Community Health Systems Inc (CYH) 2025 Q3 法說會逐字稿

Good day, and welcome to the Community Health Systems third-quarter 2025 earnings conference call. (Operator Instructions) Please note, this event is being recorded. I would now like to turn the conference over to Anton Hie, Vice President of Investor Relations. Please go ahead.

大家好，歡迎參加社區健康系統2025年第三季財報電話會議。（操作說明）請注意，本次活動正在錄影。現在我將把會議交給投資者關係副總裁安東·希耶。請繼續。

Thank you, Betsy. Good morning, everyone, and welcome to Community Health Systems' third-quarter 2025 conference call. Joining me today on the call are Kevin Hammons, President and Interim Chief Executive Officer; and Jason Johnson, Senior Vice President, Chief Accounting Officer, and Interim Chief Financial Officer.

謝謝你，貝齊。各位早安，歡迎參加社區健康系統2025年第三季電話會議。今天與我一起參加電話會議的有總裁兼臨時首席執行官凱文·哈蒙斯；以及高級副總裁、首席會計官兼臨時首席財務官傑森·約翰遜。

Before we begin, I'll 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 as 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.

在會議開始之前，我要提醒大家，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。這些前瞻性陳述受到許多已知和未知風險的影響，這些風險已在我們的 10-K 表格年度報告的「風險因素」等標題中進行了描述，並在提交給美國證券交易委員會或向其提供的其他報告中進行了描述。

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.

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重大差異。我們不打算更新任何前瞻性陳述。

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 today exclude gains or losses from early extinguishment of debt, and impairment gains or losses on the sale of businesses.

昨天下午，我們發布了一份新聞稿，其中包含了我們的財務報表以及調整後 EBITDA 和調整後 EPS 的定義和計算方法。我們也在網站上發布了補充幻燈片簡報。我們今天討論的所有計算均不包括提前償還債務的收益或損失，以及出售企業產生的減損收益或損失。

With that said, I'll turn the call over to Kevin Hammons, President and Interim Chief Executive Officer. Kevin?

接下來，我將把電話交給總裁兼臨時執行長凱文·哈蒙斯。凱文？

Thank you, Anton. Good morning, everyone, and thank you for joining our third-quarter 2025 conference call. Before we jump into discussing the quarter, I want to take a moment to thank the team here at CHS for the support they've shown me and others through the recent transition of senior leadership. It is gratifying to see our team's confidence in the work we are doing here at CHS and their commitment to our future success.

謝謝你，安東。各位早安，感謝各位參加我們2025年第三季電話會議。在我們開始討論本季之前，我想花一點時間感謝 CHS 團隊在最近高層領導過渡期間給予我和其他人的支持。看到我們的團隊對CHS的工作充滿信心，並致力於我們未來的成功，我感到非常欣慰。

Over the past 90 days or so, since stepping into my new role as Interim CEO, I've had the opportunity to visit several of our markets and speak with many of our hospital leadership teams, including operational, financial, clinical, and service line leaders. It is always inspiring to see the folks who are providing high-quality care for our patients and helps put into perspective how important our hospitals are to the people and communities they serve.

在過去 90 天左右的時間裡，自從我擔任臨時執行長這一新職務以來，我有機會走訪了我們的幾個市場，並與我們許多醫院領導團隊進行了交談，包括營運、財務、臨床和服務線領導。看到那些為我們的病人提供高品質照護的人們，總是令人鼓舞，也讓我們更深刻地認識到我們的醫院對所服務的民眾和社區有多麼重要。

At CHS, we will remain focused on supporting our caregivers, physician partners, and support teams to help ensure an exceptional healthcare experience for our patients. Next month, approximately 150 CEOs and CFOs from across the CHS network will gather for a leadership conference where we will discuss our vision for the future of the company and our ongoing commitment to investments in quality, improving both physician and patient experience, improving employee satisfaction, and achieving sustainable positive free cash flow.

在 CHS，我們將繼續專注於支持我們的護理人員、醫生合作夥伴和支援團隊，以幫助確保我們的患者獲得卓越的醫療保健體驗。下個月，來自 CHS 網路的約 150 位執行長和財務長將齊聚一堂，參加領導力會議。在會議上，我們將討論我們對公司未來的願景，以及我們對品質投資、改善醫生和患者體驗、提高員工滿意度和實現可持續正自由現金流的持續承諾。

As I've shared with many on our team already, I'm very optimistic about the future of CHS and our opportunities to continuously improve the healthcare experience, to continue to improve our operational and financial performance, and to create value for our investors through disciplined and proactive management of our business.

正如我之前與團隊中許多人分享的那樣，我對 CHS 的未來以及我們不斷改善醫療保健體驗、持續提高營運和財務業績、並透過嚴謹積極的業務管理為投資者創造價值的機會感到非常樂觀。

Now, turning to the third quarter operating results. Our operating performance was in line with our updated expectations. And our reported results were further enhanced by the recognition of a $28 million gain from the settlement with some prior litigation, which reimbursed us for previously incurred expenses.

現在，讓我們來看看第三季的經營業績。我們的經營績效符合我們更新後的預期。此外，由於與先前的一些訴訟達成和解，我們獲得了 2800 萬美元的收益，這筆款項補償了我們之前發生的支出，進一步提升了我們的業績。

Same-store net revenue for the third quarter improved 6% year-over-year. We were encouraged to see some improvement in payer mix on both a sequential and year-over-year basis, as well as realizing the incremental state directed payments from New Mexico and Tennessee when compared to the prior year.

