美國醫院公司 (HCA) 2016 Q4 法說會逐字稿

Good day, everyone, and welcome to today's HCA fourth-quarter 2016 earnings conference.

大家好，歡迎參加今天的 HCA 2016 年第四季財報會議。

Just a reminder that today's call is being recorded.

只是提醒一下，今天的通話正在錄音。

For opening remarks and introductions, I would like to turn the call over to the Senior Vice President, Mr. Vic Campbell.

對於開場白和介紹，我想將電話轉給高級副總裁維克·坎貝爾先生。

Please go ahead, sir.

請繼續，先生。

All right, Lori, thank you.

好的，洛瑞，謝謝你。

Good morning, everyone.

大家，早安。

Mark Kimbrough, our Chief Investor Relations Officer, and I would like to welcome all of you on today's call, including those of you on the webcast.

我們的首席投資者關係官馬克金布羅 (Mark Kimbrough) 和我歡迎大家參加今天的電話會議，包括網路廣播中的各位。

Here this morning, as usual, our Chairman and CEO, Milton Johnson; Sam Hazen, President and Chief Operating Officer; and Bill Rutherford, CFO and Executive Vice President.

今天早上，像往常一樣，我們的董事長兼首席執行官米爾頓·約翰遜 (Milton Johnson) 也在這裡發言。 Sam Hazen，總裁兼營運長；以及財務長兼執行副總裁 Bill Rutherford。

Before I turn the call over to Milton, let me remind everyone that should today's call contain any forward-looking statements, they're based on management's current expectations.

在我將電話轉交給米爾頓之前，讓我提醒大家，如果今天的電話會議包含任何前瞻性陳述，它們都是基於管理層當前的預期。

Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today.

許多風險、不確定性和其他因素可能導致實際結果與今天可能表達的結果有重大差異。

Many of these factors are listed in today's press release and included in our various SEC filings.

其中許多因素已在今天的新聞稿中列出，並包含在我們向 SEC 提交的各種文件中。

Several of the factors that will determine the Company's future results are beyond the ability of the Company to control or predict.

決定公司未來業績的幾個因素超出了公司的控製或預測能力。

In light of the significant uncertainties inherent in any forward-looking statements, you should not place undue reliance on these statements.

鑑於任何前瞻性陳述固有的重大不確定性，您不應過度依賴這些陳述。

The Company undertakes no obligation to revise or update any forward-looking statements whether as a result of new information or future events.

本公司不承擔因新資訊或未來事件而修改或更新任何前瞻性陳述的義務。

On this morning's call we may reference measures such as adjusted EBITDA and net income attributable to HCA Holdings, Inc., excluding losses or gains on sales of facilities, losses on retirement of debt and legal claims costs, which are non-GAAP financial measures.

在今天早上的電話會議上，我們可能會參考調整後的EBITDA 和歸屬於HCA Holdings, Inc. 的淨利潤等指標，不包括設施銷售損失或收益、債務清償損失和法律索賠成本，這些都是非GAAP財務指標。

The table providing supplemental information on adjusted EBITDA and reconciling to net income attributable to HCA Holdings, Inc.

該表提供了調整後 EBITDA 的補充資訊以及與 HCA Holdings, Inc. 歸屬淨利潤的調節。

to adjusted EBITDA is included in the fourth-quarter earnings release.

調整後的 EBITDA 已包含在第四季度收益發布中。

This morning's call is being recorded, as you know, and a replay is available later today.

如你所知，今天早上的通話正在錄音，今天晚些時候可以重播。

With that, Ill turn the call over to Milton.

這樣，我就把電話轉給米爾頓。

All right, thank you, Vic.

好的，謝謝你，維克。

And good morning to everyone joining us on the call and the webcast this morning.

今天早上參加我們電話會議和網路廣播的所有人早安。

This morning we issued our fourth-quarter and full-year 2016 earnings release.

今天上午，我們發布了 2016 年第四季和全年財報。

The release is consistent with the preview we issued on January 9. I'll make a few comments on the quarter and year end and then turn the call over to Bill and Sam to provide more detail on the quarter and 2017 guidance.

該版本與我們 1 月 9 日發布的預覽版一致。我將就季度和年末發表一些評論，然後將電話轉給 Bill 和 Sam，以提供有關季度和 2017 年指導的更多詳細資訊。

We finished the year on a solid note with fourth-quarter adjusted EBITDA totaling $2.206 billion, a record quarter for adjusted EBITDA, exceeding last year's adjusted EBITDA by 3.6%.

我們以穩健的業績結束了這一年，第四季度調整後 EBITDA 總額為 22.06 億美元，創下季度調整後 EBITDA 的記錄，比去年調整後 EBITDA 增長了 3.6%。

For the year, we reported adjusted EBITDA of $8.218 billion, up 3.8% over 2015.

今年，我們報告調整後 EBITDA 為 82.18 億美元，比 2015 年成長 3.8%。

For the full year 2016, diluted earnings per share, excluding gains and losses on sales of facilities and losses on retirement of debt and legal claims benefit costs, increased 23.6% over full-year 2015.

2016 年全年，稀釋每股收益（不包括設施銷售損益以及債務清償損失和法律索賠福利成本）比 2015 年全年增長 23.6%。

2016 was a year in which we performed well in light of difficult comparisons to prior-year growth performance.

2016 年是我們表現良好的一年，儘管與上一年的成長表現很難進行比較。

We executed our growth agenda effectively in 2016 as we continued our focus on adding access points to our network, broadening service line capabilities, and expanding debt in clinical service offerings.

2016 年，我們有效執行了成長議程，繼續專注於增加網路存取點、擴大服務線能力以及擴大臨床服務產品的債務。

Our growth agenda has delivered consistent performance.

我們的成長議程取得了一致的業績。

In fact, to illustrate, the Company has reported same-facility admissions and adjusted admissions growth for 9 consecutive years, ER visit growth for 10 consecutive years, and surgical growth for 3 consecutive years.

事實上，為了說明這一點，該公司已連續 9 年報告同一設施入院人數和調整後入院人數增長，連續 10 年報告急診就診人數增長，以及連續 3 年報告手術增長。

We believe our strategies will continue to be effective and position us well for the future.

我們相信我們的策略將繼續有效，並為我們的未來做好準備。

We believe investing capital in our existing markets is a key component of our growth strategy.

我們相信，對現有市場進行資本投資是我們成長策略的關鍵組成部分。

In 2016 we invested $2.76 billion in capital expenditures for expansion of services and capacity in our large fast-growing urban markets.

2016 年，我們投資了 27.6 億美元的資本支出，用於擴大快速成長的大型城市市場的服務和容量。

And, as you may have noted in our guidance issued this morning, we expect to invest approximately $2.9 billion in 2017.

而且，正如您在我們今天早上發布的指南中可能已經注意到的那樣，我們預計 2017 年將投資約 29 億美元。

Moving to cash flow, we generated $5.65 billion of cash flow from operating activities in 2016, up 19.4% over 2015.

轉向現金流，2016 年我們的經營活動產生了 56.5 億美元的現金流，比 2015 年成長 19.4%。

In 2016, as previously mentioned, we invested $2.7 billion in capital expenditures, we distributed $434 million to noncontrolling parties, producing free cash flow of approximately $2.5 billion.

2016年，如前所述，我們投資了27億美元的資本支出，向非控股方分配了4.34億美元，產生了約25億美元的自由現金流。

We returned $2.75 billion to shareholders in the form of share repurchases, which resulted in HCA repurchasing about 36.3 million shares of our stock, or approximately 9% of our outstanding shares since the beginning of 2016.

我們以股票回購的形式向股東返還 27.5 億美元，這導致 HCA 回購了約 3,630 萬股我們的股票，約佔 2016 年初以來我們已發行股票的 9%。

On the subject of capital allocation, the Company has not paid a regular dividend since its IPO in 2011, and we have decided to maintain our current policy on dividend payouts.

在資本配置方面，本公司自2011年IPO以來未定期派發股息，我們決定維持現行派息政策。

Although we remain confident in our long-term growth prospects, we believe it's prudent to take a conservative approach and maintain maximum financial flexibility until we gain greater clarity of health and tax policies at the federal level.

儘管我們對長期成長前景仍然充滿信心，但我們認為，在聯邦層面的健康和稅收政策更加明確之前，採取保守的做法並保持最大的財務靈活性是謹慎的做法。

Today, we believe share repurchase is the appropriate means to return free cash flow to shareholders, but we will continue to evaluate our policy over time.

今天，我們認為股票回購是向股東返還自由現金流的適當方式，但我們將隨著時間的推移繼續評估我們的政策。

I'd like to take a moment to comment on our recent settlement with the Health Care Foundation of Kansas City.

我想花點時間評論我們最近與堪薩斯城醫療保健基金會達成的和解協議。

The Missouri Court of Appeals recently reversed key parts of an earlier court's decision and confirmed that we've spent in excess of $450 million during the five-year term following our acquisition of the [health] Midwest Health System in 2003.

密蘇裡州上訴法院最近推翻了先前法院判決的關鍵部分，並確認我們在 2003 年收購[健康]中西部衛生系統後的五年任期內花費了超過 4.5 億美元。

While we disagree with the remainder of the court's ruling, we felt it was best to end this long-standing dispute and we have entered into a final resolution agreement with the Health Care Foundation of Kansas City.

雖然我們不同意法院裁決的其餘部分，但我們認為最好結束這一長期爭端，並且我們已與堪薩斯城醫療保健基金會達成了最終解決協議。

In the 14 years since our acquisition in Kansas City, we have invested over $1 billion in the market to expand and upgrade our facilities and add new services.

