美國醫院公司 (HCA) 2024 Q4 法說會逐字稿

(audio in progress) standing by.

（音訊正在播放）待命。

My name is Janine, and I will be your conference operator for today.

我叫 Janine，今天我將擔任您的會議主持人。

At this time, I would like to welcome everyone to the HCA Healthcare fourth-quarter 2024 earnings call.

現在，我歡迎大家參加 HCA Healthcare 2024 年第四季財報電話會議。

(Operator Instructions)

（操作員指令）

I will now turn the call over to Frank Morgan, Vice President of Investor Relations.

現在我將電話轉給投資者關係副總裁弗蘭克摩根 (Frank Morgan)。

Please go ahead.

請繼續。

Good morning, and welcome to everyone on today's call.

早安，歡迎大家參加今天的電話會議。

With me this morning is our CEO, Sam Hazen; and CFO, Mike Marks.

今天早上和我在一起的是我們的執行長 Sam Hazen；和財務長 Mike Marks。

Sam and Mike will provide some prepared remarks, and then we'll take questions.

山姆和麥克將發表一些準備好的發言，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 forward-looking statements, they're based on management's current expectations.

在我將電話轉給薩姆之前，讓我提醒大家，今天的電話會議如果包含前瞻性陳述，則它們基於管理層當前的預期。

Numerous risks, uncertainties, and other factors may cause actual results to differ materially from those that might be expressed today.

許多風險、不確定性和其他因素可能會導致實際結果與今天表達的結果有重大差異。

More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

有關前瞻性陳述和這些因素的更多資​​訊已列在今天的新聞稿和我們向美國證券交易委員會提交的各種文件中。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure.

在今天早上的電話會議上，我們可能會參考調整後的 EBITDA 等指標，這是非 GAAP 財務指標。

A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare Inc. is included in today's release.

今天的新聞稿中含有一個表格，提供有關調整後 EBITDA 和調節歸屬於 HCA Healthcare Inc. 的淨收入的補充資訊。

This morning's call is being recorded, and a replay of the call will be available later today.

今天上午的通話正在錄音，今天晚些時候將提供通話重播。

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

說完這些，我現在將電話轉給薩姆。

All right.

好的。

Thank you, Frank, and good morning to everybody.

謝謝你，弗蘭克，大家早安。

The company finished the year with strong business fundamentals that were consistent with the previous quarters this year.

該公司以強勁的業務基本面結束了這一年度，與今年前幾季的情況一致。

Demand for healthcare services remained strong, operations were in good order and stable, and the company continued to see favorable investment opportunities.

醫療服務需求依然旺盛，經營狀況良好，公司持續看到良好的投資機會。

These fundamentals represent a good starting point as we enter 2025.

這些基本面代表我們邁入 2025 年的一個好起點。

Our teams have done a fantastic job in remediating a number of facilities in North Carolina, Georgia, and (technical difficulty) that were impacted by the two major hurricanes we experienced a few months ago.

我們的團隊在修復北卡羅來納州、喬治亞州和（技術難題）的數個設施方面做得非常出色，這些設施在幾個月前遭遇了兩次大颶風，受到了影響。

All of these facilities, including Mission Hospital in Nashville where the community's recovery efforts continue and Largo Hospital in our West Florida Division, resumed normal operations in the quarter.

所有這些設施，包括繼續進行社區恢復工作的納許維爾 Mission 醫院和西佛羅裡達分部的 Largo 醫院，都在本季度恢復了正常運作。

As we end 2024, the first half of this decade has been another period of long-term growth for the company.

隨著 2024 年的結束，本世紀前半葉將是該公司另一個長期成長時期。

We've seen operational improvements across key performance indicators, and we have delivered increased value for our shareholders.

我們看到關鍵績效指標的營運狀況有所改善，並且我們為股東帶來了更高的價值。

These accomplishments position us well for the future.

這些成就為我們的未來奠定了良好的基礎。

I'm grateful to our colleagues who made this happen.

我非常感謝讓這成為現實的同事。

We believe the HCA way of combining our high-quality local health networks with the capabilities of a national system consistently produces better patient outcomes, drives greater innovation and efficiency, and yields stronger financial results.

我們相信，HCA 將我們高品質的本地醫療網絡與國家系統的能力相結合的方式能夠持續產生更好的患者治療效果、推動更大的創新和效率並產生更強勁的財務業績。

While gratified with these accomplishments, we will maintain our pursuit to improve outcomes further for our stakeholders.

在對這些成就感到滿意的同時，我們將繼續努力，進一步為利害關係人帶來更好的成果。

We believe the strength of our cash flow and balance sheet position position us well for investing further in our networks to increase access, expand capacity, and enhance clinical capabilities.

我們相信，強勁的現金流和資產負債表狀況使我們能夠進一步投資於我們的網絡，以增加訪問量、擴大容量並增強臨床能力。

They also allow significant investments in our people to improve training while also creating career growth at our company.

他們也對我們的員工進行了大量投資，以改善培訓，同時也為我們公司創造了職涯發展空間。

And finally, the financial strength creates opportunities to deliver value to our shareholders by effectively allocating capital to generate favorable returns.

最後，透過有效分配資本以產生豐厚的回報，財務實力為我們的股東創造了價值的機會。

Diluted earnings per share as adjusted increased 5.4% in the fourth quarter as compared to the prior year.

第四季調整後每股攤薄收益較上年同期成長 5.4%。

These results included the effects of the two major hurricanes in the quarter.

這些結果包括了本季兩次大颶風的影響。

We estimate the financial impact from increased costs and lost revenue equated to approximately $0.60 per share.

我們估計成本增加和收入損失造成的財務影響約為每股 0.60 美元。

This was in line with the estimation we provided on our previous earnings call.

這與我們上次在收益電話會議上提供的估計一致。

Revenue growth was approximately 6%.

收入增長約6%。

Demand, payer mix, and acuity continue to be strong across most service categories and markets.

大多數服務類別和市場的需求、付款人組合和敏銳度持續保持強勁。

On a same facility basis, inpatient admissions and equivalent admissions grew 3%.

以同一醫療機構計算，住院入院人數和同等入院人數增加了 3%。

Emergency room visits increased 2.4%.

急診室就診人數增加了2.4%。

Inpatient surgeries were up 2.8%.

住院手術量增加了2.8%。

Outpatient surgery cases, while down 1.3%, again due to the strong payer mix and service mix, we had solid revenue growth in this service line.

門診手術病例雖然下降了 1.3%，但同樣由於強大的付款人組合和服務組合，我們在該服務線上的收入實現了穩健的增長。

And lastly, rehab, obstetrics, and cardiac procedure volumes continued to be strong.

最後，復健、產科和心臟手術量持續保持強勁。

Operating costs were well managed teams and remained in line with our expectations.

營運成本由團隊管理良好並符合我們的預期。

Before I close, you will see that our earnings guidance for 2025 aligns with the preliminary outlook we provided on our prior call.

在我結束之前，您會看到我們對 2025 年的獲利預測與我們在上次電話會議上提供的初步展望一致。

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

說完這些，我將把電話轉給麥克，詢問詳細資訊。

Thank you, Sam, and good morning, everyone.

謝謝你，山姆，大家早安。

I will provide additional comments on the quarter and year, and then discuss our 2025 guidance.

我將對本季度和年度提供更多評論，然後討論我們的 2025 年指引。

Regarding the fourth quarter, we are pleased with results of the quarter which demonstrates the excellence of our teams in responding to challenges and still producing solid results.

關於第四季度，我們對本季度的業績感到滿意，這表明我們的團隊在應對挑戰方面表現出色，並且仍然取得了穩健的業績。

As Sam noted, we estimate that the adverse hurricane impact in fourth quarter 2024 was approximately $200 million, or $0.60 per diluted shares, in line with our expectations.

正如 Sam 所說，我們估計 2024 年第四季的不利颶風影響約為 2 億美元，或每股攤薄收益 0.60 美元，符合我們的預期。

These estimates do not include any insurance recoveries the company may receive in the future.

這些估計不包括該公司未來可能收到的任何保險賠償。

Considering the hurricane impact, we had good top-line growth.

考慮到颶風的影響，我們的營業額仍然成長良好。

Sam reviewed the volume information for the quarter.

薩姆審查了該季度的數量資訊。

Our volume in the quarter was adversely impacted by both the hurricane impact and a depressed respiratory season compared to the fourth quarter of 2023.

與 2023 年第四季相比，本季的銷售量受到颶風影響和呼吸季節低迷的不利影響。

Same facility net revenue per equivalent admissions increased 2.9% over prior year, in line with our expectations.

同一設施每票等量入場淨收入比上年增長了 2.9%，符合我們的預期。

Consistent with our [transition] year, payer mix remains strong in the fourth quarter of 2024 with same facility managed care admissions up 9.2% compared to the prior year quarter.

與我們的[過渡]年一致，2024 年第四季的付款人組合依然強勁，同一機構管理的醫療入院率與去年同期相比增長了 9.2%。

While our operations performed well in the quarter, adjusted EBITDA margin declined 60 basis points compared to the prior year quarter.

儘管本季我們的營運表現良好，但調整後的 EBITDA 利潤率與去年同期相比下降了 60 個基點。

This decline is primarily related to the impact of the hurricanes on our Largo Hospital in Tampa and the North Carolina division, which had a 100-basis-point unfavorable impact on adjusted EBITDA margin in the quarter.

這一下降主要與颶風對我們位於坦帕的拉戈醫院和北卡羅來納州分部的影響有關，這對本季度的調整後 EBITDA 利潤率產生了 100 個基點的不利影響。

Additional expenses related to these hurricanes, including repair costs for our Largo Hospital, drove the increase in other operating expenses as a percentage of revenue and half of the supply increase.

與這些颶風相關的額外費用，包括我們拉哥醫院的修復費用，導致其他營運費用佔收入的百分比增加，並佔供應量增加的一半。

Adjusted EBITDA in the quarter grew to 2.6% compared to the prior year quarter, which reflects the impact of the hurricanes.

