Encompass Health Corp (EHC) 2025 Q1 法說會逐字稿

Good morning everyone and welcome to Encompass Health's first quarter 2025 earnings conference call. (Operator Instructions) Today's conference call is being recorded. If you have any objections to potentially being recorded, you may disconnect at this time. I'll now turn the call over to Mark Miller, Encompass Health's chief investor relations officer.

大家早安，歡迎參加 Encompass Health 2025 年第一季財報電話會議。（操作員指示）今天的電話會議正在錄音。如果您對可能被錄音有任何異議，您可以在此時斷開連線。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 first quarter 2025 earnings call. Before we begin, if you do not already have a copy, the first quarter earnings release supplemental information and related Form 8-K filed with the SEC are available on our website at www.encompasshealth.com.

謝謝接線員，大家早安。感謝您參加 Encompass Health 2025 年第一季財報電話會議。在我們開始之前，如果您還沒有副本，第一季收益發布補充資訊和向美國證券交易委員會提交的相關 8-K 表格可以在我們的網站 www.encompasshealth.com 上找到。

On page two 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 the 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.

在補充資料的第二頁，您將找到安全港聲明，該聲明也在收益報告的最後一頁中有更詳細的說明。在電話會議中，我們將做出前瞻性陳述，例如指導和成長預測，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. The Form 10-K for the year ended December 31, 2024, and the Form 10-Q for the quarter ended March 31, 2025, when filed.

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、估計和期望存在重大差異，這些都在公司提交給美國證券交易委員會的文件中進行了討論，包括收益報告和相關的 8-K 表格。提交時，截至 2024 年 12 月 31 日止年度的 10-K 表，以及截至 2025 年 3 月 31 日止季度的 10-Q 表。

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.

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，並且僅代表截至今天的情況。我們不承擔更新這些前瞻性陳述的義務。

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。對於此類指標，可在補充資料末尾、收益報告末尾以及昨天向美國證券交易委員會 (SEC) 提交的 8-K 表格中找到與最直接可比較的 GAAP 指標的對賬，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. With that, I'll turn the call over to Mark Tarr, Encompass Health's President and Chief Executive Officer.

我想提醒大家，我們將遵守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。說完這些，我將把電話轉給 Encompass Health 總裁兼執行長 Mark Tarr。

Thank you, Mark, and good morning, everyone. We are pleased to report another strong quarter. First quarter revenues increased 10.6% and adjusted EBITDA increased 14.9%. First quarter, total discharge growth of 6.3% was a strong result, particularly in light of Q1 2024's 10% discharge growth.

謝謝你，馬克，大家早安。我們很高興地報告又一個強勁的季度。第一季營收成長 10.6%，調整後 EBITDA 成長 14.9%。第一季度，總排放量成長 6.3%，這是一個強勁的成績，尤其是考慮到 2024 年第一季排放量成長 10%。

Recall that Q1, 2024 benefited from an extra day due to leap year and because the quarter ended on Easter Sunday. First quarter of 2025, same store discharges grew 4.4%. Once again, the efforts of our dedicated and highly competent clinical team allowed us to accommodate this volume while maintaining outstanding patient outcomes.

回想一下，由於閏年以及該季度在復活節星期日結束，2024 年第一季額外多了一天。2025年第一季度，同店銷售額成長4.4%。再次，我們敬業且高素質的臨床團隊的努力使我們能夠滿足這一數量，同時保持出色的患者治療效果。

Our Q1 discharge community rate was 84%, our discharge to acute rate was 8.9%, and our discharge to sniff rate was down to 6.4%. Our performance on each of these quality metrics compare favorably to the industry average. We continue to invest in our clinical team by providing professional growth and development programs such as our clinical ladder and in-house continuing education opportunities.

我們的 Q1 出院社區率為 84%，出院轉急診率為 8.9%，出院轉診率下降至 6.4%。我們在每個品質指標上的表現都與行業平均值相當。我們透過提供專業成長和發展計劃（例如臨床階梯和內部繼續教育機會）繼續投資於我們的臨床團隊。

These programs contribute to the continuing improvement in our clinical turnover trends. Q1 of 2025 annualized RN turnover was 20.1%, down from previous years, 20.4%, and annualized therapist turnover rate was 6.3%, down from prior year 7.7%. Due in large part to our Q1 results, we are increasing our 2025 guidance. Doug will go into greater detail in his comments.

這些項目有助於我們臨床營業額趨勢的持續改善。2025 年第一季度，註冊護理師年流動率為 20.1%，低於前幾年的 20.4%，治療師年流動率為 6.3%，低於前一年的 7.7%。很大程度上由於我們的第一季業績，我們提高了 2025 年的預期。道格將在他的評論中更詳細地闡述。

Demand for Earth services remains strong, and we are continuing to invest in capacity additions to meet the needs of patients requiring inpatient rehabilitation services. In Q1, we opened a new 40-bed joint venture hospital in Athens, Georgia, our seventh JB Hospital in partnership with Piedmont.

對地球服務的需求仍然強勁，我們將繼續投資增加容量以滿足需要住院復健服務的患者的需求。在第一季度，我們在喬治亞州雅典開設了一家擁有 40 張床位的新合資醫院，這是我們與 Piedmont 合作開設的第七家 JB 醫院。

We also added 25 beds to existing hospitals. Over the balance of the year, we plan to open six De Novos with a total of 300 beds, as well as a 50-bed free-standing satellite hospital. Consistent with our historical practice, the satellite will be accounted for as a bed edition. We anticipate adding another 125 to 145 beds to existing hospitals in 2025, inclusive of the aforementioned satellite.

我們還在現有醫院增加了25張病床。在今年餘下的時間裡，我們計劃開設六家 De Novos 醫院，共 300 張床位，以及一間擁有 50 張床位的獨立衛星醫院。按照我們的歷史慣例，該衛星將被視為床位版。我們預計到 2025 年，現有醫院將增加 125 至 145 張病床，包括上述衛星醫院。

We continue to build and maintain an active pipeline of De Novo projects, both wholly owned and JVs while also monitoring and assessing bed expansion opportunities. Our pipeline of announced De Novo projects with opening dates beyond 2025 currently consists of 10 hospitals with 500 beds, and we anticipate additional projects will be announced over the balance of the year.

我們將繼續建立和維護 De Novo 計畫（包括獨資和合資計畫）的活躍管道，同時監控和評估床位擴展機會。我們已宣布的 De Novo 項目將於 2025 年以後開放，目前包括 10 家擁有 500 張床位的醫院，我們預計今年餘下時間還會宣布更多項目。

In response to strong volumes and current occupancy levels at some of our hospitals, we have increased our bed expansion plans and now expect to add approximately 120 beds to existing hospitals in both 2026 and 2027. The demand for inpatient rehabilitation services remains considerably underserved and continues to grow as the US population ages.

為了因應部分醫院的強勁需求和目前的入住率，我們增加了床位擴建計劃，預計在 2026 年和 2027 年為現有醫院增加約 120 張床位。住院復健服務的需求仍然嚴重不足，而且隨著美國人口老化，這種需求仍在持續增長。

We intend to continue to expand our capacity and capabilities to help meet this need. On April 11 of this year, CMS released the 2026 Earth proposed rule. This included a proposed net market basket update of 2.6%, which we estimate would result in a 2.7% increase for our Medicare patients beginning October 1, 2025 based on our current patient meds.

我們打算繼續擴大我們的能力和能力，以幫助滿足這項需求。今年4月11日，CMS發布了2026地球建議規則。其中包括擬議的 2.6% 的淨市場籃子更新，根據我們目前的患者藥物，我們估計從 2025 年 10 月 1 日起，這將導致我們的醫療保險患者的費用增加 2.7%。

Based on historical practice, we expect the Earth's final rule to be released in late July or early August. Yesterday we announced that Pat Tuer has been promoted to the newly established position of Chief Operating Officer where he will oversee hospital operations across the organization. Pat's promotion was prompted by our significant growth and robust development pipeline.

根據歷史慣例，我們預計地球的最終規則將在7月底或8月初發布。昨天，我們宣布 Pat Tuer 已被提升為新設立的營運長職位，他將負責監督整個組織的醫院運作。我們的顯著成長和強勁的發展勢頭促使帕特獲得晉升。

Since joining Encompass Health in 2018, Pat has held several leadership roles, most recently, group President overseeing three of our geographic operating regions with a total of 69 hospitals. Pat has been instrumental in shaping our operational success and driving the delivery of exceptional care to the patients and communities we serve.

自 2018 年加入 Encompass Health 以來，Pat 擔任過多個領導職務，最近擔任集團總裁，負責管理我們三個地理營運區域，共 69 家醫院。帕特在塑造我們的營運成功以及推動為我們服務的患者和社區提供卓越護理方面發揮了重要作用。

Many of you met Pat at our investor day in 2023 and at investor conferences and meetings since then. And we're excited to have him in this new role. He's with us here in the room this morning. Now I'll turn it over to Doug.

