美國醫院公司 (HCA) 2023 Q3 法說會逐字稿

Welcome to the HCA Healthcare Third 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 年第三季財報電話會議。今天的通話正在錄音。現在，我想將電話轉給投資者關係副總裁弗蘭克·摩根先生進行開場發言和介紹。請繼續，先生。

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

早安，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執行長 Sam Hazen；和財務長比爾盧瑟福。薩姆和比爾將提供一些準備好的發言，然後我們將回答問題。

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

在我將電話轉交給 Sam 之前，讓我提醒大家，今天的電話會議是否包含任何前瞻性陳述，這些陳述都是基於管理階層目前的預期。許多風險、不確定性和其他因素可能導致實際結果與今天可能表達的結果有重大差異。

More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings. On this morning's call, we will make -- reference measures such as adjusted EBITDA, which is a non-GAAP financial measure, a table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc. is included in today's release. This morning's call is being recorded, and a replay of the call will be available later today. With that, I'll now turn the call over to Sam.

有關前瞻性陳述和這些因素的更多資​​訊已在今天的新聞稿和我們向 SEC 提交的各種文件中列出。在今天早上的電話會議上，我們將提出參考指標，例如調整後EBITDA（一項非GAAP 財務指標），今天發布的新聞稿中包含一張提供調整後EBITDA 補充資訊以及調節歸屬於HCA Healthcare, Inc . 淨利的表格。今天早上的通話正在錄音，今天晚些時候將提供通話重播。現在，我將把電話轉給 Sam。

All right. Good morning. Thank you for joining the call. The business fundamentals for the company were solid in the quarter with broad-based volume growth on a same facility basis across our footprint and various service lines. These results reflected continued strong demand for our services and healthy operating margins on a same-facility basis. Across most areas of our business, we maintain the operational momentum that we experienced over the past 3 quarters, including continued progress with our labor agenda. Unfortunately, our results were unfavorably impacted by our Valesco hospital-based physician venture. Bill will give additional detail on this impact in a moment.

好的。早安.感謝您加入通話。該公司本季的業務基礎穩固，在我們的足跡和各種服務線的相同設施基礎上，銷量普遍增長。這些結果反映了對我們服務的持續強勁需求以及相同設施基礎上的健康營運利潤。在我們業務的大多數領域，我們保持了過去三個季度的營運勢頭，包括勞工議程的持續進展。不幸的是，我們的結果受到了瓦萊科醫院醫師企業的不利影響。比爾稍後將提供有關此影響的更多詳細資訊。

We are continuing our efforts to integrate this venture and anticipate implementing additional actions that should improve its operational results over the next few quarters, including less pressure for the company in the fourth quarter. Because of this issue, primarily, we have lowered the top side of our earnings guidance for the year to reflect the effects of these losses.

我們正在繼續努力整合該合資企業，並預計實施更多行動，以改善未來幾季的營運業績，包括減輕公司第四季的壓力。主要由於這個問題，我們降低了今年獲利指引的上限，以反映這些損失的影響。

It is important to understand that we believe the decision to consolidate Valesco was strategically imperative in maintaining the overall competitive positioning and capacity offerings of the company. As has been the case historically with our teams, I am confident that we will find a pathway forward to mitigate the impact it has had on our results.

重要的是要明白，我們認為整合 Valesco 的決定對於維持公司的整體競爭地位和產能供應具有戰略意義。正如我們團隊歷史上的情況一樣，我相信我們會找到一條前進的道路來減輕它對我們結果的影響。

For the third quarter, diluted earnings per share were $3.91. Same-facility admissions grew 3.4% year-over-year. Inpatient volumes were supported by continued strong acuity and a favorable payer mix with same-facility commercial admissions growing an impressive 7%. Same facility equivalent admissions increased 4.1%. This growth was driven by emergency room visits, which grew 3.5%. We are encouraged by our ER revitalization program and the results it is producing for our patients.

第三季攤薄後每股收益為 3.91 美元。同一設施的入學人數較去年同期增加 3.4%。持續強勁的敏銳度和有利的付款人組合支撐了住院人數，同一設施的商業入院人數增加了 7%，令人印象深刻。同等設施同等入學人數增加了 4.1%。這一增長是由急診就診人數增加 3.5% 所推動的。我們的急診室振興計畫及其為病患帶來的成果令我們深受鼓舞。

Outpatient surgeries on a same facility basis grew approximately 1% year-over-year. Other outpatient categories also grew, including outpatient cardiology procedures which increased almost 5%. These factors contributed to an increase in same facility revenue of 7.9% as compared to the prior year.

同一設施的門診手術量年增約 1%。其他門診類別也有所增長，其中門診心臟病手術增加了近 5%。這些因素導致同設施收入較上年增加 7.9%。

In the quarter, we continued to invest significantly in our people with additional investments in orientation programs, Galen College of Nursing and clinical education facilities. Turnover was stable in the quarter and nurse hiring was the strongest it has been all year.

本季度，我們繼續對員工進行大量投資，並對入職培訓計劃、蓋倫護理學院和臨床教育設施進行額外投資。本季營業額穩定，護理師招募達到全年最高水準。

These positive results helped reduce contract labor costs, 12.5% as compared to the third quarter last year and 11% sequentially. During the quarter, we maintained available bed capacity, instances where we could not accept patients from other hospitals representing only 0.9% of total admissions, which is consistent with the rate in the second quarter.

這些積極成果有助於降低合約勞動成本，較去年第三季下降 12.5%，比上一季下降 11%。本季度，我們維持了可用床位容量，無法接收其他醫院病患的情況僅佔總入院人數的0.9%，與第二季度的比例一致。

We believe the significant investments we are making in our networks, our people and our technology agenda will provide us with the necessary resources to improve our service offerings and deliver higher quality care to our patients with greater accessibility.

我們相信，我們在網路、人員和技術議程上進行的重大投資將為我們提供必要的資源，以改善我們的服務，並以更方便的方式為患者提供更高品質的護理。

I'm proud of our people for what they do every day to deliver on our purpose. I want to thank them for their dedication and their overall great work. HCA Healthcare has a disciplined operating culture that we will maintain into the future. This focused approach, which benefits all stakeholders enhances our ability to execute clinically strategically and financially.

我為我們的員工每天為實現我們的目標所做的一切感到自豪。我要感謝他們的奉獻精神和整體出色的工作。 HCA Healthcare 擁有紀律嚴明的營運文化，我們將在未來繼續保持這種文化。這種集中的方法有利於所有利害關係人，增強了我們在臨床策略和財務上執行的能力。

So let me close with this. We look forward to our upcoming Investor Day on November 9 and when we will provide more details about the company's approach to driving sustained long-term growth and shareholder value. We will also provide some early perspectives on the upcoming year as well as longer-term thinking on growth targets. With that, I will turn the call to Bill for more details on the quarter's results.

讓我以這個來結束。我們期待即將到來的 11 月 9 日投資者日，屆時我們將提供有關該公司推動持續長期成長和股東價值的方法的更多詳細資訊。我們也將提供對來年的一些早期展望以及對成長目標的長期思考。接下來，我將致電比爾，以了解有關本季業績的更多詳細資訊。

Great. Thank you, Sam, and good morning, everyone. I will provide some additional comments on our performance for the quarter. Consolidated net revenue increased 8.3% to $16.21 billion from $14.97 billion in the prior year period. This was driven by 4.5% growth in equivalent admissions and 3.6% increase in revenue per equivalent admission.

偉大的。謝謝你，山姆，大家早安。我將對我們本季的業績提供一些額外的評論。合併淨收入從去年同期的 149.7 億美元成長 8.3% 至 162.1 億美元。這是由同等入場人數增長 4.5% 和每等入場收入增長 3.6% 推動的。

Same-facility revenues grew 7.9%. As Sam mentioned in his comments, the Valesco joint venture had a negative impact of approximately $100 million on the company's adjusted EBITDA in the quarter as well on a year-to-date basis. A portion of the third quarter results was due to revising our revenue estimates from the second quarter as we began to see claims being paid.