自收購堪薩斯城以來的 14 年來，我們已在市場上投資超過 10 億美元，以擴大和升級我們的設施並增加新服務。

And I'm very proud of the work we have done in Kansas City.

我對我們在堪薩斯城所做的工作感到非常自豪。

And part of this settlement, and based on an earlier court's decision, the Company had a recorded liability of $478 million.

作為和解協議的一部分，根據先前法院的判決，該公司的記錄負債為 4.78 億美元。

This settlement of $188 million brings a final resolution to this dispute and allows us to continue our focus on caring for the Kansas City community.

1.88 億美元的和解協議為這項爭議帶來了最終解決方案，使我們能夠繼續專注於關懷堪薩斯城社區。

I'll close my comments with my thoughts on our 2017 guidance included in our release this morning.

我將用我對今天早上發布的 2017 年指南的想法來結束我的評論。

With respect to adjusted EBITDA growth, our guidance yields approximately 2.5% to 6% growth for 2017.

就調整後 EBITDA 成長而言，我們的預期 2017 年成長約為 2.5% 至 6%。

Our guidance reflects continued volume growth, reasonable pricing, and well-managed expense growth.

我們的指導反映了持續的銷售成長、合理的定價和管理良好的費用成長。

I'm looking forward to 2017 and I believe the Company is well positioned to achieve its goals for the year.

我對 2017 年充滿期待，我相信公司有能力實現今年的目標。

And with that Ill turn the call over to Bill.

然後我會把電話轉給比爾。

Great, thank you, Milton.

太好了，謝謝你，米爾頓。

Good morning, everybody.

大家早安。

I will cover some additional information relating to the fourth-quarter results and review our 2017 guidance, then I'll turn the call over to Sam for some comments on our operations.

我將介紹一些與第四季度業績相關的其他信息，並回顧我們 2017 年的指導，然後我會將電話轉給 Sam，徵求對我們運營的一些評論。

As Milton commented, we were pleased with the quarter's results.

正如米爾頓所說，我們對本季的業績感到滿意。

Fourth quarter was a difficult comp for us with the strong result we had in Q4 of 2015.

第四季對我們來說是一個艱難的時期，我們在 2015 年第四季取得了強勁的業績。

However, our extensive management helped deliver another good quarter and solid performance for the year.

然而，我們廣泛的管理幫助我們實現了另一個良好的季度和全年的穩健業績。

For the quarter, adjusted EBITDA increased 3.6% to $2.206 billion from $2.131 billion last year.

本季調整後 EBITDA 成長 3.6%，從去年的 21.31 億美元增至 22.06 億美元。

Adjusted EBITDA margin in the quarter was 20.7% versus 20.8% last year.

本季調整後 EBITDA 利潤率為 20.7%，去年同期為 20.8%。

In the fourth quarter, our same-facility admissions increased 1.6% over the prior year and equivalent admissions increased 1.5%.

第四季度，我們的同一設施招生人數比去年同期增加了 1.6%，同等招生人數增加了 1.5%。

During the fourth quarter same-facility Medicare admissions and equivalent admissions increased 2.7% and 3%, respectively.

第四季度，同一設施的醫療保險入院人數和同等入院人數分別增加了 2.7% 和 3%。

This includes both traditional and managed Medicare.

這包括傳統的和管理的醫療保險。

Managed Medicare admissions increased 5.3% on a same-facility basis and represent 33.6% of our total Medicare admissions.

管理式醫療保險入院人數在同一設施基礎上增加了 5.3%，佔醫療保險入院總數的 33.6%。

Same-facility Medicaid admissions and equivalent admissions increased 3.1% and 3%, respectively, in the quarter, consistent with recent trends.

本季同一設施醫療補助入院人數及同等入院人數分別成長 3.1% 及 3%，與近期趨勢一致。

Same-facility self-pay and charity admissions declined 0.3% in the quarter, representing 7.6% of our total admissions compared to the 7.7% last year.

本季同一設施的自費和慈善入場人數下降了 0.3%，佔總入場人數的 7.6%，而去年為 7.7%。

Managed care and other, which includes exchange admissions, declined 0.4%, and equivalent admissions were essentially flat on a same-facility basis in the fourth quarter compared to the prior year.

管理式醫療及其他（包括交換入學）下降了 0.4%，第四季度同等設施的同等入學人數與去年同期基本持平。

Same-facility emergency room visits increased 1.6% in the fourth quarter compared to last year.

與去年相比，第四季度同一設施急診室的就診次數增加了 1.6%。

Same-facility self-pay and charity ER visits represented 19.3% of our total ER visits in the quarter, slightly lower than the prior year.

同設施自費及慈善急診就診佔本季急診就診總數的 19.3%，略低於前一年。

Intensity of service or acuity continued to increase in the quarter, with our same-facility case mix increasing 3.3% compared to the prior-year period.

本季服務強度或敏銳度持續增加，同一設施的案件數量與去年同期相比增加了 3.3%。

Same-facility inpatient surgeries increased 1.4% and outpatient surgeries declined 0.6% from the prior year.

與前一年相比，同一設施的住院手術量增加了 1.4%，門診手術量下降了 0.6%。

Same-facility revenue per equivalent emission increased 1.9% in the quarter.

本季每當量排放量的相同設施收入增加了 1.9%。

Same-facility managed care and other revenue per equivalent admission increased 5.5% in the quarter, which is generally consistent with our recent trends.

本季同一設施管理式醫療和其他同等入院收入成長了 5.5%，這與我們最近的趨勢基本一致。

Same-facility managed care and other case mix increased 3.4% compared to last year.

與去年相比，同一設施管理式醫療和其他病例組合增加了 3.4%。

Same-facility charity care and uninsured discounts increased $660 million in the quarter compared to prior year.

與去年同期相比，本季同一設施慈善護理和無保險折扣增加了 6.6 億美元。

Same-facility charity care discounts totaled $1.047 billion in the quarter, an increase of $82 million from the prior year; while same-facility uninsured discounts totaled $3.469 billion, an increase of $578 million over the prior year.

本季同設施慈善護理折扣總額為 10.47 億美元，較上年增加 8,200 萬美元；同一設施的無保險折扣總額為 34.69 億美元，比前一年增加 5.78 億美元。

Same-facility operating expense per equivalent admission increased 2.8% compared to last year's fourth quarter.

與去年第四季相比，每同等入場人數的相同設施營運費用增加了 2.8%。

Salaries and benefits as a percentage of revenues were down slightly to 44.8% compared to the 44.9% in last year's fourth quarter.

薪資和福利佔收入的比例略有下降，降至 44.8%，而去年第四季為 44.9%。

Same-facility supply expense per equivalent admission increased 5.3% over the fourth quarter compared to prior year.

與去年同期相比，第四季每同等入場人數的相同設施供應費用增加了 5.3%。

This increase was primarily driven by growth in medical device spend and increased volume in some higher acuity services such as [tal-are] procedures, neurological cases and orthopedics.

這一增長主要是由於醫療設備支出的增長以及一些較高敏銳度服務（例如[tal-are]手術、神經病例和骨科）數量的增加所推動的。

Other operating expenses include 30 basis points from last year's fourth quarter to 17.7% of revenues.

其他營運支出較去年第四季下降30個基點，佔營收的17.7%。

Let me briefly touch on health reform activity in the quarter.

讓我簡要談談本季的醫療改革活動。

In the fourth quarter of 2016 we saw approximately 12,300 same-facility exchange admissions as compared to the 11,300 in the fourth-quarter of last year.

2016 年第四季度，我們看到約 12,300 名同一設施的交換生入學，而去年第四季為 11,300 名。

For full-year 2016, our health exchange admissions increased approximately 15% over 2015 levels and represented about 2.7% of total admissions.

2016 年全年，我們的健康交流招生人數比 2015 年增加了約 15%，約佔總招生人數的 2.7%。

We saw about 43,900 same-facility exchange ER visits in the fourth quarter compared to 38,000 in the fourth quarter 2015.

第四季同一設施交換急診就診次數約為 43,900 次，而 2015 年第四季為 38,000 次。

For full-year 2016 health exchange ER visits increased 23% and represented 2.4% of total ER visits.

2016 年全年健康交流急診就診次數增加了 23%，佔急診就診總數的 2.4%。

All in all health reform activity was generally in line with our expectations.

總而言之，醫改活動大致符合我們的預期。

As reported, earnings per share for full-year 2016 was $7.30 as compared to $4.99 in the prior year.

據報道，2016 年全年每股收益為 7.30 美元，而前一年為 4.99 美元。

2016 earnings per share includes positive benefits for $0.39 due to the Kansas City legal settlement, $0.41 due to the effect of adopting the county standard related tax benefits for equity awards, and $0.13 due to the completion of the federal tax audits for 2011 and 2012.

2016 年每股收益包括因堪薩斯城法律和解而產生的0.39 美元的正收益、因採用縣標準相關股權獎勵稅收優惠而產生的0.41 美元以及因完成2011 年和2012 年聯邦稅務審計而產生的0.13 美元。

Let me touch briefly on cash flow.

讓我簡單談談現金流。

The strength of our cash flow and the discipline and balanced approach to capital allocation remains an important advantage for the Company.

我們的現金流實力以及資本配置的紀律和平衡方法仍然是公司的重要優勢。

In the fourth quarter, cash flow from operations was $1.699 billion compared to the $1.558 billion last year.

第四季營運現金流為 16.99 億美元，去年為 15.58 億美元。

For full-year 2016, cash flow from operations was $5.65 billion, up over $900 million from the $4.73 billion last year.

