Community Health Systems Inc (CYH) 2025 Q2 法說會逐字稿

Good day, and welcome to the Community Health System's second quarter 2025 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 2025 年第二季財報電話會議。（操作員指示）請注意，此事件正在被記錄。

I would not like to turn the conference over to Mr. Anton Hie, Vice President of Investor Relations. Please go ahead, sir.

我不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, (inaudible) Good morning, and welcome to Community Health Systems second quarter 2025 earnings conference call. Joining me on today's call are Tim Hingtgen, Chief Executive Officer; and Kevin Hammons, President and Chief Financial Officer.

謝謝，（聽不清楚）早安，歡迎參加社區健康系統 2025 年第二季財報電話會議。參加今天電話會議的還有執行長 Tim Hingtgen 和總裁兼財務長 Kevin Hammons。

Before we begin I must remind everyone 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 under headings such as risk factors in our annual report on Form 10-K and other reports filed with or furnished to the SEC.

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，包括所有不完全涉及歷史或當前事實的陳述。這些前瞻性陳述受到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進行了描述。

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. Yesterday afternoon we issued a press release with our financial statements and definitions and calculations of adjusted EBITDA and adjusted EPS.

實際結果可能與今天討論中任何前瞻性陳述所表達的結果有很大不同。我們不打算更新任何這些前瞻性陳述。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。

We've also posted a supplemental slide presentation on our website. All calculations we will discuss today exclude gains from early extinguishment of debts, impairment gains or losses on the sale of businesses and expense from business transformation costs.

我們還在我們的網站上發布了補充幻燈片演示。我們今天討論的所有計算均不包括提前清償債務的收益、出售業務的減損收益或損失以及業務轉型成本的費用。

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

話雖如此，我會把電話轉給執行長 Tim Hingtgen。

Thank you, Anton. Good morning, everyone, and thank you for joining our second quarter 2025 conference call. Before we get to the quarter's results, I want to address the announcement made yesterday afternoon that I've decided to retire at the end of September.

謝謝你，安東。大家早安，感謝您參加我們的 2025 年第二季電話會議。在我們了解本季的業績之前，我想先談談昨天下午宣布的消息，我決定在九月底退休。

I'm stepping back from my role as CEO for personal reasons, the most important one being that I want to dedicate more time to my family and personal pursuits. And while I have loved the opportunity to serve as the leader of an organization that is devoted to helping people get well and live healthier, the job of CEO requires the highest degree of time, energy, and commitment, and my family has very generously supported me and my commitment to giving everything I have to leading this organization.

我因個人原因辭去執行長一職，其中最重要的原因是我想將更多的時間投入家庭和個人追求。雖然我很高興有機會擔任一個致力於幫助人們康復和更健康生活的組織的領導者，但執行長的工作需要投入最多的時間、精力和承諾，我的家人非常慷慨地支持我，支持我為領導這個組織付出一切。

I've been thinking about that a lot this year. I want to be more present for them at this stage in my life and at this stage in theirs. I also have some personal pursuits that I want to explore while I'm still young enough and eager enough to try new things. This is not a decision that was made easily or quickly or without regard to what's best for CHS.

今年我一直在思考這個問題。我希望在我人生的這個階段和他們人生的這個階段能多陪伴他們。趁著我還年輕，還渴望嘗試新事物，我還有一些個人追求想要去探索。這不是一個輕易或快速做出的決定，也不是沒有考慮對 CHS 最有利的決定。

I wrestled with whether to retire and when to retire in part out of a sense of loyalty to the organization, but even more than that, out of my sincere desire to continue to be a part of the progress happening in this company and the opportunities and achievements I still see ahead.

我一直在糾結是否退休以及何時退休，部分原因是出於對組織的忠誠，但更重要的是，我真誠地希望繼續成為這家公司進步的一部分，並繼續為我仍然看到的未來​​的機會和成就做出貢獻。

Those will continue to happen under Kevin's leadership, I am sure. But after thinking about it a lot and consulting with my family, this is the appropriate decision. Let's call it a difficult, honest, and for me a necessary choice.

我相信，在凱文的領導下，這些事情將會繼續發生。但經過深思熟慮並與家人商量後，我認為這是一個合適的決定。我們可以稱之為一個艱難、誠實且對我來說必要的選擇。

I'll be here until the end of September to support a seamless transition, but truthfully, Kevin could step into the role of CEO today, and things would be just fine. He knows CHS as much as anyone, and he cares deeply about our company, our people, and the patients who choose and rely on CHS Health systems for their medical care.

我會在這裡待到九月底，以支持順利過渡，但說實話，凱文今天就可以擔任執行長一職，一切都會好起來。他和其他人一樣了解 CHS，並且非常關心我們的公司、我們的員工以及選擇和依賴 CHS 醫療系統進行醫療護理的患者。

I want to thank the CHS board for their faith in me and the CHS team for the privilege of being their leader, and thank you to our investors for your confidence in CHS. So now with that, let me make just a few brief remarks about the quarter, and then Kevin will add quite a bit more detail and color about our results and what we see ahead, including potential impact from the Big Beautiful Bill.

我要感謝 CHS 董事會對我的信任，感謝 CHS 團隊給予我擔任他們領導的榮幸，同時感謝我們的投資者對 CHS 的信心。現在，請容許我簡單談談本季的情況，然後凱文將對我們的業績和未來展望進行更詳細和詳細的介紹，包括《美麗大法案》的潛在影響。

In the second quarter on a same-store basis, net revenue increased 6.5% year-over-year. Inpatient admissions were up 0.3% and adjusted admissions declined 0.7% with a 2.5% decline in Surgery and a 1.9% decline in ER Visits.

第二季同店淨收入較去年同期成長6.5%。住院人數上升了 0.3%，調整後入院人數下降了 0.7%，其中手術人數下降了 2.5%，急診就診人數下降了 1.9%。

While patient volumes were lower than expected and hampered our overall earnings results, we are confident that our past development and capital investment strategies have positioned CHS Health Systems very well to capture patient demand once consumer confidence returns, and it always has.

雖然患者數量低於預期並阻礙了我們的整體獲利結果，但我們相信，一旦消費者信心恢復，我們過去的開發和資本投資策略已經使 CHS 醫療系統能夠很好地滿足患者需求，而且這種情況一直存在。

Our development strategies include physical capacity and service line expansions with a balanced focus on both inpatient and outpatient care. And we are intentional about broadening the footprint of our health systems through the ongoing recruitment of primary care, specialty physicians, and other providers.

我們的發展策略包括擴大實體容量和服務線，並均衡關注住院和門診護理。我們有意透過持續招募初級保健、專科醫生和其他提供者來擴大我們的醫療系統的覆蓋範圍。

Specifically through our year-to-date recruitment activities, we have over 200 providers currently scheduled to commence in the second half of 2025, including backfilling for the departure of certain independent specialists.

具體來說，透過我們今年迄今為止的招募活動，我們目前有超過 200 名供應商計劃在 2025 年下半年開始工作，包括填補某些獨立專家的離職空缺。

We have a strong clinic services operations team, and we are committing significant resources towards ensuring the successful and rapid ramp up of our newest providers. Recent service line and capacity expansions in Knoxville, Naples, Laredo, Birmingham, and other key markets continue to ramp up and gain market share, and we have several new outpatient access points set to open in the coming months, including new ambulatory surgery centers in our Birmingham, Foley, and Tucson markets.

我們擁有強大的診所服務營運團隊，並投入大量資源以確保我們的最新供應商能夠成功且快速地發展。諾克斯維爾、那不勒斯、拉雷多、伯明翰和其他主要市場最近的服務線和容量擴張持續增加並獲得市場份額，並且我們計劃在未來幾個月內開設幾個新的門診接入點，包括伯明翰、福利和圖森市場的新門診手術中心。

Today, CHS operates more than 40 ASC, a critical component of our market growth strategy, and being well positioned to grow and serve consumer demand. We also continue to make progress on other strategic initiatives. Since our last earnings call in April, we completed the debt effiture of Cedar Park Regional Medical Center in Texas and continued to improve our maturity and leverage profile through successful debt refinancing and retirement transactions.