同設施收入成長 7.9%。正如 Sam 在評論中提到的那樣，Valesco 合資企業對該公司本季以及年初至今的調整後 EBITDA 產生了約 1 億美元的負面影響。第三季業績的一部分是由於我們開始看到索賠得到支付而修改了第二季的收入預期。

This result was not what we are expecting as we are experiencing revenue shortfalls compared to what we originally modeled. The Valesco operating results had a negative impact on adjusted EBITDA margins of approximately 80 basis points in the quarter and 40 basis points on a year-to-date basis. Going forward, we anticipate the loss from this venture to approximate $50 million a quarter.

這個結果並不是我們所期望的，因為與我們最初的模型相比，我們正在經歷收入短缺。 Valesco 經營業績對本季調整後 EBITDA 利潤率產生了約 80 個基點的負面影響，對年初至今影響約 40 個基點。展望未來，我們預計該合資企業每季的虧損約為 5,000 萬美元。

We are working diligently on multiple efforts to address these results, including making program adjustments where necessary, deploying efforts to reduce the cost structure and working with payers for more appropriate reimbursement. As we have discussed previously, we have seen subsidy requests increase from contracted hospital-based providers.

我們正在努力採取多種措施來解決這些問題，包括在必要時進行計劃調整、努力降低成本結構以及與付款人合作以獲得更適當的報銷。正如我們之前討論的，我們發現簽約醫院提供者的補貼請求增加。

Professional fee expense for contracted providers has grown approximately 20% on a year-to-date basis. Although we are encouraged, the rate of growth of these payments slowed in the third quarter as compared to the second quarter. In addition to the mitigation strategies discussed above, we continue to assess other operational adjustments with our cost resiliency programs to help offset some of the impact from these issues.

今年迄今為止，簽約提供者的專業費用支出增加了約 20%。儘管我們感到鼓舞，但與第二季相比，第三季這些付款的成長率有所放緩。除了上述討論的緩解策略之外，我們還繼續透過成本彈性計劃評估其他營運調整，以幫助抵消這些問題的一些影響。

Let me speak to some cash flow and capital allocation metrics. Our cash flow from operations was $2.48 billion in the quarter. Capital spending was $1.15 billion. We paid about $160 million of dividends and repurchased $1.14 billion of our stock during the quarter. Our debt-to-adjusted EBITDA leverage ratio remains near the low end of our stated range of 3 to 4x.

讓我談談一些現金流和資本配置指標。本季我們的營運現金流為 24.8 億美元。資本支出為 11.5 億美元。本季我們支付了約 1.6 億美元的股息，並回購了 11.4 億美元的股票。我們的債務與調整後 EBITDA 槓桿率仍接近我們規定的 3 至 4 倍範圍的低端。

As noted in our release this morning, we are updating our full year 2023 guidance as follows: we expect revenues to range between $63.5 billion and $64.5 billion, we expect net income attributable to HCA Healthcare to range between $4.94 billion and $5.13 billion, we expect adjusted EBITDA to range between $12.3 billion and $12.6 billion and diluted earnings per share to range between $17.80 and $18.50. We expect capital spending to approximately $4.7 billion for the year.

正如我們今天早上發布的新聞稿中所指出的，我們將2023 年全年指引更新如下：我們預計收入將在635 億美元至645 億美元之間，我們預計HCA Healthcare 的淨利潤將在49.4 億美元至51.3 億美元之間，我們預計調整後的 EBITDA 範圍在 123 億美元至 126 億美元之間，稀釋後每股收益範圍在 17.80 美元至 18.50 美元之間。我們預計今年的資本支出約為 47 億美元。

Before we open it up for questions, I'd like to provide some commentary on our year-to-date performance. We believe our core business metrics remained solid. Year-to-date, our same facility admissions have grown 3.3%. Equivalent admissions have grown 5.1%. Non-COVID admissions have grown 7.5% over prior year on a year-to-date basis.

在我們開始提問之前，我想對我們今年迄今為止的表現發表一些評論。我們相信我們的核心業務指標仍然穩健。今年迄今為止，我們同一設施的入院人數增加了 3.3%。同等入學人數增加了 5.1%。今年迄今為止，非新冠肺炎入院人數比前一年增加了 7.5%。

Same facility ER visits have grown 5.7%. Inpatient surgeries have grown 2.3% and outpatient surgeries are up 3.1%, all on a year-to-date basis. These volume metrics have outpaced our original expectations going into the year. Our payer mix trends remain favorable. Same facility managed care admissions increasing 5.3% and Medicare admissions increasing 4.3% on a year-to-date basis.

同一設施的急診就診量增加了 5.7%。今年迄今為止，住院手術量增加了 2.3%，門診手術量增加了 3.1%。這些數量指標超出了我們今年的最初預期。我們的付款人組合趨勢仍然有利。今年迄今，同一機構的管理式醫療入院人數增加了 5.3%，醫療保險入院人數增加了 4.3%。

Medicaid and uninsured admissions are slightly down from the prior year on a year-to-date basis. Our case mix index has held and increased slightly over prior year and our same-facility revenues have increased 6.4% on a year-to-date basis.

年初至今，醫療補助和無保險入院人數較前一年略有下降。我們的案件組合指數與去年同期相比保持不變並略有上升，我們的相同設施收入較年初至今增長了 6.4%。

Our same facility labor cost and supply costs are below prior year as a percentage of revenue. Through a focused and diligent effort, our operating teams have done an incredible job of addressing the contract labor pressures we had last year. On a year-to-date basis, our contract labor expense is down 18% or over $300 million from the prior year.

我們同一設施的勞動成本和供應成本佔收入的百分比低於前一年。透過專注和勤奮的努力，我們的營運團隊在解決去年的合約用工壓力方面取得了令人難以置信的成績。年初至今，我們的合約人工費用比前一年下降了 18%，即超過 3 億美元。

We have confidence that a similar focused and diligent effort will help address the current physician cost pressures over time. Lastly, when we look at our current adjusted EBITDA guidance for 2023, we think there are several notable items to consider. We discussed in our year-end call in January, COVID support payments, the out-of-period Texas waiver payment and the 340B impact from 2022, which all totaled approximately $500 million.

我們相信，隨著時間的推移，類似的專注和勤奮努力將有助於解決當前的醫生成本壓力。最後，當我們查看目前調整後的 2023 年 EBITDA 指引時，我們認為有幾個值得注意的項目需要考慮。我們在 1 月的年終電話會議中討論了新冠疫情支持付款、德克薩斯州期外豁免付款以及 2022 年起的 340B 影響，總計約為 5 億美元。

And when you consider the $145 million payer settlement we recorded in the first quarter of this year, as we take all of that into account, we are pleased with the growth rate we've been able to achieve. In addition, our diluted earnings per share, excluding losses on sale of facilities and losses on retirement of debt has grown 7.2% year-to-date. So I wanted to take a moment to put this quarter in some perspective. So with that, we look forward to your questions, and I'll turn the call over to Frank to open it up.

當你考慮到我們今年第一季記錄的 1.45 億美元的付款人和解時，我們將所有這些都考慮在內，我們對我們能夠實現的成長率感到滿意。此外，剔除設施出售損失和債務清償損失後，我們的攤薄每股收益今年迄今成長了 7.2%。所以我想花點時間來從某個角度來審視這個季度。因此，我們期待您提出問題，我會將電話轉給弗蘭克來打開。

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

謝謝你，比爾。 （操作員指示）Rianna，您現在可以向想提問的人發出指示。

(Operator Instructions) Our first question comes from Kevin Fischbeck with Bank of America.

（操作員說明）我們的第一個問題來自美國銀行的 Kevin Fischbeck。

Great. Maybe I just want to build on that last point there. The commentary about the year-to-date performance being strong is well taken. But I guess I get a lot of questions about whether there's anything unusual, I guess, in the performance this year. I think people are trying to figure out whether this is a good base to think about future growth or whether there's anything -- whether it's in the volumes or the rate or the payer mix that we really shouldn't be expecting to continue. So I guess, is this a good base and should we think about normal growth off of this?

偉大的。也許我只是想以最後一點為基礎。關於今年迄今表現強勁的評論很受歡迎。但我想我收到了很多關於今年的表現是否有什麼不尋常的問題。我認為人們正在試圖弄清楚這是否是考慮未來成長的良好基礎，或者是否有什麼東西——無論是數量、費率還是付款人組合，我們真的不應該期望繼續下去。所以我想，這是一個良好的基礎嗎？我們是否應該考慮在此基礎上的正常成長？

Kevin, this is Sam. It's our belief that demand for health care remains strong and will remain strong into the future. And just given the population trends that we see in our market, the aging of the baby boomers as well as chronic conditions. And though there's been a lot of concern about GLP-1 and so forth, we think it's way too early for any of that to have an impact on demand in the near term or even the intermediate term. And so from that standpoint, we're really encouraged by what we see from a demand standpoint.

