Encompass Health Corp (EHC) 2024 Q4 法說會逐字稿

Good morning, everyone, and welcome to Encompass Health's fourth-quarter 2024 earnings conference call.

大家早安，歡迎參加 Encompass Health 2024 年第四季財報電話會議。

(Operator Instructions)

（操作員指令）

Today's conference call is being recorded, and 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.

今天的電話會議正在錄音，如果您有任何異議，此時您可以掛斷電話。現在我將把電話轉給 Encompass Health 的首席投資者關係長 Mark Miller。

Thank you, operator, and good morning, everyone. Thank you for joining Encompass Health's fourth-quarter 2024 earnings call.

謝謝接線員，大家早安。感謝您參加 Encompass Health 2024 年第四季財報電話會議。

Before we begin, if you do not already have a copy, the fourth quarter earnings release, sublingual information and related 8-K filed with the SEC are available on our website at encompasshealth.com.

在我們開始之前，如果您還沒有副本，您可以在我們的網站 embracehealth.com 上找到第四季度收益報告、舌下資訊和向美國證券交易委員會提交的相關 8-K 文件。

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. During this call, we will make forward-looking statements such as guidance and growth projections, which are subject to risks and uncertainties, many of which are beyond our control.

在補充資料的第 2 頁，您將看到安全港聲明，該聲明在收益報告的最後一頁也有更詳細的說明。在本次電話會議中，我們將做出前瞻性陳述，例如指引和成長預測，這些陳述受風險和不確定性的影響，其中許多是我們無法控制的。

Certain risks and uncertainties, like those relating to regulatory developments as well as volume, bad debt and cost trends that could cause actual results to differ materially from our projections, estimates and expectations are discussed in the company's SEC filings including the earnings release and related Form 8-K and the Form 10-K for the year ended December 31, 2024, when filed. We encourage you to read them.

某些風險和不確定因素，例如與監管發展以及數量、壞帳和成本趨勢有關的風險和不確定因素，可能導致實際結果與我們的預測、估計和預期存在重大差異，這些在公司的 SEC 文件中進行了討論，包括收益報告和相關 8-K 表以及提交時的截至 2024 年 12 月 31 日的 10-K 表。我們鼓勵您閱讀它們。

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.

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，並且僅代表今天的觀點。我們不承擔更新這些前瞻性陳述的責任。

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.

我們對本次電話會議的補充資訊和討論將包括某些非公認會計準則財務指標。對於此類指標，可在收益報告末尾的補充資訊中找到與最直接可比較的 GAAP 指標的對帳表，也可以作為昨天向美國證券交易委員會提交的 8-K 表格的一部分找到，所有這些資訊均可在我們的網站上找到。

I would like to remind everyone that we will adhere to the one question and one 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.

我想提醒大家，我們將堅持一個問題和一個後續問題的規則，讓每個人都提交一個問題。如果您還有其他問題，請隨時回到佇列。

With that, I'll turn the call over to Mark Tarr, Encompass Health's President and Chief Executive Officer.

接下來，我將把電話轉給 Encompass Health 總裁兼執行長 Mark Tarr。

Thank you, Mark, and good morning, everyone. The fourth quarter was a great finish to a very positive 2024, characterized by strong financial performance, broad-based volume growth, and significant advancement of our strategic positioning.

謝謝你，馬克，大家早安。第四季為 2024 年畫上了圓滿的句號，其特點是財務業績強勁、銷售全面成長、策略定位顯著提升。

Hitting the highlights for Q4, revenue increased 12.7%. Adjusted EBITDA increased 13.6%. Adjusted EPS increased 23.2% and adjusted free cash flow increased 103.7%. Total discharge growth for the quarter was 7.8%, once again exhibiting strength across patient mix, payers and geographies.

第四季的亮點是營收成長了12.7％。調整後EBITDA成長13.6%。調整後每股盈餘成長 23.2%，調整後自由現金流成長 103.7%。本季總出院人數成長率為 7.8%，再次展現出病患結構、付款人和地理方面的強勁表現。

Same-store discharge growth was 5.8%. Our primary focus remains on serving the Medicare beneficiary population, which for more than a decade, has been the fastest-growing segment of the US population. It is estimated that by 2030, one in five Americans more than 70 million people will be aged 65 or older.

同店銷售額成長5.8%。我們的主要重點仍然是服務醫療保險受益人群，十多年來，該群體一直是美國人口中成長最快的群體。預計到2030年，五分之一的美國人（超過7,000萬人）將年齡在65歲或以上。

The 65-or-older population has been growing consistently at a CAGR of approximately 3%. And the population in our average Medicare patient age range of 75 to 79 has been growing at approximately 5%. Yet the supplied licensed IRFs in the US has increased only nominally. As a result, the demand for treatment of complex medical conditions such as stroke, necessitating IRF care intensity is significantly underserved.

65 歲或以上人口一直以約 3% 的複合年增長率成長。我們的醫療保險患者平均年齡在 75 至 79 歲之間，成長率約為 5%。然而，美國許可的 IRF 供應量僅名義上有所增加。因此，對中風等複雜醫療狀況的治療需求（需要 IRF 護理強度）明顯得不到滿足。

There are too many Medicare beneficiaries who would benefit from the clinical services required by law to be administered in an IRF are being denied access to this care. In addition to the demand-supply imbalance of IRF capacity, the access to care issue is exacerbated by ill-informed and lengthy pre-authorization requirements by Medicare Advantage plans and faulty assumptions regarding a service equivalence between IRFs and SNFs by some hospital discharge planners and attending physicians.

有太多的醫療保險受益人可以享受法律要求在 IRF 中提供的臨床服務，但卻被拒絕獲得此類醫療服務。除了 IRF 容量的供需失衡之外，醫療保險優勢計劃中不了解情況且冗長的預授權要求，以及一些醫院出院計劃人員和主治醫生對 IRF 和 SNF 之間的服務等同性的錯誤假設，也加劇了獲得醫療服務的問題。

We are one of very few providers with the means to alter this equation. We have the clinical expertise to successfully treat medically complex patients. Even with the high acuity of patients we serve during 2024, our discharge to community rate was 83.6%, up nearly 200 basis points from 2022.

我們是極少數有能力改變現狀的供應商之一。我們擁有成功治療病情複雜的患者的臨床專業知識。即使我們在 2024 年服務的病患病情嚴重程度很高，我們的出院回到社區率仍達到 83.6%，比 2022 年上升了近 200 個基點。

We are helping these patients recover and sending them home without subsequent 30-day acute care hospital readmissions. Acute care hospitals know they can reliably send complex patients to us when the time is right, thereby reducing the number of unnecessary patient days in that relatively expensive acute setting. Our attractiveness as a partner to acute care hospitals is further evidenced by the fact that 65 of our 166 hospitals are operated as joint ventures.

我們正在幫助這些患者康復並送他們回家，無需隨後 30 天內再次入院接受急診。急診醫院知道他們可以在適當的時候將病情複雜的患者可靠地送往我們這裡，從而減少在相對昂貴的急診環境中不必要的患者天數。我們作為急診醫院合作夥伴的吸引力在於，我們的 166 家醫院中有 65 家是以合資形式運作的。

There are important benefits attendant to scale that better enable us to serve patients in need of inpatient rehabilitation services. We treat more patients with IRF appropriate conditions than any other provider. This allows us to develop and refine best-in-class clinical protocols, which are then extrapolated across our hospitals via our continued best practices processes.

規模帶來的重要好處在於，我們可以更好地為需要住院復健服務的患者提供服務。我們治療的符合 IRF 條件的患者比任何其他醫療服務提供者都要多。這使我們能夠開發和完善一流的臨床方案，然後透過我們持續的最佳實踐流程在我們的醫院中推廣。

The identification, development, and implementation of these clinical protocols is enhanced by the state-of-the-art information systems we have invested in, including our IRF-specific electronic medical record. Our scale also contributes significant cost efficiencies, positioning us as a low-cost provider of high-quality IRF services, the right place to be in the value chain.

我們所投資的最先進的資訊系統（包括 IRF 特定的電子病歷）增強了這些臨床協議的識別、開發和實施。我們的規模也顯著提高了成本效率，使我們成為高品質 IRF 服務的低成本供應商，在價值鏈中佔據正確的位置。

Finally, we have the financial, administrative, and operational resources to add much needed capacity to the IRF industry. We have been deploying capital and talent to extend our services into new geographies and to increase our capacity in existing markets with unmet patient needs for IRF services.

最後，我們擁有財務、行政和營運資源，可以為 IRF 產業增加急需的產能。我們一直在部署資本和人才，將我們的服務擴展到新的地區，並提高我們在現有市場中尚未滿足的患者對 IRF 服務的需求的能力。

We accelerated our growth efforts beginning in 2020 and importantly and uniquely, our commitment to do so did not waver during the two years of the pandemic even as we promptly returned the approximately $240 million of CARES Act funding we received. From 2020 through 2024, we opened 36 new hospitals and added 474 beds to existing hospitals, increasing our total bed supply by 1,845 beds or approximately 20%.

我們從 2020 年開始加快了成長步伐，重要而獨特的是，即使我們及時歸還了收到的約 2.4 億美元《關懷法案》資金，我們在兩年的疫情期間也絲毫沒有動搖對增長的承諾。從 2020 年到 2024 年，我們將開設 36 家新醫院，並在現有醫院中增加 474 張病床，使我們的總病床供應量增加 1,845 張，約 20%。

During 2024, we invested more than $450 million into capacity expansions, opening seven new hospitals and adding 107 beds to existing hospitals. In aggregate, we added 427 beds last year. In 2025, we expect to open seven new de novo hospitals with 340 beds, one satellite hospital with 50 beds, and add approximately 100 beds to existing hospitals.

