美國醫院公司 (HCA) 2022 Q4 法說會逐字稿

Good morning, and welcome to the HCA Healthcare Fourth Quarter 2022 Earnings Conference Call. Today's call is being recorded. 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.

早上好，歡迎來到 HCA Healthcare 2022 年第四季度收益電話會議。今天的通話正在錄音中。現在，關於開場白和介紹，我想把電話轉給投資者關係副總裁 Frank Morgan 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 a few questions. Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements that 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.

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；和首席財務官 Bill Rutherford。 Sam 和 Bill 將提供一些準備好的評論，然後我們將回答幾個問題。在我把電話轉給 Sam 之前，讓我提醒大家，今天的電話應該包含任何基於管理層當前預期的前瞻性陳述。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列在今天的新聞稿和我們向美國證券交易委員會提交的各種文件中。

On this morning's call, 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.

在今天上午的電話會議上，我們可能會參考調整後的 EBITDA 等指標，這是一項非 GAAP 財務指標。今天的新聞稿中包含一張表格，其中提供了有關調整後 EBITDA 的補充信息以及歸屬於 HCA Healthcare, Inc. 的調節淨收入。

This morning's call is being recorded, and a replay of the call will be available later today. With that, I'll now turn the call over to Sam.

今天上午的通話正在錄音中，今天晚些時候將提供通話重播。有了這個，我現在將電話轉給山姆。

All right. Good morning, and thank you for joining the call. We finished 2022 as expected, with prepandemic seasonality demand norms, driving solid volume growth. Additionally, we continue to see progress with our labor agenda. These factors helped produce solid earnings in the fourth quarter that were consistent with our guidance. We are encouraged by this outcome and believe this operational momentum should position us well for 2023. 2022 was a tale of 2 halves, with the first half being more about winding down from the previous 2 years of intense COVID activity and responding to the resulting challenges.

好的。早上好，感謝您加入電話會議。我們按預期結束了 2022 年，大流行前的季節性需求規範推動了穩健的銷量增長。此外，我們繼續看到我們的勞工議程取得進展。這些因素有助於在第四季度產生符合我們指引的穩健收益。我們對這一結果感到鼓舞，並相信這種運營勢頭應該會讓我們在 2023 年處於有利地位。2022 年是一個分為兩半的故事，上半年更多是關於從前 2 年的激烈 COVID 活動中逐漸結束，並應對由此產生的挑戰.

The second half was more about normalization, which included strong demand and an improving labor market. Once again, I believe our people have demonstrated an impressive capability in the face of these dynamic forces and delivered for our patients, the communities we serve and other stakeholders. Health care people in general are unique, but I believe HCA Healthcare people are even more special, often refer to them as can-do people, and again, this past year, I think they proved it. I want to thank them for their hard work and everything they do each and every day for our company.

下半年更多是關於正常化，其中包括強勁的需求和改善的勞動力市場。再一次，我相信我們的員工在面對這些動態力量時表現出了令人印象深刻的能力，並為我們的患者、我們服務的社區和其他利益相關者提供了幫助。一般來說，醫療保健人員是獨一無二的，但我相信 HCA Healthcare 人員更加特別，經常稱他們為能幹的人，而且，在過去的一年裡，我認為他們再次證明了這一點。我要感謝他們的辛勤工作以及他們每天為我們公司所做的一切。

Same-facility volumes across the company were strong in the fourth quarter. Admissions grew 3% year-over-year. Non-COVID admissions increased in excess of 5%. Equivalent admissions were up 5.4%, with impressive growth of 11% in the emergency room. Most of our other volume categories had solid growth metrics in the quarter also.

整個公司的同設施銷量在第四季度表現強勁。入學人數同比增長 3%。非 COVID 入院人數增加了 5% 以上。等效入院人數增長了 5.4%，急診室增長了 11%，令人印象深刻。我們大多數其他銷量類別在本季度也有穩健的增長指標。

The payer mix and acuity levels in the quarter remained at favorable levels. These factors produced revenue growth against a difficult comparison of 3% in the quarter.

本季度的付款人組合和敏銳度水平保持在有利水平。這些因素導致收入增長與本季度 3% 的艱難對比。

With respect to our people agenda, we were pleased with the improvements we saw in key metrics. Turnover numbers for registered nurses were down 26% in the fourth quarter as compared to the previous 4 quarters' average. Our turnover rate is still higher than we want, but we believe it is better than the industry average.

關於我們的人員議程，我們對在關鍵指標中看到的改進感到滿意。與前四個季度的平均水平相比，第四季度註冊護士的流動率下降了 26%。我們的離職率仍然比我們想要的要高，但我們相信它比行業平均水平要好。

Employee engagement scores recovered to around prepandemic levels. Again, our engagement is above the industry average. Our recruiting teams continue to generate results for the company, hiring increased 6% year-over-year in 2022. And lastly, we opened our seventh Galen College of Nursing School this year.

員工敬業度得分恢復到大流行前的水平。同樣，我們的參與度高於行業平均水平。我們的招聘團隊繼續為公司創造成果，2022 年招聘人數同比增長 6%。最後，我們今年開設了第七所蓋倫護理學院。

With respect to labor cost during the quarter, we experienced stable labor cost per hour with utilization of contract labor declining. As we have detailed in the past, we have implemented a robust human resources plan. We executed well on it and expect to make further progress as we move into 2023. It remains a top organizational priority. Even with the progress, we continued this quarter to experience capacity constraints, creating situations where we were unable to deliver services in certain situations. Also in the quarter, we saw value from our portfolio optimization plan and closed 2 joint ventures with strategic partners, one was with our Sarah Cannon Research Institute, which we combined with McKesson's Cancer Research entity. We believe the combination of these 2 entities will produce better cancer research and more clinical trials across the country, providing even more community-based resources for physicians and patients to fight this disease.

在本季度的勞動力成本方面，我們的每小時勞動力成本穩定，合同工的使用率下降。正如我們過去詳述的那樣，我們實施了一項強有力的人力資源計劃。我們在這方面執行得很好，並希望在進入 2023 年時取得進一步進展。它仍然是組織的首要任務。即使取得了進展，我們在本季度繼續遇到容量限制，造成我們無法在某些情況下提供服務的情況。同樣在本季度，我們從我們的投資組合優化計劃中看到了價值，並關閉了與戰略合作夥伴的 2 家合資企業，其中一家是我們的 Sarah Cannon 研究所，我們將其與 McKesson 的癌症研究實體合併。我們相信這兩個實體的結合將在全國范圍內產生更好的癌症研究和更多的臨床試驗，為醫生和患者提供更多基於社區的資源來對抗這種疾病。

The second co-venture is with our core trust purchasing organization. We closed on a new partnership with Blackstone. We believe this new relationship can expand our ability to offer commercial purchasing and services solutions to a broader variety of customers. We believe both of these deals achieved our strategic objectives, and connected us with a better platforms for success in the future. We are excited to partner with both entities.

第二家合資企業是與我們的核心信託採購組織。我們與 Blackstone 建立了新的合作夥伴關係。我們相信這種新的關係可以擴大我們為更廣泛的客戶提供商業採購和服務解決方案的能力。我們相信這兩項交易都實現了我們的戰略目標，並為我們未來的成功搭建了一個更好的平台。我們很高興與這兩個實體合作。

We also implemented our capital plan for the year as expected, including redeploying the proceeds from these 2 new joint ventures. Bill will provide more details in his comments. And finally, we announced in the last quarter a significant leadership transition that we believe will position the organization better with responding timelier to market dynamics, while also strengthening the alignment of corporate functions to our strategy. The executives who are part of this transition are all proven HCA executives, they understand and appreciate our culture, and they know how to execute.

我們還按預期實施了當年的資本計劃，包括重新部署這兩家新合資企業的收益。比爾將在他的評論中提供更多細節。最後，我們在上個季度宣布了重大的領導層交接，我們相信這將使組織更好地定位，更及時地響應市場動態，同時加強公司職能與我們戰略的一致性。參與此次過渡的高管都是久經考驗的 HCA 高管，他們了解並欣賞我們的文化，並且知道如何執行。

As we push ahead into 2023 and beyond, we believe the strong demand for health care services presents opportunity for HCA Healthcare in an otherwise challenging macro environment. We believe the company is well positioned culturally, competitively and financially to capitalize. Our agenda next year will be focused on the following 3 areas: First, overcoming labor and capacity challenges. Again, we believe we have the appropriate initiatives in place to respond to these. Second, counter inflationary pressures. Again, we have numerous efforts in place to contend with these forces, while ensuring we continue to deliver high-quality outcomes to our patients. And third, accelerating growth with our winning plays. This agenda continues to leverage capital investments in outpatient facilities, clinical equipment for our physicians and service line expansion.

隨著我們進入 2023 年及以後，我們相信對醫療保健服務的強勁需求為 HCA Healthcare 在充滿挑戰的宏觀環境中提供了機會。我們相信該公司在文化、競爭和財務方面都處於有利地位，可以利用。我們明年的議程將集中在以下三個方面：第一，克服勞動力和產能挑戰。同樣，我們相信我們有適當的舉措來應對這些問題。二是抗通脹壓力。同樣，我們做出了許多努力來應對這些力量，同時確保我們繼續為我們的患者提供高質量的結果。第三，通過我們的製勝法寶加速增長。該議程繼續利用對門診設施、醫生臨床設備和服務線擴展的資本投資。

On top of our 2023 agenda, we are also making investments in our long-term plan, which includes 4 primary elements: the first one is advancing our clinical systems and digital capabilities. Second is transforming care models with innovative solutions; third is expanding our workforce development programs; and fourth, is investing capital in our networks to expand their offerings. These efforts are pressuring our results some in the current year, but we believe they are necessary in creating a platform for ultimately optimizing our networks so they can deliver even better patient care in the future.

