美國醫院公司 (HCA) 2022 Q2 法說會逐字稿

Welcome to the HCA Healthcare Second Quarter 2022 Earnings Conference Call. Today's call is being recorded.

歡迎來到 HCA Healthcare 2022 年第二季度收益電話會議。今天的電話正在錄音。

At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

在這個時候，關於開場白和介紹，我想把電話轉給投資者關係副總裁弗蘭克摩根先生。請繼續，先生。

Good morning, and welcome to everyone on today's call. With me this morning is our CEO, Sam Hazen; and CFO, Bill Rutherford. Sam and Bill will provide some prepared remarks, and then we'll take questions.

早上好，歡迎大家參加今天的電話會議。今天早上和我在一起的是我們的首席執行官 Sam Hazen；首席財務官比爾·盧瑟福。山姆和比爾將提供一些準備好的評論，然後我們將回答問題。

Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements, they are based on management's current expectations. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

在我將電話轉給 Sam 之前，讓我提醒大家，如果今天的電話中包含任何前瞻性陳述，它們是基於管理層當前的預期。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大不相同。有關前瞻性陳述和這些因素的更多信息，請參見今天的新聞稿和我們提交給美國證券交易委員會的各種文件。

On this morning's call, we may refer -- we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. is included in today's release. This morning's call is being recorded, and a replay of the call will be available later today.

在今天上午的電話會議上，我們可能會參考 - 我們可能會參考調整後的 EBITDA 等指標，這是一項非公認會計原則的財務指標。今天發布的表格提供了關於調整後 EBITDA 的補充信息和調節 HCA Healthcare, Inc. 的淨收入。正在錄製今天早上的通話，今天晚些時候將提供通話重播。

With that, I'll now turn the call over to Sam.

有了這個，我現在將把電話轉給 Sam。

All right. Thank you, Frank, and good morning to everybody. Thank you for joining today's call. We are pleased with our financial results for the second quarter. The solid results were driven by a good mix of volume with respect to payer mix and acuity coupled with progress in managing our operating costs.

好的。謝謝你，弗蘭克，大家早上好。感謝您加入今天的電話會議。我們對第二季度的財務業績感到滿意。穩健的結果是由付款人組合和敏銳度方面的良好組合以及我們在管理運營成本方面取得的進展推動的。

Although overall demand for our services was not as strong as anticipated when compared to the second quarter of last year, same facility revenue grew 4%. As indicated in our earnings release, same-facility inpatient admissions declined 1.2% and adjusted admissions grew 0.5%. COVID admissions declined 18% and represented approximately 3% of total admissions, which is generally consistent with the mix in the prior year. COVID admissions dropped 70% from the first quarter.

儘管與去年第二季度相比，對我們服務的整體需求沒有預期的那麼強勁，但相同設施的收入增長了 4%。正如我們在財報中所顯示的，同設施住院人數下降了 1.2%，調整後的住院人數增長了 0.5%。 COVID 入學人數下降了 18%，約佔總入學人數的 3%，這與上一年的總體情況基本一致。 COVID 入學率比第一季度下降了 70%。

Emergency were admitted on a same facilities basis grew 7.3%, reflecting strong demand for this service. Volumes across most categories exceeded pre-pandemic levels as compared to the second quarter of 2019. Many aspects of our business were positive considering the challenges we faced with the labor market and the other inflationary pressures on costs. Our teams executed well as they have in the past through other difficult environment. Again, I want to thank them for their dedication and excellent work.

在同一設施基礎上接受急診的人數增長了 7.3%，反映出對該服務的強勁需求。與 2019 年第二季度相比，大多數類別的銷量都超過了大流行前的水平。考慮到我們面臨的勞動力市場挑戰和其他通脹成本壓力，我們業務的許多方面都是積極的。我們的團隊在其他困難的環境中表現得和過去一樣好。再次，我要感謝他們的奉獻精神和出色的工作。

Labor metrics improved in the quarter as compared to the first quarter. Recruitment was up, turnover was down. And throughout the quarter, we lowered contract labor expenses in each successive month with June down 22% as compared to April. Overall, operating cost per adjusted admission improved on a sequential basis as compared to the first quarter.

與第一季度相比，該季度的勞動力指標有所改善。招聘增加，營業額減少。在整個季度，我們連續每個月都降低了合同勞工費用，其中 6 月份與 4 月份相比下降了 22%。總體而言，與第一季度相比，每次調整入院的運營成本環比有所改善。

Because of these positive developments, we operated with more available capacity than we did in the first quarter and had solid volume growth sequentially.

由於這些積極的發展，我們的可用產能比第一季度更多，並且銷量連續增長。

Additionally, we continue to expand our network offerings with new ambulatory centers and clinics. We opened 3 Galen nursing colleges in the quarter and 2 more are scheduled to open later this year. And lastly, we increased hospital capacity with targeted capital investments.

此外，我們繼續通過新的門診中心和診所擴展我們的網絡服務。我們在本季度開設了 3 所蓋倫護理學院，併計劃在今年晚些時候再開設 2 所。最後，我們通過有針對性的資本投資提高了醫院的容量。

As we look to the balance of the year, we see volumes returning to pre-pandemic seasonal trends but we expect growth in inpatient admissions at a more modest level than previously indicated in our guidance and in line with go-for outpatient categories. We believe our labor and resiliency plans are appropriately responsive to market dynamics and the needs of our business, and they should continue to generate improvements in our operations.

當我們展望今年的餘額時，我們看到數量恢復到大流行前的季節性趨勢，但我們預計住院人數的增長將比我們先前在指導中指出的更為溫和，並且與門診患者類別一致。我們相信我們的勞動力和彈性計劃能夠適當地響應市場動態和我們的業務需求，它們應該會繼續改善我們的運營。

So let me close with this. And as I've mentioned this in the past, HCA Healthcare has an outstanding track record of responding to our reality by adjusting our operations in an appropriate manner. That is a manner aligned with our mission to provide high-quality care to our patients while also being prudent with our financial management.

所以讓我結束這一點。正如我過去提到的那樣，HCA Healthcare 在通過以適當方式調整我們的運營來回應我們的現實方面有著出色的記錄。這與我們為患者提供高質量護理的使命相一致，同時也對我們的財務管理保持謹慎。

With that, I'll turn the call over to Bill for more details on the quarter.

有了這個，我將把電話轉給比爾，以了解本季度的更多細節。

Okay. Great. Thank you, Sam, and good morning, everyone. Let me provide some additional comments on the quarter. First, as Sam mentioned, we are pleased with the overall results of the quarter. Our diluted earnings per share was $4.21 in the quarter after excluding the $0.11 from the loss on sale of facilities and $0.20 from the retirement of debt.

好的。偉大的。謝謝你，山姆，大家早上好。讓我提供一些關於本季度的補充意見。首先，正如山姆所說，我們對本季度的整體業績感到滿意。扣除設施出售損失的 0.11 美元和債務償還的 0.20 美元後，我們本季度的攤薄後每股收益為 4.21 美元。

Adjusted EBITDA was $3.04 billion, and adjusted EBITDA margin was 20.5%. Non-COVID admissions were down 0.6% in the quarter. However, non-COVID managed care admissions were up 0.7%, reflecting favorable payer mix. Non-COVID case mix was up slightly from the prior year, maintaining the (inaudible) we have made. And overall, our same facility inpatient revenue per admission increased 3.3% from the second quarter of last year.

調整後 EBITDA 為 30.4 億美元，調整後 EBITDA 利潤率為 20.5%。本季度非 COVID 入學人數下降了 0.6%。然而，非 COVID 管理式醫療的入院人數增加了 0.7%，反映出有利的支付組合。非 COVID 病例組合比前一年略有上升，保持了我們所做的（聽不清）。總體而言，我們每次入院的同一機構住院收入比去年第二季度增長了 3.3%。

In addition, as Sam mentioned, we saw improvement in almost all key operating indicators compared to the first quarter, including our labor supply and other operating costs on both an adjusted admission and an adjusted patient day basis. We remain focused on our resiliency programs that I've highlighted in last quarter's call, including our staffing and capacity efforts, executing on our next generation of sheer services and identifying best practices across HCA Healthcare through the advancement of our benchmarking and analytic processes. These efforts continue to be an important focus for us as we respond to the current operating environment, and we are pleased with the progress in these areas.