如今，CHS 經營著 40 多家 ASC，這是我們市場成長策略的重要組成部分，並且能夠很好地滿足消費者的需求。我們也持續在其他策略舉措上取得進展。自從四月上次財報電話會議以來，我們完成了德州雪松公園地區醫療中心的債務處理，並透過成功的債務再融資和退休交易繼續改變我們的成熟度和槓桿狀況。

Now, I'll turn the call over to Kevin and as I do, I just want to once again express my full confidence in his upcoming leadership of Community Health Systems. Kevin?

現在，我將電話轉給凱文，我只是想再次表達我對他即將領導社區健康系統的充分信心。凱文？

Thank you, Tim, and good morning. Before I begin with the review of financial and operating results, I want to take a moment to acknowledge Tim's contributions to CHS over the past 17 years. Since joining the company in 2008, Tim has brought an invaluable amount of experience and insight into our organization and has been instrumental in leading the development of regional healthcare networks across the country.

謝謝你，提姆，早安。在開始回顧財務和經營業績之前，我想花點時間來感謝蒂姆在過去 17 年裡對 CHS 的貢獻。自 2008 年加入公司以來，Tim 為我們的組織帶來了寶貴的經驗和見解，並在領導全國區域醫療保健網路的發展方面發揮了重要作用。

Tim's long track record of success as an operator, his leadership qualities, and his natural way with people have been an asset to CHS and all of our teammates from us here at the corporate headquarters and throughout our entire organization.

蒂姆作為運營商的長期成功記錄、他的領導才能以及他與人相處的自然方式對 CHS 以及我們公司總部和整個組織的所有隊友來說都是一筆寶貴的財富。

For me personally, Tim, I want to say that it's been my pleasure to have been your partner here at CHS and to serve alongside you as your CFO. I believe I can speak for everyone when I wish you the best in your future endeavors.

就我個人而言，提姆，我想說，我很榮幸能夠成為您在 CHS 的合作夥伴，並擔任您的財務長。我相信，當我祝福您未來一切順利時，我可以代表大家表達我的祝福。

Turning to the results for the second quarter, CHS executed well on many of the controllable aspects of our business, such as supplies expense, wage rate growth, and overhead costs. However, we believe that external factors have affected the demand for healthcare services across our markets over the past few months.

談到第二季的業績，CHS 在我們業務的許多可控方面都表現良好，例如供應費用、工資率成長和間接費用。然而，我們認為過去幾個月外部因素影響了我們整個市場對醫療保健服務的需求。

Last quarter, we noted some deterioration in our acuity mix versus expectations with softer demand for elective surgical procedures within our commercial book.

上個季度，我們注意到我們的敏銳度組合與預期相比惡化，商業書籍中對選擇性外科手術的需求有所減弱。

While we had expected the mixed profile to improve with the typical seasonal factor of commercial patients meeting their deductibles and the slew volumes dropped off, this improvement did not materialize in the second quarter as expected. Which led to some loss of operating leverage and slight degradation and even on margin year-over-year and versus our forecasts.

雖然我們曾預期混合狀況會隨著商業患者滿足免賠額的典型季節性因素和數量下降而改善，但這種改善並沒有像預期的那樣在第二季度實現。這導致經營槓桿有所損失，利潤率甚至比去年同期和與我們的預測相比有所下降。

Despite the adverse volume and mixed profile, CHS continued to make good progress in strategic initiatives, as Tim noted in his prepared remarks.

正如蒂姆在準備好的發言中指出的那樣，儘管交易量不利且情況好壞參半，但 CHS 在戰略舉措方面繼續取得良好進展。

On June 30, we completed previously announced divestiture of our 80% ownership in Cedar Park Regional Medical Center to the minority partner Ascension Health for $436 million and in May we successfully refinanced all $700 million of our outstanding 8% senior secured notes due 2027 using proceeds from our offering of a new 10.75% senior secured notes due to 2033.

6 月 30 日，我們完成了先前宣布的以 4.36 億美元的價格將我們在 Cedar Park 區域醫療中心的 80% 所有權出售給少數股東 Ascension Health 的交易，5 月份，我們成功地利用發行新的 2033 年到期的 10.75% 優先擔保所得億美元未償還金額進行了再融資。

And also tendered and redeemed $584 million principal value of our outstanding 2028 unsecured notes using $438 million in cash on hand.

並且還使用 4.38 億美元現金投標並贖回了我們未償還的 2028 年無擔保票據的 5.84 億美元本金價值。

Turning back to operating results for the second quarter, same-store net revenue increased 6.5% year-over-year and was primarily driven by rate growth, including the recognition of revenue under Medicaid state directed payment programs in New Mexico and Tennessee, a portion of which was related to prior periods.

回顧第二季的營運業績，同店淨收入年增 6.5%，主要受利率成長推動，包括新墨西哥州和田納西州醫療補助州指導支付計畫下的收入確認，其中一部分與前期相關。

Same-store inpatient admissions increased 0.3% year-over-year, while adjusted admissions declined 0.7%. Same-store surgeries declined 2.5% and [ED] visits were down 1.9%. Adjusted EBITDA for the second quarter was $380 million compared with $387 million in the prior year period.

同店住院人數較去年同期增加 0.3%，而調整後住院人數下降 0.7%。同店手術量下降 2.5%，急診就診量下降 1.9%。第二季調整後 EBITDA 為 3.8 億美元，去年同期為 3.87 億美元。

And included approximately $75 million in net contribution from the recently approved state directed payment programs in New Mexico and Tennessee. Margin for the second quarter was 12.1% versus 12.3% in the prior year.

其中包括新墨西哥州和田納西州最近批准的州政府支付計劃提供的約 7500 萬美元的淨捐款。第二季的利潤率為 12.1%，而去年同期為 12.3%。

Turning to expense management, we continue to perform well on labor cost. With an approximate 4% year-over-year increase in average hourly wage rate, which was consistent with our range of expected growth for the year and again includes the impact from significant growth in the number of employed physicians which was consistent with our expectations.

談到費用管理，我們在勞動成本方面繼續表現良好。平均時薪率年增約 4%，這與我們對今年成長預期的範圍一致，並且再次包括了就業醫生數量大幅成長的影響，這與我們的預期一致。

Contract labor expense at $40 million was down approximately $5 million year-over-year on a consolidated basis and was flat sequentially.

合約勞務費用為 4000 萬美元，以合併基礎計算，年減約 500 萬美元，環比持平。

We also continued to perform well on supplies expense, which was down year-over-year and when adjusting for the impact from the new SDP programs in New Mexico and Tennessee, was essentially flat as a percentage of net revenue with the prior year period.

我們的供應費用也繼續表現良好，同比下降，並且在根據新墨西哥州和田納西州新的 SDP 計劃的影響進行調整後，佔淨收入的百分比與去年同期基本持平。

We believe there remain opportunities in this area as we stabilize and mature our new processes with our ERP. Medical specialist fees were $152 million in the second quarter, essentially flat year-over-year on a consolidated basis and representing 4.9% of net revenues consistent with the prior year period.

我們相信，隨著我們透過 ERP 穩定和完善新流程，該領域仍然存在機會。第二季醫療專家費用為 1.52 億美元，以合併基礎計算與去年同期基本持平，佔淨收入的 4.9%，與去年同期持平。

Cash flows from operations for $87 million for the second quarter and $208 million for the year-to-date.

第二季經營現金流為 8,700 萬美元，年初至今經營現金流為 2.08 億美元。

Note that cash flows from operations as reported include $74 million in outflows for taxes on gain on sale primarily for the Lake Norman and ShorePoint transactions. Which were paid out of dives your proceeds and were not considered in our annual guide.

請注意，報告的營運現金流包括 7,400 萬美元的銷售收益稅流出，主要用於 Lake Norman 和 ShorePoint 交易。這些是從您的收益中支付的，並且未在我們的年度指南中考慮。

When excluding this figure, our cash flows from operations were $282 million for the year-to-date, and free cash flows for the second quarter were marginally positive.