凱文，這是山姆。我們相信，對醫療保健的需求仍然強勁，並且在未來仍將保持強勁。考慮到我們在市場上看到的人口趨勢、嬰兒潮世代的老化以及慢性病。儘管人們對 GLP-1 等存在著許多擔憂，但我們認為現在對短期甚至中期的需求產生影響還為時過早。因此，從這個角度來看，我們對從需求角度看到的情況感到非常鼓舞。

Our overall competitive positioning, we believe, continues to be strong. It's indicated within our market share trends, vis-a-vis, where we were pre-pandemic. And so we're encouraged by that. We continue to have resources, we believe, to continue investing in our company appropriately in positioning our agenda with the necessary resources to accomplish our objectives.

我們相信，我們的整體競爭定位仍然強勁。與大流行前相比，我們的市場份額趨勢表明了這一點。我們對此感到鼓舞。我們相信，我們仍然擁有資源，可以繼續對我們的公司進行適當的投資，以實現我們的目標所需的資源來定位我們的議程。

And so from our standpoint, economies remain strong across our portfolio and we believe that supports some of the payer mix trends that we've seen. So we're reasonably optimistic here that the overall top line metrics that you're seeing have durability.

因此，從我們的角度來看，我們的投資組合中的經濟仍然強勁，我們相信這支持了我們所看到的一些付款人組合趨勢。因此，我們對此相當樂觀，您所看到的整體營收指標具有持久性。

Our next question comes from A.J. Rice with UBS.

我們的下一個問題來自 A.J.賴斯與瑞銀。

Obviously, as you went through strong results, obviously, the focus on this professional fee challenge. I know coming out of the second quarter, you were -- I think -- thinking it would step down in Q3 and Q4. And now it sounds like, if anything, it probably stepped up a little bit.

顯然，當你取得了強勁的成績時，顯然，重點是這個專業費用的挑戰。我知道，從第二季開始，我認為您認為它將在第三季和第四季退出。現在聽起來，如果有的話，它可能會加強一點。

I'm trying to understand what was the variance in the quarter relative to previous expectations. Was it $50 million? It sounds like even in the quarter, there's some catch-up from Q2. So maybe it's a significantly bigger number as a negative. And then is it right way to think about Q4 and into next year, a $50 million quarterly run rate that you're assuming just continues. And therefore, you've got to pick up in '24 one more $50 million adverse comparison. Hopefully, that makes sense. And if I could squeeze in just thinking about this quarter, the DPP payment from Florida. Was that in line with what you thought? Or was that -- the net benefit a little better?

我試圖了解該季度相對於之前預期的差異是多少。是5000萬美元嗎？聽起來即使在本季度，也比第二季度有所趕上。因此，作為負數，這個數字可能要大得多。然後，考慮第四季度和明年的情況是否正確，您假設季度運行率為 5000 萬美元，並且會繼續下去。因此，你必須在 24 年再進行一次 5000 萬美元的逆向比較。希望這是有道理的。如果我能擠進去想想這個季度，佛羅裡達州的民進黨付款。這符合你的想法嗎？還是淨收益好一點？

Yes. A.J., this is Bill. Let me try to take those. So let's talk about Valesco first and isolate that from a pro fees. I would tell you, our professional fee expense and on Valesco is coming in kind of what we expected. I mean, as I said, our rate of growth in the third quarter slowed from the rate of growth from the second quarter. although we continue to see subsidiary requests, and we've got efforts to mitigate those.

是的。 A.J.，這是比爾。讓我嘗試接受這些。因此，讓我們先談談瓦萊科，並將其與職業費用區分開來。我想告訴你，我們的專業費用和瓦萊斯科的費用符合我們的預期。我的意思是，正如我所說，我們第三季的成長率比第二季的成長率有所放緩。儘管我們繼續看到附屬請求，並且我們已努力減少這些請求。

There's no doubt the issue for us in the quarter was the Valesco operations, as I mentioned. We're not clearing as much revenue than we anticipated. And I think it's best you have to look at that on a year-to-date basis because we did make some revisions as we started to see claims being paid in the third quarter. And we believe, as I mentioned, it's probably about a $50 million a quarter run rate for Valesco.

正如我所提到的，毫無疑問，本季我們面臨的問題是瓦萊斯科業務。我們清理的收入沒有我們預期的那麼多。我認為你最好以今年迄今為止的基礎來看待這一點，因為當我們開始看到第三季的索賠支付時，我們確實做了一些修改。正如我所提到的，我們相信 Valesco 每季的營運費用可能約為 5000 萬美元。

We have a number of efforts underway to mitigate this that I spoke of as well. But in the short run, that's what we're sizing it out. And you're right, when you look at next year, we'll have 3 quarters of it this year versus 4 next year. But we'll give you more of our thinking when we talk about '24 later on, but you sized it about right.

我們正在採取一系列措施來緩解我提到的這個問題。但從短期來看，這就是我們正在評估的。你是對的，當你展望明年時，我們今年將有 3 個季度，而明年將有 4 個季度。但當我們稍後談論「24」時，我們會給你更多的想法，但你的尺寸是正確的。

Anything on the Florida?

佛羅裡達有事嗎？

The Florida DPP was slightly above what we expected, but we had other programs, A.J., that were less than we expected. So you got to look at it in the overall context of the revenue mix of the company. And I don't think it's that discrete necessarily to just focus on one element of it. So -- but it was slightly above.

佛羅裡達州 DPP 略高於我們的預期，但我們還有其他計劃，A.J.，低於我們的預期。所以你必須從公司收入組合的整體背景來看待它。我認為只關注其中的一個元素並不一定是離散的。所以——但略高於。

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

我們的下一個問題來自加拿大皇家銀行資本市場的本‧亨德里克斯。

Excluding Florida DPP from both quarters, EBITDA margin appears to have declined by about 180 basis year-over-year, suggesting close to $300 million total headwind. If Valesco is $100 million of that, how would you characterize the remaining $200 million or so that brings us short of the 3Q '22 margin. You mentioned the higher subsidy requests and maybe DPP in other quarters -- or in other regions other than Florida. But is there anything else to call out there that would weigh on margin?

如果將佛羅裡達州 DPP 排除在兩個季度之外，EBITDA 利潤率似乎比去年同期下降了約 180 個基點，表明總阻力接近 3 億美元。如果 Valesco 佔其中的 1 億美元，您如何描述剩餘的 2 億美元左右，這使我們達不到 22 年第三季的利潤率。您提到了更高的補貼要求，也許還有其他地區的 DPP，或佛羅裡達州以外的其他地區。但還有其他因素會影響利潤率嗎？

Yes, Ben, this is Bill. Isolate the margin really that other operating line is where you see we've lost some margin on the as reported quarter. Valesco was about 50 basis points of that when you adjust for Valesco, kind of the pro fee growth was about 40 basis points. And the balance was really due to the -- the increase of the supplemental expenses that we recorded in the quarter relative to Florida DPP and other programs.

是的，本，這是比爾。隔離利潤確實是其他業務線是我們在報告季度損失了一些利潤的地方。 Valesco 的成長約為 50 個基點，當您對 Valesco 進行調整時，專業費用成長約為 40 個基點。餘額實際上是由於我們在本季度記錄的相對於佛羅裡達州 DPP 和其他計劃的補充費用的增加。

So the way I think about it, if you exclude Valesco, other operating was off about 120 basis points, 40 to 50 was the pro fee effect and the balance was just the increase in the supplemental expenses that we recognized in the quarter. Labor was strong and I talked about is supply positive trend. So it's really isolated to those 2 issues, the Valesco supplemental payments as much as anything.

