奎斯特診斷 (DGX) 2024 Q4 法說會逐字稿

Welcome to the Quest Diagnostics fourth-quarter and full-year 2024 conference call.

歡迎參加 Quest Diagnostics 2024 年第四季和全年電話會議。

At the request of the company, this call is being recorded.

應公司要求，我們正在錄音本次通話。

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.

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。

Any redistribution, retransmission or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited.

未經 Quest Diagnostics 書面同意，嚴禁以任何形式重新分發、重新傳播或重新廣播此通話。

I'd now like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics.

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

Sir, please go ahead.

先生，請說。

Thank you, and good morning.

謝謝，早安。

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

和我一起出席的還有我們的董事長、執行長兼總裁吉姆戴維斯 (Jim Davis)；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.

在本次電話會議中，我們可能會做出前瞻性陳述並討論非公認會計準則指標。

We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release.

我們在收益新聞稿中的表格中提供了非 GAAP 指標與可比較 GAAP 指標的對帳表。

Actual results may differ materially from those projected.

實際結果可能與預測結果有重大差異。

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.

可能影響 Quest Diagnostics 未來業績的風險和不確定因素包括但不限於我們最近的 10-K 表年度報告、隨後提交的 10-Q 表季度報告和 8 表當前報告中所述的風險和不確定因素。 -K。

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

對於本次電話會議，對報告每股收益的引用是指報告的稀釋每股收益，對調整後的每股收益的引用是指調整後的稀釋每股收益。

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.

與我們的長期展望預測相關的成長率，包括合併收入成長、收購收入成長、有機收入成長和調整後收益成長都是複合年增長率。

Now here is Jim Davis.

現在請聽吉姆戴維斯的發言。

Thanks, Shawn, and good morning, everyone.

謝謝，肖恩，大家早安。

In the fourth quarter, we delivered impressive revenue growth of nearly 15%, including approximately 5% organic growth while also improving our profitability.

在第四季度，我們的營收實現了近 15% 的驚人成長，其中包括約 5% 的有機成長，同時我們的獲利能力也提高了。

For the full year, we drove revenue growth of close to 7%, including approximately 3% organic growth.

全年，我們推動營收成長近 7%，其中有機成長約 3%。

In 2024, our team completed eight acquisitions, including LifeLabs in Canada and four hospital outreach lab businesses in the US.

2024 年，我們的團隊完成了八項收購，包括加拿大的 LifeLabs 和美國的四家醫院外展實驗室企業。

We also expanded our advanced diagnostics menu and drove sustained double-digit growth in several clinical areas during the year.

我們還擴展了先進的診斷菜單，並在年內實現了多個臨床領域的持續兩位數成長。

In addition, we attracted new business across the physician, hospital and consumer channels while also forming new relationships with health plans to extend our geographic reach.

此外，我們透過醫生、醫院和消費者管道吸引了新業務，同時也與健康計劃建立了新的關係，以擴大我們的地理覆蓋範圍。

Our investments in automation and AI delivered improvements in quality, customer experience and productivity during the quarter and throughout all of 2024, which helped us deliver on our annual 3% Invigorate savings and productivity targets.

我們在自動化和人工智慧方面的投資在本季度以及整個 2024 年帶來了品質、客戶體驗和生產力的提高，這幫助我們實現了年度 3% 的節約和生產力目標。

We also meaningfully improved employee retention as we strengthened our position as employer of choice.

我們在鞏固首選雇主地位的同時，也顯著提高了員工留任率。

This morning, we provided guidance for 2025 that reflects our confidence in the core strength of our business, continuing robust utilization and the momentum from acquisitions we completed in 2024.

今天上午，我們提供了 2025 年的指引，這反映了我們對業務核心實力、持續強勁的利用率以及 2024 年完成的收購勢頭的信心。

These dynamics position us favorably to accelerate revenue and earnings growth in 2025.

這些動態有利於我們到 2025 年加速收入和獲利成長。

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 2025.

現在，我將回顧我們的策略並討論第四季度的亮點，然後 Sam 將提供有關我們的財務業績的更多詳細資訊並談論我們對 2025 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.

我們推動成長的策略專注於提供滿足核心客戶（醫生、醫院和消費者）不斷變化的需求的解決方案。

We enable growth across our customer channels through advanced diagnostics with an intense focus on faster-growing clinical areas, including brain health, advanced cardiometabolic and molecular genomics and oncology.

我們透過先進的診斷技術促進客戶管道的成長，並專注於成長較快的臨床領域，包括大腦健康、先進的心臟代謝和分子基因組學以及腫瘤學。

In addition, acquisitions are a key growth driver with an emphasis on accretive outreach purchases as well as other independent labs.

此外，收購是成長的主要動力，重點是增值外展購買以及其他獨立實驗室。

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.

我們的策略還包括透過策略性地部署自動化和人工智慧來推動整個業務的營運改進，以提高品質、服務、效率和員工體驗。

Here are a few key updates on the progress we have made in these areas in the fourth quarter of 2024.

以下是我們在 2024 年第四季在這些領域取得的進展的一些重要更新。

Please note that my following comments are focused primarily on our US operations.

請注意，我的以下評論主要集中於我們的美國業務。

In physician lab services, we delivered high single-digit revenue growth driven primarily by strong organic growth and contributions from acquisitions in the US.

在醫生實驗室服務方面，我們實現了高個位數的收入成長，這主要得益於強勁的有機成長和來自美國收購的貢獻。

As a reminder, volumes from both hospital outreach and independent lab acquisitions originate in the physician offices.

需要提醒的是，醫院外展和獨立實驗室採購的數據都源自於醫生辦公室。

Last month, we closed our acquisition of the outreach lab business of University Hospitals in Ohio and completed the transition of the business in January.

上個月，我們完成了對俄亥俄州大學醫院外展實驗室業務的收購，並於一月份完成了業務轉型。

We expect to moderate our pace of acquisitions in 2025 as we focus on driving growth from productivity from transactions completed last year.

我們預計在 2025 年放慢收購步伐，因為我們將專注於透過去年完成的交易來推動生產力的成長。

In addition to acquisitions, other growth drivers in the quarter included new customer wins as well as growth among large physician groups and community health centers.

除收購之外，本季的其他成長動力還包括新客戶的贏得以及大型醫生團體和社區健康中心的成長。

We also saw a step-up in functional medicine testing as more people take an interest in prevention and wellness.

隨著越來越多的人對預防和保健產生興趣，我們也看到功能醫學測試的進步。

In the fourth quarter and full year, we benefited from robust utilization compared to historical rates.

在第四季度和全年，我們受益於與歷史水平相比強勁的利用率。

We also continue to see strong volume and revenue growth from Medicare Advantage Plans, which value our high-quality, low-cost testing for their narrow networks.

我們也繼續看到醫療保險優勢計劃 (Medicare Advantage Plans) 的銷售和收入強勁增長，這些計劃看重我們針對其窄帶網絡的高品質、低成本測試。

We are well positioned to benefit from these dynamics as we expand access to our health plan partnerships with Elevance Health and Sentara Health Plans, both of which took effect on January 1.

隨著我們擴大與 Elevance Health 和 Sentara Health Plans 的健康計劃合作夥伴關係（均於 1 月 1 日生效），我們完全有能力從這些動態中受益。

Today, we have access to more than 90% of the in-network lives in the US.

今天，我們可以接觸到美國90%以上的網路生活。

In hospital lab services, we grew revenues nearly 3% in the fourth quarter primarily due to solid continued demand for reference testing complemented by growth in professional lab services.

在醫院實驗室服務方面，我們第四季度的收入成長了近 3％，這主要得益於對參考測試的持續強勁需求以及專業實驗室服務的成長。

Hospitals continued to order a greater range of reference tests from our expanding advanced diagnostics menu rather than performing these tests in their own labs.

醫院繼續從我們不斷擴大的高級診斷菜單中訂購更廣泛的參考測試，而不是在自己的實驗室中進行這些測試。

By referring testing to us, hospitals are free from the pressures that come from performing specialized tests in-house, such as hiring skilled lab personnel and investing in expensive lab testing equipment.

透過向我們進行檢測，醫院可以免於內部進行專門檢測的壓力，例如僱用熟練的實驗室人員和投資昂貴的實驗室檢測設備。

In professional lab services, we completed three collaborations with health systems in Connecticut, New Jersey and Pennsylvania.

在專業實驗室服務方面，我們與康乃狄克州、新澤西州和賓州的健康系統完成了三項合作。

We expect to see modest contribution from these relationships in early 2025.

我們預計在 2025 年初看到這些關係帶來適度的貢獻。

Looking at 2025, we expect hospitals to continue to struggle with high wage and supply inflation, constrained access to capital, and keeping up to date with laboratory innovation.

展望 2025 年，我們預計醫院將繼續面臨高薪和供應通膨、資本取得受限以及跟上實驗室創新的困境。

At the same time, patients and payers want greater value from lab services.