第三季同店淨收入較去年同期成長 6%。我們很高興地看到，無論從環比還是同比來看，付款方組成都有所改善，而且與前一年相比，新墨西哥州和田納西州也增加了州政府的定向付款。

As we have done all year, we continue to grow our inpatient volume. However, similar to last quarter, the overall business mix remains more heavily skewed towards medical versus surgical cases. And inpatient admissions were flat ahead of outpatient elective procedures.

正如我們今年以來所做的那樣，我們的住院人數持續成長。然而，與上個季度類似，整體業務結構仍然更嚴重地偏向內科病例而非外科病例。在門診擇期手術之前，住院人數保持穩定。

However, solid expense management across most categories helped drive slight margin expansion year-over-year, even when excluding the benefit from the legal settlement. We continue to make targeted investments and advance our competitive position in many key markets during the quarter, including capacity and service line expansions, such as the acquisition of a vascular surgery practice and the relocation of a large OB-GYN practice onto our campus, both in Birmingham, Alabama; the addition of a new urology service line in Las Cruces, New Mexico; the addition of a new neurosurgery and spine program in Laredo, Texas; and new robotic surgery programs in two of our New Mexico markets.

然而，即使不考慮法律和解的好處，大多數類別的穩健費用控制也推動了利潤率同比略有增長。本季度，我們繼續進行有針對性的投資，並在許多關鍵市場提升我們的競爭地位，包括擴大產能和服務範圍，例如收購一家血管外科診所，並將一家大型婦產科診所遷至我們位於阿拉巴馬州伯明翰的院區；在新墨西哥州拉斯克魯塞斯新增泌尿外科服務；在德克薩斯州拉雷多新神經外科和脊柱項目；以及在新墨西哥州的兩個新市場推出的機器人。

We are successfully recruiting physicians and advanced practice providers to our markets. At September 30, 2025, we had approximately 160 more employee physicians and APPs in our clinics than in the prior year. With the recent recruits and plan commencements in the fourth quarter and early next year, we should be favorably positioned as we enter 2026.

我們正在成功地為我們的市場招募醫生和高級執業人員。截至 2025 年 9 月 30 日，我們診所的員工醫生和高級執業護理師人數比前一年增加了約 160 人。隨著近期新兵的招募和計劃在第四季度和明年初啟動，我們在進入 2026 年時應該處於有利地位。

In addition, we continue to improve our capital structure, further reducing our leverage to 6.7 times, down from 7.4 times at year-end '24. Also as a reminder, during the quarter, we refinanced $1.74 billion of our senior secured notes due 2027, through the offering of $1.79 billion of 2034 notes, thereby pushing out our nearest significant maturity to 2029.

此外，我們持續改善資本結構，進一步降低槓桿至 6.7 倍，低於 2024 年底的 7.4 倍。另外提醒一下，本季我們透過發行 17.9 億美元的 2034 年到期票據，對 17.4 億美元的 2027 年到期優先擔保票據進行了再融資，從而將我們最近的重大到期日推遲到 2029 年。

At this point, I want to introduce Jason Johnson, our Interim Chief Financial Officer. And I'll turn the call over to Jason to review the financial results in greater detail and discuss our updated guidance. Jason?

在此，我想向大家介紹我們的臨時財務長傑森·約翰遜。接下來，我將把電話交給傑森，讓他更詳細地回顧財務表現並討論我們更新後的業績指引。傑森？

Thank you, Kevin, and good morning, everyone. For the third quarter, CHS delivered results generally consistent with expectations. The overall volume growth was in line with our updated guidance and with continued solid execution on controllable aspects of our business, the company achieved expansion in adjusted EBITDA margins and remains on track for the full year.

謝謝你，凱文，大家早安。第三季度，CHS 的業績大致上符合預期。整體銷售成長符合我們更新後的預期，隨著公司在可控業務方面持續穩健的執行，公司實現了調整後 EBITDA 利潤率的成長，並保持全年目標的實現。

Adjusted EBITDA for the third quarter was $376 million, compared with $347 million in the prior year period, with a margin of 12.2%, increasing 100 basis points year-over-year. Results included $28 million from the receipt of a settlement of a legal matter recognized as non-patient revenue. When excluding this amount, adjusted EBITDA was $348 million, and margin was approximately 11.4%, up 20 basis points from the prior year period.

第三季調整後 EBITDA 為 3.76 億美元，而上年同期為 3.47 億美元，利潤率為 12.2%，年增 100 個基點。業績包括因法律糾紛和解而獲得的 2,800 萬美元，該款項被認定為非患者收入。剔除該金額後，調整後的 EBITDA 為 3.48 億美元，利潤率約 11.4%，比去年同期成長 20 個基點。

Please note that the non-patient revenue related to legal settlement is excluded from the same-store metrics provided in our earnings release and supplemental materials. Same-store net revenue for the third quarter increased 6.0% year-over-year, again, driven primarily by rate growth as net revenue per adjusted admission was up 5.6% year-over-year.

請注意，與法律和解相關的非病患收入不包含在我們收益報告和補充資料中提供的同店指標中。第三季同店淨收入年增 6.0%，主要得益於票價成長，每次調整入場淨收入年增 5.6%。

Same-store inpatient admissions increased 1.3% year-over-year, and adjusted admissions were up 0.3%. Same-store surgeries declined 2.2% and ED visits were down 1.3%.

同店住院人數較去年同期增加 1.3%，調整後住院人數增加 0.3%。同店手術量下降了 2.2%，急診就診量下降了 1.3%。

We were encouraged by the sequential volume performance coming out of the second quarter, which was better than our typical seasonal experience in the third quarter. However, as Kevin previously noted, we again experienced a divergence in inpatient surgeries, which were flat year-over-year, and outpatient surgeries, which were down, reflecting continued pressure on consumer demand for elective procedure in our markets.

