Community Health Systems Inc (CYH) 2024 Q4 法說會逐字稿

Good day and welcome to the Community Health Systems fourth quarter and full year 2024 earnings conference call. (Operator Instructions) Please note this event is being recorded.

大家好，歡迎參加社區健康系統 2024 年第四季和全年財報電話會議。（操作員指示）請注意，此事件正在被記錄。

I would now like to turn the conference over to Mr. Anton Hie, Vice President of Investor Relations. Please go ahead, sir.

現在，我想將會議交給投資者關係副總裁 Anton Hie 先生。先生，請繼續。

Thank you, Chuck. Good morning, everyone, and welcome to Community Health Systems fourth quarter 2024 conference call. Joining me on today's call are Tim Hingtgen, Chief Executive Officer; Kevin Hammons, President and Chief Financial Officer; and Dr. Miguel Benet, President of Clinical Operations and Chief Medical Officer.

謝謝你，查克。大家早安，歡迎參加社區健康系統 2024 年第四季電話會議。參加今天電話會議的還有執行長 Tim Hingtgen；總裁兼財務長 Kevin Hammons；以及臨床營運總裁兼首席醫療官 Miguel Benet 博士。

Before we begin, I must remind everyone that this conference call may contain certain forward-looking statements, including all statements that do not relate solely to historical or current facts. These forward-looking statements are subject to a number of known and unknown risks, which are described in headings such as risk factors in our annual report on Form 10-K and other reports filed with or furnished to the SEC. Actual results may differ significantly from those expressed in any forward-looking statements in today's discussion. We do not intend to update any of these forward-looking statements.

在我們開始之前，我必須提醒大家，本次電話會議可能包含某些前瞻性陳述，包括所有不完全與歷史或當前事實相關的陳述。這些前瞻性陳述受許多已知和未知風險的影響，這些風險在我們提交給或提供給美國證券交易委員會的 10-K 表年度報告和其它報告中的風險因素等標題下有所描述。實際結果可能與今天討論中的任何前瞻性陳述所表達的結果有很大差異。我們不打算更新任何這些前瞻性陳述。

Yesterday afternoon, we issued a press release with our financial statements and definitions and calculations of adjusted EBITDA and adjusted EPS. We've also posted a supplemental slide presentation on our website. All calculations we will discuss exclude gains from early extinguishment of debt, impairment gains or losses on the sale of businesses, expense from government and other legal matters and related costs, expense from business transformation costs, expense related to employee termination benefits and other restructuring charges and change in estimate for professional claims liability.

昨天下午，我們發布了一份新聞稿，其中包含我們的財務報表以及調整後的 EBITDA 和調整後的 EPS 的定義和計算。我們還在我們的網站上發布了補充幻燈片演示。我們將討論的所有計算均不包括提前償還債務的收益、業務出售的減值收益或損失、政府和其他法律事務的費用及相關成本、業務轉型成本的費用、與員工終止福利和其他重組費用相關的費用以及專業索賠責任估計的變化。

With that said, I will turn the call over to Tim Hingtgen, Chief Executive Officer.

說完這些，我會把電話轉給執行長 Tim Hingtgen。

Thank you, Anton, and thanks, everyone, for joining our fourth quarter earnings conference call. I want to highlight some key performance measures for the full year and later, Kevin will cover results for the quarter. I'll start today with the strong growth we are achieving across our CHS-affiliated health systems resulting in record same store volume levels for the full year 2024 versus prior year, same-store admissions increased 3.2%, same-store adjusted admissions increased 2.7% and same-store surgeries increased 1.3%.

謝謝安東，也謝謝大家參加我們的第四季財報電話會議。我想強調全年的一些關鍵績效指標，稍後 Kevin 將介紹本季的業績。今天，我首先要介紹的是我們在 CHS 附屬醫療系統中實現的強勁增長，這使得 2024 年全年同店交易量與上一年相比創下了歷史新高，同店入院人數增長了 3.2%，同店調整後入院人數增長了 2.7%，同店手術量增長了 1.3%。

Growth like this is enabled by our capital investments, strong capacity management, and the pursuit of strategic value-generating opportunities across our core portfolio. In 2024, that included significant expansion in outpatient access such as primary care, specialty practices and urgent care centers.

這樣的成長得益於我們的資本投資、強大的產能管理以及對核心投資組合中策略價值創造機會的追求。2024 年，這將包括大幅擴大門診服務，例如初級保健、專科診所和緊急護理中心。

In addition to de novo projects, we acquired 10 urgent care clinics and Tucson, Arizona, broadening our geographic footprint and ability to care for more patients in this market. We opened two new freestanding emergency rooms in fast-growing communities, bringing our current count to 19 freestanding EDs across the portfolio.

除了新項目外，我們還收購了 10 家緊急護理診所和亞利桑那州圖森市，擴大了我們的地理覆蓋範圍和在該市場護理更多患者的能力。我們在快速發展的社區開設了兩個新的獨立急診室，使我們目前在整個投資組合中擁有 19 個獨立急診室。

We ended the year with a total of 47 ambulatory surgery centers. Within our markets, we are very well positioned for outpatient surgery. And as a result, same-store ASC cases increased 14% last year. We also completed two major campus expansion projects, including new inpatient bed towers, emergency department and surgical services capacity. These projects have further improved our competitive position in our Knoxville, Tennessee and Baldwin County, Alabama markets and both continue to ramp up nicely.

截至今年底，我們共有 47 個門診手術中心。在我們的市場中，我們在門診手術方面佔據非常有利的地位。結果，去年同店 ASC 案例增加了 14%。我們也完成了兩個主要的校園擴建項目，包括新的住院病床大樓、急診和外科服務能力。這些項目進一步提高了我們在田納西州諾克斯維爾和阿拉巴馬州鮑德溫縣市場的競爭地位，並且兩個市場都繼續保持良好的發展勢頭。

And we invested in procedural capacity such as expanding and upgrading cardiac cath labs and other procedural spaces in several health systems last year. Same store net operating revenues for the year increased 5.5% and adjusted EBITDA for the year improved 6%, which includes the benefit from supplemental state-directed payment programs in the fourth quarter, which Kevin will discuss in more detail later. We also saw improvements in both labor and supplies as a percentage of net revenue.

去年，我們對多個醫療系統的手術能力進行了投資，例如擴建和升級心導管實驗室及其他手術空間。全年同店淨營業收入成長 5.5%，全年調整後 EBITDA 成長 6%，其中包括第四季度來自國家指導補充支付計劃的收益，Kevin 稍後將對此進行詳細討論。我們也看到勞動力和供應佔淨收入的百分比都有改善。

Turning to our portfolio. In 2024, we completed divestitures in Cleveland, Tennessee and Statesboro -- I'm sorry, and in North Carolina. We also plan to finalize other announced divestitures in the first quarter, ShorePoint Health in Florida and Lake Norman Regional Medical Center in North Carolina. And we are in discussions with -- which will likely result in additional strategic divestitures in 2025.

