Cross Country Healthcare Inc (CCRN) 2022 Q4 法說會逐字稿

Good afternoon, everyone. Welcome to the Cross Country Healthcare's Earnings Conference Call for the Fourth Quarter 2022. Please be advised that this call is being recorded, and a replay of this webcast will be available on the company's website. Details for accessing the audio replay can be found on the company's earnings release issued this afternoon. (Operator Instructions)

大家下午好。歡迎參加 Cross Country Healthcare 2022 年第四季度的收益電話會議。請注意，本次電話會議正在錄音中，公司網站上將提供本次網絡直播的重播。訪問音頻重播的詳細信息可以在公司今天下午發布的收益報告中找到。 （操作員說明）

I would now like to turn the call over to Josh Vogel, Cross Country Healthcare's Vice President of Investor Relations. Thank you and please go ahead, sir.

我現在想把電話轉給 Cross Country Healthcare 的投資者關係副總裁 Josh Vogel。謝謝，請繼續，先生。

Thank you and good afternoon, everyone. I'm joined today by our President and Chief Executive Officer, John Martins, as well as Bill Burns, our Chief Financial Officer; Dan White, Chief Commercial Officer; and Marc Krug, Group President of Delivery. Today's call will include a discussion of our financial results for the fourth quarter and full year of 2022, as well as our outlook for the first quarter of 2023. A copy of our earnings press release is available on our website at crosscountry.com.

謝謝大家，下午好。今天，我們的總裁兼首席執行官約翰·馬丁斯 (John Martins) 以及我們的首席財務官比爾·伯恩斯 (Bill Burns) 也加入了我的行列；丹·懷特，首席商務官；和交付集團總裁 Marc Krug。今天的電話會議將討論我們 2022 年第四季度和全年的財務業績，以及我們對 2023 年第一季度的展望。我們的收益新聞稿副本可在我們的網站 crosscountry.com 上獲取。

Please note that certain statements made on this call may constitute forward-looking statements. These statements reflect the company's beliefs based upon information currently available to it. As noted in our press release, forward-looking statements can vary materially from actual results and are subject to known and unknown risks, uncertainties and other factors, including those contained in the company's 2021 annual report on Form 10-K and quarterly reports on Form 10-Q, as well as in other filings with the SEC. The company does not intend to update guidance or any of its forward-looking statements prior to the next earnings release.

請注意，本次電話會議的某些陳述可能構成前瞻性陳述。這些陳述反映了公司基於其當前可用信息的信念。正如我們在新聞稿中指出的那樣，前瞻性陳述可能與實際結果存在重大差異，並受已知和未知的風險、不確定性和其他因素的影響，包括公司 2021 年 10-K 表年度報告和季度報告中包含的那些因素10-Q，以及向美國證券交易委員會提交的其他文件。公司不打算在下一次財報發布之前更新指南或任何前瞻性陳述。

Additionally, we reference non-GAAP financial measures such as adjusted EBITDA or adjusted earnings per share. Such non-GAAP financial measures are provided as additional information and should not be considered substitutes for, or superior to, those calculated in accordance with U.S. GAAP. More information related to these non-GAAP financial measures is contained in our press release.

此外，我們還參考了非 GAAP 財務指標，例如調整後的 EBITDA 或調整後的每股收益。此類非 GAAP 財務指標作為附加信息提供，不應被視為替代或優於根據美國 GAAP 計算的指標。有關這些非 GAAP 財務措施的更多信息包含在我們的新聞稿中。

Also during this call, we may refer to pro forma when normalized numbers pertain to our most recent acquisitions as though the results were included or excluded from the periods presented. With that, I will now turn the call over to our Chief Executive Officer, John Martins.

同樣在這次電話會議中，當標準化數字與我們最近的收購有關時，我們可能會參考備考，就好像結果被包括或排除在所提供的時期之外一樣。有了這個，我現在將把電話轉給我們的首席執行官約翰馬丁斯。

Thanks, Josh. And thank you to everyone for joining us this afternoon. As we reported today, our fourth quarter results met or exceeded our revenue and profitability expectations, closing the full year with the highest revenue and profitability in our history. As a digitally innovative enterprise with comprehensive workforce solutions and an unwavering commitment to clinical excellence, we were able to maintain our momentum even if COVID hospitalizations and demand softened. And entering 2023, we are a fundamentally stronger organization with greater financial health and a record of superior execution.

謝謝，喬希。感謝大家今天下午加入我們。正如我們今天報導的那樣，我們第四季度的業績達到或超過了我們的收入和盈利預期，以我們歷史上最高的收入和盈利能力結束了全年。作為一家擁有全面的勞動力解決方案和對臨床卓越的堅定承諾的數字創新企業，即使 COVID 住院和需求疲軟，我們也能夠保持我們的勢頭。進入 2023 年，我們將成為一個從根本上更強大的組織，擁有更健康的財務狀況和出色的執行記錄。

Over the last year, we have been relentlessly focused on continuing to build out our sales and delivery capabilities, as well as furthering our digital transformation. In addition, I've been working closely with our Board on furthering our environmental, social and governance initiatives with particular emphasis on governance. We continue to be thoughtful in our approach to succession planning for all key roles within the company. And with respect to our Board composition, we recently added 2 new Board members to our [Board]: Venkat Bhamidipati and Dwayne Allen, both exceptional leaders bringing new skill sets, ideas, diversity and broad expertise across verticals such as technology and healthcare.

在過去的一年裡，我們一直不懈地專注於繼續建立我們的銷售和交付能力，以及進一步推進我們的數字化轉型。此外，我一直與我們的董事會密切合作，推進我們的環境、社會和治理計劃，特別強調治理。我們繼續深思熟慮地為公司內的所有關鍵角色制定繼任計劃。關於我們的董事會組成，我們最近在 [董事會] 中增加了 2 名新董事會成員：Venkat Bhamidipati 和 Dwayne Allen，兩位傑出的領導者都帶來了新的技能組合、想法、多樣性和跨垂直領域的廣泛專業知識，例如技術和醫療保健。

We believe these appointments will serve Cross Country well as we continue to advance our technology strategy of creating a world-class digital platform for professionals and clients, welcoming exceptional frictionless and seamless experiences with increased efficiencies. For many perspectives, 2022 was an unprecedented year. And I'd like to take a moment to highlight just a few of our achievements. Starting with technology. We have been redesigning our entire ecosystem from the ground up, using a data-centric model that enables us to provide the highest levels of analytics, while ensuring speed to market as well as best-in-class experiences for our candidates, clients and our teams.

我們相信這些任命將為 Cross Country 服務，因為我們將繼續推進我們的技術戰略，為專業人士和客戶創建世界一流的數字平台，以更高的效率歡迎卓越的無摩擦和無縫體驗。從許多角度來看，2022 年是前所未有的一年。我想花點時間強調一下我們取得的一些成就。從技術開始。我們一直在從頭開始重新設計我們的整個生態系統，使用以數據為中心的模型，使我們能夠提供最高水平的分析，同時確保上市速度以及我們的候選人、客戶和我們的一流體驗團隊。

Last year, we launched 2 very significant technologies including Intellify as our proprietary vendor management system, and Gateway, our career portal. We believe Intellify will be a game-changer for Cross Country and potentially the market as a whole. Our philosophy in building Intellify was to start with a client and work backwards, designing it to help our clients more effectively manage and solve their most challenging people needs through data and analytics, advice and insights. Our road map calls for further investments that are underway and we believe Intellify will continue to be highly differentiated in the industry, opening up a new addressable market for Cross Country, giving us access to billions of dollars of potential spend under management in the vendor-neutral space.

去年，我們推出了 2 項非常重要的技術，包括作為我們專有供應商管理系統的 Intellify 和我們的職業門戶網站 Gateway。我們相信 Intellify 將成為 Cross Country 乃至整個市場的遊戲規則改變者。我們構建 Intellify 的理念是從客戶開始，向後工作，設計它以幫助我們的客戶通過數據和分析、建議和見解更有效地管理和解決他們最具挑戰性的人員需求。我們的路線圖要求正在進行的進一步投資，我們相信 Intellify 將繼續在行業中保持高度差異化，為 Cross Country 開闢一個新的可尋址市場，使我們能夠獲得供應商管理的數十億美元的潛在支出-中性空間。

And Gateway offers healthcare professionals the ability to find the right job through real-time, frictionless experiences on their terms. We have thousands of daily active users and we expect that number to grow as we continue to deploy new features and functionality. In addition to our key technology initiatives, we continue to invest in our people, growing our headcount by more than 15% across virtually all lines of business, with the vast majority being revenue producers. We also brought aboard many industry leaders like our newest hire Eric Christianson, who joined us last month as the Senior Vice President for Intellify Solutions.

Gateway 為醫療保健專業人員提供了根據他們的條件通過實時、無摩擦的體驗找到合適工作的能力。我們每天有成千上萬的活躍用戶，並且隨著我們繼續部署新特性和功能，我們預計這一數字還會增長。除了我們的關鍵技術計劃外，我們還繼續投資於我們的員工，幾乎所有業務線的員工人數都增加了 15% 以上，其中絕大多數是創收者。我們還聘請了許多行業領袖，例如我們的新員工埃里克·克里斯蒂安森 (Eric Christianson)，他上個月加入我們，擔任 Intellify Solutions 高級副總裁。

Eric is a pioneer in the vendor-neutral space with a proven track record of delivering innovative tech-based solutions. We are confident that he and his team will help accelerate Cross Country's growth trajectory by leveraging our SaaS-based higher margin Vendor Neutral Platform. From an operations perspective, every line of business experienced robust growth, driven primarily by the number of professionals on assignment, with only a modest impact coming from the rise in rates. With strong execution and continued productivity gains, our consolidated revenue was up 67% over 2021 to a record $2.8 billion, adjusted EBITDA surged to $302 million from last year's record of $162 million and our adjusted EBITDA margin rose 110 basis points to 10.8% from 9.7% in 2021.

Eric 是供應商中立領域的先驅，在提供基於技術的創新解決方案方面有著良好的記錄。我們相信他和他的團隊將通過利用我們基於 SaaS 的更高利潤的供應商中立平台來幫助加速 Cross Country 的增長軌跡。從運營的角度來看，每個業務線都經歷了強勁的增長，這主要是由派遣專業人員的數量推動的，而利率上漲的影響不大。憑藉強大的執行力和持續的生產力提升，我們的綜合收入比 2021 年增長了 67%，達到創紀錄的 28 億美元，調整後的 EBITDA 從去年創紀錄的 1.62 億美元飆升至 3.02 億美元，我們調整後的 EBITDA 利潤率從 9.7 上升 110 個基點至 10.8% 2021 年的百分比。

Also in 2022, we generated a company record $134 million in annual cash flow from operations. And we completed 3 targeted acquisitions that built scale in the locum space, as well as diversified our offerings with interim leadership. HireUp, which closed late in the fourth quarter, brings us a talented team with deep expertise in leadership staffing and strong relationships that are a perfect complement to our robust network. Welcome to the family, HireUp. In August, we announced a $100 million share repurchase program and through the end of the year, we repurchased 1.4 million shares or roughly 4% of the outstanding shares. We also prepaid $100 million on our term loan during the year to reduce our total leverage as well as our interest costs.

