Aveanna Healthcare Holdings Inc (AVAH) 2023 Q1 法說會逐字稿

Good morning, and welcome to the Aveanna Healthcare Holdings First Quarter 2023 Earnings Conference Call. Today's call is being recorded, and we have allocated 1 hour for prepared remarks and Q&A.

早上好，歡迎來到 Aveanna Healthcare Holdings 2023 年第一季度收益電話會議。今天的通話正在錄音中，我們分配了 1 小時用於準備好的評論和問答。

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.

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。

Thank you, Maria. Good morning, and welcome to Aveanna's First Quarter 2023 Earnings Call. I'm 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.

謝謝你，瑪麗亞。早上好，歡迎來到 Aveanna 的 2023 年第一季度收益電話會議。我是公司的首席法務官兼公司秘書 Shannon Drake。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 file with the SEC. The company does not undertake any duty to update any 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任何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 quarterly report on Form 10-Q filed with the SEC.

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發佈在我們網站 aveanna.com 上的新聞稿以及我們向美國證券交易委員會提交的 10-Q 表格的最新季度報告中找到。

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 first quarter results and how we are progressing against our near- and longer-term objectives for 2023 and beyond.

謝謝你，香農。早上好，感謝您今天加入我們。我們感謝大家今天早上花時間更好地了解我們第一季度的業績，以及我們如何在實現 2023 年及以後的近期和長期目標方面取得進展。

My initial comments will briefly highlight our first quarter results, along with the early progress we are making in addressing the labor markets and our ongoing efforts with government and managed care payers to create additional capacity. I will then provide some thoughts regarding our liquidity and refreshed outlook for 2023 prior to turning the call over to Dave to provide further details into the quarter and full year guidance.

我的初步評論將簡要強調我們第一季度的業績，以及我們在解決勞動力市場問題上取得的早期進展，以及我們與政府和管理式醫療支付方為創造額外能力而進行的持續努力。然後，在將電話轉給 Dave 提供有關季度和全年指導的更多詳細信息之前，我將提供一些關於我們的流動性和 2023 年更新前景的想法。

Starting with some highlights for the quarter. Revenue was approximately $466.4 million, representing a 3.5% increase over the prior year period. Gross margins was $144.5 million or 31%, which is essentially flat when compared to the comparable prior year period. And finally, adjusted EBITDA was $28.5 million, representing a 25% decrease when compared to the prior year period, primarily due to the costs associated with the current labor environment.

從本季度的一些亮點開始。收入約為 4.664 億美元，比上年同期增長 3.5%。毛利率為 1.445 億美元或 31%，與去年同期相比基本持平。最後，調整後的 EBITDA 為 2850 萬美元，與去年同期相比下降了 25%，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 are aggressively addressing in 2023 to see Aveanna resume the growth trajectory that we believe our company can achieve. As a reminder, we do 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，勞動力環境是我們在 2023 年積極應對的主要挑戰，以便看到 Aveanna 恢復我們認為我們公司可以實現的增長軌跡。提醒一下，我們沒有需求問題。對家庭和社區護理的需求從未如此高漲，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。

As communicated in our previous quarter, our ability to recruit and retain the best talent is a function of 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 a competitive wage.

正如我們在上一季度所傳達的那樣，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。

Since our year-end earnings call, I am pleased with the progress we have made on several of our rate improvement initiatives with both government and managed care payers. Specifically, as it relates to our Private Duty Services business, our goal for 2023 was to execute a legislative strategy that would increase rates by double-digit percentages in 3 important states, California, Texas and Oklahoma, which represent approximately 25% of our total Private Duty Services revenue.

自我們年終財報電話會議以來，我對我們在與政府和管理式醫療付款人的多項費率改善計劃方面取得的進展感到高興。具體而言，由於它與我們的私人義務服務業務相關，我們 2023 年的目標是執行一項立法戰略，將三個重要州（加利福尼亞州、德克薩斯州和俄克拉荷馬州）的費率提高兩位數，這大約占我們總數的 25%私人義務服務收入。

In the first quarter, we were able to demonstrate the value we create for medically fragile patients in Oklahoma and have successfully secured a double-digit rate increase, which was retroactive to January 1 of this year. Since the Oklahoma rate increase, we have doubled the number of caregivers hired per week in Oklahoma, demonstrating the impact rate increases have on our ability to attract caregivers at the right wage profile.

在第一季度，我們能夠證明我們為俄克拉荷馬州身體虛弱的患者創造的價值，並成功實現了兩位數的增長率，追溯至今年 1 月 1 日。自俄克拉荷馬州加息以來，我們每週在俄克拉荷馬州僱用的看護人人數翻了一番，這表明加息對我們以合適的工資水平吸引看護人的能力產生了影響。

We have also made significant strides with the Texas legislature that gives us increased optimism that we will achieve our targeted double-digit rate increase for our Texas private duty nursing business beginning September 1. While this rate increase isn't guaranteed at this stage, early indicators reinforce our optimism that our efforts are gaining meaningful traction.

我們還與得克薩斯州立法機構取得了重大進展，這讓我們更加樂觀地認為，我們將從 9 月 1 日開始為我們的得克薩斯州私人護理業務實現兩位數的目標增長率。雖然在現階段不能保證這一增長率，但早期指標強化了我們的樂觀情緒，即我們的努力正在獲得有意義的牽引力。

Finally, we have spent considerable time with the California legislature and the governor's office, demonstrating the importance of these rate increases and how they support an overall lower health care cost, improve patient satisfaction and quality outcomes. Based on our actions to date, we believe that we are taking the appropriate steps needed to support our requested increase in this upcoming California budget cycle that is effective July 1.

最後，我們花了相當多的時間與加州立法機構和州長辦公室合作，展示了這些費率增長的重要性，以及它們如何支持降低整體醫療保健成本、提高患者滿意度和質量結果。根據我們迄今為止的行動，我們相信我們正在採取必要的適當步驟來支持我們要求在即將到來的 7 月 1 日生效的加州預算週期中增加預算。

While there is still much work to be done on the legislative front, we believe that we can accelerate our growth by increasing caregiver capacity and bringing more patients to the comfort of their 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.

雖然在立法方面仍有許多工作要做，但我們相信，我們可以通過提高護理人員的能力和讓更多患者回到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，我們成為過度擁擠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。

We also discussed the need to double the number of preferred payers in 2023. We define preferred payers as those payers that support value-based care by offering an above-market reimbursement rate and value-based payments in exchange for proven savings. Our goal for 2023 was to double our volumes from Private Duty Services preferred payers from approximately 10% of volumes to 20% by year-end 2023.

我們還討論了在 2023 年將首選付款人數量增加一倍的必要性。我們將首選付款人定義為那些通過提供高於市場的報銷率和基於價值的付款以換取已證實的儲蓄來支持基於價值的護理的付款人。我們 2023 年的目標是到 2023 年底，將來自私人義務服務首選付款人的交易量從大約 10% 增加到 20%。

In the first quarter, we've added 2 additional preferred pay agreements in key markets. Our preferred payer volumes increased to approximately 13% of PDS volumes. Also, we have a robust preferred payer pipeline and are very optimistic we will continue to execute on this strategy -- sorry, strategic initiative throughout 2023.

第一季度，我們在主要市場增加了 2 個額外的優先支付協議。我們首選的付款人數量增加到 PDS 數量的大約 13%。此外，我們擁有強大的首選支付渠道，並且非常樂觀地認為，我們將在整個 2023 年繼續執行這一戰略——對不起，戰略計劃。

Finally, we discussed the need to shift our current labor capacity to those payers that value our services and appropriately reimburse us for the care provided. We have begun several initiatives to shift caregiver capacity to our preferred payers to optimize staffing rates while minimizing days in an acute care facility. In the first quarter, our preferred payer relationships benefited from accelerated nurse hires up 2 to 3x more than our other payers, and we continued to experience staffing rates 15% to 20% greater with significantly higher patient admissions.

