美國醫院公司 (HCA) 2025 Q1 法說會逐字稿

Welcome to HCA Healthcare's first-quarter 2025 earnings conference call. Today's call is being recorded.

歡迎參加 HCA Healthcare 2025 年第一季財報電話會議。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 Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

現在，為了致開幕詞和介紹，我想將電話轉給投資者關係副總裁弗蘭克·摩根先生。先生，請繼續。

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.

早安，歡迎大家參加今天的電話會議。今天早上和我一起的有我們的執行長 Sam Hazen 和財務長 Mike Marks。山姆和麥克將發表一些準備好的講話，然後我們將回答問題。

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

在我將電話轉給 Sam 之前，請允許我提醒大家，如果今天的電話會議包含任何前瞻性陳述，那麼它們都是基於管理層當前的預期。許多風險、不確定性和其他因素可能導致實際結果與今天表達的結果大不相同。有關前瞻性陳述和這些因素的更多資​​訊列在今天的新聞稿和我們向美國證券交易委員會提交的各種文件中。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling net income attributable to HCA Healthcare, Inc., is included in today's release.

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。今天的新聞稿中包含一個表格，提供有關調整後 EBITDA 的補充資訊以及歸屬於 HCA Healthcare, Inc. 的淨收入調節表。

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

今天早上的通話正在錄音，今天晚些時候將會提供通話重播。說完這些，我現在將電話轉給 Sam。

All right. Good morning and thank you for joining the call. The solid fundamentals we have seen in our business over the past several quarters continued into the first quarter of 2025. This momentum generated strong financial results that were driven by broad-based volume growth, improved payer mix, and better operating margin.

好的。早上好，感謝您參加電話會議。過去幾個季度，我們的業務基本面表現穩健，這種勢頭將持續到 2025 年第一季。這一勢頭產生了強勁的財務業績，這得益於廣泛的銷售成長、付款人組合的改善以及更好的營業利潤率。

As we look to the rest of the year, we remain encouraged by our performance, the overall backdrop of growing demand for health care services, and the increased investments we have made across the company to serve our communities better.

展望今年剩餘時間，我們的業績、醫療保健服務需求不斷增長的總體背景以及我們在整個公司為更好地服務社區而增加的投資仍然令我們感到鼓舞。

The people of HCA Healthcare also continued to deliver for our patients in key nonfinancial metrics, including improved quality outcomes, more efficient emergency room services which have accelerated time to discharge and increased satisfaction, and finally, better inpatient capacity management with reduced length of stay. I want to thank my colleagues for their professionalism, their dedication to our mission, and the great outcomes they produce for our company to start the year.

HCA 醫療保健的員工也繼續為我們的患者提供關鍵的非財務指標，包括改善品質結果、更有效率的急診室服務（加快出院時間並提高滿意度），以及最終改善住院容量管理並縮短住院時間。我要感謝我的同事們的專業精神、對我們使命的奉獻精神以及他們為我們公司在新的一年裡創造的出色成果。

As compared to the prior year, diluted earnings per share as adjusted increased more than 20% in the first quarter to $6.45. Same facility volumes, even with the leap year effect were favorable and in line with our expectations. Inpatient admissions grew 2.6% year over year, equivalent admissions grew 2.8% and emergency room visits increased 4%. Most of our other volume categories, including cardiac procedures and rehab admissions also had solid growth in the quarter.

與去年同期相比，第一季調整後每股攤薄收益成長逾20%，達6.45美元。即使考慮到閏年因素，工廠產量仍保持良好，符合我們的預期。住院人數較去年同期增加 2.6%，等效入院人數增加 2.8%，急診室就診人數增加 4%。我們大多數其他類別的業務量，包括心臟手術和復健入院，在本季也實現了穩定成長。

Surgical volumes across the company were mixed. Inpatient surgeries were slightly up and outpatient cases were down. Same facilities revenue grew almost 6%. The volume increases I just mentioned coupled with approximately 3% higher revenue per equivalent admission drove this growth.

整個公司的手術量有好有壞。住院手術量略有增加，門診手術量下降。相同設施收入成長近6%。我剛才提到的票房成長，加上每張票的票房收入增加約 3%，推動了這項成長。

We continue to make progress on our cost agenda. Operating costs across most categories were in line with our expectations and the operating margin improved on a year-over-year basis.

我們的成本議程持續取得進展。大多數類別的營運成本符合我們的預期，且營運利潤率較去年同期有所提高。

As part of our network development plan, we used our capital spending to increase the number of facilities or sites of care by 3.3% to around 2,750 and we added approximately 2% to our inpatient bed capacity. Inpatient occupancy in the quarter was 77% as compared to 75% last year. As we move through the remainder of the year, we will focus on maintaining our operational discipline while continuing to invest appropriately in our strategic agenda. We believe this balanced approach should position the company favorably to meet our objectives.

作為我們網路發展計畫的一部分，我們利用資本支出將設施或護理站點的數量增加了 3.3%，達到約 2,750 個，並將住院床位容量增加了約 2%。本季住院率為 77%，而去年為 75%。在今年剩餘的時間裡，我們將專注於保持我們的營運紀律，同時繼續對我們的策略議程進行適當的投資。我們相信，這種平衡的方法將有利於公司實現我們的目標。

Before I finish my comments, let me address the current federal policy environment, which I know is top of mind. We are in a very fluid situation. While we have a general sense for the new administration stated priorities, we do not have any specifics. It is unclear how these efforts might be carried out and what effects they may have on our business. We are very engaged in advocacy as it relates to health policy.

在我結束我的評論之前，請允許我談談當前的聯邦政策環境，我知道這是人們最關心的問題。我們正處於非常不穩定的情況。雖然我們對新政府提出的優先事項有大致的了解，但我們並不清楚具體內容。目前尚不清楚這些努力將如何進行以及它們將對我們的業務產生什麼影響。我們積極參與與健康政策相關的宣傳工作。

Our general approach is to support reasonable reforms. However, we do not support reforms that harm coverage for families or individuals, nor do we support policies that compromise the ability for hospitals across the country to care for people in their times of utmost need.

我們的整體思路是支持合理的改革。然而，我們不支持損害家庭或個人保險的改革，也不支持損害全國各地醫院在人們最需要的時候為他們提供護理的能力的政策。

I know you would like us to size the potential impacts of health policy risk and now tariff risks, but we are not comfortable with providing estimates at this time. We just do not have enough insight into what might happen. When we gain a better understanding, we will share more information as part of our quarterly earnings process.

我知道您希望我們評估健康政策風險和現在的關稅風險的潛在影響，但我們目前不願意提供估計值。我們只是對可能發生的事情沒有足夠的了解。當我們獲得更好的了解時，我們將在季度收益過程中分享更多資訊。

As you would expect, we are developing plans in the event we face adverse impacts. Our planning draws from the experiences we had during the COVID-19 pandemic and considers both adjustments to operations and how we may utilize the flexibility our cash flow and balance sheet provides. As part of this planning process, we will maintain a long-term horizon and move forward with a sense of calm, steadiness, and confidence. We believe we can use our financial strength, mission-oriented culture and can-do attitude of our people to navigate through this uncertain period and deliver the results our stakeholders deserve.

正如您所期望的，我們正在製定應對不利影響的計劃。我們的規劃借鑒了 COVID-19 疫情期間的經驗，並考慮了營運調整以及如何利用現金流和資產負債表提供的靈活性。作為這項規劃過程的一部分，我們將保持長遠的眼光，以冷靜、穩定和自信的態度向前邁進。我們相信，我們可以利用我們的財務實力、以使命為導向的文化和員工的積極進取態度來度過這個不確定的時期，並為我們的利害關係人帶來應有的成果。

With that, I will turn the call to Mike for more detail on the quarter.

說完這些，我將把電話轉給麥克，以了解有關本季的更多詳細資訊。

Well, thank you, Sam, and good morning, everyone. We are pleased with the results of the quarter, which highlighted the continued momentum of the company and the strength of our operating performance. Sam covered our volume and revenue performance. So let me add a few notes on payer mix. Payer mix remained strong, with same facility managed care equivalent admissions by 5.4% compared to the prior year quarter.

好吧，謝謝你，山姆，大家早安。我們對本季的業績感到滿意，這凸顯了公司持續的發展動能和強勁的經營業績。Sam 介紹了我們的銷售和收入表現。因此，讓我補充一些有關付款人組合的說明。付款人組合依然強勁，與去年同期相比，同一設施管理的醫療等效入院率增加了 5.4%。

As expected, Medicaid volumes began to flatten as the redetermination process (inaudible) with a same facility equivalent admission decline of only 1.4% to the prior year quarter. And given the strong enrollment growth in the exchanges, our same facility equivalent exchange admissions, increased 22.4% over prior year quarter.

正如預期的那樣，隨著重新確定過程（聽不清楚），醫療補助量開始趨於平穩，與去年同期相比，同等設施的入院人數僅下降了 1.4%。鑑於交易所入學人數的強勁增長，我們同等設施的交易所入學人數比去年同期增加了 22.4%。

Adjusted EBITDA margins improved 110 basis points compared to the prior year quarter, driven by operating leverage from our volume growth and strong cost management performance in the quarter. Salaries and benefits as a percent of revenue improved 80 basis points, supplies improved 30 basis points, and other operating expenses were basically flat to prior year quarter.