同樣在 2022 年，我們產生了創紀錄的 1.34 億美元年度運營現金流。我們完成了 3 項有針對性的收購，在本地領域建立了規模，並在臨時領導層的幫助下使我們的產品多樣化。 HireUp 於第四季度末關閉，為我們帶來了一支才華橫溢的團隊，他們在領導人員配置方面擁有深厚的專業知識，並且建立了牢固的關係，這是對我們強大網絡的完美補充。歡迎來到 HireUp 大家庭。 8 月，我們宣布了一項價值 1 億美元的股票回購計劃，到年底，我們回購了 140 萬股股票，約佔已發行股票的 4%。我們還在年內預付了 1 億美元的定期貸款，以降低我們的總槓桿率和利息成本。

We will continue to balance investments and our technology initiatives, strategic personnel, share repurchases and tuck-in acquisitions that further bolster and diversify our portfolio. Turning to the fourth quarter, consolidated revenue was $628 million, approximately 5% above the upper end of our guidance, while adjusted EBITDA of $57 million was at the upper end of our guidance range representing a 9.1% margin. Bill will get into more detail on the bill rates. But as expected travel bill rates declined sequentially, although at a slower pace than we previously called out. The slower decline was driven in part by steady demand throughout most of the quarter amidst the continued labor shortage.

我們將繼續平衡投資和我們的技術計劃、戰略人員、股票回購和收購，進一步加強和多樣化我們的投資組合。談到第四季度，綜合收入為 6.28 億美元，比我們的指導上限高出約 5%，而調整後的 EBITDA 為 5700 萬美元，處於我們指導範圍的上限，利潤率為 9.1%。比爾將詳細介紹賬單費率。但正如預期的那樣，旅行費用率連續下降，儘管速度比我們之前預測的要慢。下降速度放緩的部分原因是在勞動力持續短缺的情況下，本季度大部分時間需求穩定。

As expected, we began to see demand for travelers begin to come down, exiting the fourth quarter and going into the start of the new year. With COVID retreating and systems increasingly seeking to lower their contingent labor spend, we expect to see continued pressure on orders and bill rates, though both continue to be above pre-COVID levels. The persistent labor shortage remains and we cannot see anything changing the backdrop in the near-term. That said, if there is a continued softening in the market, we are prepared to act swiftly to right-size our infrastructure, while ensuring our ability to grow.

正如預期的那樣，我們開始看到對旅行者的需求開始下降，從第四季度結束並進入新年伊始。隨著 COVID 的消退和系統越來越多地尋求降低其臨時勞動力支出，我們預計訂單和賬單費率將繼續面臨壓力，儘管兩者都將繼續高於 COVID 之前的水平。持續的勞動力短缺仍然存在，我們認為短期內不會有任何改變。也就是說，如果市場持續疲軟，我們準備迅速採取行動調整我們的基礎設施規模，同時確保我們的增長能力。

Following a similar trend coming while COVID highs, our local business experienced a slight sequential decline in part due to the impact from the holidays, as well as the continued normalization of bill rates. And looking at our other lines of business, we continue to see improved traction in locums education and homecare, which all posted an increase in hours and revenue on a sequential basis. Locums, in particular, was up nearly 8% sequentially on an organic basis, which goes against the normal seasonal trend for that business. It also reinforces our belief that this space will continue to see strong demand and further supports the rationale requiring Mint and Lotus in the fourth quarter.

在 COVID 高位出現類似趨勢之後，我們的本地業務經歷了輕微的環比下降，部分原因是假期的影響以及賬單利率的持續正常化。看看我們的其他業務線，我們繼續看到 locums 教育和家庭護理的牽引力有所提高，這些業務的小時數和收入都環比增加。特別是 Locums，在有機基礎上連續增長近 8%，這與該業務的正常季節性趨勢背道而馳。這也強化了我們的信念，即這個空間將繼續看到強勁的需求，並進一步支持第四季度需要 Mint 和 Lotus 的理由。

Looking at the market today, health systems that experienced major cost pressures throughout the pandemic are assessing their unique situations and seeking alternatives on ways to lower costs and ultimately their reliance on contingent labor. So some of our existing MSPs will understandably want to explore options. Cross Country remains a trusted partner to thousands of healthcare clients. We believe that our full complement of tech-enabled offerings, coupled with our commitment to deliver the highest quality of homecare will ultimately result in the growth of our market share.

縱觀當今市場，在整個大流行期間經歷重大成本壓力的衛生系統正在評估其獨特情況，並尋求降低成本的替代方法，並最終降低對臨時工的依賴。因此，我們現有的一些 MSP 想要探索各種選擇是可以理解的。 Cross Country 仍然是成千上萬醫療保健客戶值得信賴的合作夥伴。我們相信，我們對技術支持產品的全面補充，加上我們對提供最高質量家庭護理的承諾，最終將導致我們市場份額的增長。

And though we have recently experienced a higher than normal level of client attrition, our pipeline for new opportunities has never been stronger. I believe that we have an incredible value proposition for clients and that with the investments in both people and technology, we are well-positioned to win a significant amount of new business in the coming quarters. Today, more than 50% of our revenue comes from our MSPs and as of December, roughly 15% of total spend under management has been migrated to our Intellify platform. As we continue to migrate other clients to the Intellify platform, it will save us millions of dollars annually in license fees paid to third parties.

儘管我們最近經歷了高於正常水平的客戶流失，但我們尋找新機會的渠道從未如此強大。我相信我們為客戶提供了令人難以置信的價值主張，並且通過對人員和技術的投資，我們有能力在未來幾個季度贏得大量新業務。今天，我們超過 50% 的收入來自我們的 MSP，截至 12 月，大約 15% 的管理總支出已遷移到我們的 Intellify 平台。隨著我們繼續將其他客戶遷移到 Intellify 平台，它每年將為我們節省數百萬美元的支付給第三方的許可費用。

We anticipate the majority of our MSP clients will be converted in the next 12 months depending on our success in winning new accounts since they would naturally want our Intellify to go live. Intellify also offers a significant market opportunity in the vendor-neutral space, giving us the ability to capture significant incremental client spend, as well as technology extensions for direct license by clients for their internal use to help manage their continuity and their core staff labor. Looking ahead to 2023, critical staffing shortages continues to be widespread. Specifically, nurse to patient ratios remain high and we believe to be a driver of the [late] disruptions that the industry has seen in recent months.

我們預計我們的大多數 MSP 客戶將在未來 12 個月內轉換，具體取決於我們贏得新客戶的成功，因為他們自然希望我們的 Intellify 上線。 Intellify 還在供應商中立領域提供了一個重要的市場機會，使我們能夠獲得顯著的增量客戶支出，以及客戶直接許可的技術擴展供他們內部使用，以幫助管理他們的連續性和核心員工勞動力。展望 2023 年，嚴重的人員短缺問題將繼續普遍存在。具體而言，護士與患者的比例仍然很高，我們認為這是近幾個月該行業出現的[後期]中斷的驅動因素。

Supply constraint is still the biggest challenge faced by our clients. And when we look at the 2022 McKinsey study that cited a shortage of 10% to 20% of the nurses needed to care for all patients in the system by 2025 are tracked to monthly data from the Bureau of Labor Statistics that indicates a persistent wide gap between healthcare job openings and hires, it seems that supply and demand imbalance will persist for the foreseeable future. Looking at the first quarter, we expect revenue to be between $590 million and $600 million, which remains well above the level needed for us to achieve our minimal full year revenue target in 2023. We remain optimistic that we can deliver on our commitments and generate significant shareholder value.

供應緊張仍然是我們客戶面臨的最大挑戰。當我們查看 2022 年麥肯錫研究時，該研究指出，到 2025 年，護理系統中所有患者所需的護士將短缺 10% 至 20%，而勞工統計局的月度數據顯示這一差距持續存在在醫療保健職位空缺和招聘之間，供需失衡似乎將在可預見的未來持續存在。展望第一季度，我們預計收入將在 5.9 億美元至 6 億美元之間，這仍遠高於我們在 2023 年實現最低全年收入目標所需的水平。我們仍然樂觀地認為，我們能夠兌現我們的承諾並產生顯著的股東價值。

We have a proven ability to execute across many fronts and with the rollout of Intellify, in particular, we find ourselves in a great position to build upon recent successes while also continuing to capture share. We therefore believe our full year targets announced at our Investor Day in mid-September to deliver full year 2023 revenue of at least $2.2 billion and adjusted EBITDA in excess of $200 million. In closing, 2022 was a tremendous year. And we will build on this progress by making strategic investments that we believe will best position Cross Country for long-term sustained, profitable growth across all lines of business.

我們有能力在許多方面執行，尤其是隨著 Intellify 的推出，我們發現自己處於一個很好的位置，可以在最近的成功基礎上再接再厲，同時繼續佔領市場份額。因此，我們相信我們在 9 月中旬的投資者日宣布的全年目標是實現 2023 年全年收入至少 22 億美元，調整後的 EBITDA 超過 2 億美元。最後，2022 年是非凡的一年。我們將通過進行戰略投資來鞏固這一進展，我們認為這些投資將使 Cross Country 在所有業務領域實現長期持續、盈利的增長。

I want to thank all of our professionals who make Cross Country Healthcare their employer of choice. I'd also like to thank our shareholders for believing in the company and of course our talented team who I am so proud of. I am pleased to report that for the third year in a row, we were recognized by Energage with the 2023 Top Workplaces USA award. We also recently received multiple 2023 Best of Staffing Awards for Excellence from ClearlyRated. Achievements like these are a testament to our corporate culture and focus on supporting and growing our employees from within while consistently attracting and retaining top talent.

我要感謝我們所有的專業人士，他們讓 Cross Country Healthcare 成為他們的首選雇主。我還要感謝我們的股東對公司的信任，當然還有我引以為豪的才華橫溢的團隊。我很高興地報告，我們連續第三年獲得 Energage 頒發的 2023 年美國最佳工作場所獎。我們最近還獲得了 ClearlyRated 頒發的多項 2023 年最佳員工卓越獎。這些成就證明了我們的企業文化，我們專注於從內部支持和培養我們的員工，同時不斷吸引和留住頂尖人才。

With that, let me turn the call over to Bill.

