美國醫院公司 (HCA) 2024 Q1 法說會逐字稿

Welcome to the HCA Healthcare First Quarter 2024 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 2024 年第一季財報電話會議。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 that are based on management's current expectations, numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

在我將電話轉交給Sam 之前，讓我提醒大家，如果今天的電話會議包含任何基於管理層當前預期的前瞻性陳述，眾多風險、不確定性和其他因素可能會導致實際結果與可能的結果存在重大差異。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。

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 is included in today's release.

在今天早上的電話會議上，我們可能會參考調整後 EBITDA 等指標，這是一項非 GAAP 財務指標。今天的發布中包含了一份表格，提供了調整後 EBITDA 和調節 HCA Healthcare 淨利潤的補充資訊。

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

今天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. Frank, thank you. Good morning to everybody, and thank you for joining the call. The positive fundamentals we saw in our business this past year continued into the first quarter of 2024. This momentum generated strong financial results that were driven by broad-based volume growth, improved payer mix and solid operating margins. As we look to the rest of the year, we remain encouraged by our performance, the overall backdrop of growing demand for our services and our enhanced stability across our networks to serve our communities.

好的。弗蘭克，謝謝你。大家早安，感謝您加入通話。去年我們在業務中看到的積極基本面持續到2024 年第一季。 。展望今年剩餘時間，我們的業績、對我們服務的需求不斷增長的整體背景以及我們為社區服務而增強的網路穩定性仍然令人鼓舞。

The people of HCA Healthcare continue to deliver for our patients with improvements in key nonfinancial metrics, including improved quality outcomes, more efficient process measures in emergency room services, which have accelerated time to discharge and increased satisfaction, and finally, better inpatient capacity management with reduced length of stay and increased acceptance of patients who needed to be transferred to our hospitals.

HCA Healthcare 的員工繼續為我們的患者提供關鍵非財務指標的改進，包括改善品質結果、急診室服務中更有效的流程措施（這加快了出院時間並提高了滿意度），以及更好的住院容量管理縮短住院時間並提高對需要轉移到我們醫院的患者的接受程度。

As compared to the prior year, diluted earnings per share as adjusted increased almost 9% in the first quarter to $5.36. Same-facility volumes were favorable across the company. Inpatient admissions grew 6% year-over-year, inpatient surgeries were up almost 2%, equivalent admissions grew 5% and emergency room visits increased 7%. Most of our other volume categories, including cardiac procedures and rehab admissions, also had solid growth metrics in the quarter.

與去年同期相比，第一季調整後的攤薄每股收益成長近 9%，達到 5.36 美元。整個公司的同一設施容量均令人滿意。住院人數較去年同期增加 6%，住院手術人數增加近 2%，同等入院人數增加 5%，急診就診人數增加 7%。我們的大多數其他數量類別，包括心臟手術和復健入院，在本季也有穩健的成長指標。

While outpatient surgery revenue increased year-over-year due primarily to favorable payer mix, total cases declined 2%. We attribute most of this decrease to the effect of the calendar and the redetermination process, which drove a considerable decline in Medicaid volume. All the domestic divisions had growth in inpatient admissions and equivalent admissions.

雖然門診手術收入年增主要是由於有利的付款人組合，但總病例數下降了 2%。我們將這一下降大部分歸因於日曆和重新確定過程的影響，這導致醫療補助數量大幅下降。所有國內部門的住院人數和同等住院人數均有所增加。

And finally, payer mix and acuity levels improved as compared to the prior year. Commercial volumes represented approximately 36% of equivalent admissions. Last year, they were 34% of the total. The case mix for our inpatient business increased slightly, continuing the upward trend we have seen over the past few years. Same-facility revenue grew almost 9% as a result of these volume metrics, coupled with 3.5% higher reimbursement per equivalent admission.

最後，與前一年相比，付款人組合和敏銳度有所提高。商業銷售約佔同等入場量的 36%。去年，這一比例為 34%。我們的住院業務病例數略有增加，延續了過去幾年的上升趨勢。由於這些數量指標，同一設施的收入增加了近 9%，而且每次同等入場的報銷額增加了 3.5%。

We continue to make progress on our cost agenda. Operating costs across most categories were in line with our expectations. As part of our capital spending plan, the number of facilities or sites for care increased by almost 5% to around 2,600. And we added approximately 2% to our inpatient bed capacity. As we move through the remainder of the year, we will maintain a disciplined approach to our operations while continuing to invest appropriately in our strategic agenda, which we believe should position the company favorably to meet our long-term objectives.

我們繼續在成本議程上取得進展。大多數類別的營運成本符合我們的預期。作為我們資本支出計畫的一部分，護理設施或場所的數量增加了近 5%，達到約 2,600 個。我們的住院床位容量增加了約 2%。在今年剩下的時間裡，我們將保持嚴格的營運方式，同時繼續對我們的策略議程進行適當投資，我們相信這將使公司處於有利地位，以實現我們的長期目標。

With that, I will turn the call to Bill for his last earnings call. I want to congratulate him again on his tremendous career with the company. It's been my privilege to work with him over these years, and I want to thank him for a job well done.

這樣，我將把電話轉給比爾，參加他的最後一次財報電話會議。我想再次祝賀他在公司取得的輝煌職業生涯。這些年來與他共事是我的榮幸，我要感謝他所做的出色工作。

Great. Good morning, everyone. And thank you, Sam, appreciate that. We believe our first quarter performance represents a strong start to the year, and we continue to combine solid operational performance with a disciplined and balanced allocation of capital to generate value over time.

偉大的。大家，早安。謝謝你，山姆，很感激。我們相信，我們第一季的業績代表了今年的強勁開局，我們將繼續將穩健的營運業績與嚴格且平衡的資本配置相結合，以隨著時間的推移創造價值。

We had strong top line growth with revenues growing 11.2% over the prior year in the quarter. Sam highlighted the same-facility volume, acuity and mix metrics that drove our almost 9% same-facility revenue growth in the quarter. So let me highlight a few points on our operating costs.

我們的營收成長強勁，本季營收比去年同期成長 11.2%。 Sam 強調了同設施數量、敏銳度和混合指標，這些指標推動我們本季同設施收入成長近 9%。因此，讓我強調一下有關我們營運成本的幾點。

Overall, operating costs were managed well. Adjusted EBITDA margin was 19.3% in the quarter. Labor results were solid with as-reported labor cost as a percent of revenue improving 100 basis points from the prior year. We continue to see good trends on contract labor, which improved 21.7% from the prior year and represented 5.1% of total labor cost. Supply cost as a percent of revenues improved 10 basis points from the prior year.

整體而言，營運成本管理良好。本季調整後 EBITDA 利潤率為 19.3%。勞動力業績表現穩健，據報告，勞動成本佔收入的百分比比上一年提高了 100 個基點。我們繼續看到合約工的良好趨勢，比前一年提高了 21.7%，佔總勞動成本的 5.1%。供應成本佔收入的百分比比前一年下降了 10 個基點。

While other operating costs as a percent of revenue has grown compared to the prior year, it has remained relatively consistent for the past 3 quarters. The sequential growth of professional fee expense contributed -- continued to moderate and performed in line with our expectations. In addition, the Valesco operations performed better than our expectations in the quarter.

