美國醫院公司 (HCA) 2022 Q3 法說會逐字稿

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

歡迎來到 HCA Healthcare 2022 年第三季度收益電話會議。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 will 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 to 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 ACA, 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，我們可能會參考調整後 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調整後 EBITDA 的補充信息和調節 ACA, 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。

Good morning. Thanks for joining the call. As I've mentioned on past calls, it has been difficult over the pandemic period to judge our business trends because of the ups and downs we have experienced with the various COVID-19 surges. If you recall, the third quarter of 2021 was the most intense surge we saw with the Delta variant, and it significantly influenced our business, making it difficult to compare.

早上好。感謝您加入通話。正如我在過去的電話會議中提到的那樣，在大流行期間很難判斷我們的業務趨勢，因為我們在各種 COVID-19 激增中經歷了起起落落。如果您還記得，2021 年第三季度是我們看到的 Delta 變體最劇烈的激增，它對我們的業務產生了重大影響，因此難以比較。

We believe the second quarter and the third quarter of this year provide us with the most sustained period yet for us to judge our business. Generally, the financial results in the third quarter were in line with our internal expectations. As compared to the second quarter, our revenue production was consistent with overall volumes, payer mix and acuity generally stable. These results were generated with capacity constraints in certain situations caused by ongoing labor market challenges.

我們認為，今年第二季度和第三季度為我們提供了最持續的時期，供我們判斷我們的業務。總體而言，第三季度的財務業績符合我們的內部預期。與第二季度相比，我們的收入產出與整體銷量、付款人組合和敏銳度基本穩定一致。這些結果是在某些情況下由於持續的勞動力市場挑戰造成的能力限製而產生的。

In the quarter, we continue to invest significantly in our workforce, including the opening of one more Galen College of Nursing campus. These investments produced improvement in retention, more new hires and reduced contract labor expenses.

在本季度，我們繼續對我們的員工隊伍進行大量投資，包括開設另外一個蓋倫護理學院校園。這些投資提高了保留率，增加了新員工並減少了合同勞工費用。

Overall, operating margins were solid and were a positive reflection on the disciplined execution by our teams. I want to thank them for their enduring commitment to our patients and our facilities. We continue to be impressed by their resolve and dedication. These attributes were once again put to the test with Hurricane Ian. Fortunately, no patient or employee was harmed during the storm. And with the help of our partners, all facilities with the exception of one are fully operational. In the face of disasters, whether a pandemic or a hurricane, the people of HCA Healthcare continue to shine.

總體而言，營業利潤率穩健，是對我們團隊紀律執行力的積極反映。我要感謝他們對我們的患者和我們的設施的持久承諾。他們的決心和奉獻精神繼續給我們留下深刻印象。這些屬性再次受到颶風伊恩的考驗。幸運的是，風暴期間沒有患者或員工受傷。在我們合作夥伴的幫助下，除一處外的所有設施都已全面投入運營。面對災難，無論是大流行病還是颶風，HCA Healthcare 的人都繼續發光。

Normally, on this call, we attempt to provide you with some early perspectives on the upcoming year. Currently, we have reasonable insights into certain aspects of our business such as demand, which we believe will grow around 1% to 2% next year. We also expect payer mix and acuity to remain stable.

通常，在這次電話會議中，我們會嘗試為您提供一些關於來年的早期觀點。目前，我們對業務的某些方面（例如需求）有合理的洞察力，我們認為明年將增長 1% 至 2% 左右。我們還預計付款人組合和敏銳度將保持穩定。

However, with respect to inflation, we are less certain. We have responded to these unprecedented inflationary and macroeconomic pressures, and we will continue to respond with our workforce initiatives and our financial resiliency program, but it is too early to judge the effectiveness of our response as these forces and the related governmental responses continue to evolve and impact various categories of our costs.

然而，關於通貨膨脹，我們不太確定。我們已經應對了這些前所未有的通脹和宏觀經濟壓力，我們將繼續通過我們的勞動力計劃和金融彈性計劃來應對，但隨著這些力量和相關政府應對措施的不斷發展，現在判斷我們應對措施的有效性還為時過早並影響我們的各類成本。

Therefore, we will refrain from providing the typical early outlook for 2023 until we finish our planning process in early January. By then, we will have seen another 3 months of performance to assess the overall environment as well as our response to it.

因此，在 1 月初完成規劃過程之前，我們不會提供 2023 年的典型早期展望。到那時，我們將看到另外 3 個月的表現來評估整體環境以及我們對它的反應。

I will close with this. We continue our work to position the company for long-term success and sustained stakeholder and shareholder value. Our strategic plan is designed to optimize the networks we have built over the years by resourcing them with better technology and analytics, new and innovative care models and a highly trained workforce. We believe these efforts position us well to grow and effectively leverage our deployed capital. But more importantly, they position us better to deliver on our mission and provide higher quality care to our patients in a more efficient manner.

我將以此結束。我們將繼續努力使公司獲得長期成功以及持續的利益相關者和股東價值。我們的戰略計劃旨在優化我們多年來建立的網絡，為其提供更好的技術和分析、新的和創新的護理模式以及訓練有素的勞動力。我們相信，這些努力使我們能夠很好地發展並有效利用我們部署的資本。但更重要的是，他們使我們能夠更好地完成我們的使命，並以更有效的方式為我們的患者提供更高質量的護理。

Now let me turn the call over to Bill. Thank you.

現在讓我把電話轉給比爾。謝謝你。

Thank you, and good morning, everyone. Let me provide some additional comments on the quarter. As Sam mentioned, our results in the third quarter were in line with our expectations. Adjusted EBITDA was $2.902 billion. Adjusted EBITDA margin was 19.4%, and diluted earnings per share was $3.93, excluding losses on sale of facilities of $0.02.

謝謝大家，大家早上好。讓我提供一些關於本季度的補充意見。正如 Sam 所說，我們第三季度的業績符合我們的預期。調整後的 EBITDA 為 29.02 億美元。調整後的 EBITDA 利潤率為 19.4%，攤薄後每股收益為 3.93 美元，不包括 0.02 美元的設施出售損失。

Our same facility volume levels in the third quarter were generally consistent with our second quarter levels. Our volume trends compared to the prior year reflect the COVID-19 surge we experienced in the prior year. For example, our same-facility admissions are down 1.5% when compared to the prior year. COVID admissions were down almost 60% this quarter compared to third quarter of last year, and they represented almost 13% of admissions in Q3 of last year versus 5% of admissions in third quarter of this year. Non-COVID admissions increased 6.9% in the quarter as compared to the prior year and are up 2.7% year-to-date.

第三季度我們相同的設施量水平與我們第二季度的水平基本一致。與上一年相比，我們的銷量趨勢反映了我們在上一年經歷的 COVID-19 激增。例如，與上一年相比，我們的同設施入學率下降了 1.5%。與去年第三季度相比，本季度 COVID 入學人數下降了近 60%，佔去年第三季度入學人數的近 13%，而今年第三季度這一比例為 5%。與去年同期相比，本季度非 COVID 入學人數增加了 6.9%，今年迄今增加了 2.7%。

Acuity and payer mix levels were generally consistent with second quarter levels as well and led to comparable revenue per equivalent admission between the second and third quarter. As mentioned in our release, we recorded approximately $266 million of revenue and $125 million of expenses related to the Florida-directed payment program during the quarter. Approval for this program was received in September from CMS for the annual period ending September 30, 2022.

敏銳度和付款人組合水平也與第二季度的水平基本一致，並導致第二季度和第三季度的每次同等入院收入可比。正如我們在新聞稿中提到的，我們在本季度記錄了與佛羅里達定向支付計劃相關的大約 2.66 億美元的收入和 1.25 億美元的費用。 CMS 於 9 月收到了對該計劃的批准，有效期截至 2022 年 9 月 30 日。

In addition, we estimate the impact of Hurricane Ian, which made landfall on the West Coast of Florida on September 28, was approximately $35 million in the quarter. Our labor costs were generally in line with our expectations. We made market-based wage adjustments for our employee workforce and were able to absorb much of this with a 19% reduction in contract labor as compared to the second quarter. Supply cost trends remained stable, both sequentially and when compared to the prior year.

