ATI Physical Therapy Inc (ATIP) 2022 Q4 法說會逐字稿

Good afternoon, everyone, and welcome to ATI Physical Therapy's Fourth Quarter and Full Year 2022 Earnings Conference Call and Webcast. (Operator Instructions) Today's call is being recorded.

大家下午好，歡迎來到 ATI Physical Therapy 的第四季度和 2022 年全年收益電話會議和網絡廣播。 （接線員說明）今天的電話正在錄音中。

On the call today is Sharon Vitti, Chief Executive Officer; Joseph Jordan, Chief Financial Officer; Chris Cox, Chief Operating Officer; and Joanne Fog, Senior Vice President, Treasurer and Head of Investor Relations.

今天接聽電話的是首席執行官 Sharon Vitti；約瑟夫·喬丹，首席財務官；克里斯·考克斯，首席運營官； Joanne Fog，高級副總裁、財務主管兼投資者關係主管。

Ms. Fong, please go ahead.

馮女士，請繼續。

Thank you, Kalia. Good afternoon, everyone, and thank you for joining us today. Before we begin, I'd like to remind you that certain statements made during this call will be forward-looking statements that are subject to various risks and uncertainties and reflect our current expectations based on our beliefs, assumptions and information currently available to us.

謝謝你，卡利亞。大家下午好，感謝您今天加入我們。在我們開始之前，我想提醒您，在本次電話會議中所做的某些陳述將是前瞻性陳述，受各種風險和不確定性的影響，並反映我們基於我們目前可獲得的信念、假設和信息的當前預期。

Although we believe these expectations are reasonable, we undertake no obligation to revise any statements to reflect changes that occur after this call. Descriptions of some of the factors that could cause actual results to differ materially from these forward-looking statements can be found in the Risk Factors section in the company's filings with the Securities and Exchange Commission.

儘管我們認為這些預期是合理的，但我們沒有義務修改任何聲明以反映此次電話會議後發生的變化。有關可能導致實際結果與這些前瞻性陳述存在重大差異的一些因素的描述，請參見公司提交給美國證券交易委員會的文件中的“風險因素”部分。

In addition, please note that the company will be discussing certain non-GAAP financial measures that we believe are important in evaluating performance. Details on the relationship between these non-GAAP measures to the most comparable GAAP measures and reconciliation of historical non-GAAP financial measures can be found in our earnings press release as posted on ATI's website and filed with the SEC.

此外，請注意，公司將討論某些我們認為對評估業績很重要的非 GAAP 財務指標。有關這些非 GAAP 措施與最具可比性的 GAAP 措施之間關係的詳細信息以及歷史非 GAAP 財務措施的調節，請參閱我們在 ATI 網站上發布並提交給美國證券交易委員會的收益新聞稿。

With that, I'll turn the call over to Sharon.

有了這個，我會把電話轉給莎倫。

Thanks, Joanne, and welcome, everyone. Earlier today, we published our fourth quarter and full year 2022 results and announced a Transaction Support Agreement or TSA with our first lien lenders, preferred equity holders and the majority investors in our common stock.

謝謝，喬安妮，歡迎大家。今天早些時候，我們發布了第四季度和 2022 年全年業績，並宣布與我們的第一留置權貸款人、優先股持有人和我們普通股的多數投資者達成交易支持協議或 TSA。

To provide ATI with additional needed financial flexibility once the transactions contemplated by the TSA are finalized. Joe will discuss the TSA in more detail shortly. So in addition to finalizing the transactions contemplated by the TSA, a top priority at ATI continues to be achieving our near-term growth targets. So our remarks today will be centered on our growth drivers across the 3 Ps in our practice. If you remember, those are the pipeline, provider base and provider productivity.

一旦 TSA 擬定的交易最終確定，為 ATI 提供額外所需的財務靈活性。 Joe 稍後將更詳細地討論 TSA。因此，除了完成 TSA 考慮的交易之外，ATI 的首要任務仍然是實現我們的近期增長目標。因此，我們今天的發言將集中在我們實踐中跨越 3P 的增長動力上。如果您還記得的話，這些是管道、供應商基礎和供應商生產力。

I'll also cover 2022 performance highlights. Some of the initiatives we have underway, and I'll share our early 2023 performance trends. Before I dive in, I need to thank all of our teams across the ATI family, including our providers in the clinic, those in our health services practices and our corporate team for their hard work and dedication. This team of approximately 5,700 is resilient, tenacious and committed to improving access to high-quality care and delivering outcomes that enrich the lives of our patients. It's a really impressive group. Underscoring the strength of our team, we again received an exceptional rating from CMS under the Medicare Merit-Based Incentive Payment System program and maintained high marks from our patients.