此外，正如 Sam 所提到的，與第一季度相比，我們看到幾乎所有關鍵運營指標都有所改善，包括我們的勞動力供應和其他運營成本，包括調整入院和調整後的患者日。我們仍然專注於我在上季度電話會議中強調的彈性計劃，包括我們的人員配備和能力努力，執行我們的下一代純粹服務，並通過改進我們的基準測試和分析流程來確定 HCA 醫療保健的最佳實踐。在我們應對當前的運營環境時，這些努力仍然是我們的重點，我們對這些領域的進展感到高興。

So let me transition to discuss some cash flow and balance sheet metrics. Our cash flow from operations was $1.63 billion in the quarter, Capital spending was $1.08 billion, as compared to $842 million in the prior year period, and we completed just under $2.7 billion of share repurchases during the quarter.

因此，讓我轉而討論一些現金流和資產負債表指標。本季度我們的運營現金流為 16.3 億美元，資本支出為 10.8 億美元，而去年同期為 8.42 億美元，本季度我們完成了略低於 27 億美元的股票回購。

Our debt to adjusted EBITDA ratio was just above the low end of our stated leverage range, and we had just over $2.7 billion of available liquidity at the end of the quarter. Lastly, I will mention that our full year 2022 guidance remains unchanged from what we highlighted last quarter.

我們的債務與調整後的 EBITDA 比率略高於我們規定的槓桿範圍的低端，並且在本季度末我們的可用流動性剛剛超過 27 億美元。最後，我要提到的是，我們的 2022 年全年指引與我們上一季度強調的指引保持不變。

So with that, I'll turn the call over to Frank, and we'll open it up for Q&A.

因此，我將把電話轉給弗蘭克，我們將打開它進行問答。

Thank you, Bill. (Operator Instructions) Chantal, you may now give instructions to those who would like to ask a question. .

謝謝你，比爾。 （操作員說明）Chantal，您現在可以向想提問的人提供說明。 .

(Operator Instructions) Your first question comes from A.J. Rice with Credit Suisse.

（操作員說明）您的第一個問題來自 A.J.瑞信的賴斯。

Congratulations on managing very well through a tough environment. I just want to maybe near term and along there, it does seem to be some confusion out there about what's happening with volumes. And I know you guys mentioned inpatient. You're a little more cautious about the back half, it doesn't sound like much, but -- and it's about the same. Are we sort of in your mind in the new normal, there's some speculation about how the incident of COVID positivity may be affecting people's (inaudible) doctor. Are you seeing any of that have come down effects on your business?

祝賀你在艱難的環境中管理得很好。我只是想可能在短期內，在那裡，關於交易量正在發生的事情似乎確實有些混亂。我知道你們提到了住院病人。您對後半部分更加謹慎，這聽起來並不多，但是 - 大致相同。我們是否在您的腦海中處於新常態中，有人猜測 COVID 陽性事件可能如何影響人們的（聽不清）醫生。您是否看到其中任何一項對您的業務產生了影響？

I guess, do you sense that there's still a fair amount of deferral out there that needs to be worked through the system? Any comments on that? And then more broadly on the -- coming out of all of this. I know the company said from time to time, because you don't see anything that changes your view that you can grow mid-single digits EBITDA long term with often being toward the high end of a 4% to 6% target, and I wonder if that's still your thinking.

我想，您是否覺得仍有相當多的延期需要通過系統進行處理？對此有何評論？然後更廣泛地討論 - 所有這一切。我知道公司不時說，因為你看不到任何改變你的觀點的東西，你可以長期增長中個位數的 EBITDA，通常接近 4% 到 6% 目標的高端，我想知道這是否仍然是你的想法。

A.J., thank you. This is Sam. I believe when it comes to health care demand, our overarching belief is that it's pretty durable and somewhat responsive to normal trends over time. Obviously, we're still trying to sort out the implications of COVID in the pandemic on overall demand and make some judgments.

A.J.，謝謝。這是山姆。我相信當談到醫療保健需求時，我們的首要信念是它非常耐用，並且隨著時間的推移對正常趨勢有所反應。顯然，我們仍在試圖梳理新冠疫情對整體需求的影響，並做出一些判斷。

Here, again, it's only been really 5 months since the last surge when you consider February, March and then through the second quarter. And so we're making some early judgments that we believe there will be normal seasonality trends with respect to how volumes behave over the balance of the year.

再一次，當你考慮到 2 月、3 月和第二季度時，距離上一次激增只有 5 個月的時間。因此，我們正在做出一些早期判斷，我們認為在今年餘下時間的交易量表現方面將存在正常的季節性趨勢。

As it relates to long-term intermediate term demand, again, we're not seeing anything structural that would suggest that overall demand is reduced or necessarily increase beyond what its normal trends were. And we think on the inpatient side, health care demand, at least in our markets, is somewhere between 1% and 2% and a little bit more than that on the outpatient side.

同樣，由於它與長期中期需求有關，我們沒有看到任何結構性的跡象表明總體需求減少或必然增加超過其正常趨勢。我們認為，在住院方面，至少在我們的市場中，醫療保健需求在 1% 到 2% 之間，並且比門診方面的需求略高。

So that lines up with our pre-pandemic sort of thoughts around overall demand. So that's how we're seeing it. Again, we've seen incredible resiliency in our emergency room, which we were thinking that may be disrupted. Our emergency room activity is actually up over 2019. Many categories of our business, as I mentioned on the call, compared to 2019 have shown a nice stable response.

因此，這與我們在大流行前對整體需求的想法一致。這就是我們的看法。同樣，我們在急診室看到了令人難以置信的彈性，我們認為這可能會被破壞。我們的急診室活動實際上比 2019 年有所增加。正如我在電話會議上提到的，與 2019 年相比，我們的許多業務類別都顯示出良好的穩定響應。

So we're still trying to sort out a few things with the pandemic and don't necessarily have great insights yet around some of those. But we do feel confident that health care demand in general, will revert back to normal patterns as we move through the next few years.

因此，我們仍在嘗試解決與大流行有關的一些事情，並且不一定對其中一些有很好的見解。但我們確實相信，隨著未來幾年的發展，總體醫療保健需求將恢復到正常模式。

Our next question comes from Peter Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Peter Chickering。

Thank you for taking my questions. I'll sort of go on the labor question, a 2-part question. The first one is, how you think about your contract labor rates, how much visibility do you have and what the rates you're paying in the third quarter and view as it goes in the fourth quarter? And can you sort of quantify, so what contract lever you paid in 2Q and what you assume with the guidance? And then in 3Q?

謝謝你接受我的問題。我會繼續討論勞工問題，一個兩部分的問題。第一個是，你如何看待你的合同工費率，你有多少知名度，你在第三季度支付的費率是多少，以及對第四季度的看法？您能否量化一下，您在第二季度支付的合同槓桿是多少，以及您對指導的假設是什麼？然後在第三季度？

And then on the full-time labor, can you just give us any color on sort of what is your average hourly nursing wages in first quarter? And how that would sort of in the second quarter? Are we seeing a downtick as you guys bring on a new nurse's school?

然後關於全職工作，你能告訴我們你第一季度的平均小時護理工資是多少嗎？第二季度會怎樣？當你們帶來一所新的護士學校時，我們是否看到了下降？

Yes, Peter, this is Bill. Let me start first with the contract labor. I think as we discussed last quarter, it was at a peak high in the first quarter really due to the COVID services, and we anticipated to be able to see sequential improvement. And indeed, that's what we saw. We thought it would first start with being able to modify the rates that we were seeing in the market in terms of the average early rate.