2016 年全年，營運現金流為 56.5 億美元，比去年的 47.3 億美元增加了 9 億多美元。

As we mentioned, throughout the year, cash flow from operations includes approximately $160 million for the full-year 2016 from our adoption of the accounting standard on recording the tax benefits related equity awards.

正如我們所提到的，全年營運現金流包括 2016 年全年約 1.6 億美元，這是由於我們採用了記錄與股權獎勵相關的稅收優惠的會計準則而產生的。

After adjusting for this accounting change, cash from operations increased approximately $740 million or just over 15%.

調整此會計變更後，營運現金增加約 7.4 億美元，增幅略高於 15%。

In addition, cash flow from operations included an improvement in net AR days decrease from 53 last year to 50 at December 31, 2016.

此外，營運現金流量包括淨應收帳款天數的改善，從去年的 53 天減少到 2016 年 12 月 31 日的 50 天。

Capital spending for the year increased to $2.76 billion from $2.375 billion in 2015 as we continue to invest in long-term growth opportunities for the Company.

由於我們繼續投資於公司的長期成長機會，今年的資本支出從 2015 年的 23.75 億美元增加到 27.6 億美元。

Free cash flow for 2016 was $2.459 billion, a $595 million increase or 32% over $1.864 billion in 2015.

2016 年自由現金流為 24.59 億美元，比 2015 年的 18.64 億美元增加了 5.95 億美元，增幅為 32%。

As Milton mentioned, we completed $2.75 billion of share repurchases during the year.

正如 Milton 所提到的，我們在這一年完成了 27.5 億美元的股票回購。

We have approximately $1.85 billion remaining on our $2 billion authorization as of December 31, 2016.

截至 2016 年 12 月 31 日，我們的 20 億美元授權還剩約 18.5 億美元。

At the end of the quarter, we had approximately $2.1 billion available under our revolving credit facilities and our debt to EBITDA ratio was 3.8 times.

截至本季末，我們的循環信貸額度約為 21 億美元，負債與 EBITDA 的比率為 3.8 倍。

Also important to highlight is activities through our capital market transactions.

同樣需要強調的是我們透過資本市場交易進行的活動。

Over the past couple of years we have reduced our weighted average interest cost to approximately 5.3% at December 31.

在過去幾年中，截至 12 月 31 日，我們已將加權平均利息成本降低至約 5.3%。

Our return on invested capital was approximately 16.6% as of the end of the year.

截至年底，我們的投資資本報酬率約為 16.6%。

These cash flow and balance sheet metrics highlight an important key strength for the Company and allows us to continue to invest for long-term growth, distribute value through our share repurchase program, maintain ample liquidity and maintain our leverage ratio towards the lower end of our stated range.

這些現金流和資產負債表指標凸顯了公司的一個重要關鍵優勢，使我們能夠繼續投資以實現長期成長，透過股票回購計畫分配價值，保持充足的流動性並將槓桿率維持在較低水準。規定的範圍。

All of this positions us very well going into 2017.

所有這些都為我們進入 2017 年奠定了良好的基礎。

With that, I'll move into a discussion about our 2017 guidance.

接下來，我將開始討論我們 2017 年的指導。

Highlighted in our earnings release this morning, we estimate our 2017 consolidated revenues should range from $43 billion to $44 billion.

今天早上發布的財報中強調，我們預計 2017 年合併收入應在 430 億美元至 440 億美元之間。

We expect adjusted EBITDA to be between a $8.4 billion and $8.7 billion.

我們預計調整後 EBITDA 將在 84 億美元至 87 億美元之間。

Within our revenue estimates we estimate equivalent admissions growth to range between 2% and 3% for the year, and revenue per equivalent admission growth to range between 2% and 3% for 2017.

在我們的收入預測中，我們預計 2017 年同等入場人數成長將在 2% 至 3% 之間，而同等入場收入成長將在 2% 至 3% 之間。

We anticipate our Medicare revenues per equivalent admissions to reflect a composite growth rate of approximately 1% to 2%, factoring in market basket changes and ACA reductions, as well as some anticipated intensity increases.

考慮到市場籃子變化和 ACA 減少以及一些預期的強度增加，我們預計每同等入院人數的醫療保險收入將反映約 1% 至 2% 的複合成長率。

Medicaid revenues per equivalent admission are estimated to be mostly flat year over year.

據估計，每同等入院醫療補助收入與去年同期基本持平。

And managed and commercial revenues per equivalent admission are estimated to grow between 4% and 5%.

每同等入場費的管理和商業收入預計將增加 4% 至 5%。

We also anticipate a growth in share-based compensation of approximately $40 million.

我們也預計股權激勵將成長約 4,000 萬美元。

And we anticipate operating expenses per adjusted admission growth of approximately 2.5%.

我們預計每次調整後的入場費將成長約為 2.5%。

Relative to health reform, we do expect some modest growth in health exchange volumes, but isolating the net EBITDA impact to health reform from core operations is becoming more subjective and increasingly difficult.

相對於醫療改革，我們確實預期醫療交換量會出現適度成長，但將醫療改革對核心業務的 EBITDA 淨影響與核心業務隔離開來正變得更加主觀且越來越困難。

We will continue to report on exchange volumes which we can identify, but converting these variables to an EBITDA impact has a lot of imprecision in this fourth year of reform.

我們將繼續報告我們可以確定的交易量，但在改革的第四年中，將這些變數轉換為 EBITDA 影響存在很大的不精確性。

As an overall summary, we believe reform contribution in 2017 will be materially equivalent to what the contribution we experienced was in 2016.

整體而言，我們認為 2017 年的改革貢獻將與 2016 年的改革貢獻基本相當。

Relative to other aspects of our guidance, we anticipate capital spending of $2.9 billion in 2017 as we seek continued opportunities to invest in our markets and support the key strategic initiatives.

相對於我們指引的其他方面，我們預計 2017 年的資本支出為 29 億美元，因為我們尋求持續的機會投資我們的市場並支持關鍵策略舉措。

We estimate depreciation and amortization to be approximately $2.05 billion and interest expense to be approximately $1.7 billion.

我們估計折舊和攤提約為 20.5 億美元，利息支出約為 17 億美元。

Our effective tax rate is expected to be approximately 34%.

我們的有效稅率預計約為 34%。

And, lastly, our average diluted shares are projected to be approximately 376.5 million shares for the year, and earnings per diluted share guidance of 2017 is between $7.20 to $7.60.

最後，我們今年的平均稀釋後股票預計約為 3.765 億股，2017 年稀釋後每股盈餘指導值在 7.20 美元至 7.60 美元之間。

Earnings per diluted share guidance includes an estimated $150 million income tax benefit or $0.40 per diluted share related to the accounting standard on recording excess tax benefits related to equity awards, but does not include losses or gains on sale of facilities, losses on retirement of debt, or legal claim cost.

稀釋每股收益指引包括估計 1.5 億美元的所得稅優惠或每股稀釋每股 0.40 美元，與記錄與股權獎勵相關的超額稅收優惠的會計標準相關，但不包括出售設施的損失或收益、債務清償損失，或法律索賠費用。

So, that concludes my remarks and I'll turn the call over to Sam for some additional comments.

我的發言到此結束，我將把電話轉給 Sam，徵求一些補充意見。

Good morning.

早安.

Let me begin by giving you some of the volume stats that I normally provide on these calls.

讓我先向您提供一些我通常在這些通話中提供的音量統計數據。

Once again, in both the quarter and the year the Company had broad-based volume growth across our market and across most of the facilities and service lines that make up our business.

在本季和本年度，本公司在整個市場以及構成我們業務的大多數設施和服務線中再次實現了廣泛的銷售成長。

For our domestic operations on a same facilities basis, 11 of 14 divisions had growth in admissions in both the quarter and in the year, 9 divisions had growth in adjusted admissions in the quarter, and 13 divisions had growth in the year.

對於我們在相同設施基礎上的國內業務，14 個部門中的11 個部門在本季度和年內的入場人數均有所增長，9 個部門在本季度調整後的入場人數有所增長，13個部門在年內有所成長。

10 divisions had emergency rooms visits growth in the quarter.

本季有 10 個部門的急診室就診量有所增加。

Freestanding emergency rooms visits grew 11% and accounted for approximately 60% of our overall ER growth in the quarter.

獨立急診室的就診量增加了 11%，約佔本季急診室整體成長的 60%。

Hospital-based emergency room visits grew 0.7% in the quarter.

本季醫院急診就診量增加了 0.7%。

In the year, 13 divisions had emergency room visits growth.

年內，13個科室的急診就診人數有所增加。

Inpatient surgeries grew 1.7% in the quarter.

本季住院手術量成長 1.7%。

Surgical admissions were 28.1% of total admissions in the quarter.

本季手術入院人數佔總入院人數的 28.1%。

Inpatient surgical volumes were particularly strong again this quarter in cardiovascular, orthopedic, and neurosurgery categories.

本季心血管、骨科和神經外科類別的住院手術量再次特別強勁。

For the year, surgical admissions were 28.3% of total, which is an increase over the prior year.

全年手術入院人數佔總入院人數的28.3%，較上年增加。

10 divisions had inpatient surgeries growth in the year.

年內有10個科室住院手術量有所增加。

Outpatient surgeries were slightly down in the quarter, about 0.6%.

本季門診手術量略有下降，約 0.6%。

Hospital-based outpatient surgical volumes declined 0.5%.

醫院門診手術量下降 0.5%。

And volumes declined 0.7% in our freestanding ambulatory surgery division.

我們的獨立門診手術部門的銷量下降了 0.7%。

Seven of our divisions in the quarter had growth in outpatient surgery volumes.

