Community Health Systems Inc (CYH) 2026 Q1 法說會逐字稿

Good day, and welcome to the Community Health Systems first-quarter 2026 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 Community Health Systems 2026 年第一季財報電話會議。(接線員指示) 請注意，本活動將被錄音。現在我想把會議交給投資人關係副總裁 Anton Hie。請開始。

Thank you, Bailey. Good morning, everyone, and thank you, and welcome to Community Health Systems' first-quarter 2026 conference call. Joining me on today's call are Kevin Hammons, Chief Executive Officer; and Jason Johnson, Executive Vice President and Chief Financial Officer.

謝謝你，Bailey。各位早安，謝謝大家，歡迎參加 Community Health Systems 2026 年第一季電話會議。今天與我一同出席的有執行長 Kevin Hammons，以及執行副總裁兼財務長 Jason Johnson。

Before we begin, I'll remind everyone that this conference call may contain certain forward-looking statements including all statements that do not relate solely to historical or current facts. These forward-looking statements are subject to a number of known and unknown risks, which are described in headings such as Risk Factors in our annual report on Form 10-K and other reports filed with or furnished to the SEC.

在開始之前，我要提醒各位，本次電話會議可能包含某些前瞻性陳述，包括所有不僅限於歷史或當前事實的陳述。這些前瞻性陳述受到多項已知與未知風險影響，相關內容已在我們的 Form 10-K 年報及其他向 SEC 提交或提供的報告中，以「風險因素」等標題加以說明。

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.

實際結果可能與今日討論中任何前瞻性陳述所表達的內容有重大差異。我們無意更新任何此類前瞻性陳述。

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 discuss today will exclude gains or losses from an early extinguishment of debt, impairment gains or losses on the sale of businesses, and expense from business transformation costs.

昨天下午，我們發布新聞稿，內含財務報表以及調整後 EBITDA 與調整後 EPS 的定義與計算方式。我們也在網站上發布了補充簡報投影片。我們今天討論的所有計算將排除提前清償債務的損益、出售業務之減損利益或損失，以及業務轉型成本費用。

With that said, I will turn the call over to Kevin Hammons, Chief Executive Officer.

接下來，我把電話交給執行長 Kevin Hammons。

Thank you, Anton. Good morning, everyone, and thank you for joining our first-quarter 2026 conference call and for your continued interest in CHS.

謝謝你，Anton。各位早安，感謝大家參加我們 2026 年第一季電話會議，也感謝各位持續關注 CHS。

Before we begin, I want to acknowledge our employees, physicians and all of our teammates who have embraced our vision to make the healthcare experience exceptional for our patients, our communities and each other. As people across our organization share in this commitment, I am confident we will see the benefits of making that healthcare experience exceptional. And as we do, more patients will choose our health systems and will create an even stronger company.

在開始之前，我想先向我們的員工、醫師以及所有夥伴致意，感謝大家擁抱我們的願景，為病患、社區以及彼此打造卓越的醫療照護體驗。隨著組織內更多人共同承諾這項目標，我有信心我們將看到打造卓越醫療體驗所帶來的效益。而當我們做到這一點，將有更多病患選擇我們的醫療體系，並打造更強健的公司。

Earlier this week, we announced some significant investments in ambulatory surgery centers in our core markets including the pending acquisition of a majority ownership interest in the Surgical Institute of Alabama, our largest acquisition since 2016. This surgery center performs more than 8,000 cases annually, and is the largest multispecialty surgery center in Alabama. We expect to close this transaction during the second quarter.

本週稍早，我們宣布在核心市場對門診手術中心進行一些重大投資，包括擬收購阿拉巴馬外科研究院（Surgical Institute of Alabama）的控股權，這是我們自 2016 年以來最大的一筆收購。該手術中心每年執行超過 8,000 例手術，並且是阿拉巴馬州最大的多專科手術中心。我們預期將於第二季完成此交易交割。

During the first quarter, we also purchased the majority interest in South Anchorage Surgery Center in Alaska and opened two de novo ASCs in Birmingham and Foley, Alabama. These targeted investments extend CHS' ability to provide outpatient surgical care in the most advantageous way for our patients while delivering excellent outcomes, optimizing the surgical experience for our physician partners, and driving future growth for our health systems.

在第一季期間，我們也收購了阿拉斯加 South Anchorage Surgery Center 的控股權，並在阿拉巴馬州伯明罕與佛利（Foley）新設（de novo）開幕兩家 ASC。這些精準投資延伸了 CHS 以最有利於病患的方式提供門診外科照護的能力，同時帶來優異的治療成果、優化我們醫師合作夥伴的手術體驗，並推動醫療體系未來成長。

Turning to our operating performance for the first quarter of 2026, adjusted EBITDA was on the low end of our internal expectations, declining 17.8% from the prior year period, reflecting our strategic transactions to reduce our debt, macroeconomic disruptions across the country, as well as the investment CHS is making in our future.