因此，我的想法是，如果排除 Valesco，其他業務下降了約 120 個基點，其中 40 到 50 個基點是專業費用效應，餘額只是我們在本季度確認的補充費用的增加。勞動力強勁，我談到的是供給正面趨勢。所以它確實與這兩個問題無關，瓦萊科的補充付款以及其他任何事情。

I think, Bill, just to add a point to that. Our same facility operating margins, which did include those elements Bill spoke to, we're actually in line with our internal expectations. So I think from the standpoint of a little bit of pressure, we anticipated some pressure, but it was reflected again in the overall performance of our same facility. So the most of this lands on the Valesco challenge with respect to the revenue and the earnings associated with that venture.

比爾，我想補充一點。我們同一設施的營運利潤率（確實包括比爾談到的那些要素）實際上符合我們的內部預期。所以我認為，從一點壓力的角度來看，我們預計會有一些壓力，但它再次反映在我們同一設施的整體表現中。因此，其中大部分都落在瓦萊科挑戰上，即與該合資企業相關的收入和收益。

Our next question is from Gary Taylor with TD Cowen.

我們的下一個問題來自 Gary Taylor 和 TD Cowen。

One question and one clarification. Just on the clarification, I think we'll see this in the Q, but I think professional fees were 22% of other OpEx in the 1Q, 24% in the 2Q. Just wondering what that number was for the third quarter. It sounds like it maybe slowed a little bit or didn't change a lot.

一問一澄清。澄清一下，我認為我們會在第一季看到這一點，但我認為第一季專業費用佔其他營運支出的 22%，第二季為 24%。只是想知道第三季的數字是多少。聽起來好像可能慢了一點，或是沒有太大變化。

And then my real question just really was about hitting into '24. I mean, we see a lot of volume strength. I mean if we look at the stack comps year-to-year admissions, adjusted admissions, ER, all accelerated pretty nicely. I'm just wondering how you're thinking about carrying that volume strength into '24 and presumably, the guidance you'll give us in a few weeks at Investor Day.

然後我真正的問題是關於進入'24。我的意思是，我們看到了很大的成交量強度。我的意思是，如果我們看看逐年招生、調整後招生、急診室的堆疊比較，所有這些都加速得相當好。我只是想知道您如何考慮將這種交易量優勢延續到 24 年，大概您將在幾週後的投資者日向我們提供指導。

Well, Gary, this is Sam and Bill can jump in here. We believe, again, that our core business, our hospital-centric core business is performing well. I mean our volumes were broad-based. Every division in our company had admission growth had adjusted admission growth, every service category in our business offerings had growth, except for OV, our obstetrics volume. Mainly births were down slightly. Pediatric was down slightly, and our behavior was down because we made capacity adjustments, but not because demand is shrinking in behavioral just because we needed capacity that we felt might be more productive. So across geography and across service lines, really solid performance.

好吧，加里，這是薩姆，比爾可以跳到這裡。我們再次相信，我們的核心業務，以醫院為中心的核心業務表現良好。我的意思是我們的銷量基礎廣泛。我們公司的每個部門的入院人數成長都經過調整，我們業務中的每個服務類別都有成長，除了 OV（我們的產科數量）。主要是出生率略有下降。兒科略有下降，我們的行為也有所下降，因為我們進行了產能調整，但並不是因為行為需求萎縮，只是因為我們需要我們認為可能更俱生產力的產能。因此，跨地域、跨服務線，效能確實可靠。

On the labor front, we were investing in the quarter in our labor agenda at the same time as making improvements. And what I mean by that, we have invested heavily in new graduate training programs. We've done that throughout the year. That actually created a little bit of a headwind in the quarter and throughout the year for us. We think that will help us as we push into the fourth quarter and on into '24 with making adjustments to our labor agenda. We've invested in our Galen College of Nursing facilities as well as our other clinical education. So we're investing in our agenda for the long-term prospects that all of these initiatives represent.

在勞工方面，我們在本季的勞工議程中進行了投資，同時也進行了改進。我的意思是，我們在新的研究生培訓課程上投入了大量資金。我們一整年都是這麼做的。這實際上為我們在本季度和全年帶來了一些阻力。我們認為，這將有助於我們進入第四季和 24 世紀調整我們的勞工議程。我們投資了蓋倫護理學院設施以及其他臨床教育。因此，我們正在對所有這些舉措所代表的長期前景的議程進行投資。

Bill spoke to the revenue yield. I think the revenue yield from acuity, payer mix and pricing is positive. So I mentioned that our same-store results were in line with our expectation. I think the second thing that's important here, Gary, is that we pride ourselves on making adjustments if we have a variance. And I am confident in our teams. I'm confident in who we are as an organization. And we've proven it over time that we can make adjustments and find solutions to really complex problems.

比爾談到了收入收益率。我認為敏銳度、付款人組合和定價帶來的收入收益是正面的。所以我提到我們的同店業績符合我們的預期。加里，我認為第二重要的事情是，如果我們有差異，我們會為做出調整而感到自豪。我對我們的團隊充滿信心。我對我們作為一個組織的身份充滿信心。隨著時間的推移，我們已經證明，我們可以做出調整並找到真正複雜問題的解決方案。

And so we've got one. It's not what we anticipated. But again, we had the necessary requirements to consolidate a business that was struggling and somewhat distressed but very important to our offerings in the community. So I think as we work through it, as we gain a better understanding of it, we will be able to make adjustments and get the proper reimbursement we need from the payers for the services that we're now providing.

所以我們有一個。這不是我們預期的。但同樣，我們有必要的要求來鞏固一家陷入困境、有些苦惱但對我們在社區中提供的服務非常重要的企業。因此，我認為，當我們解決這個問題時，當我們更好地了解它時，我們將能夠做出調整，並從我們現在提供的服務的付款人那裡獲得我們所需的適當補償。

And so fortunately, our balance sheet remains strong, as Bill alluded to, and our ability to invest in our agenda to maintain our positioning and execute on our agenda remains strong. So when I pull up and provide some context here, I'm encouraged by what I see in the quarter and for the year and what that portends for the company as we push into the future.

幸運的是，正如比爾所提到的那樣，我們的資產負債表仍然強勁，而且我們投資於我們的議程以維持我們的定位和執行我們的議程的能力仍然很強。因此，當我在這裡提供一些背景資訊時，我對本季和今年的情況以及這對公司未來的預示感到鼓舞。

And Gary, this is Bill on your clarification. Pro fees as a percent of other operating was just under 24% in Q3, similar to what it was in Q2.

加里，這是比爾的澄清。第三季專業費用佔其他業務的百分比略低於 24%，與第二季類似。

Our next question comes from Ann Hynes with Mizuho.

我們的下一個問題來自瑞穗的安·海因斯。

I know you don't want to provide 2024 guidance now, but is there any major headwinds and tailwinds that you want to call out before heading into the event? And to that degree, I know Nevada is introducing the UPL program. Do you have any sense on what that incremental benefit will be next year?

我知道您現在不想提供 2024 年的指導，但在開始活動之前您是否想指出任何主要的逆風和順風？就這個程度而言，我知道內華達州正在引入 UPL 計劃。您對明年增量收益有什麼了解嗎？

Ann, this is Bill. Yes, there's -- Only one we'll call out, as I mentioned in my comments, is the payer settlement we recorded in the first quarter other than that, we'll give you our full commentary later on 2024. And on Nevada, it's still too early. We're waiting for the approval level. And when we discuss '24, we'll update you on what our thinking is, and that -- any estimate of that is.

安，這是比爾。是的，正如我在評論中提到的，我們唯一要指出的就是我們在第一季記錄的付款人結算，除此之外，我們將在2024 年晚些時候向您提供完整的評論。在內華達州，現在還為時過早。我們正在等待批准等級。當我們討論 '24 時，我們將向您通報我們的最新想法，以及對此的任何估計。

Our next question comes from Whit Mayo with Leerink Partners.

我們的下一個問題來自 Leerink Partners 的 Whit Mayo。

Sam, can you maybe just go back and elaborate on the ER revitalization program, how Valesco plays into that? And exactly where you are in the evolution of that program and any tangible progress that you expect to see in 2024?

Sam，你能不能回去詳細說明一下急診室振興計劃，Valesco 是如何參與其中的？您對該計劃的進展究竟處於什麼階段，以及您期望在 2024 年看到的任何實際進展？

So our ER revitalization program was initiated maybe a year ago, 9 months ago with -- I don't remember the exact point. We determined that -- a couple of things; one, demand for emergency room services continues to be robust. It was actually more resilient coming out of the pandemic than we had anticipated. So we felt we needed to reenergize our operations because we have had some turnover in our leadership, and we had the business opportunity associated with demand. So our teams came together and went about sort of revitalizing for lack of a better term, our basic operations with respect to our emergency rooms.

