奎斯特診斷 (DGX) 2022 Q4 法說會逐字稿

Welcome to the Quest Diagnostics Fourth Quarter and Full Year 2022 Conference Call. At the request of the company, this call is being recorded.

歡迎來到 Quest Diagnostics 第四季度和 2022 年全年電話會議。應公司要求，對此次通話進行錄音。

The entire contents of the call, including the presentation and question-and-answer session that will follow, are copyrighted property of Quest Diagnostics with all rights reserved. Any redistribution or retransmission of the rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited.

電話會議的全部內容，包括隨後的演示和問答環節，均為 Quest Diagnostics 的版權財產，保留所有權利。未經 Quest Diagnostics 書面同意，嚴禁以任何形式重新分發或轉發本次通話的轉播。

Now I'd like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Please go ahead, please.

現在我想介紹 Quest Diagnostics 投資者關係副總裁 Shawn Bevec。請繼續，拜託。

Thank you, and good morning. I'm joined by Jim Davis, our Chief Executive Officer and President; and Sam Samad, our Chief Financial Officer.

謝謝，早上好。我們的首席執行官兼總裁 Jim Davis 也加入了我的行列；和我們的首席財務官 Sam Samad。

During this call, we may make forward-looking statements and will discuss non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release. Actual results may differ materially from those projected. Risks and uncertainties, including the impact of the COVID-19 pandemic, that may affect Quest Diagnostics' future results include, but are not limited to, those described in our most recent annual report on Form 10-K and subsequently filed quarterly reports on Form 10-Q and current reports on Form 8-K.

在這次電話會議中，我們可能會做出前瞻性陳述，並將討論非 GAAP 措施。我們在收益新聞稿的表格中提供了非 GAAP 措施與可比 GAAP 措施的對賬。實際結果可能與預測結果存在重大差異。可能影響 Quest Diagnostics 未來結果的風險和不確定性，包括 COVID-19 大流行的影響，包括但不限於我們最近的 10-K 表年度報告和隨後提交的季度報告中描述的那些10-Q 和 8-K 表格的當前報告。

For this call, references to reported EPS refer to reported diluted EPS, and references to adjusted EPS refer to adjusted diluted EPS. Any references to base business, testing, revenues or volumes refer to the performance of our business excluding COVID-19 testing. Growth rates associated with our long-term outlook projections, including total revenue growth, revenue growth from acquisitions, organic revenue growth and adjusted earnings growth, are compound annual growth rates. Finally, revenue growth rates from acquisitions will be measured against our base business.

對於本次電話會議，報告的每股收益是指報告的稀釋每股收益，調整後的每股收益是指調整後的稀釋每股收益。對基礎業務、測試、收入或數量的任何提及均指我們的業務表現，不包括 COVID-19 測試。與我們的長期前景預測相關的增長率，包括總收入增長、收購收入增長、有機收入增長和調整後收益增長，都是複合年增長率。最後，收購的收入增長率將根據我們的基礎業務進行衡量。

Now here is Jim Davis.

現在是吉姆·戴維斯。

Thanks, Shawn, and good morning, everyone. Quest had a strong year in 2022 with base business revenues growing more than 6% in the fourth quarter and 5% for the full year. As we expected, COVID-19 testing revenues declined but still exceeded $1.4 billion in 2022.

謝謝，肖恩，大家早上好。 Quest 在 2022 年表現強勁，第四季度基礎業務收入增長超過 6%，全年增長 5%。正如我們預期的那樣，COVID-19 檢測收入有所下降，但到 2022 年仍超過 14 億美元。

Our strong performance over the last several years would not have been possible without the commitment and compassion of our nearly 50,000 colleagues who rose to the challenge of COVID-19 while growing our base business. I am incredibly proud of how this team has worked together during an unprecedented period in the lab industry to deliver insights to help create a healthier world.

如果沒有近 50,000 名同事的承諾和同情，他們在發展我們的基礎業務的同時迎接 COVID-19 的挑戰，我們就不可能在過去幾年取得出色的業績。我為這個團隊在實驗室行業前所未有的時期如何合作提供見解以幫助創造一個更健康的世界感到無比自豪。

This morning, I'll discuss our performance for the fourth quarter and full year 2022, then Sam will provide more detail on our financial results and discuss our 2023 guidance.

今天早上，我將討論我們第四季度和 2022 年全年的業績，然後 Sam 將提供有關我們財務業績的更多細節並討論我們的 2023 年指導方針。

In the fourth quarter, total revenues were $2.3 billion. Earnings per share were $0.87 on a reported basis and $1.98 on an adjusted basis. Cash from operations was $334 million. For the full year 2022, total revenues were $9.9 billion, including more than $8.4 billion in base business revenue. Earnings per share were $7.97 on a reported basis and $9.95 on an adjusted basis. Cash from operations was $1.7 billion.

第四季度總收入為 23 億美元。報告基礎上每股收益為 0.87 美元，調整後每股收益為 1.98 美元。來自運營的現金為 3.34 億美元。 2022 年全年總收入為 99 億美元，其中基礎業務收入超過 84 億美元。報告基礎上的每股收益為 7.97 美元，調整後的基礎上為 9.95 美元。來自運營的現金為 17 億美元。

As you saw this morning, we increased our quarterly dividend approximately 8% to $0.71 per share and increased our share repurchase authorization by $1 billion.

正如您今天早上看到的那樣，我們將季度股息提高了約 8% 至每股 0.71 美元，並將我們的股票回購授權增加了 10 億美元。

Before discussing additional highlights for 2022, I'd like to share some recent positive regulatory updates. First, Congress delayed Medicare reimbursement cuts under PAMA that were scheduled to take place in 2023, which would have impacted our revenue between approximately $80 million and $85 million. While we are pleased with the delay, we continue to work closely with our trade association to seek a permanent fix to PAMA.

在討論 2022 年的其他亮點之前，我想分享一些最近積極的監管更新。首先，國會推遲了原定於 2023 年進行的 PAMA 下的醫療保險報銷削減，這將影響我們的收入大約 8000 萬至 8500 萬美元。雖然我們對延遲感到滿意，但我們將繼續與我們的貿易協會密切合作，以尋求對 PAMA 的永久修復。

Second, CMS increased Medicare reimbursement for specimen collection fees for the first time in nearly 40 years. This could provide Quest with a benefit of approximately $35 million to $40 million this year.

其次，CMS 近 40 年來首次增加了 Medicare 對標本採集費的報銷。這可以為 Quest 今年帶來約 3500 萬至 4000 萬美元的收益。

Regarding COVID-19 testing revenues. While we did see a steady ramp upward in COVID-19 volume throughout Q4, our volumes have steadily declined since late December. We expect our COVID-19 revenues to be significantly lower in 2023 compared to 2022. We have lowered our prior COVID-19 volume expectations in 2023 from 10,000 to 15,000 molecular tests per day to 5,000 to 10,000 tests per day. In addition, we continue to negotiate coverage and reimbursement policies with commercial payers following the end of the PHE in May.

關於 COVID-19 測試收入。雖然我們確實看到整個第四季度 COVID-19 的交易量穩步上升，但自 12 月下旬以來我們的交易量一直在穩步下降。我們預計 2023 年我們的 COVID-19 收入將顯著低於 2022 年。我們已將之前對 2023 年 COVID-19 數量的預期從每天 10,000 到 15,000 次分子測試降低到每天 5,000 到 10,000 次測試。此外，在 PHE 於 5 月結束後，我們將繼續與商業付款人協商覆蓋範圍和報銷政策。

I will now share some recent highlights on how we are growing this business. In the fourth quarter, we completed our acquisition of the outreach laboratory services business of Summa Health, a large integrated health system serving communities in Northeastern Ohio. We also entered into an agreement to acquire select assets of Northern Light Health's outreach laboratory services business located in Maine. We will also provide professional laboratory management services for 9 of Northern Light's hospital laboratories, along with its cancer center lab.

我現在將分享一些關於我們如何發展這項業務的近期亮點。第四季度，我們完成了對 Summa Health 外展實驗室服務業務的收購，Summa Health 是一家服務於俄亥俄州東北部社區的大型綜合衛生系統。我們還簽訂了一項協議，收購位於緬因州的 Northern Light Health 外展實驗室服務業務的精選資產。我們還將為北極光的 9 個醫院實驗室及其癌症中心實驗室提供專業的實驗室管理服務。

Our M&A pipeline is strong, including potential deals with health systems, small regional labs and other capability-building assets. In particular, the funnel of opportunities with health systems, which are facing major margin pressures due to labor challenges and mix shift from inpatient to outpatient care, is very active. Quest can help through lab management, population health analytics, mobile services and/or by monetizing their outreach business.