我還將介紹 2022 年的性能亮點。我們正在進行的一些舉措，我將分享我們 2023 年初的績效趨勢。在開始之前，我需要感謝我們 ATI 家族的所有團隊，包括我們在診所的提供者、我們健康服務實踐中的提供者以及我們公司團隊的辛勤工作和奉獻精神。這個由大約 5,700 人組成的團隊富有彈性、堅韌不拔，致力於改善獲得高質量護理的機會，並提供豐富患者生活的成果。這是一個非常令人印象深刻的群體。強調我們團隊的實力，我們再次根據 Medicare Merit-Based Incentive Payment System 計劃獲得 CMS 的卓越評級，並保持患者的高分。

So turning to our financial performance. We had a good fourth quarter and delivered on our 2022 revenue and adjusted EBITDA guidance conveyed to our investors. Last year was a really important one of transformation for ATI as we added several new key team members, expanded roles and promoted talented colleagues. We also maintained a discipline focus on managing our spending and cash burn, and we believe that our results demonstrate that our approach is taking hold.

所以轉向我們的財務表現。我們第四季度表現良好，實現了 2022 年的收入和調整後的 EBITDA 指引，傳達給了我們的投資者。去年對於 ATI 來說是一個非常重要的轉型年，因為我們增加了幾個新的關鍵團隊成員，擴大了角色並提拔了有才華的同事。我們還堅持以管理支出和現金消耗為重點，我們相信我們的結果表明我們的方法正在發揮作用。

On our last call, we introduced you to Eimile Tansey, our new Chief People Officer. And today, we are pleased to introduce Chris Cox, our new Chief Operating Officer. Chris joined us just at the end of the fourth quarter in December, bringing more than 17 years of health care experience, including over a decade focused on health care operations at scale.

在上次通話中，我們向您介紹了我們的新任首席人力官 Eimile Tansey。今天，我們很高興地介紹我們的新任首席運營官 Chris Cox。 Chris 於 12 月第四季度末加入我們，帶來了超過 17 年的醫療保健經驗，其中包括十多年專注於大規模醫療保健運營的經驗。

Another great addition to our team is Scott Gregerson, our new Chief Growth Officer, who joined us in early January 2023. Scott has an extensive background in the provider and care delivery space, having spent over 2 decades developing and implementing growth in business development initiative. Scott's focus this year is on driving growth in the business, while developing our long-term growth strategy to increase revenue and further position us as a leader in the musculoskeletal space.

我們團隊的另一位重要成員是我們新任首席增長官 Scott Gregerson，他於 2023 年 1 月初加入我們。Scott 在提供者和護理提供領域擁有廣泛的背景，他花了 20 多年時間制定和實施業務發展計劃的增長. Scott 今年的重點是推動業務增長，同時制定我們的長期增長戰略以增加收入並進一步將我們定位為肌肉骨骼領域的領導者。

So turning to the 3 Ps of our practice. First, we have our pipeline. As a reminder, in the beginning of -- at the end of 2021, we brought in a consultant to develop a new marketing and referral targeting strategy. So we took that in 2022 and implemented those recommendations and rebuilt our business development team, referral relationships we re-built, care brand and our go-to-market value props. The BD team hit its stride in Q4. So we look at 2022, we started with referrals per day at approximately 80% of our pre-COVID levels and worked our way steadily to the mid-90s by Q4. In the first 2 months of 2023, referrals have exceeded pre-pandemic levels for the first time.

因此，轉向我們實踐的 3 Ps。首先，我們有我們的管道。提醒一下，在 2021 年底之初，我們聘請了一名顧問來製定新的營銷和推薦目標策略。因此，我們在 2022 年採納了這些建議並實施了這些建議，並重建了我們的業務開發團隊、我們重建的推薦關係、護理品牌和我們的上市價值支柱。 BD 團隊在第四季度取得了長足的進步。因此，我們著眼於 2022 年，我們從每天的推薦量開始，大約是我們 COVID 前水平的 80%，並在第四季度穩步上升到 90 年代中期。在 2023 年的前兩個月，轉診人數首次超過了大流行前的水平。

So looking at our second P provider productivity, we also excelled in the fourth quarter in our productivity. In the first 3 quarters of 2022, productivity plateaued relative to the comparative first 3 quarters in the prior year 2021. In Q4, our providers focused on our commitment to our patients and the increased demand for care and they increase productivity in the fourth quarter and early 2023 to historical seasonal trends. As across our national footprint, our team saw an average 9 visits per day per clinical FTE in the fourth quarter of 2022 and then carried that strong momentum into 2023 at 9.3 visits per day per clinical FTE in the 2023 year-to-date period.