2024 年，我們投資超過 4.5 億美元用於擴建容量，開設了 7 家新醫院，並在現有醫院中增加了 107 張病床。總體而言，去年我們增加了 427 張床位。2025年，我們預計將開設7家共340床的新發醫院、1家共50床的衛星醫院，並在現有醫院中增加約100張病床。

Included in our 2025 openings are 5 hospitals in State of Florida. Prior to Florida eliminating its certificate-need requirement in July of 2021, we operated 13 hospitals in the state with the CON relocation then pending, we announced that we had identified and prioritized 15 markets for new hospital activity in Florida.

我們 2025 年的空缺包括佛羅裡達州的 5 家醫院。在佛羅裡達州於 2021 年 7 月取消證書需求要求之前，我們在該州運營 13 家醫院，當時 CON 遷移尚未完成，我們宣布已經確定並優先考慮在佛羅裡達州開展新醫院活動的 15 個市場。

By this time next year, we expect to have opened 13 new hospitals in the state of Florida since the revocation of the CON requirement, and we have additional Florida opportunities in our active development pipeline. We have already added beds to one of our new Florida hospitals and plan to do so at another in 2025.

到明年此時，我們預計自取消 CON 要求以來將在佛羅裡達州開設 13 家新醫院，而且我們在積極的開發管道中還有更多佛羅裡達州的機會。我們已經在其中一家佛羅裡達州新醫院增加了床位，並計劃於 2025 年在另一家醫院增加床位。

We have continued to expand beyond Florida as well. Since 2020, we have added five new states to our map and will add another Connecticut in 2025. We now operate IRFs in 38 states in Puerto Rico, and still the market for IRF services remains substantially underserved.

我們的業務也不斷向佛羅裡達州以外擴展。自 2020 年起，我們在地圖上新增了五個新州，並將在 2025 年添加另一個康乃狄克州。我們目前在波多黎各的 38 個州經營 IRF，但 IRF 服務市場仍嚴重供不應求。

During 2024, we complemented our investments in growth with a return of approximately $63 million to our shareholders through cash dividends on our common stock and repurchased more than 350,000 shares of our common stock. Our strong free cash flow generation allowed us to fund these investments and shareholder distributions while still reducing our net leverage to 2.2 times at year-end 2024.

2024 年，我們透過普通股現金股利向股東帶來了約 6,300 萬美元的回報，並回購了超過 35 萬股普通股，從而補充了我們在成長方面的投資。我們強勁的自由現金流創造使我們能夠為這些投資和股東分配提供資金，同時在 2024 年底將我們的淨槓桿率降低至 2.2 倍。

Our investments in clinical innovations continues to advance our ability to consistently produce quality outcomes for medically complex, high-acuity patients in need of inpatient rehabilitation care. For example, we have further enhanced our fall prevention model, which combines predictive modeling with our core clinical practice protocols. Our fall prevention model was initiated in 2021, and we have since seen our fall rates per 1,000 patient days improved by more than 30% including an approximately 8% decline in 2024.

我們對臨床創新的投資不斷提高我們為需要住院復健護理的病情複雜、病情嚴重的患者持續提供高品質治療結果的能力。例如，我們進一步增強了我們的跌倒預防模型，該模型將預測模型與我們的核心臨床實踐協議相結合。我們的跌倒預防模型於 2021 年啟動，自此之後，我們看到每 1,000 名患者日的跌倒率改善了 30% 以上，其中 2024 年下降了約 8%。

We also continue to refine our ReACT predictive tool, which measures a patient's risk of being transferred back to an acute care hospital. Our ReACT 2.0 was implemented in January 2023 and through year-end 2024, we experienced a more than 100 basis point decline in our acute care transfer rate. Our clinical interventions and experience continues to extinguish us from our peers.

我們也將繼續完善我們的 ReACT 預測工具，該工具可以衡量患者被轉回急診醫院的風險。我們的 ReACT 2.0 於 2023 年 1 月實施，到 2024 年底，我們的急性護理轉移率下降了 100 個基點以上。我們的臨床幹預和經驗繼續使我們在同行中脫穎而出。

Now I'll turn it over to Doug to provide details about our Q4 and full-year results as well as our 2025 guidance.

現在，我將把話題交給 Doug，讓他提供有關我們第四季度和全年業績以及 2025 年指引的詳細資訊。

Thank you, Mark, and good morning, everyone.

謝謝你，馬克，大家早安。

Revenue for the quarter increased 12.7% to $1.4 billion and adjusted EBITDA increased 13.6% to $289.6 million. The revenue increase was comprised of 7.8% discharge growth and a 4.2% increase in net revenue per discharge.

本季營收成長 12.7% 至 14 億美元，調整後 EBITDA 成長 13.6% 至 2.896 億美元。收入增加包括排放量成長7.8%和每次排放量淨收入成長4.2%。

As Mark stated, volume strength was broad-based across geographies and patient and payer mix. Adding a bit of color on discharge growth, for the quarter, Medicare increased 6.8%, Medicare Advantage, 14.7%, and managed care 8.9%.

正如馬克所說，銷售優勢在各個地區、患者和付款人組合中都廣泛存在。本季度，醫療保險出院人數增加了 6.8%，醫療保險優勢計畫成長了 14.7%，管理式醫療成長了 8.9%，為出院人數成長增添了一點色彩。

Within patient mix, stroke discharges increased 12.6% and neurological disorders, 7.7%. Net revenue per discharge for Q4 benefited from a decrease of 200 basis points in bad debt expense to 2.1%. Recall that Q4 2023, bad debt included an approximately $22 million reserve related primarily to claims denied prior to 2018.

在病患結構中，中風出院人數增加了 12.6%，神經系統疾病出院人數增加了 7.7%。第四季每筆出院淨收入受惠於壞帳費用下降 200 個基點至 2.1%。回想一下，2023 年第四季度，壞帳包括約 2,200 萬美元的準備金，主要與 2018 年之前被拒絕的索賠有關。

SWB per FTE for Q4 increased 6.4%. Within this, salaries and wages per FTE, excluding contract labor and sign-on and ship bonuses, increased 4.8%, resulting from merit increases, market adjustments, and a change in our clinical license mix.

第四季每位全職員工的薪資上漲了 6.4%。其中，由於績效加薪、市場調整和臨床許可證組合變化，每位全職員工的薪資（不包括合約工、簽約獎金和船舶獎金）增加了 4.8%。

This latter factor is related to our implementation of nursing and therapy career ladders, which encourage our clinicians to seek incremental accreditations, which are then accompanied by compensation increases. We believe these career ladders are contributing to our improved turnover results.

後一個因素與我們實施的護理和治療職業階梯有關，這鼓勵我們的臨床醫生尋求逐步的認證，然後伴隨薪資的增加。我們相信這些職業階梯有助於我們提高營業額。

For 2024, our RN turnover was 20.4% compared to 23.1% in 2023, and therapist turnover was 7.7% compared to 7.8% in the prior year. Our Q4 benefits expense per FTE increased 30.6%. Please recall that in Q4 of 2023, benefits per FTE decreased 9.6%. So some of this year's increase is attributable to the lower base.

2024 年，我們的註冊護理師流動率為 20.4%，而 2023 年為 23.1%，治療師流動率為 7.7%，而前一年為 7.8%。我們第四季每位全職員工的福利支出增加了 30.6%。回想一下，2023 年第四季度，每位全職員工的福利下降了 9.6%。因此，今年的成長有一部分可歸因於較低的基數。

Similar to Q3 of this year, within our group medical, we continue to experience a higher incidence of large dollar claims and an increase in utilization of high specialty -- high-cost specialty drugs. While the incurrence of large dollar claims is sporadic and the frequency of such claims tends to be mean-reverting, we expect group medical prescription drug cost growth to remain elevated at least through the first half of 2025 when we anniversaried the increase in utilization of these specialty drugs.

與今年第三季類似，在我們的團體醫療中，我們繼續經歷高額索賠的發生率上升以及高專業性——高成本特種藥物的使用率增加。儘管大額索賠的發生是零星的，且此類索賠的頻率趨於均值回歸，但我們預計團體醫療處方藥成本增長將至少在 2025 年上半年保持高位，屆時我們將紀念這些特種藥物的使用量增加。

For 2024, our benefits expense per FTE increased 12.4%. This increase comes off of two very good years as in 2022, benefits expense per FTE declined 0.8%. And in 2023, the increase of this lower base was only 0.2%. Premium labor costs comprised of contract labor and sign-on and ship bonuses were $29.7 million in Q4, a decrease from $30.9 million in Q4 '23.

到 2024 年，我們每全職員工的福利支出將增加 12.4%。這一增長得益於兩年的良好表現，2022 年，每位全職員工的福利支出下降了 0.8%。而到了2023年，這個較低基數的增幅僅為0.2%。第四季度，包括合約工、簽約獎金和船舶獎金在內的優質勞動力成本為 2,970 萬美元，較 23 年第四季的 3,090 萬美元下降。

During Q4, contract labor FTEs comprised 1.4% of total FTEs. Net pre-opening and ramp-up costs were $1.3 million in Q4 '24 as compared to an adjusted EBITDA contribution of $1 million from the 2023 openings in Q4 '23.

第四季度，合約工全職當量佔全職當量總數的 1.4%。24 年第四季的淨開業前和加速成本為 130 萬美元，而 2023 年第四季 2023 年開業的調整後 EBITDA 貢獻為 100 萬美元。

Our Q4 adjusted EBITDA included approximately $7.7 million in favorable reserve adjustments for workers' comp and general professional liability insurance. On a full-year basis, 2024 included approximately $13 million and favorable reserve adjustments for the self-insured programs.