談到我們的投資組合。2024 年，我們完成了在克利夫蘭、田納西州和斯泰茨伯勒——對不起，還有北卡羅來納州——的資產剝離。我們還計劃在第一季完成其他已宣布的資產剝離，包括佛羅裡達州的 ShorePoint Health 和北卡羅來納州的諾曼湖地區醫療中心。我們正在進行討論，這可能會導致 2025 年出現更多的戰略資產剝離。

We anticipate the sale of these assets will generate meaningful proceeds and deleveraging value. While 2024 was a very good year in many regards, it was not without challenges. On our last call, we mentioned the impact of downgrades and denials, which continue to be a troubling trend for healthcare providers. However, that situation has shown some stabilization since the third quarter.

我們預計出售這些資產將產生可觀的收益和去槓桿價值。雖然 2024 年從許多方面來說都是非常好的一年，但也並非沒有挑戰。在我們上次電話會議中，我們提到了降級和拒絕的影響，這對醫療保健提供者來說仍然是一個令人不安的趨勢。不過，自第三季以來，這種情況已有所穩定。

Our utilization management and physician adviser programs are performing as expected as these clinicians advocate for our patients to receive the appropriate care in appropriate settings and as we pursue payment for those services.

我們的利用管理和醫師顧問計劃正在按預期執行，因為這些臨床醫生主張我們的患者在適當的環境中接受適當的護理，並且我們爭取為這些服務付款。

Medical specialist fees and subsidies continue to be a pressure point, particularly in anesthesia services. To mitigate this trend, we have scaled our proven capabilities for managing in-sourced hospital-based services beyond hospitalist and emergency medicine into a growing number of anesthesia programs.

醫療專家的費用和補貼仍然是一個壓力點，特別是在麻醉服務方面。為了緩解這種趨勢，我們已經將管理內部醫院服務的成熟能力從住院醫師和急診醫學擴展到越來越多的麻醉計畫。

In the fourth quarter, for instance, we rapidly in-sourced anesthesiology in one of our larger markets, a move which we are confident will lead to better, more integrated care and services in the most cost-effective manner.

例如，在第四季度，我們在一個較大的市場迅速引入麻醉學，我們相信此舉將以最具成本效益的方式帶來更好、更全面的護理和服務。

We anticipate further expansion of internally managed hospital-based provider services in 2025, which is leading to greater provider satisfaction and stability, positive quality outcomes for our patients and the opportunity for cost savings. This is just one of many strategic initiatives, highlighting how CHS is now a more agile organization, prepared and equipped to rapidly adjust to and overcome macro trends and industry headwinds as they arise.

我們預計，2025 年內部管理的醫院提供者服務將進一步擴大，這將提高提供者的滿意度和穩定性，為我們的患者帶來積極的品質結果，並提供節省成本的機會。這只是眾多策略舉措之一，彰顯了 CHS 現在已成為一個更加敏捷的組織，隨時做好準備並具備能力快速適應和克服出現的宏觀趨勢和行業逆風。

Now I'd like to spend a minute on our clinical achievements in 2024. We are proud of our advancements across many measures, including reductions in risk-adjusted mortality rates and hospital acquired infections and further advancements in patient safety.

現在，我想花一點時間談談我們在 2024 年的臨床成就。我們為在許多方面取得的進步感到自豪，包括降低風險調整死亡率和醫院內感染率以及進一步提高病患安全性。

By the end of 2024, we reached our best ever reduction in the serious safety event rate, down 90% from our baseline in 2013. We also saw notable gains in our patient experience measures. These results are made possible by the skilled and compassionate teams working across our organization.

到 2024 年底，我們的嚴重安全事件發生率將達到有史以來最大的降幅，比 2013 年基線下降 90%。我們也看到患者體驗指標取得了顯著進步。這些成果得益於我們組織內技術精湛、富有同情心的團隊。

Our work to recruit and retain a highly capable workforce continues to yield impressive results. In 2024, overall employee retention was particularly high, and we achieved our best retention rate for registered nurses in the past five years. I want to thank our frontline caregivers and support teams, our local leaders and our corporate teams for all they do every day to ensure quality care for our patients.

我們招募和留住高能力勞動力的工作持續取得令人矚目的成果。2024年，整體員工留任率特別高，我們實現了過去五年來註冊護理師的最佳留任率。我要感謝我們的第一線護理人員和支援團隊、我們當地領導和我們的公司團隊，感謝他們每天為確保為患者提供優質護理所做的一切。

We are proud of our progress throughout 2024. We believe we accomplished what we said we would do and finished the year strong by building momentum that we can carry forward. We look forward to even more progress in 2025.

我們為 2024 年所取得的進步感到自豪。我們相信，我們完成了所承諾的事情，並透過累積力量並繼續前進，圓滿結束了這一年。我們期待 2025 年能有更多進步。

Looking ahead, we expect our investments will continue to produce incremental growth. We are intensely focused on ensuring the availability of access and capacity for all of our services to help our patients get the care they need conveniently and without delay. Numerous initiatives in 2025 are designed to enhance appointment scheduling, care navigation and to help facilitate needed follow-up services, all of which support our patients and can drive additional growth.

展望未來，我們預期我們的投資將繼續實現增量成長。我們高度重視確保所有服務的可用性和容量，以幫助我們的患者方便、及時地獲得所需的照護。2025 年的眾多措施旨在加強預約安排、護理導航並幫助促進所需的後續服務，所有這些措施都為我們的患者提供支持並推動進一步增長。

With our enterprise resource planning platform now fully implemented, we have more insights and data than ever before. These tools can help drive efficiencies, streamline workflows and reduce costs. And this year, we will continue to leverage partnerships and innovation to further advance patient care and support our workforce. As always, we remain dedicated to delivering high-quality health care services for the patients and communities who count on us every day.

隨著我們的企業資源規劃平台全面實施，我們擁有比以往更多的見解和數據。這些工具可以幫助提高效率、簡化工作流程並降低成本。今年，我們將繼續利用合作夥伴關係和創新來進一步提高患者護理水平並支持我們的員工隊伍。像往常一樣，我們將繼續致力於為每天依賴我們的患者和社區提供高品質的醫療服務。

With that, let me turn the call over to Kevin Hammons, who will provide more context about our fourth quarter and 2024 results and guidance for the year ahead. Kevin?

說完這些，讓我將電話轉給凱文·哈蒙斯 (Kevin Hammons)，他將提供有關我們第四季度和 2024 年業績以及未來一年指導的更多背景信息。凱文？

Thank you, Tim, and good morning, everyone. We continue to see strong demand for care in our markets, leading to the best same-store revenue growth of the year, up 6.5% in the fourth quarter on a 3.4% increase in inpatient admissions and 3.1% growth in adjusted admissions. Same-store ED visits were up 1% and surgeries were up 0.9%.

