奎斯特診斷 (DGX) 2023 Q4 法說會逐字稿

Welcome to the Quest Diagnostics Fourth Quarter and Full Year 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 年第四季和全年電話會議。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'd now like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Please go ahead, sir.

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

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.

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。

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 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. For this call, references to reported EPS refer to reported diluted EPS and references to adjusted EPS refer to adjusted diluted EPS.

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。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。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。

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.

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。

Now here is Jim Davis.

現在請聽吉姆戴維斯的演講。

Thanks, Shawn, and good morning, everyone. For the full year 2023, we delivered strong revenue growth of 7% in our base business and delivered on our earnings commitment as we transitioned away from COVID testing. The results we announced this morning reflect a strong fourth quarter and full year for our base business in which we made substantial progress on our strategy to drive top line growth across our core customer channels and improve profitability.

謝謝肖恩，大家早安。 2023 年全年，我們的基礎業務收入實現了 7% 的強勁成長，並兌現了我們從新冠病毒檢測過渡後的獲利承諾。我們今天早上公佈的業績反映了我們的基礎業務第四季度和全年的強勁表現，我們在推動核心客戶通路營收成長和提高獲利能力的策略方面取得了實質進展。

Throughout the year, we advanced our growth strategy with innovative testing solutions, new and expanded relationships with health systems and a robust pipeline of M&A and professional lab services opportunities. We also delivered double-digit revenue growth in several clinical areas, including advanced cardiometabolic, prenatal and hereditary genetics and neurology. We also strengthened our oncology offering with a strategic investment in higher growth, minimal residual disease testing.

在這一年裡，我們透過創新的檢測解決方案、與衛生系統建立新的和擴大的關係以及強大的併購管道和專業實驗室服務機會來推動我們的成長策略。我們也在多個臨床領域實現了兩位數的收入成長，包括高級心臟代謝、產前和遺傳遺傳學以及神經病學。我們也透過對高成長、微小殘留疾病檢測的策略性投資來加強我們的腫瘤學產品。

In addition, our efforts to improve quality and productivity delivered our Invigorate goal which helped us offset the cost headwinds we faced throughout the year. This morning, we issued guidance for 2024 that reflects a return to overall revenue growth while balancing the earnings tailwinds and headwinds we see for the year. Looking beyond 2024, we are well positioned to deliver our long-term financial outlook to drive mid-single-digit revenue growth and high single-digit earnings growth.

此外，我們在提高品質和生產力方面的努力實現了我們的「活力」目標，幫助我們抵消了全年面臨的成本不利因素。今天上午，我們發布了 2024 年指引，反映了整體收入成長的回歸，同時平衡了我們今年看到的盈利順風和逆風。展望 2024 年後，我們有能力實現長期財務前景，以推動中個位數的收入成長和高個位數的獲利成長。

I'm grateful to our dedicated Quest colleagues for making this happen. Every day, they bring our purpose to life, working together to create a healthier world, one life at a time.

我感謝我們敬業的 Quest 同事讓這一切成為現實。他們每天都將我們的目標變成現實，共同努力創造一個更健康的世界，一次一個生命。

Before discussing highlights from 2023, I'd like to share some recent regulatory updates. First, as you know, Congress once again delayed Medicare reimbursement cuts and the next data collection process under PAMA that were scheduled to take place in 2024. While we are pleased with the delay, we continue to work closely with our trade association to seek a permanent fix to PAMA through SALSA, the Saving Access to Laboratory Services Act. ACLA's highest priority this year is to secure passage of SALSA.

在討論 2023 年的亮點之前，我想先分享一些最近的監管更新。首先，如您所知，國會再次推遲了原定於2024 年進行的醫療保險報銷削減和PAMA 下的下一個數據收集流程。雖然我們對這一推遲感到高興，但我們將繼續與我們的行業協會密切合作，尋求透過 SALSA（《節省實驗室服務使用權法案》）永久修復 PAMA。 ACLA 今年的首要任務是確保 SALSA 的通過。

Second, ACLA and nearly 7,000 other individuals and groups submitted comments last quarter on a rule proposed by the FDA to regulate laboratory developed tests as medical devices. Lab developed tests are essential medical innovations that are already 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 compromise patient access to a central lab testing. It would also slow diagnostic innovation and add unnecessary health care costs. We agree with ACLA that the FDA does not have the statutory authority to unilaterally regulate LDTs and believe that resuming discussions with the FDA, Congress, ACLA and other stakeholders on a legislative solution is the most prudent path forward.

其次，ACLA 和近 7,000 個其他個人和團體上季度就 FDA 提出的一項規則提交了評論，該規則旨在監管實驗室開發的測試作為醫療設備。實驗室開發的測試是重要的醫療創新，除了州、認可機構和醫療保險在確定承保範圍時的監督外，這些測試還受到稱為 CLIA 的聯邦立法的嚴格監管。如果獲得通過，FDA 提議的規則將損害患者接受中央實驗室檢測的機會。它還會減慢診斷創新並增加不必要的醫療保健成本。我們同意 ACLA 的觀點，即 FDA 沒有單方面監管 LDT 的法定權力，並認為與 FDA、國會、ACLA 和其他利益相關者就立法解決方案恢復討論是最謹慎的前進道路。

Now I'll recap our strategy and discuss highlights from the fourth quarter. Then Sam will provide more detail on our financial results and talk about our financial guidance for 2024.

現在我將回顧我們的策略並討論第四季的亮點。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 2024 年的財務指導。

Our strategy to drive growth is focused on delivering solutions that meet the evolving needs of our core customers: physicians, hospitals and consumers. We enable growth across our customer channels through advanced diagnostics with an intense focus on faster-growing clinical areas, including molecular genomics and oncology. In addition, acquisitions are a key growth driver with an emphasis on accretive hospital outreach purchases as well as smaller independent labs. Our strategy also includes driving operational improvements across the business with strategic deployment of automation and AI to improve quality, efficiency, workforce experience and service.

我們推動成長的策略重點是提供滿足核心客戶（醫生、醫院和消費者）不斷變化的需求的解決方案。我們透過先進的診斷技術實現客戶管道的成長，重點關注快速成長的臨床領域，包括分子基因組學和腫瘤學。此外，收購是一個關鍵的成長動力，重點是增加醫院外展採購以及較小的獨立實驗室。我們的策略還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、員工體驗和服務。

Here are some updates on the progress we have made in these areas in the fourth quarter. In physician lab services, we delivered mid-single-digit base business revenue growth. We attribute this growth to return to care, overall market growth and share gains driven by the competitive strengths of our scale and innovative offerings. We continue to execute hospital outreach and independent lab acquisitions, which generate volume for our physician channel.

以下是我們第四季度在這些領域取得的進展的一些最新情況。在醫師實驗室服務方面，我們實現了中個位數的基本業務收入成長。我們將這種成長歸因於我們的規模和創新產品的競爭優勢所推動的護理回報、整體市場成長和份額成長。我們繼續進行醫院外展和獨立實驗室收購，這為我們的醫生管道帶來了銷售。

In January, we entered into a definitive agreement to acquire select assets of Lenco, an independent New York-based laboratory company, and expect to complete the transaction later this quarter. In addition, we acquired outreach assets of Steward Health Care, which will deepen our reach to patients in Massachusetts, Pennsylvania and Ohio. As we said earlier, our acquisition pipeline is very strong, and we expect to complete additional transactions in 2024.

一月份，我們簽訂了最終協議，收購總部位於紐約的獨立實驗室公司 Lenco 的部分資產，並預計在本季稍後完成交易。此外，我們也收購了 Steward Health Care 的外展資產，這將加深我們對麻薩諸塞州、賓州和俄亥俄州患者的影響力。正如我們之前所說，我們的收購管道非常強大，我們預計在 2024 年完成更多交易。

Our strong relationships with health plans were also a key driver of growth in 2023 as we grew revenues from health plans by high single digits versus the prior year. As we've indicated, we successfully completed negotiations for all our strategic health plan renewals that were scheduled in 2023. Health plans and self-insured employer clients recognize the clinical and economic value we deliver to them and their members. To date, more than half of health plan revenues now come from value-based contracts, which enable faster growth compared to our traditional health plan contracts. In addition, working with health plans, we continue to reduce so-called lab leakage to high-cost out-of-network labs, partly by redirecting the volume to Quest. Importantly, this is good for both patients as well as employers, which pay for the majority of health care costs.

