Chemed Corp (CHE) 2023 Q1 法說會逐字稿

Thank you for standing by, and welcome to the Chemed First Quarter 2023 Earnings Conference Call.

感謝您的支持，歡迎來到 Chemed 2023 年第一季度收益電話會議。

(Operator Instructions)

（操作員說明）

As a reminder today's call is being recorded. I would now like to turn the conference to your host, Holley Schmidt, Assistant Controller. Ma'am, you may begin.

提醒一下，今天的通話正在錄音中。我現在想把會議轉給你的主持人，助理財務官 Holley Schmidt。女士，您可以開始了。

Good morning. Our conference call this morning will review the financial results for the First Quarter of 2023 ended March 31, 2023.

早上好。我們今天上午的電話會議將審查截至 2023 年 3 月 31 日的 2023 年第一季度的財務業績。

Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this Conference Call.

在我們開始之前，讓我提醒您，1995 年私人證券訴訟改革法案的安全港條款適用於本次電話會議。

During the course of this call, the company will make various remarks concerning management's expectations, predictions, plans and prospects that constitute forward-looking statements. Actual results may differ materially from those projected by these forward-looking statements as a result of a variety of factors, including those identified in the company's news release of April 26 and in various other filings with the SEC.

在此電話會議期間，公司將就構成前瞻性陳述的管理層預期、預測、計劃和前景發表各種評論。由於各種因素，包括公司 4 月 26 日的新聞稿和向美國證券交易委員會提交的各種其他文件中確定的因素，實際結果可能與這些前瞻性陳述所預測的結果存在重大差異。

You are cautioned that any forward-looking statements reflect management's current view only and that the company undertakes no obligation to revise or update such statements in the future.

請注意，任何前瞻性陳述僅反映管理層當前的觀點，公司不承擔在未來修改或更新此類陳述的義務。

In addition, management may also discuss non-GAAP operating performance results during today's call, including earnings before interest, taxes, depreciation and amortization or EBITDA and adjusted EBITDA. A reconciliation of these non-GAAP results is provided in the company's release -- press release dated April 26, which is available on the company's website at chemed.com.

此外，管理層還可能在今天的電話會議上討論非 GAAP 經營業績結果，包括利息、稅項、折舊和攤銷前收益或 EBITDA 和調整後的 EBITDA。這些非 GAAP 結果的對賬在公司發布的新聞稿中提供——日期為 4 月 26 日的新聞稿，可在公司網站 chemed.com 上查閱。

I would now like to introduce our speakers for today: Kevin McNamara, President and Chief Executive Officer of Chemed Corporation; Dave Williams, Executive Vice President and Chief Financial Officer of Chemed; and Nick Westfall, President and Chief Executive Officer of Chemed's VITAS Healthcare Corporation subsidiary.

我現在想介紹我們今天的演講者：Chemed Corporation 總裁兼首席執行官 Kevin McNamara； Chemed 執行副總裁兼首席財務官 Dave Williams；和 Nick Westfall，Chemed 的 VITAS Healthcare Corporation 子公司總裁兼首席執行官。

I will now turn the call over to Kevin McNamara.

我現在將把電話轉給凱文麥克納馬拉。

Thank you, Holley. Good morning. Welcome to Chemed Corporation's First Quarter 2023 Conference Call. I will begin with highlights for the quarter, and David and Nick will follow up with additional operating detail. I will then open up the call for questions.

謝謝你，霍利。早上好。歡迎來到 Chemed Corporation 2023 年第一季度電話會議。我將從本季度的亮點開始，David 和 Nick 將跟進其他運營細節。然後我將打開問題電話。

Our first quarter 2023 operating results released last night continue to show a return to a more normalized growth and operating results, post-pandemic. For VITAS, normalization involves methodically increasing capacity by expanding our staff of licensed health care professionals. In the first quarter of 2023, VITAS added 200 licensed professionals, 60% of which are licensed nurses. Since we implemented our hiring and retention program in July 2022, VITAS expanded license staffing by 475 professionals. Nick will provide more detailed information on this issue later in the call.

我們昨晚發布的 2023 年第一季度經營業績繼續顯示，在大流行病後，增長和經營業績恢復了更加正常化。對於 VITAS，正常化涉及通過擴大我們的持照醫療保健專業人員的工作人員有條不紊地提高能力。 2023 年第一季度，VITAS 新增了 200 名持照專業人員，其中 60% 是持照護士。自從我們在 2022 年 7 月實施我們的招聘和保留計劃以來，VITAS 增加了 475 名專業人員的許可人員。尼克稍後將在電話中提供有關此問題的更多詳細信息。

Although we continue to see disruption in our referral patterns when compared to pre-pandemic admissions, these disruptions continue to dissipate and reflect methodical improvement in admissions, average daily census and key pre-admit patient locations.

儘管與大流行前的入院相比，我們繼續看到我們的轉診模式受到干擾，但這些干擾繼續消散並反映出入院、平均每日人口普查和關鍵的入院前患者位置方面的有條不紊的改善。

Roto-Rooter had a solid first quarter, increasing revenue 7.9% over the prior year. Revenue in the first quarter of 2023 exceeded our internal estimates with January 2023 being exceptionally strong. March revenue was somewhat lighter than we anticipated, but still within normal patterns.

Roto-Rooter 第一季度業績穩健，收入比上年增長 7.9%。 2023 年第一季度的收入超出了我們的內部估計，2023 年 1 月的收入異常強勁。 3 月份的收入比我們預期的要少一些，但仍處於正常模式之內。

Overall, demand for key services in both commercial and residential segments continue at levels significantly above our pre-pandemic demand. This is demonstrated with commercial revenue increasing 41% and residential revenue expanding 73% when compared with the first quarter of 2019.

總體而言，商業和住宅領域對關鍵服務的需求繼續大大高於大流行前的需求水平。與 2019 年第一季度相比，商業收入增長了 41%，住宅收入增長了 73%，這證明了這一點。

Roto-Rooter continues to be well positioned, and we anticipate continued expansion of market share by pressing our core competitive advantages in terms of brand awareness, customer response time, 24/7 call centers and Internet presence.

