美國醫院公司 (HCA) 2024 Q3 法說會逐字稿

Hello. Welcome to the HCA Healthcare Third Quarter 2024 Earnings Conference Call. Today's call is being recorded.

你好。歡迎參加 HCA Healthcare 2024 年第三季財報電話會議。今天的通話正在錄音。

At this time, for opening remarks and introductions, I would like to turn the call over to the Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

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, Mike Marks. Sam and Mike will provide some prepared remarks and then we'll take questions. Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements that are based on management's current expectations, numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

早安，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；和財務長麥克·馬克斯。薩姆和麥克將提供一些準備好的發言，然後我們將回答問題。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 Shareholder Inc. is included in today's release. This morning's call is being recorded and a replay of the call will be available later today.

在今天早上的電話會議上，我們可能會參考調整後 EBITDA 等指標，這是一項非 GAAP 財務指標。今天的新聞稿中包含了一份表格，提供了調整後 EBITDA 和調節歸屬於 HCA Shareholder Inc. 淨利潤的補充資訊。今天早上的通話正在錄音，今天晚些時候將提供通話重播。

With that, I'll now turn the call over to Sam.

現在，我將把電話轉給 Sam。

All right. Good morning to everybody. Before we get to the financial results for the quarter, I want to share the heroic efforts for our people as they recently responded to, in less than 2 weeks, 2 major hurricanes that impacted some of our communities and facilities. Over the years, HCA Healthcare has developed industry-leading enterprise capabilities to support our hospitals during disasters. We have used learnings from past experiences, conducted extensive training, and built strong partnerships with key vendors to create a systematic approach to preparing for and responding to major events like hurricanes.

好的。大家早安。在我們公佈本季的財務業績之前，我想分享我們的員工所做的英勇努力，他們最近在不到兩週的時間內應對了影響我們一些社區和設施的兩場重大颶風。多年來，HCA Healthcare 開發了行業領先的企業能力，在災難期間為我們的醫院提供支援。我們吸取了過去的經驗教訓，進行了廣泛的培訓，並與主要供應商建立了牢固的合作夥伴關係，以創建一種系統的方法來準備和應對颶風等重大事件。

These resources were put to use for our teams with outstanding results over these past few weeks as the hospitals were in the path of these storms. But what's even more impressive is the unwavering dedication, remarkable bravery, and outstanding leadership demonstrated by the people in our company who worked throughout these storms and, in many instances, multiple days without rest to ensure our patients and colleagues were safe. Leveraging corporate capabilities effectively to support committed people in our facilities is fundamentally our formula for success. We call it the HCA Way. It works well in normal times, it worked well in the pandemic, and now it has proven itself again in these hurricanes.

這些資源被我們的團隊利用，在過去幾周里，由於醫院正處於這些風暴的影響範圍內，取得了出色的成果。但更令人印象深刻的是我們公司的員工在這些風暴中表現出堅定不移的奉獻精神、非凡的勇氣和出色的領導能力，他們在許多情況下連續幾天沒有休息，以確保我們的患者和同事的安全。有效地利用企業能力來支持我們工廠中忠誠的員工是我們成功的根本秘訣。我們稱之為 HCA 方式。它在正常時期運作良好，在大流行中運作良好，現在在這些颶風中再次證明了自己。

A few of our communities were significantly impacted by these storms. This is especially evident in the Asheville area and parts of Tampa St. Pete. Given the basic infrastructure role we play in our communities and the duty we have to be there for them in these situations, we have not veered from doing the right thing. I'm humbled by the determination and teamwork of HCA people.

我們的一些社區受到這些風暴的嚴重影響。這在阿什維爾地區和坦帕聖皮特的部分地區尤其明顯。鑑於我們在社區中發揮的基礎設施作用以及在這些情況下我們必須為他們服務的責任，我們並沒有偏離做正確的事情。 HCA 員工的決心和團隊合作讓我感到謙卑。

I'm honored to be associated with them, and I'm proud of how they continually show up in difficult circumstances and deliver tremendously positive outcomes for our patients, each other, and their communities. They truly demonstrate that they are, above all else, committed to the care and improvement of human life, and I want to thank them for what they do to make this company great. Now to the quarter's results. Like the first half of the year, the results for the third quarter were strong and reflected solid revenue growth and margin improvement. Diluted earnings per share, as adjusted, increased 25% to $4.90. These results include an estimated impact of $0.15 per share from lost revenue and additional expenses caused by hurricanes.

我很榮幸能與他們合作，我為他們如何在困難的情況下不斷出現並為我們的患者、彼此及其社區帶來巨大的積極成果而感到自豪。他們真正表明，他們最重要的是致力於關懷和改善人類生活，我要感謝他們為使這家公司變得偉大所做的一切。現在來看看本季的業績。與上半年一樣，第三季的業績強勁，反映出營收的穩健成長和利潤率的改善。調整後的稀釋每股收益成長 25%，達到 4.90 美元。這些結果包括預計每股 0.15 美元的收入損失影響以及颶風造成的額外費用。

While the rest of our hospitals and outpatient facilities and the path of the storms are fully operational, we have 2 hospitals that continue to deal with the aftereffects of the storms. First, HCA Mission Hospital, which is the only hospital in the Asheville area was affected by Hurricane Helene, and it has continued to operate and provide high-quality patient care even with significant city infrastructure in disrepair, and that's primarily water. As a consequence of this storm, we anticipate incurring significant expenses and lost revenue related to these issues throughout the remainder of the year. We also expect some continued, but we think, manageable impact into 2025.

雖然我們的其餘醫院和門診設施以及風暴路徑已全面投入運營，但我們有 2 家醫院仍在繼續處理風暴的後遺症。首先，HCA Mission Hospital 是阿什維爾地區唯一一家受到颶風海倫影響的醫院，儘管城市基礎設施（主要是水）年久失修，但該醫院仍在繼續運作並提供高品質的病患照護。由於這場風暴，我們預計在今年剩餘時間內將產生與這些問題相關的大量費用和收入損失。我們也預計到 2025 年會產生一些持續但我們認為是可控的影響。

As it pertains to Hurricane Milton, which hit Florida in October, our HCA Florida Largo Hospital was flooded. It is currently closed because of damage to the building's infrastructure. We anticipate significant repair expenses will be incurred at this hospital during the fourth quarter in addition to losing revenue. Our teams, however, are working around the clock to reopen it in late December. HCA Healthcare has numerous examples from past hurricanes where our hospitals have recovered from major storms and become more productive than pre-storm performance.

由於 10 月襲擊佛羅裡達州的颶風米爾頓，我們的 HCA 佛羅裡達拉戈醫院被洪水淹沒。由於建築物基礎設施受損，目前已關閉。我們預計，除了收入損失外，該醫院第四季還將產生大量維修費用。然而，我們的團隊正在日以繼夜地工作，爭取在 12 月底重新開放。 HCA Healthcare 有許多過去颶風的例子，我們的醫院已經從大風暴中恢復過來，並且比風暴前的表現更有效率。

I believe we can produce similar results with these 2 hospitals in time as we move beyond the aftereffects of these most recent storms. During the quarter, volume growth across our markets and service lines, while modestly affected by Hurricane Helene, was strong and broad-based. On a same-facilities basis, inpatient admissions grew 4.5% as compared to the prior year. Adjusted admissions also grew 4.5%. Emergency room visits increased 4.6%.

我相信，當我們擺脫最近風暴的影響時，我們可以及時與這兩家醫院取得類似的結果。本季度，我們的市場和服務線的銷售成長雖然受到颶風海倫的影響不大，但成長強勁且基礎廣泛。在相同設施的基礎上，住院人數比上一年增加了 4.5%。調整後的招生人數也增加了 4.5%。急診室就診人數增加了 4.6%。

Inpatient surgeries were up 1.6%. Other volume categories, including cardiac procedures, inpatient rehab admissions, and obstetric volumes had solid growth. Outpatient surgery was the only major service category that declined. It was down 2%. However, the revenue in this service line increased 5% because of acuity and payer mix.

住院手術量增加了 1.6%。其他交易量類別，包括心臟手術、住院復健入院和產科交易量都有穩健成長。門診手術是唯一下降的主要服務類別。下降了 2%。然而，由於敏銳度和付款人組合，該服務線的收入增加了 5%。

Payer mix across other service lines and acuity within inpatient services improved in the quarter. These factors helped generate same-facilities revenue growth of 7.1%. We continue to believe the investments we are making in our network development agenda drive value for our patients and the organization. By the end of this year, we expect to have added approximately 600 inpatient beds and 100 new outpatient facilities, bringing our total sites of care to over 2,600. Currently, the company has around $6 billion of projects under development.

