美國醫院公司 (HCA) 2025 Q3 法說會逐字稿

Hello, and welcome to the HCA Healthcare third quarter 2025 earnings conference call. Today's call is being recorded. At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

您好，歡迎參加 HCA Healthcare 2025 年第三季財報電話會議。今天的通話正在錄音。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, Samuel Hazen; and CFO, Mike Marks m. Sam and Mike will provide some prepared remarks, and then we'll take questions. Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements, they are based on management's current expectations. Numerous risks, uncertainties and other factors may cause actual results to differ materially from those that might be expressed today.

早安，歡迎大家參加今天的電話會議。今天早上和我一起出席的是我們的執行長 Samuel Hazen 和財務長 Mike Marks m。 Sam 和 Mike 將發表一些準備好的講話，然後我們將回答問題。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。

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

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。在今天早上的電話會議上，我們將參考調整後的 EBITDA 等指標，這是一種非 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。今天早上的通話正在錄音中，今天晚些時候可以重播。

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

說完這些，我現在將電話轉給 Sam。

All right. Good morning and thank you for joining the call. As reflected in our earnings release for the third quarter, the company produced strong results when compared to last year, with 42% growth in diluted earnings per share as adjusted. Revenue increased by 9.6%, which was driven by broad-based volume growth, improved payer mix, more utilization of complex services and additional revenue from Medicaid supplemental programs.

好的。早上好，感謝您參加電話會議。正如我們第三季的收益報告所反映的那樣，與去年相比，該公司的業績表現強勁，經調整後的每股攤薄收益增長了 42%。收入增長了 9.6%，這得益於廣泛的銷售增長、付款人組合改善、複雜服務的利用率提高以及醫療補助補充計劃的額外收入。

We also translated its revenue growth into better margins with disciplined operations. As a result, you will see in this morning's release that we raised our guidance for the year to reflect this performance and our outlook for the fourth quarter.

我們也透過嚴謹的營運將其收入成長轉化為更高的利潤率。因此，您將在今天上午的發布中看到，我們提高了今年的業績預期，以反映這一表現以及我們對第四季度的展望。

Our teams continue to execute our agenda at a high level. across many operational measures, including quality and key stakeholder satisfaction, outcomes were better year-over-year. I want to thank our 300,000 HCA colleagues who once again demonstrated excellence in what they do.

我們的團隊繼續高水準地執行我們的議程。在許多營運指標（包括品質和關鍵利害關係人滿意度）方面，結果比去年同期更好。我要感謝我們 30 萬名 HCA 同事，他們再次展現了卓越的工作表現。

As a team, we remain disciplined in our efforts to improve care for our patients by increasing access, investing in advanced digital tools and training our people. These investments allow us to enhance capacity, improve service offerings and gain efficiency, making it easier for our patient -- for us to provide better services to our patients, physicians and the communities we serve.

作為一個團隊，我們始終嚴格遵守紀律，努力透過增加就診機會、投資先進的數位工具和培訓員工來改善對患者的照護。這些投資使我們能夠增強能力、改善服務並提高效率，使我們的患者能夠更輕鬆地為我們的患者、醫生和我們服務的社區提供更好的服務。

Typically, on our third quarter earnings call, we provide some preliminary perspective on the upcoming year. Before I get to these, I want to comment on the enhanced premium tax credits. We continue to advocate strongly for the extension of this program for the 24 million Americans who depend on it for health insurance coverage.

通常，在第三季財報電話會議上，我們會對來年提供一些初步的看法。在談論這些之前，我想先評論一下增強的保費稅收抵免。我們繼續大力倡導將該計劃擴展到依賴其獲得醫療保險的 2,400 萬美國人。

Today, we believe there is greater recognition by legislators of the negative impact this issue will have on families, small businesses and individuals than earlier in the year. At this point, however, we still do not know how this policy will play out. Because of the fluid nature of the federal policy environment, we will limit our early thoughts for 2026 to our views on demand and the cost environment.

今天，我們相信立法者比今年早些時候更認識到這個問題對家庭、小型企業和個人的負面影響。但目前我們仍不知道這項政策將如何發揮作用。由於聯邦政策環境的流動性，我們將把對 2026 年的早期思考限制在對需求和成本環境的看法。

We continue to see solid demand across our markets for health care services and believe volumes will be within our long-term 2% to 3% growth range. As it pertains to operating costs, we expect mostly stable trends consistent with the past couple of years.