因此，看看我們的第二個 P 供應商生產力，我們在第四季度的生產力方面也表現出色。在 2022 年前三個季度，生產率相對於 2021 年同期的前三個季度趨於平穩。在第四季度，我們的供應商專注於我們對患者的承諾和對護理需求的增加，他們在第四季度提高了生產率，並且2023 年初的歷史季節性趨勢。在我們的全國足跡中，我們的團隊在 2022 年第四季度平均每個臨床 FTE 每天進行 9 次就診，然後將這種強勁勢頭延續到 2023 年，在 2023 年至今，每個臨床 FTE 每天進行 9.3 次就診。

So looking at our third P, our provider base. The labor market continues to be a headwind across PT practices and at ATI. Our clinical FTE metric was essentially flat throughout 2022, although there was a marginal uptick in the fourth quarter. Emily, our CPO has been intently focused on enhancing our talent acquisition team and updating our tools and tactics. We've increased our investment in our TA unit and are aggressively working to grow our provider base. We remain vigilant with our strategies, investments and offerings to attract and retain vital providers. Emily is equally as focused on our ATI people and culture as they are the cornerstone of our care delivery organization. She continues to modernize our programs and offerings to position ATI as an employer of choice for new and existing colleagues.

所以看看我們的第三個 P，我們的供應商基礎。勞動力市場仍然是 PT 實踐和 ATI 的逆風。我們的臨床 FTE 指標在整個 2022 年基本持平，儘管第四季度略有上升。 Emily，我們的 CPO 一直專注於加強我們的人才招聘團隊並更新我們的工具和策略。我們增加了對 TA 部門的投資，並積極努力擴大我們的供應商基礎。我們對我們的戰略、投資和產品保持警惕，以吸引和留住重要的供應商。 Emily 同樣關注我們的 ATI 人員和文化，因為他們是我們護理組織的基石。她繼續使我們的項目和產品現代化，使 ATI 成為新同事和現有同事的首選雇主。

Next, I'd like to provide an update on our geographic footprint optimization efforts. On our last call, we discussed reviewing our clinic footprint and observed the top 80% of our clinics meeting or exceeding performance targets while 20% are underperforming. In 2022, we opened 36 De Novo clinics and closed and/or divested 23 clinics. And then we kept that going in the first 2 months of 2023, we closed and/or divested 15 clinics and will continue to take swift action with select clinic locations to strengthen operations and redeployed these valuable providers to our busy clinics when possible. We finished 2022 strong and 2023 is off to a great start.

接下來，我想提供有關我們地理足跡優化工作的最新信息。在我們的最後一次電話會議上，我們討論了審查我們的診所足跡，並觀察到我們前 80% 的診所達到或超過績效目標，而 20% 的診所表現不佳。 2022 年，我們開設了 36 家 De Novo 診所，關閉和/或剝離了 23 家診所。然後我們在 2023 年的前兩個月繼續這樣做，我們關閉和/或剝離了 15 家診所，並將繼續對選定的診所地點採取迅速行動以加強運營，並在可能的情況下將這些有價值的提供者重新部署到我們繁忙的診所。我們以強勁的勢頭結束了 2022 年，2023 年有了一個良好的開端。

While labor market continues to be constrained, the entire ATI family is focused on growing the provider base, retaining our current providers and delivering excellent care, which we believe will contribute to meaningful financial results for our investors. And as we move through 2023, we are acting with urgency to harness our recent momentum and continue driving improvement in the business. We all continue to be energized by the swift and impactful actions of our teams and the successes we have seen over the last 5 months.

雖然勞動力市場繼續受到限制，但整個 ATI 家族都專注於擴大供應商基礎、留住我們現有的供應商並提供優質護理，我們相信這將為我們的投資者帶來有意義的財務業績。隨著 2023 年的到來，我們正在緊急行動，以利用我們最近的勢頭並繼續推動業務的改善。我們團隊迅速而有影響力的行動以及我們在過去 5 個月中取得的成功讓我們所有人都繼續充滿活力。

So with that, I will turn it over to Chris for a discussion of our operations in his observation on the field.

因此，我將把它交給克里斯，讓他在現場觀察中討論我們的行動。

Thank you, Sharon. I am thrilled to be here at ATI and my first 90 days have been active, engaging and productive. In my short time here, I have come to see that we have a very strong base, but also a tremendous opportunity to improve operational excellence across several areas while continuing to deliver the highest quality of care to our patients.

謝謝你，莎倫。我很高興來到 ATI，我的前 90 天一直很活躍、投入且富有成效。在我在這裡的短暫時間裡，我開始看到我們擁有非常強大的基礎，但也有巨大的機會來改善多個領域的卓越運營，同時繼續為我們的患者提供最高質量的護理。

A few weeks after I joined the company, and I was able to attend our national leadership event, where we brought together every clinic director from across the country in addition to our field and corporate leadership teams to align on our 2023 priorities and discuss operational strategies and tactics for all of our clinics. This was a great opportunity for me to meet and get to know our providers across our national footprint and hear about the things that motivate them in their roles. Our providers are passionate about achieving outstanding outcomes for their patients, and I'm excited to be able to work alongside this team to increase patient access to high-quality physical therapy care and to exceed customer expectations.

