美國醫院公司 (HCA) 2023 Q1 法說會逐字稿

Welcome to the HCA Healthcare First Quarter 2023 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.

歡迎參加 HCA Healthcare 2023 年第一季度收益電話會議。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 Rothberg. Sam and Bill will provide some prepared remarks, and then we will take 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 and 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；首席財務官 Bill Rothberg。 Sam 和 Bill 將提供一些準備好的評論，然後我們將回答問題。在我將電話轉給 Sam 之前，讓我提醒大家，如果今天的電話包含任何基於管理層當前預期的前瞻性陳述，眾多風險和不確定性以及其他因素可能導致實際結果與可能出現的結果大不相同今天表示。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 press release. 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.

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。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. Thank you, Frank, and good morning. Thank you for joining our call. The operational momentum we had at the end of the last year continued into the first quarter of 2023. The company produced solid earnings that reflected strong demand for our services and improvement in our operating costs, in particular, contract labor expenses. For the quarter, diluted earnings per share, excluding losses on sales of facilities, grew by almost 20% to $4.93. Adjusted EBITDA grew close to 8%. Same-facility volumes across the company were strong in the first quarter. Admissions grew 4.4% year-over-year. Non-COVID admissions were up 12%. Our inpatient business continued to be supported by strong acuity and a favorable payer mix. Inpatient surgeries increased 3.6%. Same facility equivalent admissions increased 7.5%. This was driven by emergency room visits, which grew 10%, and outpatient surgeries, which grew 5%. Other outpatient categories also grew, including outpatient cardiology procedures, which increased 7%.

好的。謝謝你，弗蘭克，早上好。感謝您加入我們的電話。我們在去年年底的運營勢頭一直持續到 2023 年第一季度。公司產生了可觀的收益，這反映了對我們服務的強勁需求以及我們運營成本（尤其是合同工費用）的改善。本季度，不包括設施銷售損失的攤薄後每股收益增長近 20%，達到 4.93 美元。調整後的 EBITDA 增長接近 8%。第一季度，整個公司的同設施銷量都很強勁。入學人數同比增長 4.4%。非 COVID 入院人數增加了 12%。我們的住院業務繼續得到強大的敏銳度和有利的付款人組合的支持。住院手術增加了 3.6%。相同設施的等效入場人數增加了 7.5%。這是由急診室就診量增長 10% 和門診手術量增長 5% 推動的。其他門診類別也有所增長，包括心髒病門診手術，增長了 7%。

The demand increase was broad-based across most of the company's footprint and service lines contributing the same facility revenue growth of 5% as compared to the prior year. With respect to our people agenda, we saw continued improvements across virtually all metrics. The improvement in turnover rates accelerated from the fourth quarter, and we ended the quarter close to pre-pandemic levels. Registered nurse hiring also improved in the quarter. Hiring increased almost 19% compared to the previous 4 quarter average. These positive results helped reduce contract labor costs 21% compared to last year. We continue to invest in our people through compensation programs, increased training and innovative care models. We believe these programs advanced our capabilities to provide high-quality care to our patients.

需求增長廣泛存在於公司的大部分足跡和服務線中，與上一年相比，設施收入增長了 5%。關於我們的人員議程，我們看到幾乎所有指標都在持續改進。離職率的改善從第四季度開始加速，我們在本季度結束時接近大流行前的水平。本季度註冊護士的招聘也有所改善。與前四個季度的平均水平相比，招聘人數增加了近 19%。與去年相比，這些積極成果幫助合同工成本降低了 21%。我們繼續通過薪酬計劃、增加培訓和創新護理模式來投資於我們的員工。我們相信這些計劃提高了我們為患者提供高質量護理的能力。

Once again, our colleagues demonstrated a remarkable ability to adapt and deliver value across all stakeholder groups. I want to thank them for their dedication, their hard work and their overall effectiveness.

我們的同事再次展示了在所有利益相關者群體中適應和創造價值的非凡能力。我要感謝他們的奉獻精神、辛勤工作和整體效率。

During the quarter, we continued to experience periodic capacity constraints that prevented us from fully operating our capacity as compared to the fourth quarter. Instances where we could not accept patients from other hospitals declined 25% and represented 1.5% of total admissions in the quarter, which was down from 2% in the fourth quarter. While we are pleased with this improved trend, it still remains above pre-pandemic levels. Close with this, we remain encouraged by the backdrop of strong demand that we saw in our markets. We intend to maintain our disciplined approach to executing our strategic and capital allocation plans as we push through the rest of this year.

在本季度，與第四季度相比，我們繼續經歷週期性的產能限制，這使我們無法充分利用我們的產能。我們無法接受其他醫院患者的情況下降了 25%，佔本季度總入院人數的 1.5%，低於第四季度的 2%。儘管我們對這種改善的趨勢感到滿意，但它仍高於大流行前的水平。最後，我們仍然對我們在市場上看到的強勁需求的背景感到鼓舞。我們打算在今年剩餘時間裡繼續執行我們的戰略和資本配置計劃。

And lastly, we believe the investments we are making in our network, our people and our technology will provide us with the necessary resources to improve our services and provide high-quality care to our patients. Given the strong results in the quarter and the favorable factors we expect with demand, you will see that we have increased our guidance for the year.

最後，我們相信我們在我們的網絡、我們的人員和我們的技術上所做的投資將為我們提供必要的資源來改善我們的服務並為我們的患者提供高質量的護理。鑑於本季度的強勁業績以及我們預期的需求有利因素，您會看到我們增加了今年的指導。

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

有了這個，我會把電話轉給比爾了解更多細節。

Great. Thank you, Sam, and good morning, everyone. I will provide some additional comments on our performance for the quarter. Adjusted EBITDA for the quarter was $3.17 billion as compared to $2.94 billion in the prior year. As noted in our release, in the first quarter of this year, we recorded an increase in revenues of $145 million related to resolving certain disputed claims with a commercial payer that covered a 6-year period. In the prior year quarter, we recorded an additional $244 million of revenues and $90 million of expenses that related to the Texas-directed payment program for an earlier period. I will also note, as it relates to prior year comparisons, we still were experiencing high level of COVID volumes in the first quarter of 2022. COVID admissions accounted for 9.7% of admissions last year compared to about 3% this year. In addition, in the prior year quarter, we recognized approximately $190 million of COVID-related support payments versus about $30 million in this year's first quarter.

偉大的。謝謝你，山姆，大家早上好。我將對我們本季度的表現提供一些額外的評論。本季度調整後的 EBITDA 為 31.7 億美元，上年同期為 29.4 億美元。正如我們在新聞稿中指出的那樣，在今年第一季度，我們的收入增加了 1.45 億美元，這與解決與商業付款人的某些有爭議的索賠有關，這些索賠涵蓋了 6 年。在去年同期，我們記錄了與早期德克薩斯州定向支付計劃相關的額外 2.44 億美元收入和 9000 萬美元支出。我還要指出，由於與前一年的比較相關，我們在 2022 年第一季度的 COVID 數量仍然很高。去年 COVID 入學人數佔入學人數的 9.7%，而今年約為 3%。此外，在去年同期，我們確認了大約 1.9 億美元的 COVID 相關支持付款，而今年第一季度約為 3000 萬美元。

Sam highlighted our positive volume metrics in the quarter, and this was coupled with good payer mix and case mix trends. Same facility managed care and other admissions grew 4.2% during the quarter when compared to the prior year and non-COVID managed care admissions grew 11.3% versus the prior year. Non-COVID case mix improved just under 1% as compared to both prior year and sequentially from the fourth quarter. This contributed to our non-COVID inpatient revenue per admission increasing 2.2% as compared to the first quarter of last year.

