奎斯特診斷 (DGX) 2024 Q1 法說會逐字稿

Welcome to the Quest Diagnostics First Quarter 2024 Conference Call. At the request of the company, this call is being recorded. The entire contents of the call, including the presentation and the 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 2024 年第一季電話會議。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。

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

現在我想介紹一下 Quest Diagnostics 投資者關係副總裁 Shawn Bevec。先生，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.

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 consolidated 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。與我們的長期前景預測相關的成長率，包括綜合收入成長、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. In the first quarter, we delivered nearly 6% base business revenue growth, continuing the strong momentum of recent quarters. We also grew total revenues for the first time since the height of the pandemic nearly 3 years ago. Our strong commercial focus on physicians and hospitals, combined with our broad health plan access enabled us to take advantage of sustained high rates of health care utilization and drive new customer growth. Our investments in advanced diagnostics also enabled double-digit growth within multiple key clinical areas, including brain health, women's health and advanced cardiometabolic health.

謝謝肖恩，大家早安。第一季度，我們實現了近 6% 的基礎業務收入成長，延續了最近幾季的強勁勢頭。自近三年前疫情最嚴重時期以來，我們的總收入首次出現成長。我們對醫生和醫院的強烈商業關注，加上我們廣泛的健康計劃覆蓋範圍，使我們能夠利用持續的高醫療保健利用率並推動新客戶的成長。我們對先進診斷技術的投資也實現了多個關鍵臨床領域的兩位數成長，包括大腦健康、女性健康和先進的心臟代謝健康。

In addition, our Invigorate initiative, which includes ongoing investments in automation and AI continue to improve productivity as well as service levels and quality. Given the strength of our business, we are raising our guidance for the full year. Before turning to highlights on the quarter, I'd like to briefly discuss the FDA's proposed rule to regulate laboratory developed testing services. We still encourage the administration to withdraw the proposed rule and engage in advancing appropriate legislation that preserves the critical role of laboratory diagnostics.

此外，我們的 Invigorate 計劃包括對自動化和人工智慧的持續投資，不斷提高生產力以及服務水準和品質。鑑於我們業務的實力，我們正在提高全年的指導。在討論本季度的重點之前，我想簡要討論一下 FDA 擬議的監管實驗室開發的檢測服務的規則。我們仍然鼓勵政府撤銷擬議的規則，並參與推動適當的立法，以保留實驗室診斷的關鍵作用。

We are disappointed that the FDA continues to move forward with this regulation, which we believe, if enacted, will compromise patient access to critical lab testing, slow diagnostic innovation, and add unnecessary health care costs. We also believe that the rule raises serious legal issues, including that the FDA lacks the statutory authority to unilaterally regulate these services. While we will be prepared to comply with the rule, we will continue to work with our trade association ACLA on potential next steps.

我們對 FDA 繼續推進這項法規感到失望，我們認為，如果頒布該法規，將影響患者獲得關鍵實驗室檢測的機會，減緩診斷創新，並增加不必要的醫療保健成本。我們也認為，該規則引發了嚴重的法律問題，包括 FDA 缺乏單方面監管這些服務的法定權力。雖然我們準備遵守該規則，但我們將繼續與我們的貿易協會 ACLA 合作制定後續可能採取的措施。

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

現在我將回顧我們的策略並討論第一季的亮點。然後 Sam 將提供有關我們財務業績的詳細信息，並討論我們更新的 2024 年財務指引。

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 brain health and molecular genomics and oncology.

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整個客戶管道的成長，並專注於快速成長的臨床領域，包括大腦健康、分子基因組學和腫瘤學。

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 the strategic deployment of automation and AI to improve quality, service, efficiency and the workforce experience.

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、服務、效率和員工體驗。

Here are a few key updates on the progress we've made in each of these areas. In physician lab services, we delivered high single-digit base business revenue growth driven by sustained high health care utilization, overall market growth and share gains. This growth also reflects new customer wins and our strengthening relationships with physician practices of all sizes, including large multispecialty physician groups and those owned by large retailers. A significant driver of our success in the physician channel is our broad health plan access as approximately 90% of health plan members in the U.S. have access to laboratory services at Quest Diagnostics.

以下是我們在每個領域取得的進展的一些重要更新。在醫師實驗室服務方面，由於持續的高醫療保健利用率、整體市場成長和份額成長，我們實現了高個位數的基本業務收入成長。這種增長也反映了新客戶的贏得以及我們與各種規模的醫生診所的關係的加強，包括大型多專科醫生團體和大型零售商擁有的醫生團體。我們在醫生管道取得成功的一個重要推動力是我們廣泛的健康計劃訪問權限，因為美國大約 90% 的健康計劃會員可以使用 Quest Diagnostics 的實驗室服務。

Health plans value our size, scale and innovation. We partner closely with them to reduce laboratory costs through programs that redirect volume from hospital outreach labs and out-of-network labs, which often charge significantly higher prices than we do, raising health care costs for patients and employers.

健康計畫重視我們的規模、規模和創新。我們與他們密切合作，透過重新定向醫院外展實驗室和網路外實驗室的數量的計劃來降低實驗室成本，這些實驗室的價格通常比我們高得多，從而提高了患者和雇主的醫療保健成本。

We also remain disciplined in our pricing strategy as we increase our investments in improving the customer experience such as through digital platform enhancements and adjustments to frontline pay. As we highlighted previously, we successfully renegotiated our large health plan contracts that were up for renewal last year. In addition, more than 50% of our health plan revenues now have some type of value-based incentive.

我們也保持嚴格的定價策略，增加對改善客戶體驗的投資，例如透過增強數位平台和調整第一線薪酬。正如我們之前強調的那樣，我們成功地重新談判了去年需要續約的大型健康計劃合約。此外，我們超過 50% 的健康計畫收入現在都有某種基於價值的激勵措施。

In physician services, our recent acquisition of Lenco, an independent lab in New York also contributed to growth in the quarter. Our M&A pipeline continues to be robust, and we are making progress with several promising opportunities.

在醫生服務方面，我們最近收購了紐約的獨立實驗室 Lenco，也為本季的成長做出了貢獻。我們的併購管道繼續強勁，我們正在透過一些有希望的機會取得進展。

In hospital lab services, we grew base business revenues by mid-single digits. Hospital reference testing, in particular, continued to grow faster than pre-pandemic trends, maintaining the momentum from last year. Hospitals are sending us more reference testing largely because of our innovation, our quality and our value. They also face persistent challenges with staffing certain roles in specialized fields like histology, microbiology and cytotechnology which we can more easily fill with our talent and our technology.

在醫院實驗室服務方面，我們的基本業務收入實現了中個位數成長。尤其是醫院參考檢測的成長速度持續快於疫情前的趨勢，維持了去年的動能。醫院向我們發送更多參考測試主要是因為我們的創新、我們的品質和我們的價值。他們也面臨著在組織學、微生物學和細胞技術等專業領域擔任某些角色的持續挑戰，而我們可以更輕鬆地用我們的人才和技術來填補這些職位。

In general, as hospitals face both staffing and cost challenges they continue to reevaluate their lab strategies. Additionally, as the cost of capital continues to rise, some are revisiting their investment priorities and are directing more capital into other clinical areas that generate better returns. Quest provides hospitals with a range of ways to help optimize lab operations, whether through reference testing, savings and efficiencies through professional lab services or access to capital by selling their outreach programs. Many hospitals and health system leaders are approaching us with a heightened sense of urgency for help with their lab strategies. As a result, our pipeline of both PLS and outreach opportunities remains very strong.

