奎斯特診斷 (DGX) 2023 Q3 法說會逐字稿

Welcome to the Quest Diagnostics Third Quarter 2023 Conference Call. At the request of the company, this call is being recorded. The entire contents of the call, including the presentation and question-and-answer session that will follow, are the copyrighted property of Quest Diagnostics with all rights reserved. Any redistribution, retransmission or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited.

歡迎參加 Quest Diagnostics 2023 年第三季電話會議。應本公司要求，本次通話正在錄音。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、轉發或轉播本次通話。

I would like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Go ahead, please.

我想介紹一下 Quest Diagnostics 投資者關係副總裁 Shawn Bevec。請繼續。

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

謝謝你，早安。我們的董事長、執行長兼總裁吉姆戴維斯 (Jim Davis) 也加入了我的行列。以及我們的財務長 Sam Samad。在這次電話會議中，我們可能會做出前瞻性陳述，並將討論非公認會計準則措施。我們在收益新聞稿的表格中提供了非公認會計準則衡量指標與可比較公認會計準則衡量指標的調整表。

Actual results may differ materially from those projected. Risks and uncertainties 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.

實際結果可能與預測結果有重大差異。可能影響 Quest Diagnostics 未來業績的風險和不確定性包括但不限於我們最近的 10-K 表年度報告以及隨後提交的 10-Q 表季度報告和 8-K 表當前報告中描述的風險和不確定性。

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. Now here is Jim Davis.

對於本次電話會議，提及報告的每股盈餘是指報告的稀釋每股盈餘，提及調整後的每股盈餘是指調整後的稀釋每股盈餘。任何提及基礎業務、測試、收入或數量的內容均指我們的業務表現，不包括 COVID-19 測試。與我們長期前景預測相關的成長率，包括總收入成長、收購收入成長、有機收入成長和調整後獲利成長，均為複合年增長率。最後，收購帶來的收入成長率將根據我們的基礎業務來衡量。現在請聽吉姆戴維斯的演講。

Thanks, Shawn, and good morning, everyone. We grew our base business nearly 5% in the third quarter, largely by driving growth in our physician and hospital channels. Our consumer channel also continued to produce solid base business revenue growth. In addition, we are pleased that we have now successfully completed negotiations for all our strategic health plan renewals that were scheduled for this year. These strength and collaborations will position us to build on growth opportunities going forward. Our Invigorate program is on track to deliver 3% annual productivity improvements and savings. In addition, the productivity of our base business improved sequentially and year-over-year.

謝謝肖恩，大家早安。第三季我們的基礎業務成長了近 5%，這主要是透過推動我們的醫生和醫院管道的成長。我們的消費者管道也持續帶來堅實的基礎業務收入成長。此外，我們很高興我們現在已經成功完成了原定於今年進行的所有戰略健康計劃更新的談判。這些優勢和合作將使我們能夠抓住未來的成長機會。我們的 Invigorate 計劃預計將實現每年 3% 的生產力提高和節省。此外，我們基礎業務的生產力季比和年比都有所提升。

Given the strength of our business and a robust pipeline of professional lab services and M&A opportunities, we are well positioned for continued growth. This morning, I'll discuss highlights from the third quarter, then Sam will provide more details on our financial results and talk about our updated financial guidance for 2023.

鑑於我們的業務實力以及強大的專業實驗室服務管道和併購機會，我們已做好持續成長的準備。今天早上，我將討論第三季度的亮點，然後 Sam 將提供有關我們財務業績的更多詳細信息，並討論我們更新的 2023 年財務指引。

Now let's turn to some of the highlights from the quarter. Our strategy is to drive growth by continuing to meet the evolving needs of our core customers, physicians, hospitals and consumers. We are enabling growth across our customer channels through advanced diagnostics with an intense focus on faster-growing clinical areas, including molecular genomics and oncology.

現在讓我們來看看本季的一些亮點。我們的策略是透過持續滿足核心客戶、醫生、醫院和消費者不斷變化的需求來推動成長。我們透過先進的診斷技術實現整個客戶管道的成長，並專注於快速成長的臨床領域，包括分子基因組學和腫瘤學。

In addition, acquisitions remain a key driver of our growth with an emphasis on accretive hospital outreach purchases as well as smaller independent labs. Finally, our strategy includes driving operational improvements across the business with strategic deployment of automation and AI to improve quality, efficiency and service.

此外，收購仍然是我們成長的關鍵驅動力，重點是增加醫院外展採購以及較小的獨立實驗室。最後，我們的策略包括透過自動化和人工智慧的策略部署來推動整個企業的營運改進，以提高品質、效率和服務。

Here are a few key updates on the progress we have made in these areas. In physician lab services, we delivered mid-single-digit base business revenue growth driven by the strength in our cardiometabolic and general health and wellness testing. Our strong relationships with health plans were also a key driver in the quarter.

以下是我們在這些領域取得的進展的一些重要更新。在醫師實驗室服務方面，由於我們的心臟代謝和一般健康與保健測試的實力，我們實現了中個位數的基本業務收入成長。我們與健康計劃的牢固關係也是本季的關鍵驅動因素。

As I mentioned earlier, we successfully completed negotiations for all our strategic health plan renewals that were scheduled for this year. Our success is a result of the clinical and economic value we deliver to health plans and their members.

正如我之前提到的，我們成功完成了原定於今年進行的所有戰略健康計劃更新的談判。我們的成功源於我們為健康計劃及其會員提供的臨床和經濟價值。

Today, more than 50% of the health plan revenues are generated from these value-based contracts which are fueling double-digit growth compared to our traditional health plan contracts. Together with our health plans, we've a renewed focus on initiatives to reduce leakage to high-cost out-of-network labs. In addition, we are working together to redirect volume from high-cost labs to Quest. Importantly, this is good for both patients and employers which are paying for the majority of health care costs.

如今，超過 50% 的健康計劃收入來自這些基於價值的合同，與我們傳統的健康計劃合同相比，這些合同推動了兩位數的增長。與我們的健康計劃一起，我們重新關注減少向高成本網路外實驗室洩漏的措施。此外，我們正在共同努力將產量從高成本實驗室轉移到 Quest。重要的是，這對支付大部分醫療費用的患者和雇主都有好處。

In hospital lab services, base revenues grew high single digits in the quarter as we saw strength in hospital reference testing and continued progress with our most recent PLS relationships, including Northern Light Health, Lee Health and Tower Health. Our hospital strategy is to help health systems improve productivity and patient care by delivering innovative laboratory testing that is high quality, accessible and affordable. We continue to manage a robust pipeline of professional lab services and hospital outreach acquisition opportunities.

在醫院實驗室服務方面，本季基本收入實現了高個位數成長，因為我們看到醫院參考測試的實力以及我們最近的 PLS 關係（包括 Northern Light Health、Lee Health 和 Tower Health）的持續進展。我們醫院的策略是透過提供高品質、方便且負擔得起的創新實驗室檢測來幫助衛生系統提高生產力和病患照護。我們繼續管理強大的專業實驗室服務管道和醫院外展收購機會。

Health systems continue to face labor and cost pressures, which are prompting more of them to reach out to us for help with their lab strategy and in some cases, monetize their hospital outreach business. Our professional lab services can help manage hospitals labs, supply chain and workforce. We are also providing insights from our analytical solutions to guide hospitals to deliver the right test to the right patient at the right time.

衛生系統繼續面臨勞動力和成本壓力，這促使更多的系統向我們尋求實驗室策略的幫助，並在某些情況下透過醫院外展業務獲利。我們的專業實驗室服務可以幫助管理醫院實驗室、供應鏈和勞動力。我們還提供分析解決方案的見解，以指導醫院在正確的時間向正確的患者提供正確的測試。

In addition, hospital outreach acquisitions enable health systems to focus their expertise and capital on the areas of their business that support patient care and drive growth. In Consumer Health, we generated solid base business revenue growth from our consumer-initiated testing channel in the quarter.

此外，醫院外展收購使衛生系統能夠將其專業知識和資本集中在支持患者護理和推動成長的業務領域。在消費者健康領域，本季我們透過消費者發起的測試管道實現了堅實的基礎業務收入成長。

In addition, our consumer channel was again profitable this quarter. We attribute the strong performance to continuing demand for our expanded test menu, including STIs, comprehensive health and tuberculosis blood testing. Underpinning each of these key channels, physician, hospital and consumer is our advanced diagnostics. These highly innovative higher-growth test areas include molecular genomics and oncology, as well as several other key areas.