我們的併購管道很強大，包括與衛生系統、小型區域實驗室和其他能力建設資產的潛在交易。特別是，衛生系統的機會漏斗非常活躍，由於勞動力挑戰和從住院到門診護理的混合轉變，它們面臨著巨大的利潤壓力。 Quest 可以通過實驗室管理、人口健康分析、移動服務和/或通過外展業務獲利來提供幫助。

In health plans, we continue to gain traction with value-based contracts, where we see meaningfully higher growth than with traditional contracts. Also, we've started to benefit from incentives related to these value-based contracts, which helps demonstrate the value of these strategic relationships.

在健康計劃中，我們繼續通過基於價值的合同獲得牽引力，與傳統合同相比，我們看到增長顯著提高。此外，我們已經開始受益於與這些基於價值的合同相關的激勵措施，這有助於證明這些戰略關係的價值。

With CMS' recent increase in Medicare reimbursement for specimen collections, we've begun discussions with our health plan customers about getting paid appropriately for the phlebotomy services we provide to their members. Higher specimen collection fees enable us to make continuous investment in patient services so their members continue to have the broadest access to high-quality and low-cost lab testing.

隨著 CMS 最近增加標本採集的 Medicare 報銷，我們已經開始與我們的健康計劃客戶討論如何為我們向其成員提供的採血服務獲得適當的報酬。更高的標本採集費用使我們能夠持續投資於患者服務，以便他們的成員繼續獲得最廣泛的高質量和低成本實驗室測試。

In advanced diagnostics, we generated strong double-digit growth in prenatal genetics and pharma services in 2022. In 2022, we also launched a solid tumor expanded panel as a laboratory-developed test. This 523-gene test relies upon the Illumina TruSight Oncology 500 Assay to help oncologists with therapy selection by providing comprehensive genomic profiling of a patient's tumor. This test extends our capabilities beyond tissue pathology to offer faster turnaround time from cancer diagnosis to therapy selection.

在高級診斷方面，我們在 2022 年的產前遺傳學和製藥服務方面實現了兩位數的強勁增長。2022 年，我們還推出了實體瘤擴展面板作為實驗室開發的測試。這項 523 基因測試依賴於 Illumina TruSight Oncology 500 Assay，通過提供患者腫瘤的全面基因組分析來幫助腫瘤學家選擇治療方法。該測試將我們的能力擴展到組織病理學之外，以提供從癌症診斷到治療選擇的更快周轉時間。

Throughout 2022, we continue to make investments to strengthen our bioinformatics capabilities, which supports some of the faster-growing opportunities of our portfolio, like genomic sequencing services, prenatal and hereditary genetic testing and pharma services. We also invested in our women's health sales force, which will position us well for continued strong growth in prenatal genetics.

整個 2022 年，我們將繼續投資以加強我們的生物信息學能力，這支持我們產品組合中一些增長更快的機會，例如基因組測序服務、產前和遺傳基因檢測以及製藥服務。我們還投資於我們的女性健康銷售隊伍，這將使我們在產前遺傳學領域的持續強勁增長中處於有利地位。

We continue to make progress executing our consumer-initiated testing strategy. Last year, we recorded approximately $96 million of both base and COVID-19 consumer testing.

我們繼續在執行消費者發起的測試策略方面取得進展。去年，我們記錄了大約 9600 萬美元的基礎和 COVID-19 消費者測試。

In the fall of 2022, we launched our new digital platform, questhealth.com. Consumers have found this to be a simpler, more intuitive way to order lab tests. Following the launch of our new consumer site, we began ramping up marketing spend through the fourth quarter. We saw some of the strongest order volumes to date following some Cyber Monday promotional advertising, and we are encouraged by the acceleration of growth in base testing in December.

2022 年秋季，我們推出了新的數字平台 questhealth.com。消費者發現這是一種更簡單、更直觀的實驗室測試訂購方式。在推出新的消費者網站後，我們開始在第四季度增加營銷支出。在一些網絡星期一促銷廣告之後，我們看到了迄今為止最強勁的訂單量，我們對 12 月基礎測試的加速增長感到鼓舞。

Shifting to operational excellence. In 2022, we approached our goal of 3% productivity improvements and savings through our Invigorate program. Those savings and productivity improvements did not completely offset the inflationary pressures in our business as well as the impact of a modest unit price declines.

轉向卓越運營。 2022 年，我們通過 Invigorate 計劃實現了提高 3% 的生產力和節省成本的目標。這些節省和生產力的提高並沒有完全抵消我們業務中的通脹壓力以及單價適度下降的影響。

Following the pandemic, we, like many companies, have faced significant inflation and wage pressures. We are increasing our efforts to drive productivity and expand margins in our base business. We continue to drive additional productivity improvements with lab platform consolidation and greater use of automation and artificial intelligence.

大流行之後，我們和許多公司一樣，面臨著巨大的通貨膨脹和工資壓力。我們正在加大努力，以提高生產力並擴大基礎業務的利潤率。我們通過實驗室平台整合以及更多地使用自動化和人工智能，繼續推動生產力的進一步提高。

Last year, we began a new automation conversion project in our Lenexa laboratory. This new project builds on what we've done in our Marlborough and Clifton labs. We've introduced a new microbiology platform that is highly automated and makes use of artificial intelligence to assist with sample analysis.

去年，我們在 Lenexa 實驗室開始了一個新的自動化改造項目。這個新項目建立在我們在馬爾堡和克利夫頓實驗室所做的工作之上。我們推出了一個新的微生物學平台，該平台高度自動化並利用人工智能來協助樣本分析。

Finally, we've begun to realize savings from the urinalysis platform conversion that we announced early last year.

最後，我們已經開始從去年初宣布的尿液分析平台轉換中實現節省。

Billing and retaining our frontline physicians continues to be a key priority for us. Although we have experienced higher-than-average turnover in some of our job categories, we have taken actions to stabilize our workforce and improve frontline employee engagement and retention. We expect these actions to help enhance our productivity in 2023.

為我們的一線醫生開具賬單和留住他們仍然是我們的首要任務。儘管我們的某些工作類別的人員流動率高於平均水平，但我們已採取措施穩定我們的員工隊伍並提高一線員工的敬業度和保留率。我們預計這些行動將有助於在 2023 年提高我們的生產力。

We have also taken actions to reduce our SG&A by approximately $100 million in 2023, including workforce reductions of approximately 1.5%, primarily in corporate support functions.

我們還採取行動，在 2023 年將我們的 SG&A 減少約 1 億美元，包括裁員約 1.5%，主要是在企業支持職能方面。

With that, I'll turn it over to Sam to provide more details on our performance and our 2023 guidance. Sam?

有了這個，我將把它交給 Sam 來提供更多關於我們的表現和 2023 年指導的細節。薩姆？

Thanks, Jim. In the fourth quarter, consolidated revenues were $2.33 billion, down 15% versus the prior year. Base business revenues grew 6.3% to $2.15 billion, while COVID-19 testing revenues declined 75% to $184 million.

謝謝，吉姆。第四季度，合併收入為 23.3 億美元，同比下降 15%。基礎業務收入增長 6.3% 至 21.5 億美元，而 COVID-19 測試收入下降 75% 至 1.84 億美元。

Revenues for Diagnostic Information Services declined 15.3% compared to the prior year, reflecting lower revenue from COVID-19 testing services versus the fourth quarter of 2021, partially offset by strong growth in our base testing revenue. Total volume, measured by the number of requisitions, declined 11.2% versus the fourth quarter of 2021 with acquisitions contributing 20 basis points to total volume.

診斷信息服務的收入比上年下降 15.3%，反映出 COVID-19 測試服務的收入比 2021 年第四季度減少，部分被我們基礎測試收入的強勁增長所抵消。以申請數量衡量的總交易量與 2021 年第四季度相比下降了 11.2%，收購對總交易量貢獻了 20 個基點。

For the quarter, total base testing volumes declined 0.6% versus the prior year. The year-over-year decline was primarily related to lower employer drug testing volume and adverse weather events during the quarter, which together represented a volume headwind of more than 1.5%.

本季度，基礎測試總量與去年同期相比下降了 0.6%。同比下降主要與本季度較低的雇主藥物檢測量和不利天氣事件有關，它們共同代表了超過 1.5% 的銷量逆風。

COVID-19 testing volumes contributed to decline during the fourth quarter. We req-ed approximately 1.9 million molecular tests in the quarter. This was down 1.2 million tests versus the third quarter and down approximately 5.4 million tests versus Q4 of 2021. After rising modestly throughout the fourth quarter, our COVID-19 molecular volumes declined to an average of roughly 17,000 tests per day in January and currently make up less than 3% of our daily volumes.