第二季銷售量較上季表現令人鼓舞，比我們往年第三季的季節性表現好。然而，正如凱文之前指出的那樣，我們再次發現住院手術量與去年同期持平，而門診手術量則有所下降，這反映出我們市場中消費者對擇期手術的需求持續面臨壓力。

Despite this environment, the company continued to perform well on cost controls, including labor costs. The year-over-year increase in average hourly rate was in line with our expectations and contract labor expense was down slightly on a year-over-year basis. We also performed well again on supplies expense, which were down year-over-year, and as a percentage of net revenue, fell 20 basis points to 15.0% when excluding the $28 million legal settlement.

儘管面臨這樣的環境，該公司在成本控制方面，包括勞動成本控制方面，仍然表現良好。平均時薪較去年同期上漲符合我們的預期，而合約工費用較去年同期略有下降。我們在供應費用方面也再次表現出色，年減，佔淨收入的百分比下降了 20 個基點，若不計入 2800 萬美元的法律和解金，則為 15.0%。

While we acknowledge ongoing inflationary pressures and potential incremental upward pressure from tariffs on imported products and raw materials in future periods, we believe that opportunities remain as we stabilize and mature workflows under our ERP. Medical specialist fees were $165 million in the third quarter, up approximately 4% year-over-year on a same-store basis and representing 5.4% of net revenue when excluding the legal settlement, which is generally consistent with recent quarters.

雖然我們承認持續的通膨壓力以及未來時期進口產品和原材料關稅可能帶來的進一步上行壓力，但我們相信，隨著我們在 ERP 系統下穩定和完善工作流程，機會依然存在。第三季醫療專家費用為 1.65 億美元，以同店計算年增約 4%，佔淨收入的 5.4%（不包括法律和解費用），這與最近幾季的情況基本一致。

We expect continued upward pressure on medical specialist fees in the fourth quarter and into next year, especially in radiology, while increased use of emerging or developing technology, including AI tools should eventually help on this front. Cash flows from operations were $70 million for the third quarter and $277 million for the year-to-date.

我們預計第四季度及明年醫療專家費用將繼續面臨上漲壓力，尤其是在放射科領域，而人工智慧工具等新興或發展中技術的日益普及最終應該會對此有所幫助。第三季經營活動產生的現金流量為 7,000 萬美元，年初至今為 2.77 億美元。

Cash flows from operations for the year-to-date as reported includes $126 million in outflows for taxes on gains on sales of hospitals, which are paid out of divestiture proceeds that are reported as investing cash flows. When excluding these cash taxes on divestiture gains, our adjusted cash flows from operations were $403 million for the year-to-date and adjusted free cash flows were slightly negative for the year-to-date.

截至目前為止，報告的營運活動現金流量包括 1.26 億美元的醫院出售收益稅款支出，這些稅款是從作為投資現金流量報告的資產剝離收益中支付的。如果排除這些資產剝離收益的現金稅，我們今年迄今的調整後營運現金流為 4.03 億美元，而今年迄今的調整後自由現金流略微為負。

Based on our historical performance in which the fourth quarter operating cash flows are typically the strongest of the year, we remain confident in our ability to achieve positive free cash flow for the full year of 2025 after adjusting for cash taxes paid on divestiture gain. In August, we refinanced substantially all of our 2027 maturities, using proceeds from an offering of $1.79 billion and 9.75% senior secured notes due 2034 to redeem via a tender offer $1.743 billion or 99% of our outstanding 2027 senior secured notes.

根據我們以往的業績，第四季度的經營現金流通常是一年中最強勁的，因此我們仍然有信心在扣除出售資產所得現金稅款後，在 2025 年全年實現正自由現金流。8 月，我們利用發行 17.9 億美元 9.75% 優先擔保票據（2034 年到期）的收益，對幾乎所有 2027 年到期的債務進行了再融資，並透過要約收購贖回了 17.43 億美元，即我們未償還 2027 年優先擔保票據的 99%。

As Kevin previously noted, leverage at quarter end was 6.7 times, down from 7.4 times at year-end 2024, and our next significant maturity is in 2029, providing ample runway to continue executing our strategic initiatives.

正如凱文之前指出的那樣，季度末的槓桿率為 6.7 倍，低於 2024 年底的 7.4 倍，而我們下一個重要的成熟期將在 2029 年到來，這將為繼續執行我們的戰略計劃提供充足的緩衝時間。

As expected, in October, we received $91 million in contingent cash consideration related to last year's divestiture of [Canova Cleveland]. We also continue to expect the divestiture of our Outreach Lab asset to close later this quarter with proceeds of approximately $195 million, which will provide additional liquidity to fund growth investments or further reduce our leverage.

正如預期，10月份我們收到了與去年資產剝離相關的9,100萬美元或有現金對價。[卡諾瓦克利夫蘭]。我們也繼續預計，我們的 Outreach Lab 資產剝離將於本季稍後完成，所得款項約為 1.95 億美元，這將為成長投資提供額外的流動性，或進一步降低我們的槓桿率。

Now, moving on to our updated 2025 financial guidance. Based on our operating results through the first nine months, along with the benefit from the legal settlement that was not contemplated in the previous guidance, we are tightening our adjusted EBITDA range for the full-year 2025 to $1.50 billion to $1.55 billion. Consistent with our prior approach, this guidance does not contemplate any further divestitures beyond those announced, nor does it assume contribution from any new or pending supplemental payment programs.

接下來，我們來看看更新後的 2025 年財務預期。根據我們前九個月的經營業績，以及先前預期中未考慮到的法律和解帶來的好處，我們將 2025 年全年的調整後 EBITDA 範圍收窄至 15 億美元至 15.5 億美元。與我們先前的做法一致，本指南不考慮除已宣布的資產剝離之外的任何其他資產剝離，也不假設任何新的或待定的補充支付計劃的貢獻。

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

我們的發言稿到此結束。所以現在，我們將把電話轉回給接線生進行問答環節。

(Operator Instructions) Brian Tanquilut, Jefferies.