有了這個，讓我把電話轉給比爾。

Thanks, John, and good afternoon, everyone. I'm pleased to share that with the full year now complete, 2022 was the strongest year of performance in the company's history. And for the quarter, we once again met or exceeded our expectations for both revenue and adjusted EBITDA. Our strong results were fueled by solid execution across most lines of business as well as higher than expected travel bill rates. I'll dive into the rates in just a moment. Consolidated revenue for the fourth quarter was $628 million, down 1% sequentially and 2% over the prior year. As a reminder, we completed the acquisitions of 2 locum tenens businesses, as well as our most recent acquisition of an interim leadership company during the quarter.

謝謝，約翰，大家下午好。我很高興地與大家分享，2022 年是公司歷史上表現最強勁的一年。對於本季度，我們再次達到或超過了我們對收入和調整後 EBITDA 的預期。大多數業務線的穩健執行以及高於預期的差旅費率推動了我們強勁的業績。稍後我將深入探討利率。第四季度合併收入為 6.28 億美元，環比下降 1%，比去年同期下降 2%。提醒一下，我們在本季度完成了對 2 家臨時企業的收購，以及我們最近對一家臨時領導公司的收購。

Excluding the impact from those acquisitions, consolidated revenue was down approximately 4% over the prior year, and 3% sequentially. Gross profit was $139 million, which represented a gross margin of 22.1%. The sequential decline in gross margin of approximately 50 basis points was primarily driven by higher health insurance costs incurred during the year and increasing professional liability insurance rates, as well as an actuarial adjustment for workers' compensation. As expected, we did experience a slightly stronger bill pay spread with pay rates continuing to normalize within the travel business, though it was mostly offset by the relatively high cost of housing for our travelers.

排除這些收購的影響，綜合收入比上年下降約 4%，環比下降 3%。毛利為 1.39 億美元，毛利率為 22.1%。毛利率環比下降約 50 個基點，主要是由於年內產生的健康保險費用增加、職業責任保險費率增加以及工人賠償的精算調整。正如預期的那樣，我們確實經歷了略微更大的賬單支付利差，旅遊業務中的支付率繼續正常化，儘管這在很大程度上被我們旅行者相對較高的住房成本所抵消。

Moving down the income statement, total selling, general and administrative expense was $81 million, up 1% sequentially and 23% over the prior year. The majority of the increase in SG&A over the prior year was driven by continued investments in people and higher compensation on the strong performance in 2022, as well as investments in our technology initiatives that are not capitalized. On a sequential basis, the increase was primarily attributable to the impact from our recent acquisitions. As a percent of revenue, SG&A was 12.9%, representing an increase of more than 250 basis points over the prior year, given the decline in bill rates, as well as the increased investments necessary to support the volume growth in our business.

在損益表中，總銷售、一般和管理費用為 8100 萬美元，環比增長 1%，比上年增長 23%。與上一年相比，SG&A 的大部分增長是由於對人員的持續投資和對 2022 年強勁業績的更高薪酬，以及對我們未資本化的技術計劃的投資。按順序計算，增長主要歸因於我們最近收購的影響。由於票據利率下降以及支持我們業務量增長所需的投資增加，SG&A 佔收入的百分比為 12.9%，比上一年增加了 250 多個基點。

Throughout 2022, we continue to invest in people, adding revenue-producing resources across all of our lines of business, but with the majority focused on meeting demand in our travel business. And though demand for travelers has certainly softened coming into the new year, we still see continued growth in other parts of the business such as education, homecare, and locum tenens that will likely support further investments in those areas. That said, we managed our business very tightly through capacity metrics and we're prepared to adjust course in the event that demand does continue to soften. Though the broader supply and demand imbalance remained, we obviously can't predict whether travel demand will rebound or soften further. But we're well-positioned to manage our costs over the near term to protect our level of profitability.

在整個 2022 年，我們將繼續投資於人才，在我們所有的業務線中增加創收資源，但其中大部分將專注於滿足我們旅遊業務的需求。儘管進入新的一年對旅行者的需求肯定有所減弱，但我們仍看到其他業務領域的持續增長，例如教育、家庭護理和臨時住所，這可能會支持在這些領域的進一步投資。也就是說，我們通過容量指標非常嚴格地管理我們的業務，並且我們準備在需求持續疲軟的情況下調整路線。儘管更廣泛的供需失衡仍然存在，但我們顯然無法預測旅遊需求是否會進一步反彈或走軟。但我們有能力在短期內管理我們的成本，以保護我們的盈利水平。

In addition to the investments in people, we're also investing heavily in our technology with additional resources and developers to facilitate the rapid deployment of candidate and client-facing technology like Gateway and Intellify. In 2022, we spent an estimated $16 million on IT projects, an increase of more than 30% over the prior year. Of that investment, roughly 30% was recognized as expense during the year given the nature of some of the projects. And our solid top line performance fueled another quarter of strong earnings with adjusted EBITDA up $57 million, representing a margin of 9%, consistent with our goal to maintain margins in the high single to low double digit range. Interest expense was $3.5 million, which was up 25% over the prior year, driven entirely by rising interest rates on outstanding debt.

除了對人員的投資外，我們還通過額外的資源和開發人員對我們的技術進行了大量投資，以促進快速部署候选和面向客戶的技術，如 Gateway 和 Intellify。 2022 年，我們在 IT 項目上的支出估計為 1600 萬美元，比上一年增長 30% 以上。鑑於某些項目的性質，在該投資中，大約 30% 在當年被確認為費用。我們穩健的收入表現推動了另一個季度的強勁收益，調整後的 EBITDA 增加了 5700 萬美元，利潤率為 9%，這與我們將利潤率保持在高個位數到低兩位數範圍內的目標一致。利息支出為 350 萬美元，比上年增長 25%，這完全是由於未償債務利率上升所致。

Our effective interest rate for the quarter was 8.8%, which would have been higher had we not opted to make the $50 million prepayment on our subordinated term loan at the start of the fourth quarter, bringing the full year optional prepayments to $100 million. I'll go into more detail on cash flows and our capital allocations in just a moment. And finally on the income statement, income tax expense was $7.6 million, representing an effective tax rate of 16.3%, bringing the full year effective tax rate to 26.5%. The decline in tax expense was driven by the finalization of the full year tax provision, as well as the release of an uncertain tax position pertaining to the deductibility of certain items.

我們本季度的實際利率為 8.8%，如果我們沒有選擇在第四季度初預付 5000 萬美元的次級定期貸款，那麼全年的可選預付款將達到 1 億美元。稍後我將詳細介紹現金流量和我們的資本配置。最後在損益表上，所得稅費用為 760 萬美元，有效稅率為 16.3%，全年有效稅率為 26.5%。稅收支出的下降是由於全年稅收撥備的最終確定，以及與某些項目的可扣除性有關的不確定稅收狀況的解除。

The combination of our strong performance and favorable tax adjustments resulted in an adjusted earnings per share of $1.09, up slightly over the third quarter and well above the upper end of our guidance range. Turning to the segments. Nurse and Allied reported revenue of $591 million, representing a decline of 5% over the prior year and 3% sequentially. Our largest business travel nurse and allied was down 5%, both sequentially and over the prior year. The sequential decline was primarily driven by a 3% drop in average bill rates and 2% from volume. As John mentioned a moment ago, bill rates were expected to decline in the mid single -- mid to high-single digit range. But as demand remains strong throughout most of the quarter, we experienced slightly higher bill rates on assignments, as well as a favorable mix.

我們強勁的業績和有利的稅收調整相結合，導致調整後的每股收益為 1.09 美元，比第三季度略有上升，遠高於我們指導範圍的上限。轉向細分市場。 Nurse and Allied 報告的收入為 5.91 億美元，比上年下降 5%，比上一季度下降 3%。我們最大的商務旅行護士和聯盟下降了 5%，無論是環比還是比上一年。環比下降主要是由於平均賬單費率下降 3% 和交易量下降 2%。正如約翰剛才提到的那樣，預計票據利率將下降到中個位數 - 中高個位數範圍。但由於在本季度的大部分時間裡需求依然強勁，我們的任務賬單費率略高，並且組合有利。

With respect to the comparison to the prior year, the decline was entirely due to lower average bill rates as volumes were up more than 15%. As we previously called out, we have long expected travel bill rates to decline, but with continued [high needs] by clients and persistent labor shortage, rates declined more slowly than we had expected. Now, as clients are starting to right size their contingent labor more effectively, we're seeing demand for travel physicians decline and as a result, so the bill rates. We are seeing new orders fill at a rate that is roughly 5% to 7% below the rates we experienced in the fourth quarter. If rates stabilize at these levels, the impact will mostly be seen in the second quarter with a more modest impact in the first quarter given the length of assignment.

與上一年相比，下降完全是由於平均賬單費率下降，因為交易量增長了 15% 以上。正如我們之前所說，我們長期以來一直預計差旅費率會下降，但由於客戶的持續 [高需求] 和持續的勞動力短缺，費率下降的速度比我們預期的要慢。現在，隨著客戶開始更有效地調整他們的臨時勞動力規模，我們看到對旅行醫生的需求下降，結果是賬單率下降。我們看到新訂單的填寫速度比我們在第四季度經歷的速度低大約 5% 到 7%。如果利率穩定在這些水平，其影響將主要出現在第二季度，考慮到任務期限，第一季度的影響將更為溫和。

As we've said previously, the decline in bill rates was and is expected. And though we don't have a perfect lens on where they will settle, we believe rates could decline another 5% to 10%, implying they would be roughly 40% higher than pre-pandemic rates. Our local business was in line with our expectations with revenue down roughly 4% sequentially, primarily due to the impact from holidays. Average bill rates were up 3% sequentially, principally on the mix of the business. And our other lines of business, the nurse and allied all reported strong results for the quarter with double-digit growth. Education and search both grew by more than 30% and our homecare business rose 11% over the prior year. We continue to expect these businesses will experience robust growth based on the market and the needs of our clients.

正如我們之前所說，票據利率的下降是意料之中的。儘管我們對他們的定居點沒有完美的了解，但我們認為利率可能會再下降 5% 到 10%，這意味著它們將比大流行前的利率高出大約 40%。我們的本地業務符合我們的預期，收入環比下降約 4%，這主要是由於假期的影響。平均賬單利率連續上升 3%，主要是由於業務組合。我們的其他業務、護士和相關業務都報告了本季度的強勁業績，實現了兩位數的增長。教育和搜索業務均增長了 30% 以上，我們的家庭護理業務比上一年增長了 11%。我們繼續期望這些業務將根據市場和客戶的需求實現強勁增長。

Finally, Physician Staffing delivered another strong quarter with $37 million in revenue, representing an 84% increase over the prior year and 56% sequentially. Excluding the impact from the recent acquisitions, Physician Staffing grew by 28% on an organic basis with billable days up 9% and revenue per day filled up nearly 18%. The increase in rates was extremely broad-based across virtually every specialty. With the continued growth we've experienced in this business, we anticipate further investments in capacity, as well as targeting tuck-ins that can further grow our presence in the market.