你們中的許多人在 2023 年的投資者日以及此後的投資者會議和會議上見過帕特。我們很高興他能擔任這個新角色。今天早上他就在我們這個房間裡。現在我將把話題交給 Doug。

Thank you, Mark, and good morning, everyone. Revenue for the quarter increased 10.6% to $1.46 billion, and adjusted EBITDA increased 14.9% to $313.6 million. Revenue growth for the quarter was driven by a 6.3% increase in total discharges and a 3.9% increase in net revenue per discharge. Same store discharges grew 4.4%. Our volume strength continues to be broad-based across geographies and patient and payor mix.

謝謝你，馬克，大家早安。本季營收成長 10.6% 至 14.6 億美元，調整後 EBITDA 成長 14.9% 至 3.136 億美元。本季營收的成長得益於總排放量增加 6.3% 以及每次排放淨收入增加 3.9%。同店銷售額成長4.4%。我們的銷售優勢繼續廣泛地覆蓋各個地區以及患者和付款人組合。

Net revenue for discharge growth of 3.9% was higher than anticipated due in part to payer mix. Q1 SWB per FTE increased 3.2%. Premium labor cost comprised of contract labor and sign on and ship bonuses declined $5 million from Q1'24 to $28.6 million.

出院淨收入成長 3.9%，高於預期，部分原因是付款人組合。第一季每位全職員工的主觀幸福感增加了 3.2%。包括合約工、簽約獎金和船舶獎金在內的優質勞動力成本較 2024 年第一季下降 500 萬美元至 2,860 萬美元。

Contract labor in the quarter was $16.4 million, down $2.9 million from Q1'24, and sign on and ship bonuses were $12.2 million ,down $2.1 million. Contract labor FTEs as a percent of total FTEs was 1.3% for the quarter. Consistent with our recent trend, benefits expense for FTE increased 14%. Growth in benefits expense for FTE is being driven by an increase in the severity and frequency of group medical claims.

本季合約工費用為 1,640 萬美元，比 24 年第一季下降 290 萬美元，簽約獎金和入職獎金為 1,220 萬美元，下降 210 萬美元。本季合約工 FTE 佔總 FTE 的百分比為 1.3%。與我們最近的趨勢一致，全職員工的福利支出增加了 14%。團體醫療索賠的嚴重程度和頻率的增加推動了全職員工福利費用的成長。

Root medical expense growth is expected to remain elevated in Q2 and begin to ease in the second half of the year as we anniversary the increase experienced in 2024. It's also worth noting that Q1's benefits for FTE increase comes off a low base as benefits for FTE growth in Q1 of 24 was 0.7%. Net reopening and ramp up costs were $2.1 million.

預計第二季醫療費用成長將保持高位，並在下半年開始放緩，因為我們將迎來 2024 年成長的周年紀念。另外值得注意的是，第一季 FTE 收益成長基數較低，因為第一季 24 的 FTE 收益成長為 0.7%。淨重新開業和增產成本為 210 萬美元。

As previously stated, we expect these costs to be heavily weighted towards the second half of the year due to the timing of our new hospital openings. Q1 adjusted free cash flow increased 32.7% to $222.4 million. We now expect full year adjusted free cash flow of $620 million to $715 million. Our primary use of free cash flow continues to be capacity expansions.

如前所述，由於我們新醫院開業的時間，我們預計這些成本將在很大程度上集中在下半年。第一季調整後的自由現金流成長 32.7% 至 2.224 億美元。我們現在預計全年調整後的自由現金流為 6.2 億美元至 7.15 億美元。我們對自由現金流的主要用途仍然是擴大產能。

As Mark mentioned, given the growing demand for Earth services and our increasing occupancy rates, we have increased our pipeline of bed addition projects. This is reflected both in our raised growth-related CapEx assumptions for 2025 and our estimated bed editions through 2027. For 2025, we now anticipate adding 100 to 120 beds to existing hospitals. For '26 and '27, we now anticipate adding approximately 120 beds to existing hospitals.

正如馬克所提到的，鑑於對地球服務的需求不斷增長以及我們的入住率不斷提高，我們增加了床位增加項目的管道。這反映在我們對 2025 年成長相關資本支出的假設上，以及我們對 2027 年床位版本的估計。到 2025 年，我們預計將在現有醫院增加 100 至 120 張病床。對於 26 年和 27 年，我們預計在現有醫院中增加約 120 張病床。

During Q1, we repurchased 333,679 shares of our common stock for a total of $32.1 million and declared a cash dividend of $0.17 per share. Our leverage and liquidity remain well positioned. Net leverage at quarter end was 2.1 times compared to 2.2 times at year end. We ended the quarter with $95.8 million in unrestricted cash and no amounts drawn on our billion dollar revolving credit facility.

在第一季度，我們回購了 333,679 股普通股，總計 3,210 萬美元，並宣布每股 0.17 美元的現金股息。我們的槓桿率和流動性仍然保持良好狀態。季末淨槓桿率為 2.1 倍，而年末為 2.2 倍。本季末，我們擁有 9,580 萬美元的非限制性現金，並且沒有提取任何十億美元循環信貸額度。

Moving on to guidance, as Mark stated, based primarily on our Q1 results, we are raising our 2025 guidance as follows. Net operating revenue of $5.85 billion to $5.925 billion. Adjusted EBITDA of $1.185 billion to $1.220 billion and adjusted earnings per share of $4.85 to $5.10. The key considerations underlying our guidance can be found on page 11 of the supplemental slides. With that, we'll open the lines for questions.

談到指導，正如馬克所說，主要基於我們的第一季業績，我們將 2025 年指導上調如下。營業淨收入為58.5億美元至59.25億美元。調整後 EBITDA 為 11.85 億美元至 12.20 億美元，調整後每股收益為 4.85 美元至 5.10 美元。我們的指導所依據的關鍵考慮因素可以在補充幻燈片的第 11 頁找到。接下來，我們將開始回答問題。

(Operator Instructions)

（操作員指示）

Pito Chickering, Deutsche Bank

皮托·奇克林，德意志銀行

Hey Pito.

嘿，Pito。

Hey, good morning, guys, great quarter. First question here on, it's been a long time since we've seen such a big move up in Medicare fee for service. Is this due to any strategic actions that you guys have put in place, or something else? But he added such a nice revenue per discharge in the quarter.

嘿，大家早上好，這是一個很棒的季度。第一個問題是，我們已經很久沒有看到醫療保險服務費出現如此大的上漲了。這是由於你們採取了什麼策略行動，還是其他什麼原因？但他本季增加瞭如此可觀的每次出院收入。

Yeah, Peter, your observation is absolutely correct. As a matter of fact, we haven't seen Medicare fee for service discharges grow faster than Medicare Advantage discharges since the middle of 2022, and it was somewhat of a surprise to us. It is not the result of any deliberate strategic actions in which we're favoring referrals or patient admissions from fee for service versus Medicare Advantage.

是的，彼得，你的觀察完全正確。事實上，自 2022 年中期以來，我們還沒有看到醫療保險服務出院費用的增長速度超過醫療保險優勢計劃出院費用的增長速度，這對我們來說有點令人驚訝。這不是我們採取任何刻意的策略行動的結果，在這些策略行動中，我們傾向於透過按服務收費而不是醫療保險優勢來轉診或安排患者入院。

We, like the rest of the world, have heard anecdotally about the fact that perhaps MA growth based on new enrollment may have slowed a little bit, but we really don't think that that was having a discerning impact on the mix for the quarter.

我們和世界其他地方一樣，聽說過這樣的傳聞：基於新入學人數的 MA 增長可能有所放緩，但我們真的不認為這會對本季度的組合產生明顯的影響。

One trend or one quarter is not a trend make. So we're not necessarily anticipating that this is the new normal on a go forward basis. As a matter of fact, our revised guidance assumes that we get back into the kind of payer mix dynamic that we were seeing prior to this quarter, but it's certainly something we'll keep an eye on.

單一趨勢或一個季度並不能形成趨勢。因此，我們不一定預期這將成為未來的新常態。事實上，我們修訂後的指南假設我們回到本季之前看到的那種付款人組合動態，但這肯定是我們會密切關注的事情。

Peter, just a reminder, over 9% of our admissions come directly from the acute care hospitals referral sources in our marketplaces, so. No, we don't know if this is a major trend or not, but we were pretty much just there to try to service the referral sources that are existing in our marketplaces.

彼得，提醒一下，我們超過 9% 的住院病患直接來自我們市場上的急診醫院轉診來源。不，我們不知道這是否是一個主要趨勢，但我們基本上只是試圖為我們市場中現有的推薦來源提供服務。

And it is interesting if you look at the pair mix in totality for the quarter. And even with the reversal in terms of the trend between fee for service and Medicare Advantage, Medicare care fee for service and Medicare Advantage together as a percentage of our payer mix increased about 150 basis points, and those are our two highest reimbursement payers.