雖然其他營運成本佔收入的百分比與去年相比有所增長，但在過去三個季度中保持相對穩定。專業費用支出的環比成長持續放緩，表現符合我們的預期。此外，Valesco 業務本季的表現優於我們的預期。

Adjusted EBITDA was $3.35 billion in the quarter, which represented a 5.7% increase over prior year. I will mention, as a reminder, we recorded a $145 million favorable settlement in the first quarter of last year. So we are pleased with the operational performance for the company during the first quarter.

本季調整後 EBITDA 為 33.5 億美元，比去年同期成長 5.7%。我想提醒一下，去年第一季我們達成了 1.45 億美元的有利和解協議。因此，我們對公司第一季的營運表現感到滿意。

Next, let me speak to capital allocation as we continue to employ a balanced allocation of capital. Cash flow from operations was just under $2.5 billion in the quarter. Capital expenditures totaled $1.1 billion. And we repurchased just under $1.2 billion of our outstanding shares during the quarter. Our debt to adjusted EBITDA leverage remains near the low end of our stated guidance range. And we believe we are well positioned from a balance sheet perspective. And finally, in our release this morning, we are reaffirming our full year 2024 guidance ranges.

接下來我講一下資本配置，我們繼續實施資本均衡配置。本季營運現金流略低於 25 億美元。資本支出總計 11 億美元。本季我們回購了近 12 億美元的已發行股票。我們的債務與調整後 EBITDA 槓桿率仍接近我們規定的指導範圍的低端。我們相信，從資產負債表的角度來看，我們處於有利地位。最後，在今天早上發布的新聞稿中，我們重申了 2024 年全年指引範圍。

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

因此，我會將電話轉給弗蘭克並進行問答，我們期待您的提問。

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

謝謝你，比爾。 （操作員指示） 操作員，您現在可以為想要提問的人提供指示。

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

（操作員說明）您的第一個問題來自 A.J.來自[瑞士信貸]的米。

Obviously, the inpatient side of the business was quite strong. I wondered if there were service areas that were particularly strong. Or was there anything else that you can highlight? I know at one point, as you talked about laying out the year, you thought maybe the first half comparisons would be stronger than the back half. I don't know if that's still your view. Any comment along those lines would be interesting as well.

顯然，住院業務的實力相當強勁。我想知道是否有服務特別強的領域。或者您還有什麼可以強調的嗎？我知道，當您談到對今年進行安排時，您認為上半年的比較可能會比下半年更強。我不知道這是否仍然是你的看法。任何類似的評論也會很有趣。

A.J., it's Sam. As I mentioned, we had broad-based volume growth across the company. Every division had growth in inpatient admissions. Actually, we had the best portfolio performance, I think, I've seen in my experience in the company with 56 of our hospitals growing greater than 10%. So almost 1/3 of our portfolio grew by greater than 10%. We had another 1/4 of our portfolio grow greater than 5%, so really strong volume across the company broadly.

A.J.，是薩姆。正如我所提到的，我們整個公司的銷售都有了廣泛的成長。每個部門的住院人數都有增加。事實上，我認為，根據我在公司的經驗，我們有最好的投資組合表現，我們有 56 家醫院的成長超過 10%。因此，我們的投資組合中近 1/3 的成長超過 10%。我們的投資組合中另外 1/4 的成長超過 5%，因此整個公司的交易量確實強勁。

When you look not only at the divisions in the aggregate but when you disaggregate the divisions, within our hospital portfolio, you see similar performance metrics. As far as services, the service line volume growth on the inpatient side was strong across the board. Even in obstetrics, we saw births grow on a year-over-year basis. And that's been down a little bit, so very broad-based from a service line standpoint as well.

當您不僅查看部門的整體情況，而且將部門分解時，在我們的醫院組合中，您會看到類似的績效指標。就服務而言，住院方面的服務量成長全面強勁。即使在產科領域，我們也看到出生人數逐年增加。而且這個數字已經下降了一點，所以從服務線的角度來看，基礎也非常廣泛。

And then on the outpatient side, with the exception of outpatient surgery, and it's known to everybody that the calendar effects were not necessarily favorable, that influenced the outcomes on the outpatient surgery. But underneath our volumes on the outpatient surgery, as I mentioned, it was mostly Medicaid volume which we lost.

然後在門診方面，除了門診手術之外，眾所周知，日曆效應不一定是有利的，這影響了門診手術的結果。但正如我所提到的，在我們門診手術的數量之下，我們失去的大部分是醫療補助數量。

And we think again that's due to the redetermination process. A working theory that we have is that some of those patients have migrated to the exchange or to an employer. And with co-pays and deductibles, maybe those cases are actually deferred because of that for some period of time. We just don't know at this point.

我們再次認為這是由於重新確定過程造成的。我們的一個可行理論是，其中一些患者已經轉移到交易所或雇主。有了共同支付和免賠額，也許這些案件實際上會因此被推遲一段時間。我們現在還不知道。

But our overall profitability and revenue within our outpatient surgery business was up. So at the end of the day, the metric may look challenged, but the result was positive. So I would say that, as far as volumes, as we look toward the rest of the year, we do anticipate that the volume comparisons will be slightly more difficult.

但我們門診手術業務的整體獲利能力和收入有所上升。因此，最終，該指標可能看起來受到挑戰，但結果是積極的。因此，我想說，就銷量而言，當我們展望今年剩餘時間時，我們確實預計銷量比較會稍微困難一些。

But we expect, as I mentioned in my comments, that the demand for health care over the course of the year will continue to be strong, and we will be able to sustain growth. It may not be at this particular level, but we're pretty encouraged by where we are from an overall competitive positioning standpoint as well as what we see as the backdrop of demand.

但正如我在評論中提到的，我們預計今年對醫療保健的需求將繼續強勁，我們將能夠維持成長。它可能不是在這個特定的水平，但從整體競爭定位的角度以及我們所看到的需求背景來看，我們感到非常鼓舞。

Your next question comes from the line of Ann Hynes from Mizuho.

您的下一個問題來自 Mizuho 的 Ann Hynes。

So I know, I think, in your prepared remarks, you talked about how Medicaid redeterminations was having a negative impact on volumes. Can you just quantify what you think the impact was? And then secondly, do you think you had a revenue benefit from the two-midnight rule in the quarter?

所以我知道，我認為，在您準備好的發言中，您談到了醫療補助重新確定如何對數量產生負面影響。您能量化一下您認為的影響嗎？其次，您認為本季的午夜兩點規則是否為您帶來了收入收益？

Yes. Ann, this is Bill. It's hard to quantify. Regarding Medicaid redeterminations, we are doing our best to track that. We're seeing, just as we saw towards the end of last year, a large percentage of those people maintaining coverage, which I think is positive. Perhaps 20% of those we previously saw are not. And we're seeing a large portion of those end up in either HICS or employer-sponsored coverage. So we believe there is a small positive benefit here. And we're going to continue to monitor that over time on Medicaid redeterminations.