最後，Physician Staffing 又一個強勁的季度實現了 3700 萬美元的收入，比上年增長 84%，環比增長 56%。排除近期收購的影響，醫師人員配置有機增長 28%，計費天數增長 9%，每日收入增長近 18%。幾乎所有專業的費率增長都非常廣泛。隨著我們在這項業務中經歷的持續增長，我們預計會進一步投資產能，並瞄準可以進一步擴大我們在市場上的影響力的投資。

Turning to the balance sheet, we ended the quarter with $4 million in cash and $151 million in outstanding debt, including $74 million on the subordinated term loan and $77 million in borrowings under our ABL facility. Currently the sub-debt is based on LIBOR but we anticipate it will be converted to SOFR in the first half of the year. It is also worth noting that given the strong performance and positive cash flow as of the end of the fourth quarter, we have incredibly low level of leverage with a total leverage ratio of less than 0.5x. We remain well-positioned to make further investments as well as repurchase more of our stock since we believe the company continues to be undervalued.

談到資產負債表，我們在本季度末擁有 400 萬美元現金和 1.51 億美元未償債務，其中包括 7400 萬美元次級定期貸款和 7700 萬美元 ABL 貸款下的借款。目前，次級債務基於 LIBOR，但我們預計它將在今年上半年轉換為 SOFR。還值得注意的是，鑑於截至第四季度末的強勁業績和正現金流，我們的槓桿水平非常低，總槓桿率低於 0.5 倍。我們仍然處於有利地位，可以進行進一步投資以及回購更多股票，因為我們認為該公司繼續被低估。

From a cash flow perspective, we generated $4 million in cash from operations during the quarter bringing the full year to $134 million as compared with the use of cash of $85 million in the prior year, representing a swing of more than $200 million. Our days sales outstanding increased to 72 days due primarily to slower collections from several large clients. We continue to expect receivables net of reserves to be fully collectible and believe DSO will return to more normal levels as we progress through 2023. So that may take a couple of quarters to achieve. Also in the fourth quarter, we prepaid an additional $50 million on the term loan bringing the cumulative prepayment for the year to $100 million, or roughly 60% of the principal balance for that instrument.

從現金流的角度來看，本季度我們從運營中產生了 400 萬美元的現金，使全年的現金使用量達到 1.34 億美元，而去年同期為 8500 萬美元，波動幅度超過 2 億美元。我們的未償銷售天數增加到 72 天，這主要是由於幾家大客戶的收款速度較慢。我們繼續預計扣除準備金後的應收賬款將完全收回，並相信隨著我們到 2023 年的進展，DSO 將恢復到更正常的水平。因此這可能需要幾個季度才能實現。同樣在第四季度，我們額外預付了 5000 萬美元的定期貸款，使全年累計預付金額達到 1 億美元，約佔該工具本金餘額的 60%。

And we repurchased another 350,000 shares for a total cost of $11 million, bringing our cumulative share repurchases in 2022 to 1.4 million shares at a total cost of $35 million. Looking ahead, we expect to continue to generate a significant amount of cash and we'll continue to see growth investments such as tuck-in acquisitions across our higher margin businesses. During the fourth quarter, we established a 10b5-1 trading plan to continue making share repurchases during the blackout trading windows, depending on certain conditions. And since January 1, we repurchased an additional 200,000 shares at an aggregate cost of roughly $5 million.

我們以 1100 萬美元的總成本回購了另外 350,000 股股票，使我們在 2022 年的累計股票回購達到 140 萬股，總成本為 3500 萬美元。展望未來，我們預計將繼續產生大量現金，我們將繼續看到增長投資，例如對我們利潤率較高的業務進行收購。在第四季度，我們制定了 10b5-1 交易計劃，以根據特定條件在停電交易窗口期間繼續進行股票回購。自 1 月 1 日起，我們又回購了 200,000 股股票，總成本約為 500 萬美元。

We expect to continue to be opportunistic with future share repurchases outside of the 10b5-1 trading plan, depending on factors such as available cash, the share price and alternative uses for that cash, such as debt repayments or acquisitions.

我們預計未來將繼續在 10b5-1 交易計劃之外進行股票回購，這取決於可用現金、股價和該現金的其他用途（如債務償還或收購）等因素。

And this brings me to our outlook for the first quarter. We're guiding to the first quarter revenue to be between $590 million and $600 million, representing a sequential decline of 4% to 6%, driven predominantly by the anticipated decline in travel bill rates, partly offset by growth in education and the impact from recent acquisitions. We are expecting adjusted EBITDA to be between $44 million and $49 million, representing an adjusted EBITDA margin of approximately 8%. The sequential decline in adjusted EBITDA margin is primarily due to the impact of lower gross profit on the sequential decline in revenue as well as the impact of the annual payroll tax reset in most of our businesses.

這讓我想到了我們對第一季度的展望。我們預計第一季度收入在 5.9 億美元至 6 億美元之間，環比下降 4% 至 6%，這主要是由於旅行費用率的預期下降，部分被教育的增長和最近的收購。我們預計調整後的 EBITDA 將在 4400 萬美元至 4900 萬美元之間，調整後的 EBITDA 利潤率約為 8%。調整後的 EBITDA 利潤率環比下降主要是由於毛利下降對收入環比下降的影響，以及我們大部分業務年度工資稅重置的影響。

Adjusted earnings per share is expected to be between $0.70 and $0.80 based on an average share count of 36.5 million shares. Also assumed in this guidance is a gross margin of between 21.5% and 22%, interest expense of $3.2 million, depreciation and amortization of $3.4 million, stock-based compensation of $2 million and an effective tax rate of 29%. And before we open the line for questions, I'd just like to congratulate John on being named to Staffing Industry Analysts' Top 100 Most Influential Leaders, a recognition I feel certainly well-deserved. Congrats, John. And that concludes our prepared remarks. And we would now like to open the lines for questions. Operator?

根據 3650 萬股的平均股數計算，調整後的每股收益預計在 0.70 美元至 0.80 美元之間。本指南還假設毛利率在 21.5% 至 22% 之間，利息費用為 320 萬美元，折舊和攤銷費用為 340 萬美元，基於股票的薪酬為 200 萬美元，有效稅率為 29%。在我們打開提問熱線之前，我想祝賀 John 被 Staffing Industry Analysts 評為最具影響力的 100 位領導者，我覺得這一認可當之無愧。恭喜，約翰。我們準備好的發言到此結束。我們現在想打開問題熱線。操作員？

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

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

I guess my question, just on orders and bill rates kind of like normalizing here. And in your prepared remarks, you talked about how you can right-size the infrastructure, if needed. So maybe just some thoughts on, number one, your bill rate kind of like cadence expectation for the remainder of the year. And then, second, what those levers would be that you can pull to offset that because obviously, you're maintaining guidance here for the year.

我想我的問題是，訂單和賬單費率有點像在這裡正常化。在您準備好的發言中，您談到瞭如何在需要時調整基礎架構的規模。所以也許只是一些想法，第一，你的賬單利率有點像今年剩餘時間的節奏預期。然後，第二，你可以拉動哪些槓桿來抵消這一點，因為很明顯，你將在這里維持今年的指導。

Sure, Brian. This is John. I'll talk a little bit about the levers we can pull and then I'll hand it over to Bill to talk more about the bill rates. But what we utilized, we use a pretty sophisticated capacity modeling. I think we've spoken about before where we look at each part of the business and what we can do is we can look up or down of -- when we use capacity model, we actually use it as we're growing to see the number of resources that we need to continue on the path to grow. We look at where our future business is and how we're growing the business and where we anticipate and model out to grow the business.

當然，布賴恩。這是約翰。我會稍微談談我們可以拉動的槓桿，然後我會把它交給比爾來更多地討論賬單利率。但是我們使用的是非常複雜的容量建模。我想我們之前已經談過我們在哪裡看待業務的每個部分，我們可以做的是我們可以向上或向下看——當我們使用容量模型時，我們實際上是在使用它，因為我們正在成長以看到我們需要繼續發展的資源數量。我們著眼於我們未來的業務在哪里以及我們如何發展業務以及我們預期和建模以發展業務的地方。

And also, conversely, when we see the business that is slowing down, we'll pull those same levers to take away the resources that we don't longer need to continue to have that growth. And so really, it's just based on a lot of capacity model and factors of the number of open positions we have based upon the number of velocity that we're seeing of placements happening. And of course, it's all tied to the end of the day to revenue and EBITDA.

而且，相反，當我們看到業務正在放緩時，我們將拉動同樣的槓桿來帶走我們不再需要繼續增長的資源。因此，實際上，它只是基於許多容量模型和我們所擁有的未平倉頭寸數量的因素，這些因素基於我們看到的安置發生的速度數量。當然，這一切都與一天結束時的收入和 EBITDA 息息相關。

Yes. And Brian, I'll just -- I'll just -- I'll throw in on the cost levers as well. Just ordinarily, as you would expect, as the business scales up and down, there are certain items that you're going to see rise and fall, whether that's variable compensation or even some other marketing spend that may be going along lead generation activity. So there's natural levers or hedges as the market -- as the business moves up or down, that will just happen naturally. But to John's point, on the cost side of things, obviously, we are constantly looking across the organization to rebalance those investments we've made and make sure we're getting the best return we can.

是的。布賴恩，我只是 - 我只是 - 我也會投入成本槓桿。正如您所期望的那樣，通常情況下，隨著業務規模的擴大和縮小，您會看到某些項目的漲跌，無論是可變薪酬，還是可能伴隨潛在客戶生成活動進行的其他一些營銷支出。因此，市場存在自然的槓桿或對沖——隨著業務的上升或下降，這將自然發生。但就 John 的觀點而言，在成本方面，很明顯，我們一直在整個組織中尋找重新平衡我們所做的投資，並確保我們獲得最好的回報。

With respect to bill rates, look, no perfect lenses here, right? But the market with the demand as we've seen it starting to pull back coming into the first quarter, bill rates are down, certainly on open orders is what I look at as a leading indicator relative -- and that's where I kind of made the comment in the prepared remarks that on the open orders, we're seeing bill rates starting to soften in that 5% to 10% neighborhood. But it's not -- that hasn't fully baked its way through our business yet. So you look out and you say, okay. So for the first quarter, rates will be down kind of consistent with what we saw in the fourth quarter, modest low to mid-single digits. The impact will more likely be seen in the second quarter.