除去這一數字，我們今年迄今的經營現金流為 2.82 億美元，第二季的自由現金流略為正值。

Not that the funds from the new state directed payment program in New Mexico and Tennessee likely beginning to flow in the third quarter, and the company should also see positive free cash flow in the back half of the year.

這並不意味著新墨西哥州和田納西州新的州指導支付計劃的資金可能在第三季度開始流入，該公司也應該在今年下半年看到正的自由現金流。

Additionally, we anticipate receiving the previously discussed contingent consideration related to the Tennova Cleveland Divesture and the proceeds from the sale of our reference lab business to Labcorp by the end of this year.

此外，我們預計將在今年年底前收到之前討論過的與 Tennova Cleveland 資產剝離相關的或有對價以及將我們的參考實驗室業務出售給 Labcorp 的收益。

We have received many inquiries from the investment community about the financial impact from the recently signed budget reconciliation for One Big Beautiful Bill. Based on our analysis, impacts to state directed payment programs will be phased in beginning in 2027 through 2038.

我們收到了許多來自投資界的詢問，詢問最近簽署的「一項美麗大法案」預算調節的財務影響。根據我們的分析，對國家指導支付計劃的影響將從 2027 年開始分階段顯現，直至 2038 年。

We project the combined impacts from lowering the provider tax threshold and the phase down to Medicare-linked rates across CHS states. We'll reduce EBITDA by approximately $300 million to $350 million cumulatively over the next 13 years, with no impact in 2025 or 2026. And immaterial impact in 2027 and then building from there.

我們預測了降低提供者稅收門檻和逐步降低 CHS 各州的醫療保險掛鉤費率的綜合影響。未來 13 年內，我們將累計減少 EBITDA 約 3 億至 3.5 億美元，但 2025 年或 2026 年不會受到影響。2027 年將產生非物質影響，然後從那時開始發展。

Our estimate reflects the estimated net reduction relative to total Medicaid reimbursement based on current Medicaid reimbursement rates. Our analysis does not take into account any impact from Medicaid work requirements or the various provisions that could affect enrollment and ACA plans such as expiration of the extended tax credits, since these are much more difficult to predict.

我們的估計反映了根據目前醫療補助報銷率估計的相對於醫療補助總報銷的淨減少量。我們的分析沒有考慮醫療補助工作要求的影響或可能影響入學和 ACA 計劃的各種規定（例如延長稅收抵免的到期），因為這些更難預測。

Additionally, this analysis does not assume any benefit from the proposed rural fund due to the uncertainties of how those moneys will be distributed. Nor do we assume any mitigating factors from expanded SDP programs, cost reductions, potential service line changes, strategic investments, or other actions that we may make in order to offset the financial impact of CHS.

此外，由於這些資金如何分配存在不確定性，本分析並不假設擬議​​的農村基金會帶來任何好處。我們也不會假設擴大 SDP 計劃、降低成本、潛在服務線路變化、策略投資或我們可能採取的其他行動會產生任何緩解因素，以抵消 CHS 的財務影響。

In the upcoming months, CHS will support industry efforts to aggressively pursue legislative and administrative fixes to the bill. We assume the opportunities to do so will increase as voters better understand how the cuts affect their household.

在接下來的幾個月裡，CHS 將支持業界積極推動立法和行政修復該法案。我們認為，隨著選民更了解削減開支如何影響他們的家庭，這樣做的機會將會增加。

On the subject of the Budget Reconciliation Act, I think it is also important to note that the interest deduction under Section 163(j) of the [IRS] code, which we have discussed on several occasions in the past, was restored, which will increase the amount of interest CHS can deduct for tax purposes, and along with the accelerated depreciation provisions will have the benefit to us of lowering our annual cash taxes by approximately $40 million to $60 million beginning next year.

關於預算協調法案，我認為還必須指出，我們過去曾多次討論過的美國國稅局 (IRS) 稅法第 163(j) 條下的利息扣除已恢復，這將增加 CHS 可用於稅收目的的利息扣除額，並且與加速折舊條款一起，將從明年開始將我們的年度現金稅降低約 4000 萬美元。

Now moving on to our 2025 financial guidance. Based on our operating results through the first half of the year and the lower than expected volume growth heading into the third quarter, combined with the impacts in the second half of the year from the recently completed Cedar Park Divestiture and the new state directed payment programs, we are tightening our adjusted EBITDA range for the full year 2025 to $1.45 billion to $1.55 billion.

現在來看看我們的 2025 年財務指引。根據我們上半年的經營業績以及第三季低於預期的銷售成長，再加上最近完成的 Cedar Park 資產剝離和新的國家指導支付計劃對下半年的影響，我們將 2025 年全年調整後的 EBITDA 範圍收窄至 14.5 億美元至 15.5 億美元。

We are pleased to receive the additional funding in New Mexico and Tennessee, which will be helpful to maintain service lines in the markets we serve. We believe it is prudent to take a more conservative approach to the underlying business, given the impact from macro factors that we have observed in the second quarter.

我們很高興在新墨西哥州和田納西州獲得額外資金，這將有助於維持我們所服務市場的服務線。鑑於我們在第二季度觀察到的宏觀因素的影響，我們認為對基礎業務採取更保守的態度是謹慎的。

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，因此現在我們將把電話轉回給接線員進行問答。

Thank you. We will now begin the question-and-answer session.

謝謝。我們現在開始問答環節。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Hi everybody. Want to just wish Tim best wishes, going forward, and Kevin, congratulations.

大家好。只想祝蒂姆一切順利，祝賀凱文。

Maybe I'll ask you about, two items on the guidance. You -- volumes obviously it seems like those are coming in a little more sluggish than expected to what extent did you make a tweak in your second half expectations if you did on volumes and maybe talk about the dynamics you saw in quarter.

也許我會問您有關指導的兩項內容。您 — — 顯然，交易量似乎比預期的要低一些，如果您對交易量進行了調整，您對下半年的預期在多大程度上進行了調整，也許可以談談您在本季度看到的動態。

Was there any variation and quarter on that. And then on also on the guidance, the operating cash flow I know year-to-date you free cash flow I think it's about $200 million or operating cash flow row is $200 million and I think the guidance calls for $600 million to $700 million. I know there's some unusual items like the DPP program and the way you get paid for that.

對此有沒有什麼變化和變化？然後，關於指導，我知道年初至今的經營現金流，自由現金流，我認為大約是 2 億美元，或者經營現金流是 2 億美元，我認為指導要求的是 6 億到 7 億美元。我知道有一些不尋常的事情，例如 DPP 計劃以及你獲得報酬的方式。

Can you just bridge this a little bit from what you're seeing in the first half and how you get to that second half number?

您能否根據上半年看到的情況和下半年的數字進行一些銜接？

Thanks, AJ. Let me start off. In terms of volume, in quarter, really if we go back to March, of this -- of the first quarter, we began to see some decline in consumer confidence. The consumer confidence consistently declined in April, May, and June, to the point where we're seeing now the lowest consumer confidence probably since COVID levels.

謝謝，AJ。讓我先開始吧。就數量而言，如果我們回到第一季的三月份，我們開始看到消費者信心下降。消費者信心在 4 月、5 月和 6 月持續下降，目前我們看到的消費者信心可能是自 COVID 水準以來的最低水準。

So I'm not sure we saw significant decrease, kind of month over month, but certainly as the consumer confidence is a leading indicator is has continuously declined, we're taking that into consideration. I will say that as we exited June, we did see kind of the final week of June.

因此，我不確定我們是否看到了明顯的下降，某種程度上是月環比下降，但可以肯定的是，由於消費者信心是一個領先指標，而且一直在持續下降，我們正在考慮到這一點。我想說的是，當我們走出六月時，我們確實看到了六月的最後一周。

Beginning to see some recovery in volume back to prior levels and as we look out into kind of this first part of July coming into the third quarter, although the levels are not where we had maybe originally anticipated, we are starting to see some stabilization in our volumes relative to prior year if we look out over the course of the year where we had maybe originally guided towards a 2% to 3% adjusted emission volume for the year, I think a new updated guidance would look more like 0% to 1% adjusted admissions for the year. Currently we're at 1% year-to-date.