如果你看一下本季的整體貨幣對組合，你會發現很有趣。即使服務費和醫療保險優勢計劃之間的趨勢出現逆轉，醫療保險服務費和醫療保險優勢計劃在我們付款人組合中的百分比仍然增加了約 150 個基點，它們是我們兩個最高的報銷付款人。

And then Medicaid and managed care, which are below that in terms of reimbursement, declined by about 140 basis points. And so it was those factors that really contributed significantly to the 3.9% increase in revenue per discharge.

然後，醫療補助和管理式醫療在報銷方面低於這一水平，下降了約 140 個基點。正是這些因素對每次出院收入成長 3.9% 做出了重大貢獻。

Okay, great. And then, can you talk about your employee's preoccupied bed and occupancy. It's a high class problem, but your occupancy hit a new high and your employees preoccupied bed hit a new lows provided a lot of leverage on the P&L.

好的，太好了。然後，您能談談您的員工所佔用的床位和占用情況嗎？這是一個高級問題，但您的入住率創下新高，而員工的床位佔用率創下新低，這為損益表提供了很大的槓桿作用。

Are you guys sort of behind on hiring with the current demand, or is this a seasonal, and can you sort of give us the dynamics between occupancy, employees occupied by bed, and how you think about planning for hiring in the next few quarters due to demand and productivity? Thank you.

你們在招聘方面是否落後於當前的需求，或者這是一個季節性的問題，您能否給我們提供入住率、員工床位佔用率之間的動態，以及您如何考慮在未來幾個季度根據需求和生產力進行招聘計劃？謝謝。

Yeah, Peter, we remain committed to that 3.4 number on EPOB. Clearly, we got some leverage in the first quarter, as you noted, that's the highest occupancy rate we've had. A couple of notes on that would be is remember we only had one de novo hospital came online in Q1, so you didn't have the delivering of the ramp up.

是的，彼得，我們仍然致力於將 EPOB 的數字定為 3.4。顯然，我們在第一季獲得了一些優勢，正如您所說，這是我們有史以來最高的入住率。關於這一點，有幾點需要注意的是，請記住，我們在第一季只有一家新醫院上線，因此無法實現產能提升。

We will have obviously a higher number of De Novos coming on, particularly in the third and fourth quarters. So that's going to impact your EPOB as we bring on staff at those new hospitals that had not yet opened with patients. A we're, no, I don't think we're behind. We remain committed. We have the talent acquisition team that continues to hire, particularly focused on nurses, but they've done a great deal with other positions.

顯然，我們將有更多的 De Novos 上場，特別是在第三和第四季。因此，當我們為那些尚未接收患者的新醫院招募員工時，這將對您的 EPOB 產生影響。不，我不認為我們落後。我們依然堅定承諾。我們有一個人才招募團隊，持續招聘，尤其註重護士，但他們在其他職位上也做了很多工作。

We did redirect some of those resources that were staffing new hospitals onto existing hospitals and markets where we continue to run a high percentage of contract labor that may have continued to, contributed to the decrease in the contract labor dollars you saw in the first quarter.

我們確實將一些為新醫院配備人員的資源重新分配到現有的醫院和市場，在這些醫院和市場中，我們繼續使用大量合約工，這可能繼續導致了第一季合約工費用的減少。

We're just able to fill more of those open positions at those hospitals with permanent staff versus contract labor. So, I wouldn't read a whole lot into the EPOB. We'll continue to focus on running as efficient as we can, but we still think the 3.4 number is a good number.

我們只是能夠用長期員工而不是合約工來填補這些醫院的更多空缺職位。所以，我不會對 EPOB 進行過度解讀。我們將繼續致力於盡可能高效地運行，但我們仍然認為 3.4 這個數字是一個不錯的數字。

Peter, you hit on a couple of key relationships in that number. One is that there is some seasonality factored in Q1 is normally a very good volume quarter for us, and that proved to be the case this year as well. So there is some seasonality factored in. That said, I would say that overall the discharge growth in the quarter was higher than our initial expectations.

彼得，你在這個數字中發現了幾個關鍵的關係。一是，第一季的季節性因素通常對我們來說是一個非常好的銷售季度，今年的情況也是如此。因此，其中存在一些季節性因素。話雖如此，我想說的是，本季的整體排放量成長高於我們最初的預期。

The second thing is that there's definitely a correlation between labor productivity and occupancy because you're creating patient density when you run at higher levels of occupancy, and that gives rise to coverage issues.

第二件事是，勞動生產力和占用率之間肯定存在相關性，因為當佔用率較高時，患者密度就會增加，引發覆蓋率問題。

But to Mark's point, we're not anticipating that this is a new sustainable run rate, and when you factor in the seasonality in the business and the timing of new capacity additions through the course of the year, we expect that number to gravitate a little bit north.

但正如馬克所說，我們並不認為這是一個新的可持續運行率，當你考慮到業務的季節性和一年中新增產能的時間時，我們預計這個數字會略微向北傾斜。

Andrew Mok, Barclays

巴克萊銀行 Andrew Mok

Hello Andrew.

你好，安德魯。

Whit Mayo, Leerink Partners

Leerink Partners 的 Whit Mayo

Hey guys, good morning. Congrats, yeah, congrats to Pat. I guess my first question, I'm curious just there's a lot of conversation around tariffs and wanted to just get what your updated thoughts are on either supply cost or construction expenses. So I'll just start there.

大家好，早安。恭喜，是的，恭喜帕特。我想我的第一個問題是，我很好奇，關於關稅有很多討論，我只是想了解您對供應成本或建設費用的最新想法。所以我將從那裡開始。

Yeah, like probably everybody else in this country, we're a little bit in wait and see mode. We've done a pretty thorough assessment based on the information that is available to us, and it's obviously a very dynamic environment.

是的，就像這個國家的其他人一樣，我們也處於觀望狀態。根據我們掌握的信息，我們進行了相當徹底的評估，顯然這是一個非常動態的環境。

Right now we don't believe that we have much, if any, in the way of near-term risk either with related to construction costs or more generally speaking within our supply chain. Much of the material that is related to the projects that are currently under construction has already been procured and it hasn't been subject to any of the tariffs.

目前，我們認為，無論是與建築成本相關的風險，還是更普遍地說，在我們的供應鏈中，短期風險都不會太大。與目前正在建造的項目相關的大部分材料已經採購，並且尚未受到任何關稅的影響。

And within our broader supply chain, based on some of the reconfiguration that we originally did out of COVID, and based on the underlying contracts that are in place, we're fairly insulated against that at least for fiscal year 2025. We'll continue to keep an eye on this, but right now we're not any, we're not estimating any kind of significant impact.

在我們更廣泛的供應鏈中，基於我們最初為應對 COVID 而進行的一些重新配置，以及基於現有的基礎合同，至少在 2025 財年，我們能夠相當程度地避免這種影響。我們會繼續關注此事，但目前我們還沒有估計到任何重大影響。

Okay. And then, sounds like you guys are increasing a little bit the commitments on that growth and additions next year. Just was wondering if you had any initial expectations around startup costs for 2026 and also if you could just remind us on Medicaid supplemental sort of what the exposure is there. Thanks.

好的。然後，聽起來你們明年會稍微增加對成長和增加的承諾。只是想知道您對 2026 年的啟動成本有什麼初步預期，以及您是否可以提醒我們醫療補助補充方面的風險。謝謝。

Yeah, I don't have an initial range for you on the '26 startup costs. My guess is that I'd have to look more specifically and compare timing from quarter to quarter and specifically look at what some of the timing around early 2027, but I wouldn't expect the number to be markedly different than what we're anticipating for 2025 into 2026.

是的，我沒有關於 26 年啟動成本的初步範圍可以提供給您。我的猜測是，我必須更具體地觀察並比較每個季度的時間，特別是看看 2027 年初左右的一些時間，但我預計這個數字不會與我們對 2025 年至 2026 年的預期有顯著不同。

In terms of the Medicaid supplemental payments, and as we've said previously for us, it's just not nearly as big a deal as it is for the acute care hospitals. I want to remind you of some of the historical context. If we go back to 2023, the total EBITDA impact for us from provider tax, revenue minus the provider tax expense was a negative $800,000. The year prior to in 2022 was a positive $2 million.

就醫療補助補充支付而言，正如我們之前所說，它並不像對急診醫院那麼重要。我想提醒你一些歷史背景。如果我們回到 2023 年，供應商稅（收入減去供應商稅費用）對我們的總 EBITDA 影響為負 800,000 美元。2022 年之前的一年為正 200 萬美元。

Last year was a bigger number with a $15.4 million impact, favorable impact on EBITDA, but even that pales in comparison to that which you're experiencing with some of the acute care hospitals. And for the quarter for Q1, the total impact was $33 million to EBITDA, which was a decrease of $1.9 million from the $4.9 million dollar EBITDA impact in Q1 of '24.