在我加入公司幾週後，我得以參加我們的全國領導活動，除了我們的現場和公司領導團隊之外，我們還召集了來自全國各地的每一位診所主任，以協調我們 2023 年的優先事項並討論運營戰略和我們所有診所的策略。這對我來說是一個很好的機會，可以結識並了解我們遍布全國的供應商，並了解激勵他們發揮作用的因素。我們的提供者熱衷於為他們的患者取得出色的成果，我很高興能夠與這個團隊一起工作，以增加患者獲得高質量物理治療護理的機會並超越客戶的期望。

In the fourth quarter, we elevated several individuals within my organization and reconfigured our field structure enhances our ability to drive consistent results across the country. Gary Carlson was promoted to the newly created Senior Vice President of Field Operations position, which now oversees the entire outpatient clinic footprint across the country.

在第四季度，我們提升了我組織內的幾個人並重新配置了我們的現場結構，增強了我們在全國范圍內推動一致結果的能力。加里·卡爾森 (Gary Carlson) 被提升為新設立的現場運營高級副總裁職位，該職位現在負責監督全國的整個門診診所。

Gary is himself a well-respected physical therapist and a seasoned field leader who has been with ATI for approximately 10 years, having originally joined us when the clinic he owned was acquired by ATI. Gary is also a military veteran and combining his experiences from the military and his history in physical therapy, has been valuable in coordinating multiple actions across functions and effectively leading a dispersed field team to execute against our plan.

Gary 本人是一位備受尊敬的物理治療師和經驗豐富的現場領導者，他在 ATI 工作了大約 10 年，最初是在他擁有的診所被 ATI 收購時加入我們的。加里也是一名退伍軍人，結合他在軍隊的經驗和他在物理治療方面的歷史，在協調跨職能的多項行動以及有效領導分散的現場團隊執行我們的計劃方面發揮了重要作用。

As Sharon discussed, provider productivity reached historical seasonal highs under Gary's leadership. Results speak for themselves, and it was no easy feat to finish 2022 strong with the snowstorms that we experienced in December, the holiday season and the need to backfill the higher level of paid time off we see around that time of year. And this performance has continued into the first 2 months of 2023 due to the continuation of deliberate tactics and actions. In my experience, seeing this type of performance increase occurs so rapidly is unique, and feedback from the clinics has been that they now have better understanding of their priorities with clear expectations and road maps for how to achieve those expectations. I want to thank Gary and the rest of our field team for their leadership, and I will continue to work with them on providing this clear guidance and expectations to our clinics.

正如 Sharon 所討論的那樣，在 Gary 的領導下，供應商生產力達到歷史季節性高點。結果不言而喻，要在 2022 年強勢結束並非易事，因為我們在 12 月經歷了暴風雪、假期以及需要回補我們在一年中那個時候看到的更高水平的帶薪休假。而由於蓄意的戰術和行動的延續，這種表現一直持續到2023年前2個月。根據我的經驗，看到這種類型的績效增長如此迅速是獨一無二的，而且來自診所的反饋是他們現在更好地理解了他們的優先事項，有了明確的期望和如何實現這些期望的路線圖。我要感謝加里和我們現場團隊的其他成員的領導，我將繼續與他們合作，為我們的診所提供明確的指導和期望。

In addition to Gary's new role, we have a new SVP of Clinical Excellence and an SVP of Health Services. These are equally important contributors to our results and to our go-forward strategies. These positions were also filled by widely respected and accomplished ATI-tenured employees in physical therapists. One area of distinction for ATI is that our team has been collecting functional outcomes data for nearly a decade, and we currently have outcomes from more than 2.5 million unique patient cases to inform our clinical treatment plans. This data not only shows that we deliver high-quality patient care, but it also allows us to differentiate in our discussions with payers and provider partners.

除了 Gary 的新角色外，我們還有一位新的臨床卓越高級副總裁和一位健康服務高級副總裁。這些對我們的結果和我們的前進戰略同樣重要。這些職位也由在物理治療師領域廣受尊重和成就卓著的 ATI 終身僱員擔任。 ATI 的一個突出領域是我們的團隊近十年來一直在收集功能結果數據，我們目前擁有超過 250 萬個獨特患者病例的結果，可以為我們的臨床治療計劃提供信息。這些數據不僅表明我們提供高質量的患者護理，而且還使我們能夠在與付款人和供應商合作夥伴的討論中脫穎而出。

Another priority of mine is innovation of our processes and systems to support our field and clinic teams, and I've been reviewing our intake, referral management, scheduling and revenue cycle management processes. We have opportunities across each of these areas to reduce costs, enhance revenue and drive improved customer service and outcomes. These results will be gained through process redesign, enhanced automation and in some cases, full technology overhauls. We are currently finalizing our prioritization and sizing of these initiatives, which I believe will drive enhanced value over the next couple of years. I look forward to reporting on the progress of these initiatives in the coming quarters.