我們第四季的調整後 EBITDA 包括約 770 萬美元的工人補償和一般專業責任保險的有利準備金調整。從全年來看，2024 年包括約 1,300 萬美元和針對自保計畫的有利儲備調整。

We continue to generate significant free cash flow. Q4 adjusted free cash flow increased 103.7% to $190.5 million, bringing our 2024 full year total to approximately $690 million, a 31.3% increase from 2023. Our leverage and liquidity remained very favorable. As Mark cited, net leverage at year-end was 2.2 times.

我們繼續產生大量自由現金流。第四季調整後的自由現金流成長 103.7% 至 1.905 億美元，使我們 2024 年全年總額達到約 6.9 億美元，比 2023 年增加 31.3%。我們的槓桿率和流動性仍然非常有利。正如馬克所說，年底的淨槓桿率為 2.2 倍。

Moving on to guidance. Our 2025 guidance includes net operating revenue of $5.8 billion to $5.9 billion, adjusted EBITDA of $1.16 billion to $1.20 billion, and adjusted earnings per share of $4.67 to $4.96. The key considerations underlying our guidance can be found on page 11 of the supplemental slides.

繼續指導。我們對 2025 年的預期包括淨營業收入 58 億美元至 59 億美元、調整後 EBITDA 11.6 億美元至 12 億美元，以及調整後每股收益 4.67 美元至 4.96 美元。我們的指導背後的關鍵考慮因素可以在補充幻燈片的第 11 頁找到。

There are a number of factors to keep in mind as you contemplate quarterly and year-over-year comparisons. Recall that Q1 '24 discharge growth benefited from an extra day due to leap year and because the quarter ended on Easter Sunday.

當您考慮季度和年度比較時，需要牢記許多因素。回想一下，24年第一季的排放量成長受益於閏年的額外一天，而該季度在復活節那天結束。

We are anticipating $18 million to $22 million of hospital net pre-opening and ramp-up costs. We expect these costs to be heavily weighted towards the second half of the year because five of our eight hospitals are expected to open between September and year-end. This estimate also includes costs related to openings in early 2026. 2024 included approximately $13 million in favorable reserve adjustments for workers' comp and general professional liability insurance.

我們預計醫院開業前和開業初期的淨成本為 1800 萬至 2200 萬美元。我們預計這些成本將主要集中在今年下半年，因為我們的八家醫院中，有五家預計將於 9 月至年底之間開業。該估算還包括與 2026 年初開業相關的成本。

Our second half 2024 adjusted EBITDA included approximately $2.3 million in Oracle Fusion implementation costs and approximately $3.2 million in NCI expense related to the addition of our Augusta Hospital to the Piedmont joint venture.

我們 2024 年下半年的調整後 EBITDA 包括約 230 萬美元的 Oracle Fusion 實施成本和約 320 萬美元的 NCI 費用，這些費用與將奧古斯塔醫院加入皮埃蒙特合資企業有關。

2025 will include a full-year impact of these, which we expect to be $5.5 million to $6.5 million for Oracle Fusion implementation cost and $6 million to $7 million in NCI expense related to the Augusta joint venture.

2025 年將包括這些費用的全年影響，我們預計 Oracle Fusion 實施成本為 550 萬至 650 萬美元，與奧古斯塔合資企業相關的 NCI 費用為 600 萬至 700 萬美元。

And with that, we'll now open the lines for Q&A.

現在，我們將開始問答環節。

(Operator Instructions) Whit Mayo, Leerink Partners.

（操作員指示）Whit Mayo，Leerink Partners。

My question first just on the MA growth. This has been outpacing other payer classes for some obvious reasons with all the health plan scrutiny, the fewer denials and such. But is the growth you're seeing more apparent in certain states or certain markets versus others? Is it more broad-based as a trend across the portfolio? I'm just trying to get a sense of sort of when you unpack the business where we're seeing that level of growth come from?

我的第一個問題是關於 MA 成長。由於顯而易見的原因，這一類別的付款人數量一直超過其他付款人，例如對所有健康計劃的審查、拒絕的次數較少等。但是，與其他州或市場相比，您是否看到某些州或某些市場的成長更為明顯？它是否是整個投資組合中更廣泛的趨勢？我只是想知道，當您分析業務時，我們看到的這種成長水平是從何而來的？

Yeah. Whit, it's been a little bit of both. We are seeing same-store growth in Medicare Advantage as well, but it's definitely being assisted by our movement into new markets.

是的。惠特，兩者都有一點。我們也看到醫療保險優勢計劃的同店成長，但這肯定得益於我們進入新市場的舉措。

We continue to believe that there's a lot of upside within the Medicare Advantage book of business, both because of the enrollment trends and also due to the fact that our admissions to referral rate remains substantially lower within Medicare Advantage than does within fee-for-service, and there's really no reason for that discrepancy to exist.

我們仍然相信，聯邦醫療保險優勢計劃業務具有很大的上升空間，這既是因為登記趨勢，也是因為我們在聯邦醫療保險優勢計劃中的入院轉診率仍然遠低於按服務收費計劃中的入院轉診率，而且實際上沒有理由存在這種差異。

But if we just kind of look at some of the discharge growth patterns, for the quarter, Medicare Advantage was up 14.7%, up 12% on a year-to-date basis, the same-store growth within that for the full year of 2024 was 9.9%. And we're looking at a five-year CAGR in the Medicare Advantage discharge growth of 11.6%. So we really do feel like we're making substantial inroads there.

但如果我們只看一些出院成長模式，本季度，醫療保險優勢計畫成長了 14.7%，年初至今成長了 12%，2024 年全年同店成長率為 9.9%。我們預計醫療保險優勢計劃的五年複合年增長率為 11.6%。因此，我們確實感覺到我們在那裡取得了實質的進展。

Whit, as you know, it's been a multiyear process for us in terms of making sure that we are loaded with data show our outcomes and our value proposition. So that's what we lead with whenever we go in and meet with the plans and make sure that they're aware of the outcomes we're able to get in our facilities. So we continue to refine that process and we'd expect to continue to see growth in Medicare Advantage going forward.

惠特，如你所知，我們花了很多年的時間確保我們有足夠的數據來展示我們的成果和價值主張。因此，每當我們進入並討論計劃時，我們都會以此為先，並確保他們了解我們能夠在我們的設施中獲得的成果。因此，我們將繼續完善這項流程，並預期未來醫療保險優勢計畫將持續成長。

And I think it is also important to note that it doesn't mean that Medicare fee for service is not growing. Again, Medicare discharges in the quarter up 6.8% year-to-date, which is the full year of 2024 8.6%, same store for 2024, up 5.7% and the five-year CAGR there is a little bit lower, but still impressive at 3.4%.

我認為還需要注意的是，這並不意味著醫療保險服務費用沒有成長。同樣，本季的醫療保險出院金額今年迄今成長了 6.8%，2024 年全年成長了 8.6%，2024 年同店成長了 5.7%，五年複合年增長率略低，但仍令人印象深刻，達到 3.4%。

That's helpful. Just my follow-up on free cash flow and priorities here. I mean the cash flows hit an inflection in the last two years with presumably a lot of the earnings from the prior year investments now overcoming the incremental capital investments, which you've made, which is nice. But I just want to hear any views on buybacks as a larger priority going forward? And Doug, if you could just maybe comment on total CapEx expectations for the year, I don't know if I caught that number.

這很有幫助。我只是在這裡跟進自由現金流和優先事項。我的意思是，現金流在過去兩年裡出現了一個轉捩點，大概是前一年投資的大部分收益現在已經超過了你所做的增量資本投資，這是件好事。但我只是想聽聽大家對將回購作為未來更大優先事項的看法？道格，你能否對今年的總資本支出預期發表一下評論，我不知道我是否記住了這個數字。

Yeah. So CapEx is going to be up this year. It's probably going to be up on the order of about $100 million. Most of that is in growth-related CapEx, specifically related to our continued capacity expansion. It's going to be a big year.

是的。因此今年的資本支出將會增加。其金額可能會達到約 1 億美元。其中大部分是與成長相關的資本支出，具體與我們持續的產能擴張有關。這將是重要的一年。

We expect both this year and next year with regard to bed additions, which as you know, is our highest returning form of capital deployment. So we're excited about the opportunities to bring more beds on. We've got -- also got an increased spend in de novo activity. Some of that is related to the fact that we're opening one additional hospital this year, but it also gets to the timing of the 2026 opening. So that number will be up, and it's probably approaching what we think will be a run rate for the next several years.

我們預計今年和明年都會增加床位，如你所知，這是我們回報最高的資本配置形式。因此，我們對能夠提供更多床位的機會感到非常興奮。我們在新業務活動方面的支出也增加了。這在一定程度上與我們今年將開設一家新醫院有關，但也與 2026 年開業的時間有關。因此這個數字將會上升，並且可能接近我們認為的未來幾年的運行率。

With regard to deploying cash flow beyond that, we did increase and begin utilizing the share repurchase authorization midyear of 2024, and we would expect continued and probably more consistent utilization of that program with excess free cash flow going forward.

至於除此之外的現金流部署，我們確實增加並於 2024 年中期開始使用股票回購授權，並且我們預計該計劃將繼續並且可能更加持續地利用，並在未來擁有過剩的自由現金流。

And we do have the cash dividend. That gets adjusted from time to time at the discretion of the Board. It's not specifically policy or formulaic driven, but I think once you move beyond our spend on growth-related discretionary capital expenditures, the most likely utilization of excess free cash flow given where we sit from a leverage perspective is going to continue to be shareholder distributions.

我們確實有現金紅利。董事會將根據其酌情決定隨時進行調整。這不是特定的政策或公式驅動的，但我認為，一旦你超越我們在與成長相關的可自由支配資本支出上的支出，考慮到我們從槓桿率角度所處的位置，最有可能利用的過剩自由現金流將繼續是股東分配。

Matthew Gillmor, KeyBanc.