本季調整後 EBITDA 與去年同期相比成長 2.6%，反映了颶風的影響。

Diluted earnings per share as adjusted in the fourth quarter grew 5.4% over the prior year quarter, also reflecting the impact of the hurricanes.

第四季經調整的每股攤薄收益較去年同期成長 5.4%，也反映了颶風的影響。

Let me briefly highlight our full-year results for 2024.

讓我簡要介紹一下我們 2024 年的全年業績。

We had strong top-line growth of 8.7%, with revenue per equivalent admission of 3.2% and equivalent admissions growing 4.5%.

我們的營業額實現了 8.7% 的強勁增長，其中每張等效門票收入增長 3.2%，等效門票數量增長 4.5%。

We posted a 10-basis-point improvement in adjusted EBITDA margin for the year.

我們今年的調整後 EBITDA 利潤率提高了 10 個基點。

Adjusted EBITDA increased 9% over prior year, and diluted earnings per share increased 15.5% over the prior year.

調整後 EBITDA 較上年成長 9%，每股稀釋收益較上年成長 15.5%。

We estimate that the lost revenue and additional expenses from the hurricanes adversely impacted full year 2024 about $250 million or $0.73 per diluted share.

我們估計，颶風造成的收入損失和額外費用對 2024 年全年產生了約 2.5 億美元的不利影響，或每股攤薄收益 0.73 美元。

Our full-year incremental net benefit from supplemental payment programs was approximately $400 million, with fourth quarter being the lowest incremental net benefit of the year.

我們全年從補充支付計劃中獲得的增量淨收益約為 4 億美元，其中第四季度是全年增量淨收益最低的季度。

This is an increase from the $100 million to $200 million incremental net benefit we expected largely due to one-time payments and a higher-than-expected program payments in a few states.

這比我們預期的 1 億美元至 2 億美元的增量淨收益有所增加，這主要歸功於一次性付款和一些州高於預期的計劃付款。

When we consider the $250 million unfavorable hurricane impact, the prior year $145 million payers development, and the incremental net Medicaid supplemental programs benefit in the year, we are very pleased with the core operating performance of the company in 2024.

當我們考慮到 2.5 億美元的不利颶風影響、去年 1.45 億美元的付款人發展以及當年增量的醫療補助補充計劃淨收益時，我們對該公司 2024 年的核心運營業績非常滿意。

Moving to capital allocation.

轉向資本配置。

We continue to deploy a balanced strategy of allocating capital for long-term value creation.

我們繼續部署平衡的資本配置策略，以創造長期價值。

Cash flow from operations was $2.6 billion in the quarter and $10.5 billion for the year.

本季經營現金流為 26 億美元，全年營運現金流為 105 億美元。

This represents an 11% increase in operating cash flow in 2024 over prior year, indicative of great work by our operating and administrative teams.

這意味著 2024 年的營運現金流較前一年增加 11%，顯示我們的營運和管理團隊表現出色。

Capital expenditures totaled $1.29 billion in the quarter and $4.9 billion in the year.

本季資本支出總計 12.9 億美元，全年資本支出總計 49 億美元。

And we paid $1.7 billion for repurchases of our outstanding shares during the quarter and $6 billion in the year.

我們在本季支付了 17 億美元回購流通股，全年支付了 60 億美元。

We paid a $165 million in dividends for the quarter and $609 million for the year.

我們本季支付了 1.65 億美元的股息，全年支付了 6.09 億美元的股息。

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.

我們的債務與調整後 EBITDA 槓桿率仍處於我們所述指導範圍的低端，我們相信，從資產負債表的角度來看，我們處於有利地位。

As a result, we are lowering our targeted leverage ratio from our current 3 to 4 times to 2.75 to 3.75 times.

因此，我們將目標槓桿率從目前的 3 到 4 倍降低到 2.75 到 3.75 倍。

We believe this new range fits our profile and our anticipated use of leverage as a company, assuming no significant transactions or extraordinary events.

我們相信，新的範圍符合我們的狀況以及我們作為一家公司的預期槓桿使用情況（假設沒有重大交易或異常事件）。

So with that, let me speak to our 2025 guidance for a moment.

因此，請容許我稍微談談我們的 2025 年指引。

As noted in our guidance this morning, we are providing full-year 2025 guidance as follows.

正如我們今天早上的指引中所述，我們提供的 2025 年全年指引如下。

We expect revenues to range between $72.8 billion and $75.8 billion.

我們預計營收在 728 億美元至 758 億美元之間。

We expect net income attributable to HCA Healthcare to range between $5.85 billion and $6.29 billion.

我們預計HCA Healthcare的淨收入在58.5億美元至62.9億美元之間。

We expect adjusted EBITDA to range between $14.3 billion and $15.1 billion.

我們預計調整後的 EBITDA 在 143 億美元至 151 億美元之間。

We expect our diluted earnings per share to range between $24.05 and $25.85. We expect capital spending to be approximately $5 billion to $5.2 billion.

我們預計每股攤薄收益將在 24.05 美元至 25.85 美元之間。我們預計資本支出約為 50 億至 52 億美元。

Our guidance assumes a growth and equivalent admissions between 3% and 4% and net revenue per equivalent admission between 2% and 3%.

我們的指導假設是成長率和等效門票數量在 3% 到 4% 之間，每等效門票淨收入在 2% 到 3% 之間。

Regarding the effects of the 2024 hurricanes on our earnings guidance for 2025, we expect a year-over-year increase in adjusted EBITDA from the reopening at Largo and a year-over-year decline in the North Carolina division as our current assumptions in this market will have lingering effects of Hurricane Helene throughout much of 2025.

關於 2024 年颶風對我們 2025 年盈利預測的影響，我們預計拉哥工廠重新開業後調整後的 EBITDA 將同比增長，而北卡羅來納州分部的 EBITDA 將同比下降，因為我們目前的假設是2025 年的在大部分時間裡，市場都會受到颶風海倫的持續影響。

The increase in Largo and the decline in North Carolina are expected to offset and are not expected to produce a tailwind for us in 2025.

拉哥的增長和北卡羅來納州的下降預計將互相抵消，並且預計不會在 2025 年為我們帶來順風。

Regarding Medicaid supplemental payment programs, as we've said in the past, these programs are complex, variable in timing, and do not fully cover our costs to treatment to patients.

關於醫療補助補充支付計劃，正如我們過去所說的，這些計劃非常複雜，時間不穩定，並且不能完全支付患者治療的費用。

Based on current assumptions, when we aggregate the impact of all of our supplemental payment programs, our guidance contemplate the net effect of Medicaid supplemental payment programs to range from being flat to 2024 to a $250 million headwind driven by one-time payments received in a few states in 2024.

根據目前的假設，當我們匯總所有補充支付計劃的影響時，我們的指導方針認為醫療補助補充支付計劃的淨效應範圍從到 2024 年持平，到 2.5 億美元的逆風，由一次性支付推動2024 年將有少數州加入。

The new Tennessee program is considered in this range.

田納西州的新計劃被認為屬於這個範圍。

We expect full-year margins to be consistent with 2024 and cash flow from operations to range from $10.75 billion to $11.25 billion.

我們預計全年利潤率與 2024 年保持一致，營運現金流將在 107.5 億美元至 112.5 億美元之間。

As noted in our release this morning, our Board of Directors has authorized a new $10 billion share repurchase program, and we anticipate completing a significant portion in 2025, subject to market conditions and other factors.

正如我們今天早上發布的新聞稿中所述，我們的董事會已經批准了一項新的100 億美元股票回購計劃，我們預計將在2025 年完成其中很大一部分，但要視市場情況和其他因素而定。

In addition, our Board declared an increase in our quarterly dividend from $0.66 to $0.72 per share.

此外，董事會宣布將季度股息從每股 0.66 美元增加至 0.72 美元。

And with that, I will turn the call over to Frank for questions.

說完這些，我將把電話轉給弗蘭克來回答問題。

Thank you, Mike.

謝謝你，麥克。

(Event Instructions) Janine, you may now give instructions for those who like to ask a question.

（活動說明）Janine，現在您可以為那些想提問的人提供說明。

Thank you.

謝謝。

Ladies and gentlemen, we will now begin the question-and-answer question.

女士們、先生們，我們現在開始問答環節。

(Operator Instructions) Pito Chickering, Deutsche Bank.

（操作員指示） 德意志銀行 Pito Chickering。

Hey.

嘿。

Good morning, guys, and thanks for taking my questions.

大家早安，謝謝你們回答我的問題。

This question will be on Medicaid supplemental.

此問題與醫療補助補充有關。

I just want to understand a little bit on where we were in -- for 2024, it has been bouncing around a little bit.

我只是想稍微了解一下我們所處的情況——對於 2024 年來說，它一直在一點波動。

From third quarter to fourth quarter, did that number change?

從第三季到第四季，這個數字有變化嗎？

Was that $400 million that you came in on the year?

今年的收入是 4 億美元嗎？

I guess, you bridge where you were on the last time you guided us into where it is now.

我想，您把上次引導我們到達的地方與現在的地方連結起來了。

And then for 2005 (sic - 2025), can you just make sure that we bridge where we are in 2004, 2005 (sic -2024, 2025) on what's in the low end and high end of guidance for Medicaid payments?

然後對於 2005 年（原文如此 - 2025 年），您能否確保我們在 2004 年、2005 年（原文如此 - 2024 年、2025 年）的醫療補助支付指導低端和高端之間取得平衡？

Thank you.

謝謝。

Hey, Pito.

嘿，皮托。

This is Mike.

這是麥克。

Yeah.

是的。

So if you think about the net incremental benefit from our supplemental payment programs, for the full year 2024, it's about $400 million.

因此，如果您考慮我們的補充支付計劃帶來的淨增量收益，那麼到 2024 年全年，該收益約為 4 億美元。

As I noted in my comments, fourth quarter was the lowest incremental net benefit of the four quarters in the year.

正如我在評論中指出的那樣，第四季度是今年四個季度中增量淨收益最低的季度。

You may recall from our second quarter that the second quarter of '24 was the highest benefit at $125 million.