去年的數字更大，影響達 1,540 萬美元，對 EBITDA 產生了有利影響，但即使如此，與一些急診醫院的情況相比，也顯得微不足道。對於第一季而言，EBITDA 的總影響為 3,300 萬美元，比 24 年第一季的 490 萬美元 EBITDA 影響減少了 190 萬美元。

Great, thanks.

太好了，謝謝。

Matthew Gillmor, KeyBanc

馬修·吉爾摩（Matthew Gillmor），KeyBanc

Hey Matthew.

嘿，馬修。

Hey, good morning guys, and congrats as well, Pat. Maybe going back to labor efficiency and asking about the SWB per FTE metric, it seemed like that, ran relatively modestly in the first quarter so favorable. I was curious how that played out versus your expectations and it sounded like from Doug's comments that labor and sign on and shift bonuses was favorable and I was curious sort of how you felt about the sustainability of that going forward.

嘿，大家早上好，也祝賀你，帕特。也許回到勞動效率並詢問每個 FTE 指標的 SWB，看起來，第一季的運作相對溫和，因此很有利。我很好奇這與您的預期相比如何，從 Doug 的評論來看，勞動力、簽約和輪班獎金似乎是有利的，我很好奇您對未來可持續性的看法。

Yeah, so you're absolutely right, at 3.2% in terms of the total SWB inflation rate for the first quarter, we were slightly below the low end of the guidance range that we had for the full year. The benefits piece being up 14% was pretty much in line with our expectations and again was consistent with the trend that we saw at least in Q4 of last year.

是的，您說得完全正確，第一季整體 SWB 通膨率為 3.2%，略低於全年指導範圍的低端。福利部分成長 14%，基本上符合我們的預期，並且與我們至少在去年第四季看到的趨勢一致。

The points of leverage that got us below the low end of the range were twofold. The one you just mentioned was we had anticipated that across the course of the year, and we continue to have this anticipation that the total spend on the premium labor categories from '24 to '25 would remain essentially flat from a nominal dollar perspective and we saw year over year decrease.

使我們跌破該範圍低端的槓桿點有兩個。您剛才提到的是，我們曾預計，在全年中，我們仍然預計，從名義美元角度來看，24 年至 25 年高級勞動力類別的總支出將基本保持平穩，並且我們看到同比下降。

We're not sure again that I know I've used this phrase already once today, but we're not sure that one quarter makes a trend. So we're still building into our guidance, the anticipation that flat is a good assumption. And then the second is that are just removing the premium labor categories are SW per FTE inflated at a more modest rate than we had recognized in the second half of the year.

我們不再確定，我知道我今天已經使用過一次這個短語，但我們不確定一個季度是否形成了一種趨勢。因此，我們仍在建立我們的指導方針，預期持平是一個很好的假設。第二，我們剛剛去除了優質勞動力類別，SW 每 FTE 的通貨膨脹率比我們在下半年認識到的要溫和。

Again, that we're not ready to call that a new trend, but it was a favorable outcome for the quarter.

再說一次，我們還沒有準備好稱之為新趨勢，但這對本季來說是一個有利的結果。

And I just, I would say that I mean we have a history of running relatively low contract labor. Clearly the volume growth that we've had the past couple of years has put some upward pressure on that. But our operating teams are very focused on filling their full-time and part-time positions and continuing to drive down the need for contract labor and they have the tools to do that.

我想說的是，我們的合約工使用率一直相對較低。顯然，過去幾年銷量的成長對此帶來了一些上行壓力。但我們的營運團隊非常注重填補全職和兼職職位，並繼續減少對合約工的需求，他們有工具來做到這一點。

So as we continue to see some of the labor markets normalize or even soften a bit from where they were in previous years, we remain very focused on a driving down those numbers.

因此，當我們繼續看到一些勞動力市場與前幾年相比恢復正常甚至略有疲軟時，我們仍然非常關注降低這些數字。

And we were pleased with the 1.3% of total FTEs being contract labor FTEs in the quarter. That's the lowest we've been at. In a while, I'll remind you that our run rate prior to the initial peak in labor conditions which really occurred in the third quarter of 2021, had been just below 1%. So we're not to that level. We don't know that we're getting back to that level.

我們很高興看到本季總 FTE 中 1.3% 為合約工 FTE。這是我們經歷過的最低水準。過一會兒，我會提醒您，在勞動力條件真正達到最初的高峰（實際上發生在 2021 年第三季）之前，我們的運行率略低於 1%。所以我們還沒有達到那個水準。我們不知道我們是否會回到那個水平。

The rate for contract labor also has really stabilized kind of in that $175 to $180,000 on an annualized basis. Again, that's higher than it would have been prior to this peak conditions rising in Q1 of '21, which was closer to $145 to $150,000 but it's substantially down from the peak which we hit in the first quarter of 2022, which was $240,000.

合約工的薪資也基本上穩定在每年 175,000 美元到 180,000 美元之間。再次，這比 2021 年第一季達到高峰之前的水平要高，當時的峰值接近 145 至 15 萬美元，但比 2022 年第一季度達到的峰值 24 萬美元大幅下降。

That's great. Thank you. And then one quick one on flu. I think in the past sometimes you've called out flu leading to more patients with debility coming to your facilities. Just curious if there was any of that impact in the quarter and anything to flag there.

那太棒了。謝謝。然後我們再簡單談談流感。我認為過去有時您會喊流感，導致更多體弱的患者來到您的醫療機構。我只是好奇本季是否有任何影響以及有什麼值得關注的。

I don't think there was anything that's material yes that seemed to be a pretty active flu season. The ability to measure that impact on our volumes for Q1, I think it's negligible, but It was out there, but I can't say it's any more significant or less significant than previous years.

我認為沒有什麼實質的事情，是的，這似乎是一個相當活躍的流感季節。我認為，衡量其對我們第一季銷售的影響是微不足道的，但它確實存在，但我不能說它比前幾年更重要或更不重要。

Yeah, I think within the patient mix the strength was actually more broad based and wasn't driven as much by flu volume, and you actually see that in the fact that the ability, and you're correct, Matthew, that that's typically where you'll see some of those flu volumes show up and the ability on a year over year basis only increased 1.2% in the quarter. That good growth in stroke again at roughly 4%, brain injury was up 8%, neurological up almost 7%.

是的，我認為在患者組合中，實力實際上更加廣泛，並且不受流感數量的影響，你實際上可以看到這種能力，你是對的，馬修，這通常就是你會看到一些流感數量出現的地方，而與去年同期相比，本季度的能力僅增加了 1.2%。中風發生率再次出現良好增長，約 4%，腦損傷發生率上升了 8%，神經系統疾病發生率上升了近 7%。

Got It. Thank you.

知道了。謝謝。

Ann Hynes, Mizuho Securities

安·海因斯（Ann Hynes），瑞穗證券

Morning, Anne.

早安，安妮。

Hi, good morning. Just going back to the capacity because it was so high in the quarter and this to no strategy. What, obviously it's working and what at what point do you think you could or would want to accelerate your growth strategy? Do you think that's in the courage over the next couple of years since the strategy has been so successful?

嗨，早安。只是回到容量問題，因為本季的容量太高了，而且這沒有任何策略。顯然它正在發揮作用，您認為在什麼時候您可以或想要加速您的成長策略？鑑於該策略如此成功，您認為未來幾年還會有這樣的勇氣嗎？

Well, we are accelerating the growth strategy starting with the bed expansions, and that's the most direct way to alleviate any pressures arising from higher occupancy rates. I do want to point out that because we've been increasing steadily, these portion of our portfolio that is comprised of private rooms versus semi-private rooms, our theoretical occupancy rate has been increasing along the way.

嗯，我們正在加速成長策略，從擴大床位開始，這是緩解入住率上升帶來的壓力的最直接方法。我確實想指出，由於我們一直在穩步增加，我們的投資組合中由私人房間和半私人房間組成的部分，我們的理論入住率一直在增加。

To give you some specifics on that, if we go back to 2020, just over 40% of our total beds were in private rooms. At the end of the first quarter, 56% of our total beds were in private rooms. So that 78.8% occupancy rate that we experienced was the highest that we can recall ever having occurred.

具體來說，如果我們回顧 2020 年，當時我們總床位的 40% 多一點是私人房間。截至第一季末，我們總床位的 56% 為私人房間。因此，我們所經歷的 78.8% 的入住率是我們記憶中有史以來的最高入住率。

And it does suggest that we need to accelerate some of these bed expansions over a multi-year period of time, which fortunately we have both the access to capital and the capabilities within our design and construction team to be able to do. With regard to accelerating De novo activity beyond the current range, that's got a longer lead time associated with it.

