progress quickly. Revenue from all other product categories of $174.3 million decreased 1.9% over the prior year, aligned with our expectations, driven by revenue loss from the sale of certain custom rehab assets.

這項技術於第二季推出，90 天前只有 1.5% 的 O2 患者透過這些平台訂購，因此我們正在迅速取得進展。所有其他產品類別的收入為 1.743 億美元，比上年下降 1.9%，與我們的預期一致，這是由於出售某些客製化康復資產造成的收入損失。

Turning to profitability. Third quarter adjusted EBITDA of $164.3 million reflects an adjusted EBITDA margin of 20.4%, a slight improvement over the same period last year. This margin expansion was driven by revenue mix, meaning that higher-margin products like sleep and respiratory outgrew lower-margin products like diabetes. We were pleased to maintain labor expense year-over-year as we installed enough efficiencies to pay for merit-based salary raises and other labor inflation. Operating expenses and G&A were in line with our expectations.

轉向盈利能力。第三季調整後 EBITDA 為 1.643 億美元，調整後 EBITDA 利潤率為 20.4%，較去年同期略有改善。這種利潤成長是由收入組合推動的，這意味著睡眠和呼吸系統等利潤率較高的產品的成長超過了糖尿病等利潤率較低的產品。我們很高興能夠逐年維持勞動力支出，因為我們提高了足夠的效率來支付基於績效的加薪和其他勞動力通膨。營運費用和一般行政費用符合我們的預期。

Cash flow from operations was $144.4 million. Days sales outstanding for Q3 was 47.9, down from 48.9 in the previous quarter, as accounts receivable continued to normalize following the Change Healthcare situation earlier this year. CapEx of $59.6 million represented 7.4% of revenue, down against 9.6% of revenue in the third quarter of 2023.

營運現金流為 1.444 億美元。第三季的應收帳款週轉天數為 47.9 天，低於上一季的 48.9 天，原因是今年稍早醫療保健情勢發生變化後，應收帳款持續正常化。資本支出為 5,960 萬美元，佔營收的 7.4%，低於 2023 年第三季營收的 9.6%。

Free cash flow of $84.8 million outperformed our target of $30 million. That $30 million estimate assumed that we would payoff the $40.7 million loan offered as part of Optum's temporary funding assistance program related to the Change Healthcare outage earlier this year. However, that payoff did not occur until mid-November -- excuse me, mid-October. After adjusting for the timing of that cash outflow, we still produced strong cash flows for the quarter, so we are again raising full year guidance.

自由現金流為 8,480 萬美元，超出了我們 3,000 萬美元的目標。3000 萬美元的預估假設我們將償還 Optum 與今年早些時候 Change Healthcare 中斷相關的臨時資金援助計劃的一部分提供的 4070 萬美元貸款。然而，這種回報直到 11 月中旬才出現——對不起，是 10 月中旬。在調整現金流出的時間後，我們本季仍然產生了強勁的現金流，因此我們再次提高了全年指引。

During the third quarter, we amended our debt agreement to lock a $950 million senior secured credit facility, consisting of a fully funded $650 million Term Loan A and a $300 million revolving line of credit. Proceeds from the new $650 million term loan were used to fully repay without penalty the company's existing term loan due to reach final maturity in January of 2026.

在第三季度，我們修改了債務協議，鎖定了 9.5 億美元的優先擔保信貸額度，其中包括全額資助的 6.5 億美元定期貸款 A 和 3 億美元的循環信貸額度。新的 6.5 億美元定期貸款收益用於全額償還該公司將於 2026 年 1 月最終到期的現有定期貸款，且不會受到處罰。

The new $300 million revolver replaces the company's existing $450 million revolving credit facility, which had no balance drawn at the end of the third quarter. The reduced revolver size decreases undrawn commitment fees. The interest rate pricing for the new senior secured credit facility decreased from the interest rate pricing in AdaptHealth's existing bank credit facility, and the new maturity is extended up to September 13, 2029.

新的 3 億美元循環信貸取代了該公司現有的 4.5 億美元循環信貸額度，該信貸額度在第三季末尚未提取餘額。左輪手槍尺寸的減少減少了未提取的承諾費用。新的優先擔保信貸安排的利率定價較 AdaptHealth 現有銀行信貸安排的利率定價有所下降，並且新的期限延長至 2029 年 9 月 13 日。

At the end of the third quarter, we paid an additional $50 million against the term loan A balance, resulting in a net leverage ratio of 2.87 times compared to 3.51 times in the third quarter of 2023. We are very pleased to have achieved our net leverage target of 3 times ahead of schedule and we remain focused on paying down debt. So much so that we are introducing a new multi-year net leverage target for the company at 2.5 times net leverage as defined in our covenants.

第三季末，我們對定期貸款 A 餘額額外支付了 5,000 萬美元，淨槓桿率為 2.87 倍，而 2023 年第三季為 3.51 倍。我們很高興提前實現了 3 倍的淨槓桿目標，並且我們仍然專注於償還債務。以至於我們為公司引入了新的多年淨槓桿目標，目標是我們在契約中定義的淨槓桿的 2.5 倍。

We expect to acquire home medical equipment providers in the future as access and scale are important to us. But for the next few quarters, we expect acquisition activity to be limited. When and where it makes sense, we will acquire but will otherwise remain focused on paying down debt and increasing our free cash flow conversion. For the balance of 2024, we are adjusting our revenue midpoint down $45 million and adjusted EBITDA midpoint down $15 million responding to recent trends in diabetes.

我們預計未來會收購家庭醫療設備供應商，因為通路和規模對我們來說很重要。但在接下來的幾個季度，我們預計收購活動將受到限制。在有意義的時間和地點，我們將進行收購，但否則將繼續專注於償還債務和增加我們的自由現金流轉換。對於 2024 年剩餘時間，我們將收入中點下調 4500 萬美元，調整後 EBITDA 中點下調 1500 萬美元，以應對糖尿病的最新趨勢。

Our updated full-year guidance is net revenue to be in the range of $3.22 billion to $3.26 billion, adjusted EBITDA to be in the range of $655 million to $675 million and even with these updates, given the continued positive trends in working capital, we expect free cash flow to be in the range of $175 million to $195 million.

我們更新後的全年指引是淨收入在32.2 億美元至32.6 億美元之間，調整後的EBITDA 在6.55 億美元至6.75 億美元之間，即使有了這些更新，考慮到營運資本的持續積極趨勢，我們預期自由現金流在 1.75 億美元至 1.95 億美元之間。

With that, we'll open the call up for questions. Operator?