您可能還記得，24 年第二季的收益最高，為 1.25 億美元。

And so that's how it's spread out.

這就是它傳播的方式。

The driver was really largely related to one-time payments that came in in a few states and a couple of our state programs that came in a little more favorably than we expected.

其推動因素實際上很大程度上與幾個州的一次性付款以及我們幾個州的計劃有關，這些計劃的成效比我們預期的要好一些。

So that's where we landed.

這就是我們的著陸地點。

And then as you start thinking about 2025, as I noted in my guidance, when we consider all the various programs, noting the complexity and the variability and the moving parts, we are projecting and estimating that our net effect of supplemental payment programs will range between flat to 2024 to upwards of a $250 million headwind.

然後，當你開始思考 2025 年時，正如我在指導中指出的那樣，當我們考慮所有不同的計劃時，注意到複雜性、多變性和移動部分，我們預測和估計補充支付計劃的淨效應將到2024 年將保持平穩，但逆風可能超過2.5 億美元。

That is inclusive of a pretty wide range of estimation related to the new Tennessee program.

其中包括與田納西州新計劃相關的相當廣泛的估計。

So that's how it went through the year, and that's the basis of our projections for '25.

這就是這一年的情況，也是我們對 25 年預測的基礎。

So Mike, actually, just all -- I guess, for 2024, are you saying it's $400 million?

所以麥克，實際上，只是全部 - 我猜，對於 2024 年，你是說它是 4 億美元嗎？

The highest in 2Q is $125 million, and lowest in 4Q.

其中，第二季最高，為1.25億美元，第四季最低。

I guess, can you just actually give us just a quarterly benefit because $400 million with 2Q $125 million, seems it's not that high versus the rest of the quarter?

我想，您能否實際上只給我們一個季度收益，因為 4 億美元加上第二季的 1.25 億美元，似乎與本季的其他部分相比並不高？

So any color on sort of how that flows through the whole year?

那麼，您能具體了解一下全年的流程嗎？

Well, I mean, I think you can take Q2, Pito, at $125 million as the high watermark.

嗯，我的意思是，我認為你可以將 Q2、Pito 的 1.25 億美元作為最高水位。

And then obviously, first and third quarter would be a little bit higher, and the fourth quarter will be the lowest.

顯然，第一季和第三季會略高一些，而第四季會最低。

I mean, that's the best I can give you in terms of the flow through the year.

我的意思是，就全年流量而言，這是我能給你的最好的資訊。

Great.

偉大的。

Thanks so much.

非常感謝。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

Hi, everybody.

大家好。

It sounds like the MA -- or managed care, rather, same-store admissions were strong.

聽起來，MA 或管理式醫療，更確切地說，同店入院率很高。

I wonder, because there was so much publicity in the quarter around MCOs, did you -- where are you at in your pricing for '25, '26?

我想知道，由於本季度圍繞 MCO 的宣傳非常多，您對 '25、'26 年的定價如何？

Anything new or different you're seeing in terms of utilization review, denial rates, anything along those lines?

就利用率審查、拒絕率等方面而言，您看到什麼新的或不同的情況嗎？

So hi, A.J. This is Mike.

你好，A.J。這是麥克。

In terms of our contracting, we are 80% contracted for '25, 60% contracted for '26, and I think it's 20% contracted for '27.

就我們的合約而言，25 年的合約簽訂率為 80%，26 年的合約簽訂率為 60%，而我認為 27 年的合約簽訂率為 20%。

We're still in -- on top of our range estimates, our targets, in terms of pricing.

就定價而言，我們仍然處於我們的範圍估計和目標之上。

As I think about denials and underpayments, clearly, a lot of activity.

當我想到拒絕和少付時，顯然有很多活動。

But we put a lot of effort over the last couple of two or three years in really beefing up our capabilities, managing through the denial and underpayment process.

但在過去幾年裡，我們付出了很多努力來真正增強我們的能力，管理拒絕和少付款的過程。

I would say when we think about not only fourth quarter, but the full year of '24, we are not seeing growth in denials being a material impact for the company at this point.

我想說的是，當我們考慮不僅第四季度而且 24 年全年時，我們目前還沒有看到拒絕數量的增長對公司產生重大影響。

Okay.

好的。

Thanks.

謝謝。

Whit Mayo, Leerink Partners.

惠特·梅奧（Whit Mayo），Leerink Partners 合夥人。

Hey, thanks.

嘿，謝謝。

Good morning.

早安.

I just wanted to hear maybe some of the internal initiatives that may be moving to the forefront this year.

我只是想聽聽今年可能成為焦點的一些內部舉措。

I feel like you guys have been talking a lot about throughput, ER optimization for a while, case mix, length of stay, all that.

我覺得你們已經談論了很多關於吞吐量、急診室優化、病例組合、住院時間等等的問題。

Anything on the back end with discharge management?

後端有任何與出院管理有關的事嗎？

Anything around length of stay and bottlenecks that you might be seeing around post-acute?

您可能遇到過與住院時間和急性後期相關的瓶頸問題嗎？

Thanks.

謝謝。

So yeah, case management, inpatient throughput has been a really strong initiative for us over the last couple of years with -- we even mentioned it in the Investor Day conference last year.

是的，個案管理、住院病人吞吐量在過去幾年裡一直是我們非常重視的舉措——我們甚至在去年的投資者日會議上提到了這一點。

And our work continues and continues to strengthen.

我們的工作仍在繼續，並不斷加強。

Specifically, when I think about the going forward into 2025, we have a number of initiatives within our case management infrastructure focused on improving the post-acute care placement and discharge process.

具體來說，當我想到 2025 年時，我們在個案管理基礎設施中採取了多項舉措，重點是改善急性後期照護安置和出院流程。

And I might say even especially with our Medicare Advantage payers.

我什至可能會說，尤其是對於我們的醫療保險優勢計劃的支付者來說。

And that work continues, and it's important.

這項工作仍在繼續，而且非常重要。

But if I take stock of where we are today, our length of stay performance in the year has been solid.

但如果我評估我們目前的狀況，那麼我們今年的駐村時間表現是穩健的。

And we're forecasting another good year for length of stay management as we head into 2025.

我們預測，2025 年將是住院時長管理另一個豐收年。

Yeah, let me add to that, Mike.

是的，麥克，讓我補充一點。

So I mean, we have a number of initiatives that are progressing across the company.

所以我的意思是，我們公司上下正在推動多項措施。

And when you think about our network development initiatives, we continue to add facilities.

當您考慮我們的網路發展計劃時，我們會繼續增加設施。

You'll see that we've got more facilities at the end of this year than we did last year.

您會發現，今年年底我們擁有的設施比去年更多。

So our capital, as well as some incremental acquisitions and some key markets, is allowing us to expand the reach of our networks.

因此，我們的資本以及一些增量收購和一些關鍵市場使我們能夠擴大網路覆蓋範圍。

That's showcasing itself in growing market share.

這體現在市場佔有率的不斷增長。

What we're seeing in our market share data is really encouraging and lends itself to continued opportunities in that particular initiative.

我們在市場份額數據中看到的情況確實令人鼓舞，並有助於該特定計劃繼續帶來機會。

In addition to the case management operational initiative that Mike was talking about, we've had tremendous success with our emergency room operational improvement plan as well.

除了麥克談到的個案管理營運計畫之外，我們的急診室營運改善計畫也取得了巨大成功。

And that's yielded throughput improvements, patient satisfaction improvements, and growth, allowing us again to extend the reach of that channel and meet the needs of the community in an effective way.

這帶來了吞吐量的提高、患者滿意度的提高和成長，使我們能夠再次擴大該管道的覆蓋範圍並以有效的方式滿足社區的需求。

And again, as we push into 2025, we'll see more emergency room bed supply inside of our networks as a result of the investments that we're making, and then the ability to use those beds productively with our ER revitalization program.

而且，隨著我們進入 2025 年，由於我們的投資，我們將看到我們網路內急診室床位的供應量增加，並且能夠透過我們的急診室振興計畫有效利用這些床位。

We're carrying the elements of success from that program to our operating rooms.

我們正在將該專案的成功要素帶入我們的手術室。

We have an operating room optimization initiative that we think is going to be very beneficial to our surgeons and also our patients.

我們有一個手術室優化計劃，我們認為這將對我們的外科醫生和患者非常有益。

And it mirrors a lot of the efforts and the progress we've seen with our emergency room.

它反映了我們在急診室所做的許多努力和取得的進展。

And this involves turnaround time, staffing, other elements of OR efficiency that's important to our physician partners as well as our patients.

這涉及週轉時間、人員配備以及手術室效率的其他要素，這些對我們的醫生合作夥伴和患者都很重要。

And then finally, I will say that our labor agenda continues to improve.

最後，我想說的是，我們的勞工議程不斷改善。

This past year, I'm really proud of our accomplishments as a company.

過去的一年，我為我們公司所取得的成就感到無比自豪。

Our employee engagement broadly, across all colleagues and especially inside of nursing, is at an all-time high for the company.

我們全體同事、尤其是護理部門員工的參與度達到了公司歷史最高水準。

That has allowed us to reduce turnover and really improve the capabilities of our facilities with having continuity in staffing, a more competent workforce, and the necessary capacity to really meet the demand.

這使我們能夠減少人員流動，並真正提高我們設施的能力，保持人員配置的連續性、勞動力素質更高以及真正滿足需求的必要能力。

So we have a number of what I call winning plays that are beneficial to the organization, responsive to the communities, and really position our company for success.

因此，我們有許多我稱之為成功的做法，這些做法對組織有益、對社區有回應，並且真正為我們公司的成功奠定了基礎。

As we push forward, we've talked about our longer-term initiatives.

在我們向前推進的過程中，我們討論了我們的長期計劃。

Our longer-term initiatives are geared toward technology and using technology.

我們的長期計劃是面向技術和使用技術的。

We're on our journey.

我們正在旅途中。

We're already seeing early signs of success with how AI can improve aspects of our organization administratively, operationally inside of our facilities, and we think clinically as well.