此外，我們估計 9 月 28 日在佛羅里達州西海岸登陸的颶風伊恩在本季度的影響約為 3500 萬美元。我們的人工成本大致符合我們的預期。我們對員工勞動力進行了基於市場的工資調整，並且能夠通過與第二季度相比減少 19% 的合同工來吸收其中的大部分。供應成本趨勢保持穩定，無論是環比還是與上一年相比。

Other operating expenses increased sequentially from the second quarter, but this is mostly due to the Florida DPP expenses and some increases in professional fees and utility costs. We remain focused on our resiliency programs that we've spoken to in past calls. And overall, our teams are doing a great job responding to the inflationary market dynamics while also identifying efficiency opportunities.

其他運營費用較第二季度環比增加，但這主要是由於佛羅里達州 DPP 費用以及專業費用和公用事業費用的一些增加。我們仍然專注於我們在過去的電話會議中談到的彈性計劃。總體而言，我們的團隊在應對通貨膨脹的市場動態方面做得很好，同時也發現了提高效率的機會。

Let me transition to discuss some cash flow and balance sheet metrics, which continue to be a strength for HCA Healthcare. Our cash flow from operations was $3.02 billion in the quarter, and capital spending was $1.13 billion. We completed approximately $700 million of share repurchase during the quarter and just under $5.5 billion year-to-date.

讓我轉而討論一些現金流和資產負債表指標，這些指標仍然是 HCA Healthcare 的優勢。本季度我們的運營現金流為 30.2 億美元，資本支出為 11.3 億美元。我們在本季度完成了約 7 億美元的股票回購，今年迄今略低於 55 億美元。

Our debt to adjusted EBITDA ratio was just above the low end of our stated leverage range, and we had approximately $3.9 billion of available liquidity at the end of the quarter. Lastly, I will mention that our full year 2022 guidance remains unchanged.

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有大約 39 億美元的可用流動性。最後，我要提到的是，我們的 2022 年全年指導保持不變。

So with that, let me turn the call back over to Sam for some quick comments before we go to Q&A.

因此，在我們進行問答之前，讓我將電話轉回給 Sam，以便快速發表評論。

Yes. One thing I wanted to share are the themes that we believe are takeaways from our quarter and sort of the normal business trends that we were judging between the second and third quarter. And these themes are as follows. First, again, we think our top line metrics are stable, and normal seasonality patterns are beginning to show themselves. Number two, we are making progress on our human resource agenda. Our engagement levels are up, and so we're encouraged by that. Number three, inflation is real. It's a pressure point, but we're working our way through it with our resiliency agenda and other initiatives. And then fourth is that long-term growth prospects, we believe, exist across our portfolio.

是的。我想分享的一件事是我們認為是本季度總結的主題，以及我們在第二季度和第三季度之間判斷的正常業務趨勢。這些主題如下。首先，我們認為我們的頂線指標是穩定的，並且正常的季節性模式開始顯現出來。第二，我們正在人力資源議程上取得進展。我們的參與度提高了，因此我們受到鼓舞。第三，通貨膨脹是真實存在的。這是一個壓力點，但我們正在通過我們的彈性議程和其他舉措努力克服它。第四，我們相信，長期增長前景存在於我們的投資組合中。

So those things, we think, are important to our judgment of the third quarter as compared to the second quarter and as we look to push forward on into next year and the years thereafter. So with that, Frank, I'll turn it over to you for questions.

因此，我們認為，與第二季度相比，這些事情對我們對第三季度的判斷很重要，因為我們期待著推進到明年和之後的幾年。所以，弗蘭克，我會把它交給你問問題。

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

謝謝你，山姆。 （操作員說明）Dennis，您現在可以向想提問的人發出說明。

(Operator Instructions) And your first question today comes from the line of A.J. Rice with Credit Suisse.

（操作員說明）您今天的第一個問題來自 A.J.瑞信的賴斯。

One maybe technical point. Are you just commenting on Hurricane Ian and the impact in the early part of the fourth quarter? And then my broader question is around your surgery volumes. You clearly showed good trends inpatient versus a year ago; outpatient, consistent what you've shown year-to-date. I'm assuming that some of that relates to what was happening last year with the Delta surge, but can you give us some flavor for where you're at inpatient/outpatient? And are we sort of back to a normal environment there? It sounds like you think you might see a step-up in the fourth quarter just from a normal seasonal pattern? Any comments there?

一個可能是技術點。您只是在評論颶風伊恩及其在第四季度初期的影響嗎？然後我更廣泛的問題是關於你的手術量。與一年前相比，您清楚地顯示了住院患者的良好趨勢；門診病人，與您年初至今的表現一致。我假設其中一些與去年發生的三角洲激增有關，但你能給我們一些關於你在住院/門診的情況嗎？我們是否回到了那裡的正常環境？聽起來你認為你可能會在第四季度看到一個正常的季節性模式的上升？那裡有意見嗎？

Well, A.J., this is Sam. I'll let Bill comment on the first question around Hurricane Ian and the fourth quarter. I mean we had 2 facilities -- let me back up on Hurricane Ian just to give everybody some perspective. We did evacuate, I think it was 4 hospitals in the Tampa-St. Pete area when we believed the storm was going to hit further north.

嗯，A.J.，這是山姆。我會讓比爾評論關於颶風伊恩和第四季度的第一個問題。我的意思是我們有兩個設施——讓我支持颶風伊恩，只是為了給每個人一些觀點。我們確實撤離了，我認為是坦帕街的 4 家醫院。當我們認為風暴將進一步向北襲擊時，皮特地區。

When the storm ultimately moved south on as we were able to move out our most critically ill patients out of 2 hospitals. And those 2 hospitals were hit pretty hard in Charlotte County. One of those hospitals suffered a pretty significant damage, and we were able to get aspects of it opened already. Our emergency room is back open. One of our med-surg floors is back open, and we think we'll be fully operational by the end of the year.

當風暴最終向南移動時，我們能夠將我們最危重的病人轉移出 2 家醫院。這兩家醫院在夏洛特縣受到了重創。其中一家醫院遭受了相當大的破壞，我們已經能夠打開它的各個方面。我們的急診室重新開放。我們的 med-surg 樓層之一重新開放，我們認為我們將在今年年底前全面投入運營。

Our teams in West Florida Division and really North Florida did an incredible job at responding to a really impactful hurricane. So that influenced our results in the third quarter. Our volumes were down obviously in the West Florida Division and the North Florida Division, which oversees Orlando. So we had a lot of preparation in management in advance of the storm. So it had a modest impact on our volumes.

我們在西佛羅里達分部和真正的北佛羅里達的團隊在應對一場非常有影響力的颶風方面做得非常出色。所以這影響了我們第三季度的業績。我們在西佛羅里達分部和監管奧蘭多的北佛羅里達分部的銷量明顯下降。所以在暴風雨來臨之前，我們在管理上做了很多準備。因此，它對我們的交易量影響不大。

With respect to seasonality, we do believe that normal seasonal patterns are starting to exist. And that typically yields more activity in the fourth quarter on outpatient surgery than the third quarter. So we're anticipating that, yes. And we are seeing normal patterns, we think, on other aspects of our business with respect to surgeries, cardiac procedures and so forth. And so that gives us some ability to judge where we are and what initiatives are working.

關於季節性，我們確實相信正常的季節性模式已經開始存在。這通常會在第四季度產生比第三季度更多的門診手術活動。所以我們期待著，是的。我們認為，我們在手術、心臟手術等業務的其他方面看到了正常模式。因此，這使我們有能力判斷我們在哪里以及哪些舉措正在發揮作用。

I think it's important, A.J., to understand that our capacity constraints in the third quarter were real. And some of that was the typical challenges we've had over the last 2.5 years in managing capacity. But we believe that we can continue to open more capacity as we move through the last part of this year and on into next year. But in the quarter, we declined, in many instances because we weren't able to accommodate the patients, approximately 1% to 1.5% of our total admissions simply because of capacity constraints. So we need to resolve those. Again, the progress that we're making on our HR agenda, we believe, is going to help us maintain sufficient capacity to take care of the patients who need our services. So we'll continue to push on those agendas, and we're encouraged, though, by the progress that we're making.