同時，患者和付款人希望從實驗室服務中獲得更大的價值。

Hospitals increasingly recognize that Quest can improve access to innovative and cost-efficient lab services through reference testing, lab management and outreach lab acquisitions.

醫院越來越認識到，Quest 可以透過參考測試、實驗室管理和外展實驗室收購來改善獲得創新且經濟高效的實驗室服務的管道。

In consumer-initiated testing, our consumer-facing platform, questhealth.com, grew total revenues nearly 50% in the fourth quarter and approximately 40% for the full year to just over $60 million.

在消費者發起的測試中，我們面向消費者的平台 questhealth.com 第四季度的總收入增長了近 50%，全年增長了約 40%，達到略高於 6000 萬美元。

Together with revenue from our channel partners, consumer-initiated testing revenues grew to nearly $100 million in 2024.

加上來自通路合作夥伴的收入，消費者發起的測試收入將在 2024 年成長到近 1 億美元。

During the year, we also greatly expanded our questhealth.com offering to include 135 different tests to provide a comprehensive platform for serving today's increasingly health-minded consumers.

今年，我們也大幅擴展了 questhealth.com 的服務範圍，包括 135 種不同的測試，為服務當今越來越注重健康的消費者提供了一個全面的平台。

In advanced diagnostics, we experienced double-digit growth across several clinical areas in the fourth quarter, including in brain health, advanced cardiometabolic, autoimmune and women's health.

在先進的診斷領域，我們在第四季度的多個臨床領域都實現了兩位數的成長，包括大腦健康、先進的心臟代謝、自體免疫和婦女健康。

We generated strong growth in brain health, largely due to impressive demand for our AD-Detect blood test for assessing Alzheimer's disease risk.

我們在大腦健康領域取得了強勁成長，這主要歸功於市場對用於評估阿茲海默症風險的 AD-Detect 血液檢查的巨大需求。

We will continue to explore opportunities to extend our portfolio with new biomarkers that can help providers better assess Alzheimer's and other forms of dementia.

我們將繼續探索機會，透過新的生物標記擴展我們的產品組合，以幫助服務提供者更好地評估阿茲海默症和其他形式的癡呆症。

We also generated strong growth in areas of advanced cardiometabolic and autoimmune testing, and we expect these patterns to continue in 2025.

我們也在先進的心臟代謝和自體免疫測試領域取得了強勁成長，我們預計這種模式將在 2025 年繼續下去。

Our growth in women's health was driven largely by prenatal and hereditary genetic testing.

我們在女性健康方面的進步很大程度上得益於產前和遺傳基因檢測。

We were also pleased to see strong adoption of our self-collection option for testing of genital tract infections during the quarter.

我們也很高興地看到，本季我們的生殖道感染檢測自採集選項被廣泛採用。

In molecular genomics and oncology, we spent much of last year developing and validating our Haystack MRD blood test to aid in the early detection of minimal residual disease from solid tumor cancers.

在分子基因組學和腫瘤學方面，我們去年花了大量時間開發和驗證我們的 Haystack MRD 血液測試，以幫助早期發現實體腫瘤癌症中的微小殘留疾病。

We also engaged with approximately 75 leading academic health systems and community oncology centers in our Haystack MRD Early Experience Program and are pleased with the favorable feedback we received.

我們還在 Haystack MRD 早期體驗計劃中與大約 75 個領先的學術醫療系統和社區腫瘤中心進行了合作，並對收到的正面回饋感到滿意。

We are now transitioning these organizations to a commercial program and are focused on expanding utilization among medical oncologists.

我們現在正在將這些組織轉變為商業項目，並致力於擴大腫瘤醫學專家的使用率。

Turning to operational excellence.

轉向卓越營運。

Our Invigorate program delivered our targeted 3% annual cost savings and productivity improvements.

我們的 Invigorate 計劃實現了我們每年 3% 的成本節約和生產力提高的目標。

Here are some examples of how we're improving operations.

以下是我們如何改進營運的一些範例。

We pilot many of our automation and AI solutions at our laboratory in Clifton, New Jersey.

我們在新澤西州克利夫頓的實驗室試行了許多自動化和人工智慧解決方案。

During the fourth quarter, we developed and implemented a proprietary system in Clifton that automates labeling and test tube preparation for tuberculosis testing, eliminating manual intervention and improving quality.

第四季度，我們在克利夫頓開發並實施了一套專有系統，可自動完成結核病檢測的標籤和試管準備，從而消除人工幹預並提高品質。

In addition, we began testing an automated [accessioning] solution that speeds requisition processing.

此外，我們開始測試一種可加快採購申請處理速度的自動化[接收]解決方案。

Also in Clifton, we deployed a third-party AI solution that enhances parasitology screening by flagging likely positive specimens requiring closer human examination.

此外，在克利夫頓，我們部署了第三方人工智慧解決方案，透過標記可能需要進行更仔細的人工檢查的陽性樣本來加強寄生蟲學篩檢。

We plan to roll out these solutions to our other labs later in 2025.

我們計劃在 2025 年稍後將這些解決方案推廣到我們的其他實驗室。

Improving workforce engagement remains a major priority, and I'm pleased that our retention rates significantly improved across multiple job categories in 2024.

提高員工參與度仍然是我們的首要任務，我很高興看到 2024 年我們的多個工作類別的留任率顯著提高。

Now before I turn it over to Sam, I want to thank our more than 55,000 Quest and LifeLabs colleagues for delivering on our business imperatives last year.

現在，在將麥克風交給 Sam 之前，我想感謝我們 55,000 多名 Quest 和 LifeLabs 同事去年完成了我們的業務任務。

This amazing group of people is the engine behind our growth and the reason we entered 2025 strong, energized and ready to deliver on our purpose: working together to create a healthier world one life at a time.

這群了不起的人是我們成長的引擎，也是我們在進入 2025 年時強大、充滿活力並準備實現我們的目標的原因：共同努力，為每一個生命創造一個更健康的世界。

And now Sam will provide more details on our performance and 2025 guidance.

現在，Sam 將提供有關我們的業績和 2025 年指引的更多詳細資訊。

Sam?

山姆？

Thanks, Jim.

謝謝，吉姆。

In the fourth quarter, consolidated revenues were $2.62 billion, up 14.5% versus the prior year.

第四季，綜合營收為26.2億美元，較上年同期成長14.5%。

Consolidated organic revenues grew by 4.8%.

綜合有機收入成長4.8%。

Revenues for Diagnostic Information Services were up 15.1% compared to the prior year, reflecting the contributions from recent acquisitions, including LifeLabs, as well as growth in our key physician and hospital channels.

診斷資訊服務收入比去年增長了 15.1%，反映了包括 LifeLabs 在內的近期收購的貢獻以及我們主要醫生和醫院管道的成長。

Total volume measured by the number of requisitions increased 13.9% versus the fourth quarter of 2023 with organic volume growing by 0.6%.

以採購請求數量衡量的總量與 2023 年第四季相比增加了 13.9%，有機量增加了 0.6%。

During the quarter, weather negatively impacted volume by approximately 50 basis points.

本季度，天氣對銷量產生了約 50 個基點的負面影響。

Total revenue per requisition was up 0.2% versus the prior year, driven primarily by an increase in the number of tests per req and favorable test mix, mostly offset by the impact of the LifeLabs acquisition, which carries a lower revenue per requisition.

每項申請的總收入比上年增長了0.2%，主要原因是每項申請的測試數量增加以及測試組合有利，但大部分被收購LifeLabs 的影響所抵消，因為收購導致每項申請的收入較低。

On its organic basis, revenue per req was up 3.3% in the quarter versus last year.

從有機基礎來看，本季每筆訂單收入較去年同期成長了 3.3%。

Unit price reimbursement was relatively flat, consistent with our expectations.

單位價格報銷相對平穩，符合我們的預期。

Reported operating income in the fourth quarter was $361 million or 13.8% of revenues compared to $267 million or 11.7% of revenues last year.

第四季報告的營業收入為 3.61 億美元，佔營收的 13.8%，而去年同期為 2.67 億美元，佔營收的 11.7%。

On an adjusted basis, operating income was $409 million or 15.6% of revenues compared to $338 million or 14.8% of revenues last year.

經調整後，營業收入為 4.09 億美元，佔營收的 15.6%，而去年為 3.38 億美元，佔營收的 14.8%。

The increase in adjusted operating income was due to strong organic revenue growth and the impact of recent acquisitions, partially offset by the impact of weather, wage increases and higher performance-based compensation.

調整後營業收入的成長得益於強勁的有機收入成長和近期收購的影響，但被天氣、薪資上漲和更高的績效薪酬的影響部分抵消。

We estimate the impact of weather on operating margin to be approximately 30 basis points.

我們估計天氣對營業利益率的影響約為30個基點。

Reported EPS was $1.95 in the quarter compared to $1.70 a year ago.

本季報告的每股收益為 1.95 美元，去年同期為 1.70 美元。

Adjusted EPS was $2.23 versus $2.15 the prior year.

