Amedisys Inc (AMED) 2022 Q4 法說會逐字稿

Greetings and welcome to the Amedisys Fourth Quarter 2022 Earnings Conference Call. (Operator Instructions) As a reminder, this conference is being recorded.

歡迎來到 Amedisys 2022 年第四季度收益電話會議。 （操作員說明）提醒一下，正在錄製此會議。

It is now my pleasure to introduce your host, Mr. Nick Muscato, Chief Strategy Officer. Thank you. Please go ahead.

現在我很高興向您介紹主持人，首席戰略官 Nick Muscato 先生。謝謝。請繼續。

Thank you, operator, and welcome to the Amedisys investor conference call to discuss the results of the fourth quarter and year ended December 31, 2022. A copy of our press release, supplemental slides and related Form 8-K filing with the SEC are available on the Investor Relations page of our website.

謝謝運營商，歡迎參加 Amedisys 投資者電話會議，討論截至 2022 年 12 月 31 日的第四季度和年度的結果。我們的新聞稿副本、補充幻燈片和向美國證券交易委員會提交的相關 8-K 表格備案均已提供在我們網站的投資者關係頁面上。

Speaking on today's call from Amedisys will be Paul Kusserow, Chairman and CEO; and Scott Ginn, CFO and Acting COO.

Amedisys 董事長兼首席執行官 Paul Kusserow 將在今天的電話會議上發言；首席財務官兼代理首席運營官 Scott Ginn。

Before we get started with our call, I would like to remind everyone that statements made on this conference call today may constitute forward-looking statements and are protected under the safe harbor of the Private Securities Litigation Reform Act. These forward-looking statements are based on information available to Amedisys today. The company assumes no obligation to update information provided on this call to reflect subsequent events other than as required under applicable securities laws.

在開始我們的電話會議之前，我想提醒大家，今天在電話會議上發表的聲明可能構成前瞻性聲明，並受到《私人證券訴訟改革法》安全港的保護。這些前瞻性陳述基於 Amedisys 今天可獲得的信息。除適用證券法要求外，公司不承擔更新本次電話會議提供的信息以反映後續事件的義務。

These forward-looking statements may involve a number of risks and uncertainties, which may cause the company's results or actual outcomes to differ materially from such statements. These risks and uncertainties include factors detailed in our SEC filings, including our Forms 10-K, 10-Q and 8-K. In addition, as required by SEC Regulation G, a reconciliation of any non-GAAP measure mentioned during our call today to the most comparable GAAP measure will also be available in our Forms 10-K, 10-Q and 8-K.

這些前瞻性陳述可能涉及許多風險和不確定性，這可能導致公司的結果或實際結果與此類陳述存在重大差異。這些風險和不確定性包括我們向美國證券交易委員會提交的文件中詳述的因素，包括我們的 10-K、10-Q 和 8-K 表格。此外，根據 SEC 法規 G 的要求，我們的 10-K、10-Q 和 8-K 表格中也將提供我們今天電話會議中提到的任何非 GAAP 指標與最具可比性的 GAAP 指標的對賬。

Thank you, and I'll turn the call over to Amedisys' Chairman and CEO, Paul Kusserow.

謝謝，我會把電話轉給 Amedisys 的董事長兼首席執行官 Paul Kusserow。

Thanks, Nick. Hello, everyone, and welcome to the Amedisys Fourth Quarter and Year-end 2022 Earnings Call. It's a privilege to be back and talking to you all again. In a few short months I've been back as CEO, I've had the distinct pleasure of spending time in the field with our clinicians who provide the highest-quality care to their patients wherever they call home. What you do on a daily basis is truly inspiring and reaffirms to me more than ever that the future of Amedisys is extraordinary and unique.

謝謝，尼克。大家好，歡迎來到 Amedisys 第四季度和年終 2022 年財報電話會議。很榮幸能回來和大家再次交談。在短短幾個月內，我重新擔任首席執行官，我非常高興能在現場與我們的臨床醫生共度時光，他們為患者提供最優質的護理，無論他們身在何處。你每天所做的事情真的很鼓舞人心，並且比以往任何時候都更讓我確信 Amedisys 的未來是非凡而獨特的。

Despite a choppy 2022, our 20,000-plus associates have successfully steered us to deliver results that we can really be proud of. As I've returned as CEO, the 2 questions I get are: one, what's changed?; and two, what are you going to focus on?

儘管 2022 年動盪不安，但我們的 20,000 多名員工成功地引導我們取得了令我們真正引以為豪的成果。當我重新擔任 CEO 時，我收到的兩個問題是：第一，發生了什麼變化？第二，你要關注什麼？

Our world has definitely changed. There's no question about it. As the philosopher Heraclitus said, "You can never step into the same river twice," and that's certainly the case in our industry. Our world is rapidly evolving, but mercifully, the trends are moving towards Amedisys and our industries, not away from us.

我們的世界肯定已經改變了。毫無疑問。正如哲學家赫拉克利特所說，“人永遠不可能兩次踏入同一條河流”，在我們的行業中確實如此。我們的世界正在迅速發展，但幸運的是，趨勢正朝著 Amedisys 和我們的行業發展，而不是遠離我們。

There's a new paradigm driven by consumerism, demographics, advances in care delivery and cost of driving care into the home. Various elements of our world are evolving at different speeds. Regulators, some of our Medicare Advantage partners, are moving more slowly than we would like. Others are seeing where this is going and are actively innovating with us to meet us where the world is evolving towards.

消費主義、人口統計、護理服務的進步以及將護理帶入家庭的成本推動了一種新的範式。我們世界的各種元素正在以不同的速度發展。監管機構是我們的一些 Medicare Advantage 合作夥伴，他們的行動比我們希望的要慢。其他人看到了這件事的發展方向，並與我們一起積極創新，以滿足我們世界的發展方向。

Change creates opportunity. Accelerated change creates dynamic opportunity. We're in a time of rapid change, hence, my excitement and enthusiasm for how we have positioned ourselves and the opportunities that will come.

變化創造機會。加速變革創造了動態機會。我們正處於一個快速變化的時代，因此，我對我們如何定位自己以及即將到來的機會感到興奮和熱情。

So what's different? First, there is a significant clinical labor shortage, especially in nursing. COVID did a number on field-based clinicians. Demand is outstripping supply more dramatically than ever. This is likely to continue. The winners in our world will be those companies that have the capacity to fulfill the demand.

那麼有什麼不同呢？首先，臨床勞動力嚴重短缺，尤其是在護理方面。 COVID 對現場臨床醫生做了很多工作。需求比以往任何時候都更加嚴重地超過供應。這可能會持續下去。我們世界的贏家將是那些有能力滿足需求的公司。

Second, our mix of payers is changing. Medicare Advantage is growing faster than fee-for-service. Some of our Medicare Advantage partners are enlightened and are working with us to secure the labor capacity they will need. Others are trying to play the old game of low per visit rates and expecting in an inflationary environment to keep their rates artificially low. The industry just can't do it, neither can we.

其次，我們的付款人組合正在發生變化。 Medicare Advantage 的增長速度快於按服務收費。我們的一些 Medicare Advantage 合作夥伴很開明，正在與我們合作以確保他們需要的勞動力。其他人則試圖玩低每次訪問率的老遊戲，並期望在通貨膨脹的環境中人為地保持低利率。行業做不到，我們也做不到。

When scarcity increases, demand goes up, and we are now in a new world where we must pick which visits we take or won't take. We're working through this now, giving all our partners an opportunity to understand what's going on in this emerging environment.

當稀缺性增加時，需求增加，我們現在處於一個新世界，我們必須選擇我們接受或不接受的訪問。我們現在正在努力解決這個問題，讓我們所有的合作夥伴都有機會了解這個新興環境中發生的事情。

Helping drive this change is consolidation in our industry, scarcity of supply and increasingly long lengths of stays in hospitals, which are driving an already stretched business into further losses. Many of our payer partners are talking about increased post-acute spend much due to lack of availability in at-home care. We are the most efficient alternative of all the post-acute options, and we'll increase our share of post-acute spend as we move up the acuity spectrum.

幫助推動這一變化的是我們行業的整合、供應短缺和住院時間越來越長，這使本已不堪重負的業務進一步虧損。由於缺乏家庭護理，我們的許多付款合作夥伴都在談論增加急性後支出。我們是所有急性後選項中最有效的選擇，隨著我們提升敏銳度範圍，我們將增加我們在急性後支出中的份額。

Home health and Amedisys in particular are the most cost-efficient alternative of the post-acute options, and we will increase our share of post-acute spend as we move our way up the acuity spectrum. So increasingly, payers will be coming to home health and we believe disproportionately to Amedisys as we are arguably the only company taking true post-acute risks. So changing times, exciting times.

家庭健康，尤其是 Amedisys 是急性後期選擇中最具成本效益的替代方案，隨著我們在敏銳度範圍內的發展，我們將增加我們在急性後期支出中的份額。因此，越來越多的付款人將開始關注家庭健康，我們非常相信 Amedisys，因為我們可以說是唯一一家真正承擔急性後期風險的公司。如此變化的時代，激動人心的時代。

Now how are we going to go out and get what's ours? The answer is 4 strategic initiatives, which we think will best drive our caregiving and business results. They are, one, people. As I said, luckily, the world has changed. It's all about recruiting, developing and retaining our clinicians, which drives our ability to grow and continue to provide the best-in-class clinical quality Amedisys has become known for. We're rapidly emerging into a capacity-constrained industry. Those that have the workers will win. We're the best, but that isn't good enough in this environment. We're going to be better.

現在我們要怎麼出去拿我們的東西呢？答案是我們認為最能推動我們的護理和業務成果的 4 項戰略舉措。他們是，一個，人。正如我所說，幸運的是，世界已經改變了。這一切都是關於招聘、發展和留住我們的臨床醫生，這推動了我們成長的能力，並繼續提供 Amedisys 眾所周知的一流臨床質量。我們正在迅速進入一個產能受限的行業。那些擁有工人的人將獲勝。我們是最好的，但在這種環境下這還不夠好。我們會變得更好。

We'll continue to be the best place where clinicians want to come and deliver the highest-quality care in the home. We're seeing strong results early on, especially in recruiting as we doubled down on our focus here as January was our highest single month of starts in Amedisys' history.

我們將繼續成為臨床醫生希望前來並在家中提供最高質量護理的最佳場所。我們很早就看到了強勁的結果，尤其是在招聘方面，因為我們加倍關注這裡，因為 1 月份是 Amedisys 歷史上開工率最高的一個月。

Two, growth. As capacity becomes a foundational issue, we will have to choose our partners carefully. This is a new world for us, and we will not be commoditized. We will drive predictable results and outpace the industry's growth in both home health and hospice while managing our precious clinical capacity to make sure that we can take all the patients that are coming to us. As Medicare Advantage continues to outpace fee-for-service growth, we need to align with partners who can pay us enough to deliver the quality care that's needed for their members.

二、成長。隨著能力成為一個基本問題，我們將不得不謹慎選擇我們的合作夥伴。這對我們來說是一個新世界，我們不會被商品化。我們將推動可預測的結果並超越行業在家庭健康和臨終關懷方面的增長，同時管理我們寶貴的臨床能力，以確保我們能夠接納所有來找我們的患者。隨著 Medicare Advantage 的增長速度繼續超過按服務收費的增長速度，我們需要與能夠向我們支付足夠費用以提供其會員所需的優質護理的合作夥伴保持一致。

Next, clinical optimization and automation. We must remove as much of the administrative burden from our care center staff and allow them to build a focused care center culture where clinicians want to be so that they can provide the highest-quality care to our patients. These are self-initiated efficiency moves. It's totally in our hands to drive this initiation successfully, which we will do.

接下來，臨床優化和自動化。我們必須盡可能減輕護理中心工作人員的行政負擔，並允許他們建立臨床醫生希望成為的重點護理中心文化，以便他們能夠為我們的患者提供最高質量的護理。這些是自我發起的效率舉措。成功推動這一啟動完全掌握在我們手中，我們將做到這一點。

And last, Contessa, our high-acuity segment truly differentiates us from our competition while opening up wholly new markets and growth opportunities in places few, if any, others can go. It is up to us to go show you all what this highly innovative asset can be by continuing to grow it and making it profitable. High-acuity, risk-based care in the home is the future.

最後，Contessa，我們的高敏度細分市場真正使我們從競爭中脫穎而出，同時在其他人很少（如果有的話）的地方開闢了全新的市場和增長機會。我們有責任通過繼續發展並使其盈利，向您展示這種高度創新的資產可以做什麼。高度敏銳、基於風險的家庭護理是未來。

We see the tremendous demand. Our partners are asking for more, and we're committed to giving them more. It's a good situation when demand for your product is so strong.