除了我們的 2023 年議程之外，我們還在對我們的長期計劃進行投資，其中包括 4 個主要要素：第一個是提升我們的臨床系統和數字能力。其次是通過創新解決方案轉變護理模式；第三是擴大我們的勞動力發展計劃；第四，正在對我們的網絡進行投資以擴大他們的產品範圍。這些努力給我們今年的一些成果帶來了壓力，但我們認為，它們對於創建一個平台以最終優化我們的網絡是必要的，這樣他們就可以在未來提供更好的患者護理。

Let me close with this. The last 3 years have been an extraordinary experience for everyone at HCA Healthcare. There's been no rest, nor retreat for our people, and it was truly a challenge like no other. I strongly believe, however, that our Board, our management teams and our caregivers have shined through it all. We went into the pandemic with 2 priorities, to protect our people and to protect the organization so we could continue providing high-quality health care to the communities we serve. I believe strongly that we showed up, we delivered on these priorities, and we did it the right way. I am proud of HCA Healthcare, and I'm even more proud of our people. The future for our company is even brighter because of the past 3 years and what we learned.

讓我結束這個。過去 3 年對 HCA Healthcare 的每個人來說都是非凡的經歷。我們的人民沒有休息，也沒有撤退，這確實是一次與眾不同的挑戰。然而，我堅信，我們的董事會、我們的管理團隊和我們的護理人員在這一切中都表現出色。我們以兩個優先事項進入大流行，保護我們的人民和保護組織，以便我們能夠繼續為我們服務的社區提供高質量的醫療保健。我堅信我們出現了，我們實現了這些優先事項，並且我們以正確的方式做到了。我為 HCA Healthcare 感到自豪，更為我們的員工感到自豪。由於過去 3 年和我們所學到的知識，我們公司的未來更加光明。

Now we will move into 2023 and the years ahead with greater purpose, with a renewed agenda to drive growth and with more confidence in our ability to deliver value for all of our stakeholders. With that, I will turn the call to Bill, and he will discuss the quarter's results in more detail, and our 2023 guidance.

現在，我們將帶著更大的目標邁入 2023 年和未來的歲月，制定新的議程來推動增長，並對我們為所有利益相關者創造價值的能力更有信心。有了這個，我將把電話轉給比爾，他將更詳細地討論本季度的結果以及我們 2023 年的指導。

Okay. Thank you, Sam, and good morning, everyone. I will provide some additional comments on our performance for the quarter and the year, then discuss our '23 guidance.

好的。謝謝你，山姆，大家早上好。我將對我們本季度和本年度的業績提供一些額外的評論，然後討論我們的 23 年指導方針。

We finished the year with good volume metrics. Our fourth quarter same facility admissions increased 2.9% over the prior year. For the full year, our same-facility admissions were up 0.5%. Excluding COVID admissions, our same-facility admissions grew 5.4% in the quarter and were up 3.4% for the year. For the full year, COVID admissions accounted for 5.2% of our admissions versus 7.8% in the prior year. Same-facility emergency room visits increased 11.4% in the quarter as compared to the prior year, and were up 7.6% for the full year. Our same-facility outpatient surgeries were up slightly in the quarter from the prior year, but increased 5.6% sequentially compared to the third quarter. Same-facility inpatient surgeries were basically flat as compared to the prior year. Both were impacted by one less business day in the quarter.

我們以良好的銷量指標結束了這一年。我們第四季度的同一設施入場人數比去年同期增長了 2.9%。全年，我們的同設施入學率上升了 0.5%。不包括 COVID 入場人數，本季度我們的同設施入場人數增長了 5.4%，全年增長了 3.4%。全年，COVID 入學人數占我們入學人數的 5.2%，而去年為 7.8%。與去年同期相比，本季度同一設施的急診室就診量增長了 11.4%，全年增長了 7.6%。本季度我們的同設施門診手術量較上年同期略有上升，但與第三季度相比環比增長 5.6%。同設施住院手術與上年相比基本持平。兩者都受到本季度減少一個工作日的影響。

Our same-facility revenue per equivalent admission was down 2.6% in the quarter from the prior year as this was influenced by the drop in COVID activity. Sequentially, our non-COVID revenue per equivalent admission increased approximately 3.7% as compared to the third quarter.

本季度，我們的同等入場人數的同一設施收入較上年同期下降 2.6%，這是受到 COVID 活動下降的影響。因此，與第三季度相比，我們每次等效入場的非 COVID 收入增長了約 3.7%。

Our case mix increased just under 2% sequentially from the third quarter, and our payer mix remained stable as well. We remain pleased with our team's management of operating costs even with the backdrop of higher inflation rates. Our consolidated adjusted EBITDA margins were 20.5% in the quarter and right at 20% for the full year. We continue to focus on our labor plans and supporting our teams, while appropriately managing contract labor and premium pay programs. Our total labor cost as a percentage of revenue improved both sequentially and when compared to the prior year.

從第三季度開始，我們的案件組合環比增長略低於 2%，我們的付款人組合也保持穩定。即使在通貨膨脹率較高的背景下，我們仍然對我們團隊的運營成本管理感到滿意。我們本季度的綜合調整後 EBITDA 利潤率為 20.5%，全年為 20%。我們繼續專注於我們的勞動力計劃和支持我們的團隊，同時適當地管理合同工和保費計劃。我們的總勞動力成本佔收入的百分比無論是環比還是與上一年相比都有所改善。

In addition, our supply cost trends have remained very consistent during the year, and we are pleased with these results. Other operating expenses have been subject to some inflationary cost pressures when compared to the prior year, but has run fairly consistent as a percent of revenue throughout 2022. Our cash flow and capital allocation are a key part of our long-term growth and value-creation strategies. Our cash flow from operations was $8.5 billion in 2022. Our capital spending was just under $4.4 billion for the year, which was slightly higher than our initial expectations due to some year-end real estate and information technology purchases.

此外，我們的供應成本趨勢在這一年中保持非常一致，我們對這些結果感到滿意。與上一年相比，其他運營支出受到了一些通脹成本壓力，但在整個 2022 年佔收入的百分比相當穩定。我們的現金流和資本配置是我們長期增長和價值的關鍵部分-創作策略。 2022 年，我們的運營現金流為 85 億美元。我們全年的資本支出略低於 44 億美元，由於年底的一些房地產和信息技術採購，略高於我們最初的預期。

We paid dividends of about $650 million, and we repurchased $7 billion of our outstanding stock during the year. Our debt to adjusted EBITDA leverage ratio was near the low end of our stated leverage range of 3 to 4x. For full year 2022, we realized approximately $1.2 billion in proceeds from sales of facilities and health care entities.

我們支付了約 6.5 億美元的股息，並在這一年回購了 70 億美元的已發行股票。我們的債務與調整後 EBITDA 槓桿比率接近我們規定的 3 至 4 倍槓桿範圍的低端。 2022 年全年，我們從設施和醫療保健實體的銷售中實現了約 12 億美元的收益。

So let me speak to our 2023 guidance for a moment. As noted in our release this morning, we are providing full year '23 guidance as follows: we expect revenues to range between $61.5 billion and $63.5 billion. We expect net income attributable to HCA Healthcare to range between $4.525 billion and $4.895 billion. We expect full year adjusted EBITDA to range between $11.8 billion and $12.4 billion. We expect full year diluted earnings per share to range between $16.40 and $17.60. And we expect capital spending to approximate $4.3 billion during the year. So let me provide some additional commentary on our guidance.

因此，讓我談談我們的 2023 年指南。正如我們今天早上發布的那樣，我們將提供 23 年全年指導如下：我們預計收入將在 615 億美元至 635 億美元之間。我們預計歸屬於 HCA Healthcare 的淨收入在 45.25 億美元至 48.95 億美元之間。我們預計全年調整後的 EBITDA 將在 118 億美元至 124 億美元之間。我們預計全年攤薄後每股收益在 16.40 美元至 17.60 美元之間。我們預計這一年的資本支出約為 43 億美元。因此，讓我對我們的指南提供一些額外的評論。

Our 2023 adjusted EBITDA guidance is impacted by several governmental and policy changes. In 2022, we recognized approximately $280 million in COVID support mainly from DRG add-ons, removal of sequestration cuts and HRSA reimbursement for uninsured COVID patients. We expect very little revenue from these programs in 2023. Also, as discussed in our first quarter release, we recognized $244 million of revenues and $90 million of expenses related to the Texas directed payment program that was for the last 4 months of 2021. This program that started on September 1, '21 was not improved until the first quarter of 2022. In addition, we estimate the impact of the 340B related payment reductions to be between $50 million and $100 million.

