Aveanna Healthcare Holdings Inc (AVAH) 2022 Q4 法說會逐字稿

Good morning, and welcome to Aveanna's Healthcare Holdings Fourth Quarter and Full Year 2022 Earnings Conference Call. (Operator Instructions) At this time, I'd like to turn the call over to Shannon Drake, Aveanna's, Chief Legal Officer and Corporate Secretary. Thank you. You may begin.

早上好，歡迎來到 Aveanna 的 Healthcare Holdings 第四季度和 2022 年全年收益電話會議。 （操作員說明）此時，我想將電話轉給 Aveanna 的首席法務官兼公司秘書 Shannon Drake。謝謝。你可以開始了。

Thanks, Kamila. Good morning, and welcome to Aveanna's Fourth Quarter 2022 Earnings Call. My name is Shannon Drake, the company's Chief Legal Officer and Corporate Secretary. With me today is Jeff Shaner, our Chief Executive Officer; and Dave Afshar, our Chief Financial Officer.

謝謝，卡米拉。早上好，歡迎來到 Aveanna 的 2022 年第四季度收益電話會議。我叫 Shannon Drake，是公司的首席法務官兼公司秘書。今天和我在一起的是我們的首席執行官 Jeff Shaner；和我們的首席財務官 Dave Afshar。

During this call, we will make forward-looking statements. Risk factors that may impact those statements and could cause actual future results to differ materially from currently projected results are described in this morning's press release and the reports we filed with the SEC. The company does not undertake any duty to update such forward-looking statements.

在此次電話會議中，我們將做出前瞻性陳述。今天上午的新聞稿和我們向美國證券交易委員會提交的報告中描述了可能影響這些聲明並可能導致實際未來結果與當前預測結果存在重大差異的風險因素。公司不承擔任何更新此類前瞻性陳述的義務。

Additionally, during today's call, we will discuss certain non-GAAP measures, which we believe can be useful in evaluating our performance. The presentation of this additional information should not be considered in isolation or as a substitute for results prepared in accordance with GAAP. A reconciliation of these measures can be found in this morning's press release, which is posted on our website, aveanna.com, and in our most recent annual report on Form 10-K.

此外，在今天的電話會議中，我們將討論某些非 GAAP 指標，我們認為這些指標有助於評估我們的業績。不應孤立地考慮提供此附加信息或替代根據 GAAP 編制的結果。這些措施的協調可以在今天上午的新聞稿中找到，該新聞稿發佈在我們的網站 aveanna.com 上，以及我們最近的 10-K 表格年度報告中。

With that, I will turn the call over to Aveanna's Chief Executive Officer, Jeff Shaner. Jeff?

有了這個，我將把電話轉給 Aveanna 的首席執行官 Jeff Shaner 。傑夫？

Thank you, Shannon. Good morning, and thank you for joining us today. We appreciate each of you investing your time this morning to better understand our Q4 and full year 2022 results and how we are moving forward at a -- my initial comments will briefly highlight our fourth quarter results, along with the steps we are taking to address the labor markets, and our ongoing efforts with government and commercial payers to create additional capacity.

謝謝你，香農。早上好，感謝您今天加入我們。我們感謝你們每個人今天早上花時間更好地了解我們第四季度和 2022 年全年的業績以及我們如何前進——我的初步評論將簡要強調我們第四季度的業績，以及我們正在採取的措施來解決勞動力市場，以及我們與政府和商業付款人不斷努力創造額外的能力。

I will then provide some thoughts regarding our outlook for 2023, prior to turning the call over to Dave to provide further details into the quarter and our outlook. Starting with some highlights for the quarter. Revenue was approximately $451 million, representing a 9% increase over the prior period. Gross margin was $128.8 million or 28.5%, a 3.5% increase over prior year period. And finally, adjusted EBITDA was $29.7 million, representing a 35% decrease when compared to the prior year, primarily due to the costs associated with the current labor environment.

然後我將提供一些關於我們 2023 年展望的想法，然後再將電話轉給 Dave 以提供有關本季度和我們展望的更多細節。從本季度的一些亮點開始。收入約為 4.51 億美元，較上一時期增長 9%。毛利率為 1.288 億美元或 28.5%，比去年同期增長 3.5%。最後，調整後的 EBITDA 為 2970 萬美元，與上一年相比下降了 35%，這主要是由於與當前勞動力環境相關的成本。

As we have previously discussed, the labor environment represents the primary challenge that we need to address in 2023, to see Aveanna begin to resume the growth trajectory that we believe our company can achieve. It is important to note that our industry does not have a demand problem. The demand for home and community-based care has never been higher with both state and federal governments and managed care organizations asking for solutions that can create more capacity.

正如我們之前所討論的那樣，勞動力環境是我們需要在 2023 年解決的主要挑戰，以便看到 Aveanna 開始恢復我們認為我們公司可以實現的增長軌跡。重要的是要注意我們的行業沒有需求問題。對家庭和社區護理的需求從未像現在這樣高，州和聯邦政府以及管理式護理組織都要求能夠創造更多能力的解決方案。

To begin to capitalize on this demand and free up labor capacity, we are undertaking several initiatives. First and foremost, our ability to recruit and retain the best talent is a function of a rate. Our business model offers a preferred work setting that is mission-driven, providing a deep sense of purpose for our teammates. But our caregivers need to be able to provide for themselves and their families in this inflationary environment, and we must offer competitive wages.

為了開始利用這一需求並釋放勞動力，我們正在採取多項舉措。首先，我們招募和留住最優秀人才的能力取決於比率。我們的商業模式提供了一個以使命為導向的首選工作環境，為我們的團隊成員提供了深刻的使命感。但我們的護理人員需要能夠在這種通貨膨脹的環境中養活自己和家人，我們必須提供有競爭力的工資。

While we have several initiatives underway to improve the rate we are paid by government and managed care payers for the services we provide, there are 3 primary areas of focus. First, we need to execute on our private duty legislative strategy to increase rates by double-digit percentages in 3 of our larger states, California, Texas and Oklahoma. These 3 states represent approximately 25% of our total PDS revenue, and we have active legislative, media and lobbying efforts in place to demonstrate the importance of these rate increases and how they support an overall lower healthcare costs, improve patient satisfaction and quality outcomes.

雖然我們正在採取多項舉措來提高政府和管理式醫療付款人為我們提供的服務支付的費用，但有 3 個主要重點領域。首先，我們需要執行我們的私人義務立法戰略，在我們的 3 個較大的州（加利福尼亞州、德克薩斯州和俄克拉荷馬州）將稅率提高兩位數。這 3 個州約占我們 PDS 總收入的 25%，我們有積極的立法、媒體和遊說努力來證明這些費率增加的重要性以及它們如何支持降低整體醫療成本、提高患者滿意度和質量結果。

While we continually focus on legislative activities in all of our states, if we can directly impact these 3 states in 2023, we can accelerate our growth by increasing caregiver capacity and bringing more patients to the comfort of their own home. By passing meaningful wages through to our caregivers, we become a solution for overcrowded children's hospitals and distraught parents who want their children to be cared for in the comfort of their home.

在我們繼續關注我們所有州的立法活動的同時，如果我們能夠在 2023 年直接影響這 3 個州，我們就可以通過提高護理人員的能力並讓更多患者回到自己舒適的家中來加速我們的發展。通過將有意義的工資轉給我們的護理人員，我們成為人滿為患的兒童醫院和心煩意亂的父母希望他們的孩子在舒適的家中得到照顧的解決方案。

Second, we need to double the number of preferred payers in 2023. We define preferred payers as those payers that support value-based care by offering us an above-market reimbursement rate and value-based payments in exchange for proven savings. We began this journey in 2022 with strong success in our Texas and Pennsylvania markets and have ongoing discussions to further expand these relationships in 2023, based on positive results generated for these payers to date.

其次，我們需要在 2023 年將首選付款人的數量增加一倍。我們將首選付款人定義為那些支持基於價值的護理的付款人，通過向我們提供高於市場的報銷率和基於價值的付款來換取已證實的儲蓄。我們於 2022 年開始了這一旅程，在我們的得克薩斯州和賓夕法尼亞州市場取得了巨大成功，並且根據迄今為止為這些付款人產生的積極成果，我們正在進行討論，以在 2023 年進一步擴大這些關係。

Our PDS preferred payers represent approximately 10% of our PDS volumes to date, and we see this expansion accelerating towards 20% by year-end 2023. Our dedicated payer relations team has a robust managed care payer pipeline, and I expect us to add additional preferred pay agreements in the first half of 2023. Finally, we will continue to shift our current labor capacity to those payers that value our services and appropriately reimburse us for the care provided.