我們已經看到了成功的早期跡象，即人工智慧可以在行政、設施內部運作以及臨床思考方面改善我們組織的方方面面。

So that's a very exciting agenda.

這是一個非常令人興奮的議程。

And I know others speak of AI.

我也知道其他人也在談論人工智慧。

But within the processes that exists for us as a healthcare provider, we see a lot of potential to drive better quality, greater efficiencies, and even better management of our business.

但是，作為醫療保健提供者，我們在現有的流程中看到了許多潛力，可以提高品質、提高效率，甚至改善業務管理。

And so those things continue.

這些事情就這樣繼續下去了。

I think our capital allocation is another important initiative for the company.

我認為我們的資本配置是公司另一項重要舉措。

We're investing heavily back in the business.

我們正在對該業務進行大量投資。

We'll invest somewhere between $5 billion and $5.2 billion this year.

我們今年將投資 50 億至 52 億美元。

And then we've got the ability to use the cash flow and our balance sheet to deliver even more value through shareholder programs that Mike alluded to earlier.

然後，我們就有能力利用現金流和資產負債表，透過麥克之前提到的股東計畫提供更多價值。

So all of these combine, we believe, to create value, value for our patients, value for our employees, and value for our shareholders.

因此，我們相信，所有這些結合起來將創造價值，為我們的患者創造價值，為我們的員工創造價值，為我們的股東創造價值。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Great.

偉大的。

Thank you very much.

非常感謝。

After another strong year of state exchange enrollment growth, just wanted to get your thoughts on how you see commercial mix progressing and how enrollment fared for you guys.

在州際交易所入學人數又經歷了強勁增長的一年之後，我只是想聽聽您對商業組合進展的看法，以及你們的入學情況。

In your opinion, how it's going to impact Florida and Texas?

您認為這將對佛羅裡達州和德克薩斯州產生什麼影響？

And then any thoughts broadly on the fate of the enhanced subsidies under the new administration and any efforts you've made with lobbyists or whatever in that regard?

那麼，您對新政府加強補貼的命運有何看法？

Thank you.

謝謝。

All right.

好的。

Thanks, Ben.

謝謝，本。

Clearly, the enrollments inside the exchanges continue to strengthen.

顯然，交易所內部的註冊人數持續增加。

We think it's somewhere around [25 million] at this particular juncture, so it's up 12% to 15%, I think, over '24.

我們認為，目前這個數字大約在 [2,500 萬] 左右，所以我認為，比 24 年增長了 12% 到 15%。

And we're seeing consistent growth across a number of HCA states.

我們看到許多 HCA 州都出現了持續的成長。

So that's a positive, we believe.

因此我們相信這是一件正面的事情。

It's a positive outcome for families.

這對家庭來說是一個正面的結果。

It creates greater access to care.

它創造了更多獲得護理的機會。

It improves outcomes.

它能改善結果。

So all of that as a backdrop, we think, politically, is a positive and presents an opportunity for the Trump administration, we believe, to sustain and ensure that families have coverage, they have affordability, and they have the opportunity to achieve positive outcomes for their -- for themselves and really for their family.

因此，我們認為，從政治角度來看，所有這些都是積極的，並為川普政府提供了一個機會，我們相信，這將維持並確保家庭獲得保障，負擔得起，並有機會實現積極的結果為了他們自己，也為了他們的家人。

So we don't have any current insights into where this is going.

所以我們目前還不清楚事情會如何發展。

All we know at this particular juncture is that they are due to expire at the end of next year.

目前我們所知的是，這些協議將於明年年底到期。

We think the backdrop of growth, the backdrop of satisfaction within the enrollment is a positive.

我們認為成長的背景、入學滿意度的背景是正面的。

And we see opportunities to work with the Trump administration to find a pathway forward to continue what's been a very positive community benefit, we believe, with the exchanges.

我們看到了與川普政府合作的機會，找到了一條前進的道路，繼續透過交流為社區帶來非常積極的利益。

We have a very robust agenda to partner with other organizations, to work within our coalition to support advocacy here to achieve the outcome that we think makes sense for the different communities that we serve.

我們有一個非常強大的議程，與其他組織合作，在我們的聯盟內工作，支持這裡的倡導，以實現我們認為對我們所服務的不同社區有意義的結果。

So it's too early for us to call anything on that, but we are active in the process as you would expect.

因此，現在我們對此做出任何評論還為時過早，但正如您所期望的那樣，我們正在積極參與這一進程。

And Ben, in terms of your question about payer mix and where it landed, healthcare exchanges now represents 7.5% of our equivalent admissions in 2024 and about 9% of our revenues.

本，關於你關於付款人結構及其影響的問題，醫療保健交易所目前占我們 2024 年等效入院人數的 7.5% 和我們收入的 9% 左右。

Thank you very much.

非常感謝。

Thank you.

謝謝。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

Great.

偉大的。

Thank you.

謝謝。

I just want to ask about the Medicare two-midnight rule.

我只是想問一下有關醫療保險兩夜規則的問題。

How much impact do you think that had on inpatient emissions in 2024?

您認為這對 2024 年的住院病患排放量有多大影響？

And do you think it will continue to be a benefit?

您認為它會繼續帶來好處嗎？

I think in the last earnings call, you gave a stat that detailed the difference between Medicare Advantage observation versus traditional Medicare fee for service.

我認為在上次財報電話會議上，您給出了一個統計數據，詳細說明了 Medicare Advantage 觀察與傳統 Medicare 服務費之間的差異。

Can you remind us of what that stat is?

您能提醒我們一下該統計數據是什麼嗎？

And do you think over time, you can close that gap?

您認為隨著時間的推移，這一差距能夠縮小嗎？

That would be great.

那太棒了。

Thank you.

謝謝。

Hey.

嘿。

This is Mike.

這是麥克。

So in terms of the impact, if I look at the movement from observation to inpatient status, consistent with the Medicare Advantage two-midnight rule, for the full year 2024, we estimate that it was equivalent to approximately 50 basis points of our overall admission growth.

因此，就影響而言，如果我觀察到從觀察到住院狀態的轉變，與醫療保險優勢計劃的午夜兩點規則一致，對於2024 年全年而言，我們估計這相當於我們整體入院率的約50個基點生長。

I would say that that's remained pretty consistent over the four quarters.

我想說的是，這一狀況在四個季度中保持相當穩定。

So I don't think that it's going to be -- you'll see much more movement as you go into 2025.

所以我不認為會出現這種情況——到 2025 年，你會看到更多的變化。

As to the comparison of Medicare Advantage observation mix to traditional, I would note that the Medicare Advantage observation as a percentage of total to opt-in is approximately 20% higher than traditional Medicare.

至於醫療保險優勢計劃觀察組合與傳統醫療保險的比較，我要指出的是，醫療保險優勢計劃觀察佔選擇加入總額的百分比比傳統醫療保險高出約 20%。

But I don't suspect at this rate that we're going to see material changes.

但我並不認為以這個速度我們將會看到實質的改變。

At this point, we're really focused on collecting on that revenue and working through the denial and appeal processes associated with the Medicare Advantage program.

目前，我們真正專注於收取這些收入，並完成與醫療保險優勢計劃相關的拒絕和上訴程序。

I don't think you'll see a material change in the volume trends that we've seen so far this year as we head to '25.

當我們邁向25年時，我認為你不會看到我們今年迄今為止看到的銷售趨勢發生重大變化。

Thank you.

謝謝。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning.

嗨，早安。

Hoping you could spike out the performance of Mission Hospital in the quarter and help us understand what impacts that had on same-store volumes in the quarter and the pace of recovery throughout 2025, including any explicit EBITDA functions around hurricane in the guidance.

希望您能在本季度提高 Mission Hospital 的業績，並幫助我們了解這對本季度同店銷量以及 2025 年全年復甦速度的影響，包括指導中任何明確的有關颶風的 EBITDA 功能。

Thanks.

謝謝。

Let me just talk about volumes overall, Andrew, as we think about fourth quarter.

安德魯，讓我們談談第四季度的整體銷售。

With 3% same-facility admission and equivalent admission growth to prior year in the quarter, first thing I might mention is it was a little bit of a tougher comparison to fourth quarter of '23, which had strong growth.

本季同設施入場人數和與去年同期相當的入場人數增長率為 3%，我首先要說的是，與 23 年第四季的強勁增長相比，這是一個有點難以比較的成績。

We did experience, I mentioned this overall -- and again I'm speaking overall, not just related to North Carolina division.

我們確實經歷過，我總體上提到了這一點——我再次提到了總體，而不僅僅與北卡羅來納分部有關。

But overall, we did experience a depressed respiratory season in fourth quarter of '24 compared to fourth quarter of '23.

但總體而言，與 2023 年第四季相比，2024 年第四季我們確實經歷了呼吸系統疾病的低迷季節。

Our estimate is that this depressed respiratory season had about a 1-point drag on same-facility admission growth to prior year and about a 2-point drag on same-facility emergency room visits growth to prior year.

我們估計，這個呼吸道疾病低迷季節導致同一機構的入院人數增長與去年相比下降了約 1 個百分點，導致同一機構的急診室就診人數增長與去年相比下降了約 2 個百分點。

Overall, as a company, the hurricanes as well had an impact on volume growth primarily in October but for the whole quarter.

整體而言，對一家公司而言，颶風也對銷售成長產生了影響，主要是十月的影響，但影響範圍卻擴大到了整個季度。

Our estimates are somewhere between 20 and 40 basis points of drag on volume in the quarter related to hurricanes, and that's directly attributable.

我們估計，本季颶風將對交易量造成 20 到 40 個基點的拖累，這是直接原因。

I'd also mentioned that in the month of October, if you look at the rest of the state of Florida, there was clearly some lingering effects as they recovered.

我還提到，如果你看看十月份佛羅裡達州的其他地區，你會發現，在他們復甦的過程中，明顯出現了一些揮之不去的影響。

And then we saw a good recovery in November and December.

然後我們在十一月和十二月看到了良好的復甦。

So that's a tale of the tape on volume in the quarter.