其他服務線的付款人組合以及住院服務的敏銳度在本季度有所改善。這些因素使得同設施收入增加了 7.1%。我們仍然相信，我們在網路發展議程中所做的投資將為我們的患者和組織帶來價值。到今年年底，我們預計將增加約 600 張住院床位和 100 個新門診設施，使我們的護理中心總數達到 2,600 多個。目前，該公司正在開發的項目價值約 60 億美元。

These investments, which should come online over the next few years, will add more capacity and create greater access across our networks, allowing us to meet the growing demand for health care services we anticipate in our markets. Before I turn the call to Mike, I want to close with a few early thoughts on 2025. Our planning process, which includes continuing assessment of the hurricane-related impact, has not been completed so I will caveat my comments with the fact that it is always difficult to predict with certainty the various components of our business, and these preliminary views may change. With respect to volume, we went into this year believing that growth would exceed our long-term demand assumptions of 2% to 3% and throughout the year (inaudible)

這些投資應該在未來幾年內上線，將增加更多的容量並在我們的網路中創造更多的訪問權限，使我們能夠滿足我們預期的市場對醫療保健服務不斷增長的需求。在我打電話給 Mike 之前，我想以一些關於 2025 年的早期想法作為結束語。很難準確地預測我們業務的各個組成部分，而這些初步觀點可能會改變。就數量而言，今年我們相信全年成長將超過我們 2% 至 3% 的長期需求假設（聽不清楚）

As we look to 2025, we assume volume growth will continue at elevated levels in the range of 3% to 4% for the year. With respect to our earnings outlook for next year, given the strong volume growth assumption coupled with an anticipated mostly stable operating environment, should generate earnings growth near or slightly above the upper end of our long-term target ranges for both diluted earnings per share and adjusted EBITDA. As usual, in January, we will provide you with our guidance for 2025.

展望 2025 年，我們假設全年銷售成長將繼續保持在 3% 至 4% 的較高水準。就我們明年的獲利前景而言，考慮到強勁的銷售成長假設，加上預期基本穩定的營運環境，獲利成長應該接近或略高於我們稀釋每股盈餘和每股盈餘的長期目標範圍的上限。調整後的EBITDA。像往常一樣，我們將在 1 月份為您提供 2025 年的指導。

And with that, I'll turn the call to Mike.

然後我會把電話轉給麥克。

Thank you, Sam, and good morning, everyone. We were pleased with the third quarter. We produced good volume growth and margins, especially when considering the impact of the hurricanes. I'll start with a few details of the 2 storms that impacted us recently. Hurricane Helene made landfall in the Big Bend area of Florida on September 26 and impacted our communities and operations in Florida, Georgia, and North Carolina.

謝謝你，山姆，大家早安。我們對第三季感到滿意。我們實現了良好的銷售成長和利潤率，特別是考慮到颶風的影響。我將從最近影響我們的兩場風暴的一些細節開始。颶風海倫於 9 月 26 日在佛羅裡達州大本德地區登陸，影響了我們在佛羅裡達州、喬治亞州和北卡羅來納州的社區和營運。

We had 29 hospitals in the path of the storm which had to prepare and respond. And financially, we have seen a loss of revenue and incurred additional expenses during the preparation during storm and the response phases. As an example, we are expecting to spend at least $13 million on water supply to Mission Hospital and our other health care facilities related to Hurricane Helene through the month of October. And city potable water supply is not projected to be reestablished at Mission Hospital for several more weeks. As Sam noted, we estimate that Hurricane Helene impacted the third quarter by $50 million or $0.15 per diluted share.

我們有 29 家醫院位於風暴路徑上，必須做好準備和應對。在財務上，我們在風暴期間的準備和回應階段出現了收入損失並產生了額外費用。例如，我們預計在 10 月期間將花費至少 1,300 萬美元為 Mission 醫院和與颶風海倫相關的其他醫療機構供水。預計教會醫院的城市飲用水供應在接下來的幾週內都不會恢復。正如 Sam 指出的那樣，我們估計颶風海倫對第三季的影響為 5000 萬美元，即稀釋後每股 0.15 美元。

Hurricane Milton hit the west coast of Florida, just south of Sarasota on October 9. It impacted a large portion of the Florida peninsula. We had over 34 hospitals in the path of this storm and that had to prepare and respond, including HCA Florida Largo Hospital, which is still under repair. As we think about the ongoing impacts of both major hurricanes, we anticipate additional expenses and loss of revenue will be approximately $200 million to $300 million or $0.60 to $0.90 per diluted share during the fourth quarter of 2024. This impact relates primarily to our hospitals in North Carolina and our Largo Hospital in Florida.

10 月 9 日，颶風米爾頓襲擊了佛羅裡達州西海岸，薩拉索塔以南。我們有超過 34 家醫院在這場風暴的路徑上，必須做好準備和應對，其中包括仍在維修中的 HCA 佛羅裡達拉戈醫院。當我們考慮這兩個主要颶風的持續影響時，我們預計2024 年第四季的額外費用和收入損失將約為2 億至3 億美元，或稀釋後每股0.60 至0.90 美元。與我們在北卡羅來納州和佛羅裡達州的拉戈醫院。

These estimates do not include any insurance recoveries the company may receive in the future. I would like to add my appreciation to our care teams and all of the HCA colleagues who provided support during these storms, and my concern and prayers for the communities and the people impacted as we collectively recover and respond. It is a true honor to work with our colleagues and our physicians and to serve these communities. Now let me transition to our 2024 guidance. As noted in our release, we reaffirmed our 2024 estimated guidance ranges.

這些估計不包括公司未來可能收到的任何保險賠償。我謹向在這些風暴期間提供支持的我們的護理團隊和所有 HCA 同事表示感謝，並在我們共同恢復和應對過程中對受影響的社區和人民表示關心和祈禱。與我們的同事和醫生一起工作並為這些社區服務是一種真正的榮幸。現在讓我過渡到我們的 2024 年指導。正如我們在新聞稿中指出的，我們重申了 2024 年的預計指引範圍。

Given the ongoing impact of the 2 major hurricanes on the remainder of the year, we estimate that the results are likely to be in the lower half of the ranges provided. Now to the results for the quarter. Sam reviewed our strong volumes, which resulted in revenue growth of 7.9% in the quarter over prior year, so I will focus on operating costs in the quarter. Adjusted EBITDA margin in the quarter improved 90 basis points over prior year. Labor costs as a percent of revenue improved 160 basis points from the prior year.

鑑於兩場主要颶風對今年剩餘時間的持續影響，我們估計結果可能位於所提供範圍的下半部分。現在來看本季的業績。 Sam 回顧了我們強勁的銷量，這導致本季營收比去年同期成長 7.9%，因此我將專注於本季的營運成本。本季調整後 EBITDA 利潤率較上年同期提高 90 個基點。勞動成本佔收入的百分比比前一年下降了 160 個基點。

We continue to see good results on contract labor, which improved 18% from the prior year and represented 4.6% of total labor cost. Supply cost as a percent of revenue increased 30 basis points over the prior year but were relatively consistent sequentially. Other operating costs as a percent of revenue increased 40 basis points over the prior year. Professional fee cost growth over prior year moderated to 10% and was flat sequentially to the second quarter. We had expense growth associated with Medicaid supplemental payment programs, and we had increased repair and maintenance costs related to Hurricane Helene.

我們繼續看到合約工的良好業績，比前一年提高了 18%，佔總勞動成本的 4.6%。供應成本佔收入的百分比比前一年增加了 30 個基點，但與上一季相對穩定。其他營運成本佔收入的百分比比前一年增加了 40 個基點。專業費用成本較去年同期成長放緩至 10%，與第二季持平。我們的醫療補助補充支付計劃相關的費用有所增長，而且與颶風海倫相關的維修和維護成本也有所增加。

Medicaid supplemental payment programs provided a modest benefit to our third quarter '24 overall results. So a lot of moving parts in the quarter but this was a solid quarter with over 13% growth in adjusted EBITDA, driven by strong core operating performance across our portfolio of markets. Moving to capital allocation. We continued to deploy a balanced strategy of allocating capital for long-term value creation. Cash flow from operations was $3.5 billion in the quarter.

醫療補助補充支付計劃為我們 24 年第三季的整體業績帶來了一定的好處。本季有很多變化，但這是一個穩健的季度，在我們市場組合強勁的核心營運績效的推動下，調整後 EBITDA 成長了 13% 以上。轉向資本配置。我們繼續部署平衡的資本配置策略，以創造長期價值。本季營運現金流為 35 億美元。

Capital expenditures totaled $1.19 billion, and we repurchased $1.79 billion of our outstanding shares during the quarter. We also paid $169 million in dividends. Our debt to adjusted EBITDA leverage remains at the low end of our stated guidance range, and we believe we are well positioned from a balance sheet perspective. Finally, as noted in our release, we now estimate capital expenditures for 2024 to be approximately $5 billion. This lower estimate is due primarily to the timing of capital projects, and we continue to see good opportunities for investing in our business.

本季資本支出總計 11.9 億美元，我們回購了 17.9 億美元的已發行股票。我們還支付了 1.69 億美元的股息。我們的債務與調整後 EBITDA 槓桿率仍處於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，正如我們在新聞稿中指出的，我們現在估計 2024 年的資本支出約為 50 億美元。這個較低的估計主要是由於資本項目的時機，我們繼續看到投資我們業務的良好機會。

With that, Frank, I will turn over the call to you for questions.

這樣，弗蘭克，我將把電話轉給你提問。

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

謝謝你，麥克。 （操作員指示）傑里米，您現在可以向那些想提問的人發出指示。

(Operator Instructions)

（操作員說明）

AJ Rice from Credit Suisse.