Roto-Rooter 繼續處於有利地位，我們預計通過在品牌知名度、客戶響應時間、24/7 呼叫中心和互聯網存在方面發揮我們的核心競爭優勢，繼續擴大市場份額。

With that, I'd like to turn this teleconference over to David.

有了這個，我想把這個電話會議轉交給大衛。

Thank you, Kevin. VITAS' net revenue was $310 million in the first quarter of 2023, which is an increase of 3.8% when you compare to our prior year period. This revenue increase is comprised primarily of a 3% increase in days of care, a geographically-weighted average Medicare reimbursement rate increase of approximately 2.9%, partially offset by 200 basis points as a result of CMS reimplementing the 2% sequestration cut that was suspended at the start of the pandemic in 2020. Our acuity mix shift had minimal impact in the quarter when compared to the prior year revenue and level of care mix.

謝謝你，凱文。 VITAS 2023 年第一季度的淨收入為 3.1 億美元，與去年同期相比增長 3.8%。這一收入增長主要包括護理天數增加 3%，地理加權平均醫療保險報銷率增加約 2.9%，部分被 CMS 重新實施暫停的 2% 封存削減導致的 200 個基點所抵消在 2020 年大流行開始時。與上一年的收入和護理組合水平相比，我們的敏銳度組合轉變在本季度的影響微乎其微。

Our combination of Medicare Cap and other contra revenue changes negatively impacted growth by about 10 basis points. In the first quarter of 2023, VITAS accrued $2.75 million in the Medicare Cap billing limitations. This compares to a $2.5 million Medicare Cap billing limitation in the first quarter of 2022. Of our 30 Medicare provider numbers, 25 of these provider numbers have a trailing 6-month Medicare Cap cushion of 10% or greater. One provider number has a cushion between 5% and 10%, and 1 provider has a cushion between 0% and 5%. 3 of our provider numbers do have a trailing 6-month billing limitation liability.

我們結合 Medicare Cap 和其他收入變化對增長產生了約 10 個基點的負面影響。 2023 年第一季度，VITAS 在 Medicare Cap 計費限制中累計了 275 萬美元。相比之下，2022 年第一季度的 Medicare Cap 計費限制為 250 萬美元。在我們的 30 個 Medicare 提供者中，有 25 個提供者的 6 個月 Medicare Cap 緩衝為 10% 或更高。一個提供者編號的緩沖在 5% 到 10% 之間，1 個提供者的緩沖在 0% 到 5% 之間。我們的 3 個供應商號碼確實有 6 個月的賬單限制責任。

Our average revenue per patient per day in the first quarter of 2023 was $198.86, which is 100 basis points above the prior-year period. Reimbursement for routine home care and high acuity care averaged $173.39 and $1,042.06, respectively. During the quarter, high acuity days of care was 2.9% of total days of care, essentially equal to the prior-year quarter.

2023 年第一季度，我們每位患者每天的平均收入為 198.86 美元，比去年同期高出 100 個基點。常規家庭護理和高危護理的報銷平均分別為 173.39 美元和 1,042.06 美元。本季度，高危護理天數佔總護理天數的 2.9%，與去年同期基本持平。

The first quarter 2023 gross margin, excluding Medicare Cap and the hiring and retention bonus program was 22.5%. This is a 220 point basis margin decline when compared to the first quarter of 2022. VITAS' adjusted EBITDA margin in the quarter, excluding Medicare Cap, was 15.1%, which is a 234 basis points below the prior-year period. These margin declines are the result of CMS reimplementing sequestration, which reduced our gross margin and EBITDA margin 200 basis points.

2023 年第一季度毛利率為 22.5%，不包括 Medicare Cap 和招聘和留任獎金計劃。與 2022 年第一季度相比，基差下降了 220 個基點。VITAS 本季度調整後的 EBITDA 利潤率（不包括醫療保險上限）為 15.1%，比去年同期低 234 個基點。這些利潤率下降是 CMS 重新實施封存的結果，這使我們的毛利率和 EBITDA 利潤率降低了 200 個基點。

In addition, VITAS increased the licensed health care staff by 200 professionals in the first quarter of '23. The net increase of 200 professionals hired throughout the first quarter is estimated to have negatively impacted gross margin and adjusted EBITDA margin by 50 basis points.

此外，VITAS 在 2023 年第一季度增加了 200 名持照醫療保健人員。據估計，整個第一季度淨增聘用的 200 名專業人員對毛利率和調整後的 EBITDA 利潤率產生了 50 個基點的負面影響。

Roto-Rooter generated quarterly revenue of $250 million in the first quarter of 2023, which is an increase of 7.9% compared to the prior-year period. Roto-Rooter branch commercial revenue in the quarter totaled $59.9 million, which is an increase of 10.1% over the prior year. This aggregate commercial revenue growth consisted of drain cleaning increasing 4%, plumbing expanding 10.7%, excavation increasing 26.2% and water restoration expanding 7.4%. Roto-Rooter branch residential revenue in the quarter was $169 million, an increase of 7.5% over the prior-year period.

Roto-Rooter 在 2023 年第一季度的季度收入為 2.5 億美元，比去年同期增長 7.9%。 Roto-Rooter 分支機構本季度的商業收入總計 5990 萬美元，比上年增長 10.1%。這一總商業收入增長包括排水管清理增長 4%、管道增長 10.7%、挖掘增長 26.2% 和水修復增長 7.4%。 Roto-Rooter 分支機構本季度的住宅收入為 1.69 億美元，比去年同期增長 7.5%。

The components of this is aggregate residential growth rate of drain cleaning decreasing 2.9%, plumbing expanding 3.6%, excavation expanding 3.9% and water restoration increasing 27.4%. Roto-Rooter's gross margin in the quarter was 53.1%, which is a 37 basis point increase when compared to the first quarter of 2022.