一般來說，由於醫院面臨人員配備和成本挑戰，他們會繼續重新評估其實驗室策略。此外，隨著資金成本持續上升，一些公司正在重新審視其投資重點，並將更多資金投入其他能產生更好回報的臨床領域。 Quest 為醫院提供了一系列幫助優化實驗室運作的方法，無論是透過參考測試、透過專業實驗室服務節省和提高效率，還是透過銷售其外展項目來獲得資金。許多醫院和衛生系統的領導者都帶著高度的緊迫感向我們尋求幫助，以幫助他們制定實驗室策略。因此，我們的 PLS 和外展機會管道仍然非常強大。

Consumer initiated testing revenues grew double digits, while base business revenues nearly doubled, building on the gains that we delivered last year from our consumer-facing platform, questhealth.com. Some of our most popular test categories included general health panels, STDs and tuberculosis testing. We also continue to expand our test menu such as with our launch of PFAS testing for assessing potential exposure to dangerous forever chemicals and are extending our reach through various channel partners.

消費者發起的測試收入成長了兩位數，而基礎業務收入幾乎翻了一番，這是基於我們去年面向消費者的平台 questhealth.com 所取得的成果。我們最受歡迎的一些測試類別包括一般健康小組、性傳染病和結核病測試。我們也繼續擴大我們的測試菜單，例如推出 PFAS 測試來評估潛在的永久危險化學品暴露，並透過各種通路合作夥伴擴大我們的覆蓋範圍。

In advanced diagnostics, we generated strong double-digit revenue growth within several key clinical areas, including brain health, women's health particularly prenatal and hereditary genetics, and advanced cardiometabolic health. Growth in brain health was driven largely by our Alzheimer's disease portfolio of tests which includes our Quest AD-Detect blood test for early risk assessment of Alzheimer's disease and our CSF test for diagnosing and monitoring. We are launching our AD-Detect p-tau217 blood test to providers this week and we intend to add additional biomarkers this year to further expand our menu.

在先進診斷領域，我們在幾個關鍵臨床領域實現了強勁的兩位數收入成長，包括大腦健康、女性健康（特別是產前和遺傳遺傳學）以及先進的心臟代謝健康。大腦健康的成長主要是由我們的阿茲海默症測試組合推動的，其中包括用於阿茲海默症早期風險評估的 Quest AD-Detect 血液測試以及用於診斷和監測的 CSF 測試。我們將於本周向提供者推出 AD-Detect p-tau217 血液檢測，並打算今年添加更多生物標記物以進一步擴展我們的菜單。

In molecular genomics and oncology, we completed the validation of our Haystack MRD test in March and have oversubscribed our Haystack MRD early experience program with nearly 20 leading cancer institutions as participants. The early experience program is the final step to prepare for our broad national launch of the clinical test later this year.

在分子基因組學和腫瘤學領域，我們於 3 月完成了 Haystack MRD 測試的驗證，並超額認購了 Haystack MRD 早期體驗計劃，有近 20 家領先的癌症機構作為參與者。早期體驗計劃是為今年稍後在全國範圍內廣泛啟動臨床測試做準備的最後一步。

We are also excited about the opportunities in our early blood-based cancer screening. This quarter, our Louisville, Texas site received the first specimens for the PROMISE clinical trial on a liquid biopsy screening test for colorectal cancer from our partner Universal DX. We look forward to supporting Universal's efforts to gain U.S. regulatory approval for this test.

我們也對早期血液癌症篩檢的機會感到興奮。本季度，我們位於德克薩斯州路易斯維爾的工廠從我們的合作夥伴 Universal DX 處收到了用於結直腸癌液體活檢篩檢測試的 PROMISE 臨床試驗的第一批樣本。我們期待支持環球公司為這項測試獲得美國監管機構批准的努力。

And lastly, our STEP500 somatic tumor sequencing service, which helps providers select therapy for late-stage cancers based on tumor mutation profiles is generating interest from large cancer centers. Our investments in cancer screening, treatment selection and monitoring are positioning us to be a leader in the MRD space and other fast-growth molecular genomics and oncology markets.

最後，我們的 STEP500 體細胞腫瘤定序服務可協助提供者根據腫瘤突變譜選擇晚期癌症的治療方法，引起了大型癌症中心的興趣。我們在癌症篩檢、治療選擇和監測方面的投資使我們成為 MRD 領域以及其他快速成長的分子基因組學和腫瘤學市場的領導者。

Turning to operational excellence. Our Invigorate program aims to deliver a targeted 3% annual cost savings and productivity improvements. During the quarter, we continued to deploy automation and AI to improve productivity as well as service levels and quality. For instance, we made progress creating what we term a digital front door, which will use AI in our website and service center kiosks to answer basic questions from patients reducing workload on phlebotomists and calls to our customer service team.

轉向卓越營運。我們的 Invigorate 計劃旨在實現每年 3% 的成本節約和生產力提高的目標。本季度，我們繼續部署自動化和人工智慧，以提高生產力以及服務水準和品質。例如，我們在創建所謂的數位前門方面取得了進展，它將在我們的網站和服務中心資訊亭中使用人工智慧來回答患者的基本問題，從而減少抽血醫生的工作量以及致電我們的客戶服務團隊。

We also recently automated elements of the specimen preparation process in several labs and expect to deploy these systems across other sites in 2024. These systems make our front-end operations more efficient and improve quality while also freeing our employees to focus on other value-added work.

我們最近也在多個實驗室實現了樣本製備過程的自動化，並預計於2024 年在其他站點部署這些系統。其他增值工作工作。

Finally, I'd like to personally thank my Quest colleagues for delivering a superior customer experience. Our industry just celebrated Lab Week, which reminds us of the key role labs play at the heart of health care. I'm proud that our nearly 50,000 employees bring Quest purpose to life every day, working together to create a healthier world, one life at a time.

最後，我要親自感謝我的 Quest 同事提供了卓越的客戶體驗。我們的行業剛剛慶祝了實驗室週，這提醒我們實驗室在醫療保健的核心中發揮關鍵作用。我感到自豪的是，我們近 50,000 名員工每天都將 Quest 的目標融入生活，共同努力創造一個更健康的世界，一次一個人的生活。

And 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？

Thanks, Jim. In the first quarter, consolidated revenues were $2.37 billion, up 1.5% versus the prior year while base business revenues grew nearly 6%. Revenues for Diagnostic Information Services were up 1.7% compared to the prior year reflecting strong growth in our base testing revenues, partially offset by lower revenues from COVID-19 testing services. Total volume, measured by the number of requisitions, increased 1.6% versus the first quarter of 2023, with acquisitions contributing 60 basis points to total volume. Total base testing volumes grew 3.3% versus the prior year despite the impact of severe weather in the first 2 weeks of January. During the quarter, weather negatively impacted volume growth by approximately 30 basis points.

謝謝，吉姆。第一季度，綜合營收為 23.7 億美元，比上年成長 1.5%，基礎業務收入成長近 6%。診斷資訊服務的收入比上年增長 1.7%，反映出我們的基礎測試收入的強勁增長，但部分被 COVID-19 測試服務收入的下降所抵消。以請購數量衡量的總交易量較 2023 年第一季成長了 1.6%，其中收購對總交易量貢獻了 60 個基點。儘管 1 月前兩週受到惡劣天氣的影響，基礎測試總量仍較上年增長 3.3%。本季度，天氣對銷量成長產生了約 30 個基點的負面影響。

Revenue per requisition was up slightly versus the prior year, driven primarily by an increase in the number of test per req and favorable test mix largely offset by lower COVID-19 testing. Base business revenue per req was up 2.6% due to an increase in the number of test per req and favorable test mix. Unit price reimbursement was flat.