調整後的 EBITDA 利潤率較去年同期提高了 110 個基點，這得益於本季銷售成長帶來的經營槓桿以及強勁的成本管理業績。薪資和福利佔收入的百分比提高了 80 個基點，供應品提高了 30 個基點，其他營運費用與去年同期基本持平。

Contract labor improved 9.3% from prior year quarter and represented 4.4% of total labor cost in the first quarter of '25 compared to 5.1% in the first quarter of 2024. Same-facility professional fee costs increased 11% from the prior year quarter and were approximately flat sequentially compared to the fourth quarter of 2024.

合約工比去年同期改善了 9.3%，佔 2025 年第一季總勞動成本的 4.4%，而 2024 年第一季為 5.1%。同類設施專業費用成本較去年同期成長 11%，與 2024 年第四季相比季減。

Adjusted EBITDA grew 11.3% over the prior year quarter. You will recall that our guidance assumed the impacts of the 2024 hurricanes would offset each other in 2025 and not produce a tailwind for us. This is what played out in the first quarter. Earnings were flat year over year in our hurricane-impacted markets in the first quarter of 2025 compared to the prior year quarter.

調整後的 EBITDA 較去年同期成長 11.3%。您會記得，我們​​的指導假設 2024 年颶風的影響將在 2025 年相互抵消，不會為我們帶來順風。這就是第一季發生的情況。2025 年第一季度，受颶風影響的市場收益與去年同期相比持平。

I want to remind everyone that after considering Medicaid state supplemental payments and related provider taxes, total Medicaid reimbursement does not cover our cost of caring for Medicaid patients. Considering Medicaid state supplemental payments and related provider taxes in isolation, we saw an $80 million increase in net benefits in the first quarter of 2025 compared to the prior year quarter due primarily to a reconciliation payment and a program accrual.

我想提醒大家，在考慮醫療補助州補充支付和相關提供者稅後，醫療補助總報銷金額不足以支付我們照顧醫療補助患者的費用。單獨考慮醫療補助州補充支付和相關提供者稅，我們發現 2025 年第一季的淨福利與去年同期相比增加了 8,000 萬美元，這主要歸因於對帳支付和計畫應計費用。

Moving to capital allocation. We continue to deploy a balanced strategy of allocating capital for long-term value creation. Cash flow from operations was $1.65 billion in the quarter. There are a few factors that drove our cash flow from operations down over year, all of which relate to working capital changes that are timing in nature.

轉向資本配置。我們繼續部署平衡的資本配置策略，以實現長期價值創造。本季經營活動現金流為 16.5 億美元。有幾個因素導致我們的經營現金流逐年下降，所有這些因素都與時間性質的營運資本變化有關。

Capital allocation in the first quarter of 2025 included $991 million in capital expenditures, $2.5 billion in share repurchases and $180 million in dividends. We also paid $227 million for acquisitions with the close of the transactions for Catholic Medical Center in Manchester, New Hampshire and Lehigh Medical Center in the Fort Myers, Florida area.

2025 年第一季的資本配置包括 9.91 億美元的資本支出、25 億美元的股票回購和 1.8 億美元的股利。我們也斥資 2.27 億美元收購了位於新罕布夏州曼徹斯特的天主教醫療中心和位於佛羅裡達州邁爾斯堡的利哈伊醫療中心。

Lastly, we received $161 million in proceeds from the sale of assets, primarily driven by the sale of regional medical center of San Jose. This divestiture was an important component of our portfolio optimization. It was good for the community, and it will be accretive to HCA.

最後，我們透過出售資產獲得了 1.61 億美元的收益，主要來自聖荷西地區醫療中心的出售。此次資產剝離是我們投資組合優化的重要組成部分。這對社區有益，並將為 HCA 帶來增值。

Our debt-to-adjusted EBITDA leverage remains at the lower half of our stated target range that we believe our balance sheet is strong and well positioned for the future. As noted in our release, we are reaffirming our guidance ranges for the full-year 2025.

我們的債務與調整後 EBITDA 的比率仍然處於我們既定目標範圍的下半部分，我們相信我們的資產負債表強勁且為未來做好了準備。正如我們在新聞稿中指出的那樣，我們重申了 2025 年全年的指導範圍。

I will now hand the call back to Frank Morgan for questions.

我現在將把電話交還給弗蘭克摩根 (Frank Morgan) 來回答問題。

Thank you, Mike. (Event Instructions)

謝謝你，麥克。（活動須知）

Abby, you may now give instructions to those who would like to ask a question.

艾比，現在你可以向那些想要提問的人發出指示了。

(Operator Instructions) Ann Hynes, Mizuho Securities.

（操作員指示） 安海因斯 (Ann Hynes)，瑞穗證券。

I know you reiterated guidance, but are there any major changes in assumptions embedded in that reiteration of guidance? And within that, I know you talked about, Sam, in your prepared remarks that surgeries were mixed. Did you expect them kind of flat to down because of the tough compare due to leap year? Or were they actually worse in your expectations?

我知道您重申了指導意見，但是重申指導意見中所包含的假設是否有任何重大變化？在這方面，山姆，我知道您在準備好的發言中談到了手術的混合性。您是否預計由於閏年導致的難以比較，它們的價格會持平或下降？或者實際上情況比你預期的還要糟糕？

Let's deal with guidance first, and we'll talk about outpatient surgery, Ann. So if I think about -- as Sam noted in the initial commentary, we're really pleased with the first quarter performance of the company. We continue to see solid volume growth. Revenue was in line with our expectations. And as I noted, we had strong expense management in the quarter.

我們先來處理指導，然後再討論門診手術，安。所以如果我考慮一下——正如 Sam 在最初的評論中指出的那樣，我們對公司第一季的業績感到非常滿意。我們繼續看到穩健的銷量成長。收入符合我們的預期。正如我所指出的，本季我們的費用管理非常出色。

As noted in our release, we did reaffirm guidance for 2025, its first quarter. And really, at this point of the year, we believe our guidance ranges continue to be appropriate for where we are. Certainly, as we progress through the year, we will continue to update you on our subsequent earnings calls.

正如我們在新聞稿中指出的那樣，我們確實重申了 2025 年第一季的指導。事實上，在今年的這個時候，我們相信我們的指導範圍仍然適合我們目前的狀況。當然，隨著今年的進展，我們將繼續在隨後的收益電話會議上向您通報最新情況。

Specifically to outpatient surgery, we're really pleased in the first quarter with our outpatient revenue growth, which, I mean, you take it in total, grew at a rate a bit higher than our inpatient revenue. Just as a reminder, we really categorize our outpatient revenue into four key categories: emergency services; outpatient surgery, which include both hospital based and our ambulatory surgery center platform; ambulatory, things like our physician clinics and our urgent care clinics; and other hospital-based services like cardiology, diagnostics, and observation.

具體到門診手術，我們對第一季門診收入的成長感到非常滿意，我的意思是，總體而言，門診收入的成長速度略高於住​​院收入。提醒一下，我們實際上將門診收入分為四個主要類別：急診服務；門診手術，包括醫院和我們的門診手術中心平台；門診，例如我們的醫生診所和緊急護理診所；以及其他基於醫院的服務，如心臟病學、診斷和觀察。

All four of our outpatient categories had revenue growth over the prior year quarter. On outpatient surgery specifically, we continue to see a slight decline in case volumes driven by lower acuity cases and by Medicaid and self-pay. However, we had good growth in net revenue and earnings in our outpatient surgery business overall, inclusive of both hospital and the ambulatory surgery center categories.

我們所有四個門診類別的收入都比去年同期有所成長。具體來說，在門診手術方面，我們繼續看到病例數量略有下降，這是由於嚴重程度較低的病例以及醫療補助和自費所致。然而，我們的門診手術業務（包括醫院和門診手術中心類別）的淨收入和收益總體上都實現了良好的成長。

I'll finish and just note that the leap year effect did impact the stated volume declines. If you think about outpatient surgery at a 2.1% same facility decline on a per business day basis, that's about a 1% decline.

最後，我只想指出閏年效應確實影響了所述的交易量下降。如果您考慮到同一機構每個工作日的門診手術下降率為 2.1%，那麼下降幅度約為 1%。

And inpatient, Mike, would be up about 1% per business day. So maybe a little softer, Ann, than we had expected. But the first quarter is always difficult to predict surgical period because typically, the fourth quarter is active. And so you're dealing with respiratory implications and new deductibles and co-pays and so forth. But overall, we had solid volume activity across the company, and it was broad-based across our service categories.

住院病人麥克每個工作日的收入將增加約 1%。所以，安，可能比我們預期的要軟一點。但第一季的手術期總是很難預測，因為通常第四季才是活躍的。因此，您要處理呼吸系統問題、新的免賠額和共同支付等等。但總體而言，我們整個公司的交易量都很穩定，並且廣泛涵蓋我們的服務類別。

As we mentioned, our cardiac activity on both surgeries and procedures were strong, inpatient and outpatient. Our rehabilitation, as I mentioned in my prepared comments were strong up over 4%, I think, on a same-store basis.