是的。安，這是比爾。很難量化。關於醫療補助的重新確定，我們正在盡最大努力進行追蹤。正如我們在去年底看到的那樣，我們看到很大一部分人維持保險，我認為這是積極的。也許我們之前看到的 20% 不是。我們看到其中很大一部分最終進入了 HICS 或雇主資助的保險範圍。所以我們相信這裡有一個小小的正面好處。隨著時間的推移，我們將繼續監測醫療補助的重新確定。

On the two-midnight rule, I'd say it's still early. We are starting to see some encouraging signs. We do believe it's providing a modest benefit. We're seeing some of our two-midnight inpatient volume grow. And we think that's due to statusing in accordance with the new rules. But I'll emphasize it's still early and not all claims have completed the adjudication processes. But at this point, we still believe there's going to be a modest benefit from the two-midnight rule.

關於午夜兩點的規則，我想說現在還早。我們開始看到一些令人鼓舞的跡象。我們確實相信它提供了一定的好處。我們發現午夜兩點的住院人數增加。我們認為這是由於按照新規則進行了定位。但我要強調的是，現在還為時過早，並非所有索賠都已完成裁決程序。但目前，我們仍然相信午夜兩點規則將會帶來一定的好處。

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

您的下一個問題來自德意志銀行的 Pito Chickering。

Can you talk about the OpEx pressure that you're seeing? Is there any else besides business expenses sort of going in there? And how should we think about OpEx as a percent of revenues using the first quarter as a launchpad? Does that continue to see pressure in 2Q? Does it level off at the back half of the year? And then any quantification of how Valesco is tracking better than expectations?

您能談談您所看到的營運支出壓力嗎？除了業務費用之外還有其他的費用嗎？我們應該如何以第一季為起點來考慮營運支出佔收入的百分比？第二季是否會繼續面臨壓力？下半年會趨於平穩嗎？然後對瓦萊斯科的追蹤情況是否比預期更好進行量化？

Yes, Pito, this is Bill. Let me start. So I think there's two primary factors that are influencing the year-over-year comparisons in other operating costs. I'll emphasize it's been very consistent over the past 3 quarters though. And I think, first, as you know and recall from others that we began to see the pro fee pressures mostly in the second quarter of last year. So we're still looking at some year-over-year effect of that. We're pleased that we're at least seeing the sequential growth in pro fees begin to moderate as we have for the past several quarters.

是的，皮托，這是比爾。讓我開始吧。因此，我認為有兩個主要因素影響其他營運成本的年比比較。我要強調的是，過去三個季度的情況非常穩定。我認為，首先，正如您所知並從其他人那裡回憶起的那樣，我們主要在去年第二季度開始看到職業費用壓力。因此，我們仍在研究其同比影響。我們很高興至少看到專業費用的連續成長開始放緩，就像過去幾季一樣。

And I think the second contributor is just the expected increase in provider taxes related to the supplemental payment programs that we participate in. So those are really the two primary year-over-year contributors. And I think mostly, it was in line with our expectations. As we go forward, again I think for the past 3 quarters, the OpEx percent of revenue are relatively consistent and hopefully that will continue through the balance of the year.

我認為第二個貢獻者只是與我們參與的補充付款計劃相關的提供者稅的預期增長。我認為大多數情況下，這符合我們的預期。隨著我們的前進，我再次認為在過去的三個季度中，營運支出佔收入的百分比相對穩定，希望這種情況能持續到今年的剩餘時間。

Your next question comes from the line of Whit Mayo from Leerink Partners.

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

It looks like there's about almost $500 million of revenue that's not in the same-store segment this quarter. You did modest M&A this quarter, less than $100 million, you spent. I mean, is the entirety of the almost $500 million the campuses that you acquired last quarter? Anything I'm missing? I'm just trying to figure out maybe the impact on margins. Because if those don't really have any earnings, that could be maybe like a 60, 70 basis point drag. So if you could help me out there, Bill, that would be helpful.

看起來本季有大約 5 億美元的收入不是來自同店部分。本季您進行了適度的併購，花費不到 1 億美元。我的意思是，您上季收購的近 5 億美元的全部園區都是嗎？我缺少什麼嗎？我只是想弄清楚這對利潤率的影響。因為如果這些公司實際上沒有任何收益，那麼可能會拖累 60、70 個基點。所以，如果你能幫助我，比爾，那將會很有幫助。

Yes. Well, I think there's probably two. One, the Valesco operations would be in the non-same-store. And then we did acquire the Wise Health System in the last year. And that would be probably the other entity that's the difference between same-store and consolidated.

是的。嗯，我想可能有兩個。第一，Valesco 的業務將不在同一家商店進行。去年我們確實收購了 Wise Health System。這可能是同店和合併之間的區別的另一個實體。

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, thanks for all the help over the years, and congrats on the retirement again. Just my question on labor, you touched on Valesco a little bit. Any quantification you can share with us or expectation for further improvement both in Valesco and nurse staffing on temp labor?

比爾，感謝您多年來的幫助，並再次恭喜您退休。只是我關於勞工的問題，你稍微提到了瓦萊斯科。您可以與我們分享任何量化數據或期望進一步改善 Valesco 和臨時工護理師配備嗎？

Let me start with Valesco. So as we've said in our year-end call, we anticipate the Valesco operations to kind of generate the same amount that we had in '23. But in '23, we had them for 3 quarters. Obviously, we'll have them for 4 quarters in '24. So again, I think that's resulting in some sequential improvement. But I think that's still good guidance for us is to basically be flagged on a full year basis.

讓我從瓦萊科開始。因此，正如我們在年終電話會議中所說，我們預計 Valesco 業務將產生與 23 年相同的金額。但在 23 年，我們有 3 個季度的時間。顯然，我們將在 24 年的 4 個季度內擁有它們。再說一次，我認為這會帶來一些連續的改進。但我認為這對我們來說仍然是一個很好的指導，基本上是在全年的基礎上進行標記。

On the labor cost, we continue to be pleased with the trends in contract labor. The teams have a number of initiatives as we've seen. Turnover has stabilized, recruiting and hiring, still up. As I mentioned, our contract labor is down still 20% year-over-year. We think there's still more room to go as we go forward. So again, I think we're pleased, and we're again in a good position in overall labor trends.

在勞動成本方面，我們仍然對合約工的趨勢感到滿意。正如我們所見，這些團隊有許多舉措。營業額已穩定，招募和聘用仍在增加。正如我所提到的，我們的合約工仍同比下降 20%。我們認為，我們前進的道路上還有更多的空間。所以，我認為我們再次感到高興，並且我們在整體勞動力趨勢中再次處於有利位置。

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

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

Congratulations, Bill. Wanted to follow up on some of the mix commentary. You said you had some really strong commercial mix. I wanted to see kind of more detail on how exchange volume fits into that. I know you've talked about redetermination in Medicaid losses being offset, one pickup on exchange could offset three Medicaid losses. So just wondering kind of where we are on that recapture. And are we still on a lull? Or are we seeing enough exchange volume to kind of offset that?