調整後每股收益為 2.23 美元，去年同期為 2.15 美元。

Adjusted EPS in the fourth quarter was impacted by higher interest expense and the higher tax rate versus the prior year.

第四季調整後的每股盈餘受到利息支出增加和稅率較上年同期上升的影響。

We estimate the EPS impact of weather to be approximately $0.06 in the quarter.

我們估計本季天氣對每股收益的影響約為 0.06 美元。

Cash from operations was $1.33 billion in the full-year 2024 versus $1.27 billion in the prior year.

2024 年全年營運現金流為 13.3 億美元，上年為 12.7 億美元。

Turning now to our full-year 2025 guidance.

現在來談談我們的 2025 年全年指引。

Revenues are expected to be between $10.7 billion and $10.85 billion.

預計收入在 107 億美元至 108.5 億美元之間。

Reported EPS expected to be in the range of $8.34 to $8.59 and adjusted EPS to be in the range of $9.55 to $9.80. Cash from operations is expected to be approximately $1.45 billion.

報告的每股收益預計在 8.34 美元至 8.59 美元之間，調整後的每股收益預計在 9.55 美元至 9.80 美元之間。預計經營活動現金流約 14.5 億美元。

And capital expenditures are expected to be approximately $500 million.

預計資本支出約5億美元。

We have posted a presentation on the Investor Relations page of our website that includes an adjusted EPS bridge, which shows some of the key elements to bridge from our 2024 adjusted EPS to the 2025 adjusted EPS guidance we shared today.

我們在網站的投資者關係頁面上發布了一份演示文稿，其中包括調整後的每股收益橋樑，其中展示了從2024 年調整後的每股收益到我們今天分享的2025 年調整後的每股收益指引的一些關鍵要素。

Our 2025 guidance reflects the following considerations.

我們的 2025 年指引反映了以下考量。

Our revenue guidance assumes approximately 3% organic revenue growth with the remainder coming from the acquisitions closed in 2024.

我們的營收指引假設有機收入成長約 3%，剩餘部分來自 2024 年完成的收購。

It does not assume any contribution from prospective M&A that could be completed in 2025.

它不假設 2025 年可能完成的未來併購帶來任何貢獻。

As you know, we absorbed the headwind last year related to the CrowdStrike IT outage, which we do not assume repeats in 2025.

如您所知，去年我們承受了與 CrowdStrike IT 中斷相關的不利影響，我們預計 2025 年不會再發生此類事件。

We expect to begin generating revenue from the launch of our Haystack MRD test in 2025 and continue to anticipate that Haystack Oncology will be slightly less dilutive versus the prior year.

我們預計將於 2025 年透過推出 Haystack MRD 測試開始產生收入，並繼續預計 Haystack Oncology 的稀釋度將比前一年略低。

We are making investments in 2025 to modernize our IT infrastructure as well as to comply with FDA regulations of laboratory developed tests that are scheduled to begin later this year.

我們將在 2025 年進行投資，以實現 IT 基礎設施的現代化，並遵守計劃於今年稍後開始實施的 FDA 關於實驗室開發測試的規定。

Operating margin is expected to expand versus the prior year.

預計營業利潤率將比前一年擴大。

We anticipate net interest expense to be approximately $275 million.

我們預計淨利息支出約為 2.75 億美元。

Adjusted tax rate is expected to be approximately 25%.

調整後的稅率預計約為25%。

And our average share count for the full year is expected to be approximately 114 million diluted shares outstanding.

預計全年平均流通股數約為 1.14 億股。

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

說完這些，我現在將話題轉回給吉姆。

Thanks, Sam.

謝謝，山姆。

To summarize, we delivered strong consolidated and organic revenue growth in the fourth quarter and the full year.

總而言之，我們在第四季度和全年實現了強勁的綜合和有機收入成長。

We expanded our presence in important new geographies, including Canada through eight acquisitions and new health plan relationships.

我們透過八次收購和新的健康計劃關係擴大了在包括加拿大在內的重要新地區的業務。

Our innovations in advanced diagnostics drove meaningful growth, and Haystack MRD strengthens our position in molecular genomics and oncology.

我們在先進診斷領域的創新推動了有意義的成長，而 Haystack MRD 增強了我們在分子基因組學和腫瘤學領域的地位。

Given these business strengths and robust utilization, we expect to accelerate revenue and earnings growth this year.

鑑於這些業務優勢和強勁的利用率，我們預計今年的營收和利潤將加速成長。

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

現在我們很樂意回答您的問題。

Operator?

操作員？

(Operator Instructions) Kevin Caliendo, UBS.

(操作員指示) Kevin Caliendo，瑞銀。

Just a question on guidance and some of the assumptions that are in there.

我只是想問一下關於指導和其中的一些假設。

I appreciate the earnings bridge.

我很欣賞獲利橋。

I guess, what I'm trying to understand a little bit is there's $20 million of additional investment spend for LDT and IT.

我想稍微理解一下，在 LDT 和 IT 方面還有 2000 萬美元的額外投資。

Are there any other one-timers in there?

這裡面還有其他一次性的東西嗎？

And specifically, do you expect core margins, not sort of comping out some of the other things that have happened, but you said margins expect to expand.

具體來說，您是否預期核心利潤率會擴大，而不是考慮到已經發生的其他一些事情。

Does the guidance assume that just that core margins will expand ex all of the sort of one-timers that we had from last year or the accretion from deals and things happening?

該指引是否假設核心利潤率將會擴大，扣除去年所有的一次性項目或交易和其他事件帶來的成長？

Want to understand that and weather.

想了解那和天氣。

If there's any weather built in from 1Q, whether it's the fires or the frozen tundra that we had to deal with?

如果從第一季開始出現任何天氣現象，那麼我們必須應付的是火災還是冰凍的苔原？

Very long one question, but thanks.

這個問題很長，不過還是謝謝您。

Yes.

是的。

Thanks, Kevin.

謝謝，凱文。

This is Sam.

這是薩姆。

Let me just give some comments on guidance to address your question.

讓我就解答您的問題提供一些指導意見。

First of all, the one-timers that you're asking about, they're all laid out in the bridge that we've included.

首先，您詢問的一次性事件都在我們所包含的橋樑中進行了佈局。

There are no additional one-timers that you should be adding in or taking out.

您無需添加或取出任何額外的一次性計時器。

The key things, I think, from a positive standpoint that we talked about in addition to the organic revenue growth and the M&A contribution is a benefit related to CrowdStrike, which obviously, we don't expect to repeat in '25.

我認為，從正面的角度來看，除了有機收入成長和併購貢獻之外，我們談到的關鍵因素是與 CrowdStrike 相關的好處，顯然，我們預計這種好處不會在 25 年重複出現。

We've got some benefit in terms of the Haystack reduced dilution, so some benefit year over year.

就 Haystack 減少稀釋而言，我們從中獲得了一些好處，因此逐年受益。

But then from an offset in terms of headwinds, we talked about the investments, and we can share some more comments on that and it really relates to the FDA LDT compliance investments to get us in compliance with that and to build up our regulatory capabilities in addition to some investments in terms of modernizing our systems and our IT systems and the lab information systems, and we can talk some more about that.

但是，從不利因素的角度看，我們談到了投資，我們可以就此分享更多評論，這確實與 FDA LDT 合規投資有關，以使我們遵守該規定並建立我們的監管能力除了在現代化系統、IT在系統和實驗室資訊系統方面進行一些投資之外，我們還可以就這些方面進行更多討論。

Interest expense.

利息支出。

We've talked about the fact that we had to fund the acquisitions that we took on, especially LifeLabs, that represents a $0.50 headwind.

我們已經討論過這樣一個事實，即我們必須為所進行的收購提供資金，尤其是 LifeLabs，這代表著 0.50 美元的逆風。

And then there are some other headwinds that are laid out there.

此外，還存在一些其他的不利因素。

In terms of weather, we have not built any specific, explicit assumption related to worse weather as a result of what we're seeing, but obviously we're monitoring Q1 and January closely because there have been some higher-than-expected weather disruptions, specifically the wildfires in California, specifically the freeze in the South and some of the snow that we've seen, also some lower temperatures in the Northeast and snow as well.

在天氣方面，我們還沒有根據目前的情況做出任何與惡劣天氣相關的具體、明確的假設，但顯然我們正在密切關注第一季和一月份的情況，因為出現了一些比預期更嚴重的天氣幹擾，特別是加州的山火，特別是南部的寒流和我們看到的一些降雪，還有東北部的氣溫下降和降雪。

So there are some of these.

有一些這樣的。

In terms of operating margin, we are expecting operating margin expansion in terms of what we report.

就營業利潤率而言，我們預期營業利潤率將會擴大。

You don't have to normalize or make adjustments to get to expanded operating margins.

您無需進行標準化或調整即可獲得擴大的營業利潤率。

We are expecting that our operating margin percentage, which finished at 15.6% in 2024, will expand in 2026 -- or in 2025, I should say.