這樣，我們將開始提問。操作員？

(Operator Instructions)

（操作員說明）

Kevin Caliendo, UBS.

凱文‧卡里恩多，瑞銀集團。

Sorry, I was on mute. I apologize. Thanks for taking my question. I just want to go through the diabetes issues a little bit more in-depth. How much of this is related to issues with manufacturers, is -- does it require more collaboration? Is it more of a market where the end-market, what's happening there in terms of moving pharmacy versus DME? Like any help around what's really happening in the end-markets and what's happening with your clients would be would be great.

抱歉，我當時處於靜音狀態。我道歉。感謝您提出我的問題。我只是想更深入地了解糖尿病問題。其中有多少與製造商的問題有關——是否需要更多的合作？它更像是一個終端市場，在行動藥房與 DME 方面發生了什麼？就像任何有關終端市場實際情況和客戶情況的幫助都會很棒。

Yes, Kevin. A couple of comments. No, we have not identified the compression in revenue to any specific issues with manufacturers. In fact, you know, the CGM manufacturers as well as all of the pump manufacturers have been very good parties to work with and good partners over the year -- over the years.

是的，凱文。一些評論。不，我們尚未發現製造商的任何特定問題導致收入壓縮。事實上，您知道，多年來，CGM 製造商以及所有泵浦製造商一直是非常好的合作方和良好的合作夥伴。

I mean, they have supported various integrations of data and technology coming from their devices inside of our four walls. If you've done that kind of work before, you know that that takes frankly, a tremendous amount of collaboration working across different companies.

我的意思是，他們支援來自我們四面牆內的設備的數據和技術的各種整合。如果您以前做過這類工作，您就會知道坦白地說，這需要不同公司之間進行大量協作。

We certainly are continuing to face pressure from the pharmacy channel reimbursement changes. So we referenced that in our prepared remarks. We have not seen this quarter really any shift in major payer activities against what we saw in the second-quarter or against what we saw in the first-quarter. And so even though we do have some pressure to overcome from the prior year, that environment has remained relatively steady.

我們當然繼續面臨藥局通路報銷變化的壓力。因此，我們在準備好的發言中引用了這一點。與第二季或第一季相比，我們並沒有看到本季主要付款人活動發生任何變化。因此，儘管我們確實需要克服去年的一些壓力，但這種環境仍然相對穩定。

What we are saying is that the new starts that we had expected from adding sales folks, we are not pulling through, frankly anywhere near our expectations and the growth that we believe is there in the market.

我們所說的是，我們預期透過增加銷售人員來實現新的開始，坦白說，我們並沒有實現我們的預期和我們相信市場上的成長。

And then on the recur side, we do have some operational challenges that have been unpacked and we are deploying our sleep resupply operation towards improving. I mean, just a minor tick or two in recur since it represents such an overwhelming part of revenue. If you degrade performance, it can have a big impact and that's what we're absorbing here in the third quarter.

另一方面，我們確實遇到了一些已經解決的營運挑戰，我們正在部署睡眠補給業務以尋求改善。我的意思是，重複發生的只是一兩個小勾號，因為它代表了收入的絕大多數。如果效能下降，可能會產生很大的影響，這就是我們在第三季所吸收的內容。

I'd just double down on that to say I think our partnerships with the manufacturers are strong and continuing to get stronger when meeting regularly and I am happy to see that that partnership is taking on a whole new life, so I think that is positive. The reimbursement shift actually -- obviously has been a headwind but with the message today is we should be able to grow through that given what we know about the end markets and we're not growing through it as a result of our own operational issues internally that I believe we can fix over the next couple of quarters.

我想強調的是，我認為我們與製造商的合作夥伴關係非常牢固，並且在定期會面時會繼續變得更加牢固，我很高興看到這種夥伴關係正在煥發新的活力，所以我認為這是積極的。報銷的轉變實際上——顯然是一個逆風，但今天的訊息是，鑑於我們對終端市場的了解，我們應該能夠通過這一點實現增長，而由於我們自己的內部運營問題，我們並沒有通過它實現成長。

That's helpful. If I can ask a quick follow-up then, I think a logical one is how much would you think this will impact '25? If we think about the bar for '25, the revenue growth is around 5%, not asking for guidance, but this -- the issue with diabetes that you're having now, does that spill over into '25 and that could that be an incremental headwind as we think about that?

這很有幫助。如果我可以快速跟進，我認為一個合乎邏輯的問題是，您認為這會對 25 年產生多大影響？如果我們考慮 25 年的標準，收入成長約為 5%，而不是尋求指導，但是您現在遇到的糖尿病問題是否會蔓延到 25 年，這可能是當我們想到這一點時，會遇到增量逆風嗎？

Well, Kevin, I think I'd say that we'll -- we plan to guide '25 at the -- near the end of February when we'll report the fourth quarter. When we think about the fourth quarter, I mean, we took down top line by $45 million. I mean there are ins and outs to that, but essentially what we're saying is we delivered $140 million of revenue here in the third quarter. We're not committing to more than that in the fourth quarter.

好吧，凱文，我想我會說，我們計劃在 2 月底左右指導 '25，屆時我們將報告第四季度。當我們想到第四季時，我的意思是，我們的營收減少了 4500 萬美元。我的意思是，這其中有細節，但本質上我們所說的是我們在第三季實現了 1.4 億美元的收入。我們在第四季不會承諾更多。

I mean, we have guided down, which creates a $45 million compression against the fourth quarter of last year because we don't want to overcommit. We do have, we believe, the right people in the right seats with the right organizational changes, more specifically reorganizing all resupply operations out of our resupply center in Nashville that has produced incredible performance in our sleep business for many, many years.

我的意思是，我們已經下調了指導，這比去年第四季度壓縮了 4500 萬美元，因為我們不想過度投入。我們相信，我們確實擁有合適的人在合適的位置，並進行了正確的組織變革，更具體地說，重組了納什維爾補給中心的所有補給業務，多年來，該中心在我們的睡眠業務中取得了令人難以置信的業績。

And so we are focusing on that, but we're just not going to commit to any more growth even sequentially until we know that we're confident in doing so. So, how that impacts '25, I mean, I think it goes without saying we -- as we stand here today, we anticipate some pressures in '25, but we got another 90 days ahead of us and we're going to do our work and we'll come back with updated guidance at that time.