恭喜，比爾。想要跟進一些混音評論。你說你有一些非常強大的商業組合。我想了解更多關於交易量如何適應這一點的細節。我知道您已經談到了醫療補助損失的重新確定被抵消，一次交換可以抵消三項醫療補助損失。所以只是想知道我們在重新奪回的過程中處於什麼位置。我們還處於平靜期嗎？或者我們看到足夠的交易量來抵消這一點？

Yes, Bill. Let me start with that one. We are very pleased with the mix. We're seeing our overall managed care increase in the 12%, 13% range. That is fueled by health insurance exchanges. Our exchange volume was up close to 50% in the first quarter.

是的，比爾。讓我從那個開始吧。我們對這個組合非常滿意。我們看到我們的整體管理式醫療成長了 12% 至 13%。這是由健康保險交易所推動的。第一季我們的交易量成長了近 50%。

The data we see, perhaps enrollment in our markets is up a little north of 30%. So our volume is a little higher than that. And I think that is probably attributable to redeterminations, at least a big chunk of that delta, as we are seeing some people who are redetermined off Medicaid landing in both employer-sponsored coverage as well as the HICS volume.

根據我們看到的數據，我們市場的入學人數可能略高於 30%。所以我們的體積比這個高一點。我認為這可能歸因於重新確定，至少是這一增量的很大一部分，因為我們看到一些重新確定脫離醫療補助的人同時獲得了雇主贊助的保險和 HICS 數量。

Remind you, it's still roughly 6% or so of our borrowing. But we have seen really good growth in that. And so we're pleased with that. Hard to tell where we are in that cycle. I think we may be there in the end, at least to the state's redetermination process. But we're very pleased with the trends we're seeing so far.

提醒您一下，這仍然是我們借款的大約 6% 左右。但我們在這方面看到了非常好的成長。所以我們對此感到滿意。很難說我們處於這個週期的哪個位置。我認為我們最終可能會實現這一目標，至少在國家的重新確定過程中。但我們對迄今為止所看到的趨勢非常滿意。

On the Medicaid redeterminations, as I said before, I think it has provided some benefit for us. We continue to track individuals that are presenting what their previous coverage was. And we're seeing the people who are being redetermined of landing in either employer-sponsored or HICS coverage.

關於醫療補助的重新確定，正如我之前所說，我認為它為我們提供了一些好處。我們將繼續追蹤那些展示其先前報導內容的個人。我們看到人們正在重新決定加入雇主資助的保險或 HICS 保險。

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

您的下一個問題來自 TD Cowen 的 Gary Taylor。

Bill, you'll be missed, so congrats. My two -- there were two numbers that really jumped out at me, so I just want to get your comment on those. The first is, I think, the occupancy number is all-time high you've reported or at least in the last decade. And I just want to think through, I mean, does that mean, I mean, we're peaking in terms of operating leverage on labor and other operating expense outside of professional fees? Could there still be more room on leverage?

比爾，我們會想念你的，所以恭喜你。我的兩個——有兩個數字讓我印象深刻，所以我只想聽聽您對這些數字的評論。我認為，首先是入住率達到了您報告的歷史最高水平，或者至少在過去十年中達到了歷史最高水平。我只是想想一想，我的意思是，這是否意味著，我的意思是，我們在勞動力和專業費用之外的其他運營費用方面的運營槓桿達到了頂峰？槓桿還有更多空間嗎？

And then the other would just be same-store ER visits is up 7% versus a plus 10% comp. And we had a similar phenomenon last year, where we're up huge against a very tough comp in the first quarter and then that kind of moderated. And I'm just trying to think through if there's anything around ER seasonality that's new with redeterminations or ACA, SEPs or anything that numbers like that brings to mind for you.

另外，同店 ER 訪問量增加了 7%，而同期同期則增加了 10%。去年我們也出現過類似的現象，第一季我們在非常艱難的比賽中表現出色，然後情況有所緩和。我只是想思考 ER 季節性是否有任何新的東西，包括重新確定或 ACA、SEP 或任何類似的數字讓你想起。

Gary, it's Sam. I think we're actually pretty pleased with the occupancy levels. When you look at our operating agenda, our operating agenda is making sure, number one, that we have the staffing supply necessary in order to accommodate what we believe to be again a positive demand backdrop. And we've made solid improvements over the last 18 months in recruitment, retention, enhanced care models that really create a better environment for our patients.

加里，是薩姆。我認為我們實際上對入住率非常滿意。當您查看我們的營運議程時，我們的營運議程第一要確保我們擁有必要的人員供應，以適應我們認為再次出現的積極需求背景。在過去 18 個月裡，我們在招募、保留和強化護理模式方面取得了紮實的進步，真正為我們的患者創造了更好的環境。

The second aspect to our capacity management and meeting the demand in the market is around our case management efforts. And our teams again have executed as normal inside of our company around whatever our imperatives are at a really high level. And we actually had acuity grow, as we mentioned, but length of stay went down. That allowed us to open up more beds, receive more patients in through our transfer centers and our emergency rooms and so forth. And that's not necessarily compromising our operating leverage.

我們的容量管理和滿足市場需求的第二個方面是圍繞我們的案例管理工作。我們的團隊再次在公司內部正常執行我們的高水準要求。正如我們所提到的，我們的敏銳度實際上有所提高，但住院時間卻縮短了。這使我們能夠騰出更多床位，透過轉運中心和急診室等接收更多患者。這並不一定會損害我們的營運槓桿。

1 quarter over 1 quarter is never a perfect proxy for the business. And so we're looking at the business sort of over a longer run. And with the exception of pro fees, which we believe will moderate over time, we will continue to see operating leverage in most scenarios when we have incremental volume because we have fixed cost in our labor platform, we have other fixed costs inside of our other operating expenses. So we are investing to add inpatient bed capacity. We had, I think, a little over 2% come online this year versus last year. We have a significant pipeline of capital that will help deliver more inpatient capacity over the next 2 to 2.5 years. So that's, that question.

1 個季度超過 1 個季度從來都不是業務的完美代表。因此，我們正在從更長遠的角度來看待這項業務。除了專業費用（我們相信隨著時間的推移，專業費用會下降）之外，當我們有增量時，我們將在大多數情況下繼續看到營運槓桿，因為我們的勞動力平台有固定成本，我們的其他內部還有其他固定成本營業費用。因此，我們正在投資增加住院床位容量。我認為，與去年相比，今年的上網人數略高於 2%。我們擁有大量資金，將有助於在未來 2 至 2.5 年內提供更多住院治療能力。這就是那個問題。

On the emergency room, when you look at the emergency room and look underneath the emergency room, our commercial emergency room visits were up 20% on a year-over-year basis. That is a really strong metric. We're down 10% in Medicaid, up slightly in self-pay, which speaks to the point Bill was making around redeterminations, finding a different level within the mix of our business. And so our emergency room business, obviously, we had 1 extra day, so we see the same level of emergency room business inside of the leap year dynamic this year. So that would pull it back in normal quarters. But we're encouraged about what's going on in our emergency rooms.