此外，我們的消費者通路本季再次獲利。我們將強勁的業績歸因於對我們擴展的檢測菜單的持續需求，包括性傳染感染、綜合健康和結核病血液檢測。我們先進的診斷技術支撐著每個關鍵管道、醫生、醫院和消費者。這些高度創新的高成長測試領域包括分子基因組學和腫瘤學，以及其他幾個關鍵領域。

During the quarter, we grew revenues double-digits in multiple clinical areas including neurology, women's and reproductive health, cardiometabolic and infectious disease and immunology. We are particularly encouraged by growth in our Alzheimer's disease portfolio, which features our AD-Detect blood testing services. These innovative services use highly sensitive mass spectrometry technologies to provide insight into Alzheimer's risk based on amyloid proteins and the ApoE genetic risk marker.

本季度，我們在多個臨床領域的收入實現了兩位數成長，包括神經病學、婦女和生殖健康、心臟代謝和傳染病以及免疫學。我們對阿茲海默症產品組合的成長感到特別鼓舞，其中包括我們的 AD-Detect 血液檢測服務。這些創新服務使用高度靈敏的質譜技術，根據澱粉樣蛋白和 ApoE 遺傳風險標記深入了解阿茲海默症的風險。

During the quarter, we saw strong demand for our Alzheimer's cerebral spinal fluid panel as well, which helps providers identified levels of both amyloid and tau proteins as well as the APOE status. We also grew significantly in women's and reproductive health, especially in noninvasive prenatal and carrier screening tests. During the quarter, the FDA granted breakthrough designation for our adeno-associated virus called AAV companion diagnostic which we developed in collaboration with Sarepta Therapeutics for the Duchenne muscular dystrophy gene therapy. This FDA designation places us at the forefront of AAV test innovation in the growing area of cell and gene therapies and positions us to build collaborations with other biopharmaceutical companies.

在本季度，我們看到對阿茲海默症腦脊髓液檢測的強勁需求，這有助於供應商確定澱粉樣蛋白和 tau 蛋白的水平以及 APOE 狀態。我們在婦女和生殖健康方面也取得了顯著成長，特別是在非侵入性產前和帶因者篩檢測試方面。本季度，FDA 授予我們的腺相關病毒（稱為 AAV 伴隨診斷）突破性認定，該病毒是我們與 Sarepta Therapeutics 合作開發的杜氏肌肉營養不良症基因療法的藥物。 FDA 的這項指定使我們在不斷發展的細胞和基因療法領域處於 AAV 測試創新的前沿，並使我們能夠與其他生物製藥公司建立合作。

Finally, the integration of Haystack Oncology remains on track. The acquisition positions us to enter the high-growth liquid biopsy area of minimal residual disease or MRD testing. We expect to launch our first MRD test in early 2024 from our Oncology Center of Excellence in Lewisville, Texas.

最後，Haystack Oncology 的整合仍按計劃進行。此次收購使我們能夠進入微小殘留疾病或 MRD 檢測的高成長液體活檢領域。我們預計將於 2024 年初在德克薩斯州路易斯維爾的腫瘤卓越中心啟動首次 MRD 測試。

Now turning to operational and productivity improvement. Our Invigorate program is well on its way to delivering our targeted 3% annual productivity improvements and savings. I'd like to share 3 examples of how we're improving operations. First, we are deploying front-end automation to enhance specimen processing in our Pittsburgh and Dallas laboratories, which will improve quality and productivity. More sites are planned to receive front-end automation during 2024. We are expanding the use of optical character recognition, or OCR, to scan in data from samples coming into our labs. By freeing up specimen processors from this manual data entry, we will improve our productivity of paper-based recs coming into all of our regional labs by 30%.

現在轉向營運和生產力改善。我們的 Invigorate 計劃正在順利實現每年 3% 生產力提高和節省的目標。我想分享 3 個關於我們如何改善營運的範例。首先，我們正在部署前端自動化來增強匹茲堡和達拉斯實驗室的樣本處理，這將提高品質和生產力。計劃在 2024 年期間有更多站點接受前端自動化。我們正在擴大光學字元辨識 (OCR) 的使用，以掃描進入我們實驗室的樣本中的資料。透過將樣本處理者從手動資料輸入中解放出來，我們將把進入我們所有區域實驗室的紙本記錄的生產率提高 30%。

Finally, we continue to optimize our real estate footprint. Post-pandemic, we need less space for some of our call center and administrative functions. We've reduced our real estate footprint by nearly 250,000 square feet by consolidating functions into existing spaces. Before I hand it over to Sam, I'd like to offer our perspective on the rule recently proposed by the Food and Drug Administration that would regulate laboratory developed tests as medical devices.

最後，我們繼續優化我們的房地產足跡。大流行後，我們的一些呼叫中心和行政職能所需的空間減少。透過將功能整合到現有空間中，我們已將房地產佔地面積減少了近 250,000 平方英尺。在我將其交給 Sam 之前，我想就美國食品和藥物管理局最近提出的規則提出我們的看法，該規則將監管實驗室開發的測試作為醫療設備。

Lab developed tests are essential medical innovations that providers use to guide care for patients every day. These services are highly regulated under federal legislation known as CLIA, in addition to the oversight by states, accredited bodies and Medicare as it makes coverage determinations. If enacted, the FDA's proposed rule would impact patient care by compromising access, slowing diagnostic innovation and adding unnecessary cost to our health care system. We agree with the long-standing assertion of our trade association, ACLA, that the FDA does not have the statutory authority to unilaterally regulate LDTs under its existing medical device authority.

實驗室開發的測試是重要的醫療創新，提供者用來指導患者的日常護理。這些服務受到稱為 CLIA 的聯邦立法的嚴格監管，此外還受到各州、認可機構和醫療保險在做出承保範圍決定時的監督。如果獲得通過，FDA 提議的規則將影響患者護理，影響患者的醫療服務，減緩診斷創新，並為我們的醫療保健系統增加不必要的成本。我們同意我們的產業協會 ACLA 長期以來的主張，即 FDA 沒有根據其現有醫療器材授權單方面監管 LDT 的法定權力。

Now I'll turn it over to Sam to provide more details on our performance and our updated 2023 guidance.

現在，我將把它交給 Sam，以提供有關我們的表現和更新的 2023 年指導的更多詳細資訊。

Thanks Jim. In the third quarter, consolidated revenues were $2.3 billion, down 7.7% versus the prior year. Base business revenues grew 4.6% to $2.27 billion while COVID-19 testing revenues declined 92% to $26 million. Revenues for Diagnostic Information Services declined 7.9% compared to the prior year reflecting lower revenue from COVID-19 testing versus the third quarter of 2022, partially offset by growth in our base business.

謝謝吉姆。第三季綜合營收為 23 億美元，比去年同期下降 7.7%。基礎業務收入成長 4.6% 至 22.7 億美元，而 COVID-19 檢測收入下降 92% 至 2,600 萬美元。診斷資訊服務的收入與前一年相比下降了 7.9%，反映出與 2022 年第三季相比，COVID-19 測試的收入有所下降，但部分被我們基礎業務的成長所抵消。

Total volume measured by the number of requisitions declined 0.5% versus the prior year, with acquisitions contributing 50 basis points to total volume. Total base testing volumes grew 5.7% versus the prior year. Revenue per requisition declined 7.2% versus the prior year, driven by lower COVID-19 molecular volume. Base business revenue per rec declined 0.4% due to growth in our PLS relationships and lower demand for respiratory panels, partially offset by an increase in unit price reimbursement and test mix. Positive unit price reimbursement was consistent with our expectations. Reported operating income in the third quarter was $342 million or 14.9% of revenues compared to $392 million or 15.8% of revenues last year.

以請購數量衡量的總交易量較上年下降 0.5%，其中收購佔總交易量的 50 個基點。基礎測試總量較上年增加 5.7%。由於 COVID-19 分子體積下降，每份申請的收入較前一年下降 7.2%。由於我們的 PLS 關係的成長和呼吸面板需求的下降，每項業務的基本業務收入下降了 0.4%，但單價報銷和測試組合的增加部分抵消了這一影響。正向的單價補償符合我們的預期。第三季報告的營業收入為 3.42 億美元，佔營收的 14.9%，而去年為 3.92 億美元，佔營收的 15.8%。

On an adjusted basis, operating income was $380 million or 16.6% of revenues compared to $423 million or 17% of revenues last year. The year-over-year decline in adjusted operating income is related primarily to lower COVID-19 testing revenues, wage increases and higher benefit costs, partially offset by growth in the base business, lower performance-based compensation and headcount reductions.