我認為重要的是，A.J.，了解我們在第三季度的產能限制是真實存在的。其中一些是我們在過去 2.5 年中在管理容量方面遇到的典型挑戰。但我們相信，隨著今年下半年和明年的到來，我們可以繼續增加產能。但在本季度，我們拒絕了，在許多情況下，因為我們無法容納患者，僅由於容量限制，我們的總入院人數約為 1% 到 1.5%。所以我們需要解決這些問題。同樣，我們相信，我們在人力資源議程上取得的進展將幫助我們保持足夠的能力來照顧需要我們服務的患者。因此，我們將繼續推進這些議程，不過，我們正在取得的進展讓我們感到鼓舞。

Your next question is from the line of Pito Chickering with Deutsche Bank.

您的下一個問題來自德意志銀行的 Pito Chickering。

I understand that you don't want to give sort of 2023 guidance at this point, but can you help us sort of quantify a couple of things? How should we think about top line growth next year? You talked about sort of 1% to 2% demand. Where do you expect sort of pricing to be? Any color on managed care price increases in '22 -- versus 2022?

我知道你現在不想給出 2023 年的指導，但你能幫我們量化一些事情嗎？我們應該如何看待明年的營收增長？你談到了 1% 到 2% 的需求。您期望定價在哪裡？與 2022 年相比，22 年管理式醫療價格上漲有什麼顏色嗎？

Now on the cost of the equation, what are you seeing for full-time inflation in the fourth quarter this year? I think that evolves next year. Any color on sort of how new grads coming out of the nursing schools decreases contract labor? And then any sort of thoughts around nonlabor inflation next year that you can give some color on?

現在關於等式的成本，您對今年第四季度的全時通脹有何看法？我認為明年會有所發展。關於從護理學校出來的新畢業生如何減少合同工的任何顏色？然後關於明年非勞動力通脹的任何想法，你可以給出一些顏色？

Well, Pito, this is Bill. Let me try. I mean I think Sam gave you comments on our thinking about top line. And really, the uncertainty remains around inflationary trends. And that's what we're looking at. Take the balance of the year, coupled with our experience so far to get some informed judgment as we go into 2023. So it's a bit too early to provide too many details. We're pleased with the continuation of labor agenda. We're pleased with the continuation of reduction to contract labor. And we're just going to have to judge the overall inflationary environment as we go into 2023. We think our teams and our resiliency efforts are good countermeasures to that. But that's what we're taking a little bit more time to kind of be able to judge that, and we'll give you our full commentary in January.

好吧，皮托，這是比爾。讓我試試。我的意思是，我認為 Sam 就我們對頂線的想法發表了評論。實際上，通脹趨勢仍然存在不確定性。這就是我們正在研究的。考慮到今年的餘額，再加上我們迄今為止的經驗，以便在我們進入 2023 年時做出一些明智的判斷。所以現在提供太多細節還為時過早。我們對勞工議程的延續感到高興。我們對繼續減少合同工感到高興。進入 2023 年，我們只需要判斷整體通脹環境。我們認為我們的團隊和我們的彈性工作是很好的應對措施。但這就是我們需要更多時間來判斷的原因，我們將在一月份為您提供完整的評論。

I think just to add a point to the third quarter as compared to the second quarter, our salary, wages and benefit cost per hour were flat with the second quarter. That was partially due to a 20% reduction in contract expenses. And at the same time, our normal wage timing for adjustments for our employees happens in the third quarter. And so we were able to absorb that with the management of our contract labor expenses.

我認為與第二季度相比，第三季度增加一點，我們的工資、工資和每小時福利成本與第二季度持平。這部分是由於合同費用減少了 20%。同時，我們調整員工的正常工資時間發生在第三季度。因此，我們能夠通過管理合同勞工費用來吸收這一點。

So that was encouraging. That's the first quarter in a while where we've seen stabilization in our labor cost per hour when you mix all components of our labor costs. So we'll continue to hopefully make some strides in that area and moderate some of the pressures, Pito, that exist in the labor market as we continue to execute on our recruitment agenda, our retention agenda, our capacity management and so forth.

所以這是令人鼓舞的。這是一段時間以來的第一季度，當您將勞動力成本的所有組成部分混合在一起時，我們看到每小時的勞動力成本趨於穩定。因此，我們將繼續希望在該領域取得一些進展，並緩解勞動力市場中存在的一些壓力，Pito，因為我們繼續執行我們的招聘議程、我們的保留議程、我們的能力管理等等。

Your next question is from the line of Ann Hynes with Mizuho Securities.

您的下一個問題來自瑞穗證券的 Ann Hynes。

Your volume guidance for next year is 1% to 2%. And I believe that's a little lower than historically. You typically guide 2% to 3%. Can you just talk about that and maybe what procedures aren't coming back or why you feel like it's not going to be a normal year since COVID admissions, while they still exist, aren't at the highs they used to be?

您對明年的銷量指導是 1% 到 2%。我相信這比歷史上要低一些。您通常指導 2% 到 3%。你能談談這個嗎，也許什麼程序沒有回來，或者為什麼你覺得自從 COVID 入學以來這不會是正常的一年，雖然它們仍然存在，但沒有達到以前的高點？

I think for -- this is Sam, Ann. I think the 1% to 2% is a little bit lower than maybe historical trends because we will have some COVID admission activity in '22 that we don't think will be as much in '23. So if you normalize for COVID, it's sort of in the zone of what our historical trends have been. We think outpatient activity would be a little stronger than inpatient activity as it has been historically.

我想——這是山姆，安。我認為 1% 到 2% 可能比歷史趨勢低一點，因為我們將在 22 年進行一些 COVID 錄取活動，我們認為在 23 年不會那麼多。因此，如果您對 COVID 進行正常化，它就在我們的歷史趨勢範圍內。我們認為門診活動會比住院活動強一點，因為它一直在歷史上。

But we do see, with the strong markets that we have and with the investments that we're making in our network, that we should be able to achieve those normal trends when you normalize for some of the COVID activity, which we don't anticipate at the same level next year. So that's part of the explanation. There's still a little bit of the influence there from COVID.

但是我們確實看到，憑藉我們擁有的強大市場以及我們在網絡中進行的投資，當您對某些 COVID 活動進行正常化時，我們應該能夠實現這些正常趨勢，而我們沒有這樣做預計明年保持在同一水平。所以這是解釋的一部分。那裡仍然有一點來自 COVID 的影響。

Your next question is from the line of Justin Lake with Wolfe Research.

您的下一個問題來自 Justin Lake 與 Wolfe Research 的合作。

Wanted to ask a couple of questions on 2022. So first, in the -- your update, you didn't update guidance. I assume that means that it remained intact. Just curious, given we're 3 quarters through, where you think within that guidance range you might end up.

想問幾個關於 2022 年的問題。首先，在您的更新中，您沒有更新指南。我認為這意味著它保持完整。只是好奇，鑑於我們已經完成了 3 個季度，您認為在該指導範圍內您可能最終會到達哪裡。

And then in the third quarter, to your point, COVID admissions were fluctuated pretty good. I was hoping you might be able to give us a revenue per admission number ex COVID, just so we can see what the growth is doing ex that big swing in COVID.

然後在第三季度，就你的觀點而言，COVID 錄取率波動很大。我希望您能夠為我們提供除 COVID 之外的每個錄取人數的收入，這樣我們就可以看到在 COVID 的巨大波動之前的增長正在做什麼。

Yes. Justin, this is Bill. Let me -- just on guidance first. Yes, we're maintaining our previous guidance, which does accommodate a wider range of outcomes than we might typically have at this point in the year. But given the uncertainties in the environment that we've talked about, we think it's appropriate at this time, and we'll just continue to manage our way through, through the balance of the year.