最後，我們討論了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的必要性。我們已經開始了多項舉措，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。在第一季度，我們首選的付款人關係受益於加速護士僱用比我們的其他付款人多 2 到 3 倍，我們繼續經歷 15% 到 20% 的人員配備率，患者入院率顯著增加。

The value proposition is straightforward. Preferred payers reimburse us a fair rate. We pay market competitive nurse wage rates while also earning value-based payments for achieving positive clinical outcomes and improved staffed hours. While we are encouraged by our early 2023 rate increases and subsequent recruiting results, we believe our business can rebound quickly as we achieve our rate goals previously discussed.

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士工資率，同時也為實現積極的臨床結果和改善員工工作時間賺取基於價值的報酬。雖然我們對 2023 年初的利率上漲和隨後的招聘結果感到鼓舞，但我們相信，隨著我們實現之前討論的利率目標，我們的業務可以迅速反彈。

Home and community-based care will continue to grow, and Aveanna is a comprehensive platform with a diverse payer base, providing a 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 a patient's home.

以家庭和社區為基礎的護理將繼續增長，而 Aveanna 是一個擁有多元化支付基礎的綜合平台，為更高成本的護理環境提供具有成本效益、高質量的替代方案。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 liquidity and refreshed outlook for 2023. On the liquidity front, we continue to make progress on improving our cash flow by focusing on attaining adequate reimbursement rates and growing our volumes. We are also implementing initiatives to rightsize our corporate cost structure while optimizing our cash collections. As Dave will discuss further, we have ample liquidity to operate our business while we work with government and payers to improve the reimbursement rates to reflect the current inflationary environment.

在我把電話轉給戴夫之前，讓我簡要評論一下我們的流動性和對 2023 年的更新展望。在流動性方面，我們通過專注於獲得足夠的償還率和增加我們的數量來繼續在改善現金流方面取得進展。我們還實施了調整公司成本結構的舉措，同時優化了我們的現金收款。正如戴夫將進一步討論的那樣，我們有充足的流動性來經營我們的業務，同時我們與政府和付款人合作提高報銷率以反映當前的通貨膨脹環境。

As it relates to our refreshed outlook for the year, while we exceeded our original revenue and EBITDA goals for the -- in the first quarter, we have several rate initiatives that still need to come to fruition over the next few months with particular emphasis on Texas and California. That being said, on the strength of our first quarter results, we are comfortable reiterating our full year revenue and adjusted EBITDA guidance of greater than $1.84 billion in revenue and at least $130 million in adjusted EBITDA, respectively.

由於它與我們今年更新的展望有關，雖然我們在第一季度超出了我們最初的收入和 EBITDA 目標，但我們有幾項利率計劃仍需要在未來幾個月內取得成果，特別強調得克薩斯州和加利福尼亞州。話雖這麼說，基於我們第一季度的業績，我們很樂意重申我們的全年收入和調整後的 EBITDA 指導分別超過 18.4 億美元和至少 1.3 億美元的調整後 EBITDA。

We believe it is important to continue to set expectations that acknowledge our environment we are operating in and the time it will take to transform our company and return to sustainable growth. 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.

我們認為，重要的是要繼續設定預期，承認我們所處的環境以及實現公司轉型和恢復可持續增長所需的時間。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。

Finally, I am proud of our Aveanna team as we execute on our 2023 strategic objectives. The power and efficiency of the home as a health care setting remains critical to our patients, families, payers, referral sources and government partners. The value of our clinical workforce continues to be recognized through the various rate increases across the country and through our expanding preferred payer relationships. I look forward to updating you on our results at the end of Q2.

最後，我為我們的 Aveanna 團隊感到自豪，因為我們正在執行我們的 2023 年戰略目標。家庭作為醫療保健環境的力量和效率對我們的患者、家庭、付款人、轉診來源和政府合作夥伴仍然至關重要。我們的臨床工作人員的價值繼續通過全國各地的各種費率增長和我們不斷擴大的首選付款人關係得到認可。我期待在第二季度末向您更新我們的結果。

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. I'll first talk about our first quarter financial results and liquidity before providing additional details on our refreshed outlook for 2023.

謝謝，傑夫，早上好。我將首先談談我們第一季度的財務業績和流動性，然後再提供有關我們更新後的 2023 年展望的更多細節。

Starting with the top line. We saw revenues rise 3.5% over the prior year period to $466.4 million. We experienced revenue growth in both our Private Duty Services and Medical Solutions segments, which grew by 6.5% and 10.7%, respectively, while our Home Health & Hospice segment declined by 15.8% as compared to the prior year quarter. Consolidated adjusted EBITDA was $28.5 million, a 25% decrease as compared to the prior year.

從第一行開始。我們看到收入比上年同期增長 3.5%，達到 4.664 億美元。我們的私人義務服務和醫療解決方案部門的收入分別增長了 6.5% 和 10.7%，而我們的家庭健康和臨終關懷部門與去年同期相比下降了 15.8%。合併調整後的 EBITDA 為 2850 萬美元，比上年下降 25%。

Now taking a deeper look into each of our segments, starting with Private Duty Services. Revenue for the quarter was approximately $373 million, a 6.5% increase and was driven by approximately 9.8 million hours of care, a volume increase of 1.8% over the prior year. While volumes improved over the prior year, we continue to be constrained in our top line growth due to the shortage of available caregivers although we are beginning to see early signs of improvement in the labor markets.

現在更深入地研究我們的每個細分市場，從私人義務服務開始。本季度的收入約為 3.73 億美元，增長 6.5%，這得益於約 980 萬小時的護理，比上年增長 1.8%。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，儘管我們開始看到勞動力市場改善的早期跡象。

Q1 revenue per hour of $38.12 was up $1.69 or 4.7% as compared to the prior year quarter and is a $0.46 or 1.2% sequential improvement as compared to Q4 of 2022. We expect to see continued improvement in 2023 as we execute on our rate increase initiatives, and we continue to be encouraged with our ability to attract caregivers and address the market demand for our services when we obtain adequate reimbursement rates.

第一季度的每小時收入為 38.12 美元，與去年同期相比增長 1.69 美元或 4.7%，與 2022 年第四季度相比環比增長 0.46 美元或 1.2%。我們預計在執行加息後，2023 年將繼續改善當我們獲得足夠的報銷率時，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。

Turning to our cost of labor and gross margin metrics. We achieved $104.2 million of gross margin or 27.9%, a 0.2% decrease from the prior year quarter. Our cost of revenue rate, $27.47, which is 4.9% increase as compared to the prior year, represents the rate pressures we saw in the labor markets throughout '22. That being said, our cost of revenue rate improved in the first quarter by $0.61 or 2.1% on a sequential basis. Our Q1 spread per hour was $10.65, representing a 4.2% year-over-year improvement and an 11.2% sequential improvement as compared to Q4 of '22.