是的，彼得，這是比爾。讓我先從合同工說起。我認為正如我們上個季度所討論的那樣，由於 COVID 服務，它在第一季度達到了最高點，我們預計能夠看到連續的改善。事實上，這就是我們所看到的。我們認為首先要能夠根據平均早期利率來修改我們在市場上看到的利率。

And indeed, we saw that and we were able to execute on that as the quarter went through. We finished with June at rates we were anticipating when we reset our guidance after quarter. And I think over the course of the year, we'll continue to see hopefully a reduction in the utilization of that contract labor.

事實上，我們看到了這一點，並且隨著季度的過去，我們能夠執行這一點。我們以我們在季度後重新調整指導時所預期的速度完成了 6 月。我認為，在這一年中，我們將繼續看到合同工的使用率有所下降。

And again, we were encouraged by the sequential improvement we saw. We're encouraged by kind of how we ended the quarter in the month of June. So it's pretty much in line with what we anticipated.

再一次，我們對所看到的連續改進感到鼓舞。我們對在 6 月份結束本季度的方式感到鼓舞。所以這與我們的預期幾乎一致。

Yes. I think the -- and Peter, this is Sam. The contract labor rate itself, we do believe there's still some room to go when we look at where we ended the quarter. I don't have a specific number that I think it makes sense to give you at this point. But we do anticipate some continued improvement on the rate and as Bill mentioned, the utilization.

是的。我想——還有彼得，這是山姆。合同勞工率本身，我們確實相信，當我們查看本季度結束的位置時，仍有一些空間。我沒有一個具體的數字，我認為在這一點上給你是有意義的。但我們確實預計費率會繼續提高，正如比爾提到的那樣，利用率會有所提高。

As it relates to our nurses, in our full-time nurses. We, last year, about this time, did a fairly sizable market adjustment across the organization. And since then, we've continued to do very targeted adjustments for our nurses as well as our non-nurses because we need lab techs, radiology techs and other people to support the care delivery process.

因為它與我們的護士有關，在我們的全職護士中。去年，大約在這個時候，我們在整個組織中進行了相當大的市場調整。從那時起，我們繼續對我們的護士和非護士進行非常有針對性的調整，因為我們需要實驗室技術人員、放射技術人員和其他人員來支持護理提供過程。

Again, we are making another market adjustment this year. I will tell you that our nurse wage increase is in the mid-single digits. It's manageable for us, we believe. We've been able to maintain productivity levels in certain instances. And we've been able to arbitrage, if you will, the very expensive contract labor. And that's allowed us to position our workforce better in the second quarter than we did in the previous 3 quarters.

同樣，我們今年正在進行另一次市場調整。我會告訴你，我們的護士工資增長是中個位數。我們相信，這對我們來說是可控的。在某些情況下，我們已經能夠保持生產力水平。如果你願意的話，我們已經能夠套利非常昂貴的合同勞動力。這使我們能夠在第二季度比前三個季度更好地定位我們的員工隊伍。

So we continue to believe that there is opportunity on that front. We see the market for labor moderating some and normalizing our turnover. As I mentioned, is down over 20% in the second quarter as compared to the first quarter. Our hiring and our recruitment function, which has done a wonderful job, it's up 18% in the second quarter as compared to the first quarter.

因此，我們仍然相信在這方面存在機會。我們看到勞動力市場緩和了一些並使我們的營業額正常化。正如我所提到的，與第一季度相比，第二季度下降了 20% 以上。我們的招聘和招聘功能做得非常好，與第一季度相比，第二季度增長了 18%。

So these metrics early successes, if you will, give us some promise that the combination of our compensation strategies, our retention strategy and then the mix of our labor workforce should improve as we move through the balance of the year.

因此，如果您願意的話，這些指標早期的成功給了我們一些承諾，即我們的薪酬策略、我們的保留策略以及我們的勞動力組合應該會隨著我們在今年的平衡中得到改善。

Our next question comes from Ann Hynes with Mizuho Securities.

我們的下一個問題來自瑞穗證券的 Ann Hynes。

I know it might be early, but how do you think we should think about key inflationary pressures for 2023 versus distributable trends, especially with age applies? And on the managed care side, I know that you will eventually be able to pass some of these inflationary pressures through pricing. Can you just give us some timing on how we should think about that?

我知道現在可能還為時過早，但您認為我們應該如何考慮 2023 年的關鍵通脹壓力與可分配趨勢，尤其是考慮到年齡因素？在管理式醫療方面，我知道您最終將能夠通過定價來轉移其中的一些通脹壓力。你能給我們一些時間來說明我們應該如何考慮嗎？

This is Sam. Let me speak to inflation generally. Obviously, we are seeing inflation, as we mentioned, inside of our labor cost. Again, I'll just give you an overview of how we think we're managing our way through that. And Bill can speak to some of the specific on the supply side.

這是山姆。讓我談談通貨膨脹。顯然，正如我們所提到的，我們在勞動力成本中看到了通貨膨脹。再次，我將向您概述我們認為我們如何管理我們的方式。比爾可以談談供應方面的一些具體情況。

Fortunately, in many areas, we have contracts that have terms to them today. So it gives us some protection in the short run. We think that protection allows us to reposition some of our pricing as we move through the next few years to reflect more accurately, the inflationary pressures that we're seeing and others are seeing in the provider system.

幸運的是，在許多領域，我們今天的合同都有條款。所以它在短期內給了我們一些保護。我們認為，保護使我們能夠在未來幾年重新定位我們的一些定價，以更準確地反映我們在供應商系統中看到的和其他人看到的通脹壓力。

We are seeing some early success recognition by the payers, and we expect the payers to appreciate the overall inflationary environment that the providers are in. But we're seeing some early recognition of that and some renegotiated contracts have reflected more escalation in pricing than what we had seen in our past trends. As I mentioned on the last call, we're pretty much contracted for 2022, obviously. But as we look to 2023, we'll start to see some uplift in our contracting pricing, reflecting the new contracts. And then on '24, we fully anticipate having a different trend on our pricing as a result of these renegotiations.

我們看到付款人對成功的一些早期認可，我們預計付款人會欣賞供應商所處的整體通脹環境。但我們看到一些早期認識到這一點，一些重新談判的合同反映了定價的升級，而不是什麼我們在過去的趨勢中看到了。正如我在上次電話會議中提到的，顯然，我們在 2022 年的合同已經差不多了。但是當我們展望 2023 年時，我們將開始看到我們的合同定價有所上升，這反映了新合同。然後在 24 年，我們完全預計，由於這些重新談判，我們的定價會出現不同的趨勢。

On our capital costs, we obviously experienced some inflationary pressures there. I don't know that we have visibility at this point to give you any number on any of those as we think about 2023. So we'll try to hone in on that a little bit more as we get ready for our guidance in the next year.

在我們的資本成本方面，我們顯然在那裡經歷了一些通脹壓力。我不知道在這一點上，我們是否能夠在考慮到 2023 年時為您提供任何數字。因此，當我們準備好在明年。

Our next question comes from Whit Mayo with SVB Securities.

我們的下一個問題來自 SVB 證券的 Whit Mayo。

Bill, the AR days jumped up again this quarter. I'm just trying to understand like what's driving that? Is that higher payer claim edits? Is there any underlying deterioration collection rates? Is there anything to put that into context? And if you could sort of describe how that tracked relative to your expectations? And if I could also just get the -- I don't know if I got the cost per FTE number in the quarter, maybe you shared it, but I missed it, but that would be helpful.

比爾，本季度的 AR 天數再次上升。我只是想了解是什麼驅動了它？那是更高的付款人索賠編輯嗎？是否有任何潛在的惡化收集率？有什麼可以把它放在上下文中嗎？如果你能描述一下相對於你的期望是如何跟踪的？如果我也能得到——我不知道我是否得到了本季度每個 FTE 人數的成本，也許你分享了它，但我錯過了，但這會有所幫助。

Yes, we have seen some increase in AR days as we've gone through the year. Part of that is in the prior period during COVID. I think the payers have kind of turned off many of their bill ads. We've seen some of those back into play. Pretty much in line with what we anticipated. We're kind of at a high mark right now, and we'll continue to see improvement as we go through the year. But we are seeing a little bit more kind of delays in the payment processing cycle, and we're working through that with our payers.