這就是本季成交量的情況。

And was there any explicit EBITDA assumption for hurricanes in the guidance?

該指引中是否有針對颶風的明確 EBITDA 假設？

Yeah.

是的。

So if you go back to my comments, Andrew, the way that we are guiding for hurricane impact into 2025 is this, that if you think about -- let's start with Largo.

所以，安德魯，如果你回顧我的評論，我們對 2025 年颶風影響的指導方式是這樣的，如果你考慮一下——讓我們從拉哥開始。

If you think about Largo Hospital, we do expect a year-over-year increase in adjusted EBITDA from the reopening of Largo and a year-over-year decline in the North Carolina division as our current assumption is this market will have lingering effects of the hurricane throughout much of 2025.

如果你考慮拉哥醫院，我們確實預期拉哥醫院重新開放後調整後的EBITDA 將同比增長，而北卡羅來納分部的EBITDA 將同比下降，因為我們目前的假設是，這個市場將產生揮之不去去的影響。

The guidance really contemplates that the increase at Largo and the decline in North Carolina are expected to offset and are not expected to produce a tailwind for us in 2025.

該指導實際上考慮到，拉哥的增長和北卡羅來納州的下降預計將抵消，並且預計不會在 2025 年為我們帶來順風。

So that's the way to think about the hurricanes and their impact into 2025.

這就是思考颶風及其對 2025 年的影響的方式。

Great.

偉大的。

Thank you.

謝謝。

Thank you.

謝謝。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

Hi.

你好。

Good morning.

早安.

Thank you for taking the question.

感謝您回答這個問題。

So I guess on the -- somewhat related question, I guess, on the cost side of things.

所以我想，關於這個有點相關的問題，我想，是關於成本方面的。

So thanks for the color on the impact from the hurricane in the quarter in Q4 to the other OpEx line.

感謝您介紹第四季颶風對其他 OpEx 線路的影響。

So I want to ask about professional fees.

所以我想問一下專業費用。

You've been talking about this for quite some time.

您已經談論這個問題很長時間了。

But most recently, you highlighted the higher-than-expected professional fees to continue into '25.

但最近，您強調專業費用高於預期的情況將持續到25年。

So can you talk about what you're seeing there?

那麼你能談談你在那裡看到了什麼嗎？

What do you assume in your guidance?

您在指導上有何假設？

We heard maybe radiologists or the next group of doctors that are asking for higher fees.

我們聽說放射科醫生或下一批醫生可能會要求更高的費用。

So is that what you're seeing?

那麼這就是您所看到的嗎？

And also, can you help us maybe also size that line in your other OpEx line?

另外，您能否協助我們在其他 OpEx 線路中確定該線路的尺寸？

Thank you.

謝謝。

So professional fees are about 24% of other operating expenses.

因此專業費用約佔其他營運費用的24％。

So that's how you would size it.

這就是您確定其大小的方法。

As we've mentioned in the last several calls, our operating teams have continued to work diligently to address the subsidy pressure from the hospital-based physician group component of our business.

正如我們在最近幾次電話會議中提到的那樣，我們的營運團隊一直在努力解決來自我們業務的醫院醫生團體部分的補貼壓力。

And as we've noted, as we've gone through the year, we have bent the cost curve on professional fees as we've moved through '24 really due to these efforts.

正如我們所注意到的，隨著時間的流逝，我們已經透過這些努力扭轉了專業費用的成本曲線，並在 2024 年取得了進展。

So as I think about the guidance into 2025, I would say it like this.

因此，當我思考 2025 年的指導時，我會這麼說。

We expect the cost pressures related to physician costs to moderate a bit further in '25.

我們預計與醫師成本相關的成本壓力將在25年進一步緩解。

But it's still going to be higher than just normal inflationary cost trends.

但它仍將高於正常的通膨成本趨勢。

And that's how you would think about that flow into the next year.

這就是您對明年的流量的看法。

Maybe a double-click on radiology.

也許雙擊放射學。

When you're looking at our hospital-based physician categories, clearly, the emergency room and the hospital medicine segments have moved more fully through the business challenges that we see in this segment, really especially given the significant work HCA has done with the acquisition and integration of Valesco.

當你查看我們基於醫院的醫生類別時，顯然，急診室和醫院醫學部門已經更充分地應對了我們在這一領域看到的業務挑戰，尤其是考慮到 HCA 在收購中所做的重要工作以及Valesco 的整合。

As it relates to radiology, we did see pressure as we've gone through 2024, and we expect that to continue into 2025.

就放射學而言，我們在 2024 年確實看到了壓力，我們預計這種壓力將持續到 2025 年。

But keep in mind that radiology is a much lower portion of our hospital-based physician subsidies.

但請記住，放射科只占我們醫院醫生補助的很低的比例。

I'll just finish with this, is that our teams have focused efforts between both our operating teams and our physician management teams focused on addressing radiology.

最後，我想說的是，我們的團隊已經將精力集中在營運團隊和醫生管理團隊之間，專注於解決放射學問題。

And we do not expect it to be a material impact in '25.

我們預計它不會在25年產生重大影響。

Thank you.

謝謝。

Thank you.

謝謝。

Matthew Gillmor, KeyBanc.

馬修·吉爾摩（Matthew Gillmor），KeyBanc。

Hey, thanks for the question.

嘿，謝謝你的提問。

I wanted to see if there's any commentary on the California wildfires.

我想看看是否有關於加州山火的評論。

And I know you've got a couple of facilities in the LA area.

我知道你們在洛杉磯地區有幾家設施。

But any impact there to call out or is it just not big enough at the consolidated level to make a real difference?

但是，這其中是否存在什麼影響值得關注，或者在綜合層面上是否還不夠大，無法產生真正的影響？

This is Sam.

這是薩姆。

We had no impact at our Southern California hospitals as a result of the fires.

火災並未對我們南加州的醫院造成影響。

We did have one of our facilities in Ventura County on notice, so to speak, in the sense that there was the Kenneth Fire, I think it was, that was in Ventura County.

可以這麼說，我們確實已經通知了文圖拉縣的一家工廠，因為肯尼斯大火發生在文圖拉縣。

The Palisades Fire did not reach through the valley into Ventura County.

帕利塞茲大火併未穿過山谷蔓延至文圖拉縣。

But we're on high alert, and we have fire mitigation tactics in that particular hospital due to its location and so forth.

但我們處於高度警戒狀態，並且由於該醫院的地理位置等原因，我們制定了防火策略。

And we continue to evolve that just like we do with hurricanes and making sure that we can protect our patients and protect our colleagues and protect the asset.

我們會繼續發展這個體系，就像我們在應對颶風一樣，確保我們能夠保護我們的病人、同事和資產。

And we're iterating, if you will, on our plan there to advance it even further.

如果你願意的話，我們正在重複我們的計劃，以進一步推進它。

In Riverside, California, there's been some fires in the proximity that have produced some smoke issues in the community, but no issue whatsoever on our facility there.

在加州里弗賽德市，附近發生了一些火災，導致社區出現一些煙霧問題，但我們在那裡的設施沒有任何問題。

So we're fortunate.

所以我們很幸運。

That's a horrible event, as everybody knows, but we were on the other side of the canyon with our facility in Thousand Oaks.

眾所周知，這是一次可怕的事件，但我們在千橡市的工廠就在峽谷的另一邊。

Got it.

知道了。

Thank you.

謝謝。

Thank you.

謝謝。

Brian Tanquilut, Jefferies.

傑富瑞 (Jefferies) 的 Brian Tanquilut。

Good morning, everyone.

大家早安。

This is Meghan Holtz on for Brian.

梅根霍爾茨 (Meghan Holtz) 為布萊恩 (Brian) 主持節目。

As we think about Q1 EBITDA, are there any moving pieces, including some seasonality or non-recurring items, that we should be considering?

當我們考慮第一季的 EBITDA 時，是否有一些變動因素需要我們考慮，包括一些季節性或非經常性項目？

And then just a quick clarifying question on the supplemental payments.

然後我只想快速澄清一下有關補充付款的問題。

You referred to the new Tennessee program.

您提到了田納西州的新計劃。

Does that mean it was approved recently?

這是否意味著它最近已獲得批准？

Let me handle the second one first.

讓我先處理第二個。

So in the Tennessee program, we have been notified of approval of a partial year.

因此，在田納西州的項目中，我們已收到批准部分年度計劃的通知。

And so we have -- we see an approval that would, in effect, cover July 1 of '24 through December 31 of '24.

所以我們看到，批准實際上涵蓋了 1924 年 7 月 1 日至 12 月 31 日的時間。

And then they are transitioning that to a calendar year program beginning in '25.

然後他們從'25 年開始將其轉變為日曆年計劃。

The 2025 calendar year program, which is new, has not been approved.

新的2025日曆年計劃尚未獲得批准。

And so the new administration will be addressing that.

所以新政府將會解決這個問題。

So that's the status of the new Tennessee program.

這就是田納西州新計畫的現況。

We don't give quarter-by-quarter guidance.

我們不提供逐季度的指引。

So our normal advice is just to follow our historical seasonal trends, and we would stick with that.

因此，我們的正常建議就是遵循歷史季節性趨勢，我們會堅持這一點。

So the '25 guidance is for the full year of 2025.

因此，'25 指導是針對 2025 年全年的。

Thank you.

謝謝。

Thank you.

謝謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

Hi.

你好。

Thanks.

謝謝。

It's Anna on for Justin.

安娜代替賈斯汀上場。

Have you guys attempted to size the potential impact of site neutral payments?

你們是否嘗試過衡量網站上中立支付的潛在影響？

And if so, does that alter your strategy at all surrounding your outpatient ASC footprint?

如果是這樣，這是否會改變您在門診 ASC 佈局方面的策略？

And can you tell us where also the same-store ASC revenue growth was in the quarter?

您能告訴我們本季同店 ASC 營收成長情況如何嗎？

Thanks.

謝謝。

So on site-neutral, let's start with just stating the obvious.