我們 2023 年調整後的 EBITDA 指引受到多項政府和政策變化的影響。 2022 年，我們確認了約 2.8 億美元的 COVID 支持，主要來自 DRG 附加組件、去除隔離削減和 HRSA 對未投保 COVID 患者的報銷。我們預計 2023 年這些計劃的收入很少。此外，正如我們在第一季度發布的報告中所討論的那樣，我們確認了與 2021 年最後 4 個月的德克薩斯州定向支付計劃相關的 2.44 億美元收入和 9000 萬美元費用。這21 年 9 月 1 日開始的計劃直到 2022 年第一季度才有所改善。此外，我們估計與 340B 相關的付款減少的影響在 5000 萬至 1 億美元之間。

Adjusted for these items, the midpoint of our 2023 adjusted EBITDA guidance would be in the middle of our historical 4% to 6% growth expectations that we have had over time. Within our guidance, we expect our same facility equivalent admissions to grow approximately 2% to 3%, and our revenue per equivalent admission to grow approximately 2%.

針對這些項目進行調整後，我們 2023 年調整後的 EBITDA 指引的中點將處於我們長期以來對 4% 至 6% 的歷史增長預期的中間。在我們的指導下，我們預計我們相同設施的同等入場人數將增長約 2% 至 3%，而我們的同等入場收入將增長約 2%。

Depreciation is estimated to be about $3.1 billion and interest expense is projected to be around $1.975 billion. Interest expense will be impacted by both higher rates and anticipated draws under our revolving credit facilities.

折舊估計約為 31 億美元，利息支出預計約為 19.75 億美元。利息支出將受到更高利率和我們循環信貸安排下預期提款的影響。

Finally, our fully diluted shares are expected to be about $278 million for the full year, and cash flow from operations is estimated to range between $8.5 billion and $9 billion.

最後，我們全年完全稀釋後的股份預計約為 2.78 億美元，運營現金流估計在 85 億美元至 90 億美元之間。

Also noted in our release this morning, our Board of Directors has authorized a new $3 billion share repurchase program. This will be in addition to the approximate $1.5 billion remaining authorization we had under the previous program at the end of the year. In addition, our Board has declared an increase in our quarterly dividend from $0.56 to $0.60 per share.

我們在今天上午發布的新聞稿中還指出，我們的董事會已批准一項新的 30 億美元的股票回購計劃。這將是我們在年底根據先前計劃獲得的大約 15 億美元剩餘授權的補充。此外，我們的董事會已宣布將季度股息從每股 0.56 美元增加到 0.60 美元。

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

有了這個，我會把電話轉給弗蘭克，我們會打開它進行問答。

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

謝謝你，比爾。 （操作員說明）德文，你現在可以向那些想問問題的人提供說明。

(Operator Instructions) Our first question comes from Justin Lake with Wolfe Research.

（操作員說明）我們的第一個問題來自 Wolfe Research 的 Justin Lake。

Just a couple of numbers questions here. I appreciate all the detail you've given. So first, just all thinking about 2023, can you talk us a little bit about what you're expecting for labor expense and maybe delineate the cost on permanent labor versus hopefully the downward trend, maybe give us '22 versus '23 on contract labor? And then a couple of things, exchanges and redetermination, right? Exchange growth has been big, redeterminations could be a tailwind, at least according to our estimates. Curious what you've assumed there on payer mix and kind of impact from that on 2023 guide as well?

這裡只是幾個數字問題。我很感激你提供的所有細節。因此，首先，只考慮 2023 年，您能否談談您對勞動力費用的預期，並可能描述永久性勞動力的成本與希望下降趨勢，也許給我們 '22 與 '23 合同工？然後是一些事情，交換和重新確定，對嗎？交易所增長一直很大，重新確定可能是順風，至少根據我們的估計。想知道您對付款人組合的假設以及它對 2023 年指南的影響嗎？

Yes. Justin, this is Bill. Let me start. So as it relates to labor cost, I think as a percentage of revenue, we'll keep it on an as-reported basis, flat with where we ran for the full year of this year. We continue to expect improvement in the utilization and cost of contract labor as we go through the balance of the year. And so I think that's a good output for us.

是的。賈斯汀，這是比爾。讓我開始吧。因此，由於它與勞動力成本有關，我認為作為收入的百分比，我們將保持在報告的基礎上，與我們今年全年的運行情況持平。我們繼續預計，隨著今年餘下時間的推移，合同工的利用率和成本將有所改善。所以我認為這對我們來說是一個很好的輸出。

Relative to payer mix, we think payer mix for now will mostly remain stable. We are encouraged with what we are seeing with the enrollment in the health insurance exchanges. And we believe the enrollment in our states are probably a little bit higher than what we see as a nation. And so we think we've contemplated that within the context of our overall range. But we are encouraged with some of the payer mix trends.

相對於付款人組合，我們認為目前的付款人組合將基本保持穩定。我們對健康保險交易所的註冊情況感到鼓舞。我們相信我們各州的入學率可能比我們作為一個國家看到的要高一點。因此，我們認為我們已經在我們的整體範圍內考慮了這一點。但我們對一些付款人組合趨勢感到鼓舞。

Our next question comes from A.J. Rice with Credit Suisse.

我們的下一個問題來自 A.J.瑞士信貸的大米。

Thanks for the outlook commentary and so forth. Maybe because you've got about a $600 million range on the EBITDA, range you're looking at. Can you maybe talk a little bit about what are some of the swing factors? Do you see those mainly as top line swing factors that would get you to the high or low end? Or is there expense management, open questions in your mind? And specifically on the labor, you've got quite a bit of a decline in the contract labor from what you spent in '22 versus presumably the run rate for '23. How much of that are you baking into the guidance versus how much are you saying you've got to redeploy to support permanent labor?

感謝您的展望評論等。也許是因為您在 EBITDA 上有大約 6 億美元的範圍，您正在查看的範圍。您能否談談一些搖擺因素？您是否將這些主要視為可以使您達到高端或低端的頂線搖擺因素？或者您是否有費用管理，懸而未決的問題？特別是在勞動力方面，與 22 年的支出相比，與 23 年的運行率相比，你的合同工有相當大的下降。你在指南中提到了多少，而你說你必須重新部署以支持永久性勞動力有多少？

A.J., this is Sam. I think on the guidance, I mean, we've got 2.5%, I believe, on either side of the midpoint. The top side of that range, I think, is achievable if our volume and labor agenda happens, maybe a little bit better than what we anticipate. The low side of that range would be greater inflationary pressures and maybe some more challenges in a tenuous labor market. Those are sort of the big variables, if you will, in the equation. I mean it's a fairly big number to begin with, and again, the 2.5% range on either side of the midpoint, we think, is not unreasonable. So to consider it to be very wide seems maybe to not fully appreciate some of the variables inside of it.

A.J.，這是山姆。我認為在指導上，我的意思是，我相信，我們在中點兩側各有 2.5%。我認為，如果我們的數量和勞動力議程發生，這個範圍的頂端是可以實現的，可能比我們預期的要好一點。該範圍的低端將是更大的通脹壓力，並且可能在脆弱的勞動力市場中面臨更多挑戰。如果你願意的話，這些是等式中的大變量。我的意思是一開始這是一個相當大的數字，而且我們認為，中點兩側 2.5% 的範圍並非不合理。因此，認為它非常廣泛似乎可能沒有完全理解其中的一些變量。

With respect to labor, yes, we have made significant investments in our people. We did that throughout last year, mainly in the late summer, early fall, where we adjusted our wages to deal with movement in the market, resulting from some visibility that we had with our overall competitive positioning. Some of the contract labor reductions that we expect and have already made even will be absorbed a little bit in those decisions, but we think the net of it is what Bill just alluded to, and that is that we can maintain our labor cost as a percent of revenue roughly around what we finished 2022 at. So that's how we're thinking about it. And again, we're seeing positive metrics across the key dimensions of our labor agenda that is encouraging to us. And we believe we have more room to gain with our agenda, and we're hopeful that, that will continue throughout 2023.

在勞動力方面，是的，我們對我們的員工進行了大量投資。我們在去年全年都這樣做了，主要是在夏末秋初，我們調整了工資以應對市場的變化，這是由於我們對整體競爭定位的一些了解。我們預期甚至已經做出的一些合同工削減將在這些決定中得到一點吸收，但我們認為它的淨值就是比爾剛才提到的，那就是我們可以將我們的勞動力成本維持在收入的百分比大致在我們 2022 年完成的水平附近。這就是我們考慮的方式。再一次，我們在勞工議程的關鍵方面看到了積極的指標，這對我們來說是令人鼓舞的。我們相信我們有更多的空間來實現我們的議程，我們希望這將持續到 2023 年。

Our next question comes from Gary Taylor with Cowen.

我們的下一個問題來自 Gary Taylor 和 Cowen。

Two quick ones for me. Bill, I know you said contract labor came down again, but I didn't catch if you disclosed the 4Q number. And then my other one was just also on your comment about the other OpEx line. I mean that's still a line that on a per adjusted patient day basis is up in the double digits. So any help you can give us on thinking about modeling that for '23?

兩個快速的給我。比爾，我知道你說合同工又下降了，但如果你透露了第 4 季度的數字，我沒聽清。然後我的另一個也只是關於你對另一條 OpEx 線的評論。我的意思是，在每個調整後的患者日基礎上，這仍然是兩位數增長的線。那麼，您可以幫助我們考慮為 23 年建模嗎？

Yes, Gary. On contract labor for the quarter, we were down about 16% from where we ran in the fourth quarter of last year. So continued good improvement in that area. It represented roughly 7.8% of our total salary wages and benefits. We talked about given that number before. So again, solid trends in the fourth quarter of this year compared to where we ran last year and especially where we ran in the first half of the year. Our other operating expenses, you're right, are subject to some of the general inflationary increases that we're seeing across the economy. When we think about utilities and insurance, and in addition, our professional fees areas, we're seeing some higher single-digit cost growth and other operating expenses.