我們與健康計畫的牢固關係也是 2023 年成長的關鍵驅動力，因為我們的健康計畫收入比上一年實現了高個位數成長。正如我們所指出的，我們成功完成了計劃於 2023 年更新所有戰略健康計劃的談判。健康計劃和自保雇主客戶認可我們為他們及其會員提供的臨床和經濟價值。到目前為止，一半以上的健康計劃收入來自基於價值的合同，與我們傳統的健康計劃合約相比，這可以實現更快的增長。此外，透過與健康計劃合作，我們繼續減少所謂的實驗室洩漏到高成本的網路外實驗室，部分方法是將流量重定向到 Quest。重要的是，這對患者和雇主都有好處，因為雇主支付了大部分醫療費用。

In hospital lab services, we drove high single-digit base business revenue growth in the fourth quarter with strength in both reference and professional laboratory services. Hospital reference testing, in particular, grew much faster than historical trends and well above our estimated growth for the market. Increasingly, health systems recognize that our innovative laboratory testing and collaborative lab management solutions can help them improve quality, productivity, affordability and care. They also continue to face labor and cost pressures, prompting more of them to reach out to us to help with their lab strategy. Our professional lab services help manage a hospital's lab, supply chain and workforce. We also provide insights from our analytical solutions to help hospitals manage utilization to deliver the right test to the right patient at the right time. In the fourth quarter, we completed two PLS relationships that will contribute modest growth in the first quarter of this year.

在醫院實驗室服務方面，憑藉著參考和專業實驗室服務的實力，我們在第四季度推動了單位數基礎業務收入的高成長。特別是醫院參考測試的成長速度遠快於歷史趨勢，也遠高於我們對市場的預期成長。衛生系統越來越認識到我們的創新實驗室檢測和協作實驗室管理解決方案可以幫助他們提高品質、生產力、負擔能力和護理。他們也持續面臨勞動力和成本壓力，促使更多的人向我們伸出援手，幫助他們制定實驗室策略。我們的專業實驗室服務幫助管理醫院的實驗室、供應鏈和勞動力。我們還提供分析解決方案的見解，幫助醫院管理利用率，以便在正確的時間向正確的患者提供正確的測試。在第四季度，我們完成了兩項 PLS 關係，這將為今年第一季帶來適度的成長。

We also provide health systems the opportunity to transition their noncore outreach laboratory assets to us through acquisitions. By selling their outreach assets to Quest, these hospitals are better able to redeploy scarce capital to areas of their business that have a greater impact on patient care.

我們也為衛生系統提供機會，透過收購將其非核心外展實驗室資產轉移給我們。透過將其外展資產出售給 Quest，這些醫院能夠更好地將稀缺資本重新部署到對病患照護影響更大的業務領域。

Our consumer-initiated testing service, questhealth.com, generated revenues of approximately $45 million in the full year 2023, with strong base business growth. Our return on ad spend and customer acquisition costs remained favorable in the fourth quarter.

我們的消費者發起的檢測服務 questhealth.com 在 2023 年全年創造了約 4500 萬美元的收入，基礎業務增長強勁。第四季我們的廣告支出回報和客戶獲取成本仍然有利。

Another element of our CIT strategy is to drive revenue growth through channel partners. In 2023, we generated more than $30 million through this channel. We are also excited about new product releases in 2024, including blood testing for PFAS or forever chemicals via questhealth.com. PFAS chemicals have been used in industrial and consumer products for decades and may contaminate food and water. In late January, the CDC issued new guidelines that recognize the value of PFAS blood testing for individuals that may have elevated exposure levels, which may increase risk of kidney cancer, high cholesterol and other health conditions. According to a study in the Journal of Endocrine Society, PFAS chemicals accounted for approximately $22 billion in U.S. health care costs in 2018.

我們 CIT 策略的另一個要素是透過通路合作夥伴推動收入成長。 2023 年，我們透過這個管道創造了超過 3,000 萬美元的收入。我們也對 2024 年新產品的發布感到興奮，包括透過 questhealth.com 進行 PFAS 或 Forever 化學品的血液檢測。 PFAS 化學物質已在工業和消費品中使用了數十年，可能會污染食物和水。一月下旬，疾病預防控制中心發布了新的指南，承認 PFAS 血液檢測對於暴露水平較高的個人的價值，這可能會增加腎癌、高膽固醇和其他健康狀況的風險。根據《內分泌學會雜誌》的一項研究，2018 年 PFAS 化學品在美國醫療保健費用中的支出約為 220 億美元。

In advanced diagnostics, we experienced double-digit growth across several clinical areas in the fourth quarter, including advanced cardiometabolic, prenatal and hereditary genetics and neurology. Growth in neurology was driven largely by our Alzheimer's disease portfolio of tests which is among the most comprehensive in the fast-evolving field of Alzheimer's care. Our innovations include our AD-Detect blood test for early risk assessment based on amyloid beta proteins and ApoE genetic risks. This week, we also added p-tau181 to our AD-Detect blood test line to complement insights from amyloid beta testing. In addition, our Alzheimer's disease test portfolio includes several CSF tests for diagnosis and monitoring based on amyloid beta, p-tau181 and ApoE. We intend to add additional biomarkers later this year and continue to expand our menu.

在先進診斷領域，第四季度我們在多個臨床領域實現了兩位數的成長，包括先進的心臟代謝、產前和遺傳遺傳學以及神經病學。神經病學的成長主要是由我們的阿茲海默症測試組合推動的，這是快速發展的阿茲海默症護理領域中最全面的測試組合之一。我們的創新包括 AD-Detect 血液檢測，用於根據澱粉樣β蛋白和 ApoE 遺傳風險進行早期風險評估。本週，我們也在 AD-Detect 血液檢測系列中加入了 p-tau181，以補充澱粉樣蛋白 β 檢測的見解。此外，我們的阿茲海默症測試組合包括多項基於澱粉樣蛋白 β、p-tau181 和 ApoE 進行診斷和監測的 CSF 測試。我們打算在今年稍後添加更多的生物標誌物，並繼續擴大我們的菜單。

In molecular genomics and oncology, we are on track to launch our Haystack minimal residual disease test to physicians later this year from our Oncology Center of Excellence in Lewisville, Texas. We also believe Haystack MRD can help support clinical research and recently announced clinical trial collaborations using this innovative technology with the Rutgers Cancer Institute, Alliance Foundation Trials and TriSalus Life Sciences. In the fourth quarter, we announced a collaboration with Universal DX, which has developed an innovative blood test for screening for colorectal cancer, including precancerous lesions. We look forward to supporting Universal's effort to gain regulatory approval for this test. Through our collaboration with Scipher, we are expanding patient access to the PrismRA test for aiding treatment selection for rheumatoid arthritis.

在分子基因組學和腫瘤學領域，我們預計今年稍後從德克薩斯州路易斯維爾的腫瘤學卓越中心向醫生推出 Haystack 微小殘留病測試。我們也相信 Haystack MRD 可以幫助支持臨床研究，並且最近宣布使用這項創新技術與羅格斯癌症研究所、聯盟基金會試驗和 TriSalus Life Sciences 進行臨床試驗合作。在第四季度，我們宣布與 Universal DX 合作，後者開發了一種創新的血液測試，用於篩檢大腸癌，包括癌前病變。我們期待支持環球公司為這項測試獲得監管部門批准的努力。透過與 Scipher 的合作，我們正在擴大患者使用 PrismRA 測試的機會，以幫助選擇類風濕性關節炎的治療方法。

Turning to operational excellence. Our Invigorate program delivered our targeted 3% annual cost savings and productivity improvements. Here are three examples of how we're improving operations. First, we continue to make progress in using front-end automation to enhance specimen processing. In 2023, we completed front-end automation upgrades in our Pittsburgh and Dallas laboratories which will improve quality and productivity. This year, we'll add 5 additional sites.