調整後的營業收入為 3.8 億美元，佔營收的 16.6%，而去年為 4.23 億美元，佔營收的 17%。調整後營業收入的年減主要與COVID-19檢測收入下降、工資上漲和福利成本上升有關，但部分被基礎業務的成長、基於績效的薪酬下降和員工人數減少所抵消。

We continue to closely manage the cost of our corporate and support functions and our actions to reduce support costs by approximately $100 million this year remain on track. Reported EPS was $1.96 in the quarter compared to $2.17 a year ago. Adjusted EPS was $2.22 compared to $2.36 last year. Cash from operations year-to-date was $745 million versus $1.38 billion in the prior year period. The decline in operating cash flow was primarily related to lower operating income and timing of collections.

我們繼續密切管理公司和支援職能的成本，今年我們旨在減少約 1 億美元支援成本的行動仍在按計劃進行。本季報告的每股收益為 1.96 美元，而去年同期為 2.17 美元。調整後每股收益為 2.22 美元，去年為 2.36 美元。年初至今的營運現金為 7.45 億美元，而去年同期為 13.8 億美元。經營現金流的下降主要與營業收入和收款時間的減少有關。

Turning to our updated full year 2023 guidance. Revenues are now expected to be between $9.19 billion and $9.24 billion. Base business revenues are expected to be between $8.99 billion and $9.04 billion. COVID-19 testing revenues are expected to be approximately $200 million. Reported EPS narrowed to be in a range of $7.61 to $7.71 and adjusted EPS narrowed to a range of $8.65 to $8.75 with the midpoint of $8.70, unchanged. Cash from operations is expected to be approximately $1.3 billion and capital expenditures are expected to be approximately $400 million.

轉向我們更新的 2023 年全年指引。目前預計收入在 91.9 億美元至 92.4 億美元之間。基礎業務收入預計在 89.9 億美元至 90.4 億美元之間。 COVID-19 檢測收入預計約 2 億美元。報告每股收益收窄至 7.61 至 7.71 美元，調整後每股收益收窄至 8.65 至 8.75 美元，中位數 8.70 美元不變。營運現金預計約 13 億美元，資本支出預計約 4 億美元。

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

現在，我將把它轉回給吉姆。

Thanks, Sam. To summarize, we delivered solid base business revenue growth of nearly 5% in the quarter. We successfully completed negotiations for all of our strategic health plan relationships that were scheduled for this year. We also drove improved productivity in our base business as we have done throughout 2023. Finally, given the strength of our base business, combined with a robust pipeline of professional lab services and M&A opportunities, we are well positioned for continued growth ahead. And now we'd be happy to take your questions. Operator?

謝謝，山姆。總而言之，我們本季的基礎業務收入實現了近 5% 的穩健成長。我們成功完成了原定於今年進行的所有戰略健康計劃關係的談判。正如我們在2023 年所做的那樣，我們也提高了基礎業務的生產力。最後，鑑於我們基礎業務的實力，再加上強大的專業實驗室服務管道和併購機會，我們為未來的持續成長做好了充分準備。現在我們很樂意回答您的問題。操作員？

(Operator Instructions) Our first question comes from Ann Hynes with Mizuho Securities.

（操作員指令）我們的第一個問題來自瑞穗證券的 Ann Hynes。

Can you just comment on progress on what's happening with the turnover? And do you still feel good about your 16.5% margin goal for 2023?

您能否評論一下營業額的進度？您對 2023 年 16.5% 的利潤率目標仍然滿意嗎？

Yes, the employee turnover, again, improved from Q2 to Q3. So we're certainly seeing improvements as we've marched from Q1 to Q2 to Q3 and expect to see more improvements as we go to Q4. Having said that, we're still not back to 2019 or pre-COVID levels. But we feel optimistic that as we go into next year, it will actually be a continued tailwind for us. Sam, do you want to comment on...

是的，員工流動率從第二季到第三季再次有所改善。因此，當我們從第一季到第二季再到第三季時，我們肯定會看到改進，並預計在進入第四季時會看到更多改進。話雖如此，我們仍然沒有回到 2019 年或新冠疫情之前的水平。但我們樂觀地認為，隨著明年的到來，這實際上將成為我們持續的推動力。山姆，你想發表評論嗎...

Yes, sure. Ann, thanks for the question. So as you recall on the Q2 call, we talked about operating margin, expectations being approximately 16.5%. As Jim mentioned, we're seeing slight improvement in terms of turnover. We have made some investments and are going to be making some investments in terms of frontline phlebotomist in anticipation of volumes coming into the winter season here, but also the strong utilization that we've seen.

是的，當然。安，謝謝你的提問。因此，正如您在第二季度電話會議上所回憶的那樣，我們談到了營業利潤率，預期約為 16.5%。正如吉姆所提到的，我們看到營業額略有改善。我們已經進行了一些投資，並將在一線抽血醫生方面進行一些投資，預計這裡的冬季數量將會增加，而且我們已經看到了強勁的利用率。

And with regards to margins, we now expect to be slightly below the approximately 16.5% for the year. We're making really good progress on all the cost initiatives and also the productivity improvement initiatives. Volumes have been strong, but we -- especially in light of volumes, we have to make some targeted investments in terms of frontline staff and phlebotomist.

至於利潤率，我們現在預計今年將略低於約 16.5%。我們在所有成本計劃和生產力提高計劃方面都取得了非常好的進展。銷售一直很強勁，但我們——尤其是考慮到銷量，我們必須在一線員工和抽血醫生方面進行一些有針對性的投資。

Yes. Ann, let me just make one other comment on the margins. If you go back and start with Q1 of this year. In Q1, we were just slightly north of 15% and in that quarter, we did $120 million of COVID revenue. And as you know, the reimbursement was still at $100 that quarter. We go to the second quarter, and we improved our margins up to 16.7% with COVID going from $120 million down to $41 million. And then in the second quarter COVID was at a blended rate of, call it, $75.

是的。安，讓我在頁邊發表另一條評論。如果你回顧一下今年第一季的情況。第一季度，我們的成長率略高於 15%，在該季度，我們的新冠肺炎收入為 1.2 億美元。如您所知，該季度的報銷金額仍為 100 美元。進入第二季度，隨著新冠肺炎疫情的影響，我們的利潤率從 1.2 億美元下降到 4,100 萬美元，利潤率提高到了 16.7%。然後在第二季度，新冠病毒的混合價格為 75 美元。

Now we go back into the third quarter and COVID is really insignificant in our results. It's only 1% of our total revenue and the reimbursement on that small 1%, as you know, for the whole quarter was at $50. And we hit 16.6%, so basically in line with Q2. So we're really proud of the productivity efforts and it's really coming through in these numbers and the progress that the teams have made from Q1 to Q2 to Q3.

現在我們回到第三季度，新冠疫情對我們的業績確實微不足道。這僅占我們總收入的 1%，正如您所知，整個季度對這小 1% 的補償為 50 美元。我們達到了 16.6%，基本上與第二季一致。因此，我們對生產力的努力感到非常自豪，這些數字以及團隊從第一季到第二季再到第三季的進展確實得到了體現。

And our next caller is David Westenberg with Piper Sandler.

我們的下一個來電者是 David Westenberg 和 Piper Sandler。

So just -- thank you for the commentary on the FDA's proposal on LDTs. I'm not sure if you can answer it yet because -- I mean, right now, it's still kind of maybe a little bit more hypothetical here. But how should we anticipate potential cost if it stands the way it is? I mean, is this about going back to the FDA with some of the more high-value tests? Or is this maybe about switching out to maybe IVD-cleared products? I mean, how does this look for Quest and I get some of this is maybe theoretical right now because we don't know what it's going to look like in a month?

謝謝您對 FDA 關於 LDT 提案的評論。我不確定你是否能回答這個問題，因為——我的意思是，現在，這仍然有點假設。但如果按照目前的情況，我們該如何預測潛在成本呢？我的意思是，這是要回到 FDA 進行一些更高價值的測試嗎？或者這可能是轉向使用 IVD 批准的產品？我的意思是，Quest 的情況如何，我認為其中一些現在可能是理論上的，因為我們不知道一個月後會是什麼樣子？

Yes. I think your last statement is accurate. It's largely theoretical at this point because we don't know what it's going to look like. And the FDA certainly opened this up to commentary and response back from industry and ACLA and other associations.

是的。我認為你最後的說法是準確的。目前這主要是理論上的，因為我們不知道它會是什麼樣子。 FDA 當然願意接受業界、ACLA 和其他協會的評論和回應。

Look, having said all that, LDTs are not the most significant part of our operations. In fact, it's -- on a volume basis, it's less than 10% of what we do. And the 3 labs that we do are LDTs, most -- the majority of our LDTs in are actually ISO certified. We do companion diagnostics which is a regulated form of testing, right? You're on label for a pharmaceutical drug, so it's just not -- it's not a huge deal for us right now.