正如我們所提到的，無論是住院還是門診，我們在手術和治療中的心臟活動都很活躍。正如我在準備好的評論中提到的那樣，我們的重組在同店基礎上強勁增長了 4% 以上。

Behavioral health was down, but behavioral health was down because we had repurposed quite a bit of the supply of beds over the years and repurposed for MedSurg in many instances. And so that was intentional in some facilities. Obstetrics volumes were up slightly, even with the business day decline and one wouldn't think that has an influence, but it does.

行為健康水平下降，但行為健康水平下降是因為多年來我們重新利用了相當多的床位，並且在許多情況下將其重新用於 MedSurg。在某些設施中這是故意的。儘管工作日數量減少，但產科診療量仍略有上升，人們可能認為這不會產生影響，但事實確實如此。

So overall, we're pleased with our volumes and we're encouraged by the market share gains that we're seeing across our company, and we believe we are doing the right things within each of our networks to develop them to meet the needs of the patients and the community.

因此，總體而言，我們對我們的業務量感到滿意，我們對整個公司市場份額的成長感到鼓舞，並且我們相信我們在每個網路中都做著正確的事情來發展它們，以滿足患者和社區的需求。

Great. Thanks for the detail.

偉大的。謝謝你的詳細說明。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Nice job in the quarter. I guess going to -- I guess you would be levered this quarter, pretty extraordinary the growth you saw year over year. I guess, how do you guys sort of get that much levered this quarter. And going forward, like how do you get that productivity? Are you seeing turnover increase as you're sort of getting that level of productivity. Are you sort of behind the hiring curve? I mean, how should we think about that level of productivity going forward after such a huge growth.

本季表現不錯。我想——我想你本季會利用槓桿，看到與去年同期相比相當驚人的成長。我想，你們本季如何獲得如此大的槓桿？那麼展望未來，您如何實現這種生產力？隨著生產力水準的提高，您是否看到營業額增加？您是否落後於招募潮流？我的意思是，在如此巨大的成長之後，我們應該如何看待未來的生產力水準。

Okay. Pito, this is Sam. I'm not sure I understood that question completely. Let me speak to the operating leverage. And I think that's what you're referring to. I mean, fundamentally, our business is a fixed cost business. We said that over time in the more volume we can push through the organization, the more operating leverage we create, the more contribution margin that generates and it helps our overall profitability and margins. And we have regained, as we mentioned last year, our ability to create operating leverage. That shows up in labor costs.

好的。皮托，這是山姆。我不確定我是否完全理解了這個問題。讓我來談談經營槓桿。我想這就是你所說的。我的意思是，從根本上來說，我們的業務是固定成本業務。我們說過，隨著時間的推移，我們在整個組織中推動的業務量越大，我們創造的經營槓桿就越大，產生的貢獻利潤就越大，這有助於提高我們的整體獲利能力和利潤率。正如我們去年提到的那樣，我們已經重新獲得了創造經營槓桿的能力。這體現在勞動成本上。

It shows up in some of our other operating expense categories. And we're able to do that again with a very mindful approach to our expenses. And then at the same time, using more of our asset base to absorb the volumes.

它出現在我們的其他一些營運費用類別中。透過非常謹慎地控制開支，我們能夠再次做到這一點。然後同時利用更多的資產基礎來吸收這些數量。

With respect to our human resource agenda, we've continued to progress across the company. Our turnover both nursing and non-nursing is less than it was year over year. Our contract labor utilization is down year over year. Overall engagement with our most recent engagement surveys with our employees was at a high watermark for us. And so we're very encouraged about what our human resource and operating teams are doing to create an environment where our people can succeed and deliver the outcomes that our patients deserve.

關於我們的人力資源議程，我們在整個公司範圍內不斷取得進展。我們的護理人員和非護理人員的流動率都比去年同期有所下降。我們的合約勞動力利用率逐年下降。我們最近對員工進行的敬業度調查顯示，員工的整體參與度達到了最高水準。因此，我們對我們的人力資源和營運團隊所做的努力感到非常鼓舞，他們正在努力創造一個讓我們的員工能夠取得成功並為我們的患者提供應得的結果的環境。

We believe we can continue that, that the labor market in general is stable. And we have initiatives inside the organization and then outside, if you will, with our Galen school and nursing and other workforce development initiatives to deliver the people that we need to serve the demand. The facility side, as I mentioned in my comments, is being satisfied by our capital spending, and we're adding to our networks very deliberately on that front. And then we're using our workforce development, our engagement, and other HR initiatives to deal with the people side of that.

我們相信，我們可以繼續保持這種狀態，勞動力市場整體保持穩定。我們在組織內部和外部都採取了一些舉措，如果你願意的話，我們透過蓋倫學校、護理學院和其他勞動力發展計劃來提供我們所需的人才，以滿足需求。正如我在評論中提到的那樣，設施方面已透過我們的資本支出得到滿足，並且我們正在非常謹慎地擴大我們的網路。然後，我們利用我們的勞動力發展、我們的參與和其他人力資源措施來處理人力資源方面的問題。

So we're pretty encouraged by all aspects of our operations. Our teams are doing a wonderful job in dealing with the volume and translating that, as I mentioned, to quality outcomes, efficiency, and a great place to work for our employees.

因此，我們對營運的各個方面都感到非常鼓舞。我們的團隊在處理大量工作方面做得非常出色，正如我所提到的，這為我們的員工帶來了高品質的成果、高效的工作效率和良好的工作場所。

So with the [FD] at this level, I guess, 43.6, I guess since you have IPO, we haven't seen this low, as your occupancy keeps on increasing, is it fair to think that this number can keep getting better to your point on the fixed cost leverage?

因此，當 [FD] 處於這個水平時，我猜是 43.6，我想自從您進行 IPO 以來，我們還沒有見過這麼低的水平，隨著您的入住率不斷增加，是否可以公平地認為這個數字可以繼續變得更好，以達到您關於固定成本槓桿的觀點？

Well, I think generally speaking, yes, it can improve as we deliver more volumes on the asset base that we have. And we will continue to use technology. We use our benchmarking and other tools to find ways to create efficiencies. And we feel that we're in a pretty good spot and that we can leverage again the fixed cost that we have in our system to drive efficiencies if we can grow the volumes.

嗯，我認為總體來說，是的，隨著我們在現有資產基礎上提供更多產量，情況會有所改善。我們將繼續使用科技。我們使用基準測試和其他工具來尋找提高效率的方法。我們認為我們處於一個相當不錯的位置，如果我們能夠增加產量，我們可以再次利用我們系統中的固定成本來提高效率。

Thanks so much.

非常感謝。

A.J. Rice, UBS.

瑞銀的 A.J. Rice。

The revenue per adjusted admission up 2.9%, I think, was strong, especially with surgeries up. Can you parse out a little bit more whether that was year-to-year improvement in DPP programs, rate updates generally, commercial mix, or anything? And then maybe just broadly commenting on what you're seeing in contracting with managed care. Is the debate in Washington having any impact on the discussions with managed care?

我認為，調整後入院收入成長 2.9% 是一個不錯的成績，尤其是手術量增加的情況。您能否進一步分析一下，這是否是 DPP 計劃、總體費率更新、商業組合或其他方面的逐年改進？然後也許只是廣泛地評論一下您在與管理式醫療簽訂合約時看到的情況。華盛頓的辯論對管理式醫療的討論有影響嗎？

A.J., thanks for the question. This is Mike. When I think about our net revenue per equivalent admissions, the first thing I'm going to call as basics. We continue to have payer mix trends, as I noted in my opening comments, continues to be good in that regard as well. I think, as I mentioned on the outpatient surgery comment, we actually had a little more outpatient revenue growth than we did on the inpatient side.

A.J.，謝謝你的提問。這是麥克。當我考慮我們每張等效門票的淨收入時，我首先想到的是基本收入。正如我在開場白中提到的那樣，我們繼續保持付款人組合趨勢，並在這方面繼續保持良好。我認為，正如我在門診手術評論中提到的那樣，我們的門診收入增長實際上比住院收入增長要多一些。

And even on outpatient surgery, the case decline that we saw was really driven by lower acuity cases. And from a payer mix perspective, on the outpatient surgery side continues to be driven almost entirely by Medicaid (inaudible). So that payer mix influences on both the inpatient and the outpatient side. So generally speaking, I think we're in good shape on net revenue per equivalent admission in the quarter, and we were pleased with the performance in that way.

即使在門診手術中，我們看到的病例下降實際上是由於病情嚴重程度較低造成的。從支付者組合的角度來看，門診手術方面仍然幾乎完全由醫療補助推動（聽不清楚）。因此，付款人組合對住院和門診都有影響。所以總的來說，我認為本季我們的每張等效門票淨收入狀況良好，我們對這樣的表現感到滿意。

On the payer side, and I'll start, Sam, you -- please include, but we're over 90% contracted for 2025, as you would expect. We're over 75% contracted for 2026. And call it, 25% contracted for 2027 at rates that are really similar to the last couple of years and in context of our targets.

