Encompass Health Corp (EHC) 2023 Q3 法說會逐字稿

Good morning, everyone and welcome to Encompass Health's Third Quarter 2023 Earnings Conference Call. (Operator Instructions) Today's conference call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the call over to Mark Miller, Encompass Health's Chief Investor Relations Officer. Please go ahead.

大家早安，歡迎參加 Encompass Health 2023 年第三季財報電話會議。 （操作員指示）今天的電話會議正在錄音。如果您有任何異議，您可以此時斷開連接。我現在將把電話轉給 Encompass Health 首席投資者關係長 Mark Miller。請繼續。

Thank you, operator, and good morning, everyone. Thank you for joining Encompass Health's Third Quarter 2023 Earnings Call. Before we begin, if you do not already have a copy, the third quarter earnings release, supplemental information and related form 8-K filed with the SEC are available on our website at encompasshealth.com.

謝謝接線員，大家早安。感謝您參加 Encompass Health 的 2023 年第三季財報電話會議。在我們開始之前，如果您還沒有副本，可以在我們的網站 enconcepthealth.com 上取得向 SEC 提交的第三季收益發布、補充資訊和相關表格 8-K。

On Page 2 of the supplemental information, you will find the safe harbor statements, which are also set forth in greater detail on the last page of the earnings release.

在補充資料的第二頁上，您將找到安全港聲明，這些聲明也在收益發布的最後一頁上有更詳細的說明。

During the call, we will make forward-looking statements, which are subject to risks and uncertainties, many of which are beyond our control. Certain risks and uncertainties like those relating to regulatory developments as well as volume, bad debt and labor cost trends that could cause actual results to differ materially from our projections, estimates and expectations are discussed in the company's SEC filings included in the earnings release and related Form 8-K, the Form 10-K for the year ended December 31, 2022, and the Form 10-Q for the quarters ended March 31, 2023, June 30, 2023, and September 30, 2023, when filed.

在電話會議期間，我們將做出前瞻性陳述，這些陳述受到風險和不確定性的影響，其中許多風險和不確定性是我們無法控制的。某些風險和不確定性，例如與監管發展以及數量、壞帳和勞動成本趨勢相關的風險和不確定性，可能導致實際結果與我們的預測、估計和預期有重大差異，這些風險和不確定性在公司向SEC 提交的文件中進行了討論，這些文件包含在收益報告和相關文件中。提交時截至2022年12月31日的年度的表格8-K、表格10-K以及截至2023年3月31日、2023年6月30日和2023年9月30日的季度的表格10-Q。

We encourage you to read them. You are cautioned not to place undue reliance on the estimates, projections, guidance and other forward-looking information presented, which are based on current estimates of future events and speak only as of today. We do not undertake a duty to update these forward-looking statements. Our supplemental information and discussion on this call will include certain non-GAAP financial measures. For such measures, reconciliation to the most directly comparable GAAP measure is available at the end of the supplemental information at the end of the earnings release and as part of the Form 8-K filed yesterday with the SEC, all of which are available on our website.

我們鼓勵您閱讀它們。請注意，不要過度依賴所提供的估計、預測、指導和其他前瞻性信息，這些信息基於對未來事件的當前估計，並且僅代表今天的情況。我們不承擔更新這些前瞻性陳述的責任。我們在本次電話會議上的補充資訊和討論將包括某些非公認會計準則財務指標。對於此類衡量標準，可在收益發布結束時的補充資訊末尾以及昨天向SEC 提交的8-K 表格的一部分中找到與最直接可比的GAAP 衡量標準的對賬，所有這些都可以在我們的網站上找到。網站。

I would like to remind you that we will adhere to the 1 question and 1 follow-up question rule to allow everyone to submit a question. If you have additional questions, please feel free to put yourself back in the queue. With that, I'll turn the call over to Mark Tarr, Encompass Health's President and Chief Executive Officer.

我想提醒您的是，我們將遵循 1 個問題和 1 後續問題的規則，允許每個人都提交問題。如果您還有其他問題，請隨時重新加入佇列。接下來，我會將電話轉給 Encompass Health 總裁兼執行長 Mark Tarr。

Thank you, Mark, and good morning, everyone. We're very pleased with our third quarter results, driven by continued strong volume growth and a substantial year-over-year reduction in premium labor costs. Our third quarter revenues increased 10.8% and adjusted EBITDA increased 21.6%. Q3 total discharges increased 7.3%, with same-store discharges up 4.3%. Our strong volume growth continues to underscore our value proposition to referral sources, payers and patients.

謝謝你，馬克，大家早安。在銷售持續強勁成長和優質勞動力成本同比大幅下降的推動下，我們對第三季的業績感到非常滿意。我們第三季營收成長 10.8%，調整後 EBITDA 成長 21.6%。第三季總流量成長 7.3%，同店流量成長 4.3%。我們強勁的銷售成長持續凸顯了我們對轉介來源、付款人和病患的價值主張。

Our patient acuity continue to broaden with more normalized patient flows through the health care system. Store discharges were up 5.8% year-over-year, while knee and hip replacement and fracture of the lower extremity discharges grew approximately 14% in the aggregate year-over-year though of a relatively small base. Given the strong demand for inpatient rehabilitation services, we have continued to invest in capacity additions. We opened one 40-bed de novo in the third quarter, bringing us to 6 de novos year-to-date.