是的，加里。在本季度的合同工方面，我們比去年第四季度下降了約 16%。因此，在該領域繼續取得良好進展。它約占我們工資和福利總額的 7.8%。我們之前談到過這個數字。因此，與我們去年的運行情況相比，今年第四季度的穩定趨勢再次出現，尤其是與我們在今年上半年的運行情況相比。我們的其他運營費用，你是對的，受到我們在整個經濟中看到的一些普遍通貨膨脹的影響。當我們考慮公用事業和保險，以及我們的專業費用領域時，我們看到一些更高的個位數成本增長和其他運營費用。

Fortunately, if you look across the quarters for 2022, as a percentage of revenue, you'll see our other operating expenses as a percent of revenue staying relatively flat and pretty consistent throughout the year. As we look forward to 2023, we do believe that's an area that can continue to see some higher single-digit inflationary pressures, and we factored that in to our guidance going forward. Again, we think labor supplies will keep in line and hopefully below where our revenue growth is. But the other operating cost area is around utilities, insurance pro fees are going to continue to see some pressures, and we factor that into our guidance.

幸運的是，如果您縱觀 2022 年各個季度佔收入的百分比，您會發現我們的其他運營支出佔收入的百分比在全年保持相對平穩且相當穩定。當我們展望 2023 年時，我們確實相信這是一個可以繼續看到更高的個位數通脹壓力的領域，我們將其納入我們未來的指導中。同樣，我們認為勞動力供應將保持一致，並有望低於我們的收入增長水平。但另一個運營成本領域是公用事業，保險專業費用將繼續面臨一些壓力，我們將其納入我們的指導。

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

我們的下一個問題來自 RBC Capital Markets 的 Ben Hendrix。

With regard to capacity constraints, you mentioned last quarter missing out on 1% to 1.5% of total admissions in 3Q. Can you give us an update on where that stands now? And then maybe some more commentary on progress with your HR and case management initiatives, and then the degree to which you expect those to help ease constraints and support your guidance this year?

關於容量限制，您提到上個季度錯過了第三季度總入場人數的 1% 至 1.5%。你能告訴我們現在的最新情況嗎？然後可能對您的人力資源和案例管理計劃的進展發表更多評論，然後您希望這些計劃在多大程度上幫助緩解限制並支持您今年的指導？

This is Sam. Thank you for that. I mean we did, as I mentioned in my prepared comments, had some moments in the quarter where we were unable to receive transfers in or take certain patients into our facilities. And that was actually a little bit elevated over the third quarter. We had roughly, using this as the proxy, approximately 2% of our total admissions we were unable to take through our transfer centers and had to find those patients alternative solutions where we could. We were busier in the fourth quarter than we were in the third quarter, so that was part of it. But nonetheless, we still are seeing opportunities for us to improve the throughput through our case management initiatives, as you spoke to, continue to increase the head count in our facilities in order to take care of these patients, and we're hopeful that those numbers will start to come down a little bit as we push into 2023.

這是山姆。謝謝你。我的意思是，正如我在準備好的評論中提到的那樣，我們確實在本季度的某些時刻無法接收轉移或將某些患者帶入我們的設施。這實際上比第三季度有所提高。我們粗略地使用這個作為代理，我們無法通過我們的轉運中心接受總入院人數的大約 2%，並且必須在我們可能的地方找到這些患者的替代解決方案。第四季度我們比第三季度更忙，所以這是其中的一部分。但是，儘管如此，正如您所說，我們仍然看到了通過我們的案例管理計劃提高吞吐量的機會，繼續增加我們設施的人數以照顧這些患者，我們希望那些隨著我們進入 2023 年，數字將開始略有下降。

Our next question comes from Whit Mayo with SVB Securities.

我們的下一個問題來自 SVB 證券公司的 Whit Mayo。

Sam, I wanted to go back to the long-term plan that you mentioned. You talked about advancing the transformation of care delivery models. Can you maybe elaborate more on that, sort of how that may be playing in the physician strategy, maybe a different view into working with MA plans? Or anything would be helpful.

山姆，我想回到你提到的長期計劃。您談到了推進護理提供模式的轉變。您能否詳細說明一下，這在醫生策略中可能如何發揮作用，也許對使用 MA 計劃有不同的看法？或者任何東西都會有幫助。

Well, let me give you a little bit of a backdrop on our long-term thinking with in -- and I think this can help you understand why we are investing in these categories. First and foremost, we think we have just an incredible portfolio of communities that we serve. They are growing in and out themselves. So we have opportunities to invest in that growth. We think demand is going to grow in our markets. Aging baby boomers population growth, chronic conditions, all those things unfortunately produce demand in some respect. And we think our portfolio is a little better than the national averages on that front. So we've got that as a backdrop. So there's opportunities, I'll call it, outside the walls of HCA to invest in that natural growth in demand.

好吧，讓我給你一些關於我們長期思考的背景——我認為這可以幫助你理解我們為什麼要投資這些類別。首先，我們認為我們擁有令人難以置信的服務社區組合。他們自己成長。因此，我們有機會投資於這種增長。我們認為我們市場的需求將會增長。不幸的是，老齡化的嬰兒潮一代人口增長、慢性疾病，所有這些都在某些方面產生了需求。我們認為我們的投資組合在這方面略好於全國平均水平。所以我們把它作為背景。所以有機會，我稱之為，在 HCA 的圍牆之外投資於需求的自然增長。

The second piece that we believe exists is opportunities inside of HCA. We have what we call an economy of opportunities that exist across our 180 hospitals and 2,400 outpatient facilities that we have. And that opportunity is to use big data, use better clinical system capability and better analytics to support better care. And so our technology agenda, coupled with our care transformation agenda, is really about tapping into the economy of opportunity that exist inside our organization. So we think we have 2 sets of opportunities, outside to continue to grow market share and benefit from the growth in our markets, and then continued improvement in care delivery for better patient outcomes, more efficiency, better operational management in our hospitals by infusing machine learning, advanced analytics with our care transformation agenda.

我們認為存在的第二部分是 HCA 內部的機會。我們擁有我們擁有的 180 家醫院和 2,400 個門診設施中存在的所謂機會經濟。而這個機會就是使用大數據，使用更好的臨床系統能力和更好的分析來支持更好的護理。因此，我們的技術議程，加上我們的護理轉型議程，實際上是關於利用我們組織內部存在的機會經濟。因此，我們認為我們有兩套機會，在外部繼續增加市場份額並從我們的市場增長中受益，然後通過輸液機繼續改善護理服務，以獲得更好的患者結果、更高的效率、更好的運營管理。學習、高級分析以及我們的護理轉型議程。

So our care transformation team is led by a physician and a clinical team with industrial engineers and other type of people who are big data analysts who are supporting evaluating great performance that we have inside our company and really studying the processes around those, or looking outside the company for better processes, better technologies, and again, weaving that into our overall agenda for our long run. And we're encouraged by that. We have a major initiative that we're rolling out this year in our obstetrics unit, and we're excited about the possibilities around that.

因此，我們的護理轉型團隊由一名醫生和一個臨床團隊領導，該團隊由工業工程師和其他類型的人組成，他們是大數據分析師，他們支持評估我們公司內部的出色表現，並真正研究這些過程，或向外看公司尋求更好的流程、更好的技術，並再次將其納入我們的長期總體議程。我們對此感到鼓舞。今年我們在產科部門推出了一項重大舉措，我們對圍繞它的可能性感到興奮。

On our clinical systems, we're actually in our alpha pilot on our clinical system upgrades. We'll have a beta pilot later this year. This is a system that we will be able to push more information, standardized information into the cloud and start to turn that into actionable insights that we believe can help our patient outcomes. So we're really excited about our long-run agenda. And again, it's geared toward better patient care, but capitalizing on the opportunities inside the walls of HCA.

在我們的臨床系統上，我們實際上正在進行臨床系統升級的 alpha 試點。我們將在今年晚些時候進行測試試點。這是一個系統，我們將能夠將更多信息、標準化信息推送到雲中，並開始將其轉化為我們認為可以幫助我們的患者結果的可操作見解。所以我們對我們的長期議程感到非常興奮。再次強調，它旨在提供更好的患者護理，但利用了 HCA 內部的機會。

Our next question comes from Pito Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Pito Chickering。

Focusing on the fourth quarter, you talked about 2% lower emissions via the transfers. Were those all surgeries? I'm just trying to understand why in-patient surgeries are so weak on easy comps, and why I didn't see a bigger increase in outpatient surgeries. We've seen some med tech companies report very strong U.S. surgical growth. So just trying to understand the delta. And also what are you seeing you grow in-patient surgeries and out-patient surgeries in 2023?

關注第四季度，您談到通過轉移支付減少 2% 的排放量。那些都是手術嗎？我只是想了解為什麼住院手術在簡單的治療中如此薄弱，以及為什麼我沒有看到門診手術有更大的增加。我們已經看到一些醫療技術公司報告美國外科手術增長非常強勁。所以只是想了解三角洲。還有，您看到 2023 年住院手術和門診手術的增長情況如何？

Pito, this is Bill. I think our surgical volume, the most -- the thing that flows out was, we have one less business day, one less surgical day, and so that could account for 1.5 points or 2 of that trend. And I don't think there's any other trends that we observed in our outpatient or inpatient surgery or call out other than just one less operating day. Going forward, I would say that we would anticipate our surgical volume to reflect our longer-term trends, which has historically been somewhere around that 2-point growth. And again, there are some variables that fluctuate on that. But that was the issue on the flat surgical volume for Q4, nothing other than one less surgical day.