每份申請的收入較上年略有增長，這主要是由於每份申請的測試數量增加以及有利的測試組合在很大程度上被 COVID-19 測試的減少所抵消。由於每個請求的測試數量增加以及有利的測試組合，每個請求的基本業務收入增加了 2.6%。單價報銷持平。

Reported operating income in the first quarter was $300 million or 12.7% of revenues compared to $305 million or 13.1% of revenues last year. On an adjusted basis, operating income was $349 million or 14.8% of revenues compared to $350 million or 15% of revenues last year.

第一季報告的營業收入為 3 億美元，佔營收的 12.7%，而去年為 3.05 億美元，佔營收的 13.1%。調整後的營業收入為 3.49 億美元，佔營收的 14.8%，而去年為 3.5 億美元，佔營收的 15%。

Adjusted operating income was relatively consistent versus the prior year due to strong growth in the base business, largely offset by lower COVID-19 testing revenues, wage increases and higher benefit costs. Reported EPS was $1.72 in the quarter compared to $1.78 a year ago. Adjusted EPS was $2.04, flat versus the prior year.

由於基礎業務的強勁成長，調整後的營業收入與去年相對一致，但很大程度上被 COVID-19 檢測收入下降、工資上漲和福利成本上升所抵消。本季報告的每股收益為 1.72 美元，而去年同期為 1.78 美元。調整後每股收益為 2.04 美元，與去年持平。

Cash from operations was $154 million in the first quarter versus $94 million in the prior year. Subsequent to the end of the first quarter, we repaid $300 million of senior notes, which matured on April 1.

第一季營運現金為 1.54 億美元，而去年同期為 9,400 萬美元。第一季末後，我們償還了 3 億美元的優先票據，該票據於 4 月 1 日到期。

Turning to our updated full year 2024 guidance. Revenues are expected to be between $9.4 billion and $9.48 billion. Reported EPS is expected to be in a range of $7.57 to $7.82 and adjusted EPS to be in a range of $8.72 to $8.97. Cash from operations is expected to be approximately $1.3 billion, and capital expenditures are expected to be approximately $420 million.

轉向我們更新的 2024 年全年指引。收入預計在 94 億美元至 94.8 億美元之間。預計報告每股收益將在 7.57 美元至 7.82 美元之間，調整後每股收益將在 8.72 美元至 8.97 美元之間。營運現金預計約 13 億美元，資本支出預計約 4.2 億美元。

The following are some key assumptions underlying our guidance to consider as you update your models. COVID-19 testing revenues to decline approximately $175 million for the full year. In terms of M&A, our guidance only includes acquisitions that have been announced or closed to date. No change to our expectation for dilution from Haystack oncology of an incremental $0.20 to adjusted EPS for the full year.

以下是我們在更新模型時需要考慮的指南的一些關鍵假設。全年 COVID-19 檢測收入將減少約 1.75 億美元。在併購方面，我們的指導僅包括迄今已宣布或已完成的收購。我們對 Haystack 腫瘤學的稀釋預期不變，全年調整後每股盈餘將增加 0.20 美元。

Operating margin to expand for the full year, driven by volume growth and improved productivity. Net interest expense to be approximately $190 million. Weighted average share count to be flat compared to the end of 2023. While we are only 1 quarter into the year, given the strong volume trends in Q1, we have raised our adjusted EPS guidance by $0.10 at the midpoint, which more than offsets the $0.05 to $0.07 headwind we experienced from weather in January.

在產量成長和生產力提高的推動下，全年營業利潤率將擴大。淨利息支出約為 1.9 億美元。與2023 年底相比，加權平均股數將持平。 ，這足以抵消我們在一月份的天氣中經歷了 0.05 美元至 0.07 美元的逆風。

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, our business delivered strong revenue growth across our core customer channels, physicians, hospitals and consumers, building on trends from 2023. Our strong customer relationships, broad health plan access and investments in advanced diagnostics are enabling us to take advantage of sustained high health care utilization and drive new customer growth. We are steadily improving productivity as well as service levels and quality giving us confidence in improved profitability in 2024.

謝謝，山姆。總而言之，我們的業務在2023 年的趨勢基礎上，在核心客戶管道、醫生、醫院和消費者中實現了強勁的收入增長。我們能夠利用持續的高收入醫療保健利用並推動新客戶成長。我們正在穩步提高生產力、服務水準和質量，這讓我們對 2024 年獲利能力的提高充滿信心。

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) Our first question for today will come from Patrick Donnelly of Citi.

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

I want to focus on the margins, Sam. Obviously, a big story throughout last year. Nice to see them come in a little bit better than expected this quarter. Can you talk about the moving pieces? It sounds like Haystack was as expected in terms of the dilution for the year, you're kind of maintaining that expectation. But can you talk about the better performance this quarter and then expectations as we work our way through the year, the right way to think about the cadence there? I just want to make sure we have that metric kind of ironed out as we think about the progress as we work our way through '24 here.

我想專注於邊緣，山姆。顯然，這是去年的一個大故事。很高興看到他們本季的表現比預期要好一些。您能談談移動的部分嗎？聽起來 Haystack 在今年的稀釋度方面符合預期，你有點維持這種預期。但您能否談談本季更好的表現以及我們全年工作的預期，以及思考節奏的正確方法？我只是想確保我們在思考 24 年的進展時已經解決了這個指標。

Yes. Sure, Patrick, and good morning. So maybe the best way to look at it is think about it in terms of year-over-year, we were 14.8% operating margins in Q1 of this year compared to 15% last year. So some moving parts for you to consider and think about because you can look at this many different ways. But versus last year, obviously, a big headwind in terms of COVID, both in terms of volumes, but also price. We had $90 million less COVID this quarter versus last year same quarter at a much lower price as well because we were getting reimbursed at $100 price back then.

是的。當然，派崔克，早安。因此，也許最好的看待方式是從同比角度考慮，今年第一季我們的營業利潤率為 14.8%，而去年為 15%。因此，有些活動部分需要您考慮和思考，因為您可以透過多種不同的方式來看待這個問題。但與去年相比，顯然，新冠疫情在數量和價格上都面臨巨大的阻力。與去年同期相比，本季我們的新冠肺炎疫情減少了 9,000 萬美元，而且價格也低得多，因為當時我們以 100 美元的價格獲得報銷。

If you think about other smaller headwinds, I mean, Haystack, as you said, we still expect it to be $0.20 incremental dilution versus last year for the full year, but you saw that in Q1. But then offsetting these headwinds, the biggest one being COVID was base volume growth and productivity improvements. So we actually offset almost the majority of the COVID headwind through base improvement in terms of margins.

如果你考慮其他較小的阻力，我的意思是，Haystack，正如你所說，我們仍然預計全年的稀釋度將比去年增加 0.20 美元，但你在第一季就看到了這一點。但抵消這些不利因素後，新冠疫情帶來的最大阻力是基數成長和生產力提高。因此，我們實際上透過利潤率的基本改善抵消了幾乎大部分的新冠逆風。

The consumer initiated testing business also expanded operating margins as well. We continue to see great momentum in that business and good improvement in profitability. Our base gross margins actually improved quite significantly from Q1 of last year. So very encouraged by the start that we've had and the momentum that we see going forward.