我們預計，我們的營業利潤率（2024 年為 15.6%）將在 2026 年（或應該說是 2025 年）擴大。

Yes.

是的。

Kevin, let me just provide a little more color on the investments.

凱文，讓我再多介紹一下投資的情況。

So as Sam said, there's two parts to it.

正如 Sam 所說，它分為兩個部分。

One is in preparation for the FDA requirements.

一是為滿足FDA的要求做準備。

Now the first set of requirements go into effect on May 6 this year.

第一套要求將於今年 5 月 6 日生效。

And notably, we have to stand up a complaint handling unit and enable ourselves to report any, what we call, medical device reporting to the FDA.

值得注意的是，我們必須設立一個投訴處理部門，並且能夠向 FDA 報告任何所謂的醫療器材報告。

So that does require some investment.

所以這確實需要一些投資。

It requires some additional resources to do that.

這需要一些額外的資源。

So in part, that is what some of those investments are used for.

從某種程度上來說，這就是部分投資的用途。

The second and more substantial piece is, look, as you all know, this is a digital enterprise that we operate today from order intake, to our logistics systems, to how we operate the labs, to how we provide results through our MyQuest application and our entire billing system.

第二個也是更重要的部分是，大家知道，這是一個數位化企業，我們今天運營的從訂單接收到物流系統，再到我們如何運營實驗室，再到我們如何透過 MyQuest 應用程式提供結果，以及我們的整個計費系統。

We think about that as our entire order-to-cash spectrum of systems.

我們認為這是我們整個從訂單到現金的系統範圍。

And while we have been making investments from time to time, we need to make some more substantial investments this year and next year, and the benefits from those investments are certainly going to help us improve operations and improve the entire customer experience.

雖然我們不時進行投資，但今年和明年我們需要進行一些更實質的投資，這些投資帶來的收益肯定會幫助我們改善營運並改善整個客戶體驗。

So we're modernizing this IT infrastructure.

所以我們正在對這個 IT 基礎架構進行現代化改造。

We're going to migrate some of our current systems into cloud-based systems.

我們將把一些現有系統遷移到基於雲端的系統。

And over time, that's going to dramatically reduce the complexity, it's going to create more efficiencies between our labs and it's really, really going to improve the overall customer experience.

隨著時間的推移，這將大大降低複雜性，提高我們實驗室之間的效率，並且真正改善整體客戶體驗。

Ultimately, it's going to lower our IT costs, and there's going to be a good ROI on these investments.

最終，它將降低我們的 IT 成本，而這些投資將帶來良好的回報。

We're going to lay this out more at our Investor Day on March 19, but that's really what that $0.20 is being used for.

我們將在 3 月 19 日的投資者日上進一步闡述這一點，但這 0.20 美元的真實用途正是如此。

Patrick Donnelly, Citi.

花旗銀行的 Patrick Donnelly。

Sam, maybe one for you to start, just helpful to hear you talk about the margin expansion this year overall.

Sam，也許您可以先聽聽您談論今年整體的利潤率擴張情況，這很有幫助。

Can you just talk about the cadence?

能談談節奏嗎？

Anything to call out as the year progresses?

隨著時間的推移，有什麼需要注意的嗎？

I know LifeLabs starting lower margin, it's heading to corporate average at some point.

我知道 LifeLabs 的起始利潤率較低，最終會趨近於企業平均。

So maybe just talk through that, would be helpful.

所以也許只是談論這個問題，就會有所幫助。

And then, Jim, just quickly on utilization, obviously been elevated here.

然後，吉姆，只是很快地提高了利用率，顯然在這裡得到了提升。

What have you seen as you exited 4Q into this year and just the assumptions on utilization as we work our way through '25?

當您退出今年第四季時，您看到了什麼？

Yes.

是的。

Thanks, Patrick.

謝謝，派崔克。

So on margin, so yes, again, let me reiterate, we are expecting margin expansion this year versus 2024.

因此，就利潤率而言，是的，讓我再次重申，我們預計今年的利潤率將比 2024 年有所擴大。

I think the components that you see in the bridge that we laid out in the guidance, organic revenue growth approximately 3% at the midpoint, that's basically assumed that a contribution margin that comes in at roughly about 40%.

我認為，您在我們指引中列出的橋樑中看到的組成部分是，有機收入成長在中間點約為 3%，這基本上假設貢獻利潤率約為 40%。

Then you have the acquired revenue growth, which is roughly, let's call it, $0.70 at the midpoint is basically a combination of LifeLabs, which is the more significant piece because of the fact that we have three quarters in 2025 that we didn't have in 2024 or at least the better part of three quarters.

然後，您獲得了收入成長，大致可以稱之為中間值 0.70 美元，這基本上是 LifeLabs 的組合，這是更重要的部分，因為我們在 2025 年有三個季度沒有在2024 年或至少四分之三的大部分時間裡。

And that will come in at a margin rate, which is in the low double digits, so below our corporate average.

而利潤率將處於低兩位數水平，低於我們的企業平均水平。

I think you mentioned it, and you're right.

我想你提到過這一點，而且你是對的。

LifeLabs will start at a margin rate, which is low double digits, will ramp up over two to three years to get to our corporate average.

LifeLabs 起步時的利潤率低兩位數，並將在兩到三年內逐漸增加至我們的企業平均值。

But this year, it will be lower and it's a bit of a drag on the margin rate.

但今年，這一比例將會更低，這對利潤率將產生一定拖累。

But in terms of the other acquisitions, they come in at somewhere in the 35% to 40% contribution margin.

但就其他收購而言，它們的貢獻利潤率在35%到40%之間。

So all in that acquired revenue growth is probably coming in at the high-teens in terms of contribution margin.

因此，從貢獻利潤率來看，所有獲得的收入成長可能達到十幾歲的高水準。

Now you asked about the cadence.

現在您詢問的是節奏。

And I won't talk about margin rates, although it is a bit of a proxy in terms of how EPS will come in.

我不會談論利潤率，儘管它可以在一定程度上代表每股盈餘 (EPS) 的變化。

But I think the best way to talk about cycling is really go back to our pre-COVID averages in terms of what the cycling was by quarter.

但我認為談論騎行的最好方式是回到疫情之前的季度平均騎行水平。

And I'll just mention these just as a comparative point.

我提到這些只是為了作為一個比較點。

It doesn't necessarily mean that our cycling is going to be exactly that in 2025, but it's a good proxy.

這並不一定意味著到 2025 年我們的騎乘情況會完全一樣，但它是一個很好的指標。

And it's a good proxy for how margin rate also will be across the quarters.

它可以很好地代表各季度的利潤率變化。

But in terms of contribution from EPS, I would say roughly 22.5% is what we used to see pre-COVID in the first quarter, 26.5% in the second, 26% in the third and are approximately 25% in the fourth.

但就每股收益的貢獻而言，我認為第一季約為 22.5%，與新冠疫情之前持平，第二季為 26.5%，第三季為 26%，第四季約為 25%。

Now again, I'm not telling you this is what our cycling is in 2025, but it's directional and it's a good proxy for what you would expect close to cycling to be in 2025.

再說一次，我不是要告訴你 2025 年的自行車騎行情況，但它是有方向性的，並且可以很好地代表你所期望的 2025 年自行車騎行情況。

So that's what we used to see pre-COVID.

這就是我們在新冠疫情之前看到的情況。

Yes.

是的。

And then your question on utilization.

然後是關於利用率的問題。

Look, we're pleased with the utilization coming out of the fourth quarter.

看，我們對第四季的利用率感到滿意。

We look at it in many ways and across many segments.

我們從多個角度、多個角度來看這個問題。

In terms of overall req volume, we did have a slight weather impact in the quarter because of the hurricane early in Q4.

就整體需求量而言，由於第四季初的颶風，我們本季確實受到了輕微的天氣影響。

So that cost us probably 50 basis points.

所以這可能損失了我們 50 個基點。

And then we've been getting out of certain capitated business arrangements in California that were impacting -- it's just business we weren't making money on.

然後，我們退出了加州某些有影響的按人頭計費的業務安排——這些業務我們都沒能賺錢。

So we walked away from that, and that cost us a little volume.

因此我們放棄了這項計劃，但這也讓我們損失了一些銷售量。

But when we look at the volume in our core physician and hospital segment, the req volume from those segments was very, very strong in the quarter.

但當我們查看核心醫生和醫院部門的業務量時，我們會發現本季度這些部門的業務量非常非常強勁。

Now as Sam also mentioned, our rev per req organically, ex LifeLabs, was up 3.3% in the quarter.

正如 Sam 所提到的，我們的每筆有機收入（不包括 LifeLabs）在本季上漲了 3.3%。

And as you know, there's a lot of things that go into that rev per req calculation.

如您所知，有很多因素會影響每個請求轉速的計算。

The first thing we look at is price per test, that was relatively flat in the quarter.