我們繼續看到整個市場對醫療保健服務的需求強勁，並相信其銷售量將在長期 2% 至 3% 的成長範圍內。就營運成本而言，我們預計其趨勢與過去幾年基本保持穩定。

As usual, there are some pressures in certain areas, but we believe our resiliency plan should provide some relief. It is important to note that we are still early in next year's planning process, and these preliminary views may change before our fourth quarter's earnings call when we will provide you with our guidance for 2026. So let me close with this.

像往常一樣，某些領域存在一些壓力，但我們相信我們的彈性計劃應該能夠緩解一些壓力。值得注意的是，我們仍處於明年規劃過程的早期階段，這些初步觀點可能會在我們第四季度財報電話會議之前發生變化，屆時我們將向您提供 2026 年的指導。讓我以此作為結束。

As we work to complete another successful year for HCA Healthcare, we believe the company is well positioned to sustain high levels of performance in the years to come. Organizationally, we have strengthened enterprise capabilities to execute at a higher level through our previously restructured management team and improved management systems.

在我們努力為 HCA Healthcare 創造另一個成功的一年的同時，我們相信公司已做好準備，在未來幾年保持高水準的表現。在組織上，我們透過先前重組的管理團隊和改進的管理體系，增強了企業更高層級的執行能力。

Competitively, our networks have enhanced service offerings for patients with more outpatient facilities, greater inpatient capacity and improved operations. And financially, because of the increased cash flow and stronger balance sheet, we have the resources to invest more in our strategic agenda.

在競爭方面，我們的網路透過更多的門診設施、更大的住院容量和改進的營運為患者提供了增強的服務。從財務角度來看，由於現金流增加和資產負債表增強，我們有資源在策略議程上投入更多資金。

With that, I will turn the call over to Mike for more information on the quarter and our updated guidance.

接下來，我將把電話轉給麥克，以了解有關本季和我們更新的指導的更多資訊。

Thank you, Sam, and good morning. The company produced solid results during the third quarter. The demand for health care services was strong in the third quarter with same facility equivalent admissions increasing 2.4% over the prior year.

謝謝你，山姆，早安。該公司第三季取得了穩健的業績。第三季醫療保健服務需求強勁，同等設施的入院人數比前一年增加 2.4%。

Our surgical volume growth also improved with same facility inpatient surgical volume of 1.4% and outpatient surgical volume of 1.1% in the third quarter over the prior year. Same-facility ER visits increased 1.3% in the quarter over the prior year. Commercial and Medicare ER visits combined increased 4.1% in the third quarter of 2025 to prior year, whereas Medicaid and self-pay ER visits were both down to prior year.

我們的手術量成長也有所提高，第三季同一機構的住院手術量比去年同期成長 1.4%，門診手術量增加 1.1%。本季同一機構急診室就診人數比去年同期增加了 1.3%。2025 年第三季度，商業和醫療保險急診就診次數比前一年增加了 4.1%，而醫療補助和自費急診就診次數均比上年有所下降。

We have also seen a slow start to the respiratory season in 2025, which is impacting the year-over-year growth rate in our admissions and ER visits by an estimated 50 basis points and 70 basis points, respectively.

我們也看到 2025 年呼吸道疾病季節開始緩慢，這將對我們的入院人數和急診就診人數的同比增長率分別產生約 50 個基點和 70 個基點的影響。

Our net revenue per equivalent admission growth in the quarter reflected strong payer mix, improved dispute resolution results, consistent case mix index and increased Medicaid state supplement payment revenues.

本季我們的等效入院淨收入成長反映了強勁的付款人組合、改善的爭議解決結果、一致的病例組合指數以及增加的醫療補助州補充支付收入。

Regarding payer mix during the quarter, same-facility total commercial equivalent admissions increased 3.7% over prior year with exchanges growing 8% and commercial excluding exchanges, growing 2.4%. Medicare increased 3.4% Medicaid increased 1.4% and self-pay declined 6%.

就本季的付款人結構而言，同一設施的商業等效總入場人數比上年增長了 3.7%，其中交易所增長了 8%，不包括交易所的商業入場人數增長了 2.4%。醫療保險增加了 3.4%，醫療補助增加了 1.4%，自付費用減少了 6%。

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 cost to treat Medicaid patients. Considering these programs in isolation, the revenue growth from these programs drove about half of the overall increase in net revenue per equivalent admission in the third quarter compared to prior year. And we saw an approximate $240 million increase in net benefit to adjusted EBITDA from these programs in the third quarter of 2025 over the prior year.