謝謝你，提姆，大家早安。我們繼續看到市場對醫療服務的強勁需求，從而帶來今年最好的同店收入增長，第四季度增長 6.5%，住院入院人數增長 3.4%，調整後入院人數增長 3.1%。同店急診就診量上升了 1%，手術量上升了 0.9%。

In addition to the strong volumes, same-store revenue growth reflects a 3.3% increase in net revenue per adjusted admission, driven by rate growth, including the Medicare inpatient rate update and incremental reimbursement under Medicaid supplemental payment programs, partly offset by lower acuity. Adjusted EBITDA for the fourth quarter was $428 million compared with $386 million in the prior year period. Margin for the quarter was 13.1%, up from 12.1% in the prior year period.

除了強勁的銷售量之外，同店收入增長還反映了每例調整後入院淨收入增長 3.3%，這主要得益於費率增長，包括醫療保險住院費率更新和醫療補助補充支付計劃下的增量報銷，但部分被較低的敏銳度所抵消。第四季調整後 EBITDA 為 4.28 億美元，去年同期為 3.86 億美元。本季利潤率為 13.1%，高於去年同期的 12.1%。

For the full year of 2024, adjusted EBITDA totaled $1.540 billion compared with $1.453 billion in 2023, with margin of 12.2%, an improvement of 60 basis points from the prior year. During the quarter, we recognized an incremental net benefit of approximately $40 million from Medicaid supplemental payment programs versus prior guidance, primarily relating to the approval and recognition of the New Mexico program for the period July 1 through December 31, 2024.

2024 年全年調整後 EBITDA 總計 15.4 億美元，而 2023 年為 14.53 億美元，利潤率為 12.2%，比前一年提高 60 個基點。在本季度，我們從醫療補助補充支付計劃中確認了約 4000 萬美元的增量淨收益，與先前的指引相比，這主要與 2024 年 7 月 1 日至 12 月 31 日期間新墨西哥州計劃的批准和認可有關。

As Tim noted, the impact of payer downgrades and denials has stabilized for us since calling it out in the third quarter, thanks to our ongoing utilization management efforts and physician adviser program. However, we will remain vigilant in our work and advocacy regarding this troubling trend that is affecting all health care providers.

正如蒂姆所指出的，由於我們持續的利用管理工作和醫生顧問計劃，付款人降級和拒絕的影響自第三季度提出以來已經穩定下來。然而，我們將在工作和宣傳中繼續保持警惕，並關注影響所有醫療保健提供者的這一令人不安的趨勢。

Turning to expense management. We were again pleased with our performance on labor costs with average hourly rate up approximately 4.7% year-over-year in the fourth quarter, reflecting an increase in the number of employed physicians and approximately 4% for the full year 2024, consistent with our expectations.

轉向費用管理。我們再次對勞動成本的表現感到滿意，第四季平均時薪年增約 4.7%，反映出受僱醫生數量的增加，2024 年全年平均時薪上漲約 4%，符合我們的預期。

Contract labor spend was $36 million in the fourth quarter, down another $5 million sequentially and bringing the full year 2024 total to $170 million, down an impressive 36% from full year 2023, reflecting our success with recruitment and retention.

第四季的合約勞務支出為 3,600 萬美元，比上一季下降 500 萬美元，使 2024 年全年總額達到 1.7 億美元，比 2023 年全年下降了 36%，這反映了我們在招聘和留用方面的成功。

We also continue to see improvement on supplies expense, which declined 50 basis points year-over-year to 15.5% of net revenues in the fourth quarter and for the full year 2024 declined 60 basis points to 15.4%. This reduction in supplies expense as a percent of net revenue reflects some early wins in our management of supplies as a result of implementing our ERP, increased reimbursement for Medicaid supplemental programs as well as the growth of admissions outpacing our surgical growth for the year.

我們也看到供應費用持續改善，第四季供應費用年減 50 個基點至淨收入的 15.5%，2024 年全年下降 60 個基點至 15.4%。供應費用佔淨收入的百分比減少反映了我們在供應管理方面取得的一些早期成果，這是實施 ERP 的結果，增加了醫療補助補充計劃的報銷金額，以及入院人數的增長超過了我們今年的手術增長速度。

Offsetting these gains during the fourth quarter, we experienced a somewhat sharper increase in medical specialist fees versus expectations and an acceleration from the prior -- previous three quarters. Specifically, medical specialist fees exceeded expectations, increasing approximately $20 million on a same-store basis or approximately 12% year-over-year to $170 million in the fourth quarter and for the full year totaled $640 million, up 10.9% on a same-store basis from 2023.

在第四季度，為了抵銷這些收益，我們經歷了醫療專家費用較預期略有大幅成長，且較前三個季度有所加速。具體而言，醫療專家費用超出預期，第四季同店成長約 2,000 萬美元，年增約 12%，至 1.7 億美元，全年總計 6.4 億美元，比 2023 年同店成長 10.9%。

As Tim noted, we rapidly brought anesthesia care in-house in one of our larger markets and also took over operations when a regional contractor began experiencing severe financial distress, both of which we view as strategic investments that will lead to better results and visibility over the longer term, despite the upfront costs and short-term margin dilution.

正如蒂姆所說，我們迅速在我們較大的市場之一內部引入麻醉護理，並在一個區域承包商開始遭遇嚴重財務困境時接管了業務，儘管前期成本較高且短期利潤率會被稀釋，但我們認為這兩項投資都是戰略投資，將在長期內帶來更好的業績和可見性。

While we have made good progress with our in-sourcing initiatives, we anticipate further pressure in medical specialist fees over the near term. In 2025, we anticipate these costs to grow in excess of typical inflationary trends, but still well below the spikes that we saw in 2022 and 2023.

雖然我們的內部採購計畫取得了良好進展，但我們預計短期內醫療專家費用將面臨進一步的壓力。到 2025 年，我們預計這些成本的成長將超過典型的通膨趨勢，但仍遠低於 2022 年和 2023 年的高峰。

Cash flows from operations were $216 million for the fourth quarter, up from $90 million in the fourth quarter of 2023 and $480 million for the full year of 2024 which was consistent with our guidance for $400 million to $500 million and up from the $210 million in 2023. This year-over-year growth in cash flow primarily reflects higher adjusted EBITDA, a reduction in cash interest and improvements in working capital, including the conversion of accounts receivable. For the full year 2024, we deployed $360 million on capital expenditures, in line with our guidance and down from $460 million in 2023.

第四季的 9,000 萬美元，高於 2024 年全年的 4.8 億美元，這與我們預期的 4 億至 5 億美元一致，高於 2023 年的 2.1 億美元。現金流量年增率主要反映了調整後 EBITDA 的提高、現金利息的減少以及營運資本的改善（包括應收帳款的轉換）。2024 年全年，我們將部署 3.6 億美元的資本支出，符合我們的預期，低於 2023 年的 4.6 億美元。

Transitioning to divestitures during the fourth quarter, we completed one small divestiture of Davis Regional Medical Center in Statesville, North Carolina and announced agreements to divest our other remaining North Carolina facility, Lake Norman Regional Medical Center in Mooresville as well as the ShorePoint Health System in Florida.