來自瑞士信貸的 AJ Rice。

Just maybe 1 point of clarification then a question. So on the outlook comments for '25, if we take the midpoint of your '24 guidance, $14 billion and take $250 million to $350 million of hurricane impact off of that and then grow at the high end of your 4% to 6% range, we come up with something like $14.6 billion from '25 and then we layer in hurricane recovery on top of that. I just want to make sure we're all walking away with the right framework. Is that what you're saying? And then my broader question just to throw that out would be on your volume strength.

也許只是澄清一點然後提出一個問題。因此，關於 25 年的展望評論，如果我們採用 24 年指導的中點 140 億美元，並從中扣除 2.5 億至 3.5 億美元的颶風影響，然後在 4% 至 6% 範圍的高端增長，我們從25年起就得出了大約146 億美元的資金，然後我們在此基礎上考慮了颶風復原。我只是想確保我們都使用正確的框架。你是這麼說的嗎？然後我更廣泛的問題是關於你的音量強度。

You now have anniversaried the pick up in volume post pandemic we saw last year. Are there particular areas of service lines that are remaining strong that are worth calling out even as you anniversary what was strong trends last year?

現在已經是我們去年看到的疫情後銷售回升的周年紀念日了。即使在去年的強勁趨勢週年紀念日之際，是否有一些仍保持強勁勢頭的特定服務領域值得一提？

Thanks, AJ This is Mike. As it relates to our 2025 commentary, let me say this. We generally believe that the ongoing effects of the hurricanes in 2025 which we, as Sam said, we think are manageable, will be primarily in North Carolina as we expect our Tampa facility to be operational by the end of 2024. And we took these storms and the potential lingering effects into 2025 into account when we set this being near or slightly above the upper end of our long-term growth range.

謝謝，AJ 這是麥克。因為這關係到我們2025年的評論，所以我這麼說。我們普遍認為，2025 年颶風的持續影響將主要集中在北卡羅來納州，正如 Sam 所說，我們認為颶風的持續影響是可以控制的，因為我們預計我們的坦帕工廠將在 2024 年底投入運營。當我們將這一數字設定為接近或略高於長期增長範圍的上限時，我們會考慮到2025 年的潛在揮之不去的影響。

As Sam noted as well, we will give much more context and details on our '25 formal guidance in January. As it relates to volume, the only thing I might point in addition to the point that you made relative to strong volume pickups in the last part of last year is that sequentially from Q2 to Q3 of 2024, we increased same-facility admissions by 1.4%. And that sequential increase is in line with our past sequential trend. So that's our sense of volume.

正如 Sam 也指出的那樣，我們將在 1 月提供有關 '25 正式指南的更多背景資訊和詳細資訊。由於與數量相關，除了您在去年下半年提出的相對於強勁數量回升的觀點之外，我唯一可以指出的是，從2024 年第二季度到第三季度，我們的同一設施入場量增加了1.4 %。這種連續成長與我們過去的連續趨勢一致。這就是我們的體積感。

Yes. And let me add to that, AJ. I think broadly, most of our service categories are growing really well. And we think the emergency room continues to be a very important solution for people in our communities. And it continues to grow and we continue to invest in it.

是的。讓我補充一下，AJ。我認為總的來說，我們的大多數服務類別都成長得非常好。我們認為急診室對我們社區的人們來說仍然是一個非常重要的解決方案。它繼續增長，我們繼續對其進行投資。

And we continue to improve our patient outcomes with our ER optimization agenda. We continue to see good strength in our cardiac business broadly across the organization. And as I said, across the geography of the company, we've had broad-based growth as well with very few challenges, if you will, across the important markets of our company.

我們透過急診室優化議程繼續改善患者的治療效果。我們繼續看到整個組織內心臟業務的良好實力。正如我所說，在公司的各個地區，我們都實現了廣泛的成長，並且在我們公司的重要市場中幾乎沒有什麼挑戰（如果你願意的話）。

Ben Hendrix, RBC Capital.

本‧亨德里克斯，加拿大皇家銀行資本。

A lot of discussion this earnings season around claim denial activity. I was wondering if you could touch on denial trends broadly. And then related to two-midnight claims specifically, back in July, you noted that you were just beginning to see adjudication of two-midnight-related claims from early in the year. As we approach year-end, can you offer any observations on the adjudication activity you're seeing around two-midnight? And is there anything informing your view of when we may see behavioral changes among payers and how they process those short-stay admissions?

本財報季圍繞著索賠拒絕活動進行了很多討論。我想知道你是否可以廣泛地談談否認趨勢。然後，具體與午夜兩點索賠相關，早在 7 月份，您就指出，從今年年初開始，您剛開始看到對午夜兩點相關索賠的裁決。隨著年底的臨近，您能否對午夜兩點左右的裁決活動提出一些看法？您是否認為我們何時會看到付款人的行為發生變化以及他們如何處理這些短期入住？

Let me talk about denials generally first, and then we'll pivot to two-midnight impact in the quarter. Ben, as we noted in our Investor Day, we have been working diligently on denial mitigation strategies through our integrated revenue cycle over the past several years. We certainly have seen payers ramp up the intensity level of their denial activities over the past several years. But given our focus and investment in these areas, we've been able to moderate the rate of growth and denial write-offs this year from prior year. So denials were not a material impact to HCA in third quarter of 2024.

讓我先談談一般性的否認，然後我們將轉向本季午夜兩點的影響。 Ben，正如我們在投資者日所指出的，過去幾年我們一直在透過我們的綜合收入周期努力製定拒絕緩解策略。在過去幾年中，我們當然看到付款人加大了拒絕活動的強度。但考慮到我們對這些領域的關注和投資，我們今年已經能夠比去年降低成長率並拒絕核銷。因此，否認並未對 2024 年第三季的 HCA 產生重大影響。

A quick update on the Medicare Advantage two-midnight rule adoption. Our same-facility total Medicare admissions increased 5.3% in the quarter. Traditional Medicare admits were basically flat. Medicare Advantage admissions were up 11%, and we attribute approximately 2% of that 11% growth in Medicare Advantage admissions coming from the two-midnight rule impact. This is equivalent to approximately 50 basis points of our overall admission growth and has remained consistent over the year.

關於 Medicare Advantage 午夜兩點規則採用的快速更新。本季我們同一機構的醫療保險總入院人數增加了 5.3%。傳統醫療保險的承認率基本持平。 Medicare Advantage 入院人數增加了 11%，我們將 Medicare Advantage 入院人數 11% 的增長中約 2% 歸因於午夜兩點規則的影響。這相當於我們整體入場人數增加約 50 個基點，並且全年保持穩定。

As we continue -- as I think about the denial impact, to your question on the two-midnight rule, we do continue to see a modest reduction in the prior authorization denial trends for accounts with two-midnights or greater compared to prior year so far in 2024. But we still have way too many denials. And we have a few large Medicare Advantage payers that are significant outliers driving these denials. For context, let me highlight a couple of the comparisons of Medicare Advantage to traditional Medicare. Medicare Advantage now represents 58% of total Medicare volume.

當我們繼續時——當我考慮拒絕影響時，對於你關於午夜兩點規則的問題，我們確實繼續看到與去年相比，午夜兩點或更長的帳戶的事先授權拒絕趨勢略有減少，因此距離 2024 年還很遠。我們有一些大型醫療保險優惠付款人，他們是導致這些拒絕的重要異常值。作為背景，讓我重點介紹 Medicare Advantage 與傳統 Medicare 的一些比較。 Medicare Advantage 目前佔 Medicare 總量的 58%。

The mix of observation to inpatients with Medicare Advantage is still significantly higher than traditional Medicare, even now 9 months past the implementation of the two-midnight rule. Lastly, the Medicare Advantage CMI-adjusted length-of-stay ratio is approximately 10% higher than traditional Medicare, driven by payer-driven discharge lays. These drive cost burdens to providers. So as we're working with our Medicare Advantage payers, we're really trying to address 2 things. We're trying to address this denial burden and the cost burden.

即使在午夜兩點規則實施 9 個月後，使用 Medicare Advantage 的住院患者的觀察組合仍然明顯高於傳統 Medicare。最後，醫療保險優勢 CMI 調整後的住院時間比率比傳統醫療保險高出約 10%，這是由付款人驅動的出院保險所推動的。這些都會增加提供者的成本負擔。因此，當我們與 Medicare Advantage 付款人合作時，我們實際上正在努力解決兩件事。我們正在努力解決這種拒絕負擔和成本負擔。

And so if you think about the adjudication process, we are starting to get through the first quarter's denials through -- all the way through the adjudication process, and now we are pursuing those through dispute resolution. As we've talked about before, dispute resolution can take a year to 2 years to fully complete. And so we are going to have to continue to pursue that strategy as we move forward.

因此，如果你考慮裁決過程，我們正開始克服第一季的否認——一直透過裁決過程，現在我們正在透過爭議解決來解決這些問題。正如我們之前談到的，爭議解決可能需要一年到兩年的時間才能完全完成。因此，我們在前進的過程中必須繼續推行這項策略。

Ann Hynes, Mizuho.