在付款人方面，我先來，山姆，請包括你，但正如你所期望的那樣，我們已經簽訂了 2025 年超過 90% 的合約。我們已經簽訂了 2026 年的合約超過 75%。並且，2027 年的合約率為 25%，這個比率與過去幾年的比率非常相似，並且與我們的目標相符。

We're also pleased with our contracting cycle. And our access to lives with payers are really higher than they've almost ever been, both on the commercial side and on the exchange side. So our work with our payer partners continues. Our contracting cycles continue to be productive. And I think we're off to a good start this year in terms of our net revenue per equivalent in this.

我們對我們的承包週期也感到滿意。無論從商業方面還是從交易方面來說，我們與付費者接觸生活的幾率都比以往任何時候都更高。因此，我們與付款方合作夥伴的合作仍在繼續。我們的承包週期持續富有成效。我認為，就每股淨收入而言，我們今年的開局良好。

And Mike -- this is Sam, A.J. I think a couple of points are relevant here. Our inpatient surgeries as a percent of overall admissions was down 50 basis points. That's not meaningful in the overall revenue equation. I mean, obviously, we'd rather be higher than lower. But it's only down 50 basis points. Our critical care admissions were at a really good position as it relates to total admissions. So I think there are other aspects to acuity and their overall case mix, I think, was modestly up or -- so all of that suggests that we still have the acuity within the larger population of our patients.

麥克，我是薩姆，A.J.，我認為這裡有幾點是相關的。我們的住院手術佔總入院人數的百分比下降了 50 個基點。這對於整體所得方程式來說沒有意義。我的意思是，顯然我們寧願更高而不是更低。但它只下降了50個基點。我們的重症監護入院人數相對於總入院人數而言處於非常好的位置。因此，我認為敏銳度還有其他方面，而且我認為他們的整體病例組合略有上升，或者 - 所有這些都表明我們在廣大患者群體中仍然具有敏銳度。

With respect to the managed care contracting, our overall managed care positioning with respect to the contracts that we participate in has improved on a year-over-year basis. This year, we have two markets where we have added a very important contract to our overall portfolio of participation.

關於管理式醫療合同，我們參與的合約的整體管理式醫療定位逐年改善。今年，我們在兩個市場的整體參與組合中增加了非常重要的合約。

In Denver, we are now participating provider broadly with Kaiser health plan in the Denver, Colorado market, that's a very encouraging development. And then in Chattanooga, Tennessee, with Blue Cross at Tennessee, we have advanced our position with one of their products. So we improved globally our overall positioning for access to lives. And that's played out in our HICS and exchange relationships as well.

在丹佛，我們現在與凱撒健康計畫在科羅拉多州丹佛市場廣泛合作，這是一個非常令人鼓舞的發展。然後在田納西州查塔努加，我們與田納西州藍十字合作，透過他們的一款產品提升了我們的地位。因此，我們在全球範圍內改善了生命獲取的整體定位。這也在我們的 HICS 和交易所關係中得到體現。

And then obviously, with Medicare Advantage, we continue to build capabilities there to support the Medicare Advantage payers as appropriate. So those are two important points, A.J., that I want to bring up in addition to what Mike said.

顯然，透過醫療保險優勢計劃，我們將繼續在那裡建立能力，以適當地支持醫療保險優勢計劃的付款者。因此，A.J.，除了 Mike 所說的之外，我還想提出這兩個重要觀點。

Okay. Great. Thanks a lot.

好的。偉大的。多謝。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

Just was wondering if you guys have detected any changes with the MA plan behavior, denials, any dispute resolution changes and any changes on length of stay?

只是想知道你們是否發現 MA 計劃行為、拒絕、任何爭議解決變化以及停留時間的任何變化？

Whit, let me first kind of talk about the Medicare Advantage in context of the kind of the two-midnight rule. And as we noted, really on the fourth-quarter call, we really did not see any additional movement from observation to inpatient status related to the adoption of the two-midnight rule as we move through first quarter of 2025. That was our expectation, and that's really what we saw. Medicare Advantage is now about 57% of our total Medicare admissions. A couple of notes on the Medicare Advantage compared to traditional to your question.

惠特，首先讓我根據兩夜規則的背景下談談醫療保險優勢計劃。正如我們在第四季度電話會議上所指出的，隨著 2025 年第一季的到來，我們確實沒有看到與採用兩夜規則相關的從觀察狀態到住院狀態的任何其他變化。這是我們的期望，而且我們也確實看到了這樣的結果。目前，醫療保險優勢計劃 (Medicare Advantage) 約占我們醫療保險總入院人數的 57%。針對您的問題，我對醫療保險優勢計劃與傳統計劃進行了幾點比較。

One would be that our Medicare Advantage observation mix is still about 15% higher than our traditional Medicare observation mix, and that's pretty steady at this point. [NGS] Medicare Advantage continues to run a bit harder or a little higher on length of stay than traditional Medicare as well.

一是我們的醫療保險優勢觀察組合仍然比我們的傳統醫療保險觀察組合高出約 15%，而且目前這一水平相當穩定。[NGS] 與傳統醫療保險相比，優勢醫療保險的運作成本略高一些，住院時間也略高一些。

On dispute resolution, and I'll go broadly here, not just Medicare Advantage. But there continues to be activity, as you would expect, in denials and underpayments broadly with our payer partners. Our efforts that we have invested in over the last couple of years to strengthen our response to that are paying off. And I would tell you that in first quarter, that activities like denials and underpayments did not have a material impact on our financial results.

關於爭議解決，我將廣泛地談論，而不僅僅是醫療保險優勢計劃。但正如您所預料的那樣，我們的付款合作夥伴仍然存在廣泛的拒絕付款和少付款行為。過去幾年來，我們為加強因應措施所付出的努力正在獲得成效。我想告訴你們，在第一季度，拒絕和少付款等行為並沒有對我們的財務表現產生重大影響。

My second question is, I know, Mike, you said you're not prepared to share any views on tariffs at this point. But is there any way to perhaps frame the percentage of supplies that you or HPG are sourcing from overseas? Just anything would be helpful.

我的第二個問題是，我知道，麥克，你說你現在還沒準備好分享任何有關關稅的觀點。但是，有沒有辦法可以確定您或 HPG 從海外採購的供應品百分比呢？任何事情都會有幫助。

Sure. As Sam said at the beginning, we're in a really dynamic and fluid environment right now with tariffs. So until we really have better clarity about the final status by country which goods are included or excluded, what the final tariff rates will be, it's really difficult to size the impact [ACA].

當然。正如薩姆一開始所說的，我們目前處於一個關稅非常動態和不穩定的環境中。因此，在我們真正更清楚地了解各國最終將包括或排除哪些商品、最終關稅稅率是多少之前，很難衡量其影響[ACA]。

As you know and as we talked about in previous calls, our HealthTrust organization has been working on this diligently, and I'm really proud of our HealthTrust team. And part of that work, and I'll talk about '25 and then give you a couple of other numbers for context, for 2025, part of their work was the ability to secure significant fixed pricing.

正如您所知，正如我們在先前的電話會議中所討論的那樣，我們的 HealthTrust 組織一直在努力實現這一目標，我為我們的 HealthTrust 團隊感到非常自豪。作為這項工作的一部分，我將討論 25 年的情況，然後為您提供其他幾個數字作為背景，對於 2025 年，他們的部分工作是能夠確保重要的固定價格。

When you think about finished goods, so the purchases of supplies of finished goods, about 70% of our supply expense is contracted with firm pricing for 2025. And just to give you a sense, that's upwards of 60% for some of all of 2026. Another point of context that I think is helpful 75% of our supply expense comes from either the United States, Canada, or Mexico or from products that currently have broad exemption from tariffs such as pharmaceuticals.

當您考慮成品時，即購買成品供應時，我們約 70% 的供應費用是按照 2025 年的固定價格簽訂的。給你一個大概的概念，2026 年全年的某個時間段內，這個比例將超過 60%。我認為另一個有幫助的背景是，我們 75% 的供應費用來自美國、加拿大或墨西哥，或來自目前廣泛免關稅的產品，例如藥品。

As I noted, HealthTrust continues to work on this. They're working on this to continue to secure fixed price contracting. They're continuing their work around supply chain mapping and risk assessments. And they are also deep in the middle of rationalizing suppliers' products as needed to deal with this tariff risk environment.

正如我所指出的，HealthTrust 正在繼續致力於此。他們正在努力繼續確保固定價格合約。他們正在繼續進行供應鏈規劃和風險評估工作。為了應對這種關稅風險環境，他們也正在大力合理化供應商的產品。

Lastly, I would say that we're working hand-in-hand with our partners in our supply chain, our key suppliers as they continue to work on derisking and diversifying their supply chains and specifically away from China. So I do believe that our tariff risk for 2025 is manageable, but I'll reiterate with Sam's opening comment that the environment is extremely fluid. And we are continuing to closely monitor as each day goes forward.

最後，我想說，我們正在與我們的供應鏈合作夥伴、我們的主要供應商攜手合作，繼續致力於降低風險和實現供應鏈多元化，特別是遠離中國。因此，我確實相信我們 2025 年的關稅風險是可控的，但我將重申 Sam 的開場白，即環境極不穩定。我們將繼續密切關注每一天的進展。

Okay. Thanks a lot.

好的。多謝。

Ben Hendrix, RBC Capital Markets.