馬修·吉爾摩（Matthew Gillmor），KeyBanc。

I wanted to ask about the pace of the bed additions in '25. It seems like that's accelerated a little bit this year compared to last year, and I appreciate Mark's comments at the top of the call about the supply and demand imbalance.

我想問一下'25年增加床位的速度。與去年相比，今年的情況似乎有所加速，我很欣賞馬克在電話會議開頭關於供需失衡的評論。

Should we think about 2025 and is this in terms of the pace in more just a timing issue, it happens to be a good year? Or is there anything more to discuss in terms of your ability to move projects forward and meet the demand and maybe even accelerate sort of the pace of bed additions over time?

我們是否應該考慮 2025 年？或者關於您推進專案、滿足需求的能力，甚至可能隨著時間的推移加快床位增加的速度，還有什麼可以討論的嗎？

Matt, we're adding one more hospital in 2025 than we did last year. We have seven de novos and one satellite coming on this year. We're also adding 100 beds. So both of those, it's one additional hospitals and it's a higher number of total bed additions too. You're just going to see some fluctuations from one year to the next on that. I think we've done a really nice job in and showing our ability to meet our growth target in terms of bringing on new hospitals.

馬特，2025 年我們將比去年增加一家醫院。今年我們將發射 7 顆新衛星和 1 顆即將發射的衛星。我們還增加了 100 張床位。因此，這兩者都意味著增加了一家醫院，並且增加了更多的總床位數量。您只會看到每年都會出現一些波動。我認為我們在引進新醫院方面做得非常出色，並且展現出了我們實現成長目標的能力。

As we said, we are bringing on five in the state of Florida this year, which certainly has some benefit when we see that market density in terms of staffing and having experienced members of senior management teams maybe flow from one hospital over to a new hospital to help that start-up process. But we feel pretty good about the pace that we're bringing them on. And yeah, this year is a little bit higher pace than what we had last year.

正如我們所說的，我們今年將在佛羅裡達州引進五家醫院，這無疑會帶來一些好處，因為我們看到，在人員配置方面，市場密度較高，經驗豐富的高級管理團隊成員可能會從一家醫院流向另一家新醫院，以幫助啟動過程。但我們對於目前進展的速度感到非常滿意。是的，今年的步伐比去年稍微快一點。

And Matt, if I could elaborate on that. We have more hospitals today that are candidates for bed expansions than we've had in recent history. And that is largely due to the fact that we are coming off of two years, really three years of very strong total discharge growth. If you roll all the way back to 2022, up 6.8%; '23, up 8.7%; and '24, up 8.3%. And as a result, our occupancy level has been increasing.

馬特，我可以詳細解釋一下嗎？如今，我們需要擴充床位的醫院數量比近代歷史上任何時候都多。這在很大程度上是因為我們剛剛經歷了兩年、實際上是三年的非常強勁的總排放量增長。如果一直回溯到 2022 年，則上漲 6.8%； '23，成長8.7%；和’24，成長8.3%。因此，我們的入住率一直在提高。

Now some of that is also attributable to the fact that we continue to push the percentage of our overall portfolio comprised of private beds up, but this has started to create more opportunities, more hospitals that are on our list for future period bed expansion.

現在，這在一定程度上也歸因於我們繼續提高私人床位占我們整體投資組合的比例，但這已經開始創造更多的機會，更多醫院被列入我們未來床位擴張的名單。

Our ability to move quickly on those has two primary constraints or limitations. One is a significant number of those bed expansion opportunities are subject to CON permit. That CON hurdle is a lot lower than it is for a new hospital, but it still exists and it takes some time to navigate.

我們迅速採取行動的能力受到兩個主要限製或限制。一是相當一部分床位擴建機會都需要取得 CON 許可。與新醫院相比，該 CON 門檻要低得多，但仍然存在，並且需要一些時間來解決。

And the second, quite frankly, is that the number of projects that is on our plate somewhat limited the capacity within our design and construction department. We're adding resources there. This is a high-class problem to have, but that's why some of what you're starting to see in this year's number and in what we're anticipating for 2026 as well.

第二，坦白說，我們面臨的專案數量在一定程度上限制了我們設計和施工部門的能力。我們正在那裡添加資源。這是一個很嚴重的問題，但這也是為什麼你會在今年的數字以及我們 2026 年的預測中看到這樣的情況。

That's great. And then, Doug, maybe asking about the SWB per FTE assumption in the guide. I know you've got a little bit, I think, of a deceleration in growth down to 3.5% at the midpoint. I was hoping maybe you could unpack that a little bit. It sounds like you've got a really easy comp on the benefit side. But is there anything you can call out in terms of what you're seeing in terms of other factors, whether that's wage growth or turnover that's hoping to explain that modest deceleration?

那太棒了。然後，Doug，也許會詢問指南中每個 FTE 的 SWB 假設。我知道你們的經濟成長已經稍微放緩，中間值降至 3.5%。我希望您能稍微解釋一下這一點。聽起來你在福利方面得到了非常輕鬆的補償。但是，就您所看到的其他因素而言，您是否能指出什麼，無論是薪資成長還是營業額，是否能夠解釋這種適度的減速？

I think all of that gets tossed in. And so that SWB inflation range that we have of 3.25% to 3.75% is on total SWB. So that also includes those premium labor categories. And we're making an assumption that our spend in those premium labor categories will still stay relatively constant as -- in terms of total dollars. So that's going to give us a point of leverage in the inflation rate as well. Your comment on benefits is appropriate.

我認為所有這些都被拋在了一邊。因此，我們的 SWB 通膨範圍是 3.25% 到 3.75%，是整體 SWB 的通膨範圍。因此這也包括那些優質勞動力類別。我們假設我們在這些優質勞動力類別上的支出在總額方面仍將保持相對穩定。所以這也會給我們在通貨膨脹率上提供一個槓桿點。您對福利的評論是恰當的。

As I noted in my comments just a moment ago, we do expect that group medical inflation to continue through the first half of this year. But then you're going to anniversary it in the second half of the year. And we do expect to see some benefits related to lower turnover rates.

正如我剛才的評論中提到的，我們確實預期團體醫療通膨將持續到今年上半年。但你將在今年下半年慶祝週年紀念日。我們確實希望看到與降低離職率相關的一些好處。

So all of that kind of in the mix. I will note that range is just slightly higher than what I had alluded to as a potential range in our Q3 call, but it's really just based on the trends that we witnessed in Q4 that are carrying into 2025.

所有這些都混合在一起。我要指出的是，該範圍略高於我在第三季度電話會議中提到的潛在範圍，但這實際上只是基於我們在第四季度見證的延續到 2025 年的趨勢。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

Hi, everybody. First of all, maybe just to ask about your -- or has been a great opportunity for you. How has -- are you the primary person adding IRF beds in that state? How does the overall market look now? Is it around any risk of being somewhat overbedded and people overshot the target? Or do you feel like relative to your other markets, the beds per [thousand] and so forth is still in a good stride here. How much of your overall -- once you get these all up and running, will be far (technical difficulty)

大家好。首先，也許只是想問您的——或者這對您來說是一個很好的機會。情況怎麼樣——您是該州增加 IRF 床位的主要負責人嗎？現在整體市場狀況怎麼樣？是否存在過度擁擠的風險以及人員超過目標的風險？或者您是否覺得相對於其他市場，這裡的每千張床位數量等仍然處於良好的發展階段。一旦這些都啟動並運行起來，你的整體將有多大程度（技術難度）

So let me take your first question, A.J. It's Mark. So we feel good about our growth in Florida. We are the -- the -- we've taken the lead, have been in the lead in terms of adding bets there. That was by design. When we stated we had 15 marketplaces that we were prioritizing for future growth. We went out and bought the real estate, and we're first to market, which was an important part of our strategy in the state of Florida.

那麼讓我來回答你的第一個問題，A.J。是馬克。因此我們對我們在佛羅裡達州的發展感到滿意。我們是——我們已經佔據領先地位，在增加賭注方面一直處於領先地位。這是設計使然。當我們聲明我們有 15 個市場時，我們優先考慮未來的成長。我們出去購買房地產，並率先進入市場，這是我們在佛羅裡達州策略的重要組成部分。

As we said, we already had 12 hospitals that were legacy hospitals there. So we knew exactly what markets we wanted to go into and where we would add beds to. So it's been very intentional our accelerated pace in the state of Florida.

正如我們所說，我們那裡已經有 12 家傳統醫院。因此，我們清楚地知道我們想要進入哪些市場以及在哪裡增加床位。因此，我們有意加快佛羅裡達州的步伐。

As you know, the demographics for the state of Florida play into our line of business. There continue to be strong growth in the markets that we're entering and so we don't see that state as being overbedded, if anything, as I noted, we have additional opportunities in state of Florida whether that's through new hospitals or adding beds to our existing hospitals.

如您所知，佛羅裡達州的人口統計數據與我們的業務有關。我們進入的市場繼續保持強勁增長，因此我們並不認為該州的醫院床位過剩，如果有的話，正如我所說，我們在佛羅裡達州還有更多機會，無論是通過新建醫院還是在現有醫院增加床位。

And A.J., maybe just to piggyback on that a little bit. First of all, because the CON was in place until 2021, there was an artificial cap on a number of IRF beds in the state of Florida. And as the population continues to grow even during that period preceding 2021, particularly amongst the senior population, the supply-demand gap really opened up pretty significantly. So they were starting in a very significant deficit.

而 A.J. 或許只是想稍微利用一下這一點。首先，由於 CON 將持續實施至 2021 年，因此佛羅裡達州的 IRF 床位數量存在人為上限。即使在 2021 年之前，人口仍在持續成長，尤其是老年人口，供需缺口確實相當大。因此他們一開始就面臨很大的赤字。

As Mark noted in his comments as well, and I think it's important to go back to that 2020 timeframe. Obviously, when the pandemic hit, most operators in the business kind of lost visibility into the near-term operating trends of their business. But as we've counted previously, we made the decision in April of 2020.