COVID-19 測試量導致第四季度下降。我們在本季度需要進行大約 190 萬次分子測試。與第三季度相比減少了 120 萬次測試，與 2021 年第四季度相比減少了約 540 萬次測試。在整個第四季度溫和上升之後，我們的 COVID-19 分子數量在 1 月份下降到平均每天大約 17,000 次測試，目前使增加不到我們每日交易量的 3%。

In the fourth quarter, revenue per requisition declined 5.1% versus the prior year driven primarily by lower COVID-19 molecular volume.

第四季度，每個申請的收入比上一年下降了 5.1%，這主要是由於 COVID-19 分子體積較低。

Base business revenue per req was up 6.8%. The strong increase in revenue per req was driven by a number of factors, including test and payer mix; the more favorable pricing environment with health plans, including incentives under our value-based contracts; and lower patient concessions. Unit price reimbursement pressure remained consistent with our expectations at approximately 50 basis points in the quarter.

每個請求的基礎業務收入增長了 6.8%。每個請求的收入強勁增長是由多種因素推動的，包括測試和付款人組合；更有利的健康計劃定價環境，包括我們基於價值的合同下的激勵措施；並降低患者的讓步。本季度單價報銷壓力約為 50 個基點，與我們的預期一致。

Reported operating income in the fourth quarter was $135 million or 5.8% of revenues compared to $536 million or 19.5% of revenues last year. On an adjusted basis, operating income was $330 million or 14.2% of revenues compared to $579 million or 21.1% of revenues last year. The year-over-year decline in adjusted operating income is related primarily to lower COVID-19 testing revenues and to a lesser extent a negative impact of adverse weather on our volume as well as higher investments to accelerate growth in our base business. Additionally, in the fourth quarter, we experienced a significant increase in employee health care costs.

第四季度報告的營業收入為 1.35 億美元，佔收入的 5.8%，而去年為 5.36 億美元，佔收入的 19.5%。在調整後的基礎上，營業收入為 3.3 億美元，佔收入的 14.2%，而去年為 5.79 億美元，佔收入的 21.1%。調整後營業收入的同比下降主要與 COVID-19 測試收入下降有關，在較小程度上與惡劣天氣對我們的業務量造成的負面影響以及為加速我們基礎業務增長而增加的投資有關。此外，在第四季度，我們的員工醫療保健費用大幅增加。

Reported EPS was $0.87 in the fourth quarter compared to $3.12 a year ago. Adjusted EPS was $1.98 compared to $3.33 last year. Cash from operations was $1.72 billion for full year 2022 versus $2.23 billion in the prior year period.

報告的第四季度每股收益為 0.87 美元，而一年前為 3.12 美元。調整後每股收益為 1.98 美元，而去年為 3.33 美元。 2022 年全年運營現金為 17.2 億美元，上年同期為 22.3 億美元。

Turning to our full year 2023 guidance. Revenues are expected to be between $8.83 billion and $9.03 billion. Base business revenues are expected to be between $8.65 billion and $8.75 billion. COVID-19 testing revenues are expected to be between $175 million and $275 million. Reported EPS expected to be in a range of $7.61 to $8.21 and adjusted EPS to be in a range of $8.40 to $9. Cash from operations is expected to be at least $1.3 billion, and capital expenditures are expected to be approximately $400 million.

轉向我們的 2023 年全年指導。收入預計在 88.3 億美元至 90.3 億美元之間。基礎業務收入預計在 86.5 億美元至 87.5 億美元之間。 COVID-19 測試收入預計在 1.75 億美元至 2.75 億美元之間。報告的每股收益預計在 7.61 美元到 8.21 美元之間，調整後的每股收益在 8.40 美元到 9 美元之間。運營現金預計至少為 13 億美元，資本支出預計約為 4 億美元。

For our 2023 guidance, please consider the following. As Jim highlighted, we are now assuming COVID-19 molecular volumes to average roughly 5,000 to 10,000 tests per day for the full year. Expect volumes to continue to decline through the spring and summer, but could see a modest uptick during respiratory season in Q4.

對於我們的 2023 年指南，請考慮以下內容。正如 Jim 強調的那樣，我們現在假設 COVID-19 的分子體積在全年平均每天進行大約 5,000 到 10,000 次測試。預計整個春季和夏季的銷量將繼續下降，但在第四季度的呼吸季節可能會出現小幅上升。

We assume average reimbursement for COVID-19 molecular testing to continue near recent levels through the end of the PHE. CMS has indicated that reimbursement will be $51 when the PHE expires in May. We continue to negotiate with health plans regarding coverage policies and reimbursement for COVID-19 testing post PHE.

我們假設 COVID-19 分子檢測的平均報銷將繼續接近最近的水平，直到 PHE 結束。 CMS 表示，當 PHE 於 5 月到期時，報銷金額為 51 美元。我們將繼續與健康計劃就 PHE 後 COVID-19 檢測的承保政策和報銷進行談判。

Note that our COVID-19 testing revenue guidance for 2023 is approximately $150 million lower than the expectations we had back in October. With COVID-19 testing becoming a significantly smaller portion of our overall business, we expect an earnings cadence that is more in line with pre-pandemic seasonality this year with Q1 typically being the lowest quarter of the year at roughly 22% to 23% of full year earnings.

請注意，我們 2023 年的 COVID-19 測試收入指南比我們在 10 月份的預期低約 1.5 億美元。隨著 COVID-19 測試在我們整體業務中所佔的比例明顯變小，我們預計今年的盈利節奏更符合大流行前的季節性，第一季度通常是一年中最低的季度，約為 22% 至 23%全年收益。

We have also taken actions to reduce our SG&A by approximately $100 million in 2023, including workforce reductions of approximately 1.5%, primarily in corporate support functions. The benefit of these actions will be modest in Q1 and will expand in the second quarter.

我們還採取行動，在 2023 年將我們的 SG&A 減少約 1 億美元，包括裁員約 1.5%，主要是在企業支持職能方面。這些行動的好處在第一季度將不大，並將在第二季度擴大。

With that, I will now turn it back to Jim.

有了這個，我現在將它轉回給吉姆。

Thanks, Sam. To summarize, we delivered strong growth of 5% in our base business in 2022. COVID testing revenues, as expected, declined last year and will represent a significantly smaller portion of our business going forward. We are increasing our efforts to drive productivity and expand margins in our base business.

謝謝，山姆。總而言之，我們的基礎業務在 2022 年實現了 5% 的強勁增長。COVID 測試收入正如預期的那樣，去年有所下降，並且將占我們未來業務的一小部分。我們正在加大努力，以提高生產力並擴大基礎業務的利潤率。

We look forward to sharing more of our strategy during our upcoming Investor Day on March 16 at the New York Stock Exchange. Look for an announcement soon with more details on this event.

我們期待在即將於 3 月 16 日在紐約證券交易所舉行的投資者日期間分享更多我們的戰略。有關此事件的更多詳細信息，請盡快查看公告。

And now we'd be happy to take your questions. Operator?

現在我們很樂意回答您的問題。操作員？

(Operator Instructions) The first question in the queue is from Ann Hynes with Mizuho Securities.

（操作員說明）隊列中的第一個問題來自瑞穗證券的 Ann Hynes。

Maybe can we talk about major assumptions in the low end of guidance versus what's embedded in the high end of guidance?

也許我們可以談談指導低端的主要假設與指導高端的內容嗎？

And can you also discuss the incremental $115 million to $125 million that is now benefiting 2023 versus when you reiterated that mid-$8 range back in Q3 earnings? How much has fallen to the bottom line? And how much do you expect to be invested in the business?

您能否也討論一下現在使 2023 年受益的 1.15 億美元至 1.25 億美元的增量與您在第三季度收益中重申 8 美元的中間範圍時相比？有多少跌到了底線？您希望在業務上投資多少？

Yes. Let me just speak first about the revenue guidance. As we indicated in the remarks, our COVID guidance, which had originally been 10,000 to 15,000 requisitions per day in '23, we revised that downward to 5,000 to 10,000 per day. And it's really just based on the trends we're seeing.

是的。讓我先談談收入指導。正如我們在評論中指出的那樣，我們的 COVID 指南最初是 23 年每天 10,000 到 15,000 份申請，我們將其下調為每天 5,000 到 10,000 份。它實際上只是基於我們所看到的趨勢。

It peaked in December. We averaged roughly 17,000 a day here in January, but that's had a downward slope. So we continue to expect COVID volumes to decline, and that's really had about $150 million change in revenue versus what we thought last fall.

它在十二月達到頂峰。 1 月份，我們這裡的平均每天大約有 17,000 人次，但已經呈下降趨勢。因此，我們繼續預計 COVID 銷量會下降，與我們去年秋天的預期相比，收入確實發生了大約 1.5 億美元的變化。

So again, the guidance, we've suggested a midpoint of about $225 million in COVID revenue for the year. On the base business, without acquisition help, we've assumed a 2.5% to 3% revenue growth on the total base business. So really, that's the explanation on the revenue side.