開始看到排放量有所回升，回到之前的水平，當我們展望 7 月初進入第三季度時，儘管排放量水平可能沒有達到我們最初的預期，但我們開始看到排放量相對於去年有所穩定，如果我們縱觀全年，我們最初指導的全年調整排放量為 2% 到 3%，我認為新的更新指導將是全年調整排放量為 1% 到 1%。目前，年初至今的成長率為 1%。

So hopefully that gives you a little bit of color around the volume trend. Cash flow, as we think about, our guide kind of remain the same, a couple things that point out, our adjusted cash flow from operations and we reported $208 million but that did include the $74 million cash tax payment on the gain on sale, that cash comes out of the divest your proceeds when you add that back in, cash flow from operations in the first half of the year is $282 million, which is almost halfway there for a full year guide, at least the low end of our full year guide, and typically our fourth quarter is by far the largest cash flow generating quarter of the year.

希望這能讓您稍微了解成交量趨勢。我們認為，現金流的指導方針基本上保持不變，有幾點需要指出，我們報告的調整後經營現金流為 2.08 億美元，但其中包括出售收益的 7400 萬美元現金稅款，這筆現金來自剝離收益，當你把這筆錢加回去時，今年上半年的經營現金流為 2.82 億美元，這幾乎是全年的低季度指導

The DPP programs that were approved in the second quarter in Mexico and Tennessee, those were approved just in the final days of the quarter. We've not received any of that cash yet, so those payments will be coming in the back half.

墨西哥和田納西州第二季度批准的 DPP 計劃是在本季度最後幾天批准的。我們尚未收到任何現金，因此這些付款將在下半年收到。

So with those payments and the historically better fourth quarter cash flow generation, we expect to be able to hit the range with effectively or even a guidance staying relatively flat from where we were at the beginning of the year, and our year-to-date cash flow I think will be positive in the back half of the year as well.

因此，透過這些付款和歷史上更好的第四季度現金流生成，我們預計能夠有效地達到目標範圍，甚至與年初的水平保持相對平穩，而且我認為我們今年迄今為止的現金流在今年下半年也將為正。

If I could just jump in with one follow up, there have been some pending DPP programs that were relevant to you, Indiana, Alabama, and to a lesser extent, Florida, potentially up topping up their program. Is there any update on the status of those in light of the One Big Beautiful Bill?

如果我可以繼續跟進的話，有一些待決的 DPP 計劃與您有關，印第安納州、阿拉巴馬州以及程度較輕的佛羅裡達州可能會補充他們的計劃。根據《美麗大法案》，這些人的情況有什麼更新嗎？

There is, so Florida has submitted for an update to their rate under their existing program. That submission was in on time, and we would expect that to be approved and there should be a small tailwind for us at the point in time that gets approved. Indiana likewise has submitted their preprint to CMS for a new state directed payment program which will replace their provider tax program that currently exists in the state, we would expect that to be a much more material benefit to us.

是的，因此佛羅裡達州已提交了對其現有計劃下的利率進行更新的申請。該提交已按時提交，我們預計它會被批准，並且在獲得批准時我們應該會有一個小小的順風。印第安納州同樣已向 CMS 提交了一項新的州指導支付計劃的預印本，該計劃將取代該州現有的供應商稅收計劃，我們預計這將為我們帶來更多實質性的利益。

That preprint was submitted before the deadline, and we fully expect that one will also be approved. We don't have the ability to really estimate the amounts, and we don't do that until those programs are approved, but the insight we have today and given our footprint in the state of Indiana, we would expect that to be a material benefit to us.

該預印本已在截止日期之前提交，我們完全相信其中一份也會獲得批准。我們沒有能力真正估算這些金額，而且在這些項目獲得批准之前我們不會這樣做，但根據我們今天的了解以及我們在印第安納州的足跡，我們預計這將為我們帶來實質的利益。

In terms of Alabama and Arkansas, they are not that far along yet, but we understand there may still be a path for them. It's a little less clear to us at this point, but I know those states are still working on some opportunities.

就阿拉巴馬州和阿肯色州而言，他們還沒有走那麼遠，但我們知道他們可能仍然有一條道路。目前我們還不太清楚，但我知道這些州仍在努力尋找一些機會。

Okay, great. Thanks so much.

好的，太好了。非常感謝。

Thank you.

謝謝。

Brian Tanquilut, Jeffreys.

布萊恩·坦奎魯特，傑弗里斯。

Hey, good morning, guys, and Tim, congrats on the retirement and Kevin, good luck. Maybe my first question as we think about what the right run rate is for earnings to be thinking about given the DPP from the quarter, I'm thinking like [305], is that the right way to think about it, or maybe slightly higher than that if we back out the prior period -- contribution from the 10 (inaudible) DPP.

嘿，大家早上好，祝賀蒂姆退休，祝凱文好運。也許我的第一個問題是，當我們考慮本季的 DPP 時，應該考慮的正確獲利運作率是多少，我在想 [305]，這是正確的思考方式嗎？或者如果我們退出前一時期，可能會略高於這個數字——來自 10（聽不清楚）DPP 的貢獻。

So if you just walk us through how we should be thinking about the right run rate for even that going forward.

因此，如果您能向我們介紹我們應該如何考慮未來的正確運行率。

Sure Brian, thank you. 305 I think would be we it is too low, because that's really taking out the entire DPP money that we recognize this quarter, you would want to include the current period quarter portion of that, call that roughly $30 million so starting at $335 but even at that point, volumes in the second quarter were really depressed and we don't think that's the current run rate, particularly as I mentioned, as we're exiting the quarter and seeing some visibility and some stabilization.

當然可以，布萊恩，謝謝你。305 我認為它太低了，因為這實際上已經用掉了我們本季度確認的全部 DPP 資金，您可能希望包括其中的當前季度部分，大約是 3000 萬美元，因此從 335 美元開始，但即使在那個時候，第二季度的交易量也確實很低迷，我們認為這不是目前的運行率，特別是正如我提到的，因為我們即將結束了一些穩定性。

I would say that, the real run rate in our mind is probably something in the [360] to [375] as a starting point and then as we get back to positive volume, growth and we believe, as Tim mentioned in his remarks, there are times when we go through periods where volumes, seem to dry up, but they always come back.

我想說的是，我們心中的實際運行率可能在 [360] 到 [375] 之間，作為起點，然後當我們回到正量、增長時，我們相信，正如蒂姆在他的評論中提到的那樣，有時我們會經歷交易量似乎枯竭的時期，但它們總是會回來。

We believe that most of what happened this quarter was. It's being deferred, for financial reasons, the patient behavior, but that will come back, so, kind of as a baseline starting point in the 360 to 375 range and then opportunity to grow from there.

我們認為本季發生的大部分情況都是如此。由於財務原因，患者行為被推遲，但這種情況會恢復，因此，這有點像 360 到 375 範圍內的基線起點，然後從那裡開始發展的機會。

That makes sense. And then maybe Kevin, just to double click on your comment on the OBBVA impact. Maybe if you can share with us just how you're thinking about that number meaning like what assumptions go into that and or maybe how we should be thinking about kind of trying to build that ourselves.

這很有道理。然後也許凱文，只需雙擊你對 OBBVA 影響的評論。也許您可以與我們分享您對這個數字的看法，例如其中涉及哪些假設，或者我們應該如何考慮嘗試自己建立這個數字。

Yeah, I mean there's some, probably pretty complicated math behind those, but we really went through kind of state by state, exercise taking a look at which states are expansion states, which states are non-expansion states, ratcheting down, both the rates, Medicaid rates for where we have commercial average commercial rate down to Medicare and then the states that are expansion states that have taxes, above the 3.5%, those get ratcheted down, I think 50 basis points each year, beginning in 2028.