轉向卓越營運。我們的 Invigorate 計劃實現了每年節省 3% 的成本並提高生產力的目標。以下是我們如何改善營運的三個範例。首先，我們在利用前端自動化增強標本處理方面不斷取得進展。 2023 年，我們在匹茲堡和達拉斯實驗室完成了前端自動化升級，這將提高品質和生產力。今年，我們將另外增加 5 個站點。

Second, we also expanded the use of AI to improve quality, efficiency and workforce experience in several clinical areas. AI can quickly identify patterns that signify possible disease and digital images of patient cultures and slides. In 2023, we expanded the use of AI in microbiology to help identify bacteria as well as in cytogenetics to identify chromosomal abnormalities. Looking forward, we are encouraged by the opportunities to use AI in several additional clinical areas including cytology, pathology and parasitology.

其次，我們也擴大了人工智慧的使用，以提高多個臨床領域的品質、效率和員工經驗。人工智慧可以快速識別表明可能疾病的模式以及患者培養物和切片的數位影像。 2023 年，我們擴大了人工智慧在微生物學中的應用，以幫助識別細菌，以及在細胞遺傳學中的應用，以識別染色體異常。展望未來，我們對在細胞學、病理學和寄生蟲學等其他幾個臨床領域使用人工智慧的機會感到鼓舞。

Third, in 2023, we deployed an AI tool at our Clifton lab that helps laboratory staff continuously identify ways to be more productive in their daily routines. And we look forward to introducing this AI job helper in other labs and support processes.

第三，2023 年，我們在克利夫頓實驗室部署了人工智慧工具，幫助實驗室工作人員持續尋找提高日常工作效率的方法。我們期待在其他實驗室和支援流程中引入這個人工智慧工作助手。

Finally, we made significant progress improving the margins of our base business in 2023. I'd like to personally thank our Quest colleagues whose efforts have helped make this possible.

最後，我們在 2023 年提高基礎業務的利潤率方面取得了重大進展。我要親自感謝 Quest 的同事，他們的努力幫助實現了這一目標。

With that, I'll turn it over to Sam to provide more details on our performance and our 2024 guidance. Sam?

接下來，我會將其交給 Sam，以提供有關我們的績效和 2024 年指導的更多詳細資訊。薩姆？

Thank, Jim. In the fourth quarter, consolidated revenue were $2.29 billion, down 1.9% versus the prior year. Base business revenues grew 4.7% to $2.25 billion, while COVID-19 testing revenues declined approximately 80% to $37 million. Revenues for Diagnostic Information Services declined 2% compared to the prior year, reflecting lower revenue from COVID-19 testing services versus the fourth quarter of 2022, partially offset by strong growth in our base testing revenue.

謝謝，吉姆。第四季綜合營收為 22.9 億美元，較上年同期下降 1.9%。基礎業務收入成長 4.7% 至 22.5 億美元，而 COVID-19 檢測收入下降約 80% 至 3,700 萬美元。診斷資訊服務的收入與前一年相比下降了2%，反映出與2022 年第四季度相比，COVID-19 測試服務的收入有所下降，但部分被我們基礎測試收入的強勁增長所抵消。

Total volume, measured by the number of requisitions, increased 1.9% versus the fourth quarter of 2022, with acquisitions contributing 50 basis points to total volume. Total base testing volumes grew 5.2% versus the prior year. Revenue per requisition declined 3.5% versus the prior year driven primarily by lower COVID-19 molecular volume. Base business revenue per req was up 0.2%. Unit price reimbursement was positive and consistent with our expectations. Reported operating income in the fourth quarter was $267 million or 11.7% of revenues compared to $135 million or 5.8% of revenues last year.

以請購數量衡量的總交易量較 2022 年第四季成長了 1.9%，其中收購對總交易量貢獻了 50 個基點。基礎測試總量較上年增長 5.2%。與前一年相比，每份申請的收入下降了 3.5%，這主要是由於 COVID-19 分子體積下降。每項要求的基本業務收入成長了 0.2%。單價報銷是正面的，符合我們的預期。第四季報告的營業收入為 2.67 億美元，佔營收的 11.7%，而去年為 1.35 億美元，佔營收的 5.8%。

On an adjusted basis, operating income was $338 million or 14.8% of revenues compared to $330 million or 14.2% of revenues last year. The year-over-year increase in adjusted operating income is related primarily to growth in the base business, actions taken in 2023 to reduce support costs and lower performance-based compensation, partially offset by lower COVID-19 testing revenues, wage increases, higher employee health care costs and higher deferred compensation expense. Reported EPS was $1.70 in the quarter compared to $0.87 a year ago. Adjusted EPS was $2.15 compared to $1.98 last year. Cash from operations was $1.27 billion for full year 2023 versus $1.72 billion in the prior year, driven primarily by lower COVID-19 testing revenue.

調整後的營業收入為 3.38 億美元，佔營收的 14.8%，而去年為 3.3 億美元，佔營收的 14.2%。調整後營業收入的同比增長主要與基礎業務的增長、2023 年為降低支持成本而採取的行動以及基於績效的薪酬的降低有關，但部分被 COVID-19 測試收入下降、工資上漲、員工醫療保健費用和更高的遞延補償費用。本季報告的每股收益為 1.70 美元，而去年同期為 0.87 美元。調整後每股收益為 2.15 美元，去年為 1.98 美元。 2023 年全年營運現金為 12.7 億美元，而前一年為 17.2 億美元，主要是由於 COVID-19 檢測收入下降。

Finally, our Board of Directors has authorized a 5.6% increase in our quarterly dividend from $0.71 to $0.75 per share or $3 per share annually effective with the dividend payable in April 2024. The company has raised its dividend annually since 2011.

最後，我們的董事會批准將季度股息從0.71 美元增加到5.6%，從每股0.71 美元增加到每股0.75 美元，或每年每股3 美元，並於2024 年4 月支付股息。自2011 年以來，公司每年都會提高股利。

Turning to our full year 2024 guidance. Revenues are expected to be between $9.35 billion and $9.45 billion. Reported EPS expected to be in a range of $7.69 to $7.99 and adjusted EPS to be in a range of $8.60 to $8.90. Cash from operations is expected to be approximately $1.3 billion and capital expenditures are expected to be approximately $420 million. We have posted a presentation on the Investor Relations page of our website that includes an adjusted earnings bridge which shows some of the key elements to bridge from our 2023 adjusted EPS to the 2024 adjusted EPS guidance we shared today.

轉向我們的 2024 年全年指導。收入預計在 93.5 億美元至 94.5 億美元之間。報告每股收益預計為 7.69 美元至 7.99 美元，調整後每股收益為 8.60 美元至 8.90 美元。營運現金預計約 13 億美元，資本支出預計約 4.2 億美元。我們在網站的投資者關係頁面上發布了一份演示文稿，其中包括調整後的收益橋樑，其中顯示了從2023 年調整後每股收益到我們今天分享的2024 年調整後每股收益指導的一些關鍵要素。

Our 2024 guidance reflects the following consideration. We are no longer providing detailed base business and COVID revenue guidance. However, note that we are assuming that COVID revenues will decline at least $175 million in 2024, which will partially offset the growth we expect from the base business. Most of the COVID headwind in 2024 will occur during the first quarter as we generated $119 million of COVID revenue in Q1 last year.

我們的 2024 年指導反映了以下考慮。我們不再提供詳細的基礎業務和新冠疫情收入指導。但請注意，我們假設 2024 年新冠疫情收入將下降至少 1.75 億美元，這將部分抵消我們對基礎業務的預期成長。 2024 年的大部分新冠肺炎不利因素將發生在第一季度，因為我們去年第一季的新冠肺炎收入為 1.19 億美元。

In terms of M&A, our guidance only contemplates acquisitions that have been announced or closed to date, including the outreach acquisitions from NewYork-Presbyterian and Steward Health Care, as well as Lenco, the independent lab Jay mentioned earlier. We will absorb the full year of dilution from our acquisition of Haystack Oncology with an incremental impact of approximately $0.20 to adjusted EPS in 2024.

在併購方面，我們的指引僅考慮迄今為止已宣布或已完成的收購，包括對 NewYork-Presbyterian 和 Steward Health Care 以及 Jay 之前提到的獨立實驗室 Lenco 的外展收購。我們將吸收收購 Haystack Oncology 帶來的全年稀釋，對 2024 年調整後每股盈餘產生約 0.20 美元的增量影響。

We made strong progress improving our base business operating margins in 2023 and expect margin expansion in 2024. We anticipate net interest expense to increase to approximately $190 million in 2024 as a result of higher borrowings following our debt issuance in November. We assume a roughly flat share count compared to the end of 2023. We are expecting adjusted EPS in Q1 to be roughly 21% of our full year earnings. This is slightly below the typical seasonality and reflects the significant amount of weather disruption we've experienced in January. At this point, we anticipate a weather headwind of $0.05 to $0.07 in Q1.