Sam 強調了本季度我們積極的數量指標，這與良好的付款人組合和案例組合趨勢相結合。與上一年相比，本季度同一設施管理的護理和其他入院人數增長了 4.2%，非 COVID 管理的護理入院人數比上一年增長了 11.3%。與去年同期和第四季度相比，非 COVID 案例組合改善了不到 1%。與去年第一季度相比，這導致我們每次入院的非 COVID 住院患者收入增長了 2.2%。

We remain pleased with our team's management of operating costs even with the backdrop of higher inflation. Our consolidated adjusted EBITDA margin was 20.3% in the quarter. Labor costs as a percentage of revenue improved both sequentially and when compared to the prior year, and our supply costs continue to trend favorably as well. We have discussed previously other operating expenses have been subject to some inflationary cost pressures and increased approximately 20 basis points as a percentage of revenue when compared to the prior year.

即使在通貨膨脹率上升的背景下，我們仍然對我們團隊的運營成本管理感到滿意。本季度我們的綜合調整後 EBITDA 利潤率為 20.3%。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，我們的供應成本也繼續呈有利趨勢。我們之前討論過其他運營費用受到一些通貨膨脹成本壓力的影響，與上一年相比，佔收入的百分比增加了約 20 個基點。

So let me speak to some cash flow and capital allocation metrics as they remain a key part of our long-term growth and value-creation strategies. Our cash flow from operations increased $458 million in the quarter from $1.35 billion in the prior year to $1.8 billion this year. Capital spending was just under $1.2 billion. We paid $175 million in dividends and repurchased just under $850 million of our stock during the quarter. Our debt to adjusted EBITDA leverage ratio remains near the low end of our stated leverage range of 3x to 4x.

因此，讓我談談一些現金流和資本配置指標，因為它們仍然是我們長期增長和價值創造戰略的關鍵部分。我們的運營現金流在本季度增加了 4.58 億美元，從去年的 13.5 億美元增加到今年的 18 億美元。資本支出略低於 12 億美元。本季度，我們支付了 1.75 億美元的股息並回購了近 8.5 億美元的股票。我們的債務與調整後的 EBITDA 槓桿比率仍然接近我們規定的 3 倍至 4 倍槓桿範圍的低端。

As noted in our release this morning, we are updating our full year 2023 guidance as follows: we expect revenues to range between $62.5 billion and $64.5 billion. We expect net income attributable to HCA Healthcare to range between $4.75 billion and $5.16 billion. We expect full year adjusted EBITDA at a range between $12.1 billion and $12.7 billion. And we expect full year diluted earnings per share to range between $17.25 and $18.55. And lastly, we expect capital spending to approximate $4.6 billion during the year. I will mention that our updated capital spending guidance is based on opportunities we believe exist to continue to invest growth agenda, and it also considers some land acquisitions we are planning for future development. In addition, we are seeing some inflationary increases in construction costs that we have factored into our guidance as well.

正如我們今天早上發布的那樣，我們正在更新我們的 2023 年全年指導如下：我們預計收入將在 625 億美元至 645 億美元之間。我們預計歸屬於 HCA Healthcare 的淨收入在 47.5 億美元至 51.6 億美元之間。我們預計全年調整後的 EBITDA 將在 121 億美元至 127 億美元之間。我們預計全年攤薄後每股收益在 17.25 美元至 18.55 美元之間。最後，我們預計今年的資本支出約為 46 億美元。我要提到的是，我們更新的資本支出指南是基於我們認為存在的繼續投資增長議程的機會，它還考慮了我們為未來發展計劃的一些土地收購。此外，我們也看到建築成本的一些通貨膨脹增加，我們也已將其納入我們的指導中。

Finally, I will mention in early April, we closed on a transaction to increase our ownership interest in the Velasco joint venture with envision. We will consolidate this venture beginning in the second quarter and expect the venture will generate approximately $1 billion of annual revenues with no material impact to adjusted EBITDA.

最後，我要提到的是在 4 月初，我們完成了一項交易，以增加我們在 Velasco 合資企業中的所有權權益。我們將從第二季度開始整合這家合資企業，預計該合資企業將產生約 10 億美元的年收入，而不會對調整後的 EBITDA 產生重大影響。

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

因此，我會把電話轉給弗蘭克，我們會打開它進行問答。我們期待您的提問。

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

謝謝你，比爾。 （操作員說明）Rob，你現在可以向那些想問問題的人提供說明。

(Operator Instructions)

（操作員說明）

And your first question comes from the line of A.J. Rice from Credit Suisse.

你的第一個問題來自 A.J.來自瑞士信貸的大米。

Maybe obviously, there's a lot of positive trends this quarter, both on the volume side as well as what you're seeing, particularly expenses with labor. When you sit here and look at the rest of the year, I know you updated guidance and updated it a little further than just the beat in the quarter. What are the variables that you see could swing either more positive or negative? Are there open questions with respect to how labor trends the rest of the year, how volume trends for the rest of the year? Or maybe some other metric that I'm not highlighting that you see as putting you at different points within the range or offering variability? Can you maybe flesh that out a little further?

也許很明顯，本季度有很多積極的趨勢，無論是在數量方面還是在您所看到的方面，尤其是人工費用方面。當您坐在這裡回顧今年剩餘時間時，我知道您更新了指南，並且比本季度的節拍更進一步更新了它。您認為哪些變量可能更積極或更消極？關於今年餘下時間的勞動力趨勢，今年餘下時間的數量趨勢如何，是否存在懸而未決的問題？或者我沒有強調的其他一些指標，您認為這些指標將您置於範圍內的不同點或提供可變性？你能再充實一點嗎？

Yes. A.J., this is Bill. I'll start and then Sam can add in. I think as we said in our comments, we believe there is momentum that we're seeing in the market. We saw that late '22. We were fortunate that continued into the first quarter. We continue to see good volume expectations in the market. You saw our same-store admissions. Our non-COVID volume was pretty robust, emergency room activity remains busy. So we feel reasonably positive on our volume outlook that we've given. Our revenue per unit, we're pleased with. We're pleased with the payer mix trends and the acuity and case mix. They're stable and maintaining the levels that we anticipated.

是的。 A.J.，這是比爾。我會開始，然後 Sam 可以加入。我認為正如我們在評論中所說的那樣，我們相信我們在市場上看到了勢頭。我們看到了 22 年底。我們很幸運能持續到第一季度。我們繼續看到市場上良好的銷量預期。你看到了我們的同店入場。我們的非 COVID 量非常強勁，急診室活動仍然很忙。因此，我們對我們給出的銷量前景感到相當樂觀。我們對單位收入感到滿意。我們對付款人組合趨勢以及敏銳度和案例組合感到滿意。它們很穩定並保持我們預期的水平。

And then on the cost side, we believe the teams have managed costs very well. We knew that labor improved throughout '22. Obviously, first quarter of last year was a high watermark for us in labor. So we're pleased with where it is today. We hope there's continued improvement to be made, especially around the utilization of contract labor. And so generally, we're feeling pretty good about the cost metrics. There are some inflationary cost trends we're seeing, as I mentioned, in other operating that tends to show itself around our professional fees and some of those fixed cost items that we don't have as much input over. But generally speaking, we think our revised guidance and our outlook reflects our view for the balance of the year.

然後在成本方面，我們相信團隊已經很好地控制了成本。我們知道整個 22 年勞動力都在改善。顯然，去年第一季度對我們的勞動力來說是一個高水位線。所以我們對今天的情況感到滿意。我們希望繼續改進，尤其是在合同工的利用方面。所以總的來說，我們對成本指標感覺很好。正如我所提到的，我們在其他業務中看到了一些通貨膨脹成本趨勢，這些趨勢往往圍繞我們的專業費用和一些我們沒有太多投入的固定成本項目顯示出來。但總的來說，我們認為我們修訂後的指引和展望反映了我們對今年餘下時間的看法。

And your next question comes from the line of Whit Mayo from SVB Securities.

你的下一個問題來自 SVB Securities 的 Whit Mayo。

I was just wondering if you guys could unpack some of the growth that you're seeing in outpatient surgeries between the ASCs and HOPD and maybe comment on any particular pockets of strength or weakness across some of those surgical service lines. And kind of a corollary to this question, too, is just the supply cost look very good even with the surgical growth. So if you could maybe elaborate on that dynamic, Bill, that would be helpful.