轉向我們的勞動力成本和毛利率指標。我們實現了 1.042 億美元的毛利率或 27.9%，比去年同期下降 0.2%。我們的收入成本為 27.47 美元，比上年增長 4.9%，代表了我們在整個 22 世紀勞動力市場中看到的利率壓力。話雖這麼說，我們第一季度的收入成本環比提高了 0.61 美元或 2.1%。我們的第一季度每小時價差為 10.65 美元，與 22 年第四季度相比，同比增長 4.2%，環比增長 11.2%。

Moving on to our Home Health & Hospice segment. Revenue for the quarter was approximately $56.1 million, a 15.8% decrease over the prior year but a sequential improvement of $1.4 million over the previous quarter. We're pleased with the gross margin improvement from 41.9% in Q4 of '22 to 44.6% in the current quarter as we continue to focus on additional direct and indirect 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 5610 萬美元，比上年下降 15.8%，但比上一季度環比增加 140 萬美元。我們很高興毛利率從 22 年第四季度的 41.9% 提高到本季度的 44.6%，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和間接成本舉措範圍。

We continue to see admission trends for the division return to a more normalized level. As a reminder, at our lowest point in mid-summer, our weekly home health admissions were in the low 800s. In Q4 of '22, we averaged approximately 850 home health admissions per week with an episodic rate of 63%. These positive trends continued in Q1 of '23, where we experienced approximately 900 home health admissions per week while improving our episodic mix.

我們繼續看到該部門的錄取趨勢恢復到更正常的水平。提醒一下，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 22 年第 4 季度，我們平均每週約有 850 次家庭健康入院，偶發率為 63%。這些積極趨勢在 23 年第一季度繼續，我們每周經歷大約 900 次家庭健康入院，同時改善我們的偶發組合。

Our first quarter revenue was driven by 11,700 total admissions with approximately 68% being episodic and 11,900 total episodes of care. Medicare revenue per episode for the quarter was $29.69, essentially flat with the prior year quarter and sequentially. And although '22 was a difficult year for our Home Health & Hospice segment, we firmly believe in this business and its long-term value proposition. We've established -- we have an established Home Health & Hospice platform poised for growth, focused on delivering value through sound operational management and delivering excellence in patient care. We expect to see sequential improvement throughout 2023 as our direct and indirect cost initiatives take hold.

我們第一季度的收入是由 11,700 次總入院所推動的，其中大約 68% 是偶發性的，總計 11,900 次護理。本季度每集醫療保險收入為 29.69 美元，與去年同期和環比基本持平。儘管 22 年對我們的家庭健康和臨終關懷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。我們已經建立——我們擁有一個成熟的家庭健康和臨終關懷平台，有望實現增長，專注於通過健全的運營管理創造價值，並提供卓越的患者護理。隨著我們的直接和間接成本計劃的實施，我們預計在整個 2023 年會出現連續改善。

Now to our Medical Solutions segment results for Q1. During the quarter, we produced revenue of $37.3 million, a 10.7% increase over the prior year. Revenue was driven by approximately 85,000 unique patients served and revenue per UPS of $439.29. Gross margins were $15.3 million, a $1.2 million or 8.5% improvement over the prior year quarter. Gross margins, which were 40.8% in the quarter, represented a 0.9% decline as compared to the prior year quarter but a 1.1% sequential improvement as compared to the fourth quarter of '22.

現在來看我們第一季度的醫療解決方案部門業績。本季度，我們的收入為 3730 萬美元，比上年增長 10.7%。收入是由約 85,000 名獨特的患者服務和每個 UPS 的收入 439.29 美元推動的。毛利率為 1530 萬美元，比去年同期增加 120 萬美元或 8.5%。本季度毛利率為 40.8%，與去年同期相比下降 0.9%，但與 2022 年第四季度相比環比提高 1.1%。

We continue to evaluate ways to be more efficient and effective in our 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 and to further our payer partnerships.

隨著我們的不斷發展，我們將繼續評估提高後台效率和效果的方法，以利用我們的管理費用。雖然其他腸內供應商決定在 22 年退出市場，但我們認為這是擴大我們在全國范圍內的腸內業務並進一步加強我們的付款人合作夥伴關係的機會。

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 the path forward at Aveanna. As Jeff stated, our primary challenge is reimbursement rates. With the positive momentum we saw in Q1, we're optimistic that such trends will continue into the second quarter with sequential improvement expected in all segments. As we make progress in 2023 with the rate environment, we will pass through wage improvements and other benefits to our caregivers in the ongoing effort to better improve our 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 的前進道路。正如 Jeff 所說，我們的主要挑戰是報銷率。憑藉我們在第一季度看到的積極勢頭，我們樂觀地認為這種趨勢將持續到第二季度，預計所有細分市場都會出現連續改善。隨著我們在 2023 年在費率環境方面取得進展，我們將通過不斷提高工資和其他福利給我們的護理人員，以更好地提高我們的產量。

Now moving on to balance sheet and liquidity. At the end of the first quarter, we had liquidity in excess of $215 million, representing cash on hand of approximately $34.4 million, $20 million of availability under our securitization facility and approximately $162 million of availability on our revolver, which was undrawn at the end of the quarter. Lastly, we had $38 million of outstanding letters of credit at the end of the quarter.

現在轉向資產負債表和流動性。在第一季度末，我們的流動資金超過 2.15 億美元，包括手頭現金約 3,440 萬美元、我們的證券化貸款下的可用資金 2,000 萬美元以及我們的左輪手槍的可用資金約 1.62 億美元，這些資金在年底未提取本季度。最後，本季度末我們有 3800 萬美元的未付信用證。

As we look at the timing of earnings for '23 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 the benefits of all the efforts that we're working so hard on.

當我們查看 23 年的收益時間和相關現金流量時，雖然我們可能會全年為短期時間相關項目提取循環，但我們的目標是在年底前取消循環更重要的是，隨著我們開始意識到我們正在努力進行的所有努力的好處，我們將在下半年推動正的運營現金流。

On the debt service front, we had approximately $1.48 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. Our interest rate swaps extend through June of 2026, and our interest rate caps extend through February of '27. One last item I will mention related to our debt is that we have no material term loan maturities until July 2028.

在償債方面，我們在第四季度末有大約 14.8 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。我們的利率掉期延長至 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，我們在 2028 年 7 月之前沒有到期的重大定期貸款。

Looking at cash flow. Cash provided by operating activities was $7.5 million for the quarter as a result of certain onetime working capital items, and free cash flow was $2.9 million. We also expect to see cash flow benefits throughout '23 as our top line and cost management initiatives come to fruition.

看現金流。由於某些一次性營運資本項目，本季度經營活動提供的現金為 750 萬美元，自由現金流為 290 萬美元。隨著我們的頂線和成本管理計劃取得成果，我們還希望在整個 23 年看到現金流收益。

Before I hand the call over to the operator for Q&A, let me take a moment to address our refreshed outlook for '23. While we're pleased with our first quarter results, we believe it's prudent to maintain both our original revenue and adjusted EBITDA guidance of greater than $1.84 billion and at least $130 million, respectively. The trends we saw in the first quarter continue, and we're successful in obtaining the requisite rate increases needed in California and Texas. We would plan to update our guidance in the back half of the year.

在我將電話轉給接線員進行問答之前，讓我花點時間談談我們對 23 年的更新展望。雖然我們對第一季度的業績感到滿意，但我們認為謹慎的做法是維持我們的原始收入和調整後的 EBITDA 指引分別超過 18.4 億美元和至少 1.3 億美元。我們在第一季度看到的趨勢仍在繼續，我們成功地實現了加州和德克薩斯州所需的必要加息。我們計劃在今年下半年更新我們的指南。

As we think about seasonality, we expect our revenue to grow as rate increases are implemented throughout the year and our volumes grow. We now expect approximately 45% 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.

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。我們現在預計我們全年指導調整後的 EBITDA 的大約 45% 將在 23 年上半年得到確認。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 finally, as we wrap up National Nurses Week tomorrow, we would like to take a moment to recognize our incredible caregivers and the impact they make in the lives of our patients and their families every day.