本季我們的七個部門的門診手術量有所增加。

In the divisions that were down, multiple service lines accounted for the decline.

在下降的部門中，多條服務線導致了下降。

For the year, outpatient surgeries grew 1.2% with 11 divisions showing growth.

全年門診手術量成長 1.2%，其中 11 個科室出現成長。

Behavioral health admissions grew 0.8% in the quarter and 2.2% in the year.

行為健康入院人數本季成長 0.8%，全年成長 2.2%。

Rehab admissions grew 5% in the quarter and 3.3% in the year.

康復中心入院人數本季成長 5%，全年成長 3.3%。

Deliveries were down 1.8% in the quarter and down 1% in the year.

本季交付量下降 1.8%，全年交付量下降 1%。

Again, most of these declines were in Medicaid payers.

同樣，這些下降大部分發生在醫療補助付款人身上。

Neonatal admissions increased 0.5% in both the quarter and the year.

本季及全年新生兒入院率均增加 0.5%。

Cardiology procedures grew 4.7%, which is generally consistent with the growth rate for the year.

心臟病手術成長了 4.7%，與今年的成長率基本一致。

Trauma volumes grew 18% in both the quarter and the year.

創傷量在本季和當年均增加了 18%。

Observation visits were up 2.7% in the quarter and grew 7% in the year.

本季觀察訪問量成長 2.7%，全年成長 7%。

All in all, the fourth-quarter in 2016 were solid periods of growth for the Company and they continued to show, as Milton said, a consistent pattern of growth over many years.

總而言之，2016 年第四季是該公司穩健的成長時期，正如 Milton 所說，它們繼續顯示出多年來一致的成長模式。

We believe our strong portfolio market and the favorable trends within them should yield overall demand growth in the range of 2% to 2.5% per year over the next few years.

我們相信，我們強大的投資組合市場及其內部的有利趨勢應該會在未來幾年內帶來每年 2% 至 2.5% 的整體需求成長。

Our approach to these markets remains the same as we strive to be the provider system of choice for patients and physicians.

我們對這些市場的態度保持不變，我們努力成為患者和醫生的首選供應商系統。

The improvements we have made in clinical and operational metrics, coupled with our increasing capital spending, position the Company well from a competitive position and should provide for solid growth prospects in the future.

我們在臨床和營運指標方面取得的改進，加上我們不斷增加的資本支出，使公司處於有利的競爭地位，並應為未來提供堅實的成長前景。

The Company has over $4.5 billion of capital in-flight that is yet to hit our markets.

該公司有超過 45 億美元的流動資金尚未進入我們的市場。

This in-flight capital, which is approved projects that are not yet in service and should be completed over the next three years, will add urgent care centers and freestanding emergency rooms to our provider systems, allowing us to improve patient access and experience with more conveniently located facilities.

這筆正在運作的資本是已批准但尚未投入使用的項目，應在未來三年內完成，將為我們的提供者係統增加緊急護理中心和獨立急診室，使我們能夠改善患者的就診和體驗。位置便利，設施齊全。

Additionally, it will increase capacity in existing hospitals by adding more inpatient beds, emergency room beds, and operating suites, thus relieving constraints in many situations.

此外，它將透過增加更多住院床位、急診室床位和手術室來增加現有醫院的容量，從而緩解許多情況下的限制。

And lastly, it will enhance service line offerings with new equipment and clinical technology, which will provide a better environment for nurses and physicians in delivering care to our patients.

最後，它將透過新設備和臨床技術增強服務線產品，這將為護理師和醫生為患者提供更好的護理環境。

In addition to capital spending, our growth agenda includes coordinated marketing strategies, patient care coordination systems, and multiple human resource programs that are particularly focused on physician development and nursing operations.

除了資本支出之外，我們的成長議程還包括協調行銷策略、病患照護協調系統以及特別關注醫生發展和護理業務的多個人力資源計劃。

This agenda is supported by strong execution system and resourced by the unique scale and operational capabilities of HCA.

這項議程得到了強大的執行系統的支持，並得到了 HCA 獨特的規模和營運能力的支持。

In sum, we believe we continue to have solid growth opportunities across our diversified portfolios of markets and service lines, and we believe our local provider systems are well positioned to capitalize on these opportunities in the future.

總而言之，我們相信我們在多元化的市場和服務線組合中繼續擁有堅實的成長機會，並且我們相信我們的本地供應商系統在未來能夠充分利用這些機會。

With that, let me turn the call back to Vic.

接下來，讓我把電話轉回給維克。

Thank you, Sam, and Bill and Milton.

謝謝山姆、比爾和米爾頓。

Lori, if you'd come back on and poll for questions.

洛瑞（Lori），如果你願意回來投票詢問問題的話。

As we always do, I encourage each of you to limit yourselves to one question and then if you have a second, jump back in the queue.

正如我們一貫所做的那樣，我鼓勵你們每個人只回答一個問題，然後如果還有第二個問題，請跳回到隊列中。

It's all yours, Lori.

都是你的了，洛瑞。

(Operator instructions)

（操作員說明）

Whit Mayo, Robert Baird.

惠特·梅奧，羅伯特·貝爾德。

Thanks.

謝謝。

Maybe just to start with that last point, Sam, if you could perhaps elaborate a little bit more on some of the capital priorities for 2017, or maybe just broadly the $4.5 billion of in-flight capital that you referenced.

也許只是從最後一點開始，Sam，如果您能詳細說明一下 2017 年的一些資本優先事項，或者只是粗略地說明您提到的 45 億美元的飛行資本。

Is there anything that's very unique or different this year versus the prior year, any specific or larger projects that we should be aware of?

今年與去年相比有什麼非常獨特或不同的地方嗎？有什麼我們應該注意的具體或更大的項目嗎？

And then maybe if you could just comment quickly on the cash flow expectations for 2017.

然後您能否快速評論一下 2017 年的現金流預期。

Thanks.

謝謝。

With respect to the capital spending plan for the Company, for the most part there aren't any significant changes in our approach to capital spending.

就公司的資本支出計劃而言，我們的資本支出方法在很大程度上沒有任何重大變化。

We believe the Company has solid growth prospects in many of our markets.

我們相信該公司在許多市場都有穩健的成長前景。

We've been investing to take advantage of those growth prospects by expanding, like I said, our networks where we're adding facilities and so forth.

正如我所說，我們一直在投資以利用這些成長前景，透過擴大我們的網路來增加設施等。

And then at the same time we have a number of facilities that are operating at unusually high occupancy levels, forcing us to address certain capacity constraints.

同時，我們的許多設施的入住率異常高，迫使我們解決某些容量限制。

When you look at our capital spending that we report in our cash flow statement, some of that capital is being spent but it takes a while for these projects to come online.

當你查看我們在現金流量表中報告的資本支出時，會發現其中一些資本已經被支出，但這些項目需要一段時間才能上線。

That's why I wanted to give you a sense of what's in the pipeline for the Company because we have been accelerating our capital spending.

這就是為什麼我想讓您了解公司正在計劃的事情，因為我們一直在加速資本支出。

And as this capital starts to come online more in 2017 and 2018 than it has come online in 2016 and 2015, we're expected to add roughly 1% to 1.5% to our bed capacity on the inpatient side, roughly 4% to 4.5% on our emergency room side.

由於這筆資金在 2017 年和 2018 年投入的資金開始多於 2016 年和 2015 年投入的資金，我們預計住院床位容量將增加約 1% 至 1.5%，即約 4% 至 4.5%在我們急診室那邊。

And we think those are important components of our overall growth strategy.

我們認為這些是我們整體成長策略的重要組成部分。

We spend about $250 million per year on IT capital.

我們每年在 IT 資本上花費約 2.5 億美元。

We spend about $1.5 billion on routine related capital.

我們在日常相關資本上花費了約 15 億美元。

And in the balance tends to be more strategic, addressing these growth prospects and then addressing some of these capacity constraints.

總的來說，往往更具策略性，先解決這些成長前景，然後解決其中一些能力限制。

No bolus is unusually going to one market or the other, so it's diversified from the standpoint of markets.

沒有任何一劑藥物會異常地流向一個市場或另一個市場，因此從市場的角度來看，它是多元化的。

It's further diversified from the standpoint of facilities within those markets.

從這些市場內的設施的角度來看，它進一步多元化。

And then from a service-line standpoint, I would submit that it's quite diversified, as well, and that we think this is a very conservative deployment approach.

然後從服務線的角度來看，我認為它也相當多樣化，我們認為這是一種非常保守的部署方法。

It's very effective in resourcing our growth agendas across the Company and we're optimistic that it's going to yield value for the Company over time.

它在為整個公司的成長議程提供資源方面非常有效，我們樂觀地認為，隨著時間的推移，它將為公司帶來價值。

Whit, on cash flow, we are anticipating cash flow from operations to range somewhere between $5.3 billion and $5.5 billion.

就現金流而言，我們預計營運現金流將在 53 億美元至 55 億美元之間。

It will be down slightly from this year due to some anticipated increase in cash taxes.

由於現金稅的預期增加，這一數字將比今年略有下降。

Sam, talking about the increase, just to frame it, I'm looking here, in a two-year period, 2012 and 2013, we added about 800 inpatient beds during that two-year window.

Sam，談到成長，只是為了說明這一點，我在這裡看，在 2012 年和 2013 年的兩年時間內，我們在這兩年的時間段內增加了大約 800 個住院床位。

And 2014 to 2015 two-year window we added about 900 new inpatient beds.

在2014年至2015年的兩年時間裡，我們新增了約900張新住院床位。

And for 2016 to 2017 two-year period, it'd be almost 1,000.