皮托，這是比爾。我認為我們的手術量最多——流出的是，我們少了一個工作日，少了一個手術日，因此這可能佔該趨勢的 1.5 分或 2 分。而且我認為我們在門診或住院手術中沒有觀察到任何其他趨勢，或者除了減少手術日之外沒有任何其他趨勢。展望未來，我想說我們預計我們的手術量將反映我們的長期趨勢，從歷史上看，這種趨勢一直在 2 點左右的增長。同樣，有一些變量會隨之波動。但這就是第四季度手術量持平的問題，只不過是少了一個手術日。

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

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

Great. I appreciate you guys breaking out kind of how you thought about the core pricing in the quarter. Is there a way to do that in the 2023 guidance? Obviously, the COVID is a headwind, 340B is a headwind, and then how to think about anything else that's a moving piece there? I just want to understand the core trends in pricing, and then maybe talk a little bit about commercial rate growth of what you're renegotiating today?

偉大的。我很感激你們打破了你們對本季度核心定價的看法。在 2023 年指南中有沒有辦法做到這一點？顯然，COVID 是逆風，340B 是逆風，那麼如何考慮其他任何動人的事情呢？我只想了解定價的核心趨勢，然後也許可以談談您今天重新談判的商業利率增長？

Yes, Kevin, let me start with that. So as I said in my prepared remarks, we are anticipating revenue per equivalent admission around 2%. That's on an as-reported basis. Obviously, I called out some of those nonrecurring revenue items we've had the benefit of in '22, we don't expect to continue next year. If you adjust for those, that'd probably be pushing us towards closer to 3% number, which would be, historically, we would see 2% to 3% growth. So what really moves us back into our historical pricing trends, what we would see pre-COVID is just that we're having to jump over some of that loss of cohort. So that was a 2% guidance on a revenue per equivalent admission. If you adjust that, it'd be closer to 3%, which is in line with our long-term guidance. That's contemplating both our Medicare rate updates with some improved commercial pricing that I think we've talked about in the past.

是的，凱文，讓我從這個開始。因此，正如我在準備好的發言中所說，我們預計每次同等入場的收入約為 2%。這是在報告的基礎上。顯然，我提出了一些我們在 22 年受益的非經常性收入項目，我們預計明年不會繼續。如果你對這些進行調整，那可能會將我們推向接近 3% 的數字，從歷史上看，我們會看到 2% 到 3% 的增長。因此，真正讓我們回到歷史定價趨勢的是，我們會看到 COVID 之前的情況只是我們不得不跳過一些隊列損失。因此，這是每次同等入場收入的 2% 指導。如果你調整它，它會接近 3%，這符合我們的長期指導。這是在考慮我們的 Medicare 費率更新和我認為我們過去討論過的一些改進的商業定價。

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 some of your peers have noted that physician outsourcing services, especially on the ER is a pressure point for 2023. Are you seeing that? And if so, how much of a headwind is it to EBITDA? And secondly, just on the nursing turnover, I know you said that while you had a big improvement, you're still not where you want to be. Can you talk about where you were for nursing turnover prepandemic, where you ended Q4, and maybe where you think you could end 2023?

我知道你們的一些同行已經註意到醫生外包服務，尤其是急診外包是 2023 年的一個壓力點。你看到了嗎？如果是這樣，它對 EBITDA 的不利影響有多大？其次，關於護理人員流動率，我知道你說過雖然你有了很大的進步，但你仍然沒有達到你想要的水平。你能談談你在大流行前的護理人員流動情況，你在哪裡結束了第四季度，也許你認為你可以在哪裡結束 2023 年？

So Ann, it's Sam. We, prepandemic, were somewhere around 13% or 14% for nursing turnover. We're on a run rate now 18%, 18.5%. That's down from mid-20s. We think the industry average is somewhere in the mid- to upper 20s right now from what we've seen with external benchmarks and so forth. So we're really encouraged by the progress our teams have made. And again, over the last 6 months of the year, we were starting to see improving trends. We believe we have the right initiatives in place to carry some momentum in that area into 2023. The market, as I mentioned, is a bit tenuous still, but we're encouraged by the investments we've made in our recruiting, the investments we've made in retention and leadership training and just the -- I'll call it, the hand-to-hand combat that exists in making sure that our employees have the resources on their units that are necessary for them to deliver great care to their patients and for them to be successful in whatever their role is in the company. And we think we're making progress on pretty much all of those fronts.

安，是山姆。在大流行前，我們的護理人員流失率約為 13% 或 14%。我們現在的運行率為 18%、18.5%。這比 20 多歲時有所下降。我們認為，從我們在外部基準等方面看到的情況來看，行業平均水平目前處於 20 多歲左右。因此，我們對團隊取得的進步感到非常鼓舞。同樣，在今年的最後 6 個月裡，我們開始看到改善趨勢。我們相信我們已經採取了正確的舉措，可以在 2023 年之前在該領域保持一些勢頭。正如我提到的，市場仍然有點脆弱，但我們對我們在招聘、投資方面所做的投資感到鼓舞我們已經在保留和領導力培訓方面進行了——我稱之為肉搏戰，以確保我們的員工在他們的部門擁有他們提供優質護理所必需的資源給他們的病人，讓他們在公司中的任何角色中都能取得成功。我們認為我們在幾乎所有這些方面都取得了進展。

And Ann, on the emergency room, I've broaden it to more than emergency room just hospital-based physician we have talked about in the past. We are seeing some increased pressures for subsidies around our emergency room and anesthesiologists and the like. We have a number of initiatives to try to counter those. But yes, we are expecting some upward pressure in those areas that we factored into our guidance. It rolls through, as I mentioned in the previous question, in our other operating expenses, then we could potentially see higher single-digit year-over-year growth in those categories, probably at a little bit of pace above our revenue. But we think we've made appropriate consideration for those trends inside of our guidance.

安，在急診室，我已經把它擴大到不僅僅是急診室，只是我們過去談到的醫院醫生。我們看到急診室和麻醉師等方面的補貼壓力越來越大。我們有許多舉措來嘗試應對這些問題。但是，是的，我們預計我們在指導中考慮的那些領域會出現一些上行壓力。正如我在上一個問題中提到的那樣，它在我們的其他運營費用中滾動，然後我們可能會看到這些類別的單位數同比增長可能略高於我們的收入。但我們認為我們已經在我們的指南中對這些趨勢進行了適當的考慮。

Yes. Our next question comes from Brian Tanquilut with Jefferies.

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

I guess, Sam, follow-up to Ann's question and to Bill's answer of that. I saw that you exercise the call option on the Envision JV last week. So just curious how you're thinking about operationalizing that and what would change for HCA as you bring those physicians back in-house? And maybe just thoughts on the P&L and balance sheet impact of that as well.

山姆，我想跟進安的問題和比爾的回答。我看到你上周行使了遠景合資公司的看漲期權。所以很好奇你是如何考慮實施它的，以及當你把這些醫生帶回內部時，HCA 會發生什麼變化？也許只是對損益表和資產負債表影響的想法。

So we've had a wonderful relationship with Envision over the years, and it continues to be strong across different facilities in our company. A number of years ago, we had made an investment in a co-venture with them that we felt was an opportunity for us to integrate that physician service, mainly in the ER and hospitalist medicine and a few other subspecialty categories within our hospitals as more clinically aligned and so forth. And what we see is an opportunity to further that, and so we are moving to acquire a larger percentage of that co-venture, and we think it will give us a little better visibility in how to achieve better clinical integration to improve quality.

因此，多年來我們與 Envision 建立了良好的關係，並且它在我們公司的不同設施中繼續保持強大。幾年前，我們與他們投資了一家合資企業，我們認為這是一個整合醫生服務的機會，主要是我們醫院內的 ER 和住院醫師醫學以及其他一些亞專科類別，因為更多臨床對齊等等。我們看到的是一個進一步發展的機會，因此我們正在努力獲得更大比例的合資企業，我們認為這將使我們更好地了解如何實現更好的臨床整合以提高質量。

We think we can use that platform to improve efficiency within our emergency rooms primarily and even on our med surg floors where our hospitalists work. It will support graduate medical education in some innovative ways, we believe. And then, finally, we think it offers up an opportunity for us to advance our connections to our strategic outreach partners in ways that maybe we don't necessarily accomplish in the structure we have today. So we are pushing through the final stages of that transaction. I think it's scheduled to close sometime in the spring. We will take the rest of the year to fully assimilate it, so to speak. And then as we get into 2024, we anticipate being able to execute more effectively on these categories.

我們認為我們可以使用該平台來提高我們急診室的效率，甚至可以提高我們醫院醫生工作的醫療外科樓層的效率。我們相信，它將以一些創新的方式支持研究生醫學教育。然後，最後，我們認為它為我們提供了一個機會，可以通過我們今天的結構不一定能實現的方式來推進我們與戰略外展合作夥伴的聯繫。因此，我們正在推進該交易的最後階段。我認為它計劃在春季的某個時候關閉。可以這麼說，我們將在今年餘下的時間裡完全吸收它。然後，當我們進入 2024 年時，我們預計能夠更有效地執行這些類別。

Our next question comes from Stephen Baxter with Wells Fargo.