安海因斯，瑞穗。

This is Ann. I guess part of my question you just addressed when I think about pricing assumptions for 2025, when I think ahead, I'm assuming it might be a tough compare because you have this two-midnight rule this year. You also had a nice shift from Medicaid to commercial next year and have some incremental DPP. So when we think of pricing next year, maybe in your initial guide, what do you have for maybe a benefit for continued shift to this observation to inpatient status on the Medicare Advantage side? And maybe any incremental DPPs that you have included in your initial guide because I know some states are working behind the scenes to get more programs approved?

這是安。我想，當我考慮 2025 年的定價假設時，您剛才提到的部分問題，當我展望未來時，我假設這可能是一個艱難的比較，因為今年有兩個午夜的規則。明年你也從醫療補助轉向商業，並且有一些增量 DPP。因此，當我們考慮明年的定價時，也許在您最初的指南中，繼續轉向醫療保險優勢方面的住院患者狀態觀察可能會帶來什麼好處？也許您在最初的指南中包含了任何增量 DPP，因為我知道一些州正在幕後工作以獲得更多計劃的批准？

Ann, let me say this. It's a little early to give a lot of details around 2025. And as we finish our planning process in January call, we'll give you all of those details. I would say this, though, largely, I think our cash net revenue per adjusted admission, we're planning on somewhere between 2% to 3% growth in 2025 and that's our early look at that metric. In terms of payer contracting, I don't know if this is exactly where you're going, but I'll go ahead and give you the update that we're now 80% complete in 2025, 54% complete for 2026 and just short of 20% complete for 2027. And we're still tracking in that mid-single-digit update. So that's a quick update on the commercial side.

安，我來說說吧。現在在 2025 年左右提供許多細節還為時過早。不過，我想說的是，在很大程度上，我認為我們調整後的入場現金淨收入，我們計劃在 2025 年實現 2% 到 3% 的增長，這是我們對該指標的初步看法。在付款人合約方面，我不知道這是否正是您的目標，但我會繼續向您提供最新信息，我們現在在 2025 年完成了 80%，在 2026 年完成了 54%，僅此而已。 2027 年，還不到20%。這是商業方面的快速更新。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Sort of tagging on there, sort of 2 questions here on pricing next year. Do you assume any DPPs in that guidance range that you gave us for next 2 years? And then as you think about labor and OpEx, I guess, what are you guys assuming for labor and OpEx within that guide for next year?

那裡有一些標籤，這裡有兩個關於明年定價的問題。您是否認為未來 2 年 DPP 處於您為我們提供的指導範圍內？然後，當您考慮勞動力和營運支出時，我想，你們對明年指南中的勞動力和營運支出有何假設？

So yes, I would repeat that really we'll be getting into the details of our margin profile assumptions for 2025 when we have our January call. Still in the middle of our planning process, a little early to be getting into those details now for third quarter. So let me just stay there related to that. I'm happy to give you a quick waiver update, though, for third quarter and so I'll do that here. As we've noted before, Medicaid has historically been our most challenging payer other than patients without insurance.

所以，是的，我要重複一遍，當我們召開 1 月電話會議時，我們確實會詳細了解 2025 年的利潤狀況假設。我們仍處於規劃過程中，現在討論第三季的這些細節還為時過早。所以讓我留在那裡與此相關。不過，我很高興為您提供第三季的快速豁免更新，因此我將在這裡進行更新。正如我們之前指出的，除了沒有保險的患者之外，醫療補助歷來是我們最具挑戰性的付款人。

The growth in the Medicaid supplemental payment programs across our states over the past several years have helped, but these programs are complex and variable from quarter-to-quarter, and when taken together with historical Medicare reimbursement are still short of covering the cost to treat Medicaid patients. This quarter really illustrates the complexity and variability of these programs. As noted in my comments, Medicaid supplemental payment programs produced a modest benefit in the quarter versus prior year. This modest benefit was generally the net effect of a reduction from the Florida program, given our change to accruing, as offset by receiving the North Carolina benefit in the third quarter of '24 versus fourth quarter of last year and then the new Nevada program to kick in this year. We still project that we will have $100 million to $200 million tailwind from Medicaid supplemental payment programs in 2024 to prior year but would now lean to the higher end of that range.

過去幾年，我們各州醫療補助補充支付計劃的成長有所幫助，但這些計劃很複雜，每個季度都有所不同，與歷史醫療保險報銷一起考慮，仍然不足以覆蓋治療費用醫療補助患者。本季度真正說明了這些計劃的複雜性和可變性。正如我在評論中指出的那樣，醫療補助補充支付計劃在本季度與前一年相比產生了適度的效益。這種適度的福利通常是佛羅裡達州計劃減少的淨效應，考慮到我們改為應計，與去年第四季度相比，2024 年第三季度收到的北卡羅來納州福利以及隨後的新內華達州計劃所抵消。我們仍然預計，從 2024 年到上一年，我們將從醫療補助補充支付計劃中獲得 1 億至 2 億美元的推動力，但現在傾向於該範圍的高端。

Mike, let me just add something, Pito. I think as I mentioned in my comments, that we anticipate a stable operating environment for 2025, that suggests demand sort of in the zone as we talked about, which is better than our long-term assumptions around demand. Mike just spoke to our pricing and reimbursement environment being generally consistent and sort of programmed for 2025. And then with respect to our costs, we do think inflationary trends are generally consistent with what we've seen on the labor side for 2024. And we have reasonable assumptions around the rest of our cost to be somewhat stable and in line with sort of 2024.

麥克，讓我補充一點，皮托。我認為，正如我在評論中提到的，我們預計 2025 年將出現穩定的營運環境，這表明需求處於我們所討論的區域，這比我們對需求的長期假設要好。麥克剛剛談到我們的定價和報銷環境總體上是一致的，並且是為2025 年制定的。一致。

Now we're putting a finer point on that as we finish the year and land on a few things. So that's how we're characterizing a stable operating environment.

現在，當我們結束這一年並解決一些問題時，我們將對此進行更詳細的闡述。這就是我們如何描述穩定的操作環境。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Looks like there was a deceleration in inpatient revenue per admission from 6.5% in the first half of the year, which was very strong, to about half of that in the third quarter. I just want to understand the underlying drivers there between acuity, mix and rate.

看來每次住院的住院收入從上半年的 6.5%（非常強勁）下降到第三季的一半左右。我只是想了解敏銳度、組合和速率之間的潛在驅動因素。

So when I think about the NRA growth rate in third quarter versus kind of year-to-date or the first half of the year, as you know, really, all of the decline in the growth rate is driven by state supplemental programs. We had growth in Medicaid supplemental program revenues in third quarter of '24 to prior year but well below the growth rate in the first half of 2024 to prior year. Consistent with the first 2 quarters of 2024, we had good growth in acuity and strong payer mix in the quarter.

因此，當我考慮 NRA 第三季度的成長率與年初至今或上半年的成長率時，如您所知，實際上，成長率的所有下降都是由州補充計畫推動的。我們的醫療補助補充計畫營收在 2024 年第三季較去年同期有所成長，但遠低於 2024 年上半年較去年同期的成長率。與 2024 年前 2 季一致，我們在本季的敏銳度和強勁的付款人組合方面都有良好的成長。

Joanna Gajuk, Bank of America.

喬安娜·加尤克，美國銀行。

So maybe I guess the payer mix, a little bit additional question here in terms of the exchange volumes and the Medicaid volumes in the quarter. I guess you gave us Medicare, so also commercial volume growth in the quarter. So maybe if you can kind of give us additional, I guess, data point on the payer mix and the volume growth in the quarter by payer.

所以也許我猜付款人的組合，在本季的交易量和醫療補助量方面還有一點額外的問題。我想你們給了我們醫療保險，所以本季的商業銷售也有所成長。因此，我想，如果您能為我們提供有關付款人組合和本季付款人數量增長的額外數據點。

Sure. So I'm going to use equivalent admission growth in third quarter of '24 to prior year same-facility. And so let's run down the Medicare up 5% on equivalent admissions, Medicaid down 8.5% on equivalent admissions. Managed care volume, excluding exchanges, up just short of 4%. The exchange volume was at 43% growth, same-facility to prior year.

當然。因此，我將使用 2024 年第三季與去年相同設施的同等入場成長。因此，讓我們將醫療保險 (Medicare) 的同等入院人數減少 5%，將醫療補助 (Medicaid) 的同等入院人數減少 8.5%。管理式醫療交易量（不包括交易所）僅成長了不到 4%。交易量成長 43%，設施與去年相同。

And then uninsured volumes were up 7.2%. So that equates to that total of 4.5% growth in equivalent admissions in the quarter.

然後未投保的數量增加了 7.2%。因此，這相當於本季同等入學人數增加了 4.5%。

Austin Garrick, Wolfe Research.

奧斯汀‧加里克，沃爾夫研究中心。

Wow, that's a name from the past. It's Justin Lake from Wolfe. I wanted to ask about the long-term debt and your leverage and how you're thinking about that going into next year. It looks like you're kind of ending the year around 3x. And then I apologize, I know I missed a little bit of the beginning of the call, but -- and I know you got asked about the hurricane impact in there.