在急診室方面，當您查看急診室並查看急診室下方時，您會發現我們的商業急診室就診人數比去年同期增加了 20%。這是一個非常強大的指標。我們的醫療補助減少了 10%，自費略有增加，這說明了比爾圍繞著重新確定的觀點，在我們的業務組合中找到了不同的水平。因此，我們的急診室業務顯然多了 1 天，因此我們在今年的閏年動態中看到了相同水準的急診室業務。因此，這會將其拉回正常季度。但我們對急診室裡發生的事情感到鼓舞。

We have a robust agenda there to revitalize the service levels because we've had a lot of dynamics coming out of COVID. And as I mentioned in my prepared comments, our service levels have improved. The process time for a patient to be seen as well as the process time for a patient to be discharged or admitted to the floor has improved markedly. Our patient satisfaction continues to improve on a year-over-year basis in our emergency rooms and also on a sequential basis.

我們有一個強有力的議程來重振服務水平，因為新冠疫情為我們帶來了很多動力。正如我在準備好的評論中提到的，我們的服務水準有所提高。就診患者的處理時間以及患者出院或入院的處理時間均顯著改善。我們急診室的患者滿意度逐年持續提高，並且逐年提高。

Additionally, we're investing in our emergency room platform both on-campus and off-campus. And those efforts are proving to be important to that particular service line as well. So the emergency room and our urgent care platform play a huge role in our overall network model. And we continue to be encouraged by what's going on in both areas.

此外，我們正在投資校內和校外的急診室平台。事實證明，這些努力對於特定的服務線也很重要。因此，急診室和我們的緊急護理平台在我們的整體網路模型中發揮著巨大的作用。我們繼續對這兩個領域正在發生的事情感到鼓舞。

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

您的下一個問題來自沃爾夫研究中心的賈斯汀·萊克（Justin Lake）。

Let me add my congrats to Bill on his retirement, really appreciate all your help over the years, bud. So my question was trying to get an update on your expectations for Medicaid, DPP and DSH. You reported the benefit here at $3.9 billion in 2023. I shouldn't say benefit, that's a gross number, I believe.

讓我祝賀比爾退休，非常感謝你多年來的幫助，夥計。所以我的問題是試圖了解您對 Medicaid、DPP 和 DSH 的期望的最新資訊。您報告的 2023 年效益為 39 億美元。

Appreciate the increased transparency, was hoping you could give us an update on what you're expecting for 2024 on this metric relative to 2023. Maybe how much of that -- that's a gross number again. How much should we think of as kind of the net benefit there? And then can you go back, if you have the number handy, to 2019, pre COVID, pre kind of the big increase in some of these programs and tell us what the number looked like back then?

感謝透明度的提高，希望您能向我們介紹您對 2024 年這一指標相對於 ​​2023 年的預期的最新情況。我們應該將多少視為淨收益？然後，如果您手邊有這個數字，您能否回到 2019 年，在新冠疫情之前，在其中一些項目大幅增加之前，告訴我們當時的數字是多少？

Yes. Justin, let me try. And I think we'll have to get back to you on the '19, I don't have that upfront. But if I reflect back to our year-end discussion, that's still our belief today. First, just level set, these DPP programs are really fundamentally part of our Medicaid reimbursement. There's a lot of them. We have 18 or 19 states have these programs. But a lot of them have some complexity with a lot of variables associated. So use that as a backdrop.

是的。賈斯汀，讓我試試。我想我們必須在 19 年給你回复，我沒有預先準備好。但如果我回顧我們的年終討論，今天這仍然是我們的信念。首先，就水平而言，這些 DPP 計劃實際上是我們醫療補助報銷的根本組成部分。有很多。我們有 18 或 19 個州有這些計劃。但其中許多都具有一定的複雜性，並且有許多相關的變數。所以用它作為背景。

But we still believe when we look at the full year, there's going to be a modest headwind in the revenue to these programs, '24 versus '23, largely because of some settlements that we realized in '23, we do not expect to reoccur going forward. And so that's still our belief. In any 1 quarter, there may be factors that influence quarter-by-quarterly trends. But for the full year, we think there's still going to be a modest headwind on the revenue component that we have.

但我們仍然相信，當我們審視全年時，這些項目的收入將出現適度的逆風，「24 年與23 年相比，主要是因為我們在23 年意識到的一些和解，我們預計不會再次發生」向前走。所以這仍然是我們的信念。在任何一個季度中，都可能存在影響季度趨勢的因素。但就全年而言，我們認為我們的收入部分仍將面臨適度的阻力。

Each state has a little bit different in terms of whether they're tax-based or contribution-based. So there are clearly operating expenses associated with the revenue number that you quoted that we disclosed within our 10-K. But the ratios have remained relatively consistent. And we'll have to maybe get back to you on the '19 levels, I don't have that handy.

每個州在基於稅收還是基於繳款方面都有所不同。因此，顯然存在與您引用的我們在 10-K 中披露的收入數字相關的營運費用。但這些比率仍然相對穩定。我們可能需要就 19 級的問題回覆您，我手邊沒有那個。

(Operator Instructions) Your next question comes from the line of Andrew Mok from Barclays.

（操作員說明）您的下一個問題來自巴克萊銀行的 Andrew Mok。

I just wanted to echo congratulations to Bill. I just wanted to follow up on the comments you made on other OpEx. I think the year-over-year comparisons all make sense, given the timing of Valesco. But I'm still confused on the sequential progression from Q4. Because it sounds like Valesco performed better, physician fees moderated.

我只是想向比爾表示祝賀。我只是想跟進您對其他營運支出的評論。考慮到瓦萊科的舉辦時間，我認為逐年比較都是有意義的。但我仍然對第四季的連續進展感到困惑。因為聽起來瓦萊科表現較好，所以醫生費用有所下降。

And it was my understanding that supplemental payments would actually step down a bit from elevated Q4 levels. So I'm just trying to understand why we didn't see a larger decrease or more leverage on the other OpEx line, given those trends. Is there something that we don't understand or some other unexpected kind of item in that other OpEx line?

據我了解，補充付款實際上會比第四季度的高水準有所下降。因此，考慮到這些趨勢，我只是想了解為什麼我們沒有看到其他營運支出線出現更大的下降或更多的槓桿作用。其他 OpEx 線路中是否存在我們不理解的內容或其他意外類型的項目？

No. I'd say we did have growth in our state supplemental payment expense quarter-by-quarter. As I said in Justin's response, there are certain variables that come on the timing of those. So sequentially, that was up. And the pro fees were up sequentially, it just was up small on there.

不。正如我在賈斯汀的回應中所說，這些時間安排存在某些變數。依此順序，就這樣了。專業費用連續上漲，只是漲幅很小。

So those are the two main factors to call out in the other operating is pro fees and the state supplemental payment. And I think when you look at sequentially, it makes sense, pretty much the trends were in line with our expectations, but nothing else there that I'd highlight.

因此，在其他業務中需要指出的兩個主要因素是專業費用和國家補充付款。我認為，當你按順序查看時，這是有道理的，趨勢幾乎符合我們的預期，但我沒有其他要強調的了。

Your next question comes from the line of Kevin Fischbeck, Bank of America.