（操作說明）Brian Tanquilut，傑富瑞集團。

Hey. Good morning, guys, and congrats on the quarter. Maybe, Kevin, as I think about volume performance, obviously, nice to see the positive trend in inpatient. But on the outpatient side, you still saw some weakness in surgeries and ER.

嘿。各位早安，恭喜你們本季取得佳績。凱文，或許，當我考慮業務量表現時，顯然很高興看到住院業務呈現正面趨勢。但在門診方面，手術和急診方面仍存在一些不足。

Just any thoughts you can share with us in terms of what you're seeing in terms of the recovery of volumes there? Or how are you guys thinking internally in terms of what that trajectory looks like? And maybe also the components of what outpatient is and what you're seeing in those buckets?

您能否和我們分享一下您對當地交易量恢復情況的看法？或者說，你們內部是如何看待這發展軌跡的？或許還可以考慮門診治療的組成部分，以及你在這些類別中看到的內容？

Thanks, Brian. Absolutely. So as we called out in the second quarter, and as I believe we still saw in the third quarter, some of the economic headwinds, more the macroeconomics, the climate, and consumer confidence seems to be the big headwind.

謝謝你，布萊恩。絕對地。正如我們在第二季度指出的那樣，而且我認為我們在第三季度仍然看到的情況，一些經濟逆風，尤其是宏觀經濟、氣候和消費者信心方面的逆風，似乎是最大的逆風。

And I think that continued on into the third quarter, particularly in some of our markets are experiencing some heavier or more softness economically than other markets. And so we still believe that has been the primary driver of some of the softness now.

我認為這種情況延續到了第三季度，尤其是在我們的一些市場，這些市場的經濟疲軟程度比其他市場更為嚴重。因此，我們仍然認為這是目前市場疲軟的主要原因。

As consumer confidence seems to be stabilizing, it's bounced off its lows in the second quarter a little bit and seems to be improving, we are seeing some recovery. And I think that we experienced that where we saw some improvement in payer mix into the third quarter, and we're certainly experiencing that in some of our markets.

消費者信心似乎正在穩定，從第二季的低點略有反彈，似乎正在改善，我們看到了一些復甦跡象。我認為我們在第三季看到了支付方組合的一些改善，而且我們在某些​​市場也確實看到了這種情況。

So that gives us a little more confidence as the payer mix improves and people are feeling better, they're starting to come back in for more procedures. Our -- although we were still down on an outpatient elective surgery volume year-over-year, it was improved over second quarter. So we did see some improvement there.

因此，隨著支付方組合的改善和人們感覺好轉，我們更有信心，他們開始回來接受更多手術。雖然我們的門診擇期手術量較去年同期仍下降，但比第二季有所改善。所以，我們確實看到了一些進步。

I'd also point out maybe the integration climate probably is affecting some of our markets still. If you think about markets in Arizona, across Texas, primarily, there's still probably a little bit of an overhang there where patient behavior, people are staying away from hospitals, at least on an elective basis more than we've seen in the past.

我還想指出，一體化環境可能仍然對我們的一些市場產生影響。如果你考慮亞利桑那州和德克薩斯州等地的市場，你會發現仍然存在一些滯後現象，那就是病人的行為，人們比以往更遠離醫院，至少在擇期就醫方面是如此。

Now, we're also experiencing or noticing that in our ER business. And many of those are uncompensated. So where you're seeing some lower volume and maybe why that hasn't completely been noticed in our EBITDA generation is because some of that volume that we're seeing there's lots of volume, particularly in the ERs and uncompensated care. And so that has not had an EBITDA -- negative EBITDA impact on it.

現在，我們在急診業務中也經歷或註意到了這一點。而且其中許多人都沒有得到補償。所以，您看到的某些業務量較低，而這可能並沒有完全反映在我們的 EBITDA 計算中，因為我們看到的一些業務量很大，尤其是在急診室和無償照護方面。因此，這並未對 EBITDA 產生負面影響。

That's very helpful, Kevin. And then maybe just a follow-up question for me. How should we be thinking about your divestiture plans or outlook for 2026?

這很有幫助，凱文。然後，或許您還有一個後續問題。我們該如何看待您的資產剝離計畫或2026年的展望？

Yeah. We're still pursuing; some divestitures, were in some early conversations that -- it's too early at this point. We don't know how far those will go. But certainly, we're continuing to get some inbound interest.

是的。我們仍在進行一些交易；一些資產剝離，我們之前也進行過一些初步的討論——但現在談論這些還為時過早。我們不知道這些措施能走多遠。但可以肯定的是，我們仍然不斷收到一些諮詢。

We are in some more advanced discussions on a couple of deals, which we think could be announced even later this year. But no agreements have been signed at this point. So nothing to report today that we are advancing some discussions (inaudible)

我們正在就幾項交易進行更深入的討論，我們認為這些交易甚至可能在今年稍後宣布。但目前尚未簽署任何協議。今天沒有什麼值得報告的，我們也沒有推進任何討論。（聽不清楚）

AJ Rice, UBS.

AJ Rice，瑞銀集團。

First of all, I guess, you're moving towards this year -- it sounds like you think you'll be free cash flow positive on a full-year 2025 basis, assuming the fourth quarter comes in with a couple of hundred million positive for you. Is that -- as you begin to move to a position where that's ongoing -- going to be the case, does that change your thinking on capital deployment, amount of CapEx you're going to spend, other initiatives, maybe tuck-in deals with outpatient or other things? Any thoughts on that?