是的，隨著這一年的過去，我們看到 AR 天數有所增加。其中一部分是在COVID期間的前期。我認為付款人已經關閉了他們的許多賬單廣告。我們已經看到其中一些重新發揮作用。和我們預期的差不多。我們現在處於一個很高的水平，隨著這一年的發展，我們將繼續看到進步。但是我們在支付處理週期中看到了更多的延遲，我們正在與付款人一起解決這個問題。

In terms of the cost per FTE. We saw, again, sequential improvement in the quarter compared to the first quarter. Recall in the first quarter, remained pretty high. I think it was I'll say, 7% year-over-year number or more now on the 4.5% for the second quarter. And so it was tracking about what we anticipated as we ended the first quarter.

就每 FTE 的成本而言。與第一季度相比，我們再次看到本季度的連續改善。第一季度的召回率仍然很高。我想我會說，現在第二季度為 4.5%，同比增長 7% 或更多。因此，它正在跟踪我們在第一季度結束時的預期。

Our next question comes from Gary Taylor with Cowen.

我們的下一個問題來自 Gary Taylor 和 Cowen。

Okay. Just a two-parter, both of which you've just touched on a little bit, I just wanted to make sure I understood if you'd provide a little more color. I think we sort of triangulated in the first quarter somewhere north of $600 million of contract labor spend. And I know that's down, and you said it was down, you said it was in June, but just wondering kind of where that ran for the quarter just to help us sort of modeling the rest of the year?

好的。只是一個兩部分，你剛剛觸及了一點，我只是想確保我理解你是否會提供更多的顏色。我認為我們在第一季度對 6 億美元的合同勞動力支出進行了三角測量。我知道它已經下降了，你說它下降了，你說它是在 6 月，但只是想知道這個季度的情況是為了幫助我們在今年剩下的時間裡進行建模？

And then the second parter is, with the AR growth and also payables down, you've done $3 billion cash from ops in the first half and the annual guide is 9% to 9.5%. So despite the payer edits and so forth? Do you still feel good about the cash from ops number for the year?

然後第二部分是，隨著 AR 的增長和應付賬款的下降，你在上半年從運營中獲得了 30 億美元的現金，年度指導是 9% 到 9.5%。因此，儘管付款人進行了編輯等等？您仍然對今年的運營收入感到滿意嗎？

Gary, let me start with the cash for us. This is Bill. We're continuing to look at that. I think it's probably going to be in around the 8%, maybe 8.5% level, somewhere between those. So we'll continue to track that as the year goes on. But I still think that's a very strong number for us and allows us to kind of execute on all aspects of our capital allocation philosophy.

加里，讓我從我們的現金開始。這是比爾。我們將繼續關注這一點。我認為它可能會在 8% 左右，也許是 8.5% 的水平，介於兩者之間。因此，隨著時間的推移，我們將繼續跟踪這一點。但我仍然認為這對我們來說是一個非常強大的數字，讓我們能夠在資本分配理念的各個方面執行。

When you look at the contract labor piece, we did see sequential improvement. The actual dollars amount were down from where we were in the first quarter. And when we look at contract labor as a percent of SWB, we finished at the end of the quarter of the month of June, down just above 8%. Where in the first quarter, we were running 9%, 9.2%. So again, we saw, I think, nice improvement in the absolute contract labor number.

當您查看合同工時，我們確實看到了連續改善。實際美元金額比我們在第一季度的水平有所下降。當我們將合同工視為 SWB 的百分比時，我們在 6 月份的季度末完成，略低於 8%。在第一季度，我們的運行率為 9%、9.2%。因此，我們再次看到，我認為絕對合同勞工人數有了很大的改善。

Our next question comes from Kevin Cusack with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Cusack。

Actually, this is Joanna Gajuk filling in for Kevin today. So taking the question here. So I guess, first question, and then I have a follow-up, too. But in terms of look, I know you -- maybe it's early to talk about. Next you obviously kept your guidance which was positive given the expectation here. This year has some benefits, right, from sequestration, PEG being extended. So how should we think about roughly speaking, from going from here this year a good base to grow at your long-term kind of targeted growth rate?

實際上，這是 Joanna Gajuk 今天替 Kevin 做的。所以在這裡提出問題。所以我想，第一個問題，然後我也有一個後續問題。但就外觀而言，我知道你——也許現在談論還為時過早。接下來，您顯然保留了您的指導，考慮到這裡的期望，這是積極的。今年有一些好處，對，從隔離，PEG延長。那麼我們應該如何粗略地考慮，從今年從這裡成為一個良好的基礎，以您的長期目標增長率增長？

And my follow-up question in terms of the commercial pricing discussion that you highlighted in terms of the improvement over time. So is it fair to us when you look at the history, right, of the company, should we be expecting commercial pricing that would be accelerating to say 4%, 5% at some point, like we saw in the past during a period of high cost inflation?

我的後續問題是關於商業定價討論，你強調了隨著時間的推移而改進。那麼，當您查看公司的歷史時，這對我們公平嗎？我們是否應該期望商業定價會在某個時候加速到 4%、5%，就像我們過去在高成本通脹？

Well, let me make sure I got that in track. Relative to the 2023 and kind of the pluses and minuses as we go through the year. Yes, we are anticipating as we look through the balance of this year, kind of the normal course of business has stabilized. As Sam mentioned in his comments, we think we're going to see patterns return to kind of their normal seasonal trend.

好吧，讓我確保我做到了。相對於 2023 年以及我們這一年的利弊。是的，當我們查看今年的餘額時，我們預計，正常的業務過程已經穩定下來。正如 Sam 在他的評論中提到的，我們認為我們將看到模式恢復到正常的季節性趨勢。

And so that should give us a good base to grow off of in 2023. It's a little early to be talking about all the variables in 2023, we're going to be approaching our planning process right now, but most of them are known.

因此，這應該為我們在 2023 年的發展奠定良好的基礎。現在談論 2023 年的所有變量還為時過早，我們現在將接近我們的規劃過程，但其中大多數都是眾所周知的。

And I think as Sam mentioned in her comments, we think fundamentally, there continues to be growing demand for health care in our markets, and we're well positioned to serve that. And I think that becomes a nice pace just to think about 2023 as we go forward.

我認為正如 Sam 在她的評論中提到的那樣，我們從根本上認為，我們的市場對醫療保健的需求持續增長，我們有能力滿足這一需求。我認為這是一個不錯的步伐，只是在我們前進的過程中考慮到 2023 年。

Relative to commercial pricing, as you said, you -- and as we mentioned before, we are having those discussions with the payers. We've had some early success. There's a recognition of the inflationary pressures that providers are seeing. So we'll continue to progress those discussions as we go forward. And hopefully, we'll continue to roll those and get the benefit in '23.

正如您所說，相對於商業定價，您 - 正如我們之前提到的，我們正在與付款人進行這些討論。我們已經取得了一些早期的成功。人們認識到供應商所面臨的通脹壓力。因此，我們將繼續推進這些討論。希望我們將繼續推出這些產品並在 23 年獲得收益。

Our next question comes from Justin Lake with Wolfe Research.

我們的下一個問題來自 Justin Lake 和 Wolfe Research。

Just wanted to follow up on a couple of numbers questions. First, on COVID. I know you had expected the PHE earlier to expire like most in the first half. I think your number was about $150 million of that it. Can you give us an updated number there in terms of what's in guidance?

只是想跟進幾個數字問題。首先，關於COVID。我知道你之前預計 PHE 會像大多數人一樣在上半年到期。我認為你的數字大約是 1.5 億美元。你能給我們一個關於指導內容的最新數字嗎？

Then on that commercial pricing, I know it's early and you're -- you've got some wins there, hopefully. But can you give us an idea of pricing, I think, was in the 4% to 5% range historically. Where do you think those contracts shake out in terms of as we do get through them, do you think they shake out the high single digits or something a little bit lower than that? And that's it for me.