最後，在明天結束全國護士周之際，我們想花點時間來表彰我們出色的護理人員以及他們每天對患者及其家人的生活所產生的影響。

And with that, I'll turn the call over to the operator.

有了這個，我會把電話轉給接線員。

(Operator Instructions) Our first question comes from Brian Tanquilut with Jefferies.

（操作員說明）我們的第一個問題來自 Jefferies 的 Brian Tanquilut。

I guess my first question, I know there's that CMS proposal on personal care services. Just want to clarify, I mean, will that cover the services that you provide under your PDS segment? And just any thoughts on that rule proposal from CMS.

我想我的第一個問題是，我知道有關於個人護理服務的 CMS 提案。只是想澄清一下，我的意思是，這是否涵蓋您在 PDS 細分市場下提供的服務？以及關於 CMS 的規則提案的任何想法。

Yes, Brian. Thanks. And yes, obviously, we're acutely aware of the proposed rule. And it's not material to Aveanna and our business, but we stand firm with our -- with the industry. We stand firm with our peers, the National Association for Home Care, PMHC, other trade organizations and the fact that a lot of work is left to be done. We think the precedent that the proposal creates is concerning. And certainly the open comment period that we're in right now is a very, very appropriate time for both us, the trade associations, state governments, all to give feedback to CMS.

是的，布萊恩。謝謝。是的，很明顯，我們敏銳地意識到提議的規則。這對 Aveanna 和我們的業務並不重要，但我們對我們的行業堅定不移。我們與我們的同行、全國家庭護理協會、PMHC 和其他貿易組織站在一起，而且還有很多工作要做。我們認為該提案開創的先例令人擔憂。當然，我們現在所處的公開評論期是我們、貿易協會、州政府都向 CMS 提供反饋的非常非常合適的時間。

We applaud the intent of the rule, which is to open access to Medicaid beneficiaries and certainly improve quality measures and transparency in rate setting. But the idea that CMS would set an 80% threshold for direct care workers' compensation is significantly concerning. And the precedent that, that would create we just don't think is appropriate. We also think, Brian, that as our peers have talked already, that the proposed rules significantly underestimates the oversight training, onboarding as well as the EVV or electronic visit verification expectation requirements that CMS mandates.

我們對該規則的意圖表示讚賞，該規則旨在向醫療補助受益人開放訪問權限，並且肯定會提高質量措施和費率設定的透明度。但是，CMS 為直接護理人員的薪酬設定 80% 門檻的想法非常令人擔憂。以及我們認為不合適的先例。布賴恩，我們還認為，正如我們的同行已經談到的那樣，擬議的規則大大低估了 CMS 規定的監督培訓、入職以及 EVV 或電子訪問驗證預期要求。

So in the end, we think this will play out in the next few months with a good open dialogue. And although not material to Aveanna's results, we just want to make sure that we stand firm with our peers in the industry to make sure that we find a good landing place for this final rule with CMS.

所以最後，我們認為這將在未來幾個月內通過良好的公開對話發揮作用。儘管對 Aveanna 的結果沒有實質性影響，但我們只是想確保我們與業內同行站在一起，以確保我們為 CMS 的最終規則找到一個好的著陸點。

All right. Got it. That makes sense. And then I guess my follow-up, great to hear about Oklahoma, and you called out how you saw a very notable uptick in interest and applications for new employees. So how did that work? Like when you get an increase, is it as simple as we offer higher rates and we get more people coming in to apply? Or is there like an advertising strategy that has to come along with that as you try to drive recruitment and recruiting yields higher?

好的。知道了。這就說得通了。然後我想我的後續行動，很高興聽到俄克拉荷馬州的消息，你大聲說你是如何看到對新員工的興趣和申請有非常顯著的上升。那它是如何工作的呢？就像當你得到加薪時，是否就像我們提供更高的費率並且有更多的人前來申請一樣簡單？或者當你試圖推動招聘和招聘收益率更高時，是否有類似的廣告策略必須隨之而來？

That's a great question, Brian. I'll be honest. It happens very quick. We've got a pipeline of inactive nurses, caregivers in every location, every market, the people who worked with us, enjoyed the home care setting like the one-on-one setting of being with a patient in their home. However, they left us over wage, just pure wage, $1, $2, $3 an hour.

這是一個很好的問題，布賴恩。我會說實話。它發生得非常快。我們在每個地方、每個市場都有大量不活躍的護士、護理人員，與我們一起工作的人享受家庭護理環境，比如在家裡與病人一對一的環境。然而，他們留給我們的只是工資，只是純工資，每小時 1 美元、2 美元、3 美元。

And so when you see a rate increase like Oklahoma, like what's proposed for Texas and California, we are able to -- we stay in touch with that nurse as she's moved on or he's moved on to their next jobs. The moment we can call them and say, "Hey, we got a rate increase effective yesterday. We can meet your needs of $3 more an hour, $2.50 more an hour, something meaningful," that nurse is excited to come back to us, and we see a strong movement of nurses back to us. But it's great to stay in touch with them. It's great to talk to them. But until we can meet their expectations, the conversation is a little bit mute. It's just a relationship.

因此，當你看到像俄克拉荷馬州這樣的利率上漲時，就像德克薩斯州和加利福尼亞州的提議一樣，我們能夠 - 我們與那位護士保持聯繫，因為她已經離開或者他已經轉移到他們的下一份工作。當我們打電話給他們說，“嘿，我們昨天的漲價生效了。我們可以滿足你每小時多花 3 美元，每小時多花 2.50 美元，一些有意義的東西，”那位護士很高興回到我們身邊，我們看到護士們強烈地回到我們身邊。但與他們保持聯繫真是太好了。很高興與他們交談。但在我們能夠滿足他們的期望之前，談話會有點沉默。這只是一種關係。

And so I think Oklahoma, just like other examples in our preferred payers, where -- the moment we're able to negotiate a higher rate, we focus on about a 50-ish percent pass-through directly to the caregiver of direct wages, not other benefits, but direct wages. And the ability to do that, Brian -- we were not surprised in Oklahoma, nor will we be surprised in California and Texas. As soon as we execute on those rate wins, California is effective July -- would be effective July 1, Texas would be effective in September 1, we would expect meaningful improvement in hires.

所以我認為俄克拉荷馬州，就像我們首選付款人中的其他例子一樣，在那裡——當我們能夠協商更高的費率時，我們專注於將大約 50% 的直接工資直接轉嫁給看護者，不是其他福利，而是直接工資。以及這樣做的能力，布賴恩——我們在俄克拉荷馬州並不感到驚訝，我們在加利福尼亞州和德克薩斯州也不會感到驚訝。一旦我們執行這些利率勝利，加利福尼亞州將在 7 月生效——7 月 1 日生效，德克薩斯州將在 9 月 1 日生效，我們預計在招聘方面會有有意義的改善。

And then, Brian, one of the pieces that we don't normally touch on, we have current nurses that are working for us that are also working other jobs. When we can call those nurses and say, "Hey, we can up your entire hourly wage by $3 or $4 an hour," not only do they fill the shifts they were filling, many times they fill incrementally more shifts and they'll push off that second job for us. So we get a lift internally, too, of our organic already patients that are already in service with us.