這確實表明我們需要在多年的時間內加速一些床位擴建，幸運的是，我們既有資金，又有設計和施工團隊的能力來做到這一點。至於加速 De novo 活動超越目前範圍，則需要更長的準備時間。

It's typically from the time we idea on a particular market to getting the doors open, it's about three years. As Mark alluded to in his comments, we would expect that through the course of this year we're going to be announcing additional De novo projects that will be opening beyond 2025.

通常，從我們構思某個特定市場到開始營業，大約需要三年時間。正如馬克在評論中提到的那樣，我們預計今年我們將宣布更多將於 2025 年後開放的 De novo 項目。

But for the immediate time being, we believe staying in this range of 6 to 10 per year, perhaps trying to operate at the midpoint or higher is the appropriate place for us to be. And I'll remind you beyond just the spend and the demands on our design and construction team.

但就目前而言，我們認為保持在每年 6 到 10 個的範圍內，也許嘗試在中間點或更高位置運作才是我們合適的狀態。我還要提醒大家的不僅是我們的設計和施工團隊的支出和要求。

Each one of those hospitals has to be staffed with a trained clinical workforce at capacity of 50 bed hospitals running about 100 FTEs and about 2/3 of those are clinical. We want to make sure that we are adding capacity into this demand curve, which is very real out there, that we're doing so in a way that is also ensuring that we produce high quality patient outcomes.

每家醫院都必須配備經過培訓的臨床工作人員，每家醫院擁有 50 個床位，約有 100 名全職員工，其中約 2/3 為臨床員工。我們希望確保我們能在這個需求曲線中增加容量，這是非常現實的，我們這樣做的方式也能確保我們能提供高品質的患者治療結果。

Great. And just on guidance, obviously you'd be consensus by a healthy margin, and I know Doug, I think, I believe you said during the call is that volume is ahead of your expectations. What did you beat your internal expectations by? And I guess the guidance ranges versus the beat, is that just conservatism on your part, or is there something we should model that maybe the streets miss modeling through the rest of the year?

偉大的。僅從指導角度來看，顯然您會以健康的幅度達成共識，而且我知道道格，我認為，我相信您在電話會議中說過，交易量超出了您的預期。你透過什麼超越了你的內心預期？我想，指導範圍與節拍相比，這只是您的保守主義，還是我們應該模擬一些街頭在今年剩餘時間內可能錯過的模型？

Well, that is a series of really loaded questions most of which you knew in advance I wasn't going to answer. The quarter was ahead of our expectations. I'm not going to give you a specific number on that, but I cited some of the specific areas where it was ahead earlier, which is we did a little bit better on volume than we anticipated.

好吧，這是一系列非常棘手的問題，其中大部分你事先就知道我不會回答。本季的表現超出了我們的預期。我不會給你一個具體的數字，但我列舉了一些之前領先的具體領域，那就是我們在數量上做得比我們預期的要好一點。

And the two biggest upside surprises for us were that revenue for discharge based on the payer mix that we hadn't anticipated and then also the fact that we got a lot of leverage in the SWB line. Some of that was the EPOB coming down based on the higher volume and the occupancy rate, and some of it was the leverage that we got against premium labor. So certainly, that was a favorable outcome for Q1.

對我們來說，最大的兩個驚喜是，基於付款人組合的出院收入是我們未曾預料到的，其次是我們在 SWB 線上獲得了許多槓桿。部分原因是因為產量和佔用率增加導致 EPOB 下降，部分原因是我們針對優質勞動力所採取的手段。因此，這對於第一季來說無疑是一個有利的結果。

It's uncertain to us how much of that is sustainable for the balance of the year. And so we've maintained a lot of the annual assumptions that we had in the guidance considerations, another area of favorability, we were at the low end of the of the bad debt assumption right at 2%.

我們不確定其中有多少能夠維持到今年年底。因此，我們維持了指導考慮中的許多年度假設，另一個有利的領域是，我們處於壞帳假設的低端，正好是 2%。

That owed in large part to the fact that we had only a de minimis amount of TPE activity during the quarter, and as we all experienced last year, we know that TPE audit activity can be very lumpy. And so we've left that assumption for the full year the same. It's only the first quarter. Obviously we'll be more informed about the sustainability of any of these trends after we are able to book another quarter.

這在很大程度上歸因於我們在本季度僅有極少量的 TPE 活動，而且正如我們去年所經歷的那樣，我們知道 TPE 審計活動可能非常不穩定。因此，我們對全年的假設保持不變。這還只是第一季。顯然，當我們能夠預訂另一個季度後，我們將更了解這些趨勢的可持續性。

Great, thank you.

太好了，謝謝。

Joanna Gajuk, Bank of America

喬安娜·加朱克（Joanna Gajuk），美國銀行

Hi, good morning, Joanna.

嗨，早上好，喬安娜。

Hey, morning. Thanks so much for taking that question. So, maybe on the demand where you spoke about a lot of online demand for the services where you, like you said, keep expanding your expansion plans. Right, so can you give us a little bit more there, are there some geographies that stand out or is it grow based?

嘿，早安。非常感謝您回答這個問題。因此，也許就您所談到的大量線上服務需求而言，正如您所說，您將不斷擴大擴展計劃。好的，那麼您能否向我們提供更多信息，是否有一些突出的地理位置，或者是基於增長的？

Can you talk about maybe also competitive environment like why you're the only one, I guess, aggressively building and adding that?

您能否也談談競爭環境，例如為什麼您是唯一一個積極建構和添加它的人？

Yeah, Joanne, this is Mark. I'll start. I'll say that the demand was across all geographies, as we have eight geographic operating regions and we saw nice growth in the majority of our markets and certainly across all those operating regions.

是的，喬安妮，這是馬克。我先開始。我想說的是，需求遍布所有地區，因為我們有八個地理營運區域，而且我們在大多數市場以及所有這些營運區域都看到了良好的成長。

As we've noted before, I mean, we certainly benefit from the aging demographic, and I think that's exactly what we're seeing with non-discretionary patients and patients that have multiple comorbidities and issues that require first in large part acute care level care and then ready for inpatient rehabilitation care. So, the demand continues to grow closely linked to the aging demographic.

正如我們之前提到的，我的意思是，我們確實受益於人口老化，我認為這正是我們在非自由支配患者和患有多種合併症和問題的患者身上看到的，他們首先需要大量急性護理級別的護理，然後準備住院康復護理。因此，需求持續成長與人口老化密切相關。

Yeah, to give you some specifics that we've cited before, if you look going backwards for more than a decade, the age cohort that is most served by us and by Earths in general has been growing at a keger of close to 4%. And over that same decade plus period, the total supply of earth beds in the US has increased less than 3% in total.

是的，給你一些我們之前提到的具體情況，如果回顧過去十多年，我們以及整個地球所服務的年齡群體的增長率接近 4%。而在同一十多年的時間裡，美國土床的總供應量總共只增加了不到 3%。

That's not a keger, that's total. So what already started as an inadequate supply of earth beds in this country widened substantially over that period. Why are, and we're not the only one who is adding capacity here. I think if you look at Select Medical, they've announced plans to substantially ramp up their capacity on the earth side as well. But perhaps the two of us kind of stand alone and why is that the case?

那不是啤酒，那完全是啤酒。因此，該國土床供應本來就不足的問題在那段時期內進一步惡化。為什麼呢？而且我們不是唯一在這裡增加產能的人。我想如果你看看 Select Medical，你會發現他們已經宣布了大幅提高地球產能的計畫。但也許我們兩個人有點孤立，為什麼會這樣呢？

Well, it's really difficult to do this. First of all, it requires very substantial capital outlays to build a free standing hospital or even to add capacity to existing hospitals. We've mentioned before, we feel good about we've been able to stabilize the cost per bed on De novo construction at about $1.2 million. And even for bed expansions, the cost per bed now is north of $800,000. So the capital outlay is very extensive.

嗯，這確實很難做到。首先，建造一所獨立的醫院，甚至增加現有醫院的容量，都需要非常大量的資本支出。我們之前提到過，我們很高興能夠將 De novo 建設的每張床位成本穩定在 120 萬美元左右。即使擴建床位，現在每張床位的成本也超過 80 萬美元。因此資本支出非常龐大。

The clinical expertise is to treat these very medically complex patients is also a barrier to entry, as is the need for a robust compliance function. And one of the things that we really benefit from is the fact that we enjoy substantial economies of scale that allows us to get operating leverage across these platforms and also to extrapolate best practices.

治療這些醫學狀況非常複雜的患者的臨床專業知識也是一個進入的障礙，因為需要強大的合規功能。我們真正受益的一件事是，我們享有相當大的規模經濟，這使我們能夠在這些平台上獲得營運槓桿，並推斷出最佳實踐。

So yeah, if it were if it were easy to do given the attractiveness of the market, we'd probably see a lot more capacity coming in, but that's just not the case. It is highly complex and expensive.