然後在那個商業定價上，我知道現在還早，而且你 - 希望你在那裡取得了一些勝利。但是你能給我們一個定價的想法嗎，我認為，歷史上在 4% 到 5% 的範圍內。當我們通過它們時，你認為這些合同在哪裡發生了變化，你認為它們會出現高個位數還是比這個低一點的東西？對我來說就是這樣。

Yes. Justin, let me start with your first one relative to the various COVID support. Honestly, very little did we recognize in the first quarter, probably $20 million to $25 million. If you look at last year, you (inaudible) probably hovering around million a quarter, pretty much in line with what our expectations were. Most of those programs are pretty much concluded. And so we'll run this out. I think it's probably $200 million year-to-date. So that's pretty close to what we anticipated when we turn the calendar and expectations relative to pricing.

是的。賈斯汀，讓我從你的第一個關於各種 COVID 支持開始。老實說，我們在第一季度幾乎沒有認識到，可能是 2000 萬到 2500 萬美元。如果您查看去年，您（聽不清）可能每季度徘徊在百萬左右，幾乎符合我們的預期。這些程序中的大多數都已經結束了。所以我們會用完這個。我認為今年迄今為止可能是 2 億美元。因此，這與我們在調整日曆和相對於定價的預期時的預期非常接近。

I think it's reasonable to assume that we were in the 2.5% to 4% zone previously with our commercial pricing that we are going to be in the mid-single digits as it relates to our expectations, how all those land, we don't know yet. We believe, again, with transparency and such that we're in a competitive positioning as a company globally, and that allows us to negotiate based upon the inflationary pressures on a reasonable escalator, as I mentioned.

我認為可以合理地假設我們之前處於 2.5% 到 4% 的區域，我們的商業定價我們將處於中個位數，因為這與我們的預期有關，所有這些土地如何，我們不還知道。正如我所提到的，我們再次相信，具有透明度和這樣的我們作為一家全球公司處於競爭地位，這使我們能夠根據合理的自動扶梯上的通貨膨脹壓力進行談判。

So that's sort of our targets. We're still early as our contracts come up for renewal. And we need to understand where the payers think we are, where they are in their planning as well. And I believe our relationships will allow us to get to a number that makes sense for both organizations, but I do anticipate it being somewhere around the mid-single digits.

這就是我們的目標。我們的合同即將續簽，我們還為時過早。我們需要了解付款人認為我們在哪裡，以及他們在計劃中的位置。而且我相信我們的關係將使我們得到一個對兩個組織都有意義的數字，但我確實預計它會在中個位數左右。

Our next question comes from Ben Hendrix with RBC Capital Markets.

我們的下一個問題來自加拿大皇家銀行資本市場的 Ben Hendrix。

I just wanted to ask a capital deployment question now ex these Utah hospital acquisitions. Given the FTC challenge, does this change at all your strategy or indeed the strategy of accessing patient access points in market? Could this potentially mean that you might look at some larger health system acquisitions in new markets? Just any thoughts on that.

我只是想問一個關於猶他州醫院收購案的資本部署問題。鑑於 FTC 的挑戰，這是否會改變您的所有策略，或者是否確實改變了在市場上訪問患者接入點的策略？這是否可能意味著您可能會在新市場上進行一些更大的衛生系統收購？只是對此的任何想法。

I don't think the decision in Utah necessarily changes our overall outlook. We will continue to look for opportunities that are appropriate in market. Most of those tend to be ambulatory oriented where we're able to add to our networks.

我認為猶他州的決定不一定會改變我們的整體前景。我們將繼續尋找適合市場的機會。其中大多數往往是面向流動的，我們可以添加到我們的網絡中。

Just this past quarter, we acquired another urgent care company in our Virginia division, and it solidified our network capabilities offerings in that particular state just like we've done previously in Florida. So we'll continue to look for outpatient network development opportunities. A lot of that will be our own greenfield products, but it may be some acquisition opportunities here and there.

就在上個季度，我們在弗吉尼亞州收購了另一家緊急護理公司，它鞏固了我們在該州的網絡能力產品，就像我們之前在佛羅里達州所做的那樣。因此，我們將繼續尋找門診網絡發展機會。其中很多將是我們自己的未開發產品，但可能會在這里和那裡獲得一些收購機會。

As it relates to markets, clearly, we're interested in new markets. We think we have the organizational capability and the financial capability to create a lot of value in the communities across the country. And hopefully, we will see some opportunities on that front. We're fortunate to be in a position where we have solid organic growth opportunities given the markets that we serve. And so we will continue to invest in those. I think in general, our capital allocation strategies will remain consistent. We have a very diversified approach to capital allocation and we'll continue to use that model for delivering shareholder value as well as making sure our networks are sufficiently developed with capacity and different offerings.

由於它與市場有關，顯然，我們對新市場感興趣。我們認為我們有組織能力和財務能力，可以在全國各地的社區創造很多價值。希望我們能在這方面看到一些機會。鑑於我們所服務的市場，我們很幸運能夠擁有穩固的有機增長機會。因此，我們將繼續在這些方面進行投資。我認為總的來說，我們的資本配置策略將保持一致。我們有非常多元化的資本配置方法，我們將繼續使用這種模式來提供股東價值，並確保我們的網絡充分發展，具有容量和不同的產品。

Our next question comes from Brian Tanquilut with Jefferies.

我們的下一個問題來自 Jefferies 的 Brian Tanquilut。

Sam, you mentioned in your prepared remarks how you opened 3 new Galen nursing schools this past quarter. So there's a lot of chatter about how difficult it is to add nursing school capacity here in the U.S.. Just curious in terms of how you're thinking about the ability to add more locations based on availability of professors and licenses to add to the nursing capacity in HCA?

山姆，你在準備好的評論中提到了你在上個季度如何開設了 3 所新的蓋倫護士學校。所以有很多關於在美國增加護士學校容量有多困難的討論。只是好奇你是如何考慮根據教授和許可證的可用性來增加更多地點以增加護理的能力HCA 的容量？

I think the acquisition of Galen has yielded since we closed on that transaction. We've added 8 new schools. And in most circumstances, those schools have started with an enrollment that was ahead of our model. Part of our ability to expand and open a new college as efficiently and effectively as Galen has so far is really reflective of the unique model they have, where they standardize the facility, they standardize, the curriculum and the delivery.

我認為自從我們完成那筆交易以來，對蓋倫的收購已經取得了成效。我們增加了 8 所新學校。在大多數情況下，這些學校的入學率都超過了我們的模式。到目前為止，我們能夠像 Galen 一樣高效和有效地擴展和開設一所新學院的能力確實反映了他們擁有的獨特模式，他們標準化了設施，標準化了課程和交付。

What's unique about HCA and Galen together is that we can use some of our own staff to support faculty needs in some cases and then obviously create a very efficient and effective clinical rotations. We are up to 13 schools. We will open, like I said, a couple more this year. And I think our pipeline has 6 to 8 over the following 12 to 18 months.

HCA 和 Galen 的獨特之處在於，我們可以在某些情況下使用我們自己的一些員工來支持教師的需求，然後顯然創建一個非常高效和有效的臨床輪換。我們最多有 13 所學校。就像我說的，我們今年會再開幾個。我認為我們的管道在接下來的 12 到 18 個月內有 6 到 8 個。

Our vision is that all of our major communities will have at least 1 Galen College of Nursing as part of the overall network offering. Some communities because of their size, will probably have more than 1. So we're extremely encouraged. I've visited myself, 3 of our new tools. There's tremendous enthusiasm with the students.

我們的願景是，我們所有的主要社區都將至少擁有 1 所蓋倫護理學院，作為整體網絡服務的一部分。一些社區由於其規模，可能會超過 1 個。所以我們非常鼓勵。我參觀了我自己，我們的 3 個新工具。學生們的熱情很高。

There's tremendous enthusiasm with the faculty and their tremendous enthusiasm with our nursing leadership across the company about the unique possibilities that the integration of nursing education with clinical operations in facilities at sort of an integrated model is something that is differentiated and it's going to create better nurses, better value for the patient, and we think its supply for HCA facilities that's unique in most circumstances.