話雖如此，LDT 並不是我們營運中最重要的部分。事實上，就數量而言，它還不到我們所做工作的 10%。我們的 3 個實驗室都是 LDT，我們的大多數 LDT 實際上都經過了 ISO 認證。我們進行伴隨診斷，這是一種受監管的測試形式，對吧？你的藥品標籤上有藥物標籤，所以這對我們來說並不是什麼大事。

Now having said all that, we're going to work with our trade association. We don't believe that we will make sense. We don't believe it's fair. And we'll continue to work to arrive at something that we do think is good for everyone.

話雖如此，我們將與我們的行業協會合作。我們不相信我們會有意義。我們不相信這是公平的。我們將繼續努力達成我們認為對每個人都有利的目標。

Our next question comes from Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的麗莎吉爾。

I'm just curious if you have an update as to how we should think about PAMA or SALSA going into 2024 just given the current environment in D.C.?

我只是好奇，鑑於華盛頓特區當前的環境，我們應該如何考慮 PAMA 或 SALSA 進入 2024 年？

Sure. Well, you're right. The current environment is a little uncertain at this point. And -- but here's what I would say. The current standstill in Congress, I think will make, what we call, a comprehensive PAMA reform more difficult, right? So SALSA, I think, will be more difficult to get through this year.

當然。嗯，你是對的。目前的環境有點不確定。而且——但這就是我要說的。我認為國會目前的停滯狀態將使我們所說的全面的 PAMA 改革變得更加困難，對嗎？所以我認為SALSA今年會更難通過。

Having said all that, PAMA, a delay in the cuts of PAMA, again, went to the CBO. So this is a new analysis from the CBO updated versus last year. And again, the CBO scored a 1-year delay as a significant cost savings to the government. And again, the reasons for that is because if you continue to delay the PAMA cuts, you're going to continue to delay a new data collection process. And we, our trade association and obviously, the CBO is convinced that a new data collection process will lead to higher rates.

話雖如此，PAMA 削減的延遲再次交給了國會預算辦公室 (CBO)。這是國會預算辦公室與去年相比更新的新分析。國會預算辦公室再次認為推遲了一年，為政府節省了大量成本。再次強調，這樣做的原因是，如果你繼續推遲 PAMA 削減，你將繼續推遲新的資料收集過程。我們、我們的貿易協會，顯然還有國會預算辦公室 (CBO) 相信，新的資料收集流程將帶來更高的費率。

So we feel good that the likelihood of a fourth PAMA delay will occur. But certainly, it has to be part of some broader health care package. And there's a lot of things that will be in that health care package that are important to a lot of different constituencies. So we're confident that something will get done there.

因此，我們對第四次 PAMA 延遲發生的可能性感到滿意。但當然，它必須成為更廣泛的醫療保健計劃的一部分。醫療保健計劃中的許多內容對許多不同的選民都很重要。所以我們有信心在那裡會有所作為。

And our next question comes from Pito Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Pito Chickering。

You've got Kieran Ryan on for Pito. Just looking at the sequential margin progression implied from 3Q to 4Q this year, it looks like it's materially better than kind of what you averaged in that pre-COVID 2017 to 2019 range. So is that just really the tailwinds you have around CIT Invigorate better turnover and lower deferred comp just combining to drive better trends than normal? And I was just wondering, is there any offset there on some of these oil and commodity-related costs that we've seen step-up relatively recently?

基蘭瑞安 (Kieran Ryan) 代替皮托 (Pito)。只要看看今年第三季到第四季的連續利潤率進展，看起來就比 2017 年新冠疫情之前到 2019 年範圍內的平均值要好得多。那麼，這真的是 CIT Invigorate 帶來的順風車嗎？更好的營業額和更低的遞延薪資相結合，推動了比正常情況更好的趨勢？我只是想知道，我們最近看到的一些與石油和大宗商品相關的成本是否有任何抵消？

Yes, Kieran, this is Sam. Thank for the question. So I think some of the drivers that would expect in Q4 are -- what we've been executing and seeing in Q3 and earlier in the year, I mean, Jim talked about the sequential improvement in operating margins despite the fact that COVID is coming down significantly. So what we would expect in Q4 is the following that helps our margins, which has been playing out so far over the course of the year. One is price. We continue to see a healthy positive environment around price and we, in fact, saw positive price in Q3, and we expect to see positive price in Q4. And that's driven by all the work that we're doing around the strategic plan, the third-party plan renewals and some of the value-based contracting that we're doing there.

是的，基蘭，這是山姆。謝謝你的提問。因此，我認為第四季度的一些驅動因素是我們在第三季度和今年早些時候執行和看到的，我的意思是，吉姆談到了營運利潤率的連續改善，儘管事實上新冠病毒即將到來顯著下降。因此，我們對第四季度的預期是，以下內容將有助於提高我們的利潤率，這一點在今年到目前為止一直在發揮作用。一是價格。我們繼續看到圍繞價格的健康積極的環境，事實上，我們在第三季度看到了積極的價格，我們預計第四季度也會看到積極的價格。這是由我們圍繞戰略計劃、第三方計劃更新以及我們正在做的一些基於價值的合約所做的所有工作所推動的。

So definitely, the healthiest pricing environment that we've seen in a while. CIT, as you said, is a factor. It was dilutive in the first quarter. It turned profitable in the second quarter. It was profitable in the third, and we expect it to be profitable again in the fourth. We continue to do the cost -- I mean, the benefit of the cost reductions in Q4. We talked about $100 million of annual impact of cost reductions on the SG&A line, and we expect to see that at least 1/3 of that be in Q4 as well because those savings started in Q2 and then we're taking a lot of actions as well around improving productivity. Invigorate is one of them that you mentioned, but that's also factoring into margin. So all of that is driving the better than pre-pandemic trends that you've talked about.

毫無疑問，這是我們一段時間以來見過的最健康的定價環境。正如您所說，CIT 是一個因素。第一季它被稀釋了。第二季扭虧為盈。第三季實現獲利，我們預計第四季將再次獲利。我們繼續關注成本——我的意思是，第四季度成本降低的好處。我們談到了成本削減對 SG&A 線的年度影響為 1 億美元，我們預計其中至少 1/3 也會出現在第四季度，因為這些節省是在第二季度開始的，然後我們將採取很多行動以及圍繞提高生產力。 Invigorate是您提到的其中之一，但這也影響了利潤。因此，所有這些都推動了比您談到的大流行前更好的趨勢。

Now as I said earlier, we are still seeing turnover in -- higher than what we would expect. It has improved slightly in Q3, but it is still trending higher than where it was pre-pandemic. And as I said, given the strong utilization that we're seeing across the business, and we saw that in Q3 as well, we're having to make some targeted increases across frontline staff and phlebotomists to help service some of these volumes. And we expect that to be an impact in Q4 and offsetting more of a headwind of an impact.

現在，正如我之前所說，我們的營業額仍然高於我們的預期。第三季略有改善，但仍高於疫情前的水準。正如我所說，鑑於我們在整個業務中看到的強勁利用率，並且我們在第三季度也看到了這一點，我們必須對一線員工和抽血醫生進行一些有針對性的增加，以幫助服務其中一些數量。我們預計這將在第四季度產生影響，並抵消更多影響的阻力。

Our next caller is Elizabeth Anderson with Evercore.

我們的下一個來電者是 Evercore 的 Elizabeth Anderson。

I guess I just want to double-click on the gross margin a little bit more in the third quarter. I think in different answers, you've given us bits and pieces. But if you could just talk either sequentially or on a year-over-year basis, sort of rank or -- either if you have dollar amounts or sort of rank order the biggest contributing factors?

我想我只是想在第三季再雙擊毛利率。我認為在不同的答案中，你給了我們一些零碎的東西。但是，如果您可以按順序或逐年比較，排序或 - 如果您有美元金額或排序排序最大的影響因素？

And then secondly, it sounds like you have some good sightline into the Invigorate savings to the fourth quarter and some continued productivity initiatives. How do we think about the flow-through on sort of that as we start to think about 2024 and sort of what we might be expecting from those sort cost saving in Invigorate programs?

其次，聽起來您對第四季度的激勵儲蓄和一些持續的生產力計劃有一些很好的了解。當我們開始考慮 2024 年時，我們如何看待此類流程以及我們對 Invigorate 計劃中的此類成本節約的期望？

Yes, thank you. So with regards to gross margin, gross margins in Q3 were in line with our expectations. I mean, the key driver, I would say, for them being below Q2 levels, were the fact that we had lower revenues of $45 million going in Q3 versus Q2. So sequentially, we saw a $45 million lower revenues. Now a portion of that was COVID, not the biggest portion. It was about roughly $15 million lower revenues in terms of COVID.