哇，這是過去的名字。這是沃爾夫的賈斯汀·萊克。我想問長期債務和你們的槓桿率，以及你們如何看待明年的情況。看起來你今年的收尾率大約是 3 倍。然後我道歉，我知道我錯過了電話開頭的一些內容，但是 - 我知道你被問到了颶風的影響。

But anything that I might have missed in terms of how you are thinking about the hurricane and the potential it reoccurs next year within your guidance or your high -- your 6% or how are you thinking about that $300 million?

但我可能錯過了關於您如何看待颶風以及明年颶風在您的指導或最高水平（您的 6% 或您如何看待這 3 億美元）內再次發生的可能性的任何內容？

Great, Justin. So as it relates to cash flow, we had a really strong quarter in third quarter '24. We did end right at the lower end of the range on our leverage target and we've talked about this before. But every year at this time, as part of our planning and budgeting process, we're working with our finance investment committee and doing an evaluation of financial policies, and we'll announce any changes to those if there are any on our first quarter call. So we're still in the middle of that planning process related to those kinds of financial policies.

太棒了，賈斯汀。因此，就現金流而言，我們在 24 年第三季的表現非常強勁。我們確實以槓桿目標範圍的下限結束，我們之前已經討論過這一點。但每年的這個時候，作為我們規劃和預算流程的一部分，我們都會與財務投資委員會合作並對財務政策進行評估，如果第一季有任何變化，我們將宣布稱呼。因此，我們仍處於與此類金融政策相關的規劃過程中。

But we are at the bottom of that leverage ratio. And what we articulated related to 2025 in hurricanes, it's just that we generally believe that the ongoing effects of the hurricanes in 2025, which we think are going to be manageable are primarily in our North Carolina market as our Tampa facility will be operational by the end of the year. We did take that into account, Justin, when we crafted our early-look comments at being near or slightly above the upper end of our long-term growth ranges. And as always, we'll give you a lot more details and context around our '25 look when we do formal guidance update in January.

但我們的槓桿率處於底部。我們在 2025 年颶風方面所闡述的內容只是我們普遍認為 2025 年颶風的持續影響（我們認為這些影響將是可控的）主要發生在我們的北卡羅來納州市場，因為我們的坦帕工廠將由年底。賈斯汀，當我們制定接近或略高於長期增長範圍限制的早期評論時，我們確實考慮到了這一點。像往常一樣，當我們在一月份進行正式指導更新時，我們將向您提供有關 '25 外觀的更多詳細資訊和背景資訊。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

As I think about the work that you're doing with the communities and the disruption, how are you thinking about insurance claims or insurance reimbursement that you got? And then maybe, Mike, just any color you can share on the change to the CapEx guidance?

當我想到您正在為社區所做的工作和造成的破壞時，您如何看待您獲得的保險索賠或保險報銷？然後，麥克，您可以分享一下關於資本支出指南變化的任何顏色嗎？

So on insurance, and we noted this in our release, the impacts that we've noted related to fourth quarter and third quarter did not include any estimate related to insurance recoveries at this point. It's still early. We're working through that now. We do anticipate having insured losses related to these hurricanes. It's a little early yet, and we're really not in a position to provide an estimate either to the timing of a potential recovery or the amount.

因此，在保險方面，我們在新聞稿中指出了這一點，我們注意到與第四季度和第三季度相關的影響目前不包括與保險賠償相關的任何估計。現在還早。我們現在正在解決這個問題。我們確實預計已為與這些颶風相關的損失投保。現在還為時過早，我們確實無法對潛在復甦的時間或金額進行估計。

But we do believe that there will be a claim for sure, given the size of these storms. Related to the change in CapEx, it's really just the timing of capital projects. These are, especially the bigger projects, as you know, take a long time and the timing can flow a little bit up and down. But there's no -- there's an implication there. We're still seeing a lot of really good opportunities to invest in our business.

但考慮到這些風暴的規模，我們確實相信肯定會有索賠。與資本支出的變化相關的，其實只是資本項目的時機。如您所知，這些項目，尤其是較大的項目，需要很長時間，而且時間安排可能會有些波動。但沒有——那裡有一個暗示。我們仍然看到很多非常好的投資我們業務的機會。

And so I would just articulate the slight decrease in what we think we're going to spend this year on CapEx being related more to timing.

因此，我只想闡明，我們認為今年在資本支出上的支出略有減少，更多與時機有關。

Whit Mayo, SVB Securities.

惠特·梅奧，SVB 證券公司。

Sam, you've had a big focus on the AI and technology investments. Just wondering if there's any new learnings, any efficiencies that you guys are seeing from those investments maybe around labor management or other areas that you can share that you find encouraging, that would be helpful.

Sam，您非常關注人工智慧和技術投資。只是想知道是否有任何新的經驗教訓，你們從這些投資中看到的任何效率，可能是圍繞勞動力管理或其他領域，你們可以分享，你們覺得令人鼓舞，這會有所幫助。

So we, yesterday, actually presented our full plan on our digital agenda and how we are approaching advancing technology and, in particular, AI into the company's business over the next 5 to 7 years. And we see many opportunities to improve our administrative functioning, our operational management of our business, and then ultimately, the clinical outcomes for our patients. And so we're early. In that journey, we do have some areas where we're seeing promising results as it relates to using technology and, in particular, artificial intelligence more effectively. Some of that is in our scheduling capabilities, where we've been able to improve the tools that our managers can use with more precise demand forecasting, better allocation of workforce to meet the patient demand and such.

因此，昨天，我們實際上介紹了我們的數位議程的完整計劃，以及我們如何在未來 5 到 7 年內將先進技術，特別是人工智慧融入公司業務。我們看到了許多改善我們的行政職能、業務營運管理以及最終改善患者臨床結果的機會。所以我們還早。在這個過程中，我們確實在一些領域看到了有希望的結果，因為這與更有效地使用技術，特別是人工智慧有關。其中一些是在我們的調度能力中，我們已經能夠改進我們的經理可以使用的工具，進行更精確的需求預測，更好地分配勞動力以滿足患者需求等。

So that's encouraging and giving us a little bit of confidence. We have aspects of artificial intelligence embedded into our revenue cycle, as Mike mentioned, to manage the receivables performance and the revenue performance of the company more effectively and mitigate some of the pressures and so forth. So those are early stage initiatives that are yielding positive results for us. They're not material yet but we do see a growing set of initiatives. We're organizing around the agenda.

所以這令人鼓舞並給了我們一點信心。正如麥克所提到的，我們將人工智慧的各個方面嵌入到我們的收入週期中，以更有效地管理公司的應收帳款績效和收入績效，並減輕一些壓力等。因此，這些都是早期舉措，正在為我們帶來正面的成果。它們還不是實質的，但我們確實看到了越來越多的舉措。我們正在圍繞議程進行組織。

We're going to be resourcing it even more as we push into the next few years, and we expect to get incremental improvements in '25 and '26 and on into the rest of this decade as we mature our efforts on this particular front. I mean, it's our view that we're at an inflection point. HCA Healthcare historically has performed at high levels across all elements of our business, I believe. Obviously, our growth has been good. Our margin performance has been good. Our clinical outcomes and quality performance to date is better than it was in 2019 so pre pandemic. So now we've improved overall quality. And then with respect to our constituency engagements, employees, physicians, and even community, we've advanced that. So we're at this incredible inflection point because of these tools. And in our business, we see a lot of application.

隨著我們在未來幾年的推進，我們將為其提供更多的資源，並且隨著我們在這一特定領域的努力日益成熟，我們預計將在25 年和26 年以及本十年的剩餘時間內獲得漸進式改善。我的意思是，我們認為我們正處於一個轉折點。我相信，HCA Healthcare 歷來在我們業務的所有方面都表現出色。顯然，我們的發展勢頭良好。我們的利潤率表現良好。迄今為止，我們的臨床結果和品質表現比 2019 年大流行前的情況要好。所以現在我們提高了整體品質。然後，在我們的選區參與、員工、醫生甚至社區方面，我們已經取得了進展。由於這些工具，我們正處於這個令人難以置信的轉折點。在我們的業務中，我們看到了大量的應用。

And so we're very excited about the potential that this particular agenda presents for our company.

因此，我們對這項特定議程為我們公司帶來的潛力感到非常興奮。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

I just wanted to ask about the volume growth assumption for next year, the 3% or 4%. I was looking back at last quarter, I think you suggested the exchange is potentially were worth as much as maybe 200 or 250 basis points of your growth this year. Just trying to understand how you're thinking about some of these unusual coverage dynamics in the exchanges. And I guess for Medicaid, is it a headwind this year? Does it keep declining as you think about next year?

我只是想問明年的銷售成長假設，3% 或 4%。我回顧了上個季度，我認為您認為該交易所的價值可能高達今年增長的 200 或 250 個基點。只是想了解您如何看待交易所中的一些不尋常的報道動態。我想對於醫療補助來說，今年會是個逆風嗎？您認為明年它會繼續下降嗎？

Is that stabilized? Just trying to understand some of these more like macro-driven dynamics inside your function.