我們看到了巨大的需求。我們的合作夥伴要求更多，而我們致力於為他們提供更多。當對您的產品的需求如此強勁時，這是一個很好的情況。

These are the big 4. That's what we'll measure ourselves on. We'll report out to you on these measures and their impacts as we progress through the year. Now let's dive a little deeper into each and what you should expect in 2023.

這些是四巨頭。這就是我們衡量自己的標準。隨著我們這一年的進展，我們將向您報告這些措施及其影響。現在讓我們更深入地探討每一個問題以及您在 2023 年應該期待什麼。

Growth and people are joined at the hip. As I mentioned, demand for our services is at an all-time high, while access to clinicians to fulfill this increase in demand has been challenged. In order to service the increased number of referrals, we must have the clinical capacity to do so.

增長和人是緊密相連的。正如我所提到的，對我們服務的需求處於歷史最高水平，而獲得臨床醫生來滿足這種需求增長卻受到了挑戰。為了為越來越多的轉介提供服務，我們必須具備這樣做的臨床能力。

As we continue to dig in our employees -- into our employees' data, we have found that 66% of clinical turnover happens in year 1, a dynamic we are aggressively changing. As mentioned, our enhanced talent acquisition team has done a great job bringing more qualified clinicians on board, but we must keep them once they are here. In fact, from August 2022 through January 2023, we had 26% more nursing starts than January through July of '22, and January of 2023 was our best month ever for overall offers.

隨著我們繼續深入了解我們的員工——深入了解我們員工的數據，我們發現 66% 的臨床人員流動發生在第一年，我們正在積極改變這種動態。如前所述，我們增強的人才招聘團隊在吸引更多合格臨床醫生方面做得很好，但一旦他們來到這裡，我們就必須留住他們。事實上，從 2022 年 8 月到 2023 年 1 月，我們的護理開始比 22 年 1 月到 7 月多 26%，而 2023 年 1 月是我們有史以來最好的整體報價月份。

So what else are we doing about staffing? We are going further and creating an unrivaled people experience here at Amedisys by simplifying our administrative processes, enabling our caregivers with tools to make their jobs easier, improving our leadership development for our 550 dues, streamlining onboarding -- our onboarding processes, investing in our employees and rolling out an enhanced benefit package specifically focused on aligning with what is important to our clinicians.

那麼我們在人員配備方面還做了些什麼？我們正在走得更遠，通過簡化我們的行政流程，使我們的護理人員能夠使用工具使他們的工作更輕鬆，改善我們的 550 會費領導力發展，簡化入職 - 我們的入職流程，投資於我們員工，並推出增強的福利方案，特別側重於與對我們的臨床醫生重要的事情保持一致。

The combination of these activities will truly enable Amedisys to hold its position as the health care employer of choice. It will decrease our turnover, increase our clinical capacity and in turn, continue to supercharge our growth. We've done it before. We'll do it again, and we will update you on how we're doing.

這些活動的結合將真正使 Amedisys 保持其作為首選醫療保健雇主的地位。它將減少我們的營業額，提高我們的臨床能力，進而繼續推動我們的增長。我們以前做過。我們會再做一次，我們會向您介紹我們的進展情況。

Growth has been and always will be a key initiative for Amedisys. Although the way in which we think about growth has been challenging as our markets look different today than they have in the past, the demand for our services in home health is at an all-time high as patients and payers continue to recognize and demand that more and more care can be delivered in the home. That is where patients want to be and the costs are less than any other site of care while we deliver outcomes that are equal and in many times better than institutional care. Hospice is the same: high demand to die with dignity at home.

增長一直是並將永遠是 Amedisys 的一項關鍵舉措。儘管我們考慮增長的方式一直具有挑戰性，因為我們的市場今天看起來與過去不同，但由於患者和付款人繼續認識到並要求我們在家庭健康方面的服務需求處於歷史最高水平越來越多的護理可以在家中提供。這就是患者想要去的地方，而且成本低於任何其他護理場所，而我們提供的結果與機構護理相同，而且在很多時候更好。臨終關懷是一樣的：對在家中有尊嚴地死去的要求很高。

We know that the industry over the medium term should be growing at a mid-single-digit pace. What has been different for us has been where the growth is coming from. Historically, fee-for-service has been our main driver of revenue growth. However, as Medicare Advantage penetration continues to significantly outpace fee-for-service growth, we must think differently about how and where we grow. Amedisys has been at the forefront of working with Medicare Advantage plans for the past number of years.

我們知道，從中期來看，該行業應該以中個位數的速度增長。對我們來說不同的是增長的來源。從歷史上看，按服務收費一直是我們收入增長的主要驅動力。然而，隨著 Medicare Advantage 滲透率繼續顯著超過按服務收費的增長速度，我們必須以不同的方式思考我們的增長方式和地點。在過去的幾年裡，Amedisys 一直處於與 Medicare Advantage 計劃合作的最前沿。

We have executed innovative case rate contract with our partners at CVS and Aetna and figured out ways to work strategically with our convener partners, and at the same time, have taken market share and fee-for-service. We have developed great relationships with some plans who recognize how our quality and scale differentiates us from our peers.

我們已經與 CVS 和 Aetna 的合作夥伴執行了創新的案例費率合同，並想出了與我們的召集合作夥伴進行戰略合作的方法，同時已經獲得了市場份額和按服務收費。我們與一些認識到我們的質量和規模如何使我們有別於同行的計劃建立了良好的關係。

That said, not all plans are created equal. And for those plans that continue to view us simply as a cheap per visit provider and won't recognize that labor inflation is real and try to simply cram lower rates and lower utilization on us, we will no longer be working with them. We just can't afford to. We have a finite amount of clinical capacity, and we must be paid in a manner that allows us to provide quality of care with the excellent outcomes Amedisys is known for. If plans do not want to partner with us on reasonable terms, we will have to cancel contracts and defer our capacity to our strategic partners who value our results.

也就是說，並非所有計劃都是平等的。對於那些繼續將我們簡單地視為每次就診便宜的提供者並且不承認勞動力通脹是真實的並試圖簡單地向我們收取較低利率和較低利用率的計劃，我們將不再與他們合作。我們只是負擔不起。我們的臨床能力有限，我們的報酬必須能夠讓我們提供優質的護理，並取得 Amedisys 眾所周知的卓越成果。如果計劃不想以合理的條件與我們合作，我們將不得不取消合同並將我們的能力推遲給重視我們結果的戰略合作夥伴。

In order to allow our clinicians to focus on what matters most, patient care, our care center leadership, focusing on building culture that recruits and retains the best people, we will continue with the clinical optimization activities we rolled out in the second half of 2022. We want to remove as much of the administrative burden as is possible in our care centers. This will not only drive improved and focused culture, but it will allow us to scale our infrastructure in a more cost-effective manner while building in yet another layer of efficiency and accuracy across our processes.

為了讓我們的臨床醫生專注於最重要的事情，患者護理，我們的護理中心領導，專注於建立招聘和留住最優秀人才的文化，我們將繼續開展我們在 2022 年下半年推出的臨床優化活動. 我們希望盡可能減輕護理中心的行政負擔。這不僅會推動改進和專注的文化，而且將使我們能夠以更具成本效益的方式擴展我們的基礎設施，同時在我們的流程中建立另一層效率和準確性。

To date, we have centralized our volunteer and bereavement services across our hospice locations, our intake functions across home health, and we have a number of other pilots set to roll out in 2023. As Scott will discuss, the impact of these initiatives will drive nearly $20 million in cost savings in 2023, and we should see another step-up in savings as we enter 2024.

迄今為止，我們已將我們的志願者和喪親服務集中在我們的臨終關懷地點，我們的接收功能在家庭健康中，我們還有許多其他試點計劃將於 2023 年推出。正如 Scott 將討論的那樣，這些舉措的影響將推動到 2023 年將節省近 2000 萬美元的成本，進入 2024 年，我們應該會看到節省的成本再次增加。

Finally, Contessa, our innovative high-acuity care acquisition that closed in August of 2021, has not been immune to the impacts of hospital performance and the labor environment that has had its effect on health care services. Though we recognize we are behind our original plan, we are growing nicely and planfully. We have tremendous conviction for what Contessa does, where it will take us and the growth potential for its lines of business.

最後，我們於 2021 年 8 月完成的創新性高敏度護理收購 Contessa 未能倖免於醫院績效和對醫療保健服務產生影響的勞動環境的影響。儘管我們認識到我們落後於最初的計劃，但我們正在有條不紊地成長。我們對 Contessa 所做的事情、它將把我們帶到哪里以及其業務線的增長潛力充滿信心。

In fact, in Q4, total admissions from Hospital and SNF at Home were 482, representing a 69% growth rate year-over-year. For full year 2022, we treated 607 patients in our hospital and SNF programs, representing 100-plus percent growth year-over-year.

事實上，在第四季度，醫院和 SNF 在家的總入院人數為 482 人，同比增長 69%。 2022 年全年，我們在醫院和 SNF 項目中治療了 607 名患者，同比增長 100% 以上。

Contessa is focused on mining and growing our core partnerships while executing 2 to 3 new partnerships a year. The patients we admitted to these high-acuity models continue to generate positive clinical and financial outcomes. Our patient satisfaction remains in excess of 85%. And these programs continue to deliver on quality by driving down repeat hospitalizations when compared to traditional care pathways.

Contessa 專注於挖掘和發展我們的核心合作夥伴關係，同時每年執行 2 到 3 個新的合作夥伴關係。我們接納這些高敏度模型的患者繼續產生積極的臨床和財務結果。我們的患者滿意度保持在 85% 以上。與傳統護理途徑相比，這些計劃通過降低重複住院率繼續提供優質服務。

Our ability to reduce patients' total cost of care through high-touch clinical management continues to track with our expectations for MLR performance. We are also excited with the recent regulatory development in this space. As part of the Omnibus spending bill that became law on December 29, 2022, CMS extended the acute hospital care at-home initiative until December 31, 2024. While Contessa's work began much before the public health emergency, the CMS initiative began during the pandemic as a way to address the safe expansion of hospital capacity.

我們通過高接觸臨床管理降低患者總護理成本的能力繼續符合我們對 MLR 性能的期望。我們也對這一領域最近的監管發展感到興奮。作為於 2022 年 12 月 29 日成為法律的綜合支出法案的一部分，CMS 將急性醫院在家護理計劃延長至 2024 年 12 月 31 日。雖然 Contessa 的工作早在突發公共衛生事件之前就開始了，但 CMS 計劃是在大流行期間開始的作為解決醫院容量安全擴展的一種方式。

With this recognition, an extended acceptance of Hospital at Home programs by CMS, our view is that we are likely to see acceleration of the proliferation of high-acuity, in-home programs in years to come.

有了這種認識，以及 CMS 對家庭醫院計劃的廣泛接受，我們的觀點是，我們很可能會在未來幾年看到高敏度家庭計劃的擴散加速。

Lastly and most importantly, I've been out visiting our JV partners. And the biggest issue they have with us is they want more faster, a good situation to be in when your customer's main issue is they can't get enough of what you have. We are focused on scaling our operations up. The potential of each of our partners is enormous.

最後也是最重要的是，我一直在外地拜訪我們的合資夥伴。他們對我們最大的問題是他們想要更快，當你的客戶的主要問題是他們無法獲得足夠的東西時，這是一個很好的情況。我們專注於擴大我們的業務。我們每個合作夥伴的潛力都是巨大的。

As Scott will lay out in our 2023 guidance, revenue at Contessa will be nearly $50 million driven by increased volume from our current JV partners, new volume from JVs we have recently signed but not implemented. And maybe most excitingly, our new risk partnership with Blue Cross Blue Shield of Tennessee to provide palliative care services at home. This new innovative partnership really showcases the power of a combined Amedisys and Contessa clinical asset. And we are thankful for our partners at Blue Cross Blue Shield of Tennessee and their desire to disrupt how health care is provided to their high-acuity Medicare Advantage members.