我們首先看的是每次測試的價格，本季該價格相對持平。

But the second and biggest driver of that rev per req increase is test per req.

但是，每個請求速度增加的第二個也是最大的驅動因素是每個請求測試。

And that was probably two-thirds of the increase in the overall organic rev per req in the quarter.

這大概佔本季整體有機收入增幅的三分之二。

And so that's utilization as well.

這也是一種利用。

And what's driving it is some of the new tests that we've rolled out, the brain health, AB 42/40 and the tau markers, our advanced cardiometabolic testing.

推動這項進程的是我們推出的一些新測試，如大腦健康、AB 42/40 和 tau 標記物，以及我們先進的心臟代謝測試。

We're seeing big increases in things like Lp(a) and ApoB.

我們看到 Lp(a) 和 ApoB 等物質大幅增加。

Our autoimmune testing has been really propelling some of the test per req growth.

我們的自身免疫測試確實推動了一些測試需求的成長。

And then finally, I'd mention, we're seeing a nice uptick in volume from what we call functional health types of physicians.

最後，我想說的是，我們看到所謂的功能健康類型的醫生的數量呈現良好上升趨勢。

And as you probably know, they look at a lot of things and a lot of hormone testing and things like that.

您可能知道，他們會檢查很多東西，進行很多激素測試等等。

So the trends on test per req, the trends on volume in our core physician and hospital segment remain very, very strong.

因此，我們核心醫生和醫院部門的每次測試需求趨勢和數量趨勢仍然非常強勁。

Michael Cherny, Leerink Partners.

Leerink Partners 的 Michael Cherny。

Congratulations on a great quarter.

恭喜您本季取得優異成績。

Maybe if I can just pull a little bit that thread there on rev per req.

也許如果我可以按照要求在轉速上稍微拉一下那條線。

It's obviously a really strong year over the course of 2024.

顯然，2024 年將是真正強勁的一年。

As you think about that dynamic heading into '25 and beyond, how much of the continued technological advancements are the drivers of this versus payer arrangements and marketing?

當您思考 25 年及以後的動態時，與付款人安排和行銷相比，持續的技術進步在多大程度上是推動這一趨勢的因素？

And how should we think about this in terms of a long-term trajectory?

那麼從長期發展角度來看，我們該如何看待這個問題呢？

Okay.

好的。

So again, let's fast-forward into 2025, we'll start with price, price per test.

因此，讓我們再次快轉到 2025 年，我們從價格、每次測試的價格開始。

At this point in the year, it could probably swing between plus or minus 30 basis points, okay?

今年這個時候，它的波動幅度可能會在正負 30 個基點之間，好嗎？

There are still lots of contracts to negotiate as we go through the year.

今年我們仍有許多合約需要談判。

And the one segment that has been experiencing some price pressure is the hospital segment, in particular, reference testing.

而受到價格壓力的一個領域是醫院領域，特別是參考測試。

I think we've indicated on the past calls, during the entire COVID period from 2020 through 2023, hospitals really didn't go out to RFP for reference testing providers, right?

我認為我們在過去的電話會議中已經指出，在 2020 年至 2023 年的整個 COVID 期間，醫院實際上並沒有向 RFP 尋求參考檢測提供商，對嗎？

They were so busy with other things.

他們正忙著做其他事。

So we're seeing an uptick in RFPs and there's still price pressure in that segment.

因此，我們看到 RFP 數量有所上升，並且該領域仍然存在價格壓力。

So on par, though, look, we think it's again within a range of plus or minus 25 to 30 basis points.

因此，我們認為，相較之下，它再次處於正負 25 到 30 個基點的範圍內。

The test per req, we expect it to continue.

按照要求進行的測試，我們希望它能繼續下去。

We're still at the very early stages.

我們仍處於非常早期的階段。

So when I talk about incredible test growth on things like ApoB and LP(a) and the brain health portfolio, the overall volume of these tests is still relatively low.

因此，當我談到 ApoB 和 LP(a) 以及大腦健康組合等方面的驚人測試增長時，這些測試的總數仍然相對較低。

So we still think there's significant growth in these segments left.

因此我們仍然認為這些領域還有顯著的成長空間。

Autoimmune disorders is another one.

自體免疫疾病是另一種。

We're just seeing skyrocketing autoimmune disorders across the country.

我們看到全國各地自體免疫疾病發生率急劇上升。

So we expect those trends to continue.

因此我們預計這些趨勢將會持續下去。

The last thing that goes into it is payer mix.

最後要考慮的是付款人組合。

And I didn't mention, but in the fourth quarter, and we saw it all last year, our mix of Medicare, Medicare Advantage, that segment of our business has been growing faster than the rest of the business.

我沒有提到，但是在第四季度，我們看到去年我們的醫療保險、醫療保險優勢計劃組合，這部分業務的成長速度一直快於其他業務。

And so that is actually a good business mix because they're generally heavier reqs, they're more frequent reqs, and as you know, many Medicare beneficiaries have co-morbidities that just lead to more testing.

所以這實際上是一個很好的業務組合，因為它們通常有更重的要求，更頻繁的要求，而且如你所知，許多醫療保險受益人患有合併症，這需要進行更多的檢測。

So all of that is pretty favorable.

因此，所有這些都是非常有利的。

Maybe I can add just a couple of comments, Mike, from a financial standpoint.

麥克，也許我可以從財務的角度補充幾點評論。

In terms of if you look at the rev per req, in Q4, it was up 3.3% organically.

從每個請求收入來看，第四季其有機成長率為 3.3%。

If you break that down between the components that Jim talked about, two-thirds of that is really a benefit from test per req, which has been increasing continuously over the last number of quarters.

如果你將其分解到 Jim 談到的各個部分，其中三分之二實際上來自於按要求進行的測試，並且在過去幾個季度中，該數字一直在持續增加。

And then the other third benefit is really a combination of payer mix and test mix, test mix being some of the innovations that we have.

第三個好處實際上是付款人組合和測試組合的結合，測試組合是我們的一些創新。

Payer mix is just driven off of reimbursement and which payers were getting the contribution from the different payers.

付款人組合只是由報銷以及哪些付款人從不同的付款人那裡獲得貢獻決定的。

As we look towards 2025 or this year, test per req will continue to improve, although our expectation is that it will slow in terms of the improvement.

展望 2025 年或今年，按要求進行的測試將繼續改進，儘管我們預計改進速度會有所放緩。

So that improvement we don't expect it to be at the same pace that we've seen.

因此，我們預計這種改善不會以我們已經看到的速度進行。

I mean, we have been increasing quite substantially over a number of quarters.

我的意思是，我們在多個季度內一直保持著大幅成長。

And I wouldn't say we've peaked.

我不會說我們已經達到頂峰。

But definitely, that rate of improvement is not going to be at the same rate.

但可以肯定的是，改善的速度不會是一樣的。

So that's the only other comment that I would provide with regards to rev-req expectation in 2025.

所以這是我關於 2025 年 rev-req 預期的唯一其他評論。

Elizabeth Anderson, Evercore ISI.

伊麗莎白·安德森（Elizabeth Anderson），Evercore ISI。

This is Joanna for Elizabeth.

這是伊莉莎白的喬安娜。

Maybe go back to that $0.20 IT investment for '25.

也許會回到25年的那筆0.20美元的IT投資。

I think you guys said it's most related to the LDT regulation.

我認為你們說這與 LDT 法規最相關。

Is that expected to be a onetime investment or should we kind of expect to repeat in '26 and beyond?

這預計是一次性投資嗎，還是我們應該預計在 26 年及以後重複進行？

Yes.

是的。

First, we said on the $0.20, the majority of it will be on modernizing our IT infrastructure, but there is a portion in there that is for FDA readiness.

首先，我們說過，這 0.20 美元中的大部分將用於現代化我們的 IT 基礎設施，但其中有一部分用於 FDA 的準備。

Now it's difficult to tell what the future will be for that.

現在很難預測未來將會如何。

As you know, there's a lawsuit in front of the courts right now that ACLA and other trade associations brought and there'll be oral hearings on that lawsuit on February 19.

如您所知，目前法院正在審理由 ACLA 和其他行業協會提起的訴訟，並將於 2 月 19 日對該訴訟進行口頭聽證。

And we expect the case to likely be settled by the end of the first quarter or early second quarter.

我們預計該案件可能在第一季末或第二季初得到解決。

So depending on the outcome of that, if the outcome supports the FDA position, then yes, there'll be some continued investments.

因此，取決於結果，如果結果支持 FDA 的立場，那麼是的，將會繼續進行投資。

If the outcome favors our trade association, then those investments could certainly moderate.

如果結果對我們的行業協會有利，那麼這些投資肯定會減少。

Now remember, outside of what we're doing on the core clinical business to get ready, we do have segments in Quest Diagnostics that already operate under 21 CFR Part 820.