首先，我猜你是在著眼於今年——聽起來你認為在2025年全年，你的自由現金流將為正，假設第四季度能為你帶來幾億美元的正收益。當你開始進入一個需要持續投入的職位時，情況是否會改變？這是否會改變你對資本部署、資本支出金額、其他舉措、以及與門診或其他方面的合作交易的想法？對此有什麼看法？

Thanks, AJ. Absolutely. I think that it frees us up a little bit and does allow us to think and be a little more strategic in terms of how we think about either deploying capital. It gives us some optionality of whether we use incremental free cash flows to further delever the company to -- which in effect would have a virtuous cycle benefit because it reduces future cash flows.

謝謝你，AJ。絕對地。我認為這讓我們稍微擺脫了一些束縛，也讓我們在思考如何部署資本方面能夠更具策略性。這讓我們有一定選擇權，可以選擇是否利用新增的自由現金流進一步降低公司的槓桿率——這實際上會產生良性循環的好處，因為它可以減少未來的現金流。

We could use it where there are opportunities for some tuck-in deals to spend capital more strategically in areas of things that we think could generate further EBITDA. So it does free stuff and should then, again, create a little more of a virtuous cycle for us.

我們可以利用它進行一些補充交易，以便更有策略地將資金投入到我們認為可以產生更多 EBITDA 的領域。所以它會提供免費的東西，然後應該會再次為我們創造一個良性循環。

Okay. And then, I mean it's early, I know, but when you look at '26 and you're starting your budgeting process, et cetera, are there headwinds or tailwinds that you would call out that we should keep in mind as we try to model '26?

好的。我知道現在還早，但是當你展望 2026 年並開始製定預算等計劃時，有哪些不利因素或有利因素是我們嘗試預測 2026 年時應該注意的？

Yeah. I think I could point out a few things. Certainly taking into consideration the divestitures that we've completed this year, Lake Norman and ShorePoint early in the year, Cedar Park divestiture, midyear. We did recognize some prior year SVP for Tennessee that's about $15 million to $20 million that we'll have this year towards the settlement gain that we recognized this quarter.

是的。我覺得我可以指出幾點。當然，考慮到我們今年已經完成的資產剝離，年初剝離了諾曼湖和肖爾波因特，並在年中剝離了雪松公園。我們確認了上一年田納西州的高級副總裁（SVP）約 1500 萬至 2000 萬美元，這筆款項將計入我們本季確認的結算收益中。

As I think about 2026, directionally, some of the things -- Medicare rate increase will be strong for 2026. We potentially -- there's a couple of other SDP programs out there in Georgia, Florida, Indiana, the Rural Health fund, which we don't know; can't quantify at this point but that should be incrementally positive for us.

展望 2026 年，從發展方向來看，一些事情－2026 年醫療保險費率將大幅上漲。我們可能——喬治亞州、佛羅裡達州、印第安納州還有其他一些 SDP 項目，以及農村衛生基金，我們目前還不清楚；無法量化，但這應該會對我們產生一些積極影響。

And then we're making -- continue to make some growth adjustments, you just mentioned, with positive free cash flow this year, continue on into next year may allow us to further invest in incremental growth capital.

然後，正如你剛才提到的，我們將繼續進行一些成長調整，今年的正自由現金流，如果能延續到明年，可能會使我們能夠進一步投資於增量成長資本。

I might add, Kevin. This is Jason. That you might want to include that $28 million legal settlement this quarter, [exclude] that from the jump off for 2025.

我還要補充一點，凱文。這是傑森。您可能希望將本季 2800 萬美元的法律和解金計入，[但]將其從 2025 年的初始目標中排除。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，加拿大皇家銀行資本市場。

Just a quick question for Kevin and Jason in turn. Just a little bit more color on your early observations in your roles. Kevin, you mentioned you've visited some facilities, any surprises or anything out of expectation in your review of the platform?

我分別想問凱文和傑森一個問題。請再詳細描述您在早期工作中的觀察。凱文，你提到你參觀了一些設施，在對該平台進行評估時，有沒有什麼意想不到的情況或出乎意料之處？

And then any initiatives you guys are looking at? And you talked a little bit already about capital deployment, but anything in operations or balance sheet management that could deviate from your prior practice? Thanks.

那麼，你們正在考慮哪些措施呢？您之前已經稍微談到了資本部署，那麼在營運或資產負債表管理方面，是否有任何可能與您之前的做法有所不同的地方？謝謝。

Thanks, Ben. I appreciate the question. I think the short answer is, say, I'm really excited about the direction of the company and I'm confident that we have the right strategies and people in place to execute on our opportunities. We've had a, I believe, a very smooth transition of leadership. And I believe we're already picking up momentum in a number of key areas.

謝謝你，本。感謝您的提問。簡而言之，我對公司的發展方向感到非常興奮，並且相信我們已經擁有正確的策略和人才來把握機會。我認為，我們的領導交接非常順利。我相信我們在許多關鍵領域已經取得了進展。

As I mentioned in my prepared remarks, we have taken the time to visit several local health systems. We've met with health system leaders and I think, substantially, all of our major markets already. They're very enthusiastic about the progress we're making.

正如我在準備好的演講稿中提到的，我們花時間拜訪了幾個當地的醫療機構。我們已經與醫療系統領導人會面，我認為，基本上已經與我們所有主要市場的所有領導人會面了。他們對我們所取得的進展感到非常興奮。

And I just -- am becoming increasingly confident that our investments, our strategic priorities, and the resources that we're appropriately laser-focused on, those most important aspects of our business, I think we'll see some of that come to fruition here in the near-term with a few areas. I'm highly focused on quality of care.