我只是想知道你們是否可以解開您在 ASC 和 HOPD 之間的門診手術中看到的一些增長，並可能評論其中一些外科服務線的任何特定優勢或劣勢。這個問題的一個推論也是，即使在手術增長的情況下，供應成本看起來也非常好。因此，如果你可以詳細說明這種動態，Bill，那將會很有幫助。

Whit, this is Sam. Thank you for your question. We had strong activity in both settings. Our surgical volumes and our hospital outpatient units were up actually slightly more than what was inside of our ambulatory surgery centers. Across all service categories within both settings, we saw a really solid volume growth. So it was broad-based, as I mentioned in my comments. We continue to invest in both. We have a more significant investment in our ambulatory surgery center development pipeline with a number of new developments as well as some possible acquisitions that are complementary to the networks that we have across the company.

惠特，這是山姆。謝謝你的問題。我們在這兩種情況下都有很強的活動。我們的手術量和醫院門診病房的增長實際上略高於門診手術中心的增長。在這兩種環境下的所有服務類別中，我們都看到了非常穩健的銷量增長。正如我在評論中提到的那樣，它具有廣泛的基礎。我們繼續投資於兩者。我們對我們的門診手術中心開發管道進行了更重大的投資，其中包括許多新開發項目以及一些可能的收購，這些收購與我們在整個公司擁有的網絡相輔相成。

We're really pleased with our surgical activity. We're also very pleased with our inpatient surgical activity as we've seen growth in both our emergency surgeries as a result of our emergency room activity as well as elective surgeries across different disciplines. The only category that was down actually our C-sections, where we didn't have as much obstetric volume as we did in other parts of our business. And so if you normalize for that, dynamic, we were actually up more significantly in the more acute categories of our service lines. So a very solid result for us from a surgical volume standpoint.

我們對我們的手術活動非常滿意。我們也對我們的住院手術活動感到非常滿意，因為我們已經看到，由於我們的急診室活動以及不同學科的擇期手術，我們的急診手術都有所增長。唯一下降的類別實際上是我們的剖腹產，我們的產科數量不如我們業務的其他部分那麼多。因此，如果你對此進行標準化，動態的，我們實際上在我們服務線的更尖銳的類別中有更顯著的提升。因此，從手術量的角度來看，這對我們來說是一個非常可靠的結果。

Our supply costs have continued to perform well. We have a great supply chain capability in our company, and we utilize it to leverage best practices, contracting logistics, inventory management and so forth. And we continue to maintain even with increased acuity, increased surgical activity good metrics around our supply cost.

我們的供應成本繼續表現良好。我們公司擁有強大的供應鏈能力，我們利用它來利用最佳實踐、承包物流、庫存管理等。即使敏銳度提高，手術活動增加，我們仍繼續保持供應成本的良好指標。

And your next question comes from the line of Justin Lake from Wolfe Research.

你的下一個問題來自 Wolfe Research 的 Justin Lake。

I wanted to follow up on the labor side. I think you said temp labor costs were down 21% year-over-year. Can you confirm that for me? And then just give us a little color in terms of the percentage of hours, nursing hours that came from temp labor, temp labor as a percentage of SW or -- temp labor as a percentage of SWB dollars and anything else kind of in terms of trends that you're expecting in temp labor through the year that's implied in guidance? Where do you expect to come out of the year on some of those metrics?

我想跟進勞動力方面。我想你說過臨時工成本同比下降了 21%。你能幫我確認一下嗎？然後就工作時間百分比、來自臨時工的護理時間、臨時工佔 SW 的百分比或臨時工佔 SWB 美元的百分比以及其他任何類型的內容，給我們一些顏色您對指導中暗示的全年臨時工的預期趨勢是什麼？您預計這些指標中的某些指標會在今年取得怎樣的成績？

Yes. Thanks, Justin. This is Bill. So yes, I'll confirm our contract labor was down about 20% year-over-year, and again, we're continuing to be pleased with the trends in there. It's really rooted in the fact that our recruitment is up and turnover is down. So a lot of effort in that front. For the quarter, our contract labor was about 7.1% of our SWB. That compares to about 9.5% last year, and we were running mid-7s through the last half of '22, so good trends.

是的。謝謝，賈斯汀。這是比爾。所以是的，我會確認我們的合同工同比下降了約 20%，而且我們繼續對那裡的趨勢感到滿意。這真正植根於我們的招聘人數增加而人員流動減少的事實。在這方面付出了很多努力。本季度，我們的合同工約占我們 SWB 的 7.1%。相比之下，去年這一比例約為 9.5%，而且我們在 22 世紀的後半年一直在 7 年代中期運行，趨勢非常好。

Contract labor as a percent of ours was about 10.3% where, this time last year, we were 11.5%, almost 11.6%. So again, continued improvement in that area, really just rooted by lot of efforts we have in the recruitment and retention. As we go through the year, we hope we'll continue to see favorable trends in that, hoping we can get in that 6.5% to 7% by the time we finish this year. So a lot of effort continues by the teams to focus on that.

合同工占我們的百分比約為 10.3%，而去年這個時候，我們是 11.5%，幾乎是 11.6%。因此，在該領域的持續改進，實際上只是植根於我們在招聘和保留方面所做的大量努力。在我們度過這一年時，我們希望我們能繼續看到有利的趨勢，希望到今年結束時我們能達到 6.5% 到 7%。因此，團隊繼續為此付出了大量努力。

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

你的下一個問題來自 RBC 資本市場的 Ben Hendrix。

Could you comment a little further on the same-facility revenue per admission and equivalent admission comps? It looks like maybe lower year-over-year rates in the outpatient volume offset inpatient rate growth. Perhaps you could flesh out the dynamics there for the first quarter and how that could play out for the balance of the year. .

您能否進一步評論一下每次入場的同一設施收入和同等入場收入？看起來門診量的同比下降可能抵消了住院率的增長。也許你可以充實第一季度的動態，以及這將如何影響今年的平衡。 .

Yes. I'll make a first step, Ben. I think, first, you have to recognize on the year-over-year comparisons, the COVID activity has a significant influence on the year-over-year comparisons. When our COVID admissions went from 9.7% last year to 3%, and COVID revenue per admission runs much higher than our non-COVID, is really influencing the as reported. That's why in my prepared remarks I talked about our non-COVID revenue per admission was 2.2% growth. We've seen sequential improvement in case mix. I think overall, I'd say we're pleased with where the performance is and our acuity in our payer mix and the revenue yield we have when we look at sequentially especially on that.

是的。我會邁出第一步，本。我認為，首先，你必須認識到同比比較，COVID 活動對同比比較有重大影響。當我們的 COVID 入場人數從去年的 9.7% 上升到 3% 時，每次入場的 COVID 收入比我們的非 COVID 高得多，這確實影響了報導。這就是為什麼在我準備好的發言中，我談到我們每次入場的非 COVID 收入增長了 2.2%。我們已經看到案例組合的連續改進。我認為總的來說，我想說我們對我們的表現以及我們在付款人組合中的敏銳度以及我們在順序查看時的收入收益率感到滿意，尤其是在這一點上。

So that was the main thing affecting the as reported, was the COVID volume. When we exclude COVID, we're really pleased with the revenue per unit ramps. Outpatient growth was heavy during the quarter, driven, as we talked about, with the emergency room. So that is influencing the per equivalent admission statistics while we broke down the per admission as well. But again, very pleased with the outpatient growth demand that we're seeing as well as the inpatient. So we're pleased with the top line metrics that we're seeing.

因此，據報導，影響的主要因素是 COVID 量。當我們排除 COVID 時，我們對每單位收入的增長非常滿意。正如我們所說，急診室推動了本季度的門診病人增長。因此，當我們也分解每次入場時，這會影響每個等效入場統計數據。但同樣，我們對門診病人和住院病人的增長需求感到非常滿意。因此，我們對我們看到的頂線指標感到滿意。

Just as a quick follow-up, can you parse out the degree to which your -- the acuity that you're seeing is just kind of normalization in terms of admission patterns versus kind of some of the investments you've made to expand your network capabilities?