2023 年，我們在提高基礎業務營運利潤率方面取得了巨大進展，預計 2024 年利潤率將擴大。由於 11 月發行債券後借款增加，我們預計 2024 年淨利息支出將增加至約 1.9 億美元。我們假設與 2023 年底相比，股票數量大致持平。我們預計第一季調整後每股盈餘將約為全年收益的 21%。這略低於典型的季節性，反映了我們在一月份經歷的大量天氣幹擾。目前，我們預計第一季的天氣阻力為 0.05 美元至 0.07 美元。

And finally, as Jim mentioned earlier, we are well positioned to deliver our long-term financial outlook to drive mid-single-digit revenue growth and high single-digit earnings growth.

最後，正如吉姆之前提到的，我們有能力實現長期財務前景，以推動中個位數的收入成長和高個位數的獲利成長。

With that, I'll now turn it back to Jim.

有了這個，我現在將把它轉回給吉姆。

Thanks, Sam. Finally, I'd like to take a moment to remember Dr. Paul A. Brown, who passed away in January of this year. In 1967, Dr. Brown founded MetPath the predecessor company of Quest Diagnostics, providing basic lab services from his apartment in New York City. Dr. Brown was a pioneer who invented the blueprint for our industry that today is recognized as essential to quality health care, and we are grateful for his vision and leadership.

謝謝，山姆。最後，我想花點時間紀念今年一月去世的保羅·A·布朗博士。 1967 年，Brown 博士創立了 MetPath，這是 Quest Diagnostics 的前身公司，在他位於紐約市的公寓中提供基本的實驗室服務。布朗博士是一位先驅，他為我們的行業製定了藍圖，如今該藍圖被認為是高品質醫療保健的關鍵，我們感謝他的遠見和領導力。

To summarize, we delivered strong base business revenue growth in 2023 and achieved our EPS commitments. Our guidance in 2024 reflects a return to total revenue growth while balancing the earnings tailwinds and headwinds we see for the year.

總而言之，我們在 2023 年實現了強勁的基礎業務收入成長，並實現了每股盈餘承諾。我們對 2024 年的指導反映了總收入成長的回歸，同時平衡了我們今年看到的獲利順風和逆風。

Looking beyond 2024, we are well positioned to deliver our long-term financial outlook to drive mid-single-digit revenue growth and high single-digit earnings growth. And I'm grateful to our dedicated Quest colleagues who bring our purpose to life every single day, working together to create a healthier world, one life at a time.

展望 2024 年後，我們有能力實現長期財務前景，以推動中個位數的收入成長和高個位數的獲利成長。我感謝我們敬業的 Quest 同事，他們每天都將我們的目標變為現實，共同努力創造一個更健康的世界，一次一個人的生活。

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) And our first question of the day will come from Patrick Donnelly of Citi.

（操作員說明）今天我們的第一個問題將來自花旗銀行的帕特里克·唐納利（Patrick Donnelly）。

Probably one for Sam, just on the margin outlook for '24. Can you just expand a little bit on expectations there, including maybe the cadence for the year? And then just on the margin front with PAMA. Obviously, the push out, it's not a function of you getting any windfall by any means, but just that potential headwind being alleviated. Were there investments that you guys were kind of holding off on until you got more clarity on the outcome there? And then as you plan the budget, you greenlit some more of those as PAMA got pushed out. Just wondering how you thought about that expense piece there and a bit more color on margins.

可能是 Sam 的一個，只是關於 24 年的利潤前景。您能否稍微擴展一下那裡的期望，包括今年的節奏？然後與 PAMA 處於邊緣前沿。顯然，推出並不是你以任何方式獲得任何意外之財的函數，而只是潛在的逆風得到緩解。你們是否推遲了某些投資，直到對結果有了更清晰的了解為止？然後，當你計劃預算時，你又批准了更多預算，因為 PAMA 被淘汰了。只是想知道您如何看待那裡的費用部分以及利潤率上的更多色彩。

Yes. Thank you, Patrick. So listen, we made a lot of great progress in 2023 in terms of expanding our margins and offsetting the COVID headwind that we saw in '23. In terms of '24 expectations, as we mentioned on the prepared remarks, we're looking to expand margins, to continue to expand margins in '24 with, again, the key drivers of that are going to be volume growth, the expectation of volume growth that we have in the plan, that's going to be the biggest impact in terms of driving margins. We're going to be looking at continuing the great work that we're doing on Invigorate and offsetting any cost headwinds. We're assuming the labor inflation to be in line with what we saw in 2023, so somewhere in that 3% to 4% growth range, not necessarily expecting it to get worse, but not necessarily expecting it to get better either.

是的。謝謝你，派崔克。所以聽著，我們在 2023 年在擴大利潤和抵消 23 年看到的新冠逆風方面取得了很大進展。就 24 年的預期而言，正如我們在準備好的發言中提到的那樣，我們希望擴大利潤率，並在 24 年繼續擴大利潤率，其中的關鍵驅動因素將是銷量增長，預計我們計劃中的銷售成長，這將是對提高利潤率的最大影響。我們將考慮繼續我們在 Invigorate 方面所做的偉大工作，並抵消任何成本阻力。我們假設勞動力通膨與我們在 2023 年看到的情況一致，因此在 3% 至 4% 的增長範圍內，不一定預期會變得更糟，但也不一定會預期會好轉。

In terms of your question on PAMA, Patrick, you're absolutely right. It's not a positive, it's the absence of a negative. So essentially, the delay gives us certainty now for '24 that we're not going to see a decline. And had PAMA occurred or had PAMA come back in 2024, you're right in the sense that we would have had to potentially defer certain investments. We would have had to make some potentially difficult cuts to offset some of that impact. And the fact that we have a delay affords us the ability now to make certain investments and to avoid some of those difficult cuts that I referenced. But I think the key punchline for 2024 is that we continue to expand operating margins.

派崔克，就你關於 PAMA 的問題而言，你是完全正確的。這不是積極的，而是缺乏消極的。因此，從本質上講，延遲現在讓我們確信 24 年我們不會看到下降。如果 PAMA 發生或 PAMA 在 2024 年捲土重來，你說得對，我們可能不得不推遲某些投資。我們將不得不進行一些可能困難的削減，以抵消部分影響。事實上，我們的延遲使我們現在有能力進行某些投資，並避免我提到的一些困難的削減。但我認為 2024 年的關鍵亮點是我們繼續擴大營業利潤率。

Jim, you wanted to make a...

吉姆，你想做一個...

Yes. So Patrick, you heard me discuss in our prepared remarks. We're going to continue to invest in our Alzheimer's portfolio of tests. There's still one important blood-based biomarker that we will bring up later this year and that will complete our investments in our Alzheimer's testing from a blood-based standpoint. You heard me mention that PFAS testing. We're bringing that test up. We'll be launching that here in the first quarter. We have gotten significant consumer and physician demand to bring that test up. And then finally, we're upgrading some of our laboratory information systems in a couple of our esoteric labs. And so the lack of this PAMA cut gives us the ability to continue to make those investments.

是的。派崔克，你聽到我在準備好的發言中進行了討論。我們將繼續投資於阿茲海默症測試組合。我們仍將在今年稍後提出一種重要的血液生物標記物，這將從血液的角度完成我們對阿茲海默症測試的投資。你聽到我提到了 PFAS 測試。我們正在進行該測試。我們將在第一季在這裡推出它。消費者和醫生強烈要求我們進行該測試。最後，我們正在升級幾個深奧實驗室的一些實驗室資訊系統。因此，沒有 PAMA 削減使我們有能力繼續進行這些投資。

The next question comes from Elizabeth Anderson with Evercore ISI.

下一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I have a sort of unrelated 2-part combo one. One, can you talk about sort of the progress you're making on Haystack? I know sort of you ended up sort of on the higher end of the dilution. Is that because you're sort of accelerating test pushout and have seen incremental progress on that side?