正如 Scott 將在我們的 2023 年指南中所闡述的那樣，Contessa 的收入將接近 5000 萬美元，這得益於我們當前合資夥伴的銷量增加，以及我們最近簽署但尚未實施的合資企業的新銷量。也許最令人興奮的是，我們與田納西州的 Blue Cross Blue Shield 建立了新的風險合作夥伴關係，以提供居家姑息治療服務。這種新的創新合作夥伴關係真正展示了 Amedisys 和 Contessa 臨床資產相結合的力量。我們感謝我們在田納西州 Blue Cross Blue Shield 的合作夥伴，感謝他們希望打破向高敏度 Medicare Advantage 會員提供醫療保健的方式。

In our palliative care at-home model, Blue Cross Blue Shield of Tennessee's members can receive palliative care in person or via telehealth from Amedisys' clinicians, including doctors, nurse practitioners and nurses at no additional cost. We started with a middle Tennessee rollout in January and have plans to expand to the entire state as we prove out performance in the model. I'm incredibly excited by this opportunity, and you all should be expecting more innovative partnerships like this to come in the future.

在我們的居家姑息治療模式中，Blue Cross Blue Shield of Tennessee 的成員可以親自或通過 Amedisys 臨床醫生（包括醫生、執業護士和護士）的遠程醫療接受姑息治療，無需額外費用。我們從 1 月份開始在田納西州中部推出，併計劃在我們證明模型的性能時擴展到整個州。我對這個機會感到非常興奮，你們都應該期待未來會有更多像這樣的創新合作夥伴關係。

Much like our core lines of business, our pipeline of future growth opportunities remain strong and exciting. We continue to make significant progress in our pursuit of direct relationships with health systems, looking for the leading comprehensive care at-home partner as well as health plans interested in innovative value-based arrangements for in-home services, including palliative care.

就像我們的核心業務線一樣，我們未來增長機會的管道仍然強勁而令人興奮。我們在尋求與衛生系統的直接關係方面繼續取得重大進展，尋找領先的綜合家庭護理合作夥伴以及對創新的基於價值的家庭服務安排感興趣的健康計劃，包括姑息治療。

In other news, we announced yesterday that we will be divesting the operational portion of our personal care line of business to Houseworks, a Massachusetts-based operator of personal care assets and turning -- and in turn, adding Houseworks to our personal care network. We continue to believe in the need for and the importance of personal care services as a key piece of whole-person care. And as such, we are committed to continuing to push to grow the utilization of our personal care network.

在其他新聞中，我們昨天宣布，我們將把個人護理業務的運營部分剝離給總部位於馬薩諸塞州的個人護理資產運營商 Houseworks，並轉而將 Houseworks 添加到我們的個人護理網絡中。我們仍然相信個人護理服務作為全人護理的關鍵部分的必要性和重要性。因此，我們致力於繼續推動提高我們個人護理網絡的利用率。

As we continue to work on contract innovation with managed care, having access to personal care services across our nationwide footprint will be a key value driver. Our commitment is to contract and build networks with personal care at this point, not to own it.

隨著我們繼續致力於管理式護理的合同創新，在我們全國范圍內獲得個人護理服務將成為關鍵的價值驅動力。我們的承諾是在這一點上以個人關懷的方式簽約和建立網絡，而不是擁有它。

With that, I'll turn it over to Scott, who will take us through our Q4 performance and a more detailed review of our operational and financial performance for the quarter and our projections for 2023. Scott?

有了這個，我將把它交給斯科特，他將帶我們了解我們第四季度的業績，並更詳細地審查我們本季度的運營和財務業績以及我們對 2023 年的預測。斯科特？

Thanks, Paul. For the fourth quarter of 2022 on a GAAP basis, we delivered net income of $31.7 million or $0.97 per diluted share on $562 million in revenue, a revenue increase of $3 million compared to 2021. For the full year 2022 on a GAAP basis, our net income was $119 million or $3.63 per diluted share or $2.22 billion in revenue. For the quarter, our results were impacted by income or expense items, adjusting our GAAP results that we've been characterized as noncore, temporary or onetime in nature.

謝謝，保羅。 2022 年第四季度，按 GAAP 計算，我們實現淨收入 3170 萬美元或攤薄後每股收益 0.97 美元，收入為 5.62 億美元，比 2021 年增加 300 萬美元。按 GAAP 計算，我們的 2022 年全年收入為淨收入為 1.19 億美元或每股攤薄收益 3.63 美元或收入 22.2 億美元。本季度，我們的業績受到收入或支出項目的影響，調整了我們被描述為非核心、臨時或一次性性質的 GAAP 結果。

Slide 14 of our supplemental slides provides detail regarding these items and the income statement line items each adjustment impacts. For the full year of 2022 on an adjusted basis, revenue grew $25 million or 1% to $2.2 billion. EBIT decreased $38 million or 12.5% to $262 million. EBITDA as a percentage of revenue decreased 190 basis points to 11.7%, and EPS decreased $0.94 to $5.01. The key drivers of our decrease in EBITDA were the reinstatement of sequestration during 2022 and losses from the acquisitions, which negatively impacted EBITDA by $47 million for 2022. Adjusting for these items, our legacy operations improved $9 million over prior year and a year with a significant shift in business mix and continued wage pressures.

我們的補充幻燈片的第 14 張提供了有關這些項目的詳細信息以及每個調整影響的損益表項目。調整後的 2022 年全年收入增長 2500 萬美元或 1% 至 22 億美元。息稅前利潤減少 3800 萬美元或 12.5% 至 2.62 億美元。 EBITDA 佔收入的百分比下降 190 個基點至 11.7%，EPS 下降 0.94 美元至 5.01 美元。我們減少 EBITDA 的主要驅動因素是 2022 年恢復封存和收購損失，這對 2022 年的 EBITDA 產生了 4700 萬美元的負面影響。調整這些項目後，我們的遺留業務比上一年增加了 900 萬美元，並且一年增加了業務結構的重大轉變和持續的工資壓力。

For the fourth quarter on an adjusted basis, our results were as follows. Revenue grew $3 million to $562 million. EBITDA decreased $5 million or 7.6% to $60 million. The reinstatement of sequestration and acquisitions reduced EBITDA by $13 million over prior year. Performing a similar normalization, our debt for full year results in $8 million year-over-year improvement in legacy performance. EBITDA as a percentage of revenue decreased 90 basis points to 10.7%. EPS decreased $0.02 to $1.16 per share.

在調整後的第四季度，我們的業績如下。收入增長了 300 萬美元，達到 5.62 億美元。 EBITDA 減少 500 萬美元或 7.6% 至 6000 萬美元。恢復扣押和收購使 EBITDA 比上一年減少了 1300 萬美元。執行類似的標準化，我們全年的債務導致遺留業績同比增長 800 萬美元。 EBITDA 佔收入的百分比下降 90 個基點至 10.7%。每股收益下降 0.02 美元至 1.16 美元。

Now turning to our fourth quarter adjusted segment performance. Keep in mind, segment-level EBITDA is pre-corporate allocation. In home health, revenue was $343 million, up $5 million or 2% compared to prior year. Revenue per episode was $30 -- was up $38 or 1.3%. The increase in revenue per episode is a result of a 3.2% increase in reimbursement, partially offset by the reinstatement of sequestration at 2%.

現在轉向我們第四季度調整後的部門業績。請記住，分部級 EBITDA 是公司前分配。在家庭保健方面，收入為 3.43 億美元，比上年增長 500 萬美元或 2%。每集收入為 30 美元，上漲 38 美元或 1.3%。每集收入的增加是報銷增加 3.2% 的結果，部分被恢復 2% 的扣押所抵消。

Total same-store admissions were up 5% driven by growth in our per visit payers. Business and commission costs per visit increased $6.64. An increase in cost per visit was driven by planned wage increases, an increase in salary employees and the impact of lower visits. G&A increased approximately $4 million mainly driven by acquisitions.

受每次訪問付費人數增長的推動，同店總入場人數增長了 5%。每次訪問的業務和佣金成本增加了 6.64 美元。每次訪問成本的增加是由計劃的工資增長、員工薪水增加和訪問量減少的影響推動的。 G&A 增加了約 400 萬美元，主要受收購推動。

Segment EBITDA decreased $4 million to $60 million, which is inclusive of a $7 million impact from the reinstatement of sequestration and acquisitions. EBITDA margin declined 140 basis points to 7.4% as our increase in revenue per episode and the decrease in visits per episode were not enough to overcome labor pressures and a changing mix of business.

部門 EBITDA 減少 400 萬美元至 6000 萬美元，其中包括恢復扣押和收購產生的 700 萬美元影響。 EBITDA 利潤率下降 140 個基點至 7.4%，因為我們每集收入的增加和每集訪問量的減少不足以克服勞動力壓力和不斷變化的業務組合。

Now turning to our hospital segment results. For the fourth quarter, revenue was $198 million, down $7 million over prior year. Net revenue per day was down $1.42. The 3.8% rate increase was offset by the reinstatement of sequestration and revenue adjustments.

現在轉向我們的醫院部門結果。第四季度收入為 1.98 億美元，比上年同期減少 700 萬美元。每天的淨收入下降了 1.42 美元。 3.8% 的增長率被恢復扣押和收入調整所抵消。

Hospice cost per day decreased $3.24 primarily due to clinical optimization and reorganization initiatives, lower staffing levels and lower contractor utilization. EBITDA was $44 million, up approximately $3 million, which is inclusive of the negative impact of $4 million from the reinstatement of sequestration. G&A decreased $3 million due to clinical optimization and reorganization initiatives and lower staffing levels.

臨終關懷每天的成本減少了 3.24 美元，這主要是由於臨床優化和重組計劃、較低的人員配置水平和較低的承包商利用率。 EBITDA 為 4400 萬美元，增加了約 300 萬美元，其中包括恢復扣押產生的 400 萬美元的負面影響。由於臨床優化和重組計劃以及較低的人員配置水平，G&A 減少了 300 萬美元。

Our business development strategy of shifting our referral patterns has resulted in lower admit volume, which allowed us to offset some of the typical Q4 seasonality around discharge rates. We are very pleased with our 220 basis point improvement in EBITDA margin despite census pressure. The combination of a fair rate update and our clinical optimization initiatives positions the segment for strong performance as our census recovers.

我們改變推薦模式的業務發展戰略導致錄取量減少，這使我們能夠抵消第四季度出院率的一些典型季節性。儘管存在人口普查壓力，我們對 EBITDA 利潤率提高 220 個基點感到非常滿意。隨著我們的人口普查恢復，公平費率更新和我們的臨床優化計劃相結合，使該部門表現強勁。

Turning to our total general and administrative expenses. On an adjusted basis, total G&A was $189 million or 33.6% of total revenue, up 80 basis points. Excluding acquisitions, G&A was flat. Sequentially, G&A is up $7 million driven by higher incentive compensation costs, lower gains on the sale of fleet vehicles and the seasonality-driven increase in health insurance.

談到我們的總一般和行政費用。在調整後的基礎上，G&A 總額為 1.89 億美元，佔總收入的 33.6%，上升 80 個基點。不包括收購，G&A持平。相應地，G&A 增加了 700 萬美元，原因是激勵補償成本增加、車隊車輛銷售收益減少以及健康保險的季節性增長。

For the quarter, we generated $41 million in cash flow from operations, which includes $27 million in repayment of deferred payroll taxes. For the year, we generated $133 million in cash flow from operations, which includes both the payment of deferred payroll taxes in the current quarter and the $34 million paid in Q3 for the ZPIC settlement. Our net leverage ratio at the end of the quarter was 1.5x.

本季度，我們從運營中產生了 4100 萬美元的現金流，其中包括 2700 萬美元的遞延工資稅償還。今年，我們從運營中產生了 1.33 億美元的現金流，其中包括本季度支付的遞延工資稅和第三季度為 ZPIC 結算支付的 3400 萬美元。我們在本季度末的淨槓桿率為 1.5 倍。

As you can see on Page 16 of our supplemental slide deck, we're initiating our guidance ranges for 2023. Our guidance ranges are adjusted revenue of $2.244 billion to $2.274 billion, adjusted EBITDA of $230 million to $240 million, and adjusted EPS of $4.13 to $4.36 on an estimated 32.9 million shares outstanding.

正如您在我們補充幻燈片的第 16 頁上看到的那樣，我們正在啟動 2023 年的指導範圍。我們的指導範圍是調整後的收入為 22.44 億美元至 22.74 億美元，調整後的 EBITDA 為 2.3 億美元至 2.4 億美元，調整後的每股收益為 4.13 美元估計有 3290 萬股流通股，增至 4.36 美元。

Before I go into more details around our 2023 guidance, I think it is helpful to remind everyone that changes in our current 2023 outlook compared to our thoughts as we began 2022. First, our expectations for 2023 included a home health Medicare rate update of 2% to 3%, which would have added $20 million to $30 million in EBITDA. Secondly, we anticipated being further along in our high-acuity segment and expect a reduction in EBITDA losses. Additionally, 2023 will be the first year since 2019 that we will not benefit from the suspension of sequestration or the add-back of COVID-related costs.