隨著醫療保健系統中的患者流動更加正常化，我們的患者敏銳度繼續擴大。商店出院人數同比增長 5.8%，而膝關節和髖關節置換術以及下肢骨折出院人數同比增長約 14%，儘管基數相對較小。鑑於住院復健服務的強勁需求，我們持續投資增加產能。我們在第三季重新開設了 40 個床位，今年迄今已新增 6 個床位。

We also added 26 beds to existing hospitals in the third quarter for total capacity additions of 340 beds over the first 9 months of 2023. Based on favorable weather conditions and construction efficiencies, we are accelerating the opening of our Fitchburg, Wisconsin hospital from first quarter of 2024 to fourth quarter of 2023. As a result, we now plan to open 2 de novos in Q4 and add 5 beds to existing hospitals, resulting in a total of 441 beds for the year. Three of our bed addition projects originally scheduled for 2023 have shifted to 2024 due in each case to local permitting issues.

我們也在第三季為現有醫院增加了26 個床位，到2023 年前9 個月的總容量增加了340 個床位。基於有利的天氣條件和施工效率，我們正從第一季開始加快威斯康辛州州菲奇堡醫院的開業速度2024年至2023年第四季。因此，我們現在計劃在第四季度重新開設2家醫院，並在現有醫院基礎上增加5張床位，使全年床位總數達到441張。由於當地許可問題，我們原定於 2023 年進行的三個床位增加項目已推遲到 2024 年。

As a result of this shift, we expect to add more than 150 beds to existing hospitals in 2024. We continue to build and maintain an active pipeline of de novo projects both wholly owned and JVs with acute care hospitals. We currently have announced 18 de novos with opening dates beyond 2023. During Q3, we again met the increasing demand for our services while reducing contract labor and sign-on and shift bonus expenditures.

由於這一轉變，我們預計到 2024 年將為現有醫院增加 150 多個床位。我們將繼續建造和維護一系列活躍的從頭項目，包括全資醫院和與急診醫院的合資企業。目前，我們已宣布 18 個新項目，開業日期將在 2023 年之後。第三季度，我們再次滿足了對服務不斷增長的需求，同時減少了合約工以及簽約和輪班獎金支出。

Contract labor was down approximately $6 million or 24% from Q3 of 2022 while sign-on and ship bonuses decreased approximately $10 million or 41% from Q3 of 2022. For the second consecutive quarter, our talent acquisition efforts resulted in over 200 net same-store RN hires. Please be mindful that hiring results may vary significantly from quarter-to-quarter based on seasonality and other factors. Review Choice Demonstration, or RCD, began on August 21 in Alabama. Recall that under RCD, every claim is reviewed for documentation and medical necessity.

合約工比2022 年第三季減少了約600 萬美元，即24%，而簽約和交付獎金比2022 年第三季度減少了約1000 萬美元，即41%。連續第二個季度，我們的人才招聘工作導致了200 多個淨相同-商店 RN 員工。請注意，根據季節性和其他因素，每季的招募結果可能會大不相同。審查選擇示範（RCD）於 8 月 21 日在阿拉巴馬州開始。回想一下，根據 RCD，每項索賠都會經過文件記錄和醫療必要性審查。

We elected pre-claim review, as we believe it allows for a more iterative process and the potential for real-time adjustments. Our results thus far are encouraging. The affirmation rate target set by CMS under RCD is 80% of claims submitted during the first 6 months and our affirmation rate is well above that. Given our Q3 results and expectations for Q4, we are updating our 2023 guidance to include net operating revenue of $4.77 billion to $4.8 billion, adjusted EBITDA of $940 million to $955 million and adjusted earnings per share of $3.41 to $3.52.

我們選擇了索賠前審查，因為我們相信它可以實現更迭代的流程並具有即時調整的潛力。迄今為止我們的成果令人鼓舞。 CMS 在 RCD 下設定的確認率目標是前 6 個月內提交的索賠的 80%，而我們的確認率遠高於該目標。鑑於我們第三季的業績和第四季的預期，我們正在更新2023 年指導，包括淨營業收入47.7 億美元至48 億美元，調整後EBITDA 9.4 億美元至9.55 億美元，調整後每股收益3.41美元至3.52 美元。

The key considerations underlying our guidance can be found on Page 12 of the supplemental slides. Now with that, I'll turn it over to Doug for further color.

我們的指導背後的關鍵考慮因素可以在補充幻燈片的第 12 頁找到。現在，我將把它交給道格進一步上色。

Thanks, Mark, and good morning, everyone. As Mark stated, we are very pleased with our Q3 results. We continue to see significant improvement and year-over-year premium labor costs. Our Q3 contract labor plus sign-on and ship bonuses of $33.3 million was comprised of approximately $18.9 million in contract labor and $14.4 million in sign-on and ship bonuses. This compares favorably to $24.8 million in contract labor and $24.2 million in sign-on and ship bonuses in Q3 last year. Contract labor utilization declined year-over-year and sequentially. Q3 contract labor FTEs of 388 represented a 19% decline from Q3 '22, and an 18% decline from Q2 of '23. Contract labor FTEs as a percent of total FTEs was 1.5%, a 40 basis point decline from Q3 '22 and a 30 basis point decline sequentially.