然後，布賴恩，我們通常不會觸及的部分之一，我們有現任護士為我們工作，他們也在從事其他工作。當我們可以打電話給那些護士說，“嘿，我們可以將你的整個小時工資提高每小時 3 美元或 4 美元，”他們不僅會填補他們正在填補的班次，而且很多時候他們會逐漸填補更多的班次，他們會推動為我們完成第二份工作。因此，我們在內部也提升了已經為我們服務的有機患者。

So it's really a win-win. And I think Oklahoma recognized that opportunity and came through very strong with the rate increase. And our conversations in the Texas legislature and the California legislature are very similar to that of Oklahoma. It's the same story, and it seems to be resonating very well.

所以這真的是雙贏的。而且我認為俄克拉荷馬州認識到了這個機會，並且隨著利率的提高而非常強勁。我們在德克薩斯州立法機構和加利福尼亞州立法機構的對話與俄克拉荷馬州的對話非常相似。同一個故事，似乎引起了很好的共鳴。

Our next question comes 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've got Kieran Ryan on for Pito. So looking at PDS this quarter, I think volumes came in about where you expected them and then obviously some nice acceleration on rates. Looking at the gross margin there as the year progresses and you think about these other rate increases coming through, do you think 1Q is a fair kind of baseline to use for the rest of the year at this point? Or is it still a little too volatile out there to make that call this early?

你讓 Kieran Ryan 代替 Pito。因此，看看本季度的 PDS，我認為交易量達到了您預期的水平，然後顯然出現了一些不錯的利率加速。隨著時間的推移，看看那裡的毛利率，你會想到這些其他的利率上漲，你認為 1Q 是今年剩餘時間使用的一個公平的基線嗎？或者它仍然有點太不穩定了，不能這麼早做出這個決定嗎？

Yes. First of all, it's a very thoughtful question. And I think the thing that we've really kept focusing on is driving rate to then pass-through wage, just like Brian's question. And so I think as you think about a 28% gross margin up in Q1, we'll be in that range as we push forward. We make it a temporary point where we get more rate than wage pass-through, but that's a timing issue. Our goal is to get these rates to the caregivers and move volumes and overall revenue.

是的。首先，這是一個非常深思熟慮的問題。而且我認為我們真正一直關注的事情是推動利率然後傳遞工資，就像布賴恩的問題一樣。所以我認為當你考慮第一季度 28% 的毛利率時，我們將在我們前進的過程中處於這個範圍內。我們把它作為一個臨時點，我們得到的利率高於工資轉嫁，但這是一個時間問題。我們的目標是將這些費率提供給護理人員，並提高銷量和總收入。

In the process, I think, Kieran, what you'll see is us be in or around that 28%. Getting back to 30%, where we were a couple of years ago, is probably not in the game. Could we touch 28.5%? Absolutely. But I think it's more of a timing thing that, as to your point, as the rate comes through, we may get a little bump. But we're aggressively pushing that rate through to the caregiver with the intent to really drive more volume, more shifts and really more missions.

在這個過程中，我認為，Kieran，你會看到我們處於或接近 28%。回到幾年前的 30%，這可能不在遊戲中。我們可以達到 28.5% 嗎？絕對地。但我認為這更像是一個時機問題，就你的觀點而言，隨著利率的提高，我們可能會遇到一些衝擊。但我們正在積極地將這一比率推向護理人員，目的是真正推動更多的工作量、更多的班次和更多的任務。

Got it. That's helpful. And then just a quick follow-up. Could you quantify or maybe just speak a little more to how much of the overall PDS rate performance in 1Q came from steering more of that business to the preferred payers?

知道了。這很有幫助。然後只是快速跟進。您能否量化或多談一談 1Q 的整體 PDS 利率表現有多少來自將更多業務轉向首選付款人？

Yes. I think in our prepared remarks, we talked about going into the year, 10% of our PDS volume was driven by preferred payers. By the -- we started the year with 7 preferred payers. We signed 2 more preferred payers in the quarter. So we're at 9 within our PDS segment. We moved 10% volume to 13% volume, so we had a nice bump. We're excited to talk about Q2's performance. We've already signed more agreements already effective in Q2. So we have a strong pipeline for Q2.

是的。我認為在我們準備好的評論中，我們談到了進入這一年，我們 10% 的 PDS 數量是由優先付款人推動的。到 - 我們今年年初有 7 個首選付款人。我們在本季度又簽署了 2 個首選付款人。所以我們在 PDS 細分市場中排名第 9。我們將 10% 的音量移動到 13% 的音量，所以我們有了一個很好的提升。我們很高興談論第二季度的表現。我們已經簽署了更多已在第二季度生效的協議。所以我們有一個強大的第二季度管道。

Some of the preferred payers are smaller. So some of them, they're not all at the same amount of volume, the same amount of covered member lives. So some of the preferred payers that we'll sign won't be as big as some of the current preferred payers we have on service. But as we think about the year playing out, 20% was an aggressive goal to be at by the end of the year. But I think you should think about 10% to 13%, in line with 13% to maybe 15% in Q2 and the back half of the year, we would be driving that to the high teens and probably ending the year right at about 18%, 19%, 20% of our business is now in the preferred payer.

一些首選付款人規模較小。所以他們中的一些人，他們的數量不一樣，覆蓋成員的生命數量也不一樣。因此，我們將簽署的一些首選付款人不會像我們目前服務的一些首選付款人那樣大。但當我們考慮到這一年結束時，20% 是到年底要達到的一個雄心勃勃的目標。但我認為你應該考慮 10% 到 13%，與第二季度和今年下半年的 13% 到 15% 一致，我們將把它推向高位，並可能在 18 歲左右結束這一年%, 19%, 20% 我們的業務現在都在首選支付方。

And you asked the right question. Yes, our preferred payers and our government wins are what's driving the rate, right? So the reimbursement rate is being driven by this strategy. I'll also say, as a follow-up, if you look at our wage rate, our wage rate is growing almost the same rate as our reimbursement rate is in PDS. So it's proof that we're pushing that rate through to the caregiver every day, and that's our intention.

你問了正確的問題。是的，我們的首選付款人和我們的政府獲勝是推動利率的因素，對吧？因此，報銷率是由該策略驅動的。我還要說，作為後續行動，如果你看一下我們的工資率，我們的工資率的增長速度幾乎與 PDS 中的報銷率相同。所以這證明我們每天都在將這個比率推給護理人員，這就是我們的意圖。

Our next question comes from A.J. Rice with Credit Suisse.

我們的下一個問題來自 A.J.瑞士信貸的大米。

I appreciate the comments about Oklahoma, Texas and California. I just want to make sure I understand. So your guidance that you have now, does that embed those rate increases from Texas and California? Is that part of the step-up in the back half? And I know those are big states for you, but any comment on the other -- the rest of the market and what you're seeing in terms of rate updates?

我很欣賞有關俄克拉荷馬州、德克薩斯州和加利福尼亞州的評論。我只是想確保我理解。那麼您現在的指導是否包含德克薩斯州和加利福尼亞州的加息？這是後半部分升級的一部分嗎？我知道那些對你來說是大州，但對其他國家有什麼評論——市場的其他部分以及你在利率更新方面看到的情況？

I'll start with kind of the other, and then we'll back into guidance. Yes, I think we're very pleased with where we sit at this point in the year. I'll say the next 60 days are probably the most important 60 days of the year as most state governments are in their kind of their final 6 to 8 weeks push to putting through their annual budgets or buying budgets. But the known rate increases we have today are equal to or slightly ahead of our expectations going into the year and what we included in guidance. We did not include our guidance Oklahoma coming out at the place. Oklahoma did.