我越來越有信心，我們的投資、策略重點以及我們重點關注的資源，這些我們業務中最重要的方面，我認為在不久的將來，我們會在一些領域看到一些成果。我非常注重醫療品質。

So our quality ratings, our patient and physician experience, employee satisfaction, and I won't take my CFO hat on, and I'll continue to be laser-focused on free cash flow and making sure we've made such great progress over the last, probably, nine quarters in a row on free cash flow trending positively, now that we're getting to cross over from being negative to positive free cash flow.

所以，我們的品質評級、患者和醫生的體驗、員工滿意度，我不會以首席財務官的身份來看待這個問題，我將繼續專注於自由現金流，確保我們在過去可能連續九個季度在自由現金流方面取得了巨大進步，並且現在我們即將從負自由現金流轉為正自由現金流。

I think that's going to give us a lot more opportunity. So as I think though about those five priority areas for myself and the progress that we're already making on quality and getting focused on the others, I think that will help really accelerate what we can do in the future.

我認為這會為我們帶來更多機會。所以，當我思考這五個優先領域以及我們在品質方面已經取得的進展，並專注於其他方面時，我認為這將有助於真正加快我們未來能夠做的事情。

And Brian, this is Jason. Kevin alluded to CFO [has]. I'm in the position of following the [guide] that's still here. And Kevin put into place to focus on adjusted free cash flow and that virtuous cycle, and that's -- we're continuing to make sure that we're laser focused on that. So no change there.

布萊恩，這位是傑森。Kevin 暗示了 CFO [有]。我目前的情況是，要按照現有的[指南]來做。凱文制定了專注於調整後自由現金流和良性循環的策略，我們將繼續確保我們始終專注於此。所以這方面沒有變化。

I do think about that we got the ERP fully implemented earlier this year. So continuing to optimize that as a big focus; evaluation of the most efficient use of proceeds from any divestitures, whether that's investment in capital or deleveraging through debt repurchases.

我確實認為我們今年早些時候已經全面實施了ERP系統。因此，我們將繼續把優化作為重點；評估如何最有效地利用任何資產剝離所得款項，無論是投資資本還是透過債務回購來降低槓桿率。

So from my standpoint, it's just -- I've been here with Kevin for a number of years. So I understand what his vision is financially and the lives with it and we're continuing on.

所以從我的角度來看，就是──我和凱文在這裡已經很多年了。所以我理解他在財務上的願景以及隨之而來的生活，我們將繼續前進。

Great. Appreciate that. Just a quick follow-up to a prior comment. With the sequential surgical trend you saw from 2Q into 3Q, anything changing in the way we should think about typical 4Q elective seasonality? Thanks.

偉大的。謝謝。簡單補充一下之前的評論。從第二季到第三季度，我們觀察到手術量呈現連續上升趨勢，那麼對於典型的第四季擇期手術季節性，我們該如何看待這個問題呢？謝謝。

I do feel that with the improvement in payer mix in Q3, it gives me a little more confidence that Q4 could look more like the normal seasonal recovery. There was some concern that if commercial patients did not come back in Q3, and you get to late in the year and people have not met their (inaudible) deductible, yes, they may put it off until early 2026.

我確實覺得，隨著第三季支付方結構的改善，這讓我更有信心第四季可能更像正常的季節性復甦。有人擔心，如果商業病人在第三季沒有回來，到了年底，人們還沒有達到他們的（聽不清楚）自付額，那麼他們可能會把就醫推遲到 2026 年初。

It's looking less likely that that will occur. But with the continued headlines around healthcare and some uncertainty, we did not want to get ahead of ourselves in terms of guidance or suggesting that it could be better. But I think we're in a pretty good position coming into Q4.

這種情況發生的可能性似乎越來越小了。但鑑於醫療保健方面的新聞不斷，而且存在一些不確定性，我們不想在指導意見方面操之過急，也不想暗示情況可以變得更好。但我認為我們進入第四季時處於相當有利的地位。

There's also potentially an opportunity that if people are concerned who have exchange insurance about losing it. There may be some more of that comes back in Q4. It's a relatively small component of our net revenue. It's less than 5% of our net revenues. So I don't think it's a real material needle mover for us, but it potentially could be a slight positive.

還有一個潛在的機會是，如果有人擔心購買了交易所保險會失去它。第四季可能會有更多類似的情況出現。這在我們淨收入中所佔比例相對較小。這不到我們淨收入的5%。所以我認為這對我們來說不會是一個真正的實質影響因素，但有可能帶來一些正面影響。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

I think I want to just follow up on some of those encouraging volume trends. Were those trends you saw exiting 3Q or at the start of 4Q? And from a category standpoint, what are you seeing? And is the payer mix improvement generally driven more by the employer-based coverage or the ACA? Thanks.

我想繼續關注這些令人鼓舞的交易量趨勢。這些趨勢是在第三季末還是第四季初觀察到的？從類別角度來看，你看到了什麼？支付方結構的改善總體上更多是由雇主提供的醫療保險還是《平價醫療法案》(ACA) 推動的？謝謝。

So we saw the payer mix improvements really beginning early Q3 in July. So the -- we saw that improvement throughout Q3. So I think our expectation would be that that will likely continue into Q4.

因此，我們看到支付方組合的改善真正開始於7月初的第三季。所以——我們在整個第三季都看到了這種改善。所以我認為，這種情況很可能會持續到第四季。

Now, from a comp perspective, Q4 of 2024 was strong and, particularly, the post-election period, we saw consumer confidence spike in Q4 of last year. So we will have that to climb over. But all in all, directionally and sequentially, I would say that we should continue or we expect that we could continue to see some improvement Q3 to Q4.