現在請記住，除了我們在核心臨床業務上所做的準備之外，Quest Diagnostics 中確實有一些部門已經按照 21 CFR Part 820 進行運作。

These are segments that serve our pharmaceutical industry customers, and so there'll continue to be some investments to improve those systems in readiness.

這些部門是為我們的製藥業客戶提供服務的，因此我們將繼續進行一些投資以改善這些系統的準備。

But look, a lot of the future investments related to the FDA will depend on the court case.

但是，許多與 FDA 相關的未來投資都將取決於法庭案件。

And then the other part of that $0.20 that you referenced is the IT investments that we're going to make that Jim talked about earlier, those investments will continue.

然後，您提到的那 0.20 美元的另一部分是 Jim 之前談到的我們將要進行的 IT 投資，這些投資將繼續進行。

We have investments to modernize our system.

我們進行了投資以實現我們的系統的現代化。

So we don't expect that to be just this year.

因此我們預計這不會只發生在今年。

However, we talked on the Q3 call about our long-term guide in terms of expecting high single-digit EPS over the long term and that we still -- we reaffirm.

不過，我們在第三季電話會議上談到了我們的長期指導方針，預計長期每股收益將達到高個位數，我們仍然重申這一點。

So those investments will continue, but they're part of our long-term guide expectation.

因此，這些投資將會持續，但它們是我們長期指導預期的一部分。

Luke Sergott, Barclays.

巴克萊銀行的盧克‧塞戈特 (Luke Sergott)。

This is Salem on for Luke Sergott.

這是 Luke Sergott 的薩勒姆 (Salem)。

Just to start off, could you guys provide a little more detail on what you expect the revenue contribution will be for the outreach lab services business acquisition you guys had with University Hospitals?

首先，你們能否提供一些細節，說明你們與大學醫院收購外展實驗室服務業務預計會帶來多少收入貢獻？

And then assuming you will get some benefit from the value-based contracts you have in place with payers, first, what's like the typical rate you get on top of your average reimbursement at the onset of these contracts?

然後假設您將從與付款人簽訂的基於價值的合約中獲得一些好處，首先，在這些合約開始時您在平均報銷金額之上獲得的典型費率是多少？

And how does that trend down in the next couple of years?

未來幾年這趨勢會如何？

And can we expect that kind of typical rate for this transaction?

我們能預期這筆交易的典型利率嗎？

Maybe I'll start with the University Hospital one, and Jim, if you want to talk about value-based compensation or incentives in general.

也許我應該從大學醫院開始，吉姆，如果你想談談基於價值的薪酬或一般激勵措施。

But in terms of University Hospital, we made this acquisition, we closed it at the end of the year.

但就大學醫院而言，我們進行了這項收購，並在年底完成了收購。

So right at the end of 2024.

所以就在 2024 年底。

It's an acquisition of roughly $180 million.

此次收購價值約1.8億美元。

We don't usually provide revenue per each of these outreach acquisitions.

我們通常不會為每一次外展收購提供收入。

So we're not going to provide exactly what the revenue is.

所以我們不會提供具體的收入金額。

But I'll give you a couple of points here to consider.

但我在這裡要給幾點給大家考慮。

Usually, there's a certain valuation that we pay for those acquisitions, which is somewhere around 3.5x of revenues.

通常，我們會為這些收購支付一定的估值，大約是營收的 3.5 倍。

That doesn't mean that's what University Hospital is, but there's a certain valuation we pay for these outreach acquisitions and this is a ballpark kind of number on average.

這並不意味著大學醫院就是這樣的，但是我們為這些外展收購支付了一定的估值，這是一個平均的大概數字。

And then the other piece that you need to consider is that this contribution from University Hospital is going to be in that acquired revenue growth bar that you see in the bridge that we have included on our website, and so it's part of that $0.65 to $0.75 contribution in terms of EPS from acquisitions.

然後你需要考慮的另一件事是，大學醫院的這筆貢獻將包含在我們在網站上提供的橋樑中看到的收購收入增長欄中，因此它是 0.65 美元到 0.75 美元的部分收購帶來的每股收益貢獻。

Now as I said before, LifeLabs is a healthy portion of that.

正如我之前所說，LifeLabs 是其中健康的一部分。

There's other carryover from outreach acquisitions that we made in '24 beyond just University, but that is included in that piece.

我們在 24 年進行的外展收購不僅包括大學，還帶來了其他成果，但這些都包含在那篇文章中。

Jim, did you want to give any comments on value-based incentives?

吉姆，你想對基於價值的激勵措施發表什麼評論嗎？

Yes.

是的。

From time to time, and we didn't really see any in the fourth quarter, but from time to time, we get value-based incentive payments that are tied to moving reqs from expensive health systems into Quest Diagnostics that generally helps the payer, obviously, and as importantly, it helps the employer and it helps the patient.

時不時地，我們在第四季度並沒有真正看到任何獎勵，但時不時地，我們會獲得基於價值的激勵付款，這些付款與將需求從昂貴的醫療系統轉移到Quest Diagnostics 有關，這通常會幫助付款人，顯然，同樣重要的是，它既幫助了雇主，也幫助了病人。

And so some of those incentives come at a 6-month period, some come after a 12-month period look-back, so they're hard to predict.

因此，有些激勵措施是在 6 個月內推出的，有些則是在 12 個月回顧期之後推出的，因此很難預測。

And again, we call them out generally in our quarterly results when they do occur.

並且，當這些情況確實發生時，我們一般會在季度業績中予以公佈。

Now the other way we do collect some of these incentives is when we make these outreach acquisitions.

現在，我們收集這些獎勵的另一種方式是我們進行這些外展收購。

And as you know, some of these health systems are getting 2x to 3x the rates that we're getting.

如您所知，一些醫療系統的收費是我們的 2 倍到 3 倍。

Over time, our rates don't just migrate exactly to Quest Diagnostics rates.

隨著時間的推移，我們的費率不會完全遷移到 Quest Diagnostics 費率。

They'll come down over a period of two to three years.

它們將在兩到三年的時間內消失。

And so there's, what I call, incremental pricing.

這就是我所說的增量定價。

So as we move it from a health system payer rate to a Quest Diagnostics payer rate, sometimes those come as bonus payments and sometimes it's just part of the overall pricing.

因此，當我們將其從醫療系統付款人費率轉變為 Quest Diagnostics 付款人費率時，有時這些是以獎金形式支付的，有時它只是整體定價的一部分。

Pito Chickering, Deutsche Bank.

德意志銀行的 Pito Chickering。

Looking at the competitive environment, you expanded access to several states in 2025 with two payers then lost one state.

看看競爭環境，你在 2025 年透過兩家付款人將服務擴展到了幾個州，然後又失去了一個州。

How do you see the landscape shaping up in 2025?

您認為 2025 年的情況將會如何？

And do you see more RFPs coming up this year that could result in more turnover sort of next year?

您是否認為今年將會出現更多 RFP，從而帶來明年更多的營業額？

It's just been a couple of years since we've seen sort of this much volatility with states turnover.

我們看到州政府更替出現如此大的波動僅僅是幾年的事了。

Yes.

是的。

So first of all, net-net, on all of the payer changes that came about in 2024, we're better off.

因此，首先，總體而言，對於 2024 年出現的所有付款人變化而言，我們的情況會更好。

So when we look at the lives that we picked up through Elevance in Colorado, Nevada, Virginia and we were not in network with some of the plans in Georgia, when we look at the lives that we pick up from Sentara and then we subtract the lives we lost in Alabama, we're better off by well more than 1 million lives.

因此，當我們查看透過科羅拉多州、內華達州和維吉尼亞州的 Elevance 獲得的生命時，我們並沒有加入喬治亞州的一些計劃，當我們查看從 Sentara 獲得的生命時，然後我們減去雖然我們在阿拉巴馬州失去了超過100 萬人的生命，但我們所獲得的利益卻比這多得多。

So our access in total has significantly improved as we enter 2025.

因此，當我們進入 2025 年時，我們的整體訪問能力將顯著提高。

In terms of agreements that we will negotiate here in 2025, look, as you know, the typical health plan contract is somewhere between three and five years.

就我們將在 2025 年進行談判的協議而言，如您所知，典型的健康計畫合約期限為三至五年。

So every year, we renew somewhere between 25% and 30% of health plan arrangements.

因此，每年我們都會更新25%到30%的健康計畫安排。

And this year, we'll be in that typical range.

今年，我們將處於這一典型範圍。

So more to come on that.

對此，我們也將進行更多探討。

But every year, we're renewing agreements in that magnitude and we're going to do it again this year.

但每年我們都會續簽如此規模的協議，今年我們也會再這樣做。

David Westenberg, Piper Sandler.

大衛‧韋斯滕伯格，派珀‧桑德勒。

So just on the acquisition and integration, I believe you completed -- my count is eight acquisitions in 2024, including big ones like LifeLabs, had a lot of inorganic growth.

因此，僅在收購和整合方面，我相信您就完成了 - 我的統計是，2024 年有 8 次收購，其中包括像 LifeLabs 這樣的大公司，實現了很大的無機增長。

How do you expect those acquisitions to enhance the revenue stream?