在2016年至2017年的兩年時間裡，這個數字幾乎是1000個。

So, as Sam was saying, it's increasing the amount of capital coming online, and we expect that to grow when you think about 2017, 2018, as well.

因此，正如 Sam 所說，線上資本數量正在增加，當您考慮 2017 年和 2018 年時，我們預計這一數字也會增長。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Thanks, hi, everybody.

謝謝大家好。

I'm going to try to squeeze in two here real quick, if I could.

如果可以的話，我會嘗試盡快擠進兩個人。

One, obviously there's been a lot of focus on the repeal-and-replace discussion.

第一，顯然，廢除和取代的討論受到了很多關注。

But there's other things that are in the works, too, one of which is the repatriation potentially.

但還有其他事情也在進行中，其中之一就是可能的遣返。

You guys have been overseas, in London in particular, for a long period of time.

你們已經在海外，特別是在倫敦待了很長一段時間了。

Do you have any significant cash that you might consider bringing back if there is a [holiday]?

如果有[假期]，您是否有大量現金可以考慮帶回來？

And then my strategic question was, in the last couple of years we've seen payers get involved in purchasing physicians, then they moved to urgent care centers, and now very recently there's been this move to ASC markets.

然後我的策略問題是，在過去幾年中，我們看到付款人參與購買醫生，然後他們轉向緊急護理中心，現在最近又轉向 ASC 市場。

Any thoughts about that?

對此有什麼想法嗎？

Has that changed the competitive landscape?

這是否改變了競爭格局？

Has it changed anything that you want to do?

它改變了你想做的事情嗎？

Or just business as usual?

還是一切如常？

Any response to that new competitive evolution?

對這種新的競爭演變有何反應？

All right.

好的。

A.J., we're going to let BIll take the first piece on the repatriation, and maybe Sam has some comments.

A.J.，我們將讓比爾負責關於遣返的第一篇文章，也許山姆有一些評論。

A.J., real quick on the cash overseas, we have had London, some international operations.

A.J.，海外現金儲備非常快，我們在倫敦設有一些國際業務。

We have approximately $400 million cash overseas that if there's an opportunity, that would give us some opportunity to repatriate that.

我們在海外擁有約 4 億美元的現金，如果有機會，我們就有機會將其匯回國內。

So, we will just wait to see how certain tax policies may unfold to see how we deal with that.

因此，我們將拭​​目以待，看看某些稅收政策將如何展開，看看我們如何應對。

And there was a second question about payers getting into the provider space.

還有第二個問題是關於付款人進入提供者領域的。

There had to have been significant movement across our market with payers entering the provider space.

隨著付款人進入提供者領域，我們的市場必定發生了重大變化。

Optum and United have made a couple of strategic acquisitions but they are sprinkled from one market to the other and they don't really have what I'd call a concentrated influence on any one particular market.

Optum 和 United 已經進行了幾項策略性收購，但它們分散在一個市場到另一個市場，實際上對任何特定市場都沒有我所說的集中影響力。

Obviously we see opportunities for us to work with the payers as they try to build out provider systems because of what we're doing as an organization.

顯然，我們看到了與付款人合作的機會，因為他們試圖建立供應商系統，因為我們作為一個組織正在做的事情。

And we're having discussions with the payers around using our network and our footprint in these areas to accommodate their objectives.

我們正在與付款人討論如何使用我們的網路和我們在這些領域的足跡來滿足他們的目標。

And we think there's a lot of opportunities there for HCA and other payers to accomplish that.

我們認為 HCA 和其他付款人有很多機會來實現這一目標。

We're not seeing any significant competitive dynamics to date, nor do we see it in the foreseeable future, coming from those strategic moves across the markets.

到目前為止，我們沒有看到任何重大的競爭動態，在可預見的未來，我們也沒有看到來自市場上這些策略舉措的任何重大競爭動態。

Again, within a particular market, there could be a bit of concentration around that.

同樣，在特定市場內，可能會存在一定程度的集中度。

But we've had some of those in situations in the past in markets already and we seem to be able to work with the payers, or around the payers in those instances, to accomplish what we need to get done in those individual markets.

但我們過去在市場上已經遇到過一些情況，我們似乎能夠與付款人合作，或者在這些情況下圍繞付款人合作，以完成我們在這些個別市場中需要完成的工作。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great.

偉大的。

Just wanted to understand the comments around capital deployment.

只是想了解有關資本部署的評論。

You mentioned, both wanting to understand the impacts to the healthcare regulatory environment as well as the tax policy.

您提到，雙方都想了解對醫療保健監管環境以及稅收政策的影響。

Which one is more of a driver, in your view?

在您看來，哪一個更像是司機？

And when you think about the impacts on healthcare, is there an expectation that there may be an acceleration in deals going forward if things do change for the worse?

當您考慮對醫療保健的影響時，是否預期如果情況確實變得更糟，未來的交易可能會加速？

Would you expect the M&A to be a bigger part of this or would you still expect, for the most part, your share repurchase to be the biggest use of excess free cash flow?

您是否預計併購將成為其中更重要的一部分，或者在很大程度上，您是否仍預計股票回購將成為多餘自由現金流的最大用途？

Kevin, this is Milton.

凱文，這是米爾頓。

You're asking which one is the most important for emphasis, health policy changes or tax changes.

您問的是，醫療政策變化或稅收變化哪一項最重要。

With respect to our decision around dividend payment, I would say it's equally driven.

至於我們關於股利支付的決定，我想說這也是同樣的驅動力。

Right now, we need to understand how will dividends be taxed in the future versus share repurchase opportunities.

現在，我們需要了解未來將如何對股利與股票回購機會徵稅。

I'd like to have some more clarity around that before we make a decision on a dividend and have a fixed charge on the Company.

在我們做出股息決定並對公司收取固定費用之前，我想更清楚地了解這一點。

Obviously health policy is something we're concerned about, as well, and we're following very closely in Washington.

顯然，衛生政策也是我們關心的事情，我們在華盛頓密切關注。

So, I can't really necessarily rank them because they're both important to the decision around the dividend.

因此，我實際上不一定會對它們進行排名，因為它們對於股利決策都很重要。

I think with respect to opportunities for acquisitions in this environment, we do have a pipeline today.

我認為就這種環境下的收購機會而言，我們今天確實有管道。

I will comment that I think -- I will also say, as usual, it's very difficult to know how some of the opportunities and discussions we are having will actually turn out.

我會評論說，我認為 - 我還會說，像往常一樣，很難知道我們正在進行的一些機會和討論實際上會如何結果。

But I will say that the pipeline today is a little more robust than it has been in recent years, and the transactions feel like they could be more realizable.

但我要說的是，今天的管道比近年來更加穩健，交易感覺更容易實現。

That's just my feel for the market right now.

這只是我對目前市場的感覺。

So that's a piece of it.

這就是其中的一部分。

But with our strong cash flow that we have and strong balance sheet, I feel like we've got the ability to remain active with the share repurchase program and be acquisitive.

但憑藉我們強勁的現金流和強勁的資產負債表，我覺得我們有能力維持積極的股票回購計畫並進行收購。

So, I don't see a trade-off there.

所以，我不認為這需要權衡。

But, as I said in my comments, we want to remain at this point conservative with our approach, we want maximum financial flexibility for the Company to be able to take advantage of the opportunities that could come in the coming few months or few years.

但是，正如我在評論中所說，我們目前希望對我們的方法保持保守，我們希望公司具有最大的財務靈活性，以便能夠利用未來幾個月或幾年可能出現的機會。

So we will, as I said in my comments, consider to evaluate our policy around dividends going forward.

因此，正如我在評論中所說，我們將考慮評估我們未來的股息政策。

It's just in the current environment, we'd like to have more clarity before making the decision that's really a permanent decision with respect to the Company's use of cash.

只是在當前環境下，我們希望在做出關於公司現金使用的永久性決定之前更清楚。

Matthew Borsch, Goldman Sachs.

馬修·博爾什，高盛。

Yes, just a question, as you think about potential tax reform in particular, are you trying to get EPS to be the primary earnings metric that investors look at?

是的，只是一個問題，當您特別考慮潛在的稅務改革時，您是否試圖讓每股盈餘成為投資者關注的主要獲利指標？

And is that something that you've found investors are more receptive to as compared to a few years ago?

您是否發現投資者比幾年前更容易接受這一點？

Again, this is Milton.

再說一次，這是米爾頓。

And Bill may want to jump in.

比爾可能想加入進來。

But we definitely believe that investors should be looking at EPS.

但我們絕對相信投資人應該關注每股盈餘。

We have been a consistent repurchaser of our stock.

我們一直是股票的回購者。

We believe we've created a lot of value for our shareholders since the IPO via -- I don't have the numbers off the top of my head, but billion of dollars, maybe approaching $9 billion to $10 billion in share repurchase since the IPO.

我們相信，自首次公開募股以來，我們已經透過股票回購為股東創造了很多價值——我腦子裡沒有具體數字，但價值數十億美元，也許接近 90 億至 100 億美元的股票回購。首次公開募股。

We think that's a very effective way, also a very tax effective way, to return cash to shareholders.

我們認為這是向股東返還現金的一種非常有效的方式，也是一種非常節稅的方式。

And, of course, it does result in higher growth in EPS.

當然，它確實會帶來每股收益的更高成長。

So, it's something that we would like investors to focus on with our current strategy.

因此，我們希望投資者在我們目前的策略中關注這一點。

We think it's a low-risk way to return cash and create value for our shareholders.

我們認為這是返還現金並為股東創造價值的低風險方式。

So, we definitely think that it should be a metric that our investors should be paying more attention to.