我將從其他方面開始，然後我們將回到指導。是的，我認為我們對今年此時的位置感到非常滿意。我會說接下來的 60 天可能是一年中最重要的 60 天，因為大多數州政府都在他們的最後 6 到 8 週內努力完成年度預算或購買預算。但我們今天已知的加息幅度等於或略高於我們對今年的預期以及我們在指導中所包含的預期。我們沒有包括我們的俄克拉荷馬州指南。俄克拉荷馬州做到了。

And so I think as you think about Texas and California, again, our second half of the year guidance assumes that we do get some rate lift in those 2 states but not the ask that we have on hand in both of the legislatures in Texas and California. But I think we expected this to be a good year, A.J., in all things PDS rate, non-Medicare oriented. I think as we ultimately sit here in May, we sit in a very good place.

因此，我認為，正如您對德克薩斯州和加利福尼亞州的看法，我們今年下半年的指導假設我們確實在這兩個州獲得了一些利率提升，但不是我們在德克薩斯州和加利福尼亞州的兩個立法機構中提出的要求加州。但我認為我們預計今年會是一個好年頭，A.J.，在所有 PDS 率方面，非醫療保險導向。我認為當我們最終在 5 月坐在這裡時，我們坐在一個非常好的地方。

And I'll emphasize, we need to finish Texas and California. So those are the 2 most important outcomes for us over the next really 30 to 40 days as they come to a conclusion, finishing that exercise. We've been engaged with both legislatures and governor's office now for pushing almost a year. It's important for us to finish those 2, not just for us but the entire industry, to ensure that both in Texas and California, we can meaningfully impact the families and get them out of children's hospitals.

我要強調，我們需要完成得克薩斯州和加利福尼亞州。因此，在接下來的 30 到 40 天內，當他們得出結論並完成該練習時，這些是我們最重要的 2 個結果。現在，我們已經與立法機構和州長辦公室進行了近一年的接觸。完成這兩項對我們來說很重要，不僅對我們而且對整個行業，以確保在德克薩斯州和加利福尼亞州，我們都能對家庭產生有意義的影響，並讓他們離開兒童醫院。

Dave, you have comments about guidance?

戴夫，你對指導有意見嗎？

Yes, I'd say that's a fair statement, Jeff. And A.J., when you think about it, I mean, we do -- we are expecting rate increases in both states. And it does -- our guidance does incorporate, call it, mid- to high single-digit rate increases. As Jeff said, we think we're pretty well positioned to achieve those, and we're working collaboratively with the states on it. But -- and there's a lot of moving parts. Obviously, the guidance -- things can come up and down, but I think mid- to high single digits for those states.

是的，我會說這是一個公平的聲明，傑夫。 A.J.，當你想到它時，我的意思是，我們確實 - 我們預計這兩個州都會加息。它確實 - 我們的指導確實包含了，稱之為中高個位數的增長率。正如 Jeff 所說，我們認為我們完全有能力實現這些目標，並且我們正在與各州合作。但是 - 並且有很多活動部件。顯然，指導 - 事情可能會上下波動，但我認為這些州的中高個位數。

All right. Maybe my follow-up to ask you about the labor situation. I understand if you get the rate increases, you can get incremental caregivers. I wondered sort of within the sort of steady-state environment, is it getting any easier to recruit caregivers with the volatility around the economy in certain parts of the country? Are you seeing your turnover rate improve? Any updates on sort of a steady-state environment and what you're seeing?

好的。也許我後續要問你關於勞動的情況。我知道如果你的費率增加了，你就能得到更多的看護人。我想知道在這種穩定的環境中，隨著該國某些地區經濟的波動，招聘護理人員是否變得更容易了？你看到你的離職率提高了嗎？關於穩態環境和您所看到的情況的任何更新？

A.J., I think as we said in March, we felt a little bit of a pop out of the first -- out of the holidays coming into 2023, both in Indeed and some of our large, large recruitment platforms. We saw more applicants, more people engaged. That's really settled. I think in our steady state, we're still in a slugfest. And it's why we're so committed to this preferred payer strategy, because I think long term, we're going to continue to struggle with just inflation and eating up any current rate we have or steady-state rates.

A.J.，我認為正如我們在 3 月份所說的那樣，我們在進入 2023 年的假期中感受到了一些衝擊，無論是在 Indeed 還是我們的一些大型招聘平台上。我們看到更多的申請者，更多的人參與其中。真的就這麼定了我認為在我們的穩定狀態下，我們仍然處於混戰狀態。這就是為什麼我們如此致力於這種首選的付款人策略，因為我認為從長遠來看，我們將繼續與通貨膨脹作鬥爭，併吞噬我們現有的任何當前利率或穩態利率。

So I'd love to sit here and tell you, yes, the nurses are coming back, and they're just -- but no, I think we saw a little pop first part of the year. Our growth in our caregivers paid, our growth in our volumes, our growth in our hours is really around preferred payers and the states in which rate has been passed through. And so that's our strategy. We're sticking to it. We're not just waiting around for nurses to show up. And we've got great social media ads, recruitment strategies, but the #1 strategy is move rate, move volume, pass-through wage. And so I think that's where you'll see us focused not only in '23, but in '24 as well.

所以我很想坐在這裡告訴你，是的，護士們回來了，他們只是——但不，我想我們在今年上半年看到了一點點流行。我們支付的護理人員的增長、數量的增長、工作時間的增長實際上都圍繞著首選付款人和費率已經通過的州。這就是我們的策略。我們堅持下去。我們不僅僅是在等待護士出現。我們有很棒的社交媒體廣告、招聘策略，但排名第一的策略是調動率、調動量和轉嫁工資。所以我認為這就是你會看到我們不僅關注 23 年，而且關注 24 年的地方。

And A.J., I can tell you from talking to numerous of our larger Medicaid MCO partners, they feel the improvement. They feel faster discharges. Less hospitalizations, less hospitalized days. And that's -- it's almost a $5 to $1 savings to them. For every dollar they spend in PDN, they save between $5 and $6 in total health care costs, specifically from the acute care center. So we're hearing our payer partners telling us it's working. But I think you'll continue to see Aveanna shift our caregiver capacity to those partners that want to partner with us long term.

A.J.，通過與我們許多較大的 Medicaid MCO 合作夥伴的交談，我可以告訴你，他們感受到了進步。他們感覺放電更快。住院次數少，住院天數少。那就是——這幾乎為他們節省了 5 到 1 美元。他們在 PDN 上每花費 1 美元，就可以節省 5 到 6 美元的總醫療保健費用，尤其是急症護理中心的費用。所以我們聽到我們的付款合作夥伴告訴我們它正在工作。但我認為你會繼續看到 Aveanna 將我們的護理人員能力轉移給那些希望與我們長期合作的合作夥伴。

(Operator Instructions) Our next question comes from Joanna Gajuk with Bank of America.

（操作員說明）我們的下一個問題來自美國銀行的 Joanna Gajuk。

So the first question, I think you talked about $6.6 million settlement money, I guess, you actually received in the quarter. So did that benefit your cash flow and adjusted EBITDA?

所以第一個問題，我想你談到了 660 萬美元的和解金，我猜你實際上在本季度收到了。那麼這對您的現金流和調整後的 EBITDA 有好處嗎？

Joanna, can you clarify on the $6.6 million settlement?

喬安娜，你能澄清一下 660 萬美元的和解協議嗎？

Yes. It looks like it was a positive, like you received that money in the quarter, if I'm reading it correctly.

是的。如果我沒看錯的話，這看起來是積極的，就像你在本季度收到了這筆錢。

Overall, what I could tell you, Joanna, is that in the first quarter, we talked about a legal matter where we had some cash that was garnished from accounts in connection with a legal matter, and we posted in the [pellet] bond, and we were able to recover that cash of approximately $18 million before the end of the quarter, and then we substituted cash for letters of credit for about $18 million. So we had a positive outcome there while we pursue the appeal on that case.