您預期這些收購將如何增強收入來源？

And how should we think about as they lap the organic revenue growth, would that actually accelerate?

我們應該如何看待他們實現有機收入成長，這實際上會加速嗎？

And just thinking about puts and takes on integration speed, what exactly do you have to do this year, given the amount of acquisitions you did in the last year?

僅考慮整合速度的利弊，考慮到您去年進行的收購數量，今年您到底要做什麼？

And what would make you go back to a little bit more aggressive acquisitions, just given the fact that there is a lot out there available to you.

考慮到市場上有大量可用資源，什麼會促使您採取更積極的收購行動？

Sorry, that was long.

抱歉，太長了。

Yes.

是的。

Sure.

當然。

So as Sam indicated in his comments, the 2025 revenue growth that is coming from acquisitions, carryover acquisitions, is about 6%.

正如 Sam 在評論中所指出的，來自收購、結轉收購的 2025 年營收成長約為 6%。

And as you know, we only carry that growth through the 12-month anniversary, okay?

而且正如你所知，我們只會在 12 個月的周年紀念日期間實現這種增長，好嗎？

So we closed LifeLabs in September of last year, it had five months of impact -- four months of impact last year.

因此，我們在去年 9 月關閉了 LifeLabs，這產生了五個月的影響——去年是四個月的影響。

And so we carry that through the first seven, eight months of this year.

因此，我們在今年前七、八個月一直堅持這項做法。

So in total, it's about 6 percentage points of our growth in 2025 and more than two-thirds of that is LifeLabs, okay?

所以總的來說，到 2025 年，我們的成長將達到約 6 個百分點，其中三分之二以上來自 LifeLabs，好嗎？

So we feel good about that.

因此我們對此感到很高興。

Now, yes, the team is hard at work at integrating these acquisitions and yet the funnel of opportunities remains strong.

現在，是的，團隊正在努力整合這些收購，但機會管道仍然強勁。

So we'll continue to assess the opportunities.

因此，我們將繼續評估這些機會。

We're not backing away from any.

我們不會退縮。

If it fits our criteria of we have great payer access in that market, if our share is very small in that market, then it becomes an attractive opportunity for us to look at.

如果它符合我們的標準，即我們在該市場擁有很好的付款人管道，如果我們的份額在該市場很小，那麼它對我們來說就成為一個有吸引力的機會。

So while we have a lot of work to do to integrate what we've got on our plate, we're not going to be shy about picking things up and going after things that improve our market access.

因此，儘管我們還有很多工作要做，以整合我們現有的資源，但我們會毫不猶豫地接受並努力改善我們的市場准入。

Maybe I can add just a couple of quick comments, Dave.

也許我可以補充幾點簡短的評論，戴夫。

You talked about sort of difficulty of integration and complexity of integration.

您談到了整合的難度和整合的複雜性。

And yes, there were a lot of acquisitions in 2024.

是的，2024 年有很多收購。

Now remember, LifeLabs is more of a stand-alone entity that's in Canada, it's an established company.

現在請記住，LifeLabs 更像是位於加拿大的獨立實體，它是一家成熟的公司。

They have labs that are established.

他們已經建立了實驗室。

There's a lot of things that they can learn from us, but we can learn from them as well.

他們可以從我們身上學到很多東西，但我們也可以向他們學習。

So I would say the integration is lighter there because they are already operating and we're not looking to close labs or move them to our systems at this point.

因此我想說那裡的整合更為輕鬆，因為它們已經在運行，我們目前不打算關閉實驗室或將它們轉移到我們的系統中。

So that's an easier integration.

因此這是一個更容易的整合。

And then you asked about sort of the cadence of M&A, what would it take to do more.

然後您詢問了併購的節奏，需要做些什麼才能做得更多。

Just keep in mind, I mean, it's not that we're not doing any more M&A in '25, we have not included in our guide any new M&A that has not been announced, but we do have in our capital plan, we have allocated certain capital for potential, what we call, tuck-in M&A.

請記住，我的意思是，這並不是說我們在 25 年不會再進行任何併購，我們的指南中沒有包括任何尚未宣布的新併購，但我們的資本計劃中確實有，我們有為潛在的、我們所說的「插入式併購」分配了一定的資本。

It's mostly focused on the hospital outreach lab acquisitions.

其主要專注於醫院外展實驗室的收購。

So we will do more M&A because these are very attractive opportunities that scale very quickly and get to a healthy contribution margin.

因此，我們將進行更多的併購，因為這些都是非常有吸引力的機會，可以快速擴大規模並實現健康的貢獻利潤率。

So I just want to make sure that people don't expect that we're not going to do any more M&A.

所以我只是想確保人們不會認為我們不會再進行任何併購。

Andrew Brackmann, William Blair.

安德魯布拉克曼、威廉布萊爾。

I wanted to ask on Haystack.

我想在 Haystack 上詢問。

First, can you maybe just sort of shed a little bit more light on any volume or reimbursement expectations for that asset in '25?

首先，您能否進一步說明 25 年該資產的數量或報銷預期？

But I guess, also a bigger picture here and way more important than '25, as you're moving these customers to those commercial programs, how should we be thinking about any additional pull-through or halo effect that having this asset now in the commercial phase should allow on the Oncology side of the business?

但我想，這裡還有一個更大的圖景，比25 年更重要，當你把這些客戶轉移到那些商業項目上時，我們應該如何考慮現在擁有這項資產所帶來的任何額外的拉動動作用或光環效應？

Yes.

是的。

Thanks, Andrew.

謝謝，安德魯。

So look, we're pleased with the progress that we've made with Haystack.

所以，我們對 Haystack 所取得的進展感到非常滿意。

As we mentioned in the comments, we served over 70 customers on a nonrevenue basis last year, a really nice mix of academic medical centers, community oncology.

正如我們在評論中提到的，去年我們以非營利的方式為超過 70 名客戶提供了服務，這些客戶是學術醫療中心和社區腫瘤學的完美組合。

And so the emphasis right now is on moving those customers into full commercial arrangements.

因此，目前的重點是讓這些客戶轉向全面的商業安排。

Now as we start, we're going to build.

現在我們開始動工，準備建造。

We're going to build Medicare.

我們將建立醫療保險。

We're going to build Medicare Advantage.

我們將建立醫療保險優勢計劃。

We expect denials to be high at the beginning, but you then fight those denials and you then begin the conversations with the appropriate MAC or the appropriate Medicare Advantage Plan around the goodness of the test and why it is important for patients.

我們預計一開始拒絕率會很高，但隨後您會對這些拒絕提出異議，然後開始與適當的 MAC 或適當的醫療保險優勢計劃討論測試的優點及其對患者的重要性。

And so we do expect, as Sam indicated, to get modest revenue from that business this year.

因此，正如 Sam 所說，我們確實預計今年將從該業務中獲得適度的收入。

Now you asked about other opportunities.

現在您詢問其他機會。

First, let me remind everyone.

首先我要提醒大家。

Look, oncology is a $1 billion business for Quest Diagnostics today.

你看，腫瘤學如今已經成為 Quest Diagnostics 價值 10 億美元的業務。

That includes some of our screening assays, that includes a very, very strong anatomical pathology business and it includes a very, very strong hematology business.

其中包括我們的一些篩選檢測，包括非常非常強大的解剖病理學業務，也包括非常非常強大的血液學業務。

So we actually expect to get pull-through of our MRD assay from the existing set of customers that we have, and we're already seeing that pay off.

因此，我們實際上期望從現有的客戶群中獲得 MRD 檢測的拉動，而且我們已經看到了回報。

In addition to an MRD assay, we have a therapy planning assay, our TSO 500 assay.

除了 MRD 檢測以外，我們還有治療計劃檢測，即 TSO 500 檢測。

And so we expect to get some benefits in that segment of our business as well.

因此我們希望也能從該業務領域獲得一些利益。

(Operator Instructions) Tycho Peterson, Jefferies.

（操作員指示） Tycho Peterson，Jefferies。

This is Noah on for Tycho.

這是 Noah 為 Tycho 所做的。

I wanted to ask about preventative screening, particularly with the [Braidwell] case going on.

我想詢問有關預防性篩檢的問題，特別是在 [Braidwell] 案件正在進行的情況下。

I was wondering how big your exposure is to preventative screening and if you have any assumptions on potential impact if USPSTF loses authority?

我想知道您對預防性篩檢的了解程度有多大，以及您對 USPSTF 失去權力後可能產生的影響有何假設？

I'm sorry.

對不起。

I mean, you mentioned that Braidwell kits?

我的意思是，您提到了 Braidwell 套件？

Case.

案件。

Yes.

是的。

You were cutting out a little bit there, so I'm not familiar with the case.

你剛才說得有點多了，所以我對這個案例不太熟悉。

Sam, I think you are.

山姆，我認為你是。

Okay.