迄今為止，我們的 PDS 首選付款人約占我們 PDS 數量的 10%，我們預計到 2023 年底，這一增長將加速至 20%。我們專門的付款人關係團隊擁有強大的管理式醫療付款人管道，我希望我們能增加更多2023 年上半年的首選薪酬協議。最後，我們將繼續將我們目前的勞動力轉移給那些重視我們的服務並適當補償我們所提供護理的付款人。

We have begun a number of initiatives to shift caregiver capacity to our preferred payers to optimize staffing rates while minimizing days in an acute care facility. Our preferred payer relationships are experiencing nurse hires approximately 2x to 3x more than our other payers. We are experiencing staffing rates 15% to 20% greater with preferred payers and significantly higher patient admissions from children's hospitals.

我們已經開始採取多項舉措，將護理人員的能力轉移給我們首選的付款人，以優化人員配備率，同時最大限度地減少急症護理機構的天數。我們首選的付款人關係正在經歷比我們其他付款人多大約 2 到 3 倍的護士僱用。我們正在經歷 15% 到 20% 的員工配置率與首選付款人的增加以及兒童醫院的患者入院率顯著增加。

The value proposition is straightforward, preferred payers reimburse us a fair rate, and we pay market competitive nursing wage rates while also earning value-based payments for achieving positive clinical outcomes and improved [staffed hours]. In addition to improving rates, we are also evaluating how we go to market to recruit and retain new talent. We are getting back to the basics, taking a data-driven approach to setting our expectations and proactively monitoring our execution.

價值主張很簡單，首選付款人向我們償還公平的費用，我們支付具有市場競爭力的護理工資率，同時還賺取基於價值的付款，以實現積極的臨床結果和改善[工作時間]。除了提高利率外，我們還在評估我們如何進入市場以招聘和留住新人才。我們正在回歸基礎，採用數據驅動的方法來設定我們的期望並主動監控我們的執行情況。

We are encouraged by our early 2023 recruiting results and believe our business can rebound quickly if we can achieve our rate goals previously discussed, home and community-based care will continue to grow, and Aveanna is a comprehensive platform with a diverse payer base, providing cost-effective, high-quality alternative to higher cost care settings. And most importantly, we provide this care in the most desirable setting, the comfort of the patient's home.

我們對 2023 年初的招聘結果感到鼓舞，並相信如果我們能夠實現之前討論的費率目標，我們的業務可以迅速反彈，家庭和社區護理將繼續增長，Aveanna 是一個擁有多元化支付基礎的綜合平台，提供高成本護理環境的成本效益高、質量高的替代方案。最重要的是，我們在最理想的環境中提供這種護理，即患者家中的舒適環境。

Before I turn the call over to Dave, let me briefly comment on our initial outlook for 2023. As we start this next chapter, we believe it's important to set expectations that acknowledge the environment we are operating in and the time it will take to transform our company and return to sustainable growth. Accordingly, we currently expect full year 2023 revenue to be greater than $1.84 billion and adjusted EBITDA of at least $130 million. We believe our outlook provides a prudent view considering the challenges we face with the current inflationary labor environment, and hopefully, it proves to be conservative as we execute throughout the year.

在我將電話轉給戴夫之前，讓我簡要評論一下我們對 2023 年的初步展望。在我們開始下一章時，我們認為設定預期非常重要，以承認我們所處的環境以及轉型所需的時間我們的公司並恢復可持續增長。因此，我們目前預計 2023 年全年收入將超過 18.4 億美元，調整後的 EBITDA 至少為 1.3 億美元。考慮到我們在當前通貨膨脹的勞動力環境中面臨的挑戰，我們相信我們的前景提供了審慎的觀點，並且希望在我們全年執行時證明它是保守的。

In closing, I am proud of our Aveanna team. We offer a cost-effective patient-preferred and clinically sophisticated solution for our patients and families. Furthermore, we are the right solution for our payers, referral sources and government partners. By partnering with preferred payers, we can and will move the rate and wage metrics in meaningful ways that support our growth. This will allow us to hire, retain and engage more caregivers in providing the mission of Aveanna every day.

最後，我為我們的 Aveanna 團隊感到自豪。我們為我們的患者和家人提供了一種符合成本效益的患者首選且臨床成熟的解決方案。此外，我們是我們的付款人、推薦來源和政府合作夥伴的正確解決方案。通過與首選付款人合作，我們能夠並且將會以有意義的方式改變費率和工資指標，以支持我們的增長。這將使我們能夠僱傭、留住和吸引更多的護理人員每天提供 Aveanna 的使命。

With that, let me turn the call over to Dave to provide further details on the quarter and our 2023 outlook. Dave?

有了這個，讓我把電話轉給戴夫，提供有關本季度和我們 2023 年展望的更多細節。戴夫？

Thanks, Jeff, and good morning. First, I'll talk about our fourth quarter financial results and liquidity before providing detail on our outlook for 2023. Starting with the top line. We saw revenues rise 9% over last year to $451 million. We saw revenue growth across all 3 of our operating segments with Private Duty Services, Home Health & Hospice, and Medical Solutions growing by 9.3%, 12.4% and 0.7%, respectively.

謝謝，傑夫，早上好。首先，在詳細介紹我們對 2023 年的展望之前，我將談談我們第四季度的財務業績和流動性。從頂線開始。我們看到收入比去年增長 9%，達到 4.51 億美元。我們看到我們所有 3 個運營部門的收入都在增長，其中私人責任服務、家庭健康和臨終關懷以及醫療解決方案分別增長了 9.3%、12.4% 和 0.7%。

Consolidated adjusted EBITDA was $29.7 million, a 35% decrease as compared to the prior year. Now taking a deeper look into each of our segments. Starting with private-duty services, revenue for the quarter was approximately $361 million, a 9.3% increase and was driven by approximately 9.6 million hours of care, a volume increase of 6.1% over the prior year. And while volumes improved over the prior year, we continue to be constrained in our top line growth due to the shortage of available caregivers.

合併調整後的 EBITDA 為 2970 萬美元，與上一年相比下降 35%。現在更深入地研究我們的每個細分市場。從私人值班服務開始，本季度收入約為 3.61 億美元，增長 9.3%，這主要得益於約 960 萬小時的護理服務，較上年同期增長 6.1%。雖然數量比上一年有所改善，但由於可用護理人員短缺，我們的收入增長繼續受到限制。

Q4 revenue per hour of $3766 was up $0.82 sequentially from Q3 or 2.2%, and we were pleased with the rate improvement we experienced throughout 2022. Turning to our cost of labor and gross margin metrics, we achieved $91.9 million of gross margin or 25.4%, a 0.8% decrease from the prior year quarter.

第 4 季度的每小時收入為 3766 美元，比第 3 季度連續增長 0.82 美元或 2.2%，我們對整個 2022 年的費率提高感到滿意。談到我們的勞動力成本和毛利率指標，我們實現了 9190 萬美元的毛利率或 25.4% ，比去年同期下降 0.8%。

Our cost of revenue rate of $28.08 reflects the commitment we've made to passing through our rate wins to our caregivers as well as continued rate pressures that we see in the labor market. Our Q4 spread per hour was $958, we experienced improvement in our preferred payer volumes with select payers year-to-date organic growth rates reaching the low double digits. We continue to be encouraged with our ability to attract caregivers and address the market demand for our services when we obtain adequate rates.

我們 28.08 美元的收入成本率反映了我們做出的承諾，將我們的利率勝利轉嫁給我們的護理人員，以及我們在勞動力市場上看到的持續利率壓力。我們的第四季度每小時價差為 958 美元，我們的首選付款人數量有所改善，精選付款人年初至今的有機增長率達到低兩位數。當我們獲得足夠的費率時，我們繼續受到鼓舞，因為我們有能力吸引護理人員並滿足市場對我們服務的需求。

Moving on to our Home Health & Hospice segment. Revenue for the quarter was approximately $54.7 million, a 12.4% increase over the prior year and a sequential improvement of $4.9 million over the previous quarter. We're also pleased with our gross margin improvement from 33.9% in Q3 to 41.9% in Q4 as we continue to focus on additional direct labor cost initiatives necessary to achieve our targeted gross margins in the 45% to 46% range.

繼續我們的家庭健康和臨終關懷部門。本季度收入約為 5470 萬美元，比上年增長 12.4%，比上一季度環比增加 490 萬美元。我們也很高興我們的毛利率從第三季度的 33.9% 提高到第四季度的 41.9%，因為我們繼續專注於實現 45% 至 46% 的目標毛利率所必需的額外直接勞動力成本舉措。

As we discussed in the third quarter, we're excited to be fully converted to the Homecare Homebase operating system. We're beginning to see admission trends for the division return to a more normalized level. As a point of reference, at our lowest point in mid-summer, our weekly home health admissions were in the low 800s. In Q4, we averaged approximately 850 home health admissions per week with an episodic rate of 63%. We believe we will return to more than 900 home health admissions per week in the first quarter of '23, while maintaining our episodic mix.