其中的組成部分是排水管清理的總住宅增長率下降 2.9%，管道擴張 3.6%，開挖擴張 3.9%，水恢復增長 27.4%。 Roto-Rooter 本季度的毛利率為 53.1%，與 2022 年第一季度相比增長了 37 個基點。

Adjusted EBITDA in the first quarter of '23 totaled $71.8 million, which is an increase of 9%, and the adjusted EBITDA margin in the quarter was 28.8%, which is a 29 basis point expansion compared to the prior year.

23 年第一季度調整後的 EBITDA 總計 7180 萬美元，增長 9%，本季度調整後的 EBITDA 利潤率為 28.8%，比上年增長 29 個基點。

I will now turn this call over to Nick Westfall, President and Chief Executive Officer of our VITAS Healthcare business segment.

我現在將把這個電話轉交給我們 VITAS 醫療保健業務部門的總裁兼首席執行官 Nick Westfall。

Thanks, David. As we've mentioned in the past, we implemented a targeted hiring and retention bonus program at VITAS, effective July 1, 2022. This program is focused on licensed nurses, nurse managers, home health aides and social workers. These onetime retention bonuses range from $2,000 to $15,000 per licensed health care professional. The total 12-month forward-looking cost of this program, including payroll taxes and government mandated overtime calculations, is estimated at $40 million.

謝謝，大衛。正如我們過去提到的，我們在 VITAS 實施了一項有針對性的招聘和保留獎金計劃，該計劃將於 2022 年 7 月 1 日生效。該計劃的重點是持照護士、護士經理、家庭保健助理和社會工作者。這些一次性保留獎金的範圍從每位持照醫療保健專業人員 2,000 美元到 15,000 美元不等。該計劃的 12 個月前瞻性總成本估計為 4000 萬美元，包括工資稅和政府強制計算的加班費用。

All retention bonus payments are individually cliff-vested and paid out after the employee has successfully completed 12 additional months of continuous employment.

所有留任獎金均單獨發放，並在員工成功完成額外 12 個月的連續工作後支付。

During the first quarter, we expanded this licensed health care professional staff by 200 employees, bringing total licensed health care staffing expansion attributed to this program to 475. It is important to note the majority of this increase in staffing is for licensed nurses, including admission nurses.

在第一季度，我們將持照醫療保健專業人員的人數增加了 200 人，使該計劃帶來的持照醫療保健人員總數增加到 475 人。值得注意的是，增加的人員中大部分是持照護士，包括入院護士。

In the first quarter of 2023, our average daily census was 17,830 patients, an increase of 517 or 3% when compared to the prior year and an increase of 396 or 2.3% sequentially. The sequential monthly ADC growth within the fourth quarter of 2022 and the first quarter of 2023 is very encouraging, given the timing lag of increased staffing following subsequent admissions and census expansion.

在 2023 年第一季度，我們的平均每日人口普查為 17,830 名患者，與去年同期相比增加了 517 名或 3%，環比增加了 396 名或 2.3%。考慮到在隨後的招生和人口普查擴大之後人員配置增加的時間滯後，2022 年第四季度和 2023 年第一季度的連續月度 ADC 增長非常令人鼓舞。

In the first quarter of 2023, VITAS' total admissions were 16,179. This is a 2.1% decline when compared to the first quarter of 2022 and a 9.1% sequential improvement when compared to the fourth quarter of 2022. I'm very encouraged by the last 2 quarters of sequential growth in admissions. A primary driver for our admissions growth is a result of our increased capacity expansion derived from our hiring and retention program.

2023 年第一季度，VITAS 的總錄取人數為 16,179 人。與 2022 年第一季度相比下降了 2.1%，與 2022 年第四季度相比環比增長了 9.1%。我對過去兩個季度的入學人數環比增長感到非常鼓舞。我們的招生增長的主要驅動力是我們的招聘和保留計劃帶來的產能擴張增加的結果。

In the first quarter, our nursing home admissions increased 6.6% and assisted facility admissions increased 10.6%. Hospital-directed admissions declined 4.9% and home-based patient admissions declined 2.9% in the quarter. As compared to the fourth quarter of 2022, all pre-admit segments improved, with our nursing home admissions increasing 5.2%, assisted facility admissions expanding 13%, hospital-directed admissions increasing 8% and home-based patient admissions improving 10.4% in the quarter.

第一季度，我們的療養院入院人數增加了 6.6%，輔助設施入院人數增加了 10.6%。本季度醫院定向入院人數下降 4.9%，家庭入院人數下降 2.9%。與 2022 年第四季度相比，所有預入院部分均有所改善，我們的療養院入院人數增加了 5.2%，輔助設施入院人數增加了 13%，醫院定向入院人數增加了 8%，家庭患者入院人數增加了 10.4%四分之一。

Our average length of stay in the quarter was 99.9 days. This compares to 104.8 days in the first quarter of '22, and 103.9 days in the fourth quarter of '22. Our median length of stay was 15 days in the quarter and compares to 14 days in the first quarter of '22 and 16 days in the fourth quarter of '22.

我們在本季度的平均停留時間為 99.9 天。相比之下，22 年第一季度為 104.8 天，22 年第四季度為 103.9 天。本季度我們的中位停留時間為 15 天，而 2022 年第一季度為 14 天，22 年第四季度為 16 天。

To recap, what our team has recently accomplished, we have now generated 3 quarters of sequential growth in licensed health care workers, 2 quarters of sequential growth in both admissions as well as ADC. We have developed what I believe is a very sustainable path to building back our capacity and patient base to pre-pandemic levels and beyond.

回顧一下，我們的團隊最近取得的成就，我們現在已經實現了 3 個季度的持照醫護人員連續增長，2 個季度的入院人數和 ADC 連續增長。我們已經開發出一條我認為非常可持續的途徑，可以將我們的能力和患者基礎重建到大流行前甚至更高的水平。

With that, I'd like to turn this call back over to Kevin.

有了這個，我想把這個電話轉回凱文。

Thank you, Nick. Now it's an appropriate time for considering questions.

謝謝你，尼克。現在是考慮問題的適當時機。

(Operator Instructions)

（操作員說明）

Our first question comes from Joanna Gajuk of Bank of America.