消費者發起的測試業務也擴大了營業利潤。我們繼續看到該業務的強勁勢頭和盈利能力的良好改善。我們的基礎毛利率實際上比去年第一季有了顯著提高。我們已經擁有的開始和我們看到的前進勢頭讓我們深受鼓舞。

In terms of cadence, I think to answer your second question, it's, I'd say, normal seasonality that you would expect going forward. A step up in Q2 in terms of operating margins, maybe consistent operating margins to Q2 and Q3 and then a step down in Q4, which is, I would say, normal pre-COVID seasonality for us.

就節奏而言，我想回答你的第二個問題，我想說的是，你預計未來會出現正常的季節性。第二季的營業利潤率有所上升，可能與第二季和第三季的營業利潤率保持一致，然後第四季有所下降，我想說，這對我們來說是新冠疫情爆發前的正常季節性。

The next question will come from Ann Hynes of Mizuho Securities.

下一個問題將由瑞穗證券的安·海因斯提出。

Great. So you'd be consensus by 11% but only raised EPS by $0.01. I mean, I'm sorry, 1%. Can you tell us what Q1 came in versus your internal expectations? And should we view that differential as conservatism? Or is there something else we should consider as we model.

偉大的。因此，您的共識是 11%，但 EPS 只提高了 0.01 美元。我的意思是，對不起，1%。您能告訴我們第一季的情況與您的內部預期相比如何嗎？我們是否應該將這種差異視為保守主義？或者我們在建模時還應該考慮其他什麼。

So let me start, Ann. And thank you for the question, by the way. This is Sam. And Jim, if you want to add anything as well, by all means.

那麼就讓我開始吧，安。順便說一句，謝謝你提出這個問題。這是薩姆。吉姆，如果您還想添加任何內容，請務必添加。

We beat in Q1, both in terms of versus external expectations, but also versus our own internal expectations. So we came in better. We had called out at the beginning of the year on the Q4 earnings call that we expected a $0.05 to $0.07 headwind from weather in terms of EPS headwind from weather. And that was, at the time, driven by the fact that really the first 2 weeks, 3 weeks of January were quite tough for us in terms of utilization and in terms of weather. We offset a significant portion of that.

我們在第一季的表現超出了外部預期，也超出了我們自己的內部預期。所以我們表現得更好。我們在今年年初的第四季財報電話會議上曾表示，我們預計天氣因素對 EPS 的不利影響為 0.05 至 0.07 美元。當時，這是因為一月份的前兩週、三週對我們來說在利用率和天氣方面都非常困難。我們抵消了其中的很大一部分。

I mean you heard on the prepared remarks that we had a 30 basis point headwind impact as a result of weather. But really, we offset most of the headwinds in terms of the EPS impact. So the $0.05 to $0.07, largely we feel good that that's behind us, and that's essentially taken off the table. So we felt comfortable increasing our EPS by $0.10 at the midpoint.

我的意思是，您在準備好的發言中聽說，由於天氣原因，我們受到了 30 個基點的逆風影響。但實際上，我們抵銷了每股盈餘影響的大部分不利因素。因此，0.05 美元到 0.07 美元的價格，很大程度上我們感覺很好，因為這已經過去了，而且基本上已經從桌面上消失了。因此，我們放心地將每股收益中點增加 0.10 美元。

Now it's only -- we're only in the second quarter here. We still have 3 quarters to go. Utilization was really strong, especially base business utilization in the first quarter. We're expecting in the next 3 quarters that we go back to, I would say, more normal utilization, not what we saw in Q1. So that's what our EPS range is also driven by. But I would say very pleased with the beat that we had in Q1 and taking the weather headwind off the table.

現在只是——我們才進入第二季。我們還有 3 個季度的時間。利用率確實很高，尤其是第一季的基礎業務利用率。我想說，我們預計在接下來的三個季度中，我們將恢復到更正常的利用率，而不是我們在第一季看到的情況。這也是我們每股盈餘範圍的驅動因素。但我想說，我們對第一季的表現非常滿意，並且消除了天氣逆風。

Yes. The only thing I'd add, Ann, is that the volume growth was broad-based. We saw it across all physician channels, and we saw it in health systems as well. So it did beat our internal expectations. After a slow start in January, it came back very nicely in February and March, and we finished strong.

是的。安，我唯一要補充的是，銷量成長是廣泛的。我們在所有醫生管道中都看到了這一點，在衛生系統中也看到了這一點。所以它確實超出了我們的內部預期。經過一月份的緩慢開局後，二月和三月恢復得非常好，我們最終表現強勁。

The next question comes from Kevin Caliendo of UBS.

下一個問題來自瑞銀集團的 Kevin Caliendo。

So I wanted to ask a little bit about LDT. I'm sure you were hoping that the ruling was going to come out before you reported so that you can actually address it. But maybe talk a little bit now that you've had some time to go over the initial proposal and maybe what you're expecting in the final proposal, maybe can you let us know about the scope of the tests that you think are going to be included?

所以我想問一些關於LDT的事情。我相信您希望在您報告之前就可以做出裁決，以便您可以實際解決該問題。但也許現在您已經有一些時間來討論最初的提案，也許您對最終提案的期望是什麼，也許您可以讓我們知道您認為要進行的測試的範圍被包括在內？

And any sort of financial implications that you might have for fiscal '24, did it change the way you were guiding? Is there anything in the guidance for this and maybe how you think it plays out with regards to, are you going to try to get an injunction or anything like that through an ACLA.

您對 24 財年可能產生的任何財務影響，是否改變了您的指導方式？指南中對此有何說明，也許您認為它會如何發揮作用，您是否會嘗試透過 ACLA 獲得禁令或類似的東西。

Yes. So thanks, Kevin. So look, we don't know what the final rule is yet. We've all seen the proposed rule. It's largely follows 21 CFR Part A 20, which is the regulated device code. So we're preparing for it. But let me just tell you, look, we start with a strong quality management system and a very strong quality organization in Quest Diagnostics today. As you know, we follow the CLIA guidelines, CLIA was implemented in 1988. It's a very robust and guidelines that we follow. And we feel good about that.

是的。所以謝謝，凱文。所以看，我們還不知道最終規則是什麼。我們都已經看到了擬議的規則。它很大程度上遵循 21 CFR Part A 20，即受監管的設備代碼。所以我們正在為此做準備。但讓我告訴你，看，我們今天的 Quest Diagnostics 擁有強大的品質管理系統和非常強大的品質組織。如您所知，我們遵循 CLIA 指南，CLIA 於 1988 年實施。我們對此感覺很好。

I would also tell you that myself and many other people other from Quest Diagnostics come from regulated device manufacturing companies in the health care space. So we know what to do. We know how to do it. Certainly, there's gaps between what CLIA recommends and what 21 CFR recommends. And we'll address those gaps once we know what the final rule is. But we'll be prepared there's not going to be any impact on earnings or EPS here in 2024. As you know, the time frame laid out was a 3- to 4-year time frame. So we'll address this in a thoughtful way. We'll be prepared, and we've got the confidence and quality organization in place to do it.