您的下一個問題來自美國銀行的 Kevin Fischbeck。

So maybe two questions. I guess, one question, I guess, just about the guidance, I guess, there's been a lot of talk about how you guys are thinking about providing guidance. And you reaffirmed guidance in the quarter. I wasn't sure if that was trying to move away from providing an update every Q1 or whether that was -- you're actually reaffirming guidance because everything is exactly in line, so you're changing your communication around that without giving an update on that.

所以也許有兩個問題。我想，有一個問題，我想，只是關於指導，我想，已經有很多關於你們如何考慮提供指導的討論。您重申了本季的指引。我不確定這是否是試圖擺脫每個第一季提供更新的局面，還是——你實際上是在重申指導，因為一切都完全一致，所以你正在改變圍繞這一點的溝通，而不提供更新關於這一點。

But then second, just really about the volumes. Obviously, 3% to 4% volume for the year. You're above 5% to start. So does that imply that you're going to end the year more like 2%? And what we're seeing this year is 3% to 4%. How do you think about where volume will be in 2024 relative to that long-term trend line with the demand that you see in your markets? Are we maybe more or less back to that long-term trend line in 2024? Or is there still some room for that to kind of move up towards a longer-term trend line?

但其次，只是關於數量。顯然，今年的銷量將成長 3% 至 4%。開始時您的進度已超過 5%。那麼這是否意味著今年年底的成長率將接近 2%？今年我們看到的是 3% 到 4%。您如何看待 2024 年相對於長期趨勢線以及您在市場中看到的需求的成交量？ 2024 年我們是否會或多或少回到長期趨勢線？或者仍有空間往長期趨勢線上升？

Kevin, this is Bill. Let me start and I'll ask Sam to add in. On the guidance, we typically would not adjust guidance in Q1 in normal years. But as we talked in our year-end call and as we've tried to set the guidance ranges, I believe the ranges are wide enough to accommodate a range of outcomes. And so we want to get out of the trend, if you will, of trying to reset guidance every quarter-by-quarter.

凱文，這是比爾。讓我開始，我會請 Sam 補充。但正如我們在年終電話會議中所討論的那樣，以及當我們試圖設定指導範圍時，我相信這些範圍足以適應一系列結果。因此，如果你願意的話，我們希望擺脫試圖每季重置指導方針的趨勢。

I think the long-term business trends that we've highlighted over the years and we highlighted in our Investor Day last year, we believe, are solid. They're kind of durable. And they've been pretty predictable over time. And our overall guidance is based on that. So we're not planning to adjust quarter-by-quarter unless there's material circumstances to warrant on either side of that.

我認為我們多年來強調的以及去年投資者日強調的長期業務趨勢是穩固的。它們很耐用。隨著時間的推移，它們是相當可預測的。我們的整體指導就是基於此。因此，我們不打算逐季度進行調整，除非雙方都有重大情況需要。

And on the volume trends, again, Sam can comment on here. As we've said, we're very pleased, very strong volume, very strong demand. And perhaps we do end up on the high side of our overall annual guidance. We'll remind you as we get into kind of the second half year-over-year comparisons, we started to see some volume -- positive volume trends in the third and fourth quarter last year. So the year-over-year comps will adjust a little bit. But we're very pleased where the volume trends are. And with these efforts, hopefully, we will end up on the high side.

關於成交量趨勢，Sam 可以在這裡發表評論。正如我們所說，我們非常高興，銷量非常強勁，需求也非常強勁。也許我們最終確實處於整體年度指導的偏高位置。我們會提醒您，當我們進入下半年的年比比較時，我們開始看到一些交易量——去年第三和第四季的正向交易趨勢。因此，同比比較將會略有調整。但我們對銷售趨勢非常滿意。透過這些努力，希望我們最終能夠取得較高的成績。

Nothing else to add. Thank you.

沒什麼好補充的了。謝謝。

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

您的下一個問題來自富國銀行的史蒂芬·巴克斯特。

Just to hopefully put a bow on the Medicaid state-directed payment question, can you just remind us, are we at the point now that you're accruing these evenly each quarter in 2024? Is there any lumpiness to kind of keep in mind about the first quarter or the rest of the year?

只是為了希望解決醫療補助國家指導的支付問題，您能否提醒我們，我們現在是否已經到了 2024 年每季平均累積這些費用的時候了？關於第一季或今年剩餘時間，是否有任何波動需要記住？

And then just to tie on to that, the final rule that got published earlier this week around this issue, do you feel optimistic that maybe more of your states kind of have more to do here? Or do you think maybe your states are doing a better job of proactively seeking these programs out?

然後，為了聯繫到這一點，本週早些時候圍繞這個問題發布的最終規則，你是否樂觀地認為，也許更多的州在這裡有更多的事情要做？或者您認為您所在的州在主動尋求這些計劃方面做得更好嗎？

Yes, let me. There is some variability in the timing of when we recognize these. For the most part, programs we've had under a while were on an accrual basis. With new programs, we would typically wait until we get some established history and actually funds starting to flow. So it's a little bit of a mix. But there is some variability that we see as we go year-by-year. Remind people, previous to this year, we were recognizing Florida on an annual lump sum basis. We started accruing. We started a little bit, but we tried to accrue those as much as we can as we got some historical practices.

是的，讓我吧。我們認識到這些的時間存在一些差異。在大多數情況下，我們一段時間以來的計劃都是基於權責發生製的。對於新項目，我們通常會等到獲得一些既定的歷史記錄並且資金實際上開始流動。所以它有點混合。但隨著時間的推移，我們會看到一些變化。提醒人們，在今年之前，我們是按年度一次性付款的方式承認佛羅裡達州的。我們開始累積。我們開始了一點點，但我們嘗試盡可能地累積這些，因為我們得到了一些歷史實踐。

Relative to the rule that was released earlier this week, it's still early. We're working our way through the assessment. But generally, we review it as positive. It removes the potential for some [capi add-on] payments. And there's a potential for changes in terms of how providers receive payments. It will take a little bit of time for states to work through those and implement it. But generally, we view that as a positive development for us.

相對於本週早些時候發布的規則來說，還為時過早。我們正在努力完成評估。但總的來說，我們認為它是積極的。它消除了某些 [capi add-on] 付款的可能性。提供者接收付款的方式也可能會改變。各州需要一些時間來完成這些工作並實施它。但總的來說，我們認為這對我們來說是一個積極的發展。

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

您的下一個問題來自花旗銀行的 Jason Cassorla。

I just want to follow up on labor. I know you're benefiting from reduced contract labor spend and the like. When we think about the first quarter SWB per just a patient day of about 3%, can you give us a sense of how wage growth trended in the quarter and then offsets on the productivity front that you're seeing and if there's anything within the first quarter that gives you confidence on your labor agenda kind of for the balance of the year?