就像快速跟進一樣，您能否分析出您所看到的敏銳度在入學模式方面的正常化程度與您為擴大您所做的一些投資的程度網絡能力？

It's hard to parse it out. I mean it's all inclusive. I mean, obviously, with a good surgical volume that we had, that helped fuel that. We do continue to see recovery of demand in the marketplace. But we continue to invest in growing our service offerings and our higher acuity services. So it's hard to parse out and attribute that from one or the other, but both I think are factors in the trends we're seeing.

很難解析出來。我的意思是它是全包的。我的意思是，很明顯，我們擁有良好的手術量，這有助於推動這一點。我們確實繼續看到市場需求的複蘇。但我們繼續投資於增加我們的服務產品和更高敏銳度的服務。所以很難從一個或另一個中分析出並歸因於它，但我認為兩者都是我們所看到的趨勢的因素。

Yes, and Bill, I think it's important to understand that our acuity or case mix index, the composite view of that is holding strong and actually up over 2019 when you consider we've lost a really high case mix component in total joint surgery. So I think that speaks to the underlying acuity mix within our remaining inpatient portfolio. We also had total joint surgery growth when you look at inpatient and outpatient again in the quarter.

是的，比爾，我認為重要的是要了解我們的敏銳度或病例組合指數，當你認為我們在全關節手術中失去了一個非常高的病例組合成分時，綜合觀點在 2019 年保持強勁並且實際上有所上升。所以我認為這說明了我們剩餘的住院病人投資組合中潛在的敏銳度組合。當您在本季度再次查看住院病人和門診病人時，我們的關節手術總量也有所增長。

But nonetheless, those cases are now in the outpatient setting and out of our inpatient mix, but yet we've been able to sustain really strong acuity mix in total. And that's due to, again, program development, as Bill alluded to, specific efforts in certain markets and certain facilities to advance their clinical capabilities, and it's yielding what we hoped.

但是儘管如此，這些病例現在處於門診環境中並且不在我們的住院病人組合中，但我們已經能夠維持非常強大的總體敏銳度組合。這再次歸因於程序開發，正如比爾提到的那樣，某些市場和某些設施為提高其臨床能力所做的具體努力，它正在產生我們所希望的結果。

Your next question comes from the line of Gary Taylor from Cowen.

你的下一個問題來自 Cowen 的 Gary Taylor。

One of my favorite expressions is when Sam starts talking about EBITDA clearance rates. So I was disappointed not to hear that catch phrase this morning, but otherwise really solid quarter. My question is about commercial rate cycle. I think with all the moving parts with COVID, even when we see the Q, it's going to be hard to sort of tease out what's happening there. So just wanted to see if you could just update us on how you're doing on your commercial rate renewals. Is there any material activity on off-cycle renewals? Does this $145 million settlement say anything about the environment in terms of how you're positioned with the payers? Or is it just completely sort of a one-off?

我最喜歡的表達方式之一是當 Sam 開始談論 EBITDA 清算率時。所以我很失望今天早上沒有聽到那個流行語，但在其他方面確實很穩固。我的問題是關於商業利率週期。我認為對於 COVID 的所有活動部件，即使我們看到 Q，也很難梳理出那裡發生的事情。所以只是想看看您是否可以向我們介紹您在商業利率續訂方面的表現。是否有關於非週期更新的任何實質性活動？這筆 1.45 億美元的和解協議是否說明了您與付款人之間的關係？還是完全是一次性的？

So Gary, not to disappoint our EBITDA clearance in the quarter was 36%. So that's a really good metric for us, recognizing operating leverage in the face of really inflation. So it sort of proves the model when we can drive activity into our facilities where we have embedded fixed cost, we're able to turn that into earnings in a very productive way. Again, it speaks to our management team's ability to manage their operations effectively.

所以加里，不要讓我們失望，本季度的 EBITDA 清算率為 36%。所以這對我們來說是一個非常好的指標，在真正的通貨膨脹面前認識到運營槓桿。因此，當我們可以將活動驅動到我們嵌入固定成本的設施中時，它就證明了這個模型，我們能夠以一種非常富有成效的方式將其轉化為收益。這再次說明了我們的管理團隊有效管理其運營的能力。

We're pleased with what's going on in our payer contracting cycles. As we said, we're targeting mid-single-digit increases, and we are achieving that in most circumstances. And I think the payers recognize again the pressures in the marketplace for providers and are allowing sort of responsible increases. So we are roughly contracted for 2023. We're 93% of the way there. We're about 2/3 of the way through 2024 and about 1/4 of the way through 2025. And at this particular point in time, we're able to maintain the trend that we feel is necessary and appropriate for today's circumstances.

我們對付款人合同周期中發生的事情感到滿意。正如我們所說，我們的目標是實現中等個位數的增長，並且在大多數情況下我們都在實現這一目標。而且我認為付款人再次認識到供應商在市場上的壓力，並且正在允許某種負責任的增加。所以我們大致與 2023 年簽約。我們已經完成了 93%。到 2024 年，我們已經完成了大約 2/3，到 2025 年，我們已經完成了大約 1/4。在這個特定的時間點，我們能夠保持我們認為對今天的情況來說必要和適當的趨勢。

The one payer settlement that we talked about, we have processes in place in our Parallon organization, which we believe is a best-in-class revenue cycle capability. And through their efforts and through our support efforts of other components of our business, we were able to resolve some claims that we felt were underpaid in previous years, and those payments were recognized in this particular quarter. I don't know that it's reflective of anything in the marketplace other than the specifics around that particular circumstance.

我們談到的單一付款人結算，我們在 Parallon 組織中有適當的流程，我們認為這是一流的收入周期能力。通過他們的努力以及我們業務其他部門的支持努力，我們能夠解決我們認為前幾年支付不足的一些索賠，並且這些付款在本季度得到確認。我不知道它是否反映了市場上的任何情況，除了特定情況下的具體情況。

I will say that we are focused on making sure that we have the right controls in place, the right relationships in place and the right procedures around ensuring that we get the reimbursement that we have earned. And if there are underpayments or denials that we think are not appropriate, then we will make sure that we work our way through those disputes to get to the answer that we think is appropriate for the company. And I wouldn't say that's anything new necessarily, but it continues to be an ongoing opportunity.

我要說的是，我們專注於確保我們擁有適當的控制措施、適當的關係以及確保我們獲得應得的報銷的正確程序。如果存在我們認為不合適的少付或拒絕，那麼我們將確保我們努力解決這些爭議，以找到我們認為適合公司的答案。我不會說這一定是什麼新東西，但它仍然是一個持續的機會。

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

你的下一個問題來自德意志銀行的 Pito Chickering。

Any color on how full-time nurse wage inflation is tracking so far this year versus your expectations? And are you seeing any competitors increase their wages again in 2023? Or is it pretty stable at this point? And on the non-nursing staff, where is that tracking? And can you reflect us on what you assume for nursing and non-nursing wage inflation for 2023 in your guidance?

與您的預期相比，今年到目前為止全職護士工資上漲的趨勢如何？您是否看到任何競爭對手在 2023 年再次增加工資？還是在這一點上相當穩定？對於非護理人員，跟踪在哪裡？您能否反映我們在您的指導中對 2023 年護理和非護理工資通脹的假設？

Pito, this is Sam. I think our overall compensation per hour across all aspects of our workforce are trending where we expected them to trend this year. And we're pleased with the progress. And that's in the face of us making some fairly significant increases over the latter part of '22. And we continue to make modest increases in certain market circumstances in '23, responding to new data or new understandings around what's happening from one market to the other.

皮托，這是山姆。我認為我們員工隊伍各個方面的每小時整體薪酬趨勢與我們今年預期的趨勢一致。我們對進展感到滿意。這就是我們在 22 世紀後期做出一些相當顯著的增長。我們繼續在 23 年的某些市場環境中適度增加，以響應新數據或對從一個市場到另一個市場正在發生的事情的新理解。

As I mentioned on our call, our turnover was down. Our nursing turnover was approaching pre-pandemic levels. We were running about 15% -- 14.5% to 15% in 2018 and 2019. We're running about 17% when you look at the last 6 months annualized. So a very good trend happening. And we think it's again a factor of the macro trends, some of our specific actions around compensation program, efforts to really increase resourcing and capabilities for our nurses and other caregivers. So we're really encouraged by the efforts of our teams, the recruitment metrics that we're seeing and where we are competitively in the market.