我還要告訴您，我本人和 Quest Diagnostics 的其他許多人都來自醫療保健領域受監管的設備製造公司。所以我們知道該怎麼做。我們知道該怎麼做。當然，CLIA 的建議與 21 CFR 的建議之間存在差距。一旦我們知道最終規則是什麼，我們將解決這些差距。但我們會做好準備，2024 年的收益或每股盈餘不會受到任何影響。因此，我們將以深思熟慮的方式解決這個問題。我們會做好準備，我們有信心和高品質的組織來做到這一點。

The next question will come from Brian Tanquilut of Jefferies.

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

You've got Taji on for Brian. So first, just on the M&A contribution, obviously, called out 60 basis points contribution to total volume. Just curious, is the 50 basis point expectation for the full year contribution to revenues still stand?

你已經為布萊恩安排了塔吉。首先，就併購貢獻而言，顯然，它對總交易量的貢獻為 60 個基點。只是好奇，全年收入貢獻 50 個基點的預期是否仍然成立？

Well, if we don't do any other acquisitions this year, then yes, the 50 basis point trend will continue for the following quarters. But as we mentioned in the script, our funnel is good. It's robust. And we would expect to close some additional transactions this year. But timing is involved, and these things do take time. So, but we're cautiously optimistic.

好吧，如果我們今年不進行任何其他收購，那麼是的，50 個基點的趨勢將在接下來的幾個季度繼續下去。但正如我們在腳本中提到的，我們的管道很好。它很堅固。我們預計今年將完成一些額外的交易。但牽涉到時間，而這些事情確實需要時間。所以，但我們持謹慎樂觀的態度。

Yes. And just to be clear, our consistent approach is always going to be that we will include in the guidance that we provide only the things that have been announced and our carryover acquisition. So anything that we haven't announced will not be included in our guidance.

是的。需要明確的是，我們一貫的做法始終是，我們將只提供已宣布的內容和我們的結轉收購，將其納入指導中。因此，我們尚未宣布的任何內容都不會包含在我們的指南中。

So to Jim's point, if we do close any other transactions, we will include them in our guidance prospectively going forward.

因此，就吉姆的觀點而言，如果我們確實完成了任何其他交易，我們將把它們納入我們未來的指導中。

The next question will come from Erin Wright of Morgan Stanley.

下一個問題將由摩根士丹利的艾琳·賴特提出。

I wanted to ask on just the broader advanced diagnostics segment, how that's tracking relative to kind of internal expectations. You've made advances in areas like Alzheimer's, for instance, and obviously have the Haystack acquisition. And can you talk a little bit about potential holes in your offering that you see as opportunities? And then on the Haystack front? Just what's the next catalyst on that front?

我想詢問更廣泛的高階診斷領域，相對於內部預期的追蹤情況如何。例如，你們在阿茲海默症等領域取得了進展，顯然也收購了 Haystack。您能否談談您認為是機會的產品中潛在的漏洞？那麼乾草堆前線呢？這方面的下一個催化劑是什麼？

Yes. So from an advanced diagnostic standpoint, it certainly met and even exceeded our expectations here in the quarter. So let me talk about brain health first. The uptake of our AB 42/40 test, which is a blood-based test for amyloid plaque has again exceeded expectations. We're really, really pleased with how that test is doing. We announced yesterday in a press release that we've added p-tau217. We had already introduced p-tau181. So we feel like the brain health, blood-based portfolio is in great shape. As well, the CSF side of the portfolio that continues to do well as well.

是的。因此，從高級診斷的角度來看，它肯定達到甚至超出了我們本季的預期。那麼讓我先談談大腦健康。我們的 AB 42/40 測試（一種基於血液的澱粉樣斑塊測試）的使用率再次超出了預期。我們對測試的進展非常非常滿意。我們昨天在新聞稿中宣布我們增加了 p-tau217。我們已經引進了p-tau181。所以我們覺得以大腦健康、血液為基礎的投資組合狀況良好。此外，投資組合的 CSF 方面也持續表現良好。

On the women's health care side, prenatal genetics and carrier screening are doing very well. We continue to see double-digit growth there.

在婦女保健方面，產前遺傳學和攜帶者篩檢做得很好。我們繼續看到兩位數的成長。

With respect to Haystack, as you know, it's still pre-revenue. But we are about to embark on what we call our early experience program. We've said in the script that we were oversubscribed. We saw it somewhere between 15 and 20 partners to start the program with. And we filled that up a lot more quickly than we thought and had to cut it off at 20 customers.

如你所知，Haystack 仍處於獲利前階段。但我們即將開始所謂的早期體驗計劃。我們在劇本中已經說過，我們已經超額認購了。我們發現有 15 到 20 個合作夥伴可以啟動該計劃。我們填滿的速度比我們想像的要快得多，並且不得不在 20 個客戶處停止。

So we feel good about that. We're going to run that early experience program for the next several months, which will position us for a broader national launch later in the quarter. So feeling good about the contribution of advanced diagnostics across our portfolio of tests.

所以我們對此感覺良好。我們將在接下來的幾個月內運行該早期體驗計劃，這將使我們能夠在本季度晚些時候在全國範圍內進行更廣泛的發布。因此，我們對先進診斷在我們的測試組合中的貢獻感到滿意。

The next question will come from Michael Cherny of Leerink Partners.

下一個問題將由 Leerink Partners 的 Michael Cherny 提出。

Maybe, Sam, if I can turn back to the guidance, you talked about the dynamics of utilization and the expectation that it will be a slightly more normal environment. As you think about that, how does that factor into your expectations for organic volume not only on the total number, but also on mix and how that.

也許，薩姆，如果我可以回到指導，你談到了利用率的動態以及對這將是一個稍微更正常的環境的期望。當您思考這一點時，這如何影響您對有機數量的期望，不僅包括總數，還包括組合及其方式。

Mike, sorry, we kind of lost you for few seconds there. Can you please repeat the question because I missed a portion of it.

麥克，抱歉，我們有幾秒鐘失去了你。你能重複一下這個問題嗎，因為我錯過了一部分。

Is this better?

這是否更好？

Yes, this is much better. Thank you.

是的，這好多了。謝謝。

Okay. I'm trying to fix my headset. So just -- it's a question just on the dynamics, what's ingrained in the organic volume expectations is included both from a normalization of the market, but also a mix perspective and how that factors into your expectations for margin expansion? And where are the push and pull points that will allow you to make sure you hit the margin expansion versus areas that you could potentially fall short?

好的。我正在嘗試修理我的耳機。所以，這只是一個關於動態的問題，有機銷售預期中根深蒂固的內容既包括市場正常化的內容，也包括混合的角度，以及這如何影響您對利潤率擴張的預期？能夠確保利潤擴張而不是可能達不到目標的推動點和拉動點在哪裡？

Yes. I mean I can start and by all means, Jim, you can add some color as well.

是的。我的意思是我可以開始了，無論如何，吉姆，你也可以添加一些顏色。

I think as Jim talked about earlier, Mike, we've got some areas within advanced diagnostics that are growing in the double digits, which really helps us from growing some of the key tests that we have in that portfolio and also helps us from a profitability standpoint as well. But overall base volumes we grew 5 -- in revenues, 5.7%, grew less than that in volumes in Q1. Our expectation is that we're growing in the sort of close to mid-single digits, maybe slightly below that in terms of volumes, and that drives a lot of productivity and improvement in terms of our margins as we look forward.