因此，再次重申，我們建議今年 COVID 收入的中點約為 2.25 億美元。在基礎業務方面，在沒有收購幫助的情況下，我們假設基礎業務總收入增長 2.5% 至 3%。所以真的，這就是收入方面的解釋。

Yes. So maybe I'll add a couple of comments, Ann, and thank you for the question. This is Sam. So versus what we shared back when we talked about in Q3 of 2022 around the fact that we were somewhere in that $8.50 range. Obviously, some positives that you mentioned, which is, I think what you're referring to, is the $115 million to $125 million, which includes the PAMA delay, which includes also the reimbursement of the specimen collection fees which we now benefit from.

是的。所以也許我會添加一些評論，Ann，謝謝你提出這個問題。這是山姆。因此，與我們在 2022 年第三季度談到我們處於 8.50 美元範圍內的事實時分享的內容相比。顯然，你提到的一些積極因素，我認為你指的是 1.15 億至 1.25 億美元，其中包括 PAMA 延遲，其中還包括我們現在受益的標本採集費的報銷。

But there are a couple of things also that have changed to the negative. Really, the key one being -- or just one thing really that's changed to the negative, I should say, which is COVID. The COVID assumptions that we had back then were, as Jim just said, 10,000 to 15,000 a day. Now we're seeing volumes, as we mentioned on the prepared remarks, 17,000 a day in January. And January is typically around the peak of the respiratory season, and then it starts to come down from there. So our expectations of 10,000 to 15,000 a day for the year are, I would say, realistic.

但也有一些事情已經變成了消極的。真的，關鍵的一個是——或者說只有一件事真的變成了負面的，我應該說，這就是 COVID。正如吉姆剛才所說，我們當時的 COVID 假設是每天 10,000 到 15,000。正如我們在準備好的評論中提到的那樣，現在我們看到的是 1 月份每天 17,000 件。一月通常是呼吸季節的高峰期，然後開始下降。因此，我想說，我們對一年中每天 10,000 到 15,000 人的期望是現實的。

And -- but in terms of the range itself and what differentiates the bottom versus the top, I think it's going to be really around the COVID assumptions. But again, keep in mind, we've taken COVID down by $150 million in terms of total revenues versus what we really shared back in October when we expected 10,000 to 15,000.

而且——但就範圍本身以及底部與頂部的區別而言，我認為這將真正圍繞 COVID 假設。但請再次記住，就總收入而言，我們已經將 COVID 減少了 1.5 億美元，而我們在 10 月份實際分享的收入為 10,000 至 15,000 美元。

We've also -- from the benefit itself, the $115 million to $125 million that you referenced, we've also carved out a small amount for investments in the business, strategic investments that as we said a couple of months ago, we said we will reserve some of that benefit to invest in the business for long-term growth.

我們還——從收益本身，即你提到的 1.15 億美元到 1.25 億美元，我們還抽出少量資金用於業務投資，正如我們幾個月前所說的那樣，我們說我們將保留部分收益用於投資業務以實現長期增長。

Our next question is from Patrick Donnelly with Citi.

我們的下一個問題來自花旗的 Patrick Donnelly。

Sam, maybe one for you. Margins came in a little light of where we were expecting in 4Q. Can you just talk about the puts and takes there between DTC growth investments, inflation, pricing?

山姆，也許一個給你。利潤率略低於我們對第四季度的預期。你能談談 DTC 增長投資、通貨膨脹和定價之間的看跌期權嗎？

And then going into '23, it seems like the base business margins need to step up. You called out the $100 million SG&A cut. Are you guys changing any plans for DTC investments? Just want to get comfortable with that margin bridge from the lower 4Q number and the moving pieces.

然後進入 23 年，基礎業務利潤率似乎需要提高。您要求削減 1 億美元的 SG&A。你們是否正在改變任何 DTC 投資計劃？只是想從較低的 4Q 數字和移動件中適應那個保證金橋。

Sure, Patrick, yes. And thank you for the question. So let me talk a little bit about Q4 and the margin rate in Q4, the 14.2%. So here are some of the headwinds, some of which we were seeing throughout the year. But obviously, we also had a drop in COVID revenues in Q4, which was significant versus Q3, at least sequentially, which impacted the margin as well.

當然，帕特里克，是的。謝謝你的問題。那麼讓我談談第四季度和第四季度的保證金率，即 14.2%。所以這裡有一些不利因素，其中一些是我們全年都看到的。但顯然，我們在第四季度的 COVID 收入也出現了下降，這與第三季度相比是顯著的，至少是連續的，這也影響了利潤率。

But in terms of the margin rate itself, we had inflation I would say per expectations, but still elevated. We had growth investments of roughly about $40 million that impacted Q4, which were fairly in line with Q3, what we had in terms of investments, so not necessarily a sequential driver.

但就保證金率本身而言，我想說的是符合預期的通貨膨脹，但仍然很高。我們有大約 4000 萬美元的增長投資影響了第四季度，這與我們在投資方面的第三季度相當一致，因此不一定是連續的驅動因素。

One driver in Q4 that impacted our margin rate was higher employee health care costs. That was higher than our expectations, and some of it driven by higher utilization, especially towards the end of the year after employees had met their deductibles, but also higher cost of health care in general. And so that was about 80 basis points of impact on the quarter in terms of negative rate impact. So that was another thing.

第四季度影響我們利潤率的一個驅動因素是更高的員工醫療保健成本。這高於我們的預期，部分原因是更高的利用率，尤其是在員工支付了免賠額後的年底，以及總體醫療保健成本的提高。因此，就負利率影響而言，這對本季度的影響約為 80 個基點。所以那是另一回事。

And I talked about, obviously, if you're looking at things sequentially, you have to factor in that COVID revenues were $184 million roughly versus approximately $313 million in Q3. So a big drop in COVID revenues.

我談到，顯然，如果你按順序看事情，你必須考慮到 COVID 收入大致為 1.84 億美元，而第三季度約為 3.13 億美元。因此 COVID 收入大幅下降。

Now if you look prospectively in 2023, here are some of the things that obviously give us confidence that we can achieve the rate that we have in our projections and that's factored into the guidance that we gave.

現在，如果你展望 2023 年，這裡有一些事情顯然讓我們相信我們能夠實現我們預測中的速度，並且這已被納入我們給出的指導中。

We have taken $100 million in SG&A reductions, and I would say 90% of those have already been implemented. Now you won't see the benefit starting in Q1. You'll probably see it in the latter part of Q1 and really taking effect in Q2 more fully. But that's $100 million in SG&A reductions that we expect to see over the course of this year.

我們已經削減了 1 億美元的 SG&A，我想說其中 90% 已經實施。現在您不會看到從第一季度開始的好處。你可能會在第一季度的後半部分看到它，並在第二季度真正發揮更充分的作用。但這是我們預計今年將看到的 SG&A 減少 1 億美元。

In terms of investments, you referenced that we expect investments to be less dilutive in 2023 versus 2022 because we start to see the benefit from some of these investments towards the growth of our business.

在投資方面，您提到我們預計 2023 年的投資比 2022 年的稀釋性要小，因為我們開始看到其中一些投資對我們業務增長的好處。

And then finally, obviously, the margin rate is going to benefit from the specimen collection fee reimbursement that we have. And we have a volume growth assumption as well and a revenue growth assumption that, at the midpoint of the guidance range, is on the base business of approximately 3%. And so that's going to drive also additional margin improvement based on the drop down from those revenues.

最後，顯然，保證金率將從我們擁有的標本採集費報銷中受益。我們還有銷量增長假設和收入增長假設，即在指導範圍的中點，基礎業務的增長率約為 3%。因此，基於這些收入的下降，這也將推動額外的利潤率提高。

Next question is from Jack Meehan with Nephron Research.

下一個問題來自 Nephron Research 的 Jack Meehan。

I had a few questions on Quest Health. So first, of the $96 million you talked about on sales, is there a rough breakdown you can share of COVID versus base? Then second, on the base sales, how did that ramp after the fall push? And then finally, just what are your expectations for consumer-initiated testing revenue and investment for 2023?

我有幾個關於 Quest Health 的問題。所以首先，在你談到的 9600 萬美元的銷售額中，你是否可以粗略地分享 COVID 與基礎的細分？其次，在基礎銷售方面，秋季推動後的增長情況如何？最後，您對 2023 年消費者發起的測試收入和投資有何期望？

Yes. So Jack, let me start. So on CIT, our consumer-initiated testing business, the total $96 million, more of it was COVID than our base business. However, our base business, once we launched the new platform, once we launched the marketing spend, actually performed as expected in November and December. We got significant growth year-over-year, over 50% growth in the month of December based on the initiatives we put in place. So as we've said, this year, we expect that business to be less dilutive versus more -- versus 2022.