我們的第一個問題來自美國銀行的 Joanna Gajuk。

So first, I could, please. You don't plan to update the guidance like you just typically do with this quarter, but can you talk about how the quarter came in versus your internal expectations? I mean you made a comment that Roto-Rooter was better on the revenue side, but I guess how would VITAS and then when you -- and how do you view the quarter on the consolidated basis?

所以首先，我可以，請。您不打算像本季度通常所做的那樣更新指南，但您能談談本季度與您的內部預期相比如何嗎？我的意思是你發表評論說 Roto-Rooter 在收入方面更好，但我想 VITAS 會怎麼樣，然後你 - 你如何看待合併基礎上的季度？

Yes, I'll take it on a macro basis, Joanna, and then flip it to Kevin and Nick for more detail. But no, our internal estimates, both Roto-Rooter and VITAS exceeded them. So we were very pleased on a macro basis with the quarter in both segments.

是的，喬安娜，我會從宏觀角度考慮，然後將其交給凱文和尼克了解更多細節。但不，我們的內部估計，Roto-Rooter 和 VITAS 都超過了它們。因此，我們對這兩個細分市場的季度宏觀數據感到非常滿意。

What I would say is, again, capital commentary on how the quarter came in. VITAS, we saw continued improvement in what has been a key aspect of what Nick is trying to do, and that is adding more licensed health care professionals. We're adding those. The expectation is that we want to add them faster than the average daily census comes in for a couple of reasons.

我要說的是，再一次，對本季度如何到來的資本評論。VITAS，我們看到 Nick 正在努力做的一個關鍵方面的持續改進，那就是增加更多有執照的醫療保健專業人員。我們正在添加這些。出於幾個原因，我們希望比平均每日人口普查更快地添加它們。

One is stay ahead of the power curve and we want to build up a cushion for the end of the retention program. So that's going well according to plan, Roto-Rooter capsule commentary, I'd say, very strong early part of the quarter. Little bit slower down -- a little bit from those halcyon days, a little slower in the latter part of the quarter. We get some questions. Is that indicative of the economy slowing down. Some of the activities Roto-Rooter that are less emergency, is that kicking in? Maybe to a small extent.

一個是保持領先於權力曲線，我們希望為保留計劃的結束建立緩衝。所以這按計劃進行得很順利，Roto-Rooter 膠囊評論，我想說，本季度初期非常強勁。慢一點——從那些平靜的日子開始，在本季度的後半段慢一點。我們得到一些問題。這是否表明經濟放緩。一些不那麼緊急的 Roto-Rooter 活動開始了嗎？也許在很小的程度上。

It largely comes down for us, taking advantage of the opportunities with experienced management. And we're still suffering a little bit in Roto-Rooter from the fact that a lot of our managers have been hired away by private equity for various service offerings. We've -- I think we've done a good job in closing the door on that, but we're still suffering from some of the losses we had in the 12 months period preceding the recent quarter.

這在很大程度上歸功於我們，利用經驗豐富的管理層的機會。我們在 Roto-Rooter 仍然受到一些影響，因為我們的許多經理已被私募股權公司聘用以提供各種服務。我們 - 我認為我們在關閉大門方面做得很好，但我們仍在遭受最近一個季度之前 12 個月期間的一些損失。

So the capsule commentary is overall good, some expenses at VITAS that we knew about dealing with the end of the relaxation of sequestration, adding the employees and -- in Roto-Rooter, it's a little bit different business in Roto-Rooter. We want the phone ringing in Roto-Rooter, and then we want to effectively respond to those phone calls. And that's a constant battle. So -- but overall, happy with the results. Nick, anything to add?

所以膠囊評論總體上是好的，我們知道 VITAS 的一些費用是關於處理封存放鬆的結束，增加員工以及 - 在 Roto-Rooter 中，這在 Roto-Rooter 中有點不同。我們希望 Roto-Rooter 中的電話響起，然後我們希望有效地響應這些電話。這是一場持久戰。所以——但總的來說，對結果感到滿意。尼克，有什麼要補充的嗎？

VITAS is in just one level deeper. When you think about the expansion of clinical capacity that continues to be a result actually of better performance, both from a hiring and turnover improvement, which is very encouraging. On the admission side, as I referenced on sequential admissions growth compared to the fourth quarter.

VITAS 只是更深一層。當你考慮到臨床能力的擴大實際上仍然是更好的表現的結果，包括招聘和營業額的改善，這是非常令人鼓舞的。在錄取方面，正如我提到的與第四季度相比連續錄取增長。

Every segment was up high single digits to low single digits on a percentile basis and the resulting days of care expansion are coming in line to beating some internal expectations. So really pleased with a lot of the granular pieces that result in some of the metrics we report.

每個細分市場在百分位數的基礎上都從高個位數上升到低個位數，由此產生的護理天數超出了一些內部預期。對導致我們報告的某些指標的許多細粒度部分感到非常滿意。

On the last point on improving capacity, adding the staff, it sounds like you're going faster than you initially expected. So if you continue at this pace, right, does that change your view in terms of when you expect to be back to pre-COVID census levels? And I guess what's your latest view on that?

關於提高能力、增加員工的最後一點，聽起來你們的進展速度比最初預期的要快。因此，如果您繼續以這種速度前進，這是否會改變您對何時恢復到 COVID 前人口普查水平的看法？我猜你對此有何最新看法？

Let me start by saying, yes, generally, we -- it's a range. And to be very helpful, I'd say, yes, it looks like a little bit sooner rather than later. But it's hard to be precise on that. But it's not surprising that in this environment, if you have the staff, we have a better shot at getting the patients. And that's all -- so the way we look at it is VITAS' internal metrics during the pandemic were worsening on a month-by-month basis. And it was inevitable, what was going to happen to the ADC.

首先讓我說，是的，一般來說，我們 - 這是一個範圍。為了非常有幫助，我會說，是的，它看起來有點早而不是晚。但很難準確地說出這一點。但毫不奇怪，在這種環境下，如果你有員工，我們就能更好地吸引病人。僅此而已——所以我們看待它的方式是 VITAS 在大流行期間的內部指標逐月惡化。 ADC 將要發生的事情是不可避免的。

It's just one of the other side of that. It's almost just as inevitable on the improvement on ADCs as it is once you have the staff. And we have not done. I mean we're not being coy. We haven't done precise calculations as far as when the -- when we're going to get back to that to, let's say, our pre-pandemic ADC level.