我認為，正如吉姆早些時候談到的那樣，麥克，我們在高級診斷領域的一些領域正在以兩位數的速度增長，這確實有助於我們發展該產品組合中的一些關鍵測試，也有幫助於我們從獲利能力的角度也是如此。但整體基數成長了 5 倍——營收成長了 5.7%，低於第一季的銷量成長。我們的預期是，我們的成長速度接近中個位數，在銷售方面可能略低於這個數字，這將在我們的未來推動生產力和利潤率的大幅提高。

So both in terms of mix and some of these advanced diagnostics tests that we have, but also in terms of volume growth overall for the remaining 3 quarters, we expect that to drive an improvement in terms of productivity. Now remember, we are in the next 3 quarters, we're not assuming that we continue at the same level and same rate of whether you call it base revenue growth and maybe to some extent, based clinical volume growth.

因此，無論是在組合和我們擁有的一些先進診斷測試方面，還是在剩餘 3 個季度的整體銷售成長方面，我們預計這將推動生產力的提高。現在請記住，我們在接下來的三個季度中，我們不會假設我們繼續保持相同的水平和速度，無論您稱之為基礎收入增長，也許在某種程度上，基於臨床數量的增長。

We do expect that some of this excess utilization starts to come down and normalize. Maybe that's a conservative assumption, not sure. But at this point, we're more comfortable saying that it's going to be -- volume growth is going to be closer to that just slightly lower than mid-single digits.

我們確實預期這種過剩利用率會開始下降並恢復正常。也許這是一個保守的假設，不確定。但在這一點上，我們更放心地說，銷售成長將接近略低於中個位數的水平。

Jim, anything you would add there?

吉姆，你還有什麼要補充的嗎？

Yes. I would just say, look, the mix in the quarter was really good. On a total basis, so all in, even with COVID, we still had 10 basis points of growth from a rep-per-req standpoint, pricing relatively flat. So it suggests that test per req and test mix were really, really strong. And remember, that offset, as Sam said in the script, $90 million worth of COVID decline. COVID that last year was at $100 per test. So we completely offset that from a mix standpoint and still saw growth in rep-per-req. So really happy with the mix that we saw in the quarter.

是的。我只想說，看，本季的組合非常好。總的來說，即使有新冠疫情，從每項需求的重複次數來看，我們仍然有 10 個基點的成長，定價也相對穩定。因此，這表明按要求進行的測試和測試組合確實非常非常強大。請記住，正如薩姆在劇本中所說，這種抵消額是價值 9000 萬美元的新冠疫情下降。去年的新冠肺炎每次檢測費用為 100 美元。因此，從混合的角度來看，我們完全抵消了這一影響，並且仍然看到了每次請求的重複次數的增長。我們對本季看到的組合非常滿意。

Next question comes from Jack Meehan of Nephron Research.

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

Was hoping if you could unpack the core growth a little bit more. So nearly 6%. That was a 3% beat versus what I was looking for. Historically, the lab has been a pretty steady business, so it supposed to be like this is pretty notable. Can you just lay out the factors for why maybe outside of core utilization growth came in a lot stronger in the quarter? And any thoughts on share gains? Was that a dynamic?

希望你能更多地釋放核心成長。所以接近6%。這比我想要的要低 3%。從歷史上看，該實驗室一直是一項相當穩定的業務，所以它應該是非常引人注目的。您能否列出一些因素來解釋為什麼本季核心利用率之外的成長可能要強勁得多？對股票收益有什麼想法嗎？那是動態嗎？

Yes, I think it's all of the above, Jack. Certainly, the utilization remains strong, consistent with what we've seen in the last 3 or 4 quarters. But we also said that, yes, we think we're picking up share. We closed several large transactions with 2 integrated large physician groups in the quarter. Our core physician volume growth was strong. Our hospital reference growth was strong. Our PLS volume relatively strong in the quarter.

是的，我想以上都是，傑克。當然，利用率仍然強勁，與我們在過去三、四個季度看到的情況一致。但我們也說過，是的，我們認為我們的份額正在增加。本季我們與 2 個綜合性大型醫生集團完成了幾筆大型交易。我們的核心醫生數量增長強勁。我們醫院的參考成長強勁。本季我們的 PLS 銷量相對強勁。

So that suggests utilization in hospitals was also up. And our pathology business contributing as well to growth. So we see it across all physician types, all physician channels, retailers as well as these large physician groups. And it's a combination of utilization plus share gains.

這顯示醫院的利用率也有所上升。我們的病理學業務也為成長做出了貢獻。因此，我們在所有醫生類型、所有醫生管道、零售商以及這些大型醫生群體中都看到了這一點。它是利用率和份額收益的結合。

Yes. And Jack, this is Sam. I'll mention one other thing as well. If you're looking at overall base business growth, I mean the Quest Health consumer-initiated testing business as well was a very good strength and tailwind in the quarter. Basically, that base business, excluding COVID almost doubled in the quarter, so year-over-year.

是的。傑克，這是山姆。我還要提另一件事。如果您專注於整體基礎業務成長，我的意思是 Quest Health 消費者發起的測試業務也是本季度的一個非常好的優勢和推動力。基本上，不包括新冠疫情的基礎業務在本季幾乎翻了一番，與去年同期相比幾乎翻了一番。

The next question comes from Elizabeth Anderson of Evercore ISI.

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

Maybe a slight two-parter for me. In the first, just to pick up, Sam, you were just saying about the consumer business. Can you talk about when you sort of think about -- how you think about the margin progression of that like what your expectations are for that to get more towards the corporate average?

也許對我來說是輕微的兩方。首先，山姆，你剛剛提到了消費者業務。您能否談談您如何看待利潤率的成長，例如您對公司平均的期望是多少？

And then secondarily, could you just comment on the continued labor environment? How are you seeing sort of wages and turnover versus the prior quarter?

其次，您能否評論一下持續的勞動力環境？與上一季相比，您對薪資和營業額有何看法？

Yes. I'll address both. So the margins on our consumer business are consistent with the margins in the overall business. So it's right there. It's at the meeting for the company. And continue to improve all last year, and so we feel good about that.

是的。我將解決這兩個問題。因此，我們消費者業務的利潤率與整體業務的利潤率是一致的。所以它就在那裡。是在公司開會的時候。去年我們繼續進步，所以我們對此感覺良好。

In terms of the labor environment, we definitely saw a tick down in -- or a tick up, let's just say, and our retention rates not yet back to pre-COVID levels but below in the high teens, below the 20% threshold that we were running at last year. So we feel good about that. We saw a downward tick in logistics attrition, our specimen processing. It was across the board. All frontline jobs improved in the quarter, and we feel good about the direction that, that's moving in.

就勞動力環境而言，我們確實看到了下降——或者說是上升，我們的保留率尚未回到新冠疫情前的水平，但低於十幾歲，低於 20% 的門檻。所以我們對此感覺良好。我們看到物流消耗和樣本處理都在下降。這是全面的。本季所有第一線工作都有所改善，我們對目前的發展方向感到滿意。

The next question comes from Lisa Gill of JPMorgan.

下一個問題來自摩根大通的麗莎吉爾。

In your prepared comments, you talked about 50% of health plans now having some type of value-based care arrangement. Can you maybe just give us an example of what that looks like and talk about what that means to the margin?