談到 2026 年第一季的營運表現，調整後 EBITDA 落在我們內部預期的低端，較去年同期下滑 17.8%，反映我們為降低負債所進行的策略性交易、全國性的總體經濟干擾，以及 CHS 對未來所做的投資。

The quarter's results include an approximate $50 million year-over-year EBITDA drag from recently completed divestitures that went from being positive contributors in the prior year period to negative in the first quarter of 2026. Closing these divestitures will remove the negative EBITDA drag from future quarters.

本季結果包含約 5,000 萬美元的 EBITDA 年對年拖累，來自近期完成的資產剝離案；這些資產在去年同期仍為正向貢獻者，但在 2026 年第一季轉為負向。完成這些剝離後，未來季度將不再承受該等負向 EBITDA 拖累。

Additionally, while we benefited from some out-of-period revenue related to the Georgia State Directed Payment Program, this tailwind was partially offset by out-of-period provider tax increases related to the Indiana program. Same-store net revenue increased 3.1% year-over-year, driven by 3.7% growth in net revenue per adjusted admission, partly offset by a 0.5% decline in same-store adjusted admissions.

此外，雖然我們受惠於與喬治亞州「州指導支付計畫」（Georgia State Directed Payment Program）相關的跨期收入，但此一利多部分被與印第安納州計畫相關的跨期提供者稅（provider tax）調升所抵銷。同店淨營收年增 3.1%，主要由每調整後入院（adjusted admission）淨營收成長 3.7%帶動，但部分被同店調整後入院量下滑 0.5%所抵銷。

We believe volume and payer mix challenges in the first quarter reflect a temporary disruption in demand for healthcare services in our markets, largely driven by consumer fears related to geopolitical instability and increased cost of living, as well as ongoing aggressive practices used by the managed care companies that drive inefficiency, unnecessarily delayed payment, and interfere with the delivery of medical care.

我們認為第一季的量能與付款方組合（payer mix）挑戰，反映我們市場對醫療服務需求的短期干擾，主要由消費者對地緣政治不穩與生活成本上升的擔憂所驅動；同時也受到受管理式照護公司採取的持續激進作法影響，這些作法造成效率低落、不必要的延遲付款，並干擾醫療照護的提供。

I'd like to spend just a minute on our top priorities this year as we work to enhance quality, patient experience, physician experience, and employee satisfaction. We are realizing operational improvements at an accelerating pace, and our ability to advance in each of these areas will also ultimately drive enhanced financial performance and long-term value creation for our organization and shareholders.

我想用一點時間談談我們今年的首要重點：提升品質、病患體驗、醫師體驗與員工滿意度。我們正以加速的速度實現營運改善，而我們在這些領域的推進能力，最終也將帶動更佳的財務表現，並為本組織與股東創造長期價值。

For example, in the area of quality, when the Spring 2026 Leapfrog Safety Grades are released next month, we expect as many as 80% of CHS hospitals to receive a Leapfrog A or B grade, up significantly from just 48% this time a year ago. We also expect 56% of our hospitals to receive a CMS rating of three or more stars when those metrics are published next month, up from 45% in the 2025 ratings.

例如在品質方面，當 2026 年春季 Leapfrog 安全評等於下月公布時，我們預期多達 80% 的 CHS 醫院將獲得 Leapfrog A 或 B 等級，較一年前同期的 48% 大幅提升。我們也預期在下月公布相關指標時，56% 的醫院將獲得 CMS 三星或以上評等，高於 2025 年評等的 45%。

These achievements demonstrate our commitment to continuous improvement and our ability to drive stronger performance in this area. We are hyper-focused on improving the experiences of the people working in our organization, especially our physicians and employees. And we have numerous initiatives underway to increase patient satisfaction as well.

這些成果展現我們對持續改善的承諾，以及我們在此領域推動更強表現的能力。我們高度聚焦於改善在本組織工作的每一位成員的體驗，特別是我們的醫師與員工。同時，我們也正在推動多項計畫以提升病患滿意度。

On the physician experience front, we are currently deploying an ambient listening technology in our clinics and hospitals, which will help reduce administrative burdens and optimize the time physicians and other providers spend face-to-face with their patients. Investment CHS has made to expand service lines, add new access points, recruit positions to our markets, and improve our quality and experience have us better positioned and prepared to accommodate demand as soon as it returns to normal levels.

在醫師體驗方面，我們目前正在診所與醫院部署環境聆聽（ambient listening）技術，這將有助於降低行政負擔，並優化醫師與其他提供者面對面陪伴病患的時間。CHS 在擴展服務線、增加新的就醫入口、為市場招募職位，以及提升品質與體驗方面的投資，使我們在需求一旦回到正常水準時，能更有利地定位並做好承接準備。

Before I pass the call over to Jason, I'd also like to discuss the policy backdrop. Similar to our hospital peers and others in the healthcare industry, we continue to monitor developments related to Medicaid supplemental payment programs and the Rural Health Transformation Fund, as well as ACA Enhanced Premium Tax Credit expiration and Medicaid work requirements and redeterminations among other changes.