是的。賈斯汀，這是比爾。讓我 - 只是先指導。是的，我們正在維持我們之前的指導，它確實適應了比我們在今年這個時候通常可能擁有的更廣泛的結果。但是考慮到我們所討論的環境的不確定性，我們認為此時是合適的，我們將繼續管理我們的方式，通過今年的剩餘時間。

Relative to non-COVID revenue for adjusted admission, we saw growth in both overall as well as managed care. If you'd bear with me for a minute, I'll get you the exact number. So yes, we were up about 2 points on revenue per adjusted admission on the non-COVID for the quarter.

相對於調整入院的非 COVID 收入，我們看到整體醫療和管理式醫療都有增長。如果你能容忍我一分鐘，我會給你確切的數字。所以，是的，我們在本季度非 COVID 每次調整後的收入增加了約 2 個百分點。

And Bill, that would strip out the Florida revenues as well?

還有比爾，這也會剝奪佛羅里達州的收入嗎？

Yes, it would.

是的，它會的。

Your next question is from the line of Gary Taylor with Cowen.

您的下一個問題來自 Gary Taylor 和 Cowen。

Two quick ones. The first is when we think about some of the headwinds for '23 that you talked about before, the Texas out of period, some of the COVID reimbursement, et cetera. Does the Florida DPP, does that constitute a headwind for '23? Or is that a program if it's -- you'd expect to continue such that the annual number is the same?

兩個快的。首先是當我們考慮你之前談到的 23 年的一些不利因素時，德克薩斯州過期，一些 COVID 報銷等等。佛羅里達民進黨，這是否構成了 23 年的逆風？或者如果它是一個程序 - 你希望繼續這樣每年的數字是一樣的？

And then my second question is I hear your comments on inflation. And obviously, if we look at the pretty good labor performance this quarter and supply cost per adjusted patient actually down year-over-year. So are you signaling that there's a new inflection point in inflation that you're concerned about for '23? And is that in the labor? Or is that in other operating, so it's utilities and insurance and that sort of thing?

然後我的第二個問題是我聽到你對通貨膨脹的評論。顯然，如果我們看一下本季度相當不錯的勞動力表現，每個調整後的患者的供應成本實際上同比下降。那麼，您是否在暗示您擔心 23 年通脹出現新的拐點？那是在勞動中嗎？或者是在其他運營中，所以它是公用事業和保險之類的東西？

Gary, this is Bill. Let me address the Florida DPP. We are not anticipating that to be a headwind next year. That is an annual program that receive annual approval. So we are subject to approval. But as you might recall, we recorded some amounts in the fourth quarter of last year. And with this amount, we would, at this point, anticipate that program will continue in its material form next year, but we'll continue to evaluate that.

加里，這是比爾。讓我談談佛羅里達民進黨。我們預計明年這不會成為逆風。那是一個獲得年度批准的年度計劃。所以我們有待批准。但您可能還記得，我們在去年第四季度記錄了一些金額。在這一點上，我們預計該計劃將在明年以物質形式繼續進行，但我們將繼續評估這一點。

Yes. And Gary, this is Sam. On inflation, we're not really signaling anything. We're just suggesting that we want to go 3 more months and understand the progress that we hope to make with our labor agenda and some of our other efforts. And that will give us, hopefully, 9, 10 months' worth of normal run of business. Again, we haven't had that for 3 years. And that will help inform where we think the market is, where we think our initiatives are and how that's positioning us for '23, and we'll give you more specificity at that particular point in time on the different cost categories and inflationary pressures that exist within each of those.

是的。加里，這是山姆。關於通貨膨脹，我們並沒有真正發出任何信號。我們只是建議我們再堅持 3 個月，了解我們希望在勞工議程和其他一些努力方面取得的進展。這將給我們帶來 9 到 10 個月的正常業務運營。同樣，我們已經有 3 年沒有這樣了。這將有助於告知我們認為市場在哪裡，我們認為我們的舉措在哪裡，以及這對我們 23 年的定位如何，我們將在特定時間點為您提供更多關於不同成本類別和通脹壓力的具體信息存在於其中的每一個之中。

Your next question is from the line of Andrew Mok with UBS.

您的下一個問題來自瑞銀的 Andrew Mok。

I understand you're not commenting on 2023 at this point, but can you help us understand the level of nonrecurring benefits in 2022 so we can bridge to a proper 2022 baseline?

我知道您此時並未對 2023 年發表評論，但您能否幫助我們了解 2022 年的非經常性福利水平，以便我們可以過渡到適當的 2022 年基線？

Well, I mean, we've talked publicly before around the Texas out-of-period amounts that we recorded earlier in the year that related to last year. That was approximately $150 million. And then we've sized the various COVID support payments we received this year that we don't anticipate to continue around $300 million. And so those would be the 2 areas we've talked about before. There's other pluses and minuses, 340Bs out there. But those are the 2 things that I would highlight at this point.

好吧，我的意思是，我們之前已經公開談論過我們在今年早些時候記錄的與去年相關的德克薩斯州的期外金額。那大約是1.5億美元。然後，我們對今年收到的各種 COVID 支持付款進行了估算，我們預計這些付款不會持續到 3 億美元左右。這就是我們之前討論過的兩個領域。還有其他優點和缺點，340B。但這些是我在這一點上要強調的兩件事。

Your next question is from the line of Whit Mayo with SVB Securities.

您的下一個問題來自 SVB 證券的 Whit Mayo。

I just want to go back to contract labor for a minute. I appreciate the disclosure that it declined 19%. Can you maybe frame that as a percentage of SWB in the third quarter and also maybe what the exit rate is. And also, Bill, your comment on market-based wage adjustments, is there any way to maybe quantify that on an FTE basis or a per hour basis, just to put into perspective the level of inflation that you're seeing and how different that is maybe from the beginning of the year?

我只想回去做一分鐘的合同工。我很欣賞它下降了 19% 的披露。您能否將其描述為第三季度 SWB 的百分比，以及退出率是多少。而且，比爾，你對基於市場的工資調整的評論，有沒有辦法可以在 FTE 或每小時的基礎上量化它，只是為了透視你所看到的通貨膨脹水平以及它有多麼不同也許是從年初開始的？

Yes. On the contract labor percent of SWB, it was about 7.2% for the quarter, and that's pretty much close to our exit rate, as you say, for the quarter. So that's good improvement. Roughly speaking, half of that was through the continued reduction of the average hourly rate and half through reduction of utilization of contract labor. So we're very pleased with those trends going forward.

是的。在 SWB 的合同勞動百分比上，本季度約為 7.2%，這與您所說的本季度的退出率非常接近。所以這是一個很好的改進。粗略地說，其中一半是通過繼續降低平均時薪，一半是通過減少合同工的使用。因此，我們對未來的這些趨勢感到非常滿意。

Yes. Typically -- Whit, this is Sam. We give our wage increases in the third quarter. It varies a little bit market to market, but that's when the lion's share of our increases go through. And we've been a little bit active throughout the last year or so with targeted market adjustments here and there throughout the year, but we felt we needed to be a little bit more significant. So we -- the composite is a little north of 4%, if you look at third quarter to second quarter, as far as average hourly rate increases for our employed forces. Again, that's just third quarter to second quarter, and we were able to absorb that inside of our contract labor expense management and yielded again, labor cost as a composite flat with the third quarter compared to the second quarter.

是的。通常 -- Whit，這是 Sam。我們給出了第三季度的工資增長。它因市場而異，但那是我們增長的最大份額的時候。在過去一年左右的時間裡，我們一直在積極地進行有針對性的市場調整，但我們覺得我們需要更加重要。所以我們 - 如果你看第三季度到第二季度，就我們僱傭部隊的平均小時工資增長而言，綜合增長率略高於 4%。同樣，這只是第三季度到第二季度，我們能夠在我們的合同勞動力費用管理中吸收這一點，並再次產生，勞動力成本與第三季度相比與第二季度持平。

We still are running with a lot more nurses in contract labor than we did in 2019. So we have room to go, we believe. We obviously have to execute on our human resource agenda to make that happen. And we've invested heavily in our recruitment capabilities, and they've done a wonderful job of improving our recruitment processing and really creating a better applicant experience as well as a better management experience for our management teams out there. We have very intentional retention efforts, including compensation and benefits and flexible scheduling and so forth in order to improve retention, and we're seeing progress there. Our engagement results just came in, very positive.