從比較的角度來看，2024 年第四季表現強勁，尤其是在大選後的時期，我們看到去年第四季消費者信心飆升。所以我們要翻過那道牆。但總的來說，從方向和順序上看，我認為我們應該繼續，或者我們預計在第三季到第四季之間可能會繼續看到一些改善。

In terms of where we're seeing improvement in terms of the breakdown, it was primarily in commercially insured business, although we did see improvement in exchange as well. But again, the exchange business is a relatively small component of our overall net (inaudible)

就我們看到的故障率下降情況而言，主要體現在商業保險業務方面，儘管我們也看到交易所方面有所改善。但再次強調，外匯交易業務在我們整體淨利潤中所佔比例相對較小。（聽不清楚）

Great. And on the government side of things, Indiana is one of your largest states, which I think has one of the largest declines in state Medicaid enrollment to date. Are you seeing the impact of tighter Medicaid eligibility in states like Indiana impact your Medicaid volume results? Thanks.

偉大的。而就政府方面而言，印第安納州是你們最大的州之一，我認為該州迄今為止的州醫療補助計劃參保人數下降幅度最大。您是否發現印第安納州等州收緊醫療補助資格對您的醫療補助業務量產生了影響？謝謝。

We've not experienced any significant impact, specifically to Indiana, from that.

我們沒有感受到由此對印第安納州造成任何重大影響。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢美術館。

I just wanted to touch quickly. I think you noted thinking about 2026 and the favorable Medicare OPPS coming in. Obviously, the -- we're waiting on the final outpatient rule. But like as you think about -- if the outpatient were to come in as proposed, like how do you think about the net of those two pieces as it relates to 2026? Were they largely offset each other? Or are there nuances from a Medicare rate perspective if the OPPS comes in as proposed? Thanks.

我只是想快速地觸碰一下。我想你提到過，你在考慮 2026 年以及即將實施的有利的 Medicare OPPS 政策。顯然，我們還在等待最終的門診規則。但是，當你思考這個問題時——如果門診病人按照提議進入，你如何看待這兩部分與 2026 年的關係？它們之間是否基本上相互抵消？如果 OPPS 按提議實施，從 Medicare 費率的角度來看，是否存在一些細微差別？謝謝。

I would say with the proposed outpatient, but we know an inpatient proposed outpatient, I still think it's a little net positive to 2026 over 2024 -- sorry, 2025.

我會說，考慮到擬議的門診治療方案，但我們知道擬議的門診治療方案是住院治療，我仍然認為到 2026 年比 2024 年（抱歉，是 2025 年）略有利好。

Okay. Great. And maybe just more of a high-level question. On the ambulatory front, I know you have new access points opening up, including a few ASCs.

好的。偉大的。或許這只是一個更宏觀的問題。在門診方面，我知道你們有一些新的就診點正在開放，包括一些門診手術中心。

But as you step back, can you just discuss your ambulatory strategy or remind us? Help frame maybe what inning you're in in terms of building out those access points and how that's helped your market share position? And anything else along those front would be very helpful. Thanks.

但是，您退後一步，能否談談您的步行策略或提醒我們？請您幫忙分析一下，在拓展這些接入點方面，您目前處於哪個階段，以及這些舉措如何幫助您提升市場佔有率？此外，在這方面提供的任何資訊都將非常有幫助。謝謝。

Sure. So we are -- continue to look at access points. We've been investing in those for some time. I think each market -- in our markets, each market is a little bit different. We've taken a little different strategy in those markets where we've had capacity constraints.

當然。所以我們正在繼續尋找接入點。我們已經投資這些領域一段時間了。我認為每個市場——在我們所在的市場中，每個市場都略有不同。在那些產能受限的市場，我們採取了略有不同的策略。

On the inpatient side, we have invested in more inpatient dollars, such as this past year, we opened up new towers in Knoxville, Tennessee, where we added, I believe, 58 beds, and we added a new patient tower in Foley, Alabama. Both of those markets, we had capacity constraints.

在住院方面，我們增加了住院資金投入，例如去年，我們在田納西州諾克斯維爾開設了新的大樓，據我所知，我們在那裡增加了 58 張床位，我們還在阿拉巴馬州福利增加了一座新的病人大樓。這兩個市場我們都面臨產能限制。

Currently, we do not have any of those larger construction projects on the inpatient side in flight. And so as we move through '25 and into 2026, more of our dollars will be focused on the access points, whether that's urgent care, pre-standing EDs, ASCs, and so forth. And so I think those are lower dollar. We can do more of them for the same amount of capital.

目前，我們在住院部還沒有任何大型建設項目正在進行中。因此，隨著我們進入 2025 年和 2026 年，我們將把更多的資金投入醫療服務點，無論是緊急護理、預備急診室、門診手術中心等等。所以我認為這些價格會更低。我們可以用同樣的資金做更多這樣的專案。

Now we have been opening three to four freestanding EDs per year. We have, I believe, three ASCs scheduled for opening this quarter here in 2025 -- in the fourth quarter of 2025. We'll probably target six to eight ASCs for next year in 2026 along with some additional freestanding EDs and possibly emergent care centers. And then we're always also acquiring clinics and hiring new doctors into our existing clinics as well.

現在我們每年開設三到四家獨立急診室。我相信，我們有三家 ASC 計劃於 2025 年本季（即 2025 年第四季）在這裡開業。我們可能會在 2026 年（明年）設立 6 到 8 家 ASC，以及一些獨立的急診室，可能還會設立緊急護理中心。此外，我們也持續收購診所，並為我們現有的診所招募新醫生。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

This is [Mitchell] on for Steve. Can you please highlight what drove the 5.6% growth in same-store revenue per admission and what you see as a sustainable rate there? Thank you.