是的，謝謝。因此，就毛利率而言，第三季的毛利率符合我們的預期。我的意思是，我想說，他們低於第二季的關鍵驅動因素是我們第三季的收入比第二季低了 4500 萬美元。因此，我們的收入連續減少了 4500 萬美元。現在其中一部分是新冠病毒，而不是最大的部分。受新冠疫情影響，收入減少了約 1500 萬美元。

And then because of seasonality, as expected, we saw lower revenues on the base business as well. So when you think about the impact on gross margins and gross margins were down a percentage point sequentially, that's almost entirely driven by revenue, the revenue decline. And then on COVID, we're also talking about -- or what we are seeing in Q3 was a lower price around COVID. In Q2, driven by the fact that the PHE didn't end until midway through the quarter, we saw a higher price on average for COVID, we saw a lower price in Q3. So that has an impact on gross margin as well.

然後，正如預期的那樣，由於季節性因素，我們的基礎業務收入也有所下降。因此，當你考慮對毛利率的影響時，毛利率連續下降了一個百分點，這幾乎完全是由收入驅動的，收入下降。然後，關於新冠病毒，我們也在談論——或者說我們在第三季度看到的是新冠病毒期間價格較低。在第二季度，由於PHE直到本季中期才結束，我們看到新冠病毒的平均價格較高，而第三季的價格較低。因此這也會對毛利率產生影響。

So those are the key drivers on gross margin. It's in line with our expectations. Invigorate, and Jim will make a couple of comments on Invigorate here. But with regards to Invigorate, the actions are yielding the 3% productivity improvements and cost reductions that we expected. And those will continue into 2024. But Jim, maybe will make a couple of comments.

因此，這些是毛利率的關鍵驅動因素。這符合我們的預期。 Invigorate，吉姆將在這裡對 Invigorate 發表一些評論。但就 Invigorate 而言，這些行動帶來了我們預期的 3% 的生產力提高和成本降低。這些將持續到 2024 年。但是吉姆也許會發表一些評論。

Yes, certainly, Elizabeth. So we're going to set targets going into 2024 that are similar to what we've done in the past. So we expect to generate approximately 3% variable cost productivity throughout our entire operations. That's phlebotomy, logistics, the front end of our lab and then actually all of the processing. We've talked broadly about the use of automation. We're driving that as fast and furious as we can. We've talked about the use of artificial intelligence to do some of the manual work at our lab text, this could be automated -- reading of curves.

是的，當然，伊莉莎白。因此，我們將設定 2024 年的目標，這些目標與我們過去所做的類似。因此，我們預計整個營運過程中的變動成本生產力將提高約 3%。這就是放血、物流、我們實驗室的前端以及實際上所有的處理。我們已經廣泛討論了自動化的使用。我們正在盡我們所能快速而激烈地推動這一進程。我們已經討論過使用人工智慧在我們的實驗室文本中完成一些手動工作，這可以是自動化的——讀取曲線。

We've talked about in the past, the use of artificial intelligence and microbiology, hematology, urinalysis, and then we continue to work. The standard things that we always work as a business, reimbursement and denials is always a big bucket of opportunity for us.

我們過去談到了人工智慧和微生物學、血液學、尿液分析的使用，然後我們繼續工作。作為一個企業，我們一直在做的標準事情，報銷和拒絕對我們來說總是一個很大的機會。

Paper reqs, I talked in the prepared remarks about implementing OCR technology to read all of these paper reqs that still come in. We work them down every single year, but there's still a fair number. Even if it's 15% to 20%, when you do the math on that, it's close to 200 million rec, there's still a ton of opportunity there. So we feel good about our productivity efforts going into next year. We invest in it. We put talented teams around it, and we'll continue to drive it hard.

紙張要求，我在準備好的發言中談到瞭如何實施 OCR 技術來閱讀仍然存在的所有這些紙張要求。我們每年都會對它們進行處理，但仍然有相當多的數字。即使是 15% 到 20%，當你計算時，它也接近 2 億筆記錄，那裡仍然有大量的機會。因此，我們對明年的生產力工作感到滿意。我們對此進行投資。我們組建了才華橫溢的團隊，並將繼續努力推動這一目標。

Next caller is Derik De Bruin from Bank of America.

下一個來電者是來自美國銀行的 Derik De Bruin。

So I've got two. The first one, just going back to PAMA. In 2023, it got delayed, and I think it will probably get delayed in '24. But in '23, we didn't see a lot of the savings dropped down to the bottom line because of Haystack and some of the other investments that you're doing. I guess, for '24, does that drop-down if we're to get delayed, i.e., is it accretive to what your plans would be is that you're going to do it? Or does it get offset by that? So that's the first one. And then I've got a follow-up.

所以我有兩個。第一個，回到PAMA。 2023年，它被推遲了，我認為它可能會在24年被推遲。但在 23 年，由於 Haystack 和您正在進行的其他一些投資，我們並沒有看到很多節省的資金下降到底線。我想，對於 24 年，如果我們要推遲的話，這個下拉式選單是否會增加，也就是說，你打算這樣做會增加你的計畫嗎？或者它會因此被抵消嗎？這是第一個。然後我有一個後續行動。

Yes. Well, first, I'd say, with respect to the drop-down, when we look at the drop-down on the incremental growth we've gotten through our base business and we look at the drop-down on that growth, we're pretty happy with it, okay? And that is after the dilution effect that we've seen from Haystack, the investments we're making there, which are going to propel future growth. As we go into next year, we will take -- we're not going to give guidance today, but we're going to take a close look. If PAMA does get delayed, we'll obviously look at both investment opportunities to drive future growth.

是的。好吧，首先，我想說，關於下降，當我們看到我們透過基礎業務獲得的增量成長的下降時，我們看到成長的下降，我們我們對此很滿意，好嗎？這是在我們從 Haystack 看到的稀釋效應之後，我們在那裡進行的投資將推動未來的成長。當我們進入明年時，我們今天不會提供指導，但我們會仔細研究。如果 PAMA 確實被推遲，我們顯然會關注這兩個投資機會來推動未來的成長。

We'll look at investment opportunities to drive margin improvement, Invigorate investments. And then we'll also obviously look at returning like we always do, the majority of our free cash to shareholders.

我們將尋找投資機會來推動利潤率的提高，振興投資。然後，我們顯然也會考慮像往常一樣，將大部分自由現金回饋給股東。

And just a follow-up on the Alzheimer's diagnostics, are you going to seek FDA approval for that? I'm just sort of curious on reimbursement, patient cost, what's the test cost in doing it? I'm just curious on sort of what your strategy is there given that it is a new diagnostic category?

只是阿茲海默症診斷的後續行動，您是否會尋求 FDA 的批准？我只是有點好奇報銷、病患費用、這樣做的測試費用是多少？我只是好奇你的策略是什麼，因為它是一個新的診斷類別？

Okay. So there is reimbursement for the test today. CMS has established about $100 reimbursement for the blood-based AD 4240 test. Having said all that, the preponderance of our orders and the preponderance of our reimbursement actually comes from client bill, where we directly bill health systems that are carrying for these patients. And I would tell you that the reimbursement is better than what we see on average from Medicare because it's an incredibly value-added test. So we price it appropriately.

好的。所以今天的測試有報銷。 CMS 已為基於血液的 AD 4240 檢測提供約 100 美元的報銷。話雖如此，我們的大部分訂單和大部分報銷實際上來自客戶帳單，我們直接向為這些患者提供服務的醫療系統開立帳單。我想告訴你，報銷比我們從醫療保險中看到的平均報銷要好，因為這是一項令人難以置信的增值測試。所以我們對其進行適當定價。

At this point, we're not seeking FDA approval for it. It's an LDT like many of the LDTs that we run. And so we're pretty happy with it. The growth has been substantial. And I would also tell you that the growth of our CSF testing, the cerebral spinal fluid testing, is also significantly up in the quarter as clinicians are using both CSF and blood-based biomarkers to make -- to help with the diagnosis of patients.

目前，我們並未尋求 FDA 的批准。它是一個 LDT，就像我們運行的許多 LDT 一樣。所以我們對此非常滿意。成長非常可觀。我還想告訴您，我們的腦脊髓液檢測（腦脊髓液檢測）在本季度也顯著增長，因為臨床醫生正在使用腦脊髓液和血液生物標記來幫助診斷患者。

And Derik, maybe just to come back to the PAMA question and add a couple of points there for you and others that are on the call. Given the uncertainty around PAMA, we will plan today as if PAMA is going to come back and will not be delayed in 2024. That's -- I'd say, that's the prudent thing to do. That's the only thing we can do at this stage given the uncertainty. So we will plan as if prices will come down next year because PAMA will come back.