與 2019 年相比，我們仍然有更多的合同工護士。所以我們相信，我們還有很大的發展空間。顯然，我們必須執行我們的人力資源議程才能實現這一目標。我們在招聘能力上投入了大量資金，他們在改善招聘流程方面做得非常出色，真正為我們的管理團隊創造了更好的申請體驗和更好的管理體驗。我們有非常有意識的留住工作，包括薪酬和福利以及靈活的日程安排等，以提高留存率，我們看到了這方面的進展。我們的參與結果剛剛出來，非常積極。

So we're really encouraged by our abilities to capitalize on modifying our workforce over time. That can change. We understand that, but at this particular juncture, that's where we are.

因此，隨著時間的推移，我們有能力利用改變我們的員工隊伍，我們真的很受鼓舞。這可以改變。我們理解這一點，但在這個特殊的時刻，這就是我們所處的位置。

Your next question is from the line of Ben Hendrix with RBC Capital Markets.

您的下一個問題來自加拿大皇家銀行資本市場的 Ben Hendrix。

One of your -- your competitor noted an increase in clinicians out on quarantine this quarter, and clearly, they had an impact on agency labor. And you seem to have managed obviously agency labor much better. And I'm wondering what you saw in terms of staff quarantine rates and -- this quarter versus prior. And how are you able to manage that? And if you saw any scheduling delays on the outpatient electives as a result of changing quarantine rates?

你的一個 - 你的競爭對手注意到本季度隔離的臨床醫生有所增加，很明顯，他們對機構勞動力產生了影響。而且您似乎對代理勞動力的管理顯然要好得多。我想知道您在員工隔離率方面看到了什麼，以及本季度與上一季度的對比。你怎麼能做到這一點？如果您發現由於隔離率的變化而導致門診選修課的安排出現延誤？

This is Sam. Thank you for that question. We -- I don't know of any quarantine issues that we experienced in the third quarter this year. Obviously, last year, with the Delta variant, we had a number of our staff who were out on quarantine. But this year, that has not surfaced as an issue for us across our divisions. I mean I'm sure there were some people who experienced some COVID in our workforce, but it wasn't a significant piece of issue for us.

這是山姆。謝謝你的問題。我們——我不知道我們在今年第三季度遇到的任何隔離問題。顯然，去年，使用 Delta 變體，我們的一些員工被隔離了。但今年，這並沒有成為我們各個部門的問題。我的意思是，我確信在我們的員工隊伍中有些人經歷了一些 COVID，但這對我們來說不是一個重要的問題。

Your next question is from the line of Lance Wilkes with Bernstein.

你的下一個問題來自伯恩斯坦的蘭斯威爾克斯。

Could you talk a little bit about rate negotiations with managed care, what progress you're seeing on that? And maybe if you can give some context on the market environment, if you're seeing any smaller hospitals that are terming contracts or if you, in fact, termed any contracts.

您能否談談與管理式醫療的費率談判，您在這方面看到了什麼進展？如果您可以提供有關市場環境的一些背景信息，如果您看到任何正在簽訂合同的小型醫院，或者您實際上是否簽訂了任何合同。

Well, we've mentioned in the past that we felt the inflationary pressures that we're incurring on our cost structure are being received reasonably well by the payer community. And that has, in fact, happened. We closed some additional contracts in the third quarter of this year, and they were generally in the target of where we had indicated previously that we expected our new contracts to land, and that was somewhere in the mid-single digits. So we are making progress with respect to our renegotiations.

好吧，我們過去曾提到，我們感覺到我們對成本結構產生的通貨膨脹壓力正在被付款人社區接受得相當好。事實上，這已經發生了。我們在今年第三季度完成了一些額外的合同，它們通常處於我們之前表示我們預計新合同將登陸的目標位置，並且在中個位數的某個位置。因此，我們正在重新談判方面取得進展。

As I mentioned, we were already partially negotiated for 2023, and we continue to add to that negotiation in contract completion rate as we move through the third quarter. So we're encouraged by the renegotiations that have occurred, and we are about 70% contracted for 2023 and about 45% contracted for 2024, and we're seeing elevated escalators by comparison to our historical trends on our commercial contract book.

正如我所提到的，我們已經就 2023 年進行了部分談判，隨著我們進入第三季度，我們將繼續在合同完成率方面進行談判。因此，我們對已經發生的重新談判感到鼓舞，我們在 2023 年簽約約 70%，在 2024 年簽約約 45%，與我們商業合同簿上的歷史趨勢相比，我們看到自動扶梯升高。

As it relates to our competitors, there's always pockets of negotiations where there's terminations and so forth. We have not had to terminate any contracts in any significant fashion. We've been able to reach agreements that work for us and work for the payers, and we'll continue to hopefully be able to make that happen.

因為它與我們的競爭對手有關，所以總是有一些談判存在終止等等。我們不必以任何重大方式終止任何合同。我們已經能夠達成對我們和付款人有用的協議，我們將繼續希望能夠實現這一目標。

We are working with the payers with respect to making sure that our accounts receivables are handled timely and appropriately with respect to denials and so forth, and we are incorporating that into our discussions in a way that we think will be productive for us and hopefully productive for the payers.

我們正在與付款人合作，以確保我們的應收賬款在拒絕等方面得到及時和適當的處理，我們正在將其納入我們的討論中，以一種我們認為對我們有成效並希望有成效的方式為付款人。

Your next question is from the line of Brian Tanquilut with Jefferies.

您的下一個問題來自傑富瑞的 Brian Tanquilut。

Sam, I appreciate you guys providing some insight into next year's volume expectations. But as we stare down a recession here, I mean, how are you thinking about the resilience of the business? You guys did fairly well during the last recession. But just some thoughts on that and maybe your thoughts on any differences this time around versus '07 to 2012.

山姆，感謝你們對明年的銷量預期提供一些見解。但是，當我們凝視這裡的經濟衰退時，我的意思是，您如何看待業務的彈性？你們在上次經濟衰退期間做得相當不錯。但只是對此的一些想法，也許你對這次與 07 年至 2012 年的任何差異的想法。

Well, I think the most material difference, and I mentioned this on the last earnings call we had, is that the Affordable Care Act and the exchange community provides a potential safety net that heretofore in previous recessionary cycles we didn't have. And that, for us, we believe, is a positive.

嗯，我認為最重要的區別，我在上次財報電話會議上提到的，是平價醫療法案和交換社區提供了一個潛在的安全網，在之前的經濟衰退週期中我們沒有。我們相信，這對我們來說是積極的。

As it relates to the other aspects of our business, our demand for health care services tends to lag the rest of the economy, and we tend to see demand in the earlier part of a recessionary cycle sort of hold, and that was when people were under COBRA benefits and so forth and then it would fade over time. But with the Affordable Care Act and the support that the exchanges provide, we're not sure how to gauge that at this particular juncture because it's a new dynamic, but we believe it to be a favorable dynamic. So that would be where we are at this particular point with judging the future impact of a recessionary cycle.

由於它與我們業務的其他方面有關，我們對醫療保健服務的需求往往落後於經濟的其他部門，我們傾向於看到需求在衰退週期的早期階段保持不變，那時人們在 COBRA 福利等下，它會隨著時間的推移而消失。但是有了平價醫療法案和交易所提供的支持，我們不確定如何在這個特定的時刻衡量它，因為這是一個新的動態，但我們認為這是一個有利的動態。因此，這就是我們在判斷衰退週期的未來影響時所處的特定時刻。

I think our teams are working to -- with our resiliency agenda and other efforts to anticipate where they can anticipate and make adjustments where they can to put us in the best position to be successful. We think our balance sheet is strong and that should create opportunities for us to invest in certain situations and hopefully gain market share. You look at our markets as a whole, Florida, Texas, Nashville, Vegas, These are fairly strong durable economies, we believe. It may be a little stronger than the nation as a whole. So that can hopefully add some support as we go into a recessionary cycle potentially in the future.