總的來說，喬安娜，我可以告訴你的是，在第一季度，我們討論了一個法律問題，我們有一些現金是從與法律問題有關的賬戶中扣押的，我們在 [pellet] 債券中發布，我們能夠在本季度末之前收回大約 1800 萬美元的現金，然後我們用現金代替大約 1800 萬美元的信用證。因此，當我們對該案提出上訴時，我們在那裡取得了積極的結果。

There was another case that we funded about $7 million to an escrow account subsequent to quarter end in connection with the sellers of the Epic transaction. But overall, from a legal perspective, we're pleased with where we sit right now.

在另一個案例中，我們在季度結束後向一個與 Epic 交易的賣家有關的託管賬戶提供了大約 700 萬美元的資金。但總的來說，從法律的角度來看，我們對我們現在的處境感到滿意。

Yes. And Joanna, although it did have a positive impact to our cash flow in Q1, it had nothing -- no impact on adjusted EBITDA. It did help our Q1 cash flow but not our adjusted EBITDA.

是的。喬安娜，雖然它確實對我們第一季度的現金流產生了積極影響，但它沒有任何影響 - 對調整後的 EBITDA 沒有影響。它確實幫助了我們第一季度的現金流，但沒有幫助我們調整後的 EBITDA。

Okay. Because yes, that was my follow-up. I was just trying to clarify because cash flow was actually positive, right? And previously, you talked about positive cash flow, I guess, in second half. How should we think about the full year? Any kind of color you might give us how the cash flow will actually turn out for the full year?

好的。因為是的，那是我的後續行動。我只是想澄清一下，因為現金流實際上是正的，對吧？之前，我猜你在下半年談到了正現金流。我們應該如何看待全年？您可以給我們任何一種顏色，說明全年的現金流實際情況如何？

Yes. I mean, Joanna, like we've disclosed, we had positive cash flow in Q1 related to a couple of onetime working capital items that were benefits to us. Our goals remain the same, which is to be -- which is to drive positive operating cash flows in the second half of the year, whether it's Q3 or Q4. That's our goal, is to drive the business, execute on all the initiatives that we've been talking about and drive positive operating cash flow in the second half.

是的。我的意思是，喬安娜，正如我們所披露的那樣，我們在第一季度的正現金流與幾個對我們有利的一次性營運資本項目有關。我們的目標保持不變，即在今年下半年推動正的經營現金流，無論是第三季度還是第四季度。這就是我們的目標，即推動業務發展，執行我們一直在談論的所有計劃，並在下半年推動正的運營現金流。

And Joanna, I think we would not be surprised if Q2 is slightly negative and even potentially Q3 is about slightly negative or breakeven, right? So some of those onetimers drove the Q1 positive cash flow that Dave talked about. But again, I think Dave said it well, our goal is to end this year as a positive cash flow company and start '24 on that footing.

喬安娜，我認為如果第二季度略有負數，甚至可能第三季度略有負數或盈虧平衡，我們也不會感到驚訝，對吧？因此，其中一些曾經的人推動了 Dave 談到的第一季度正現金流。但同樣，我認為 Dave 說得很好，我們的目標是在今年結束時成為一家正現金流公司，並在此基礎上開始 24 年。

Our next question comes from Scott Fidel with Stephens Inc.

我們的下一個問題來自 Stephens Inc. 的 Scott Fidel。

First question, I actually just was hoping to get just a little more of a clarification just on the first question on the proposed rule in the gross margin cap. I guess, Jeff, just to be specific here, is it more that you're concerned about a precedent that could potentially lead to private duty nursing also having gross margin cap? Or is there -- is the gross margin cap actually attributable to PDN? Just trying to sort of understand whether you think that if this rule did go into effect, whether that 28% gross margin would be secure longer term or whether there would be risk to that.

第一個問題，實際上我只是希望就毛利率上限中擬議規則的第一個問題得到更多的澄清。我想，Jeff，在這裡具體來說，你是否更關心可能導致私人護士也有毛利率上限的先例？或者是否存在 - 毛利率上限是否實際上歸因於 PDN？只是想了解你是否認為如果這條規則真的生效，28% 的毛利率是否會長期安全，或者是否會有風險。

I think you're reading it the right way, that as we read it and as our legal lawyers and lobbyists have read it, it does not pertain to private duty nursing, but it does create a precedent that would be unfounded in Medicaid today. And as we talked to many of our state governors, Medicaid offices, they don't like the idea of this precedent, right, because they have a lot of their own oversight of the Medicaid program and a lot of oversight of the workforce in their state.

我認為您正在以正確的方式閱讀它，正如我們以及我們的法律律師和遊說者所閱讀的那樣，它與私人護理無關，但它確實創造了一個在今天的醫療補助計劃中毫無根據的先例。當我們與我們的許多州長、醫療補助辦公室交談時，他們不喜歡這個先例的想法，對吧，因為他們對醫療補助計劃有很多自己的監督，並且對他們的勞動力有很多監督狀態。

So we've long been a supporter of driving minimum wage, encouraging minimum wage lifts. Many of our states have minimum wage movements in them already that we operate with. But it's really the first part of your answer, Scott, is the precedent that it would set for all of health care services and all of health care is just -- we think it's just a dangerous precedent to be set.

因此，我們長期以來一直支持推動最低工資，鼓勵提高最低工資。我們的許多州已經在我們開展業務時進行了最低工資變動。但這實際上是你答案的第一部分，斯科特，是它將為所有醫療保健服務設定的先例，而所有醫療保健只是 - 我們認為這只是一個危險的先例。

And again, I think our state legislatures and our partners in the industry all agree on that, especially when you disclude so many of the things that we have to do that are mandated by law like EVV and compliance and oversight. So yes, it is -- as it's written today, as we have viewed it and our lawyers have viewed it, it is not material to Aveanna and its co-propose, but we do think it's a dangerous precedent to set in the industry.

再一次，我認為我們的州立法機構和我們的行業合作夥伴都同意這一點，尤其是當你排除了我們必須做的許多事情時，這些事情是法律規定的，比如 EVV 和合規與監督。所以是的，它是——正如今天所寫的那樣，正如我們所看到的和我們的律師所看到的那樣，這對 Aveanna 及其共同提案並不重要，但我們確實認為這是在行業中樹立一個危險的先例。

Okay. Got it. So more of the concern around a slippery slope as compared to a direct impact. Okay. And then on -- I appreciate that clarification. Then just a follow-up, yes, I don't know if you guys are comfortable doing it, but just to the extent that 25% that's from the 3 key states, would you be willing to break out what Texas and California are either independently or in aggregate just so we could ring-fence that?

好的。知道了。因此，與直接影響相比，更多的是擔心滑坡。好的。然後 - 我很欣賞這種澄清。然後只是一個跟進，是的，我不知道你們是否願意這樣做，但就來自 3 個關鍵州的 25% 而言，你們是否願意打破德克薩斯州和加利福尼亞州的情況獨立地或整體地只是為了我們可以圍欄嗎？

So I guess that's sort of part 1. And then part 2 would just be on the preferred providers as it relates to moving over to those partners, do we think about the financial benefits be more that you drive better volume there and you sort of are able to achieve that 28% plus gross margin? Or do you actually see a higher gross margin potential with those preferred partners?