在我把電話交給 Jason 之前，我也想談談政策背景。與我們的同業醫院及醫療產業其他公司類似，我們持續關注與 Medicaid 補充支付計畫及「鄉村健康轉型基金」（Rural Health Transformation Fund）相關的發展，以及 ACA 強化保費稅額抵免（Enhanced Premium Tax Credit）到期、Medicaid 工作要求與資格重新認定（redeterminations）等其他變動。

It is still very early to gauge the impact of these external factors, while there are a lot of moving pieces, unknown variables, and potential consequences. Given CHS' historical and current presence in many rural and underserved markets, we remain actively engaged with policymakers across each of our states to help ensure that programs under the rural health fund are directed towards hospitals and other providers delivering care in these communities, which we believe was the original intent of the fund.

目前仍處於非常早期階段，難以評估這些外部因素的影響，因為其中存在許多變動因素、未知變數與潛在後果。鑑於 CHS 過去與目前在許多鄉村及服務不足市場的布局，我們仍積極與各州政策制定者互動，以協助確保鄉村健康基金下的計畫資源能導向在這些社區提供照護的醫院與其他提供者；我們相信這也是該基金的原始設立意圖。

We've set up a formal structure with dedicated internal and external resources working to evaluate each state's various programs as details emerge. And to apply for any and all funding available to us in order to ensure continued access to quality care in our rural communities.

我們已建立正式架構，配置專責的內部與外部資源，隨著細節逐步明朗，持續評估各州的各項計畫。並申請我們可取得的任何與所有可用資金，以確保我們的鄉村社區能持續獲得高品質照護。

At this point, I will turn the call over to our Chief Financial Officer, Jason Johnson, to review financial results and other information in greater detail. Jason?

接下來，我將把電話會議交給我們的財務長 Jason Johnson，請他更詳細地回顧財務結果與其他資訊。Jason？

Thank you, Kevin, and good morning, everyone. For the first quarter, CHS delivered financial results toward the low end of expectations. The company continued to execute well on the controllable aspects of our business, demonstrate significant progress on our top priorities, and further deleverage the balance sheet.

謝謝你，Kevin，各位早安。第一季，CHS 的財務表現落在預期區間的低端。公司持續在我們可控的業務面向上執行良好，在最優先事項上展現顯著進展，並進一步降低資產負債表槓桿。

However, volumes and payer mix were below expectations, including noteworthy softness in electric procedures such as hips and knees, which, along with negative contribution from recently divested operations, led to margin compression.

然而，服務量與付款方組合低於預期，包括髖、膝等選擇性手術量明顯偏弱；再加上近期已出售業務帶來的負面貢獻，導致利潤率受到擠壓。

Adjusted EBITDA for the first quarter was $309 million with margin of 10.4%. Recently divested hospitals produced approximately $25 million of negative adjusted EBITDA in the first quarter compared to positive $25 million in the prior year period. A portion of the negative results from the hospitals divested in the first quarter was attributable to impact from winter storm burns.

第一季調整後 EBITDA 為 3.09 億美元，利潤率為 10.4%。近期已出售的醫院在第一季產生約 2,500 萬美元的負向調整後 EBITDA，而去年同期為正向 2,500 萬美元。第一季出售之醫院的部分負面結果，歸因於冬季風暴造成的影響。

Results included approximately $25 million in contribution from Georgia State Directed Payment Program that was approved in mid-March, approximately two-thirds of which related to prior period since the program was retroactive to July 1, 2025. As Kevin previously noted, half of this out-of-period benefit was offset by higher operating expense related to out-of-period Indiana provider taxes.

本季結果包含約 2,500 萬美元來自喬治亞州「州指示支付計畫」（State Directed Payment Program）的貢獻；該計畫於 3 月中旬獲批，其中約三分之二與前期期間相關，因為該計畫追溯自 2025 年 7 月 1 日生效。如 Kevin 先前所述，這項跨期收益的一半被較高的營運費用所抵銷，該費用與跨期的印第安納州提供者稅（provider taxes）較高有關。

Same-store net revenue for the first quarter increased 3.1% year-over-year, again, driven primarily by rate growth as net revenue per adjusted admission was up 3.7% year-over-year, including the benefit from new State Directed Payments Programs, partly offset by unfavorable payer mix shift. Same-store inpatient admissions declined 1.3% and adjusted admissions were down 0.5% year-over-year. Same-store surgeries declined 2.2% and ED visits were down 2.8%.

第一季同店淨營收年增 3.1%，主要仍由費率成長帶動；每調整後入院（adjusted admission）的淨營收年增 3.7%，其中包含新的州指示支付計畫帶來的效益，但部分被不利的付款方組合變化所抵銷。同店住院入院人次年減 1.3%，調整後入院年減 0.5%。同店手術量年減 2.2%，急診（ED）就診人次年減 2.8%。

Labor cost was well managed overall with approximately 2% year-over-year growth in average hourly rate and same-store contract labor spend down 11% from the prior year period. However, salaries and benefits expressed as a percentage of revenue increased 50 basis points year-over-year on a same-store basis due partly to increased physician employment, consistent with the investments Kevin highlighted, as well as continued in-sourcing, which we believe position the company well to capture share of patients in our markets return to the healthcare system.