穩定了嗎？只是試圖理解其中一些更像是函數內部的宏觀驅動動態。

Yes, great question. Largely, I think exchange enrollment will moderate next year. Maybe in the 8% to 10% growth in enrollment is the best estimates we have versus in our states this year, enrollment growth was over 30%. So that's 1 factor, certainly. I do think that Medicaid volumes will flatten out a bit in '25 versus '24 as we kind of sunset through the Medicaid redetermination process.

是的，很好的問題。很大程度上，我認為明年交換生入學人數將會減少。也許 8% 到 10% 的入學率成長是我們的最佳估計，而今年我們各州的入學率成長超過 30%。所以這當然是第一個因素。我確實認為，隨著醫療補助重新確定過程的結束，醫療補助數量在 25 年與 24 年相比將會趨於平緩。

So largely, I would say those are the 2 biggest dynamics. I think the net effect of that will be generally stable payer mix as we move from 2024 to 2025.

在很大程度上，我想說這是兩個最大的動力。我認為，從 2024 年到 2025 年，其最終影響將是付款人組合整體穩定。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Interested if you can update us on the contracting environment and with Medicare Advantage plans, just separate from the two-midnight rule dynamic and sort of how those trends have been playing out as some of the MA plans or a lot of them have been experiencing a lot of pressure on their rates and margins as well. And then just a quick follow-up just around the '25 preliminary outlook, understanding it's only early. Would there be any view on any impact on the cadence of EBITDA just around the impacts from the hurricanes and the timing of recovering from that?

如果您能向我們介紹合約環境和 Medicare Advantage 計劃的最新情況，請與午夜兩點的規則動態分開，以及這些趨勢如何發揮作用，因為一些 MA 計劃或其中許多計劃正在經歷他們的利率和利潤也面臨很大的壓力。然後對 25 年初步展望進行快速跟進，了解這還為時過早。對於颶風的影響以及從中恢復的時間對 EBITDA 節奏的影響是否有任何看法？

Let me cover the contracting piece and then we'll jump to your second question. Generally speaking, we're largely contracted across the major Medicare Advantage payers. And as we've done our normal kind of set of renewals in 2024, we've been able to come to agreement with our payer partners in the Medicare Advantage space. That is our intention to continue to do that. We continue to work with our Medicare Advantage payer partners to work through the challenges that they have and that we have as a provider in their contracted network.

讓我介紹合約部分，然後我們將跳到你的第二個問題。一般來說，我們主要與主要 Medicare Advantage 付款人簽訂合約。隨著我們在 2024 年完成一系列正常的續訂，我們能夠與 Medicare Advantage 領域的付款合作夥伴達成協議。這就是我們繼續這樣做的意圖。我們將繼續與我們的 Medicare Advantage 付款人合作夥伴合作，共同應對他們所面臨的挑戰以及我們作為其簽約網絡中的提供者所面臨的挑戰。

But in terms of contracting, I would say that we are fairly consistent where we've been in the past, which is largely contracted. And we've been able to secure renewals as we've gone through our 2024 renewal cycle. In terms of cadence of EBITDA, again, I think it's a little early to get into trying to think about earnings by quarter in 2025 at this point. So I'll push that answer to when we come together in January.

但就合約而言，我想說，我們與過去的情況相當一致，很大程度上是合約。隨著 2024 年續訂週期的結束，我們已經能夠確保續訂。就 EBITDA 的節奏而言，我認為現在開始考慮 2025 年季度收益還為時過早。所以我會把這個答案推遲到我們一月聚在一起的時候。

Ryan Langston.

瑞恩·蘭斯頓.

I mean, hurricanes are just kind of a fact of life in the southern states, typically not as severe, of course, as this year, but you did see some effects a couple of years ago. I don't think you'd be overly reactive to this, but does this maybe cycle of hurricane activity do anything to affect sort of long-term strategy on capital allocation, M&A in terms of building, buying facilities and maybe look outside of those geographies, even if only maybe somewhat incrementally?

我的意思是，颶風只是南部各州生活中的事實，當然通常不像今年那麼嚴重，但幾年前你確實看到了一些影響。我認為你不會對此過度反應，但這可能是颶風活動的周期會影響資本配置、建設、購買設施方面的併購以及可能將目光投向這些之外的長期戰略嗎？ ？

This is Sam. I think the short answer to that is no. We have seen our facilities, as I mentioned in my comments, recover, and I'll just give you an example. Hurricane Ian, which affected our hospital in Port Charlotte, HCA Faucette Hospital a couple of years ago, that hospital was actually repaired, hardened, if you will, to hurricanes. And we're actually performing at a higher level than we were pre-Hurricane Ian.

這是薩姆。我認為簡短的回答是否定的。正如我在評論中提到的，我們已經看到我們的設施已經恢復，我只想給您一個例子。幾年前，伊恩颶風影響了我們位於夏洛特港的醫院 HCA Faucette 醫院，該醫院實際上經過了修復和加固，如果你願意的話，可以抵禦颶風。事實上，我們的表現比颶風伊恩之前的水平更高。

Hurricane Michael, which hit Panama City, Florida, also has been repaired and significantly and hardened some as well. Obviously, a hurricane had hit it again and damaged it, but that hospital is performing at a higher level than it was pre storm. Hurricane Harvey, which hit Houston a number of years ago and was a significant flood event. As a result, our Houston system has recovered and is also exceeding pre-Harvey performance as well. So we still believe that the state of Florida, the Gulf Coast of Texas and so forth are very significant opportunities for our company.

襲擊佛羅裡達州巴拿馬城的颶風邁克爾也已修復，部分區域也得到了顯著加固。顯然，颶風再次襲擊並損壞了它，但該醫院的表現比風暴前更高。颶風哈維多年前襲擊了休士頓，是一次重大洪水事件。結果，我們的休士頓系統已經恢復，也超過了哈維之前的表現。因此，我們仍然相信佛羅裡達州、德克薩斯州墨西哥灣沿岸等地區對我們公司來說是非常重要的機會。

We invest, we believe wisely in those communities. We hardened our facilities as much as we possibly can. But they are, in fact, a way of life. I will tell you, this year and I had experienced -- personal experience with Katrina is very similar to the effects of Katrina. I mean, Hurricane Helene was a Category 4 storm.

我們投資並明智地相信這些社區。我們盡可能加固我們的設施。但事實上，它們是一種生活方式。我會告訴你，今年我所經歷的——卡崔娜颶風的個人經歷與卡崔娜颶風的影響非常相似。我的意思是，颶風海倫是 4 級風暴。

And if you would have asked me what 2 communities were most impacted, I would have never said in 100 years, Augusta, Georgia, and Asheville, North Carolina. And so we dealt with an unprecedented storm. And again, HCA, we showed the power of the company, I think, but more importantly, the power of its people to respond to that. And I think we're going to be stronger as a result of it in those markets. We believe that our portfolio of communities that we serve are very well positioned for long-term growth, as we've indicated.

如果你問我哪兩個社區受到的影響最大，我 100 年內都不會說：喬治亞州奧古斯塔和北卡羅來納州阿什維爾。就這樣，我們應對了一場史無前例的風暴。我認為，HCA 再次展示了公司的力量，但更重要的是，公司員工對此做出回應的力量。我認為我們將因此在這些市場變得更強大。正如我們所指出的，我們相信我們所服務的社區組合非常有利於長期成長。

We understand the risks associated with hurricane and such. That's why we've built the capabilities that we've got. And we think we're diversified enough across those communities to deal with that particular risk.

我們了解與颶風等相關的風險。這就是我們建立現有功能的原因。我們認為，我們在這些社區中的多元化程度足以應對這種特定風險。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Outpatient surgical trend remained negative despite a lower comp. In your 4Q and '25 guide, do you assume that stabilizes or turns positive? What's driving that pressure? And then just a quick clarification on the business interruption insurance comment that you made. What level of insurance do you carry?

儘管比較較低，門診手術趨勢仍呈現負面趨勢。在您的 4Q 和 25 年指南中，您認為情況穩定還是轉為正值？是什麼推動了這種壓力？然後快速澄清您對業務中斷保險的評論。您持有什麼等級的保險？

So on outpatient surgery, as we indicated, nothing has changed from the trends we've seen this year. The declines have been focused almost entirely in Medicaid and uninsured. That's why our revenue per surgical case has been up 7%. We've seen acuity growth, and we've also seen payer mix improvement in our outpatient surgery. The profitability of our outpatient surgery service is better as a result.

因此，正如我們所指出的，在門診手術方面，我們今年看到的趨勢沒有任何變化。下降幾乎完全集中在醫療補助和無保險方面。這就是為什麼我們每個手術病例的收入增加了 7%。我們看到了門診手術的敏銳度有所提高，付款人組合也有所改善。因此，我們門診手術服務的獲利能力較好。

So on the headline, volume is down. On the bottom line, profits are up with respect to outpatient surgery. So we're comfortable with that outcome. As it relates to next year, we don't anticipate any significant changes at this particular juncture. We believe our overall volume guidance includes the different categories that we've got.