好的。

So look, in general, there seems to be what I would call a shift in focus going on across the country.

所以，總體來說，似乎全國各地正在發生我所說的關注點的轉移。

And that shift in focus from taking -- of spending all our time and effort on sickness and curing disease to this shift towards what I would call prevention and wellness.

我們的關注點從花費所有的時間和精力治療疾病，轉向我所說的預防和保健。

And in general, we actually think that is a wonderful shift for the lab industry, right?

總的來說，我們確實認為這對實驗室產業來說是一個偉大的轉變，對嗎？

We strongly believe, it's tied to our purpose, that lab testing should be used early, early and often in order to ensure somebody is not moving from one morbidity to another morbidity.

我們堅信，這與我們的宗旨息息相關，應儘早、儘早並經常進行實驗室檢測，以確保某人不會從一種疾病轉變為另一種疾病。

And so we're excited by a lot of the work that's going on in functional medicine today because that focus is really on prevention and wellness.

因此，我們對當今功能醫學領域所進行的大量工作感到興奮，因為其重點實際上是預防和健康。

So we feel good about that, and we think those trends are going to help the lab industry.

所以我們對此感到高興，並且我們認為這些趨勢將有助於實驗室行業。

Jack Meehan, Nephron Research.

傑克‧米漢（Jack Meehan），腎元研究室。

Wanted to get -- not sure if this was addressed, I don't think it was -- but latest thoughts on Haystack.

想要得到 — — 不確定這是否已解決，我不認為已解決 — — 但關於 Haystack 的最新想法。

I know you talked about expecting to generate some initial revenue here.

我知道您談到期望在這裡產生一些初始收入。

But can you talk about expectations for clinical data updates we might be able to expect this year and just progress in terms of getting Medicare payment for the test?

但是，您能否談談我們今年可能期待的臨床數據更新，以及在獲得醫療保險支付測試方面的進展？

Yes.

是的。

Thanks, Jack.

謝謝，傑克。

So I could give you a few brief comments, but just [a priority], we went through this Early Experience Program for six to seven months during 2024.

因此我可以給你一些簡短的評論，但只是[優先事項]，我們在 2024 年進行了為期六到七個月的早期體驗計劃。

And so we gathered a lot of insights on our new assay.

因此，我們對我們的新分析方法收集了許多見解。

We gathered a lot of experience with close to [75] customers that touched academic medical centers as well as community oncology centers.

我們與近 [75] 位涉及學術醫療中心和社區腫瘤中心的客戶合作，累積了豐富的經驗。

So we're now in the process of moving those customers to full commercial arrangements which will include billing of Medicare and Medicare Advantage plans.

因此，我們現在正致力於讓這些客戶享受全面的商業服務，其中包括醫療保險和醫療保險優勢計劃的計費。

Like any new test, you start the billing process, you expect some denials, you respond to those denials in a very thoughtful way and you engage with the appropriate MAC as well as the Medicare Advantage Plans.

與任何新測試一樣，您開始計費流程，您預計會遇到一些拒絕，您以非常周到的方式回應這些拒絕，並且您與適當的 MAC 以及 Medicare Advantage 計劃進行接觸。

And so look, we have a ton of experience with this, as you know.

所以，正如你所知，我們在這方面擁有豐富的經驗。

Our broad reach into every Medicare Advantage Plan in the country, our health plan access, our relationships are all very positive.

我們與全國每項醫療保險優勢計劃的廣泛聯繫、我們的健康計劃訪問權限以及我們的關係都非常積極。

And so we will get revenue in this segment this year.

因此我們今年將從該部門獲得收入。

So in terms of new clinical studies, all I would say is stay tuned.

因此，就新的臨床研究而言，我只想說，請繼續關注。

Haystack for many, many years, even prior to ownership by Quest Diagnostics, had funded many clinical trials, some of which are coming near an end.

多年來，Haystack（甚至在被 Quest Diagnostics 收購之前）已經資助了許多臨床試驗，其中一些試驗已接近尾聲。

And we'll be able to publish, I think, some great results this year.

我認為，今年我們將會發表一些出色的成果。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

Just a bigger picture question as we head into kind of 2025 and how you think about how it's progressing in terms of market share gains versus underlying utilization, what's embedded in your expectations on that front.

當我們進入 2025 年時，這是一個更大的問題，您如何看待它在市場份額增長與潛在利用率方面的進展，您在這方面的期望是什麼。

I know you talked a little bit about the underlying environment.

我知道您談論了一些底層環境。

But I particularly want to know because is it accelerating in terms of the underlying market share gains that you're seeing as well?

但我特別想知道，因為就您所看到的潛在市場佔有率成長而言，它是否正在加速？

And then also, just lastly, if I can sneak one in there, on PAMA/SALSA regulatory environment.

最後，如果我可以偷偷地講一下 PAMA/SALSA 監管環境的話。

You spoke to LDT stuff, but any thoughts in terms of the change in kind of administration and how you're viewing your visibility into that?

您談到了 LDT 的事情，但對於管理方式的改變以及您如何看待這一點您有什麼看法嗎？

Yes.

是的。

So let me start with the latter question on PAMA.

那麼讓我先回答關於 PAMA 的後一個問題。

So as you know, the rate cuts did not go into place.

如你所知，降息並未實施。

So this was the fifth year that rates were left the same, and we feel good about that.

這是利率不變的第五年，我們對此感到滿意。

I would actually say there's going to be renewed focus on PAMA reform this year.

我實際上想說，今年我們將重新關注 PAMA 改革。

As you know, there's three committees that we generally work with.

如您所知，我們通常與三個委員會合作。

There's the Senate Finance Committee, the House Ways and Means Committee and the House Energy and Commerce Committee.

其中包括參議院財政委員會、眾議院籌款委員會以及眾議院能源和商業委員會。

Those three committees are really charged with all things health care in this country.

這三個委員會實際上負責這個國家的所有醫療保健事務。

So the committee -- in two of the three, there's new committee chair people.

因此，在三個委員會中，有兩個委員會更換了新委員會主席。

We know who they are.

我們知道他們是誰。

We've already had outreach to them.

我們已經與他們進行了聯繫。

And I would say, look, there is strong bipartisan support to actually solve it this year.

我想說，看，兩黨都大力支持今年真正解決這個問題。

So we're excited about the opportunity to get a final solution to PAMA as we work throughout 2025.

因此，我們很高興有機會在 2025 年獲得 PAMA 的最終解決方案。

I can tell you, it's the number one priority of our ACLA trade association and we've been hard at work since January 2 to get a solution in place.

我可以告訴你，這是我們 ACLA 貿易協會的首要任務，自 1 月 2 日以來我們一直在努力尋找解決方案。

So on the market share utilization question.

因此關於市場佔有率利用率的問題。

Look, I think, in general, for the independent labs, that all independent labs are making progress from a market share standpoint.

我認為，總體而言，對於獨立實驗室而言，從市場份額的角度來看，所有獨立實驗室都在取得進展。

What you see, the outreach acquisitions that we've done is a sign that hospitals are less focused on gathering that work in the communities and more focused on deploying their capital, their assets, their resources, their know-how to other parts of the health system operations.

您所看到的，我們所做的外展收購表明，醫院不再專注於在社區開展工作，而是更專注於將其資本、資產、資源和專業知識部署到衛生系統運作。

So I feel good about our prospects.

所以我對我們的前景充滿信心。

It was a share gain year.

這是股價上漲的一年。

And again, I just think we're seeing health systems pay less attention to that outreach book of business than they have in the past, and I think that's great signs for Quest Diagnostics as well as the independent lab industry.

而且，我認為我們看到醫療系統對外展業務的關注度比過去有所降低，我認為這對 Quest Diagnostics 以及獨立實驗室行業來說都是好兆頭。

That was our final question for today, sir.

先生，這是我們今天的最後一個問題。

Thank you for participating in Quest Diagnostics' fourth-quarter and full-year 2024 conference call.

感謝您參加 Quest Diagnostics 2024 年第四季和全年電話會議。

Thanks, everyone.

謝謝大家。

We appreciate you joining in, and look forward to seeing you all on March 19 at our Investor Day in New York City.

感謝您的加入，並期待在 3 月 19 日紐約投資者日上見到大家。

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 866-360-8701 for domestic callers or 203-369-0179 for international callers.

本次電話會議的準備好的發言記錄將於今天稍晚在 Quest Diagnostics 的網站 www.questdiagnostics.com 上發布。您可以透過網站 www.questdiagnostics.com/investor 在線收聽此電話會議的重播，或撥打 866-360-8701（國內來電者）或 203-369-0179（國際來電者）收聽。

Telephone replays will be available from approximately 10:30 AM Eastern Time on January 30, 2025, until midnight Eastern Time, February 13, 2025.

電話重播將於 2025 年 1 月 30 日東部時間上午 10:30 左右至 2025 年 2 月 13 日東部時間午夜提供。

Thank you, and goodbye.

謝謝你，再見。