因此，我們的急診室振興計畫大約是在一年前，九個月前啟動的——我不記得確切的時間了。我們確定了──有幾件事；第一，急診室服務需求持續強勁。實際上，疫情過後的復原力比我們預期的還要強。因此，我們認為我們需要重振我們的運營，因為我們的領導層發生了一些變動，並且我們擁有與需求相關的商業機會。因此，我們的團隊聚集在一起，開始對急診室的基本運作進行振興，因為缺乏更好的術語。

We have proven standards and processes over time that we think create a really good experience and a positive outcome for our patients. And so we wanted to retrain a number of our new leaders, including some of our physician leaders through Valesco and others into these standards in these processes. And the early results of our program are really positive. Our patient satisfaction is up 4 or 5 points from when we began the program.

隨著時間的推移，我們已經證明了標準和流程，我們認為這些標準和流程可以為我們的患者創造真正良好的體驗和積極的結果。因此，我們希望對一些新領導者進行再培訓，包括 Valesco 的一些醫生領導者和其他人，以適應這些流程中的這些標準。我們計劃的早期結果非常積極。與我們開始該計劃時相比，我們的患者滿意度提高了 4 或 5 個百分點。

Our throughput continues to improve. I think we're seeing an ER patient within 9 or 10 minutes with a clinician. As soon as they present to our door, our throughput times with respect to discharging our patients has improved as well as those who get admitted, we're able to get them on to the floors more efficiently than we were before.

我們的吞吐量持續提高。我想我們會在 9 到 10 分鐘內與臨床醫生一起探望急診室的病人。一旦他們出現在我們門口，我們在出院患者和入院患者方面的吞吐時間就得到了改善，我們能夠比以前更有效地讓他們到達樓層。

We continue to believe we have opportunities to strengthen that program. And so we're expanding the reach of our training. Again, that will include our physician leadership, both in Valesco as well as other hospital provider contractors that we have. And we think this will play in well into our investments that we're making into our emergency room platform, both hospital-based as well as our freestanding emergency rooms, which continue to perform at an even higher level.

我們仍然相信我們有機會加強該計劃。因此，我們正在擴大培訓範圍。同樣，這將包括我們在瓦萊科以及我們擁有的其他醫院提供者承包商的醫生領導。我們認為這將很好地發揮我們對急診室平台的投資，包括醫院急診室和獨立急診室，這些平台將繼續以更高的水平運作。

So all of that to say is it's yielded volume growth, it's yielded patient throughput improvement. And most importantly, it's yielded patient satisfaction increases that we are encouraged by. We will continue to hopefully achieve.

所以所有這些都是說它帶來了數量的增長，它帶來了患者吞吐量的提高。最重要的是，它提高了患者滿意度，我們對此感到鼓舞。我們將繼續滿懷希望地實現這一目標。

Our next question comes from Brian Tanquilut with Jefferies.

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

Sam, it seems like you have an idea of what needs to be done in Valesco. But maybe going down to the nuts and bolts of it. As we think about the fact that you employ these docs now, it sounds like there's more of a revenue issue. So is that just a matter of tacking them on to the HCA contract? Or what needs to be done there? And maybe just for Bill, kind of related to this, if you can give us the contribution of Valesco to revenue per same-store admit.

山姆，看來你知道在瓦萊斯科需要做什麼。但也許會深入到它的具體細節。當我們考慮您現在使用這些文件的事實時，聽起來似乎有更多的收入問題。那麼這只是將它們附加到 HCA 合約中的問題嗎？或說那裡需要做什麼？也許只是對比爾來說，與此有關，如果您能給我們 Valesco 對同店收入的貢獻。

Let me speak to how we're approaching it. Again, we're learning as we go. I forgot -- I think it was like 5,000 physicians across, how many, 200 different programs. A really large-scale business that, again, we felt we were at a point where we had to make a decision, and I'm comfortable that we made the right decision for the company long term. So as we learn more and more about this business, we think there are going to be opportunities on how we allocate the staffing underneath this business.

讓我談談我們是如何實現這一目標的。再說一遍，我們邊走邊學習。我忘了——我想大概有 5,000 名醫生，有多少，200 個不同的計畫。這是一家非常大型的企業，我們再次覺得我們正處於必須做出決定的時刻，我很高興我們為公司的長期發展做出了正確的決定。因此，隨著我們對這項業務的了解越來越多，我們認為在如何分配這項業務下的人員配置方面將有機會。

Obviously, our emergency rooms are 24/7, 365, won't necessarily change the staffing per se, but there could be complementary approaches to that. There are overhead opportunities. We think, over time, we will be able to get to. But you're right. Ultimately, we will need to get paid for these services appropriately. We do have some contracts today. We feel like those will have to be adjusted in the future. And we're confident that we can achieve appropriate reimbursement underneath these programs and get us to where it's an appropriate service that's reimbursed reasonably as we get through it.

顯然，我們的急診室是 24/7、365 的，不一定會改變人員配置本身，但可能會有補充方法。有開銷的機會。我們認為，隨著時間的推移，我們將能夠實現這一目標。但你是對的。最終，我們需要為這些服務獲得適當的報酬。我們今天確實有一些合約。我們認為這些未來必須進行調整。我們相信，我們可以在這些計劃下實現適當的報銷，並使我們獲得適當的服務，並在完成後得到合理的報銷。

But that's just not happening immediately. And that's part of the challenge. And again, we need anesthesiologists. We need emergency room physicians. We need hospitals in order to deliver the volume and maintain positioning. And so that rationale into our decision-making. And so now we have to rationalize the operations, and I think those are the areas that we're going to focus on. And we believe in a reasonable period of time, we'll make progress on that.

但這並不會立即發生。這就是挑戰的一部分。再說一遍，我們需要麻醉師。我們需要急診室醫生。我們需要醫院來提供數量並保持定位。以便將此基本原理納入我們的決策中。所以現在我們必須合理化運營，我認為這些是我們要關注的領域。我們相信在一段合理的時間內，我們會在這方面取得進展。

Brian, to your revenue numbers, Valesco revenue is just under $400 million year-to-date, about $380 million on a year-to-date basis.

Brian，根據您的收入數據，Valesco 年初至今的收入略低於 4 億美元，以年初至今計算，約為 3.8 億美元。

Our next question comes from Stephen Baxter with Wells Fargo.

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I appreciate all the commentary on the professional fees and the growth slowing in the third quarter. So it does still seem like a pretty challenging environment out there for those firms. And as we do some checks here, and anesthesia in particular remains a pressure point. Is this something that you think you can manage closer to flat going forward? Or is it just becoming part of the new norm around something that you'll need to offset as you think about the puts and takes for 2024?

我感謝所有關於專業費用和第三季成長放緩的評論。因此，對於這些公司來說，這似乎仍然是一個相當具有挑戰性的環境。當我們在這裡進行一些檢查時，尤其是麻醉仍然是一個壓力點。您認為您可以在未來實現更接近持平的目標嗎？或者它只是成為新常態的一部分，當你考慮 2024 年的看跌期權時，你需要抵消一些東西？

Well, it's hard to call. We do believe the rate of growth should slow going forward compared to what we've seen this year. As I said, we're working diligently on multiple work efforts not only in Valesco but working with our contracted providers as well. So again, I think we'll see a slowing growth. We we've dealt with some of the more acute issues out there. But the subsequent question is still there, but we're managing through it, and we'll continue to do that as we continue to go on. We'll update you on our progress, but we're working diligently to effect and slow that rate of growth and its impact on us.

嗯，打電話很難。我們確實相信，與今年相比，未來的成長率應該會放緩。正如我所說，我們不僅在瓦萊科，而且還與我們的簽約供應商合作，在多項工作上努力工作。再說一次，我認為我們會看到成長放緩。我們已經處理了一些更尖銳的問題。但隨後的問題仍然存在，但我們正在解決它，並且隨著我們繼續前進，我們將繼續這樣做。我們將向您通報最新進展情況，但我們正在努力實現和減緩成長速度及其對我們的影響。

I think Bill alluded to this in his commentary earlier about the pressures we saw with contract labor, nurse shortages, capacity management [before]. And I would submit that we've worked our way through that reasonably well. And we still believe there are opportunities for us to make strides forward on that agenda.