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

I just have a broader labor-related question. We've heard from providers in the past that recessionary environments generally loosen the nursing labor market. It still seems like there's a lot of competition. Just based on your observations from the past, how reactive is the labor market to recession expectations? And is there any change to your wage inflation forecast in this current environment?

我只是有一個與勞工相關的更廣泛的問題。我們過去從供應商聽說，經濟衰退環境通常會放鬆護理勞動市場。看起來競爭仍然很激烈。僅根據您過去的觀察，勞動市場對經濟衰退預期的反應如何？在當前環境下，您對薪資通膨的預測有什麼變化嗎？

Well, our experiences are different through different recessions. I think in general, your comment, Ben, is right, and that is that the labor market tends to ease somewhat during a recessionary cycle, and that can put some downward pressure on wages. Now we went through the most intense labor market environment from 2021, 2022 and early part of 2023. So our wage trends have come down from that quite significantly.

嗯，在不同的經濟衰退時期，我們的經驗是不同的。我認為總體而言，本，你的評論是正確的，那就是在經濟衰退週期中，勞動力市場往往會有所放緩，這可能會對工資造成一些下行壓力。現在，我們經歷了 2021 年、2022 年和 2023 年初最緊張的勞動市場環境。因此我們的薪資趨勢已經大幅下降。

Will it come down further? Possibly, but it's way too early to provide any kind of forecast with respect to what a potential recession could do to the labor market. I think as we said at this particular point in the year, we believe our guidance around our wages for 2025 will hold and be somewhere close to what we have indicated already.

還會進一步下跌嗎？有可能，但現在就經濟衰退可能對勞動市場造成的影響做出任何預測還為時過早。我認為，正如我們在今年這個時候所說的那樣，我們相信我們對 2025 年工資的指導將保持不變，並接近我們已經指出的水平。

Thank you.

謝謝。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

You guys had strong growth from both inpatient and outpatient cardiac surgeries. How are you using your CapEx to support forward growth of that. Can you give us some insight into how you're thinking about dividing your spend into high acuity versus low acuity or outpatient?

你們的住院和門診心臟手術都取得了強勁成長。您如何使用資本支出來支持其未來成長。您能否向我們介紹一下您如何考慮將支出分為高敏銳度、低敏銳度或門診？

Well, this is Sam. Our capital allocation within our capital spending hasn't really changed, and I don't anticipate it's going to change materially as we push forward here. We have a very significant facility and ambulatory development strategy. Fortunately, the capital requirements for most of those facilities are small by comparison to what it takes to build out inpatient capacity.

嗯，這是薩姆。我們的資本支出中的資本配置實際上並沒有改變，而且我預計隨著我們向前推進，它不會發生實質變化。我們有一個非常重要的設施和門診發展策略。幸運的是，與建造住院容量所需的資金相比，大多數此類設施的資本需求較小。

Today, we have about $6.2 billion of capital that has been approved and is in a construction or development phase that will come online in '25, '26 or the first part of '27. Those capital dollars go toward inpatient capacity. I think our inpatient capacity with respect to that pipeline is roughly 2.5%-plus greater than what we have today. So a significant portion of that goes toward the inpatient capacity.

目前，我們已經獲得批准約 62 億美元的資本，目前正處於建設或開發階段，預計將於 2025 年、2026 年或 2027 年初投入使用。這些資金將用於增加住院容量。我認為我們在這方面的住院容量比現在大約高出 2.5% 以上。因此，其中很大一部分用於住院容量。

We have outpatient capacity that includes outpatient facilities, emergency room capacity, cath lab capacity, as you spoke to, ambulatory capacity from a surgery standpoint, those are smaller dollars in the overall scheme of what it takes to build out those type of facilities. And then obviously, we have a lot of clinical technology that we invest in so that our physicians and patients have the latest access to clinical technologies that can provide a more efficient or a better environment for patient care.

我們的門診容量包括門診設施、急診室容量、心導管室容量，正如你所說的，從手術的角度來看，這些是建造這些設施所需的總體方案中較小的資金。顯然，我們投資了大量臨床技術，以便我們的醫生和患者能夠使用最新的臨床技術，為患者護理提供更有效率或更好的環境。

I don't have the exact equipment spend within all of our totals there, but that is a component as well. So that's largely unchanged. It's growing because we are running the company at high levels of occupancy. We continue to have a nice pipeline of new projects that we think will make sense beyond the ones that we've approved, and it won't be any material change in sort of the allocation of the dollars within those categories.

我沒有我們所有設備支出的確切總額，但這也是一個組成部分。所以基本上沒有變化。它之所以不斷成長，是因為我們以高入住率經營公司。我們繼續擁有一系列不錯的新項目，我們認為這些項目除了我們已經批准的項目之外，還有其他意義，而且這些類別的資金分配不會發生任何實質變化。

Brian Tanquilut, Jefferies.

傑富瑞的布萊恩‧坦奎魯特 (Brian Tanquilut)。

Maybe just a follow up just to the comments that you made in a different light. So as we think about CapEx spend for the quarter, it was a little lower than typical range like 5.4% revenue. So just curious if there's anything there we need to be thinking about and maybe broader capital allocation, good buyback during the quarter. How should we be thinking about pace of repurchases for the year?

也許只是從不同角度跟進您所做的評論。因此，當我們考慮本季的資本支出時，它略低於 5.4% 收入的典型範圍。所以只是好奇我們是否需要考慮任何事情，也許是更廣泛的資本配置，本季的良好回購。我們該如何考慮今年的回購步伐？

Brian, this is Mike. Let me cover the share repurchase first, and then we'll talk about CapEx a bit. So as you will note or you noted in our first-quarter release, we completed $2.5 billion of share repurchase in the first quarter and we anticipate completing a significant portion of the $10 billion authorization in 2025, obviously, subject to market conditions and other factors.

布萊恩，這是麥克。讓我先介紹一下股票回購，然後再談資本支出。因此，正如您所注意到的或您在我們的第一季新聞稿中指出的那樣，我們在第一季度完成了 25 億美元的股票回購，並且我們預計將在 2025 年完成 100 億美元授權中的很大一部分，當然，這取決於市場條件和其他因素。

On CapEx, you're right, I mean we spent $991 million in the quarter which seemed a little light as to your question. We still believe we're on track of getting to the -- to our targeted level of capital spend and anticipate a bit of a step-up here as we go through the remaining part of the year. So we still think we're in this $5 billion -- maybe as high as $5.2 billion of CapEx spend in the year.

關於資本支出，您說得對，我的意思是我們在本季度花費了 9.91 億美元，對於您的問題來說，這似乎有點少。我們仍然相信，我們正朝著實現目標資本支出水準的方向前進，並且預計在今年剩餘時間內，這一數字還會有所提升。因此，我們仍然認為，我們今年的資本支出總額可能在 50 億美元左右——甚至可能高達 52 億美元。

As Sam indicated, we continue to see a robust pipeline of really good projects from our markets. And so I believe that, that level of capital spend is appropriate.

正如 Sam 所指出的，我們繼續看到市場上湧現大量真正優秀的項目。因此我認為，這種程度的資本支出是適當的。

Awesome. Thank you.

驚人的。謝謝。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hoping you can clarify your hurricane commentary. I think first, you noted that hurricane earnings were flat year over year in your impacted markets, but I'm not 100% I understand that because you have two markets that were hurricane impaired in Q1 this year that were not impaired at this time last year. And if that's true, wouldn't that point to a year-over-year tailwind for the full year as those markets continue to improve against a more negative impact in the back half of last year?

希望您能澄清您的颶風評論。我認為，首先，您指出，在受影響的市場中，颶風收益同比持平，但我不能 100% 理解這一點，因為今年第一季有兩個市場受到颶風影響，而去年同期並未受到影響。如果這是真的，那麼隨著這些市場在去年下半年受到較大負面影響後繼續改善，這是否意味著全年將出現同比順風？

Yeah. Thanks, Andrew. This is how we think about it. And you'll recall that when we did our 2025 guidance that our guidance assumed that the impacts of the hurricanes would offset each other during the course of 2025 and would not produce a full-year tailwind for us. As it relates to first quarter, this is largely what played out.

是的。謝謝，安德魯。我們是這樣想的。您會記得，當我們制定 2025 年指導時，我們的指導假設颶風的影響將在 2025 年期間相互抵消，並且不會為我們帶來全年的順風。就第一季而言，情況基本上是如此。

If you take the earnings growth year over year from our two main impacted markets in North Carolina division and West Florida or specifically Largo Medical Center, our earnings were flat year over year. In other words, the year-over-year earnings change was about negative -- about neutral in those two markets year over year. And then I would just point you back to our original guidance for the year as it relates to the full year impact of the hurricanes.

如果從我們受影響最嚴重的兩個市場——北卡羅來納州分部和西佛羅裡達州，特別是拉哥醫療中心來看，其盈利同比增長，那麼我們的盈利同比持平。換句話說，這兩個市場的獲利年增率基本上為負值，基本上為中性。然後，我只想向您指出我們對今年的最初指導，因為它與颶風全年的影響有關。

Matthew Gillmor, KeyBanc.