在第四季度轉向資產剝離的過程中，我們完成了對北卡羅來納州斯泰茨維爾戴維斯地區醫療中心的小規模剝離，並宣布了剝離我們在北卡羅來納州剩餘的其他醫療設施、摩爾斯維爾的諾曼湖地區醫療中心以及佛羅裡達州的 ShorePoint 醫療系統的協議。

We anticipate both of these transactions will close in the first quarter of 2025, providing nearly $550 million in gross proceeds. These transactions reflect attractive double-digit multiples on trailing EBITDA, leading to further deleveraging. In addition to these previously announced transactions, we continue to advance discussions on additional divestitures that we expect to announce in the near future, also at very attractive multiples.

我們預計這兩筆交易將於 2025 年第一季完成，總收益近 5.5 億美元。這些交易反映了具有吸引力的兩位數的過去 EBITDA 倍數，從而進一步去槓桿化。除了這些先前宣布的交易之外，我們還在繼續推進有關其他資產剝離的討論，我們預計將在不久的將來宣布這些資產剝離，而且估值倍數也非常吸引人。

All told, these pending and expected transactions should generate more than $1 billion in total proceeds, which we expect to lead to meaningful deleveraging and increased shareholder value. At year-end, net debt to trailing adjusted EBITDA was 7.4 times, improved from 7.6 times in the prior quarter and 7.9 times at the end of 2023.

總而言之，這些待定和預期交易應產生超過 10 億美元的總收益，我們預計這將帶來有意義的去槓桿化和股東價值的提高。截至年底，淨債務與調整後 EBITDA 的比率為 7.4 倍，高於上一季的 7.6 倍和 2023 年底的 7.9 倍。

We continue to believe we have more than adequate liquidity to meet our needs going forward with approximately $500 million of borrowing capacity under our ABL, along with available working capital and pending asset sale proceeds. We look forward to providing additional details on these transactions as they become available. Finishing up 2024, we completed the implementation of our new ERP and workflows under Project Empower as scheduled.

我們仍然相信，我們擁有足夠的流動資金來滿足我們未來的需求，我們的 ABL 擁有約 5 億美元的借貸能力，以及可用的營運資金和待定的資產出售收益。我們期待在這些交易公佈後提供更多詳細資訊。到 2024 年，我們按計畫完成了 Project Empower 下新 ERP 和工作流程的實施。

The final phase, which involves transitioning on to new workforce management tools for HR, payroll and timekeeping allows us to move beyond the investment and implementation phases and begin focusing on optimizing our use of the new tools and realizing tangible benefits throughout the remainder of 2025. We estimate that as a result of this work, we will save between $40 million and $60 million this coming year.

最後階段涉及過渡到人力資源、工資和計時等新的勞動力管理工具，這使我們能夠超越投資和實施階段，並開始專注於優化我們對新工具的使用並在 2025 年剩餘時間內實現實際利益。我們估計，透過進行這項工作，我們明年將節省 4,000 萬至 6,000 萬美元。

Moving on to our initial guidance for 2025. We anticipate net revenue of $12.2 billion to $12.6 billion, adjusted EBITDA of $1.450 billion to $1.600 billion; cash flow from operations of $600 million to $700 million and capital expenditures of $350 million to $400 million. Our guidance does not include directed payment program reimbursement for New Mexico or Tennessee as those programs have not yet been approved by CMS for 2025.

繼續我們對 2025 年的初步指導。我們預計淨收入為 122 億美元至 126 億美元，調整後 EBITDA 為 14.5 億美元至 16 億美元；經營活動現金流為 6 億至 7 億美元，資本支出為 3.5 億至 4 億美元。我們的指導不包括新墨西哥州或田納西州的定向支付計劃報銷，因為這些計劃尚未獲得 CMS 2025 年的批准。

If those programs get approved for 2025, we believe it will add an incremental $100 million to $125 million to our annual guided run rate of EBITDA. Likewise, we have not considered in our guidance any additional divestitures beyond those that have already been announced. If completed, any such transactions would reduce net revenues and EBITDA in 2025, the amount of which is dependent on timing of completion, but would also allow further reductions in our leverage and would therefore be accretive to our equity value.

如果這些計劃在 2025 年獲得批准，我們相信它將為我們的年度 EBITDA 指導運行率增加 1 億至 1.25 億美元。同樣，除了已經宣布的資產剝離之外，我們也沒有在我們的指導中考慮任何其他資產剝離。如果完成，任何此類交易都會減少 2025 年的淨收入和 EBITDA，具體金額取決於完成時間，但也將進一步降低我們的槓桿率，從而增加我們的股權價值。

This concludes our prepared remarks. So at this time, we will turn the call back over to the operator for Q&A.

我們的準備好的演講到此結束。因此此時，我們將把電話轉回給接線生進行問答。

(Operator Instructions)

（操作員指令）

Brian Tanquilut, Jefferies.

傑富瑞 (Jefferies) 的 Brian Tanquilut。

Hey, good morning guys, and congrats on the quarter. Maybe, Kevin, my first question for you. As I think about the guidance for 2025, maybe if you can just help us bridge '24 to '25. I know there's so many moving pieces here. And then if there are any specific call-outs for one-timers that we need to consider maybe for Q1?

嘿，大家早上好，恭喜本季取得佳績。也許，凱文，這是我要問你的第一個問題。當我思考 2025 年的指導方針時，也許您能幫助我們從 2024 年到 2025 年跨越。我知道這裡有很多活動的東西。那麼，是否有任何針對一次性事件的特定呼叫，我們可能需要考慮 Q1？

Sure. Thanks, Brian. I appreciate it. So as I mentioned, the guidance does not include Tennessee and New Mexico DPP and only includes the announced divestitures. So maybe to do a high-level bridge, starting with EBITDA, where we finished up 2024 at $1.540 billion. I think we could take out approximately $40 million of DPP funds that were recognized in 2024 in the fourth quarter. That was the New Mexico piece.

當然。謝謝，布萊恩。我很感激。正如我所提到的，該指南不包括田納西州和新墨西哥州的 DPP，僅包括已宣布的資產剝離。因此，也許可以建立一個高水準的橋樑，從 EBITDA 開始，到 2024 年，我們的 EBITDA 達到 15.4 億美元。我認為我們可以在第四季度提取 2024 年確認的約 4000 萬美元 DPP 資金。那是新墨西哥州的作品。

Take out $50 million to $60 million related to the announced divestitures as we go in, so roughly, call it, $100 million reduction, add in organic growth of $75 million to $100 million in 2025, and that gets you back to a midpoint of our guide of about $1.525 billion.