整體而言，人力成本控管良好，平均時薪年增約 2%，同店合約人力支出較去年同期下降 11%。然而，以營收百分比表示的薪資與福利在同店基礎上年增 50 個基點，部分原因是醫師僱用增加（與 Kevin 提到的投資一致），以及持續將業務內製（in-sourcing）；我們相信這些將使公司在我們的市場中，於病患回流醫療體系時更有利於取得市占。

Supplies expense remained well controlled, declining 60 basis points year-over-year to 14.9% of net revenue, which largely reflected the decline in surgical volumes along with better procurement and inventory management under our ERP. Medical specialist fees were up approximately 11% year-over-year on a same-store basis, slightly ahead of our forecast for 5% to 8% growth, but were generally consistent as a percentage of net revenue at 5.5%.

耗材費用仍維持良好控管，以淨營收百分比計年減 60 個基點至 14.9%，主要反映手術量下降，以及在我們的 ERP 系統下更佳的採購與庫存管理。同店醫療專科費用年增約 11%，略高於我們原先預估的 5% 至 8% 成長，但占淨營收比重整體仍大致持平於 5.5%。

Cash flows from operations were a use of $297 million for the first quarter versus positive $120 million in the prior year period. Approximately one-quarter of the year-over-year decline was due to core operating performance, but the remainder primarily attributed to timing of certain items such as Medicaid supplemental payments and provider tax payments that should reverse in future quarters. We also experienced a large buildup of AR related to Medicare Advantage accounts due to delayed payments, which we expect to collect throughout the remainder of the year.

第一季營運活動現金流為流出 2.97 億美元，去年同期則為流入 1.20 億美元。年減幅度約四分之一來自核心營運表現，其餘主要歸因於部分項目的時點差異，例如 Medicaid 補充款項與提供者稅款的支付時點，預期將在未來季度回轉。我們也因 Medicare Advantage 帳戶付款延遲而出現應收帳款（AR）大幅增加，預期將在今年剩餘期間陸續收回。

As expected, during the quarter, we completed the Clarksville, Tennessee; Pennsylvania; and Huntsville, Alabama divestitures, generating more than $1.1 billion in gross proceeds. And in early February, used a portion of the proceeds to redeem $223 million of the 2032 notes at [103] via the special call provision.

如預期，在本季期間我們完成了田納西州 Clarksville、賓夕法尼亞州以及阿拉巴馬州 Huntsville 的資產出售，產生超過 11 億美元的總收益（gross proceeds）。並於 2 月初，運用部分收益依特別提前贖回條款（special call provision），以 [103] 的價格贖回 2.23 億美元的 2032 年到期票據。

As Kevin previously noted, the company's leverage was down slightly at quarter end to 6.5 times versus 6.6 times at year-end 2025, and down from 7.4 times at year-end 2024. Our next significant maturity is in 2029, and at quarter end, we had no amounts drawn on our ABL.

如 Kevin 先前所述，公司槓桿倍數於季末小幅下降至 6.5 倍，低於 2025 年底的 6.6 倍，也低於 2024 年底的 7.4 倍。我們下一筆重要到期日在 2029 年；且於季末，我們的 ABL 並無任何動用金額。

In early March, we announced a definitive agreement to divest four hospitals in Arkansas to Freeman Health Systems for $112 million in cash and the assumption by the buyer of certain real estate leases. The transaction is expected to close in the second quarter of 2026, further enhancing liquidity to continue to reduce net debt and leverage or to fund growth investments.

3 月初，我們宣布已與 Freeman Health Systems 達成最終協議，將阿肯色州四家醫院以 1.12 億美元現金出售，並由買方承接部分不動產租賃。該交易預計於 2026 年第二季完成交割，將進一步提升流動性，以持續降低淨負債與槓桿，或用於成長投資。

Following the completion of the Arkansas divestiture, our net debt will be approximately $9.3 billion, down from $10.1 billion at year-end 2025 and $11.4 billion at year-end 2024. As Kevin previously noted, earlier this week, we announced several ASC investments in Alabama and Arkansas that are either pending or recently completed with a combined price tag of approximately $85 million. We will continue to evaluate opportunities for growth investments across each our core markets.

在完成阿肯色州出售後，我們的淨負債將約為 93 億美元，低於 2025 年底的 101 億美元與 2024 年底的 114 億美元。如 Kevin 先前所述，本週稍早我們宣布在阿拉巴馬州與阿肯色州進行數項 ASC 投資，這些投資目前仍在待完成或近期已完成，合計金額約 8,500 萬美元。我們將持續評估在各核心市場的成長投資機會。

Our financial guidance for 2026 remains unchanged. While new developments have emerged relative to the outlook that we provided in February, including the approval of Georgia's State Directed Payment Program, the pending divestiture of our Arkansas operations and the ASC investment, we believe these are captured within the initial range for adjusted EBITDA of $1.34 billion to $1.49 billion.