因此，從頭條新聞來看，成交量有所下降。總而言之，門診手術的利潤增加。所以我們對這個結果感到滿意。由於與明年有關，我們預計在這個特定時刻不會發生任何重大變化。我們相信我們的整體銷售指導包括我們擁有的不同類別。

Our efforts on outpatient surgery continue to advance. We're advancing the number of surgery centers that we have in our company through greenfield development as well as some targeted acquisitions. And we continue to improve operations of our hospital-based outpatient surgery centers, providing better environments for our physicians and better care environments for our patients.

我們在門診手術方面的努力持續取得進展。我們正在透過綠地開發和一些有針對性的收購來增加公司的手術中心數量。我們繼續改善醫院門診手術中心的運營，為醫生提供更好的環境，為患者提供更好的護理環境。

And on your insurance question, we certainly have business interruption coverage as part of our property insurance program. But at this time, we're really not in a position to provide estimates related to either the timing or the potential recovery under those insurance policies or the limits thereof. So that's where we are now.

關於您的保險問題，我們當然有業務中斷保險作為我們財產保險計劃的一部分。但目前，我們確實無法提供與這些保單或其限制下的時間或潛在恢復相關的估計。這就是我們現在的處境。

John Ransom.

約翰·蘭塞姆.

Just kind of backing up. I'm trying to think about things that we worried about 5 years ago that we don't talk about anymore. And one thing that comes to mind is value-based care and all that stuff. And I'm just curious, your commercial contracts in particular, I know they're fee-for-service. But what kind of kickers do you get in 2024 for things like hospital-acquired infections, readmissions, other quality metrics? What kind of kickers are you getting now versus then? Have they grown? And what are some examples of that?

只是一種備份。我正在嘗試思考五年前我們擔心但現在不再談論的事情。我想到的一件事是基於價值的護理等等。我只是很好奇，特別是你們的商業合同，我知道它們是按服務付費的。但是，到 2024 年，您會在醫院獲得性感染、再入院和其他品質指標等方面遇到什麼樣的問題呢？與過去相比，你現在得到了什麼樣的踢球？他們長大了嗎？有哪些例子？

John, this is Sam. Those are very incremental inside of our overall revenue contracts with payers. And I won't say they're de minimis but they're not material to the overall escalators that we have or the overall revenue equation inside of those contracts. We have some contracts that have modest provisions around those. But when you aggregate it for the company as a whole, it's a very small component of the escalators that we get.

約翰，這是薩姆。這些在我們與付款人的總體收入合約中是非常增量的。我不會說它們是微不足道的，但它們對於我們擁有的整體自動扶梯或這些合約內的整體收入方程式並不重要。我們有一些合約對此有適度的規定。但當你將整個公司的數據匯總時，你會發現它只是我們獲得的自動扶梯的一小部分。

I mean, we are committed at our core to providing better care to our patients. And that's part and parcel to why our quality outcomes, as I mentioned, are better than they were in 2019. And we have a robust agenda across the organization to improve the outcomes for our patients, including some of the service metrics that you referenced there. So that's sort of core to how we approach it. And it's embedded, I think, in the offering of HCA facilities to payers and their members.

我的意思是，我們的核心致力於為患者提供更好的護理。正如我所提到的，這就是為什麼我們的品質結果比 2019 年更好的部分原因。 。這就是我們處理問題的核心。我認為，它已嵌入到向付款人及其會員提供 HCA 設施中。

And that's allowed us, we believe, to get to a point where we contract on a pretty consistent cycle. We've actually advanced the number of commercial contracts this year that we participate in with 2 major contract signings, Kaiser in Denver and then Blue Cross of Tennessee and Chattanooga. So we have very few commercial contracts across the country now where we don't participate. It's less than a handful. And we think that's a result of our access capabilities with our outpatient platform as well as our quality and comprehensive service offerings that we provide back in our facilities.

我們相信，這使我們能夠達到以相當一致的周期簽訂合約的地步。實際上，今年我們參與的商業合約數量有所增加，簽署了兩份主要合約：丹佛的 Kaiser 以及田納西州和查塔努加的 Blue Cross。所以現在我們在全國範圍內幾乎沒有我們不參與的商業合約。還不到一把。我們認為這是我們門診平台的訪問能力以及我們在設施中提供的優質和全面服務的結果。

If I could just tag on. When you define quality, I know that's an amorphous concept to some people. But what's the data set that you use and how has that changed?

如果我能繼續下去就好了。當你定義品質時，我知道這對某些人來說是一個模糊的概念。但是您使用的資料集是什麼？

I mean, I don't know that we have enough time on this call, John, to talk about the data set that we have around quality. I mean, we have an increasing data set around quality. We have better insights into it as an organization. It includes everything from complications to mortality to hospital-acquired infections to length of stay to a specific service line, metrics for cardiovascular care, for bone marrow transplant, for ER processing, as I mentioned before. I can go on and on about it.

我的意思是，約翰，我不知道我們在這次電話會議上有足夠的時間來討論我們擁有的有關品質的資料集。我的意思是，我們關於品質的資料集越來越多。作為一個組織，我們對它有更好的見解。正如我之前提到的，它包括從併發症到死亡率、到醫院獲得性感染、到特定服務線的住院時間、心血管護理指標、骨髓移植指標、急診處理指標等一切。我可以繼續說下去。

We have a very integrated quality agenda with our leadership corporately and with our hospital teams. And all of that comes together in an advanced state for us as an organization. As we think about AI and the question that was asked earlier, we see that as the next frontier allowing us to get even better at it, more efficient and more transparent. So it's really a fairly comprehensive program that we've continued to grow simply because our service offerings are more complex, our ability to use our quality to attract physicians and patients and be more responsive to our communities is just sort of core to what we do day in and day out.

我們與公司領導層和醫院團隊制定了非常全面的品質議程。對於我們這個組織來說，所有這些都以先進的狀態結合在一起。當我們思考人工智慧和先前提出的問題時，我們認為這是下一個前沿領域，讓我們能夠做得更好、更有效率、更透明。因此，這確實是一個相當全面的計劃，我們不斷發展，只是因為我們的服務產品更加複雜，我們利用我們的品質來吸引醫生和患者以及對社區做出更積極響應的能力只是我們所做工作的核心日復一日。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Can you just talk a little bit about some of the improvements you've been seeing in your wage and compensation expense ratio? In particular, what sort of wage inflation you're seeing currently in your contracting with nurses, et cetera? What your growth rates are looking like there? And then maybe just a quick cleanup, if you could just talk a little about bad debt impacts you're seeing as a result of Medicaid redetermination, that would be great, too.

您能否簡單談談您在薪資和薪資費用率方面所看到的一些改善？特別是，您目前在與護士等簽訂的合約中看到了什麼樣的薪資上漲？你們的成長率是多少？然後也許只是快速清理，如果您能談談您因醫療補助重新確定而看到的壞帳影響，那也很好。

So generally speaking, as we've come through this year, the wage rates that we're seeing across our markets are generally pretty stable. I think we've marked before somewhere between the 2.5% to 3.5% range is about kind of what we're seeing. And that -- if I think about for next year, as Sam mentioned, that we're anticipating and planning for a fairly stable operating environment, including wage inflation. So that would be the wage part of that. On bad debt impacts, as we noted, I would use just the volume as an example.

因此，總的來說，正如我們今年所經歷的那樣，我們在整個市場上看到的工資率總體上相當穩定。我認為我們之前已經標記過 2.5% 到 3.5% 之間的範圍，這與我們所看到的差不多。而且，如果我考慮明年，正如薩姆所提到的那樣，我們預計併計劃一個相當穩定的營運環境，包括薪資通膨。所以這就是工資的一部分。關於壞帳影響，正如我們所指出的，我將僅使用數量作為例子。

But if you think about the uninsured volume growth for equivalent admissions in the quarter at about 7%, we give you a sense of that. But in terms of bad debt or uninsured cost, it's pretty stable, and we don't anticipate significant changes to the stability as we go into next year.

但如果您考慮本季同等入院人數的無保險數量增加約 7%，我們就能讓您感受到這一點。但就壞帳或未保險成本而言，它相當穩定，我們預計明年的穩定性不會發生重大變化。

Craig Hettenbach, Morgan Stanley.

克雷格‧赫滕巴赫，摩根士丹利。

Mike, can you touch on just the resiliency program of $600 million to $800 million in savings? Just how are you thinking about that in 2025 and beyond from a timing perspective?

麥克，您能談談節省 6 億至 8 億美元的彈性計畫嗎？您從時間角度如何看待 2025 年及以後的情況？

Yes, good question. As I think about resiliency, we continue to see good output from the results of our work around our resiliency program. A few points of that would be, one, the length of stay and their case management agenda, where this year, we've seen about a 1.5% reduction in our length of stay this year, which has been very helpful as we've managed both our labor and our capacity as we've gone through this year and accommodated additional volume growth. Labor management, which we've just talked about, as we've gone here through the third quarter. Our resiliency actions have allowed us to show margin improvement in labor and can really kind of contribute to as we think about '25 and beyond.