在您準備好的評論中，您談到 50% 的健康計劃現在有某種類型的基於價值的護理安排。您能否給我們一個例子，並談談這對邊緣意味著什麼？

Yes. So we call it value-based incentives is what we're talking about here. And generally, there's two types. So one is related to acquisitions. So when we acquire an outreach book of business, and let's say, the health plan was paying that health system 200% to 300% of Medicare. It is not going to come down to the rates that we are contracted with that health line with on day 1. It will step down over time. So in fact, there's -- again, since it doesn't step right down to our rate, we're getting paid a higher price for that work over some period of time.

是的。所以我們稱之為基於價值的激勵，這就是我們在這裡討論的。一般來說，有兩種類型。其中之一與收購有關。因此，當我們獲得一份外展業務手冊時，假設健康計劃向該醫療系統支付 200% 到 300% 的 Medicare。它不會下降到我們在第一天與該健康線簽訂的合約的費率。所以事實上，同樣，由於它並沒有直接降低到我們的費率，因此我們在一段時間內為這項工作支付了更高的價格。

The second incentive types of broad-based or types of incentives are really related to volume movement. So movement of high-priced requisitions from health system laboratories or from out-of-network laboratories into Quest Diagnostics. And so it's -- in essence, it's -- you're getting paid for share gains at that health plan that are tied to share gains coming from moving those requisitions from, again, health systems and out-of-network labs. So really, those are the two types of value incentives that we get.

第二種廣泛的激勵類型或激勵類型實際上與交易量變動有關。因此，高價申請從衛生系統實驗室或網路外實驗室轉移到 Quest Diagnostics。因此，從本質上講，您透過該健康計劃的份額收益獲得報酬，這些收益與從衛生系統和網路外實驗室轉移這些申請而獲得的份額收益相關。事實上，這就是我們獲得的兩種價值誘因。

And Jim, just to confirm, there's no impact from the change cyberattack at all on Quest in the quarter.

Jim，只是想確認一下，本季的網路攻擊根本沒有對 Quest 造成任何影響。

No, less than 2% of our requisitions were ever moving through those pipes from an adjudication standpoint. They're somewhere between a $15 million and $20 million cash impact but no revenue impact in the quarter.

不，從裁決的角度來看，我們的請購單中只有不到 2% 曾經通過這些管道。它們對本季的現金影響介於 1500 萬美元到 2000 萬美元之間，但對收入沒有影響。

And just to be clear, the cash impact is really a delay, not necessarily any impact to revenue.

需要明確的是，現金影響其實是一種延遲，不一定對收入有任何影響。

Okay, great. Thanks for the comment.

好的，太好了。感謝您的評論。

The next question comes from Michael Ryskin of Bank of America.

下一個問題來自美國銀行的邁克爾·里斯金。

Congrats on the quarter. I want to follow up on an earlier point. You touched on the COVID headwind that you overcame in the quarter and just how to think about price for the rest of the year. So as you said, impressive that you saw revenue per requisition growth despite some of that headwind. How should we think about that through the rest of the year? I mean -- and again, that's kind of a two-parter in terms of COVID headwinds and basing as you go through the year and then the pricing benefit, you had some major health plan renegotiations that concluded last year. Is that what's driving some of that growth? And anything else in that arena that we should be thinking of for the rest of the year?

恭喜本季。我想跟進之前的一點。您談到了本季克服的新冠疫情逆風以及如何考慮今年剩餘時間的價格。正如您所說，令人印象深刻的是，儘管存在一些不利因素，但每個請購單的收入仍在增長。在今年剩下的時間裡我們該如何思考這個問題？我的意思是，再說一次，就新冠疫情的不利因素而言，這是一個兩方合作的局面，而且隨著這一年的發展，定價優勢也隨之而來，去年結束了一些重大健康計劃的重新談判。這是推動部分成長的原因嗎？在今年剩下的時間裡，我們還應該考慮這個領域的其他事情嗎？

Yes. So let me start, and then I'll let Sam make some comments.

是的。那麼讓我開始吧，然後我會讓 Sam 發表一些評論。

So remember, in the rev rec calculation, there's multiple moving parts here. The first one is pure price. We said it was flat in the quarter, and we expect it to be flattish for the rest of the year. We also said in the rev req calculation is test per req, and test per req, test mix and then payer mix. Test per req positive in the quarter. We expect that to continue. Test mix was favorable in the quarter, we expect that to continue. So all told, we like the trend that we saw in the first quarter. Now there's always puts and takes as we move through each quarter and we'll have to see how it plays out. But Sam, do you.

所以請記住，在轉速記錄計算中，這裡有多個移動部件。第一個是純價格。我們說過本季持平，我們預計今年剩餘時間也將持平。我們還說過，在 Rev Req 計算中，先是按要求進行測試，然後是按要求進行測試，然後是測試組合，然後是付款人組合。本季按要求進行的測試為陽性。我們預計這種情況會持續下去。本季的測試組合非常有利，我們預計這種情況將持續下去。總而言之，我們喜歡第一季看到的趨勢。現在，隨著每季的進行，總是會有一些變化，我們必須看看結果如何。但是山姆，你呢。

Yes. I mean I'll add maybe a couple of things. One, first of all, the COVID point, Michael, COVID not really material for the rest of the year. We said for the full year, it's going to be $175 million decline. We've had $90 million of that decline happen in Q1. So the biggest impact really was going to be felt in Q1. But yes, there is a price impact related to it given the fact that -- a small minor price impact actually because the price went down middle of May last year. So really, it's a minor price impact.

是的。我的意思是我可能會添加一些內容。首先，關於新冠肺炎的問題，邁克爾，新冠肺炎在今年剩下的時間裡並不重要。我們預計全年將減少 1.75 億美元。其中 9000 萬美元的下降發生在第一季。因此，最大的影響確實會在第一季感受到。但是，是的，確實存在與之相關的價格影響，因為事實上，價格影響很小，因為去年五月中旬價格下降了。所以實際上，這對價格影響很小。

And then just a little bit of color on the pricing dynamics. Jim, as Jim said, it's flattish for the full year in terms of price impact. if you look at the ingredients within that, the health plans, we expect them to be modestly up in terms of price. The health system is a negative impact in terms of price. Then we have some other businesses where we've had some price increases that helps. So overall, I think the net neutral in terms of price impact for the year.

然後稍微介紹一下定價動態。吉姆，正如吉姆所說，就價格影響而言，全年表現平平。如果你看看健康計畫中的成分，我們預期它們的價格會適度上漲。衛生系統在價格方面受到負面影響。然後我們還有一些其他業務，我們的價格上漲有所幫助。總的來說，我認為今年的價格影響是淨中性的。

(Operator Instructions) Our next question comes from Stephanie Davis of Barclays.

（操作員說明）我們的下一個問題來自巴克萊銀行的史蒂芬妮戴維斯。

Congrats on the quarter. You touched a bit on the automation opportunity in your centers in your prior remarks. So I was hoping you could help us tease out what the mix of the cost structure looks like in these centers. How should we think about phlebotomy talent that will be difficult to improve with AI solutions versus how much of that cost is more admin or front desk and could have that AI opportunity coming up?

恭喜本季。您在先前的演講中談到了您中心的自動化機會。所以我希望你能幫助我們弄清楚這些中心的成本結構組合是什麼樣的。我們應該如何考慮難以透過人工智慧解決方案提高的放血人才，以及其中有多少成本更多地用於管理或前台，並且可能會出現人工智慧機會？

Well, Stephanie, we've always said that about 50% of the cost structure in the company is wages, labor. And within the laboratories, it's obviously higher than that. Within phlebotomy, as you know, it's mostly a people expense, although there's supplies and rent for our patient service centers. I would say in the laboratories, much of the automation efforts continue in the specimen processing area, what we call sorting, aliquoting, pouring off tubes of urine and things like that. And that's where our automation efforts continue to pay dividends for us.