因此，我們正在關注這一點，但在我們知道我們有信心這樣做之前，我們不會承諾任何更多的成長，甚至是連續的成長。所以，這對25 年有何影響，我的意思是，我認為這是不言而喻的——當我們今天站在這裡時，我們預計25 年會面臨一些壓力，但我們還有90 天的時間，我們會做我們的工作，屆時我們將帶來更新的指導。

Appreciate the color. Thanks.

欣賞顏色。謝謝。

Matthew Blackman, Stifel.

馬修布萊克曼，史蒂菲爾。

Great. Good morning, everybody. Thank you for taking my questions. I'm also going to touch on diabetes here. And maybe sort of frame it this way, it does sound like you're still bullish on the long-term prospects of this business. I think in the recent past, you've talked about diabetes maybe growing higher single-digits. Is that still in play perhaps, of course, over a longer timeframe?

偉大的。大家早安。感謝您回答我的問題。我在這裡還要談談糖尿病。也許可以這麼說，聽起來您確實仍然看好這項業務的長期前景。我想在最近，你談到糖尿病可能會成長到更高的個位數。當然，在更長的時間內，這種情況是否仍在發揮作用？

And then maybe a follow-up question. I was just hoping to understand how you better get after new patients in the CGM franchise. Obviously, there's been a sales force expansion, but just practically speaking, how do you execute on getting new patients into the business? I would be interested in hearing your thoughts there. Thank you.

然後也許是一個後續問題。我只是希望了解如何更好地治療 CGM 特許經營中的新患者。顯然，銷售團隊已經擴大，但實際上，您如何讓新患者進入業務？我有興趣聽聽您的想法。謝謝。

Okay. I'll start with the second part of the question and Jason will go back to the numbers. So the third point of the plan around obviously increasing CGM new starts is the number-one thing we need to do literally across the business. And the plan there is you cannot, in my opinion, just go continue to put out more and more salespeople and expect a different result. They can only sell as good as we are on the operational side.

好的。我將從問題的第二部分開始，傑森將回到數字。因此，圍繞著明顯增加 CGM 新開工的計劃的第三點是我們在整個業務中真正需要做的第一件事。在我看來，你不能繼續派出越來越多的銷售人員來期待不同的結果。他們只能在營運方面賣得和我們一樣好。

And so what I've uncovered this quarter is that we have to beef up or improve the timeliness and ease in which you can order a CGM for us, how we bring that new patient in. And so we're pushing on two fronts. One is our operations team is looking at how do we streamline the processes, make it easier so that when our salespeople go out to a referring provider, we can promise service levels that are more in line with the market.

因此，我本季發現，我們必須加強或改善為我們訂購 CGM 的及時性和便利性，以及我們如何引入新患者。因此，我們正在兩個方面努力。一是我們的營運團隊正在研究如何簡化流程，使其變得更容易，以便當我們的銷售人員去找推薦提供者時，我們可以承諾更符合市場的服務水準。

And unfortunately, over the last couple of quarters, we have been lagging behind in the timeliness of delivering on that promise. And so we're stabilizing the sales force, making sure we're going out and having a high-touch white glove experience with our referring providers. And at the same time, our operators are charged with streamlining the workflows and their performance so that we can deliver with speed and quality.

不幸的是，在過去的幾個季度中，我們在兌現這項承諾的及時性方面一直落後。因此，我們正在穩定銷售隊伍，確保我們走出去並與我們的推薦提供者一起獲得高接觸的白手套體驗。同時，我們的操作員負責簡化工作流程及其效能，以便我們能夠快速、高品質地交付。

I think, Matt, in regard to the question about the end market and the growth, we'd offer two different ways to look at that. Firstly, I think if we consider the Q3 comments from the CGM manufacturers, I think one reporting very low-single digits and the other reporting mid-20% growth.

馬特，我認為，關於終端市場和成長的問題，我們會提供兩種不同的方式來看待這個問題。首先，我認為，如果我們考慮 CGM 製造商的第三季評論，我認為其中一家報告的個位數成長率非常低，而另一家報告的成長率為 20% 左右。

They're not 50-50 in the marketplace necessarily, but when accounting for that, I mean you're going to be in a -- whether it's 10%, 12%, 9%, somewhere in that ballpark. The second data point is that, look, some of our public competitors have recently reported what we believe to be upper single-digit growth for the quarter.

他們在市場上的比例不一定是 50-50，但考慮到這一點，我的意思是，無論是 10%、12%、9%，都在這個範圍內的某個地方。第二個數據點是，看，我們的一些公開競爭對手最近報告了我們認為本季較高個位數成長的情況。

I mean as a segment producing 5% to 6% growth and when asked, diabetes is leading the way, implying they're growing faster than us. So those two data points alone, we do believe that the market is growing upper-single digit, perhaps lower double-digit.

我的意思是，作為一個產生 5% 至 6% 成長的細分市場，當被問到時，糖尿病處於領先地位，這意味著他們的成長速度比我們快。因此，僅憑這兩個數據點，我們確實相信市場正在以高個位數成長，甚至可能以低兩位數成長。

And in fact, we compressed almost 12% this quarter. So like Suzanne said in her prepared remarks, the market is growing, our competitors are growing, we are not. And so that's the work that we're putting in to fix these operational challenges.

事實上，本季我們壓縮了近 12%。正如蘇珊娜在她準備好的發言中所說，市場正在成長，我們的競爭對手正在成長，而我們卻沒有。這就是我們為解決這些營運挑戰所做的工作。

Got it. And if I could just squeeze one follow-up, maybe, Suzanne, and organic growth, I think in particular, you've sort of identified, you said, opportunities for organic growth. I think in the past, I've heard you talk about things like national accounts and contracting. Can you maybe just give us a sense of some of the other opportunities or if you want to talk a little bit about national accounts and what kind of opportunity that could be for Adapt as we think about the organic profile of the company over the next several years, would be interested in hearing that. Thank you.

知道了。如果我能擠出一個後續行動，也許蘇珊娜，以及有機成長，我特別認為，你已經確定了有機成長的機會。我想過去我聽過你談論國民帳戶和合約等問題。您能否讓我們了解一些其他機會，或者您是否想談談國民經濟核算，以及當我們考慮公司在接下來的幾年中的有機概況時，Adapt 可能會遇到什麼樣的機會？興趣聽到這個。謝謝。

Appreciate that question. Yes. So, as I said at the end, we were able to continue to improve bottom line even though we made technology and people investments. Those people investments this last quarter did come from beefing up our national accounts or what we're calling enterprise sales team. And the reason for that is, I believe there's two additional organic growth drivers here.