馬修·吉爾摩（Matthew Gillmor），KeyBanc。

I wanted to ask about the competitive environment in your markets. So with the ongoing policy and macro uncertainty, do you see health system competitors behaving any differently in terms of their CapEx priorities or investments, maybe that creates an opportunity for HCA? Or is the competitive dynamic not really impacted by the macro at this point?

我想詢問一下你們市場的競爭環境。那麼，在持續的政策和宏觀不確定性的情況下，您是否認為醫療系統競爭對手在資本支出優先事項或投資方面的行為有任何不同，也許這為 HCA 創造了機會？或者說，目前的競爭動態其實並未受到宏觀因素的影響？

This is Sam. I would say at this particular point in time, we haven't seen any substantial changes in competitors and how they interact in the market. Now obviously, if NIH funding continues to be challenging for certain academic medical centers that may influence their behaviors and spending. There are other policy adjustments that take place that could play out. We do think with our scale, with our diversification across the portfolio of markets that provides a different level of capability than a lot of our local competitors who tend to only be in one particular market.

這是薩姆。我想說，在這個特定的時間點，我們還沒有看到競爭對手以及他們在市場上的互動方式發生任何實質的變化。顯然，如果 NIH 資金繼續對某些學術醫療中心構成挑戰，這可能會影響他們的行為和支出。也可能出現其他政策調整。我們確實認為，憑藉我們的規模和遍布市場的多元化組合，我們比許多只專注於特定市場的本地競爭對手擁有不同程度的能力。

But our competitors in many instances have solid balance sheets, and we have to be able to anticipate their behaviors and their spending. And as I mentioned in my comments, we have, in fact, regained growing market share in a large portion of our markets. So we're very encouraged by the progress we're making in light of the past spending and practices of our competitors. So if they're compromised in any fashion going forward, then maybe that presents an opportunity for us to pick up even more market share.

但在許多情況下，我們的競爭對手擁有穩健的資產負債表，我們必須能夠預測他們的行為和支出。正如我在評論中提到的那樣，事實上，我們已經在很大一部分市場重新獲得了不斷增長的市場份額。因此，考慮到我們競爭對手過去的支出和做法，我們對自己所取得的進展感到非常鼓舞。因此，如果他們在未來以任何方式受到損害，那麼這也許為我們提供了一個獲得更多市場份額的機會。

Got it. Thank you.

知道了。謝謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Just wanted to talk about the exchanges. First, can you give us the percentage of volumes in revenue in the quarter that came from the exchanges? I apologize if I missed them. And then bigger picture question, just some of the academic work out there, guys, indicates that if the subsidies do go away, there's a real potential that a lot of these folks will go back to commercial-based insurance. I've seen numbers as high as almost half the people that lose coverage via the subsidies would go back to the commercial pool. Just curious if you have any view on that in terms of what could happen there?

只是想談談交流。首先，您能否告訴我們本季來自交易所的收入佔總收入的百分比？如果我錯過了，我深感抱歉。然後是更大的問題，夥計們，一些學術研究表明，如果補貼真的消失，那麼很多人很可能會重新選擇商業保險。我看到的數字是，幾乎有一半因補貼而失去保險的人將回到商業保險體系。我只是好奇，對於那裡可能發生的事情，您有什麼看法？

This is Mike. Specifically on exchanges, let me give you a quick update here. I think you know this, the 2025 was another year of strong enrollment growth. In our states, the growth was about 12% over prior year, and we're up across the United States, now up to 24 million loss covered for HCA in the quarter, the exchange volume represented about 8% of equivalent admissions and about 10% of our revenues. So that's the update for the quarter.

這是麥克。具體來說，關於交易所，讓我在這裡向大家簡要介紹一下最新情況。我想你知道這一點，2025 年又是入學人數強勁成長的一年。在我們所在的州，成長率比上年同期成長了約 12%，並且我們在全美範圍內都有所增長，本季度 HCA 的損失已彌補至 2400 萬美元，交易量約佔等效入場人數的 8% 和我們收入的 10%。這就是本季的更新情況。

I think there's still a lot of unknowns here about what could happen if the EPTC, the enhanced premium tax credits do sunset and -- or not extending their current form or through some revised form. And so we're going to have to wait and see exactly how it plays out, and we're really not in a position to comment on estimates related to how many go back to employee-sponsored insurance, although I think we generally agree that there will be some that would go back to employee-sponsored insurance.

我認為，如果 EPTC、增強保費稅收抵免確實終止，或者不延長其目前的形式或透過某種修改的形式，會發生什麼，這裡仍然存在許多未知數。因此，我們將不得不拭目以待，看看事情究竟如何發展，我們實際上無法評論有關有多少人會回到員工贊助的保險的估計，儘管我認為我們普遍認為會有一些人回到員工贊助的保險。

I think there'll be some that would stay on the exchanges and maybe drop (inaudible). And then others that if these enhanced premium tax credits do sunset that would lose coverage and become uninsured. And so we're not in a position yet until we have a little more clarity around what's going to happen in the legislative environment, just to specifically size it or comment on others' research in this space.

我認為有些會留在交易所，但可能會掉下來（聽不清楚）。其他人則認為，如果這些增強的保費稅收抵免確實到期，人們將失去保險，變得沒有保險。因此，在我們更清楚立法環境將會發生什麼之前，我們還不能具體地確定其規模或對其他人在這個領域的研究進行評論。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

Thanks so much for taking the question. I guess maybe first on just clarifying the comment around your DPP benefits, you said it increased year over year by $80 million. So can you confirm whether there was anything unusual in there? Is it as expected what you had expected in the quarter? And do you still expect the full year, to be flat to down $150 million.

非常感謝您回答這個問題。我想也許首先要澄清一下有關您的 DPP 福利的評論，您說它比去年同期增加了 8000 萬美元。那麼你能確認那裡是否有任何異常嗎？本季是否符合您的預期？您是否仍預期全年銷售額將持平或下降 1.5 億美元？

Joanna, this is Mike. So yes, during the quarter, we recognized an approximately $80 million increase in our net benefit year over year. The largest driver of this is really the increase in one state where we received a reconciliation payment and began accruing for that program in Q4 of last year. So that was what drove it. As we've talked about on past calls, the projecting or the guidance related to state supplemental payment programs are really the most difficult thing that we predict.

喬安娜，這是麥克。是的，在本季度，我們的淨利潤年增了約 8,000 萬美元。造成這一現象的最大驅動因素實際上是某個州的付款額度增加，我們在該州收到了一筆和解付款，並從去年第四季開始為該計劃累積款項。這就是推動它的原因。正如我們在過去的電話會議中談到的那樣，與國家補充支付計劃相關的預測或指導確實是我們預測的最困難的事情。

And so we keep those updated for you when we meet quarterly, obviously, on the calls. I would say now based on what we know now after our first-quarter activity, that we would be thinking about for a full-year '25 versus '24, something like $50 million better to a $200 million decline now. So that would be the general update that we could give you on range.

因此，當我們每季召開電話會議時，我們顯然會為您更新這些資訊。我想說的是，根據我們在第一季活動之後所了解的情況，我們會考慮 2025 年全年與 2024 年相比，大約是增長 5000 萬美元，而現在則下降 2 億美元。這就是我們可以向您提供的有關範圍的一般更新。

As it relates to just kind of a general update on state supplemental payment programs, we continue to generally get a flow of funds on our legacy programs. I would say that we were encouraged over the last couple of weeks that we've seen a couple of approvals by CMS, one in Arizona and one in Nevada that were hopeful. And so largely, that would be kind of where we are right now in state supplemental payment programs.

由於它與國家補充支付計劃的一般更新有關，我們通常會繼續從我們的遺留計劃中獲得資金流。我想說的是，過去幾週我們看到了 CMS 的幾項批准，一項來自亞利桑那州，另一項來自內華達州，這讓我們感到鼓舞。基本上，這就是我們目前在國家補充支付計劃中所處的狀態。

I'm sorry. So you said that Arizona Nevada approved. So is that the reason why you're thinking DPP payment for the year higher or there was just something that happened in Q1 that this $80 million makes you feel better about the year?

對不起。所以你說亞利桑那州內華達州批准了。那麼，這就是您認為今年的 DPP 支付額更高的原因嗎？還是只是因為第一季發生了一些事情，這 8000 萬美元讓您對今年的支付額感覺更好？

Yeah. I think that the Q1 outcome was a bit better than we expected. Our expectation was really that the first half of the year would be flat with potential declines primarily coming in the back half of the year. So based on this first-quarter net benefit we are comfortable now sizing or estimating that the supplemental payments would be something like $50 million better for the full year to a $200 million decline.

是的。我認為第一季的結果比我們預期的要好一些。我們實際上的期望是，今年上半年將保持平穩，而潛在的下降主要出現在下半年。因此，基於第一季的淨利潤，我們現在可以放心地估算或判斷，補充支付將使全年淨利潤增加 5,000 萬美元，而減少 2 億美元。

Really, that range is largely associated with Tennessee, Joanna. And we -- first of all, let me just say we did not report anything related to Tennessee in the quarter and that we have not received approval for Tennessee at this point.

確實，這個範圍很大程度上與田納西州有關，喬安娜。首先，我要說的是，我們本季沒有報告任何與田納西州有關的事情，而且我們目前還沒有收到田納西州的批准。

Because that was my question. So just to clarify, do you still assume Tennessee benefits in that full-year number, correct?