正如我們在第三季度討論的那樣，我們很高興能夠完全轉換為 Homecare Homebase 操作系統。我們開始看到該部門的錄取趨勢恢復到更正常的水平。作為參考，在我們仲夏的最低點，我們每週的家庭健康入院人數在 800 左右。在第四季度，我們平均每週約有 850 次家庭健康入院，偶發率為 63%。我們相信，我們將在 23 年第一季度恢復每週 900 多次家庭健康入院，同時保持我們的偶發組合。

Our fourth quarter revenue was driven by 11,000 total admissions with approximately 63% being episodic and 11,000 total episodes of care. Revenue per episode for the quarter was $3,009, essentially flat with the third quarter. Although 2022 is a difficult year for our HHH segment, we firmly believe in this business and its long-term value proposition. We now have an established platform that is poised for growth focused on delivering value through sound operational management and delivering excellence in patient care.

我們第四季度的收入是由 11,000 次總入院所推動的，其中大約 63% 是偶發性的，總計 11,000 次護理。本季度每集收入為 3,009 美元，與第三季度基本持平。儘管 2022 年對我們的 HHH 部門來說是艱難的一年，但我們堅信這項業務及其長期價值主張。我們現在擁有一個成熟的平台，該平台有望實現增長，專注於通過健全的運營管理和提供卓越的患者護理來創造價值。

And now moving on to our Medical Solutions segment results for Q4. During the quarter, we produced revenue of $35.2 million, a 0.7% increase over the prior year. Revenue was driven by approximately 83,000 unique patients served and revenue per UPS of $423.51. Volumes were up 2.4% from Q3. However, revenue per UPS was $39.90 lower than Q3, which resulted in margins declining to 39.7%. As a result, our gross margins were $13.9 million, a $1.4 million decline over the prior year quarter. However, we expect revenue per UPS and gross margins to rebound in the first quarter of '23 to our typical margin profile.

現在繼續討論我們第四季度的醫療解決方案部門業績。本季度，我們的收入為 3520 萬美元，比上年增長 0.7%。收入是由大約 83,000 名獨特的患者服務和每個 UPS 的收入 423.51 美元推動的。銷量較第三季度增長 2.4%。然而，每台 UPS 的收入比第三季度低 39.90 美元，導致利潤率下降至 39.7%。因此，我們的毛利率為 1390 萬美元，比去年同期下降 140 萬美元。但是，我們預計每個 UPS 的收入和毛利率將在 23 年第一季度反彈至我們的典型利潤率。

Continue to evaluate ways to be more efficient and effective in our medical solutions back office to leverage our overhead as we continue to grow, while other enteral providers decided to exit the market in '22, we see this as an opportunity to expand our national enteral presence into further our payer partnerships.

繼續評估在我們的醫療解決方案後台更高效和有效的方法，以在我們繼續增長的同時利用我們的管理費用，而其他腸道供應商決定在 22 年退出市場，我們認為這是擴大我們國家腸道的機會進一步加強我們的付款人合作夥伴關係。

In summary, we continue to fight through a difficult labor and inflationary environment while keeping our patients care at the center of everything we do. It's clear to us that shifting caregiver capacity to those preferred payers who value our partnership is a path forward at Aveanna. And as Jeff stated, our primary challenge is reimbursement rates as we continue to make progress in 2023 with the rate environment, we'll pass through those wage improvements and other benefits to our caregivers in the ongoing effort to better improve volumes.

總而言之，我們將繼續與艱難的分娩和通貨膨脹環境作鬥爭，同時將患者護理置於我們所做一切工作的中心。我們很清楚，將護理人員的能力轉移給那些重視我們合作夥伴關係的首選付款人是 Aveanna 的前進之路。正如 Jeff 所說，我們的主要挑戰是報銷率，因為我們將在 2023 年繼續在費率環境下取得進展，我們將通過不斷努力更好地提高數量，將這些工資提高和其他福利傳遞給我們的護理人員。

Now moving to our balance sheet and liquidity. At the end of the fourth quarter, we had liquidity in excess of $230 million, representing cash on hand of approximately $19.2 million, $35 million of availability under our securitization facility, and $180 million of availability on our revolver, which was undrawn as of December 31.

現在轉向我們的資產負債表和流動性。截至第四季度末，我們的流動資金超過 2.3 億美元，包括手頭現金約 1,920 萬美元、證券化貸款下的 3,500 萬美元可用資金以及截至 12 月未提取的循環貸款可用資金 1.8 億美元31.

Last, we had $20 million of outstanding letters of credit as of December 31. As we look at the timing of earnings for 2023 and the related cash flows, while we may draw on the revolver for short-term timing-related items throughout the year, our goals are for the revolver to be undrawn as of year-end and more importantly to drive positive operating cash flows in the second half of the year as we begin to realize all the benefits of the efforts Jeff and I have talked about today.

最後，截至 12 月 31 日，我們有 2000 萬美元的未兌現信用證。當我們審視 2023 年收益的時間和相關現金流時，我們可能會在全年為短期時間相關項目動用循環貸款，我們的目標是在年底前將左輪手槍提現，更重要的是在下半年推動積極的經營現金流，因為我們開始意識到傑夫和我今天談到的努力的所有好處。

As a reminder, regarding revolver availability, the leverage covenants under our revolver become applicable if more than 30% of the total revolver facility availability under the credit facility has been utilized, subject to a $15 million carve-out for letters of credit. Should the leverage covenant become applicable, maximum allowable first lien leverage would be 7.6x.

提醒一下，關於循環貸款的可用性，如果信貸額度下可用的循環貸款總額的 30% 以上已被使用，則我們的循環貸款下的槓桿契約將適用，但須遵守 1500 萬美元的信用證分拆條款。如果槓桿契約變得適用，最大允許的第一留置權槓桿將為 7.6 倍。

On the debt service front, we had approximately $1.46 billion of variable rate debt at the end of Q4. Of this amount, $520 million is hedged with fixed rate swaps and $880 million is subject to an interest rate cap, which limits further exposure to increases in LIBOR above 3%. Accordingly, substantially all of our variable rate debt is hedged.

在償債方面，第四季度末我們有大約 14.6 億美元的可變利率債務。其中，5.2 億美元通過固定利率掉期進行對沖，8.8 億美元受利率上限限制，這限制了 LIBOR 升幅超過 3% 的進一步敞口。因此，我們幾乎所有的可變利率債務都進行了對沖。

Our interest rate swaps extend through June 2026 and our interest rate caps extend through February 2027, and one last item I would mention related to our debt is that we have no material term loan matures until July 2028. Looking at cash flow, 2022 cash used in operating activities was $48.4 million and free cash flow was negative $81.5 million.

我們的利率互換期限延長至 2026 年 6 月，我們的利率上限延長至 2027 年 2 月，我要提到的最後一項與我們的債務相關的是，我們沒有重大定期貸款在 2028 年 7 月之前到期。看看現金流，2022 年使用的現金經營活動為 4840 萬美元，自由現金流為負 8150 萬美元。

Bear in mind, though, that 2022 cash flows were impacted by certain CARES Act items, including the final $25 million repayment of deferred payroll taxes to the IRS in December, and the repayment of $3.5 million of CMS advances over the course of 2022. And looking forward to '23, we expect to make progress on improving our cash flow by focusing on improving reimbursement rates and growing our volumes, reducing costs and optimizing our collections.

不過請記住，2022 年的現金流量受到某些 CARES 法案項目的影響，包括 12 月向 IRS 最終償還 2500 萬美元的遞延工資稅，以及在 2022 年期間償還 350 萬美元的 CMS 預付款。展望 23 年，我們希望通過專注於提高報銷率和增加我們的數量、降低成本和優化我們的收款，在改善我們的現金流方面取得進展。

In a more limited M&A environment, integration and system transition costs should be significantly lower than 2022. And our 2023 cash flow will also not be impacted by the CARES Act items I just discussed.

在更有限的併購環境中，整合和系統轉型成本應該會大大低於 2022 年。而且我們 2023 年的現金流也不會受到我剛才討論的 CARES 法案項目的影響。

Before I hand the call over to the operator for Q&A, let me take a moment to address 2023 guidance. As Jeff outlined, we currently expect full year 2023 revenue to be greater than $1.84 billion and adjusted EBITDA of at least $130 million. As we think about seasonality, we expect our revenue to grow as rate increases are implemented throughout the year and our volumes grow.

在我將電話轉給接線員進行問答之前，讓我花點時間談談 2023 年的指導方針。正如 Jeff 概述的那樣，我們目前預計 2023 年全年收入將超過 18.4 億美元，調整後的 EBITDA 至少為 1.3 億美元。當我們考慮季節性因素時，我們預計我們的收入會隨著全年實施加息和我們的銷量增長而增長。

Accordingly, we expect approximately 18% to 19% of our full year adjusted EBITDA guidance to be recognized in the first quarter and approximately 43% of our full year guided adjusted EBITDA to be recognized in the first half of '23. As most of our annual rate increases typically become effective in the second half of the year, we expect our adjusted EBITDA to ramp as we use the increases to attract and retain more caregivers and drive volumes. Our EBITDA will also ramp as we realize the benefits of our cost savings initiatives.