Derik，也許只是想回到 PAMA 問題並為您和其他參加電話會議的人補充幾點。鑑於 PAMA 的不確定性，我們今天將計劃好，就好像 PAMA 將在 2024 年回歸，並且不會推遲。我想說，這是明智之舉。考慮到不確定性，這是我們現階段唯一能做的事。因此，我們會計劃明年價格會下降，因為 PAMA 會回來。

Now if -- as we -- I would say, on balance, I'd say, there's a likely chance that PAMA will get delayed. And if that were to happen, and as we've talked about before, we could see an $80 million to $90 million benefit as a result of that delay, not benefit versus this year, but benefit versus our planning. And when that -- and if that happens, I should say, then we will assess how much we invest in the business to everything that Jim said earlier to how much potentially could drop to the bottom line to EPS. But that decision is not made yet. We'll make that decision when we set guidance. And we will evaluate investments that we can make and then evaluate what we can drive as EPS improvement.

現在，如果——正如我們——我會說，總的來說，我會說，PAMA 很可能會被推遲。如果這種情況發生，正如我們之前討論過的，我們可能會看到由於延遲而帶來的8000 萬至9000 萬美元的收益，不是與今年相比的收益，而是與我們的計劃相比的收益。當這種情況發生時——我應該說，如果發生這種情況，那麼我們將根據吉姆之前所說的一切來評估我們對該業務的投資額，以及每股收益可能下降多少。但該決定尚未做出。當我們制定指導方針時，我們將做出決定。我們將評估我們可以進行的投資，然後評估我們可以推動每股盈餘的改善。

Our next caller is Andrew Brackmann with William Blair.

我們的下一個來電者是安德魯·布拉克曼和威廉·布萊爾。

Jim, I want to go back to your comments around reducing leakage to high cost labs. I think you talked about in your opening remarks. I know that's sort of part of the strategy here, but can you maybe just sort of talk about that opportunity broadly and just sort of quantify how big that could be for your growth going forward?

吉姆，我想回到您關於減少高成本實驗室洩漏的評論。我想你在開場白中談到了這一點。我知道這是策略的一部分，但您能否廣泛地談論這個機會，並量化它對您未來的成長有多大？

Yes. I think there's 2 buckets of opportunity there. One is reducing leakage to out-of-network labs. And then the second is, what I would call, steerage of work from high-priced in-network labs generally in health systems to independent labs like Quest Diagnostics. So generally 2 different initiatives, but it really starts with just very strong and tight collaboration with our commercial payers.

是的。我認為那裡有兩個機會。一是減少向網路外實驗室的洩漏。第二個是，我所說的，從衛生系統中的高價網路實驗室到像 Quest Diagnostics 這樣的獨立實驗室的工作指導。一般來說，有兩個不同的舉措，但它實際上是從與我們的商業付款人非常強大和緊密的合作開始的。

We work hand-in-hand with them. They provide us the information on what physicians are using out-of-network high-priced laboratories, and they provide us the information that what doctors are sending work into health system labs, which, as you know, not good for patients who are going to pay higher deductibles, higher co-pays and obviously not good for the people that are paying for the health care in general, that's still employers in the country.

我們與他們攜手合作。他們為我們提供了哪些醫生正在使用網絡外高價實驗室的信息，他們還為我們提供了哪些醫生正在將工作發送到衛生系統實驗室的信息，正如你所知，這對正在接受治療的患者來說並不好。支付更高的免賠額、更高的共付額，這顯然對支付醫療保健費用的人不利，但仍然是該國的雇主。

So it's a really tight partnership. We get the information. We distribute that information out to our commercial team. We call on the customers, try to convince them to move the work. At the same time, we're always messaging as are the commercial payers out to patients to remind them that they can save money by using independent labs like Quest Diagnostics. We continue to message physicians and providers, and that's why we're seeing significantly higher growth rates with the commercial plans where we have established these types of relationships.

所以這是一個非常緊密的合作關係。我們得到資訊。我們將該資訊分發給我們的商業團隊。我們拜訪客戶，試圖說服他們轉移工作。同時，我們和商業付款人一樣，總是向患者發出訊息，提醒他們可以透過使用像 Quest Diagnostics 這樣的獨立實驗室來省錢。我們繼續向醫生和提供者發送訊息，這就是為什麼我們在建立此類關係的商業計劃中看到了顯著更高的成長率。

Our next caller is Kevin Caliendo with UBS.

我們的下一個來電者是瑞銀集團的 Kevin Caliendo。

Congrats on the contract renewals with your major payer partners. Can you maybe talk a little bit about if there's anything new in the contracts, the duration of the contracts? Is there -- the last time you did this, there were incentives that actually benefited you in terms of driving volumes. Just wondering if anything has changed, both positively or negatively, pricing, duration, terms, incentives, that kind of thing?

恭喜您與主要付款合作夥伴續約了合約。您能否談談合約中是否有任何新內容以及合約期限？上次您這樣做時，有沒有激勵措施在提高銷售方面確實使您受益。只是想知道定價、期限、條款、激勵措施等方面是否發生了正面或負面的變化？

Yes. We generally don't talk about the terms, duration and things like that. But what I will tell you is that the trend continues. We seek to establish a fair price first and foremost. And then second, as I just mentioned in the previous question, where we can move these requisitions and improve our share of the commercial payer spend, we try to design incentives around that.

是的。我們通常不會談論條款、期限之類的事情。但我要告訴你的是，這種趨勢仍在持續。我們首先尋求建立一個公平的價格。其次，正如我在上一個問題中提到的，我們可以在哪裡轉移這些請購單並提高我們在商業付款人支出中的份額，我們嘗試圍繞這一點設計激勵措施。

In addition, we try to design incentives when we do a hospital outreach acquisition and the prices go from 300% of Medicare as an example down to our rates, we try to step those rates down over a period of time so that we derive benefit and the commercial plan derives benefit. So we work hard to build those types of incentives into the agreement, and I think the trend just continues in the direction we want.

此外，當我們進行醫院外展收購時，我們嘗試設計激勵措施，價格從 Medicare 的 300% 降低到我們的費率，我們嘗試在一段時間內降低這些費率，以便我們獲得利益和商業計劃產生效益。因此，我們努力將這些類型的激勵措施納入協議中，我認為這種趨勢只會朝著我們想要的方向發展。

Does this lead to sort of more value-based care potential for you guys going forward?

這是否會為你們帶來更多基於價值的照護潛力？

Well, I separate again, value-based care from value-based contracts. These are, what we call, value-based contracts, meaning when we deliver value back to the commercial payer, there can be incentive payments involved in that. When we talk about value-based care, these are really our arrangements with some of these ACO reach organizations and some of the other large physician groups that have taken on risk from Medicare plans and we continue to embed ourselves within these ACO reach programs and continue to work closely with large physician groups that take on this risk and as we've said in the past, these types of relationships are really good for the lab industry, they -- if you're managing risk, you're managing the cost of health care to a fixed number every year, you're generally going to be incented to provide early care and early diagnostics so that you don't let disease progress into more expensive inpatient care and we continue to work towards that.

好吧，我再次將基於價值的護理與基於價值的合約分開。我們稱之為基於價值的合同，這意味著當我們將價值返還給商業付款人時，可能會涉及激勵付款。當我們談論基於價值的護理時，這些實際上是我們與一些 ACO 覆蓋範圍組織和其他一些承擔醫療保險計劃風險的大型醫生團體的安排，我們繼續將自己融入這些 ACO 覆蓋範圍計劃中，並繼續與承擔這種風險的大型醫生團體密切合作，正如我們過去所說，這些類型的關係對實驗室行業確實有好處，他們——如果你管理風險，你就管理成本每年的醫療保健費用達到固定數量，通常會激勵您提供早期護理和早期診斷，這樣您就不會讓疾病發展為更昂貴的住院護理，我們將繼續為此努力。

Our next caller is Jack Meehan with Nephron Research.

我們的下一個來電者是 Nephron Research 的 Jack Meehan。

I have a couple of cleanup questions for Sam. First is on collections. So seeing a little AR build. I know you called it out, but anything -- any color you can add on that? And then second is on the base growth, 5% pretty good. I was just wondering if weather weekdays had any impact could have actually been better on an underlying basis?