是的，我的意思是，這些背後可能有一些相當複雜的數學計算，但我們確實對各州進行了研究，看看哪些州是擴張州，哪些州是非擴張州，逐步降低稅率，醫療補助率，我們將商業平均商業稅率降至醫療保險，然後是擴張州，稅率高於 3.5%，這些稅率將從 2028 年開始每年基點逐步降低 50 個。

Got it. Thank you.

知道了。謝謝。

Ben Hendrix, RBC.

本‧亨德里克斯 (Ben Hendrix)，加拿大皇家銀行。

Thank you very much. With the recognition of the DPP revenue from Tennessee and New Mexico and then also the developments on the commercial elective weakness, maybe you can kind of just recap the bridge to the revised 2025 EBITDA guidance for us.

非常感謝。隨著對田納西州和新墨西哥州 DPP 收入的認可，以及商業選修課疲軟的發展，也許您可以以為我們回顧一下修訂後的 2025 年 EBITDA 指南。

Sure, Ben, we started called the midpoint at the [$525 billion]. If you add in, and that did not include, any DPP from Mexico or Tennessee, add in call it $140 million of EPP, [monies] for Tennessee and New Mexico, back out call it 20 to 25 from the Divestiture of Cedar Park, roughly $70 million, which is probably the miss in the second quarter and then the remainder being kind of revision to the back half of the year, based off of our previous expectations to get us to a new guide of a $5 billion at the midpoint.

當然，本，我們開始把中點稱為[5250億美元]。如果加上（這還不包括）來自墨西哥或田納西州的任何 DPP，再加上田納西州和新墨西哥州的 1.4 億美元 EPP，再減去從雪松公園資產剝離中獲得的 2000 到 2500 萬美元，大約 7000 萬美元，這可能是第二季度的未達標金額，其餘部分將根據我們的預期在下半年進行修正。

Got you. And then just a follow up I know, on some of the mixed trends you're saying -- you're seeing, I know that payer mix has been a topic of discussion in recent quarters. So just wondering if you could walk through the components of pay or mix trend you're seeing, and then, Medicare Advantage in particular the type of growth, you're seeing there.

明白了。然後，我知道，關於您所說的一些混合趨勢，我知道付款人組合是最近幾季討論的話題。所以我只是想知道您是否可以介紹您所看到的薪酬或混合趨勢的組成部分，然後，特別是您所看到的醫療保險優勢的增長類型。

Sure, the biggest declines we had were in surgical, and about half of those surgical declines were orthopedics. Most of the declines were primarily commercial, Blue Cross business, so that's where we're seeing the biggest headwinds, which certainly impacted our net revenue for adjusted admission, impacted the flow through the EBITDA and also lends us to believe that the consumer confidence and impact on household incomes and how people are spending their money making decisions on healthcare is really the true reason for some of the headwind on surgical and care delivery at this point.

當然，我們遭遇的最大下滑是在外科手術方面，其中大約一半的外科手術下滑是骨科手術。大部分下滑主要發生在商業、藍十字業務方面，因此我們看到最大的阻力來自這些領域，這無疑影響了我們調整後的入院淨收入，影響了 EBITDA 的流動，也讓我們相信，消費者信心和對家庭收入的影響以及人們如何花錢做出醫療保健決策才是目前外科手術和護理服務面臨一些阻力的真正原因。

It's those patients who have the highest co-pays and deductibles that are being most impacted, and I think even if you look at some other industry across the country where we're seeing consumers not spending money, their discretionary income on things. So, again that's the biggest declines in terms of the exchange business, overall volume of exchange business was up, but acuity of exchange business was severely down, with the biggest component of that being surgeries of exchange patients.

受到最大影響的是那些共同支付和免賠額最高的患者，我認為，即使你看看全國其他一些行業，我們也看到消費者沒有把可自由支配的收入花在東西上。因此，就交換業務而言，這再次出現了最大的下降，交換業務的總體量有所上升，但交換業務的敏銳度卻嚴重下降，其中最大的組成部分是交換患者的手術。

So there again led us to the same conclusion because most of the exchange contracts have some higher co-pays and deductibles.

因此，我們再次得出了同樣的結論，因為大多數交換合約都有較高的共同支付和免賠額。

Thank you very much and congratulations to Tim on retirement, and to Kevin and Jason on the appointments.

非常感謝，並祝賀蒂姆退休，以及凱文和傑森就任。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great, thanks, best of luck to Tim in your retirement, and congrats, Kevin. Maybe I just want to start on leverage you've got some cash coming in the second half. You've done some refinancing activity earlier this year, but are there other areas you're hoping to refinance at this point, maybe drive some incremental, interest cost savings, whether debt takeout or otherwise and kind of just follow to that you're still about a little less than 1.5 away from your below 5.5 times leverage target, maybe only a turn one factor in the back half cash generation, incoming proceeds in payments.

太好了，謝謝，祝蒂姆退休後一切順利，恭喜凱文。也許我只是想利用槓桿，在下半年獲得一些現金。您在今年早些時候已經進行了一些再融資活動，但是目前您是否希望對其他領域進行再融資，也許可以實現一些增量利息成本節省，無論是債務承擔還是其他方式，並且您距離低於 5.5 倍的槓桿目標還有不到 1.5 倍的距離，也許只是下半年現金生成和支付收益中的一個轉折點。

But perhaps can you just walk us through the remaining building blocks that get you toward that below 5.5 target at this point. Thanks.

但是，您能否向我們介紹目前實現低於 5.5 的目標所需的剩餘基礎要素。謝謝。

Thank you. Yeah, happy to walk through that. So right now as we look at our debt stack, we've got some 2027 $750 million of 2027 that are our next current maturity. Those become current in March of 2026, and we've been pretty diligent over the years of trying to or disciplined I should say maybe over the years of trying to make sure we take care of those debts and not get too close to things becoming current.

謝謝。是的，很高興能經歷這一切。因此，現在當我們查看我們的債務堆疊時，我們有大約 2027 年的 7.5 億美元，這是我們下一個目前到期的債務。這些債務將於 2026 年 3 月到期，多年來我們一直非常勤奮地嘗試，或者說嚴格遵守紀律，我應該說，多年來我們一直試圖確保我們能夠處理好這些債務，並且不會讓事情太接近到期。

So that's top of our list of things we want to get handled and get that debt pushed out. Now that debt currently has a coupon of five and 58%. Probably a little bit lower than the market's going to absorb right now and we'll see a little bit of additional interest expense from that.

因此，這是我們最想解決的問題之一，可以延遲債務的發生。目前該債務的票面利率為 5.58%。可能比市場目前的吸收量略低一些，因此我們將看到一些額外的利息支出。

But as we continue to make progress on some divestitures and chipping away at other pieces of debt, we'll have an opportunity to offset any of those interest expense increases from the rate. And continue to lower our leverage. As we look out, in the nearest term, over the next couple quarters I mentioned we've got the proceeds coming in from the [Labcorp] sale which is almost $200 million and we have the contingent payment from the sale of -- to Tennova Cleveland, which we should (inaudible) in the area of $100 million.

但隨著我們在剝離部分資產和削減其他債務方面不斷取得進展，我們將有機會透過利率來抵銷任何利息支出的增加。並繼續降低我們的槓桿率。正如我們所看到的，在最近的一段時間內，在接下來的幾個季度裡，我提到，我們將從 [Labcorp] 的銷售中獲得近 2 億美元的收益，並且我們還有從向 Tennova Cleveland 的銷售中獲得的附帶付款，我們應該（聽不清）在 1 億美元左右。

So we should be getting approximately $300 million coming in in the back half of this year, and then we're continuing to pursue some additional dive best care opportunities. There's a number of transactions that are in various stages, we're still getting some inbound interest. And we'll continue to look at that to manage our portfolio not only where we believe we have the best opportunities to invest and to grow, but then also with some opportunities to maybe put that money to other use, whether that's directly paying down debt or investing in some growth opportunities, both of which would help us to lever.