嗯，史蒂芬妮，我們總是說公司成本結構的 50% 左右是薪資和勞動力。而在實驗室內，它顯然比這個還要高。如您所知，在靜脈放血中，儘管我們的患者服務中心有物資和租金，但它主要是人員費用。我想說的是，在實驗室中，大部分自動化工作仍在樣本處理領域繼續進行，我們稱之為分類、等分、倒出尿液管等。這就是我們的自動化努力繼續為我們帶來獎金的地方。

On the phlebotomy side, as I mentioned, yes, it's a highly labor-intensive operation. Now in a typical 10 to 12 minutes draw time, there's still probably 5 to 6 minutes of that time doing manual paperwork, computer entry type of stuff. The biggest opportunity there to improve that is still the movement from paper requisitions to electronic requisitions. What still comes into our patient service center today is 35% to 45% paper that we end up having to input that information into our Quest system.

在放血方面，正如我所提到的，是的，這是一項高度勞力密集的操作。現在，在典型的 10 到 12 分鐘繪圖時間中，可能仍然有 5 到 6 分鐘的時間進行手動文書工作、電腦輸入類型的工作。改進這一點的最大機會仍然是從紙本請購單轉向電子請購單。今天進入我們的患者服務中心的仍然有 35% 到 45% 的紙張，我們最終必須將這些資訊輸入到我們的 Quest 系統中。

So we work back through the physician offices that send us that paper and try to convert that. I would tell you also, we're working on some other hits that could allow for some self-draw. So these are early stages, early stage development. But we continue to work on some other things that should make our phlebotomy staff even more productive.

因此，我們透過向我們發送該文件的醫生辦公室進行回溯，並嘗試將其轉換。我還要告訴你，我們正在開發其他一些可以允許一些自畫的熱門作品。所以這些都是早期階段，早期發展階段。但我們繼續致力於其他一些事情，這些事情應該可以提高我們的靜脈放血人員的工作效率。

And our final question today will come from Andrew Brackmann of William Blair.

今天我們的最後一個問題將來自威廉布萊爾的安德魯布拉克曼。

Maybe just following up on some of the questions related to advanced diagnostics from earlier. I guess it's been about a year since you guys announced that Haystack acquisition. So can you maybe just talk about how your views on the MRD segment or that asset in particular, may have evolved since then? And I know you mentioned no change in dilution or spending related to it this year, but how should we be thinking about potential additional investments here in the future to drive some of those share wins?

也許只是跟進之前與高級診斷相關的一些問題。我猜你們宣布收購 Haystack 已經過了一年。那麼，您能否談談您對 MRD 細分市場或特別是該資產的看法從那時起可能發生了怎樣的變化？我知道你提到今年稀釋或與之相關的支出沒有變化，但我們應該如何考慮未來潛在的額外投資以推動其中一些份額的成長？

Yes. Well, our -- Andrew, our thesis hasn't changed at all on the Haystack acquisition. The MRD market continues to grow by our estimates, strong double digits. I mean there's one primary competitor in that space today that is doing very, very well with the test and making inroads in the market, and we applaud them, and they're doing terrific. So we think having a second, third credible offering in the marketplace that has a very, very good basis for competition, very strong and very low limits of detection. So feel good about that test. So it's -- we still feel great about the investment and where this market is going.

是的。好吧，我們的——安德魯，我們關於 Haystack 收購的論點根本沒有改變。根據我們的估計，MRD 市場將繼續以兩位數的強勁速度成長。我的意思是，如今該領域有一個主要競爭對手，在測試方面做得非常非常好，並在市場上取得了進展，我們為他們鼓掌，他們做得非常好。因此，我們認為市場上有第二、第三種可靠的產品，它們具有非常非常好的競爭基礎、非常強大且檢測極限非常低。所以對這次測試感覺良好。所以，我們仍然對這項投資和這個市場的發展方向感到滿意。

We're going to build on that. We've launched our STEP500 assay as well that allows cancer doctors, medical oncologists to get advice from a treatment planning, therapy planning standpoint. So we feel good about that.

我們將以此為基礎。我們也推出了 STEP500 檢測，讓癌症醫師、腫瘤內科醫生能夠從治療計畫、治療計畫的角度獲得建議。所以我們對此感覺良好。

We like -- by the way, on Haystack, it's a tumor-informed test. And again, we feel good about the technology. As we mentioned earlier, we've signed up 20 prelaunch customers for this early experience program. These are a broad-based set of customers from community-based oncologists to academic medical centers. So we like the mix of customers that have come to us right away for this. And once we wrap this early experience program up, we'll be launching on a national basis later this year.

順便說一句，我們喜歡 Haystack 上的腫瘤資訊測試。再說一次，我們對這項技術感覺很好。正如我們之前提到的，我們已經為這個早期體驗計畫簽了 20 個預發布客戶。這些客戶群範圍廣泛，從社區腫瘤學家到學術醫療中心。因此，我們喜歡立即來找我們的客戶群。一旦我們完成這個早期體驗計劃，我們將在今年稍後在全國推出。

And Andrew, just to add -- this is Sam, from a dilution standpoint. So our expectations this year have not changed. It's still in total, [35] to (inaudible) solution, which is $0.20 of incremental dilution versus last year. For next year, we expect less dilution from Haystack. So on a year-over-year basis, it's actually a tailwind. And then we expect to be basically to start being neutral to accretive as we look towards '26. So nothing has changed from a dilution or financial expectations, and we're really thrilled about the interest in the early experience program that Jim referenced.

安德魯補充一下——從稀釋的角度來看，這是山姆。所以我們今年的預期沒有改變。總的來說，[35] 到（聽不清楚）解決方案，與去年相比，稀釋增量為 0.20 美元。明年，我們預計 Haystack 的稀釋程度會減少。因此，與去年同期相比，這實際上是一種順風。然後，當我們展望 26 年時，我們預計基本上會開始從中性轉向增值。因此，稀釋或財務預期沒有任何變化，我們對吉姆提到的早期體驗計劃的興趣感到非常興奮。

And that was the final question.

這是最後一個問題。

All right. Thanks, operator, and thanks again for joining our call today. We really appreciate your continued support. Have a good day, everyone.

好的。謝謝接線員，再次感謝您今天加入我們的通話。我們非常感謝您持續的支持。祝大家有美好的一天。

Thank you for participating in the Quest Diagnostics First Quarter 2024 Conference Call. A transcript of 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) 369-0197 for international callers or (866) 363-1809 for domestic collars. Telephone replays will be available from approximately 10:30 Eastern Time on April 23, 2024, until midnight Eastern Time, May 7, 2024. Goodbye.

感謝您參加 Quest Diagnostics 2024 年第一季電話會議。本次電話會議的準備演講稿將於今天稍晚發佈在 Quest Diagnostics 網站 www.questdiagnostics.com 上。通話重播，也可透過 www.questdiagnostics.com/investor 線上查看通話重播，也可透過電話（國際電話撥打 (203) 369-0197 或國內電話撥打 (866) 363-1809）查看通話重播。電話重播將於 2024 年 4 月 23 日東部時間 10:30 左右開始，直至 2024 年 5 月 7 日東部時間午夜。