我有一個不相關的兩部分組合。第一，您能談談您在 Haystack 上的進展嗎？我知道你最終處於稀釋的較高端。這是因為您正在加速測試推出並且已經看到了這方面的漸進進展嗎？

And then secondarily, can you remind us on your thoughts about share repo for the year? I know that's not in your current base guidance assumptions, but just wanted to hear your updated thoughts on that for capital deployment.

其次，您能否提醒我們您對今年股票回購的看法？我知道這不在您目前的基本指導假設中，但只是想聽聽您對資本部署的最新想法。

Okay. Let me address the -- our progress on Haystack, Sam will take the second question. So Haystack is proceeding as we expected. There's no incremental investment versus what we thought. We said last year, $0.15 to $0.20 for the half year. And then likewise, $0.15 to $0.20 incremental this year. We are bringing the assay up in our Lewisville, Texas Cancer Center of Excellence. It's proceeding as we expected. We announced -- you heard in my prepared remarks, discussions of three clinical trials. So we are doing testing right this moment. Obviously, we're not getting paid for that testing as we continue to validate the assay. But we expect to have it launched here in the first half of the year for commercial purposes.

好的。讓我談談我們在 Haystack 上的進展，Sam 將回答第二個問題。所以 Haystack 正在按照我們的預期進行。與我們想像的相比，沒有增量投資。我們去年說過，半年為 0.15 至 0.20 美元。同樣，今年增加了 0.15 至 0.20 美元。我們正在德克薩斯州路易斯維爾癌症卓越中心進行該檢測。事情正在按照我們的預期進行。我們宣布——你們在我準備好的發言中聽到了對三項臨床試驗的討論。所以我們現在正在進行測試。顯然，當我們繼續驗證檢測時，我們不會因為該測試而獲得報酬。但我們預計會在今年上半年在這裡推出商業目的。

Yes. And I'll take the second question. Elizabeth, just to be clear, the Haystack dilution in 2023 was in line with our expectations. It was $0.15 to $0.20. That's what we had called and that's where it came in, in that range of $0.15 to $0.20. With regard to share repo, so we did $275 million of share repo in Q4. Our current expectations are to basically offset equity dilution -- sorry, I said in '24, it's '23 in Q4. And our expectations are to offset equity dilution in '24. And that would work out to something in the similar range that we did in Q4, so somewhere around $250 million to $275 million. That's the base assumption, which is to offset equity dilution.

是的。我將回答第二個問題。 Elizabeth，需要澄清的是，2023 年 Haystack 的稀釋符合我們的預期。價格為 0.15 美元至 0.20 美元。這就是我們所說的，這就是它的用武之地，範圍在 0.15 美元到 0.20 美元之間。關於股票回購，我們在第四季進行了 2.75 億美元的股票回購。我們目前的預期是基本上抵消股權稀釋——抱歉，我在 24 年說過，現在是 23 年第四季。我們的預期是在 24 年抵消股權稀釋。這將與我們在第四季度所做的類似，大約在 2.5 億至 2.75 億美元之間。這是基本假設，即抵消股權稀釋。

Our next question will come from Pito Chickering of Deutsche Bank.

我們的下一個問題將來自德意志銀行的皮托·奇克林。

There are a lot of moving pieces in the 2024 bridge you provided. If we look at operating margins, excluding Haystack dilution, how are operating margins in 2024 versus 2023? And then 4Q margins missed the street by a decent amount. Can you help us bridge the 4Q margins to what you're guiding to for 2024?

您提供的 2024 年橋樑中有很多令人感動的部分。如果我們看看營業利潤率（不包括 Haystack 稀釋），2024 年與 2023 年的營業利潤率如何？然後第四季的利潤率就大幅落後於市場。您能否幫助我們將第四季的利潤率與您為 2024 年制定的目標連結起來？

Sure. Why don't I take that, Pito. So first of all, in terms of operating margin for 2024, what's implied in the guide at the midpoint is expansion of operating margins. We're not calling out specifically what the operating margin rate, but there's definitely growth in terms of the operating margin rate and operating margin dollars in '24 versus '23 where we came in. And that's what's implied in the guide that we gave.

當然。為什麼我不接受這個，皮托。所以首先，就2024年的營業利益率而言，指引中點暗示的是營業利益率的擴張。我們並沒有具體指出營業利潤率是多少，但與我們進入的 23 年相比，24 年的營業利潤率和營業利潤美元肯定有所增長。這就是我們提供的指南中所暗示的內容。

With regard to the moving parts around Q4 and then how you bridge that into 2024, listen, there were three things that really impacted us in Q4 from an operating margin rate perspective. We came in at 14.8%. It was still growth year-over-year, significant growth year-over-year despite a significant drop in COVID revenues. But in terms of versus expectations, yes, we missed in terms of operating margin for three key reasons. Number one was employee health care costs. So I would weigh these three reasons, by the way, equally, so 1/3, 1/3, 1/3. But basically, employee health care costs was 1/3 of that miss. They came in higher than expected in Q4, and we can talk a little bit about what we're doing in '24 with regard to that. Additional -- some additional investments that we made towards the end of the year and some higher costs that we made, not necessarily related to labor costs, but some investments that we made, targeted investments in Q4, namely IT. So that was 1/3 of the miss as well.

關於第四季左右的變化，以及如何將其過渡到 2024 年，聽著，從營業利潤率的角度來看，有三件事在第四季度真正影響了我們。我們的得分為 14.8%。儘管新冠疫情收入大幅下降，但它仍然同比增長，同比顯著增長。但就與預期相比而言，是的，我們由於三個關鍵原因而未能實現營業利潤率。第一個是員工醫療保健費用。所以我會平等地權衡這三個原因，所以 1/3，1/3，1/3。但基本上，員工醫療保健費用僅佔該錯誤的 1/3。他們在第四季的表現高於預期，我們可以談談我們在 24 年在這方面所做的事情。額外的——我們在年底進行的一些額外投資以及我們進行的一些更高的成本，不一定與勞動力成本相關，但我們進行的一些投資是第四季度的目標投資，即IT。所以這也是失誤的 1/3。

And then 1/3 was deferred compensation expense, which came in higher. Now remember, that's not an EPS impact. That's an operating margin impact that gets offset on the nonoperating expense line. But that impacted our margins again to the tune of 1/3 of that miss versus our expectations.

然後1/3是遞延補償費用，這個比例更高。現在請記住，這不是每股收益的影響。這是對營業利潤率的影響，但會在非營業費用項目中抵銷。但這再次影響了我們的利潤率，達到了我們預期的 1/3。

Now if you look towards '24, the employee health care costs, I mean, we've factored that into our guide. We've also taken steps to lower employee health care costs by -- I mean we had frozen, for the last 3 years, the employee contribution part of our employee health care cost plan. And we're having now to pass some of that on back to employees in 2024 because we had, as I said, frozen them over the last 3 years, even with the significant inflation that you've seen in terms of health care. So that's already assumed in 2024. As I mentioned to Patrick, what's assumed is also volume growth that's going to help us grow margins. The deferred compensation, that's just noise. We don't really budget for that. If there's a headwind or a tailwind in '24, that just gets offset on the nonoperating line and it shows up as neutral in EPS.

現在，如果您關注“24”，員工醫療保健費用，我的意思是，我們已將其納入我們的指南中。我們也採取措施降低員工醫療保健成本，我的意思是，在過去的三年裡，我們凍結了員工醫療成本計畫中的員工繳款部分。我們現在必須在 2024 年將其中的一部分轉嫁給員工，因為正如我所說，我們在過去 3 年裡凍結了他們，即使醫療保健方面出現了嚴重的通貨膨脹。所以這已經是 2024 年的假設了。正如我向派崔克提到的，假設銷售成長也將幫助我們提高利潤。延期補償，那隻是噪音。我們並沒有真正為此做預算。如果 24 年出現逆風或順風，它就會在非營業線上被抵消，並在 EPS 中顯示為中性。

And then as I said, we made some additional investments in Q4 to position the business for 2024, and that's factored into the guide in terms of any additional investments that we make in '24. So we feel confident about our growth in terms of operating margins next -- this year.