謝謝，馬克，大家早安。正如馬克所說，我們對第三季的業績非常滿意。我們繼續看到勞動成本顯著改善和年比溢價。我們第三季的合約工加上簽約和交付獎金為 3,330 萬美元，其中包括約 1,890 萬美元的合約工和 1,440 萬美元的簽約和交付獎金。與去年第三季的 2,480 萬美元合約工以及 2,420 萬美元簽約和發貨獎金相比，這一數字相當可觀。合約工利用率年比和季減。第三季合約工 FTE 為 388 人，比 22 年第三季下降 19%，比 23 年第二季下降 18%。合約工 FTE 佔 FTE 總數的百分比為 1.5%，比 22 年第三季下降 40 個基點，比上一季下降 30 個基點。

Agency rates declined year-over-year and were up modestly sequentially. Our Q3 '23 agency rate for FTE was approximately $192,700, down from approximately $204,600 in Q3 '22. I'll remind you that rates are impacted by the license level of the clinician utilized as well as by geographic specific market conditions.

代理費率較去年同期下降，並連續小幅上升。我們 23 年第 3 季的 FTE 代理費率約為 192,700 美元，低於 22 年第 3 季的約 204,600 美元。我要提醒您的是，費率受到所使用的臨床醫生的執照等級以及特定地理市場條件的影響。

Sign-on and shift bonuses decreased $9.8 million or 41% from Q3 '22 and were roughly flat sequentially. As we consider contract labor and shift bonuses for Q4, it is worth noting that holiday coverage typically requires premium pay rates. Partially offsetting the benefit of lower premium labor costs in Q3 was an increase in our internal SW per FTE rate. This rate, which excludes contract labor and sign-on and shift bonuses increased 6% over Q3 '22, similar to the level of increase we saw in Q2. The increase was attributable to proactive market adjustments primarily for nurses, higher compensation for new hires and planned merit increases.

與 22 年第三季相比，簽約獎金和輪班獎金減少了 980 萬美元，即 41%，與上一季基本持平。當我們考慮第四季度的合約工和輪班獎金時，值得注意的是，假期保險通常需要溢價。我們的內部 SW 每 FTE 比率的增加部分抵消了第三季優質勞動成本降低的好處。這一比率（不包括合約工以及簽約和輪班獎金）比 22 年第三季度增長了 6%，與我們在第二季度看到的增長水平相似。這一增長歸因於主要針對護理人員的主動市場調整、新員工的薪酬提高以及計劃中的績效增長。

These actions are contributing to our success in new hiring and improvement in turnover. Our updated guidance assumes a continuation of this trend in Q4. In line with expectations, EPOB for the quarter was 3.41, an increase from 3.39 in Q3 '22 and from 3.38 in Q2 '23. Revenue reserves related to bad debt increased 20 basis points to 2.2% as a result of write-offs of older claims denied by the Departmental Appeals Board, which we have elected not to appeal the Federal District Court.

這些行動有助於我們成功招募新員工並提高營業額。我們更新的指導假設第四季將延續這一趨勢。與預期一致，本季 EPOB 為 3.41，高於 22 年第三季的 3.39 和 23 年第二季的 3.38。由於部門上訴委員會拒絕了舊索賠的沖銷，與壞帳相關的收入準備金增加了 20 個基點，達到 2.2%，我們選擇不對聯邦地方法院提出上訴。

Our de novo embedded edition strategy continues to generate solid growth and contribute to share gains. Our de novo has performed exceptionally well in Q3, contributing $900,000 in adjusted EBITDA. This brings year-to-date net preopening and ramp-up costs to $7.6 million. We still expect full year preopening and ramp-up costs to be $10 million to $12 million due to the opening of 2 hospitals in Q4 and the cost we expect to incur in Q4 for hospitals scheduled to open in the first half of 2024.

我們的從頭嵌入式版本策略持續實現穩健成長，並為份額成長做出貢獻。我們的 de novo 在第三季表現異常出色，調整後 EBITDA 貢獻了 90 萬美元。這使得年初至今的淨預開業和擴建成本達到 760 萬美元。由於第四季度開設了 2 家醫院，以及我們預計計劃於 2024 年上半年開業的醫院在第四季度產生的成本，我們仍然預計全年開業前和啟動成本將為 1000 萬至 1200 萬美元。

As it can be seen on Page 14 of the supplemental information, the acceleration of our Fitchburg opening into 2023 and the progress on a number of pipeline projects scheduled for 2024 and 2025, has led to an upward revision of our 2023 de novo capital expenditures estimate to $315 million to $325 million. Year-to-date adjusted free cash flow of $432.2 million represented a 47% increase from the first 9 months of 2022. As it can be seen on Page 13 of the supplemental information, we have updated our assumptions for certain cash flow items, contributing to an increase in our 2023 adjusted free cash flow estimate $445 million to $500 million.