正如馬克在他的評論中提到的那樣，我認為回到 2020 年的時間範圍很重要。顯然，當疫情來襲時，大多數營運商都對其業務的近期營運趨勢失去了洞察力。但正如我們之前計算的那樣，我們在2020年4月做出了這個決定。

And even in the midst of all of that to begin pushing forward with this accelerated de novo program and doing things like purchasing land in the state of Florida for de novos because we had identified those markets previously. That had the effect of creating a first-mover advantage and frankly, made a lot of our competitors shy away from adding capacity because they weren't in a position to do so.

甚至在這一切之中，我們開始推進這個加速的 de novo 計劃，並做一些事情，例如在佛羅裡達州為 de novos 購買土地，因為我們之前已經確定了這些市場。這產生了創造先發優勢的效果，並且坦白說，使得我們的許多競爭對手不願增加產能，因為他們沒有能力這樣做。

The final thing that I would add is if you just look at the current rate environment versus what it was several years ago, for those IRF operators that are owned by private equity sponsors that have been heavily reliant on levered transactions with refinancing, the economics have just become a lot less powerful. If you combine elevated construction costs, with higher cap rate costs embedded in those leases is just difficult, particularly without enjoying the same economies of scale that we do to make the numbers work.

我最後要補充的是，如果將當前的利率環境與幾年前的利率環境進行比較，你會發現，對於那些由私募股權發起人擁有、嚴重依賴槓桿交易和再融資的 IRF 運營商而言，其經濟效益已經大大減弱。如果將高昂的建築成本與租賃中所包含的更高的資本化率成本結合起來，那就很困難了，特別是在沒有像我們一樣享受規模經濟的情況下，這些數字是可行的。

Okay. Great. Maybe just my follow-up. Obviously, there's a lot of focus across healthcare services on the new administration, the new Congress, and what they might do. It seems like you're fairly insulated from the laundry list of Medicaid reforms and so forth.

好的。偉大的。也許只是我的後續行動。顯然，醫療保健服務部門非常關注新政府、新國會以及他們可能採取的行動。看起來你對醫療補助改革清單等內容相當陌生。

But are there any areas where you're launching better a particular area of focus. And then as well on the -- you mentioned prior authorization, there's been some chatter about that. Are you advocating for some relief relative to MA and other health plans on prior authorizations? And what's the prospects for that?

但是，您是否在哪些領域可以更好地進行特定的重點關注工作？然後還有——您提到了事先授權，對此有一些討論。您是否主張對 MA 和其他健康計劃在事先授權方面給予一些寬限？其前景如何？

So A.J., as you know, there's not a lot of specifics coming out relative to policy from D.C. right now until the confirmation of HHS and CMS or RFK Jr. and Dr. Oz. But we've spent some time up there. We've had a chance to meet some of the incoming senior staffers for CMS and otherwise. And we made the point of wanting to make sure that there is not regulatory overreach, and those are unnecessary expenditures and have no positive benefits for the patients.

所以 A.J.，如你所知，在衛生與公眾服務部 (HHS) 和CMS 或羅伯特·肯尼迪 (RFK) Jr. 和奧茲博士的確認之前，目前華盛頓還沒有出台很多有關政策的具體細節。但我們已經在那裡待了一段時間了。我們有機會會見了 CMS 和其他部門的一些新任高級職員。我們希望確保監管範圍不過度，否則會產生不必要的開支，並且不會為患者帶來任何積極的好處。

And so we're watching it closely. We're not hearing anything of concern right now that are specific policy changes or regulatory changes facing the IRF industry, but we will absolutely remain active and involved in D.C. and want to be on the front edge of meeting the new incoming leaders of CMS.

因此我們正在密切關注。目前我們還沒有聽到任何值得擔憂的消息，即 IRF 行業面臨的具體政策變化或監管變化，但我們絕對會繼續活躍並參與華盛頓特區的活動，並希望站在最前沿，迎接 CMS 的新領導人。

And A.J., I would say that with regard to conversations that we have with CMS and then also with our elected representatives on the subject of Medicare Advantage, our two primary focus points are improvements in pre-authorization processes and philosophies. And then the second is, as we've discussed before, right now, there is no requirement for Medicare Advantage plans to include IRFs in their definition of network adequacy. And we think that, that is simply an oversight that should be corrected.

A.J.，我想說，就我們與 CMS 以及我們選出的代表就醫療保險優勢計劃問題進行的對話而言，我們的兩個主要關注點是改進預授權流程和理念。第二，正如我們之前討論過的，目前，醫療保險優勢計劃沒有要求將 IRF 納入其網路充分性的定義中。我們認為，這只是一個應該糾正的疏失。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

You noted that group medical prescription drug costs are expected to continue to increase through the first half of '25 before you anniversary some of the acceleration. Can you give us a bit more detail on the trends you're seeing there? Are there any specific drugs or categories that you would call out as driving the increase in the group medical line?

您指出，預計團體醫療處方藥成本將在 2025 年上半年繼續增加，之後會出現一些加速。您能否向我們詳細介紹一下您所看到的趨勢？您認為有哪些特定藥品或類別能夠推動團體醫療線的成長？

Yeah, there are three. So the two largest -- there will be no surprise to anybody on this call. One is certainly GLP-1, and it is just getting -- even though we limit that to those that are at risk or have diabetes, physicians are prescribing it much more widely as even somewhat of a prophylactic.

是的，有三個。因此，這兩個最大的數字——這次電話會議不會讓任何人感到驚訝。其中一種肯定是 GLP-1，它正在逐漸普及——儘管我們將其僅限於有糖尿病風險或患有糖尿病的人群，但醫生們正在更廣泛地開出它，甚至將其作為預防藥物。

So we're seeing increased utilization there, and it remains expensive. We're hopeful that given the number of entrants into the GLP-1 category that over time, the cost of that drug will decrease. Right now, what we're counting on is anniversary-ing the stepped-up usage in the second half of the year.

因此，我們看到那裡的利用率正在增加，但價格仍然昂貴。我們希望，隨著 GLP-1 類別藥物數量的增加，隨著時間的推移，該藥物的成本將會下降。現在，我們期望在今年下半年實現使用量週年提升。

The second is there are a -- and this is a good thing, but there are a number of notable enhanced cancer-related drugs that we're seeing increased utilization of, those are expensive as well. I'd make similar comments with regard to cost trend and utilization trend there.

第二，這是件好事，但我們看到許多顯著增強的抗癌藥物的使用率有所提高，這些藥物也很昂貴。我對那裡的成本趨勢和利用趨勢發表類似的評論。

And then the third and I don't know that I can pronounce the name of it even if I wanted to, is there is one drug that's specifically related to eyesight and eye health that has popped up a little bit more frequently.

然後第三個，即使我想讀出它的名字，我也不知道是否可以讀出，有一種藥物特別與視力和眼睛健康有關，出現的頻率更高一些。

Got it. That's helpful. And if I could just follow up. I think the total net benefit from provider taxes this year totaled $16 million, I think, for the year. How should we be thinking about this for 2025? Is there an explicit assumption around these items in guidance? And is that benefit in 2024 largely expected to recur? Any color there would be helpful.

知道了。這很有幫助。請容許我繼續跟進。我認為，今年供應商稅收的淨收益總額應該達到 1,600 萬美元。我們該如何思考2025年這個問題？指導中是否對這些項目有明確的假設？預計 2024 年這項福利將再次出現嗎？任何顏色都有幫助。

Sure. So the EBITDA impact from net provider taxes, so the revenue less the associated expense for 2024, it was $15.4 million. As we've noted previously, approximately $5 million of that was related to prior periods, and there really isn't any reason to expect that, that portion would repeat itself. The balance then of about $10 million, as we've talked about before, has a low level of predictability to it. To reinforce that point, we just -- we point to the net impact from provider taxes in the two prior years.

當然。因此，淨供應商稅對 EBITDA 的影響，即 2024 年的收入減去相關費用，為 1,540 萬美元。正如我們之前所指出的，其中約 500 萬美元與前期有關，而且確實沒有理由預期這一部分會重複出現。正如我們之前談到的，大約 1000 萬美元的餘額可預測性較低。為了強調這一點，我們只是——我們指出前兩年供應商稅的淨影響。

In 2023, the net provider tax impact to EBITDA was a decrease of $800,000. And in 2022, it was an increase of $2 million. So this feels a little bit like an outlier, and we'll just have to wait to see.

2023 年，淨供應商稅對 EBITDA 的影響減少了 80 萬美元。到 2022 年，這一數字將增加 200 萬美元。所以這感覺有點像是異常值，我們只需要拭目以待。

In terms of the 2025 guidance, we haven't included a point estimate for provider taxes within that guidance range. It is highly variable. And wherever provider taxes winds up falling in 2025 will obviously be a determinant as to where we land within that $40 million EBITDA guidance range.

就 2025 年指導而言，我們尚未在該指導範圍內包含提供者稅的點估計。它的變化性很強。而 2025 年供應商稅最終下降的位置顯然將決定我們能否在 4,000 萬美元的 EBITDA 指引範圍內達到目標。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

So I guess, first, a follow-up on the maintenance CapEx in the slides, you talk about major innovation projects and programmatic hospital asset replacement. So a little bit of color there. Is there something that you do this year differently than prior's?

所以我想，首先，在幻燈片中跟進維護資本支出，您談到了重大創新項目和計劃性醫院資產更換。那裡有一點顏色。今年您所做的事情與以往有何不同？

Yes. So just -- we've got more hospitals now. The hospitals utilize a lot of the same equipment, and we have programs that will, in order to leverage our scale, buy that equipment and replace it on a regular basis, sometimes in cycles across the hospitals and sometimes more uniformly. The spend specifically in that programmatic category for 2025 relates to bed replacement. About every five to seven years, all of the beds need to be replaced in order to ensure safety and comfort for our patients.