然後，正如我所說，我們在第四季度進行了一些額外投資，以定位 2024 年的業務，這已納入我們在 24 年進行的任何額外投資的指南中。因此，我們對明年（今年）營業利潤率的成長充滿信心。

Yes. Peter, let me just go back to Q4 just to talk about the progress we made year-over-year. So as Sam indicated, our revenue in Q4 versus '22 was down $45 million. And if you look at the mix of that revenue, COVID was down $145 million year-over-year. And remember, we were getting paid $100 a req at that point. Our base business offset $100 million of that, which is why we were down $45 million. Despite that, bad mix and the lower revenue, we still improved our operating margin by 60 basis points. So we made significant progress in the quarter and that progress will continue as we march into 2024.

是的。彼得，讓我回到第四季來談談我們同比的進展。正如 Sam 所說，我們第四季的營收與 22 年相比下降了 4,500 萬美元。如果你看看這些收入的組合，你會發現新冠疫情年減了 1.45 億美元。請記住，那時我們每個請求的報酬是 100 美元。我們的基礎業務抵消了其中的 1 億美元，這就是我們減少 4500 萬美元的原因。儘管有糟糕的組合和較低的收入，我們的營業利潤率仍然提高了 60 個基點。因此，我們在本季度取得了重大進展，並且在進入 2024 年時，這種進展將繼續下去。

The next question comes from Jack Meehan of Nephron Research.

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

Jim, I was hoping to hear from you, like what are you assuming in terms of core utilization in terms of the guide? You've had elevated rates the last couple of years coming out of the pandemic. Do you think that can sustain? Or are you seeing moderation in any areas?

吉姆，我希望收到您的來信，例如您對指南中的核心利用率有何假設？過去幾年，疫情過後，發病率上升。你認為這樣的情況能持續下去嗎？或者您在某些領域看到了適度的做法嗎？

Yes. So for the fourth quarter, Jack, we saw volume growth of 5.1%. For the total year, we had volume growth of 6.5%. Now I would tell you at the very beginning portion of this year, the first 2 to 3 weeks, with the weather that we saw across the U.S., volume growth was stunted a bit. But in the last week or so, we've seen volume recover to the normal rates and expectations that we have for the year. So you've heard several of the health plans have reported higher utilization in the fourth quarter. We, ourselves, because of our own health care costs, we know there was higher utilization of our own employees. So we expect it to continue at slightly above the normal market rates, albeit the first month of the year has been tempered a little bit by weather.

是的。 Jack，第四季的銷量成長了 5.1%。全年銷量成長 6.5%。現在我可以告訴你，今年年初，前兩到三週，由於我們在美國各地看到的天氣，銷量增長受到了一些阻礙。但在上週左右，我們看到成交量恢復到今年的正常水準和預期。您聽說過一些健康計劃報告第四季度的利用率更高。我們自己，由於我們自己的醫療保健費用，我們知道我們自己的員工的利用率更高。因此，我們預計價格將繼續略高於正常市場價格，儘管今年第一個月因天氣原因有所緩和。

The next question will come from Brian Tanquilut of Jefferies.

下一個問題將由 Jefferies 的 Brian Tanquilut 提出。

Maybe, Sam, as I think about all the comments from Jim on how it looks like the revenue outlook is good, right, you have all these tailwinds, potentially going forward with new tests and whatnot, help us bridge to getting back to that EPS or earnings growth in the long-term outlook that you've provided. Because obviously, '24 is an aberration or there some one-timers here, but how do you get comfortable in that long-term earnings growth, '25 going forward?

也許，山姆，當我想到吉姆關於收入前景看起來不錯的所有評論時，對吧，你有所有這些順風，可能會進行新的測試等等，幫助我們恢復每股收益或您提供的長期前景中的收入增長。因為顯然，「24」是一種異常現象，或者這裡有一些一次性的情況，但你如何適應「25」未來的長期獲利成長？

Yes. Thanks, Brian. So first of all, let me say definitively that we are absolutely still confident about our long-term growth guide that we gave, which is essentially to grow revenues in the mid-single digits, to grow EPS in the high single digits. So long-term growth is unchanged.

是的。謝謝，布萊恩。首先，我要明確地說，我們對我們給予的長期成長指引仍然充滿信心，這基本上是使收入成長到中個位數，使每股盈餘成長到高個位數。所以長期成長沒有改變。

As you yourself mentioned, there are some headwinds in 2024 that I think are transient or temporary that we see this year. So we've got a COVID revenue decline, which is approximately $175 million or roughly $0.50 year-over-year. You've got -- and we've called this before, but you've got Haystack dilution, which is now full year dilution versus a half year dilution that we saw in '23. And then you've got interest expense, which is to the tune of about $0.25 which is really as a result of the additional debt that we took on and the higher borrowing costs driven by the macro environment that we're in.

正如您自己所提到的，2024 年會出現一些逆風，我認為這些逆風是短暫的或暫時的，我們今年會看到這些逆風。因此，我們的新冠疫情收入下降了約 1.75 億美元，年減了約 0.50 美元。我們之前也這麼稱呼過，但 Haystack 稀釋，現在是全年稀釋，而不是我們在 23 年看到的半年稀釋。然後還有利息費用，約為 0.25 美元，這實際上是由於我們承擔的額外債務以及我們所處的宏觀環境導致的更高的借貸成本造成的。

But that's really to fund acquisitions and to fund growth in the business as well, in the base business. We've got a strong pipeline, and we feel really confident about the M&A landscape and the M&A opportunities ahead of us. And we upsized the issuance in November to basically partly pay for the acquisitions that we made in '23, Haystack and to some extent, NewYork-Presbyterian, but also to fund the future acquisitions, some of which are not included in this guide. So I would say the punchline is we're definitely still confident about the long-term growth of the business and the EPS guide that we gave.

但這實際上是為了為收購提供資金，並為基礎業務的業務成長提供資金。我們擁有強大的管道，我們對併購前景和擺在我們面前的併購機會充滿信心。我們在11 月擴大了發行規模，基本上是為了部分支付我們在23 年、Haystack 以及某種程度上紐約長老會醫院的收購費用，同時也為未來的收購提供資金，其中一些收購未包含在本指南中。因此，我想說的重點是，我們對業務的長期成長和我們提供的每股盈餘指南仍然充滿信心。

The next question comes from Kevin Caliendo of UBS.

下一個問題來自瑞銀集團的 Kevin Caliendo。

It's Andrea Alfonso in for Kevin. I, unfortunately, am in the enviable position of asking yet another question around margin expectations. But I guess my question is, when we think about just the expansion of margins you expect and thinking about the puts and takes into next year, I guess, I want to isolate like what gets better. I know that there's maybe some assumption in there around the M&A you've absorbed so far. Is that mildly accretive or just sort of in line or maybe below the margin? Some of your -- in one of your slides, I think there was some mention of GAAP charges around workforce reductions, et cetera. Is that sort of just lingering on from 2023? Or is that a new tranche? Just trying to get an understanding on those two items.

安德里亞·阿方索 (Andrea Alfonso) 代替凱文 (Kevin)。不幸的是，我處於一個令人羨慕的位置，提出了另一個關於利潤率預期的問題。但我想我的問題是，當我們考慮您期望的利潤率擴張並考慮明年的看跌期權和期權時，我想，我想像變得更好的情況一樣進行隔離。我知道您到目前為止所吸收的併購可能存在一些假設。這是溫和的增值還是只是在一定範圍內或可能低於利潤？在你們的一張投影片中，我認為其中提到了有關裁員的 GAAP 費用，等等。這種情況會從 2023 年開始持續嗎？或者這是一個新的部分？只是想了解這兩個項目。

Yes. So thank you for the question. With regard to margin expansion, I mean, as I mentioned earlier, a big factor is going to be driven by volume growth that we see in 2024. That's really the key factor. We're going to continue to invigorate the actions that we have talked about to the tune of 3% cost reduction across our entire cost base. And that's -- we actually met that target in '23, we slightly exceeded it. And in '24, it's going to be continuing with those initiatives.