關於醫療補助補充支付計劃，正如我們過去所說，這些計劃很複雜，時間上變化很大，並且不能完全涵蓋我們治療醫療補助患者的費用。單獨考慮這些項目，這些項目的收入增長推動了第三季度與去年同期相比每張等效門票淨收入總體增長的約一半。我們發現，2025 年第三季這些項目帶來的調整後 EBITDA 淨收益比前一年增加了約 2.4 億美元。

This increase was largely driven by Tennessee program payments and the approvals of grandfathered applications in Kansas and Texas. We were pleased with our operating leverage and expense management in the quarter. The improvement in adjusted EBITDA margin was driven primarily by good performance in labor and supplies. As expected, we did see contract labor expenses flat in the prior year.

這一增長主要得益於田納西州的計劃付款以及堪薩斯州和德克薩斯州祖父條款申請的批准。我們對本季的營運槓桿和費用管理感到滿意。調整後的 EBITDA 利潤率的提高主要得益於勞動力和供應方面的良好表現。正如預期的那樣，我們確實看到合約工費用在上一年持平。

Same-facility contract labor was basically flat in third quarter of 2025 to the prior year and represented 4.2% of total labor cost in the third quarter of 2025. The increase in other operating expenses as a percentage of revenue in the quarter was driven primarily by increased expenses related to Medicaid state supplemental payments, and to a lesser extent, professional fees compared to the prior year.

2025 年第三季度，同設施合約勞動力與去年基本持平，佔 2025 年第三季總勞動成本的 4.2%。本季其他營運費用佔收入的百分比增加，主要是由於與醫療補助州補充支付相關的費用增加，以及與去年相比專業費用的增加（但程度較小）。

Our work progress to both enhance and accelerate our resiliency program as we prepare for the future. Through these efforts, we continue to identify a robust set of opportunities across revenue and cost to improve efficiencies. The growth in our adjusted EBITDA in the third quarter reflects our strong operating performance and the increase in supplemental payments. We would also note the estimated $50 million impact from the hurricanes in third quarter of 2024.

我們的工作進展既加強了我們的彈性計劃，也加速了我們的彈性計劃，為未來做好了準備。透過這些努力，我們繼續在收入和成本方面尋找一系列強有力的機會來提高效率。第三季調整後的 EBITDA 成長反映了我們強勁的經營業績和補充支付的增加。我們還要指出的是，2024 年第三季颶風造成的損失預計為 5,000 萬美元。

Moving to capital allocation. We continue to execute our strategy of allocating capital for long-term value creation. Cash flow from operations was $4.4 billion in the quarter, with $1.3 billion in capital expenditures, $2.5 billion in share repurchases and $166 million in dividends.

轉向資本配置。我們繼續執行配置資本以創造長期價值的策略。本季經營現金流為 44 億美元，其中資本支出 13 億美元，股票回購 25 億美元，股利 1.66 億美元。

Year-to-date, we've been able to defer approximately $1.3 billion in federal income tax payments to the fourth quarter due to the IRS providing relief to Tennessee taxpayers in the aftermath of severe weather in the early April.

今年迄今為止，由於美國國稅局在 4 月初惡劣天氣之後向田納西州納稅人提供了減稅，我們已能夠將約 13 億美元的聯邦所得稅繳納推遲到第四季度。

Our debt-to-adjusted EBITDA leverage remained in the lower half of our steady guidance range, and we believe our balance sheet is strong and well positioned for the future. So with that, let me speak to our 2025 guidance. As noted in our release this morning, we are updating the full year guidance as follows, we expect revenues to range between $75 million and $76.5 billion. We expect net income attributable to HCA Healthcare to range between $6.50 billion and $6.72 billion. We expect adjusted EBITDA to range between $15.25 billion and $15.65 billion.