從補充資料第 14 頁可以看出，我們的 Fitchburg 專案加速開放至 2023 年，以及計劃於 2024 年和 2025 年進行的一些管道專案的進展，導致我們上調了 2023 年重新資本支出估算至3.15 億至3.25 億美元。年初至今調整後自由現金流為 4.322 億美元，較 2022 年前 9 個月增長了 47%。正如補充資料第 13 頁所示，我們更新了對某些現金流項目的假設，貢獻我們將2023 年調整後自由現金流預估增加4.45 億至5 億美元。

Finally, we ended Q3 with a net leverage ratio of 2.8x, down from 3.4x at the end of 2022. Our balance sheet and liquidity remain well positioned. With that, we'll open the lines for Q&A.

最後，我們第三季末的淨槓桿率為 2.8 倍，低於 2022 年底的 3.4 倍。我們的資產負債表和流動性保持良好。這樣，我們將打開問答線。

At this time, we will open the floor for questions. (Operator Instructions) We ask that you limit yourself to 1 question and 1 follow-up question. Our first question will come from Kevin Fischbeck with Bank of America.

現在，我們將開始提問。 （操作員說明）我們要求您只回答 1 個問題和 1 個後續問題。我們的第一個問題將來自美國銀行的凱文·菲施貝克（Kevin Fischbeck）。

So I guess I would like to ask about labor. Obviously, a lot of progress on contract labor expense and sign-on bonuses, but overall the wage outlook has gone up and that we see sequentially contract labor wage has gone up for a couple of quarters now. How would you characterize the overall labor market today and how do you think about the ability to -- if this you have the benefit of contract labor coming down, how do you think about the ability to manage through labor pressure into next year.

所以我想我想問一下關於勞動力的問題。顯然，合約工費用和簽約獎金方面取得了很大進展，但總體而言，工資前景有所上升，而且我們看到合約工工資已經連續幾個季度上漲。您如何描述當今整體勞動力市場的特徵？您如何看待這種能力——如果您受益於合約工下降，您如何看待明年應對勞動力壓力的能力。

Kevin, this is Mark. As you know, we've made really nice progress on the contract labor side and the premium pay categories. I would characterize it is still a very tight market out there. Certain markets are a little bit more challenging than others to find staff. We've done a really nice job in terms of our recruitment of RNs, which is the most challenging segment of our staffing base at this point. But I think we put systems in place and have the initiatives at our hospitals to be successful going into next year, and competing very strong and this really tight market.

凱文，這是馬克。如您所知，我們在合約工方面和加薪類別方面取得了非常好的進展。我認為這仍然是一個非常緊張的市場。某些市場在尋找員工方面比其他市場更具挑戰性。我們在註冊護士的招募方面做得非常好，這是目前我們人員配置中最具挑戰性的部分。但我認為我們的系統已經到位，我們的醫院也採取了一些舉措，以便在明年取得成功，並在這個非常緊張的市場中進行強有力的競爭。

Yes. Just to add a couple of things to that, Kevin. First of all, I think what you're seeing in terms of the sequential increase in rates has more to do with the fact that as we reduce our reliance on contract labor, what we're seeing is more of a concentration at higher license levels and in those geographies that are more expensive and where it's a little bit tighter. So some of that is kind of self filling.

是的。凱文，我想補充幾件事。首先，我認為您所看到的費率連續增長更多地與以下事實有關：隨著我們減少對合約工的依賴，我們看到更多的是集中在更高的許可證級別在那些價格更高且更緊張的地區。所以其中一些是自我填充的。

As we look to 2024, from a premium labor perspective, we think that it's either going to be stable or improving further. We've been successful in getting the contract labors, FTEs down to 1.5%. That's not where we were pre-pandemic, which was just under 1%. Do we think that there's an opportunity for further progress? Yes, but a minimum, we don't see that kicking back up above that. Then, we also think that with regard to the 6% increase in SW per FTE that we've been running this year, evidence of the fact that we've been able to hire 404 -- or 402 net new RNs in each of the last 2 quarters, we believe that we've hit the right level -- excuse me, that was over the last 2 quarters, cumulative.

展望 2024 年，從優質勞動力的角度來看，我們認為要么會保持穩定，要么會進一步改善。我們成功地將合約工 FTE 降低至 1.5%。這不是我們在大流行前的情況，當時的比例略低於 1%。我們認為還有進一步進步的機會嗎？是的，但至少，我們沒有看到這種情況反彈到該水平之上。然後，我們還認為，今年我們每 FTE 的 SW 增加了 6%，這證明我們已經能夠在每個國家僱用 404 名或 402 名淨新註冊護士。過去兩個季度，我們相信我們已經達到了正確的水平——對不起，這是過去兩個季度的累積水準。

We believe that we've hit the right level in terms of being able to procure that new talent and our turnover has been reduced as well. And as a result of those factors, we don't think that we're going to have to anniversary another 6% on top of the 6% this year. We would expect labor inflation to moderate considerably next year.

我們相信，我們在招募新人才方面已經達到了正確的水平，而且我們的營業額也有所減少。由於這些因素，我們認為在今年 6% 的基礎上，我們不會再慶祝 6% 的周年紀念日。我們預計明年勞動力通膨將大幅放緩。

Okay. That's helpful. And then, I guess, as far as volumes go, there's been a lot of talk about seasonality -- normal seasonality I guess. Where do you think that you are in the industry is as far as IRF volumes? Are we back to kind of normal and normalish growth from here? Is there any pent-up demand? How are you thinking about this as a base for future growth but also seasonality?