是的，好問題。當我考慮彈性時，我們繼續看到圍繞彈性計畫的工作成果取得了良好的成果。其中有幾點是，第一，停留時間和他們的案件管理議程，今年我們的停留時間減少了約 1.5%，這非常有幫助，因為我們已經今年我們管理了我們的勞動力和產能，並適應了額外的產量成長。我們剛剛討論了勞動力管理，因為我們已經討論了第三季。我們的彈性行動使我們能夠顯示出勞動力利潤率的提高，並且在我們考慮 25 世紀及以後時確實可以做出貢獻。

Using this resiliency program to help fund and support the investments that we're making in our tech and innovation programs and still allow us to produce good returns to our global set of stakeholders. So generally speaking, I'd say we're on track. And as we noted at Investor Day, the next 2, 3 years here are going to be largely using our resiliency program to pay for tech and innovation investments. And then as we kind of move deeper into the decade to support our margins and deal with the challenges that may come. But I'm pleased with the current status and the trajectory of our overall resiliency program, and that would be a status update that I would give for now.

利用這項彈性計畫來幫助資助和支持我們在技術和創新計畫中所進行的投資，同時仍使我們能夠為全球利害關係人帶來良好的回報。所以總的來說，我想說我們正在步入正軌。正如我們在投資者日所指出的，未來兩三年將主要利用我們的彈性計畫來支付技術和創新投資。然後，隨著我們進入這個十年，以支持我們的利潤並應對可能到來的挑戰。但我對我們整體彈性計畫的當前狀態和軌跡感到滿意，這將是我現在要提供的狀態更新。

Got it. And then just a quick follow-up on professional fees leveling off on a sequential basis. Do you expect that to be stable in 2025 as well?

知道了。然後快速跟進專業費用依序趨於平穩的情況。您預計 2025 年這一情況也會穩定嗎？

Well, it's again, a little early to be giving that level of detail for '25. Clearly, we are pleased and encouraged with the work that our operating and our physician services teams have been doing to deal with the pressures and really specifically in a hospital-based physician world. As you kind of walk through the quarters this year, our first quarter grew 20% to prior year. Our second quarter grew 13% to prior year. And now in the third quarter, we're down to 10%.

好吧，現在再給 25 年的詳細資料還為時過早。顯然，我們對我們的營運團隊和醫生服務團隊為應對壓力所做的工作感到高興和鼓舞，特別是在醫院醫生世界中。當你回顧今年的季度時，你會發現我們第一季比去年同期成長了 20%。我們第二季比去年同期成長 13%。現在在第三季度，我們下降到了 10%。

That we were able to keep that growth fairly sequential from second to third quarter. I do think, given what we're seeing in the results of our work that, that's part of Sam's comment for next year of a stable operating environment. And so I think that I would, for now until we get to January, I would largely articulate the pro fee environment in that same concept.

我們能夠從第二季到第三季保持相當連續的成長。我確實認為，考慮到我們在工作結果中看到的情況，這是 Sam 對明年穩定營運環境的評論的一部分。因此，我認為，從現在開始，直到一月份，我都會用同樣的概念來闡明職業環境。

Jamie Perse, Goldman Sachs.

傑米·珀斯，高盛。

I was just looking for a Valesco update. What's the status of losses in the third quarter? Where are you in turning around that enterprise and getting improved pricing there? And just what are your latest thoughts on timing of when you can get that to breakeven or potentially profitable?

我只是在尋找 Valesco 的更新。三季虧損情況如何？您在扭轉該企業並提高定價方面處於什麼位置？您對何時實現損益兩平或潛在獲利的最新想法是什麼？

This is Sam. On Valesco, we're pleased with the integration that's happened this year. We were able to assimilate, as we've mentioned before, 5,500 physicians from that particular group into HCA management systems and so forth. Our objectives with Valesco are to get it to an appropriate level of financial performance. This year, we are, in fact, on our plan, maybe slightly ahead of it but it's not material to the company as a whole.

這是薩姆。在瓦萊科，我們對今年發生的整合感到滿意。正如我們之前提到的，我們能夠將來自該特定群體的 5,500 名醫生納入 HCA 管理系統等。我們與 Valesco 的目標是使其達到適當的財務績效水準。事實上，今年我們已經按照我們的計劃進行了，也許稍微提前了一點，但這對整個公司來說並不重要。

Our long-term objectives with Valesco are to create an internal capability with this particular physician group that basically turns this into a strategic asset. And by that, I mean, we have the ability to improve our clinical outcomes and quality results for our patients because we have a physician group that is fully integrated as an employed base inside of HCA. We can build more rigor, more routines, more standards in how we do clinical processing. The second thing we think we can accomplish in our journey to make it a strategic asset is to improve efficiency, embed these physicians more into how we manage our emergency room, how we execute on our case management agenda and so forth. And then thirdly, we think we can leverage this group to help us with our tech agenda, to help us with our growth agenda by building relationships with referring physicians and help us with outreach.

我們與 Valesco 的長期目標是與這個特定的醫生團隊建立內部能力，基本上將其轉變為策略性資產。我的意思是，我們有能力改善患者的臨床結果和品質結果，因為我們擁有一個完全整合為 HCA 內部僱用基地的醫生團隊。我們可以在臨床處理方面建立更嚴格、更常規、更多標準。我們認為在使其成為策略性資產的過程中我們可以完成的第二件事是提高效率，讓這些醫生更參與我們如何管理急診室、如何執行我們的個案管理議程等等。第三，我們認為我們可以利用這個團隊來幫助我們實現技術議程，透過與轉診醫生建立關係來幫助我們實現成長議程，並幫助我們進行外展。

So those aspects of value creation that we see with Valesco far exceed sort of the financial performance inside the group. We continue to improve our reimbursement with the payers as it relates to hospital-based physicians. But these other elements provide more value, we think, globally to the organization and will be part and parcel to our core initiatives.

因此，我們在 Valesco 看到的價值創造方面遠遠超出了集團內部的財務表現。我們繼續改善與付款人的報銷，因為這與醫院醫生有關。但我們認為，這些其他要素在全球範圍內為組織提供了更多價值，並將成為我們核心計畫的重要組成部分。

Okay. Jeremy, we'll take 1 more question.

好的。傑里米，我們再回答 1 個問題。

Joshua Raskin, Nephron.

約書亞·拉斯金，尼弗龍。

So I heard Medicaid's adjusted admissions were down 8.5% in the quarter. It's actually not as big as the decline in total Medicaid lives in the market. So I'm curious if these additional state subpayments and sort of broad increases to Medicaid funding has impacted strategy around serving Medicaid patients. Are you thinking differently about capacity or service lines to Medicaid specifically?

我聽說醫療補助調整後的入院人數在本季下降了 8.5%。實際上並不像市場上醫療補助總生命的下降那麼大。因此，我很好奇這些額外的州分付款和醫療補助資金的廣泛增加是否影響了為醫療補助患者提供服務的策略。您對醫療補助的容量或服務項目有不同的看法嗎？

Josh, this is Sam. Actually, no, on the contrary, we are finding opportunities to improve offerings for Medicaid beneficiaries through some of our outpatient development in certain markets. The supplemental payment programs that Mike has alluded to over the past have created reimbursement in some situations where it makes it easier for us to invest in services and capabilities that help the Medicaid beneficiaries and produce better environments for them to get care. So I don't see that anything has changed our core thinking around how we provide available services to that particular beneficiary and we'll continue to evaluate that. I think for HCA as a whole, 17%, 18% of our adjusted admissions are Medicaid so it's a large piece of our organization. The decline this year is really centered around redeterminations mostly, not funding from 1 state to the other. It was through that process of redetermination that some of the business moved amongst the payer classes as we've indicated over the year. That will slow down because we don't have a redetermination process next year. And we will continue to evaluate how to use our investments to properly allocate to meet the needs of our communities broadly and, in some cases, specifically for Medicaid.

喬什，這是山姆。事實上，不，相反，我們正在透過在某些市場的一些門診開發來尋找機會改善醫療補助受益人的服務。麥克過去提到的補充支付計劃在某些情況下創造了報銷，使我們更容易投資於幫助醫療補助受益人的服務和能力，並為他們創造更好的獲得護理的環境。因此，我認為沒有任何事情改變了我們關於如何向特定受益人提供可用服務的核心思維，我們將繼續評估這一點。我認為對於整個 HCA 來說，我們調整後的招生中有 17%、18% 是醫療補助，所以它是我們組織的很大一部分。今年的下降實際上主要集中在重新確定上，而不是從一個州向另一個州提供資金。正如我們在一年中所指出的，正是透過重新確定的過程，一些業務在付款人類別中轉移。這將會放緩，因為我們明年沒有重新確定過程。我們將繼續評估如何利用我們的投資進行適當分配，以滿足我們社區的廣泛需求，在某些情況下，特別是醫療補助。

All right. That is all the questions in the queue so I'll turn it back over to Mr. Frank Morgan for closing remarks.

好的。這就是隊列中的所有問題，因此我將把它轉回給弗蘭克摩根先生做結束語。

Jeremy, thank you for your help today and thanks to everyone for joining our call. Hope you have a great weekend. I'm around this afternoon if I can answer additional questions you might have. Good day.

傑里米，感謝您今天的幫助，也感謝大家加入我們的電話會議。希望您週末愉快。如果我可以回答您可能有的其他問題，我今天下午會來。再會。

That does conclude today's conference. Have a pleasant day, everyone.

今天的會議到此結束。祝大家有個愉快的一天。