教職員工和我們整個公司的護理領導層都充滿熱情，他們對護理教育與設施中的臨床操作以某種綜合模式相結合的獨特可能性充滿了熱情，這是一種差異化的東西，它將創造出更好的護士，為患者帶來更好的價值，我們認為它對 HCA 設施的供應在大多數情況下都是獨一無二的。

Our next question comes from Joshua Raskin with Nephron Research.

我們的下一個問題來自 Nephron Research 的 Joshua Raskin。

Are there certain parts of the health care delivery ecosystem that you think are more attractive now that you're talking about the sort of new stabilization that just haven't been as attractive in the past? Are there areas of growth for HCA in the future that you just haven't looked at in the past?

醫療保健提供生態系統的某些部分是否更具吸引力，因為您現在談論的是過去沒有那麼吸引人的那種新的穩定機制？未來 HCA 是否有您過去從未關注過的增長領域？

I don't think there's anything that's completely changed. Obviously, outpatient facilities, pre-pandemic were very important aspects to our network. We have roughly 2,500 outpatient facilities that are part of our hospital network ecosystem. So it's about, what, 12:1 in our company.

我不認為有什麼完全改變了。顯然，大流行前的門診設施對我們的網絡非常重要。我們有大約 2,500 個門診設施，是我們醫院網絡生態系統的一部分。所以它是關於，什麼，我們公司的 12:1。

We were very intentional over the last decade in building out our outpatient network to support our hospitals, which is sort of the core of who we are. And that integrated network model, we think will very effective and very supportive of our ability to go from 3% market share in 2011 to 28% market share today. As we push forward into the future, I do anticipate more velocity, if you will, in the network development we've had previously. But that really is across all aspects of outpatient development.

在過去的十年裡，我們非常有意建立我們的門診網絡來支持我們的醫院，這在某種程度上是我們的核心。我們認為這種集成網絡模型將非常有效並且非常支持我們從 2011 年的 3% 市場份額到今天的 28% 市場份額的能力。隨著我們向未來邁進，如果您願意的話，我確實預計我們之前的網絡開發速度會更快。但這確實涉及門診發展的各個方面。

Our philosophy is to create convenience for the patient, efficiency for the patient with different price points and then integration with the full system approach so that the patient can get whatever services they need inside of our overall provider system.

我們的理念是為患者創造便利，為不同價位的患者創造效率，然後與完整的系統方法集成，以便患者可以在我們的整體供應商系統中獲得他們需要的任何服務。

I don't know that anything is uniquely differentiated in that though. And I think it takes a comprehensive and complementary approach to be most effective and most responsive to our patients and our physicians.

不過，我不知道有什麼獨特之處。我認為需要一種全面和互補的方法才能對我們的患者和醫生最有效和最敏感。

Our next question comes from Lance Wilkes with Bernstein.

我們的下一個問題來自 Lance Wilkes 和 Bernstein。

Yes. Just wanted to understand a little bit about kind of volume constraints that have been in place during COVID and including labor supply constraints. And maybe how you track those metrics to see if those are starting to kind of loosen up a little bit, that be aiding volume in addition to just normal resumption of volume trends out there. So how are you looking at it? And what are some of the steps you're taking to kind of improve labor supply there?

是的。只是想了解一下在 COVID 期間已經存在的數量限制，包括勞動力供應限制。也許你如何跟踪這些指標，看看它們是否開始有點放鬆，除了正常恢復成交量趨勢之外，這有助於成交量。那你怎麼看？您正在採取哪些措施來改善那裡的勞動力供應？

Well, let me speak to our occupancy. This is Sam again. We ran about 72% in occupancy in the second quarter. as I mentioned in my prepared comments, we did open up more capacity than we had in the first quarter. We were a bit constrained with staffing. We had surges we were dealing with. So our overall availability of capacity was not as much as it was in the second quarter.

好吧，讓我談談我們的入住情況。這又是山姆。我們在第二季度的入住率約為 72%。正如我在準備好的評論中提到的那樣，我們確實開放了比第一季度更多的產能。我們在人員配備方面有點受限。我們正在處理激增。因此，我們的整體可用產能不如第二季度那麼多。

In the second quarter, however, we did have periods of time where our staffing constrained are capacity, and we weren't able to take transfers in through our transfer centers, which are a very important element of our network that I just talked about with our network model. And we saw situations where we couldn't take patients in certain facilities at certain times. It wasn't structural, but it was episodic in how much activity we had at a particular facility at a particular point in time as well as the staffing.

然而，在第二季度，我們確實有一段時間我們的人員配置受限於容量，我們無法通過我們的轉會中心接受轉會，這是我剛剛談到的我們網絡的一個非常重要的元素我們的網絡模型。我們看到了在某些時候我們無法在某些設施中接收患者的情況。這不是結構性的，但在特定時間點我們在特定設施的活動量以及人員配備方面是偶然的。

Our overall staffing supply agenda, I've spoken to that already around recruitment, retention, different care models that we're trying to use in managing our case management capabilities at a totally different level. We've seen improvement in every 1 of those categories, and that's helped us stretch our capacity, if you will, in appropriate ways that deliver outcomes for patients that are appropriate.

我們的整體人員供應議程，我已經談到了招聘、保留、不同的護理模式，我們試圖在完全不同的水平上管理我們的案例管理能力。我們已經看到這些類別中的每一個都有改進，這有助於我們擴展我們的能力，如果你願意的話，以適當的方式為患者提供適當的結果。

So we'll continue to move on all of those initiatives. And we think it will allow us over time to continue to open up more and more capacity. We've seen a lot of pressure in our behavioral health services where we have a reasonable number of facilities that are operating less than at full capacity.

因此，我們將繼續推進所有這些舉措。而且我們認為這將使我們隨著時間的推移繼續開放越來越多的容量。我們在行為健康服務中看到了很大的壓力，因為我們有合理數量的設施，但它們的運行量低於滿負荷運行。

We've had the same thing in our rehab services, and we had the same thing in other aspects of our business. But again, it's improved sequentially, and we think it will continue to improve as we move through the year. Does that significantly compromise our volume? No, but it does create some opportunities for more volume as we manage through those initiatives.

我們的康復服務也有同樣的事情，我們業務的其他方面也有同樣的事情。但同樣，它是連續改進的，我們認為隨著我們這一年的發展，它會繼續改進。這會顯著影響我們的音量嗎？不，但是當我們通過這些舉措進行管理時，它確實創造了一些增加銷量的機會。

Our next question comes from Scott Fidel with Stephens.

我們的下一個問題來自 Scott Fidel 和 Stephens。

Was interested if you can give us your perspectives on the evolving primary care environment just with all the focus on value-based care. And then with the emergence of some new players in the space, I guess, including yesterday. And then for HCA, how you think that could impact physician recruitment or network development longer term?

如果您能向我們提供您對不斷發展的初級保健環境的看法，並且將重點放在基於價值的護理上，那麼您很感興趣。然後隨著該領域一些新玩家的出現，我猜，包括昨天。然後對於 HCA，您認為這會如何影響醫生招聘或網絡發展的長期？

This is an interesting point in health care, generally speaking. I mean primary care is a multifaceted offering. It has urgent care, it has women services, pediatric services, telemedicine, internal medicine, even the emergency room in some cases, serves as a primary care platform for many people. So our approach is to have as many components of the primary care offering set as we possibly can.

一般來說，這是醫療保健中的一個有趣點。我的意思是初級保健是一個多方面的產品。它有緊急護理，有婦女服務、兒科服務、遠程醫療、內科，在某些情況下甚至還有急診室，是許多人的初級保健平台。因此，我們的方法是盡可能多地提供初級保健服務的組件。

In some cases, that's employed. We have employed physicians in our physician model. We have our urgent-care offerings. We have telemedicine offerings. We have pediatric offerings and so forth. In many instances, it's a combination of employee and affiliate physicians or affiliate providers. It could be providers of other healthcare centers or other physicians and so forth.