因此，我們應該在今年下半年獲得約 3 億美元的收入，然後我們將繼續尋求一些額外的潛水最佳護理機會。有許多交易處於不同階段，我們仍然收到一些入站興趣。我們將繼續關注這一點，不僅在我們認為擁有最佳投資和成長機會的地方管理我們的投資組合，而且還可能將這些資金用於其他用途，無論是直接償還債務還是投資於一些成長機會，這兩者都將有助於我們發揮槓桿作用。

I think we've given that. A goal of below 5.5 times by 2027 so we got a little bit of time although time, clicking away here ticking away. But I would go back and if you track our leverage over the last two years we've consistently, been bringing it down, over a two-year period. I'm fully confident we'll continue to make progress there, and get to our goal.

我想我們已經給了。我們的目標是到 2027 年低於 5.5 倍，因此我們還有一點時間，儘管時間正在流逝。但我要回顧一下，如果你追蹤我們過去兩年的槓桿率，你會發現我們在兩年內持續降低槓桿率。我完全有信心我們會繼續取得進展並實現我們的目標。

Got it. Okay, thanks. Helpful. And maybe just as a follow up, on the heels of the Labcorp deal, obviously a nice cash flow or cash inflow there. But maybe are there other opportunities for the enterprise that you're either evaluating to maybe outsource or maybe other non-core assets that you could look to offload that could drive that incremental cash or even benefits at this point. Thanks.

知道了。好的，謝謝。很有幫助。也許只是作為後續行動，緊接著 Labcorp 交易之後，顯然會出現不錯的現金流或現金流入。但是，也許企業還有其他機會，您可以評估外包，或考慮卸載其他非核心資產，從而在此時帶來增量現金甚至收益。謝謝。

Great question. We continue to look at our business seeing where we can, make little tweaks, similar to what we did our outpatient reference lab, business is something that was not a core competency, and I actually believe that by completing this deal with Labcorp we're going to provide a better experience for our physicians and also potentially get some savings to the company will be using Labcorp almost exclusively, for our reference lab and outsource business, and we'll be getting better pricing where we had been using them sporadically in the past or other outsource services we can move that to Labcorp at a better pricing going forward we continuously look at our business.

好問題。我們將繼續審視我們的業務，看看在哪些方面我們可以做出一些小的調整，類似於我們對門診參考實驗室所做的那樣，業務不是核心競爭力，而且我實際上相信，通過完成與 Labcorp 的這筆交易，我們將為我們的醫生提供更好的體驗，並且還可能為公司節省一些成本，公司將幾乎專門使用 Labcorp進行我們的參考實驗室和外包業務，我們將獲得更好的價格，我們過去只是偶爾使用它們或其他外包服務，我們可以以更好的價格將其轉移到 Labcorp，未來我們會不斷關注我們的業務。

I don't know that we have anything currently in [flight] that I would call out as being something that we could monetize, there are areas of our business that we consider as we grow and invest and develop that may be sources of revenue for us in the future, and those are something that we're looking at and which could be margin of creative, if we were to decide to do that or get to a point where we think it's viable that we could, sell some services.

我不知道我們目前在[飛行]中有什麼可以貨幣化的東西，我們業務中的一些領域，隨著我們的成長、投資和發展，我們認為這些領域可能成為我們未來的收入來源，這些都是我們正在關注的，如果我們決定這樣做，或者達到我們認為可行的程度，我們可以出售一些服務，那麼這些領域可能具有創意空間。

Okay great. Thank you.

好的，太好了。謝謝。

Andrew Mock, Barclays.

巴克萊銀行的安德魯·莫克。

Hi, good morning. Wanted to follow up on volumes because I'm having a hard time reconciling the lower volumes that you're calling out with some of the callouts of accelerating cost trends from payers. Was there anything else you saw impacting volume trends beyond consumer confidence that might be more regional specific or anything on the policy front that you suspect is driving a hesitation to use the healthcare system? Thanks.

嗨，早安。想要跟進交易量，因為我很難將您所說的交易量較低與付款人所說的成本趨勢加速聯繫起來。除了消費者信心之外，您是否還看到其他因素影響了數量趨勢，這些因素可能更具區域性，或者您懷疑在政策方面有什麼因素導致了人們對使用醫療保健系統的猶豫？謝謝。

Maybe the only other item I might call out and it's admittedly difficult when patients don't come to your system to know exactly why they aren't coming and who those patients are when they're not showing up, but the other item that I would call out would be immigration and certainly in some of our markets that may have larger concentrations of the immigrant community in states like Arizona and Texas, possibly even Florida, there has been a well-documented instances of individuals in the immigrant community not participating in some normal everyday things, not going to church, school, going to the hospital, not going to concerts, doing things like that.

也許我唯一要提到的其他事項是，當患者沒有來到你的系統時，確實很難確切地知道他們為什麼不來，以及沒有出現的那些患者是誰，但我要提到的另一件事是移民問題，當然在我們的一些市場中，移民社區可能更集中，例如亞利桑那州和德克薩斯州，甚至可能是佛羅裡達州，有充分的記錄表明，移民社區可能會更集中，例如亞利桑那州和德克薩斯州，甚至可能是佛羅裡達州，有充分的記錄表明，社區中的個人不參與一些移民社區。

I know the hospitals are no longer considered a sanctuary location, and there is concern even among immigrants with legal status. That there's, some fear in that community, that's likely caused, at least in some of our markets, some softness in the volumes.

我知道醫院不再被視為庇護所，甚至擁有合法身分的移民也感到擔憂。這個社區中存在一些恐懼，這很可能導致至少在我們的一些市場中交易量有所疲軟。

Great, maybe just as a quick follow up appreciate all the color on the estimated impact of state directed payments. Is there any way you can share thoughts for how the expiration of enhanced subsidies might impact your business next year? Thanks.

太好了，也許只是作為快速跟進，了解對國家指導支付的預計影響的所有細節。您能否分享一下對於增強補貼到期可能對您明年的業務產生什麼影響的看法？謝謝。

That one's difficult to quantify in any real way. So, I can say what we're doing relative to that is investing in some -- with our, excuse me. Our lobbying efforts in Washington, and continue to work on that from a legislative standpoint, but in terms of quantifying, no we don't have an estimate at this point.

這一點很難用任何實際方法來量化。因此，我可以說，我們正在做的是投資一些——對不起。我們在華盛頓進行遊說活動，並繼續從立法的角度開展工作，但就量化而言，我們目前還沒有估計。

Great. Thank you.

偉大的。謝謝。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi, thanks. I just wanted to kind of continue the guidance bridge conversation just to make sure that we understand, kind of how you're carrying things forward. So I think the items you're flagging is the $70 million underperformance on a core basis during the quarter, the $25 million for Cedar Hill.

你好，謝謝。我只是想繼續指導橋樑對話，以確保我們理解您如何推進事情的發展。所以我認為您標記的項目是本季核心業務表現不佳 7000 萬美元，Cedar Hill 表現不佳 2500 萬美元。

Did you give us the all-in increase to Medicaid supplemental program expectations? I think there's more than just 100 to maybe 120 that you kind of led on before. I'm just trying to really understand as we think about the back half of the year, relative to the $70 million underperformance, I guess how much of that are you carrying through into this guidance provision that you made? Thank you.

您是否向我們提供了醫療補助補充計劃預期的全面增加？我認為您之前領導的人數不止 100 到 120 人。我只是想真正了解一下，當我們考慮下半年的情況時，相對於 7000 萬美元的表現不佳，我想其中有多少是您在製定的指導條款中考慮到的？謝謝。

Thanks Steve, and yeah, let me give you some more clarity on those state directed payment programs and sorry if I did not make that clear.

謝謝史蒂夫，是的，讓我給你更清楚地介紹一下那些國家指導的支付計劃，如果我沒有說清楚的話，我很抱歉。

So we had previously indicated $100 million to $125 million of state directed payments. A possibility that there's an annual run rate for Tennessee and New Mexico. That was just a 12 month run rate for each of the combined two states. In the second quarter we actually picked up a retroactive piece back to 2024 for Tennessee, plus six months of Tennessee and six months of New Mexico.