我們的下一個問題來自 Wells Fargo 的 Stephen Baxter。

Just wanted to ask a follow-up on the 2023 guidance. I was hoping you could talk a little bit more specifically about your expectations on inpatient admissions. I guess, first, how are you thinking about where the COVID figure goes in 2023 compared to the 5.2% of admissions in 2022? Any implication being I'd love to hear how you're thinking about non-COVID admission growth in 2023.

只是想詢問有關 2023 年指南的後續信息。我希望您能更具體地談談您對住院治療的期望。我想，首先，與 2022 年 5.2% 的入學率相比，您如何看待 2023 年 COVID 數字的變化？我很想听聽您對 2023 年非 COVID 入學人數增長的看法。

Yes. So I'll start with that. So we expect a continued decline of COVID admission as you've mentioned, and I said in my prepared remarks, they represent about 5.2% of our total admissions. This year, we're thinking next year, probably somewhere between 3% and 4% of our total admissions. We believe right now, our inpatient admission growth somewhere around that 2% number, and that's embedded within the equivalent admission guidance that I gave between 2% to 3%. And again, we'll continue to monitor that as we go through the year. We continue to believe that there's strong demand in our markets, and we're positioned well to serve that demand. So inpatient volume, we're thinking hovering around 2%, and then outpatient revenue probably continue to grow in that mid-single-digit level. And that helps us get to the 2% to 3% equivalent admissions that's -- that our guidance entails.

是的。所以我將從那個開始。因此，正如您所提到的，我們預計 COVID 入場人數將持續下降，我在準備好的發言中說過，它們約占我們總入場人數的 5.2%。今年，我們正在考慮明年，可能占我們總錄取人數的 3% 到 4% 之間。我們相信，現在我們的住院病人入院人數增長大約在 2% 左右，這包含在我給出的 2% 到 3% 之間的等效入院指導中。再一次，我們將在這一年中繼續監控這一點。我們仍然相信我們的市場有強勁的需求，並且我們有能力滿足這種需求。所以住院量，我們認為徘徊在 2% 左右，然後門診收入可能會繼續以中等個位數水平增長。這有助於我們達到我們的指導要求的 2% 到 3% 的等效入學率。

Our next question comes from Scott Fidel with Stephens.

我們的下一個問題來自 Scott Fidel 和 Stephens。

Interested if you can just recap for us what the non-COVID acuity and case mix trends were in 2022. And then what you're building in for your assumptions for 2023?

如果您能為我們回顧一下 2022 年的非 COVID 敏銳度和案例組合趨勢，您有興趣嗎？然後您為 2023 年的假設建立了什麼？

Yes. So I don't know if I have the case mix necessarily. We've seen relatively flat, as I recall on the COVID case mix, right? Our non-COVID mix improved about 2% sequentially from the third quarter to the fourth quarter going forward. Our revenue per equivalent admission was roughly flat for the year-over-year comparisons.

是的。所以我不知道我是否一定有案例組合。正如我在 COVID 案例組合中所記得的那樣，我們看到的情況相對平穩，對吧？從第三季度到第四季度，我們的非 COVID 組合環比提高了約 2%。與去年同期相比，我們每次同等入場的收入大致持平。

And then, Bill, on the outlook for '23.

然後，比爾，關於 23 年的展望。

For non-COVID?

對於非 COVID？

Yes.

是的。

Yes, that would be embedded in our revenue per equivalent admission of about 2%. And then when you factor out the loss of the revenue items, I think, as I mentioned earlier, that pushes us closer to 3%. And that would be just a combination of all factors of acuity as well as payer mix and pricing trends underneath...

是的，這將包含在我們每次等效入場收入中約 2%。然後當你考慮到收入項目的損失時，我認為，正如我之前提到的，這會使我們接近 3%。這只是敏銳度的所有因素以及付款人組合和定價趨勢的組合......

And Bill, if I can add. I think it's important for everybody to understand it. Strategically, we continue to invest in programs, as I mentioned in my prepared comments, a lot of those programs are farther up the acuity ladder, if you will. They're more significant programs. They're extensions of existing programs, and as we get our footing, so to speak, with a mid-level program or an upper mid-level program, then we can move into a more acute level program, and that helps with our overall acuity statistic. So that part of our strategy, we're doing that on top of the same fixed cost platform. So our hospitals have the same fixed cost regardless of the acuity in many instances. And so if we can increase the acuity, we get operating leverage from that. So strategically that's a very important initiative of ours.

還有比爾，如果我可以補充的話。我認為讓每個人都理解這一點很重要。從戰略上講，我們繼續投資於項目，正如我在準備好的評論中提到的那樣，如果你願意的話，其中很多項目都在敏銳度階梯上走得更遠。它們是更重要的程序。它們是現有項目的延伸，當我們站穩腳跟時，可以說，中級項目或中高級項目，然後我們可以進入更尖銳的項目，這有助於我們的整體敏銳度統計。因此，我們戰略的這一部分是在同一個固定成本平台上進行的。因此，在許多情況下，無論敏銳度如何，我們的醫院都有相同的固定成本。因此，如果我們能夠提高敏銳度，我們就能從中獲得經營槓桿。所以從戰略上講，這是我們的一項非常重要的舉措。

The transfers in that we haven't been able to take care of tends to be slightly more acute than our average in most instances. And here, again, that's why it's so important for us to get more employees across the organization to take care of these patients who need our services. But all of that's embedded inside of a real strategic initiative that we have.

在大多數情況下，我們無法處理的轉移往往比我們的平均水平稍微嚴重一些。在這裡，再一次，這就是為什麼讓整個組織的更多員工來照顧這些需要我們服務的患者如此重要的原因。但所有這些都包含在我們擁有的真正戰略計劃中。

Our next question comes from Calvin Sternick with JPMorgan.

我們的下一個問題來自摩根大通的 Calvin Sternick。

It looks like another strong quarter for ER volumes. Can you talk a bit about the trends you've seen there in the last few quarters in terms of payer and acuity mix, and what you're expecting for sort of (inaudible) as you think about the volume trends across the business over the last couple of quarters, are there any service lines or categories that have either over underperformed relative to your expectations? And any color you can give on those going into 2023?

這看起來是 ER 銷量的又一個強勁季度。你能談談你在過去幾個季度看到的付款人和敏銳度組合方面的趨勢，以及你在考慮整個業務的數量趨勢時對某種（聽不清）的期望嗎？過去幾個季度，是否有任何服務線或類別的表現低於您的預期？你可以給那些進入 2023 年的人塗上什麼顏色？

This is Sam. Let me speak to some of our service lines trends. During the pandemic, we felt the emergency room might be disrupted from what our previous beliefs were. And there was new uses of telemedicine alternatives that were being experienced, we thought. What we've seen is just the opposite. The resiliency of the emergency room for communities is even greater than we thought. And the demand there is very strong because our emergency rooms and other people's emergency rooms are a solution set for people whenever health care is needed. So our trends in the emergency room have been very solid over the course of the year. And when you look at them really without the COVID activity, it's especially impressive, I think.

這是山姆。讓我談談我們的一些服務線趨勢。在大流行期間，我們覺得急診室可能會從我們以前的信念中被打亂。我們認為，正在經歷遠程醫療替代品的新用途。我們所看到的恰恰相反。社區急診室的彈性比我們想像的還要大。那裡的需求非常強勁，因為我們的急診室和其他人的急診室是為需要醫療保健的人們提供的一套解決方案。因此，在這一年中，我們在急診室的趨勢非常穩固。我認為，當你真的在沒有 COVID 活動的情況下觀察它們時，它特別令人印象深刻。

We have seen good volume growth in our orthopedics. Our total joint business for the quarter was up 6%. In many instances, we fully absorbed, we believe, most of the shift over the last 3 years during the pandemic, with the orthopedic business moving from inpatient to outpatient. And in most instances, we believe the large majority of that is behind us. And so we don't have that as a pressure point like we've had over the past 3 years. But nonetheless, we've grown that business in the face of the site of care shift. We have a very robust pipeline for our emergency rooms, especially our freestanding emergency room platform, a very significant development opportunity there for us across our communities, and we're investing in that.

我們的骨科業務量增長良好。我們本季度的總聯合業務增長了 6%。我們相信，在許多情況下，我們完全吸收了過去 3 年大流行期間的大部分轉變，骨科業務從住院病人轉移到門診病人。在大多數情況下，我們相信其中大部分已經過去了。因此，我們沒有像過去 3 年那樣將其作為壓力點。但儘管如此，面對護理場所的轉移，我們已經發展了該業務。我們有一個非常強大的急診室管道，尤其是我們的獨立急診室平台，這對我們整個社區來說都是一個非常重要的發展機會，我們正在對此進行投資。

Our urgent care center platform continues to grow. We're up to 260 urgent care centers. We will probably push through 300 in 2023. Our ambulatory surgery center platform continues to grow. Here, again, we have more de novo development inside of our ambulatory surgery center platform than we've had in the past, and we're encouraged by how that fits into our networks in a very productive way. So we're really pretty excited about our investments in our ambulatory network, our investments in our acuity programs and our higher service lines, and we will continue to, we believe, be well positioned to deal with the growing demand that we see in the market.

我們的緊急護理中心平台不斷發展壯大。我們有多達 260 個緊急護理中心。我們可能會在 2023 年突破 300 個。我們的門診手術中心平台將繼續增長。在這裡，我們的門診手術中心平台內部比過去有更多的從頭開發，我們對它如何以非常高效的方式融入我們的網絡感到鼓舞。因此，我們對我們對門診網絡的投資、我們對敏銳度計劃和更高服務線的投資感到非常興奮，我們相信，我們將繼續做好準備，以應對我們在市場。

Our next question comes from Lance Wilkes with Bernstein.