我們對 2026 年的財務指引維持不變。儘管相較於我們 2 月提供的展望，已出現一些新進展，包括喬治亞州州指示支付計畫獲批、阿肯色州業務待完成出售，以及 ASC 投資，但我們認為這些已包含在調整後 EBITDA 13.4 億至 14.9 億美元的初始區間之內。

There are multiple items on the horizon that could affect guidance in the future, most notably the potential approval of new or enhanced State Directed Payment Programs and potential tailwinds from the Rural Health Transformation Program. We don't have sufficient data to adjust the outlook at this early stage in the year.

未來仍有多項因素可能影響指引，最值得注意的是可能核准新的或加強版的州指示支付計畫，以及「鄉村健康轉型計畫」（Rural Health Transformation Program）可能帶來的順風。在今年這麼早的階段，我們尚無足夠數據來調整展望。

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

以上為我們的準備發言。接下來，我們將把電話會議交回給接線員，進行問答。

(Operator Instructions) Brian Tanquilut, Jefferies.

(接線員指示) Brian Tanquilut，Jefferies。

This is Meghan Holtz on for Brian Tanquilut. I guess it would be helpful if you could start on the payer mix and volume pressures that you saw in the quarter. Is it due to the macro environment? Or are you seeing particular pressures in your markets, particularly as you start to see some green shoots in Q4 around your commercial book?

我是代替 Brian Tanquilut 的 Meghan Holtz。我想如果你們能先談談本季看到的付款方組合與量的壓力，會很有幫助。這是因為總體環境嗎？還是你們在自身市場看到特定壓力，尤其是你們在第四季於商業保險業務（commercial book）方面開始看到一些回溫跡象？

And then how should we be just thinking about volume for the full year as you had been originally guiding to 1.5% to 2.5% of that 5% revenue growth? Should we still be thinking about that as comps get easier in the second half and you guys hopefully recover some volume?

另外，對於全年服務量我們應該如何思考？你們原先指引中，5% 營收成長裡有 1.5% 到 2.5% 來自量的成長。隨著下半年比較基期變得更容易、且你們有望回補部分量，我們是否仍應以此方式看待？

Sure, I'll start off and then Jason, feel free to jump in. The volume pressures we really saw were across the board. I wouldn't call out any specific markets that were worse than others. So we really do believe that it was a broad pressure on volume. It was also concentrated more so in individuals with commercial and health exchange coverage.

當然，我先開始，然後 Jason 也歡迎隨時補充。我們看到的量能壓力其實是全面性的。我不會特別點名任何一個市場比其他市場更糟。所以我們確實認為這是對量能的廣泛性壓力。而且這種情況更集中在擁有商業保險與健康保險交易所（exchange）保障的個人身上。

So that leads us to believe a couple of things. One, it's macroeconomic issues because those are the individuals with high deductibles and the more aggressive behavior by the managed care companies is -- we understand at least anecdotally that there's been -- they've turned the dial up on benign pre-authorizations in more cases. So oftentimes, those patients are not even getting to it because of that.

因此，這讓我們相信有幾件事。第一，是總體經濟因素，因為這些人通常有較高的自付額；另外，管理式醫療公司更積極的作為——我們至少從一些軼聞了解到——他們在更多案例中把對非緊急（benign）項目的事前授權（pre-authorization）要求提高了。所以很多時候，病患甚至還沒走到那一步就被擋下來了。

Yeah. Maybe I would just add, as it relates to our guidance, we're assuming low single-digit volume growth for the year. So we're a negative 0.5% adjusted admission for the first quarter. We do think that that should recover. And I think payer mix was the other piece that came in less than our expectations for the full year. And similar, we think that comes back as the economy continues to improve.

是的。也許我再補充一點，關於我們的指引（guidance），我們假設全年量能成長為低個位數。所以第一季調整後入院（adjusted admission）是負 0.5%。我們確實認為這應該會回升。我想付款方組合（payer mix）是另一個低於我們對全年預期的部分。同樣地，我們認為隨著經濟持續改善，這也會回來。

Okay. And then as a quick follow-up, operating cash flow looked a little weak in the quarter. We assume it's working capital timing related headwinds that you'll ultimately recapture. But can you just give us the moving pieces on what was going on in the operating cash flow line in the quarter?

好的。接著快速追問一下，本季營運現金流看起來有點偏弱。我們推測這是與營運資金時點相關的不利因素，之後你們最終會回收。但你們能否說明一下，本季營運現金流這一行到底發生了哪些變動因素？

Sure. I'll take that one. This is Jason. Yeah, there are several items that are timing related that we expect to flip for the rest of the year. I'll name a few here. There's about $90 million of Medicaid and supplemental payments, provided tax payment timing.

當然。這題我來回答。我是 Jason。是的，有幾個項目屬於時點差異，我們預期在今年剩餘期間會反轉。我先列幾個。大約有 9,000 萬美元的 Medicaid 與補充性款項（supplemental payments），與提供者稅（provider tax）付款時點有關。

In other words, we're timing difference between when we either recognize the revenue or the expense of some of the provider taxes versus when we received those payments or make the tax payments. $50 million to $60 million, I mentioned in our references in my comments that there's a buildup of Medicare Advantage accounts and that's about $50 million to $60 million, which we do expect to collect the rest of the remainder of the year.