是的。傑克，讓我開始吧。因此，在 CIT 上，我們的消費者發起的測試業務總計 9600 萬美元，其中 COVID 比我們的基礎業務更多。然而，我們的基礎業務，一旦我們啟動了新平台，一旦我們啟動了營銷支出，實際上在 11 月和 12 月的表現符合預期。根據我們實施的舉措，我們實現了同比顯著增長，12 月份增長超過 50%。因此，正如我們所說，今年，我們預計與 2022 年相比，該業務的稀釋性將更少而不是更多。

In terms of the total revenue projection for CIT, we'll give you something at Investor Day. Obviously, the COVID will significantly ramp down, but we expect our base to significantly ramp up. And we'll give you a better view of that at Investor Day.

關於 CIT 的總收入預測，我們將在投資者日為您提供一些信息。顯然，COVID 將顯著下降，但我們預計我們的基礎將顯著上升。我們將在投資者日讓您更好地了解這一點。

Great. And then one follow-up on COVID. If we do a look-back on 2022, is it possible to call out how much of the sales came from serology, your CDC contract or anything kind of outside of the core molecular? And just what you're assuming there for 2023?

偉大的。然後是關於 COVID 的後續行動。如果我們回顧 2022 年，是否有可能指出有多少銷售額來自血清學、您的 CDC 合同或任何核心分子之外的東西？您對 2023 年的假設是什麼？

So here's what I say. As we indicated, the volume is coming down, right? We said 10,000 to 15, 000 last fall. We now expect 5,000 to 10,000 for the year. The one thing I'll say on serology, we had a significant contract with the CDC. It was simply a test add-on seroprevalence study. That contract, as expected, ended in December. The CDC just doesn't need that information anymore.

所以這就是我要說的。正如我們指出的那樣，音量正在下降，對嗎？去年秋天我們說 10,000 到 15, 000。我們現在預計今年有 5,000 到 10,000 人。關於血清學，我要說的一件事是，我們與 CDC 簽訂了重要合同。這只是一項測試附加血清陽性率研究。正如預期的那樣，該合同於 12 月結束。 CDC 只是不再需要這些信息了。

What does remain, in addition to the PCR volume, is we've got a roughly $25 million contract with the CDC to do continuous sequencing work of the positive cases to help inform the CDC and others about the spread or the development of new variants that continue to pop up.

除了 PCR 量之外，剩下的是我們與 CDC 簽訂了大約 2500 萬美元的合同，以對陽性病例進行持續測序工作，以幫助 CDC 和其他機構了解新變種的傳播或發展情況繼續彈出。

Next question is from A.J. Rice with Credit Suisse.

下一個問題來自 A.J.瑞士信貸的大米。

Yes. Obviously, it continues to be a steady pipeline of hospital-related deals. Can you tell us whether -- and I know your closest peers announcing transactions, too. Do you see any change in the competitive landscape for those deals on the terms on which those deals are being done?

是的。顯然，它仍然是醫院相關交易的穩定渠道。你能告訴我們是否——我知道你最親密的同行也宣布了交易。您是否看到這些交易的競爭格局在這些交易的條款上有任何變化？

And then you also mentioned seeing some more activity in small regional labs. What do you attribute that to? As the COVID testing is running off, are you seeing some of the regional labs express more interest in potentially aligning with you?

然後你還提到在小型區域實驗室中看到了更多活動。你認為這是什麼原因？隨著 COVID 測試的結束，您是否看到一些地區實驗室對可能與您結盟表現出更大的興趣？

Yes. A.J., thanks for the question. So I would tell you, no, there's no real change in the competitive dynamic in terms of pursuit of these hospital outreach deals or professional lab services types of engagements. What I would tell you is the funnel is as big as it's ever been. We expect to close several deals here in the first half of the year. So still feel very good about that.

是的。 A.J.，謝謝你的提問。所以我會告訴你，不，在追求這些醫院外展交易或專業實驗室服務類型的參與方面，競爭動態沒有真正的變化。我要告訴你的是，這個漏斗比以往任何時候都大。我們預計今年上半年將在這裡完成幾筆交易。所以還是覺得很好。

In terms of small regional labs that are out there, first, I'd say there's not that many left out there that are of significant size. Certainly, those that participated in COVID testing and now that, that volume is declining, yes, we are seeing a few raise their hands and put up the retirement flag and potentially sell out.

就那裡的小型區域實驗室而言，首先，我想說沒有那麼多規模很大的實驗室。當然，那些參與了 COVID 測試的人現在數量正在下降，是的，我們看到一些人舉手舉起退休旗幟並可能賣光。

So we look at each and every one of them. If we think it adds to our competitive position in a certain geographic marketplace, we'll look at it. If we don't think we need it from a competitive standpoint, then we take a bye on those.

因此，我們會審視他們中的每一個。如果我們認為它增加了我們在某個地理市場的競爭地位，我們就會考慮它。如果我們認為從競爭的角度來看我們不需要它，那麼我們就再見了。

Next question is from Pito Chickering with Deutsche Bank.

下一個問題來自德意志銀行的 Pito Chickering。

Quest has a very long track record of finding cost efficiencies through Invigorate. So I'm curious how the SG&A cost cutting of $100 million compares to what Invigorate usually finds in SG&A. Or are most cost savings via like Invigorate are usually done in cost of services and fixed cost leverage on volume?

Quest 在通過 Invigorate 尋找成本效益方面擁有非常悠久的記錄。所以我很好奇 1 億美元的 SG&A 成本削減與 Invigorate 通常在 SG&A 中發現的相比如何。還是通過類似 Invigorate 節省的大部分成本通常是在服務成本和固定成本槓桿方面完成的？

Yes. So first, the $100 million cost takeout is incremental to our Invigorate plan for 2023. With our Invigorate plan, we target roughly 3% of our entire cost base for the company. So call that $6.4-ish billion, 3%, call it, $180 million, $190 million a year. We actually got very close to that target in 2022. As we said in the prepared remarks, it did not completely offset wage inflation and the slight price headwind that we did see along with just other nonlabor inflationary pressures.

是的。因此，首先，1 億美元的成本支出是我們 2023 年 Invigorate 計劃的增量。根據我們的 Invigorate 計劃，我們的目標是大約占公司整個成本基礎的 3%。所以稱那 64 億美元左右，3%，稱它為 1.8 億美元，每年 1.9 億美元。實際上，我們在 2022 年非常接近該目標。正如我們在準備好的發言中所說，它並沒有完全抵消我們確實看到的工資通脹和輕微的價格逆風以及其他非勞動力通脹壓力。

Now as we go into 2023, we've got a full funnel of productivity ideas, productivity initiatives that we're driving through the company. And I would say the other thing that we think will really help us in 2023 is simply the stabilization of our workforce. Attrition has really a major impact on your productivity when you're constantly churning phlebotomists, logistics and specimen processing.

現在，當我們進入 2023 年時，我們已經有了一個完整的生產力理念漏斗，我們正在推動整個公司的生產力舉措。我想說的是，我們認為在 2023 年真正對我們有幫助的另一件事就是穩定我們的勞動力。當您不斷更換抽血師、後勤人員和標本處理人員時，人員流失確實會對您的工作效率產生重大影響。

So that has stabilized. It's coming down. We feel good about it. And we feel good about the overall productivity plan in terms of offsetting inflation, which we expect to be slightly softer, easier in 2023. And we expect price, all in across Quest Diagnostics, to actually be a positive for 2023.

這樣就穩定了。它正在下降。我們對此感覺很好。我們對抵消通貨膨脹方面的整體生產力計劃感覺良好，我們預計 2023 年該計劃將略微疲軟、更容易。我們預計整個 Quest Diagnostics 的價格實際上對 2023 年是積極的。

So just at the risk of being redundant here, I'm still going to repeat something from what Jim said at the beginning because it's really important for your -- all your assumptions, is the productivity improvements and the Invigorate actions, which is the 3% that we expect to get. That's in addition on top of the $100 million of SG&A reductions that we've already taken, for the most part.

因此，冒著重複的風險，我仍然要重複 Jim 一開始所說的話，因為這對你來說非常重要——你所有的假設，是生產力的提高和鼓舞人心的行動，這是 3我們期望得到的百分比。在大多數情況下，這是在我們已經採取的 1 億美元 SG&A 削減之外的補充。

Got it. And sort of 2 quick follow-ups. You talked about the phlebotomists. I was just curious where the phlebotomist hourly wage is today and kind of do you think that is sort of the right level to compete against retail channels?

知道了。以及 2 次快速跟進。你談到了抽血師。我只是好奇今天抽血師的時薪是多少，你認為這是與零售渠道競爭的合適水平嗎？

And second one is the public lab supply companies have talked about pricing for a while. Just curious, as one of the large labs in the U.S., what do you assume for supply inflation for '23? Or can you offset that inflation simply by changing vendors and/or leveraging your scale?