扣除與宣布的資產剝離相關的 5000 萬至 6000 萬美元，粗略地說，減少 1 億美元，加上 2025 年 7500 萬至 1 億美元的有機增長，就回到我們指南的中間值，即約 15.25 億美元。

So even without the DPP, at that midpoint, it would still be deleveraging given that we have about $550 million of proceeds coming in related to those divestitures. And then factoring in if or when Tennessee and New Mexico get approved, and we do fully expect them to get approved, that would add an additional $100 million to $125 million to that annual run rate of EBITDA.

因此，即使沒有 DPP，在那個中間點，考慮到我們有大約 5.5 億美元的收益來自這些資產剝離，它仍然會去槓桿。然後考慮到田納西州和新墨西哥州是否獲得批准，我們確實完全預期它們會獲得批准，這將使 EBITDA 的年運行率增加 1 億至 1.25 億美元。

Got you. Okay. That makes sense. And then maybe, Tim, as I think about some of the things that you've done in 2024, you're still looking to do some divestitures here, but you've also added some urgent care locations. Just curious how we should be thinking about where you stand today on kind of the strategic moves that you still want to do. And I know you mentioned that you've got a couple of deals here in the pipeline. But once we get past that, I mean, how should we be thinking about kind of like the moves that we should expect out of you guys?

明白了。好的。這很有道理。然後也許，提姆，當我想到你在 2024 年所做的一些事情時，你仍然希望在這裡進行一些資產剝離，但你也增加了一些緊急護理地點。我只是好奇我們應該如何看待您目前的立場以及您仍然想採取的策略舉措。我知道您曾提過您正在籌備幾筆交易。但是一旦我們克服了這一點，我的意思是，我們該如何思考我們應該對你們的舉動抱持怎樣的期望？

Sure. Thanks, Brian. I'm happy to shed some color on that. Obviously, we're pleased with our ability to invest in and grow the core portfolio. We've been speaking to our investable opportunities for the last several years, and it's always good to see that pull through in terms of the volume and earnings progression.

當然。謝謝，布萊恩。我很高興能夠對此作出一些解釋。顯然，我們對投資和發展核心投資組合的能力感到滿意。過去幾年來，我們一直在談論可投資的機會，很高興看到這些機會在交易量和獲利成長方面取得進展。

I think we've called this out in a number of occasions, but it's a smaller portfolio generating roughly a similar amount of net revenue as three or four years ago. So we know that our investments are yielding the intended outcomes, caring for more patients and driving that type of growth.

我想我們已經多次提到這一點，但這是一個較小的投資組合，產生的淨收入與三、四年前大致相同。因此，我們知道我們的投資正在產生預期的結果，照顧更多的患者並推動這種成長。

Now in terms of where we go next, we still have some runway left on, obviously, some past capital investments, particularly around our expansion projects. I called out that they're ramping up nicely. But by any stretch of the imagination, we built them for further growth capabilities in the quarters ahead.

現在就我們下一步的目標而言，我們仍然有一些剩餘的空間，顯然是一些過去的資本投資，特別是圍繞我們的擴張項目。我大聲喊道，他們正在順利地進步。但無論如何，我們建造它們都是為了在未來幾季實現進一步的成長能力。

Also, we've also talked extensively about where we're investing our capital dollars, and it goes beyond just inpatient capacity and procedural capacity on our campuses. They're really driving that access point strategy. So we have a pipeline of incremental ASC expansions or de novo projects underway. We also have more freestanding ED projects in flight, some of them going through certificate of need processes. So we still see a good portion of the portfolio still having investable opportunities for more organic growth.

此外，我們還廣泛討論了我們的資本投資方向，這不僅限於我們校園的住院容量和程序容量。他們確實在推動該接入點策略。因此，我們目前正在進行一系列增量 ASC 擴展或從頭開始專案。我們還有更多的獨立 ED 專案正在進行中，其中一些專案正在經歷需要證明的流程。因此，我們仍然看到很大一部分投資組合仍有可投資的機會，實現更多有機成長。

In terms of the post-acute and behavioral health side of the business, we think we've done a nice job of growing that side of the business. We believe there's also more expansion opportunities and growth opportunities in that regard.

就業務的急性後和行為健康方面而言，我們認為我們在發展該業務方面做得很好。我們相信這方面還有更多的擴張機會和成長機會。

And then the last thing I'll put out there, again, speaking to where we have insights into the business, beyond just the ERP implementation, seeing where we can better manage the business for the last, I'd say, seven or eight years, we've leveraged the transfer center rather extensively to always help us identify new opportunities for service line expansion.

最後我要說的是，再次談談我們對業務的見解，除了 ERP 實施之外，我們還在了解如何在過去的七、八年中更好地管理業務，我們相當廣泛地利用了轉移中心來幫助我們發現服務線擴展的新機會。

We continue to see in the majority of our transfer center markets, the ability to expand our service areas by taking in patients from further out as we add those specialties. So we don't believe we've reached the end of that road either. So again, a lot of growth opportunities on an organic basis.

我們繼續看到，在大多數轉診中心市場中，隨著我們增加這些專業，我們有能力透過接收更遠地方的患者來擴大我們的服務區域。所以我們也不相信我們已經走到了這條路的盡頭。因此，再一次強調，有機基礎上存在著許多成長機會。

Tim, maybe if I might follow up, just as I think about your mid-teens EBITDA margin guidance and you did 13%-ish coming out of Q4. So putting all the things that you mentioned together and then maybe considering medical specialist fees, what's that line of sight like? And what will it take for you to hit that mid-teens target number?

提姆，也許我可以跟進一下，正如我所想的那樣，你的 EBITDA 利潤率預計在十幾歲，而你在第四季度的利潤率達到了 13% 左右。那麼，將您提到的所有因素放在一起，然後再考慮醫療專家的費用，視線是什麼樣的？那麼，您需要怎麼做才能達到十幾歲的目標數字呢？

I'll let Kevin start with the answer kind of where we pegged that midterm guidance. I'll add a few things at the end, which I think tie back to my comments.

我會讓凱文先回答我們對中期指導的看法。最後我將補充一些內容，我認為這些內容與我的評論有關。

Sure. There's a couple of things. We've had a little bit of drag with some medical specialist fees, which we -- even though we do believe they're continuing to increase, we are getting some stabilization. Our work with ERP and getting that project completed, which has also been a little bit of a drag on us, but should turn into a tailwind. And with the functionality and the work and visibility we have and improving decision support, we think we can take out some material costs.

當然。有幾件事。我們在一些醫療專家費用方面遇到了一些阻力，儘管我們確實認為這些費用會繼續上漲，但我們正在逐漸穩定下來。我們的 ERP 工作以及專案的完成，也為我們帶來了一些拖累，但應該會變成順風。而且，憑藉我們現有的功能、工作和可視性以及不斷改進的決策支持，我們認為我們可以節省一些材料成本。

We've made some -- what we believe to be really good investments in capital growth projects. And then we continue to believe we can get some leverage on both acuity and payer mix as some of our markets grow.