在詳細介紹我們的 2023 年指南之前，我認為有必要提醒大家，與我們在 2022 年開始時的想法相比，我們當前的 2023 年前景發生了變化。首先，我們對 2023 年的預期包括家庭健康醫療保險費率更新 2 % 至 3%，這將使 EBITDA 增加 2000 萬至 3000 萬美元。其次，我們預計在我們的高敏度部分會走得更遠，並預計 EBITDA 損失會減少。此外，2023 年將是自 2019 年以來我們將無法從暫停扣押或 COVID 相關成本的追加中受益的第一年。

Normalizing for the $13 million in sequestration and $6 million in COVID costs results in a 2022 starting point of $243 million as we bridge to 2023. Beyond the sequestration and COVID costs, there are several key factors impacting our 2023 guidance, which are outlined on Slides 17 and 18 of our supplemental slides.

將 1300 萬美元的封存和 600 萬美元的 COVID 成本標準化後，我們到 2023 年時的 2022 年起點為 2.43 億美元。除了封存和 COVID 成本之外，還有幾個影響我們 2023 年指導的關鍵因素，幻燈片中概述了這些因素我們補充幻燈片的 17 和 18。

These items consist of the following. Higher-than-normal labor costs and enhancements to our benefit plans result in approximately $45 million headwind; keep in mind, our first half of 2022 results were impacted by raises given in August of 2022; an incentive compensation headwind of $23 million; continued mix shift away from episodic past to per visit resulted in a $14 million headwind; other items totaling approximately $10 million, such as an increase in the mileage reimbursement rate for our commissions and higher supply and freight costs; and last, the divestiture of our PCL line of business, which contributed $6 million segment-level EBITDA in 2022 and was budgeted to contribute $4 million of EBITDA between May and December of 2023.

這些項目包括以下內容。高於正常水平的勞動力成本和我們福利計劃的改進導致了大約 4500 萬美元的逆風；請記住，我們 2022 年上半年的業績受到 2022 年 8 月加薪的影響； 2300 萬美元的激勵薪酬逆風；持續的組合從過去的情節轉變為每次訪問導致了 1400 萬美元的逆風；總計約 1000 萬美元的其他項目，例如提高我們佣金的里程報銷率以及更高的供應和運費；最後，剝離我們的 PCL 業務線，該業務線在 2022 年貢獻了 600 萬美元的分部級 EBITDA，併計劃在 2023 年 5 月至 12 月期間貢獻 400 萬美元的 EBITDA。

We expect revenue growth, margin improvement, clinical optimization, reorganization initiatives and a hospice rate increase of 3.8% to be our key drivers in overcoming the majority of the headwinds. Keep in mind that while the industry's home health rate update is expected to be 0.7%, our modeling suggests a flat update for our operations in 2023. As such, the net pricing update for the home health and hospice segments for 2023 is $14 million net of sequestration reinstatement.

我們預計收入增長、利潤率提高、臨床優化、重組計劃和臨終關懷率增長 3.8% 將成為我們克服大部分不利因素的主要驅動力。請記住，雖然該行業的家庭健康率更新預計為 0.7%，但我們的模型表明我們的業務在 2023 年將持平。因此，2023 年家庭健康和臨終關懷部門的淨定價更新為 1400 萬美元淨額扣押恢復。

Some additional items which are typical as we move from Q4 to Q1 are: the impact of 2 less calendar days estimated to impact cost as EBITDA by approximately $2 million and an increase in payroll taxes of approximately $2 million. Some impacts new for 2023 are an increase of $3 million due to 2023 incentive compensation. Keep in mind, 2022 was impacted by performance coming in below-plan metrics. This increase is approximately $2 million higher than prior year. And an increase of $2 million related to COVID costs, which will be no longer added back. Additionally, in prior year, our sequential change from Q4 to Q1 included a $7 million benefit from the 2022 home health rate update.

當我們從第 4 季度移至第 1 季度時，一些典型的額外項目是：估計減少 2 個日曆日的影響將 EBITDA 成本影響約 200 萬美元，工資稅增加約 200 萬美元。由於 2023 年的激勵補償，2023 年的一些新影響是增加了 300 萬美元。請記住，2022 年受到低於計劃指標的績效影響。這一增長比上一年增加了約 200 萬美元。並增加了 200 萬美元與 COVID 相關的費用，這些費用將不再加回。此外，在前一年，我們從第 4 季度到第 1 季度的連續變化包括 2022 年家庭健康費率更新帶來的 700 萬美元收益。

Despite the significant headwinds for 2023, demands for services remain strong, and I'm confident that the plans we have in place for 2023 will position us for future success.

儘管 2023 年面臨重大阻力，但對服務的需求依然強勁，我相信我們為 2023 年制定的計劃將為我們未來的成功做好準備。

This ends our prepared remarks. Operator, please open up the line for questions.

我們準備好的發言到此結束。接線員，請打開問題熱線。

(Operator Instructions) Today's first question is coming from Brian Tranquilut of Jefferies.

（操作員說明）今天的第一個問題來自 Jefferies 的 Brian Tranquilut。

I guess, just my question on the guidance, Scott, really appreciate all the color that you've given. But maybe as I think about the bridge, right, I mean, just any detail that you can give us that would highlight your confidence in the achievability of this given kind of like the guidance track record last year? And then maybe for Paul, how are you thinking about guidance-setting this year? And what do you need to do to deliver and execute on these targets that you've set for earnings this year?

我想，只是我關於指南的問題，Scott，非常感謝您提供的所有顏色。但也許當我想到這座橋時，對吧，我的意思是，你可以給我們提供任何細節，以突出你對這種給定的可實現性的信心，比如去年的指導記錄？然後也許對保羅來說，你如何看待今年的指導設定？您需要做些什麼來實現和執行您為今年的收益設定的這些目標？

Yes. I can -- let me just start off in terms of what our expectations are. And Scott has been -- we've been working on this for a long time and really thinking it through. It's conservative. We do have to hit marks, for sure, in this environment. But I think what we've done, and Nick has been really good helping us with this, we're pulling on the right levers.

是的。我可以——讓我從我們的期望開始。斯科特一直——我們已經為此工作了很長時間，並且認真考慮過。這是保守的。當然，在這種環境下，我們確實必須達到目標。但我認為我們所做的，尼克在這方面幫助我們做得很好，我們正在使用正確的槓桿。

So if we do the right thing in terms -- particularly in terms of turnover and -- which has a big flow through, we are able to go back to some of the payers and renegotiate some of these contracts, maybe move some to case rate drive down. I'm confident we can drive down the Contessa losses as we dig in deeper to the clients. So I feel very -- but I'm always this way, I'm always very optimistic about this. I think I think we have a lot to say grace over, and I feel very good about it.

因此，如果我們在條款方面做正確的事情 - 特別是在營業額方面 - 並且有很大的流量，我們能夠回到一些付款人並重新談判其中一些合同，也許將一些轉移到案例費率壓低。我相信，隨著我們深入了解客戶，我們可以降低 Contessa 的損失。所以我感覺非常——但我一直都是這樣，我一直對此非常樂觀。我想我認為我們有很多話要說，我對此感覺很好。

But we do have -- this is a year of tremendous execution. And I feel good about Scott in the COO seat. So I think he's going to drive the results well. So I'll turn it over to him after I set him up for this.

但我們確實有——這是執行力極強的一年。我對首席運營官席位上的斯科特感覺很好。所以我認為他會很好地推動結果。所以我會在我為此設置他之後將它交給他。

I appreciate it. Brian, certainly a lot of thought and a lot of learnings over the last couple of years from a guidance perspective. I think if you look back and kind of think about how to view this, I would say that I think there's more predictability in some of the outcomes. I think there's still a lot of moving parts around mix. We talk about labor will still be a challenge. But we are seeing some -- a little bit more consistency in hospice discharge rates.

我很感激。布賴恩，在過去的幾年裡，從指導的角度來看，當然有很多想法和很多經驗。我認為，如果您回顧過去並考慮如何看待這一點，我會說我認為某些結果具有更高的可預測性。我認為混音仍然有很多變化的部分。我們談論勞動力仍然是一個挑戰。但我們看到一些 - 臨終關懷出院率更加一致。

The volume is strong from a home health perspective. It's to be how do we manage that capacity. So I think there's enough levers and opportunities in the year for us to perform. And if you go step back historically and you can kind of look at how we've done some things, is that we probably were a little bit more aggressive on the top line in the past and left more room on the cost side. I think we took a different approach for that. We always pulled down on costs. We're significantly under what we thought last year, but not enough to overcome the misses around the top line.

從家庭健康的角度來看，銷量很大。這將是我們如何管理這種能力。所以我認為今年有足夠的槓桿和機會讓我們發揮作用。如果你回顧歷史，你可以看看我們是如何做一些事情的，我們過去可能在收入方面更具侵略性，並在成本方面留有更多空間。我認為我們為此採取了不同的方法。我們總是降低成本。我們大大低於我們去年的預期，但還不足以克服頂線附近的失誤。

So I think we were more thoughtful and gave ourselves more run rate moving into 2023. So I feel good about what we put together. But we're 1 month in and so far, so good. And we'll talk again after another quarter.

所以我認為我們在進入 2023 年時考慮得更周到，給了自己更多的運行率。所以我對我們放在一起的東西感覺很好。但到目前為止，我們已經 1 個月了，一切都很好。我們將在另一個季度後再次討論。

Yes, it's been a good start.

是的，這是一個好的開始。

The next question is coming from Matt Larew William Blair.

下一個問題來自 Matt Larew William Blair。

Maybe I'll just pile a couple here on the MA side. One would be just in terms of the Aetna deal, if you could just give us an update on how that has been progressing after the positive update you gave last quarter. And then within the MA book, I think you'd referenced that about half of that revenue base was in the process of being moved over. Just either what's contemplating guidance or more of what your expectations are in terms of when and if that piece is over?

也許我會在 MA 一側堆放一些。一個是關於安泰的交易，如果你能告訴我們在上個季度你給出積極更新後進展如何的最新情況。然後在 MA 書中，我想你提到了大約一半的收入基礎正在被轉移。只是考慮指導或更多關於該作品何時以及是否結束的期望？

And Paul, is there sort of a cutoff at some point here where you're going to add negotiations and kind of move on to the other business? Just trying to think about how you're pressuring the payers to sort of get with the program.

保羅，在這裡的某個時候是否有某種截止點，您要增加談判並轉向其他業務？只是想想想你是如何向付款人施壓，讓他們接受這個項目的。

Yes. We've been sitting down with quite extensive maps. And again, we -- as I talked about in the prepared remarks, we believe that the paradigm is changing. And I think with the absorption, as we talked about last night, there's 3 -- traditionally 3 big players, 2 of them are going away. And so we're the big independent one. And I think a lot of people are coming to us and trying to figure out how to get that capacity that potentially could be absorbed into the 2 large MA players that are going to be taking out the 2 competitors.

是的。我們一直坐下來處理相當廣泛的地圖。再一次，我們——正如我在準備好的發言中所說的那樣，我們相信範式正在發生變化。而且我認為，正如我們昨晚談到的那樣，有 3 名 - 傳統上有 3 名大牌球員，其中 2 名正在離開。所以我們是獨立的大公司。而且我認為很多人都來找我們，試圖弄清楚如何獲得可能被 2 個大型 MA 參與者吸收的能力，這些參與者將淘汰 2 個競爭對手。

So I feel that it's going to be a very, very different paradigm with capacity constraints. So we're at the table with all the big payers. As I talked about, we've gotten a lot of anecdotal evidence that post-acute costs are going up. I've definitely heard with some large hospital systems that have gone to bid that the length of stay is a significant problem because of the inability to discharge into the home. So again, that's pushing demand.

所以我覺得這將是一個非常非常不同的範例，具有容量限制。所以我們和所有的大付款人坐在一起。正如我所說，我們已經獲得了很多軼事證據表明急性期後成本正在上升。我肯定聽說過一些已經競標的大型醫院系統，因為無法出院回家，所以住院時間是一個重大問題。因此，這再次推動了需求。

So as the -- as we are able to secure all the -- the big thing for us is securing that labor supply and making sure we have it. And then I think at that -- then we want to go back and start to do our own utilization with case rate like we've been doing with Aetna and then give that back to them in terms of capacity.