感謝這個問題。是的。因此，正如我最後所說，即使我們進行了技術和人員投資，我們仍能夠繼續提高利潤。上個季度的人員投資確實來自於加強我們的國民帳戶或我們所說的企業銷售團隊。原因是，我相信這裡還有兩個額外的有機成長驅動力。

One is in larger health systems. We do a very, very nice job in certain geographies around partnering with large health systems to have a seamless experience when patients are discharged from the health systems, but we have not nationalized that program and we are now in the process of doing that, which I'm optimistic about. I think we have an incredible value proposition on that front. So we're investing in that area.

一是在較大的衛生系統中。我們在某些​​地區與大型衛生系統合作，在患者從衛生系統出院時獲得無縫體驗方面做得非常非常好，但我們尚未將該計劃國有化，我們現在正在這樣做，這我很樂觀。我認為我們在這方面有令人難以置信的價值主張。所以我們正在該領域進行投資。

And then the other area that we're highly focused on is increasing the total covered lives. So, our managed-care team and how do we make sure that we have our fair share of covered lives, so that when our sales force goes in, we can basically be a one-stop shop for any referral sources as we can take almost any payer and we offer the total portfolio of products. If you send it to us, we promise we can deliver well for your patient.

我們高度關注的另一個領域是增加總覆蓋壽命。因此，我們的管理式醫療團隊以及我們如何確保我們擁有公平的承保生活份額，以便當我們的銷售人員介入時，我們基本上可以成為任何推薦來源的一站式商店，因為我們幾乎可以採取任何付款人，我們提供完整的產品組合。如果您將其發送給我們，我們承諾可以為您的患者提供良好的服務。

Thank you.

謝謝。

Eric Coldwell, Baird.

埃里克·科德威爾，貝爾德。

Okay. It very well could be redundant and obvious, but last year in diabetes, you did $185 million in sales in the fourth quarter. This quarter, you're only committing to $140 million. So that's the equivalent of the $45 million midpoint revenue guidance cut. I just want to confirm that the only adjustment to revenue guidance is this diabetes change.

好的。這很可能是多餘和明顯的，但去年在糖尿病領域，第四季的銷售額為 1.85 億美元。本季度，您僅承諾投入 1.4 億美元。因此，這相當於收入指導中點削減 4500 萬美元。我只是想確認收入指導的唯一調整是糖尿病的變化。

And then secondarily, you missed diabetes a little bit here this quarter, handful of millions of dollars, margin was good, but this is a much bigger step-down. So what is the margin impact whether it's fourth quarter or going into '25 from the significantly reduced diabetes revenue outlook? Thank you very much.

其次，本季你錯過了一點糖尿病，幾百萬美元，利潤率很好，但這是一個更大的下降。那麼，無論是第四季還是進入 25 世紀，糖尿病收入前景大幅下降對利潤率有何影響？非常感謝。

Sure, Eric. Yes, we'll confirm that the guide down is diabetes. I mean we are guiding down due to the recent CGM performance. When we think about what we were aiming at internally, Q3, we were down about $10 million top-line for diabetes. And so that's a little bit of this. We've rolled that ahead. But the rest of it is just not just not committing to any sequential growth in the quarter.

當然，埃里克。是的，我們會確認下來的指引是糖尿病。我的意思是，由於最近 CGM 的表現，我們的指引是向下的。當我們思考第三季的內部目標時，我們因糖尿病而減少了約 1000 萬美元的收入。這就是其中的一點點。我們已經將其推進了。但剩下的不僅僅是不承諾本季的任何連續成長。

Now it's pretty typical to get a bump-up as deductibles have reset and there's a big push in the fourth quarter. But again, until we resolve these operational issues, we just aren't ready to commit to higher growth, but it is all diabetes impacted.

現在，隨著免賠額的重置以及第四季度的大幅推動，獲得提升是很常見的。但同樣，在我們解決這些營運問題之前，我們還沒有準備好致力於更高的成長，但這都是糖尿病的影響。

When you think of the EBITDA the same way, I mean, we took about a third of that, top-line of the $45 million and we passed through $15 million flow-through to the bottom-line. Again, we wanted to put out numbers that we feel very good about hitting for the fourth quarter, and as we think about '25, as referenced earlier, I mean, we'll come forth with that guidance at the end of February.

當你以同樣的方式考慮 EBITDA 時，我的意思是，我們拿走了其中的大約三分之一，即 4500 萬美元的頂線，並且我們通過了 1500 萬美元的流入到底線。再次，我們希望公佈我們對第四季度達到的目標感到非常滿意的數字，並且當我們考慮 25 時，如前所述，我的意思是，我們將在 2 月底提出該指導。

And so, Jason, for both the revenue and the EBITDA, all of the -- all of the change was diabetes-specific?

那麼，傑森，對於收入和 EBITDA 來說，所有的變化都是針對糖尿病的？

Yes. Correct.

是的。正確的。

Okay. So you fixed that problem, you're back on track, there's nothing else here.

好的。所以你解決了這個問題，你又回到了正軌，這裡沒有其他的了。

Yes, that's right. I mean, when we look at the other product lines, we expect a solid fourth quarter out of sleep. As we've -- as we demonstrated, I think frankly, year-over-year respiratory, we believe, will continue to compound slowly. We add a couple of million a quarter consistently and that's what we're expecting out of that product line, and then all other categories, that -- which is will get reported in the future as wellness at home, we're expecting generally flat performance.

是的，沒錯。我的意思是，當我們審視其他產品線時，我們預計第四季將表現穩定。正如我們所展示的那樣，坦白說，我認為，我們相信，呼吸系統將繼續緩慢複合。我們每季持續增加數百萬，這就是我們對該產品線的預期，然後是所有其他類別，這將在未來作為家庭健康報告，我們預計總體持平表現。

I mean, we're going to take out about $7 million to $8 million from the custom rehab asset disposition. We accounted for that in the last guidance update when we reported Q2. So, yes, I think that if we're able to do better in diabetes, that will mean we'll do better as a portfolio, but the rest of the product lines are performing as expected.