第二個是公共實驗室供應公司已經討論了一段時間的定價。只是好奇，作為美國的大型實驗室之一，您如何看待 23 年的供應膨脹？或者您是否可以通過更換供應商和/或利用您的規模來抵消通貨膨脹？

Yes. So our phlebotomy rates vary by region of the country. What I would tell you is our increase in wages for phlebotomy were certainly in line with the 3% to 4% wage impact that we saw last year. It's what we're planning for 2023. And as I indicated, our retention has improved, our attrition has certainly stabilized and declined. So we feel good about that.

是的。因此，我們的放血率因國家地區而異。我要告訴你的是，我們因放血而增加的工資肯定與我們去年看到的 3% 至 4% 的工資影響一致。這就是我們 2023 年的計劃。正如我所指出的，我們的保留率有所提高，我們的流失率肯定已經穩定下來並有所下降。所以我們對此感覺很好。

Then on the supply inflation? Just curious.

那麼關於供給通脹呢？只是好奇。

Yes. I'm sorry, the supply inflation. So again, 70% of what we purchase each year is under contract. When those contracts come up, they generally represent an opportunity for deflation, meaning we're going to run a competition between the vendors. And we look for improvements from a cost, quality and turnaround time perspective.

是的。對不起，供應膨脹。同樣，我們每年採購的產品中有 70% 是根據合同進行的。當這些合同出現時，它們通常代表通貨緊縮的機會，這意味著我們將在供應商之間進行競爭。我們從成本、質量和周轉時間的角度尋求改進。

So where the inflation hit us in 2022 is really on some of the nonsupplies, the reagents and things like that. Some of that could have been pre-analytical supplies, masks, gowns, things like that; as well as just the normal inflation that you all see in your businesses, which could be hotels, air travel and things like that. Now again, we think that's softening here as we get into 2023, and we certainly put guardrails on travel and living-in expenses and things like that.

因此，2022 年通貨膨脹對我們造成的影響實際上是一些非供應品、試劑和類似的東西。其中一些可能是分析前用品、口罩、防護服之類的東西；以及你們在企業中看到的正常通貨膨脹，可能是酒店、航空旅行等。現在，我們再次認為，隨著我們進入 2023 年，這種情況會有所緩和，我們當然會在旅行和生活費用等方面設置護欄。

Next question is from Brian Tanquilut with Jefferies.

下一個問題來自 Jefferies 的 Brian Tanquilut。

Jim, just a quick question on rates from payers. I think in the past, you've expressed some optimism in seeing a little bit of rate improvement on the commercial side. But I think in your prepared remarks, you called out a little bit of reimbursement pressure at 60 basis points or so. So just curious, how do you reconcile that? And maybe just broadly speaking, what you're seeing in terms of payer receptivity to increasing rates on the reimbursement front.

吉姆，只是一個關於付款人費率的快速問題。我認為在過去，您對商業方面的利率有所提高表示樂觀。但我認為在你準備好的發言中，你提出了 60 個基點左右的一點報銷壓力。所以只是好奇，你如何調和呢？也許從廣義上講，您所看到的付款人對報銷方面提高利率的接受程度。

Yes. I think we said in the prepared remarks that our pricing was down about 50 basis points, which actually represents the best that I've seen in my time with Quest Diagnostics. So we feel good about that.

是的。我想我們在準備好的評論中說過我們的定價下降了大約 50 個基點，這實際上代表了我在 Quest Diagnostics 期間看到的最好的價格。所以我們對此感覺很好。

We've also said that, as we renegotiate new contracts, and every one of these contracts is 4 to 5 years in length. So you can expect that 20% to 25% will renew this year, which they will. And the preponderance of those contracts, we've seen rate increases, at a minimum rate, holding rate flat to prior contracts. So we view that as a very positive.

我們還說過，當我們重新談判新合同時，每一份合同的期限都是 4 到 5 年。所以你可以預計今年會有 20% 到 25% 的公司續約，他們會的。而這些合同的優勢，我們已經看到利率上漲，最低利率，保持利率與之前的合同持平。所以我們認為這是非常積極的。

What we've also said is, look, we got a 40 -- $35 million to $40 million rate increase through Medicare draw fees increases. And today, we get reimbursed on roughly 25% of the commercial draws that we do. We're going to push hard not only to expand that 25%, but those that do reimburse us to take those rates up as well. So we are pushing hard at every turn to increase prices across this business.

我們還說過，看，通過增加 Medicare 提取費用，我們的費率增加了 40-3500 萬至 4000 萬美元。今天，我們所做的大約 25% 的商業抽獎得到了報銷。我們不僅要努力擴大這 25%，而且那些確實報銷我們的人也會提高這些利率。因此，我們每時每刻都在努力提高整個行業的價格。

The last thing I'd say is, look, there's a portfolio of $700 million, $800 million of other businesses in Quest Diagnostics. That can be our ExamOne business, our employer solutions business, our employee population health business. And we pushed for 2% to 3% price increases on that portfolio of business, and we've largely gotten those in place for 2023.

我要說的最後一件事是，看，Quest Diagnostics 有 7 億美元的投資組合，8 億美元的其他業務。這可以是我們的 ExamOne 業務、我們的雇主解決方案業務、我們的員工人口健康業務。我們推動該業務組合的價格上漲 2% 至 3%，並且我們在 2023 年基本上已經到位。

So again, this is the most optimistic price outlook that we've put forward since I joined Quest in 2013.

再次重申，這是自我 2013 年加入 Quest 以來我們提出的最樂觀的價格前景。

Yes. Maybe just to put maybe a couple of points of emphasis around it. In the prepared remarks, we talked about a price impact in Q4 of roughly 50 basis points year-over-year, price headwind. As we look towards 2023, what's reflected in our guidance right now is actually a positive price impact year-over-year. And obviously, that's benefited from the reimbursement of the specimen collection fee. But it's definitely a positive. We've managed to really make some good progress in terms of our pricing.

是的。也許只是圍繞它強調幾點。在準備好的評論中，我們談到了第四季度的價格影響，同比上漲約 50 個基點，價格逆風。當我們展望 2023 年時，我們目前的指引中反映的實際上是同比價格的積極影響。顯然，這得益於標本採集費的報銷。但這絕對是積極的。我們在定價方面確實取得了一些不錯的進展。

The other thing I want to mention is we've talked about these value-based contracts. And over 30% of our health plan contracts have some type of incentive for us to earn additional value, which we actually don't put into the price equation, but it's really good payer mix.

我想提的另一件事是我們已經討論過這些基於價值的合同。我們超過 30% 的健康計劃合同有某種激勵我們賺取額外價值，我們實際上沒有將其納入價格等式，但它確實是很好的付款人組合。

These incentives could be based on share of spend with Quest Diagnostics. It could be based on leakage. It could be based on the movement of requisitions from high-priced hospital labs into laboratories like Quest Diagnostics. So those value-based incentives are an important part of our business. And as we succeed in achieving that value for the health plans, there's rewards that come back to us.

這些激勵措施可以基於與 Quest Diagnostics 的支出份額。它可能基於洩漏。它可能基於從高價醫院實驗室向 Quest Diagnostics 等實驗室轉移申請。因此，那些基於價值的激勵措施是我們業務的重要組成部分。當我們成功實現健康計劃的價值時，我們就會得到回報。

Brian, this is Shawn. Just one last thing I wanted to add. Most of the price impact that we saw in 2022 was largely driven by some of the client bill largely with the hospitals. The health plan book was actually pretty good, pretty stable. So.

布賴恩，這是肖恩。我想補充的最後一件事。我們在 2022 年看到的大部分價格影響主要是由一些主要與醫院有關的客戶賬單推動的。健康計劃書其實還不錯，挺穩的。所以。

The next question is from Kevin Caliendo with UBS.

下一個問題來自瑞銀的 Kevin Caliendo。

I'm really just trying to understand all these puts and takes a little bit. And I guess my first one is, is the $100 million of SG&A, it's incremental. Is that -- Invigorate typically offsets some other inflationary pressures, labor costs and the like. Is this $100 million incremental such that it drops to the bottom line? Or is there other offsets there?

我真的只是想了解所有這些 put 和 takes 一點點。我想我的第一個是 1 億美元的 SG&A，它是增量的。那是——振興通常會抵消其他一些通脹壓力、勞動力成本等。這 1 億美元的增量是否會下降到底線？還是那裡有其他抵消？

And two, is there any change with the pricing benefit that you're talking about, better pricing is certainly a tailwind, I would think, for '23. So how do we think about that in terms of is there an offset there on mix on the margin for basically your volume mix, something to that effect? Just trying to understand the puts and takes.

第二，你所說的定價優勢是否有任何變化，我認為更好的定價肯定是 23 年的順風。那麼我們如何考慮基本上您的音量組合的邊際混合是否存在抵消，是否有這種影響？只是想了解 puts 和 takes。

Yes. Again, the $100 million, it is incremental to our Invigorate plan of record, and yes, it drops right to the bottom line.