我的另一個優先事項是創新我們的流程和系統以支持我們的現場和診所團隊，我一直在審查我們的接收、轉診管理、日程安排和收入周期管理流程。我們在這些領域中的每一個領域都有機會降低成本、增加收入並推動改善客戶服務和成果。這些結果將通過重新設計流程、增強自動化以及在某些情況下進行全面技術檢修來獲得。我們目前正在確定這些舉措的優先級和規模，我相信這將在未來幾年推動價值的提升。我期待在未來幾個季度報告這些舉措的進展情況。

Finally, as Emily and her team work to recruit and hire new providers, we remain focused on supporting our clinicians in the field so they can continue providing excellent care to our patients. When our providers feel cared for by the organization, they in turn both take the best care of our patients and want to stay with our organization. So this is critical for us to minimize turnover. Despite the tough labor market, our ATI clinical employee attrition rate was in the mid-20% throughout 2022, which was a significant improvement versus 2021.

最後，隨著 Emily 和她的團隊努力招募和僱用新的提供者，我們仍然專注於支持我們在該領域的臨床醫生，以便他們能夠繼續為我們的患者提供優質護理。當我們的提供者感受到組織的關心時，他們反過來會為我們的患者提供最好的照顧，並希望留在我們的組織中。因此，這對我們最大限度地減少營業額至關重要。儘管勞動力市場艱難，但我們的 ATI 臨床員工流失率在整個 2022 年處於 20% 左右，與 2021 年相比有了顯著改善。

While we cannot control the supply-demand balance in the macro physical therapy labor market, we will continue using all the tools we have to decrease turnover through both national and local engagement efforts. At the same time, we're driving accountability and ownership with our field teams to take all actions they can to improve staffing levels. From leaning in with our talent acquisition team on referrals and hiring, we're working on specific tactics related to reducing non-value add work so that we can, therefore, increase the number of hours our clinicians are on the floor treating patients. These actions have started to impact the productivity results that we referenced earlier, and we will continue to identify and drive new actions along the same lines.

雖然我們無法控制宏觀物理治療勞動力市場的供需平衡，但我們將繼續使用我們擁有的所有工具，通過國家和地方的參與努力來減少人員流動。與此同時，我們正在與我們的現場團隊一起推動問責制和所有權，以採取一切可能的行動來提高人員配備水平。通過與我們的人才招聘團隊合作進行推薦和招聘，我們正在研究與減少非增值工作相關的具體策略，因此我們可以增加臨床醫生在場治療患者的時間。這些行動已經開始影響我們之前提到的生產力結果，我們將繼續沿著同樣的路線確定和推動新的行動。

I want to personally thank our field clinic teams and health services teams who take care of our patients every day. Their success is ATI's success. And everything we do is to support their efforts to help our patients return to better health. I'm very proud to be a part of the ATI team who are passionate about our overarching mission to helping patients reach their full potential. We look forward to seeing what we can achieve together.

我要親自感謝每天照顧我們患者的現場診所團隊和衛生服務團隊。他們的成功就是ATI的成功。我們所做的一切都是為了支持他們幫助我們的患者恢復更好健康的努力。我很自豪能成為 ATI 團隊的一員，他們熱衷於我們幫助患者充分發揮潛力的首要使命。我們期待看到我們可以共同取得的成就。

Now I'd like to turn the call over to Joe to provide an in-depth review of our financial results.

現在我想把電話轉給喬，讓他對我們的財務業績進行深入審查。

Thank you, Chris, and thanks everyone for joining the call today. I will cover our fourth quarter and our full year 2022 financial results, and I'll touch on the Transaction Support Agreement that was announced earlier today.

謝謝克里斯，感謝大家今天加入電話會議。我將介紹我們的第四季度和 2022 年全年財務業績，我將談談今天早些時候宣布的交易支持協議。

Starting with 2022 results. Our net revenue in the fourth quarter was $162 million, which is a 3.9% increase year-over-year from $156 million in Q4 of the prior year. Net patient revenue was $146 million, increasing 4.2% year-over-year, while other revenue was $16 million, which is a 0.5% increase year-over-year. Visits per day per clinic during the quarter was 24.1, sequentially increasing 0.9 visits from 23.2 in the third quarter. And while the fourth quarter is typically flat to marginally lower than the third quarter due to holidays and due to inclement weather, this was not the case in 2022.