我們的債務與調整後 EBITDA 槓桿率仍處於穩定指導範圍的下半部分，我們相信我們的資產負債表強勁且為未來做好了準備。因此，讓我來談談我們的 2025 年指引。正如我們今天早上發布的新聞稿中所述，我們正在更新全年指引，預計收入將在 7,500 萬美元至 765 億美元之間。我們預計HCA Healthcare的淨收入將在65億美元至67.2億美元之間。我們預計調整後的 EBITDA 將在 152.5 億美元至 156.5 億美元之間。

We expect diluted earnings per share to range between $27 and $28. We expect capital spending to be approximately $5 billion. We now anticipate our supplemental payment full year net benefit to be $250 million to $350 million favorable comparing full year 2025 versus 2024.

我們預計每股攤薄收益將在 27 美元至 28 美元之間。我們預計資本支出約為 50 億美元。我們現在預計，與 2024 年全年相比，2025 年全年補充支付淨收益將達到 2.5 億至 3.5 億美元。

This guidance update does not include any potential impact in 2025 from any additional approvals of grandfathered applications under the act. And at the midpoint, this guidance assumes a $120 million decline in net benefit from Medicaid state supplemental payments in fourth quarter of 2025 versus the prior year due to onetime payments in the price.

本指南更新不包括 2025 年根據該法案額外批准祖父條款申請可能產生的影響。而在中間點，該指南假設由於價格的一次性支付，2025 年第四季醫療補助州補充支付的淨收益將比前一年減少 1.2 億美元。

Consistent with our comments on second quarter call, we believe our hurricane-impacted markets will produce approximately $100 million in adjusted EBITDA growth and full year 2025 over 2024. The Year-to-date, adjusted EBITDA in our hurricane markets is modestly below prior year, and we are anticipating all of this growth will occur in the fourth quarter.

與我們在第二季度電話會議上的評論一致，我們相信受颶風影響的市場將產生約 1 億美元的調整後 EBITDA 增長，並且 2025 年全年的 EBITDA 將超過 2024 年。年初至今，我們颶風市場的調整後 EBITDA 略低於去年同期，我們預計所有成長都將發生在第四季。

We are increasing our earnings guidance at the midpoint of adjusted EBITDA by $450 million. This represents an expected $250 million increase in net benefit from the state supplemental payment programs and $200 million increase from operational performance. With that, I will turn the call over to Frank for questions.

我們將調整後 EBITDA 中點的獲利預期提高 4.5 億美元。這意味著預計州補充支付計畫的淨收益將增加 2.5 億美元，營運績效將增加 2 億美元。說完這些，我將把電話轉給弗蘭克來回答問題。

Thank you, Mike. (Event Instructions) Frey, you may now give instructions to those who would like to ask a question.

謝謝你，麥克。（活動說明）弗雷，現在你可以向那些想要提問的人發出指示了。

(Operator Instructions)

（操作員指示）

Ann Hynes, Mizu Securities.

安·海因斯（Ann Hynes），瑞足證券（Mizu Securities）。

Great. Can you remind us -- I know there's other states that have preprints and for approval for grandfather programs. Can you remind us of what states are still pending? And any quantification of what we could incremental would be great.

偉大的。您能提醒我們嗎——我知道其他州也有預印本並批准祖父計劃。您能提醒我們哪些州仍處於等待狀態嗎？並且，對於我們可以增加的內容的任何量化都是很好的。

So as you think about kind of the states, there are several that have applied under grandfathering. We mentioned Florida before and certainly that one is under review. There are a few others as well. And I mentioned Georgia and Virginia as well being in that list. We do not expect that CMS will be approving these additional grandfathering programs during the shutdown.

因此，當您考慮各州的情況時，您會發現有幾個州已經根據祖父條款申請了豁免。我們之前提到過佛羅裡達州，當然該州正在審查中。還有一些其他的。我還提到喬治亞州和維吉尼亞州也在這個名單上。我們預計 CMS 不會在停擺期間批准這些額外的祖父條款計劃。

I would say that we have reports that indicate, though, that the reviews between CMS and these states are active and those reviews continue during the shutdown. I might also mention that we were encouraged coming up to the shutdown in, some states had approvals coming into the shutdown. So I think we're in a pretty good environment.

我想說的是，我們有報告表明，CMS 和這些州之間的審查正在進行中，並且這些審查在關閉期間仍會繼續進行。我還要提到，我們在關閉前受到了鼓舞，一些州在關閉前獲得了批准。所以我認為我們處於一個非常好的環境。

We are, at this point, not going to size those potential applications until they get approved. But I did note in my comments and I'll note again that the guidance that we gave you just now on this call does not include any potential impact from the applications that are still pending review with CMS.