這是米切爾替史蒂夫上場。請您重點說明是什麼因素推動了同店每人次入場收入成長 5.6%，以及您認為可持續的成長速度是多少？謝謝。

Hey, Steve. This is Jason. About a third of that 5.6% improvement in same-store net revenue per AA is a result of the Tennessee and New Mexico state direct co-payment programs that were approved in the second quarter.

嘿，史蒂夫。這是傑森。每位 AA 的同店淨收入成長 5.6%，其中約三分之一是由於田納西州和新墨西哥州在第二季批准的直接共同支付計畫所致。

And then the rest of the improvement is payer mix related. And there is some offset. We did have a little bit lower acuity.

其餘的改進都與支付方組合有關。而且存在一些偏差。我們的視力確實稍差一些。

I might -- just to add in terms of what's sustainable. We think a mid-single-digit net revenue growth and net revenue per AA growth is a sustainable number. And between your Medicare rate increases, our commercial rate increases, we expect acuity to recover going forward.

我可能會——只是想補充一點關於永續性的內容。我們認為，淨收入成長和每AA淨收入成長達到中個位數是一個可持續的數字。隨著您的醫療保險費率上漲，以及我們的商業費率上漲，我們預計未來病情會有所改善。

Right now, there is some dilutive impact on the net revenue per AA with the softer outpatient surgeries, particularly orthopedic and cardiac surgeries, which have been areas of softness. But as those come back, we should see a lift in the net revenue per AA, just that they're higher acuity services.

目前，由於門診手術（尤其是骨科和心臟手術）的疲軟，每位 AA 的淨收入受到了一定的稀釋影響，這些手術一直是疲軟的領域。但隨著這些服務恢復，我們應該會看到每位 AA 的淨收入有所提升，因為它們提供的是更高水準的服務。

Josh Raskin, Nephron.

Josh Raskin，腎病學。

We appear to have lost connection with Josh --

我們似乎和喬希失去了聯繫。--

Hi. I'm sorry, do you guys hear me?

你好。不好意思，你們聽得到我說話嗎？

We can.

我們可以。

Sorry about that. Saved by the bell. Sorry. Can you speak to trends from payers around denials and underpayments, maybe just an update there and more importantly, around maybe the mitigation of those pressures?

抱歉。幸虧鈴聲及時趕到。對不起。您能否談談付款方在拒付和少付方面的趨勢，或許可以更新一下這方面的情況，更重要的是，能否談談如何緩解這些壓力？

And I'm curious if you're using any external vendors? Or is it all internal services on the RCM side and maybe any changes that have been there through the year?

我很好奇你們是否使用了任何外部供應商？或者，這是否都是 RCM 方面的內部服務，以及今年以來發生的任何變化？

Sure. So we called out, really, third quarter last year and in 2024 a big spike in denials. And since that time, it's stabilized. It is not really gotten any worse. But we continue to invest in our physician adviser program.

當然。因此，我們預測，去年第三季和 2024 年的否認率將大幅上升。自那時起，情況就穩定下來了。情況其實並沒有變得更糟。但我們會繼續投資我們的醫生顧問計劃。

We're investing in some AI tools in terms of how we do denials with our internal recycle team. We are using a combination of third-party vendors as well as internally developed products on that for purposes of our revenue cycle team.

我們正在投資一些人工智慧工具，以改善我們內部回收團隊的拒收流程。為了滿足收入週期團隊的需求，我們結合了第三方供應商的產品以及內部開發的產品。

Our revenue cycle is managed internally with our own team that they do use a combination of products. So as we get better at it, I would say, we've been able to hold things stable, which would indicate that the payers are probably also denying more claims, but we've been more efficient or better at overturning some of those denials in order to keep things status quo.

我們的收入週期由我們自己的團隊內部管理，他們會使用多種產品組合。所以隨著我們在這方面做得越來越好，我認為我們已經能夠保持穩定，這表明付款方可能也在拒絕更多的索賠，但我們在推翻其中一些拒絕方面效率更高，或者說做得更好，以維持現狀。

Perfect. That's helpful. And maybe just a quick one. Flu season. It seems like off to a little bit of a slow start. I assume that's contemplated in guidance and I'd be curious if you guys are seeing any updates into October as we move into flu season?

完美的。那很有幫助。或許就簡單說一下。流感季。開局似乎有點慢。我想這應該在指導意見中有所考慮，隨著流感季的臨近，我很想知道你們在十月是否有任何更新？

Yeah. It is contemplated in guidance and we haven't seen any big pickup yet in our facilities and the heavy flu. So at this point, I'm not sure we'll -- what we'll see yet for the remainder of the quarter, but we have taken that into consideration.

是的。指導意見中已經考慮過這個問題，而且我們還沒有在我們的機構中看到任何大規模的病例增加，也沒有看到嚴重的流感病例。所以目前我還不確定——本季剩餘時間我們會看到什麼，但我們已經考慮到了這一點。

This concludes our question-and-answer session. I would like to turn the conference back over to Mr. Hammons for any closing remarks.

我們的問答環節到此結束。我謹將會議交還給哈蒙斯先生，請他作總結發言。

Thank you, everyone, for joining us on the call today. I want to close by reiterating my thanks for our team members at CHS for their commitments and confidence through the leadership transition as we approach the future together. If you have any additional questions, you can always reach us at 615-465-7000. Have a good day, everyone.

感謝各位今天參加我們的電話會議。最後，我要再次感謝 CHS 的團隊成員，感謝他們在領導層過渡期間所展現出的奉獻精神和信任，讓我們攜手共創未來。如果您還有其他疑問，可以隨時撥打 615-465-7000 與我們聯絡。祝大家今天過得愉快。

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

會議已經結束。感謝各位參加今天的報告會。您現在可以斷開連線了。