這只是其中的另一面。 ADC 的改進幾乎是不可避免的，就像你擁有員工一樣。而我們還沒有完成。我的意思是我們不是害羞。我們還沒有精確計算到什麼時候——什麼時候我們要回到大流行前的 ADC 水平。

But if we wanted to invest in an algorithm, it probably could come up with a pretty good estimate, but not too much use for that. But that's one of the reasons why we compare and contrast, we mentioned about Roto-Rooter. I mean it's such a difference. In VITAS, we're fighting very hard to get back to where we were at the start of the pandemic. In Roto-Rooter, residential sales were up 73% from that period. So it's a tale of 2 cities, and Nick and the people are making progress at a good, solid pace.

但如果我們想投資於一種算法，它可能會得出一個相當不錯的估計，但用處不大。但這是我們比較和對比的原因之一，我們提到了 Roto-Rooter。我的意思是這是一個很大的區別。在 VITAS，我們正在努力爭取回到大流行開始時的狀態。在 Roto-Rooter，住宅銷售額比同期增長了 73%。所以這是兩個城市的故事，尼克和人們正在以良好、穩固的步伐取得進步。

Yes. Directionally, if you were to say, is it faster today than what we would have anticipated 4, 5 months ago? Obviously, I think that answer is yes. And the bottom line is if we can continue to win the war on talent, which is very thoughtful, and we have the demand there for that talent to admit and care for patients, which we do. It's just a question of trajectory, right, at this point.

是的。在方向上，如果你要說，今天它比我們 4、5 個月前預期的要快嗎？顯然，我認為答案是肯定的。底線是我們能否繼續贏得人才戰爭，這是非常周到的，我們在那裡需要人才來接納和照顧病人，我們就是這樣做的。這只是軌蹟的問題，對吧，在這一點上。

So as long as we can continue to do that, whether it's 200 a quarter, whether it's 250, whether it's 150, we are right now in many of the markets in which we operate, the teams are very -- being very successful in that, and it has a compounding effect for existing staff and their level of satisfaction and what we're able to do for the community. So really, really excited about the compounding morale and cultural impact that comes with that.

因此，只要我們能夠繼續這樣做，無論是每季度 200 個，還是 250 個，無論是 150 個，我們現在在我們運營的許多市場中，團隊都非常 - 在這方面非常成功，它對現有員工及其滿意度以及我們能夠為社區做些什麼產生了複合效應。對隨之而來的複合士氣和文化影響真的非常非常興奮。

And I guess, as it relates to expanding of -- expansion of staff and how it translates into census to your point that you've seen this nice sequential growth. So would you characterize that it's also been happening faster? I mean, you haven't guided for the full year. And I guess prior comments were that we expect more of this census growth in the second half of the year. So this 3% growth year-over-year this quarter, was it better than expected or kind of -- way you've been thinking previously when it comes to the full year?

我想，因為它與員工的擴展有關，以及它如何轉化為人口普查，你已經看到了這種良好的連續增長。那麼您是否認為它也發生得更快？我的意思是，你一整年都沒有指導。我猜之前的評論是我們預計今年下半年人口普查的增長會更多。那麼本季度 3% 的同比增長，是好於預期還是有點——你之前在談到全年時一直在想的方式？

Joanna, this is Dave. It's gone better than I expected. As you remember, when we developed the business plan, we conservatively estimated would add 25 net increase in licensed health care workers per month, 75 per quarter. And obviously, we've been beating that in all 3 quarters, we had the hiring and retention program, almost tripled it what we did in Q1.

喬安娜，這是戴夫。它比我預期的要好。您還記得，當我們制定商業計劃時，我們保守估計每月將淨增加 25 名持照醫護人員，每季度淨增加 75 名。顯然，我們在所有 3 個季度都在擊敗它，我們有招聘和保留計劃，幾乎是我們在第一季度所做的三倍。

So I guess what we're trying to avoid, but -- is having a line in the sand of when we get back to normal. But I'll stick my neck out a little bit and just say if the current rate of capacity expansion continues in running more like 50, 75 increased licensed health care workers per month, 200 plus per quarter. In '24, where we returned to our pre-pandemic census. But that's a big -- if the rate of expansion of capacity continues at the same pace.

所以我想我們正在努力避免什麼，但是 - 在我們恢復正常時有一條界限。但我會稍微伸出我的脖子，只是說如果目前的產能擴張速度繼續運行，每月增加 50、75 名持照醫療保健人員，每季度增加 200 名以上。在 24 年，我們回到了大流行前的人口普查。但這是一個很大的問題——如果產能擴張的速度繼續保持同樣的速度。

And Dave, it's interesting because of the lag, we'll be at our pre-pandemic licensed health care professional level months before with this census level.

戴夫，這很有趣，因為滯後，我們將在這次人口普查前幾個月達到大流行前的許可醫療保健專業人員水平。

Almost by definition.

幾乎按照定義。

Yes. And that's what's straining our margins now is we have to build capacity before it contributes to census and then that census is negative margin until they've been in program for about 30 days or longer, that incremental piece. So that's why we're having margin pressure today because we're building back capacity. But that capacity, as Joanna you pointed out, is getting to work pretty quick to subsequent quarter, much faster than we first anticipated when we put this program in place in July of '22.

是的。這就是我們現在的利潤緊張的原因是我們必須在它為人口普查做出貢獻之前建立能力，然後人口普查是負利潤，直到他們已經在計劃中進行了大約 30 天或更長時間，即增量部分。所以這就是為什麼我們今天面臨利潤壓力，因為我們正在重建產能。但是，正如您指出的喬安娜所指出的那樣，這種能力在下個季度開始變得非常快，比我們在 22 年 7 月實施該計劃時最初預期的要快得多。

So nothing changes regarding timing expectations inside of the year related to that, but really excited about getting off to a very fast start.