正如我在電話中提到的，我們的營業額下降了。我們的護理人員流動率接近大流行前的水平。我們在 2018 年和 2019 年運行了大約 15%——14.5% 到 15%。當你看過去 6 個月的年化率時，我們運行了大約 17%。所以一個非常好的趨勢正在發生。我們認為這又是宏觀趨勢的一個因素，我們圍繞薪酬計劃採取的一些具體行動，真正為我們的護士和其他護理人員增加資源和能力的努力。因此，我們對團隊的努力、我們看到的招聘指標以及我們在市場上的競爭力感到非常鼓舞。

Will there be a market here or there that we have to adjust to as we move through the year? Yes. We believe that's factored into our guidance appropriately, and we should be able to manage through those changes as the year progresses.

在我們度過這一年的過程中，這里或那裡會有我們必須調整的市場嗎？是的。我們認為，這已適當地納入我們的指導方針，隨著時間的推移，我們應該能夠應對這些變化。

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

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

Could you speak to the increase in CapEx guidance for the year? And I'm curious if you accelerate anything specifically in 1Q as that came in a little bit above where we were thinking? I'm specifically interested in the types of projects that are getting funded and especially the ones that have been -- that weren't contemplated maybe 3 months ago? And then lastly, I heard real estate purchases. I'm assuming those are for new inpatient hospital facilities over time.

你能談談今年資本支出指導的增加嗎？我很好奇你是否在第一季度特別加速了任何事情，因為它比我們想像的要高一點？我對獲得資助的項目類型特別感興趣，尤其是那些可能在 3 個月前沒有考慮過的項目？最後，我聽說了房地產購買。我假設這些是隨著時間的推移用於新的住院醫院設施。

Yes. This is Sam. Thank you for the question. We have a number of communities that we serve where we believe, over time, we're going to need to add to our hospital network, We're obviously adding significantly to our outpatient network. We have approximately 2,500 outpatient facilities that support our 180 or so hospitals across our communities. But we believe that over time, as our communities continue to grow, and we believe that's one of the differentiating attributes of HCA, that are -- we're in great markets that have great growth prospects in and of themselves, before we get to share gain possibilities in those markets, that is going to require us to build out some new hospital facilities.

是的。這是山姆。感謝你的提問。我們有許多我們服務的社區，我們相信，隨著時間的推移，我們將需要增加我們的醫院網絡，我們顯然正在顯著增加我們的門診網絡。我們擁有大約 2,500 個門診設施，為我們社區中的 180 多家醫院提供支持。但我們相信，隨著時間的推移，隨著我們社區的不斷發展，我們相信這是 HCA 的差異化屬性之一，即 - 在我們進入之前，我們處於本身俱有巨大增長前景的偉大市場分享這些市場的收益機會，這將要求我們建造一些新的醫院設施。

We do have a new hospital opening in -- or under construction in San Antonio -- actually 2 in San Antonio as we speak, but San Antonio is one of those markets where we have uniquely high occupancy. That market, for example, we run approximately 90% occupancy. And we think it's better for us to open up new hospitals as opposed to keep adding on in every circumstance in that particular community. But we do own land in Austin, Texas, for new hospitals, we own land in Dallas for new hospitals. We just recently purchased in the first quarter land for new hospitals in Las Vegas and Salt Lake City. We have land for new hospitals in a number of Florida markets. So that's part of what you're seeing in our capital spending, is that we are acquiring land for future network development.

我們確實在聖安東尼奧開設了一家新醫院或正在建設中——實際上在我們說話時在聖安東尼奧有 2 家，但聖安東尼奧是我們擁有獨特高入住率的市場之一。例如，該市場的入住率約為 90%。我們認為開辦新醫院比在特定社區的任何情況下都增加醫院更好。但我們在得克薩斯州奧斯汀擁有新醫院的土地，我們在達拉斯擁有新醫院的土地。我們剛剛在第一季度為拉斯維加斯和鹽湖城的新醫院購買了土地。我們在佛羅里達州的許多市場擁有用於新建醫院的土地。因此，這就是您在我們的資本支出中看到的一部分，即我們正在為未來的網絡發展收購土地。

In addition to that, we have significantly advanced our outpatient facility development. That doesn't put too much pressure on our capital spending, but there are some elements of it that are in the increased guidance. And then finally, I think it's important for everybody to understand, we are still in a situation where we have a lot of facilities that have high levels of occupancy. In the first quarter, the company ran approximately 73% to 74% occupancy in its inpatient facilities. And we need to have sufficient capacity as we build up our staffing over time. We need physical capacity to accommodate what we believe to be the demand for healthcare.

除此之外，我們還顯著推進了門診設施的發展。這並沒有給我們的資本支出帶來太大壓力，但其中有一些因素在增加的指導中。最後，我認為每個人都應該明白，我們仍然處於這樣一種情況，即我們有很多設施的入住率很高。第一季度，該公司住院設施的入住率約為 73% 至 74%。隨著時間的推移，我們需要有足夠的能力來增加我們的人員配置。我們需要身體能力來滿足我們認為對醫療保健的需求。

So the projects are really mixed among those 3 things: land acquisitions for future hospital development, outpatient network development and then relieving capacity constraints on the existing platform of facilities that we have today.

因此，這些項目實際上混合了這三件事：為未來醫院發展徵地、門診網絡發展，然後緩解我們今天現有設施平台的容量限制。

And Josh, this is Bill. I'll add. We obviously can accommodate that increasing capital within the resources we're generating and within our overall capital allocation philosophies that we have. And we also continue to see really strong returns on invested capital. So we have confidence that these investments will continue to generate growth for us into the future.

喬希，這是比爾。我會補充。我們顯然可以在我們正在產生的資源和我們擁有的整體資本配置理念中容納不斷增加的資本。我們也繼續看到非常強勁的投資回報。因此，我們有信心這些投資將繼續為我們帶來未來的增長。

Your next question comes from the line of Brian Tanquilut from Jefferies.

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

Bill, maybe just a question on how we should be thinking about the moving pieces or considerations for the second quarter. I know you called out the Envision contribution to revenue and then maybe the New Orleans Hospital. But anything that we should be thinking about sequentially and year-over-year?

比爾，也許只是一個關於我們應該如何考慮第二季度的變化或考慮因素的問題。我知道你提到了 Envision 對收入的貢獻，然後可能是新奧爾良醫院。但是我們應該按順序和逐年考慮什麼？

Yes. Brian, nothing material. I mean, once we kind of anniversary the high-COVID volume, which is principally first quarter. Second quarter of last year, we began to see the start of normalization. Obviously, we're coming off some continued high labor costs in the first quarter. We saw some improvement in the second quarter and obviously improvement as we went through the balance of the year. So I can't say there's anything material, I can call out, especially one quarter to the next. We typically wouldn't do that. But for the balance of the year, now that we've got the majority of the high COVID behind us in terms of the year-over-year comparisons, things should begin to normalize for the most part.

是的。布賴恩，沒什麼實質性的。我的意思是，一旦我們慶祝高 COVID 量，主要是第一季度。去年第二季度，我們開始看到正常化的開始。顯然，我們在第一季度擺脫了一些持續高企的勞動力成本。我們在第二季度看到了一些改善，並且在我們度過了今年餘下的時間後明顯改善。所以我不能說有任何實質性的東西，我可以大聲疾呼，尤其是四分之一到下一個季度。我們通常不會那樣做。但是對於今年餘下的時間，既然就同比比較而言，我們已經將大部分高 COVID 拋在腦後，大部分情況應該會開始正常化。

Your next question comes from the line of Andrew Mok from UBS.

你的下一個問題來自瑞銀的 Andrew Mok。

You provided some breakeven metrics on Medicaid redeterminations in the past. Hoping you could provide an updated view on how you expect that to play out over the next 18 to 24 months and what sort of impact that could have on near and intermediate-term operating results. .