我們已經做了一些——我們認為是對資本成長項目真正好的投資。然後，我們繼續相信，隨著某些市場的成長，我們可以在敏銳度和付款人組合方面獲得一些優勢。

Yeah. And I would layer on to that opportunities for margin expansion, obviously, over the next couple of years, hopefully, with some moderation in inflation and continued strengthening in payer mix and rates on the commercial side of the business. Obviously, there's some risk embedded with the governmental programs. But in general, targeting the payer mix through our access point strategy has worked out really well for us.

是的。顯然，我會在未來幾年中抓住這些機會來擴大利潤率，希望通貨膨脹能夠有所緩和，商業業務的付款人結構和利率能夠繼續加強。顯然，政府計劃中存在一些風險。但總體而言，透過我們的接入點策略來定位付款人組合對我們來說確實非常有效。

We also see some opportunities, as I said, to ramp up these projects and improve our fixed cost leverage. So I think that will pull through in terms of hitting that midterm target as well.

正如我所說，我們也看到了一些機會，可以加強這些項目並提高我們的固定成本槓桿。所以我認為從實現中期目標的角度來看這也將取得成功。

Maybe the last point I'd make is as we continue to de-lever and have opportunities for deleveraging, we are getting to positive free cash flow, able to get our debt down and lower our cash interest, even if we aren't at those mid-teen margins, being positive on all those other things will generate sufficient cash flow and sufficient EBITDA to continue to progress and make the investments that we need.

也許我要說的最後一點是，隨著我們繼續去槓桿，並有去槓桿的機會，我們將獲得正的自由現金流，能夠減少債務並降低現金利息，即使我們的利潤率沒有達到中等水平，在所有其他方面保持積極態度將產生足夠的現金流和足夠的 EBITDA，以繼續取得進展並進行我們所需的投資。

Awesome. Thank you, guys.

驚人的。謝謝你們。

Thank you.

謝謝。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Great, thank you guys very much. I just wanted to follow up on some of your thoughts on DPP. First of all, in 4Q, the $40 million of New Mexico DPP that you recognized, just wanted -- it seems to be it was about twice what you had expected. Does that reflect just conservatism around this program initially versus your expectations? Or was there something structurally that changed that drove that outperformance?

太好了，非常感謝你們。我只是想了解你對 DPP 的一些想法。首先，在第四季度，您承認的新墨西哥州 DPP 的 4000 萬美元，只是想要——這似乎是您預期的兩倍。這是否反映出該計劃最初與您的預期相反，只是採取了保守態度？還是某種結構性變化推動了這種優異表現？

And then just secondly, the exclusion of DPP in guidance suggests a more cautious stance than what we heard back in October, clearly. I just wanted to get your latest thoughts on your assessment of the risk of these programs and how you're thinking about them under the new administration. Thanks.

其次，指導意見中排除 DPP 顯然表明了比我們 10 月聽到的更謹慎的立場。我只是想了解您對這些專案風險的評估的最新想法，以及您對新政府領導下這些專案的看法。謝謝。

Sure. Thanks, Ben. We did not include the New Mexico or Tennessee programs in our guidance in 2024. So although we've been working closely with the state, and following very closely with that program, we weren't sure of the timing of approval. So we did not include it in the guidance. It was approved, I believe, in December. So we were able to recognize and we recognize the period from July 1 through December. So two quarters worth recognized all in the fourth quarter.

當然。謝謝，本。我們沒有將新墨西哥州或田納西州的計畫納入 2024 年的指導範圍內。因此，儘管我們一直與州政府密切合作並密切關注該計劃，但我們不確定批准時間。所以我們沒有將其納入指導中。我相信它已於 12 月獲得批准。所以我們能夠識別並認識到從 7 月 1 日到 12 月的時期。因此兩季的價值全部在第四季得到確認。

I think kind of at the end of the day, what we had provided on an outlook back after the third quarter was those two states combined, we believe, should contribute about $100 million to $125 million to an annual run rate of EBITDA. We still believe that that's the right number. So it's in line. New Mexico is really in line with our expectations around that. But we just did not have it in the guidance for 4Q because of timing and uncertainty around the approval process.

我認為，歸根結底，我們在第三季後的展望中提供的是，我們認為這兩個州合計應為年 EBITDA 貢獻約 1 億至 1.25 億美元。我們仍然相信這是正確的數字。因此這是符合的。新墨西哥州確實符合我們的期望。但由於時間原因以及審批流程的不確定性，我們在第四季的指引中並沒有提到這一點。

Going forward, again, we do expect those programs to get approved, New Mexico, which is basically a renewal and then Tennessee to get approved here right now, as I understand, there's a freeze on communications from CMS until we get confirmation of the Secretary and leadership there. But that should be coming hopefully soon. And we don't see that there is probably going to be a big headwind.

展望未來，我們確實預計這些項目將獲得批准，新墨西哥州基本上是一次續簽，然後田納西州也將獲得批准，據我了解，目前 CMS 的通訊處於凍結狀態，直到我們得到那裡部長和領導層的確認。但希望這很快就會實現。我們認為可能不會出現太大的阻力。

We believe these programs will continue relatively in their current form going forward. They've been successful programs, many states -- actually, there's been bipartisan support in both red states and blue states. And if I think about the current administration and where some of these programs are used to a high degree in states like Texas and Florida and more recently, Mississippi, Tennessee also being a red state that has applied for one, I don't see that they will not be approved going forward.

我們相信這些項目未來將以相對目前的形式繼續下去。這些計劃在許多州都取得了成功——實際上，紅州和藍州都獲得了兩黨的支持。如果我考慮到目前的政府以及這些項目在德克薩斯州和佛羅裡達州等州得到廣泛應用的情況，以及最近密西西比州和田納西州作為申請該項目的紅州的情況，我認為這些項目在未來一定會獲得批准。

Yeah. And Ben, I'll add on to that. I think Kevin is spot on. Obviously, Medicaid has traditionally been an underfunded payer source for us. So these programs are critically important to sustain the level of services to the Medicaid population. And irrespective of whether it's a red state or a blue state, giving people coverage and access to health care is such a critical issue for their well-being, but also just from, I guess, I'll say, from a political agenda as well, making sure that we're not taking things away from people that are so important to them, especially as we transition to the new administration.

是的。本，我會補充一點。我認為凱文說得對。顯然，醫療補助傳統上一直是我們資金不足的支付來源。因此，這些計畫對於維持醫療補助人口的服務水準至關重要。無論是紅州還是藍州，為人們提供保障和獲得醫療保健都是對他們福祉至關重要的問題，但從政治議程來看，我們要確保我們不會從那些對他們如此重要的人手中奪走東西，特別是在新政府過渡期間。

I do think in terms of the programs that we're doing a lot of work around lobbying activities, obviously, making sure that the reason why these programs are important is clearly understood by our elected officials. And as Kevin said, we've had broad support in our discussions with many of them to get these programs adjusted or modified to strengthen the access to health care in their communities. So we hope that bodes well for us going forward in terms of the durability of the supplemental programs.