我認為我們的團隊正在努力——通過我們的彈性議程和其他努力來預測他們可以預測的地方，並在他們可以做出調整的地方使我們處於成功的最佳位置。我們認為我們的資產負債表很強勁，這應該為我們在某些情況下投資創造機會，並有望獲得市場份額。你把我們的市場看成一個整體，佛羅里達、德克薩斯、納什維爾、維加斯，我們相信這些都是相當強大的耐用經濟體。它可能比整個國家強一點。因此，當我們未來可能進入衰退週期時，這有望增加一些支持。

Your next question is from the line of Kevin Fischbeck with Bank of America.

您的下一個問題來自美國銀行的 Kevin Fischbeck。

I guess there's somewhat of a question about how we should be thinking about volume normalization. You guys are above 2019, but you're probably 4% to 7% below where you would have thought if you were to grow 2% to 3% every year after 2019. And it looks like you're still talking about that growth rate being below average again next year. I mean, how are you -- so it sounds like you're saying you think that demand in your markets is durable, but it still feels like you're getting farther and farther away from that trend line in the near term.

我想關於我們應該如何考慮音量標準化存在一些問題。你們都高於 2019 年，但如果在 2019 年之後每年增長 2% 到 3%，你可能會比你想像的低 4% 到 7%。看起來你還在談論這個增長率明年再次低於平均水平。我的意思是，你好嗎 - 所以聽起來你是在說你認為你的市場需求是持久的，但在短期內你仍然覺得你離這條趨勢線越來越遠。

So can you just help us frame how we should be thinking about that? Is it labor that is the gating factor to getting back there? Are there other things -- and how long if that time line is the right way to think about it, I guess you can say that or not? But if it is the right way to think about it, how are you thinking about what has to happen to get us back to that trend line?

那麼你能不能幫助我們確定我們應該如何思考這個問題？勞動力是回到那裡的關鍵因素嗎？還有其他事情嗎？如果該時間線是正確的思考方式，我猜你可以這麼說嗎？但是，如果這是正確的思考方式，那麼您如何考慮必鬚髮生什麼才能讓我們回到那條趨勢線？

Let me make a couple of comments. I do think there is an imbalance between supply of health care and demand for health care right now primarily because of some of the labor constraints. And people are being pushed out. They're being held up. Again, transfers are not happening as we had anticipated. So there is some influence to that.

讓我發表幾點意見。我確實認為目前醫療保健的供應和醫療保健需求之間存在不平衡，主要是因為一些勞動力限制。人們被趕出去了。他們被攔住了。同樣，轉移並沒有像我們預期的那樣發生。所以有一些影響。

Anecdotally, we've heard from some of our physicians that their clinic practices are starting to recover in ways that maybe earlier in the year, they didn't recover. So that's encouraging to us at some level. Obviously, during the comparison of 2019 to today, our total joint business migrated fairly significantly to outpatient activity.

有趣的是，我們從我們的一些醫生那裡聽說，他們的臨床實踐開始以可能在今年早些時候沒有恢復的方式恢復。所以這在某種程度上對我們來說是鼓舞人心的。顯然，在 2019 年與今天的比較期間，我們的總聯合業務相當顯著地轉移到了門診活動。

When you look at 2019, on the outpatient side against the third quarter of 2022, we think our outpatient activity has grown 5% or 6% over that time period. Our inpatient activity is down a little bit, most of which is explained by the total joint movement. So we were asking ourselves when you think about it, did that business go away or not?

當您查看 2019 年的門診量時，與 2022 年第三季度相比，我們認為我們的門診量在此期間增長了 5% 或 6%。我們的住院活動有所下降，其中大部分是由整體關節運動來解釋的。因此，當您考慮它時，我們會問自己，該業務是否消失了？

So I think when you look at our non-COVID admission activity, which year-to-date has grown 3% and grown a little bit more even in the commercial business, it is actually sequentially growing third quarter to second quarter. That gives us encouragement that we're moving closer to the historical trend. Again, we have a little bit of COVID influence this year because we had activity in the first quarter and a little bit of activity this quarter.

因此，我認為，當您查看我們的非 COVID 招生活動時，今年迄今已增長 3%，甚至在商業業務中也增長了一點點，實際上它在第三季度到第二季度連續增長。這讓我們感到鼓舞，我們正在接近歷史趨勢。同樣，今年我們有一點 COVID 影響，因為我們在第一季度有活動，本季度也有一點活動。

But when we look at non-COVID by itself, we're encouraged by what we're seeing. ER visits have rebounded and shown a great deal of resiliency. So we think it's migrating closer to the historical trend than not.

但是，當我們單獨看待非 COVID 本身時，我們會為所看到的感到鼓舞。急診室就診已經反彈並顯示出很大的彈性。所以我們認為它比沒有更接近歷史趨勢。

Would you say then that the hip-knee move out is something that's unusual? Or I mean there's always a shift to outpatient every...

你會說髖膝外移是不尋常的嗎？或者我的意思是每次都會轉診到門診...

Yes, there are always some elements of it. I think that was the more pronounced one that we've seen in a long time.

是的，它總是有一些元素。我認為這是我們在很長一段時間內看到的更明顯的一個。

Your next question is from the line of Scott Fidel with Stephens.

您的下一個問題來自 Scott Fidel 和 Stephens 的觀點。

Question just around -- obviously, another one of the sort of uncertain swing factors for 2023 is just around the public health emergency and whether that gets finally pulled back or not. Can you just remind us for ACA again, just what the key impacts or benefits that you've been seeing from the PHE would be and how that would factor into your thinking for next year if we do ultimately see the public health emergency go away? Clearly, return of redeterminations in Medicaid is probably the biggest item, but just any others as well would be helpful.

問題就在眼前——顯然，2023 年的另一個不確定的波動因素就是圍繞公共衛生緊急事件，以及它是否最終會被撤回。您能否再次提醒我們 ACA，您從 PHE 中看到的主要影響或好處是什麼，以及如果我們最終看到公共衛生緊急情況消失，這將如何影響您明年的想法？顯然，在 Medicaid 中恢復重新確定可能是最大的項目，但其他任何項目也會有所幫助。

Yes. Scott, this is Bill. I think the primary was COVID add-on to the DRG payments that we've spoken about. Given the COVID volume has kind of moderated, that hasn't been material for us. So that's the area there.

是的。斯科特，這是比爾。我認為主要是我們所說的 DRG 付款的 COVID 附加項。鑑於 COVID 的數量有所緩和，這對我們來說並不重要。這就是那裡的區域。

As you said -- then the next area, and probably more significant, is just if it does -- when it does expire, what the Medicaid redetermination process will occur by various states. We've evaluated that. We've got, I think, good planning exercise around it. So those would be the 2, I think, consequences or effects of the PHE, not material on the DRG add-on at this point, and we'll prepare ourselves to go through Medicaid redeterminations.

正如你所說——那麼下一個領域，可能更重要的是，如果它確實到期——當它到期時，各個州將發生什麼醫療補助重新確定過程。我們對此進行了評估。我認為，我們已經圍繞它進行了良好的規劃練習。因此，我認為，這將是 PHE 的 2 個後果或影響，而不是在這一點上對 DRG 附加組件產生重大影響，我們將準備好通過 Medicaid 重新確定。

Your next question is from the line of Jason Cassorla with Citi.

您的下一個問題來自花旗銀行的 Jason Cassorla。

Just related to fourth quarter, I guess, COVID has trended higher so far this year than perhaps your previous expectations, but can you help on how you're thinking about COVID activity for fourth quarter and if you're thinking it will accelerate versus this quarter?

與第四季度有關，我猜，今年到目前為止，COVID 的趨勢可能比您之前的預期要高，但是您能否幫助您了解第四季度的 COVID 活動以及您是否認為它會加速四分之一？

And then also, just what your expectations are for flu trends, maybe just in guidance and for 4Q and how we should think about what an elevated flu environment would mean for this year, maybe just in context of the current labor backdrop and versus historical flu seasons.