因此，與此相關的年內時間預期沒有任何變化，但對於能夠快速開始感到非常興奮。

Got it. Definitely good traction there for sure. And I guess another topic on VITAS side in terms of Medicare, right? So the proposal that came on calls only for 3% market basket year update, which is worse than the 4% in '23. So kind of what is your expectation there? I know you -- on the last call, you said you would assume it should be more closer to like 5%.

知道了。肯定有很好的牽引力。我猜 VITAS 方面的另一個話題是關於 Medicare 的，對吧？因此，提出的提案僅要求 3% 的市場籃子年更新，這比 23 年的 4% 還差。那麼你的期望是什麼？我認識你——在上次電話會議上，你說你會認為它應該更接近 5%。

So obviously, well below that. But is there a reason why you would think that the final rate update will be better similar to what happened last year? Or are we kind of back to maybe not much of an improvement and you're going to have to deal with the 3% market basket.

很明顯，遠低於此。但是，您是否有理由認為最終利率更新會更類似於去年發生的情況？或者我們有點回到可能沒有太大改善，你將不得不處理 3% 的市場籃子。

And what I would say, Joanna, as we talked to a number of shareholders and analysts, we put a number out in the fourth quarter what we think the minimum should be given inflation within the hospital wage index basket and what the hospice industry is experiencing. CMS has basically been caught using what I would call forecasted data that maybe historically forecast and actual turns out to be pretty similar in terms of inflation by component.

我要說的是，喬安娜，當我們與一些股東和分析師交談時，我們在第四季度給出了一個數字，我們認為最低應該在醫院工資指數籃子內給出通貨膨脹以及臨終關懷行業正在經歷的事情. CMS 基本上是在使用我稱之為預測數據的情況下被發現的，這些數據可能是歷史預測，實際結果在組件通貨膨脹方面非常相似。

But with the spike in inflation that happened over the last 18 months, it appears from our perspective that CMS uses forecasted data that is badly below actual inflation, and they never true up from forecasted to actual inflation measurements as done by the Bureau of Labor and Statistics. So CMS has been caught lagging the increase, and it really hasn't been noticed though because forecast in actual have been running pretty low 2.5% historically for what, a decade plus.

但隨著過去 18 個月通貨膨脹率的飆升，從我們的角度來看，CMS 使用的預測數據似乎遠低於實際通貨膨脹率，而且它們從未像勞工局和統計數據。因此，CMS 被發現落後於增長，但實際上並沒有引起人們的注意，因為實際預測在過去十年多的時間裡一直運行在 2.5% 的相當低的水平。

Now inflation is running through health care more significantly. And CMS, I think, has been caught, not passing through true inflation, and that's why MedPAC issued 2 separate reports in March of '23 and April 23, frankly, pointing out how badly flawed the market basket CMS is utilizing because they are not accurately measuring appropriate inflation in health care models. And it is a problem. And we will do just fine.

現在，通貨膨脹正在更顯著地貫穿於醫療保健領域。我認為 CMS 已經被發現，沒有通過真正的通貨膨脹，這就是為什麼 MedPAC 在 23 年 3 月和 4 月 23 日發布了兩份單獨的報告，坦率地說，指出 CMS 使用的市場籃子有多麼嚴重的缺陷，因為它們沒有準確衡量醫療保健模型中的適當通貨膨脹。這是一個問題。我們會做得很好。

We have scale, so we have leverage. So we end up with the upper quartile of adjusted EBITDA and gross margins. Most of the competitors in hospice are small not-for-profit hospices, many in rural markets, who lack the scale to have really good margins, but to provide a needed care they're getting squeezed Joanna. And if CMS does not fix this issue of not passing through appropriate inflation reimbursement increases, capacity for some of our small competitors will shrink and access to hospice in rural markets specifically will be limited. So we are pointing out painfully if CMS does not start approaching hospice in giving increases in inflation, the smaller hospices will struggle and probably go out of business.

我們有規模，所以我們有影響力。因此，我們最終得到調整後 EBITDA 和毛利率的上四分位數。臨終關懷中的大多數競爭對手都是小型非營利性臨終關懷機構，其中許多位於農村市場，它們的規模不足以獲得真正可觀的利潤，但為了提供所需的護理，他們受到了喬安娜的擠壓。如果 CMS 不解決這個沒有通過適當的通貨膨脹報銷增加的問題，我們的一些小競爭對手的能力將會縮小，特別是在農村市場獲得臨終關懷的機會將受到限制。因此，我們痛苦地指出，如果 CMS 不開始接近臨終關懷醫院以提高通貨膨脹率，較小的臨終關懷醫院將陷入困境並可能倒閉。

Which is also -- just to add here, but no, we don't anticipate a significant change from the preliminary number at this point. And again, it doesn't -- we're -- it just gives us our marching orders. And we tried -- in the fourth quarter, we tried to send the message out to CMS and the market as far as what we're observing as far as the inflation factor for hospice. But again, from some -- I think, some poor structure with regard to the adjustment mechanism. We're -- comes out as approximately 2.8, I mean, which is -- no one thinks that's what the inflation factor is in the wage market for hospitals and hospices.

這也是 - 只是在這裡添加，但不，我們預計目前初步數字不會有重大變化。再一次，它沒有——我們——它只是給了我們行軍命令。我們嘗試過——在第四季度，我們試圖將信息發送給 CMS 和市場，就我們所觀察到的臨終關懷通貨膨脹因素而言。但同樣，我認為，在調整機制方面有些結構不佳。我們 - 結果大約為 2.8，我的意思是 - 沒有人認為這就是醫院和收容所工資市場中的通貨膨脹因素。

Only other piece to highlight is, I think it is better understood inside of DC now being openly advocated for and debated, not only within the hospice segment, but just as importantly, within the hospital segment and those trade associations since we're paid against that hospital market basket index, as everybody knows.