我確實認為，就這些計劃而言，我們在遊說活動方面做了很多工作，顯然是為了確保我們的民選官員清楚地理解這些計劃的重要性。正如凱文所說，我們在與許多人的討論中得到了廣泛支持，要求調整或修改這些計劃，以加強他們社區獲得醫療保健的機會。因此，我們希望這對我們補充計劃的持久性來說是一個好兆頭。

Thank you very much.

非常感謝。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

Please go ahead.

請繼續。

Hi, everybody. Thanks, for the question. On the organic growth of $75 million to $100 million, as part of the bridge you talked about earlier. Do you mind just giving us some sense of what you're thinking of for same-store revenues, same-store volume, same-store margins perhaps. I know you've got a slight uptick in the overall margin, but I don't think that teases out what the same-store number is. I apologize if I missed it. But just some metrics around what you think the underlying same-store portfolio is doing.

大家好。謝謝你的提問。關於從 7500 萬美元到 1 億美元的有機增長，這是您之前談到的橋樑的一部分。您介意告訴我們您對同店營收、同店銷售、同店利潤率的看法嗎？我知道整體利潤率略有上升，但我認為這並不能說明同店銷售額到底是多少。如果我錯過了，我深感抱歉。但這只是圍繞著您認為底層同店投資組合表現的一些指標。

Sure. Thanks, A.J. So in terms of kind of volume, we're looking at 2% to 3% volume growth in 2025, similar in pricing, so you can think about net revenue growing in the mid-single-digit area contributing. Margin-wise, slight increase in same-store margin is more of that organic growth we would expect to flow through to the bottom line.

當然。謝謝，A.J.因此從銷售量來看，我們預計 2025 年銷售量將成長 2% 至 3%，定價也類似，因此您可以認為淨收入將成長到中等個位數。從利潤率來看，同店利潤率的輕微增長更多的是我們預計將流入底線的有機增長。

In terms of some inflationary trends, we're thinking about something in the neighborhood of 3.75% on salaries and wages. That's a little bit less than 2024, but still not back to where we had previously thought. Something probably in the 3% range on most other expenses from an inflationary trend. With the exception of medical specialist fees, we're probably looking at -- and we've budgeted for an increase in the 8% to 12% range on medical specialist fees. It was up 12% this year -- or I'm sorry, 10.9% for the full year. And so we're kind of budgeting in that 8% to 12%.

就一些通膨趨勢而言，我們考慮工資和薪金的通膨率約為 3.75%。這比 2024 年略少，但仍未回到我們之前認為的水平。由於通膨趨勢，大多數其他支出的通膨率可能在 3% 左右。除醫療專家費用外，我們可能正在考慮——並且我們預算將醫療專家費用增加 8% 至 12%。今年上漲了 12% —— 或者抱歉，全年上漲了 10.9%。所以我們的預算大概在 8% 到 12% 之間。

And then on ERP, to help offset some of those inflationary increases, we're looking at some offsetting savings as a result of our ERP work and now having that fully implemented in the $40 million to $60 million range.

然後是 ERP，為了幫助抵消部分通貨膨脹的成長，我們正在考慮透過 ERP 工作來抵消一些通貨膨脹帶來的節約，現在 ERP 已經全面實施，節省的資金在 4,000 萬至 6,000 萬美元之間。

Okay. No, that's helpful. And then just not to belabor the DPP program questions, but some of your peers felt like Tennessee got approved at least for the six month stub in '24. It doesn't sound like you booked any of that either in '24 or in your guidance for '25. Can you comment on that?

好的。不，這很有幫助。然後，我們不再贅述 DPP 計劃的問題，但您的一些同行認為田納西州至少在 1924 年獲得了六個月的批准。聽起來你在24年或25年的指導中都沒有預定任何這些。您能對此發表評論嗎？

And then also, I know for some time, you're one that has some major states that have not yet adopted DPP programs or at least have not upgraded DPP programs to the extent that they might. And specifically, people typically call out Alabama, Indiana and Arkansas. Any update on where those stand at this point?

而且我也知道，一段時間以來，你們的一些主要州還沒有採用 DPP 計劃，或者至少還沒有將 DPP 計劃升級到可能的程度。具體來說，人們通常會提到阿拉巴馬州、印第安納州和阿肯色州。目前這些情況還有更新嗎？

Yes. I can give you an update on those. So Tennessee, in January, we did get word that the program in Tennessee was approved, at least the structure of the program, but the funding for Tennessee's DPP program has not yet been approved. So we're just being prudent and conservative in our guidance without the funding being approved and the freeze on communications coming out of Washington or out of CMS, we decided not to put that in our guidance. But again, fully expect that, that funding does get approved.

是的。我可以向你通報最新情況。因此，在一月份，我們確實得到消息說，田納西州的計劃已獲批准，至少是計劃結構已獲批准，但田納西州 DPP 計劃的資金尚未獲得批准。因此，我們在指導方面只是採取謹慎和保守的態度，在沒有獲得資金批准以及華盛頓或 CMS 的通訊凍結的情況下，我們決定不將其納入我們的指導中。但再次強調，我完全有理由相信，這筆資金確實能夠獲得批准。

Tennessee, the TennCare program was a block grant program. So I think there was an additional level of approval that was needed or a waiver for that going forward, and we're just waiting on that final step.

田納西州的TennCare計劃是一項整體撥款計劃。因此，我認為需要額外一級的批准或豁免，我們只是在等待最後一步。

In terms of additional states, we do have some pretty meaningful states, Indiana, Tennessee and Arkansas and Alaska, which do not have programs, do not have DPP programs or at least not fully implemented. Indiana is probably the farthest along, although no certainty of where that ends up. We do know that the state legislature is considering it. They're in session right now, and there's a plan that's been presented for them for approval. So that is farthest along. We are in discussions in Alabama and Arkansas.

就其他州而言，我們確實有一些相當有意義的州，印第安納州、田納西州、阿肯色州和阿拉斯加州，這些州沒有計劃，沒有 DPP 計劃或至少沒有完全實施。印第安納州可能是走得最快的，儘管還不確定最終結果會如何。我們確實知道州立法機構正在考慮此事。他們現在正在開會，並且已經提交了一份計劃供他們批准。這是最遠的。我們正在阿拉巴馬州和阿肯色州進行討論。

I would say that they're a little farther behind or maybe said differently, they're at the earlier stages of considering and developing plans in those states, but all of those states have certainly expressed interest in taking a look at these programs and looking for additional Medicaid funding through these.