從 2022 年的結果開始。我們第四季度的淨收入為 1.62 億美元，比去年第四季度的 1.56 億美元同比增長 3.9%。患者淨收入為 1.46 億美元，同比增長 4.2%，而其他收入為 1600 萬美元，同比增長 0.5%。本季度每個診所每天的就診次數為 24.1 次，比第三季度的 23.2 次增加了 0.9 次。儘管由於假期和惡劣天氣，第四季度通常持平或略低於第三季度，但 2022 年情況並非如此。

We began execution in the fourth quarter with the new leadership team focused on clinic footprint optimization and our 4-wall operational plans. And the early results are starting to show in the form of stronger, more vibrant clinics, and in unit KPIs. Visits per day per clinic increased 1.3 visits year-over-year in the fourth quarter of 2022 compared to being essentially flat year-over-year in the second quarter and the third quarter. Our rate per visit during the quarter was $103.99, which is an increase of 0.5% from $103.46 in the third quarter of 2022. The improvement in rate was primarily due to mix shift in services driven by our patient base. Moreover, the rate per visit stabilized around $103 since the first quarter compared to the downward trend that we were experiencing during the highs of COVID.

我們在第四季度開始執行，新的領導團隊專注於診所足跡優化和我們的 4 牆運營計劃。早期的結果開始以更強大、更有活力的診所和單位 KPI 的形式顯現。與第二季度和第三季度同比基本持平相比，2022 年第四季度每個診所每天的訪問量同比增加 1.3 次。我們在本季度的每次就診費率為 103.99 美元，比 2022 年第三季度的 103.46 美元增長了 0.5%。費率的提高主要是由於我們的患者群推動了服務的混合轉變。此外，與我們在 COVID 高潮期間經歷的下降趨勢相比，自第一季度以來每次訪問的費用穩定在 103 美元左右。

Salaries and related costs in the fourth quarter of 2022 was $91 million, a 2.9% increase year-over-year from $88 million in Q4 of the prior year. PT salaries and related costs per visit during the quarter were $54.92, decreasing 2.3% from $56.20 in the third quarter and improving 1.4% year-over-year from $55.73 in the fourth quarter of 2021.

2022 年第四季度的工資和相關成本為 9100 萬美元，比上年第四季度的 8800 萬美元同比增長 2.9%。本季度每次就診的 PT 工資和相關費用為 54.92 美元，比第三季度的 56.20 美元下降 2.3%，比 2021 年第四季度的 55.73 美元同比增長 1.4%。

The decreases in cost per visit were primarily due to higher labor productivity as visits per day per clinical FTE was 9.0 in the fourth quarter, improving from 8.7 in the third quarter and 8.3 in Q4 of 2021. The decreases in cost per visit were partially offset by higher clinician labor costs due to the tight labor market.

每次就診成本的下降主要是由於更高的勞動生產率，因為第四季度每個臨床 FTE 每天的就診次數為 9.0，高於第三季度的 8.7 和 2021 年第四季度的 8.3。每次就診成本的下降被部分抵消由於勞動力市場緊張導致臨床醫生勞動力成本上升。

Rent, clinic supplies, contract labor and other in the fourth quarter was $49 million, a 2.8% increase year-over-year from $48 million, primarily due to having more clinics. PT rent, clinic supplies, contract labor and other per clinic during the quarter was approximately $51,000, decreasing 5% from $54,000 in the third quarter and essentially flat, increasing 0.5% compared to the fourth quarter prior year. The sequential decrease was primarily driven by less use of contract labor and the impact of cost control actions.

第四季度的租金、診所用品、合同工和其他費用為 4900 萬美元，較上年同期的 4800 萬美元增長 2.8%，這主要是由於診所數量增加。本季度每個診所的 PT 租金、診所用品、合同工和其他費用約為 51,000 美元，比第三季度的 54,000 美元下降 5%，與去年第四季度相比基本持平，增長 0.5%。環比下降主要是由於減少使用合同工和成本控制措施的影響。

Provision for doubtful accounts during the quarter was approximately $2 million or 1.7% of PT revenue and has trended favorably each sequential quarter in 2022, starting at 3.7% of PT revenue in Q1. For the full year, the provision was 2.4% of PT revenue compared to full year 2021 at 2.9% and full year 2020 at 3.1%. These improvements are a result of deliberate collection efforts by our team and those efforts remain ongoing in 2023.

本季度的呆賬準備金約為 200 萬美元，佔 PT 收入的 1.7%，並且從第一季度開始佔 PT 收入的 3.7%，到 2022 年每個連續季度都呈現良好趨勢。全年，準備金佔 PT 收入的 2.4%，而 2021 年全年為 2.9%，2020 年全年為 3.1%。這些改進是我們團隊刻意收集努力的結果，這些努力將在 2023 年繼續進行。

SG&A during the quarter was $28 million, a 7.6% decrease year-over-year from $30 million in Q4 of the prior year, and it's primarily driven by lower non-ordinary legal and regulatory spend and executive search fees, partially offset by higher severance cost resulting from building out the new executive leadership team.