因此，我們預計我們全年調整後 EBITDA 指導的約 18% 至 19% 將在第一季度確認，我們全年指導調整後 EBITDA 的約 43% 將在 23 年上半年確認。由於我們的大部分年度加息通常會在下半年生效，我們預計調整後的 EBITDA 會隨著我們利用加息來吸引和留住更多的護理人員並推動銷量而上升。隨著我們意識到成本節約計劃的好處，我們的 EBITDA 也會增加。

And with that, let me turn the call over to the operator. Operator?

就這樣，讓我把電話轉給接線員。操作員？

(Operator Instructions)

（操作員說明）

And our first question is from Brian Tanquilut with Jefferies.

我們的第一個問題來自 Jefferies 的 Brian Tanquilut。

You have Taji on for Brian. So Jeff, as I think about the 3 priorities that you laid out for the year. I just kind of want to dive deeper into the preferred payer strategy. As it relates to your guidance, is the 10% improvement that you're expecting by the end of the year already embedded in the guidance? And if not, can you kind of just quantify what that flow-through would look like to the bottom line?

你讓 Taji 代替 Brian。傑夫，當我想到你為今年制定的 3 個優先事項時。我只是想更深入地研究首選付款人策略。就您的指導而言，您期望到年底實現 10% 的改進是否已經包含在指導中？如果不是，你能不能量化一下這種流動對底線的影響？

Yes. Taji, thanks for joining this morning. I think as -- I'm going to go back to our prepared remarks for a minute and just say as we think of our guidance, we recognize our guidance is likely conservative yet as we sit at this point, very, very prudent. I think as Dave and I have thought about the year, we felt like it was important to kind of reset expectations and then show our commitment to beating those expectations.

是的。塔吉，感謝今天早上的加入。我認為——我將回到我們準備好的評論中，並在我們考慮我們的指導意見時說，我們認識到我們的指導意見可能是保守的，但我們現在坐在那裡，非常非常謹慎。我認為，正如 Dave 和我對這一年的思考，我們覺得重新設定期望並展示我們對超越這些期望的承諾很重要。

As you think of the year, Taji and you think of our -- especially our 3 states we talked about California, Texas, Oklahoma, most of those or all of those 3 those rate increases would be effective in Q3 and the beginning of Q4. So if you listen to Dave's comments, our guidance would suggest that second half of the year is significantly greater than first half of the year. I think Dave talked about 43% of the guidance in the first half of the year and implies 57% of the guidance in the second half of the year.

當你想到這一年時，塔吉和你想到我們——尤其是我們談到的加利福尼亞州、德克薩斯州、俄克拉荷馬州的 3 個州，其中大部分或所有這 3 個州的加息將在第三季度和第四季度初生效。因此，如果您聽取 Dave 的評論，我們的指導意見會建議下半年明顯高於上半年。我認為戴夫在上半年談到了 43% 的指導，並在下半年暗示了 57% 的指導。

And really, the driver of that is 2 things. It's the rate we just talked about the improvement in rate driving the second half of the year. But also one of our key initiatives this year was to identify and reduce costs where appropriate, both in corporate and field. And so as some of those cost reductions play out through the year, we see a greater profitability in the second half of the year. But those are the 2 primary drivers of that.

實際上，驅動因素有兩點。就是我們剛才講到下半年帶動利率提升的利率。但我們今年的一項關鍵舉措是在公司和現場適當地確定和降低成本。因此，隨著部分成本削減在全年發揮作用，我們將在今年下半年看到更高的盈利能力。但這些是其中的兩個主要驅動因素。

We don't comment on any specific state and the actual revenue or percentage growth in any specific state. But those are the 2 biggest drivers, Taji, of our guidance. And yes, they are baked into our -- at least $130 million, but I think we also recognize that it's prudent for us to be conservative at this point.

我們不對任何特定州以及任何特定州的實際收入或百分比增長發表評論。但這些是我們指導的兩個最大驅動因素，Taji。是的，它們被納入我們的 - 至少 1.3 億美元，但我認為我們也認識到在這一點上我們保持保守是謹慎的。

Great. And just 1 more follow-up just on the labor front. Just curious, I guess, how your metrics that you've seen in Q4 have trended in relation to the beginning of the year, right? And essentially, how does the outlook look currently, right? Like are you seeing an uptick in applications as your retention improving throughout the year? We'd just love to see how that's been trending as the year's going on.

偉大的。僅在勞工方面再進行 1 次跟進。我想，只是好奇，您在第四季度看到的指標與年初相比有何趨勢，對嗎？從本質上講，目前的前景如何，對嗎？就像您看到應用程序的增加一樣，因為您全年的保留率都在提高？我們只是想看看這一年的趨勢如何。

Absolutely, absolutely. And it's a great question, Taji. Like many of our peers, we experienced positive recruitment applications and hiring trends right out of the New Year. So coming out of the holidays, we saw more applications. We saw more people interested in coming back to work, new -- and these were new applicants, applicants who had not worked with us before. So that was a nice trend out of the New Year. And I think we've seen our peers experience similar trends.

絕對，絕對。這是一個很好的問題，塔吉。與我們的許多同行一樣，我們在新年伊始就經歷了積極的招聘申請和招聘趨勢。所以在假期結束後，我們看到了更多的應用程序。我們看到更多的人有興趣回來工作，新的——這些是新的申請人，以前沒有和我們一起工作過的申請人。所以這是新年的一個很好的趨勢。我認為我們已經看到我們的同行經歷了類似的趨勢。

I think the part that we would want to pound home though is those are good trends. They're not as good as our preferred payer trends. And our preferred payer strategy, as we laid out, as we talked about today, we're seeing caregiver hires pushing 3x greater than our nonpreferred payers. So our preferred payers value our value proposition. They believe in our value proposition. They're paying us an appropriate wage -- sorry, appropriate rate that allows us to pay at least a market level wage, if not slightly above the market level wage.

我認為我們想要強調的部分是那些好的趨勢。它們不如我們首選的付款人趨勢。正如我們今天所討論的那樣，我們的首選付款人策略，我們看到看護人的招聘人數比我們的非首選付款人高出 3 倍。因此，我們首選的付款人重視我們的價值主張。他們相信我們的價值主張。他們向我們支付適當的工資——對不起，適當的工資使我們至少可以支付市場水平的工資，如果不是略高於市場水平的工資的話。

And because of that, we're seeing in that 10% of our PDS volumes, really the ability to be hiring out in front of the market. And everyone is winning. What we're staffing is we talked about 15% to 20% greater staffing rates with our preferred payers, we're bringing children home at a pace of almost 5x or 6x greater than a nonpreferred payer.

正因為如此，我們在 PDS 數量的 10% 中看到了真正在市場面前招聘人才的能力。每個人都在贏。我們的人員配置是我們與首選付款人討論了 15% 到 20% 的員工配置率，我們將孩子帶回家的速度比非首選付款人高出近 5 倍或 6 倍。

So I think we highlight that to say even though the trends out of the first of the year were positive, our strategy is not to expect the wage market to settle or nurses just to come back in droves, our strategy is to drive rate and reinvest rate into wage and outpace the market specifically in our PDS business.

因此，我認為我們要強調的是，儘管今年第一年的趨勢是積極的，但我們的策略不是期望工資市場穩定下來或護士只是成群結隊地回來，我們的策略是推動利率和再投資在我們的 PDS 業務中，提高工資率並跑贏市場。

I would say, in our Home Health & Hospice business, we're certainly competing with our peer group in that space. And I will say that at least wages have seen in the last 3 to 4 months to have settled. And I think settled is probably the best word I can use. They don't seem to be continue to be going up. And so we're focused just on retaining, engaging and maintaining the core caregiving staff we have in the Home Health & Hospice side. Hopefully, that was helpful.

我想說，在我們的家庭健康和臨終關懷業務中，我們肯定會在該領域與我們的同行競爭。我會說至少工資在過去 3 到 4 個月內已經穩定下來。我認為安定下來可能是我能用的最好的詞。他們似乎不會繼續上漲。因此，我們只專注於保留、聘用和維護我們在家庭健康和臨終關懷方面的核心護理人員。希望這對您有所幫助。

Our next question is from Joanna Gajuk with Bank of America.

我們的下一個問題來自美國銀行的 Joanna Gajuk。

So I guess, can I use this as a follow-up to the prior question, which I didn't feel like I got the answer here in terms of the preferred payer strategy and the increasing, I guess, growth from that. Is that actually specifically included in the guidance or not? Because I guess you made it sound like that you have seen the rate increases in the cost cutting, but you didn't highlight the perfect strategy and whether it's actually included in the guidance?