我的意思是，我們將從定制康復資產處置中拿出大約 700 萬至 800 萬美元。當我們報告第二季度時，我們在上次指導更新中考慮了這一點。所以，是的，我認為如果我們能夠在糖尿病方面做得更好，這將意味著我們的產品組合會做得更好，但其餘產品線的表現符合預期。

Brian Tanquilut, Jeffries.

布萊恩·坦奎魯特，傑弗里斯。

Hi, good morning. Jason, in the prepared remarks, you guys talked about the app and the quick progress that you're seeing there, so just curious how you're thinking about the savings opportunity from reducing call center operations or call center interactions with patients over the next year or next 18 months?

嗨，早安。傑森，在準備好的發言中，你們談到了該應用程式以及您在那裡看到的快速進展，所以只是好奇您如何考慮在接下來的時間里通過減少呼叫中心運營或呼叫中心與患者的互動來節省成本的機會是今年還是未來 18 個月？

Yes, good question, Brian. I may answer that with some nuance. The intent of assembling the company going forward against these large patient chronic disease states, right, respiratory being one of them. The intent is really to focus our resources and our people against getting after that TAM, and in each of these categories, it's large TAM, it's growing rapidly, particularly in sleep respiratory, I mean, we're market leaders, and so the intent here is to assemble our resources and people around taking more than our fair share of really growing that top-line.

是的，好問題，布萊恩。我可能會稍微回答一下這個問題。組成公司的目的是對抗這些大型患者的慢性疾病，呼吸系統疾病就是其中之一。其目的實際上是集中我們的資源和人員來追趕TAM，在每個類別中，它都是大型TAM，它正在快速增長，特別是在睡眠呼吸領域，我的意思是，我們是市場領導者，因此意圖我們的目標是聚集我們的資源和人員，以超出我們應有的份額來真正增加營收。

As well, the intent is to improve the patient experience, drive better patient outcomes. Figure out how that converts to potentially rate increases or more volumes, right? So, we really want people and resources waking up every day and focus all day on those goals.

此外，其目的是改善患者體驗，並推動更好的患者治療結果。弄清楚這如何轉化為潛在的利率上漲或銷量增加，對嗎？因此，我們確實希望人員和資源每天醒來並專注於這些目標一整天。

And so yes, there's been great tech already installed here with respiratory. We think with dedicated leadership, those conversions will go faster. We'll learn more. We're capturing a tremendous amount of data from these interactions through this new tech that's been rolled out and these people are going to be focused on capitalizing on that growth going forward.

所以，是的，這裡已經安裝了很棒的呼吸技術。我們認為，有了專注的領導，這些轉變將會更快。我們會了解更多。我們正在透過已經推出的新技術從這些互動中捕獲大量數據，這些人將專注於利用未來的成長。

Got it. And then these - go ahead, Suzanne.

知道了。然後是這些——繼續吧，蘇珊娜。

Can I just add one thing on that? I just want to say, I know it's early days for us in terms of the automation and the AI and our launch of myAPP. But I have been incredibly encouraged by our ability to move quickly, as I said, it's a matter of weeks that we put something into production. That is because our existing tech architecture and infrastructure was already prepared to take on this more advanced technology.

我可以在此基礎上添加一件事嗎？我只是想說，我知道就自動化、人工智慧以及 myAPP 的推出而言，我們還處於早期階段。但我對我們快速行動的能力感到非常鼓舞，正如我所說，我們將產品投入生產只需要幾週的時間。這是因為我們現有的技術架構和基礎設施已經準備好採用這種更先進的技術。

And so our partner that we work with on this front said most companies do not have the infrastructure that's already ready to go. And so we have this diamond in the rough, if you will, of a strong technology infrastructure that we're going to be able to rapidly deploy responsibly the myAPP features and increased automation in AI. So more to come, early days as I suggested, but I do think it's the strength of AdaptHealth.

因此，我們在這方面的合作夥伴表示，大多數公司都沒有準備就緒的基礎設施。因此，如果您願意的話，我們擁有強大的技術基礎設施，我們將能夠快速、負責任地部署 myAPP 功能並提高人工智慧的自動化水平。正如我所建議的，未來還會有更多，但我確實認為這是 AdaptHealth 的優勢。

I appreciate that. And then maybe, Jason, my follow-up, just as I think about Medicare rates for calendar 2025, do you have visibility into what that rate adjustment looks like?

我很欣賞這一點。然後，Jason，我的跟進者，正如我思考 2025 年的醫療保險費率一樣，您是否了解費率調整的情況？

Well, we don't have visibility. We don't want to speculate, but we will offer some data. We would fully expect the DMEPOS Fee Schedule. It's typically published December 6, 7, kind of, in that ballpark. That is our expectation based on what we're hearing out of Washington. For those that may not follow that fee schedule, how it's constructed very closely, I mean it is an inflation-based measure. It compares the CPIU through June of the prior year. They take those rolling 12 months of the prior year.

好吧，我們沒有可見性。我們不想猜測，但我們會提供一些數據。我們完全期待 DMEPOS 費用表。它通常在 12 月 6 日至 7 日發布，大概是在那個球場上。這是我們根據從華盛頓聽到的消息得出的預期。對於那些可能不遵循該費用表的人，我的意思是它是一種基於通貨膨脹的衡量標準。它比較了去年 6 月的 CPIU。他們採用上一年滾動 12 個月的數據。

And so we know that number already. That's about 3% or so. Historically, there has been a labor productivity factor applied against that inflation measure that brings the rates down. It depends on the year. It could be half a point, it could be a point. So somewhere in that ballpark is generally what we are thinking. But again, we don't want to speculate on any of this until things are formally published, but hopefully that provides some perspective.

所以我們已經知道這個數字了。大約是3%左右。從歷史上看，一直有一個勞動生產力因素來對抗通膨指標，從而降低利率。這取決於年份。可以是半分，也可以是一分。所以我們通常在這個範圍內的某個地方思考。但同樣，在事情正式發布之前，我們不想對此進行任何猜測，但希望這能提供一些觀點。

I understand. Thank you.

我明白。謝謝。

Whit Mayo, Leerink Partners.

惠特·梅奧，Leerink 合夥人。

Thanks. Good morning. I got just one quick one. Just on the Humana contract, how that's tracking versus internal expectations, what you're excited about, not excited about? And just any other conversations with other payers? Is this something that you still want to expand? Just any additional thoughts would be helpful. Thanks.