我認為比爾早些時候在他的評論中提到了這一點，關於我們在合約工、護士短缺、產能管理方面看到的壓力。我想說的是，我們已經相當順利地解決了這個問題。我們仍然相信我們有機會在這項議程上取得進展。

We're going to learn from that how we managed that at timely aggressively and responsibly and I think apply those same learnings to the situation we have here and get to an answer that makes sense for the company. And so I'm confident, as I said, that we have the mindset and the wherewithal to work through these and get us to a reasonable solution.

我們將從中學習如何及時、積極、負責任地管理這個問題，我認為將這些經驗應用到我們目前的情況，並得到對公司有意義的答案。因此，正如我所說，我相信我們有足夠的心態和資金來解決這些問題並找到合理的解決方案。

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。

There are a lot of moving parts to the margin this quarter. But if you normalize for the Florida DPP and the $50 million from prior period in Valesco, and look at the implied fourth quarter margin ramp it looks higher than normal sequential margin improvement from the fourth quarter. So can you help bridge us sort of what are the key drivers to get to that implied guidance for margins for 4Q?

本季有很多變動的部分。但如果你將佛羅裡達州 DPP 和 Valesco 前期的 5000 萬美元標準化，並查看隱含的第四季度利潤率增長，它看起來高於第四季度的正常連續利潤率改善。那麼，您能否幫助我們了解實現第四季利潤率隱含指引的關鍵驅動因素是什麼？

Yes. Historically, our fourth quarter is our best margin performance quarter. Obviously, this quarter was impacted a little higher than normal because of the Valesco 80 basis points I talked about and the Florida DPP. Our same facility margins were over 20%. So we think our guidance is reasonable based on our outlook right now. But I think it's a combination of maybe not having some of the -- the immediate pressures we had this quarter and the expectation that the fourth quarter tends to trend stronger than our average.

是的。從歷史上看，我們的第四季是我們利潤率表現最好的季度。顯然，由於我談到的 Valesco 80 個基點和佛羅裡達州 DPP，本季受到的影響略高於正常水平。我們同一家工廠的利潤率超過 20%。因此，根據我們目前的前景，我們認為我們的指導是合理的。但我認為，這可能是我們本季面臨的直接壓力以及第四季度趨勢將強於平均水平的預期的結合。

Our next question comes from Cal Sternick with JPMorgan.

我們的下一個問題來自摩根大通的卡爾·斯特尼克。

Just wanted to go back to Valesco for a second. So is the expectation that the $50 million loss per quarter persist this level throughout next year? Or would you expect to end the year at a slightly lower run rate? And then just on the mitigation levers, I mean, obviously, it sounds like reimbursement is probably the bigger component here. But is there any way to give a sense for magnitude of the cost side. I'm just wondering if you could give some color on what those levers are and just how much of that $50 million you think could offset purely just with cost reductions.

只是想回到瓦萊斯科一會兒。那麼，每季虧損 5,000 萬美元的預期是否會在明年持續這個水準？或者您預計年底的運行率會略低嗎？然後就緩解措施而言，我的意思是，顯然，報銷可能是這裡更大的組成部分。但有沒有什麼方法可以讓我們了解成本方面的大小。我只是想知道您能否詳細說明一下這些槓桿是什麼，以及您認為純粹透過降低成本可以抵消 5000 萬美元中的多少。

Yes. I mean, so right now, as I said, probably $50 million a quarter, but we're working diligently to mitigate that. And as we go through the next couple of quarters and into '24, we'll continue to update on our progress on that. We view the primary issue as revenue shortfalls, and that's what we're working through. There may be some cost adjustments we can make, but I think it's primarily a revenue approach that we're going to take to try to turn the results around.

是的。我的意思是，正如我所說，現在可能每個季度 5000 萬美元，但我們正在努力減輕這種情況。隨著我們進入接下來的幾個季度並進入 24 年，我們將繼續更新我們在這方面的進展。我們認為首要問題是收入短缺，這就是我們正在解決的問題。我們可能可以進行一些成本調整，但我認為這主要是我們將採取的一種收入方法，以嘗試扭轉結果。

And I just have to -- but it's $50 million a quarter, and we have confidence that we've dealt with several issues in the past and we'll work through that. It's primarily a revenue challenge that we'll get through. And didn't mention earlier, but with our increased position, we now manage the revenue cycle all the way through. So I think that puts us in a much better position to assess and address some of these revenue trends. So we have the revenue cycle function from contracting to coding to billing and collections. And so we think we're in a reasonably good position to be able to at least assess those trends and then come up with appropriate actions to respond to them.

我只是必須這樣做，但每個季度需要 5000 萬美元，我們有信心我們過去已經處理過幾個問題，我們會解決這些問題。這主要是我們要克服的收入挑戰。之前沒有提到，但隨著我們地位的提高，我們現在可以全程管理收入週期。因此，我認為這使我們能夠更好地評估和解決其中一些收入趨勢。因此，我們擁有從承包到編碼再到計費和收款的收入週期功能。因此，我們認為我們處於一個相當有利的位置，至少能夠評估這些趨勢，然後採取適當的行動來應對它們。

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 guess with surgery is up about 1% in the quarter, a little bit better on the inpatient side. I wanted to ask about trends within service lines. And the comp was a little bit difficult this quarter. But anything to call out there? And then Sam, it sounds like from your comments, you're not seeing any impact on GLP-1, so you don't expect much there, but just making sure we caught that right. And if you have any other thoughts on potential impacts, underlying demand or trends in the line would be helpful.

偉大的。我猜本季手術治療的成長率約為 1%，住院病患的成長率好一些。我想詢問服務領域的趨勢。本季的競爭有點困難。但有什麼需要注意的嗎？然後 Sam，從您的評論來看，您沒有看到對 GLP-1 的任何影響，所以您對此沒有太多期望，但只是確保我們抓住了這一點。如果您對潛在影響有任何其他想法，潛在需求或趨勢將會有所幫助。

Yes. Let me start with the GLP issue. We think it's way too early to make any judgment about the effects on our business generally. I think the second point that I would make related to GLP-1 is the fact that we have a very diversified mix of revenue as a company. I mean, obviously, we've gone through orthopedic total joints going from inpatient to outpatient. We've seen other drugs come into the mix, statin as an example with cardiology and we're actually doing more cardiology procedures in the company now that we've ever done in the history of the company. So I don't really know how to judge the implications.

是的。讓我從 GLP 問題開始。我們認為現在就對我們業務的整體影響做出任何判斷還為時過早。我認為我要提出的與 GLP-1 相關的第二點是，我們公司的收入組合非常多元化。我的意思是，顯然，我們已經經歷了從住院到門診的全關節骨科治療。我們已經看到了其他藥物的混合，例如他汀類藥物在心臟病學領域的應用，我們實際上正在公司進行更多的心臟病學手術，這是我們在公司歷史上所做的。所以我真的不知道該如何判斷其影響。

Bariatric surgeries in our company is a really small program, less than 0.5% of overall revenue. Obviously, we have patients who do have diabetes, but some of those patients aren't going to lose it necessarily immediately either. So it's way too early to make judgments, we believe, around that. When you look at the mix of business, again, as I said earlier, we had very broad-based service line performance that was solid. Very few service categories were down. We actually had a calendar headwind and in the quarter with respect to surgical days and cardiology procedure days where we had 1 less surgical day in the quarter than we did last year. So our performance in the face of that headwind was strong as well.

我們公司的減重手術是一個很小的項目，不到總收入的 0.5%。顯然，我們有患有糖尿病的患者，但其中一些患者也不一定會立即失去糖尿病。因此，我們認為，現在對此做出判斷還為時過早。當你審視業務組合時，正如我之前所說，我們擁有非常廣泛且穩定的服務線績效。很少有服務類別下降。事實上，我們在日曆上遇到了逆風，在本季度的手術天數和心臟病手術天數方面，我們本季的手術天數比去年少了 1 個。因此，面對逆風，我們的表現也很強勁。

So that's what I would say it was similar on the inpatient and outpatient as far as the mix of service volume growth and so forth. So very consistent, very broad-based, again, across our geography. And so we're pretty pleased with the outputs.