所以我想，我可以用這個作為先前問題的後續行動嗎，我覺得我在這裡沒有得到關於首選付款人策略的答案，我想，從中增長。這實際上是否明確包含在指南中？因為我猜你說得好像你已經看到成本削減的速度增加了，但你沒有強調完美的戰略以及它是否真的包含在指導中？

Thanks for your question. Yes, in our 130 guidance, it does include the idea of rate increases. I think as we said in my prepared remarks, we're highly focused on these 3 states in this year because we feel like these 3 states are not currently competitive with the market wages for nurses in those states. And we think we think it's highly, highly important for California, Texas and Oklahoma to move those rates so that we can attract nurses and help solve the value proposition, which is getting patients home. And yes, we did bake the idea of overall rates into our guidance.

謝謝你的問題。是的，在我們的 130 指南中，它確實包含了加息的想法。我認為，正如我們在準備好的發言中所說，今年我們高度關注這三個州，因為我們認為這三個州目前與這些州護士的市場工資相比沒有競爭力。我們認為，我們認為加州、德克薩斯州和俄克拉荷馬州提高這些費率非常非常重要，這樣我們才能吸引護士並幫助解決讓病人回家的價值主張。是的，我們確實將整體費率的想法納入了我們的指南。

Now in our prepared remarks, we talked about we are asking in all of those states for double-digit rate increases. And our full year guide does not fully bake in the idea of these 3 states giving us double-digit rate increases. It's overall rate increases. But if you think of California, the last rate increase they gave us, it was July of 2018, and that rate is no longer market. And we talked about that in the last couple of earnings calls.

現在，在我們準備好的發言中，我們談到了我們要求所有這些州都以兩位數的速度增加利率。我們的全年指南並沒有完全體現這三個州給我們帶來兩位數增長率的想法。它的整體速度增加了。但如果你想想加利福尼亞，他們給我們的上一次加息是在 2018 年 7 月，而且那個利率不再是市場。我們在最近幾次財報電話會議上談到了這一點。

And so we are aggressively lobbying, using media campaigns, meeting with the governor's office, meeting with legislatures in California. And we fully expect California to give us a sizable rate increase, not because of any other reason, then the value proposition says, if you pay a nurse a fair wage in California, we can staff the cases and we can bring these children's home.

因此，我們正在積極遊說，利用媒體宣傳活動，會見州長辦公室，會見加利福尼亞州的立法機構。我們完全希望加州給我們一個可觀的利率增長，而不是因為任何其他原因，然後價值主張說，如果你在加州支付護士合理的工資，我們可以為案件配備人員，我們可以把這些孩子帶回家。

We've got research in California that shows us that we save around $6,000 a day, so bringing a child home 1 day faster in the state of California saves California Medicaid systems $6,000 a day, that value proposition is landing very well in the legislature as well as the Governor's office and Medi-Cal itself, they understand investing in our services truly saves total healthcare costs for states like California.

我們在加利福尼亞州進行的研究表明，我們每天可以節省大約 6,000 美元，因此在加利福尼亞州，將孩子帶回家的時間提前 1 天可以為加利福尼亞州醫療補助系統每天節省 6,000 美元，該價值主張在立法機構中得到了很好的體現以及州長辦公室和 Medi-Cal 本身，他們明白投資於我們的服務確實為加利福尼亞等州節省了總醫療保健成本。

And although $6,000 sounds like a lot in California, it's not materially different than any other state we operate in. We save the system between $4,000 and $6,000 a day by bringing a patient home 1 day faster. So I hope that addresses the guidance question, but we have a strong level of conviction on continuing to move both legislative rates and, at the same time, moving our managed care and commercial payers from being a payer to a preferred partner. And as we define a preferred partner is both above market rate as well as value-based incentive payments.

儘管 6,000 美元在加利福尼亞州聽起來很多，但它與我們開展業務的任何其他州並無本質區別。通過將患者送回家的速度加快 1 天，我們每天可為系統節省 4,000 至 6,000 美元。因此，我希望這能解決指導問題，但我們堅信繼續提高立法利率，同時將我們的管理式醫療和商業支付者從支付者轉變為首選合作夥伴。正如我們所定義的，首選合作夥伴既高於市場價格又提供基於價值的激勵付款。

Thanks for the additional color, because I guess it's an important part to understand what you include in the guidance now for the rates, I guess, is a little bit lower than maybe what you're asking for, which is prudent. And my question is in your 10-K, you disclosed $12 million higher general professional liability expense associated with the accrued legal settlements.

感謝您提供額外的顏色，因為我想這是了解您現在在指南中包含的費率的重要部分，我想這比您要求的要低一點，這是謹慎的。我的問題是在你的 10-K 中，你披露了與應計法律和解相關的 1200 萬美元的一般專業責任費用。

So can you tell us what does it relate to? And I guess it looks like that's included in the cost of services in the PDS segment. So is it fair to adjust it? Because you also mentioned almost a similar amount when it comes to it sounds like lower COVID-related costs. So I just want to clarify how we should think about gross margin in the PDS segment for this quarter, adjusting for these items?

那麼你能告訴我們它與什麼有關嗎？我想這看起來像是包含在 PDS 部分的服務成本中。那麼這樣調整是否公平呢？因為您還提到了幾乎相似的數額，這聽起來像是降低了與 COVID 相關的成本。所以我只想澄清我們應該如何考慮本季度 PDS 部門的毛利率，調整這些項目？

Sure, Joanna. So yes, there's a legal matter that we've been defending that originally rose back in 2019. And in connection with those -- with legal matters we accrued additional legal settlement costs in the end of Q4. Those matters are currently under appeal, and we intend to avail ourselves of all appellate options as we disclosed in the 10-K. And so we continue to work through that matter.

當然，喬安娜。所以，是的，有一個我們一直在捍衛的法律問題，該問題最初在 2019 年重新出現。與此相關——在法律問題上，我們在第四季度末產生了額外的法律和解成本。這些事項目前正在上訴中，我們打算利用我們在 10-K 中披露的所有上訴選項。因此，我們將繼續解決該問題。

As we go, you're right, that was an additional approximate $12 million in the current quarter. A year ago quarter, what you saw was just that we had -- we did not have the $12 million of incremental COVID-related costs from a year ago. But I think just to answer what I think your question might be is that we see our PDS spread in the $10 to $10.50 range and I think that's what you could probably expect in Q1.

隨著我們的發展，你是對的，本季度額外增加了大約 1200 萬美元。一年前的一個季度，你所看到的只是我們擁有的——我們沒有一年前增加的 1200 萬美元與 COVID 相關的成本。但我想只是回答我認為你的問題可能是我們看到我們的 PDS 在 10 美元到 10.50 美元的範圍內傳播，我認為這就是你在第一季度可能期望的。

And Joanna, we felt it was prudent to kind of put that on the boats, put it behind us, at least from a GAAP accounting standpoint, we thought that, that was very prudent to do to kind of clean that up at the end of the year. Outside of that, our Q4 spread would have been in the $10.50, $10.60 range. I think as Dave said, we have a payroll tax in Q1. So we think that will be in the $10.30 to $10.50 range for Q1.

喬安娜，我們覺得把它放在船上是謹慎的，把它放在我們身後，至少從 GAAP 會計的角度來看，我們認為，在年底清理它是非常謹慎的那一年。除此之外，我們的第四季度價差將在 10.50 美元和 10.60 美元之間。我認為正如戴夫所說，我們在第一季度有工資稅。因此，我們認為第一季度將在 10.30 美元至 10.50 美元的範圍內。

Okay. And if I may sneak in on the home health segment. So you said that you're seeing some improvement there, I guess, [post some construction in] Q3 and you're still excited about that business. Can you talk about the reimbursement of '23 [we know] the rates? And I guess we're waiting for the '24 proposal to come out, so what do you expect to see in this proposal to expect a second half of the behavioral adjustment will be included for '24? And I guess, if you do, can you talk about how you trying to offset that the rates growing much less than your costs?

好的。如果我可以潛入家庭健康領域。所以你說你在那裡看到了一些改進，我猜，[在第三季度發布一些建設]你仍然對這項業務感到興奮。你能談談 '23 [我們知道] 費率的報銷嗎？而且我想我們正在等待 '24 提案的出台，那麼您希望在該提案中看到什麼，以期望行為調整的下半部分將包含在 '24 中？我想，如果你這樣做了，你能談談你是如何試圖抵消利率增長遠低於成本的嗎？

Yes, that's a great question. Thanks, Joanna. First, let us go on record with the entire Home Health & Hospice industry by saying we do not think that, that putting the behavioral adjustment in 2024 is the right thing to do. We stand firm with the entire National Association for Home Care, all of our peers by saying that is a devastating temporary rate impact to the business, it's unnecessary certainly inflation in the last 3 years of inflation have far outpaced the basically flat to slightly negative rate in home health. So let me go on record by saying Aveanna supports the industry and saying that that's not a good outcome.