我只是想跟進分娩情況。我知道您正受益於合約勞動力支出的減少等。當我們考慮第一季每個病人日的主觀幸福感約為 3% 時，您能否讓我們了解該季度的工資增長趨勢，然後抵消您所看到的生產力方面的影響，以及是否有任何變化第一季是否讓您對今年剩餘時間的勞工議程充滿信心？

Yes, I mean, obviously, as we've talked about over the past year, we've got a lot of initiatives on labor and our teams are executing very well from turnover reductions to recruitment and retention efforts on there. And our core labor trends are in line with our expectations. We said we anticipate wage inflation in that 2.5% to 3% level. And we're starting to -- and we are seeing that. And that's helping to offset, and we continue to be pleased with the contract labor trends. So I would say the core labor trends that we are seeing this year are right in line with our expectations. And the initiatives that we have continue to be underway.

是的，我的意思是，顯然，正如我們在過去一年中談到的那樣，我們在勞動力方面採取了很多舉措，我們的團隊從減少營業額到招聘和保留工作都執行得很好。我們的核心勞動力趨勢符合我們的預期。我們表示，我們預計薪資通膨率將達到 2.5% 至 3% 的水平。我們正在開始——而且我們正在看到這一點。這有助於抵消，我們繼續對合約工趨勢感到滿意。所以我想說，我們今年看到的核心勞動趨勢完全符合我們的預期。我們的舉措仍在繼續進行中。

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

你的下一個問題來自伯恩斯坦的蘭斯威爾克斯。

One follow-up on the labor question. And that's just if you could give any comment on hiring pipeline and if there are any categories where you're seeing either more appetite out there or any sort of constraints. And then my real question was on your comment on folks getting shifted over due to redeterminations and maybe that impacting outpatient surgeries. I was wondering if you're seeing any impacts of that sort of stuff on bad debt or any other things where perhaps the overall backdrop is impacting consumers here.

關於勞工問題的一項後續行動。這只是如果你能對招募管道發表任何評論，以及是否有任何類別你看到了更多的興趣或任何類型的限制。然後我真正的問題是關於你對人們因重新決定而被轉移的評論，這可能會影響門診手術。我想知道你是否看到這類事情對壞帳或任何其他事情的影響，這些事情可能是整體背景正在影響這裡的消費者。

Yes, let me attempt on that. Relative to the pipeline of labor, I don't know if there's any specific things I'd call out. I mean, obviously, we have diversity of geography, diversity of different employer cohorts. And labor teams are doing a great job. Our nurse hiring is up. And so I don't think there's anything unique I would call on that. And Sam or others can add in on that.

是的，讓我嘗試一下。相對於勞動力管道，我不知道是否有任何具體的事情可以提出來。我的意思是，顯然，我們的地理位置具有多樣性，不同雇主群體也具有多樣性。勞工團隊做得很好。我們的護士招募已經開始了。所以我認為這沒有什麼特別之處。 Sam 或其他人可以補充這一點。

And relative to the redeterminations and perhaps that influencing our outpatient surgery, I think both the combination of the HICS volume growth that we spoke about earlier, some of that due to the Medicaid redetermination, it is just a working thesis that perhaps there's a little bit more sensitivity on some of those elective procedures early in the year relative to deductible and co-pays. As Sam mentioned in his comments, almost all of our drop in outpatient surgeries was in Medicaid and self-pay levels. So we'll need a little bit more time to see how that plays out. And perhaps there will be some rebound on that as that begins to kind of normalize throughout the year.

相對於重新確定以及可能影響我們門診手術的因素，我認為我們之前談到的 HICS 數量增長的組合，其中一些是由於醫療補助重新確定，這只是一個工作論文，也許有一點相對於免賠額和自付費用，年初對某些選擇性程序更加敏感。正如薩姆在評論中提到的那樣，我們的門診手術數量幾乎全部下降都是在醫療補助和自費水平上。因此，我們需要更多的時間來看看結果如何。隨著全年開始趨於正常化，這種情況也許會出現一些反彈。

And on your question relative to the impact of that on bad debts, we're saying, no, I can't say we've seen any impact on that right now. There's still some of our self-pay growth are individuals that are in what we call a pending Medicaid status as we're pursuing eligibility efforts on there. But it has not yet resulted in any material change in our collectibility or bad debts at this stage.

關於你提出的有關壞帳影響的問題，我們的意思是，不，我不能說我們現在已經看到了任何影響。我們的自費成長仍然有一些是處於我們所謂的待定醫療補助狀態的個人，因為我們正在努力爭取那裡的資格。但現階段尚未對我們的可收回性或壞帳產生任何重大變更。

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

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

Bill, I'll also add my congrats, and thanks for all the help. My question is just on CapEx. Could you speak to the CapEx and sort of the deployment in the quarter. It was down a tiny bit, so let's call it flattish year-over-year, but generally been trending higher in recent years. I guess, maybe there's obviously a lot of timing. And then any new capacity specifically to call out in the next 12 months? I know you've got a bunch of projects over the next sort of 2 to 2.5 years as well.

比爾，我也要表示祝賀，並感謝您的所有幫助。我的問題只是關於資本支出。您能談談本季的資本支出和部署情況嗎？它略有下降，所以我們可以稱之為同比持平，但近年來總體呈上升趨勢。我想，也許顯然有很多時機。那麼在接下來的 12 個月內，有哪些新的產能需要專門投入使用呢？我知道您在接下來的 2 到 2.5 年內還有很多項目。

This is Sam. The amount for the quarter is flattish, to your point. And it is timing. We haven't slowed anything down. Some of our construction projects move at different paces than we anticipate at some level. But we expect for the year to be somewhere close to the number that we guided to last quarter, which is somewhere around $5.2 billion or so. So we're investing more in the business than we've ever invested because of the capacity that we need in the network development that we want. And so those efforts continue as we go through the course of this year.

這是薩姆。就您而言，本季的金額持平。這是時機。我們沒有放慢任何事情。我們的一些建設項目的進展速度與我們在某種程度上的預期不同。但我們預計今年的數字將接近我們上季指引的數字，約 52 億美元。因此，我們對業務的投資比以往任何時候都多，因為我們需要網路開發的能力。因此，在今年的過程中，這些努力將會持續下去。

As far as any particular capacity that I would call out, I would tell you we have a new hospital in San Antonio, Texas that will open up later this year on the west side of that community. We're excited about that. We have other major projects on a host of campuses that will come online over the year. I think our bed capacity, when we conclude the year, will be somewhere similar to the growth that we experienced this year, which is maybe another 2% or so.

至於我要提到的任何特定能力，我會告訴你，我們在德克薩斯州聖安東尼奧有一家新醫院，將於今年晚些時候在該社區的西側開業。我們對此感到興奮。我們在許多校區還有其他重大項目，這些項目將在今年上線。我認為，當我們今年結束時，我們的床位容量將與今年的成長類似，可能會再成長 2% 左右。

As I mentioned previously, our emergency room capacity is also growing as we invest in new units or as we expand existing units. I don't have the number in front of me as to exactly how much we're anticipating there. But we're investing consistently as far as in the areas of our business. But we're investing more inside of those as a reflection of our overall spending.