你過去提供了一些關於醫療補助重新確定的盈虧平衡指標。希望您能就您預計在未來 18 到 24 個月內將如何發揮作用以及這可能對近期和中期經營業績產生什麼樣的影響提供最新觀點。 .

Yes. Thanks. I mean, obviously, this is an area we continue to pay attention to. We've got a fairly formalized approach inside of the company. We haven't seen any impact yet as those redeterminations are just beginning to occur, but we are keeping very close to state plans. We've also made outreach to our Medicaid patients to help them look at alternative coverage in the event they find themselves displaced to Medicaid. We continue to be encouraged with some of the third-party studies that we read that a relatively high percentage of those individuals potentially qualify for employer-sponsored coverage or through enhanced subsidies coverage within the health insurance marketplace.

是的。謝謝。我的意思是，顯然，這是我們繼續關注的領域。我們在公司內部有一個相當正式的方法。我們還沒有看到任何影響，因為這些重新確定才剛剛開始，但我們非常接近州計劃。我們還與我們的 Medicaid 患者進行了外展，以幫助他們在發現自己流離失所到 Medicaid 的情況下尋找替代保險。我們繼續對我們讀到的一些第三方研究感到鼓舞，這些研究表明，相對較高比例的個人可能有資格獲得雇主贊助的保險或通過醫療保險市場內加強的補貼覆蓋。

So we are staying very close to that. We are increasing our efforts to help people identify coverage that are available to them, trying to work with states and other community agencies where necessary to help people land coverage. So too early to be able to quantify what the impact of that may be. But ultimately, I believe when people can find coverage in the exchanges or through their employer. We wouldn't really anticipate any material downside, and hopefully, there could be some upside benefit to that over the long run.

所以我們非常接近那個。我們正在加大力度幫助人們確定他們可以使用的覆蓋範圍，並在必要時嘗試與各州和其他社區機構合作，以幫助人們獲得覆蓋範圍。現在量化其影響還為時過早。但最終，我相信人們何時可以在交易所或通過他們的雇主找到保險。我們不會真的預計會有任何實質性的負面影響，希望從長遠來看可能會有一些好處。

Your next question comes from the line of Scott Fidel from Stephens.

你的下一個問題來自 Stephens 的 Scott Fidel。

Interested if you could talk about how you're thinking about the sustainability of the surgical growth trends over the balance of the year, both in inpatient and outpatient. And interested if -- was there any catch-up just as COVID really diminished in the first quarter? Or do you see those types of growth trends are sustainable over the course of the year?

如果您能談談您如何考慮住院和門診手術增長趨勢在今年餘下時間的可持續性，我很感興趣。並且感興趣的是 - 是否有任何追趕，就像第一季度 COVID 真的減少一樣？或者你認為這些類型的增長趨勢在一年中是可持續的嗎？

We're looking -- one, we're pleased with the trends. It's hard to parse exactly the contribution of that. I think overall, we're pleased with the demand and the activity we see in the market. We continue to see -- believe that we're going to return to normal historical volume patterns. And if that does show itself, we should see continued growth in both inpatient and outpatient surgical volume. We continue to invest in our outpatient footprint. That should help drive reasonable outpatient surgical growth. Our program development in the inpatient side should help continue to show good inpatient surgical growth as well. So we'll just have to see that. I think, typically, we would see 1% to 2% type of surgical growth. And as the year goes on, hopefully, we'll continue to see that.

我們正在尋找 - 第一，我們對趨勢感到滿意。很難準確解析它的貢獻。我認為總體而言，我們對市場上的需求和活動感到滿意。我們繼續看到 - 相信我們將恢復正常的歷史交易量模式。如果確實如此，我們應該會看到住院和門診手術量的持續增長。我們繼續投資於我們的門診足跡。這應該有助於推動合理的門診手術增長。我們在住院方面的項目開發也應該有助於繼續顯示良好的住院手術增長。所以我們只需要看看。我認為，通常情況下，我們會看到 1% 到 2% 的手術增長。隨著時間的推移，希望我們能繼續看到這一點。

Yes. And just to add to that, Bill. I think as we continue to increase our staffing capacity, it also affects our surgical capacity because we do have instances where we're not able to open all of our operating rooms as sufficiently as we would prefer also. And so as our labor situation continues to get better, we think that will allow us to open up more surgical capacity, and we believe the demand in the market is still there. So we're encouraged by where we are with our surgical volumes, and we think we have some things that should prop it up, if you will, as we move through the year with our staffing agenda and our human resource strategies.

是的。再補充一點，比爾。我認為，隨著我們繼續增加人員配備能力，這也會影響我們的手術能力，因為我們確實有一些情況無法像我們希望的那樣充分開放所有手術室。因此，隨著我們的勞動力狀況持續好轉，我們認為這將使我們能夠開放更多的手術能力，我們相信市場需求仍然存在。因此，我們對我們的手術量所處的位置感到鼓舞，並且我們認為，如果你願意的話，我們有一些東西可以支撐它，因為我們在今年的人員配置議程和人力資源戰略中取得了進展。

Your next question comes from the line of Lance Wilkes from Bernstein.

你的下一個問題來自 Bernstein 的 Lance Wilkes。

Actually, that's a perfect lead into my question. Could you talk a little bit about your outlook for staff growth? And in particular, obviously, you had the shift from temporary to permanent which has been great. Can you talk about how your staff has grown or maybe registered nurse staff or something like that over the last year? And then as you're looking forward, are there any particular impediments to continued levels of growth?

實際上，這是我提出問題的完美線索。您能談談您對員工成長的展望嗎？特別是，很明顯，你已經從臨時轉變為永久，這很好。你能談談你的員工在過去一年裡是如何成長的，或者是註冊護士或類似的事情嗎？然後，正如您所期待的那樣，持續增長水平是否有任何特別的障礙？

Well, our total headcount was up around 2% when you look at this first quarter against last first quarter, and let me make sure that -- actually, it's more like 3% when you factor out the 2-lane divestiture. So we're up 3% quarter-over-quarter, which is obviously solid improvement in the market. As we've mentioned in the third quarter and the fourth quarter of last year, we were starting to see some momentum with our hiring, some momentum with our retention programs and so forth. And that's carried through into the first quarter really well.

好吧，當你看到第一季度與上一季度相比時，我們的總員工人數增加了約 2%，讓我確保——實際上，當你考慮到 2 車道資產剝離時，它更像是 3%。所以我們比上一季度增長了 3%，這顯然是市場的穩固改善。正如我們在去年第三季度和第四季度提到的那樣，我們開始看到招聘方面的一些勢頭，我們的保留計劃等方面的一些勢頭。這很好地延續到了第一季度。

I think our overall hiring was up 13% or something like that. But in the quarter compared to the running average, it was up 19%, and that's mostly in nursing. I don't know that it will run that hot as we move through the rest of the year nor will we need it to run that hot as we move through the rest of the year. So our efforts with our recruitment, our efforts with retention will continue. We're encouraged by other programs that we have to support our people and put them in the best position to succeed and deliver high-quality care.

我認為我們的整體招聘人數增長了 13% 左右。但在本季度，與運行平均值相比，增長了 19%，這主要是在護理領域。我不知道它會在我們今年餘下的時間裡運行得那麼熱，也不知道我們在今年餘下的時間裡也不需要它運行得那麼熱。因此，我們在招聘和留住人才方面的努力將繼續下去。我們對其他計劃感到鼓舞，我們必須支持我們的員工並使他們處於成功和提供高質量護理的最佳位置。

We have a significant investment we're making in clinical education. Our Galen School of Nursing continues to grow, and we're really encouraged by what those programs will do for our facilities and our people over time. So those things are all part and parcel to a very comprehensive effort to make sure we have the right amount of staff, they're supplied with the right technology and resources to deliver high-quality care and they can be successful in growing our company. So we're pretty encouraged by where we are.

我們在臨床教育方面進行了大量投資。我們的蓋倫護理學院不斷壯大，隨著時間的推移，這些項目將為我們的設施和員工帶來的影響讓我們深受鼓舞。因此，這些事情都是非常全面的努力的一部分，以確保我們擁有合適數量的員工，為他們提供合適的技術和資源來提供高質量的護理，他們可以成功地發展我們的公司。所以我們對我們所處的位置感到非常鼓舞。

Your next question comes from the line of Calvin Sternick from JPMorgan.