是的，這是一個很好的問題。謝謝，喬安娜。首先，讓我們向整個家庭健康和臨終關懷行業鄭重聲明，我們不認為將行為調整放在 2024 年是正確的做法。我們堅定地支持整個全國家庭護理協會，我們所有的同行都說這對企業造成了毀滅性的臨時利率影響，這是不必要的，當然過去 3 年的通貨膨脹率遠遠超過基本持平或略微負的利率在家庭健康方面。因此，讓我公開表示 Aveanna 支持該行業並說這不是一個好結果。

With that said, we are expecting rate to be continued to be a headwind or choppy for the next few years in home health. And because of that, we're focused on now, as Dave mentioned, we're fully operational, fully implemented Homecare Homebase. We're focused on operating the business, doing the things that we can do to provide the best care with the best outcomes and also provide an appropriate gross margin and margin profile.

話雖如此，我們預計未來幾年家庭健康的增長率將繼續成為逆風或波動。正因為如此，正如 Dave 提到的，我們現在專注於，我們正在全面運作，全面實施 Homecare Homebase。我們專注於經營業務，盡我們所能提供最好的護理和最好的結果，並提供適當的毛利率和利潤率。

Part of that is we are committed to being an episodic reimbursed home health business. And in our comments, we commented that we're 63% episodic business. We're slightly ahead of that in the first quarter of 2023. And I think we're ahead of the industry in that, that we stay committed to being an episodic reimbursed primary reimbursed focus. The flip side of that is we're not going to give away our limited Home Health & Hospice clinical resources for discounted payers and discounted prices.

其中一部分是我們致力於成為一家定期報銷的家庭保健企業。在我們的評論中，我們評論說我們是 63% 的情景業務。我們在 2023 年第一季度略微領先。我認為我們在這方面領先於行業，我們仍然致力於成為一個偶發性報銷的主要報銷重點。不利的一面是，我們不會為折扣付款人和折扣價格放棄我們有限的家庭健康和臨終關懷臨床資源。

And so we would rather take our resources and put them with the payers that value our services. And because of that, I think that we can stay and -- achieve and stay in that 45% to 46%, maybe 47% gross margin range here in 2023 and truly continue to grow the Home Health & Hospice segment, but also maintain profitability at the gross margin and contribution line.

因此，我們寧願把我們的資源交給重視我們服務的付款人。正因為如此，我認為我們可以在 2023 年保持並保持在 45% 到 46%，也許是 47% 的毛利率範圍內，真正繼續發展家庭健康和臨終關懷部門，同時保持盈利能力在毛利率和貢獻線。

Our next question is from Raj Kumar with Stephens Inc.

我們的下一個問題來自 Stephens Inc. 的 Raj Kumar。

This is Raj on for Scott Fidel. So you just called out where you expect Home Health & Hospice gross margins to land in 2023. So could you kind of maybe provide more insight into where you expect that to be for PDS and Medical Solutions business as well?

這是斯科特菲德爾的拉吉。所以你剛剛提出了你預計家庭健康和臨終關懷毛利率在 2023 年會下降的地方。那麼你能否提供更多關於你對 PDS 和醫療解決方案業務的預期情況的見解？

Yes. Yes, Raj. I think -- and Dave put it in some of his prepared remarks, [AMS], we fully expect to stay in that 42% to 43% range. As you look at Q4, you'll see we had a little bit of reserve adjustment in the quarter that brought it down just below 40%, but strong expectations for Medical Solutions this year, we'll be right in that 42% to 43%, maybe 43.5% gross margin range.

是的。是的，拉吉。我認為 - 戴夫在他準備好的一些評論中說，[AMS]，我們完全希望保持在 42% 到 43% 的範圍內。當你看第四季度時，你會看到我們在本季度進行了一些準備金調整，使其下降到略低於 40%，但今年對醫療解決方案的強烈預期，我們將在 42% 到 43% 之間。 %，也許是 43.5% 的毛利率範圍。

And then if you normalize PDS for that legal reserve that we took, we're still in that 28.5%, just shy of 29% gross margin. I think we would tell you that's probably where we'll land in 2023, even though we're shifting volume away from lower-paying payers towards more appropriate paying -- payers with our preferred payer strategy. We will continue to pass on that incremental portion to our nurses and our caregivers to drive our volume growth. So I think you'll see us stay in that, Dave, I would say 28% to 29%, maybe slightly above 29% from a gross margin in PDS.

然後，如果您將 PDS 標準化為我們所採用的法定儲備，我們仍處於 28.5%，略低於 29% 的毛利率。我想我們會告訴你，這可能是我們將在 2023 年登陸的地方，即使我們正在將交易量從支付較低的支付者轉向更合適的支付——採用我們首選的支付策略的支付者。我們將繼續將增加的部分傳遞給我們的護士和護理人員，以推動我們的銷量增長。所以我想你會看到我們留在那個，戴夫，我會說 28% 到 29%，可能略高於 PDS 毛利率的 29%。

And then as a follow-up, what are your expectations for operating cash flow and CapEx in 2023? And then what do you expect leverage to come to in 2023 -- at the end of 2023?

然後作為後續行動，您對 2023 年的經營現金流和資本支出有何預期？然後，您預計 2023 年 - 2023 年底的槓桿作用是什麼？

Thanks, Raj. I'll hop it to Dave here in a second. I think it's just important. Dave and I are both very confident in our overall liquidity position. And I give Dave credit, a couple of years ago, he hedged all of our debt. Virtually, all of our debt is hedged. And we have a great lending group. We have great equity partners that are fully committed to Aveanna.

謝謝，拉吉。稍後我會把它傳給這裡的戴夫。我認為這很重要。戴夫和我都對我們的整體流動性狀況非常有信心。我相信戴夫，幾年前，他對沖了我們所有的債務。實際上，我們所有的債務都進行了對沖。我們有一個很棒的貸款小組。我們擁有出色的股權合作夥伴，他們完全致力於 Aveanna。

So as we think of overall liquidity, I think Dave and I both feel very confident. I do want to give Dave and his collection teams credit. They've done an unbelievable job in collecting our cash. We just ended 2022. We basically collected 99.99% of our revenue for the year. So 100% of our revenue was collected in cash in '22, which is a phenomenal outcome in this business.

因此，當我們考慮整體流動性時，我認為戴夫和我都非常有信心。我確實想讚揚戴夫和他的收款團隊。他們在收集我們的現金方面做得令人難以置信。我們剛剛結束了 2022 年。我們基本上收集了全年收入的 99.99%。所以我們 100% 的收入是在 22 年以現金形式收取的，這在這項業務中是一個了不起的結果。

And then Dave just does a really nice job managing our cash position, making sure that we've got ample room for borrowing capacity so that we can manage our business and invest in the business. So as I talk today, I just want to say, I'm -- as a new guy, as a new CEO, I am very confident in our overall liquidity position, and just that we've got a great team with a lot of tenure managing the important parts like collections, like cash management. So I think we're in a great position as we start the year, and we've got opportunity to invest in our company as needed.

然後戴夫在管理我們的現金頭寸方面做得非常好，確保我們有足夠的借貸能力空間，以便我們可以管理我們的業務並投資於業務。所以當我今天講話時，我只想說，作為一個新人，作為一個新 CEO，我對我們的整體流動性狀況非常有信心，而且我們有一個很棒的團隊，有很多管理重要部分的任期，如收款，如現金管理。所以我認為我們在今年開始時處於有利地位，我們有機會根據需要投資我們的公司。

And just to add on. With regarding the question on CapEx, we're judicious with the CapEx dollars this year. So in the past, we've seen CapEx at around 1% of revenue. I think we'll see lower than that this year. So judicious with the CapEx dollars. In terms of operating cash flow, our goal is to turn operating cash positive in the second half of the year.

並且只是為了補充。關於資本支出的問題，我們對今年的資本支出金額持謹慎態度。所以在過去，我們看到資本支出佔收入的 1% 左右。我認為我們今年會看到更低的水平。對資本支出美元如此明智。在經營現金流方面，我們的目標是在下半年將經營現金轉為正數。

So we're working towards that. And we think we'll make significant improvements from where we landed last year, both on operating cash and free cash flow. The 1 thing I will call out is as we look at our cash flows as we go across 2023 is based on how we account for our derivatives since we don't use hedge accounting, the benefits of our interest rate caps will come through operating cash flows. The benefits of our interest rate swaps will come through financing cash flows. And that's one of the reasons why we focus on free cash flow to incorporate the benefits of our interest rate swaps in 2023.

所以我們正在為此努力。我們認為我們將在去年的基礎上做出重大改進，包括運營現金和自由現金流。我要指出的一件事是，當我們查看 2023 年的現金流量時，我們將基於我們對衍生品的會計處理方式，因為我們不使用對沖會計，我們利率上限的好處將來自運營現金流動。我們的利率互換的好處將來自融資現金流。這就是我們關注自由現金流以納入 2023 年利率掉期收益的原因之一。

Our next question is from Pito Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Pito Chickering。

You got Benjamin Shaver on for Pito. So when you're looking at the leadership at the central level and also at the divisional level, do you guys believe you have the right team in place? Or do you think there needs to be some adjustments in 2023?