謝謝。早安.我只有一張快的。就Humana合約而言，與內部預期相比，情況如何，你對什麼感到興奮，什麼不興奮？以及與其他付款人的任何其他對話嗎？這是您還想擴展的東西嗎？任何額外的想法都會有所幫助。謝謝。

Hi, Whit. I'll say that Humana is doing incredibly -- right, spot on, very good. We want more of this business. If you link back to my comments around putting more investment in people into the business on enterprise national accounts and managed care engagement, they are tasked with, are there more opportunities like Humana, we are exploring those and that's the type of business that I think is very good for us. So Humana has worked out very good, good partnership there, and hopefully, we'll have more of those to share soon.

嗨，惠特。我想說Humana 做得非常好——對，非常好。我們想要更多的這項業務。如果你連結回我關於在企業國民帳戶和管理式醫療參與方面對人員進行更多投資的評論，他們的任務是，是否有更多像Humana這樣的機會，我們正在探索這些，這就是我認為的業務類型對我們來說非常好。因此，Humana 在那裡建立了非常良好的合作關係，希望我們很快就能分享更多這樣的合作關係。

Great. Thanks.

偉大的。謝謝。

Richard Close, Canaccord.

理查德·克洛斯，Canaccord。

Yes. Just two questions, Suzanne, can you talk a little bit about the -- more the investments in the team, the changes that have been made, I guess, specifically on diabetes as well? And then the potential divestiture of these other businesses that Jason highlighted?

是的。只有兩個問題，蘇珊娜，你能談談對團隊的更多投資，我想，特別是在糖尿病方面所做的改變？那麼傑森強調的這些其他業務的潛在剝離呢？

Okay. I'll let Jason address the divestitures and let me talk about the team. So, the way we were organized is we had President of Diabetes, the COO, a sales group leader and diabetes was somewhat standalone, if you will, and then we have the remainder of the business.

好的。我會讓傑森解決資產剝離問題，並讓我談談團隊。因此，我們的組織方式是，我們有糖尿病總裁、營運長、銷售組領導，如果你願意的話，糖尿病在某種程度上是獨立的，然後我們擁有其餘的業務。

So in these changes, what we did is we tapped a very experienced, as I said, former CEO of one of our larger acquisitions, his name is Gary Sheehan to be General Manager, so we've abandoned the President role. The General Manager is going to report into our new Chief Operating Officer, Scott Barnhart, who I've mentioned in the past.

因此，在這些變化中，我們所做的是聘請一位經驗豐富的人擔任總經理，正如我所說，他是我們一項大型收購的前首席執行官，他的名字是加里·希恩（ Gary Sheehan），因此我們放棄了總裁的角色。總經理將向我之前提到的新任營運長 Scott Barnhart 匯報。

The reason for that change in reporting is because so much of what we need to do is to leverage our strengths on the sleep and respiratory side, the remainder of the business, for the diabetes business where it makes sense. And so having the GM sit underneath the Chief Operating Officer that can leverage the entire Adapt business where it makes sense was an important first step.

報告發生變化的原因是，我們需要做的大部分事情是利用我們在睡眠和呼吸方面的優勢，即業務的其餘部分，對於糖尿病業務來說是有意義的。因此，讓總經理擔任營運長的領導，可以在有意義的情況下利用整個 Adapt 業務，這是重要的第一步。

Given that Gary has a long history in leading Sleep HME business, in his words, he'll say, diabetes is essentially the same business without the big CPAP machine, the timeliness of service, the catering for the patient, the experience.

鑑於加里在領導睡眠 HME 業務方面擁有悠久的歷史，用他的話來說，糖尿病本質上是同樣的業務，沒有大型 CPAP 機器、服務的及時性、患者的餐飲和體驗。

So I'm very optimistic about his experience in leading the business, but also the mindset in the -- how he's going to think about leveraging the broader AdaptHealth business to improve our diabetes business.

因此，我對他領導業務的經驗以及他將如何考慮利用更廣泛的 AdaptHealth 業務來改善我們的糖尿病業務的心態非常樂觀。

Second to that, we appointed a new sales leader for the diabetes business, someone with med device background, his name is Graham Ward. He's been a top-season sales leader at the likes of Medtronic, had spent time in -- at Cardinal, and then most recently came over from Google where he was in a national accounts role.

其次，我們任命了一位新的糖尿病業務銷售主管，他有醫療設備背景，他的名字是格雷厄姆·沃德（Graham Ward）。他曾是美敦力（Medtronic）等公司的旺季銷售領導者，曾在卡迪納爾（Cardinal）工作過一段時間，最近從谷歌離職，擔任國民帳戶職位。

Graham has joined us and brings that very deep sales experience that he's getting his arms around the salesforce that we have understanding why that expansion didn't perform like it should have, putting in quotas territory management, but more importantly, doing exactly as Gary is doing where he's looking at the 700 salespeople we have out there on the HME side and saying how do we work together to not only use our 78 today's diabetes salespeople, but how do we bring our army of 700 to help support the cause because everyone across AdaptHealth knows that turning around diabetes is the most important thing we need to do.

格雷厄姆加入了我們，帶來了非常深厚的銷售經驗，他正在幫助銷售人員，我們了解為什麼擴張沒有達到應有的效果，實行配額區域管理，但更重要的是，完全按照加里的方式行事他看著我們HME 方面的700 名銷售人員，說我們如何共同努力，不僅利用我們今天的78 名糖尿病銷售人員，而且我們如何讓我們的700 名銷售人員來幫助支持這項事業，因為每個人都AdaptHealth 知道扭轉糖尿病是我們需要做的最重要的事情。

In addition to that, we talked about moving the Resupply business. It became obvious that we have a Diabetes Resupply business and then we have this crown jewel at AdaptHealth of our Sleep Resupply Center of Excellence out of Nashville. That leadership team is solid.

除此之外，我們也討論了轉移補給業務的問題。很明顯，我們擁有糖尿病補給業務，然後我們在納許維爾的 AdaptHealth 睡眠補給卓越中心擁有這顆皇冠上的寶石。這個領導團隊很紮實。

They have clear standard work, processes, proven excellence, and so we shifted our Resupply business to that team and that organization, and so through that infrastructure, we believe we'll be able to deliver a better resupply experience to the patient, and so I'm excited about that work. Those are the bigger changes.