換句話說，這是我們在認列部分提供者稅的收入或費用，與我們收到相關款項或支付稅款之間的時點差異。另有 5,000 萬到 6,000 萬美元——我在評論中提到——Medicare Advantage 應收帳款增加，約 5,000 萬到 6,000 萬美元，我們預期在今年剩餘期間會收回。

We make our bonus payments annually in the first quarter every year. That's about $50 million. So that will continue to flip back the other way as the accrual for this year builds up. There's $25 million to $50 million of AP timing that occurs that usually does kind ofhappen at year-end versus the first quarter.

我們每年都在第一季一次性發放年度獎金。大約是 5,000 萬美元。因此，隨著今年的應計（accrual）逐步累積，這部分會往相反方向反轉。另外還有 2,500 萬到 5,000 萬美元的應付帳款（AP）時點差異，通常比較會發生在年底，而不是第一季。

And then there's -- the final thing I'll mention is about a $15 million initial interest payment on the 2034 note that were deferred from September 2025 in May this quarter. Those notes were issued in August of last year and rather than make the initial payment a month or so later, it was deferred until the first quarter.

最後一點我提一下，大約有 1,500 萬美元，是 2034 年到期票據（2034 note）的首次利息支付；原本從 2025 年 9 月延後到本季 5 月支付。這些票據是去年 8 月發行的，原本應在一個月左右後進行首次付息，但改為延後到第一季。

Ben Hendrix, RBC.

Ben Hendrix，RBC。

Great. I appreciate that it's early in the quarter, but just wanted to talk about the [HIX] exchange headwind from the EPTC expiry that we -- that you are assuming in your guidance. I think in the bridge that we have here, we had about $110 million of revenue, about $25 million of EBITDA assumed.

很好。我知道現在才剛進入本季不久，但我想談談你們在指引中所假設、因 EPTC 到期而帶來的 [HIX] 交易所逆風。我想在我們這裡的橋接（bridge）中，假設約 1.1 億美元營收、約 2,500 萬美元 EBITDA。

And I just wanted to see kind of based on some of the reports that have come out in your quarter and your experience, just if there's any kind of change to that progression? And if you're seeing any kind of regional variation?

我想根據本季期間出來的一些報告以及你們的經驗，看看這個走勢是否有任何變化？以及你們是否看到任何區域性的差異？

Yeah. So we haven't made any changes to our assumptions yet. I don't -- we're still really don't have a lot more data than we had in February. I do know that our HIX revenue and adjusted admissions remain between 4% and 5%. Both the first quarter of this year and last year, our revenue actually went up.

是的。所以我們目前還沒有對假設做任何調整。我們——老實說——目前也沒有比 2 月時更多太多的資料。我知道我們的 HIX 營收與調整後入院占比仍在 4% 到 5% 之間。今年與去年第一季，我們的營收其實都有上升。

But we did see about a 3.9% drop in adjusted admissions and thus the exchange plan patients. But that's, I think, similar to what we see with a lot of plans that have the high deductibles that at the beginning of the year that we think are staying out in the system.

但我們確實看到調整後入院下降約 3.9%，因此交易所計畫（exchange plan）病患也隨之下降。不過我認為，這與我們在許多高自付額方案上看到的情況類似：在年初時，我們認為他們會先暫時不進入醫療體系。

Certainly, there's some portion of those people that may have lost dropped the coverage or moved another plan or self-pay but we don't really have any new information yet. I think that's still going to be second or third quarter before we get a better feel for that.

當然，其中有一部分人可能已經失去或取消了保障、或轉到其他方案、或變成自費（self-pay），但我們目前確實還沒有新的資訊。我認為要到第二或第三季，我們才會更有感覺。

And then just on the core growth that you're anticipating, obviously coming a little bit softer than expected in the first quarter, but how do we think about that phasing through the rest of the year? And I know that you've kind of mentioned some consumer confidence and how do you see that developing as we get closer to the end of the year?

另外，關於你們預期的核心成長（core growth），第一季顯然比預期稍微疲弱一些，那我們該如何看待接下來全年其餘時間的節奏分布（phasing）？我知道你們提到一些消費者信心的因素；隨著接近年底，你們怎麼看它的發展？

Sure. I think we indicated, even at the fourth quarter earnings release, we expected this year to be more heavily weighted on the back half. We had anticipated starting off the year a little softer given the consumer confidence coming out of December was muted and low and then kind of throughout the first quarter.

當然。我想我們甚至在第四季財報發布時就指出，今年的表現會更偏向下半年。我們原本就預期年初會比較疲弱一些，因為從 12 月出來的消費者信心偏低、偏保守，並且在第一季期間大致如此。

We saw jobs report the math that was much worse than expected. And then the conflict in the Middle East that transpired in March, and the rise of price of oil and gas and price at the pump and so forth. We do believe that we'll see some economic recovery in the back half of the year. Second quarter will be a little bit of an easier comp for as well.