關於賬單率，看，這裡沒有完美的鏡頭，對吧？但正如我們所看到的那樣，市場需求在第一季度開始回落，票據利率下降，當然，在未結訂單上，我認為這是一個相對領先的指標——這就是我所做的準備好的評論中的評論是，在未結訂單上，我們看到賬單利率在 5% 到 10% 的範圍內開始走軟。但事實並非如此——這還沒有完全貫穿我們的業務。所以你往外看，然後說，好吧。因此，對於第一季度，利率將下降，與我們在第四季度看到的情況一致，適度低至中個位數。這種影響更有可能在第二季度顯現出來。

And then after that is where it gets a little bit fuzzy as to how -- where the rates trend after that. We did say that rates could fall a little bit further. But I think at some point, the market will obviously, I think, correct itself from a demand perspective because we've seen this play out a couple of times where demand has ebbed and flowed and we've seen it where it kind of comes down a little sharply, a little quickly, and then it starts to rebound. So we're just looking out in the back half. But I would just leave you with -- we look at the full year, we reiterated the full year minimum guidance and that $2.2 billion number that we've thrown out there, we're well on pace for that, certainly, coming through the first quarter. And so I think if you look at that relative to our other comments about rates, you can kind of see where the back half might come out.

然後在那之後它變得有點模糊 - 在那之後利率趨勢如何。我們確實說過利率可能會進一步下降一點。但我認為在某個時候，我認為市場顯然會從需求的角度進行自我糾正，因為我們已經看到這種情況發生了幾次，需求起伏不定，我們也看到了它的到來急劇下降，快速下降，然後開始反彈。所以我們只關注後半部分。但我想留給你——我們看看全年，我們重申了全年的最低指導和我們已經投入的 22 億美元的數字，我們正在朝著這個目標邁進，當然，通過第一季度。因此，我認為，如果您將其與我們關於利率的其他評論相比較，您就會看到後半部分可能會出現在哪裡。

No, I appreciate those comments, Bill. And then I guess as I think about your comment on margins for Q1, right, so I get the payroll tax and just the lower volume -- lower bill rate, but how should we be thinking about margin trend post Q1? And then maybe factoring in as well the business mix with locums becoming a bigger portion of your business with the last 2 acquisitions.

不，我很欣賞這些評論，比爾。然後我想當我想到你對第一季度利潤率的評論時，對，所以我得到了工資稅和較低的數量——較低的賬單利率，但我們應該如何考慮第一季度後的利潤率趨勢？然後可能還會考慮業務組合，在最近的兩次收購中，locums 成為您業務的更大一部分。

Yes, I'll start and then I don't know if John or Marc or Dan want to jump in. But when you look at the margin for the first quarter, payroll tax for us hits us in the gross margin line, usually about 40 to 50 basis points. And just given the size and scale of our SG&A, the impact to SG&A is about $1 million as well from additional payroll taxes that we'll see in the first quarter. So that's a pretty sizable bite when you look at our overall seasonality and the impact of the first quarter. I think your question really is about the gross margin of the business. And obviously, I called out in travel what we're seeing. The pay-bill spreads are normalizing. As the bill rates come down, the payroll has been coming down. The piece that hasn't moved as fast as the pay rates has really been the housing cost.

是的，我會開始，然後我不知道約翰、馬克或丹是否想加入。但是當你看第一季度的利潤率時，我們的工資稅會影響我們的毛利率，通常約為40 到 50 個基點。考慮到我們 SG&A 的規模和規模，我們將在第一季度看到的額外工資稅對 SG&A 的影響約為 100 萬美元。因此，當您查看我們的整體季節性和第一季度的影響時，這是相當大的一口。我認為您的問題實際上是關於業務的毛利率。顯然，我在旅行中大聲疾呼我們所看到的。工資單利差正在正常化。隨著票據利率下降，工資單一直在下降。沒有像工資率那樣快速移動的部分實際上是住房成本。

So that element that we have, the travelers on assignment, has been kind of stubbornly high. So that's kind of eating into that pay-bill improvement. Coupled with that with a couple of other items that we called out, professional liability insurance rates are rising, we've -- that's now factored in after the fourth quarter and you'll see that roll into -- there shouldn't be an incremental increase in the first quarter off of that. Health insurance for us was sort of a year-end anomaly. We saw a spike in the number of clinicians. We are self-insured, so spike in the number of clinicians using healthcare. So that was a bit of a rise. That should return to normal as we go into the first quarter.

因此，我們所擁有的因素，即執行任務的旅行者，一直居高不下。所以這有點影響了支付賬單的改善。再加上我們提到的其他幾個項目，專業責任保險費率正在上升，我們已經——現在已經在第四季度之後考慮到了這一點，你會看到——不應該有第一季度的增量增加。對我們來說，健康保險有點像年底的異常情況。我們看到臨床醫生的數量激增。我們是自我保險的，因此使用醫療保健的臨床醫生數量激增。所以這有點上升。當我們進入第一季度時，這應該會恢復正常。

Yes, this is John. I'd add that when we look at the business and our gross margin, we really look at it from a portfolio basis, as you were saying, Brian, with -- looking at locums. And from the Nurse and Allied travel standpoint, on the transactional, the day-to-day deals that we're doing, we're not anticipating to see a large uptick in gross margin there. There's some, obviously, room for improvement over the next several quarters in this year that will pick up. But really, when we look at how we're going to improve our overall gross margins in the portfolio, it's going to be by growing the higher-margin businesses such as locums, such as our education business, our HireUp, which is our new interim executive business and also our Workforce Solutions Group, which is our home health business.

是的，這是約翰。我要補充一點，當我們審視業務和毛利率時，我們真的是從投資組合的角度來看待它，就像你說的那樣，布賴恩，著眼於 locums。從 Nurse and Allied 旅行的角度來看，在我們正在進行的交易和日常交易中，我們預計毛利率不會大幅上升。顯然，今年接下來的幾個季度會有一些改進的空間。但實際上，當我們考慮如何提高投資組合的整體毛利率時，將通過發展利潤率較高的業務，如 locums，例如我們的教育業務、我們的 HireUp，這是我們的新業務臨時執行業務以及我們的 Workforce Solutions Group，這是我們的家庭健康業務。

Those are all higher margin profile businesses that help us overall grow. And then the other part, which is really key to seeing our portfolio gross margins increase is as we enter into the vendor-neutral space with Intellify, that's where we're looking at gross margins. Those are the gross margins that are at 90% gross margins with EBITDA margins between 60% and 80%. And so in the future, what we'll see is we'll see the balance of our business as it grows in the other non-nurse travel, nurse and allied businesses help improve the overall portfolio margins.

這些都是利潤率較高的業務，可以幫助我們實現整體增長。然後另一部分，這是看到我們的投資組合毛利率增加的真正關鍵是，當我們通過 Intellify 進入供應商中立的空間時，這就是我們關注毛利率的地方。這些是毛利率為 90% 的毛利率，EBITDA 利潤率在 60% 到 80% 之間。因此，在未來，我們將看到我們的業務平衡，因為它在其他非護士旅行、護士和相關業務中的增長有助於提高整體投資組合的利潤率。

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。

Maybe a couple of questions, if I could. I think it sounds like what you're suggesting when you lay out the quarters from '23 relates mostly to sort of the post-pandemic continued moderation in (inaudible) bill rates. Can you just remind us, do you think normal seasonality will come back as you lay out the quarters? And how would you lay out? It's been a while since we've had a normal seasonal year, how would you lay out the quarters generally from a seasonal perspective in a normal year?

如果可以的話，也許有幾個問題。我認為這聽起來像是你在佈置 23 年的季度時所建議的，主要與大流行後（聽不清）賬單利率的持續放緩有關。你能不能提醒我們，你認為正常的季節性會在你佈置季度時回來嗎？你會如何佈局？自從我們有一個正常的季節性年份以來已經有一段時間了，在正常年份中，您如何從季節性的角度大致佈置季度？

A.J., this is John, and then I'm going to hand it over to Bill on this one. But I think it's too early to say if seasonality is back yet. And so right now, yes, we are seeing from the triple threat that we saw in the fourth quarter that came in the fall of RSV, COVID and the flu. We're obviously seeing some of that wane now as we're getting out. So you could say -- you can indicate that maybe it's starting to get more seasonal. But if we recall for the last 2 seasons, we've also seen the COVID summer happen. And so I don't think we're ready to say that we're getting into a normal cyclical traditional travel nurse seasonal business.

A.J.，我是約翰，然後我將把這個交給比爾。但我認為現在說季節性是否回歸還為時過早。所以現在，是的，我們從第四季度看到的三重威脅中看到了 RSV、COVID 和流感的秋季。隨著我們的退出，我們顯然看到其中一些正在減弱。所以你可以說 - 你可以表明它可能開始變得更具季節性。但如果我們回顧過去的兩個賽季，我們也會看到 COVID 夏季的發生。因此，我認為我們還沒有準備好說我們正在進入一個正常的周期性傳統旅行護士季節性業務。

But Bill, do you want to add that?

但是比爾，你想補充一下嗎？

yes. I'd just throw out -- when you look across the rest of our business, A.J., locum tenens generally, again, this is historical, right, normally has its strongest quarter in the third quarter. And so you would anticipate to see a sequential change in that business. It usually steps back in the fourth quarter. That did not happen and we actually surged that 8% we called out and that is on an organic basis. So I think locum tenens has a lot of runway for us right now to continue to see sequential growth quarter-over-quarter despite the seasonal trends that we would normally experience. What I'll just say is, I think, if we look at Q2 and again we're not guiding here, but if I was going to look at Q2, I'd say that the bill rate headwinds coming out of the travel business probably points to a sequential decline over the first quarter.

是的。我只想說——當你審視我們的其他業務時，A.J.，一般情況下，這是歷史性的，對，通常在第三季度是最強勁的季度。因此，您會期望看到該業務的連續變化。它通常在第四季度退步。那沒有發生，我們實際上激增了我們呼籲的 8%，這是在有機的基礎上。因此，我認為 locum tenens 現在有很多跑道讓我們繼續看到季度環比增長，儘管我們通常會遇到季節性趨勢。我只想說的是，我認為，如果我們看一下第二季度，我們不會在這裡提供指導，但如果我要看第二季度，我會說來自旅遊業務的票據利率逆風可能表明第一季度環比下降。

And you couple that with the fact that in the education business, you get the start of the summer break, plus the spring break this year falls into the second quarter as well. So just those 2 factors alone would point to a sequential step down to the second quarter. But then I think the seasonality of locums plays into the third quarter and, of course, when schools resume in the fourth quarter. So it's hard to say, but much will be depending on what really happens in the travel business.