是的。所以——我們現在有更多的醫院。各家醫院使用許多相同的設備，為了充分利用我們的規模，我們制定了相關計劃，購買這些設備並定期更換，有時是在各家醫院之間循環更換，有時則是更統一的方式。2025 年此計畫類別中的專門支出與床位更換有關。大約每五到七年，所有的床都需要更換，以確保患者的安全和舒適。

Other categories that will occasionally fall into that wheelchairs or pretty significant spend. Sometimes the machinery that we utilized dispense narcotics -- not narcotics, drugs, prescription drugs is a better term, will fall into that category as well. So we just -- we think it's really important that we maintain all facets of the -- of our hospitals.

偶爾會落入的其他類別是輪椅或相當可觀的開支。有時我們用來分發麻醉劑的機器──不是麻醉劑，而是毒品，更確切地說是處方藥，也屬於這一類。因此我們認為維護醫院的各個方面確實非常重要。

Okay. That's helpful. And if I may, so the adjusted free cash flow came in, call it, $100 million is still better than expected in your prior guidance for the full year. So what drove that? Was there some sort of pull forward from '25? Because now I guess your guidance for '25 kind of calls for the client from '24 because '24 came in so much better.

好的。這很有幫助。如果可以的話，調整後的自由現金流為 1 億美元，這仍然好於您先前對全年的預期。那麼，是什麼導致了這現象呢？從 25 年開始是否存在某種向前推進的趨勢？因為現在我猜你對 25 年的指導有點像對 24 年客戶的呼籲，因為 24 年的情況要好得多。

Yeah. So it's really two things. One is EBITDA came in better than we expected. The second is the favorable result in working capital was better than we expected. And some of that will definitely be a pull forward because some of that relates to the increase in claims activity under our group medical, where we're seeing a liability and near-term liability increase and it doesn't translate into cash until you get into subsequent periods.

是的。所以這其實是兩件事。一是 EBITDA 好於我們的預期。第二是營運資本的良好結果好於我們的預期。其中一些肯定會向前推動，因為其中一些與我們團體醫療索賠活動的增加有關，我們看到負債和近期負債在增加，直到進入後續期間才會轉化為現金。

Ann Hynes, Mizuho.

安海因斯（Ann Hynes）、瑞穗（Mizuho）。

So I know post the pandemic, Encompass really benefited from gaining market share from nursing home. What is that like now? Is that still a tailwind for the company?

所以我知道疫情過後，Encompass 確實從養老院市場份額中獲益。現在情況怎麼樣？這對公司來說仍然是一個順風嗎？

Yeah, Ann, it is. I mean we -- I think we, along with the industry, as itself, distinguish ourselves from the nursing homes and the differences that in terms of patients that could be treated, we continue to see increasing numbers of stroke and other neurological types of patients that are typically higher acuity in our hospitals.

是的，安，確實如此。我的意思是，我認為我們和產業本身都將自己與療養院區分開來，就可治療的患者而言，我們繼續看到越來越多的中風和其他神經系統類型的患者，這些患者的病情通常在我們的醫院中更為嚴重。

And we think the outcomes that we are able to get versus what previous referral sources saw from nursing homes. That has had some stickiness to it in terms of changing the referral patterns in some of our marketplaces.

我們認為，我們能夠獲得的結果與先前的轉診來源從療養院看到的結果不同。就改變我們某些市場的推薦模式而言，這具有一定的黏性。

I think there's no perfect way to measure market share gains from the SNF industry, but I'd point to a couple of things. One is we've now had 10 straight quarters where our same-store discharge growth was north of 4%. And that is growing faster than the underlying demographic, which means that we are taking market share from some place. The patients that we're treating are not patients that were eligible for discharged directly home, so the most likely source is either from SNFs or other IRFs. But I think that's a pretty good indication of the fact that we are gaining market share.

我認為沒有完美的方法來衡量 SNF 行業的市場份額成長，但我想指出幾點。一是，我們已連續 10 個季度實現同店銷售額增幅超過 4%。而且這一成長速度比基礎人口成長速度要快，這意味著我們正在從某個地方搶佔市場份額。我們所治療的患者不符合直接出院回家的條件，因此最有可能的來源是 SNF 或其他 IRF。但我認為這很好地表明了我們的市場份額正在擴大。

Great. And then just on the -- like Florida is an interesting stage just because they were able to lift the CON laws. Is there any other state that is on the company's radar that would be similar to Florida, and if not, do you have that type of expansion potential in other states that you currently operate like Florida?

偉大的。然後就像——佛羅裡達州是一個有趣的舞台，因為他們能夠取消 CON 法律。貴公司關注的還有其他州與佛羅裡達州類似嗎？

Yeah. So Ann, there are other states that we have on our radar screen. Clearly, we have a strong presence in the state of South Carolina and only have one in the state of North Carolina, but if you look at the growth in the state of North Carolina, it would be a very attractive state for us to have a greater presence than what we currently have.

是的。安，我們的關注範圍內還有其他州。顯然，我們在南卡羅來納州擁有強大的影響力，而在北卡羅來納州只有一家門市，但如果你看看北卡羅來納州的成長情況，你會發現，對於我們來說，在這個州擴大影響力是非常有吸引力的。

And particularly when you consider the fact that South Carolina and North Carolina are really -- those are destination states for retiring seniors right now, and they are considerably underbedded.

特別是當你考慮到南卡羅來納州和北卡羅來納州實際上是——這兩個州目前是退休老年人的目的地，而且它們的人口嚴重不足。

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

(inaudible) touch on the implied EBITDA margins in the guide. At the midpoint, it would imply a modest around 30 basis points contraction year over year, obviously, a very strong year in 2024. Just to, I guess, sort of put a fine pen on that. Sort of what would you say sort of be the drivers of that? And then more importantly, maybe some of the upside opportunities that you see tangible to potentially ultimately get margins landing at stable or even improving year over year in 2025.

（聽不清楚）談談指南中隱含的 EBITDA 利潤率。從中點來看，這意味著年比將溫和收縮約 30 個基點，顯然，2024 年將是一個非常強勁的一年。我想，只是為了用好筆寫這篇。您認為造成這種情況的因素是什麼？更重要的是，也許您看到的一些切實可行的上行機會最終可能會使利潤率在 2025 年達到穩定水平，甚至逐年提高。

Yeah. So a number of things. One is we continue to believe that EBITDA dollars are better than EBITDA margin. It's tough to pay the bills with a margin. Some considerations in terms of the comparison from '24 to '25.

是的。有很多事情。一是我們仍相信 EBITDA 美元金額優於 EBITDA 利潤率。用保證金來支付帳單很困難。關於 '24 年與 '25 年的比較的一些考慮。

As I mentioned in my comments, '24 included $13 million in favorable self-insurance accrual adjustments as we just mentioned when we were responding to Andrew's question. '24 benefited from $15.4 million in provider tax impact, including $5 million of out-of-period. If you look at the start-up and ramp-up costs associated with new hospitals, the midpoint of the range is about $5 million higher in 2025 than it was in 2024, owing both to the fact that five of our hospitals in 2025 will open between September and the end of the year.

正如我在評論中提到的那樣，'24 包括 1300 萬美元的有利自保應計調整，正如我們在回答安德魯的問題時提到的那樣。 '24 受益於 1540 萬美元的供應商稅收影響，其中包括 500 萬美元的期外稅收。如果您查看與新醫院相關的啟動和升級成本，則會發現 2025 年的中間值比 2024 年高出約 500 萬美元，這歸因於我們 2025 年的五家醫院將在 9 月至年底之間開業。

And right now, we are targeting three new hospitals opening up in the first quarter of 2026, and then the delta on a year-over-year basis in terms of the G&A expense and NCI impact of Piedmont -- of the Piedmont joint venture, specifically our contribution of the Augusta hospital to that and Fusion implementation cost is $7 million.

目前，我們的目標是在 2026 年第一季開設三家新醫院，然後根據 G&A 費用和 Piedmont 合資企業的 NCI 影響，與去年同期相比有所增加，特別是奧古斯塔醫院和 Fusion 實施成本的貢獻為 700 萬美元。

So I think if I do the math right on all of those items, including just, say, the $5 million of out-of-period on provider tax impact, right there, you've got about $30 million of EBITDA that needs to be overcome moving from '24 to '25.

因此，我認為，如果我對所有這些項目進行正確計算，包括比方說 500 萬美元的期外供應商稅影響，那麼從 24 年到 25 年，需要克服的 EBITDA 約為 3000 萬美元。

Okay. That's helpful. And then for my follow-up question, especially given just all of the development activity playing out. It would be great if you could give us an update just on sort of construction sort of inflation dynamics. Obviously, that's been swinging around?

好的。這很有幫助。然後是我的後續問題，特別是考慮到所有的開發活動都在進行中。如果您能向我們提供有關建築業通膨動態的最新信息，那就太好了。顯然，情況一直在改變？

And then related to that, just curious whether -- as you sort of think about the prefab model that you spent a lot of time putting into place, have you been able to do any type of analysis around Trump's tariffs? And are there any sort of, I guess, elements of those prefabs that may come from international sources that could be affected by the tariffs and have alternative options in the US. Just curious on sort of what work you've been doing or if there is even any effect on the tariff side?

然後與此相關，只是好奇 - 當你思考花費大量時間建立的預製模型時，您是否能夠對川普的關稅進行任何類型的分析？我猜想，這些預製件中是否有來自國際來源的元素可能會受到關稅的影響，而在美國有替代選擇。只是好奇您在做什麼工作或對關稅方面是否有任何影響？

Yeah, absolutely. I'll try to take those in order. One is construction -- new construction costs have continued to stabilize right around $1.2 million per bed. For new hospitals, somewhat lower, closer to $800,000 of bed for bed additions, but it depends on the specific project. And we're not seeing any overt inflationary pressures on that cost right now. If anything, we think that we may be seeing some green shoots in terms of maybe some relief on that, but it's too early to call the ball.