他們擁有明確的標準工作、流程和經過驗證的卓越能力，因此我們將補給業務轉移給該團隊和該組織，因此透過該基礎設施，我們相信我們將能夠為患者提供更好的補給體驗，因此我對這項工作感到很興奮。這些是更大的變化。

So from the top, we have the new Chief Operating Officer, who is driving timely quality service. We have a new General Manager that's paying attention to the manufacturing relationships, how do we integrate and use the best of the best across AdaptHealth. A new sales leader and then a gentleman named, Matt Cox, who runs our sleep resupply that will be taking on the diabetes resupply for us.

因此，從高層來看，我們有新的首席營運官，他負責推動及時的優質服務。我們有一位新的總經理，他專注於製造關係，我們如何整合和利用整個 AdaptHealth 的精華。一位新的銷售主管和一位名叫馬特·考克斯（Matt Cox）的紳士負責管理我們的睡眠補給，該補給將負責為我們提供糖尿病補給。

And then switching gears, Richard, to potential disposition of assets. We're really talking about some of the subcategories in what we -- in the future we will be calling wellness at home. And so there's different products inside of wellness at home. Some include the classic bend metal, beds, wheelchairs, walkers. Now we like that business a lot.

然後，理查德，轉向潛在的資產處置。我們真正談論的是我們未來將稱之為家庭健康的一些子類別。因此，家庭健康領域有不同的產品。有些包括經典的彎曲金屬、床、輪椅、助行器。現在我們非常喜歡這項業務。

It's very important, particularly in securing hospital relationships where you're able to be the easy button for those preferring providers that are discharging patients, and as you deliver excellent service, you earn more referrals in our other core areas, most notably respiratory and sleep.

這非常重要，特別是在確保與醫院的關係方面，您可以成為那些喜歡為患者出院的提供者的簡單按鈕，並且當您提供優質的服務時，您可以在我們的其他核心領域（尤其是呼吸和睡眠）獲得更多轉介。

And so those products are ancillary, if you will, into the core, into those three core products that were -- that we intend to segment around. There's other lines of business inside of wellness to home, home infusion is one that comes to mind. I mean much like custom rehab, we've built up somewhat of a collection of assets over the years that were pieces and parts of other acquisitions.

因此，如果您願意的話，這些產品是輔助產品，是我們打算圍繞其細分的三個核心產品。除了家庭健康之外，還有其他業務，我想到的是家庭輸液。我的意思是，就像定制康復中心一樣，多年來我們已經建立了一些資產集合，這些資產是其他收購的一部分。

When you do this long enough and some of these can get pretty large. So does -- we're asking ourselves questions like, well, does that product line deliver ancillary business into the core? And so we're in process of answering those questions and making those determinations. I mean, there are other examples, but I won't get into those today. But that's really where our focus is to take areas where we just haven't paid enough attention.

當你這樣做足夠長的時間時，其中一些可能會變得相當大。我們也在問自己這樣的問題：該產品線是否將輔助業務納入核心業務？因此，我們正在回答這些問題並做出這些決定。我的意思是，還有其他例子，但我今天不會討論這些例子。但這確實是我們重點關注的領域，而我們還沒有給予足夠的重視。

These assets will be better owned by someone else. They're pretty low-growth for us and should improve margin, frankly, if and when we decide to dispose of them. And we'll continue to provide updates going forward.

這些資產最好由其他人擁有。它們對我們來說成長相當低，坦白說，如果我們決定處置它們，利潤率應該會提高。我們將繼續提供更新。

Okay, thank you.

好的，謝謝。

(Operator Instructions)

（操作員說明）

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hi guys, thanks for taking my questions. Can you talk a little back to the CGM reordering issues that you talked about on the call, you have such a good model for DME, reordering for your whole business. So can you quantify how big those CGM delays were in the reordering, why those were delayed and how you can fix it and if those delays were in both pharmacy and DME?

大家好，感謝您回答我的問題。您能否稍微回顧一下您在電話中談到的 CGM 重新排序問題，您有一個很好的 DME 模型，可以為您的整個業務重新排序。那麼，您能否量化重新訂購過程中 CGM 延遲有多大、延遲的原因以及如何修復它，以及這些延遲是否同時存在於藥房和 DME 中？

So, a couple of things, Pito. First, we'd say that starting with sleep resupply in our Nashville operations center, I mean we've got hundreds and hundreds of people working out of that center, the tech that is used there that sits on top of Brightree.

所以，有幾件事，皮托。首先，我們想說，從我們納許維爾營運中心的睡眠補給開始，我的意思是我們有成百上千的人在該中心工作，該中心使用的技術位於 Brightree 頂部。

Some of that core design was frankly developed by AdaptHealth and employees at AdaptHealth and it's so ingrained into our workflows. So it operates with the precision of knowing exactly what the patient qualifies for.

坦白說，其中一些核心設計是由 AdaptHealth 和 AdaptHealth 的員工開發的，並且它已深深融入我們的工作流程中。因此，它的運作精確地了解患者的資格。

We know the benefits of proper resupply following proper cadence and that team works to advise patients -- work with patients on things that aren't their adherence, like things aren't fitting properly or they might have a different model that they want to explore. And so those teams are just so highly skilled with that.

我們知道按照適當的節奏進行適當補給的好處，並且該團隊致力於為患者提供建議 - 與患者一起處理不符合他們要求的事情，例如事情不合適或他們可能有他們想要探索的不同模型。所以這些團隊在這方面的技術非常高超。

Historically, we have not yet integrated our diabetes resupply operation into Nashville, frankly, because we had integration work to do on the eight different diabetes companies that we bought. And so there was a couple of years of work that went into consolidating all of those patients onto single platforms, single databases, and that work has been completed.

坦白說，從歷史上看，我們尚未將我們的糖尿病補給業務整合到納許維爾，因為我們需要對我們收購的八家不同的糖尿病公司進行整合工作。因此，我們花了幾年的時間將所有這些患者整合到單一平台、單一資料庫上，而這項工作已經完成。

And so a very quick move that Suzanne has directed and the team is carrying out is to now take advantage of all the capability and infrastructure that we've got out of Nashville and bring diabetes into that.

因此，蘇珊（Suzanne）指導和團隊正在執行的一個非常快速的行動是，現在利用我們從納許維爾獲得的所有能力和基礎設施，並將糖尿病納入其中。

In terms of quantifying, I mean, the overarching compression over the prior year. I mean, think of it in three buckets, fairly equal buckets. The first being real reimbursement change, pressure from specific payers that we've named in previous calls that shifted to 100% pharmacy, and that was ground that we had to make up.