因此，我們絕對認為這應該是我們的投資者應該更加關注的指標。

Justin Lake, Wolf Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks, good morning.

謝謝，早安。

Just wanted to ask one clarification and then jump on my question.

只是想澄清一下，然後繼續我的問題。

Sam, you said 1.5% growth in inpatient beds and 4% growth in ER capacity.

Sam，您說住院床位成長 1.5%，急診室容量成長 4%。

Is that an annual number?

這是每年的數字嗎？

And over what period, if it is?

如果是的話，需要多長時間？

I just want to confirm.

我只是想確認一下。

It is an annual number.

這是一個年度數字。

That's on average.

這是平均水平。

We have about 38,000 inpatient beds that are operational, so the 400 or so that Milton counted is a 1% increase in capacity.

我們大約有 38,000 個正在運行的住院床位，因此米爾頓計算的 400 個左右意味著容量增加了 1%。

And than our ER beds, we have about 5,000 ER beds, so if we're adding 150 to 200, again, that's where we get the 4%.

與我們的急診室床位相比，我們大約有 5,000 個急診室床位，因此，如果我們再增加 150 到 200 個床位，這就是我們得到的 4%。

It's important to understand that our inpatient bed occupancy for the Company is at record highs.

重要的是要了解我們公司的住院床位佔用率創下歷史新高。

We're operating over 70% inpatient occupancy utilization on our operating beds.

我們的手術床位住院病人使用率超過 70%。

Our emergency room bed utilization is running almost 90% utilization.

我們的急診室床位使用率接近 90%。

Again, those constraints create some challenges for us in many facilities until our capital can get there.

同樣，在我們的資本到達之前，這些限制給我們的許多設施帶來了一些挑戰。

So, that's where the numbers come from, Justin.

所以，這就是數字的來源，賈斯汀。

Those are some of the metrics underneath it.

這些是其下面的一些指標。

And that's how we're thinking about the roll forward there.

這就是我們考慮向前邁進的方式。

Josh Raskin, Barclays.

喬許‧拉斯金，巴克萊銀行。

Thanks.

謝謝。

Just a question around the outpatient services trends, maybe specifically the ASC volumes, we saw outpatient surgeries actually ticking negative.

只是關於門診服務趨勢的問題，也許特別是 ASC 數量，我們看到門診手術實際上呈現負數。

I'm curious, is there's something going on there?

我很好奇，是不是有什麼事發生？

Anything that you can point to that would be a change?

您能指出什麼會帶來改變嗎？

Do you think there's now saturation of facilities?

您認為現在設施飽和了嗎？

Is there too much competition?

競爭太多？

Or is it just one quarter doesn't make a trend and we'll see later?

或者只是有一個季度沒有形成趨勢，我們稍後會看到？

In general, I think it's more the latter than anything else.

總的來說，我認為後者更多。

There hasn't been a significant amount of new supply of ambulatory surgery centers across our markets.

我們的市場上還沒有大量新增門診手術中心。

We do have some underneath movement of physicians from one center to the other.

我們確實有一些醫生從一個中心轉移到另一個中心的暗中流動。

That's typical.

這是典型的。

We have had pretty good growth trends in our ambulatory surgery center division, as well as our hospital base, outpatient units over the past few years.

在過去的幾年裡，我們的門診手術中心部門、醫院基地、門診部都有很好的成長趨勢。

But the last two quarters have been a little softer than we anticipated.

但過去兩個季度的情況比我們預期的要軟一些。

We do have half the Company's divisions showing growth and then half that are down, with a variety of reasons driving some of the declines in some of the markets.

我們確實有一半的公司部門顯示出成長，然後一半的部門出現了下降，有許多原因導致了一些市場的下降。

We're still bullish on both components of our outpatient surgical initiatives.

我們仍然看好門診手術計劃的兩個組成部分。

We're investing in capacity in those areas in some markets; we're adding technology in others.

我們正在一些市場的這些領域進行產能投資；我們正在其他方面添加技術。

And we continue to work with physicians to create the environment that they want for their patients.

我們繼續與醫生合作，為患者創造他們想要的環境。

And I anticipate that we'll be back to our normal growth trends over the coming periods.

我預計我們將在未來一段時間內恢復正常的成長趨勢。

Bill?

帳單？

I just wanted to agree with Sam totally on that.

我只是想完全同意薩姆的觀點。

I'm looking here at our freestanding outpatient surgery growth in different quarters.

我在這裡關注的是我們在不同季度的獨立門診手術成長。

This is the first quarter we've had negative growth in the last eight, to Sam's point.

薩姆表示，這是過去八個季度中我們第一次出現負成長。

So, we've been very consistent growth around 1% to just under 3%.

因此，我們的成長率一直非常穩定，介於 1% 到略低於 3% 之間。

In the first quarter of 2016, as a matter of fact, the growth was 5%.

事實上，2016年第一季的成長率為5%。

It's been a consistent grower for us.

對我們來說，它一直是穩定的種植者。

This is the first quarter that we've reported negative growth in freestanding outpatient surgery in eight quarters.

這是我們八個季度以來首次報告獨立門診手術負成長。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Good morning, guys.

早上好傢伙。

Milton, as we think about the ACA, obviously a lot of unknowns there.

米爾頓，當我們想到 ACA 時，顯然有很多未知數。

But where you guys were sitting right after the election, what's the view or what was the decision internally in terms of the plan B, as we think about the potential of the ACA being repealed in terms of mitigation and driving growth going forward?

但是，當我們考慮在緩解和推動未來成長方面廢除《平價醫療法案》的潛力時，選舉結束後你們的看法或內部決定是什麼？

I don't think that as we go through -- and, of course, there's uncertainty with respect to where Trump is going to go, were it rebuilt, replaced.

我不認為在我們經歷的過程中——當然，川普將走向何方，是否會重建、更換，存在不確定性。

I do believe, thought, and I think the Management Team here believes, that if there's a repeal, there will be a replacement.

我確實相信，我認為，而且我認為這裡的管理團隊也相信，如果廢除，就會有替代品。

What that replacement will look like and how many lives it will cover, we don't know.

我們不知道這個替代品會是什麼樣子，以及它會涵蓋多少人的生命。

But I will say I don't see us going back to pre-2014 uninsured volume, lives and percentage of population uninsured that we had coming into 2014.

但我想說的是，我認為我們不會回到 2014 年之前的未投保人數、生命和未投保人口比例，進入 2014 年。

We've had a long history, Brian, of being able to react to the marketplace and to deal with changes in healthcare policy, and this is one we will work through.

布萊恩，我們在能夠對市場做出反應並應對醫療保健政策變化方面有著悠久的歷史，這也是我們將要解決的問題。

I'm confident of that.

我對此很有信心。

I don't see today any changes, and I think we've articulated that in our call this morning, changes in our operations and our strategy around operations.

我今天沒有看到任何變化，我認為我們已經在今天早上的電話會議中闡明了我們的營運和營運策略的變化。

We're moving forward, we're investing capital.

我們正在前進，我們正在投資。

We continue to see demand growth in our markets.

我們持續看到市場的需求成長。

The exchange business is important to us but yet it's only about 2.5% of our total volume.

交易所業務對我們來說很重要，但只占我們總業務量的2.5%左右。

So, we watch the market [take] very closely to be able to react to it when we see change coming.

因此，我們非常密切地關注市場，以便在看到變化即將到來時能夠做出反應。

And this is one of those situations we're going to continue to do that.

這是我們將繼續這樣做的情況之一。

This next year we'll be watching the market very closely.

明年我們將密切關注市場。

As we get more clarity around how we think health policy changes, if any, in the next two to three years will impact ACA, we'll be very clear in articulating that to our investors and trying to quantify any potential impact.

隨著我們更清楚地了解未來兩到三年內衛生政策變化（如果有的話）將如何影響 ACA，我們將非常清楚地向投資者闡明這一點，並嘗試量化任何潛在影響。

But today we remain very optimistic with our guidance for 2017, and then we will have to see how things work out later in the year.

但今天我們對 2017 年的指導仍然非常樂觀，然後我們將不得不看看今年晚些時候情況如何。

Ralph Giacobbe, Citi.

拉爾夫·賈科布，花旗銀行。

Thanks, good morning.

謝謝，早安。

Can you talk a little about the commercial mix decline?

能談談商業組合下降的情況嗎？

It's been negative for a few quarters now.

幾個季度以來一直呈負值。

And, Sam, I know you usually cite market share stats, give an update to that.

而且，山姆，我知道您通常會引用市場份額統計數據，請提供最新資訊。

I know it's typically lagged six months but any visibility there would be helpful.

我知道它通常會滯後六個月，但任何可見性都會有所幫助。

Thanks.

謝謝。

The market share data that we have, which is most current, is through the second quarter of 2016.

我們掌握的最新市佔率數據截至 2016 年第二季。

Our overall market share is flat.

我們的整體市佔率持平。

We have seen some pressures on our overall market share where we are flat at around 25% for that 12-month period ending second quarter of 2016.

我們看到我們的整體市佔率面臨一些壓力，在截至 2016 年第二季的 12 個月期間，我們的市佔率持平在 25% 左右。

I think there are two issues for our overall market share being flat.

我認為我們的整體市佔率持平有兩個問題。

One, we have seen increased competition, as I've mentioned in the past, in the form of new facilities in a lot of our markets, both on the inpatient side and the outpatient side.

第一，正如我過去提到的，我們看到競爭加劇，在我們的許多市場上，無論是住院區還是門診區，都以新設施的形式出現。

And we can point to that as a fairly significant contributor to some of the pressure.