你的下一個問題來自摩根大通的 Calvin Sternick。

Wanted to ask about capacity. I know you said 1.5% for the quarter but still above pre-pandemic levels and labor improving. So just want to get a sense, what are some of the other key variables for getting the declination rate back down to historical levels? And where do you think you can get to by year-end?

想問容量。我知道你說本季度增長 1.5%，但仍高於大流行前的水平，勞動力也在改善。所以只是想了解一下，讓偏角率回到歷史水平的其他一些關鍵變量是什麼？你認為到年底你能到達哪裡？

Well, hopefully, we get back to prepandemic levels. We benchmarked a lot of our metrics against where we were in 2019 so that we can have a comparison of sort of more normalized environment. But obviously, our leverage, and as I just mentioned, is very important to our abilities to open up all of our bed capacity and surgical capacity and so forth. Even our emergency room capacity sometimes can be constrained because of staffing levels and such. I think it will continue to get better.

好吧，希望我們能回到大流行前的水平。我們根據 2019 年的情況對很多指標進行了基準測試，以便我們可以比較更規範化的環境。但顯然，正如我剛才提到的，我們的影響力對於我們開放所有床位容量和手術容量等的能力非常重要。由於人員配備水平等原因，有時甚至我們的急診室容量也會受到限制。我認為它會繼續變得更好。

As we went through the first quarter, March was better than January as an example. So that's a positive trend within the quarter. We're hopeful that, that will sustain itself as we move through the balance of the year. And as we look at some of our hiring and the timing of that hiring, that should line up with some continued improvement as we sequentially move through the year.

當我們經歷第一季度時，例如，3 月好於 1 月。所以這是本季度的積極趨勢。我們希望，在我們度過今年餘下的時間時，這種情況會持續下去。當我們查看我們的一些招聘和招聘時間時，這應該與我們在這一年中連續移動的一些持續改進保持一致。

So those are the main things. Some -- we have capital that will come online over the course of the year, as we always do. That will help in certain circumstances. But I think the most important variable is staff and getting sufficient staff into our facilities, allowing us to open up our beds and so forth appropriately.

所以這些是主要的事情。一些 - 我們有資本將在一年中上線，就像我們一直做的那樣。這在某些情況下會有所幫助。但我認為最重要的變量是工作人員，讓足夠的工作人員進入我們的設施，讓我們能夠適當地開放床位等等。

Your next question comes from the line of Steven Valiquette from Barclays.

你的下一個問題來自巴克萊銀行的 Steven Valiquette。

So really one main question here. When looking at some of the hospital-related volume commentary from medical device companies over the past week or 2, at least one of them suggested from their view that hospital volumes were the strongest in January and February then normalized in March. And I know no one really likes questions on the monthly performance. So really just my more high-level question is if you could just comment on whether or not the momentum in your overall operations was generally pretty consistent throughout the quarter. And then also, is the full year '23 guidance increase meant to reflect mainly just the upside witnessed in 1Q? And is the rest of the year outlook is generally unchanged from your prior view? Or should we all expect strong momentum from the first quarter to continue into 2Q? Just kind of can I have your thoughts around all that for just the overall operations would be helpful?

所以這裡真的是一個主要問題。在查看過去一周或兩週內醫療器械公司的一些與醫院相關的數量評論時，至少有一家公司表示，他們認為醫院數量在 1 月和 2 月最為強勁，然後在 3 月恢復正常。而且我知道沒有人真正喜歡關於月度表現的問題。所以我的更高層次的問題是，你是否可以評論一下整個季度整體運營的勢頭是否總體上相當一致。然後，23 年全年的指導增長是否主要反映了第一季度的上行趨勢？今年剩餘時間的前景是否與您之前的看法大致相同？還是我們都應該期待第一季度的強勁勢頭會持續到第二季度？我能否了解您對整體運營有幫助的所有想法？

Well, again, I think we've seen momentum on there. So yes, the guidance is, I think, is referenced by a few others, principally the performance in the first quarter that we saw. But as we look at volume through the quarter, I think it was pretty consistent on there. We're feeling positive with some of the trends we're seeing. It's hard to call exactly what may happen and exactly what period they will. But we continue to see good demand in the markets. We continue to add our capacity, continue to be able to serve that. So we think we've incorporated all reasonable assumptions into the guidance going forward. And that's where we stand right now and we'll continue to monitor as the year goes on.

好吧，我想我們已經看到了那裡的勢頭。所以是的，我認為該指導被其他一些人參考，主要是我們看到的第一季度的表現。但是當我們看整個季度的交易量時，我認為它在那裡非常一致。我們對所看到的一些趨勢感到樂觀。很難準確預測可能會發生什麼以及它們會發生在什麼時期。但我們繼續看到市場需求良好。我們繼續增加我們的能力，繼續能夠提供服務。所以我們認為我們已經將所有合理的假設納入了未來的指導中。這就是我們現在的立場，隨著時間的推移，我們將繼續監測。

Your next question comes from the line of Jason Cassorla from Citigroup.

你的下一個問題來自花旗集團的 Jason Cassorla。

You noted favorable payer mix in the quarter. I was hoping you can give us a sense on commercial -- core commercial volume growth split out between exchange-related volumes and then just pure commercial. And perhaps if you saw in 1Q or are currently seeing any commercial volume pull forward perhaps ahead of potential coverage changes later this year? Or do you think that commercial volume trend is just more broad-based? Any color on that would be very helpful.

您注意到本季度有利的付款人組合。我希望你能讓我們了解商業——核心商業量增長分為交易所相關量和純商業量。也許如果您在第一季度看到或目前看到任何商業量可能會在今年晚些時候潛在的覆蓋範圍變化之前出現？還是您認為商業量趨勢只是基礎更廣泛？上面的任何顏色都會非常有幫助。

Yes. I mean, as I mentioned in my comments, our non-COVID commercial volume was up a little over 11%. So obviously, that's a stat we're very pleased. We're very pleased with the exchange enrollment. We saw really good enrollment across our states. Some of the publicly released data that you've seen, we've seen exchange enrollment in Florida up 18%, Texas up close to 30%. And that generally (inaudible) is pretty well with where we would expect exchange volume to be.

是的。我的意思是，正如我在評論中提到的，我們的非 COVID 商業廣告量增長了 11% 以上。很明顯，這是一個我們非常滿意的數據。我們對交流招生非常滿意。我們看到我們各州的入學率非常高。您看到的一些公開發布的數據，我們看到佛羅里達州的交換入學人數增長了 18%，德克薩斯州增長了近 30%。通常（聽不清）與我們預期的交易量相當。

Our exchange volume just year-over-year was up, what, 19% or so for the quarter. It's hard to make some of those comparisons pure on the non-exchange because COVID has such an impact on that. But if I back up and look at the non-COVID growth of managed care at 11% is still so pretty strong. And even overall, we were up 4%. So again, we're thinking that there's good payer mix will continue, good demand. We still see basically full employment in most of our markets. So we'll see where that plays out. But we are pleased with the health insurance exchange activity that we're seeing across the markets.

我們的交易量同比增長了 19% 左右。很難將其中一些比較純粹放在非交換上，因為 COVID 對此有如此大的影響。但是，如果我回過頭來看看管理式醫療的非 COVID 增長 11% 仍然非常強勁。甚至總體而言，我們上漲了 4%。因此，我們再次認為，良好的付款人組合將繼續存在，需求良好。在我們的大部分市場中，我們仍然看到基本充分就業。因此，我們將看看結果如何。但我們對我們在市場上看到的健康保險交易活動感到滿意。

Your next question comes from the line of Sarah [Gains] from Cantor Fitzgerald.