我們的下一個問題來自 Lance Wilkes 和 Bernstein。

Could you just talk a little bit about permanent nurses and understand the retention rates are getting better there, can you talk a little bit about new hirings, what sort of growth you're seeing there? What are maybe some of the drivers of access to nurses there, where are they coming from? And then also, if you could just talk a little bit about, you said the investment spend was pressuring, and the long-term plan was pressuring '22 a little bit. Can you talk a little bit about how '23 might look compared to '22 with that?

您能否談談長期護士並了解那裡的保留率正在提高，您能否談談新員工，您看到了什麼樣的增長？在那裡接觸護士的一些驅動因素可能是什麼，他們來自哪裡？然後，如果你能稍微談談，你說投資支出有壓力，長期計劃給 22 年帶來了一點壓力。你能談談 23 年與 22 年相比如何嗎？

Why don't you take, Bill, the last question?

比爾，你為什麼不回答最後一個問題？

Yes. This is Bill, on the investments. When you think about the technology investments, the investments we're making in some of the clinical transformation. And I'd also say, with the expansion of our nursing schools going forward, probably is somewhere around an incremental investment of $150 million in '23 compared to what we ran in '22. We didn't call that out, but it's part of a long-term investment, we think, that will continue to drive performance and value for us.

是的。這是比爾，關於投資。當您考慮技術投資時，我們正在對一些臨床轉型進行投資。而且我還要說，隨著我們護士學校的不斷擴大，與我們在 22 年的運營相比，23 年的增量投資可能約為 1.5 億美元。我們沒有說出來，但我們認為這是長期投資的一部分，它將繼續推動我們的業績和價值。

So our hiring in 2022 was up a little north of 6%, just a huge number of new hires. And so that's the total number just as a starting point. Where that is coming from? That's coming from new grads. There is still is a decent pipeline of new graduate nurses in our communities. We have academic partnerships with different colleges beyond Galen that are important to that pipeline. We are also seeing some travelers decide that, "Okay, enough, we traveled. We want to come back," and we've been able to recover some of the employees who traveled for a period of time back into our organization. So we continue to be focused on trying to recover them. And I think, again, with our benefits and with our wage adjustments and all the investments we're making in clinical education and other components of our labor agenda, we're starting to see more favorable trends in our recruitment function that we think, if they carry into 2023 and through the year, should be positive for us.

因此，我們在 2022 年的招聘人數略高於 6%，只是大量新員工。所以這就是總數，只是作為一個起點。那是從哪裡來的？這是來自新畢業生。我們的社區仍然有大量新畢業護士。我們與蓋倫以外的不同學院建立了學術合作夥伴關係，這些學院對該管道很重要。我們還看到一些旅行者決定，“好吧，夠了，我們旅行了。我們想回來，”我們已經能夠讓一些旅行了一段時間的員工回到我們的組織。因此，我們繼續專注於嘗試恢復它們。我再次認為，憑藉我們的福利和工資調整以及我們在臨床教育和勞工議程的其他組成部分所做的所有投資，我們開始在我們認為的招聘職能中看到更有利的趨勢，如果它們延續到 2023 年並貫穿全年，對我們來說應該是積極的。

Our next question comes from Jason Cassorla with Citigroup.

我們的下一個問題來自花旗集團的 Jason Cassorla。

Great. I just wanted to ask a bit more on your capital priorities. You've recently divested ownership in some hospitals, but just wondering how you're viewing the M&A backdrop and if you're seeing opportunities to increase your footprint in your current markets or potentially entering into new markets? And then just on share repurchases, you've increased your authorization by $3 billion, you have $4.5 billion left remaining. It's just in light of the $7 billion this year, just curious how you're thinking about share repurchases in the context of your larger capital deployment priorities?

偉大的。我只是想多問一下你的資本優先事項。您最近剝離了一些醫院的所有權，但只是想知道您如何看待併購背景，以及您是否看到了增加您在當前市場中的足跡或可能進入新市場的機會？然後就股票回購而言，你的授權增加了 30 億美元，你還剩下 45 億美元。只是考慮到今年的 70 億美元，只是好奇您在更大的資本部署優先事項的背景下如何考慮股票回購？

Yes, let me take that. This is Bill. Let me take the latter one first. I think share repurchases, you spend an important part of our overall balanced capital allocation. As you mentioned, we did $7 billion in '22. We have authorization close to $4.5 billion. I think we plan on completing the majority of it sometime in this calendar year with a little bit of roll forward afterwards. And again, we'll continue to adjust as kind of market conditions present, but a share repurchase program has just been part of our overall balanced allocation of capital going forward.

是的，讓我接受。這是比爾。讓我先說後者。我認為股票回購是我們整體平衡資本配置的重要組成部分。正如你提到的，我們在 22 年做了 70 億美元。我們獲得了近 45 億美元的授權。我認為我們計劃在本日曆年的某個時候完成大部分工作，然後再向前推進一點。再一次，我們將繼續根據當前的市場狀況進行調整，但股票回購計劃只是我們未來整體平衡資本配置的一部分。

For M&A, we have been fairly active in market with outpatient acquisitions again when they come available, whether it's urgent care, some freestanding emergency room, some ASC, some physician clinics and so forth. And those are very complementary, synergistic to our network acquisitions, and we will continue to pursue those as they develop. We have not had too many opportunities on hospital acquisitions, although, recently there was an announced LOI on a hospital just outside of the Dallas-Fort Worth market that we think is synergistic with respect to clinical services and so forth with our system in Dallas-Fort Worth.

對於併購，我們在市場上一直相當活躍，門診收購一旦可用，無論是緊急護理、一些獨立的急診室、一些 ASC、一些醫生診所等等。這些與我們的網絡收購非常互補、協同，我們將繼續追求它們的發展。我們在醫院收購方面沒有太多機會，儘管最近在達拉斯-沃斯堡市場以外的一家醫院宣布了意向書，我們認為這與我們在達拉斯的系統等臨床服務等方面具有協同作用-沃思堡。

So we'll continue to look for those. We do have a pipeline of greenfield hospitals because the acquisition environment is not as robust end market as maybe we would have hoped. So we need to consider greenfield projects, and we do have a number of those that are in the works. We have one under construction currently in San Antonio. And I want to say we have 7 or 8 parcels of land, maybe 10, that are designed for future hospital development when the time is right for us to make those investments.

所以我們會繼續尋找那些。我們確實有一系列新建醫院，因為收購環境並不像我們希望的那樣強勁的終端市場。所以我們需要考慮綠地項目，我們確實有一些項目正在進行中。我們目前在聖安東尼奧有一個正在建設中。我想說的是，我們有 7 或 8 塊土地，也許 10 塊，是為未來的醫院發展而設計的，當時正是我們進行這些投資的時候。

Our next question comes from Steven Valiquette with Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

So just on the surgical volumes, you addressed most of the key questions related to the volumes for both the fourth quarter and the full year '23. But just a follow-up on that topic to get, I guess, a little bit more. I was just curious whether or not you do see any notable pent-up demand for any surgical cases exiting out of 4Q '22 that might be falling at least into the early part of '23 for various reasons, just curious any visibility on early '23 at this stage.

因此，僅就外科手術量而言，您就解決了與第四季度和 23 年全年的手術量相關的大部分關鍵問題。但我想，只是對該主題的後續跟進，以獲得更多信息。我只是好奇你是否確實看到任何顯著的被壓抑的需求從 22 年第四季度退出的任何手術病例可能由於各種原因至少進入 23 年初，只是好奇早期的任何可見性現階段23人。

It's hard for us to really judge the -- whether there's demand on the sidelines, and we don't see it. I mean we get some anecdotal information from our physicians who might indicate that, "Okay, there clinic patient profiles were better in the fourth quarter than they were at any point in time in 2022." I don't know if that's a precursor or not for pent-up elective surgical demand. I think we're just going to have to wait and see. But I believe it's a positive metric and a positive anecdote that their clinic roles, patient roles appear to be at a higher level than they were in previous parts of 2022.

我們很難真正判斷——是否有旁觀者的需求，我們沒有看到。我的意思是我們從我們的醫生那裡得到了一些軼事信息，這些信息可能表明，“好吧，第四季度的診所患者情況比 2022 年的任何時間點都要好。”我不知道這是否是被壓抑的擇期手術需求的先兆。我想我們只能拭目以待了。但我相信這是一個積極的指標和一個積極的軼事，他們的臨床角色、患者角色似乎比 2022 年之前的部分水平更高。

Our next question comes from Jamie Perse with Goldman Sachs.

我們的下一個問題來自高盛的 Jamie Perse。

Just a follow-up on the commercial reimbursement dynamics. First, can you remind us what percent of contracts have been recently negotiated that will take us back at the higher rate January 1? And then secondly, can you give us a little bit of color on what the initial bump in those contracts looks like relative to the rate escalators that are locked in place for the next couple of years?