我有幾個清理問題要問 Sam。首先是關於收藏。所以看到了一些 AR 構建。我知道你已經說過了，但是你可以在上面添加任何顏色嗎？其次是基礎成長率，5% 相當不錯。我只是想知道工作日的天氣是否有任何影響，實際上在根本上可能會更好嗎？

Yes. Sure. I'll take the first one, Jack, and Jim will talk a little bit about the -- any one-timer, so to speak, whether weather or days. Listen, collections nothing of note there. I think AR trending or DSO is trending a bit up, that's really more normal trends given the reduction in COVID. With COVID, I think that would help our DSOs overall a shorter collection window and DSOs were down as a result of a higher mix of COVID. But if you look back to pre-pandemic, I think the DSOs are kind of trending back to where they were pre-pandemic. So really nothing of note there. There's some timing at the end of Q3 as well, but that's just normal timing within quarters.

是的。當然。我將討論第一個，傑克，吉姆將談論一些關於任何一次性的事情，可以這麼說，無論是天氣還是日子。聽著，那裡沒有什麼值得注意的收藏。我認為 AR 趨勢或 DSO 趨勢有所上升，考慮到新冠疫情的減少，這確實是更正常的趨勢。對於新冠病毒，我認為這將有助於我們的 DSO 整體上縮短收集窗口，並且由於新冠病毒混合情況的增加，DSO 會下降。但如果你回顧一下大流行前的情況，我認為 DSO 有點回到大流行前的水平。所以真的沒有什麼值得注意的。第三季末也有一些時間安排，但這只是季度內的正常時間安排。

So I would say, in general, collections are on track and we're happy with where things are. But Jim, did you want to make a couple of comments around base earning growth and any one-timers?

所以我想說，總的來說，系列工作正在步入正軌，我們對現狀感到滿意。但是吉姆，您想就基本收入成長和一次性收入發表一些評論嗎？

Yes, weather and days and things like that, versus last year, weather was a slight help. I mean, not significant at all, Jack, but it was a slight help because last year's hurricane in September was worse than this year's hurricane. The only other comment on days that I would make is early in the quarter in July. The fourth of July fell on a Tuesday this year versus a Monday last year. So in essence, your Monday and Tuesday are really, really bad days versus a year ago. You only had one bad day called a Monday because the fourth fell on a Monday. But again, that's one day out of 90. So yes, I mean, a little bit of an impact there, but not that significant.

是的，天氣、日子和類似的事情，與去年相比，天氣有點幫助。我的意思是，一點也不重要，傑克，但這有點幫助，因為去年九月的颶風比今年的颶風更嚴重。我唯一要發表的其他評論是在 7 月的季度初。今年的七月四日是星期二，而去年是星期一。所以從本質上講，與一年前相比，你的周一和周二真的非常非常糟糕。你只有一個糟糕的日子被稱為星期一，因為第四天是星期一。但同樣，這是 90 天內的一天。所以，是的，我的意思是，那裡有一點影響，但不是那麼重要。

Our next caller is Patrick Donnelly with Citi.

我們的下一個來電者是花旗銀行的派崔克唐納利。

Maybe a couple of follow-ups on Haystack. It sounds like still a 24 time line there. Can you just talk about I guess, any more specific timing in the catalyst set there when we could expect to see some data? And then just also the spend expectations related to getting that through the approval process we work away from '24 would be helpful?

也許 Haystack 上有一些後續行動。聽起來還是24小時的時間軸。您能否談談我猜，當我們期望看到一些數據時，催化劑中設定的任何更具體的時間？然後，與我們在 24 年後透過審批流程相關的支出預期也會有所幫助嗎？

Yes. As we've said, Haystack continues on the time line that we set for ourselves, for the team. There's been evidence generation. Obviously, that's what we made our -- was part of our decision-making process. Now as we get the assay, what I call, ready for commercial release, commercial production, we're in the process of establishing relationships with some of our key oncology partners. So when the assay is ready, we'll start to do some of the testing, likely we'll use a lot of that early testing to then seek reimbursement once we get a substantial buildup of testing that we feel good about approaching the (inaudible) and so far, so good. We're bringing up the assay, as we mentioned, in our Lewisville, Texas Oncology Center of Excellence and feel good about that.

是的。正如我們所說，Haystack 繼續按照我們為自己和團隊設定的時間表進行。已經有證據產生了。顯然，這就是我們的決策過程的一部分。現在，當我們獲得了我所說的檢測方法，準備進行商業發布、商業生產時，我們正在與一些主要的腫瘤學合作夥伴建立關係。因此，當檢測準備好時，我們將開始進行一些測試，可能我們會使用大量早期測試，然後一旦我們獲得大量測試積累，我們對接近（聽不清）感到滿意，我們就會尋求報銷）到目前為止，一切都很好。正如我們所提到的，我們正在德克薩斯州路易斯維爾腫瘤學卓越中心進行這項檢測，對此我們感覺很好。

I'll let Sam touch on the financials with respect to...

我會讓 Sam 談談關於…的財務狀況。

Yes, sure. I mean, with regards to spend, I'll talk in dilution terms and EPS terms here this year, and then I'll talk -- address your question around '24, Patrick. So again, very pleased with the progress that the team is making. This year, we're expecting EPS dilution to be in the $0.15 to $0.20 range. We talked about that on the Q2 call. It's still in the same range, $0.15 to $0.20.

是的，當然。我的意思是，關於支出，今年我將在這裡討論稀釋術語和每股收益術語，然後我將在 24 年左右討論您的問題，帕特里克。再次強調，我們對團隊所取得的進展感到非常滿意。今年，我們預計 EPS 攤薄將在 0.15 美元至 0.20 美元之間。我們在第二季的電話會議上討論了這一點。它仍然在相同的範圍內，0.15 美元到 0.20 美元。

If you look towards '24, what we've said and this still applies, is that the annualized dilution in 2024 is going to be less than what we expect to see -- what you see this year. So the $0.15 to $0.20, if you annualize that, that's $0.30 to $0.40 next year. So we expect on an annual basis next year to be less than where things are trending this year.

如果你展望 24 年，我們已經說過並且這仍然適用，那就是 2024 年的年化稀釋將低於我們預期的情況 - 今年的情況。因此，如果將其年化，那麼明年的 0.15 美元到 0.20 美元就是 0.30 美元到 0.40 美元。因此，我們預計明年的年度成長率將低於今年的趨勢。

So improvement just on an annual basis. And then as we look forward, we expect '25 dilution to be lower than '24, and then we expect '26 to actually be accretive. So that's consistent with what we said when we announced the deal consistent with what we said on the Q2 call.

因此，僅以每年為基礎進行改進。然後，當我們展望未來時，我們預計 25 年的稀釋度將低於 24 年，然後我們預計 26 年實際上會增加。因此，這與我們宣布該交易時所說的一致，也與我們在第二季電話會議上所說的一致。

Our next caller is Erin Wright with Morgan Stanley.

我們的下一個來電者是摩根士丹利的艾琳·賴特 (Erin Wright)。

You laid out some of those key profit drivers for the fourth quarter. And as we think about what kind of continues into 2024, I think you mentioned in the previous question kind of -- or a previous question, productivity gains should continue, and I understand there's PAMA dynamics as well that are somewhat unknown. But should we anticipate a deviation from the long-term profit guidance is like 50 to 100 basis points operating margin expansion next year?

您列出了第四季度的一些關鍵利潤驅動因素。當我們思考 2024 年會是什麼樣的情況時，我認為您在上一個問題中提到過——或者說上一個問題，生產率的提高應該繼續下去，而且我知道 PAMA 的動態也有些未知。但我們是否應該預期明年營業利潤率會出現 50 至 100 個基點的偏離長期利潤指引的情況？

Well, let me clarify, Erin, and thanks for the question, by the way. So what we talked about at Investor Day is an improvement of 75 to 150 basis points over the 3 years and that's off of the rate that we have for 2023. So we had said at the time the rate was approximately 17%. We said we could improve over the next 3 years by 75 to 150 basis points in terms of operating margin with the lower end being if PAMA did come back in '24 and the higher end of 150 being either if we had comprehensive reform around SALSA or PAMA gets delayed.

好吧，讓我澄清一下，艾琳，順便說一句，謝謝你提出這個問題。因此，我們在投資者日討論的是三年內改善 75 至 150 個基點，這低於我們 2023 年的利率。所以我們當時說過利率約為 17%。我們表示，未來 3 年我們的營業利潤率可以提高 75 至 150 個基點，下限是 PAMA 在 24 年回歸，上限是 150 個基點，如果我們圍繞 SALSA 進行全面改革或PAMA 延誤了。

So the 75 to 150 over the 3 years still applies. That has not changed. Now it's going to apply off of a lower base in 2023 because our operating margin expectations have come down. As I said earlier on the call, we expect it to be slightly below -- marginally below the approximately 16.5% that we talked about on the Q2 call.