是的，絕對是如此。我將盡量按順序進行。一是建設——新建築成本繼續穩定在每張床位約 120 萬美元。對於新建醫院來說，增加床位的費用會稍微低一些，接近 80 萬美元，但這取決於具體項目。目前我們還沒有看到該成本面臨任何明顯的通膨壓力。如果有的話，我們認為我們可能看到了一些曙光，也許可以緩解這一局面，但現在下結論還為時過早。

The second is we remain very pleased with our prefabrication effort. Mark mentioned earlier that in the fourth quarter, we brought on our first fully prefabricated hospital, that's 61-bed facility in Houston, Texas. Our second fully prefabricated hospitals getting ready to open any day right now in Athens, Georgia. So that will continue to be part of our construction strategy along with hospitals that are utilizing components of prefab everywhere from headwalls to bathrooms to the Uber modules, which are groups of rooms that are attached by a corridor.

第二，我們對我們的預製工作仍然非常滿意。馬克之前提到，在第四季度，我們建立了第一家完全預製的醫院，位於德克薩斯州休斯頓，擁有 61 張床位。我們的第二座完全預製的醫院即將在喬治亞州雅典投入營運。因此，這將繼續成為我們建造策略的一部分，同時醫院也將利用預製組件，從頭牆到浴室，再到 Uber 模組（透過走廊連接的房間組）。

The cost for the prefabrication right now from a per bed perspective is essentially right on top of conventional construction as well. The primary benefit that we're seeing today is on the full prefab, we're getting about a 25% enhancement in terms of the speed to market, which is not insignificant.

目前，從每張床位的角度來看，預製成本基本上也高於傳統建築成本。我們今天看到的主要好處是在完全預製方面，我們在上市速度方面獲得了約 25% 的提升，這並不是微不足道的。

With regard to the threat of tariffs in the near term, it's very low for us in terms of design and construction. There could be some impact if you impose those upon Mexico in terms of our concrete cost, but that's a very small component of our overall construction costs.

至於近期的關稅威脅，就設計和施工而言，對我們來說，可能性很低。如果將這些要求強加給墨西哥，可能會對我們的混凝土成本產生一些影響，但這只是我們整體建築成本的一小部分。

With regard to steel, we use predominantly US source steel and much of it is recycled specialty steel that comes out of the US. We did a broader analysis of our potential exposure to tariffs coming out of Mexico, Canada and China around overall supplies.

就鋼鐵而言，我們主要使用美國原產鋼鐵，其中大部分是從美國生產的再生特種鋼鐵。我們對墨西哥、加拿大和中國關稅對整體供應的潛在影響進行了更廣泛的分析。

It's difficult to say what that might look like right now because we don't know how comprehensive it would be. You should also bear in mind that in prior periods when tariffs have been invoked, typically, medical supplies have been exempted from those tariffs. Having said that, we do not believe that there's a lot of near-term risk to the imposition of any tariffs. It's certainly something we'll continue to monitor.

現在很難說它會是什麼樣子，因為我們不知道它會有多全面。您還應該記住，在之前徵收關稅的時期，醫療用品通常不受關稅限制。話雖如此，我們認為徵收關稅在短期內不會帶來太大風險。我們肯定會繼續關注此事。

Pito Chickering, Deutsche Bank.

德意志銀行的 Pito Chickering。

I guess looking for 2024, with provider taxes, the medical fees, and then looking at '25 with the headwinds and startup losses and then the Oracle and Fusion implementation, I just want to be sure that we're modeling the year right.

我想展望 2024 年，考慮到提供者稅、醫療費用，然後展望 2025 年，考慮到逆風和新創公司的損失，以及 Oracle 和 Fusion 的實施，我只是想確保我們對這一年的建模是正確的。

Looking at quarterly EBITDA seasonality, is 2025 different than a normal year? And if so, how should we think about EBITDA in the first half of the year versus the back half of the year and any thoughts on leap year and the Oracle infusion on the first quarter?

從季度 EBITDA 季節性來看，2025 年與正常年份有何不同？如果是這樣，我們應該如何看待上半年和下半年的 EBITDA，以及對於閏年和第一季 Oracle 的注資有何看法？

Yeah. So a couple of things. One is in terms of our assumptions regarding specifically group medical expense, and Oracle, Fusion implementation and the NCI impact from the contribution of Augusta to the Piedmont joint venture, you had those second half expenses in 2024. So it's really going to be a more pronounced impact on EBITDA from a comparison perspective in 2025.

是的。有幾件事。一是就我們對特定團體醫療費用以及 Oracle、Fusion 實施以及奧古斯塔 (Augusta) 對皮埃蒙特 (Piedmont) 合資企業的貢獻對 NCI 的影響的假設而言，您在 2024 年下半年就有這些費用。因此，從比較的角度來看，它對 2025 年的 EBITDA 的影響將更加明顯。

The second thing to keep in mind is one that I just alluded to with regard to the pace of the preopening and ramp-up costs, and that is that it's going to be skewed more heavily towards the back half of the year because of the timing of the openings in '25 and '26.

要記住的第二件事是我剛才提到的關於開業前和提升成本的速度，那就是由於'25年和'26年開業的時間，它將更加傾向於今年下半年。

And then the other thing I'd ask you to remember is that we had that spike in bad debt expense in Q2 because timing of the GPE review by Palmetto, which subsequently then reversed itself in the second half of the year.

然後我想請大家記住的另一件事是，我們在第二季度的壞帳費用激增，是因為 Palmetto 進行 GPE 審查的時間安排，但隨後在下半年出現了逆轉。

And there's a chance just based on what we've seen in terms of the historical review pattern from Palmetto over the last couple of years that you see a similar spike in Q2 of this year, but there's no real way for us to determine that. I think those are the primary pacing considerations I can think of, Pito.

而且，根據過去幾年 Palmetto 的歷史回顧模式來看，今年第二季也有可能出現類似的飆升，但我們無法真正確定這一點。我認為這些是我能想到的主要節奏考慮因素，Pito。

And then a follow-up to Whit's question on leverage. Is there a minimum leverage ratio where you deploy all excess free cash flow into repo? Just looking at the share guidance of $103 million and looking at your EBITDA growth and the cash flow generation, it just seems like a minimum leverage ratio would be helpful for investors to just calculate how much cash could be returned via share repo.

然後是對 Whit 關於槓桿率的問題的後續回答。是否存在一個最低槓桿率，可以將所有超額自由現金流部署到回購中？只需查看 1.03 億美元的股票指引並查看您的 EBITDA 成長和現金流產生，最低槓桿率似乎有助於投資者計算可以透過股票回購返還多少現金。

Yes, it's a fair question. I wouldn't draw a hard line there, but I would say that, certainly, if we see the leverage drop below 2 times, it's feeling like there's a lot of inefficiency in our cost of capital.

是的，這是一個合理的問題。我不會在這裡劃一條硬線，但我想說，如果我們看到槓桿率降至 2 倍以下，我們就會感覺到我們的資本成本有很大的效率低下。

All right. So 2 times is a minimum where we'll model all that going into a repo going forward?

好的。所以，我們將這一切模擬到 repo 中，最少需要 2 次嗎？

Minimal is your term, not my term. As I said, I'm not putting a hard line there, but I would make the observation if we fall below 2 times, then we're going to be looking hard at what I would view as an unnecessary inefficiency in our weighted average cost of capital.

最低限度是你的條件，不是我的條件。正如我所說的，我並沒有在這裡設定一個強硬的界限，但是我會觀察到，如果我們低於 2 倍，那麼我們將認真審視我認為的加權平均資本成本中不必要的低效率。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Just wondering if we could get a quick update on the managed care contracting environment, rate assumptions and guidance seemed consistent with last year. And I know you guys have historically maintained favorable spread between MA and Medicare rates, but with the ongoing margin pressure among some payers, just anything changing in your negotiations? And separately, any changes in how payers are assessing patient eligibility for health care?

只是想知道我們是否可以快速更新管理式醫療承包環境、費率假設和指導似乎與去年一致。我知道你們歷來都保持著 MA 和 Medicare 費率之間的有利差價，但隨著一些付款人持續面臨利潤壓力，你們的談判中會有什麼變化嗎？另外，付款人評估患者醫療資格的方式有任何變化嗎？

Yeah. I would say the answer there is nothing new. So we continue to do, I think, well with regard to our managed care, including Medicare Advantage contract negotiations. The rates that we're seeing in terms of the update are pretty consistent with what we've seen in recent history, which is somewhere kind of call it, the mid to high 2%.

是的。我想說答案是沒有什麼新的。因此，我認為，我們在管理式醫療方面，包括醫療保險優勢合約談判，繼續做得很好。我們在更新中看到的利率與我們近期歷史上看到的利率非常一致，也就是所謂的 2% 的中高水準。

We're not seeing any pressure against those based on some of the conditions that are facing Medicare Advantage plans and some of that just relates to the fact that when they were seeing 6% and 8% increases, they weren't passing those on to us. So it seems only appropriate -- they appear to recognize this as well that they not try to reverse that trend when they're seeing more pressure. I think they also understand that we provide great value.

我們沒有看到針對那些面臨某些醫療保險優勢計劃條件的人的任何壓力，其中一些只是與這樣一個事實有關：當他們看到 6% 和 8% 的增長時，他們並沒有將這些增長轉嫁給我們。因此，這似乎是唯一合適的——他們似乎也認識到了這一點，當他們看到更大的壓力時，他們不會試圖扭轉這種趨勢。我想他們也明白我們提供巨大的價值。

And finally, we continue to make progress, albeit it's more marginal, just given the substantial improvement in our overall base on converting more of our per diem MA contracts to an episodic basis. We've got a really good team that oversees our Medicare Advantage and our managed care contracting, and they continue to make good progress.