你的下一個問題來自 Cantor Fitzgerald 的 Sarah [Gains]。

I'm trying to piece together a few of the comments that you made on contract labor. You talked about getting down to about 6.5% to 7% exiting the year. Is that in line with what you've been thinking before? I thought you guys were a little bit lower. And then how do you think about reinvesting the savings of that? So how much is going to wage inflation versus actually increasing headcount? Or is any of it falling to the bottom line as sort of a margin relief?

我正在嘗試拼湊您對合同工發表的一些評論。你談到今年退出率降至 6.5% 至 7% 左右。這與你之前的想法一致嗎？我還以為你們低了點那麼您如何看待將節省下來的資金進行再投資？那麼，工資通脹與實際增加的員工人數相比有多少呢？還是其中任何一項都作為保證金減免而跌至底線？

Well, I mean, there's a lot of moving parts in our labor side. And obviously, our focus has been reducing the utilization of our premium labor, and that has allowed us to continue to invest in our employed workforce. And we continue to invest in our existing employees both through wage rates as well as hiring that was spoken about earlier on the call. And so when we roll it all up, we kind of look at the overall impact.

好吧，我的意思是，我們的勞動力方面有很多活動部件。顯然，我們的重點一直是減少對優質勞動力的利用，這使我們能夠繼續投資於我們的就業勞動力。我們繼續通過工資率以及在電話會議上早些時候談到的招聘來投資於我們現有的員工。因此，當我們將其全部匯總時，我們會查看整體影響。

And yes, we are fortunate that as we've been able to reduce contract labor, that's allowed us to make the investments into our employed workforce. I think that will continue. I think our commentary around our expectations has been reasonably consistent. If you looked at where we ran kind of pre-COVID, it was probably in that 6% range. We think we can continue to make progress on that. So it's fairly consistent. But again, we are investing much of the benefit of contract labor back into our existing employees.

是的，我們很幸運，因為我們能夠減少合同工，這使我們能夠對我們的就業勞動力進行投資。我認為這將繼續下去。我認為我們對我們的期望的評論是相當一致的。如果你看看我們在 COVID 之前運行的地方，它可能在 6% 的範圍內。我們認為我們可以繼續在這方面取得進展。所以它是相當一致的。但同樣，我們正在將合同工的大部分收益重新投入到我們現有的員工身上。

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

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

I just wanted to follow up on another question. You mentioned having a pretty decent amount of visibility on 2024 contracting at this point. I mean, can you just remind us how the 2/3 compared to where you might have been in a more typical pre-COVID environment? And I think you also alluded that the commercial rate dynamics continuing to be acknowledged by payers at the same general magnitude. Just want to confirm if that was what you meant by those comments.

我只是想跟進另一個問題。你提到在這一點上對 2024 年的合同有相當大的可見度。我的意思是，您能否提醒我們，與您在更典型的 COVID 前環境中所處的位置相比，2/3 的情況如何？而且我認為你還提到商業利率動態繼續被付款人以同樣的普遍程度承認。只是想確認這些評論是否就是您的意思。

I'm not sure I understood the second part of that question. But the first part of the question, we're, like I said, running mid-single digits on our renewed contracts. We were running 3.5% or so prepandemic with our commercial contracting. So it is up a little bit. Again, it's reflective of, I think, the overall inflationary environment that most organizations find themselves. But we think it's a responsible ask and it's been received reasonably well by the payers that we've renewed. What was the second question?

我不確定我是否理解該問題的第二部分。但問題的第一部分，就像我說的，我們在續簽合同上運行中個位數。我們的商業合同在大流行前運行了 3.5% 左右。所以它上漲了一點。同樣，我認為它反映了大多數組織發現自己的整體通脹環境。但我們認為這是一個負責任的要求，我們已經續籤的付款人已經很好地接受了它。第二個問題是什麼？

Well, I think the other one was around the percentage of our contracts that are completed for '24? Is it consistent with where its historical...

好吧，我認為另一個是關於我們在 24 年完成的合同的百分比？它是否符合其歷史...

Oh, yes, it is.

哦，是的，是的。

And if it is consistent with where we would have historically been.

如果它與我們歷史上的位置一致。

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

你的下一個問題來自高盛的 Jamie Perse。

I wanted to ask a question about the procedure shift to outpatient. First, can you help us quantify what the headwind from that shift has been to revenue and EBITDA over the last couple of years? And then two, categories like knees and hips, so a little bit more homogenous, how do we think about the shift of categories like cardiology? You mentioned that was up 7% in the outpatient setting in the quarter. Are there big categories in cardiology that are analogous to total joints that you think are a big category that is so amenable to that shift to outpatients that we should be thinking about impacting the transition in the near term?

我想問一個關於程序轉移到門診的問題。首先，您能否幫助我們量化過去幾年這種轉變對收入和 EBITDA 的不利影響？然後是兩個，膝蓋和臀部等類別，所以更加同質化，我們如何看待心髒病學等類別的轉變？你提到本季度門診病人增加了 7%。心髒病學中是否有類似於全關節的大類別，您認為這些大類別非常適合門診病人的轉移，我們應該考慮在短期內影響這種轉變？

We don't see any particular procedural category facing the same type of pressure as total joints did. I think our company is somewhere around 80% of our total joints today are done as an outpatient with 20% done as an inpatient. That was reversed prepandemic. So we've absorbed all of that. And it was a headwind with respect to a P&L impact over this time period. The rest of the categories are not as discrete as total joints.

我們沒有看到任何特定的程序類別面臨與全關節相同類型的壓力。我認為我們公司今天大約有 80% 的關節是作為門診病人完成的，20% 是作為住院病人完成的。這是大流行前的逆轉。所以我們已經吸收了所有這些。就這段時間的損益影響而言，這是一個逆風。其餘類別不像總關節那樣離散。

And in cardiac, particularly, a large piece of our cardiac volumes today are already in the outpatient setting. And so we don't anticipate anything in that particular category shifting like total joints have shifted. We've seen some shift over time in spine, and that's more incremental than it is holistic like total joints. We've seen some in cardiac over the years. We've seen some with our robotics platform. Those continue sort of on the margin. They're not structurally repositioning like total joints did.

特別是在心臟方面，我們今天的大部分心臟體積已經在門診病人中。因此，我們預計該特定類別中不會發生任何變化，例如總關節已經發生變化。我們已經看到脊柱隨著時間的推移發生了一些變化，而且這種變化比像總關節那樣的整體變化更大。多年來，我們在心臟方面看到了一些。我們已經在我們的機器人平台上看到了一些。那些仍然處於邊緣。它們不像總關節那樣在結構上重新定位。

And so our company has effectively navigated that transition. Again, we have a multifaceted offering for patients and physicians, both in our facilities, outpatient within our facilities, ambulatory surgery centers and so forth. And that's -- one of those settings is the right setting for just about every patient. And I think our organization has been able to grow as a result of that multifaceted offering. And our total joints, like I said earlier, are actually up year-over-year and they were up last year compared to the previous year. So we've seen good growth in our orthopedic programs, and we continue to work with our surgeons and our service line leaders to advance our capabilities as well.

因此，我們公司有效地駕馭了這一轉變。同樣，我們為患者和醫生提供多方面的服務，包括我們的設施、我們設施內的門診病人、門診手術中心等等。那就是——其中一個設置對幾乎每個病人都是正確的設置。而且我認為我們的組織已經能夠通過提供多方面的服務而發展壯大。正如我之前所說，我們的總關節數實際上同比增長，去年與前一年相比有所增長。因此，我們的骨科項目取得了良好的發展，我們將繼續與我們的外科醫生和服務線負責人合作，以提高我們的能力。

And there are no further questions at this time. Mr. Frank Morgan. I turn the call back over to you for some final closing remarks.

目前沒有其他問題。弗蘭克·摩根先生。我將電話轉回給您，請您作最後的結束語。

Rob, thank you for your help today, and thanks for everyone for joining the call. We hope you have a great weekend. I'm around this afternoon. If we can answer any additional questions you might have, reach out. Thank you.

Rob，感謝你今天的幫助，感謝大家加入電話會議。我們希望你有一個愉快的周末。我今天下午在附近。如果我們可以回答您可能有的任何其他問題，請聯繫我們。謝謝。

This concludes today's conference call. Thank you for your participation. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。