好的。這很有幫助。然後，我想，就銷量而言，人們對季節性有很多討論——我想是正常的季節性。就 IRF 數量而言，您認為您在該行業中處於什麼位置？我們是否會從現在開始恢復正常成長？是否存在被壓抑的需求？您如何看待這作為未來成長和季節性的基礎？

Kevin, we've commented in past quarters, and I think that, that holds true now, is that the pandemic gave IRF a real chance to show the difference in post-acute settings, and I believe that we have continued to take market share from skilled nursing facilities or other areas that otherwise may have taken similar types of patients. And so I think we're well positioned going forward to continue to provide value to referral sources and the payers.

凱文，我們在過去的幾個季度中發表過評論，我認為，現在也是如此，大流行給了 IRF 一個真正的機會來展示急性後環境的差異，我相信我們將繼續佔據市場份額來自熟練的護理機構或其他可能曾接收類似類型患者的地區。因此，我認為我們處於有利位置，可以繼續為推薦來源和付款人提供價值。

As you think about our discharge growth for the second half of this year, of course, Q3 we just reported, recall that we are up against more challenging comps from last year. In the back half of last year, total discharge growth was running north of 7% with more than 4% of that coming from same store. And so we really felt like the seasonal patterns started to reestablish themselves in the second half of this year, and it feels like that is continuing this year.

當然，當您考慮今年下半年我們剛剛報告的第三季的排放量成長時，請記住，我們面臨去年更具挑戰性的競爭。去年下半年，總銷售額成長超過 7%，其中超過 4% 來自同店。因此，我們確實覺得季節性模式在今年下半年開始重新建立，今年感覺這種情況仍在繼續。

With regard to pent-up demand, there's no doubt that we are seeing an increased flow of some of those lower acuity hip and knee replacements that Mark described, what's offsetting some of that is a reduction in COVID patients. And so the demand that we're seeing in those categories is actually probably a little bit higher than might otherwise show through into the total discharges. But generally speaking, it feels like we're kind of back into our traditional seasonal flows.

就被壓抑的需求而言，毫無疑問，我們看到馬克描述的一些視力較低的髖關節和膝關節置換術的流量有所增加，而新冠患者數量的減少抵消了其中一些需求。因此，我們在這些類別中看到的需求實際上可能比總排放量中顯示的需求要高一些。但總的來說，感覺我們又回到了傳統的季節性流動。

Our next question will come A.J. Rice with UBS.

我們的下一個問題將來自 A.J.賴斯與瑞銀。

First question was more technical. You're highlighting this $3.5 million write-off of the de novo project. I don't know if there's any background that is sort of unusual for you not to move forward with one. But -- I mean my main point on that is you've updated the guidance. It looks like you're including that so that the actual underlying increase in operating results is a little more than on the surface might include, but I want to just confirm that.

第一個問題更具技術性。您強調了 de novo 專案的 350 萬美元沖銷。我不知道是否有任何不尋常的背景讓你無法繼續前進。但是——我的意思是我的主要觀點是你已經更新了指南。看來您將其包括在內，以便營運績效的實際潛在成長比表面上可能包括的要多一些，但我想確認這一點。

And A.J., I'm sorry, we didn't make that more clear in our materials. That write-off is below the adjusted EBITDA line. And you're right, it's less unusual in terms of the fact that we're deciding not to press forward with a de novo project and more unusual in terms of its scope. We're managing an active pipeline of approximately 50 projects and then what you don't necessarily see is there are about 20 behind that, that are in what we ineloquently describe as exploratory mode.

A.J.，很抱歉，我們沒有在材料中更清楚地說明這一點。此沖銷低於調整後的 EBITDA 線。你是對的，就我們決定不推進從頭開始的項目這一事實而言，這並不罕見，而就其範圍而言，這更不尋常。我們正在管理大約 50 個項目的活躍管道，但你不一定會看到後面還有大約 20 個項目，這些項目處於我們毫不客氣地描述為探索模式的狀態。

We will from time to time than we have in the past have a project that for various reasons, sometimes it's getting hung up in the CON process, will elect not to move forward with. In almost all instances, those items are less than $1 million. We had one that was approximately $1 million. It was actually included in Q3. What was unusual about this project is that we had gotten further along. It's the project in the Midwest. It was with an existing joint venture partner. We had acquired some land. We were actually doing some of the site work.

與過去相比，我們有時會遇到一個項目，由於各種原因，有時會在 CON 流程中陷入困境，會選擇不再繼續前進。幾乎在所有情況下，這些物品的價值都低於 100 萬美元。我們有一個價值約 100 萬美元的項目。它實際上包含在第三季度中。這個專案的不同尋常之處在於我們取得了進一步的進展。這是中西部的計畫。它是與現有的合資夥伴合作的。我們已經獲得了一些土地。我們實際上正在做一些現場工作。

And unfortunately, every time we refined our estimate for the cost to build this facility, it was getting worse and worse in a way that we weren't able to use some of the other offsets we've effectively used on other projects. In addition to that, this was a particular market where the labor market conditions were moving in an adverse direction as well. So we had some difficult talks with our joint venture partner, but ultimately, we concluded together that it did not make sense to press forward at this time and so we took the write-off.