我們可以指出，這是造成某些壓力的一個相當重要的因素。

And then the second point, which ties right back into our capital discussion, is we do have significant capacity constraints in a number of our facilities that are poised for growth.

第二點與我們的資本討論緊密相關，即我們的許多準備成長的設施確實存在嚴重的產能限制。

As we get this capital aligned we think that will open up some market share opportunities for the Company.

當我們獲得這筆資本時，我們認為這將為公司帶來一些市場份額機會。

On the commercial side, we have seen a little bit of a drop in our market share.

在商業方面，我們的市佔率略有下降。

It's isolated to a handful of markets but they happen to be big commercial markets for ACA where we've seen an accelerated level of competition in some of these suburban markets where there's density in commercial side.

它與少數幾個市場隔離，但它們恰好是 ACA 的大型商業市場，我們看到其中一些商業密集的郊區市場的競爭加劇。

We have what we think are responsible strategies for dealing with that.

我們有我們認為負責任的策略來處理這個問題。

That's where our urgent care outreach, some of our physician initiatives and marketing strategies, we think, are going to help us in that particular front.

我們認為，這就是我們的緊急護理外展、我們的一些醫生舉措和行銷策略將在這一特定領域為我們提供幫助的地方。

But it is quite competitive on the commercial side in many of our markets.

但在我們許多市場的商業方面，它具有相當的競爭力。

Sheryl Skolnick, Mizuho Securities.

謝麗爾·斯科尼克（Sheryl Skolnick），瑞穗證券。

Thank you so much.

太感謝了。

It was a tough comp and not an easy business ever, so good job.

這是一個艱難的競爭，從來都不是一件容易的事，所以乾得好。

And thank you for the guidance and the explanation.

並感謝您的指導和解釋。

I wanted to dig in a little bit more into your thought process, though, about the 2017 and then preparing perhaps for changes in the ACA.

不過，我想更深入地了解您對 2017 年的思考過程，然後為 ACA 的變化做準備。

For 2017 can you help me think about how you're positioning the Company vis-a-vis what we seem to see in the rest of the industry, which is declining inpatient utilization, coupled with what sounds like some changes in the dynamic with managed care in some of your markets.

2017 年，您能否幫助我思考一下，相對於我們在行業其他公司中看到的情況，您如何定位公司，住院患者利用率正在下降，加上託管動態的一些變化？關心您的一些市場。

When do you start seeing that pressure reverse?

你什麼時候開始看到壓力逆轉？

Is it a second-half 2017 where you start to get the lift up of the investments you're making versus the competition, and maybe gaining back some of that commercial market share?

是在 2017 年下半年，您的投資相對於競爭對手開始有所提升，並且可能會重新獲得一些商業市場份額？

Or are we likely to see some increasing pressure of managed care trying to pull patients out of the hospital and balancing that out, and we look the way we do at the beginning of the year?

或者，我們可能會看到管理式醫療的壓力越來越大，試圖將病患從醫院拉出來並平衡這一點，而我們看起來就像今年年初？

Because I think that volume assumption is really key to the guidance.

因為我認為成交量假設對於指引來說確實很關鍵。

And then also what preparation, if any, you're making this year for the potential for having more uninsured next year.

然後，您今年將為明年可能會有更多的人沒有保險做好準備（如果有的話）。

First of all, we don't believe that inpatient utilization is declining.

首先，我們不認為住院病人的利用率正在下降。

We think in ACA market it is growing because of population trends, because an aging of the baby boomers, because of clinical technologies,.

我們認為 ACA 市場正在成長，因為人口趨勢、嬰兒潮世代的老化、臨床技術。

All of the things that have been driving demand historically are going to drive demand in the future, at least in the intermediate run, we believe.

我們相信，歷史上一直推動需求的所有因素都將推動未來的需求，至少在中期是如此。

Clearly we had a five- or six-quarter cycle that was accelerated demand, that we experienced tremendous volume growth.

顯然，我們有一個五到六個季度的周期，需求加速，我們經歷了巨大的銷售成長。

That's part of the comparison challenges that we've had in the past year.

這是我們去年遇到的比較挑戰的一部分。

But we've seen it normalize to where we believe the markets are going to yield inpatient demand growth of roughly 2% across our markets.

但我們已經看到它已經正常化，我們相信市場將帶來約 2% 的住院需求成長。

As far as any managed care activity, I don't sense that there's any unique managed care utilization management initiatives or care model initiatives that are impacting the market in any significant way.

就任何管理式醫療活動而言，我不認為有任何獨特的管理式醫療使用管理舉措或護理模式舉措對市場產生任何重大影響。

Possibly on the fringes here or there but not anything at its core in how it's impacting overall demand.

可能處於邊緣，但在影響整體需求方面卻沒有任何核心內容。

Nor do we see that in the short run, the intermediate run either.

我們也沒有看到短期和中期的情況。

So, those two dynamics aren't really evident across HCA's markets.

因此，這兩種動態在 HCA 市場上並不明顯。

With respect to our capital and some of our initiatives, that amount of money is feathering in throughout the year.

就我們的資本和一些措施而言，這筆資金全年都會不斷增加。

It feathers in, in 2016.

2016 年，它開始嶄露頭角。

A lot of our projects come in online at different points in 2017, 2018, and so forth.

我們的許多項目在 2017 年、2018 年等不同時間點上線。

So, it is difficult to say that there's a bolus that's going to hit in the last half of the year or the first half of the year that's going to change our volume prospects.

因此，很難說今年下半年或上半年會出現大量的藥物來改變我們的銷售前景。

It tends to feather itself into our overall capacity and opportunities over a consistent timeline where it's just happening from month to month to month.

它往往會在一個一致的時間表內融入我們的整體能力和機會，並且每個月都會發生。

So, we're not anticipating anything unique.

因此，我們並沒有期待任何獨特的事物。

As far as changing our model and approach to the prospects for growing uninsured, this past year our uninsured activity was flat to down.

就改變我們的模型和方法來應對不斷增長的無保險前景而言，去年我們的無保險活動持平甚至下降。

I think, Bill, in total --

我認為，比爾，總的來說——

4% growth.

4%的成長。

We were down in the fourth quarter.

我們在第四季表現不佳。

Yes, in the fourth quarter.

是的，第四季。

We've gone through cycles where payer mix has shifted a bit.

我們經歷了付款人結構發生了一些變化的週期。

Clearly for us it's the variable costs that we would incur in taking care of those patients, is the incremental impact.

顯然，對我們來說，我們在照顧這些患者時會產生可變成本，這是增量影響。

Obviously if the Affordable Care Act strips away 100% of the insurance, like Milton was saying, that's a different dynamic for us.

顯然，如果《平價醫療法案》剝奪了 100% 的保險，就像米爾頓所說，這對我們來說是一個不同的動態。

But I don't think it significantly changes our core strategy.

但我認為這不會顯著改變我們的核心策略。

We may do some things on the fringes around how we pace initiatives or how we do certain decision making around that.

我們可能會圍繞如何調整計劃或如何做出某些決策來做一些邊緣的事情。

But we still have opportunities, we believe, on the core operations of HCA, and that they can continue to yield value for the Company.

但我們相信，在 HCA 的核心業務上我們仍然有機會，並且它們可以繼續為公司創造價值。

Gary Lieberman, Wells Fargo.

加里‧利伯曼，富國銀行。

Good morning, thanks.

早安，謝謝。

You did a good job of controlling labor expense in the quarter.

本季人工費用控製做得很好。

Can you talk about the more broad pressures you're seeing on labor supply and how much of that is a risk to your numbers in 2017?

您能否談談您在勞動力供應方面看到的更廣泛的壓力以及其中對您 2017 年數據構成的風險有多大？

And then maybe just comment on the robust trauma growth that you saw this year.

然後也許只是評論一下你今年看到的創傷的強勁增長。

Okay.

好的。

This is Sam again.

這又是薩姆。

On labor expenses, I'm really pleased with how the Company was able to manage its labor expenses this year.

在人工費用方面，我對公司今年的人工費用管理方式感到非常滿意。

We saw a modest productivity improvement, which I think is somewhat a reflection of the operating leverage that we had from the volume growth.

我們看到生產力略有提高，我認為這在某種程度上反映了我們從銷售成長中獲得的營運槓桿。

We were able to moderate our contract labor growth for the year.

我們能夠減緩今年合約工的成長。

It was only up 6% for the quarter, it was up 4%.

本季僅上漲 6%，實際上漲了 4%。

Nursing continues to be a challenge for the Company, but we're making progress with a number of our initiatives around onboarding nurses, around training nurses, around recruitment and those areas.

護理仍然是公司面臨的挑戰，但我們在護理師入職、培訓護理師、招募等領域的一系列措施正在取得進展。

And we think we can continue to manage that particular component of our expense structure effectively.

我們認為我們可以繼續有效地管理我們費用結構的特定組成部分。

The trends going forward are modestly under pressure compared to this past year.

與去年相比，未來的趨勢略有壓力。

We're expecting wages to be up a little bit, maybe 50 basis points over where they were, but that's embedded in the guidance that Bill gave.

我們預計工資會略有上漲，可能比原來高出 50 個基點，但這已包含在比爾給出的指導中。

From a supply and other-expense standpoint, no significant inflationary pressures that we see at this particular point in those categories that are creating any unusual risk in our expense structure for 2016.

從供應和其他支出的角度來看，目前我們在這些類別中沒有看到重大的通膨壓力，不會給我們 2016 年的支出結構帶來任何不尋常的風險。

So, we feel pretty good about where the Company is from that standpoint.