再加上在教育行業，暑假開始了，今年的春假也落在了第二季度。因此，僅這兩個因素就會指向第二季度的連續下降。但我認為 locums 的季節性會影響到第三季度，當然，當學校在第四季度恢復時。所以很難說，但很大程度上取決於旅遊行業的實際情況。

Okay. That's great. Thanks for the commentary about the MSPs and 50% of your revenues coming from that. I know in the pandemic, there was difficulty filling orders and a lot of orders got subcontracted, maybe even some MSPs got open to third parties coming in on the margin. Can you comment on where you're at today as your fill rate as things are normalizing, stepped up meaningfully or a lot of the percent of orders going completely unfilled? Has that come down a lot? How would you describe it?

好的。那太棒了。感謝您對 MSP 的評論以及您 50% 的收入來自於此。我知道在大流行期間，很難完成訂單，很多訂單被分包，甚至一些 MSP 也向第三方開放，以賺取利潤。您能否評論一下您今天的處境，因為事情正在正常化，有意義地加強或很多訂單完全未完成的百分比？那下降了很多嗎？你會怎麼描述它？

Yes, that's come down a lot. We're in the high 90% of fill rate. And as we -- we're still at a capture rate of around 70%. And so we're filling the needs that the clients have right now.

是的，下降了很多。我們的填充率高達 90%。正如我們——我們的捕獲率仍然在 70% 左右。所以我們正在滿足客戶現在的需求。

Yes. We didn't -- A.J., this is Bill. We didn't call it out in the prepared remarks, but the capture rate declined about 1%. So we were a little over 70% in the third quarter. We were at 69% in the fourth quarter, so holding steady. And it's kind of moved -- bounced in that 69% to 70% range.

是的。我們沒有——A.J.，這是比爾。我們沒有在準備好的評論中指出這一點，但捕獲率下降了約 1%。所以我們在第三季度略高於 70%。我們在第四季度為 69%，因此保持穩定。它有點移動——在 69% 到 70% 的範圍內反彈。

Yes. And I'd just add on that, A.J. One of the things -- reasons why we keep that the capture rate at that 69% or 70% is because we want to have the excess supply and capacity because what we do is this is a market where we're seeing a lot -- that we called out, we had a higher-than-normal attrition of our clients. And typically, we have 1 or 2 clients leaving a year and we had higher than that. But the whole industry as a whole is having that issue. And part of that reason is because usually a typical VMS or MSP contract is 3 years. And during COVID, people and hospitals deferred going out to bid for that COVID period. And so now we're seeing a lot of contracts all coming up, the extended contracts. So all the contracts are coming up. And so -- in some hospitals -- actually, quite a few hospitals, they were actually required to go out to bid.

是的。我還要補充一點，A.J.其中一件事 - 我們將捕獲率保持在 69% 或 70% 的原因是因為我們希望擁有過剩的供應和產能，因為我們所做的是這是一個我們看到很多的市場 -我們呼籲，我們的客戶流失率高於正常水平。通常，我們每年有 1 或 2 個客戶離開，而且我們的客戶數量要多於此。但整個行業都存在這個問題。部分原因是因為通常典型的 VMS 或 MSP 合同是 3 年。在 COVID 期間，人們和醫院推遲外出競標該 COVID 時期。所以現在我們看到很多合同即將簽訂，延長合同。所以所有的合同都來了。所以——在一些醫院——實際上，相當多的醫院，他們實際上被要求出去投標。

So right now, we're seeing more hospitals going out to bid and that creates a larger opportunity for us to win new deals. Now at Cross Country, we're probably -- at the larger companies, we're on the smaller side of the MSP standard of management. So we're losing some clients, we have more opportunity to win. And as we called out in our prepared remarks, we've never had a larger pipeline in MSP in Cross Country's history. And so when we have this excess supply, what we do with this is we take this excess supply and have additions at clients to go and show that we can fill better than their incumbents and win the business over. So that's why it's really important for us to keep that capture rate at 70% or even lower. So we have that supply to win more deals.

所以現在，我們看到越來越多的醫院出去競標，這為我們贏得新交易創造了更大的機會。現在在 Cross Country，我們可能 - 在較大的公司，我們處於 MSP 管理標準的較小一側。所以我們正在失去一些客戶，我們有更多的機會贏得勝利。正如我們在準備好的評論中所說的那樣，在 Cross Country 的歷史上，我們從未有過更大的 MSP 管道。因此，當我們有這種過剩供應時，我們所做的就是利用這種過剩供應並增加客戶數量，以表明我們可以比他們的現任者更好地填補並贏得業務。所以這就是為什麼將捕獲率保持在 70% 甚至更低對我們來說非常重要。所以我們有足夠的供應來贏得更多交易。

Okay. That's interesting. Maybe just a final question on your prepared comments, you talked about being prepared to, if necessary, make adjustments to infrastructure. I guess, a, that begs the question, what would -- I mean, I assume you're sort of tweaking things on an ongoing basis, but what would prompt you to make a bigger adjustment? And then what types of things are you talking about doing if you had to?

好的。那很有意思。也許只是關於您準備好的評論的最後一個問題，您談到準備在必要時對基礎設施進行調整。我想，a，這引出了一個問題，我的意思是，我假設你在不斷地調整事情，但是什麼會促使你做出更大的調整？如果必須的話，你會說做哪些類型的事情？

Yes. A.J., this is Bill again. So I've mentioned some of the things that will happen organically. I'll say it that way. But I think it's really just about when you look across the entire landscape of all the resources we have and all the different roles that we have, every single role, whether you're looking at from a recruitment function, the supporting functions, the onboarding, everything, all of our functions, we've got capacity metrics that help us understand exactly how many resources we need.

是的。 A.J.，我又是比爾。所以我已經提到了一些將自然發生的事情。我會這樣說。但我認為這真的只是當你審視我們擁有的所有資源和我們擁有的所有不同角色的整個景觀時，每一個角色，無論你是從招聘職能、支持職能、入職，我們所有的功能，我們都有容量指標，可以幫助我們準確了解我們需要多少資源。

So yes, we don't want to overreact. I think the important thing here is demand, we know will ebb and flow and we've seen this a couple of times over the -- throughout the pandemic. Nothing's fixed the long-term issues in the marketplace. So we don't want to overreact and start reducing costs too fast because, again, we want to have that organic capacity to grow. And so I think it's really just one about rightsizing your cost structure across your headcount as well as some of those other third-party expenses that you have.

所以是的，我們不想反應過度。我認為這裡重要的是需求，我們知道需求會起伏不定，而且在整個大流行期間我們已經多次看到這種情況。沒有什麼能解決市場上的長期問題。因此，我們不想反應過度並開始過快地降低成本，因為我們再次希望擁有這種有機增長能力。因此，我認為這實際上只是關於在您的員工人數以及您擁有的其他一些第三方費用中合理調整您的成本結構。

Yes. And this is John. I would just add that as we've said consistently for the last 9 months or a year that we're going to maintain a high single-digit to low double-digit EBITDA and that's really what drives where we're looking into resource planning.

是的。這是約翰。我只想補充一點，正如我們在過去 9 個月或一年中一直所說的那樣，我們將保持高個位數到低兩位數的 EBITDA，這才是我們正在研究資源規劃的真正動力.

And one last comment, A.J., before I turn it back to you if you have another question. Just if you think about it, there's a natural level of attrition in any business. And so the capacity metrics allow us to also think -- be thoughtful about when to backfill and not to backfill. So attrition through those avenues will be another way in which we'll see costs self-correct themselves naturally without us taking action, but we won't backfill if we've got the -- if we don't have the need for those roles.

最後一點，A.J.，如果你有其他問題，我會先回复你。仔細想想，任何企業都會自然而然地出現人員流失。因此，容量指標讓我們也可以思考 - 考慮何時回填和不回填。因此，通過這些途徑進行的減員將是另一種方式，我們將看到成本在我們不採取行動的情況下自然地自我糾正，但如果我們有 - 如果我們不需要這些，我們就不會回填角色。

Okay, great.

好的，太好了。

Our next question comes from Kevin Fischbeck with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

This is [Noemi Gutierrez] on for Kevin. Can you give us an update on the deal pipeline? What areas are you focusing on? And how are you thinking about multiples?

這是凱文的 [Noemi Gutierrez]。你能給我們介紹一下交易渠道的最新情況嗎？你關注哪些領域？您如何看待倍數？

Sure. This is John. I'll start with that. So yes, we look at the continuing healthcare and what is on the continuing healthcare for our deal. So we look at any type of organizations and businesses that are in the pre-acute to acute to post-acute care. And with our recent acquisitions, the last couple of years of the home health space and the pace centers, the pay centers are still very attractive to us. And we had the 2 locums acquisitions in the fourth quarter and we believe that locums is continuing to be a great place to be in as well as any -- some ancillary businesses that could help service our clients just like the acquisition of HireUp. So really, our strategy comes down to -- really to 2 different points. One is, can we add -- expand our share of the market by acquiring a company in a certain space, number one. And then number two, can we add additional services to enhance our service to our clients to become and create more services, become more sticky with our clients.

當然。這是約翰。我會從那個開始。所以是的，我們著眼於持續醫療保健以及我們交易的持續醫療保健。因此，我們著眼於處於急性期到急性期到急性期後護理階段的任何類型的組織和企業。通過我們最近的收購，過去幾年的家庭健康空間和步伐中心，支付中心對我們仍然非常有吸引力。我們在第四季度進行了 2 次 locums 收購，我們相信 locums 仍然是一個很好的地方，以及任何可以幫助為我們的客戶提供服務的輔助業務，就像收購 HireUp 一樣。所以真的，我們的戰略歸結為 - 真的有兩個不同的點。一個是，我們可以添加 - 通過收購某個領域的公司來擴大我們的市場份額，第一。然後是第二，我們能否添加額外的服務來增強我們對客戶的服務，從而成為和創造更多的服務，讓我們的客戶更加粘稠。

Our next question comes from Tobey Sommer with Truist Securities.

我們的下一個問題來自 Truist Securities 的 Tobey Sommer。

I was hoping that you could describe what you're hearing from customers, hospitals, hospital systems as they try to sort of regain controls whether they feel like they lost during the pandemic. And in particular, 2 areas, vendor-neutral MSP, VMS and if maybe you can comment about if any of your client losses were because of sort of a philosophical change and a change not necessarily to another staffing company, but to vendor-neutral. And what sort of energy investment innovation are you seeing on the local side that customers are trying to do to satisfy more of their contract needs?