只是對商業報銷動態的跟進。首先，您能否提醒我們最近談判的合同中有多少百分比將使我們在 1 月 1 日以更高的利率恢復？其次，你能給我們一些關於這些合同的初始漲幅相對於未來幾年鎖定的利率扶梯的情況的一些顏色嗎？

We have, I want to say, Bill, maybe 70% of our contracts for 2024 contracted. I will tell you that most of the contracts, if not all of the contracts we closed in the last 3 quarters of '22 were in line with our expectations, which was around mid-single-digit inflators. So those have to work their way into the '23 portfolio of contracts and on into the 2024. So we are encouraged by the outcomes of those negotiations. I think there's a general recognition in the payer community that the input costs for providers is up, or up. And so given those inflationary pressures, they recognize that there's a sensitivity to respond to that. And we're trying to be appropriate in our app. And I think that been received well, and we've been able to close these contracts reasonably timely.

我想說，比爾，我們有 70% 的 2024 年合同已經簽訂。我會告訴你，大多數合同，如果不是我們在 22 年最後 3 個季度完成的所有合同，都符合我們的預期，即大約中個位數的通脹率。因此，這些必須進入 23 年的合同組合併繼續進入 2024 年。因此，我們對這些談判的結果感到鼓舞。我認為付款人社區普遍認識到提供商的投入成本上升或上升。因此，鑑於這些通貨膨脹壓力，他們認識到對此做出反應的敏感性。我們正努力在我們的應用程序中做到合適。而且我認為收到的很好，我們已經能夠合理及時地關閉這些合同。

So we still have 30% or so of 2023 that will get negotiated over the first part of this year, and will carry us through all of '23 and into '24. We're about 40% contracted on '24. Again, the tail effect of some of the closed contract negotiations that we've just achieved will carry into 2024.

因此，我們仍有 30% 左右的 2023 年將在今年上半年進行談判，並將帶領我們度過整個 23 年並進入 24 年。我們在 24 日簽訂了約 40% 的合同。同樣，我們剛剛達成的一些封閉式合同談判的尾部效應將延續到 2024 年。

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。

I know CapEx guidance for 2023 is only down slightly, and I know it's still January, but it would be the first time in a long, long time, the CapEx would be down year-over-year, not counting 2020. I was wondering if you could just speak to any changes in budgeting or strategy or if there's anything that could be tempering that investment?

我知道 2023 年的資本支出指導只是略有下降，我知道現在還是 1 月，但這將是很長一段時間以來的第一次，資本支出同比下降，不包括 2020 年。我想知道您是否可以談談預算或戰略的任何變化，或者是否有任何可以緩和該投資的事情？

Yes, John. I don't think there's anything tempering in the investment at all. I think 4.3% is our expectation. As I mentioned in my comments, we initially expected 4.2% for '22. It came in a little higher because we had some year-end activity that I mentioned around some real estate and some IT. So I wouldn't read anything from down to the 4.4% to 4.3%. It's actually up compared to where our initial expectations are. But as a summary, we still see very good opportunities to deploy capital, we believe, to capture growth opportunities in the marketplace. And we've talked about some of that, whether that be through our freestanding EDs, whether there's some development of new hospitals, whether it be expansion of campuses. So again, I think it's an important part of our overall capital allocation and I think an important part of our continued long-term focus on growing.

是的，約翰。我認為投資根本沒有任何回火。我認為 4.3% 是我們的預期。正如我在評論中提到的，我們最初預計 22 年的增長率為 4.2%。它稍微高一點，因為我們有一些年終活動，我提到了一些圍繞一些房地產和一些 IT 的活動。所以我不會閱讀任何從 4.4% 到 4.3% 的內容。與我們最初的預期相比，它實際上有所上升。但總而言之，我們仍然看到很好的機會來部署資本，我們相信，以抓住市場的增長機會。我們已經討論了其中的一些，無論是通過我們的獨立急診室，是否有新醫院的一些發展，是否是校園的擴建。因此，我認為這是我們整體資本配置的重要組成部分，也是我們持續長期關注增長的重要組成部分。

Our next question comes from Andrew Mok with UBS.

我們的下一個問題來自瑞銀集團的 Andrew Mok。

I was hoping you could provide a bit more color on the supply cost trends into 2023. What are the assumptions around unit cost increases versus what steps did you take to manage inflationary pressure for multiyear contracts?

我希望您能對 2023 年的供應成本趨勢提供更多的顏色。關於單位成本增加的假設是什麼，以及您採取了哪些措施來管理多年合同的通脹壓力？

Well, thank you for the question. Our teams and our supply chain teams have done an incredible job over the past 12 to 18 months on our supply cost portfolio, and especially with the backdrop inflationary increases. And we've talked about through the year, we've been really seeing really positive trends in and actually to keep our supply cost growth below our revenue growth. Much of that was because some of our contracts, 60% of our contracts or so was under firm pricing for the most of '22. As we look forward, I think our basic assumption is to continue to keep our supply cost as a percent of revenue flat from where we ran full year '23. That would imply our supply cost per unit is somewhere around that 2% level, plus or minus a little bit. But again, we're expecting continued good results in that.

嗯，謝謝你的問題。在過去的 12 到 18 個月裡，我們的團隊和我們的供應鏈團隊在我們的供應成本組合方面做了令人難以置信的工作，尤其是在通脹上升的背景下。我們在這一年裡一直在談論，我們確實看到了非常積極的趨勢，並且實際上使我們的供應成本增長低於我們的收入增長。這在很大程度上是因為我們的一些合同，大約 60% 的合同在 22 年的大部分時間裡都是固定定價的。展望未來，我認為我們的基本假設是繼續保持供應成本佔收入的百分比與 23 年全年持平。這意味著我們的單位供應成本大約在 2% 左右，上下浮動一點。但同樣，我們期待在這方面繼續取得良好的成果。

And again, our team is doing a nice job. We can keep that supply cost as a percent of revenue flat with where we ran this year with the backdrop of inflationary that's pretty positive. We have a number of initiatives underway that our teams use. Part of our benchmarking initiatives is to look at utilization and identify best practices across the organization. We also are looking at product selection, partnering with our clinical teams. So we have a number of initiatives underneath our supply chain operations that are helping us to achieve those results, and we look forward to those continuing as we go into '23.

再一次，我們的團隊做得很好。在通貨膨脹的背景下，我們可以將供應成本佔收入的百分比與今年的水平持平，這是非常積極的。我們有許多正在進行的計劃供我們的團隊使用。我們的基準測試計劃的一部分是查看利用率並確定整個組織的最佳實踐。我們也在考慮產品選擇，與我們的臨床團隊合作。因此，我們在供應鏈運營下採取了許多舉措，幫助我們取得這些成果，我們期待這些舉措在我們進入 23 世紀時繼續進行。

Our final question comes from John Ransom with Raymond James.

我們的最後一個問題來自 John Ransom 和 Raymond James。

So, for me, if we think about, as you reduce your labor turnover, so let's say it goes hypothetically from 25 to 20, how does that -- how would that affect your labor cost per -- either for revenue or per unit? How does that factor into a savings algorithm for us to think about?

所以，對我來說，如果我們考慮，當你減少你的勞動力流動率時，假設它從 25 減少到 20，這將如何影響你的勞動力成本 - 無論是收入還是單位？這如何影響我們考慮的儲蓄算法？

How it affects our revenue per unit?

它如何影響我們的單位收入？

No, no. I mean, salary -- either salary as a percent of adjusted admits or salaries a percent of revenue, how does reducing turnover? If you reduce turnover about say, 500 bps, how would that affect the labor margin?

不，不。我的意思是，薪水——無論是薪水佔調整後錄取的百分比還是薪水佔收入的百分比，如何減少人員流動？如果您將營業額減少大約 500 個基點，這將如何影響勞動利潤率？

Well, in theory, will flow through as reduction of our contract labor. And so the margin, if you will, on the contract labor as we replace an individual from a contractor to an employed one is that we'll save that margin and being able to reinvest and what we've been able to do this year is reinvest back into our employee workforce and that's part of that turnover level.

好吧，理論上，我們的合同工會減少。因此，如果你願意的話，當我們將一個人從承包商替換為受僱人員時，合同工的邊際是我們將節省該邊際並能夠進行再投資，而我們今年能夠做的是再投資於我們的員工隊伍，這是營業額水平的一部分。

And I think all of that, John, I would say, is incorporated, if you look at the overall labor spend. I mean there's a lot of components into that. And as we said, we think we can maintain our labor cost as percent of revenue where we are finished this year. It's a function of reducing those premium labor and reinvesting back into our employee workforce and keeping that relatively flat year-over-year. And I think that's a good result for us and allows us to continue to recognize the important work our employees do for us.

如果你看一下整體勞動力支出，我認為所有這些，約翰，我會說，都是合併的。我的意思是其中有很多組成部分。正如我們所說，我們認為我們可以將我們的勞動力成本維持在我們今年完成的收入的百分比。這是減少這些優質勞動力並重新投資於我們的員工隊伍並保持與去年同期相對持平的功能。我認為這對我們來說是一個好結果，讓我們能夠繼續認識到我們的員工為我們所做的重要工作。

There are no further questions at this time. I'll now turn the call over back to Mr. Frank Morgan.

目前沒有其他問題。我現在將電話轉回給 Frank Morgan 先生。

Devin, thank you for your help today, and thanks to everyone for joining us on this call. We hope you have a great weekend. I'm around this afternoon. If I can answer additional questions you might have. Have a great day.

德文，感謝你今天的幫助，並感謝大家加入我們的電話會議。我們希望你有一個愉快的周末。我今天下午在附近。如果我可以回答您可能有的其他問題。祝你有美好的一天。

That concludes today's conference. Thank you for attending today's presentation. You may now disconnect.

今天的會議到此結束。感謝您參加今天的演講。您現在可以斷開連接。