唯一要強調的是，我認為現在在 DC 內部得到更好的理解，不僅在臨終關懷部門，而且同樣重要的是，在醫院部門和那些貿易協會內，因為我們得到了報酬那個醫院市場籃子指數，眾所周知。

This proposal, and there were other things included in there around increased service more oversight. Some questions there from CMS and also even higher penalty for those not submitting the quality data. So in that context, how is VITAS positioned there? Do you expect to look at some assets, maybe that would be there to be acquired as they look to kind of to your point, scale up? And would VITAS kind of act on that? And I guess for this increased services and other things in the rack, I guess, also how VITAS is positioned there?

該提案以及其中包含的其他內容圍繞著加強服務和更多監督。 CMS 提出了一些問題，並且對那些未提交質量數據的人進行了更高的處罰。那麼在這種情況下，VITAS 是如何定位的呢？您是否希望查看一些資產，也許這些資產會被收購，因為它們看起來有點符合您的觀點，擴大規模？ VITAS 會對此採取行動嗎？我想，對於這種增加的服務和機架中的其他東西，我想，VITAS 是如何定位的？

So Joanna, just to speak to that, many of the things, and I'll bucket it as program integrity. We are in support of as well as the trade associations who had made those joint recommendations on behalf of their membership to be proactive in the way in which the government could go thinking about helping the industry and supporting long-standing, mission-driven providers.

所以 Joanna，就此而言，很多事情，我將其視為程序完整性。我們支持代表其成員提出這些聯合建議的貿易協會，以積極主動地採取政府可以考慮幫助該行業並支持長期存在的、以使命為導向的供應商的方式。

The issue is more abuse of expansion of licenses that are not providing care in local markets, heavily concentrated in 4 states, including California. And so some of the pieces they're talking about of expanding penalties to 4%, et cetera, don't have -- first and foremost, don't have applicability to VITAS. We conform and comply with everything on day 1. And some of those providers that would be impacted by it wouldn't necessarily become acquisition targets because they're not submitting the data because they're not caring for patients.

問題是更多地濫用不在本地市場提供護理的許可證擴展，這些市場主要集中在包括加利福尼亞在內的 4 個州。因此，他們正在談論的將罰款擴大到 4% 等的一些內容沒有——首先，也是最重要的，不適用於 VITAS。我們在第一天就遵守並遵守所有規定。其中一些會受到影響的提供者不一定會成為收購目標，因為他們沒有提交數據，因為他們不關心病人。

Therefore, they have no real strategic value from an acquisition standpoint. There's some actions that can be taken to clean up optics of provider expansion that wouldn't impact members inside of the community. And I think that's really what a lot of those items are focused on. Not the fact that something is wrong with the benefit or that there's quality concerns around going back to mission-focused long-standing providers that are actually providing care in the communities.

因此，從收購的角度來看，它們沒有真正的戰略價值。可以採取一些措施來清理供應商擴張的影響，而不會影響社區內部的成員。我認為這確實是很多項目所關注的。這並不是因為福利有問題，也不是因為回到以任務為中心的長期提供者那裡存在質量問題，這些提供者實際上在社區中提供護理。

(Operator Instructions)

（操作員說明）

Our next question comes from the line of Ben Hendrix of RBC.

我們的下一個問題來自 RBC 的 Ben Hendrix。

I was hoping you could give us your thoughts on the Medicare Cap runway. You had shifted your referral strategy amid staffing shortages, which you noted could eventually press Cap limitations. Any update on the Cap trajectory overall now that hiring capacity is opening back up?

我希望你能告訴我們你對 Medicare Cap 跑道的看法。您在人員短缺的情況下改變了推薦策略，您指出這最終可能會限制上限。既然招聘能力正在恢復，那麼 Cap 整體軌蹟有任何更新嗎？

Yes. Ben, this is Dave Williams. Of course, during the pandemic, we were actually -- stayed out of any significant Cap problem because although our admissions had dropped, our revenue dropped as well and specifically a shift to less high acuity care as we are capacity constrained. So it's actually the drop in that high acuity care that really gave us room under the Medicare Cap building limitation liability.

是的。本，這是戴夫威廉姆斯。當然，在大流行期間，我們實際上 - 沒有遇到任何重大的 Cap 問題，因為儘管我們的入院人數下降了，但我們的收入也下降了，特別是由於我們的能力有限，我們轉向了不太高的敏銳度護理。因此，實際上是高敏度護理的下降真正給了我們在 Medicare Cap 建築限制責任下的空間。

So during the pandemic, we were actually just fine and many programs had actually expanded. However, there is a limitation, and we can't have length of stay go up indefinitely. And that's why we were -- as we would have expected and in our modeling, we actually saw our average length of stay drop below 100. What was at 99...

所以在大流行期間，我們實際上還不錯，許多項目實際上已經擴大了。但是，這是有限制的，我們不能無限期地增加停留時間。這就是為什麼我們 - 正如我們所預期的那樣，在我們的模型中，我們實際上看到我們的平均停留時間下降到 100 以下。99 是什麼......

99.9.

99.9。

And now at 15 median length of stay, too, that's kind of in our sweet spot where historically pre-pandemic it averaged between 14 and 16.

現在，中位停留時間也為 15 天，這在我們的甜蜜點上也是如此，從歷史上看，大流行前平均停留時間在 14 到 16 歲之間。

So it's a long-winded way of saying is we've avoided any Medicare Cap billing limitation with the drop in admissions because we had a drop in high acuity care. Now that we're back to admissions growing and actually now that we're back to slowly increasing our presence in hospitals as a pre-admit location of referrals we should be back into expanding admissions and once again being -- or continuing to be nicely below the billing limitations.

因此，這是一種冗長的說法，即我們避免了任何 Medicare Cap 計費限制，因為我們的高敏護理有所下降。現在我們又回到了入院人數的增長，實際上現在我們又回到了慢慢增加我們在醫院的存在，作為預入院轉診地點，我們應該回到擴大入院人數，並再次成為——或者繼續保持良好狀態低於計費限制。

But it would have been a problem if we didn't start growing admissions with capacity expansion. That's what was done now, basically for 3 quarters.