我希望你能描述你從客戶、醫院、醫院系統那裡聽到的內容，因為他們試圖重新獲得控制權，無論他們是否覺得自己在大流行期間失去了控制。特別是 2 個領域，供應商中立的 MSP、VMS，如果您可以評論一下您的客戶損失是否是由於某種哲學變化和變化不一定是另一家人力資源公司，而是供應商中立的。您在當地看到了什麼樣的能源投資創新，客戶正在努力滿足他們更多的合同需求？

Sure, Tobey. This is John. I'll start and Dan and Marc will probably go in. And yes, so we definitely saw some client attrition that went over to vendor-neutral. But we've -- what I would say is if we look at the market, the addressable market in the staffing industry, I think SIA has 2023 at $50 billion. And of course, that may go down -- if bill rates go down, right, not exactly to your calculation of that. But in that market, about 40% is MSP. Roughly we believe 40% is vendor-neutral and about 20% is direct clients. And as we've mentioned earlier, all these MSPs, which are typically in VMS contract with typically 3 years -- 3-year contracts as a lot of them are coming up right now and going out to bid. A lot of clients are looking to say, "Hey, was the grass greener on the other side?"

當然，托比。這是約翰。我會開始，Dan 和 Marc 可能會進去。是的，所以我們確實看到了一些客戶流失，這些客戶流失到供應商中立。但是我們 - 我想說的是，如果我們看看市場，人力資源行業的潛在市場，我認為 SIA 到 2023 年將達到 500 億美元。當然，這可能會下降——如果賬單利率下降，對，不完全是你的計算。但在那個市場中，大約 40% 是 MSP。我們大致認為 40% 是供應商中立的，大約 20% 是直接客戶。正如我們之前提到的，所有這些 MSP，通常與 VMS 簽訂合同，通常為期 3 年 - 3 年合同，因為他們中的很多人現在都在出價。許多客戶想說，“嘿，另一邊的草更綠嗎？”

And really, there's really 4 categories. It's, "Hey, do I do it direct?" It's "Do I go to VMS or do I change over to MSP?" And so we're seeing clients change from VMS to MSP because they want to try a different model. And then the other model that they're going to is can I take it in-house and use technology-only. And so we're definitely seeing a bit of that mix happen. Now we feel very fortunate because we launched Intellify, our vendor-neutral VMS system late last year. And as we mentioned in our prepared remarks, we hired Eric Christianson, who is a pioneer in the vendor-neutral space. And as we start building out our vendor-neutral business, we think that there's a lot of upside for us to capture that market. And so I'll hand it over to Dan.

真的，真的有 4 個類別。是，“嘿，我直接做嗎？”它是“我是去 VMS 還是轉到 MSP？”因此，我們看到客戶從 VMS 轉變為 MSP，因為他們想嘗試不同的模型。然後他們將採用的另一種模式是我可以在內部使用它並僅使用技術。所以我們肯定會看到一些混合發生。現在我們感到非常幸運，因為我們在去年年底推出了 Intellify，這是我們的供應商中立的 VMS 系統。正如我們在準備好的評論中提到的，我們聘請了 Eric Christianson，他是供應商中立領域的先驅。當我們開始建立供應商中立的業務時，我們認為我們有很多優勢可以佔領該市場。所以我會把它交給丹。

Thanks, John, and Tobey, it's Dan. I'll just add a couple of things you were asking specifically about the local business. One of the key sets of features inside of Intellify is our ability to manage internal resource pools for them that would allow for them to manage their own resources, clearly, but add incremental local resources to supplement those -- that staff as well even before they go to a travel kind of a resource. In addition to that, we are adding capabilities. We just, for example, at the beginning of the quarter, added locums to one of our clients on the Intellify platform as well, which, as you can imagine, is a huge upside for us for the rest of our customer base as well.

謝謝，約翰和托比，我是丹。我將添加一些您特別詢問的有關本地業務的內容。 Intellify 內部的一組關鍵功能是我們為他們管理內部資源池的能力，這將允許他們管理自己的資源，顯然，但添加增量本地資源來補充那些——甚至在他們之前的員工去旅游資源。除此之外，我們正在添加功能。例如，在本季度初，我們還在 Intellify 平台上為我們的一個客戶添加了 locums，正如您可以想像的那樣，這對我們的其他客戶群來說也是一個巨大的優勢。

I think lastly, when we think about the capabilities that are really important to customers for these technology platforms, whether they run them themselves or have us do that for them is having kind of a pre-integrated set of suppliers that they can just turn on with a switch. I'm super grateful. Today, we had a whole house full of suppliers here talking about their support for this platform for our programs and just a little bit of a shout-out to them first. But for their ability to turn this on gives, again, that local flavor and the more broad flavor really great strength in terms of turning it on quickly and managing it fast.

最後，我認為，當我們考慮對這些技術平台的客戶真正重要的功能時，無論是他們自己運行還是讓我們為他們運行，都是擁有一組他們可以打開的預先集成的供應商用一個開關。我超級感激。今天，我們滿屋子的供應商都在談論他們對我們項目平台的支持，並首先向他們大聲疾呼。但是，由於他們能夠開啟這一點，因此在快速開啟和快速管理方面再次賦予了地方風味和更廣泛的風味真正強大的力量。

And Tobey, this is John again. I'll also add to Dan's comments that what we're seeing in the local market and the hospitals that -- and the clients that were in front of is that they are looking to expand their internal resource pool, and that's part of what Dan was saying and utilizing our Intellify product to do that. But also to help them build those internal resource pools, how can we help them move quicker to get the local resources in play. And that's what we're hearing from many of our clients right now.

托比，這又是約翰。我還要補充 Dan 的評論，我們在當地市場和醫院看到的 - 以及前面的客戶是他們正在尋求擴大內部資源庫，這就是 Dan 的一部分正在說並利用我們的 Intellify 產品來做到這一點。還要幫助他們建立這些內部資源庫，我們如何才能幫助他們更快地行動以發揮當地資源的作用。這就是我們現在從許多客戶那裡聽到的。

And then I wanted to ask about bill rates in comparison to full-time comp and I know that's sometimes a difficult analysis because you have to try to make it an all-in number for full-time comp. How much could bill rates fall before sort of the -- what I've always perceived as a natural at least hourly premium for a nurse to go to another city and sleep in a strange bed for 3 months before we sort of get there and get to sort of a natural differential between the 2 categories?

然後我想問一下與全職薪酬相比的賬單費率，我知道這有時是一個困難的分析，因為您必須嘗試將其作為全職薪酬的全部數字。在某種程度上，我一直認為護士去另一個城市並在一張陌生的床上睡 3 個月，然後我們才到達那裡並到達之前，賬單費率會下降多少？對這兩個類別之間的自然差異進行排序？

Yes. You know what, I don't think we -- we don't necessarily track that side of it specifically. But what I'd say is what we've seen always is always going to be a little bit of a premium paid for your travel -- the travel nurse. But when you look at the total compensation package for a travel nurse compared to the total all-in package of a core staff nurse, including all their benefits, all of their long-term, short-term benefits. A lot of times, hospitals will look at it and see it's actually cost savings. And because you have the flexibility to bring on talent, bring off talent, it ends up being a cheaper version of that. So we think it's -- and that's one point.

是的。你知道嗎，我不認為我們 - 我們不一定專門跟踪它的那一面。但我要說的是，我們一直看到的總是會為您的旅行支付一點額外費用——旅行護士。但是，當您將旅行護士的總薪酬方案與核心護士的總薪酬方案進行比較時，包括他們的所有福利、所有長期和短期福利。很多時候，醫院會查看它並發現它實際上節省了成本。而且因為你可以靈活地引進人才，帶走人才，它最終成為一種更便宜的版本。所以我們認為這是 - 這是一點。

I think the other point on that [were the fill rates to go] downward, it doesn't make a difference for that nurse to sleep in a different bed. Well, what's interesting is 65% of our clinicians actually (inaudible) the number dropped to 64% of our clinicians are millennials or less. And that means they're aged 41 or younger. And we're still hearing from those clinicians, they want to sleep in that bed in a different town and they want to experience different experiences, and they want to be part of that gig economy. So there's still very much attraction to being a travel nurse and exploring and experiencing and having that travel nurse experience.

我認為另一點是[填充率下降]，護士睡在不同的床上並沒有什麼不同。好吧，有趣的是我們 65% 的臨床醫生實際上（聽不清）這個數字下降到 64% 我們的臨床醫生是千禧一代或更少。這意味著他們的年齡在 41 歲或以下。我們仍然從那些臨床醫生那裡聽到，他們想睡在不同城鎮的那張床上，他們想體驗不同的經歷，他們想成為零工經濟的一部分。因此，成為一名旅行護士並探索、體驗和擁有旅行護士的經歷仍然非常有吸引力。

Last question for me. What are the M&A opportunities like in the market? And would you feel comfortable buying properties for valuations in excess of the company's stock?

我的最後一個問題。市場上有哪些併購機會？您是否願意購買估值超過公司股票的房產？

Yes. Well, definitely valuations we're seeing are trending down a little bit. And of course, as interest rates have spiked up, we've seen valuations come down a little bit. And in terms of what's our appetite for that, what we look at it, is it a strategic fit for the organization? Will it help us be accretive to our gross margins and our EBITDA and how it fits into the organization? I don't know, Bill, do you want to add anything else to that?

是的。好吧，我們看到的估值肯定有一點點下降。當然，隨著利率飆升，我們看到估值略有下降。就我們對此的興趣、我們的看法而言，它是否適合組織的戰略？它會幫助我們增加毛利率和 EBITDA 以及它如何融入組織嗎？我不知道，比爾，你還想補充什麼嗎？

No, I think you said it. The multiples are certainly trending to a more favorable level. But I think your inherent question was, would we be willing to pay a multiple higher than the current multiple that Cross Country trades. And I think the short answer is yes, depending on the property, if it's a strategic fit goes along with what we're trying to accomplish in terms of the continuum of care and fits our profile for higher-margin businesses and the like. So yes, I think especially if it's going to be a competitive process where you're looking to acquire a good property that fits well, you're going to have to pay a fair market price.

不，我想你說過。倍數肯定趨向於更有利的水平。但我認為你固有的問題是，我們是否願意支付比目前 Cross Country 交易的倍數更高的倍數。我認為簡短的回答是肯定的，這取決於財產，如果它在戰略上符合我們在連續護理方面想要實現的目標，並且符合我們對高利潤業務等的形象。所以，是的，我認為特別是如果這將是一個競爭過程，您希望獲得適合的優質房產，那麼您將不得不支付公平的市場價格。

Our final question comes from Bill Sutherland with The Benchmark Company.