因此，關於網站中立，我們先來陳述一下顯而易見的事。

We're against program implementations that would cut Medicare hospital outpatient reimbursement, nor do we think programmatically that it makes sense to pay the same rate for a hospital.

我們反對實施削減醫療保險醫院門診報銷金額的計劃，也不認為從計劃上對醫院支付相同的費率是合理的。

And I'll use surgery, but you could use all of our service that operates on a 24/7 basis with full capabilities of physicians, of staff, and equipment.

我會使用手術，但你可以使用我們所有的服務，這些服務全天候運營，並配備醫生、工作人員和設備的全部功能。

If you'll compare that, for example, to our surgery centers who generally operate 8 to 4, Monday through Friday, and do much less complex work, the idea of paying the same rate for those does not seem to make a lot of sense to us.

例如，如果你將其與我們的手術中心進行比較，這些中心通常從週一到週五，早上8 點到下午4 點營業，並且所做的工作要簡單得多，那麼為這些中心支付相同的費用似乎沒有多大意義對我們來說。

As it relates to sizing the potential impact, we have not seen a bill yet that would give us enough information to estimate a potential impact.

至於潛在影響的規模，我們還沒有看到任何能為我們提供足夠資訊來估計潛在影響的法案。

In the past, as you've seen various proposals and discussions around this, there's been a range of procedures being considered for Medicare site neutral.

過去，正如您所看到的，圍繞這一問題有各種提案和討論，已經有人考慮採取一系列程序以實現醫療保險站點中立。

On one end of the range would be proposals around hospital-based physician clinic visits and outpatient infusion facilities.

一方面是圍繞醫院醫生門診和門診輸液設施的提案。

At that end of the range, HCA would not be materially impacted, given how we structure our physician clinics.

考慮到我們的醫生診所的結構，HCA 不會受到太大影響。

In other draft proposals, we've seen certain outpatient surgical procedures being considered for cuts to hospital outpatient reimbursement.

在其他提案草案中，我們看到某些門診手術正在考慮削減醫院門診報銷金額。

We would expect that those would have a bit more notable impact to HCA.

我們預計這些會對 HCA 產生更顯著的影響。

But like a lot of these healthcare policy debates that are going through the government right now, we continue to monitor them closely, as I'm sure you do, and we'll be tracking.

但就像政府目前正在討論的許多醫療政策辯論一樣，我們將繼續密切關注它們，我相信你們也會這樣做，我們會追蹤的。

And Mike, I don't see that any site-neutral policy, per se, will force us or cause us to rethink our strategy around building out our outpatient networks.

麥克，我並不認為任何站點中立政策本身會迫使我們或導致我們重新考慮建立門診網路的策略。

We believe we are finding opportunities to extend the reach of our networks into new communities, again, make it more convenient and more efficient for the patient.

我們相信，我們正在找到機會將我們的網路覆蓋範圍擴展到新的社區，從而為患者提供更便利、更有效率的服務。

And then fully integrate that particular facility into the larger hospital-centric health system is part and parcel to our network development strategy.

然後將該特定設施完全整合到以醫院為中心的更大的醫療系統中，這是我們網路發展策略的重要組成部分。

So I don't see any changes to that as a result of a Medicare site-neutral provision if one were to be implemented.

因此，如果實施醫療保險站點中立條款，我認為不會帶來任何變化。

And to your question around the growth in ASC revenues, it's about right at 5% to 6% growth over prior year.

關於 ASC 收入成長的問題，我認為與前一年相比，其收入成長大約在 5% 到 6% 之間。

Thank you.

謝謝。

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

Hi.

你好。

Thanks.

謝謝。

Good morning.

早安.

I wanted to stick on the policy side and was curious just in understanding -- it's clearly still very early, but -- if you've done any type of preliminary analysis around Trump's tariff proposals and if you think there could be any net effect or economic impact from that.

我想堅持政策方面，只是很好奇——現在顯然還為時過早——但是——如果你對川普的關稅提案做過任何類型的初步分析，如果你認為可能會產生任何淨效應或由此帶來的經濟影響。

And then also from some of the recent executive orders that he's already been tossing out at a brisk rate as it relates to foreign workers and immigrants, et cetera, just curious if you think any of those may have an effect on either the labor or demand environment.

此外，從他最近迅速推出的一些與外國工人和移民等有關的行政命令來看，我很好奇，你是否認為這些命令可能會對勞動力或需求產生影響環境。

Thanks a lot.

多謝。

On tariffs, our HealthTrust, a great purchasing organization, has been working on tariff mitigation strategies for many years, including actions like fixed price contracting, supply chain mapping and risk assessments, and a lot of work on sourcing.

關於關稅，我們的健康信託（HealthTrust）是一家優秀的採購組織，多年來致力於制定關稅緩解策略，包括固定價格合約、供應鏈映射和風險評估等行動，以及大量的採購工作。

Many of our team suppliers have been working on derisking and diversifying their supply chains over the last many years, really especially away from China.

過去多年以來，我們團隊的許多供應商一直致力於降低風險並實現供應鏈多樣化，尤其是遠離中國。

Like you, we are closely monitoring the announcements on tariffs from the new administration, including which countries are targeted, the rate of tariffs being implemented, and potential tariff exclusions for healthcare-related items.

與您一樣，我們也密切關注新政府發布的關稅公告，包括針對哪些國家、實施的關稅稅率以及醫療相關商品的潛在關稅豁免。

I would note that for 2025, we have about 70% of our supplies being contracted with firm pricing.

我想指出的是，到 2025 年，我們約有 70% 的供應是按照固定價格簽訂的合約。

As it relates to sizing it, we need more specific information on the details of these tariff policies as noted, and we're going to need that before we can produce additional estimates of impact.

至於規模，我們需要更多關於這些關稅政策細節的具體信息，而且我們需要這些資訊才能得出額外的影響估計。

On the other related items, we're tracking those carefully, as all of you are.

對於其他相關事項，我們正在密切跟踪，就像你們所有人一樣。

We don't hire undocumented workers.

我們不僱用無證工人。

And so the impact would be more on supply demand for labor in those skill mixes, and we're tracking it like you are, but no special insight or note that we can give you at this point.

因此，影響將更多地集中在這些技能組合的勞動力供需上，我們像您一樣正在追蹤它，但目前我們無法給您任何特別的見解或說明。

Thank you.

謝謝。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯 (Sarah James)，費茲傑拉領唱者。

Thank you.

謝謝。

I just want to clarify again the bridge on equivalent admissions going from the 4.5% to the 3% to 4%.

我只是想再次澄清同等錄取率從 4.5% 到 3% 再到 4% 的橋樑問題。

So it sounds like you're implying Mission and Largo offset each other explicitly on EBITDA, but implied on volumes.

所以聽起來你是在暗示 Mission 和 Largo 在 EBITDA 上明確地相互抵消，但在數量上卻有所暗示。

And then we're calculating 27 bps from a non-repeated leap year.

然後我們從非重複閏年開始計算 27 個基點。

And I'm not sure if you're assuming any pull forward of procedures from consumers that may be concerned about expanded subsidies going away.

我不確定您是否認為消費者可能會因為擔心擴大的補貼而提前採取任何措施。

So I'd love to know that.

所以我很想知道這一點。

And then just the rest of it, is that just conservatism going back to the mean?

那麼剩下的，是不是就是保守主義回歸中庸了？

Or is there anything specific exiting 4Q that you saw that led you to be conservative?

或者，您是否看到了第四季度的某些特定表現，從而導致您採取保守態度？

So when I think about our '25 guidance on volume -- and so we're projecting a 3% to 4% growth in equivalent admissions for '25.

因此，當我考慮我們'25 年的數量指導時 - 我們預計'25 年的等效入學人數將增長 3% 至 4%。

And as you noted, we ran higher than that through September year to date, call it, a 5% growth.

正如您所提到的，今年截至 9 月份，我們的成長率已經超過了這一水平，達到了 5%。

And then fourth quarter was a little bit more in line with that at a 3% growth.

第四季的成長率與此略有一致，為 3%。

Although, as I noted on an earlier question, we did see in fourth quarter a bit of impact with depressed flu season -- sorry, respiratory season and a little bit of drag in fourth quarter related to hurricanes.

不過，正如我在之前的問題中提到的那樣，我們確實看到第四季度受到流感季節的低迷（抱歉，是呼吸道疾病季節）的影響，並且第四季度還受到了與颶風有關的一點拖累。

As I bridge our volume into '25, I mean, I might note a couple of things.

當我將我們的業務量擴展到 25 歲時，我可能會注意到幾件事。

One would be -- and probably the big one is just the healthcare exchanges.

其一是——可能最大的一個就是醫療保健交易所。

We had big enrollment growth in 2024, call it, 30%.

2024 年我們的入學人數將大幅成長，預計達到 30%。

And we had big volume growth in 2024, 44%, 45% growth in exchange volume in 2024.

2024 年我們的交易量將大幅成長，2024 年交易量將成長 44% 至 45%。

As we look at enrollment into 2025 on the healthcare exchanges, we're seeing, call it, 13%, 14%, 15% growth in enrollment in our states for 2025.

當我們展望 2025 年醫療保健交易所的入學人數時，我們發現到 2025 年我們各州的入學人數將增加 13%、14% 或 15%。

And so we do expect that there will be less volume growth in '25 related to healthcare exchanges than we saw in '24.

因此，我們確實預計，25年與醫療保健交易相關的交易量成長將低於24年。

That's one of the big drivers of the pullback there.

這是導致那裡經濟回落的一個重要因素。

I mentioned earlier that we had an admission benefit related to the Medicare Advantage two-midnight rule in '24 that I don't think repeats in '25.

我之前提到過，我們在 1924 年享受了與醫療保險優勢計劃 (Medicare Advantage) 午夜兩點規則相關的入院福利，但我認為 1925 年不會再重複這一福利。

And so -- and then the other thing would be the Medicaid redetermination process that was down this year.

所以 — — 另一件事是今年醫療補助重新確定程序陷入停滯。

I think it flattens out next year.