因此，從這個角度來看，我們對公司的現狀感到非常滿意。

We have a host of initiatives underneath our expense structure that are driving toward efficiencies, and we continue to evolve those.

我們的費用結構下有許多旨在提高效率的舉措，並且我們將繼續發展這些舉措。

They center around better labor management approaches with our OneHR platform.

它們以我們的 OneHR 平台更好的勞動力管理方法為中心。

Our Performance Improvement Teams, which we've talked about in the past, continue to find opportunities to enhance processes in our facilities and efficiencies.

我們過去談到的績效改善團隊繼續尋找機會來增強我們設施的流程和效率。

And our clinical agenda is continuing to identify opportunities to improve supply cost utilization, blood utilization, better patient length of stay, and those kinds of things.

我們的臨床議程是繼續尋找改善供應成本利用率、血液利用率、延長病患住院時間等的機會。

So, the combination of those are still positive opportunity for HCA, and one in which we believe we can execute on and mitigate some of these pressures.

因此，這些因素的結合對於 HCA 來說仍然是積極的機會，我們相信我們可以執行並減輕其中一些壓力。

(Operator Instructions)

（操作員說明）

Michael Newshel, Evercore ISI.

邁克爾·紐謝爾，Evercore ISI。

Thanks, good morning.

謝謝，早安。

With the caveat, as you said earlier, it's getting harder to estimate, but can you just confirm what you think ACA contributed to EBITDA in 2016, and whether that's in line with what you were expecting?

正如您之前所說，有了警告，估計就變得越來越困難，但是您能否確認一下您認為 ACA 對 2016 年 EBITDA 的貢獻，以及這是否符合您的預期？

This is Bill.

這是比爾。

It did and in line with our expectations.

它確實做到了，並且符合我們的預期。

We said it's contributing 5% to 6% of adjusted EBITDA, and that's about where we finished 2016.

我們說它貢獻了調整後 EBITDA 的 5% 到 6%，這就是我們 2016 年結束時的情況。

Scott Fidel, Credit Suisse.

斯科特·菲德爾，瑞士信貸。

Thanks.

謝謝。

Just if you can give us an update on the Florida Medicaid outpatient rate cuts and what you're assuming in guidance.

只要您能給我們提供有關佛羅裡達州醫療補助門診費率削減的最新資訊以及您在指導中的假設。

I know that you and some of your peers have been protesting those, so just interested if there's an update on that process there.

我知道您和您的一些同事一直在抗議這些，所以只是感興趣是否有關於該流程的更新。

No.

不。

This is Bill.

這是比爾。

There's several efforts to try to adjust that, but it does not have a material impact on HCA or inside our guidance for 2017.

我們已經做出了一些努力來嘗試調整這一點，但這不會對 HCA 或我們 2017 年的指導產生重大影響。

Gary Taylor, JPMorgan.

加里泰勒，摩根大通。

Hi, good morning.

早安.

I have a two-parter on CapEx just because it's such a big part of the strategy.

我在資本支出方面有兩個合作夥伴，因為它是策略的重要組成部分。

It's more than doubled since the IPO.

自首次公開募股以來，該數字已增加了一倍以上。

It's running almost 7% of revenues in the 2017 guidance, which I think is around the highest in the decade.

它的收入幾乎佔 2017 年指導收入的 7%，我認為這大約是十年來的最高水準。

So, the two-part question is, is there a point where you see absolute CapEx dollars coming down?

因此，由兩部分組成的問題是，您是否會看到絕對資本支出下降？

Are we rolling on a bolus CapEx cycle and that could slow?

我們是否正在推進資本支出週期並且這可能會放緩？

The reason I ask is I know you're trying to point investors towards earnings, but in 2016 there were $2.7 billion in CapEx and only $1.9 billion of depreciation.

我問這個問題的原因是我知道你們試圖引導投資者關注獲利，但 2016 年資本支出為 27 億美元，而折舊僅為 19 億美元。

So, there's certainly some EPS benefit that isn't reflected in free cash flow and I'm just wondering when those two numbers might narrow.

因此，肯定有一些每股收益收益沒有反映在自由現金流中，我只是想知道這兩個數字何時可能會縮小。

Gary, let me take a shot at it.

加里，讓我試試。

Sam and Bill may also have some comments on it.

Sam 和 Bill 也可能對此有一些評論。

Our capital spending is really a direct reflection of the opportunities we see in the marketplace and demand that we see.

我們的資本支出實際上直接反映了我們在市場上看到的機會和我們看到的需求。

Sam was talking about in certain markets if we don't invest and expand to add more capacity then our growth will be limited by lack of capacity.

薩姆談到，在某些市場，如果我們不投資和擴張以增加更多產能，那麼我們的成長將因產能不足而受到限制。

So, we're trying to stay up to speed of that or ahead of that.

因此，我們正在努力跟上或領先。

So, we have been increasing our capital spend up to record levels, quite frankly.

因此，坦白說，我們一直在將資本支出增加到創紀錄的水平。

And the same time, as Bill mentioned in his comments, we have been reporting and seeing record levels of return on invested capital as we've been spending more capital.

同時，正如比爾在評論中提到的那樣，隨著我們花費更多的資本，我們一直在報告並看到創紀錄的投資資本回報率。

So, I think those investments have turned out to be very solid and good investments and value-creating opportunities for our shareholders.

因此，我認為這些投資對我們的股東來說是非常可靠和良好的投資和創造價值的機會。

Now, if the marketplace changes, we certainly have the ability to ratchet down capital spending.

現在，如果市場發生變化，我們當然有能力減少資本支出。

We've been through different cycles before.

我們之前經歷過不同的週期。

When we went through the recession back in 2009, it takes a little while to ratchet down the projects in process.

當我們在 2009 年經歷經濟衰退時，我們需要一段時間才能縮減正在進行的項目。

But we do have the ability, we've demonstrated the ability, to slow it down based on market needs and the like.

但我們確實有能力，我們已經展示了這種能力，根據市場需求等來放慢速度。

I don't see today as being any different.

我不認為今天有什麼不同。

So right now, we're seeing demand in our markets and we're investing to meet the requirements of that demand.

所以現在，我們看到了市場的需求，我們正在投資來滿足這種需求。

Again, I've been quite pleased with the return overall on the investments that we've been making.

再說一次，我對我們所做投資的整體回報感到非常滿意。

Paula Torch, Avondale Partners.

保拉·托奇，埃文代爾合夥人。

Thanks for fitting me in.

謝謝你讓我融入。

I was just curious, on patient access and maybe going back to the growth in the ER beds, wondering where that's coming from in particular.

我只是對病人的就診感到好奇，也許還會回到急診室床位的成長，想知道這到底是從哪裡來的。

Is it mostly growth in the freestanding ED space or is it hospital ER beds?

主要成長的是獨立的急診室空間還是醫院的急診床位？

And just given the competition that's increasing in the freestanding ED space, are you spreading that growth to other markets that you have where there's less competition?

鑑於獨立式 ED 領域的競爭日益加劇，您是否會將這種成長擴展到競爭較少的其他市場？

Or are you still seeing growth in some of your more concentrated areas?

或者您仍然看到一些更集中的領域出現成長？

Let me give you some facility numbers first, Paula.

讓我先給你一些設施號碼，保拉。

This is Sam again.

這又是薩姆。

On the urgent care side, we operate 72 urgent care centers today.

在緊急護理方面，我們目前經營 72 個緊急護理​​中心。

And we will, we believe, be somewhere around 120 urgent care centers by the end of the year.

我們相信，到今年年底，我們將擁有約 120 個緊急護理​​中心。

The freestanding emergency rooms, we operate roughly 62, I think, today.

我想，今天我們營運的獨立式急診室大約有 62 個。

One of them just got converted to a hospital yesterday, actually.

事實上，其中一個昨天才剛被轉入醫院。

It opened in Orlando, Florida.

它在佛羅裡達州奧蘭多開業。

So, we're down to 61, I think, as a result of that conversion.

因此，我認為，由於這種轉換，我們的數量減少到了 61 個。

But we should be somewhere around 80 freestanding emergency rooms in operation by the first part of 2018.

但到 2018 年上半年，我們應該會有大約 80 個獨立急診室投入運作。

But when you look at the bed complement of emergency room beds growth, it's a blend between, probably 50/50, thereabouts -- I don't have the exact number off the top of my head but it's pretty close to that, between hospital ER bed expansion as well as freestanding emergency room expansion.

但是，當你看看急診室床位增長的床位補充時，它是一個混合體，可能是 50/50，大約 - 我沒有確切的數字，但它非常接近，在醫院之間急診室床位擴展以及獨立式急診室擴展。

I do think some of the market dynamics for freestanding emergency rooms has slowed a bit.

我確實認為獨立式急診室的一些市場動態已經放緩了一些。

We're not anticipating the growth in competitor units in 2017 that we've seen in the past 24 months.

我們預計 2017 年競爭對手的銷售量不會像過去 24 個月那樣成長。

So, we see opportunities for HCA to deploy these facilities strategically across various markets to put our networks in the best position they can possibly be.

因此，我們看到 HCA 有機會在各個市場策略性地部署這些設施，以使我們的網路處於最佳位置。

Thank you, that's helpful.

謝謝，這很有幫助。

You're very welcome.

非常不客氣。

I want to thank everyone for being on today's call.

我要感謝大家參加今天的電話會議。

We look forward to talking to you and seeing you soon.

我們期待與您交談並很快見到您。

Ladies and gentlemen, once again that does conclude today's conference.

女士們、先生們，今天的會議再次結束。

Again, I'd like to thank everyone for joining us today.

我要再次感謝大家今天加入我們。