我們的最後一個問題來自 The Benchmark Company 的 Bill Sutherland。

Well, it's the last question, guys. So clarification, Bill, if you don't mind on the 5% to 10%, I think it's the range you used on the travel -- on the open travel orders. You would normally see some seasonality -- excuse me -- 2Q over 1Q with new in terms --

好吧，這是最後一個問題，伙計們。所以澄清一下，比爾，如果你不介意 5% 到 10%，我認為這是你在旅行中使用的範圍——在開放的旅行訂單上。你通常會看到一些季節性 - 對不起 - 2Q 超過 1Q 新的條款 -

Not necessarily from a bill rate perspective, Bill. So I mean, like the bill rates don't normally ebb and flow. I mean, there's demand that spikes in certain parts of the country through the winter months. You'll see the snowbird states like Florida. We'll see a spike in demand as that starts to wind down. You'll see less needs there. But I don't generally see bill rates moving a whole heck of a lot. I think, Marc, you could certainly speak to this as well, but I don't generally see a lot of rate movement throughout the year. Same as the pandemic, of course.

不一定從票據利率的角度來看，比爾。所以我的意思是，就像賬單利率通常不會起伏一樣。我的意思是，在整個冬季，該國某些地區的需求會激增。你會看到像佛羅里達這樣的雪鳥州。隨著需求開始減少，我們將看到需求激增。你會在那裡看到更少的需求。但我一般不會看到票據利率有太大變動。我想，馬克，你當然也可以這麼說，但我一般不會看到全年利率有太大變動。當然，與大流行一樣。

Yes. Typically, we don't see the bill rate fluctuations. We do see the demand fluctuations seasonally. But the last few years, especially, we have not seen that.

是的。通常，我們看不到賬單利率波動。我們確實看到了季節性的需求波動。但是，尤其是最近幾年，我們還沒有看到這一點。

So if you have the 5% to 10%, that's just bill rates you're respecting -- that you're referring to. And so there might be some seasonal volume on top of that and if I'm thinking about 2Q?

所以如果你有 5% 到 10%，那隻是你所尊重的賬單利率——你指的是。因此，除此之外可能還有一些季節性銷量，如果我在考慮第二季度？

Yes. Well, again, I'm saying what I -- what we're seeing right now is looking at open orders, right? So we track what's our current book of business, what are we locking orders at and what are the open orders, what's the average bill rate across open orders. So we looked at that across time to see how things are trending. And so what we're seeing now is that the open order average rate is starting to move downward about 5% to 10% week-to-week, it moves, of course. And there's always a mix component.

是的。好吧，我再說一遍——我們現在看到的是未結訂單，對吧？因此，我們跟踪我們當前的業務簿是什麼，我們鎖定的訂單是什麼，未結訂單是什麼，未結訂單的平均賬單率是多少。因此，我們跨時間研究了這一點，以了解事情的趨勢。因此，我們現在看到的是，未結訂單平均利率開始每週下降約 5% 至 10%，當然，它會下降。而且總有一個混合組件。

So I want to be clear about this. The open order bill rate is not necessarily indicative of what we'll experience because we may have orders that we won't fill and there's orders that we're going to certainly strive for the higher bill rate orders. So I think that doesn't always play out that way. So it's a little bit of a guesswork to say, look, the bill rates of what we've locked are down about 5% that won't impact Q1 all that much. As I've said, it's probably a similar play out to Q4, which is down low mid-single and then that -- the rest of that rate decline plus the impact from the broader market is more likely to be seen in Q2.

所以我想清楚這一點。未結訂單費率不一定表示我們將經歷什麼，因為我們可能有我們不會填寫的訂單，並且有一些訂單我們肯定會爭取更高的賬單費率訂單。所以我認為這並不總是這樣。所以說有點猜測，看，我們鎖定的賬單利率下降了大約 5%，這不會對第一季度產生太大影響。正如我所說，這可能與第 4 季度的情況類似，第 4 季度處於中低位，然後是——其餘的利率下降加上大盤的影響更有可能在第 2 季度看到。

All things being equal, I don't -- if rates do continue to decline, we don't anticipate them to have steep declines after our second quarter. I think they start to -- really start to be at near the bottom. There might be a little bit of pressure into the back half, but I just think it starts to get to a point to the earlier question that Tobey asked about what the market bears and what it takes to get a clinician to the bedside.

在所有條件相同的情況下，我不會——如果利率確實繼續下降，我們預計它們不會在第二季度後大幅下降。我認為他們開始 - 真的開始接近底部。後半部分可能會有一點壓力，但我只是認為它開始涉及早先的問題，即托比詢問市場承受什麼以及讓臨床醫生到床邊需要什麼。

Right. And so not (inaudible) that, but so on the volume side, you might see some seasonal softness into 2Q and then normally, it would level into the back half? Or --

正確的。所以不是（聽不清），但是在數量方面，您可能會看到第二季度出現一些季節性的疲軟，然後通常情況下，它會在後半部分趨於平穩？或者 -

Yes. If you're speaking to the volume side of things, I think there's a couple of things. Number one, in the fourth quarter -- going into the first quarter, we did have some rapid response and a little bit of labor disruptions that you can never count on. So that's going to be a little bit of a volume headwind going into Q1. From Q1 to Q2, we don't generally have a tremendous softness. In fact, our travelers on assignment ramps throughout the first quarter and maybe dissimilar to some other companies out there. But in general, we start the year off a little softer and then that headcount gradually ramps all throughout January and into February. So we're building that headcount up as we're moving through the quarter right now.

是的。如果你說的是事情的數量方面，我認為有幾件事。第一，在第四季度——進入第一季度，我們確實有一些快速反應和一些你永遠無法指望的勞動力中斷。所以這將是進入第一季度的一點點逆風。從第一季度到第二季度，我們通常不會出現巨大的疲軟。事實上，我們的差旅人員在整個第一季度都在增加，這可能與其他一些公司不同。但總的來說，我們今年開始時會稍微溫和一些，然後整個 1 月和 2 月的員工人數逐漸增加。因此，隨著我們現在進入本季度，我們正在增加員工人數。

Okay. Good. That's a good clarification. The -- I guess, the bundle that you're kind of classifying as workforce solution and maybe that's not your words, but something on that order with education, interim, et cetera, what does that aggregate to now on a run rate -- on a revenue run rate basis?

好的。好的。這是一個很好的澄清。 - 我想，您將其歸類為勞動力解決方案的捆綁包，也許這不是您的話，而是與教育、臨時等等有關的東西，現在按運行率匯總到什麼 -以收入運行率為基礎？

Yes. We don't put education in there. I mean workforce solutions for us --

是的。我們不把教育放在那裡。我的意思是我們的勞動力解決方案——

No, I think (inaudible) Workforce Solutions Group.

不，我認為（聽不清）勞動力解決方案小組。

Workforce Solutions Group, I am sorry. Yes, well, our internal acronym is WSG. So I mean, they're on track over 100 -- a little over $100 million kind of run rate now.

勞動力解決方案組，對不起。是的，我們的內部首字母縮寫詞是 WSG。所以我的意思是，他們正處於 100 多個軌道上——現在的運行率略高於 1 億美元。

So the homecare is a $100 million rate. The education is a $75 million -- $80 million run rate.

因此，家庭護理費用為 1 億美元。教育費用為 7500 萬至 8000 萬美元。

And RPO is probably on the 25 to --

RPO 可能在 25 日到——

Well, plus HireUp. So with HireUp probably about a $30 million run rate. And then, of course, locums we have it at -- somewhere we're at about $150 million to $180 million run rate. We don't segment that into one group.

好吧，加上 HireUp。因此，HireUp 的運行率可能約為 3000 萬美元。然後，當然，我們擁有它的位置 - 我們的運行率約為 1.5 億至 1.8 億美元。我們不會將其分成一組。

[Locums]

[位置]

Locums, not that the other one. So we actually have to add them up.

Locums，不是另一個。所以我們實際上必須把它們加起來。

So when you look at Physician Staffing, is that including all this? Or is that just locums?

因此，當您查看醫師人員配備時，是否包括所有這些？還是那隻是地方？

Physician Staffing is only locums and advanced practitioners. There's no perm placement in there. There's no interim leadership in there. That's all part of Nurse and Allied. So within Physician Staffing, the growth you saw, the $37 million that we reported in revenue for the fourth quarter was a combination of organic as well as the acquisitions of Mint and Lotus that were closed at the beginning of the fourth quarter.

醫師編制只是臨時和高級醫師。那裡沒有燙髮位置。那裡沒有臨時領導。這就是 Nurse and Allied 的全部內容。因此，在 Physician Staffing 中，您看到的增長，我們報告的第四季度收入為 3700 萬美元，是有機結合以及第四季度初完成的對 Mint 和 Lotus 的收購。

Okay. Okay. And then last one, Bill. If you are successful in migrating Intellify to essentially all your MSPs by the end of this year, what's kind of the dollar impact of that?

好的。好的。最後一個，比爾。如果您在今年年底之前成功地將 Intellify 遷移到基本上所有的 MSP，這會對美元產生什麼樣的影響？

It's a great question. And what I would just say is, let me put it into percentages. So whatever our spend under management is today, we're spending somewhere between, on average, 85 to 120 basis points. So call it 1%. I think if you just use that as a place hold at 1% of spend under management generally runs through a vendor management system, and that today is a fee we're paying to someone else that we will avoid.

這是一個很好的問題。我只想說，讓我用百分比表示。因此，無論我們今天管理的支出是多少，我們的支出平均在 85 到 120 個基點之間。所以稱之為 1%。我認為，如果您只是將其用作佔管理支出 1% 的地方，通常會通過供應商管理系統運行，而今天我們要向其他人支付的費用我們將避免。

Got it.

知道了。

Ladies and gentlemen, this does conclude the Q&A period. I will now turn it over to John Martins for closing remarks.

女士們，先生們，問答環節到此結束。我現在將把它交給 John Martins 作結束語。

Thank you, operator. Before wrapping up, Cross Country is proud to join celebrating Black History Month. Our company has a longstanding commitment to diversity, equity and inclusion, including our continued financial support of the National Black Nurses Association. In closing, I'd like to thank everyone for participating in today's call, and we look forward to updating you on the progress of the company in the next call in May.

謝謝你，運營商。在結束之前，越野很自豪地加入慶祝黑人歷史月。我們公司長期致力於多元化、公平和包容，包括我們對全國黑人護士協會的持續財政支持。最後，我要感謝大家參加今天的電話會議，我們期待在 5 月的下一次電話會議中向您通報公司的最新進展。

Ladies and gentlemen, this does conclude today's conference call. Thank you for your participation. You may now disconnect.

女士們，先生們，今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。