因此——因為我們能夠確保所有——對我們來說最重要的是確保勞動力供應並確保我們擁有它。然後我認為 - 然後我們想回去並開始使用我們自己的利用率，就像我們一直在與 Aetna 一起做的那樣，然後在容量方面將其還給他們。

So Aetna is going well. It's early days, but it's going well. And we're clearly engaging with the rest of the industry to bring some others over the line so that we can have case -- more case rate deals versus per visit deals.

所以 Aetna 進展順利。現在還早，但進展順利。而且我們顯然正在與業內其他公司合作，讓其他一些人越線，這樣我們就可以有案例——更多案例率交易與每次訪問交易。

I don't know, Scott, did I miss anything?

我不知道，斯科特，我錯過了什麼嗎？

I think you covered it. I think that we see that as an opportunity as we manage it. I think one thing, as you look at our -- we've called out some clinical optimization initiatives out there. Centralization of intake is one item we did, and I think that gives us -- will give us a better visibility into the appropriate management of our capacity, which we'll speak a lot into how we deal with the managed care issues going forward. So we think there's a lot of opportunities there. And we expect to be aggressive around the table to get the right rates that we deserve.

我想你涵蓋了它。我認為我們在管理它時將其視為一個機會。我想一件事，當你看到我們的——我們已經提出了一些臨床優化計劃。攝入量的集中化是我們所做的一個項目，我認為這給了我們——將使我們更好地了解我們能力的適當管理，我們將在未來如何處理管理式醫療問題上談很多。所以我們認為那裡有很多機會。我們希望在談判桌前積極進取，以獲得我們應得的正確利率。

Yes. And in places -- I guess, let me just answer your question directly also, Matt. If we can't get better contracts and we have other places to take our business, we'll start to either cancel those contracts and start to move our business. So we clearly have been looking at the maps and studying. If we have to get to that level, we'll do it.

是的。在某些地方——我想，讓我也直接回答你的問題，馬特。如果我們無法獲得更好的合同並且我們有其他地方可以開展業務，我們將開始取消這些合同並開始轉移我們的業務。所以我們顯然一直在查看地圖並進行研究。如果我們必須達到那個水平，我們就會做到。

The next question is coming from Justin Bowers of Deutsche Bank.

下一個問題來自德意志銀行的賈斯汀鮑爾斯。

So a 2-parter for me. One, just on hospice. It sounds like discharge rates are stabilizing, and we know that's been sort of an industry-wide issue during the pandemic. But as you look forward to 2023, how do you parse out sort of your ability to execute versus what may or may not be some lingering structural challenges in the issue with the hospice guide? And then Scott, if you could just help us bridge 4Q to 1Q 2023 with all the moving parts, that would be helpful.

所以對我來說是兩個人。一，只是臨終關懷。聽起來出院率正在穩定，我們知道這在大流行期間一直是整個行業的問題。但是，當您展望 2023 年時，您如何分析您的執行能力與臨終關懷指南問題中可能存在或可能不存在的一些揮之不去的結構性挑戰？然後 Scott，如果你能幫助我們將 2023 年第四季度與 2023 年第一季度的所有活動部分聯繫起來，那將會很有幫助。

Yes. Sure, Justin. So from a discharge rate, you're absolutely right, we've seen stabilization around those. I think we're seeing it more predictable. The patterns match up to what they have been historically. They're just still at a higher rate. So that -- it hasn't exactly returned, but I feel like we've got a good line of sight there.

是的。當然，賈斯汀。所以從出院率來看，你是絕對正確的，我們已經看到了這些情況的穩定。我認為我們看到它更可預測。這些模式與歷史上的模式相匹配。他們只是仍然處於更高的速度。所以——它還沒有完全恢復，但我覺得我們在那裡有很好的視線。

I mean, I think what it's pushed us from an admit perspective is really watching our referral sources. And we ran through some periods where we had high high-churn patients, which took a toll in our commissions. And we looked at data. If you have more than 6 deaths in a month, the propensity of turnover is much higher. So that became a concern for us. So I think we've gotten more directed in how we're really look at our referral sources and as we manage it.

我的意思是，我認為從承認的角度來看，推動我們的是真正關注我們的推薦來源。我們經歷了一些高流失率患者的時期，這對我們的佣金造成了損失。我們查看了數據。如果一個月內死亡人數超過 6 人，離職傾向就會高得多。所以這成了我們的一個擔憂。所以我認為我們在如何真正看待我們的推薦來源以及我們如何管理它方面變得更加直接。

And we've guided to roughly a 3% ADC growth. That will be a slow and steady slog throughout the year, but I think it's achievable and I feel good about what our teams have in place going forward.

我們已經指導了大約 3% 的 ADC 增長。這將是全年緩慢而穩定的過程，但我認為這是可以實現的，我對我們的團隊在未來的發展感到滿意。

If we think about just going to the Q4 to Q1, Q1 is going to be interesting. And we've always said to talk about year-over-year and sequestration issues. Remember, we'll still have sequestration in the comps in prior year. So the Q1 margins are going to be the toughest ones because they had a full sequestration benefit in Q1 of last year.

如果我們考慮從 Q4 到 Q1，Q1 會很有趣。而且我們一直說要談論年復一年和封存問題。請記住，我們仍然會在前一年的補償中進行扣押。因此，第一季度的利潤率將是最艱難的，因為他們在去年第一季度獲得了完全的封存收益。

As we think about the walk forward, I called out some items that certainly were impactful, and some of them are normal seasonality, one around the 2-day differential in days on hospice, which is roughly $4 million, payroll tax reset is roughly $2 million. And we do put back our STI and LTI plans. That's probably another $3 million. So you've got roughly a $9 million noise going from Q4 to Q1.

當我們考慮向前走時，我提出了一些肯定有影響的項目，其中一些是正常的季節性，一個大約是臨終關懷天數的 2 天差異，大約是 400 萬美元，工資稅重置大約是 2 美元百萬。我們確實推遲了我們的 STI 和 LTI 計劃。這可能又是 300 萬美元。所以從第四季度到第一季度，你有大約 900 萬美元的噪音。

This year is even going to be a bigger issue because we have the COVID cost issue coming in. That's another $1.5 million to $2 million because we will not be adding that back. And then last year, we had a $7 million good guy for rate increase on home health. So that's not going to be here this year. So last year, we were plus $1.5 million. So I would say that number is going to be closer to a 50 type of a number in this year when you kind of put all those pieces together.

今年甚至會成為一個更大的問題，因為我們有 COVID 成本問題。那又是 150 萬到 200 萬美元，因為我們不會把它加回來。然後去年，我們有一個 700 萬美元的好人來提高家庭健康費率。所以今年不會在這裡。所以去年，我們增加了 150 萬美元。所以我想說，當你將所有這些部分放在一起時，今年這個數字將接近 50 類型。

The next question is coming from A.J. Rice of Credit Suisse.

下一個問題來自 A.J.瑞士信貸大米。

I might just ask a little bit more on the labor. Paul, you're talking about being sure you differentiate yourself. And I know one thing you guys have talked about is making sure there's some fuel subsidies and so forth. I wonder if you'd talk more in a tight market how Amedisys is going to differentiate itself among the labor pool and get that incremental nurse. I don't think it's paying more. And then specifically to understand how tight it is, are you turning away volume at this point? Or are you able to get -- cover the volume that you want to get that's coming your way?

我可能會問更多關於勞動力的問題。保羅，你說的是確保你與眾不同。我知道你們討論過的一件事是確保有一些燃料補貼等等。我想知道你是否願意在緊張的市場中更多地談論 Amedisys 如何在勞動力池中脫穎而出並獲得增量護士。我不認為它付出更多。然後具體了解它有多緊，此時你是否正在調低音量？或者你是否能夠獲得 - 涵蓋你想要獲得的數量？

Yes. In certain cases -- I'll answer that, but we have our fantastic new Head of Human Resources here. I'm going to punt to him because he's got all the details, which thus far, he's done a great job. But yes, are there -- are we turning away business in certain markets where we're having a hard time hiring? Yes, we call them NTUCs, and we do have NTUCs. I think the question that I'm always looking with NTUCs is there's some I don't mind and there's others I do mind.

是的。在某些情況下——我會回答這個問題，但我們這裡有我們出色的新人力資源主管。我要向他下注，因為他掌握了所有細節，到目前為止，他做得很好。但是，是的，我們是否在某些難以招聘的市場中拒絕業務？是的，我們稱他們為 NTUC，我們確實有 NTUC。我認為我一直在尋找 NTUC 的問題是有些我不介意，有些我確實介意。

So -- but in general, we're pretty accommodating, and we make it work because we have a good PRN pool and we can bring that to work. We don't like bringing in contractors to do it, but in certain cases, we've done that. And that's what we're trying to do is bring that pool, our PRN pool, so that we can take care of it that way.

所以 - 但總的來說，我們非常樂於助人，我們讓它發揮作用，因為我們有一個很好的 PRN 池，我們可以讓它發揮作用。我們不喜歡引入承包商來做這件事，但在某些情況下，我們已經做到了。這就是我們正在嘗試做的就是帶來那個池，我們的 PRN 池，這樣我們就可以那樣處理它。

But in general, our NTUCs are quite under control and only in a couple places. I'll turn it over to Adam to talk about how we're doing competitively and why we're going to produce some of the fantastic results we say we're going to produce.

但總的來說，我們的 NTUC 完全受到控制，而且只在幾個地方。我會把它交給亞當來談談我們是如何競爭的，以及為什麼我們要產生一些我們說我們要產生的奇妙結果。

Yes. Sure. Thanks, Paul. And A.J., great question. I'll just highlight a few things. Obviously, on the people, labor side, it's 2 parts of the equation: it's bringing talent in the door, and then it is keeping them here. I'll highlight on the talent side. Paul alluded to January was our best month of offers. On the clinical side, I would just say it was 15% better than we've ever done before. And this comes on the heels of a very, very strong Q4 as we looked at sort of offers and starts. So this is a -- we're feeling really good about the trend that, that sort of highlights.

是的。當然。謝謝，保羅。 A.J.，好問題。我只強調幾件事。顯然，在人員、勞動力方面，這是等式的兩個部分：將人才帶入大門，然後將他們留在這裡。我會強調人才方面。 Paul 提到 1 月是我們最好的報價月份。在臨床方面，我只想說它比我們以前做過的要好 15%。這是在我們查看各種報價和開始時非常非常強勁的第四季度之後出現的。所以這是一個 - 我們對這種趨勢感覺非常好，那種亮點。

To your specific question around how we're differentiating, there's a few things I'd point to. I think in the second half of last year, our talent acquisition team and our operators did a really nice job of operationalizing how we looked at care centers in need. So we target where our biggest issues are and really focused on that.

對於您關於我們如何與眾不同的具體問題，我要指出幾件事。我認為在去年下半年，我們的人才招聘團隊和我們的運營商在實施我們如何看待有需要的護理中心方面做得非常好。因此，我們瞄準了我們最大的問題所在，並真正專注於此。

And then I would say on the second part is we are opening up the aperture as we look at pools of talent. The good news for us is there are so many nurses in the U.S. And I think that we've seen that as we've gone through the pandemic, the need to look at not just sort of the core of home health nurses, but there's lots of incredibly talented nurses in the hospital setting, those who have just recently graduated. And we put the support mechanisms in place to have them do really well.

然後我要說的第二部分是，我們在尋找人才庫時正在打開光圈。對我們來說，好消息是美國有這麼多護士。我認為我們已經看到，在我們經歷大流行病的過程中，不僅需要關注家庭保健護士的核心，而且還有醫院裡有很多才華橫溢的護士，他們剛剛畢業。我們建立了支持機制，讓他們做得很好。

The last thing I'll highlight on the acquisition side is we've made some investments recently from a technology standpoint that really is putting us at a different level in our ability to find, attract and simplify the process of bringing in talent.

在收購方面，我要強調的最後一件事是，我們最近從技術角度進行了一些投資，這確實使我們在尋找、吸引和簡化人才引進過程方面處於不同的水平。

The other side of that equation, certainly is the retention side. That's always the harder piece. I think we have continued to be better than our peers as it relates to retention. But we're targeting pretty big numbers in terms of bringing our retention of even higher on the clinical side. And there's a few key things I would sort of highlight around sort of really looking at from a focus standpoint, operationalizing how we look at our turnover. And one of the things I've been really impressed, amongst other things joining the Amedisys team, is when our leaders focus on something and with the rigor that we've always had around things, the numbers move and the outcomes are there.