不幸的是，每次我們改進建造該設施的成本的估計時，情況都會變得越來越糟，以至於我們無法使用我們在其他項目中有效使用的一些其他補償。除此之外，這是一個勞動市場狀況也朝著不利方向發展的特殊市場。因此，我們與合資夥伴進行了一些艱難的談判，但最終，我們共同得出結論，此時繼續推進沒有意義，因此我們取消了。

I really view that as an anomaly given its size because it's unusual for us to get that far down the path before we make that kind of decision. I don't think it speaks to any lack of enthusiasm with regard to our continuing development pipeline, I do think it highlights the fact that we are disciplined in our approach.

考慮到它的規模，我確實認為這是一種反常現象，因為在我們做出這樣的決定之前，我們走得這麼遠是不尋常的。我不認為這表明我們對持續開發管道缺乏熱情，我確實認為這凸顯了我們在方法上遵守紀律的事實。

Okay. All right. And maybe just a follow-up, I'll take a stab at this one. I know you're not going to give formal '24 guidance until you report fourth quarter or at least around the first of the year. But you've talked about labor inflation moderating some of the things around volume and de novos, what, in your mind, are the puts and takes we should keep in mind as we're trying to develop forecast in any areas of particular variability, as you sit right now and think about next year?

好的。好的。也許只是後續行動，我會嘗試這個。我知道，在您報告第四季度或至少在今年第一季之前，您不會給出正式的 24 年指引。但是你談到了勞動力通膨會緩和一些有關數量和從頭開始的事情，在你看來，當我們試圖在任何特定變化的領域進行預測時，我們應該牢記哪些看跌期權和賣出期權，當你現在坐下來思考明年的時候？

I think you've hit on the keys, which is, one, we look at volume growth heading into next year. Obviously, we'll be up against challenging comps given the good discharge growth we've had this year. But we're going to benefit from the continued maturation of 25 de novos that were added from 21 through the end of '23 and the addition of 150 beds to existing hospitals. And we do anticipate that moderating labor inflation will occur as we anniversary the 6% increase in SW, FTE, we're anticipating for '23. Those are going to be the primary drivers.

我認為你已經抓住了關鍵，第一，我們著眼於明年的銷售成長。顯然，鑑於今年我們的排放量成長良好，我們將面臨具有挑戰性的競爭。但我們將從 21 年至 23 年底新增的 25 個新醫院的持續成熟以及現有醫院新增的 150 個床位中受益。我們確實預計，隨著我們預計 23 年 SW、FTE 成長 6% 週年紀念日，勞動力通膨將會放緩。這些將成為主要驅動力。

We'll take our next question from Brian Tanquilut with Jefferies.

我們將接受 Jefferies 的 Brian Tanquilut 提出的下一個問題。

Congrats on the quarter. Doug, I guess my first question, as I think about your revised guidance for the year and what you've reported so far in the first 3 quarters. The Q4 kind of like is a little different from typical seasonality in terms of contribution to the year. So just curious, is there anything we should be thinking about in terms of what that like sequential decline or flattening that imply on the guide for Q4.

恭喜本季。道格，我想是我的第一個問題，因為我想到了您今年修訂後的指導以及您在前三個季度迄今為止所報告的內容。就對全年的貢獻而言，第四季與典型的季節性略有不同。所以只是好奇，我們是否應該考慮第四季度指南中暗示的連續下降或持平等問題。

Yes. So as we move into Q4, we're obviously benefiting from the price increase, not surprisingly because we have really kind of established normalized seasonal flows. We would expect discharges from Q3 to Q4 to be kind of relatively flat in that range. So you're not getting a pickup there sequentially. You're consuming a pretty good chunk of the pricing increase with the merit increase, which was a little over 3%.

是的。因此，當我們進入第四季度時，我們顯然從價格上漲中受益，這並不奇怪，因為我們確實已經建立了正常化的季節性流量。我們預計第三季到第四季的排放量在該範圍內相對持平。所以你不會按順序在那裡接載。隨著績效的增加，你消耗了相當大一部分的價格上漲，略高於 3%。

And then we're also anticipating that you'll see somewhat of an increase, which is not atypical. It was a little bit of an anomaly in Q4 last year and the length of stay. And then just kind of some regular way increases in supplies and OOE, some of which is attributable to seasonality. So not a lot to call out there. And again, it's -- you had a very strong Q3. So it's not surprising that we're kind of calling the ball here for Q4.

然後我們也預計您會看到一定程度的成長，這並不罕見。去年第四季的情況和停留時間都有點異常。然後供應和 OOE 會定期增加，其中一些歸因於季節性。所以沒有太多好說的。再說一次，你的第三季非常強勁。因此，我們在這裡宣布第四季度的比賽也就不足為奇了。

Okay. That makes sense. And then, Mark, maybe as I think about your comments in the release on -- or in the slide deck on pricing on the commercial side. How should we be thinking about commercial price trend -- share price strategy we look at 2024?