我認為明年這一趨勢將會趨於平穩。

So all in, we're still forecasting what we think to be strong demand for healthcare services in '25.

總的來說，我們仍然預測25年對醫療保健服務的需求將會強勁。

A 3% to 4% growth is still above our long-term guide of 2% to 3% and feels rational as we think about the balance of 2025 compared to where we landed in '24.

3% 至 4% 的成長率仍然高於我們 2% 至 3% 的長期指導水平，當我們考慮 2025 年與 24 年相比的平衡時，這種成長率似乎是合理的。

Thank you.

謝謝。

Jamie Perse, Goldman Sachs.

高盛的傑米·珀斯 (Jamie Perse)。

Hey.

嘿。

Thank you.

謝謝。

Good morning.

早安.

Just on M&A, you guys have had a couple of smaller transactions recently.

光是在併購方面，你們最近就進行了幾筆小規模的交易。

I wanted to see what you're seeing just in terms of market activity; how you're thinking about the portfolio overall, including adding scale in existing markets or going to new markets; and just the aggressiveness you guys could show on the deal front in 2025.

我想看看你在市場活動方面看到了什麼；您如何考慮整體投資組合，包括在現有市場擴大規模或進入新市場；以及你們在 2025 年交易方面所展現的積極性。

So our primary growth in capacity is going to be through our capital spending and, I'll call it, organic measures where we add bed supply, we add outpatient facilities, as we mentioned.

因此，我們產能的主要成長將是透過資本支出以及我稱之為有機措施的措施來實現的，正如我們所提到的，我們增加床位供應，增加門診設施。

Those are central elements to our network development strategies and have proven to be very successful and have proven to be very productive from a capital return standpoint.

這些是我們網路發展策略的核心要素，並且已被證明非常成功，而且從資本回報的角度來看非常有成效。

We have, as you've mentioned, added when we can to our existing networks.

正如您所說，我們會盡力擴充現有網路。

We bought outpatient businesses.

我們收購了門診業務。

We've complemented our hospital networks with rural facilities and surgical facilities and so forth.

我們透過鄉村設施和外科設施等補充了我們的醫院網路。

And that will continue, I think, into 2025.

我認為這種情況將持續到 2025 年。

We don't necessarily have any significant items to point to at this particular juncture.

在這個特定時刻，我們不一定有任何重要的事情可以指出。

However, we do have a new hospital acquisition that we are expecting to close in the first quarter in Manchester, New Hampshire.

然而，我們確實有一家新醫院的收購，預計將於第一季在新罕布夏州曼徹斯特完成。

That will add to and round out our New Hampshire network and give us a fairly broader and more productive, we think, overall southern New Hampshire network.

這將增強和完善我們在新罕布夏州的網絡，並為我們帶來一個相當廣泛和更有效率的整個新罕布夏州南部的網絡。

We're excited about that.

我們對此感到非常興奮。

But most of our investments are going to go towards, I'll call it, just organic system development.

但我們大部分的投資將用於我所說的有機系統開發。

We'll have to wait and see if the market starts to shift and more inorganic growth opportunities develop.

我們將不得不拭目以待，看看市場是否開始轉變，並出現更多的無機成長機會。

But at this particular point, we're not anticipating anything material.

但在現階段，我們還沒有期待任何實質的進展。

Okay.

好的。

Thank you.

謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Hi.

你好。

Thanks.

謝謝。

Same-store inpatient surgical growth looked pretty strong in the quarter.

本季同店住院手術成長相當強勁。

Can you maybe just give us a sense on the types of procedures that was driving that?

您能否向我們簡單介紹一下推動這現象的程序類型？

And outpatient surgical again was down, I think, the last couple of quarters.

我認為，最近幾季門診手術數量再次下降。

You've said that was mostly in the Medicaid and uninsured categories.

您說過，這主要涉及醫療補助和無保險類別。

Maybe I missed it in your commentary, but I'm just wondering if that's still the case.

也許我錯過了你的評論，但我只是想知道是否仍然如此。

Thank you.

謝謝。

So this is Sam.

這就是薩姆。

On the inpatient side, we did see a very solid growth in the quarter, fairly broad-based.

在住院方面，我們確實看到本季非常穩健的成長，而且成長範圍相當廣泛。

Again, I think our diversified array of service offerings allows us to move through cycles and then also have less risk with the programs that we have.

再次，我認為我們多樣化的服務產品使我們能夠跨越週期，並降低我們現有專案的風險。

But we saw strong neurosciences.

但我們看到了強大的神經科學。

We saw strong orthopedics.

我們看到了強大的骨科技術。

We saw solid general surgery and vascular.

我們看到了實體普通外科和血管外科。

So it's really broad-based on the inpatient side.

因此，從住院方面來看，其範圍確實很廣泛。

On the outpatient side, again, it's driven largely by Medicaid declines, which were down 10%.

就門診方面而言，這主要還是受醫療補助下降（下降了 10%）的影響。

Our commercial and exchange volumes were up a little over 1%.

我們的商業和交易量增加了1%多一點。

Self-pay was down.

自付費用下降了。

So that's why we indicated that our revenue growth and our profitability growth within our outpatient surgery category was up again in the quarter and for the year because of the mix and the payer mix.

因此，我們指出，由於產品組合和付款人組合，我們的門診手術類別的收入成長和獲利成長在本季和全年均再次上升。

And that's added to more capacity for those types of cases.

這也增加了處理此類案件的容量。

So we're not concerned about the outpatient surgery activity in the company when we look underneath the hood.

因此，當我們深入調查時，我們並不擔心公司的門診手術活動。

Steve Baxter, Wells Fargo.

富國銀行的史蒂夫·巴克斯特。

Hi.

你好。

Thanks for the question.

謝謝你的提問。

I'm just trying to understand some of the moving parts in the quarter a little bit better.

我只是想更了解本季的一些活動部分。

I mean, it looks like broadly, you met expectations in the quarter.

我的意思是，從總體來看，你在本季度達到了預期。

But the Medicaid supplemental benefit on a full-year basis is now, I think, $200 million larger than what you discussed on the third quarter call.

但我認為，全年的醫療補助補充福利現在比您在第三季電話會議上討論的金額高出 2 億美元。

And hurricanes, I think, came in at maybe the (technical difficulty) end of the guidance range that you previously provided.

我認為，颶風可能已經達到了您之前提供的指引範圍（技術難度）的極限。

I think what people are trying to square those moving parts and whether that's the right way to think about it or that's a misinterpretation of how to look at the quarter.

我認為人們正在試圖理順這些變動的部分，以及這是否是正確的思考方式，或者是對如何看待本季的誤解。

Thank you.

謝謝。

Sure, this is Mike.

當然，我是麥克。

The way I would frame fourth quarter, as you think through the moving parts here, the first, as we've mentioned, would be the hurricane impact as noted.

我對第四季的預測是，當你思考這裡的變動因素時，第一個因素，正如我們已經提到的，就是颶風的影響。

In terms of the supplemental payment benefits, I think our description of the fourth quarter having the lowest portion of the net benefit in supplement payments for the year is a good way to think about that component.

就補充支付福利而言，我認為我們對第四季度的描述是全年補充支付淨福利中最低的部分，這是思考這一部分的好方法。

And then a couple of other things I might mention when you're thinking about our fourth quarter '24 earnings growth or adjusted EBITDA growth would be, one, that fourth quarter of 2023 was very strong.

當您考慮我們 24 年第四季的獲利成長或調整後的 EBITDA 成長時，我可能會提到另外幾件事：第一，2023 年第四季的表現非常強勁。

So it was a little bit of a tougher comparison in fourth quarter of this year to last year.

因此，今年第四季與去年第四季的比較有點困難。

And then the second thing just to keep in mind, and this is somewhat related to the depressed respiratory season, is that our admission growth in the quarter was at 3% versus if you think about more akin to 5% September year to date of '24.

然後要記住的第二件事是，這在某種程度上與呼吸道感染低迷的季節有關，即本季我們的入院人數增長率為3%，而去年同期的入院人數增長率則更接近5 %。

So those are some thoughts.

這些就是我的一些想法。

I might mention that if you look at that growth rate, we do believe it's consistent from a launching point as we think about the midpoint of our 2025 guidance range as well.

我想說的是，如果你看一下這個成長率，我們確實相信它與起點是一致的，因為我們也考慮了 2025 年指導範圍的中點。

So we're pleased with the quarter and felt like, given everything the company was dealing with in the fourth quarter of 2024, it was a good quarter.

因此，我們對本季的表現感到滿意，並認為，考慮到公司在 2024 年第四季所處理的所有事情，這是一個不錯的季度。

Thanks.

謝謝。

And just to clarify, the Tennessee portion of the 2024 payment recognized in the fourth quarter or is that in the 2025 guidance now?

需要澄清的是，2024 年付款的田納西部分是在第四季度確認的，還是現在在 2025 年的指導中？

Thank you.

謝謝。

Yeah, it was not recognized in fourth quarter of '24.

是的，它在 24 年第四季沒有被承認。

It will be a '25 event.

這將是一次’25盛事。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究公司。

Hi.

你好。

Thanks.

謝謝。

Good morning.

早安.

Could you speak a little bit more to the ASC performance in the quarter, maybe more specifics on rate versus volume underneath that 5% to 6% revenue growth that you talked about and then, more broadly, how you think about the opportunity?

您能否再多談談本季的ASC 表現，也許更具體地說，您提到的5％ 至6％的收入增長之下的費率與銷量，然後更廣泛地說，您如何看待這個機會？

And I'm specifically interested, are there any markets where you've got significant inpatient acute care share, but maybe not there on the ASC side yet?

我特別感興趣的是，在哪些市場中你們擁有較大的住院急診份額，但在 ASC 方面可能還沒有？

So let's start with the numbers.

那我們就從數字開始吧。

We're at 124 surgery centers now.

我們現在有 124 個手術中心。

In my previous comment, I mentioned that the net revenue was up 5% to 6% in the quarter.

在我之前的評論中，我提到本季淨收入成長了 5% 至 6%。

The case volumes were down 1% in the quarter.