該等式的另一端，當然是保留端。那總是最難的部分。我認為我們在保留方面一直優於同行。但我們的目標是相當大的數字，使我們在臨床方面的保留率更高。並且有一些關鍵的事情我會強調一些關於真正從焦點的角度來看的事情，操作我們如何看待我們的營業額。在加入 Amedisys 團隊的其他事情中，我真正印象深刻的一件事是，當我們的領導者專注於某件事時，並且以我們一直以來對事情的嚴謹態度，數字會發生變化，結果就會在那裡。

And then again, Paul alluded to earlier, we did a pretty significant investment around our benefit platform to make sure that we are leading the pack as it relates to supporting our people with an unrivaled caregiver experience. And then a lot of work and investment has been put into how we are developing our leaders to make sure that they're taking care of the people in the way that is deserved and needed. So those are a few of the things I would sort of highlight as we look at the things that are on our plate.

然後，Paul 早些時候提到，我們圍繞我們的福利平台進行了相當大的投資，以確保我們處於領先地位，因為它與支持我們的員工提供無與倫比的護理體驗有關。然後，我們在如何培養我們的領導者方面投入了大量工作和投資，以確保他們以應得和需要的方式照顧人民。因此，當我們查看盤子裡的東西時，我會強調一些事情。

So you asked, A.J. and Adam delivered, so thanks.

所以你問，A.J.亞當交付了，非常感謝。

Our next question is coming from Ben Hendrix of RBC Capital Markets.

我們的下一個問題來自 RBC Capital Markets 的 Ben Hendrix。

What are your plans for the proceeds from the personal care divestiture? Specifically, are you're marking any of that for reinvestment into the PC network strategy or to other developments? And then related to that, you noted really strong reception among regional PC providers when you announced that network strategy some years ago. Just wondering if you can update us on how that's grown and how impactful that could be as a top line contribution over the long term.

您對個人護理業務剝離的收益有何計劃？具體來說，您是否將其中任何一項標記為對 PC 網絡戰略或其他開發進行再投資？然後與此相關的是，當您幾年前宣布該網絡戰略時，您注意到區域 PC 供應商的接受度非常高。只是想知道你是否可以向我們介紹它是如何發展的，以及從長遠來看，它作為頂線貢獻的影響力有多大。

Let me -- I'll start with just the proceed question and let Paul talk a little bit more about the network. So from a proceed perspective, we have a robust M&A pipeline, and we're excited to have that. We've got some good opportunities ahead of us. Right now, we're sitting on -- at the end of 12/31, nothing drawn on our revolver. So certainly, a lot of dry powder, and this would add to it.

讓我 - 我將從繼續問題開始，然後讓 Paul 多談談網絡。因此，從收益的角度來看，我們擁有強大的併購管道，我們很高興擁有它。我們前面有一些很好的機會。現在，我們坐在 - 12/31 結束時，我們的左輪手槍上沒有任何東西。所以當然有很多乾粉，這會增加它。

I think a buyback is always something we can think about. We have $100 million authorized under -- from our Board of Directors. So we can do that. But I think my immediate desire would see where we're going is M&A pipeline first. I mean interest rates have creeped up. We're sitting at a 5% rate on that revolver at this point. So that's somewhat meaningful. So right now, we'll kind of hold it a bit and see if we can get some deals over the finish line. If not, we certainly can buy back some stock at an opportune time.

我認為回購總是我們可以考慮的事情。我們的董事會授權了 1 億美元。所以我們可以這樣做。但我認為我的直接願望是首先看到我們要去的地方是併購管道。我的意思是利率已經攀升。目前，我們對該左輪手槍的利率為 5%。所以有點意思。所以現在，我們會稍等一下，看看我們是否能在終點線上達成一些交易。如果沒有，我們當然可以在適當的時候回購一些股票。

Yes. And Ben, good question on the personal care. We have a network. So we've put that together. We've just added Houseworks who -- the CEO of Houseworks who used to run our personal care business. So we sold it back to him. So we're very -- and a lot of the needs are based in the Northeast. So we feel good about that.

是的。本，關於個人護理的好問題。我們有一個網絡。所以我們把它放在一起。我們剛剛添加了 Houseworks，他是 Houseworks 的首席執行官，曾負責我們的個人護理業務。所以我們把它賣回給他。所以我們非常——很多需求都來自東北部。所以我們對此感覺很好。

Our primary partners are Brightstar and WellSky, and so we cover almost all the ZIP codes in the U.S. So when we need them, we've been integrating them in. It's largely been a-- basically been mainly focused on running the business in the 3 states we're in, but we're going to move that. And the reason why we think this is the right time to start to move the network is, particularly with Contessa scaling up, there's a lot of need for personal care in there, particularly with a higher-acuity patient to make sure that their activities of daily living are taken care of, their social determinants, that sort of thing, which is what this group is good at.

我們的主要合作夥伴是 Brightstar 和 WellSky，因此我們幾乎涵蓋了美國所有的郵政編碼。因此，當我們需要它們時，我們一直在將它們整合進去。它主要是 a-- 基本上主要專注於在美國開展業務我們處於 3 個州，但我們將移動它。我們認為現在是開始移動網絡的正確時機的原因是，特別是隨著 Contessa 的擴大，那裡非常需要個人護理，特別是對於視力較高的患者，以確保他們的活動日常生活被照顧，他們的社會決定因素，諸如此類的事情，這是這個群體擅長的。

So I think we're going to be employing that network pretty heavily through Contessa. Also as we move into the palliative care business, we do need personal care. I was out visiting some care centers last week up in New England and was just looking at how they were staffing. And again, I think there's going to be more need for personal care. So we anticipate in coordination with the clinical care that we're delivering both on the home health and hospice side. So I feel very good about how that's going to grow.

所以我認為我們將通過 Contessa 大量使用該網絡。此外，當我們進入姑息治療業務時，我們確實需要個人護理。上週我去了新英格蘭的一些護理中心，只是想看看他們是如何配備人員的。再一次，我認為個人護理的需求會增加。因此，我們期望與我們在家庭健康和臨終關懷方面提供的臨床護理相協調。所以我對它的增長方式感到非常滿意。

But we built it now -- the field of dreams, we built it. And we're going to make sure they come. And I don't know what we're going to be expecting from a top line growth, but this business will grow because we put together a rather unique asset, particularly for our benefit.

但我們現在建造了它——夢想的領域，我們建造了它。我們將確保他們來。而且我不知道我們對收入增長有什麼期望，但這項業務將會增長，因為我們匯集了一項相當獨特的資產，特別是為了我們的利益。

The next question is coming from John Ransom of Raymond James.

下一個問題來自 Raymond James 的 John Ransom。

Paul, when you got back under the hood and looked at Contessa, what do you think the core issue is in terms of it being slower to ramp? Do you think it's just your hospital partners being more bureaucratic than you thought? Or is it payers resisting, doctors resisting? What do you think the real is here is there?

保羅，當你回到引擎蓋下並查看 Contessa 時，你認為核心問題是什麼，因為它的增長速度較慢？你認為只是你的醫院合作夥伴比你想像的更官僚嗎？還是付款人抵制，醫生抵制？你認為真實的是什麼？

I think everybody loves the idea, and I think everybody is addicted to the idea. I think once we actually look at the complication of implementing the idea -- again, I went to some big systems and really dug in to see what's going on. It's making sure the hospitalists, the folks running the ERs are all bought in reselling, reselling, reselling. I think that's it.

我認為每個人都喜歡這個想法，而且我認為每個人都沉迷於這個想法。我認為，一旦我們真正了解了實施該想法的複雜性——再次，我去了一些大型系統並真正深入了解發生了什麼。它確保住院醫生，運行急診室的人都被轉售，轉售，轉售。我想就是這樣。

I also think that some of the hospitals are plugged up. And particularly, I think we're -- there's some big benefits for us though. As their length of stay continues to go up, they're going to have to find ways to decant a lot of these patients and push them elsewhere. And that's what Contessa is very good at.

我還認為一些醫院被堵塞了。特別是，我認為我們 - 雖然對我們來說有一些很大的好處。隨著他們住院時間的延長，他們將不得不想方設法將這些患者轉移到其他地方。而這正是 Contessa 非常擅長的。

And then we've been talking with them about saying, if you're really having length of stay issues, these DRGs are the ones you don't want to get locked up in the hospital system. So I think a lot of it's working through convincing them that the 111 DRGs that we do target that generally are not moneymakers for these hospitals are what's appropriate. So I feel good about that, particularly with the length of stay pressures on the financials for the hospitals.

然後我們一直在與他們討論說，如果你真的有住院時間問題，這些 DRG 是你不想被關在醫院系統中的。因此，我認為很多工作都是通過說服他們我們所針對的 111 個 DRGs 進行的，這些 DRGs 通常不是這些醫院的賺錢工具是合適的。所以我對此感覺很好，特別是考慮到住院時間的長短對醫院的財務造成壓力。

On the payer side, it's -- on the payer side, they take a while to do risk-based programs. They want to look at the corridors, they want to look at our algorithms. I feel in the Tennessee deal that we just closed and announced, that took a year. And what we ended up was a really good deal with the folks, but it was very fair. But I think that going through that exercise was good. We're going through the exercise with other payers.

在付款人方面，它是 - 在付款人方面，他們需要一段時間來執行基於風險的計劃。他們想看看走廊，他們想看看我們的算法。我覺得我們剛剛完成並宣布的田納西州交易花了一年時間。我們最終與人們達成了一筆非常好的交易，但這是非常公平的。但我認為完成那個練習很好。我們正在與其他付款人一起進行練習。

Again, the value proposition of Contessa is so good from the perspective of the providers, the payers, the patients. You get a trifecta with that. And I think that ultimately is what's pushing Contessa through. But they -- but our -- very clear, we've heard -- I've heard in all 14 partners I've gone to see, they want more. And so that's what we're figuring out now is how to scale, get there faster because I think we've been slow out of the gate.

同樣，從提供者、支付者和患者的角度來看，Contessa 的價值主張非常好。你得到了一個三重奏。我認為這最終是推動伯爵夫人度過難關的原因。但是他們 - 但我們 - 非常清楚，我們聽說過 - 我聽說我去過的所有 14 個合作夥伴都想要更多。所以這就是我們現在正在弄清楚的是如何擴展，更快地到達那裡，因為我認為我們一直很慢。

The next question is coming from Scott Fidel of Stephens Inc.

下一個問題來自 Stephens Inc. 的 Scott Fidel。

Two quick questions. First, just on Contessa. It would be helpful if you can walk us through the full year loss expectation and then how you expect that may sort of trend over the course of the year in terms of the quarters. And then second, just if you've got a view on operating cash flow expectations for 2023.

兩個快速問題。首先，就在 Contessa 上。如果您能向我們介紹全年的虧損預期，然後您如何預期在一年中的季度趨勢可能會有所幫助，那將會很有幫助。其次，如果您對 2023 年的運營現金流預期有一個看法。

You want to take that one?

你想拿那個嗎？

Yes. Sure. I'll tell you. Just from a loss perspective, we're pretty much flat to where we are late this year. I think we came in around a $30 million EBITDA drag. I think that will kind of be in that range again next year. And from a -- how to think about the timing, that I would say probably 54% of that losses will be in the first half with around 40 -- the rest of it, the 46%, in the back half.

是的。當然。我會告訴你。僅從虧損的角度來看，我們與今年晚些時候的表現基本持平。我認為我們的 EBITDA 拖累了大約 3000 萬美元。我認為明年將再次處於該範圍內。從一個——如何考慮時間點來看，我想說可能有 54% 的損失發生在上半年，大約 40%——剩下的 46%，在後半段。

You're going to have some early quarter loading around some of this risk from the accounting from a risk-based perspective. So you'll have a little bit heavier cost potentially early on there. So that's what we see that from a view perspective. I think we feel good about how that develops throughout the year.

從基於風險的角度來看，您將從會計中的一些風險中獲得一些早期的季度負載。因此，您可能會在早期付出更多的成本。這就是我們從視圖角度看到的。我認為我們對全年的發展情況感到滿意。

From a cash flow from ops, we're looking somewhere around, I'd say, 2 10 million to 2 15 type of million dollar number, which is pretty strong for us. Had a decent year this year even without -- with the payback and deferred. We had that ZPIC payback that I mentioned in my prepared comments. So we expect another strong year of cash flow from ops as we bridge into a year with about to have another $50 million in cash coming on to the sale of PCL with only 1.5x levered. So we would be very excited about getting some of these deals that we have in this pipeline closed.