我們看到就業報告的數據遠比預期差。接著是 3 月發生的中東衝突，以及油價與汽油價格上升、加油站價格上漲等等。我們確實相信下半年會看到一些經濟復甦。第二季的比較基期（comp）也會相對容易一些。

And we think that with the work that we're doing on improving, as I mentioned, improving quality, improving our patient experiences, that gives more traction will really be positioned well that with this deferred business as people ultimately will come back and have these procedures done, we believe we'll be positioned well to capture that business and maybe uniquely positioned to capture that business in our markets, and that should serve us well. But that would likely to happen until the back half of the year.

而且我們認為，透過我們正在做的改善工作——如我提到的，提升品質、改善病患體驗——將帶來更多動能；當這些被延後的需求（deferred business）最終回來、把這些處置（procedures）做完時，我們相信我們會處於有利位置去承接這些業務，甚至在我們的市場中可能是獨特地有利，這應該會對我們很有幫助。但這很可能要到下半年才會發生。

AJ Rice, UBS.

AJ Rice，UBS。

Maybe first on these acquisitions, the Surgical Institute of Alabama and the Alaska one. I know traditionally, I have tended to think of you guys as doing -- when it's something like an ASC within your existing markets, I'm not sure whether you describe these as being adjacent to existing hospitals? Or are you pivoting to now maybe looking more at freestanding ASCs as an investment opportunity? And should we think that there will be some capital devoted (technical difficulty)

也許先談這些併購：阿拉巴馬外科研究所（Surgical Institute of Alabama）以及阿拉斯加那一個。我知道傳統上，我一直把你們視為——當是像在既有市場內的 ASC 這類交易時——我不確定你們是否會把這些描述為既有醫院的鄰近（adjacent）資產？或者你們是否正在轉向，現在更把獨立式（freestanding）ASC 視為一個投資機會？以及我們是否應該認為會有一些資本投入（技術問題）

Thanks, AJ. Great question. These acquisitions, we would still characterize as being part of our network to pair extending the care area that we're treating patients from those hospitals that's still connected within our markets and just an extension of those networks. So not going into what I would call new markets with just an ASC strategy.

謝謝你，AJ。好問題。這些收購案，我們仍會將其定位為我們網絡的一部分，用以搭配並延伸我們在這些醫院所服務病患的照護範圍；這些醫院仍與我們的市場相連，基本上就是既有網絡的延伸。因此不是以單純的 ASC 策略進入我所謂的新市場。

Okay. All right. And just maybe some a update on what you're seeing with labor, hourly wages, contract labor, and then professional fees as well?

好的。好。另外，能否更新一下你們看到的勞動情況：時薪、合約人力，以及專業費用方面？

Yeah. The average hourly rate increase was 2.3% during the first quarter versus the prior year. We did make an investment in physicians. We have 30 net physicians added in the first quarter. That's probably about $5 million of salaries, logical benefits.

是的。第一季平均時薪較去年同期增加 2.3%。我們確實對醫師做了投資。第一季淨增加 30 位醫師。這大概是約 500 萬美元的薪資與相關福利。

And we in-sourced one anesthesia program in November 2025, and that's about $2 million to $2.5 million of additional expenses this quarter. Contract labor came down 11%. I think we're continuing to see return to rating usage that are more consistent with prior to the pandemic.

另外，我們在 2025 年 11 月將一個麻醉計畫內部化（in-source），本季因此增加約 200 萬至 250 萬美元的費用。合約人力成本下降 11%。我認為我們持續看到使用率回到更接近疫情前的水準。

And maybe if I could just add a little more color. I think Jason absolutely got that right. But as I think about Jason's comments that we added some additional positions during the quarter, part of what we experienced and as we're being intentional about working on physician experience, our physician turnover decreased during the quarter.

如果我可以再補充一些背景。我認為 Jason 的說法完全正確。但就 Jason 提到我們本季新增了一些職缺而言，我們的經驗是：由於我們有意識地改善醫師體驗，本季醫師流動率下降了。

We were able to continue to hire new positions that the previous pace we have been hiring at, which has allowed us to add net new physicians. That positions -- it's another area that positions us well. It comes at a little bit of a cost right now without the volume, but adding -- and adding physicians to the labor cost, but that will position us well in the future that as this business comes back, we'll have more capacity to take on additional patients with the additional physicians. So again, we look at that as a net positive for us, even though it's coming in a little bit of an extra cost this quarter.

我們得以持續以先前的招聘速度招募新職位，這讓我們能夠淨增加醫師人數。這也是另一個讓我們處於有利位置的面向。在目前量能尚未回來的情況下，這會帶來一些成本——增加醫師也會推升人力成本——但這將使我們在未來更具優勢；當業務回升時，因為有更多醫師，我們將有更大的產能承接更多病患。所以我們仍將其視為對我們的淨正面因素，即使本季因此多了一點額外成本。

Stephen Baxter, Wells Fargo.