所以，是的，如果考慮到市場的吸引力，這很容易做到，我們可能會看到更多的產能湧入，但事實並非如此。它非常複雜且昂貴。

Right, exactly. Thanks for that. I guess related question on your bed expansions, right? So it sounds like, you expect or, generating more free cash flow, but then you also raising your bed expansion outlook. I mean, I guess it's portion but also by the occupancy being higher.

對，沒錯。謝謝。我猜這是與您的床擴展相關的問題，對嗎？因此聽起來，您期望或產生更多的自由現金流，但同時您也提高了床位擴張前景。我的意思是，我猜這是部分原因，但入住率也較高。

So should we expect the additional free cash flow to just go towards these bed additions? Can you remind us the returns you get on these, bed additions and maybe are contracted with De novo? Thank you.

那麼，我們是否應該期望額外的自由現金流僅用於增加這些床位呢？您能否提醒我們您在這些床位增加方面獲得的回報以及可能與 De novo 簽訂的合約？謝謝。

Yeah, so consistent with our previous statements, the highest and best use of capital for us is on capacity expansions through both de novo and bet expansions, and bed expansions are the highest return of capital we have because we're leveraging components of the fixed infrastructure and we're building into a market where we already enjoy a presence and where the demand curve has already been established.

是的，與我們先前的聲明一致，對於我們來說，資本的最高和最佳用途是透過從頭擴張和賭注擴張來實現產能擴張，而床位擴張是我們獲得的最高資本回報，因為我們正在利用固定基礎設施的組成部分，並且我們正在進入一個我們已經享有存在並且需求曲線已經建立的市場。

The occupancy rates are driving our decision to put more capital into the bed expansions. Fortunately, we have the capabilities again within our design and construction area to push forward some of those projects, as we and Mark mentioned in his comments, we've now run 11 straight quarters with same store growth north of 4%.

入住率促使我們決定投入更多資金用於床位擴張。幸運的是，我們在設計和施工領域再次擁有能力來推動其中一些項目，正如我們和馬克在評論中提到的那樣，我們現在已經連續 11 個季度實現同店增長率超過 4%。

And so as a result, the pipeline of our hospitals that are qualifying for bed expansions based on their occupancy rates is increased. And so we're definitely going to give a prioritization with regard to capital allocation to adding capacity so that we're able to serve the needs of the patients in those markets. Thank you.

因此，根據入住率，符合擴建床位條件的醫院數量增加。因此，我們肯定會優先考慮資本配置以增加產能，以便能夠滿足這些市場患者的需求。謝謝。

Brian Tanquilut, Jefferies

布萊恩·坦奎魯特（Brian Tanquilut），傑富瑞

Hey guys, good morning. Congrats on the quarter. Maybe, yeah, Doug, maybe I'll follow up just on the comments you made to Joanna's question. So, as we think about some of these challenges that hospitals are staring down with DPP payments, probably going away or getting cut and whatnot.

大家好，早安。恭喜本季取得佳績。是的，道格，也許我會跟進你對喬安娜的問題的評論。因此，當我們思考醫院在 DPP 付款方面面臨的一些挑戰時，可能會出現取消或削減等情況。

Are you seeing anything in the market in terms of maybe either increased interest in partnering with you guys or the opposite where they're pulling back from plans to open earth that if that's the path that they were looking at just curious what you're seeing.

您是否看到市場出現任何變化，要么是人們對與您合作的興趣增加，要么是相反的情況，即他們正在撤回開採地球的計劃，如果這是他們正在考慮的道路，那麼我很好奇你看到了什麼。

Yeah, I think it's the former. I think we continue to see more and more interest from various acute care hospitals about wanting to partner, and that's reflected in our in our pipeline. So, we continue to believe that probably at least half of De novos that will be opening over the next several years are likely to be in joint ventures. We get a great example again.

是的，我認為是前者。我認為，我們不斷看到各急診醫院對合作的興趣日益濃厚，這也反映在我們的合作管道中。因此，我們仍然相信，未來幾年開業的 De novos 酒店中至少有一半可能會以合資形式開業。我們又得到了一個很好的例子。

Mark mentioned in his comments. We've now got seven hospitals as part of the Piedmont joint venture. And that's the kind of success that really, I think, makes other acute care systems take notice of the effectiveness of these types of partnership relationships.

馬克在他的評論中提到。目前，我們在皮埃蒙特合資企業中擁有七家醫院。我認為，這種成功確實讓其他急性照護系統注意到此類合作關係的有效性。

Hey Brian. So we also have a note. I mean there are a number of our existing partnerships, systems that currently have one or more rehab hospital JB with us that continue to look at their marketplace and as they expand their presence, they are also taking into account the needs for rebilitation.

嘿，布萊恩。因此我們也有一個註釋。我的意思是，我們現有的許多合作夥伴、系統目前都與我們合作了一家或多家康復醫院 JB，他們繼續關注他們的市場，隨著他們擴大影響力，他們也在考慮到康復的需求。

So, you can look at Piedmont, our partnership and the St. Louis marketplace with BJC. Those are two examples of partners where we have multiple rehab hospitals as part of that overall relationship.

因此，您可以看看皮埃蒙特、我們的合作夥伴關係以及與 BJC 的聖路易斯市場。這兩個是我們合作夥伴的例子，我們與多家復健醫院是整體合作關係的一部分。

And I think what the acute care hospitals are increasingly aware of is that either a formal or an informal relationship with us in terms of having a freestanding herb in the market can increase their capacity in one of two ways.

我認為急診醫院越來越意識到，無論是與我們建立正式或非正式的關係，在市場上擁有獨立的草藥，都可以透過兩種方式之一來提高他們的治療能力。

One is we have demonstrated consistently that we have the ability to take highly complex medical patients out of the acute care hospitals earlier than other providers in their stay without in any way endangering the patient's recovery path. And so when we're doing that, we're allowing them to free up that bed more quickly.

一是我們已經證明，我們有能力比其他醫療機構更早地將病情高度複雜的患者轉出急診醫院，而不會以任何方式危及患者的康復之路。因此，當我們這樣做時，我們可以讓他們更快地騰出那張床位。

The second of the more tangible way is when we use our model of going in and removing a unit from an acute care hospital and folding it into a free standing hospital so that space within the acute care hospital can be repurposed for general medical and surgical purposes and increase their overall capacity to address those patient needs.

第二種更切實可行的方法是，我們使用我們的模型，進入急診醫院並將其拆除，將其折疊成一個獨立的醫院，以便急診醫院內的空間可以重新用於一般醫療和外科目的，並提高其滿足患者需求的總體能力。

Yeah, I appreciate that. And then maybe my follow up, Mark, as I think about, maybe an economic slowdown here, you guys have been there in in conference for a while and experienced previous recessions. Just curious how you're thinking about the durability of demand, and maybe Doug just to kind of layer onto this, any comment you can make on like exchange subsidy exposure just exchange exposure within your patient population. Thanks.

是的，我很感激。然後也許我的後續問題，馬克，正如我所想，也許這裡出現了經濟放緩，你們已經參加過一段時間的會議，經歷過以前的經濟衰退。我只是好奇您如何看待需求的持久性，也許 Doug 只是想在此基礎上進行闡述，您可以對諸如交易所補貼風險以及患者群體中的交易所風險發表任何評論。謝謝。

So I take first question. I mean, the demand for our services does not fluctuate with the economic status. I mean, it's, patients are non-discretionary and therefore, if you look back historically during periods of recession or high growth in the in the economy, it doesn't necessarily reflect and influence the need for our services. So I would not anticipate any decline in a recessionary economy.

我回答第一個問題。我的意思是，我們服務的需求不會隨著經濟狀況的變化而波動。我的意思是，病人是不可自由支配的，因此，如果你回顧歷史，在經濟衰退或高成長時期，這並不一定反映和影響對我們服務的需求。因此，我預期經濟衰退不會帶來任何下滑。

And your second question, Brian, we have de minimis exposure to the exchanges.

布萊恩，你的第二個問題是，我們對交易所的接觸很少。

Awesome thank you.

太棒了謝謝。

AJ Rice, UBS

瑞銀集團 AJ Rice

Hi, thanks everybody, talk to everybody. First, I guess on the benefit expense, I think you called out that it was up 14%. This is sort of the second quarter where you've called that out. I wonder how much of a headwind is that? I don't know if you size benefit as a percentage of your SWMB.

嗨，謝謝大家，和大家聊聊。首先，關於福利支出，我想您提到它上漲了 14%。這是您在第二季度提出這一點的時候。我想知道那阻力有多大？我不知道您是否將收益以 SWMB 的百分比來衡量。

But it would be just interesting to know that and is there anything you can do, or you just have to wait for your anniversary that and then, it'll moderate as a pressure point or is there anything you can proactively do to manage that in a different way?