本季度的 SG&A 為 2800 萬美元，比上年第四季度的 3000 萬美元同比下降 7.6%，這主要是由於非常規法律和監管支出以及高管搜索費用的減少，部分被較高的遣散費所抵消建立新的執行領導團隊所產生的成本。

Noncash goodwill, intangible and other asset impairment charge in the fourth quarter was $96 million. And the impairments were due to a multitude of factors, which include valuation inputs such as the industry cost of capital and guideline public company multiples in addition to revised near-term company expectations given labor market headwinds.

第四季度的非現金商譽、無形資產和其他資產減值費用為 9600 萬美元。減值是由於多種因素造成的，其中包括行業資本成本和指導性上市公司倍數等估值輸入，以及鑑於勞動力市場逆風而修改的近期公司預期。

Operating loss, excluding impairment charges in the fourth quarter of 2022 was $8 million, decreasing year-over-year from an operating loss of $12 million in Q4 of the prior year, which reflects early results of the multiyear business improvement initiatives that we started in the second half of 2022. Notable below-the-line items during the quarter included income resulting from a decrease in the fair value of certain liabilities acquired in connection with our business combination that we entered into in June 2021, specifically the warrants and contingent common shares, which totaled $10 million.

2022 年第四季度的營業虧損（不包括減值費用）為 800 萬美元，較上年第四季度的 1200 萬美元營業虧損同比下降，這反映了我們於2022 年下半年。本季度值得注意的線下項目包括因我們於 2021 年 6 月進行的業務合併而獲得的某些負債的公允價值下降導致的收入，特別是認股權證和或有普通股股票，總額為 1000 萬美元。

The mark-to-market was based on fair value valuation analysis as of December 31, 2022. Our interest expense in the fourth quarter was $13 million compared to $7 million in the fourth quarter of the prior year with the increase primarily driven by higher interest rates under the company's credit agreement at the year-end 2022 compared to the credit agreement at the year-end 2021 as well as an overall higher interest rate environment in 2022. Income tax benefit for the quarter was $5 million, consistent with Q4 2021.

按市值計價基於截至 2022 年 12 月 31 日的公允價值估值分析。我們第四季度的利息支出為 1300 萬美元，而去年第四季度為 700 萬美元，增加的主要原因是利息增加與 2021 年底的信貸協議相比，公司 2022 年底信貸協議下的利率以及 2022 年整體較高的利率環境。本季度的所得稅收益為 500 萬美元，與 2021 年第四季度一致。

Our net loss during the quarter was $102 million compared to net income of $2 million in the fourth quarter of 2021. For the full year 2022, revenue was $636 million, a 1.2% increase year-over-year from $628 million. The revenue of $636 million compares to revenue guidance of $635 million to $655 million. While visits per day increased 5.9% year-over-year, rate per visit declined 2.3% in 2022, mostly driven by Medicare rate cuts, Medicare sequestration reductions and less favorable payer and state mix.

我們本季度的淨虧損為 1.02 億美元，而 2021 年第四季度的淨收入為 200 萬美元。2022 年全年收入為 6.36 億美元，比去年同期的 6.28 億美元增長 1.2%。收入為 6.36 億美元，而收入指引為 6.35 億美元至 6.55 億美元。雖然每天的就診量同比增長 5.9%，但到 2022 年每次就診率下降了 2.3%，這主要是由於 Medicare 降息、Medicare 扣押減少以及不太有利的付款人和國家組合所推動的。

Adjusted EBITDA during the full year 2022 was approximately $7 million, decreasing year-over-year from $40 million in 2021. The $7 million of adjusted EBITDA compares to an adjusted EBITDA guidance range of $5 million to $15 million. Cash generated during 2022 was approximately $35 million, broken down between $65 million used to fund operations, $28 million used in investing activities, and $128 million provided by financing activities.

2022 年全年調整後的 EBITDA 約為 700 萬美元，較 2021 年的 4000 萬美元同比下降。調整後的 EBITDA 為 700 萬美元，而調整後的 EBITDA 指導範圍為 500 萬至 1500 萬美元。 2022 年產生的現金約為 3500 萬美元，分為用於為運營提供資金的 6500 萬美元、用於投資活動的 2800 萬美元和由融資活動提供的 1.28 億美元。

Cash used in operations included $18 million in payments in connection with the Medicare accelerated and advanced payment program and deferral of employer portion of social security taxes under the CARES Act. As of December 31, 2022, available liquidity was approximately $83 million, comprised of cash and cash equivalents with no available revolver capacity.