你讓 Benjamin Shaver 代替 Pito。因此，當您審視中央級別和部門級別的領導層時，你們認為您擁有合適的團隊嗎？或者您認為2023年需要做一些調整嗎？

Great question. And Ben, I think as you think about our organization, I made the comment about our -- the experience and maturity we've got at our cash collections, RCM. As I look out in the business and actually all 3 of our business divisions, our division presidents or our region presidents, they average between a low of 20 years of experience in the high of 30 to 35 years of experience, most of those years have been with us or with companies that we've run in the past, whether it be Gentiva, Healthfield, PSA. And so as we think down in the business, both at the payer relations, government affairs, sales, clinical oversight, operating side of the business, all the way down through the business, down to the actual branch locations, we've got a tremendous amount of tenure, both on the Medicaid side, the Private Duty side, on the Home Health & Hospice side as well as our Medical Solutions team.

很好的問題。本，我想當你想到我們的組織時，我對我們的現金收集 RCM 的經驗和成熟度發表了評論。當我審視業務時，實際上我們所有 3 個業務部門、我們的部門總裁或我們的地區總裁，他們平均有 20 年的低經驗和 30 到 35 年的高經驗，這些年中的大部分時間都有與我們或我們過去經營的公司一起工作，無論是 Gentiva、Healthfield 還是 PSA。因此，當我們向下思考業務時，無論是在付款人關係、政府事務、銷售、臨床監督、業務運營方面，一直到整個業務，一直到實際的分支機構位置，我們都有一個在 Medicaid 方面、私人職責方面、家庭健康和臨終關懷方面以及我們的醫療解決方案團隊擁有大量的任期。

And so we are blessed in the fact that we've got a deep bench of 10-year talent. We're having -- we're bringing some new blood in, some younger blood in, even the younger folks in, so we can continue to replenish the talent as many of our leaders are in their second and third decade of leading post-acute healthcare companies. But I don't worry every night about the quality of our leadership team at any level in our organization. I will say, and you've heard us say this before, in the last 2 years, we took one FTE in payer relations and government affairs to now approaching 20 (inaudible) bodies. So we have significantly increased our government payer relations teams and we continue to invest in those teams because they are producing the greatest outcome for our company. I'll also mention that we've made significant investments in our clinical outcomes, our data analysis and the ability to prove our value-based story through clinical outcomes.

因此，我們很幸運，因為我們擁有一批擁有 10 年經驗的人才。我們正在——我們正在引進一些新鮮血液，一些更年輕的血液，甚至是年輕人，所以我們可以繼續補充人才，因為我們的許多領導人都處於領導崗位的第二個和第三個十年——急性醫療保健公司。但我不會每天晚上都擔心我們組織中任何級別的領導團隊的素質。我會說，你以前聽過我們這樣說過，在過去的 2 年裡，我們在付款人關係和政府事務中採用了一個 FTE，現在接近 20 個（聽不清）機構。因此，我們顯著增加了政府付款人關係團隊，我們繼續投資於這些團隊，因為他們正在為我們公司帶來最大的成果。我還要提到的是，我們在臨床結果、數據分析以及通過臨床結果證明我們基於價值的故事的能力方面進行了大量投資。

So our clinical team has grown as well. And that's part of why we talked about cost reductions, and we've invested significant dollars in these core areas, at the same time, we're going to go back through the business and just find areas where we can be more efficient and more effective so that we can truly get our profitability back up towards that 10% goal we've had all along. I appreciate the question.

因此，我們的臨床團隊也在壯大。這就是我們談論降低成本的部分原因，我們在這些核心領域投入了大量資金，與此同時，我們將回顧業務，找到我們可以更高效、更有效的領域有效，這樣我們才能真正讓我們的盈利能力回到我們一直以來的 10% 目標。我很欣賞這個問題。

And just 1 more follow-up real quick. I appreciate the color you gave on kind of free cash flow conversion, but do you guys have any leverage ratio that you're shooting for coming out of '23?

很快再進行 1 次跟進。我很欣賞你在自由現金流轉換方面給出的顏色，但是你們有沒有為 23 年後的槓桿率？

We don't typically provide guidance on leverage. I mean, obviously, we'd all like it to be lower, as we drive our operating cash and drive our free cash, the ultimate goal of that is to ultimately build cash on the balance sheet and lower our net debt and leverage.

我們通常不提供有關槓桿的指導。我的意思是，很明顯，我們都希望它更低，因為我們推動我們的運營現金和自由現金，其最終目標是最終在資產負債表上建立現金並降低我們的淨債務和槓桿率。

So I'd just say that we're very focused on operating the business and driving all the benefits that Jeff and I have talked about. And like we said, getting to positive free cash -- I'm sorry, positive operating cash in the second half and just driving on all fronts there.

所以我只想說，我們非常專注於經營業務並推動傑夫和我談到的所有好處。就像我們說的那樣，獲得正的自由現金——對不起，下半年有正的運營現金，只是在所有方面都在推動。

Our next question is from Ben Hendrix with RBC Capital Markets.

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

Just a quick follow-up on those executive -- or I'm sorry, on the PD legislation efforts in California, Texas and Oklahoma, just wondering if you could kind of handicap each of those and kind of let us know what your thoughts are on kind of the probability of actually getting those at a double-digit level that you're expecting, where is the biggest headwinds? Where is the most likelihood and kind of how you're handicapping that increase overall?

只是對那些高管的快速跟進——或者我很抱歉，關於加利福尼亞州、德克薩斯州和俄克拉荷馬州的 PD 立法工作，只是想知道你是否可以對每一個進行障礙並讓我們知道你的想法是什麼關於實際獲得您期望的兩位數水平的可能性，最大的阻力在哪裡？您阻礙整體增長的可能性和類型在哪裡？

Great question, Ben. And yes, I think I'll state the obvious, and that is the value proposition is the same conversation in every 1 of our 33 states. It's the same, it's not unique to California compared to Oklahoma. It's the same exact conversation, which is just investing an additional $150 to $200 a day in incremental nursing wages in the home saves you between $4,000 and $6,000 a day, right?

好問題，本。是的，我想我會說的很明顯，那就是價值主張在我們 33 個州中的每一個州都是相同的對話。這是一樣的，與俄克拉荷馬州相比，這並不是加利福尼亞州獨有的。這是完全相同的對話，只是每天額外投資 150 到 200 美元，增加家庭護理工資，每天可以節省 4,000 到 6,000 美元，對嗎？

And it's -- the research shows that our medically fragile patient population is spending anywhere between a minimum of 30, a maximum of 90 extra days in children's hospital that is unnecessary for their care because there's not enough home nursing services. So the research, the conversation is the same across. What's different is each state has its own budget process, its own set of issues, its own set of priorities. And so that's really where we get into the -- to your point, the uniqueness in each state.

而且它——研究表明，我們身體虛弱的患者群體在兒童醫院多呆了至少 30 天，最多 90 天，這對他們的護理來說是不必要的，因為沒有足夠的家庭護理服務。所以研究，對話是一樣的。不同之處在於每個州都有自己的預算流程、自己的一系列問題、自己的一系列優先事項。所以這就是我們真正進入的地方——就你的觀點而言，每個州的獨特性。

At the end of the day, I would tell you I believe firmly that California, Texas and Oklahoma will all pass through PDN rate increases. I'm hopeful that, that will be in this legislative session in 2023. And I think they, the legislatures that we have talked to in the States, we've spoken with the Governor's offices in all 3 states, they understand the issue. They are supportive of the issue.

歸根結底，我會告訴你，我堅信加利福尼亞州、德克薩斯州和俄克拉荷馬州都將通過 PDN 費率增長。我希望這將在 2023 年的立法會議上進行。我認為他們，我們在美國與立法機構交談過，我們已經與所有 3 個州的州長辦公室交談過，他們理解這個問題。他們支持這個問題。

I think what it comes down to sometimes, Ben, is sometimes there's just other macro stuff going on. And if you take California as an example, sometimes there's just macro stuff going on in the state that has nothing to do with nursing, children, home services that just takes the attention of a Governor or a legislature away from an important issue like ours. And so end of the day, as Tony and I talked about in the last couple of calls, these states are going to pass through rate increases. It's just a matter of when and how much, I'm confident that we're going to come out of this summer with a very good outcome in all 3 of these states. It may not be exactly, I think, as Joanna mentioned, we've asked for more in each state than we've assumed we're going to get in our guidance, right? And that's just us being prudent.