但了解這一點很有趣，您可以做些什麼嗎？或者您只需要等到週年紀念日，然後它就會作為壓力點緩和下來，或者您可以主動做些什麼來以不同的方式來管理它？

Yeah, so, first part of your question is benefits expense in total typically runs about 10% or 11% of total SWB. In terms of what we can do, we proactively work with our third party consultants, kind of assessing our trends versus broader trends within the US with large employers and specifically within the healthcare community.

是的，所以，你問題的第一部分是福利總支出通常佔 SWB 總支出的 10% 或 11%。就我們能做的事情而言，我們積極與第三方顧問合作，評估我們的趨勢與美國大型雇主，特別是醫療保健界的更廣泛趨勢。

We look at things like any changes to the composition of our benefits programs, the relationship between employee and employer responsibility, and so forth, and so on a regular basis we're making changes to those programs to try to contain the cost, but also to make sure that we're offering the most competitive benefits program we can from an employee's perspective because that's a big aspect of retention, and we'll continue to do that proactively.

我們會關注福利計劃構成的任何變化、僱員和雇主責任之間的關係等等，因此，我們會定期對這些計劃進行修改，以試圖控製成本，同時也確保從員工的角度提供最具競爭力的福利計劃，因為這是保留員工的一個重要方面，我們將繼續積極地這樣做。

We do think, and you pointed this out, AJ, that we're going to see that growth rate begin to moderate as we move into the second half of the year simply because we saw that step up in the second half of last year. In our discussions with our consultant, what we're seeing in our program apparently is pretty consistent with the peer group that's out there.

我們確實認為，正如 AJ 所指出的，隨著我們進入今年下半年，我們將看到成長率開始放緩，因為我們在去年下半年就看到了這一增長。在與顧問的討論中，我們發現我們的計劃與現有的同儕情況非常一致。

Okay, and then the follow-up question, I know last year about this time, there was some noise in the numbers with the Palmetto audits and the TPE program, and how that was playing out. Any updated thoughts on where all that stands at this point and, are you back to sort of a normal situation, pretty much here?

好的，然後是後續問題，我知道去年這個時候，Palmetto 審計和 TPE 計劃的數字存在一些問題，以及這些問題的進展。對於目前的情況，您有什麼最新的想法嗎？現在情況是否已經基本恢復正常了？

I think there's the potential for some of the same dynamic to exist. And so this is the interplay specifically with Palmetto between RCD and Alabama and TPE. And as a reminder, Palmetto is our largest Mac. They're responsible for approximately 80% of our overall hospitals, including the seven that we have in Alabama.

我認為，同樣的動態有可能存在。這就是 RCD、Alabama 和 TPE 之間與 Palmetto 的相互作用。提醒一下，Palmetto 是我們最大的 Mac。他們負責我們大約 80% 的醫院，包括我們在阿拉巴馬州的七家醫院。

And so, they remain consumed with the RCD program in Alabama under which, by the way, our performance has gotten better, but it is not where it ought to be and it remains a lot of hand to hand combat in trying to overcome very inconsistent treatment by Palmetto on those claims. But with regard to TPE, what we've seen at least since RCD has been in place.

因此，他們仍然沉迷於阿拉巴馬州的 RCD 計劃，順便說一句，我們的表現有所改善，但還沒有達到應有的水平，而且在試圖克服 Palmetto 對這些索賠的非常不一致的處理方式時，仍然需要進行大量的肉搏戰。但就 TPE 而言，至少自 RCD 實施以來我們就看到了這種情況。

Is that they seem to lack the capacity to run a consistent TPE program and administer RCD, and so the TPE activity at least last year proved to be very lumpy. We have left some room for that kind of lumpiness in our assumption regarding bad debt for the full year. As a corollary to that, I'll remind you we had that big step up when those claims were selected by Palmetto under TPE for review of the second quarter.

他們似乎缺乏運行一致的 TPE 程序和管理 RCD 的能力，因此至少去年的 TPE 活動被證明是非常不穩定的。我們在對全年壞帳的假設中為這種不平衡留了一些空間。作為這一結論的必然結果，我要提醒大家，當 Palmetto 根據 TPE 選擇這些索賠進行第二季度審查時，我們已經取得了巨大的進步。

But what we've seen is those have played out over a multi-quarter period of time is that our recovery rate against those claims or our success rate against those claims selected from review has been highly favorable.

但我們看到，經過多個季度的觀察，我們對這些索賠的恢復率或從審查中選出的索賠的成功率非常高。

So there's the chance that you might see a blip, just based on our reserve methodology if we see the same kind of pattern under TPE that we saw last year, but I don't think it causes us concern that the aggregate level of bad debt expense is on the rise.

因此，如果我們看到 TPE 下與去年相同的模式，那麼根據我們的儲備方法，您可能會看到一個小波動，但我不認為這會引起我們擔心壞帳費用的總體水平正在上升。

Okay, thanks a lot.

好的，非常感謝。

(Operator Instructions)

（操作員指示）

Jared Haase, William Blair

賈里德·哈斯、威廉·布萊爾

Hey Jared.

嘿，賈里德。

Good morning, Jared.

早上好，賈里德。

Hey, good morning. Thanks for taking the questions, and I'll echo the congrats on a strong quarter. Maybe I'll ask one on the quarter just to kind of put a fine point on things and specifically the strong EBITDA performance.

嘿，早安。感謝您回答這些問題，我也對本季的強勁表現表示祝賀。也許我會就本季的情況詢問一位分析師，以便對情況進行更詳細的說明，特別是強勁的 EBITDA 表現。

I know we've obviously focused a lot on the trends around labor, but curious if there were any other, I guess, areas in OpEx where you saw a good leverage or operating efficiency and if you could talk about the durability of some of those areas of leverage if you saw things.

我知道我們顯然非常關注勞動趨勢，但我很好奇在營運支出中是否還有其他領域您可以看到良好的槓桿率或營運效率，如果您看到這些領域的槓桿率持久性，您是否可以談談這些領域的槓桿率持久性。

Yeah, anytime you're running at high volumes and particularly with the density that comes with the higher occupancy rate, you're creating OpEx leverage throughout the P&L. But definitely the more pronounced, the most pronounced area of that, and it's because it's our single largest expense category was in the SW line.

是的，任何時候，當您以高容量運行，特別是隨著更高入住率而來的密度時，您就會在整個損益表中創造營運支出槓桿。但絕對是最明顯、最明顯的領域，這是因為我們最大的單一支出類別是在 SW 線上。

I think we've pretty well already addressed our thoughts regarding the sustainability of that. We expect the as the primary measure of productivity, we expect the EPOB number to move north over the balance of the year just based on the seasonality and based also on the capacity expansions that are coming on through the course of the year.

我認為我們已經很好地討論了關於其可持續性的想法。我們預計，作為衡量生產力的主要指標，EPOB 數字將在全年餘額中向北移動，這不僅基於季節性，也基於全年的產能擴張。

Perfect. That's helpful. And then maybe I'll go back to something you talked about in the prepared remarks, just some of the consistent performance you've had and your discharge rates and quality metrics.

完美的。這很有幫助。然後，也許我會回到您在準備好的發言中談到的一些內容，只是一些您一直保持的穩定表現以及您的出院率和品質指標。

And I guess I'll just ask, what are the sort of biggest drivers in your view in terms of the ability to sustain that level of performance and quality just considering how rapidly you've grown the business over the last couple of years.

我想我只想問一下，考慮到過去幾年業務的快速成長，您認為維持這種性能和品質水準的最大驅動力是什麼？

Yeah, we said earlier, bringing new staff in and making sure as we add capacity that we are appropriately staffed, that we have the staff on boarded that even at our existing hospitals as we bring on new staff. We are training them and getting them oriented. So, I feel like our quality and if you just look at our trends, we continue to increase the quality, if you look at our discharge community, the reduced number of discharges being sent to skilled nursing facilities.

是的，我們之前說過，我們會引進新員​​工，並確保在增加容量時配備適當的人員，即使在我們現有的醫院引進新員工時，我們也會有合適的員工。我們正在對他們進行培訓並指導他們。所以，我覺得我們的質量，如果你看看我們的趨勢，我們會繼續提高質量，如果你看看我們的出院社區，就會發現送往專業護理機構的出院人數減少了。

We always focus on patient satisfaction with our net promoter scores. So we would not be adding growth if we couldn't assure ourselves that we could show and produce the quality outcomes that we do as an organization. So I think it's very sustainable. We're very proud of where we're headed, particularly in those discharge status metrics, and we continue to focus on our with our clinical teams on how can we get incremental outcomes every day.