然後，您對流感趨勢的期望是什麼，也許只是在指導和第四季度，以及我們應該如何思考今年流感環境升高意味著什麼，也許只是在當前勞動力背景和歷史流感的背景下季節。

Yes. I'll start with COVID volumes. We don't have specific fourth quarter projections. As I said in my comments, we ran about 5% of our admissions in the third quarter. We ran about 3% in the second. So my intuition says somewhere between those areas might be an area we see in the fourth quarter on there.

是的。我將從 COVID 卷開始。我們沒有具體的第四季度預測。正如我在評論中所說，我們在第三季度進行了大約 5% 的招生。我們第二次跑了大約 3%。所以我的直覺說，這些區域之間的某個地方可能是我們在第四季度看到的一個區域。

In terms of flu volumes, again, we haven't made any specific projections for flu, but clearly, we're paying attention to the flu volumes that are out there in the anticipation that it might be a busy flu season. But I don't think that necessarily changes the trajectory of our fourth quarter compared to what we previously thought.

同樣，就流感數量而言，我們沒有對流感做出任何具體預測，但很明顯，我們正在關注流感數量，因為預計這可能是一個繁忙的流感季節。但與我們之前的想法相比，我認為這並不一定會改變我們第四季度的軌跡。

Your next question is from the line of John Ransom with Raymond James.

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

I'm just thinking about sequential labor trends from 3Q to 4Q. I heard you say you gave the 4% update in 3Q. Does 4Q look flattish if you account for maybe continued reduction in temp labor? Or if you hit a plateau in that 7%-ish range that you talked about?

我只是在考慮從第三季度到第四季度的連續勞動力趨勢。我聽說你說你在第三季度提供了 4% 的更新。如果考慮到臨時工可能持續減少，第四季度是否看起來平淡？或者，如果你在你所說的那個 7% 左右的範圍內達到了一個平台期？

Well, I think it's something we're going to have to see. The contract labor levels, we feel good about, I mean, not only the progress we've made. This year, as you know, we were hovering around 9% in the early part in terms of contract labor [versus] SWB down to 7%. We think we can stay in that range for the balance of the year.

好吧，我認為這是我們必須看到的。我的意思是，我們對合同勞動水平感到滿意，不僅是我們取得的進步。如您所知，今年，我們在合同勞動方面徘徊在 9% 左右 [與] SWB 下降到 7%。我們認為我們可以在今年餘下時間保持在這個範圍內。

And so yes, I think we feel generally positive about the labor environment we're in. Too early to call specifically about, is it flat, is there some growth? But I think -- we think we can hold the majority of the contract labor trends. Some incremental improvement with utilization as we continue to see recruitment and retention improve. So again, I think we'll just have to see how it turns out, but we're feeling positive about the labor agenda at this point.

所以是的，我認為我們總體上對我們所處的勞動環境感到樂觀。現在談具體情況還為時過早，是否持平，是否有一些增長？但我認為 - 我們認為我們可以掌握大部分合同勞工趨勢。隨著我們繼續看到招聘和保留的改善，利用率得到了一些增量改進。再說一次，我認為我們只需要看看結果如何，但我們目前對勞工議程感到樂觀。

Your next question is from the line of Joshua Raskin with Nephron Research.

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

I was wondering, Bill, if you could give us an update on your returns that you're seeing on your capital expenditures, maybe how you're thinking about spend into 2023. And maybe related to capital, anything we should read into the lower share repurchases in the last quarter here?

我想知道，比爾，您能否向我們提供有關您在資本支出中看到的回報的最新信息，也許您如何考慮到 2023 年的支出。也許與資本有關，我們應該讀到較低的任何內容上個季度的股票回購在這裡？

No. This is Bill. I don't think there's anything you should read into that. And in terms of capital returns, we continue to see good projects to deploy capital. We continue to believe our total capital spending this year will hover around $4.2 billion. We're in the planning stages for next year, but I anticipate it stays materially in that range. And I think that is an indication of the opportunities we continue to see to put capital to work, to meet what will be a growing demand in both inpatient capacity as well as in outpatient and program development.

不，這是比爾。我不認為有什麼你應該讀進去的。在資本回報方面，我們繼續看到部署資本的好項目。我們仍然相信我們今年的總資本支出將徘徊在 42 億美元左右。我們正處於明年的計劃階段，但我預計它基本上會保持在這個範圍內。我認為這表明我們繼續看到將資金投入工作的機會，以滿足住院容量以及門診和項目開發方面日益增長的需求。

And again, I think with the cash profile of HCA, we've got a pretty balanced allocation of capital. The balance sheet is in a great position. I think our share repurchase program this year will hover around $7 billion for the full year. So again, I think it's strong allocation of capital. We're intending to drive reasonable returns going forward.

再說一次，我認為 HCA 的現金狀況，我們的資本分配相當平衡。資產負債表處於有利位置。我認為我們今年的股票回購計劃全年將徘徊在 70 億美元左右。再說一次，我認為這是強大的資本配置。我們打算在未來推動合理的回報。

And Bill, I think you've said in the past something around north of 15% total, total return on CapEx, including maintenance and growth. Is that still the right range? Are you guys still generating sort of mid-teens returns on those CapEx projects?

還有比爾，我想你過去曾說過，資本支出的總回報率大約在 15% 以上，包括維護和增長。這仍然是正確的範圍嗎？你們還在為那些資本支出項目產生十幾歲左右的回報嗎？

Yes. I mean, obviously, each project varies. But when I step up and look at our overall return on invested capital, we're in the high teens. So we're encouraged by the net effect of all of our investment decisions.

是的。我的意思是，顯然，每個項目都各不相同。但是當我站出來查看我們的投資資本總體回報率時，我們正處於十幾歲。因此，我們對所有投資決策的淨效應感到鼓舞。

Your next question is from the line of Jamie Perse with Goldman Sachs.

您的下一個問題來自高盛的 Jamie Perse。

I wanted to see if you could talk about length of stay. It's still quite elevated versus 2019. What are the key bottlenecks you're facing both on inpatient throughput as well as discharge? Do you think those will go away over the course of 2023? And what does that mean in terms of your capacity expansion and also managing costs on a per patient day or per admission basis?

我想看看你能不能談談逗留時間。與 2019 年相比，它仍然相當高。您在住院吞吐量和出院方面面臨的主要瓶頸是什麼？你認為這些會在 2023 年消失嗎？這對於您的容量擴展以及按患者日或每次入院管理成本而言意味著什麼？

I think one thing, this is Sam, that's important to understand, our length of stay is up over 2019. But our case mix is up even more. So when you look at our length of stay on a case mix adjusted basis, it's actually down. So that's encouraging.

我認為有一件事，這是山姆，了解這一點很重要，我們的逗留時間比 2019 年增加了。但我們的案例組合更多。因此，當您在調整病例組合的基礎上查看我們的逗留時間時，它實際上是下降的。所以這是令人鼓舞的。

Now we have opportunities. We have significant opportunities, we believe, with better case management protocols, better use of technology, better partnerships with subacute providers and our own providers in that space to really improve the throughput in our facility.

現在我們有機會了。我們相信，通過更好的病例管理協議、更好地利用技術、與亞急性提供者和我們自己的提供者在該領域建立更好的合作夥伴關係，我們有很大的機會來真正提高我們設施的吞吐量。

Just this past week, actually, we had an update on our case management agenda, and we continue to be encouraged by the progress incrementally that they're making. And we think as we move on into 2023, that will continue. That is a key part of our capacity management and labor management as well. So it's got a lot of efficiencies connected to it.

實際上，就在過去一周，我們對案例管理議程進行了更新，我們繼續為他們所取得的進展感到鼓舞。我們認為，隨著我們進入 2023 年，這種情況將繼續下去。這也是我們能力管理和勞動力管理的關鍵部分。所以它有很多與它相關的效率。

But we have significantly increased our case mix over 2019, and that's influenced our length of stay somewhat as well. But I believe our overall program, which is a key ingredient to our resiliency effort, is in fact, adding value and will continue to add value for our patients as well as for the efficiency and the throughput within our facilities.