目前，我們不會對這些潛在申請進行評估，直到它們獲得批准。但我在評論中確實指出過，我會再次指出，我們剛才在這次電話會議上給您的指導並不包括仍在等待 CMS 審查的申請的任何潛在影響。

A.J. Rice, Credit Suisse.

瑞士信貸的 A.J. Rice。

Just to maybe ask on the public exchanges. So there's been some chatter and some of the managed care companies are talking about anticipating a potential step-up in volumes in the fourth quarter likely procedures because people are worried that they're going to lose coverage or their co-pays and deductibles will go up dramatically.

也許只是想在公開交流中詢問一下。因此，出現了一些傳言，一些管理式醫療公司正在談論預計第四季度的醫療量可能會增加，因為人們擔心他們會失去保險，或者他們的共同支付和免賠額會大幅上升。

I wonder if you're seeing an early scheduling for surgeries, for example, active surgeries or anything else that would indicate that we might see that in the fourth quarter. And then if we do get disruption where people go off during the traditional open enrollment period, but then we are able to reset because an after open enrollment -- special enrollment period is set up, would you be able if people show up in your emergency room? Are you basically set up so you could get them resigned up if that's a possibility under the special enrollment provisions if we get an extension, but it comes late.

我想知道您是否看到了手術的早期安排，例如主動手術或任何其他表明我們可能會在第四季度看到的情況。然後，如果我們確實遇到中斷，人們在傳統的開放註冊期間離開，但是我們能夠重新開始，因為開放註冊之後 - 特殊註冊期已經設置，如果有人出現在你的急診室，你能做到嗎？如果我們獲得延期但時間已晚，您是否已做好基本準備，以便根據特殊招生規定讓他們辭職（如果這是可能的）。

So if you think about APTCs and what happens with these exchanges, I would mention a couple of things. I mean right now, we're really not sizing the potential impact given the fact that it's so fluid there's going to be an enrollment period, as you know, that opens up here in a couple of weeks.

因此，如果您考慮 APTC 以及這些交易所會發生什麼，我會提到幾件事。我的意思是，現在我們還沒有真正評估其潛在的影響，因為情況非常不穩定，正如你所知，幾週後就會有一個招生期。

When we get to the fourth quarter call, A.J, we'll have a lot more information, first about what is the deal potentially that comes out of this work in the government. We do think it's extended. If they do get extended, what is the form of that extension.

當我們進入第四季度電話會議時，A.J，我們將獲得更多信息，首先是關於政府這項工作可能產生的交易。我們確實認為它已經延長了。如果確實延長了，延長的形式是什麼？

And then third, to your point, is time. Do we end up with a special enrollment period at the end? And so it's really difficult to size the potential impact of that until we get a little bit closer to the fourth quarter call. And that's when we'll intend to do that. We do have our financial counseling teams through our peer line revenue cycle that helps our patients, both with things like Medicaid and with exchanges.

第三，正如您所說，是時間。我們最後會有一個特別的註冊期嗎？因此，在接近第四季度電話會議之前，很難評估其潛在影響。那時我們就打算這麼做。我們確實有財務諮詢團隊透過同儕收入週期來幫助我們的患者，包括醫療補助和交易所等。

Is -- the idea of them being able to do that on site is not something that we can do, but we certainly can connect them to the appropriate resources to help them navigate that, and I think we've mentioned this in previous calls, we have structured our efforts here as we've gone through the balance of this year into next year to really beef up our resources with Parallon and broadly as a company, to help patients navigate coverage both on Medicaid and on the exchanges. And we feel really good about our preparation in that area, and we're going to try to help our patients navigate this season is very best as we can.

是 - 讓他們能夠在現場做到這一點不是我們能做到的，但我們當然可以將他們與適當的資源聯繫起來，以幫助他們解決這個問題，我想我們在之前的電話會議中提到過這一點，我們已經在這裡構建了我們的努力，因為我們已經度過了今年到明年的平衡時間，以真正加強我們與 Parallon 的資源，並且作為一家醫療交易所幫助交易所的醫療範圍。我們對這方面的準備感到非常滿意，我們將盡力幫助我們的患者度過這個季節。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

The quarter was a pretty strong beat even if we exclude the sum payments in the 3Q, but guidance can go up a whole lot past the beat you guys did this quarter, at least at the midpoint of the range. Can you give us any color on how we should think about the range of guidance implied in the fourth quarter?