正如我之前提到的，隨著我們投資新單位或擴大現有單位，我們的急診室容量也在增加。我面前沒有具體的數字來說明我們對此的具體預期。但我們一直在我們的業務領域進行投資。但我們在這些方面投入了更多資金，以反映我們的整體支出。

We also continue to invest in basic infrastructure in our facilities. Whether it's capabilities and technology for our nurses or surgical equipment and so forth, those investments continue again at elevated levels to improve the offerings for our physicians and patients. And so we have some increases embedded in that as well. So we're really excited about what we're spending our money on. And our patterns have proven that we can generate very positive returns. And we continue to believe that's the case.

我們也繼續投資於我們設施的基礎設施。無論是我們護理人員的能力和技術，還是手術設備等，這些投資都會繼續保持在較高水平，以改善我們為醫生和患者提供的服務。因此，我們也對此進行了一些增加。所以我們對我們花錢的地方感到非常興奮。我們的模式已經證明我們可以產生非常積極的回報。我們仍然相信情況就是如此。

Your next question is from the line of Sarah James, Cantor Fitzgerald.

你的下一個問題來自莎拉詹姆斯、康托費茲傑拉。

I was wondering if you could give us what the commercial outpatient surgeries were. Just with the moving pieces, I think we're all just trying to understand if that piece was where you expected it to be. I know it's coming off of a tough comp last year. But was it still positive like it was the last few quarters?

我想知道您能否告訴我們商業門診手術是什麼。就移動的部分而言，我想我們都只是想了解該部分是否在您期望的位置。我知道去年的比賽非常艱難。但它仍然像過去幾個季度一樣積極嗎？

And then Galen, I think, you guys are within a few weeks of your first graduating class. So just wondering strategically, how has that panned out? Did you get your share or better of the work commitments of the graduating class?

然後蓋倫，我想你們距離第一屆畢業班還有幾週的時間。所以只是從戰略上想知道，結果如何？您是否得到了應屆畢業生的工作承諾或更好的工作承諾？

This is Sam. On the commercial side of outpatient surgery, I would say it's generally flat, so it performed better than the aggregate as a whole. Again, the calendar effects affected outpatient surgery in general. Specifically, it had a more dramatic effect on Medicaid, as we mentioned. But we aren't anticipating or seeing anything that's structural with our outpatient surgery business. And as I just mentioned, our capital spending has investments in our outpatient surgery platform as well.

這是薩姆。在門診手術的商業方面，我想說它總體上持平，因此它的表現比整體上要好。同樣，日曆效應總體上影響了門診手術。具體來說，正如我們所提到的，它對醫療補助產生了更顯著的影響。但我們並沒有預期或看到任何與我們的門診手術業務結構性的事情。正如我剛才提到的，我們的資本支出也投資於我們的門診手術平台。

With respect to Galen, we have had graduating classes in the past. We continue to have larger ones as we expand that component of our organization. And one of our priorities within our facilities and within our nursing agenda is to integrate the Galen campuses into sort of the organization more effectively. And we are seeing incremental improvement in retaining those graduates within our company. And we continue to see opportunities for improvement there. It's really early to say it's completely solidified. We have numerous campuses that are in early stages of development.

關於蓋倫，我們過去有過畢業班。隨著我們組織的這一組成部分的擴展，我們將繼續擁有更大的組織。我們的設施和護理議程中的優先事項之一是更有效地將蓋倫校區融入組織中。我們看到公司在留住這些畢業生方面取得了逐步進展。我們繼續看到那裡有改進的機會。現在說它已經完全凝固還為時過早。我們有許多處於開發早期階段的校園。

We will have again somewhere around 30 campuses by the end of 2027 with roughly 30,000 students across those campuses graduating somewhere between 7,000 or 8,000 per year, allowing us to pipeline and hopefully create a really good student experience, integrate them into the system through clinical integration and retain them when they graduate. So that's our strategy. And we're still early in seeing the effects of that. But we're encouraged by the efforts.

到2027 年底，我們將再次擁有約30 個校區，這些校區約有30,000 名學生，每年畢業人數在7,000 至8,000 人之間，這使我們能夠進行管道輸送，希望創造真正良好的學生體驗，透過臨床整合將他們整合到系統中並在他們畢業時留住他們。這就是我們的策略。我們仍處於早期觀察其影響的階段。但我們對這些努力感到鼓舞。

Your next question is from the line of Cal Sternick from JPMorgan.

您的下一個問題來自摩根大通的卡爾·斯特尼克。

We've heard commentary from some others that January and February were strong from a volume perspective with some softening of demand in March. Can you talk about what you saw in the quarter? And then if you're seeing the expected rebound volumes into April?

我們聽到其他一些人的評論稱，從銷售角度來看，一月和二月表現強勁，而三月需求有所疲軟。您能談談您在本季看到的情況嗎？然後，您是否看到預期的 4 月份銷售反彈？

And if I could also just ask one clarification on the Medicaid supplemental payments, do you have any visibility right now into any retro programs that could come through in the second quarter?

如果我還可以要求對醫療補助補充付款進行澄清，您現在是否了解第二季可能實施的任何復古計劃？

This is Bill, I'll answer the last one. No, we don't have specific visibility. There's always timing differences of certain aspects, but no specific visibility, no.

我是比爾，我來回答最後一個問題。不，我們沒有具體的可見性。某些方面總是存在時間差異，但沒有具體的可見性，不是。

As far as the volumes, every quarter has calendar effects. And again, as I mentioned previously, we judge the business over a longer period of time to really understand what's working and what's not working. March was a difficult calendar for purposes of elective outpatient business and elective inpatient business simply because we had less working days, business days, and we had the Easter holidays during that time period. So it was clearly softer.

就數量而言，每個季度都有日曆影響。正如我之前提到的，我們會在較長一段時間內對業務進行評估，以真正了解哪些有效，哪些無效。對於選擇性門診業務和選擇性住院業務來說，三月是一個困難的日曆，因為我們的工作日、營業日較少，而且我們在那段時間有復活節假期。所以它明顯更柔軟。

We actually grew our inpatient admissions, however, in March. But our outpatient activity was soft and influenced sort of the aggregate for the quarter. We don't give guidance with respect to 1 month into the next quarter. I will tell you, as I mentioned in my prepared comments, that we're encouraged by the overall backdrop of demand in our markets.

然而，三月我們的住院人數實際上有所增加。但我們的門診活動疲軟，並影響了本季的總量。我們不會給出下一季 1 個月的指導。正如我在準備好的評論中提到的那樣，我會告訴您，我們市場的整體需求背景令我們感到鼓舞。

And this concludes our Q&A session for today. And I would like to turn the call back over to Frank Morgan for closing remarks.

今天的問答環節到此結束。我想將電話轉回給弗蘭克摩根，讓他發表結束語。

Wally, thank you for your help today, and thanks, everyone, for joining our call. We hope you have a nice weekend. I'm around this afternoon if you have additional questions. Give us a call. Have a good day.

沃利，感謝您今天的幫助，也感謝大家加入我們的電話會議。我們希望您週末愉快。如果您還有其他問題，我今天下午會來的。給我們打電話。祝你有美好的一天。

This concludes today's conference call. Enjoy the rest of your day. You may now disconnect.

今天的電話會議到此結束。享受你一天剩下的時間。您現在可以斷開連線。