我想說的是，他們稍微落後了一點，或者換句話說，他們正處於這些州考慮和製定計劃的早期階段，但所有這些州都明確表示有興趣研究這些計劃，並尋求通過這些計劃獲得額外的醫療補助資金。

We view these programs really as just part of Medicaid funding. Overall, we typically consider Medicaid or delivery of Medicaid business at a loss. These programs help bridge that gap as part of the reimbursement for Medicaid. And I know the states are looking for some additional money. So we would expect some potential there, but Alabama and Arkansas probably not in 2025, that's probably a 2026 is the earliest.

我們認為這些項目其實只是醫療補助資金的一部分。整體而言，我們通常認為醫療補助或醫療補助業務的提供是虧損的。這些計劃作為醫療補助報銷的一部分，有助於彌補這一差距。我知道各州正在尋求一些額外的資金。因此，我們預計那裡會有一些潛力，但阿拉巴馬州和阿肯色州可能不會在 2025 年出現，最早也要到 2026 年。

Okay, thanks a lot.

好的，非常感謝。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. It looks like you're forecasting operating cash flow to improve $150 million to $200 million in 2025 on a lower EBITDA base. So hoping you could flesh out the drivers of that better conversion? And then as a follow-up, to the extent that there's an incremental $100 million plus from the state-directed payment programs, would that all drop through to operating cash flow? Thanks.

嗨，早安。看起來您預測在較低的 EBITDA 基數上，2025 年營運現金流將增加 1.5 億至 2 億美元。所以希望你能充實出更好轉變的驅動因素嗎？然後作為後續問題，如果從國家指導支付計劃中獲得 1 億美元以上的增量，這些資金是否都會轉移到營運現金流？謝謝。

Sure, Andrew. Thanks for the question. So there are a couple of moving parts on the cash flows. So the New Mexico DPP program that we did recognize in 2024, that was in the fourth quarter, that $40 million roughly would be paid in cash received in 2025. So that's a nice carryover and would contribute to the cash.

當然，安德魯。謝謝你的提問。因此，現金流中存在一些變動因素。因此，我們確實在 2024 年（也就是第四季度）確認的新墨西哥州 DPP 計劃中，大約 4000 萬美元將以現金形式在 2025 年支付。所以這是一個很好的結轉並且會增加現金。

Also, as we wrapped up our implementation of our ERP conversion, that has been a drag on cash flows for us. Although we've been backing out the income statement impact or at least a portion of the income statement impact of that program from adjusted EBITDA, we've not backed out the cash component of that from cash flows. So I think that also contributes to some improved cash flow generation in 2025. Another positive impact is we've gotten word that our tax refund is being processed by the IRS. This is the tax refund that we've been waiting on for a number of years.

此外，當我們完成 ERP 轉換實施時，這對我們的現金流量造成了拖累。雖然我們一直在從調整後的 EBITDA 中抵銷該計劃對損益表的影響或至少部分損益表的影響，但我們尚未從現金流量中抵銷其中的現金部分。所以我認為這也有助於 2025 年現金流的增加。另一個正面的影響是，我們得到消息說我們的退稅正在由國稅局處理。這是我們多年來一直等待的退稅。

So we would expect roughly $70 million to $75 million of cash coming in on that. Those will be offset. We will have higher cash interest payments in 2025, primarily related to the timing of cash interest payments, particularly around the refinancing, which we did refinance some debt this past year at a higher interest rate, but just the timing of payments will cause cash interest to increase about $40 million in 2025. So that will be offsetting.

因此我們預計該業務的現金流入約為 7,000 萬至 7,500 萬美元。這些將被抵消。2025 年我們的現金利息支付將更高，這主要與現金利息支付的時間有關，特別是在再融資期間，去年我們確實以更高的利率對一些債務進行了再融資，但僅支付時間就將導致現金利息在 2025 年增加約 4,000 萬美元。這樣就可以產生抵銷作用。

Got it. That's helpful. And then just to clarify a point on the state-directed payments. I think you called out $100 million to $125 million in incremental annual benefit from Tennessee and New Mexico. That doesn't include the retro Tennessee piece. Is that correct?

知道了。這很有幫助。然後只是想澄清關於國家指導支付的一點。我認為您所說的田納西州和新墨西哥州每年的增量收益為 1 億至 1.25 億美元。這還不包括田納西州的復古作品。那正確嗎？

That is correct. That does not include the retro Tennessee piece. So that would be an addition. And those programs will accrue to our cash flow, will flow through EBITDA and cash flow as well in '24.

正確。這還不包括田納西州的復古作品。所以這將是一個補充。這些項目將累計到我們的現金流中，並將在24年流入EBITDA和現金流。

Great. Thanks for the color.

偉大的。謝謝你的顏色。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

This is Mitchell on for Steve. I wanted to see if you could quantify the continued hurricane impact in Q4? And do you expect volumes to fully recover in 2025? Thanks.

米切爾代替史蒂夫上場。我想看看您是否可以量化第四季颶風的持續影響？您預計 2025 年銷售量會完全恢復嗎？謝謝。

Sure. How are your today? We had -- as we indicated in our guide for Q4, we expected about a $10 million impact from the hurricane. It was as expected and really didn't see any additional impact. We have one hospital that continues to be shut down as a result of that hurricane.

當然。你今天好嗎？正如我們在第四季度指南中所指出的，我們預計颶風將造成約 1000 萬美元的影響。這與預期一致，確實沒有看到任何額外的影響。我們有一家醫院因颶風而繼續關閉。

It was shut down for the entire quarter and into Q1. The assets that were impacted by the hurricane, ShorePoint Health System are assets that we are being sold. Those were -- that deal was announced, and we expect that deal to close here in the first quarter. So we do not expect any ongoing impact since those assets will be gone.

整個季度以及第一季都處於關閉狀態。受到颶風影響的資產，ShorePoint Health System 是我們正在出售的資產。這些是 - 該交易已經宣布，我們預計該交易將在第一季完成。因此，我們預計這些資產將消失，因此不會產生任何持續影響。

Great. Thank you.

偉大的。謝謝。

(Operator Instructions)

（操作員指令）

Josh Raskin, Nephron Research.

喬希‧拉斯金 (Josh Raskin)，腎元研究公司。

Hi Thanks. Good morning.

嗨，謝謝。早安.

It seems that our questioner has disconnected.

看來我們的提問者已經斷線了。

This leaves no questions in the question queue. I would like to turn the conference back over to Mr. Tim Hingtgen for any closing remarks.

這樣問題隊列中就不會再留下任何問題。我想將會議交還給 Tim Hingtgen 先生，請他作最後發言。

Great. Thank you, Chuck, and thanks to all of you for joining our call today. As always, if you have additional questions, you can reach us at 615-465-7000. Thanks again, and have a great day.

偉大的。謝謝你，查克，也謝謝大家今天參加我們的電話會議。像往常一樣，如果您還有其他問題，可以撥打615-465-7000聯絡我們。再次感謝，祝您有愉快的一天。

The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.

會議現已結束。感謝您參加今天的演講。您現在可以斷開連線。