是的。謝謝你的提問。關於利潤率擴張，我的意思是，正如我之前提到的，一個重要因素將由我們在 2024 年看到的銷售成長所驅動。這確實是關鍵因素。我們將繼續推動我們已經討論過的行動，在整個成本基礎上降低 3% 的成本。那就是——我們實際上在 23 年就達到了這個目標，我們稍微超越了它。 24 年，它將繼續實施這些措施。

With regard to any workforce reductions, there aren't any workforce reductions planned right now. Usually, when we have -- when you look at that GAAP to non-GAAP, we just have a placeholder for potential workforce reductions there or potential restructuring charges. But there isn't anything that's related specifically to any headcount cuts.

關於裁員，目前沒有任何裁員計畫。通常，當我們查看公認會計原則和非公認會計原則時，我們只是為潛在的勞動力削減或潛在的重組費用提供了一個佔位符。但沒有任何與裁員具體相關的內容。

Now we do have the cost reductions in '24 that we continue to see. So in Q1, for instance, we have some benefit from some cost reductions that we didn't see in Q1 of last year, but then we'll continue to be very disciplined about our P&L as we go forward in '24. So yes, so that's really the key driver in terms of our margin growth.

現在，我們確實在 24 年繼續看到成本降低。例如，在第一季度，我們從去年第一季沒有看到的一些成本削減中受益，但隨著我們在 24 年的前進，我們將繼續嚴格遵守損益表。是的，這確實是我們利潤成長的關鍵驅動力。

The next question will come from Lisa Gill of JPMorgan. (Operator Instructions)

下一個問題將由摩根大通的麗莎·吉爾提出。 （操作員說明）

You talked a lot about volume growth this morning, but I'm just curious on the price side. So if I go back to the last couple of quarters, you talked about stabilizing pricing with health plans. You talked earlier about health plan leakage and the opportunity there. So maybe can you put those 2 pieces together for us as we think about the growth for next year of how much is volume and how much of that is on the price side?

今天早上您談論了很多關於銷量成長的問題，但我只是對價格方面感到好奇。因此，如果我回到過去幾個季度，您談到了透過健康計劃來穩定價格。您之前談到了健康計劃洩露和那裡的機會。那麼，當我們考慮明年銷量的成長以及其中價格方面的成長時，您能否為我們將這兩部分放在一起？

Yes. So let me just recap '23 and then we'll get into '24. So in 2023, price, pure price, price per test, provided us a slight lift year-over-year, okay? So our base rev per req that we've reported was up 1.2% and price was a positive contributor towards that. Now going into 2024, we expect, again, price to be flat to slightly up for the year. We concluded all of the significant health plan renegotiations in '23. Obviously, there's a new tranche that always comes about 1/3 -- 25% to 33% renew every year, but we feel confident that prices will remain flat to slightly up as we enter 2024.

是的。讓我回顧一下 23 年，然後我們將進入 24 年。因此，到 2023 年，價格，純價格，每次測試的價格，使我們同比略有提升，好嗎？因此，我們報告的每個要求的基本轉速上漲了 1.2%，而價格對此做出了積極貢獻。現在進入 2024 年，我們再次預計今年價格將持平或小幅上漲。我們在 2023 年完成了所有重要的健康計畫重新談判。顯然，每年都會有大約 1/3 的新份額——25% 到 33% 更新，但我們相信，進入 2024 年，價格將保持持平或略有上漲。

The next question will come from Derik De Bruin of Bank of America.

下一個問題將由美國銀行的 Derik De Bruin 提出。

So changing track a little. Look, the LDT legislation looks like it's making more progress than it has. It's like, can you quantify what your exposure is to LDTs and sort of your thought process here? I mean you're -- introducing a bunch of new tests would qualify for that. So how do you think about incremental investments if that goes through? And would you discontinue tests there?

所以稍微改一下軌道。看，LDT 立法看起來比實際取得的進展要多。就像，你能量化你對 LDT 的接觸程度以及你的思考過程嗎？我的意思是，引入一系列新測試就可以滿足這項要求。那麼，如果這種情況發生，您如何看待增量投資？您會停止那裡的測試嗎？

And then as a follow-up, there's been some legal movement lately on the MRD space. There's been some litigation that's happened that has blocked some other players from the market. Does Haystack have freedom to operate as you sort of look at what's changed in the IP landscape on that? And how do you think about your IP portfolio on Haystack and being able to not get sued.

接下來，最近 MRD 領域出現了一些法律動向。發生的一些訴訟阻止了其他一些參與者進入市場。當你看看智慧財產權版圖發生了什麼變化時，Haystack 是否有營運自由？您如何看待 Haystack 上的知識產權組合併能夠不被起訴。

Yes. So let me address your second question first. We have no risk with respect to the IP on the underlying technology that we're using in Haystack. We feel very confident about it. Much of that IP comes out of John Hopkins University, and we're solid there. So no risk.

是的。那麼讓我先回答你的第二個問題。對於我們在 Haystack 中使用的底層技術的知識產權，我們沒有任何風險。我們對此感到非常有信心。大部分智慧財產權來自約翰霍普金斯大學，我們在那裡很穩固。所以沒有風險。

In terms of LDTs, I think we've said in the past, about 10% of our tests are considered LDTs. We'll wait to hear from the FDA in April what the final rule is, and then we'll make decisions as an industry from there. What I would tell you is that we do a significant amount of work for the pharmaceutical industry today, and we do a significant amount of work for international laboratories. Both of those require us to be ISO certified and when you're doing work for the pharmaceutical industry, especially for companion diagnostics, you're essentially operating already under FDA regulation. So it's not going to be anything radical that we don't know what we need to do. Will there be further investments and steps required to get all of our laboratories that do LDTs accredited? Yes, there will be. But it's not a heavy lift for Quest Diagnostics.

就 LDT 而言，我想我們過去說過，我們大約 10% 的測試被認為是 LDT。我們將等待四月份 FDA 的最終規則是什麼，然後我們將作為一個行業做出決定。我要告訴你的是，我們今天為製藥業做了大量的工作，也為國際實驗室做了大量的工作。這兩者都要求我們獲得 ISO 認證，當您在製藥業工作時，尤其是伴隨診斷，您基本上已經在 FDA 監管下運作。因此，如果我們不知道需要做什麼，這不會是任何激進的事情。是否需要進一步的投資和步驟才能使我們所有進行 LDT 的實驗室獲得認可？是的，會有的。但這對 Quest Diagnostics 來說並不是一個沉重的負擔。

(Operator Instructions) The next question will come from Andrew Brackmann of William Blair.

（操作員說明）下一個問題將來自威廉布萊爾的安德魯布拉克曼。

I want to go back to the Alzheimer's offerings and the investments that you're making there. Can you maybe just sort of talk at a high level about the opportunity that you see for that category. Should we sort of think about this market kind of ultimately looking something like oncology where you have screening, therapy selection, monitoring, et cetera? Or does it sort of take a different path for you guys?

我想回到阿茲海默症產品以及你們在那裡進行的投資。您能否從高層次談談您在該類別中看到的機會？我們是否應該考慮這個市場最終看起來像腫瘤學，有篩檢、治療選擇、監測等？或者你們會採取不同的道路嗎？

Yes. So thanks for the question. It's a great question. So first, I would say that there's just broader awareness of testing the options that are now available to both consumers and to physicians. In part, this is because of new therapeutics that have been introduced that has just created widespread awareness. As you know, the majority of testing today for Alzheimer's is conducted via PET CT, which are expensive $2,500 to $4,000 exams or CSF testing, cerebral spinal fluid, which is not an expensive lab test, however, the procedure to extract CFS out of the human body is an expensive procedure. And likewise, the total cost of that is roughly $1,000.

是的。謝謝你的提問。這是一個很好的問題。首先，我想說的是，人們對測試現在可供消費者和醫生使用的選項有了更廣泛的認識。部分原因是新療法的推出引起了廣泛的關注。如您所知，目前大多數阿茲海默症檢測都是透過PET CT 進行，該檢查的費用為2,500 至4,000 美元；或者是腦脊髓液檢測、腦脊髓液檢測，這不是一項昂貴的實驗室檢測，但是，從人體是一個昂貴的過程。同樣，總成本約為 1,000 美元。

We have brought up blood-based assays or ApoE, which is a genetic risk for Alzheimer's. We brought up a blood-based assay for what we call AB 42/40, which is generally considered the earliest indicator amyloid plaque, the earliest indicator of dementia and/or Alzheimer's onset. And then we brought up one of the two protein markers that are also involved, the tau markers. We brought up 181 and there's a second one, 217, that we will be bringing up later this year. That, in essence, completes our blood-based offering. And I think there's widespread consumer interest, widespread interest amongst primary care physicians. And we've had double-digit growth all year long in both our blood-based assays and CSF testing, and we expect that double-digit growth to continue on in 2024 and beyond.