我們始終關注患者對淨推薦值的滿意度。因此，如果我們不能保證我們能夠展示和產生我們作為一個組織所做的高品質成果，那麼我們就不會實現成長。所以我認為它非常可持續。我們對我們的前進方向感到非常自豪，特別是在那些出院狀態指標方面，我們將繼續與我們的臨床團隊一起專注於如何每天獲得漸進的成果。

Just to underscore what Mark said there because I think it's important to note and we have experienced very rapid growth both in terms of on the same store basis and through the past expansions over a multi-year period of time. And yet we now have the highest net promoter scores and the highest employment employee engagement scores that we've ever had, and that's something that we're really proud of.

我只是想強調馬克所說的話，因為我認為值得注意的是，無論是在同一家店面的基礎上，還是在過去多年的擴張中，我們都經歷了非常快速的增長。然而，我們現在擁有最高的淨推薦值和最高的就業員工敬業度得分，這是我們有史以來所取得的成就，這是我們真正感到自豪的事情。

That's great to hear. Thank you.

聽到這個消息真是太好了。謝謝。

Andrew Mok, Barclays

巴克萊銀行 Andrew Mok

Hi, good morning. The revenue discharge per discharge number was pretty strong in the quarter of 3.9% and finished above the underlying pricing expectations. So I know that number contemplates a number of items including core pricing, acuity, and bad debt.

嗨，早安。本季每排放的營收排放數字相當強勁，達到 3.9%，且高於基本定價預期。所以我知道這個數字考慮了許多因素，包括核心定價、敏銳度和壞帳。

Bad debt came in on the lower end of expectations, but it still looks like it's strong. Can you flush out kind of like the underlying drivers of that number and what, how we should expect that to trend for the balance of the year? Thanks.

壞帳規模低於預期，但看起來仍然強勁。您能否闡明該數字的潛在驅動因素以及我們應該如何預期該數字在今年餘下時間的趨勢？謝謝。

Now, you're exactly right. It was, and there are a number of things that go into it. The largest ones I'd point out were that bad debt was at the low end of the range that you just cited. The second is that we had that shift in the payer mix, which I alluded to earlier, and it was not only that fee for servers grew faster than Medicare Advantage.

現在，你完全正確。確實如此，而且其中涉及許多因素。我想指出的最大問題是壞帳處於您剛才提到的範圍的低端。第二，我們的付款人結構發生了變化，正如我之前提到的，而且不僅僅是服務員的費用增長速度快於醫療保險優勢計劃。

It's when you look more broadly at the change in the overall mix that, whereas Medicare Advantage and Medicare fee for service as a percentage of the payer mix in total for the quarter moved up 150 basis points, and those are our two highest reimbursement categories. You had managed care and Medicaid by far being our lowest, moved down 140 basis points. So that's a real favorable shift there.

當你更廣泛地看待整體組合的變化時，你會發現，醫療保險優勢計劃和醫療保險服務費佔本季度付款人組合的百分比上升了 150 個基點，這是我們兩個最高的報銷類別。你們管理的醫療和醫療補助是迄今為止最低的，下降了 140 個基點。所以這是一個真正有利的轉變。

We also had some favorable trends within our quality metrics that help improve our reimbursement as well. In terms of our assumptions on a go forward basis, again, we don't believe that one quarter makes a trend. So we're not assuming that this slip in the growth rates between Medicare Advantage and fee for service will sustain itself for the balance of the year.

我們的品質指標中也出現了一些有利趨勢，這也有助於提高我們的報銷水準。就我們對未來的假設而言，我們再次不相信一個季度就能形成一種趨勢。因此，我們並不認為醫療保險優勢計劃和服務費之間的成長率下滑會在今年餘下時間內持續下去。

Great. And then maybe just a follow up on share repurchase. I know you lowered the share account number and the guidance, but how are you thinking about the level of share repurchase contemplated in the guide? Did you give that number and how do you expect that to evolve over the next 12 to 18 months? Thanks.

偉大的。然後可能只是跟進股票回購。我知道您降低了股票帳戶數量和指導，但您如何考慮指導中設想的股票回購水準？您給了這個數字嗎？您預計未來 12 到 18 個月內這個數字會如何變化？謝謝。

We did not put out a specific number. I will note that with the share repurchases that we made in the first quarter actually slightly exceeded those that we made to all of 2024. We've talked previously about the fact that we find ourselves in the enviable position of being able to fund all or at least the vast majority of our capacity expansions with internally generated funds.

我們沒有給出具體的數字。我要指出的是，我們在第一季進行的股票回購實際上略微超過了我們在 2024 年全年進行的股票回購。我們之前曾談到，我們處於令人羨慕的地位，能夠利用內部籌集的資金來資助我們全部或至少絕大多數的產能擴張。

We've also been seeing, based predominantly on the growth in our EBITDA, the net leverage ratio come down. So, that is creating capacity for us to allocate more capital to share repurchases, and we think that's an appropriate utilization and a good complement to the growth CapEx we have. So I think you should anticipate continued activity under the share repurchase program.

我們也看到，主要基於 EBITDA 的成長，淨槓桿率下降。因此，這為我們分配更多資本用於股票回購創造了能力，我們認為這是一種適當的利用，也是我們現有成長資本支出的良好補充。因此我認為你應該預期股票回購計畫將繼續進行活動。

Great. Thank you.

偉大的。謝謝。

John Ransom, Raymond James

約翰蘭塞姆、雷蒙詹姆斯

Good morning, John.

早安，約翰。

So, you're a key care. I won't call them peers, but the key care industry's been kind of reporting some issues and changes of behavior with Medicare Advantage. Are you guys, I mean, they've been under a lot of stress, as but are you guys see anything new or different, in your managed care negotiations, not just rate but other behavior changes, as they try to manage their cost?

所以，你是個重點照顧者。我不會稱他們為同行，但關鍵護理行業一直在報告醫療保險優勢計劃的一些問題和行為變化。你們，我的意思是，他們承受著很大的壓力，但是你們在管理式醫療談判中是否看到了任何新的或不同的東西，不僅僅是費率，還有其他行為變化，因為他們試圖控製成本？

I think from a contracting perspective we continue to have success and we're already at a very high level of moving away from per diem contracts to episodic contracts and tying those new contracts, even if they initially started a discount directly to the service reimbursement.

我認為從合約的角度來看，我們繼續取得成功，並且我們已經處於從每日合約轉向間歇合約並將這些新合約捆綁在一起的非常高的水平，即使他們最初直接對服務報銷給予折扣。

I will say that the overall level of price increase that we saw within our Medicare Advantage book of business in the first quarter was a bit higher than we anticipated. It came in at about 5%. Again, not ready to call that a new normal. So I don't know whether it's reflective, John, of the overall environment out there with Medicare Advantage, but we do feel like we're having good success with regard to our Medicare Advantage contract.

我想說的是，我們在第一季的醫療保險優勢業務中看到的整體價格上漲水準比我們預期的要高一些。其比例約為 5%。再說一遍，我還沒準備好稱之為新常態。所以約翰，我不知道這是否反映了醫療保險優勢計劃的整體環境，但我們確實覺得我們的醫療保險優勢計劃合約取得了良好的成功。

I would say that the whole pre-authorization process continues to be challenging, and I would say it's probably a little early to say whether or not we're seeing significant differences or new trends enter around the pre-authorization process in most of our markets.

我想說的是，整個預授權流程仍然充滿挑戰，我想說，現在判斷我們是否在大多數市場中看到了預授權流程的重大差異或新趨勢還為時過早。

And some things that we noted before continue to persist, which is the ratio of admits to referrals for Medicare Advantage is substantially below what it is for a fee for service, and we see no reason why that should exist.

我們之前提到的一些情況仍然存在，即醫療保險優勢計劃的入院與轉診比例大大低於按服務收費的比例，我們認為沒有理由存在這種情況。

And then also the number of days between a referral and ultimately a decision coming through Medicare Advantage plans is much slower than it is for fee for service, which does not endure to the benefit of the patient or the acute care hospital housing patient.

而且，從轉診到最終透過醫療保險優勢計劃做出決定所需的天數比按服務收費的速度要慢得多，這對患者或急診醫院的病人沒有好處。

5% is pretty stout. Thanks guys. I appreciate it.

5% 相當高了。謝謝大家。我很感激。

Thank you.

謝謝。

Thank you.

謝謝。

And there are no further questions on the line at this time. I'll turn the program back to Mark Miller for any additional remarks.

目前我們還沒有其他問題。我將把節目交還給馬克·米勒，詢問他是否有任何補充意見。

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

謝謝您，接線生。如果有人還有其他問題，請撥打我的電話 205-970-5860。再次感謝您參加今天的電話會議。

This does conclude today's program. Thank you for your participation, and you may now disconnect.

今天的節目到此結束。感謝您的參與，您現在可以斷開連接。