所以我想說的是，就服務量增長等方面而言，住院病人和門診病人的情況是相似的。同樣，在我們的地理範圍內，非常一致、基礎非常廣泛。所以我們對輸出非常滿意。

Our next question comes from Scott Fidel with Stephens.

我們的下一個問題來自斯科特·菲德爾和史蒂芬斯。

I was hoping you could maybe talk about some of these recent developments in the environment as it relates to the potential indicators around future wage trends and in particularly thinking about some of the union actions that we've been seeing in some of these minimum wage laws that are getting passed at the state level, such as in California. Just curious on sort of whether you see these in aggregate potentially creating some more pro inflationary pressure on wages? Or do you think that there may be a bit over sort of focused on and won't affect the overall trajectory of the wage environment?

我希望您能談談環境方面的一些最新發展，因為它與未來工資趨勢的潛在指標有關，特別是考慮我們在一些最低工資法中看到的一些工會行動這些法案正在州一級獲得通過，例如在加州。只是好奇你是否認為這些總體上可能會對薪資造成更多的通膨壓力？或者您認為可能有點過度關注並且不會影響工資環境的整體軌跡？

The market for labor has normalized in very material ways compared to where it was 1 year or 1.5 years ago. And we're seeing it in our cost per hour as a company, which has really lined up with the expectations we had for the year, and we've seen stabilization across the elements of our compensation programs and so forth.

與 1 年或 1.5 年前相比，勞動市場已經在非常實質的方面實現了正常化。作為一家公司，我們在每小時成本中看到了這一點，這確實符合我們今年的預期，而且我們已經看到薪酬計劃等要素的穩定性。

There are some minimum wage laws out in California that has a very de minimis impact on our company. Most of our compensation was already in line with that have very few issues with that. Unionization across the country beyond the health care industry is an issue as everybody understands but we have been successful in pushing through those issues organizationally and have landed in a spot that we think is not going to put too much pressure on our business in the near term.

加州的一些最低工資法對我們公司的影響非常小。我們的大部分薪酬已經符合這項要求，幾乎沒有什麼問題。醫療保健行業以外的全國範圍內的工會化是每個人都理解的一個問題，但我們已經成功地在組織上解決了這些問題，並且我們認為短期內不會給我們的業務帶來太大壓力。

And so that's where we are. Obviously, the markets change. They're dynamic, and we have to adjust to those but we're seeing positive signs with respect to turnover with respect to hiring and even the number of new students who are populating our Galen College of Nursing programs is very encouraging, suggesting that there's a sufficient pipeline of new nurses who want to be educated and go into the workforce.

這就是我們現在的處境。顯然，市場發生了變化。他們是充滿活力的，我們必須適應這些，但我們看到招聘人員流動方面的積極跡象，甚至蓋倫護理學院計畫的新生人數也非常令人鼓舞，這表明有足夠的新護士管道，他們希望接受教育並進入勞動市場。

So we're pretty encouraged by the macros that we're seeing. There are obviously issues that we have to pay attention to, and we are but we're reasonably encouraged with our overall agenda as it relates to our people and the efforts that we have in place.

因此，我們對所看到的宏感到非常鼓舞。顯然，我們必須注意一些問題，我們確實注意到了，但我們對我們的整體議程感到相當鼓舞，因為它與我們的人民和我們所做的努力有關。

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 bigger picture question for you guys. You've talked about longer-term margins, 19% to 20% being a fairly sustainable range for you. A lot of moving parts right now. So just at a high level, is there anything you see in the business right now that can take you off of that trajectory more permanently and just your level of confidence in getting back to that margin rate and sustaining it going forward?

對你們來說只是一個更大的問題。您談到了長期利潤率，19% 到 20% 對您來說是一個相當可持續的範圍。現在有很多活動部件。因此，從較高的層面來看，您現在在業務中看到的任何東西是否可以讓您更永久地偏離該軌道，以及您對恢復到該利潤率並維持其未來的信心程度？

Yes. I mean, this is Bill. I think we have a reasonably long track record of producing margins that are in a pretty tight range. Even as we've dealt with periodic cost pressures, whether it be contract labor before or maybe bad debts in the previous cycle and or physician costs now. So I think as a team, we have confidence we can continue to operate the company at reasonably strong efficiency levels.

是的。我是說，這是比爾。我認為我們在生產利潤方面有著相當長的歷史記錄，而且利潤範圍相當小。即使我們已經處理了週期性的成本壓力，無論是之前的合約工，還是上一個週期的壞賬，或者現在的醫生費用。因此，我認為作為一個團隊，我們有信心能夠繼續以相當高的效率水準經營公司。

We've spoken in the past. We have a number of initiatives around technology and innovation on resiliency programs that continue to target the opportunities to operate even more efficiently in the future. So I think our historical performance is a reasonable expectation for us and we've got opportunity to continue to drive efficiencies through the organization.

我們過去已經談過。我們圍繞彈性計畫的技術和創新採取了許多舉措，這些舉措繼續瞄準未來更有效率的營運機會。因此，我認為我們的歷史表現對我們來說是一個合理的期望，我們有機會繼續提高整個組織的效率。

Our next question comes from John Ransom with Raymond James.

我們的下一個問題來自約翰·蘭塞姆和雷蒙德·詹姆斯。

If I take your $380 million of Valesco, I think you did a little over $220 million in 2Q. So that means the revenue dropped sequentially by like $60 million. I know you're talking about this a revenue problem, but in your guidance going forward, maybe you could clarify kind of your revenue and cost outlook to get you to that minus 50. And again, why was it such a -- I know seasonality is a lot -- such as steep ramp in 3Q or decline in 3Q on revenue unless the number wrong.

如果我拿你在 Valesco 的 3.8 億美元，我想你第二季的營收略高於 2.2 億美元。這意味著收入連續下降了大約 6000 萬美元。我知道你正在談論這是一個收入問題，但在你未來的指導中，也許你可以澄清你的收入和成本前景，讓你達到負 50。再說一次，為什麼會這樣——我知道季節性因素很多——例如第三季營收急遽上升或第三季營收下降，除非數字錯誤。

John alluded to this in my comments, we did make some revisions to our revenue estimates in the third quarter. In the second quarter, it's still new. We were putting providers on new contracts still, we have not received a lot of claims being paid as -- claims started to be adjudicated and paid. So I think it's better to just look at that on a year-to-date basis on there. It's roughly $200 million a quarter, somewhere around that neighborhood is kind of what we think the model will be going forward, again, may fall on either side of that. But I think it's best to look at the year-to-date. We understand the third quarter, John, but it's really just because we had no history on there and as claims started to be paid, we were able to revise that. So that's why it's $100 million EBITDA for year -- for the quarter, it's about the same year-to-date. It kind of ties into our $50 million going forward.

約翰在我的評論中提到了這一點，我們確實對第三季的收入預測進行了一些修改。到了第二季，還是新鮮的。我們仍在與提供者簽訂新合同，但我們尚未收到大量已支付的索賠——索賠已開始裁決和支付。所以我認為最好只看今年迄今為止的情況。每季度大約 2 億美元，我們認為該模型將在該社區附近的某個地方繼續發展，同樣，可能會落在該社區的任何一邊。但我認為最好看看今年迄今為止的情況。我們了解第三季度，約翰，但這實際上只是因為我們在那裡沒有歷史記錄，隨著索賠開始支付，我們能夠修改它。這就是為什麼今年的 EBITDA 為 1 億美元，而本季的 EBITDA 與年初至今大致相同。這與我們未來 5000 萬美元的發展息息相關。

So it's $200 million revenue, $250 million cost business is what's embedded in your guide going forward, just to be clear.

因此，需要明確的是，您的未來指南中將包含 2 億美元的收入、2.5 億美元的成本業務。

Yes. If you want to think very broadly, that would be pretty consistent.

是的。如果你想非常廣泛地思考，那將是相當一致的。

Our next question comes from Justin Lake with Wolfe Research.