運營中使用的現金包括與 Medicare 加速和預付款計劃相關的 1800 萬美元付款，以及根據 CARES 法案推遲繳納的雇主部分社會保障稅。截至 2022 年 12 月 31 日，可用流動資金約為 8300 萬美元，包括現金和現金等價物，沒有可用的周轉能力。

Next, I would like to speak to the going concern opinion included in our filed Form 10-K. In accordance with U.S. GAAP, an analysis was conducted contemplating our current liquidity and our projected cash flows for the next 12 months. And under that analysis, there's a risk that the company would not meet certain of its financial covenants in our credit agreement, which is the basis for our going concern conclusions.

接下來，我想談談我們提交的 10-K 表格中包含的持續經營意見。根據美國公認會計原則，對我們當前的流動性和未來 12 個月的預計現金流量進行了分析。根據該分析，公司有可能無法滿足我們信貸協議中的某些財務契約，這是我們持續經營結論的基礎。

As Sharon and Chris discussed, we're seeing improved operational performance in the clinics in 2023. We're also cognizant of the need to grow the provider base in a tight labor market, and it's important that we have financial flexibility as we execute against our strategy. As such, we partnered with certain of our lenders, our preferred equity holders and the majority holders of our common stock to design new credit agreement terms to address potential liquidity constraints in the near term.

正如 Sharon 和 Chris 所討論的那樣，我們看到 2023 年診所的運營績效有所改善。我們也認識到需要在緊張的勞動力市場中擴大提供者基礎，並且在執行時具有財務靈活性很重要我們的戰略。因此，我們與我們的某些貸方、我們的優先股持有人和我們普通股的多數持有人合作，設計新的信貸協議條款，以解決短期內潛在的流動性限制。

We entered into a Transaction Support Agreement this week, which was announced today, and we're currently working through the details and the definitive agreements. The new and amended agreements are intended to enhance our liquidity position, putting funding in place for working capital purposes, should we need it as well as providing covenant relief as we execute our strategy.

我們本週簽訂了一項交易支持協議，該協議已於今天宣布，我們目前正在研究細節和最終協議。新的和修訂後的協議旨在增強我們的流動性狀況，在我們需要時為營運資金提供資金，並在我們執行戰略時提供契約救濟。

To that end, we reached agreement on a delayed draw of up to $25 million in the form of new second lien PIK exchangeable notes. Additionally, we agreed to further increase cash available for operations by exchanging $100 million of our existing first lien term loan, which has required cash interest payments into new second lien PIK debt. We also agreed to amend our credit agreement to include less burdensome financial covenants. Additional details of the TSA and the term sheet have been filed as an exhibit to our Form 10-K.

為此，我們就以新的第二留置權 PIK 可交換票據的形式延遲提取高達 2500 萬美元的款項達成協議。此外，我們同意通過將我們現有的第一留置權定期貸款中的 1 億美元交換為新的第二留置權 PIK 債務需要支付現金利息，從而進一步增加可用於運營的現金。我們還同意修改我們的信貸協議，以包括負擔較輕的財務契約。 TSA 和條款清單的其他詳細信息已作為附件提交到我們的 10-K 表格中。

We look forward to keeping you updated on our progress as we move through the execution phase of these transactions, which we expect to complete in the second quarter of 2023. We also plan to provide guidance for fiscal year 2023 as part of our first quarter earnings release.

在這些交易的執行階段，我們期待著讓您了解我們的最新進展，我們預計這些交易將在 2023 年第二季度完成。我們還計劃提供 2023 財年的指導，作為我們第一季度收益的一部分發布。

I'll now turn the call back over to Sharon for closing remarks.

我現在將電話轉回給 Sharon 以作結束語。

Thanks, Joe. 2022 was a year of strengthening our team, assessing our business and operations and refining our strategy. And we have hit the ground running. We believe that our performance demonstrates that we are taking the right steps, and we are excited about the expanded runway the transactions contemplated by the TSA will provide.

謝謝，喬。 2022 年是加強我們團隊、評估我們的業務和運營以及完善我們戰略的一年。我們已經開始運行。我們相信我們的表現表明我們正在採取正確的步驟，我們對 TSA 擬議的交易將提供的擴展跑道感到興奮。

I am confident we have the right team and strategies in place. I look forward to providing updates as we make progress. On that note, because of our ongoing discussions to execute the transaction outlined in the Transaction Support Agreement, we will not be taking questions on today's call. We will provide an update after the transaction is finalized, which, as Joe said, we expect to be in the second quarter.

我相信我們擁有合適的團隊和適當的戰略。我期待在我們取得進展時提供更新。在這一點上，由於我們正在討論執行交易支持協議中概述的交易，我們不會在今天的電話會議上回答問題。我們將在交易完成後提供更新，正如喬所說，我們預計將在第二季度完成。

Appreciate everyone's time. Thank you, and I'll now hand it back to the operator.

珍惜每一個人的時間。謝謝，我現在將它交還給接線員。

And again, that will conclude today's conference. You may now disconnect. Thank you for joining us.

再一次，今天的會議到此結束。您現在可以斷開連接。感謝您加入我們。