我認為有時歸根結底，本，有時只是其他宏觀因素在發生。如果你以加利福尼亞州為例，有時該州發生的只是一些與護理、兒童、家庭服務無關的宏觀事情，這些事情只會讓州長或立法機構的注意力從像我們這樣的重要問題上轉移開來。所以最終，正如托尼和我在最近幾次電話中談到的那樣，這些州將通過加息。這只是時間和程度的問題，我相信我們將在今年夏天在這三個州取得非常好的結果。我認為，這可能不完全是，正如喬安娜提到的那樣，我們在每個州要求的比我們假設我們將獲得的指導要多，對吧？那隻是我們謹慎行事。

But we're not asking for $1 a rate increase. I mean, we're asking for 20%, 25%, 30%, 35%, 40% rate increases in these states because that's what it takes to ultimately materially move the needle in the home nursing. So again, you're hearing me be positive. California has a July 1 effective date. Texas is a September 1 effective date, Oklahoma, an October 1 effective date.

但我們並不是要求加息 1 美元。我的意思是，我們要求在這些州增加 20%、25%、30%、35%、40% 的比率，因為這是最終在家庭護理中實質性地移動針頭所需要的。再一次，你聽到我是積極的。加利福尼亞州的生效日期為 7 月 1 日。德克薩斯州的生效日期為 9 月 1 日，俄克拉荷馬州的生效日期為 10 月 1 日。

We'll know the answer to all 3 of these by early June, some cases, late May. So we're heads down for the next 90 days, driving this, let's say agenda, not only in these 3 states, but every single 1 of our 33 states, and I think we feel very confident we're going to have a great year related to government affairs rate in PDS.

我們將在 6 月初之前知道所有這 3 個問題的答案，有些情況下，5 月底。因此，我們將在接下來的 90 天裡全力以赴，推動這個，比方說議程，不僅在這 3 個州，而且在我們 33 個州中的每一個州，我認為我們非常有信心我們將有一個偉大的PDS 中與政府事務率相關的年份。

(Operator Instructions)

（操作員說明）

Our next question comes from Matt Borsch with Water Tower Research.

我們的下一個問題來自 Water Tower Research 的 Matt Borsch。

I had a question about -- I know demand trends are not an issue. You've got more demand than can be handled for yourselves in the industry. But how do you see that evolving on the PDS side for maybe in the near term and longer term? I mean it's more clear we can see that the accelerators of demand on the adult home health side. Can you just talk to that?

我有一個問題——我知道需求趨勢不是問題。您的需求超出了您自己在行業中的處理能力。但是，您如何看待 PDS 方面在近期和長期內的發展？我的意思是，我們可以更清楚地看到成人家庭健康方面的需求加速器。你能和那個談談嗎？

Yes. Yes, thanks for the question. I think -- there are more children who need more home care services in America than there are home care companies to take them home or the appropriate rate. So we don't lose sleep at night on is our demand 18 months, 24 months, 36 months in the future, going to be less, more, equal to on the PDS side of the business.

是的。是的，謝謝你的提問。我認為 - 在美國，需要更多家庭護理服務的兒童數量超過了將他們帶回家或適當費用的家庭護理公司。因此，我們不會因為未來 18 個月、24 個月、36 個月的需求而失眠，在業務的 PDS 方面將變得更少、更多、相等。

I think as the federal government has leaned into home and community-based services, which is now a defined term in CMS and the federal government, that's good for us. That is a broader group of families who can receive both highly acute skills at home, moderate acute skills at home and even lesser acute skills at home. And I think as we think of the long-term macro 10-year outlook, I think PDS has got great tailwinds from a long-term demand standpoint, it truly will come down to the supply of caregivers, both family caregivers in the home and skilled acute nurses that are coming to the home.

我認為，由於聯邦政府已經傾向於家庭和社區服務，這現在是 CMS 和聯邦政府的一個定義術語，這對我們有好處。這是一個範圍更廣的家庭群體，他們可以在家中獲得高度敏銳技能、在家中獲得中等敏銳技能甚至在家中獲得較低敏銳技能。而且我認為，當我們考慮 10 年的長期宏觀前景時，我認為從長期需求的角度來看，PDS 有很大的推動力，它真正歸結為護理人員的供應，包括家中的家庭護理人員和即將上門的熟練急救護士。

And so again, it's a great question. To us, the long-term demand metrics for PDS still make a ton of sense, and it continues to be a supply issue for as far as we can see in the next 3 to 5 years, it truly continues to be the ability to attract and retain both skilled and lesser skilled caregivers.

再一次，這是一個很好的問題。對我們來說，PDS 的長期需求指標仍然很有意義，而且就我們未來 3 到 5 年的情況而言，它仍然是一個供應問題，它確實繼續成為吸引並保留熟練和不太熟練的護理人員。

And maybe just a follow-up on a different topic. I know you've talked a lot about the rate side of the business. And I gather that on the rate side, a lot of the problem is organizational attention and initiative, whether you're talking about a state agency or managed care commercial payer. Is that about right? Or do you have some of these -- because you can say, higher rate is going to save you money. And do you find that you have real opposition to that argument or people with a different theory.

也許只是對不同主題的跟進。我知道你已經談了很多關於業務的利率方面。我認為在費率方面，很多問題是組織的關注和主動性，無論你是在談論國家機構還是管理式醫療商業付款人。這樣說對嗎？或者你有其中的一些——因為你可以說，更高的利率會為你省錢。你是否發現你真的反對那個論點或持不同理論的人。

No. But by the way, your question is very thoughtful, Matt. And that is a lot of times, it's just giving the attention, right? It's getting the attention of the Legislature of Texas or the Governor and getting their attention to matter. As I think of MCO payer partners, it's a similar conversation. It's just that the MCO partners figured it out faster, that they see, hey, I can say, $5,000 a day, even if they start giving us what's called single case agreements, which mean that they approve 1 family at a time at a new rate, we see the MCO partners moving in a matter of hours and days versus months and years from our state partners.

不，但是順便說一句，馬特，你的問題很周到。很多時候，它只是給予關注，對吧？它引起了德克薩斯州立法機關或州長的注意，並引起了他們對此事的關注。當我想到 MCO 付款合作夥伴時，這是一個類似的對話。只是 MCO 合作夥伴想得更快，他們看到，嘿，我可以說，每天 5,000 美元，即使他們開始給我們所謂的單一案例協議，這意味著他們一次批准一個新的家庭速度，我們看到 MCO 合作夥伴在幾小時和幾天內移動，而我們的州合作夥伴則需要幾個月和幾年。

So the MCO partners are just able to move faster than their legislative counterparts. I will say, over the first -- we're about 18 months into this strategy. We now have markets where we have a preferred payer in a specific market and then we have nonpreferred payers, the nonpreferred payers, it took them about 9 months to call us and say, why can't I get any of your nurses? And our answer was, because unfortunately, you're not paying us -- you're not a partner of ours in this market.

因此，MCO 的合作夥伴只能比他們的立法夥伴行動得更快。我會說，首先 - 我們已經實施了大約 18 個月的戰略。我們現在的市場在特定市場中有優先付款人，然後我們有非優先付款人，非優先付款人，他們花了大約 9 個月的時間打電話給我們說，為什麼我找不到你們的護士？我們的回答是，因為不幸的是，你沒有付錢給我們——你不是我們在這個市場上的合作夥伴。

And so we've seen MCO payers go from not interested now, not now to, "Oh my God, what do I have to do to get what the other payer in this market has gotten from Aveanna which to us shows the power of the partnership, and I think, again, I'll go back to the legislative comment.

因此，我們看到 MCO 付款人從現在不感興趣，到現在不感興趣，“天哪，我必須做什麼才能獲得這個市場上其他付款人從 Aveanna 獲得的東西，這向我們展示了 Aveanna 的力量夥伴關係，我想，我會再次回到立法評論。

I think you read into it right. It's just getting the attention of the right people in a legislative process like a California to understand the issue. They all get the issue. They -- it's not hard to sell the issue. It's just getting their attention from floods and snow and gas prices and all the other stuff that's on their desk to deal with in making this a priority. And that's really our job is to -- and our lobbyist job is to just drive this home.

我認為你沒看錯。它只是在像加利福尼亞這樣的立法程序中引起合適的人的注意，以了解這個問題。他們都明白這個問題。他們 - 出售這個問題並不難。這只是讓他們的注意力從洪水、雪和天然氣價格以及他們辦公桌上所有其他需要處理的事情中得到關注，從而將其作為優先事項。這真的是我們的工作——我們說客的工作就是開車回家。

There are no further questions at this time. I would like to turn the floor back over to CEO, Jeff Shaner for closing comments.

目前沒有其他問題。我想把發言權交還給 CEO Jeff Shaner 以發表結束評論。

Well, thank you, operator, and to everyone. Thank you for joining our earnings call today. And most importantly, thank you for your interest in our Aveanna story, we look forward to updating you on our progress at the end of Q1 in mid-May. Have a great day, and operator, thanks so much.

好吧，謝謝接線員，也謝謝大家。感謝您參加我們今天的財報電話會議。最重要的是，感謝您對我們的 Aveanna 故事感興趣，我們期待在 5 月中旬第一季度末向您更新我們的進展情況。祝你有美好的一天，接線員，非常感謝。

Thank you. This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.

謝謝。今天的電話會議到此結束。此時您可以斷開線路。感謝您的參與。