最後，我們繼續取得進展，儘管進展比較微小，但考慮到我們在將更多每日 MA 合約轉換為間歇性合約方面總體基礎的實質改善。我們擁有一支非常優秀的團隊，負責監督我們的醫療保險優勢計劃和管理式醫療承包，並且他們不斷取得良好的進展。

Appreciate that. And just as a quick follow-up to something you mentioned in your prepared remarks. I think you noted some misconceptions among discharge planners around IRF versus SNF care. And I was wondering, as you're entering new markets, ramping up de novos, what is involved in that education process? And how long does it take to break that muscle memory among the discharge planners and still the value proposition of IRF versus SNF care?

非常感謝。這只是對您在準備好的演講中提到的一些事情的快速跟進。我認為您注意到了出院計劃人員對 IRF 與 SNF 護理的一些誤解。我想知道，當您進入新市場、擴大規模時，教育過程涉及哪些內容？那麼，需要多長時間才能打破出院計劃人員的肌肉記憶，並且仍然保留 IRF 與 SNF 護理的價值主張？

Yeah, Ben, it's a great question. So yes, that is a -- that's a priority whenever we enter a new market, we'll have our nurse (inaudible) on. We'll have our administrative staff, we'll have our medical director. Whoever we can get out and whoever will listen to what we describe goes on in our hospitals and the differences between an IRF at SNF, especially in a marketplace that has no other facilities in there. But just talking about the differences and the intensity of care, the types of patients, the length of stay, what typically happens at the time of discharge.

是的，本，這是一個很好的問題。所以是的，這是一個優先事項，每當我們進入一個新市場時，我們都會讓護士（聽不清楚）上班。我們將有行政人員，有醫療主任。無論我們能找到什麼人，無論誰願意聽我們描述醫院的情況，以及 IRF 與 SNF 之間的差異，特別是在沒有其他設施的市場中。但只是談論差異和護理強度、病人類型、住院時間長短以及出院時通常發生的情況。

That can vary from market to market, but I think we've gotten really refined on that. I think that has proven in the ramp-up of the de novos. You've seen us bring on the last several years. But what you identified is a -- that's a key priority as we go into the new marketplace with both the newly hired staff that are there as well as existing staff that may come from that region or the home office going in to educate the marketplace.

這可能因市場而異，但我認為我們已經對此進行了非常完善。我認為這在 de novos 的提升中已經得到證明。你們已經看到我們過去幾年的發展。但是，您所指出的是——這是我們進入新市場時的一個關鍵優先事項，無論是新聘用的員工，還是來自該地區或總部的現有員工，都將負責對市場進行教育。

And that education process starts as early as six months prior to projected opening. What we frequently encounters and some of the confusion is related to as simple a concept as the naming convention. And unfortunately, there's no prohibition within the Medicare regulations from a skilled nursing facility calling itself a rehabilitation center.

這項教育過程早在預計開業前六個月就開始了。我們常遇到的一些混淆都與命名約定這樣簡單的概念有關。不幸的是，醫療保險法規中並沒有禁止專業護理機構自稱為復健中心。

They can't call themselves a rehabilitation hospital because you have to be licensed as an acute care hospital, which all of our IRFs are in order to be able to use that naming convention. But it's just things like that, and we've demonstrated great success of being able to overcome those challenges.

他們不能稱自己為復健醫院，因為必須獲得急診醫院的許可，我們所有的 IRF 都獲得急診醫院許可才能使用該命名約定。但就是這樣的事情，我們已經證明能夠克服這些挑戰並取得巨大成功。

Part of that education, if we can get people over to tour of the hospital, they'll see a big difference between a real hospital and a nursing home.

作為教育的一部分，如果我們可以讓人們參觀醫院，他們將看到真正的醫院和療養院之間的巨大差異。

Brian Tanquilut, Jefferies.

傑富瑞 (Jefferies) 的 Brian Tanquilut。

Doug, maybe just one question for me. As I think about the vital caring ruling that came out, how should we be thinking about the benefits to you guys or how you'd be recognizing that ruling on the P&L going forward?

道格，也許我只想問一個問題。當我思考出台的至關重要的關懷裁決時，我們應該如何考慮給你們帶來的好處，或者你們如何在未來的損益表中承認這項裁決？

Yeah. So first of all, a great outcome for us. We're just really pleased with the judge's ruling on that. This is ongoing litigation. So we're not really able to comment further. And it's still playing out. So we can't give you with any specificity what it's ultimately going to look like. But as it does and as it proceeds, and we are able to share more with you, we will do so in a timely manner.

是的。首先，這對我們來說是一個很好的結果。我們對法官的裁決非常滿意。這是正在進行的訴訟。所以我們無法進一步發表評論。而且它還在繼續上演。所以我們無法具體告訴你它最終會是什麼樣子。但隨著它的進行和進展，我們能夠與你們分享更多信息，我們會及時這樣做。

Jared Haase, William Blair.

賈里德·哈塞、威廉·布萊爾。

I'll stick to one also. I just wanted to follow up on some of the comments you made about career ladders or career progression for the workforce. I thought that's under interesting. And I was just curious like what percent of the workforce today. Would you say is taking advantage of the progression opportunities that you offer?

我也會堅持一個。我只是想跟進您關於職業階梯或勞動力職業發展的一些評論。我認為這很有趣。我只是好奇現在勞動力的百分比是多少。您是否認為這是利用了您提供的晉昇機會？

And then you mentioned that's supporting better turnover. I was wondering if there's anyway to, I guess, quantify or unpack what you see in terms of turnover among those clinicians that pursue additional certifications versus those that don't?

然後您提到這支持了更好的營業額。我想知道是否有辦法量化或解析那些追求額外認證的臨床醫生與沒有追求額外認證的臨床醫生的流動率？

Jared, I don't know that we have an exact number for you in terms of the participation level and the subsequent impact on our turnover, if you can -- if you just take our turnover for RNs for 2024, we had taken that down to 20.4% for RNs and then therapist turnover was 7.7%.

賈里德，我不知道我們是否能為您提供有關參與水平以及隨後對我們的營業額的影響的確切數字，如果可以的話——如果您只看 2024 年註冊護士的營業額，我們已經將註冊護士的營業額降至 20.4%，而治療師的營業額為 7.7%。

So both of those are on the downtrend for us, certainly at or below pre-pandemic levels, specifically the turnover rate. This improvement in retention is playing in a number of different ways. There's not one particular approach, I think, to addressing retention, but clinicians appreciate having the opportunity to continue to learn and improve their skills and providing those opportunities to them through clinical ladders and exposure to different experiences that has proven itself over the years to be a really effective way to retain them.

因此，對我們來說，這兩項都處於下降趨勢，肯定處於或低於疫情前的水平，特別是離職率。保留率的提高以多種不同方式發揮作用。我認為，沒有一種特定的方法可以解決保留問題，但臨床醫生很高興有機會繼續學習和提高他們的技能，並透過臨床階梯和接觸不同的經驗為他們提供這些機會，多年來事實證明這是一種真正有效的保留他們的方法。

And if they're interested in working in a rehabilitation hospital, there's a strong chance they're going to be in Encompass and whether that's a therapist or nurses, we put a lot of effort and thought in terms of the educational opportunities that we provide for the staff members.

如果他們有興趣在復健醫院工作，很有可能他們會進入 Encompass，無論是治療師還是護士，我們都在為員工提供的教育機會方面投入了大量的精力和心思。

Jared, you've given us something that we now need to add to our preparatory materials because as I'm sitting here, I know that our HR team tracks both the percentage of our clinicians, nurses and therapists to participate in these programs. I also know that they're tracking the change in turnover within those groups. I simply don't have those at our disposal, but we won't be caught off guard on that question in future periods. So thank you for asking it.

賈里德，你給了我們一些現在需要添加到我們的準備材料中的東西，因為當我坐在這裡時，我知道我們的人力資源團隊會追蹤參與這些計畫的臨床醫生、護士和治療師的百分比。我還知道他們正在追蹤這些群體內的營業額變化。我確實沒有這些可供我們使用，但在未來的時期內我們不會對這個問題感到措手不及。感謝您提出這個問題。

I do want to note that when you consider our hospital staffing, just a reminder, that about -- about 36% of our overall FTEs in a hospital are going to be comprised of nursing FTEs and about 20% are therapy FTEs. So again, great question, and we will be better prepared to answer that with specificity in future periods.

我確實想指出的是，當你考慮我們醫院的人員配備時，需要提醒的是，醫院中大約 36% 的整體 FTE 將由護理 FTE 組成，約 20% 是治療 FTE。所以，這又是一個好問題，我們將在未來有更充分的準備來具體回答這個問題。

Thanks for giving us another metric, Jared.

感謝您為我們提供另一個指標，賈里德。

Of course. Yes, happy to give you more work here on I appreciate all the context -- thank you. You're welcome.

當然。是的，很高興能在這裡給你更多的工作，我感謝所有的背景 - 謝謝。不客氣。

And this does conclude today's Q&A session. Mr. Mark Miller, I'm pleased to turn it back to you, sir, for any additional or closing remarks you have.

今天的問答環節到此結束。馬克·米勒先生，先生，如果您有任何其他補充或結束語，我很樂意把時間交還給您。

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

謝謝。如果有人還有其他問題，請撥打 (205) 970-5860 與我聯絡。再次感謝您參加今天的電話會議。

Ladies and gentlemen, this does conclude today's teleconference, and we do thank you all for your participation. You may now disconnect your lines.

女士們、先生們，今天的電話會議到此結束，我們感謝大家的參與。現在您可以斷開線路了。