但我們在 2019 年顯著增加了病例組合，這也對我們的逗留時間產生了一定影響。但我相信，我們的整體計劃是我們恢復能力工作的關鍵要素，實際上正在增加價值，並將繼續為我們的患者以及我們設施的效率和吞吐量增加價值。

Your next question is from the line of Calvin Sternick with JPMorgan.

您的下一個問題來自摩根大通的 Calvin Sternick。

I think you noted the impact that capacity had on volumes in the quarter. Just curious, I guess, one, if you think that's going to be relatively consistent going into the fourth quarter.

我想你注意到了產能對本季度銷量的影響。只是好奇，我猜，一個，如果你認為進入第四季度會相對一致。

And then it looks like same-store ER visits picked up a bit sequentially. Just curious, are you starting to see some more episodic care start to bounce back in that setting? And has there been any shift in the payer mix you're seeing there?

然後看起來同店 ER 訪問量有所增加。只是好奇，您是否開始看到更多的偶發性護理開始在這種情況下反彈？您在那裡看到的付款人組合是否有任何變化？

We will still have some capacity constraints in the fourth quarter. I'm hopeful that we will relieve some of it with our recruitment agenda and the fact that we're adding more headcount and opening beds. I think also, as I just mentioned, our case management efforts will create capacity for us as well.

在第四季度，我們仍將面臨一些產能限制。我希望我們能夠通過我們的招聘議程以及我們正在增加更多的員工人數和開放床位這一事實來減輕一些負擔。我還認為，正如我剛才提到的，我們的案例管理工作也會為我們創造能力。

So -- but I do anticipate us having some closures here and there with respect to being able to take new patients at certain times. It just unfortunately happened at this particular point. And it happened pre-pandemic, but on a much lower level than it is today.

所以 - 但我確實預計我們會在這里和那里關閉一些關於能夠在特定時間接收新患者的情況。不幸的是，它發生在這個特定的時刻。它發生在大流行之前，但比今天低得多。

As it relates to the ER, we've been impressed by how resilient our emergency room services are. We continue to work on our operations and our throughput within our emergency rooms so we can take care of people as they deserve to be taken care of. We've added capacity with our overall platform of emergency room offerings inside of our hospitals as well as some of our freestanding facilities, and that's been important to our outreach in that area. We believe fundamentally that the emergency room is a key ingredient to the health care system overall, and it provides a very important 24/7, 365 capability for our communities. And so we're still investing, as I mentioned, in our emergency rooms in very selective ways in order to make sure that we have the right supply available for what we believe to be growing demand.

由於它與急診室有關，我們對急診室服務的彈性印象深刻。我們將繼續致力於我們的運營和急診室的吞吐量，以便我們能夠照顧那些值得照顧的人。我們通過醫院內急診室產品的整體平台以及我們的一些獨立設施增加了容量，這對我們在該領域的外展工作很重要。我們從根本上認為，急診室是整個醫療保健系統的關鍵組成部分，它為我們的社區提供了非常重要的 24/7、365 功能。因此，正如我所提到的，我們仍在以非常有選擇性的方式對我們的急診室進行投資，以確保我們有合適的供應來滿足我們認為不斷增長的需求。

Your next question is from the line of Stephen Baxter with Wells Fargo.

您的下一個問題來自富國銀行的 Stephen Baxter。

I wanted to ask about the mix of outpatient revenue in the quarter. It looks like that stepped down a bit more than you might have expected in a typical year. What should we think about as the key drivers of that? I guess, with some distance, does it look like Q2 might have benefited from some pent-up demand? And it doesn't sound like it based on your comments, but any impact you'd flag from outpatient surgeries moving back to inpatient at least maybe compared to earlier in the year?

我想問一下本季度門診收入的組合。看起來這比你在典型年份的預期要低一些。作為其中的關鍵驅動因素，我們應該考慮什麼？我想，在一定距離內，第二季度看起來是否可能受益於一些被壓抑的需求？根據您的評論，這聽起來不像，但您認為門診手術轉回住院病人的任何影響至少可能與今年早些時候相比？

No, I don't think there's anything structurally. I think the outpatient revenue last year was busy during the Delta COVID -- the Delta surge when inpatient capacity was being managed and constrained and potentially, we saw more activity in outpatient of second quarter last year. But in terms of sequential trends, we don't see anything structurally different going on between Q3 and Q2 on outpatient trends.

不，我認為結構上沒有任何東西。我認為去年的門診收入在 Delta COVID 期間很忙——當住院容量受到管理和限制時，Delta 激增，並且可能，我們看到去年第二季度的門診活動更多。但就連續趨勢而言，我們沒有看到第三季度和第二季度在門診趨勢方面存在任何結構性差異。

And today's final question comes from the line of Sarah James with Barclays.

今天的最後一個問題來自巴克萊銀行的莎拉詹姆斯。

Has there been a lift to acuity mix in '22 from some of the low acuity falling off related to consumer reactions, either due to COVID or the economy? And what would that do to revenue per admission as it normalizes?

由於 COVID 或經濟原因，與消費者反應相關的一些低敏銳度下降是否使 22 年的敏銳度組合有所提升？當它正常化時，這會對每次入場的收入產生什麼影響？

And then just a quick clarification. Earlier, you mentioned the '24 payer contract has labor cost escalators. Can you clarify if that's static or dynamic? Because I think some of the [acutes] we're talking about dynamic escalators coming in to reflect labor cost fluctuations.

然後只是一個快速的澄清。早些時候，您提到 '24 付款人合同有人工成本自動扶梯。你能澄清一下這是靜態的還是動態的？因為我認為我們正在談論的一些 [急性] 動態自動扶梯進來反映勞動力成本波動。

This is Sam. I'll answer the last question. Most of our inflators are static. We do have some contracts that have corridors, if you want to call that, or dynamic components to it with respect to inflation. So most of our '24 will be more of a static inflator that we negotiate on the front end. And so that's how most of our contracts are structured.

這是山姆。我會回答最後一個問題。我們的大多數充氣機都是靜態的。我們確實有一些合同有走廊，如果你想稱之為走廊，或者與通貨膨脹有關的動態組件。因此，我們 24 年的大部分內容將更像是我們在前端協商的靜態充氣機。這就是我們大多數合同的結構。

Yes. In terms of the case mix, I mean, we're seeing some growth in our non-COVID case mix trends. We've been -- case mix has been stable for us. So we haven't noticed any remarkable decline in that.

是的。就病例組合而言，我的意思是，我們看到非 COVID 病例組合趨勢有所增長。我們一直 - 案例組合對我們來說一直很穩定。所以我們沒有註意到任何顯著的下降。

In the COVID business, obviously, COVID ran a higher case mix than our non-COVID. So that's been a factor. But when we look at basic trends or the acuity levels have been stable, mostly between Q3 and Q2. So we're reading that as a fairly positive indicator.

顯然，在 COVID 業務中，COVID 的案例組合比我們的非 COVID 更高。所以這是一個因素。但是當我們查看基本趨勢或敏銳度水平時，主要是在第三季度和第二季度之間。因此，我們將其視為一個相當積極的指標。

Okay. So there's not a falloff of low acuity non-COVID just from people either worried about the economy or COVID that's kind of...

好的。因此，僅僅因為擔心經濟或 COVID 的人們，非 COVID 的低敏銳度並沒有下降，這有點……

No, we're not seeing anything of that trend at this stage.

不，在這個階段我們沒有看到任何這種趨勢。

And at this time, there are no further questions. Please continue with any closing remarks.

而此時，沒有進一步的問題。請繼續任何結束語。

Dennis, thank you so much for your help today. Thanks, everyone, for joining us on the call. Hope you have a wonderful weekend. I'm around this afternoon, if I can answer any additional questions. Thank you very much.

丹尼斯，非常感謝你今天的幫助。謝謝大家加入我們的電話會議。希望你有一個美好的周末。我今天下午就到了，如果我能回答任何其他問題。非常感謝。

This concludes the HCA Healthcare Third Quarter 2022 Earnings Conference Call. Thank you for your participation. You may now disconnect.

HCA Healthcare 2022 年第三季度收益電話會議到此結束。感謝您的參與。您現在可以斷開連接。