在某些情況下，這是使用的。我們在我們的醫師模型中僱傭了醫師。我們有我們的緊急護理產品。我們有遠程醫療產品。我們有兒科產品等等。在許多情況下，它是員工和附屬醫師或附屬提供商的組合。它可能是其他醫療保健中心或其他醫生等的提供者。

What's developed with the One Medical, it's been just another component of a possible affiliated network offering. I don't know that it completely changes the paradigm that exists across the multifaceted aspects of primary care and how people access care through those different dimensions. So we will continue to have a pluralistic approach to primary care, and we think that's the model that works for us. as we push through our system approach to health care in these communities.

One Medical 開發的產品只是可能的附屬網絡產品的另一個組成部分。我不知道它是否完全改變了存在於初級保健多方面的範式，以及人們如何通過這些不同的維度獲得護理。因此，我們將繼續採用多元化的初級保健方法，我們認為這就是適合我們的模式。當我們在這些社區推行我們的醫療保健系統方法時。

Our next question comes from John Ransom with Raymond James.

我們的下一個問題來自 John Ransom 和 Raymond James。

Bill, you said on the first quarter, you thought the kind of short-term margin was in the 19% to 20% range with the new realities, has your thinking changed on that?

比爾，你在第一季度說，你認為隨著新的現實，短期利潤率在 19% 到 20% 的範圍內，你的想法有改變嗎？

No, John, not really. I mean you look we did, I think we had [97] in the first and 20.5% in the second, there's pluses and minus. As you know, there's a lot of variables that go into the actual margin number. And we continue to focus to operate the company as efficiently as possible. But I think that 19% to 20% range is a good planning horizon for us. I think there'll be periods we're north of that, some periods we're within that. So no, I still think that thinking holds today.

不，約翰，不是真的。我的意思是你看起來我們確實做到了，我認為我們在第一階段有 [97]，在第二階段有 20.5%，有優點也有缺點。如您所知，實際保證金數字中有很多變量。我們將繼續專注於盡可能高效地運營公司。但我認為 19% 到 20% 的範圍對我們來說是一個很好的規劃範圍。我認為會有一些時期我們在北邊，有些時期我們在那個範圍內。所以不，我仍然認為這種想法在今天仍然成立。

Your next question comes from Stephen Baxter with Wells Fargo.

您的下一個問題來自富國銀行的 Stephen Baxter。

With the commentary you gave on the non-COVID admission metrics, it seems like you're seeing growth in managed care, but I guess that implies declines on the government side of the business or the uninsured side of the business. I was hoping you could provide some insight into what you think is driving that differential. And then as a follow-up, just wondering how we should be thinking about the growth of surgical volumes for the balance of the year?

根據您對非 COVID 入學指標的評論，您似乎看到了管理式醫療的增長，但我想這意味著政府方面的業務或未投保的業務方面有所下降。我希望你能提供一些關於你認為是什麼推動了這種差異的見解。然後作為後續行動，只是想知道我們應該如何考慮今年餘下時間手術量的增長？

Well, this is Bill, let me start with the non-COVID piece. I think there's a couple of things at play there. One, we did see growth in the non-COVID managed care. And that continued, I think, a favorable payer mix trend that we were seeing. And again, as I said in my remarks, we also saw the acuity levels maintained. So those are 2 areas that we're focused for us and we were pleased with that.

好吧，這是比爾，讓我從非 COVID 部分開始。我認為那裡有幾件事在起作用。一，我們確實看到了非 COVID 管理式醫療的增長。我認為，這繼續是我們看到的有利的付款人組合趨勢。同樣，正如我在講話中所說，我們也看到了保持敏銳度水平。所以這是我們關注的兩個領域，我們對此感到滿意。

Relative to the governmental activity in a non-COVID fluctuation. We are seeing some growth in the Medicare, which is still a good thing for us. Our total Medicare admissions, I think, were up 0.6% for the quarter, but we also saw growth in the managed care side. So I think, ultimately, what we expect to see is a return to historical growth patterns and pretty consistent among those payer classes. And as I've talked about in various settings, it may see a return of both governmental payer classes as well as the commercial. And net-net, those are still positive and productive for us.

相對於非 COVID 波動中的政府活動。我們看到醫療保險有所增長，這對我們來說仍然是一件好事。我認為，本季度我們的醫療保險總入院人數增長了 0.6%，但我們也看到了管理式醫療方面的增長。所以我認為，最終，我們期望看到的是恢復到歷史增長模式，並且在這些支付者類別中非常一致。正如我在各種環境中所談到的那樣，它可能會看到政府付款人類別以及商業的回歸。而net-net，這些對我們來說仍然是積極的和富有成效的。

Your next question comes from Andrew Mok with UBS.

您的下一個問題來自瑞銀的 Andrew Mok。

Given the footprint of your hospitals, it seems like you are well positioned to benefit from stronger ACA enrollment helped by enhanced premium tax credits. Can you help size the benefit in terms of revenue or volumes from those programs? And how are you thinking about the impact to your business should those enhanced subsidies expire?

鑑於您的醫院的足跡，您似乎處於有利地位，可以從增強的保費稅收抵免幫助下獲得更強的 ACA 註冊中受益。您能否幫助確定這些計劃的收入或數量方面的收益？如果這些增強的補貼到期，您如何看待對您的業務的影響？

Yes, that's a great question. And obviously you're paying attention to that, and we have some hope that we'll see those in huge subsidies have some continuation and we'll pay attention to that as the year goes on. And we'll try to assess any impact of that in 2023. There's no doubt. We talked about that through 2021. We saw growth in the health insurance exchange activity across HCA, primarily due to the enrollment increases that we saw on there.

是的，這是一個很好的問題。顯然你正在關注這一點，我們希望我們會看到那些獲得巨額補貼的人有一些延續，隨著時間的推移，我們會關注這一點。我們將嘗試在 2023 年評估它的任何影響。毫無疑問。我們一直在討論到 2021 年。我們看到整個 HCA 的健康保險交換活動有所增長，這主要是由於我們在那裡看到的入學人數增加。

So if the subsidies end up being reduced, it would have impact on enrollment. It couldn't have an impact on our volume. We haven't fully sized all of that. We're going to wait to see how the various proposals work through Congress and the houses and again, hopefully get some extension on there.

因此，如果補貼最終減少，將對入學率產生影響。它不會對我們的音量產生影響。我們還沒有完全確定所有這些的大小。我們將拭目以待，看看各種提案如何通過國會和眾議院，並再次希望在那裡得到一些擴展。

But as we go into '23, that's obviously a key area that we're going to have to focus on soon. But we saw, I think, through the course of '21. Our health insurance exchange growth probably 20% to 25% in a given period. And again, I do think that was primarily attributable to the increase in enrollment that I think is attributable to the enhanced subsidies. So we'll just have to see how that plays out.

但隨著我們進入 23 世紀，這顯然是我們很快將不得不關注的關鍵領域。但我認為，我們在 21 年的過程中看到了。我們的健康保險兌換率在特定時期可能增長 20% 到 25%。再說一次，我確實認為這主要歸因於入學人數的增加，我認為這歸因於補貼的增加。所以我們只需要看看結果如何。

We're hopeful that they find ways to continue those and you won't see a drop of people gaining coverage to the health fixed-interest exchange as we go through the balance of the year.

我們希望他們能找到繼續這些方法的方法，並且在我們度過今年餘下的時間時，您不會看到有下降的人獲得健康固定利息交換的保險。

Your next question comes from Jason Cassorla with Citi.

您的下一個問題來自花旗銀行的 Jason Cassorla。

Great. Just with year-to-date CapEx spending close to $2 billion, you're seemingly tracking towards your '22 guidance of $4.2 billion. But I was wondering if your expectations on areas for allocation for service line specifically has changed given trends so far, perhaps different service line build-outs just given the volume and labor backdrop? Any help there would be great.