是的。同樣，這 1 億美元是我們記錄在案的 Invigorate 計劃的增量，是的，它直接落到了底線。

In terms of pricing, no, the improvement drops to the bottom line as well. We're not suggesting any other offset at this point. Obviously, we had strong rev per req both in Q4 and for the year. That benefit, we would put in 3 buckets.

在定價方面，不，改進也落到了底線。我們目前不建議任何其他抵消。顯然，我們在第 4 季度和全年都有強勁的需求增長。這個好處，我們會放入 3 個桶。

Test mix, which was very positive for the year. We saw a big surge of flu and RSV testing, along with COVID, but flu and RSV that came in Q4, that has since moderated. And then our business mix was good in terms of payer mix. And then finally, year-over-year, we made nice improvements in patient concessions. So our ability to collect, our ability to reduce denials and get paid for the work we do was certainly a positive tailwind for us in 2022.

測試組合，這一年非常積極。我們看到流感和 RSV 測試以及 COVID 的激增，但在第四季度出現的流感和 RSV 測試已經有所緩和。然後我們的業務組合在付款人組合方面很好。最後，年復一年，我們在患者讓步方面取得了很大的進步。因此，我們的收集能力、減少拒絕的能力以及為我們所做的工作獲得報酬的能力無疑對我們在 2022 年起到了積極的推動作用。

And if I can just ask one quick follow-up. Should we assume in our models the $1 billion buyback gets used in 2023?

如果我可以問一個快速跟進。我們是否應該假設在我們的模型中 10 億美元的回購將在 2023 年使用？

No, Kevin. So the -- sorry, the $1 billion share authorization increase, that's in addition to the $311 million that we currently have on the previous authorization. But you should not expect that, that is what's assumed in the guidance.

不，凱文。所以 - 抱歉，10 億美元的股票授權增加，這是我們目前在先前授權中獲得的 3.11 億美元的補充。但是您不應該期望那樣，這就是指南中的假設。

What we've assumed actually is that any share buybacks we do are to offset equity dilution so essentially the share count is roughly flat with where we are at the end of the year. So don't assume the $1 billion to be built into the projections.

我們實際上假設的是，我們所做的任何股票回購都是為了抵消股權稀釋，因此基本上股票數量與我們年底時的數量大致持平。因此，不要假設將 10 億美元計入預測中。

Next question is from Andrew Brackmann with William Blair.

下一個問題來自 Andrew Brackmann 和 William Blair。

Maybe as it relates specifically to the COVID test reimbursement with the PHE ending, can you maybe just give us a little bit more detail on how those conversations with commercial payers are trending, and how we should be thinking about expectations there?

也許因為它與 PHE 結束時的 COVID 測試報銷特別相關，您能否向我們提供更多細節，說明與商業付款人的對話趨勢如何，以及我們應該如何考慮那裡的期望？

And then I guess just relatedly to that, how are you thinking about any permanent changes to your respiratory testing portfolio broadly now that we've lived through sort of 3 years of COVID?

然後我想與此相關的是，既然我們已經經歷了大約 3 年的 COVID，您如何考慮廣泛地對您的呼吸測試組合進行任何永久性更改？

Yes. So again, CMS, and we've had direct discussions with them. It's very clear that once the public health emergency ends, the rate will go to $51. We are certainly expecting and driving those discussions with commercial payers, that we expect that rate to be $51 as well. It's a new test that should be treated as such.

是的。再一次，CMS，我們已經與他們進行了直接討論。很明顯，一旦突發公共衛生事件結束，費率將升至 51 美元。我們當然期待並推動與商業付款人的討論，我們預計該費率也為 51 美元。這是一個新的測試，應該這樣對待。

Some may have a slightly different opinion on that, Andrew. So that's where we negotiate. In addition to that, there's coverage policy decisions that all need to be worked out as well, asymptomatic versus symptomatic testing.

Andrew，有些人可能對此有不同的看法。這就是我們談判的地方。除此之外，還有所有需要製定的覆蓋政策決定，無症狀測試與症狀測試。

So we're bullish that the country needs these tests, commercial payers need these tests. And we're going to drive these discussions in the most favorable way that we can.

所以我們看好國家需要這些測試，商業付款人需要這些測試。我們將以最有利的方式推動這些討論。

In terms of respiratory panels. Obviously, with COVID still out there, it's not going to go away in 2023. When patients presented in the fall/winter here in January with respiratory symptoms, some physicians ordered 3 tests, some physicians ordered 1 and then reflexed to others depending on if the first one turned out to be negative. So there were a variety of patterns that were out there. But we don't expect COVID to go away in 2023. So whether RSV and flu tick up like they did in 2022 remains to be seen. And so we'll just have to see how it plays out in the late fall, early winter.

在呼吸面板方面。顯然，由於 COVID 仍然存在，它不會在 2023 年消失。當患者在 1 月份的秋冬季節出現呼吸道症狀時，一些醫生要求進行 3 次檢查，一些醫生要求進行 1 次檢查，然後根據是否有反應轉給其他人第一個結果是負面的。所以那裡有各種各樣的模式。但我們預計 COVID 不會在 2023 年消失。因此 RSV 和流感是否會像 2022 年那樣流行還有待觀察。所以我們只需要看看它在深秋初冬的表現如何。

The next question is from Derik De Bruin with Bank of America.

下一個問題來自美國銀行的 Derik De Bruin。

So one quick housekeeping question and then a follow-up. So the housekeeping question, just expectations for net interest expense for the year.

所以一個快速的內務問題，然後是一個後續問題。所以內務管理問題，只是對今年淨利息支出的預期。

And then how should we think -- and also then how should we think about the M&A contribution that's embedded in your revenue and your volume growth in the '23 guide? And should we still think about that 2% bogey as the way to look at it for going forward on the revenue contribution?

然後我們應該如何思考 - 然後我們應該如何考慮嵌入在您的收入中的併購貢獻和您在 23 年指南中的銷量增長？我們是否仍應考慮將 2% 的柏忌作為看待它以推動收入貢獻的方式？

Derik, so I'll handle the questions, but I missed the part on the expense. What type of expense?

Derik，所以我會處理這些問題，但我錯過了關於費用的部分。什麼類型的費用？

I'm sorry, net interest expense.

對不起，淨利息支出。

Oh, net interest expense. Okay. That's roughly flat, I'd say, year-over-year in terms of '22 to '23, Derik, is the assumption to take there.

哦，淨利息支出。好的。這大致持平，我想說，從 22 年到 23 年，Derik 是假設要達到那裡。

In terms of M&A, what we have assumed in our guide for 2023 is really no material prospective M&A. So essentially, what's closed already, what was included in '23 in terms of deals that have been made, any outreach, for instance, hospital deals that have already closed in '22, those, you'll see a benefit from in '23, but there is no prospective M&A included.

在併購方面，我們在 2023 年的指南中假設實際上沒有重大的前瞻性併購。因此，從本質上講，已經關閉的內容，'23 中已達成的交易中包含的內容，任何外展，例如，'22 中已經關閉的醫院交易，那些，你會在 '23 中看到好處，但沒有包括預期的併購。

So when you think about our long term target that we had talked about, around 2% contribution from M&A, we have not assumed any prospective M&A in '23 on top of our base revenue growth.

因此，當您考慮我們已經談到的我們的長期目標時，併購的貢獻約為 2%，我們沒有假設 23 年除了我們的基本收入增長之外還有任何潛在的併購。

All right. So with completed M&A, then what's the contribution for '23?

好的。那麼完成併購後，'23 的貢獻是什麼？

It's not significant. We're not going to give the exact contribution, but it's really not that material in terms of what we have this year that carries into next year.

這並不重要。我們不會給出確切的貢獻，但就我們今年的貢獻和明年的貢獻而言，這真的不是那麼重要。

Derik, we had 1 month of Pack Health because that's what closed last year at the end of January. And then the Summa Health and the Northern Light outreach acquisitions, those were pretty small.

Derik，我們有 1 個月的 Pack Health，因為那是去年 1 月底關閉的。然後是 Summa Health 和 Northern Light 外展收購，這些收購規模很小。

And the last question in the queue is from Elizabeth Anderson with Evercore ISI.

隊列中的最後一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I had a question about advanced diagnostics and sort of your assumptions for '23, including sort of contribution, and then more specifically on the positive impact in pricing. And any kind of incremental investments that you think specifically for 2023 will be necessary to sort of sustain that growth, accelerate it.

我有一個關於高級診斷的問題，以及你對 23 年的假設，包括某種貢獻，然後更具體地說是對定價的積極影響。您認為專門針對 2023 年的任何類型的增量投資對於維持和加速增長都是必要的。

Yes. So we've talked about our investments in really 3 categories. First, consumer-initiated testing, which we've covered. We will -- that business will continue to grow on the base side of our testing in 2023. And as we've indicated, it will certainly be less dilutive than it was in 2022.