因為這就是我的問題。因此，只是為了澄清一下，您是否仍然假設田納西州的全年收益為正確金額？

So let's take the quarter first. We reported nothing in Tennessee in the quarter, in the first quarter. So the back half of 2024 interim payment was not received. We did not report it, and we have not received approval for the 2025 calendar year program from CMS.

我們先來看看本季。我們在第一季沒有報告田納西州的情況。因此，2024 年下半年的臨時付款尚未收到。我們沒有報告此事，而且我們也沒有收到 CMS 對 2025 日曆年計劃的批准。

The guidance, if you think about this range of guidance from a $50 million improvement to prior year for the full year to a $200 million decline, largely that range is associated with whether or not Tennessee gets approved. And so that's how I would context that for you, Joanna.

如果您考慮這個指導範圍，從比去年全年增加 5000 萬美元到減少 2 億美元，那麼這個範圍很大程度上與田納西州是否獲得批准有關。這就是我要向你解釋的情況，喬安娜。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

I'm wondering just how the surgical schedules and block time utilization kind of looking and progressing. I'm not trying to get quarterly guidance, but just wondering if we can glean anything just given potentials for tariffs, recession, and just consumer confidence declining. Wondering if there's having any impact on the elective procedural side and patient behavior?

我想知道手術安排和時間段利用情況如何，進展如何。我並不是想獲得季度指導，只是想知道，考慮到關稅、經濟衰退和消費者信心下降的可能性，我們是否可以收集到任何資訊。想知道這是否會對選擇性手術方面和患者行為產生影響？

This is Sam. I don't have that information in front of us as far as forward scheduling. We have systems within each of our facilities where that information is available. We don't roll that up at the corporate level. So I'm not able to give you that answer at this point.

這是薩姆。就未來安排而言，我目前還沒有這方面的資訊。我們每個設施內都有提供該資訊的系統。我們不會在公司層面實施這項措施。所以我現在還不能給你答案。

I think, again, in general, we think demand for healthcare is going to be there. Our inpatient surgeries up on a per business day. So as we normalize calendar effects and we have sort of comparable calendar dynamics, we expect our surgical volumes to recover to levels that we think are in line with market share trends or market share gains that we have expected. So that's how we're thinking about it.

我認為，總的來說，我們認為對醫療保健的需求將會存在。我們的住院手術按工作日進行。因此，當我們使日曆效應正常化並且我們有類似的日曆動態時，我們預計我們的手術量將恢復到我們認為符合市場份額趨勢或我們預期的市場份額增長的水平。這就是我們的想法。

And we continue to build our medical staff, which are critically important. As I mentioned, we're adding facilities where we need to adding technology. We've got a robust workforce development agenda to support our surgical services and we continue to make inroads into better operations, which are beneficial to our physicians and surgeons and beneficial to our patients. So all that's sort of converging on our viewpoints that surgical demand is reasonable and we can execute underneath that.

我們將繼續建立我們的醫務隊伍，這至關重要。正如我所提到的，我們正在需要添加技術的地方添加設施。我們擁有強大的勞動力發展計劃來支持我們的外科服務，我們將繼續努力實現更好的運營，這有利於我們的醫生和外科醫生，也有利於我們的患者。所以，所有這些都表明我們的觀點是，手術需求是合理的，我們可以在這種合理的情況下執行。

Okay. Thanks.

好的。謝謝。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究。

I was wondering if you could speak to your technology agenda and maybe specifically some investments that you think differentiate HCA on the clinical care side and I'm going to assume that AI is a part of that conversation.

我想知道您是否可以談談您的技術議程，特別是您認為在臨床護理方面區分 HCA 的一些投資，我認為 AI 是這次對話的一部分。

We are investing heavily in our tech agenda. One of the key initiatives that we have within our strategic plan is advancing technology and applying it broadly to the organization. We set up a new function department in our company called the Digital Transformation and Innovation Group, and they are leading the charge for us as we push forward on this particular initiative. We have three areas that we think we can benefit our business using better digital tools, using automation, and using AI.

我們正在大力投資我們的技術議程。我們的策略計劃中的一項關鍵舉措是推進技術並將其廣泛應用於組織。我們在公司設立了一個新的職能部門，稱為數位轉型與創新集團，他們將帶領我們推動這項特定措施。我們認為有三個領域可以使我們的業務受益：使用更好的數位工具、使用自動化和使用人工智慧。

The first categories are administrative functioning. When you think about our Parallon services or supply chain services, human resource functioning and so forth, we have early tools that are being developed and implemented in those areas, which are incrementally adding value. The second category for us is operational. And by that, I mean what goes on in our facilities, primarily our hospitals where we can improve staffing and scheduling and create better tools for our management teams, better tools and insights for our employees as they schedule to meet their needs.

第一類是行政職能。當您考慮我們的 Parallon 服務或供應鏈服務、人力資源功能等時，我們在這些領域已經開發和實施了早期的工具，這些工具正在逐步增加價值。對我們來說，第二類是操作性的。我指的是我們設施中發生的事情，主要是我們的醫院，我們可以在那裡改善人員配備和時間安排，為我們的管理團隊創造更好的工具，為我們的員工提供更好的工具和見解，以滿足他們的需求。

Another area in our operational categories is with case management functions as it relates to length of stay management, as it relates to prior authorizations, all of these things that go into the operations at a facility level we are deploying tools in those areas.

我們營運類別中的另一個領域是個案管理功能，因為它與住院時間管理有關，與事先授權有關，所有這些都涉及設施層級的運營，我們正在這些領域部署工具。

And then the holy grail for us is clinical, as you mentioned. We do have some opportunities there. We're slowly moving into that space where we can use, again, some digital tools, we can use our data to source best practices, and we're working to create value for our physicians and our caregivers in a way that they have the advantages that come from those insights.

正如您所說，我們的終極目標是臨床。我們確實在那裡有一些機會。我們正在慢慢進入這個領域，我們可以使用一些數位工具，我們可以使用我們的數據來獲取最佳實踐，我們正在努力為我們的醫生和護理人員創造價值，使他們能夠從這些見解中獲得優勢。

We're early in that space because it's very important that we be accurate. It's very important that we'd be compliant and that the tools that we provide truly add value. And we've got some areas, obstetrics, where we're working with one of our partners where we think we can improve labor and delivery process with these tools, and we've got early signs of success there. But it's really early in that particular category.

我們處於該領域的早期階段，因為準確性非常重要。我們必須遵守規定，我們提供的工具必須真正增加價值，這一點非常重要。在產科等一些領域，我們正在與我們的合作夥伴合作，我們認為我們可以利用這些工具來改善分娩過程，並且我們已經取得了成功的早期跡象。但對於這個特定類別來說，現在還為時過早。

So I'm encouraged by where we are. We continue to find ways to advance the use of digital tools and technology across the different spectrum of our business. And that, I believe, is going to be something that we build upon in the years to come.

所以我對我們的現狀感到鼓舞。我們不斷尋找方法來推動數位工具和技術在我們業務的不同領域的使用。我相信，這將是我們未來幾年繼續努力的基礎。

Great. Thanks.

偉大的。謝謝。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Just another question kind of the managed care, the 5.4% you gave on the managed care volumes. Just to make sure, was that inclusive of the exchanges or excluding that? I think if it's including that, would you be able to give just a standalone managed care exchange number for the quarter?

關於管理式醫療的另一個問題，您給予的管理式醫療量為 5.4%。只是為了確認一下，這是否包括了交換還是不包括交換？我認為如果包括這一點，您能否給出本季的獨立管理式醫療交換號碼？

Yeah, this is Mike. So the 5.4% equivalent admission same facility growth in total managed care does include exchanges. If you parse those apart, the exchanges were up 22% and the kind of core (inaudible) employee-sponsored insurance was up about, let's just call it, just short of 0.5 point over prior year.

是的，我是麥克。因此，整體管理醫療中 5.4% 的等效入院相同設施成長率確實包括了交易所。如果將這些分開分析，你會發現交易所上漲了 22%，而核心（聽不清楚）員工贊助保險的漲幅大約為，我們就這麼說吧，比上年略高出 0.5 個百分點。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

I'm going to be the slow child in class, so forgive me. But if we're just to look at Asheville and Largo, is your new guidance assume that the EBITDA is now flat in '25 versus '24.

我將成為班上最慢的孩子，所以請原諒我。但如果我們只看阿什維爾和拉哥，您的新指導是否假設 25 年的 EBITDA 與 24 年持平。

So the guidance -- if you think about the full-year guidance we gave on our fourth-quarter '24 earnings call, what we indicated is that we thought with the lingering effects of the hurricane that the earnings -- year-over-year earnings impact of the hurricane-affected markets would kind of be flat, would be neutral and would not produce a tailwind for the company.

因此，如果您考慮我們在 2024 年第四季度收益電話會議上給出的全年指引，我們表明，我們認為，由於颶風的持續影響，受颶風影響的市場對收益的同比影響將比較平穩、中性，不會給公司帶來順風。

But the report out here in our first quarter call is that's largely what played out. So if you think about the year-over-year earnings change in West Florida, in the Largo area, compared to the year-over-year earnings change in North Carolina is flat -- were flat, and they offset each other to a large degree, and that's our update for the first quarter.