從運營的現金流來看，我們正在尋找周圍的某個地方，我想說，2 1000 萬到 2 15 百萬美元的數字，這對我們來說非常強大。即使沒有回報和延期，今年也過得不錯。我們有我在準備好的評論中提到的 ZPIC 回報。因此，我們預計 ops 將迎來又一個強勁的現金流年，因為我們即將迎來另外 5000 萬美元的現金用於出售 PCL，而槓桿率僅為 1.5 倍。因此，我們很高興能夠完成我們在這條管道中的一些交易。

Yes. We like it. Do you want to talk a little bit about the pipeline? What you're looking at? What we like?

是的。我們喜歡它。你想談談管道嗎？你在看什麼？我們喜歡什麼？

Sure. I think the one thing to really kind of update from our dialogues probably in the past is we talked to a lot of heavy, heavy on home health. We want to do small home health deals. I think one I'd say that -- a lot of JV conversations in the pipeline now, which has been new. And I think Contessa is really -- which has driven that. More hospice coming in lately, which has been interesting. And I think we're ready to -- the deal that we can get through diligence and has the best fit geographically will be the one we get done. So a lot of great deals, a lot of things that have come into play recently, and we feel very good to have such a full pipeline.

當然。我認為從過去的對話中真正更新的一件事可能是我們談了很多關於家庭健康的沉重話題。我們想做一些小型的家庭健康交易。我想我會這麼說——現在有很多合資對話正在進行中，這是新的。而且我認為 Contessa 確實 - 推動了這一點。最近有更多臨終關懷醫院進來，這很有趣。而且我認為我們已經準備好 - 我們可以通過勤奮達成並且在地理上最合適的交易將是我們完成的交易。所以很多很棒的交易，很多事情最近開始發揮作用，我們對擁有如此完整的管道感到非常高興。

Yes. Low leverage, full pipeline and lower prices. So it's time to go out and buy. So we're focusing on that.

是的。低杠桿、完整的管道和更低的價格。所以是時候出去買東西了。所以我們專注於此。

The next question is coming from Tao Qiu of Stifel.

下一個問題來自 Stifel 的陶秋。

I'd like to ask about the home health visit per episode. That number dipped further to 12.5 in the fourth quarter. I think last quarter, you guys mentioned that the metrics would stabilize at 13.2 to 13.4. Is there any structural reason that could keep visitation lower than the stabilized level for longer? And what's a good number to use in our assumption for the year?

我想問一下每集的家庭健康訪問。該數字在第四季度進一步下降至 12.5。我想上個季度，你們提到指標會穩定在 13.2 到 13.4。是否有任何結構性原因可以使訪問量低於穩定水平的時間更長？在我們對這一年的假設中使用什麼數字比較合適？

Yes. I think the pressure -- some of the pressure around that is you do see some softer visits and higher lupus coming out of the holiday months into the winter months. So that's coming down a bit, stepping down. It's probably not unusual. I think capacity issues certainly play into that, unfortunately. We don't like to see that impact the care about patients, but it's the reality of where we are today.

是的。我認為壓力 - 周圍的一些壓力是你確實看到從假期到冬季月份出現了一些更溫和的訪問和更高的狼瘡。所以這有點下降，下台。這可能並不罕見。不幸的是，我認為能力問題肯定會影響到這一點。我們不希望看到這影響對患者的護理，但這是我們今天所處的現實。

I would expect -- and if you get last year, I think we were in the 13-ish type of range. I think you would see us probably hover around there. I think you'll still -- from a cost perspective, we'll be lower probably in Q1, and they'll probably even out. But I think in that 13, 13.2 is probably a range that makes sense. But you won't get back there immediately just from the dynamics coming off of holiday months and so forth. And Q1 will probably stay pretty light.

我希望 - 如果你去年得到，我認為我們處於 13 左右的範圍內。我想你會看到我們可能在那裡徘徊。我認為你仍然會——從成本的角度來看，我們在第一季度可能會更低，而且他們可能會持平。但我認為在 13 中，13.2 可能是一個有意義的範圍。但是你不會僅僅因為假期月份等的動態而立即回到那裡。而且第一季度可能會保持相當低的水平。

The next question is coming from Whit Mayo of SVB Securities.

下一個問題來自 SVB Securities 的 Whit Mayo。

I think, Paul, one of the reasons that you and the industry have taken Medicare Advantage in the past is that your referral sources asked for it. They frankly require you to take it. And historically, it just feels like they've been intertwined to a degree. And so how do you ring fence the risk that if you go down the path of going out of network or cutting off MA referrals that you could inadvertently impact your fee-for-service, too? It just feels going down this path, there is risk that the strategy could disrupt overall operations. Just how do you think about that dynamic?

保羅，我認為你和整個行業過去採用 Medicare Advantage 的原因之一是你的推薦來源要求它。他們坦率地要求你接受它。從歷史上看，感覺它們在某種程度上交織在一起。那麼，如果您走上脫離網絡或切斷 MA 推薦的道路，您將如何避免可能無意中影響您的服務費用的風險？只是感覺沿著這條路走下去，該戰略有可能擾亂整體運營。您如何看待這種動態？

No. That's a great question. Thanks. Yes, so I've been out -- obviously, I don't want to start to say that I'm going to start to redirect business unless I go out and figure out with the people that are directing the business. So I've been out talking to discharge planners, case managers, talking with our CTCs who are in the hospitals, talking with the folks who are out there in -- our account executives who are talking to doctors.

不，這是一個很好的問題。謝謝。是的，所以我已經出去了 - 顯然，我不想開始說我將開始重新定向業務，除非我出去與指導業務的人一起弄清楚。因此，我一直在與出院計劃人員、個案經理交談，與我們在醫院的 CTC 交談，與外面的人交談——我們的客戶經理正在與醫生交談。

And the issue is -- it used to be -- as you alluded to, it used to be, I'm going to give you a bundle and there's good stuff in the bundle and there's not-so-good stuff from a business perspective, and you take the whole bundle or you go to the back of the line. And that's how -- when there was ample capacity, we took that.

問題是——它曾經是——正如你提到的，它曾經是，我會給你一個捆綁包，捆綁包中有好東西，從商業角度來看，也有不太好的東西，然後你拿走整個包裹，或者你走到隊伍的後面。這就是 - 當有足夠的能力時，我們就這樣做了。

Now you go to the discharge planners, and there is just take it. Whatever you can take, take. And since our quality is so good, we're always at the first of the line in terms of -- because we've been producing on STARS.

現在你去找出院規劃師，就拿去吧。拿什麼就拿什麼。而且由於我們的質量非常好，所以我們始終處於領先地位——因為我們一直在 STARS 上製作。

So I think we can have more serious negotiations with these folks. And I've talked to them about this. And I think -- and since managed care is absorbing a fair amount of the capacity of our competitors. I think that capacity will get steered towards our competitors, which is lower-paying business.

所以我認為我們可以與這些人進行更認真的談判。我已經和他們談過這個。而且我認為 - 因為管理式醫療正在吸收我們競爭對手的相當多的能力。我認為產能將轉向我們的競爭對手，這是低薪業務。

So I think in general, it's going to -- I think it's, again, a new paradigm. I think it's a new conversation. We got 850 salespeople who got to go out and have these conversations. But I'm comfortable because length of stay is such an intensive pressure right now. I think they just want to get people out of the hospital bed. So I think it's going to move to our benefit. Again, it's like in a capacity-constrained environment.

所以我認為總的來說，它會——我認為這又是一種新的範例。我認為這是一個新的對話。我們有 850 名銷售人員必須出去進行這些對話。但我很舒服，因為現在逗留時間是一個巨大的壓力。我認為他們只是想讓人們離開醫院的病床。所以我認為這將對我們有利。同樣，這就像在容量受限的環境中。

The next question is coming from Gary Taylor of Cowen.

下一個問題來自 Cowen 的 Gary Taylor。

I had 2 questions. The first on Contessa, I know the last couple of quarters, you've given EPS dilution. It sort of seems like that's running maybe $8 million or $9 million EBITDA loss a quarter. And so maybe that's somewhere between $30 million and $40 million EBITDA loss in '22. I just want to make sure I had that right.

我有兩個問題。第一個關於 Contessa，我知道最近幾個季度，你已經稀釋了每股收益。似乎每個季度的 EBITDA 損失可能為 800 萬美元或 900 萬美元。因此，22 年的 EBITDA 損失可能在 3000 萬到 4000 萬美元之間。我只是想確保我做對了。

And then from the third quarter, I thought -- I might not remember this, but I thought there was a thinking maybe that would improve $20 million or so. So I guess, I just want to get to kind of -- is that about where you were running? And how much improvement is embedded in the '23 guidance for Contessa.

然後從第三季度開始，我想——我可能不記得了，但我認為有一種想法可能會增加 2000 萬美元左右。所以我想，我只是想談談——那是關於你跑步的地方嗎？以及 Contessa 的 23 年指南中嵌入了多少改進。

Yes, you're right on top of that. We did for the full year, Contessa lost about $30 million. I would say we're going to continue on with that kind of $30 million type of loss, we think, which is embedded in our guidance right now. Do we get ahead of that and outperform? Potentially. But right now, we're considering it from a loss perspective, flat year-over-year.

是的，你就在上面。我們做了全年，Contessa 損失了大約 3000 萬美元。我想說，我們將繼續承受這種 3000 萬美元的損失，我們認為，這已包含在我們的指導中。我們是否領先於此並表現出色？潛在的。但現在，我們正在從虧損的角度考慮它，同比持平。

I think if you go back in my prepared comments, we would have thought -- I think we would have brought down Contessa probably roughly $10-ish million at the beginning. But I think some developments in palliative care as we stand up that program as well as some slowness in hitting some of the -- where we thought we would be with some other JV relationships, I think we're behind. I think we've acknowledged that, but I think we feel very good about where this is headed from a long-term perspective.

我想如果你回顧一下我準備好的評論，我們會認為 - 我認為我們一開始可能會降低 Contessa 大約 1000 萬美元。但我認為，隨著我們開展該計劃，姑息治療取得了一些進展，但在實現某些目標方面進展緩慢——我們認為我們會與其他一些合資企業建立關係，我認為我們落後了。我想我們已經承認了這一點，但我認為從長遠的角度來看，我們對這件事的發展方向感到非常滿意。

Yes. And I think what we've also done is we've brought over some really good new clients that we are ramping up on -- some prestigious ones. So Memorial Hermann, Baylor Scott & White, University of Arkansas are doing really interesting stuff. So we're going to jump in on those because we think that, one, there's a tremendous depth of business that we can go in and have really good contributions. And we've made that choice, and I think it was a good choice.

是的。而且我認為我們還做的是我們帶來了一些我們正在增加的非常好的新客戶 - 一些有聲望的客戶。因此，阿肯色大學的 Memorial Hermann、Baylor Scott & White 正在做一些非常有趣的事情。因此，我們將參與其中，因為我們認為，第一，我們可以深入開展業務並做出非常好的貢獻。我們做出了這個選擇，我認為這是一個不錯的選擇。

The next question is coming from Joanna Gajuk of Bank of America.

下一個問題來自美國銀行的 Joanna Gajuk。

So when it comes to your guidance, you talk about a 5% volume growth target for home health. So inside that target, what do you assume the Medicare people service volume growth to be versus the non-Medicare? Because including the Medicare, at least the way you disclosed, the Medicare fee-for-service revenue has been declining high single digits, while the other piece is growing much faster. So that's the first part of the question. And I guess it's tied to my second question around staffing. So do you need to grow your clinical staff, the 5% in home health and 3% in hospice, on a net basis to drive the volumes? And I guess, how did you do in terms of net staffing last year?

所以當談到你的指導時，你談到了家庭健康 5% 的銷量增長目標。因此，在該目標內，您認為醫療保險人員服務量增長與非醫療保險相比如何？因為包括 Medicare，至少按照你透露的方式，Medicare 按服務收費的收入一直在下降高個位數，而另一部分增長得更快。這是問題的第一部分。我想這與我關於人員配備的第二個問題有關。那麼，您是否需要在淨基礎上增加您的臨床人員（5% 的家庭保健人員和 3% 的臨終關懷人員）以推動數量增長？我想，您去年在淨人員配置方面做得如何？

Yes. So first, on the growth, we guide to 5% growth. That total admit growth, really didn't give a color. We haven't really given a lot of color on Medicare. But I would say that in order to keep -- and moving that, I would say we had some slight growth in Medicare business going forward. I think we're being pretty conservative around that number based on what we've seen with enrollment numbers as well as utilization. Utilization of the Medicare benefit for Medicare enrollees actually came down in that back half of the year, which has probably surprised the industry a bit. We've seen it as we look at data from competitors across the board. So we still believe we're taking share even in a market that's depressed. So we'll continue to do that. But that will certainly -- as it develops throughout the year, we'll be thing we'll watch closely.