本季度案件數量下降了 1%。

We feel good about our ambulatory surgery center network.

我們對我們的門診手術中心網絡感到滿意。

They're an important part of our overall network in the markets we serve.

它們是我們服務市場中整體網絡的重要組成部分。

And it will be -- it will continue to be a part of our network development and optimization work as we go through into '25 and beyond as part of that work.

而且它將繼續成為我們網頁開發和優化工作的一部分，並將持續到2025年及以後。

Sam, I don't know if you have

山姆，我不知道你有沒有

--

--

Well, I'm sitting here just canvassing across the company and thinking about the number of surgery centers vis-a-vis the number of hospitals that we have.

好吧，我坐在這裡，在公司裡四處徵求意見，思考手術中心的數量與醫院的數量之間的關係。

And we do have a few markets for a variety of reasons that don't have an average number of facilities per hospital.

而且，由於各種原因，我們確實有一些市場沒有達到每家醫院平均擁有設施數量的標準。

We've talked about -- on average, we have roughly 14 outpatient facilities, including ASCs, clinics, urgent care, and so forth per hospital.

我們已經討論過了——平均而言，每家醫院大約有 14 個門診設施，包括 ASC、診所、緊急護理等。

That's an average.

這是平均值。

We have, in some markets, because there's no certificate of need in some markets where we can move much more quickly and aggressively to build out our outpatient network.

在某些市場，我們已經這樣做了，因為在某些市場沒有需要證明，我們可以更快、更積極地建立我們的門診網路。

In some markets like in Georgia, where they have restrictive CON, it limits our ability to execute a strategy, same in Virginia and in North Carolina.

在某些市場，例如喬治亞州，由於其 CON 具有限制性，這限制了我們執行策略的能力，弗吉尼亞州和北卡羅來納州的情況也是如此。

So you have some differences because of those dynamics.

因此，由於這些動態，會出現一些差異。

Where we have sort of control over our own destiny, if you will, we're fairly consistent with a large outpatient network by including ASCs per hospital.

如果你願意的話，我們可以在某種程度上掌控自己的命運，透過在每個醫院設立 ASC，我們可以與大型門診網路保持相當的一致性。

So I'm really struggling to point to a particular market where we feel like we're out of physician, if you will, in this space.

因此，我真的很難指出一個特定的市場，如果你願意的話，我們感覺在這個領域缺乏醫生。

Mike talked about 125 ambulatory surgery centers.

麥克談到了 125 個門診手術中心。

We probably have another 20 or 25 GI centers that we don't even include in our number, and that's part of our larger outpatient network.

我們可能還有另外 20 或 25 個胃腸病中心，甚至沒有包括在我們的數字內，但它們是我們更大的門診網絡的一部分。

Those continue to grow incrementally also.

這些也持續逐步增長。

So I think the limitation for us is mostly regulatory, and we have to work our way through that, as you would expect, through that administrative process.

因此，我認為我們面臨的限制主要是監管方面的，正如你所期望的那樣，我們必須透過行政程序來解決這個問題。

Helpful.

很有幫助。

Thank you.

謝謝。

(technical difficulty) Bernstein.

（技術難題） 伯恩斯坦。

Great.

偉大的。

Thanks a lot.

多謝。

Could you talk a little bit about the progress on labor and labor agenda you've been making, in particular, talking to the pace of hirings in like nurse and support staff in '24 and what the guidance is and what's implied in '25?

您能否談談您在勞工和勞工議程方面取得的進展，特別是談到'24年護士和支援人員的招聘速度，以及'25年的指導方針和暗示是什麼？

Maybe a little commentary on wage inflation.

也許對薪資通膨有一點評論。

And then if you could just give a little background on -- what's the total exposure in the supplemental programs these days?

然後，您能否簡單介紹一下背景—目前補充計畫的整體曝光率是多少？

And what would be the margin on Medicaid without those programs?

如果沒有這些項目，醫療補助的利潤會是多少？

Obviously, those are essential to get to an appropriate margin level there.

顯然，這些對於達到適當的利潤水平至關重要。

Thanks.

謝謝。

Yeah.

是的。

Let's cover labor first.

我們先來談談勞動力。

I think a good way to measure the progress we've been making is looking at our use of premium labor or contract labor.

我認為衡量我們所取得的進展的一個好方法是看我們對優質勞動力或合約勞動力的使用。

And contract labor continues to improve.

合約工狀況持續改善。

It moved down 8% or so for the quarter to prior year.

與去年同期相比，本季下降了 8% 左右。

Our contract labor as a percentage of SWD was down to 4.6%, 4.5% in the quarter.

我們的合約工佔 SWD 的百分比在本季度下降到了 4.6% 到 4.5%。

And it really represents, I think, a lot of really good work that our teams have done, both in terms of improving the retention and reducing the turnover rates we've seen over the last couple of years coming out of the pandemic and a lot of good work on workforce development, including targeted hiring.

我認為，這確實體現了我們團隊所做的大量出色工作，無論是在提高員工留存率方面，還是在降低過去幾年疫情過後的離職率方面，還有很多在勞動力發展方面做得很好，包括有針對性的招募。

Our workforce development plan is robust.

我們的勞動力發展計畫非常健全。

We've talked in the past about -- that we're continuing to add Galen Colleges of Nurses in our key markets.

我們過去曾談過——我們將繼續在我們的主要市場增加蓋倫護理學院。

We're continuing to see increases in enrollment in Galen, and we have a robust academic medicine plan where we go out and work with other nursing schools really across our markets.

我們看到 Galen 的入學人數不斷增加，並且我們有一個強大的學術醫學計劃，我們會走出去並與我們市場上的其他護理學校合作。

And we're a really large hirer of graduate nurses.

我們確實大量僱用畢業護士。

So I think overall, the labor agenda has gone and progressed really well.

所以我認為總體來說，勞工議程進展順利。

In terms of wages in fourth quarter, the wages were stable.

從薪資方面來看，第四季薪資狀況保持穩定。

Wage inflation was stable.

薪資通膨穩定。

And our guidance really contemplates -- if you think about our margin guidance, really contemplate a steady operating environment as we head into 2025, including overall wage inflation being what I think is stable and rational.

我們的指引確實考慮到了——如果你考慮到我們的利潤率指引，那麼在我們邁向 2025 年時，確實考慮到了穩定的營運環境，包括我認為穩定和合理的整體工資通膨。

So we're in a good spot on labor.

因此，我們在勞動力問題上處於有利地位。

On Medicaid, I'll just mention this.

關於醫療補助，我只想提一下這一點。

When you take total Medicaid reimbursement, including the effects of supplemental payment programs on Medicaid, we're still short of covering the cost of care around Medicaid.

當您獲得全部醫療補助報銷金額（包括補充支付計劃對醫療補助的影響）時，我們仍然無法支付與醫療補助相關的醫療費用。

These programs are important, and they're important to the industry and not just HCA, but the wide range of not-for-profit and public hospitals across America.

這些項目非常重要，它們對產業、不僅對 HCA 很重要，而且對美國各地的非營利和公立醫院也很重要。

So that's where I'll leave on margins for Medicaid.

這就是我為醫療補助留下的利潤空間。

Great.

偉大的。

Thanks.

謝謝。

Janine, maybe time for one more.

珍妮，也許還有時間再做一次。

We're right at the top of the hour.

我們現在正處於整點。

Thank you.

謝謝。

Ben Rossi, JPMorgan.

摩根大通的本‧羅西 (Ben Rossi)。

Good morning.

早安.

Thanks for squeezing me in here for one last one.

感謝您抽出時間讓我在這裡聽最後一次。

So your 2025 CapEx guide at about $5.1 billion.

因此，您的 2025 年資本支出指南約為 51 億美元。

I think historically, you've weighted this to 50-50 growth between CapEx maintenance and growth CapEx.

我認為從歷史上看，您會將資本支出維護和成長資本支出之間的比例設定為 50-50。

Just with the hurricane recovery, is there any shift in this prioritization in the near term or is 50-50 still a fair consideration for 2025?

就颶風過後的恢復而言，短期內這種優先順序是否會發生變化，或者對於 2025 年來說 50-50 仍然是一個公平的考慮？

I think that's a fair number.

我認為這是一個合理的數字。

The hurricane is not changing our capital spending.

颶風不會改變我們的資本支出。

The dynamics in North Carolina really weren't around physical plant destruction.

北卡羅來納州的動態實際上與物理工廠的破壞無關。

It was community destruction.

這是對社區的破壞。

Our hospitals mostly were on higher levels than the community as a whole, so we didn't experience it.

我們的醫院大多位於比整個社區更高的級別，所以我們沒有遇到這種情況。

In Largo, where we dealt with that, that was mostly repair costs, as Mike mentioned in his commentary.

在拉哥，我們處理了這個問題，主要是維修費用，正如麥克在評論中提到的那樣。

So our capital spending is really consistent, and it's geared toward our network development.

因此，我們的資本支出確實很穩定，並且主要用於網路建設。

It's geared toward making sure we have the clinical capabilities and the environment necessary to deliver high-quality care.

其目的是確保我們擁有提供高品質護理所需的臨床能力和環境。

So that will continue.

這種情況將會持續下去。

Got it.

知道了。

Thank you.

謝謝。

Thank you.

謝謝。

Okay, Janine.

好的，珍妮。

That concludes our Q&A session.

我們的問答環節到此結束。

I would now like to turn the call over back to Frank Morgan for closing remarks.

現在，我想將電話轉回給弗蘭克摩根 (Frank Morgan) 作結束語。

Janine, thanks for your help today, and thanks to everyone for joining the call.

Janine，感謝您今天的幫助，也感謝大家參加電話會議。

We hope you have a good weekend.

我們希望您度過一個愉快的週末。

We're around this afternoon if we can answer any additional questions.

如果我們還有任何其他問題，我們今天下午就可以回答。

Thank you.

謝謝。

That concludes our conference call for today.

今天的電話會議到此結束。

You may now disconnect.

您現在可以斷開連線。