好的。這就說得通了。然後，馬克，也許當我想到您在新聞稿中或幻燈片中有關商業方面定價的評論時。我們該如何思考商業價格趨勢—我們展望 2024 年的股價策略？

We continue to work on payers, as we've done in past quarters with the MA contract negotiations we've had. As we move more contracts towards CMG, you're starting to see less of the differential between the fee-for-service Medicare and MA plans. I think it was down to 3% or 4% differential this last quarter. So we continue to make progress there. And I think you expect to see that going forward.

我們將繼續與付款人合作，就像我們在過去幾季進行的 MA 合約談判中所做的那樣。隨著我們將更多合約轉向 CMG，您開始看到按服務收費的 Medicare 和 MA 計劃之間的差異越來越小。我認為上個季度的差異已降至 3% 或 4%。所以我們繼續在那裡取得進展。我認為您希望看到這種情況的發展。

Yes, Brian, the other thing you got to call out as you think about the movement from Q3 to Q4 is the impact of the 2023 de novos. As we discussed in our comments earlier, we had a really strong quarter in Q3 where those actually contributed $900,000 in EBITDA. But we're still anticipating that the preopening and ramp-up costs for the full year will be in that $10 million to $12 million range, which implies a $3.5 million to $5.5 million, swing the other way in Q4.

是的，Brian，當你思考從第三季到第四季的變化時，你必須指出的另一件事是 2023 年新一輪的影響。正如我們之前在評論中討論的那樣，我們在第三季度的季度業績非常強勁，這些業務實際上為 EBITDA 貢獻了 90 萬美元。但我們仍預計全年的開業前和啟動成本將在 1,000 萬至 1,200 萬美元範圍內，這意味著 350 萬至 550 萬美元，而第四季則相反。

(Operator Instructions) Our next question comes from Pito Chickering with Deutsche Bank.

（操作員指示）我們的下一個問題來自德意志銀行的 Pito Chickering。

You've got [Kieran Ryan] on for Pito. You mentioned that the hip and knee patients continue to present at a pretty good rate in 3Q, and I know you called out some strong ortho demand in the second quarter. So I guess, just could you just comment on if that strength in ortho continued into 3Q, and if there's any other specialties you want to call out, whether that's neuro, stroke or anything like that?

你已經為皮托選擇了[基蘭·瑞安]。您提到髖關節和膝關節患者在第三季度繼續以相當好的速度呈現，我知道您在第二季度提出了一些強勁的矯形需求。所以我想，您能否評論一下正交的優勢是否持續到第三季度，以及您是否想指出任何其他專業，無論是神經、中風還是類似的專業？

We continue to see growth in our stroke program. I think as I noted in my comments around the orthopedic, we're just kind of getting back to normalized flow that we had seen prior to the pandemic. So it's not an area that is growing off of a very large base, but we have placed a huge focus over the past several years in growing our stroke program. We've seen nice gains on that. We've seen nice gains and other neuro and continue to focus on those categories.

我們的中風計劃繼續增長。我認為，正如我在有關骨科的評論中指出的那樣，我們只是回到了大流行之前所看到的正常流程。因此，這不是一個從非常大的基礎上發展的領域，但我們在過去幾年中非常注重發展我們的中風項目。我們已經看到了這方面的良好成果。我們已經看到了不錯的收益和其他神經，並將繼續關注這些類別。

Again, these are some smaller categories, but brain injury was up 8.6%. Cardiac was up 2.4%, so a little bit lower there. Major multiple trauma up 10.4%. This was a quarter again, and we discussed this more in Q2, where the strength of our discharge growth was across patient categories and across -- very broad-based across geographies as well, which is encouraging to us.

同樣，這些都是一些較小的類別，但腦損傷上升了 8.6%。心臟指數上漲了 2.4%，因此略有下降。重大多發傷上漲10.4%。這又是一個季度，我們在第二季度對此進行了更多討論，我們的出院增長勢頭遍及各個患者類別和各個地區，而且基礎非常廣泛，這對我們來說是令人鼓舞的。

Awesome. And then just a quick follow-up. Would you be able to give an update on RN turnover. I think you were running at 22% year-to-date after 2Q. It sounded like maybe a little bit more sequential improvement there or...

驚人的。然後進行快速跟進。您能否提供 RN 營業額的最新資訊？我認為第二季之後，今年迄今的成長率為 22%。聽起來可能有更多的連續改進，或者...

Our most recent quarter and most recent trend on a month basis -- that 22%, 23% turnover rate continued with what we have seen progress on. We've put a lot of focus on is the turnover within 1 year of hiring of the RNs, and that's an area that we knew we could see improvement on. We've seen improvement on that. We've put a lot of focus on the orientation and onboarding of our nurses, which we think will help us longer term and continuing to hold or decrease that turnover rate.

我們最近一個季度和最近一個月的趨勢——22%、23% 的周轉率繼續保持著我們所看到的進展。我們非常關注註冊護士聘用後一年內的人員流動情況，我們知道這是一個可以改進的領域。我們已經看到了這方面的改進。我們非常注重護理師的入職培訓和入職培訓，我們認為這將有助於我們長期維持或降低流動率。

It's important to note as well, we tend to focus on the nursing, but our therapist turnover on a year-to-date basis at the end of the third quarter was less than 8%.

還要注意的是，我們傾向於專注於護理，但截至第三季末，我們的治療師年初至今的流動率不到 8%。

Our next question will come from Matt Larew with William Blair.