所以3年內75到150仍然適用。這一點沒有改變。現在，由於我們的營業利潤率預期有所下降，因此 2023 年的基數將較低。正如我之前在電話會議上所說，我們預計該數字將略低於我們在第二季電話會議中談到的約 16.5%。

The positive drivers and by the way, that operating margin expansion was for 3 -- over the 3 years, not for 2024. But the positive drivers in 2024 still apply. I mean, first of all, first and foremost, I would say, is the pricing environment. We are very encouraged by the pricing environment. We talked about the strategic relationships that have been renewed, and we're seeing positive price ex PAMA, depending on what happens next year, but we're seeing positive price, and we expect that to continue.

順便說一句，營業利潤率的成長是在 3 年內實現的，而不是 2024 年。但 2024 年的積極驅動因素仍然適用。我的意思是，首先，我想說的是定價環境。我們對定價環境感到非常鼓舞。我們討論了已經更新的戰略關係，我們看到 PAMA 的正價格，這取決於明年會發生什麼，但我們看到正價格，我們預計這種情況會持續下去。

We're seeing the growth investments starting to yield fruit and CIT being one of them. And we talked about that becoming profitable. Productivity improvement, both in terms of Invigorate and also hires that we do, for instance, phlebotomist that we're adding we expect that productivity or their productivity to improve next year as well as they gain more experience and they're more productive. So all of those drivers we expect to continue.

我們看到成長投資開始取得成果，CIT 就是其中之一。我們談到了盈利的問題。生產力的提高，無論是在激勵方面，還是在我們聘用的人員方面，例如，我們正在增加的抽血醫生，我們預計明年的生產力或他們的生產力會提高，他們會獲得更多經驗，生產力也會更高。因此，我們預計所有這些驅動因素都會繼續下去。

Turnover is a bit of an uncertain item. We don't necessarily expect it to become worse than it is today. But it's too early to say right now whether that improves markedly in 2024. The early signs that we saw in Q3 right now were encouraging. We saw some slight improvement, but it's too early to say to project what that would mean for 2024.

營業額是一個有點不確定的項目。我們不一定期望它會變得比今天更糟。但現在判斷這種情況在 2024 年是否會顯著改善還為時過早。我們在第三季度看到的早期跡象令人鼓舞。我們看到了一些輕微的改善，但現在預測這對 2024 年意味著什麼還為時過早。

Yes. Erin. The last thing I'd say is we're encouraged by the volume trends. And as you know, incremental volume coming into the business in a business that has lots of fixed costs certainly mixes up the existing margin rate. So we feel good about the volume trends in our physician office. We feel good about the volume trends in health systems. And as I mentioned in the script, we feel good about our funnel of M&A opportunities that are in front of us as we march through the fourth quarter and early next year.

是的。艾琳。我要說的最後一件事是我們對成交量趨勢感到鼓舞。如您所知，在具有大量固定成本的業務中，增量業務量肯定會影響現有的利潤率。因此，我們對醫生辦公室的數量趨勢感到滿意。我們對衛生系統的數量趨勢感到滿意。正如我在劇本中提到的，我們對第四季和明年初所面臨的併購機會感到滿意。

Our last caller is Brian Tanquilut with Jefferies.

我們的最後一位來電者是 Jefferies 的 Brian Tanquilut。

I guess, Sam, just to follow up on Erin's question really quickly. If we think about the composition of margin between gross profit and G&A, is this the right baseline to build off of -- factoring all the things that you mentioned, such productivity gains and maybe PAMA.

我想，山姆，只是為了快速跟進艾琳的問題。如果我們考慮毛利和一般行政費用之間的利潤率組成，這是否是正確的基線——考慮到您提到的所有因素，例如生產力的提高，也許還有 PAMA。

And then maybe just, Jim, a quick follow-up on hospital deals. Obviously, you've had some growth there. How should we be thinking about the pipeline and your ability to sustain the growth rate given what's in the pipeline today?

吉姆，也許只是對醫院交易進行快速跟進。顯然，你在那裡有了一些成長。鑑於目前正在醞釀的內容，我們應該如何考慮通路以及您維持成長率的能力？

Yes. I mean, with regards to the first question, Brian, we believe it is the right baseline to build off of. 2024 is not the period to look at in terms of that improvement that we talked about, the 75 to 150. There are a couple of factors in there. One of them is, there's the uncertainty of PAMA, obviously. But the other one is COVID, which is approximately $200 million this year, is going to be a factor next year in terms of the drop off. It's going to be a negative factor. Again, albeit a much smaller one than what we saw from '22 into '23, but it's still going to be a factor in terms of the approximately $200 million going to something we believe much less than that as it becomes just another regular test like a flu test, for instance. But the baseline, we believe, is the right one, and we are still confident about the 75 to 150 basis point improvement on operating margin over the 3 years.

是的。我的意思是，關於第一個問題，布萊恩，我們認為這是正確的基礎。 2024 年並不是我們所討論的 75 到 150 改善的時期。其中有幾個因素。其中之一是，PAMA 顯然存在不確定性。但另一個因素是新冠疫情，今年的損失約 2 億美元，明年將是造成損失的因素。這將是一個負面因素。再說一次，儘管比我們從22 年到23 年看到的要小得多，但它仍然是一個因素，因為大約2 億美元將用於我們認為遠少於此的項目，因為它只是另一項常規測試，例如例如，流感測試。但我們相信基準是正確的，並且我們仍然對 3 年內營業利潤率提高 75 至 150 個基點充滿信心。

Yes. Brian, as I said in the script, we're encouraged by the breadth and depth of our funnel of opportunities in hospital outreach as well as PLS. And I say that our teams are working them very hard. And the trends are pointing them in our direction, right, with the cost of capital going up for health systems, their investments, I think, are truly focusing on the things that will drive growth for health systems, whether that's investments in neurology, cardiology, cancer, obstetric, those are the things that drive growth in health systems.

是的。 Brian，正如我在劇本中所說，我們對醫院外展和 PLS 機會管道的廣度和深度感到鼓舞。我說我們的團隊正在非常努力地工作。這些趨勢為他們指明了我們的方向，對吧，隨著衛生系統的資本成本上升，我認為他們的投資真正集中在那些將推動衛生系統成長的事情上，無論是對神經病學、心臟病學的投資、癌症、產科，這些都是推動衛生系統發展的因素。

And so when you make all those investments, albeit now at capital costs that are significantly higher, they can turn to us to make the investments they need in laboratories. When you see institutions like New York Presby sell their outreach book of business and really focus their investments on the things that are driving their growth, I think that's a good sign of how health care systems, the really good strategic ones are really thinking today.

因此，當您進行所有這些投資時，儘管現在的資本成本明顯更高，但他們可以向我們尋求實驗室所需的投資。當你看到像紐約普雷斯比這樣的機構出售他們的外展業務並真正將投資集中在推動其成長的事情上時，我認為這是一個很好的跡象，表明醫療保健系統，真正好的戰略系統今天正在如何思考。

That was our last question for the day.

這是我們今天的最後一個問題。

All right. Everyone, thanks again for joining our call today. We certainly appreciate all your continued support. I also want to thank the Quest Diagnostics team who, as we've transitioned away from COVID, have really done a magnificent job in continuing to drive growth in our base business, drive productivity and continue to satisfy our patients, providers and all those that use Quest Diagnostics. So thanks, everyone, and have a great day.

好的。大家，再次感謝您今天加入我們的電話會議。我們當然感謝您一直以來的支持。我還要感謝Quest Diagnostics 團隊，隨著我們擺脫新冠疫情的影響，他們在繼續推動我們基礎業務的增長、提高生產力並繼續滿足我們的患者、醫療服務提供者和所有相關人員方面確實做了出色的工作。使用 Quest 診斷。謝謝大家，祝您有美好的一天。

Thank you for participating in the Quest Diagnostics Third Quarter 2023 Conference Call. A transcript of the prepared remarks on this call will be posted later today on Quest Diagnostics website at www.questdiagnostics.com. A replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at (203) 369-303502 for international callers or 1-800-945-5759 for domestic callers. Telephone replays will be available from approximately 10:30 a.m. Eastern Time on October 24, 2023, until midnight Eastern Time, November 7, 2023. Thank you, and goodbye.

感謝您參加 Quest Diagnostics 2023 年第三季電話會議。本次電話會議準備好的演講稿將於今天稍晚發佈在 Quest Diagnostics 網站 www.questdiagnostics.com 上。您可以透過 www.questdiagnostics.com/investor 在線查看通話重播，或撥打 (203) 369-303502（國際來電者）或 1-800-945-5759（國內來電者）。電話重播將於 2023 年 10 月 24 日東部時間上午 10:30 左右至 2023 年 11 月 7 日東部時間午夜進行。謝謝，再見。