我們提出了基於血液的檢測或 ApoE，這是阿茲海默症的遺傳風險。我們提出了一種基於血液的 AB 42/40 檢測方法，它通常被認為是澱粉樣斑塊的最早指標，也是癡呆症和/或阿茲海默症發病的最早指標。然後我們提出了也涉及的兩個蛋白質標記之一，即 tau 標記。我們提出了 181 個，還有第二個，217 個，我們將在今年稍後提出。從本質上講，這完成了我們的基於血液的產品。我認為消費者和初級保健醫生都有廣泛的興趣。我們的血液檢測和腦脊髓液檢測全年都實現了兩位數成長，我們預計 2024 年及以後將繼續保持兩位數成長。

The next question will come from Stephanie Davis of Barclays.

下一個問題將來自巴克萊銀行的史蒂芬妮戴維斯。

So I was hoping to dig in a little bit more on to the AI question you're having and discussions around the prepared remarks. Could you tell me just a little bit more about what you'll be investing into and how maybe the rollout of things of the AI job helper will help you guys out? And then I guess on a follow-up to that one, is it safe to assume that you'll have more IT investments as you develop some of these AI solutions that will then have more out year yield for your margin opportunity?

因此，我希望進一步深入探討您所提出的人工智慧問題以及圍繞準備好的評論進行的討論。您能否告訴我更多有關您將投資什麼的信息，以及人工智慧工作助理的推出將如何幫助您？然後我想，在這個問題的後續行動中，當你開發一些人工智慧解決方案時，你會擁有更多的IT 投資，這些解決方案將為你的利潤機會帶來更多的年收益率，是否可以安全地假設你會擁有更多的IT 投資？

Yes. So good question. The AI tool that we referred to with respect to our Clifton lab, is really -- it was a tool that we used to analyze workflow within several departments in the Clifton laboratory that actually looked at from fairly simple things like steps and movement between equipment, loading and unloading of certain racks, and we reviewed it and you find some really quick easy simplification efforts to adjust equipment, move equipment, to minimize the human content or labor involved in each one of these steps.

是的。好問題。我們在克利夫頓實驗室提到的人工智慧工具實際上是一種我們用來分析克利夫頓實驗室幾個部門內工作流程的工具，它實際上是從相當簡單的事情（例如設備之間的步驟和移動）來觀察的，某些機架的裝載和卸載，我們對其進行了審查，您會發現一些非常快速簡單的簡化工作來調整設備、移動設備，以最大程度地減少每個步驟中涉及的人力或勞動力。

More broadly, we've deployed AI in two critical areas. One is in microbiology. Microbiology, as you know, you grow things in a dish, you look at it under a microscope. But with one of our partners, we now -- we can take digital images of what's growing in the dish and the system actually reviews those images and makes the initial call of a negative or a positive. We still review the positives by eye, but it's a digital image as opposed to doing it under a microscope. But it's a much quicker read because the system has generally indicated -- the system has already indicated if it is positive.

更廣泛地說，我們在兩個關鍵領域部署了人工智慧。一是微生物學。微生物學，如你所知，你在培養皿中培養東西，你在顯微鏡下觀察它。但與我們的合作夥伴之一一起，我們現在可以拍攝培養皿中生長的植物的數位影像，系統實際上會審查這些影像並做出負面或正面的初步判斷。我們仍然透過肉眼觀察正面的情況，但它是數位影像，而不是在顯微鏡下進行的。但它的讀取速度要快得多，因為系統通常已經表明——系統已經表明它是否是積極的。

We're also in the process of deploying artificial intelligence and digitizing pathology. So as you know, pathology is generally read under a microscope. We're in the process of implementing digital systems that allow for one to read off of a monitor versus under a microscope. And once you've digitized that slide, you're now able to apply algorithms to, again, at least help with what we call region of interest, pointing out to the pathologist where they should look and inevitably helping the pathologists make the proper diagnosis.

我們也正在部署人工智慧和數位化病理學。如您所知，病理學通常是在顯微鏡下讀取的。我們正在實施數位系統，該系統允許人們在顯示器上而不是在顯微鏡下讀取數據。一旦您將幻燈片數位化，您現在就可以再次應用演算法，至少幫助我們所謂的興趣區域，向病理學家指出他們應該查看的位置，並不可避免地幫助病理學家做出正確的診斷。

And the last question for today's call will come from Eric Coldwell of Baird.

今天電話會議的最後一個問題將來自貝爾德 (Baird) 的 Eric Coldwell。

I have actually going to have a couple here. First, the -- I missed this, what was the M&A contribution to revenue growth in 2024 guidance?

我實際上打算在這裡有一對夫婦。首先，我錯過了這一點，併購對 2024 年指導營收成長的貢獻是多少？

So it's about 50 basis points right now is what's in the guide, Eric. And it really reflects, as we mentioned in the prepared remarks, the carryover that we have from the acquisitions that we did in '23, which is really NewYork-Presbyterian, the Steward Health Care, the Lenco acquisition that we signed. And really, that's it.

埃里克，指南中的內容目前約為 50 個基點。正如我們在準備好的演講中提到的那樣，它確實反映了我們在 23 年進行的收購中獲得的結轉，這實際上是紐約長老會醫院、Steward Health Care 以及我們簽署的 Lenco 收購。真的，就是這樣。

So if I take midpoint revenue guidance at $1.6 million, remove the COVID headwind, you get to about 3.5% on the base and then take out 50 bps from M&A, you're at 3% organic on the base.

因此，如果我採用 160 萬美元的中點收入指導，消除新冠疫情的不利因素，您的基礎增長率約為 3.5%，然後從併購中扣除 50 個基點，則有機增長率為 3%。

That's -- yes. That's correct.

那是——是的。這是正確的。

Okay. Second question, a higher mix of hospital reference testing, it sounds like. You talked about trends in hospital reference being above, plan being above long-term history. What kind of an impact does that have on gross margin in the quarter?

好的。第二個問題，聽起來像是醫院參考測試的更高組合。您談到醫院參考的趨勢高於上面，計劃高於長期歷史。這對本季的毛利率有何影響？

Yes. So in general, our reference testing, which is more LDT-like than it is the routine testing, as you know, Eric. In general, that carries a higher test margin, higher gross margin. And in general, right, we're not drawing specimens that are derived or taken in hospitals. So there's very little phlebotomy cost involved in reference work.

是的。所以總的來說，我們的參考測試比常規測試更像 LDT，正如你所知，Eric。一般來說，測試利潤率較高，毛利率也較高。一般來說，我們不會抽取在醫院取得或採集的標本。因此，參考工作中涉及的放血成本非常低。

So generally, the operating margin of our hospital-based tests are going to be higher than the average of the business. So that business did grow at a faster rate than our overall book of business, both in Q4 as well as for the total year. So it was good mix.

因此，總的來說，我們醫院檢測的營業利潤率將高於企業的平均水平。因此，無論是第四季還是全年，該業務的成長速度確實比我們的整體業務成長速度更快。所以這是很好的組合。

And that was our final question for today.

這是我們今天的最後一個問題。

All right. Well, thank you, everyone, for joining our call, and we look forward to further updates through the year. Everyone, have a great day.

好的。好的，謝謝大家加入我們的電話會議，我們期待今年的進一步更新。大家，祝你有美好的一天。

A replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at (203) 369-3391 for international callers or 800 934-9421 for domestic callers. Telephone replays will be available from approximately 10:30 a.m. Eastern Time on February 1, 2024, until midnight Eastern Time, February 15, 2024. Thank you for your participation, and you may now disconnect.

您可以透過 www.questdiagnostics.com/investor 在線查看通話重播，或撥打 (203) 369-3391（國際來電者）或 800 934-9421（國內來電者）。電話重播將於 2024 年 2 月 1 日東部時間上午 10:30 左右至 2024 年 2 月 15 日東部時間午夜進行。感謝您的參與，您現在可以斷開連接。