所以我想那是第 1 部分。然後第 2 部分只是關於首選供應商，因為它與轉移到這些合作夥伴有關，我們是否認為經濟利益更多，你在那裡推動更好的數量，你有點是能達到28%以上的毛利率嗎？或者您是否真的看到了這些首選合作夥伴的更高毛利率潛力？

Great. Great question, Scott. Thank you. We'll start with the preferred payers and kind of work backwards. The intent of the preferred payer relationship is not to drive more margin percentage, although temporarily, it does happen as we get incremental rate and are passing it through to the caregivers. We'll temporarily get a bump in the margin percentage. What we're really, really engaged in is more volume, both more patients because we're getting more patients home from the hospitals, and we've seen that in our current 9 preferred payers, but also just more hour staff. And that's what the preferred payer wants. The payer wants us to staff all of the hours that are authorized, not most of them or some of them but all of them.

偉大的。很好的問題，斯科特。謝謝。我們將從首選付款人開始，然後進行一些倒退的工作。首選付款人關係的目的不是為了提高利潤率，儘管暫時，當我們獲得增量費率並將其傳遞給護理人員時，它確實會發生。我們會暫時提高保證金百分比。我們真正真正參與的是更多的數量，更多的病人，因為我們讓更多的病人從醫院回家，我們已經在我們目前的 9 個首選付款人中看到了這一點，但也只是更多的小時工。這就是首選付款人想要的。付款人希望我們在授權的所有時間配備員工，不是大部分時間或部分時間，而是所有時間。

And then the second part of it, Scott, is many of our preferred payers then have value-based bonus payments on a quarterly basis. And so we're 3 quarters in now to earning value-based bonuses for reducing hospitalization both in days and cost as well as staffing more hours. And eventually, we think some of our payers will move us to really admitting more patients. More volume of new patients will be in that as well. So 3 quarters in, we're now comfortable and confident with what we can do to earn those bonuses. We're earning bonuses. Those are in our results, both in Q4 and Q1. And it's -- to us, it's getting more comfortable earning those bonuses and beginning to pass some of those through to the caregivers as well.

然後它的第二部分，斯科特，我們的許多首選付款人然後每季度支付一次基於價值的獎金。因此，我們現在已經有 3 個季度的時間來賺取基於價值的獎金，以減少住院天數和費用，以及增加工作時間。最終，我們認為我們的一些付款人會讓我們真正接納更多的病人。也將有更多的新患者。所以 3 個季度後，我們現在對我們可以做些什麼來賺取這些獎金感到滿意和自信。我們正在賺取獎金。這些都在我們的結果中，包括第四季度和第一季度。而且它 - 對我們來說，賺取這些獎金並開始將其中的一些獎金也傳遞給護理人員變得更加自在。

So again, the long game here is being a partner, not a provider but being a partner, with the nation's largest Medicaid MCOs and truly helping them bend the cost curve and improve patient satisfaction. To us long term, that aligns us with the best payers in America and ultimately drives more volume for Aveanna.

因此，這裡的長期遊戲是與美國最大的醫療補助 MCO 成為合作夥伴，而不是提供者，而是成為合作夥伴，真正幫助他們降低成本曲線並提高患者滿意度。從長遠來看，這使我們與美國最好的付款人保持一致，並最終為 Aveanna 帶來更多銷量。

Anything else on the preferred payer, Scott, before we switch back to your questions on California and Texas?

在我們切換回您關於加利福尼亞和德克薩斯的問題之前，斯科特還有關於首選付款人的其他信息嗎？

No, that was great, Jeff. Appreciate that. So yes, just back, I guess, on California and Texas.

不，那太好了，傑夫。感謝。所以是的，我猜是在加利福尼亞州和德克薩斯州。

So we don't disclose specifically the amount of volume or the amount of rate. But I think we've been clear. These are 2 of our 3 largest states that we operate in from a Medicaid standpoint. And so we are -- we, Aveanna, are leading the charge in both states. We have -- I think we mentioned on the last call, we have engaged a research group out of Washington, D.C. We did studies in both California and Texas on the value of what private duty nursing means to the overall health care spend. In California, it showed that we saved $6,000 a day for every day we can get a child out of a hospital. We save $6,000 by getting them home. In Texas, it showed a similar outcome, but it was $5,000 a day just because of the difference in rate economics in those 2 states.

所以我們不具體透露數量或費率。但我認為我們已經很清楚了。從醫療補助計劃的角度來看，這些是我們運營的 3 個最大州中的 2 個。所以我們——我們 Aveanna 在這兩個州都處於領先地位。我們 - 我想我們在上次電話會議上提到過，我們聘請了華盛頓特區的一個研究小組。我們在加利福尼亞州和德克薩斯州進行了研究，研究私人護理對整體醫療保健支出的意義。在加利福尼亞州，它表明我們每天可以讓一個孩子出院，從而每天節省 6,000 美元。讓他們回家，我們節省了 6,000 美元。在得克薩斯州，它顯示了類似的結果，但它是每天 5,000 美元，這僅僅是因為這兩個州的費率經濟學不同。

But both studies were crystal clear. The more a state invests in PDN, the more they save total net health care savings. And it's material. It's hundreds of millions of dollars. In some cases, in California, Texas, it's pushing $1 billion a year in savings. And so that has resonated really, really, really well in both Austin and Sacramento with both governor's offices, Medicaid directors.

但兩項研究都非常清楚。一個州對 PDN 的投資越多，他們節省的總淨醫療儲蓄就越多。而且它很重要。這是數億美元。在某些情況下，在德克薩斯州的加利福尼亞州，它每年可以節省 10 億美元。因此，這在奧斯汀和薩克拉門託與州長辦公室和醫療補助計劃主管之間產生了非常、非常、非常好的共鳴。

And again, we're partnering with our peer group. We're partnering with the state associations. But it's so meaningful to Aveanna that we've taken the leadership role in both states, and we believe we're in a very good position today as that relates to our guidance. And I think we've been appropriately [vague] to say that we expect to get something in both states, but our back half of the year guidance does not include us getting double digit or certainly, I'll use 20% or greater rate increases in either of both states.

再一次，我們正在與我們的同行團體合作。我們正在與州協會合作。但這對 Aveanna 來說意義重大，我們在這兩個州都發揮了領導作用，我們相信我們今天處於非常有利的地位，因為這與我們的指導有關。而且我認為我們已經恰當地[含糊]地說我們希望在這兩個州都能有所作為，但我們下半年的指導不包括我們獲得兩位數或者當然，我將使用 20% 或更高的利率兩種狀態中的任何一種都增加。

And so we see that as a great opportunity. And our next call is in August, and we see -- obviously, we'll know both outcomes by then. We see it's a great opportunity in August to really readdress the back half of the year and also how we're trending going in 2024 at that point.

所以我們認為這是一個很好的機會。我們的下一次電話會議是在 8 月，我們會看到——顯然，到那時我們會知道兩種結果。我們認為 8 月是一個很好的機會，可以真正重新解決下半年的問題，以及我們在 2024 年的趨勢。

We have reached the end of our question-and-answer session. I would now like to turn the floor back over to Jeff Shaner for closing comments.

我們的問答環節已經結束。我現在想將發言權轉回給 Jeff Shaner 以發表結束評論。

Thank you, Maria, and thank you, everyone, for joining our Q1 earnings call today. And again, thank you for your interest in our Aveanna story. We look forward to updating you on our progress at the end of Q2 in August. Thanks, and have a great day.

謝謝瑪麗亞，也謝謝大家今天參加我們的第一季度財報電話會議。再次感謝您對我們的 Aveanna 故事的關注。我們期待在 8 月第二季度末向您通報我們的進展情況。謝謝，祝你有美好的一天。

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

今天的會議到此結束。此時您可以斷開線路。感謝您的參與。