因此，我們先前曾表示將向國家提供 1 億至 1.25 億美元的直接付款。田納西州和新墨西哥州有可能存在年度運行率。這只是兩個州合計 12 個月的運行率。在第二季度，我們實際上追溯了田納西州 2024 年的數據，以及田納西州六個月的數據和新墨西哥州六個月的數據。

So for the full year 2025, those two states will be about $140 million. That's the amount we're putting in our guide kind of is the midpoint, for the DPP program. So that's the addition, starting again, I'll run through it quickly. A $525 billion at the midpoint of the starting point we added $140 million. That's the $100 million to $125 million run rate plus the retroactive piece then taking out 20 to 25 for Cedar Park, taking out the second quarter miss and then adjusting our expectations in the back half of the year slightly.

因此，到 2025 年全年，這兩個州的收入將達到約 1.4 億美元。對於 DPP 計劃來說，這是我們指南中給出的中間值。這就是補充，重新開始，我會快速瀏覽一遍。在起點的中點 5,250 億美元中，我們增加了 1.4 億美元。這是 1 億到 1.25 億美元的運行率加上追溯部分，然後為 Cedar Park 扣除 20 到 25，扣除第二季度的未達預期，然後稍微調整我們對下半年的預期。

Okay, got it, thank you very much. And just it's really helpful to have these, the sizing around the impacts from the bill. Is there an absolute number you can give us for what the current annual run rate of these programs are so not including any of the out of period stuff but just so we can maybe contextualize this as a percentage decline that would also be I think pretty helpful to people. Thank you.

好的，知道了，非常感謝。了解這些對於評估法案的影響確實很有幫助。您能否提供一個絕對數字來表示這些項目當前的年度運行率，不包括任何超出週期的內容，但我們可以將其具體化為百分比下降，我認為這對人們非常有幫助。謝謝。

No, I don't have that that number exactly. We really look at those state directed payment programs once they're in place, they become part of the normal Medicaid reimbursement strategy for that state and normal Medicaid kind of reimbursement, process those programs oftentimes have many different variations within a state, both at the district level, county level, state level, states then make decisions about increasing their rates or increasing the programs at various stages once they're in place.

不，我沒有那個確切的數字。我們確實會關注這些州指導支付計劃，一旦這些計劃到位，它們就會成為該州正常醫療補助報銷策略和正常醫療補助報銷的一部分，處理這些計劃通常在一個州內有許多不同的變化，包括區級、縣級、州級，然後各州會在計劃到位後的各個階段決定提高費率或增加計劃。

So we don't really call those out, separately because they again, once in place they kind of move more as an aggregate number within the state versus each individual program being on its own.

因此，我們實際上不會單獨地調用它們，因為它們一旦到位，它們就會在州內以總數的形式移動，而不是每個單獨的項目都是獨立的。

Okay, maybe just one more, if I can squeeze it in, just could you talk a little bit? I know a lot of this, you think it's driven on the volume side by the consumer confidence changes, kind of in the early part of this year. Are you seeing any kind of volume change in the Medicare part of your business given that obviously, it seems like there would generally be less economic sensitivity there'd be curious to kind of for a comment on Medicare specific trends if possible.

好的，也許再多說一句，如果我能擠出時間的話，你能講一小會兒嗎？我對此了解很多，您認為這是在今年年初消費者信心變化的影響下銷量上漲的。您是否看到您的業務中的醫療保險部分出現任何類型的數量變化，因為顯然，似乎通常對經濟的敏感度較低，如果可能的話，您會好奇地對醫療保險的具體趨勢發表評論。

Yeah, we haven't seen much change in the Medicare book of business, and interestingly, the Medicare book of business has the lowest deductible component, so that is the group of patients least impacted, I think, by some of this consumer confidence issue, I think that really further supports maybe our beliefs that what's driving some of the patient behavior is around financial decisions, and so those patients are government insured patients who don't have high co-pays and deductibles haven't really changed their behavior in terms of coming to receive health care.

是的，我們沒有看到醫療保險業務發生太大變化，有趣的是，醫療保險業務的免賠額部分最低，所以我認為，他們是受消費者信心問題影響最小的患者群體，我認為這進一步支持了我們的信念，即驅動部分患者行為的因素是財務決策，因此，這些患者是政府投保的患者，他們沒有高額的共同支付和免賠額，這並沒有真正改變他們接受醫療保健的行為。

Josh Raskin, Nephron Research.

Josh Raskin，腎元研究。

Hi, thanks. Good morning. I'll congratulate Tim as well and Kevin and Jason as well. I want to go back to the difference in trends that that you guys are seeing from the volume perspective relative to some of the hospital peers and certainly relative to the commentary from the payers and I appreciate the commentary you've made but you think there's any difference from whether it's geographies or lines of business or outpatient networks that could explain that do you think others are embracing more technology or AI on the RCM side, do you think any of that could be contributing to this?

你好，謝謝。早安.我也要祝賀提姆、凱文和傑森。我想回到你們從數量角度看到的與一些醫院同行相比的趨勢差異，當然還有與付款人的評論相比的趨勢差異，我很欣賞你的評論，但你認為無論是地域、業務線還是門診網絡有什麼不同嗎？這可以解釋為什麼你認為其他人在 RCM 方面採用了更多的技術或人工智慧，你認為這些因素是否有助於解決這個問題？

There could be some differential in terms of location types of markets, urban versus non-urban, type markets, it's hard to say, exactly, again I would point to when patients don't show up it's very hard to necessarily know why or to track that. But I do think the differential between urban markets and non-urban markets, could be part of that in terms of difference between what we're experiencing and the payers they're experiencing, much of their cost increases could be coming from pharmaceutical side, maybe behavioural business, not necessarily a change in acute payments to the providers, I think their headwinds really are probably somewhere else, and otherwise I can't really reconcile to them. Tim, I don't know if there's something you might want to add on this.

就市場位置類型（城市市場與非城市市場）而言，可能會存在一些差異，很難確切地說，我再次指出，當患者沒有出現時，很難知道原因或追蹤原因。但我確實認為，城市市場和非城市市場之間的差異可能是我們所經歷的和他們所經歷的付款人之間的差異的一部分，他們的成本增加大部分可能來自製藥方面，也許是行為業務，不一定是向供應商支付的急性費用的變化，我認為他們的阻力可能真的在其他地方，否則我真的無法接受他們。提姆，我不知道你是否想對此補充一些內容。

Yeah, Josh. Thanks for the question. I'll add on to the payer answer. I think the other area where I'm not going to say it's an outsized impact, but we've been speaking for several quarters on our investment and physician advisory services and really (inaudible) in on where we believe we should be getting appropriate reimbursement for care and services delivered.

是的，喬希。謝謝你的提問。我將補充付款人的答案。我認為，我不會說另一個領域的影響過大，但我們已經連續幾個季度談論我們的投資和醫生諮詢服務，並且真正（聽不清楚）談論我們認為我們應該為所提供的護理和服務獲得適當的報銷。

We have not seen an increase in our downgrades and denials as a percentage of net because of those efforts, and I hope it means we're keeping more of the rightfully earned dollars coming into our pockets versus into the payers' pockets.

由於這些努力，我們的降級和拒絕率並沒有增加，我希望這意味著我們能將更多合法賺到的錢留在自己的口袋裡，而不是落入付款人的口袋裡。

So that's one element I would throw in there. I don't think it's material, but we have not allowed that slippage to continue, which we said we'd be fixated on as a strategy for the company. In terms of your other question regarding strategy and or technology and AI that has also been a core strategy for CHS.

這就是我要提到的一個元素。我認為這不是什麼實質的問題，但我們不會允許這種下滑繼續下去，我們表示我們會將此作為公司的策略。至於您關於策略和技術以及人工智慧的另一個問題，這也是 CHS 的核心策略。

I believe I mentioned last quarter our investment and growth in robotic surgery platforms. We continue to see really strong growth in our robotic assisted surgeries in the company, so I don't think it's due to any underinvestment into emerging technologies or services in our communities.