我們的下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

I'm going to pile on with this physician stuff. So just -- I've never seen a business kind of be off this far from, like you guys are obviously very, very good at what you do. I know this is a new business, but to be $50 million of revenue on a $200 million -- let's say, $250 million baseline, 20%. So just the -- like can you triple click on that for me and just say like what did you think was going on versus what is? And then the -- for -- when you gave your headwinds, tailwinds for next year, the only headwind you talked about with that payment, which makes sense. But you've given some numbers around the subsidy costs, right, the physician costs that run through other operating. And they do seem like they've been a pretty big drag on margins. My estimate is somewhere around $300 million, give or take, year-over-year versus kind of revenue growth.

我要繼續講這些醫生的事情了。所以，我從來沒有見過一家企業如此偏離，就像你們顯然非常非常擅長自己所做的事情一樣。我知道這是一項新業務，但在 2 億美元的基礎上實現 5,000 萬美元的收入——比方說，2.5 億美元的基準，即 20%。所以，就像你可以幫我三次點擊它，然後說你認為發生了什麼與實際發生了什麼？然後，當你給出明年的逆風、順風時，你談到的與這筆付款有關的唯一逆風，這是有道理的。但你已經給了一些有關補貼成本的數字，對吧，其他手術中的醫生成本。而且它們似乎確實對利潤造成了相當大的拖累。我的估計是，與去年同期相比，營收成長大約在 3 億美元左右。

Are you assuming that that's not going to grow at anywhere close to that pace next year? Or do you think you could like -- and therefore, it's not another $300 million headwind next year? Or are you just assuming that we can offset it? And so we kind of grow normally ex the $145 million?

您是否認為明年的成長速度不會接近這個速度？還是你認為你會喜歡——因此，明年不會再出現 3 億美元的逆風？或者你只是假設我們可以抵消它？那麼我們在 1.45 億美元之外的成長是正常的嗎？

All right, Justin. Well, a couple of things. One, [never] really talk about '24. We'll give you our '24 guidance assumptions some of that on the Investor Day in more detail as we go through the planning on there. But as I said, we are expecting to pro fee growth rate trends to lower going forward. And we're working diligently to make that happen.

好吧，賈斯汀。嗯，有幾件事。第一，[永遠]真正談論'24。當我們在投資者日進行規劃時，我們將向您提供我們的 24 年指導假設，其中一些更詳細。但正如我所說，我們預計未來費用成長率趨勢將下降。我們正在努力實現這一目標。

On your opening question around Valesco just to emphasize what Sam said, this was a very complex and large integration of 200 programs, 5,000 providers that happen very quickly. And we were operating maybe on some incomplete historical data. And as we started to see claims being paid, the revenue is just clearing at lower rates than we anticipated. And again, I think we've got a number of initiatives to try to offset that. And so we're working on both of those.

關於 Valesco 的開場問題，只是為了強調 Sam 所說的，這是一個非常複雜且大規模的集成，涉及 200 個項目、5,000 個提供商，而且發生得非常快。我們可能正在根據一些不完整的歷史資料進行操作。當我們開始看到索賠得到支付時，收入的清算速度比我們預期的要低。再說一遍，我認為我們已經採取了一些措施來試圖抵消這一影響。所以我們正在努力解決這兩個問題。

But -- so that's how I would address the Valesco shortfall right now. And then we're continuing to work on the pro fee and we do expect that growth rate to decline going forward.

但是——這就是我現在解決瓦萊斯科短缺問題的方法。然後我們將繼續研究專業費用，我們確實預計未來成長率會下降。

Our next question comes from Sarah James with Cantor Fitzgerald.

我們的下一個問題來自莎拉·詹姆斯和康托·菲茨杰拉德。

So when I look at the moving pieces in the guidance revision and the change in the Valesco revenue. It looks like you guys are implying core is doing a little bit better, especially if I use midpoint. So can you give us an update on what you're seeing so far in the first couple of months into 4Q volumes and how we should think about what 2023 guidance implies for the volume transition from 3Q to 4Q?

因此，當我查看指導修訂中的動態內容以及瓦萊斯科收入的變化時。看來你們暗示核心做得更好一點，特別是如果我使用中點的話。那麼，您能否向我們介紹一下您在第四季度的前幾個月中所看到的最新情況，以及我們應該如何考慮2023 年指導對從第三季度到第四季度的銷量過渡意味著什麼？

Yes. So as you know, we don't comment on the current quarter. We've made, I think, several comments on the core business trends we're seeing with really strong volume, reasonable pricing, the core operating expenses of the company are doing well in labor and supplies. I think as a broad brush, it would be our expectation, those trends generally continue going forward. We don't see anything from a macro perspective changing that.

是的。如您所知，我們不對當前季度發表評論。我認為，我們已經對我們所看到的核心業務趨勢做出了一些評論，銷售量非常強勁，定價合理，公司的核心營運費用在勞動力和供應方面表現良好。我認為作為一個廣泛的刷子，這將是我們的預期，這些趨勢通常會繼續向前發展。從宏觀角度來看，我們沒有看到任何改變。

But again, too early, we're not commenting on kind of intra-quarter or early quarter activities. But as I said and Sam mentioned in his comments, we're pleased with the core fundamentals that we're seeing. Good demand in the market. We're positioned very well and our same facility operations is going pretty well. Unfortunately, we are dealing with the Valesco integrations and we'll overcome that. But I think you can reasonably expect that our core trends that we've seen year-to-date should, for the most part, continue at a reasonable pace.

但同樣，為時過早，我們不會評論季度內或季度初的活動。但正如我和 Sam 在評論中提到的那樣，我們對所看到的核心基本面感到滿意。市場需求良好。我們的定位非常好，我們的設施營運也進展順利。不幸的是，我們正在處理 Valesco 整合問題，我們會克服這個問題。但我認為你可以合理地預期，我們今年迄今為止所看到的核心趨勢在很大程度上應該會以合理的速度繼續下去。

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。

Hate to beat this dead horse. But just on the reduction in revenues on Valesco as the claims were getting processed. I'm just curious what was causing that reduction in revenue? Was that a lower rate issue? Was that payer mix? Was that reduction in codes submitted versus paid? Or was that just less services? And then I know there's been some challenges there no surprise at underway that the arbitration process just started back up again. Is any event going to mitigate any of the impact there?

討厭打敗這匹死馬。但隨著索賠的處理，瓦萊斯科的收入減少了。我只是好奇是什麼導致了收入減少？這是利率較低的問題嗎？付款人是混合的嗎？提交的程式碼與付費的程式碼相比是否減少了？還是只是服務減少了？然後我知道存在一些挑戰，仲裁程序剛剛重新開始，這並不奇怪。是否有任何事件可以減輕那裡的影響？

Yes, Jeff. So it's hard to attribute the shortfall in any one area. As I said, we were operating on maybe some incomplete historical data as our model is and probably an array of other issues that potential other hospital providers are experiencing. And so yes, we've got a number of initiatives that we're going to try to address that we've talked about. We can continue to see -- we prefer to be an in-network providers to avoid the out of the surprise billing and that IDR process. And so we're working with our payers diligently to be in network and to get reasonable rates going forward, and that's going to be part of our action plan.

是的，傑夫。因此，很難將短缺歸因於任何一個領域。正如我所說，我們可能正在處理一些不完整的歷史數據，就像我們的模型一樣，並且可能是其他潛在醫院提供者正在經歷的一系列其他問題。所以，是的，我們已經採取了一些舉措，我們將嘗試解決我們已經討論過的問題。我們可以繼續看到 - 我們更願意成為網路內供應商，以避免意外計費和 IDR 流程。因此，我們正在與付款人努力合作，加入網路並獲得合理的費率，這將成為我們行動計劃的一部分。

Our next question comes from Brian Tanquilut with Jefferies.

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

Rianna, I think we're done. If you want to close the queue.

瑞安娜，我想我們已經完成了。如果你想關閉隊列。

Thank you. Seeing no further questions, I will now turn the call back over to Frank Morgan for closing remarks.

謝謝。由於沒有其他問題，我現在將把電話轉回給弗蘭克摩根進行總結發言。

Rianna, thank you so much for your help today, and thanks to everyone for joining on the call. I'm around this afternoon, if I can answer any additional questions you might have. Have a great day.

Rianna，非常感謝您今天的幫助，也感謝大家加入通話。我今天下午就在，如果我能回答你可能有的任何其他問題。祝你有美好的一天。

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。您現在可以斷開連線。