在量化方面，我的意思是前一年的整體壓縮。我的意思是，將其分為三個桶，相當相等的桶。第一個是真正的報銷變化，來自我們在之前的電話中提到的特定付款人的壓力，這些付款人轉向了 100% 藥房，這是我們必須彌補的。

And so we're continuing to absorb that and we will as well in the fourth quarter until we lap those changes next year. The second is in new starts. I mean, we were a little short in Q2, but it was too early to call revenue down as a lot of these sales folks are still new. As Suzanne said, I mean, there's a lot to be done to optimize their workflows and we think that Gary, Graham, and others are going to do a great job with that.

因此，我們將繼續吸收這一點，我們也會在第四季度進行，直到明年我們完成這些變化。二是新起點。我的意思是，我們第二季的業績有點短缺，但現在就下調收入還為時過早，因為許多銷售人員仍然是新人。正如蘇珊所說，我的意思是，優化他們的工作流程還有很多工作要做，我們認為加里、格雷厄姆和其他人會在這方面做得很好。

But just that miss in Q2 and then in Q3, the in-quarter miss against new starts that had an impact. And has a carry forward into Q4 that we made an adjustment for. And then finally, is on the recur. Frankly, just dropping the ball in who is eligible, when, and making sure that we've got timely order confirmation and delivery of products, so those are the three buckets and those are the three areas that Suzanne brought forth the plan that we're going to run against here over the next 90 days.

但正是第二季和第三季的失誤，季內對新開局的失誤產生了影響。並結轉到第四季度，我們對此進行了調整。最後，是循環。坦白說，只是決定誰有資格、何時，並確保我們及時確認訂單和交付產品，所以這些是三個桶，這些是蘇珊娜提出的計劃的三個領域。這裡進行競選。

Okay, great. And then a follow-up question here is, just looking at the overall market growth between the two channels, pharma channel and DME, I guess, what do you think that those two channels are growing in 2024? And as you think about sort of growth in the out years, kind of where do you guys think that you guys can grow within both channels? Thanks.

好的，太好了。接下來的問題是，只要看看製藥通路和 DME 這兩個通路之間的整體市場成長，我想，您認為這兩個通路在 2024 年的成長情況如何？當你考慮未來幾年的成長時，你們認為你們可以在這兩個管道中實現哪些成長？謝謝。

Yes. I mean, it's again too early for us to comment on '25 or even beyond. We do know that right now, there are competitors in this space with same or similar capabilities that we have that are growing quite nicely. And so our job is to first stabilize and prevent compression and then get back to growth mode, and that's what we're focused on.

是的。我的意思是，我們現在對 25 年甚至更久的事情發表評論還為時過早。我們確實知道，目前這個領域的競爭對手與我們具有相同或相似的能力，並且發展得相當不錯。所以我們的工作是先穩定並防止壓縮，然後回到成長模式，這就是我們的重點。

Okay. Great. Thanks so much.

好的。偉大的。非常感謝。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Hi, guys. Thanks for squeezing me in here. Just a quick question and apologies if I missed this, but I think last quarter you talked about some of that channel shift, maybe some reabsorption or transition back among some carriers to the DME channel. Just wanted to see if there was any -- you've kind of outlined your expectations for 4Q, but is there any indication to how that could look into next year? Is there any transition back incremental that you're seeing or any indication of how that balance will kind of even out long-term? Thanks.

嗨，大家好。謝謝你把我擠在這裡。只是一個簡單的問題，如果我錯過了這一點，我深表歉意，但我認為上個季度您談到了一些管道轉移，也許一些運營商之間有一些重新吸收或過渡回 DME 管道。只是想看看是否有任何 - 您已經概述了您對第四季度的期望，但是否有任何跡象表明明年會如何？您是否看到任何回增量的轉變，或有任何跡象表明這種平衡將如何長期平衡？謝謝。

Hi, Ben, it's Jason. You know, not since last quarter. I mean, we did call reference to two Southeast states regarding Medicaid where they laid in new policy that was somewhat advantageous. And so, we're doing our work there to start earning some business. But it's nothing material that's impacting the top line.

嗨，本，我是傑森。你知道，從上個季度開始就沒有了。我的意思是，我們確實提到了關於醫療補助的兩個東南部州，他們制定了一些有利的新政策。因此，我們在那裡開展工作是為了開始賺取一些業務。但這並不影響營收。

Regarding any future shifts or changes one way or the other, I think we'll reserve those comments until open enrollment season wraps up and payers publish new policy as we're getting into January and we'll have something to talk about when we report at the end of February.

關於任何未來的轉變或改變，我認為我們會保留這些評論，直到開放註冊季節結束並且付款人在我們進入一月份時發布新政策，當我們報告時我們會有一些東西要討論二月底。

Great, thanks, guys.

太好了，謝謝你們。

Thank you. And it appears that we have no further questions at this time. I will now turn the program back to Suzanne Foster.

謝謝。目前看來我們沒有其他問題了。現在我將把這個節目轉回給蘇珊娜·福斯特。

Well, once again, everyone, I just want to thank you for tuning in this morning. I mean, the takeaway, hopefully, you get the gist of it is that kind of the 80-20 role is with diabetes being 17% of our revenue, we definitely have an opportunity there and we are incredibly focused on improving in that area. And the guide that we issued today is really to de-risk that and give the team time to perform. But 80% of our business continues to perform solid.

好吧，再次感謝大家，我只是想感謝你們今天早上的收聽。我的意思是，希望你能明白重點是，80-20 的角色是糖尿病占我們收入的 17%，我們絕對有機會，而且我們非常專注於在該領域進行改進。我們今天發布的指南實際上是為了降低風險並給團隊時間來執行。但我們 80% 的業務仍表現穩健。

There's obviously an opportunity for continuous improvement, but we are working on that as well with the addition of a lot of technology and myAPP and people and org structure will continue that work, but very optimistic about the core of our business and our future. So I hope to see you all out there on the road and thanks again.

顯然有一個持續改進的機會，但我們也在努力增加大量技術，myAPP 以及人員和組織結構將繼續這項工作，但對我們業務的核心和未來非常樂觀。因此，我希望在路上見到你們，並再次表示感謝。

Thank you. This does conclude today's presentation. Thank you for your participation. You may disconnect at any time.

謝謝。今天的演講到此結束。感謝您的參與。您可以隨時斷開連線。