我們的下一個問題將由馬特·拉魯和威廉·布萊爾提出。

A follow-up a bit on the patient mix question, but obviously, it was another strong quarter on the MA side, as it has been really for the last several quarters in particular. And so similar to Kieran's question, any particular patient categories or already trends to call out on the MA side?

對患者組合問題進行了一些跟進，但顯然，這是 MA 方面的另一個強勁季度，尤其是過去幾個季度。與 Kieran 的問題類似，MA 方面有任何特定的患者類別或已經出現的趨勢嗎？

No. So if we look in aggregate at MA, for the quarter, total MA discharges were up approximately 13%. That takes us to just other -- under 18% on a year-to-date basis. And importantly, when you look in the same store for MA, it was 11% for Q3 and just under 15% on a year-to-date basis, continue to see very good growth in MA for stroke patients, but 1 of the things that we've highlighted with regard to this overall discharge growth in MA is our value proposition now seems to be resonating with those MA plans across the broader patient spectrum. So we're seeing the broadening of the acuity there as well.

不會。因此，如果我們從 MA 的總體情況來看，本季度的 MA 總排放量增加了約 13%。這讓我們看到了其他的情況——今年迄今為止，這一比例低於 18%。重要的是，當你在同一家商店尋找 MA 時，第三季度的增長率為 11%，年初至今略低於 15%，中風患者的 MA 繼續保持良好增長，但其中 1 件事我們強調，關於MA 的整體出院成長是我們的價值主張，現在似乎與更廣泛的患者範圍內的那些MA 計劃產生了共鳴。所以我們也看到那裡的敏銳度在擴大。

Okay. And then just a follow-up on the hospital that you put forward from 24% to 23%, what really allowed you to accelerate that opening process? Is this related to the prefabrication that you've been doing? Or is this more of a licensing or staffing issue? And depending on what it is, can you apply this to the extensive pipeline you have in place right now?

好的。然後只是對您提出的從 24% 到 23% 的醫院的後續行動，是什麼真正讓您加速了開放進程？這和你們一直在做的預製件有關嗎？還是這更多的是許可或人員配置問題？根據具體內容，您能否將其應用到您目前擁有的廣泛管道中？

Yes. So we'll be honest with you. The single biggest factor was favorable weather patterns. But it was also then we are getting more efficient with regard to the utilization of prefabrication. So that contributed. We've been stating all along that our objective with regard to the moving to full prefabrication was to realize a 15% cost reduction versus conventional and an improvement of 25% in terms of speed to market. So we're not quite there yet on all of the projects in the pipeline, but we're making good headway.

是的。所以我們會對你誠實。最大的一個因素是有利的天氣模式。但也正是在那時，我們在預製件的利用上變得更有效率。所以這就做出了貢獻。我們一直在聲明，我們轉向全預製的目標是實現比傳統方式降低 15% 的成本，並將上市速度提高 25%。因此，我們尚未完成所有籌備中的項目，但我們正在取得良好進展。

We've had (inaudible) staffing in that marketplace -- so it was all around the construction side and not about staffing or just being prepared to take that first patient.

我們在那個市場上有（聽不清楚）人員配備——所以這都是圍繞施工方面的，而不是人員配備或只是準備接收第一個病人。

Our next question will come from Ann Hynes with Mizuho Securities.

我們的下一個問題將來自瑞穗證券的安·海因斯。

So the ramp-up cost of $10 million to $12 million this year, is that a good number to use for 2024? It would be my first question. And then secondly, is there anything on the regulatory or legislative side that is on your radar for 2024?

那麼，今年 1,000 萬至 1,200 萬美元的提升成本對於 2024 年來說是一個合適的數字嗎？這是我的第一個問題。其次，您對 2024 年監管或立法方面有什麼關注嗎？

So Ann, on the first one, I haven't quite put a pencil to it yet for 2024, but I think it's probably a pretty good proxy since we opened 8 this year, and we're looking to open up another 8 next year.

所以，安，關於第一個，我還沒有完全確定 2024 年的情況，但我認為這可能是一個非常好的代理，因為我們今年開設了 8 個，並且我們希望明年再開設 8 個。

Ann, we continue to stay focused on the regulatory side. Everything from discussions around MedPAC with site neutral to -- we commented here on RCD and there are other things out there, but I would say those 2 things are closest to mine right now.

安，我們持續關注監管方面。從圍繞 MedPAC 的討論到網站中立的一切——我們在這裡對 RCD 進行了評論，還有其他的事情，但我想說這兩件事現在與我的最接近。

At this time, we have no further questions in queue. I will turn the call back to Mark Miller for any additional or closing remarks.

目前，我們隊列中沒有其他問題。我會將電話轉回給馬克米勒 (Mark Miller)，以獲取任何補充或結束語。

Thank you. If anyone else has additional questions, please call me at (205) 970-5860. Thank you again for joining today's call.

謝謝。如果其他人有其他問題，請致電 (205) 970-5860 與我聯絡。再次感謝您參加今天的電話會議。

This does conclude today's call. We thank you for your participation. You may disconnect at any time.

今天的電話會議到此結束。我們感謝您的參與。您可以隨時斷開連線。