但如果我們不開始通過擴容來增加入學人數，那將是一個問題。這就是現在所做的，基本上持續了 3 個季度。

So I think Medicare Cap as a risk continues to dissipate, except in California, where we have exceptionally high reimbursement geographically, but the Medicare Cap protection is a uniform rate throughout the country. So high reimbursement markets continue to run a bit of risk on Medicare Cap billing. On the other hand, even with Medicare Cap and the 2 programs we're watching, they're very, very profitable. We don't anticipate Medicare Cap being a material issue, certainly in 2023.

因此，我認為 Medicare Cap 作為一種風險會繼續消散，除了在加利福尼亞州，我們在地理上的報銷率非常高，但 Medicare Cap 保護在全國范圍內是統一的。因此，高額報銷市場繼續在 Medicare Cap 計費方面存在一些風險。另一方面，即使有 Medicare Cap 和我們正在觀看的 2 個項目，它們也非常非常有利可圖。我們預計 Medicare Cap 不會成為一個實質性問題，當然在 2023 年也是如此。

And just to reinforce it, I want to go back to sequential admissions growth in the hospital pre-admit segment. Fourth quarter to first quarter was up 8%. So while we talk about it from a community access, we still are servicing all of our key partners in the market, including the hospital segment. That helps to provide a data point and a full agreement around lack of concern. Correct.

為了加強這一點，我想回到醫院預入院部分的順序入院增長。第四季度比第一季度增長了 8%。因此，雖然我們從社區渠道談論它，但我們仍在為市場上所有主要合作夥伴提供服務，包括醫院部門。這有助於提供數據點和關於缺乏關注的完整協議。正確的。

And clearly, better-than-expected progress on the hiring front. Any change in your thoughts on how retention shakes out on those new hires? And any chance that you could re-up your retention program with more funding to address that?

顯然，招聘方面的進展好於預期。您對保留這些新員工的影響有何看法？你有沒有機會用更多的資金來重新啟動你的保留計劃來解決這個問題？

So let me start by saying it's -- we've been pretty clear that we -- the program was to address some historical -- I mean not historical, but things that were happening for the first time in history. As an accountant, so I'd like to say onetime events, but we do not anticipate reinstituting a different retention program, making it permanent.

所以讓我首先說它是 - 我們已經很清楚我們 - 該計劃是為了解決一些歷史問題 - 我的意思不是歷史，而是歷史上第一次發生的事情。作為一名會計師，我想說的是一次性事件，但我們預計不會重新制定不同的保留計劃，使其永久化。

Well, our view was for one moment in time. And it seemed to -- we put it in. We waited for an inflection point. We put the system in at that point. It had great success, but it's -- I think at a certain point, it becomes self-propagating.

好吧，我們的觀點只是暫時的。它似乎——我們把它放進去。我們等待一個拐點。我們在那個時候安裝了系統。它取得了巨大的成功，但它——我認為在某個時候，它會自我傳播。

I mean there's an element that Nick said. To the extent that you have more staff, everyone who is on your staff is happier and thinks that the company is doing a better job and people are not wrapped around the axle. So to the extent that you have those forces working with you, we do not anticipate continuing it.

我的意思是尼克說了一個要素。如果你有更多的員工，你員工中的每個人都會更快樂，並認為公司做得更好，人們不會被束縛在車軸上。因此，就您與這些力量合作的程度而言，我們預計不會繼續下去。

Now having said that, I can't imagine any set of circumstances where we will continue it. I don't want to sound doctrinaire on the point and say if there was some reason that made abundant sense to reinstitute another program, we would do it, but we don't see those facts lining up, yet could be in the realm of possibility.

現在話雖如此，我無法想像我們將繼續它的任何情況。我不想在這一點上聽起來教條主義，並說如果有某種理由可以充分說明重新制定另一個計劃，我們會這樣做，但我們看不到這些事實，但可能處於可能性。

Just a little more color with that, Ben. I don't see that as a need, while we talk about it on these calls, as though it's a singular item driving it. There is a large subset of well north of a dozen plus other complementary pieces that also contribute to a lot of the metric improvement. And obviously, we track both hiring turnover satisfaction on a bunch of different layers. And all those things are directionally improving. And so that tells me the program itself has been very beneficial.

本，再多一點顏色。我不認為這是必要的，而我們在這些電話中談論它，就好像它是一個單一的項目驅動它。有十幾個以北的一個很大的子集加上其他補充部分也有助於很多指標改進。顯然，我們在許多不同的層面上跟踪了招聘人員的離職率滿意度。所有這些事情都在定向改善。因此，這告訴我該計劃本身非常有益。

But in the same regard, getting back to a lot of our more normalized pieces, but also making sure there's sufficient time being spent, recognizing, rewarding, celebrating employees, highlighting the mission of why people join hospice, but also what makes VITAS special in that situation is all the real compounding effect that's helping these things in a substantial way and makes it sustainable. That's why I can use the word confidently sustainable on a go-forward basis.

但在同樣的方面，回到我們許多更規範化的部分，但也要確保有足夠的時間用於表彰、獎勵、慶祝員工，強調人們加入臨終關懷的使命，以及 VITAS 的特別之處這種情況是所有真正的複合效應，它以實質性的方式幫助這些事情並使其可持續。這就是為什麼我可以在前進的基礎上自信地使用可持續這個詞。

Thank you. I'm showing no further questions at this time. I'd like to turn the call back over to Kevin McNamara for any closing remarks.

謝謝。我現在沒有進一步的問題。我想將電話轉回給凱文麥克納馬拉，聽取任何結束語。

Well, I just wanted to thank everyone for their kind attention, and we're very comfortable with the results, and we'll get back about 3 months from today and report on what's going on presently. Thank you.

好吧，我只是想感謝大家的關注，我們對結果感到非常滿意，我們將在大約 3 個月後的今天回來報告目前的情況。謝謝。

Thank you. Ladies and gentlemen, this does conclude today's conference. Thank you all for participating. You may now disconnect. Have a great day.

謝謝。女士們，先生們，今天的會議到此結束。謝謝大家的參與。您現在可以斷開連接。祝你有美好的一天。