是的。所以首先，在增長方面，我們指導 5% 的增長。那總認增長，真沒出彩。我們並沒有真正對醫療保險給出很多顏色。但我要說的是，為了保持——並推動這一點，我想說我們未來的醫療保險業務會有一些小幅增長。我認為，根據我們在註冊人數和利用率方面看到的情況，我們對這個數字持相當保守的態度。 Medicare 參保人的 Medicare 福利的使用率在今年下半年實際上有所下降，這可能讓整個行業感到有些驚訝。當我們全面查看競爭對手的數據時，我們已經看到了這一點。因此，我們仍然相信，即使在低迷的市場中，我們也能搶占市場份額。所以我們會繼續這樣做。但這肯定會——隨著它在全年的發展，我們將密切關注。

From a staffing, we're going to have to continue to grow staffing. I think there are certain markets where we do have better opportunity on Medicare, where we were probably lighter staffed. Our Northeast region is an area that we have some opportunity. So we're focused, and Adam alluded to really having some focused care center calls where we really need to get staffing in. So we'll continue to do that. And we're going to one on one, add staff, slow down the turnover and make sure all these clinical optimization initiatives that our clinicians can be as efficient as possible where we maximize productivity. That's really our goal for 2023.

從人員配置來看，我們將不得不繼續增加人員配置。我認為在某些市場上，我們在 Medicare 方面確實有更好的機會，我們可能在這些市場上人員較少。我們東北地區是我們有機會的地方。所以我們很專注，亞當提到確實有一些重點護理中心的電話，我們真的需要在這些地方配備人員。所以我們會繼續這樣做。我們將一對一地增加員工，降低營業額，並確保所有這些臨床優化計劃，我們的臨床醫生可以在我們最大限度地提高生產力的情況下盡可能高效。這確實是我們 2023 年的目標。

The next question is coming from Andrew Mok of UBS.

下一個問題來自瑞銀集團的 Andrew Mok。

Just wanted to follow up on Contessa. Was hoping you could give us a bit more detail on the financial outlook and time line there. You mentioned stable operating results, I think, for '23 from an operating loss perspective. But it sounds like there's a lot of activity with respect to JV partnerships. So just curious when the revenue from those JV partnerships will materialize in results. And what's the new time line to break even from all of this?

只是想跟進 Contessa。希望你能給我們提供更多關於財務前景和時間表的細節。我認為，從經營虧損的角度來看，你提到了 23 年穩定的經營業績。但聽起來在合資夥伴關係方面有很多活動。所以只是好奇這些合資夥伴關係的收入何時會在結果中實現。從所有這些中收支平衡的新時間表是什麼？

Andrew, this is Nick. I can take that one. This is one of those questions where we're going to answer with it. It depends, right? And I think a lot of that is dependent upon which line of business within Contessa is growing and where the payer interest has been, right? So we have our core group of joint venture partners today where we're doing Hospital at Home, SNF at Home, and we'll look to grow that number into the future.

安德魯，這是尼克。我可以拿那個。這是我們要回答的問題之一。這取決於，對吧？而且我認為這在很大程度上取決於 Contessa 內的哪條業務線正在增長以及付款人的興趣在哪裡，對吧？因此，我們今天擁有我們的核心合資夥伴團隊，我們在家做醫院，在家做 SNF，我們希望在未來增加這個數字。

You're going to see some additional volume opportunity within kind of that core business set as JVs that we executed but were not implemented in 2022 come online in 2023. So that will be a partial driver of the top line. And then as you can see in kind of the bridge that we laid out in the guide, the palliative business has the opportunity to grow top line pretty significantly as we get better experience and more experience with that business. There should be some earnings that come along with that.

您將在核心業務集中看到一些額外的數量機會，因為我們執行但未在 2022 年實施的合資企業將於 2023 年上線。因此這將成為頂線的部分驅動力。然後，正如您在我們在指南中搭建的橋樑中看到的那樣，隨著我們在該業務中獲得更好的經驗和更多經驗，姑息業務有機會顯著增加收入。隨之而來的應該是一些收益。

So you could see some significant step-ups in revenue in the coming years, especially land more palliative deals. And that's not going to directly result in a moderation of those losses. So it really depends on which line of business is growing the fastest.

因此，您可能會在未來幾年看到一些顯著的收入增長，尤其是達成更多姑息性交易。這不會直接導致這些損失的減輕。所以這真的取決於哪個業務線增長最快。

We continue to work every day, like Paul said, with our joint venture partners to increase volume to service their needs. That is obviously a cost-effective way to help impact that loss number. Not ready to come out and give specific guidance around when we get to breakeven because we need to see how some of these new contract developments play out over the course of this year. But as soon as we have better line of sight around that, obviously, we will let you guys know.

正如保羅所說，我們每天都在繼續與我們的合資夥伴合作，以增加產量以滿足他們的需求。這顯然是幫助影響損失數量的一種具有成本效益的方法。不准備就我們何時達到收支平衡給出具體指導，因為我們需要了解其中一些新合同的發展在今年的過程中如何發揮作用。但是，一旦我們有了更好的視線，顯然，我們就會讓你們知道。

We do think that, as we stated last year, we're at kind of the nexus from a loss perspective. So things will only improve from here. But again, it's just going to depend on what those payer relationships look like and what those hospital relationships would look like as we move throughout 2023.

我們確實認為，正如我們去年所說的那樣，從虧損的角度來看，我們處於某種聯繫之中。所以事情只會從這裡改善。但同樣，這將取決於這些付款人關係的情況以及我們在整個 2023 年移動時這些醫院關係的情況。

And I think just to add to what Nick is saying, Andrew, is we -- the palliative -- if we do palliative right, we can solve a lot of the loss issues with 2 or 3 more palliative deals. So we're out pushing those very hard and having a lot of conversations. So we're hopeful we can do that.

我想補充一下尼克所說的話，安德魯，我們——姑息療法——如果我們採取姑息療法，我們可以通過 2 到 3 筆姑息療法來解決很多損失問題。所以我們非常努力地推動這些，並進行了很多對話。所以我們希望我們能做到這一點。

And again, we've got 12 extremely good partners, 14 all in, but 12 really good places to go very deep and continue to -- we'll continue to focus on growing those 5, 10x what they currently are today. So again, we just have to play where we already are and dig deeper. So we view the opportunity as fairly close at hand.

再說一次，我們有 12 個非常好的合作夥伴，14 個都在，但 12 個非常好的地方可以深入並繼續——我們將繼續專注於將這 5 個、10 倍的數量增長到今天的水平。因此，我們只需要在我們已經存在的地方發揮作用並深入挖掘。因此，我們認為機會近在咫尺。

And the other thing is, as these prestigious systems come to us and want to partner with us, we believe that we're going to continue to take them. And then hopefully, as we do that, we'll get more efficient at getting them up to scale faster than what we're doing now.

另一件事是，隨著這些享有盛譽的系統來到我們身邊並希望與我們合作，我們相信我們將繼續採用它們。然後希望，當我們這樣做時，我們將比現在做的更有效地讓他們更快地擴大規模。

The last question today is coming from John Ransom of Raymond James.

今天的最後一個問題來自 Raymond James 的 John Ransom。

Just the connectRN investment, I know the hope was to try to integrate a gig staffing model inside your home health business. Where is that going relative to your initial expectations? And what are the plans for that in 2023?

只是 connectRN 投資，我知道希望是嘗試將零工人員配置模型整合到您的家庭健康業務中。相對於您最初的期望，這會發生什麼變化？ 2023 年的計劃是什麼？

John, thanks for the question. I would say when we talked about the connectRN investment, we talked about kind of a 2-part phasing of how we utilize their services. One, kind of using the platform as is to help us find contracted staff in areas of acute need, which we did kind of in the Northeast last year and had a couple of pilots running for specifically kind of that Phase 1 implementation.

約翰，謝謝你的提問。我想說的是，當我們談到 connectRN 投資時，我們談到了我們如何利用他們的服務的兩部分分階段。第一，按原樣使用該平台來幫助我們在急需的地區找到合同工，我們去年在東北部做了一些工作，並有幾個試點專門針對第一階段的實施。

Phase 2 has always been what I think is the more interesting opportunity, especially as we talk about capacity constraints and this dynamic of people coming on to Amedisys and then transitioning to part time and then to PRN. So we have a large untapped capacity opportunity within our PRN staff. And we are now piloting in 2 of our home health regions. And we'll be rolling this out likely to the remainder of the organization throughout the year, utilizing that platform to offer our PRN workforce shift-based labor with the hopes that we get an additional couple of visits out of those folks a week.

第 2 階段一直是我認為更有趣的機會，尤其是當我們談論容量限制以及人們進入 Amedisys 然後過渡到兼職然後過渡到 PRN 的這種動態時。因此，我們的 PRN 員工中有大量未開發的能力機會。我們現在正在我們的 2 個家庭健康區域進行試點。我們可能會在全年將此推廣到組織的其餘部分，利用該平台為我們的 PRN 勞動力提供輪班工作，希望我們每週能從這些人那裡獲得額外的幾次訪問。

Like Scott said, I think, on this call, those are people that are already credentialed, already provisioned. They know our system. And so in a world where capacity is key, if we're able to drive additional productivity out of that group, that's a big offset to potential contractor cost that we see in our cost per visit. So that pilot is rolling out as we speak today.

正如 Scott 所說，我認為，在這次電話會議上，這些人已經獲得了資格認證，已經準備就緒。他們了解我們的系統。因此，在容量至關重要的世界中，如果我們能夠提高該團隊的生產力，那將大大抵消我們在每次訪問成本中看到的潛在承包商成本。因此，正如我們今天所說，該試點正在推出。

I think we would probably got to this point a little bit faster than we thought we would just kind of given the need. And so the connectRN team has been incredibly receptive and helpful to helping us think through what is a very differentiated kind of staffing strategy within home health, and we'll look to kind of maximize that opportunity throughout the year.

我認為我們達到這一點的速度可能比我們想像的要快一些。因此，connectRN 團隊非常樂於接受並幫助我們思考家庭健康領域的一種非常差異化的人員配置策略，我們將在全年尋求最大限度地利用這一機會。

Yes. And just to follow up on Nick, John, I was out in Wakefield, Massachusetts where we were piloting connectRN and got some direct feedback about how in a very constrained labor environment, it was enabling them to take care of more patients so -- as well as helping them build out a PRN pool, so bringing in outside folks as well as taking and making our existing pool more efficient. So we feel good about it. And that's the future, particularly as the gig economy kicks in to health care workers who want that level of independence. This is going to be a key thing.

是的。只是為了跟進尼克，約翰，我在馬薩諸塞州的韋克菲爾德，在那裡我們正在試行 connectRN，並得到了一些直接反饋，說明在非常受限的勞動環境中，它如何使他們能夠照顧更多的病人，所以——以及幫助他們建立一個 PRN 池，從而引入外部人員並利用並提高我們現有池的效率。所以我們對此感覺很好。這就是未來，尤其是當零工經濟開始影響到想要那種程度的獨立性的醫護人員時。這將是一件關鍵的事情。

At this time, I would like to turn the floor back over to Mr. Kusserow for closing comments.

現在，我想將發言權轉回給 Kusserow 先生以徵求結束意見。

Well, thank you very much. I appreciate it. I want to thank everyone who joined us on our call today. I would also like, again, to thank all of our caregivers who delivered yet another great quarter of results. Thank you for all you do. Thanks for taking care of the patients that really need us. So it's much appreciated.

好的，謝謝。我很感激。我要感謝今天加入我們電話會議的每一個人。我還要再次感謝我們所有的護理人員，他們又取得了四分之一的好成績。謝謝你所做的事。感謝您照顧真正需要我們的患者。所以非常感謝。

I'd like to thank all of you on the phone as well and on the webcast for your interest in Amedisys and care in the home, and I'm looking forward to seeing you all out there on the road in the coming weeks. Until then, take care. Thanks for listening.

我還要通過電話和網絡廣播感謝大家對 Amedisys 的興趣和家庭護理，我期待著在接下來的幾周里在路上見到你們。在那之前，保重。感謝收聽。

Ladies and gentlemen, thank you for your participation. This concludes today's event. You may disconnect your lines or log off the webcast at this time, and enjoy the rest of your day.

女士們，先生們，感謝你們的參與。今天的活動到此結束。此時您可以斷開線路或退出網絡廣播，然後享受接下來的一天。