我相信我上個季度提到我們在機器人手術平台方面的投資和成長。我們公司機器人輔助手術持續保持強勁成長，因此我認為這並不是因為我們社區對新興技術或服務的投資不足。

In terms of the AI component, one of the things I'm really proud of is our investment into the development of a strong data science group here at CHS. We have some of the leading industry experts on supporting our efforts. We have deeper insights into the business as a result of that. And I'd also layer on the investment into the ERP, the enterprise resource planning tools.

就人工智慧組件而言，我真正感到自豪的事情之一是我們對 CHS 強大的數據科學團隊的發展進行了投資。我們有一些行業頂尖專家支持我們的努力。因此，我們對業務有了更深入的了解。我也會對 ERP（企業資源規劃工具）進行分層投資。

Again, we're, I think in the early innings of that investment, but the insights that's gleaning into our business and our operations and our opportunities, I think it'll be a really strong benefit and tailwind of the company for many quarters and years to come.

再說一次，我認為我們正處於這項投資的早期階段，但從我們的業務、營運和機會中獲得的見解，我認為在未來的許多季度和幾年裡，它將為公司帶來真正的巨大利益和順風。

So I don't think there's really anything in terms of where we may be missed it strategically. I think it really is a lull in consumer confidence, as we've called out, and as I said in my prepared remarks, I can't remember a time in this industry where the consumer hasn't come back. We still believe we provide absolutely essential services to the communities we serve.

因此，我認為從策略角度來說，我們不會錯過任何機會。我認為，正如我們所呼籲的，這確實是消費者信心的低迷，正如我在準備好的發言中所說的那樣，我不記得這個行業有哪個時候消費者沒有回歸。我們仍然相信我們為我們服務的社區提供了絕對必要的服務。

Right, great, that all makes sense. Just a quick follow up on the lab core. We were your reference, labs was that were those assets EBITDA positive for you in the past? And then is it conceivable that having labor take care of those assets is actually additive to EBITDA?

對，太好了，這一切都說得通。只是對實驗室核心進行快速跟進。我們是您的參考，實驗室過去那些資產的 EBITDA 對您來說是正面的嗎？那麼，是否可以想像，讓勞動力來照顧這些資產實際上會增加 EBITDA 呢？

We don't have an exact measure because it wasn't a business that we ran separately but certainly we've done, a fair amount of work before making the decision to sell that part of our business as I mentioned, it was not a core competency of ours. It may have been marginally EBITDA (inaudible) marginal EBITDA generation from that, relatively small, and I think that again overall, getting some cash up front and providing a much better experience for our physicians will be much more beneficial to our practices and ultimately to our EBITDA going forward also keep in mind that our -- even our employee physicians did not use our in-house, outreach lab, business exclusively.

我們沒有確切的衡量標準，因為這不是我們單獨經營的業務，但正如我所提到的，在決定出售該部分業務之前，我們確實做了大量的工作，這不是我們的核心競爭力。這可能是邊際 EBITDA（聽不清）邊際 EBITDA 產生，相對較小，我認為總的來說，預先獲得一些現金並為我們的醫生提供更好的體驗將對我們的實踐更有利，並最終對我們未來的 EBITDA 更有利，還要記住，即使我們的僱員醫生也沒有專門使用我們的內部外展實驗室業務。

We were still sending portions of our business out (inaudible) to request to other third party labs. So we really have now an opportunity to partner with Labcorp on this and bring just a better solution with their technology and it is their core competency, and they'll be able to deliver those services at a cost cheaper than we could provide them ourselves.

我們仍在將部分業務發送出去（聽不清楚）以請求其他第三方實驗室。因此，我們現在確實有機會與 Labcorp 合作，利用他們的技術帶來更好的解決方案，這是他們的核心競爭力，而且他們能夠以比我們自己提供的服務更便宜的成本提供這些服務。

Got it. Perfect, thanks.

知道了。非常好，謝謝。

Ben Hendrix, RBC.

本‧亨德里克斯 (Ben Hendrix)，加拿大皇家銀行。

Great, thank you very much for squeezing me in here with one more. I just, we've gotten a lot of questions on the rural health transformation program and the $50 billion allocated under the OBBB Act.

太好了，非常感謝您抽空再跟我聊一次。我只是，我們收到了很多關於農村衛生轉型計劃和 OBBB 法案下分配的 500 億美元的問題。

Any way to frame kind of your contribution there to what extent you're including those funds in your outlook and how do we frame kind of what the benefit could be even if just, an assessment of how much of your program would be eligible for those -- for that program. Thanks.

有什麼方法可以確定您的貢獻，您在多大程度上將這些資金納入您的展望，以及我們如何確定可能帶來的利益，即使只是評估您的計劃中有多少資金有資格獲得這些資金 - 對於該計劃。謝謝。

Great question, Ben, and one we've received a couple times already and one we're thinking about, quite a bit again, we're investing in lobbying efforts around that. There is no clear answer at this point as to how that money is going to be spent, or divvied up amongst the rural health providers, so that's all yet to be determined. I believe my understanding is 50% of that will be at the discretion of CMS and the other 50% given to the states to determine and even they may determine differently in each state how they distribute the money, so a lot more to come.

很好的問題，本，這個問題我們已經收到過幾次了，我們正在考慮這個問題，而且考慮得相當多，我們正在就此進行遊說工作。目前還沒有明確的答案說明這筆錢將如何使用，或在農村醫療服務提供者之間分配，所以這一切都還有待確定。我的理解是，其中 50% 將由 CMS 自行決定，另外 50% 由各州自行決定，甚至各州可能以不同的方式決定如何分配資金，因此還有很多事情要做。

I also understand that there's been a proposed bill in the Senate to increase the amount from $50 billion to $100 billion, so that is still yet to come as we look at our portfolio of hospitals, I would say roughly 40% of our beds we believe would qualify in terms of a definition of rule but even that isn't entirely clear because, throughout, the medical regulations and CMS there's multiple definitions of what is rule.

我還了解到，參議院已提出一項法案，將金額從 500 億美元增加到 1000 億美元，因此，當我們審視我們的醫院組合時，這仍未實現，我認為大約 40% 的床位符合規則的定義，但即使這樣也不完全清楚，因為在整個醫療法規和 CMS 中，對規則的定義有多種。

And I'm not sure, which is the exact one that'll apply here. We're giving our best estimate, that is about 40% of our bed.

我不確定哪一個才是真正適用於這裡的。我們給出的最佳估計是，這大約占我們床位的 40%。

Thank you.

謝謝。

This concludes our question-and-answer session. I would like to turn the conference back over to Mr. Tim Hingtgen, Chief Executive Officer for any closer remarks. Please go ahead, sir.

我們的問答環節到此結束。我想將會議交還給執行長 Tim Hingtgen 先生，請他發表更詳細的評論。先生，請繼續。

Great, thanks Chuck, and thank you everyone for joining the call today. I want to close by thanking the amazing people who work across the CHS organization for the opportunity to serve as their CEO and to support their commitment to provide quality, compassionate care for all of their patients, and I want to say once again that I'm grateful to be passing the torch to Kevin Hammons because he's a capable and committed leader for CHS.

太好了，謝謝查克，也謝謝大家今天參加電話會議。最後，我要感謝 CHS 組織內所有出色的員工，感謝他們給我機會擔任首席執行官，支持他們為所有患者提供優質、富有同情心的護理的承諾，我想再次說，我很高興將火炬傳遞給 Kevin Hammons，因為他是 CHS 一位有能力且有責任心的領導者。

I look forward to all of the good things ahead for Community Health Systems. If you have any additional questions you can always reach us at 615-465-7000. Have a great day everyone.

我期待社區衛生系統未來一切順利。如果您有任何其他問題，可以隨時撥打 615-465-7000 與我們聯絡。祝大家有個愉快的一天。

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。