Stephen Baxter，富國銀行。

This is [Mitchell] on for Steve. Can you give us a sense of the financial profile of the four Arkansas hospitals you announced are going to be divested as well as the large ASC investment? Just trying to better understand how that fits into the guidance.

我是 [Mitchell]，代替 Steve 發問。你們能否說明一下，宣布將出售的阿肯色州四家醫院的財務概況，以及大型 ASC 投資的財務概況？我想更好地理解這些如何納入你們的財測指引。

Yeah, Stephen, thanks for the question. The $112 million proceeds Arkansas, that's about, I think a [10 to 12] multiple, and that was not reflected in our initial guidance in February. So that will come out for about half a year. But the ASC investment, which we are going to -- are largely going to offset that, they're just about to wash. So no effects on our guidance between getting those soon.

好的，Stephen，謝謝提問。阿肯色州這筆 1.12 億美元的出售所得，我想大約是 [10 到 12] 倍的倍數，而且這並未反映在我們 2 月的初始指引中。因此大約會在半年期間退出。但 ASC 的投資，我們將——在很大程度上——用來抵銷它，基本上差不多打平。所以在指引上不會有影響，因為這些很快就會發生。

Andrew Mok, Barclays.

Andrew Mok，巴克萊。

This is Thomas Walsh on for Andrew. Can you help us better understand the uncompensated care and self-pay mix shifts in the quarter as ACA exchange disenrollment picked up? What's the most direct driver of higher uncompensated care, higher uninsurance or worsening collections from the insured population?

我是 Thomas Walsh，代替 Andrew 發問。隨著 ACA 交易所退保加速，你們能否協助我們更好理解本季無償照護（uncompensated care）與自付（self-pay）組合的變化？推升無償照護的最直接驅動因素是：未投保人數增加，還是已投保族群的收款情況惡化？

Yeah. Over time, the selections experience does continue to draw a natural trend that we see. I don't think there is anything outsized this quarter. There was an increase in self-pay volumes this quarter. So relative to the overall net revenue, it increased as a percentage of total.

是的。長期來看，選擇（selections）的經驗確實延續我們看到的自然趨勢。我不認為本季有任何特別異常的情況。本季自付量有增加。因此相對於整體淨營收，自付占比提高。

I don't know that there's any one thing that we can point to except, I don't know, part of this could be the behavior of those folks don't have insurance that they continue to coming to the health systems regardless of what's happening in the broader macro environment.

我不確定是否能指向單一因素；但我想其中一部分可能是，沒有保險的族群不論更廣泛的總體環境如何變化，仍持續到醫療體系就醫的行為所致。

I do think it's a fair point and we've taken into consideration the additional risk of collectability of co-pays and deductibles in that amount and have adjusted accordingly.

我確實認為這點很合理，我們也已將共付額與自付額可收回性的額外風險納入考量，並據此做了調整。

Great. And following up, there are a number of moving parts inside the pricing of 3.7% in the quarter. Could you help us understand the contribution of normal course rate increases, incremental state directed payments, and then the payer mix or acuity headwinds?

很好。接著追問，本季 3.7% 的定價之中有不少變動因素。你們能否協助我們理解：例行性調價、額外的州政府定向支付（state directed payments），以及付款方組合或病情嚴重度（acuity）逆風，各自的貢獻？

Yeah. The normal rate increases are, I think, consistent with our value around 3% of the impact. And then the Medicaid supplemental payments, Georgia, which I mentioned, was approved this quarter. That was about $30 million of revenue, $25 million of EBITDA. That's not much worth for three quarters. So that's worth about $10 million a quarter on revenue and $8 million or $9 million on EBITDA.

好的。例行性調價，我認為與我們一貫的水準一致，影響約 3%。接著是我提到的喬治亞州醫療補助（Medicaid）補充支付，本季獲得核准。那帶來約 3,000 萬美元營收、2,500 萬美元 EBITDA。這在三個季度的影響不算大。因此大約相當於每季 1,000 萬美元營收，以及 800 萬或 900 萬美元 EBITDA。

And then the rest of the decline was volume and payer mix that -- or sorry, that netted against those benefits probably evenly between slight drop in acuity as well, but it's more about payer mix and volume offsetting those total rate increases.

其餘的下滑則來自量能與付款方組合——抱歉，這些因素與上述利多相互抵銷；其中也可能有一點病情嚴重度略降的影響，但主要還是付款方組合與量能抵銷了整體的調價增幅。

This concludes our question-and-answer session. I would like to turn the conference back over to Kevin Hammons, Chief Executive Officer, for any closing remarks.

問答環節到此結束。我想把電話會議交回給執行長 Kevin Hammons，請他做結語。

Thank you, everyone, for joining the call today. If you have any additional questions, you can always reach us at (615) 465-7000. Have a good day, everyone.

感謝各位今天參與本次電話會議。如有任何其他問題，歡迎隨時致電 (615) 465-7000 與我們聯繫。祝各位有美好的一天。

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

本次電話會議到此結束。感謝各位參加今天的簡報。您現在可以掛線。