是的。所以我們已經討論了我們在 3 個類別中的投資。首先，我們已經介紹了消費者發起的測試。我們將 - 該業務將在 2023 年的測試基礎上繼續增長。正如我們所指出的那樣，它的稀釋性肯定會低於 2022 年。

The second big area of investments has been in oncology and what we call genomic sequencing services and really building out what we call our integrated genomics platform. As I mentioned in the prepared remarks, we brought up a new LDT in Q4 using the Illumina platform. It's referred to as a TSO 500, but it is a Quest LDT. And is really important in therapy selection decisions for cancer, and we're really happy about that. We brought it up at our SJC facility, and we'll be expanding that to a second facility here in early 2023. So we certainly expect that business to grow.

第二大投資領域是腫瘤學和我們所說的基因組測序服務，以及真正構建我們所說的綜合基因組學平台。正如我在準備好的評論中提到的，我們在第四季度使用 Illumina 平台推出了一個新的 LDT。它被稱為 TSO 500，但它是 Quest LDT。並且在癌症的治療選擇決策中非常重要，我們對此感到非常高興。我們在我們的 SJC 設施中提出了它，我們將在 2023 年初將其擴展到這裡的第二個設施。因此我們當然希望該業務能夠增長。

On this integrated genomics platform, look, the world has moved from microarray testing to whole exome to whole transcriptome and now moving quickly to whole genome testing. And we expect, with this platform, to have a really good sample to complete information platform, low cost, high throughput, really good turnaround time. And we'll update you more about that at our upcoming Investor Day.

在這個集成的基因組學平台上，看，世界已經從微陣列測試轉向整個外顯子組，再轉向整個轉錄組，現在正迅速轉向全基因組測試。我們希望通過這個平台，有一個非常好的樣本來完成信息平台，低成本，高吞吐量，非常好的周轉時間。我們將在即將到來的投資者日向您更新更多相關信息。

The final thing is we refer to it as pharma services, which grew over 15% last year. And this is Quest that -- this is us participating in companion diagnostics. We participate in Phase I clinical trials, either from a pharma company or from a CRO. And then we do a lot of testing and validation work for our IVD partners in the industry, and that business continues to grow as well.

最後一件事是我們將其稱為製藥服務，去年增長超過 15%。這就是 Quest——這是我們參與伴隨診斷。我們參與了來自製藥公司或 CRO 的 I 期臨床試驗。然後我們為行業內的 IVD 合作夥伴做了大量的測試和驗證工作，並且該業務也在繼續增長。

So the last thing I'd say is, look, we felt really good about our growth in prenatal testing this year and other rare genetic disorders. So it's a business that continues to grow in the high single, low double digits for Quest Diagnostics.

所以我最後要說的是，看，我們對今年產前檢測和其他罕見遺傳疾病的增長感到非常滿意。因此，Quest Diagnostics 的業務繼續以高個位數、低兩位數的速度增長。

There is one more question that popped in the queue from Rachel Vatnsdal with JPMorgan.

JPMorgan 的 Rachel Vatnsdal 提出了另一個問題。

So first up, we've previously talked about some of the uneven recoveries by geography. Last quarter, you noted that New York City was still not fully recovered. So can you just give us the latest update on the recovery there in New York?

因此，首先，我們之前已經討論過按地域劃分的一些不均衡的複蘇。上個季度，您注意到紐約市仍未完全恢復。那麼，您能否向我們介紹一下紐約復甦的最新情況？

And then my follow-up is just on the Analyst Day on this March. Can you walk us through some of the topics that you plan on hitting on, and any expectations for that?

然後我的後續行動就在今年三月的分析師日。您能否向我們介紹一下您計劃討論的一些主題，以及對此有何期望？

Yes. So in terms of -- thank you, Rachel, for the question. This is Sam. In terms of the geography, I think it's consistent with what we said before, and let me repeat what we said because we haven't seen really a major change in the dynamic yet.

是的。所以就——謝謝瑞秋提出的問題。這是山姆。在地理方面，我認為這與我們之前所說的一致，讓我重複我們所說的話，因為我們還沒有看到真正的動態重大變化。

We are back to pre-pandemic levels across and above across most geographies. The exception, notable exception being the East, where New York City, I think we've seen roughly 3% to 5% outflow from the city in terms of population, 3% to 5% of the population leaving the city. And we haven't seen that fully come back yet even though the city is much more vibrant, and there's more activity. But I don't think in terms of people coming back and getting health care in New York City, I don't think it's back to where it was pre-pandemic by any means.

在大多數地區，我們都回到了大流行前的水平。例外，值得注意的例外是紐約市東部，我認為我們已經看到大約 3% 到 5% 的人口從城市流出，3% 到 5% 的人口離開城市。我們還沒有看到這種情況完全恢復，儘管這座城市更有活力，活動也更多。但我認為，就人們返回紐約市並獲得醫療保健而言，我認為它無論如何都不會回到大流行前的狀態。

The other thing we look at is ridership on public transportation as an indicator, as a key metric, to see how is that also coming back. And it's still about 35% or so below pre-pandemic levels in terms of ridership based on the last data points that we got. So the punch line here being that the East is still lagging. But everywhere else is above pre-pandemic levels in terms of utilization.

我們關注的另一件事是將公共交通的乘客量作為一個指標，作為一個關鍵指標，看看它是如何回歸的。根據我們獲得的最後數據點，就乘客量而言，它仍然比大流行前水平低 35% 左右。所以這裡的妙語是東方仍然落後。但就利用率而言，其他任何地方都高於大流行前的水平。

Yes. And then, Rachel, thanks for the question on Investor Day. So I think there's really 4 broad topics that we're going to talk about. First, around growth. We'll go deep on what we're doing from an oncology and genomic sequencing standpoint. We'll give you a lot more color on our consumer-initiated testing business, the progress we're making and why we continue to be excited about that.

是的。然後，雷切爾，感謝您在投資者日提出的問題。所以我認為我們真的要討論 4 個廣泛的主題。首先，圍繞增長。我們將從腫瘤學和基因組測序的角度深入探討我們正在做的事情。我們將為您詳細介紹我們的消費者發起的測試業務、我們正在取得的進展以及我們為何繼續對此感到興奮。

And then we'll also address the core part of this business, which is serving physicians, serving health systems and what we're doing to continue to drive growth in those segments.

然後我們還將討論這項業務的核心部分，即為醫生、衛生系統服務以及我們為繼續推動這些領域的增長所做的工作。

Finally, and as always, we'll address what we're doing to improve the customer experience and drive productivity in this business. It's a never-ending part of what we do, and we continue to drive productivity. And we'll give you our plans for '23 and beyond.

最後，一如既往，我們將解決我們正在做的事情，以改善客戶體驗並提高該業務的生產力。這是我們所做工作永無止境的一部分，我們將繼續提高生產力。我們將為您提供 23 年及以後的計劃。

Finally, just as a reminder, it is March 16. It will be at the New York Stock Exchange. And we'll obviously provide our long-term outlook as part of that session.

最後，提醒一下，今天是 3 月 16 日。它將在紐約證券交易所舉行。作為該會議的一部分，我們顯然會提供我們的長期展望。

I'm showing no further questions in the queue.

我不會在隊列中顯示更多問題。

Okay. So I wanted to thank everybody for joining the call today. We look forward to seeing you all on March 16 at the New York Stock Exchange. And have a great afternoon. Thanks, everyone.

好的。所以我想感謝大家今天加入電話會議。我們期待 3 月 16 日在紐約證券交易所與大家見面。祝你下午愉快。感謝大家。

Thank you, everybody.

謝謝大家。

Thank you for participating in the Quest Diagnostics Fourth Quarter and Full Year 2022 Conference Call. A transcript of prepared remarks on this call will be posted later today on Quest Diagnostics' website at www.questdiagnostics.com.

感謝您參加 Quest Diagnostics 第四季度和 2022 年全年電話會議。今天晚些時候，將在 Quest Diagnostics 的網站 www.questdiagnostics.com 上發布關於此次電話會議的準備好的發言稿。

A replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at (203) 369-3056 for international callers or (888) 566-0498 for domestic callers. Telephone replays will be available from approximately 10:30 a.m. Eastern Time on February 2, 2023, until midnight, Eastern Time, February 16, 2023. Goodbye.

可在 www.questdiagnostics.com/investor 在線訪問通話重播，國際用戶可撥打 (203) 369-3056，國內用戶可撥打 (888) 566-0498。電話重播將從東部時間 2023 年 2 月 2 日上午 10:30 左右開始，直到東部時間 2023 年 2 月 16 日午夜為止。再見。