偉大的。僅憑年初至今的資本支出接近 20 億美元，您似乎正在朝著 22 年 42 億美元的指導目標邁進。但我想知道，鑑於迄今為止的趨勢，您對服務線分配區域的期望是否發生了變化，也許只是考慮到數量和勞動力背景，服務線的擴建有所不同？那裡的任何幫助都會很棒。

This is Sam. I don't think we're going to see any material change in how we allocate capital. We believe we have a sufficient allocation around our technology agenda, our outpatient development agenda. And then as I mentioned in my comments, targeted hospital investments to support a growth opportunity or relieve a capacity constraint or really even create a better environment for our patients in some instances.

這是山姆。我認為我們不會在我們的資本配置方式上看到任何實質性的變化。我們相信我們在技術議程、門診發展議程方面有足夠的分配。然後正如我在評論中提到的那樣，有針對性的醫院投資以支持增長機會或緩解容量限制，或者在某些情況下甚至為我們的患者創造更好的環境。

So I don't anticipate significant shifting of categories. We will obviously adjust the overall market demand picture and such on community to the other, and we'll weave into that inside of those categories primarily.

因此，我預計類別不會發生重大變化。我們顯然會調整社區的整體市場需求情況等，我們將主要在這些類別中進行編織。

Your next question comes from Sarah James with Barclays.

您的下一個問題來自 Barclays 的 Sarah James。

So as I think about the 10,000 nurses seems for you that could be graduating from Galen. How much of those are actually taking full-time positions at HCA? What your capture rate? And then is there anything that you can be doing with tuition reimbursement to try to improve your capture rate?

所以當我想到 10,000 名護士對你來說可能從蓋倫畢業時。其中有多少人實際上在 HCA 擔任全職職位？你的捕獲率是多少？然後你可以通過學費報銷做些什麼來提高你的捕獲率？

Well, that's a great question. We are evolving our integration model, as I mentioned, with nurse students and externs and rotations and so forth. And it's a little early to give an indication as to what the capture rate will be, if you will, partly due to the fact that the schools are new, and we aren't seeing graduates just yet.

嗯，這是一個很好的問題。正如我所提到的，我們正在發展我們的整合模型，包括護士生、實習生和輪換等等。如果你願意的話，現在就給出捕獲率的指示還為時過早，部分原因是這些學校是新的，而且我們還沒有看到畢業生。

We only have 2 schools today in HCA markets where they're graduating students. And we're improving sequentially our capture rate to use your term in those 2 schools, and that's in Tampa and San Antonio. We are seeing more Galen students land in HCA facilities. We have a very robust academic partnership strategy. It's not just Galen. Galen can't solve all of the nursing needs for the organization. They can come in a very significant way as mentioned, but our broader academic partnership agenda is working with other schools out there that provide nursing care.

我們今天在 HCA 市場只有 2 所學校，他們正在畢業。我們正在按順序提高我們的捕獲率，以便在這 2 所學校使用你的學期，那就是在坦帕和聖安東尼奧。我們看到越來越多的蓋倫學生進入 HCA 設施。我們有一個非常強大的學術合作戰略。不僅僅是蓋倫。 Galen 無法解決組織的所有護理需求。如前所述，它們可以以非常重要的方式出現，但我們更廣泛的學術合作議程正在與其他提供護理的學校合作。

And we think what we can do is learn from our Galen experience, integrate with other academic centers more effectively create a better experience for their students and maybe a better pathway forward into HCA for in the future. We do have numerous programs that support HCA colleagues in getting nursing degrees. We have tuition support.

我們認為我們能做的就是從我們的 Galen 經驗中學習，更有效地與其他學術中心整合，為他們的學生創造更好的體驗，並為將來進入 HCA 提供更好的途徑。我們確實有許多項目支持 HCA 同事獲得護理學位。我們有學費支持。

We have other programs that create opportunities for our people inside of Galen, and we're continuing to evolve those, but I'm encouraged by some of the early indications of how many HCA colleagues are actually participating in Galen schools now. So we will hopefully see some benefit from that in the future.

我們還有其他計劃為蓋倫內部的員工創造機會，我們正在繼續發展這些計劃，但我對一些早期跡象感到鼓舞，這些跡象表明現在有多少 HCA 同事實際參與蓋倫學校。因此，我們希望將來能從中受益。

Your next question comes from Jamie Perse with Goldman Sachs.

您的下一個問題來自高盛的 Jamie Perse。

You commented earlier just on your ability to flex and adapt, and you saw that this quarter and really the last couple of years. So I'm curious how you think about a recessionary scenario or just lower growth overall constrained consumers, weaker job growth. How should we be thinking about that type of environment? And what types of things that are in your playbook to adapt to a more challenging macro?

你早些時候評論了你的靈活性和適應能力，你在本季度和過去幾年看到了這一點。所以我很好奇你是如何看待經濟衰退的情景，或者只是整體上的低增長限制了消費者，就業增長疲軟。我們應該如何思考這種環境？你的劇本中有哪些類型的東西可以適應更具挑戰性的宏觀？

Well, we have gone through numerous recessionary cycles just as other companies have gone through, and we're preparing ourselves for what that could be if it does develop in this cycle, and Bill alluded to a number of the programs that we have trying to make sure our efficiencies and other resiliency items are pushing forward regardless of the circumstance because we see value there and opportunities.

好吧，就像其他公司經歷的一樣，我們經歷了無數次衰退週期，我們正在為如果它在這個週期中發展可能發生的情況做好準備，比爾提到了我們試圖實施的一些計劃確保我們的效率和其他彈性項目在任何情況下都在推進，因為我們看到了那裡的價值和機會。

I think what is potentially different in a very significant and structural way now is how the Affordable Care Act in exchanges and Medicaid expansion play in a recessionary cycle. We have never had that safety net during that type of cycle. In those past cycles, if person was -- lost their job, they went into an uninsured ranks. I think what we have today is a unique safety net for those people in the Affordable Care Act programs that should provide some support by comparison to past cycles.

我認為現在在一個非常重要和結構性的方式上可能存在的不同之處在於，平價醫療法案在交易所和醫療補助擴張中如何在衰退週期中發揮作用。在這種類型的周期中，我們從未擁有過這樣的安全網。在過去的那些週期中，如果有人 - 失去了工作，他們就會進入沒有保險的行列。我認為我們今天擁有的是一個獨特的安全網，為那些參與平價醫療法案計劃的人提供了與過去的周期相比應該提供一些支持的人。

Typically, we lag, as many of you know, and how demand behaves in a recessionary cycle, but it provides labor relief also for us. So there's a balance between the 2. HCA Healthcare has performed well in past recessionary cycles, I'm confident that we can perform reasonably well in future recessionary cycles as we get more adaptability in our business. And then again, as the Affordable Care Act provides some level of support that we hadn't seen in the past.

正如你們許多人所知，通常情況下，我們落後於需求在衰退週期中的表現，但它也為我們提供了勞動力救濟。因此，兩者之間存在平衡。 HCA Healthcare 在過去的衰退週期中表現良好，我相信我們可以在未來的衰退週期中表現得相當好，因為我們在業務中獲得了更多的適應性。再說一次，因為“平價醫療法案”提供了我們過去從未見過的某種程度的支持。

We have reached the end of the question-and-answer session. I will turn the call back over to Frank Morgan for closing remarks.

我們已經到了問答環節的尾聲。我將把電話轉回給弗蘭克摩根，以便結束髮言。

Chantel, thank you for your help today, and thanks, everyone, for joining our call. I hope you have a wonderful weekend. I'll be around today if I can answer any additional questions you might have. Have a great day.

Chantel，感謝您今天的幫助，也感謝大家加入我們的電話。我希望你有一個美好的周末。如果我能回答您可能有的任何其他問題，我今天會在。祝你有美好的一天。

This concludes today's conference call. You may now disconnect.

今天的電話會議到此結束。您現在可以斷開連接。