但我們在第一季電話會議上發布的報告顯示，情況基本上就是這樣的。因此，如果您考慮西佛羅裡達州、拉哥地區的同比收入變化，與北卡羅來納州的同比收入變化相比，它們是持平的 - 持平的，並且它們在很大程度上相互抵消，這就是我們對第一季度的更新。

Okay. Thank you.

好的。謝謝。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Can you talk a little bit about how you're seeing the downstream impacts from the pressure on the managed care organizations, both in the quarter and the outlook going forward for the year? And what I'm thinking about is increased use or not increased use of value-based care? Are you seeing any of the changes in deductibles or out of pocket for consumers and some of the products having impacts on bad debt or utilization. And then just a point of clarification. What do you see as far as flu impacts both to the positive and negative in the quarter?

您能否稍微談談您如何看待管理式醫療組織所承受的壓力對本季以及今年前景的下游影響？我在想的是是否增加使用基於價值的照護？您是否看到消費者的免賠額或自付費用發生了任何變化，並且某些產品對壞帳或利用率產生了影響。然後只是澄清一點。您認為流感對本季有何正面和負面影響？

So let me cover respiratory first, and then we'll get to the -- your payer questions. On respiratory volumes, I would refer you back to fourth quarter where clearly, in fourth-quarter '24, our respiratory-related volumes were behind prior year, and we indicated that the respiratory season had a bit of a late start compared to the previous year.

因此，讓我先介紹一下呼吸系統，然後我們再討論付款人的問題。關於呼吸量，我想請您回顧一下第四季度，顯然，在 24 年第四季度，我們的呼吸相關量落後於去年，並且我們指出，與去年相比，呼吸季節開始得有點晚。

So what we saw in first quarter of '25 was they were pretty significantly up over fourth quarter of '24. But when I look at first quarter of '25 compared to first quarter of '24, our respiratory volumes in total were pretty much in line. They were just a tick to prior year, our first-quarter '24, pretty much in line with prior year levels. And you may recall, but if you go back to that prior year flu season, it started early, so it started kind of at the beginning of the fourth quarter of '23, and it persisted pretty much through the end of first quarter at 24%. So that's the year-over-year comp on the respiratory season.

因此，我們看到 25 年第一季的銷售額比 24 年第四季大幅成長。但是，當我將 25 年第一季與 24 年第一季進行比較時，我們的總呼吸量基本上一致。與去年同期相比，也就是 2024 年第一季度，它們只是略有下降，與去年同期水準基本持平。您可能還記得，但如果您回顧去年的流感季節，它開始得比較早，大約在 2023 年第四季度初就開始了，並且一直持續到第一季末，發病率達到 24%。這就是呼吸季節的同比情況。

When I think about the impact on patient receivables and you'll remember from past conversations on this over the years. But we monitor this closely and what we're looking at is kind of what happens over time to the patient portion or the patient balance as the employer benefit plan changes or design changes are made every year.

當我考慮對患者應收帳款的影響時，您會記得多年來關於此事的討論。但我們會密切監控這一點，我們關注的是隨著雇主福利計劃每年變化或設計每年發生變化，患者部分或患者餘額會發生什麼變化。

Historically, for our commercial payers, we experienced increases in average patient balances in the mid-single-digit range on an annual basis. In our recent quarters, we have seen increases a little higher than that, but not material. The increases certainly have been influenced by growth in health -- the exchange volumes, which tend to have a slightly higher patient responsibility compared to traditional commercial.

從歷史上看，對於我們的商業付款人而言，我們每年的平均患者餘額增長在中等個位數範圍內。在最近幾季中，我們看到增幅略高於此，但並不顯著。這種增長肯定受到了醫療保健增長的影響——與傳統商業相比，醫療保健的交易量往往對患者的責任略高。

On collectability, we generally maintain our historical level of collection on patient balances across either kind of our population. As it relates to the exchanges, the range of collections on patient balances is a bit lower than the traditional employees sponsored insurance population. But while lower, the exchanges have not had a material impact on the collectability of our patient receivables in the aggregate. So that's a bit of an update there on patient receivables.

在可收集性方面，我們通常會維持針對任何類型的人群的患者餘額的歷史收集水準。就交易所而言，病患餘額的收取範圍比傳統員工贊助的保險族群低。但是，儘管金額較低，但這些交易總體上並沒有對我們患者應收帳款的可收回性產生重大影響。這是關於患者應收帳款的一些更新資訊。

I think it's safe to say, Mike, that value-based care, co-pays, and deductibles are in any fashion disrupting the demand curve. And that's sort of our overarching view when we look across our markets and we look at what demand trends suggest we don't see those items influencing in any material way our thinking around overall demand.

麥克，我認為可以肯定地說，基於價值的護理、共同支付和免賠額無論如何都會擾亂需求曲線。當我們縱觀整個市場並觀察需求趨勢時，這就是我們的總體觀點，我們認為這些項目不會以任何實質的方式影響我們對整體需求的思考。

Ben Rossi, JPMorgan.

摩根大通的班羅西。

Thanks for taking my questions. So for the executive order from the other week, there was a call out on hospital admission costs for covered outpatient drugs at HOPDs. It sounds like this will be more geared towards drug administration. I appreciate the uncertainty here with the broader discussion on Medicare site neutral in your opening comments. But just curious how you're thinking about the initial impact here. Will this encompass more of a lower acuity set of procedures relative to your broader set of outpatient services?

感謝您回答我的問題。因此，根據上週的行政命令，要求對 HOPD 的門診藥品收取住院費用。這聽起來更適合藥物管理。我很欣賞您在開場白中對醫療保險網站中立性進行更廣泛的討論所帶來的不確定性。但我只是好奇您如何看待這裡的最初影響。相對於更廣泛的門診服務，這是否會包含更多低敏銳度的程序？

Yes. So we're certainly aware of the executive order from the administration on potentially our directing agencies to lower drug prices. We're going to have to see the draft rules that come out of this. We believe it will be part of a public comment and notice period and we're going to need that additional specificity to be able to kind of comment on what potential impact it could have on HCA.

是的。因此，我們當然知道政府可能會發布行政命令，要求我們的指導機構降低藥品價格。我們將必須看到由此產生的規則草案。我們相信這將是公眾評論和通知期的一部分，我們將需要額外的具體資訊才能評論它可能對 HCA 產生的潛在影響。

Got it.

知道了。

Craig Hettenbach, Morgan Stanley.

摩根士丹利的克雷格·赫滕巴赫。

Just, Sam, going back to the demand backdrop, can you just talk about the durability of demand in particular in light of the equivalent admissions growth target of 3% to 4% this year, kind of how you see that playing out.

山姆，回到需求背景，您能否談談需求的持久性，特別是考慮到今年 3% 至 4% 的入學成長目標，您如何看待這種情況。

Well, as I've just mentioned, I don't think we are seeing anything currently that suggest that the demand assumptions that we have are wrong. We looked at the first quarter, if you take the leap year effect in, our adjusted admissions were almost 3.8% up. So that's a really good metric for us. And we're encouraged by that year-over-year growth, as we mentioned.

嗯，正如我剛才提到的，我認為我們目前沒有看到任何表明我們的需求假設是錯誤的跡象。我們來看看第一季度，如果考慮閏年效應，我們的調整後入院人數增加了近 3.8%。所以這對我們來說是一個非常好的指標。正如我們所提到的，我們對這種同比增長感到鼓舞。

From a competitive standpoint, we don't feel like there's anything happening that's compromising our ability to gain share. From sort of a model standpoint, I just mentioned that value-based care and the other efforts aren't necessarily negatively influencing demand. And so as we push through the rest of this year, we continue to believe that our range of assumptions around volumes hold and should materialize unless something dramatic happens. And at this point, we don't know what that would be.

從競爭的角度來看，我們並不認為有什麼事情會損害我們獲得市場份額的能力。從模型的角度來看，我剛才提到基於價值的護理和其他努力不一定會對需求產生負面影響。因此，當我們度過今年剩餘的時間時，我們仍然相信，我們圍繞產量做出的一系列假設仍然成立，並且應該會實現，除非發生一些戲劇性的事情。目前我們還不知道那會是什麼。

Understood. Thanks for the color.

明白了。謝謝你的顏色。

And ladies and gentlemen, that concludes our question-and-answer session. I will now turn the conference back over to Mr. Frank Morgan for closing remarks.

女士們、先生們，我們的問答環節到此結束。現在我將會議交還給弗蘭克·摩根先生，請他致閉幕詞。

Abby, thank you for your help today, and thanks to everyone for joining our call. Hope you have a good weekend. I'm around this afternoon, if you have any additional questions -- to answer any additional questions you might have. Thank you.

艾比，謝謝你今天的幫助，也謝謝大家參加我們的電話會議。祝你周末愉快。如果您還有其他問題，我今天下午會在您身邊——可以回答您可能有的任何其他問題。謝謝。

And this concludes today's call. We thank you for your participation. You may now disconnect.

今天的電話會議到此結束。我們感謝您的參與。您現在可以斷開連線。