即使我們不考慮第三季的全部付款，本季的業績表現也相當強勁，但指導值可能會大幅超過本季的業績表現，至少在區間的中點是如此。您能否告訴我們應該如何看待第四季隱含的指導範圍？

And if we just steer towards one or the other. And also if you can help provide a bridge for 3Q into 4Q as you think about moving parts between hurricanes and supplemental payments.

如果我們只選擇其中一個。此外，如果您能幫助為第三季到第四季度建立橋樑，同時考慮颶風和補充支付之間的轉移部分。

Pito, when I think about fourth quarter growth rate is really two main considerations that I would think about. And then the third being just operations. But the first would be the hurricane impact for Fire. And then the second would be the decline in exceptional payments that I noted in my comments, when you compare fourth quarter of '25 to prior year. When we take those two factors into consideration, we believe the impact growth rate is still solid for fourth quarter in the kind of high single-digit range, maybe 7%, roughly.

皮托，當我考慮第四季的成長率時，我主要會考慮兩個因素。第三個就是營運。但首先是颶風對火災的影響。然後，第二個是當你將 25 年第四季與上一年進行比較時，我在評論中指出的特殊付款額有所下降。當我們考慮這兩個因素時，我們認為第四季的影響成長率仍然穩定在高個位數範圍內，大約是 7%。

And then the other note that we give you, when you take the same considerations into account, our sequential growth from third quarter to fourth quarter, is in line with our past trends. And so we feel that our guidance for fourth quarter is solid. I might also just note that our range in our guidance is intended to really cover a range of outcomes, including at the high end of the range, even stronger performance as well. So that's how we're reviewing the fourth quarter.

然後，我們給您的另一點是，當您考慮相同的因素時，我們從第三季到第四季的連續成長與我們過去的趨勢一致。因此我們認為，我們對第四季的預測是可靠的。我還要指出的是，我們的指導範圍旨在真正涵蓋一系列結果，包括範圍的高端，甚至更強勁的表現。這就是我們對第四季的回顧。

Ben Hendricks, RBC Capital Markets.

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

Just a quick follow-up on the STP guidance is how much in there did you recognize in the fourth -- or in the third quarter and is included in guidance for Tennessee specifically? And did you include recognizing anything in the quarter and in guidance related to Texas, some of that got approved later in the quarter. I just wanted to see if you were including anything in there.

對 STP 指導的快速跟進是，您在第四季度或第三季度認識到了多少，並且具體包含在針對田納西州的指導中？您是否在本季度和與德克薩斯州相關的指導中確認了任何內容，其中一些內容在本季度後期獲得了批准。我只是想看看你是否在其中包含了任何東西。

So Tennessee was the largest driver of our net benefit in third quarter. We did receive cash in the third quarter of 2025, and we began accruing this program. So that's the update. We tend to see Texas, as you know, we did receive approval of the grandfathered application. This approval was really an enhancement to an existing program. This was really accrued just in our normal manner for third quarter of 2025.

因此，田納西州是我們第三季淨利潤的最大推動力。我們確實在 2025 年第三季收到了現金，並且開始累積該計劃。這就是更新內容。我們傾向於認為德克薩斯州確實獲得了祖父條款申請的批准。此項批准實際上是對現有計劃的增強。這實際上是按照我們 2025 年第三季的正常方式累積的。

I might note being though that this grandfathered application really only had one month of impact for third quarter. The third one that we mentioned on calls Kansas, where we also received approval of the grandfathered application, we received caps for this program in third quarter 2025 as well. This is a calendar year program. So nine months of impact recorded in third quarter of '25

我可能會注意到，這個祖父級的應用程式實際上只對第三季產生了一個月的影響。我們在堪薩斯州的電話會議上提到的第三個項目，我們也獲得了祖父條款申請的批准，我們也在 2025 年第三季度獲得了該項目的上限。這是一個日曆年計劃。因此，2025 年第三季記錄了 9 個月的影響

And Ben, let me just mention, like always with these programs, we always talk about they're complex and variable. There were another number pluses and minuses that you see across our portfolio of programs. So these three states with those plus minuses of all the other programs really led to the aggregate of the $240 million net benefit. It's always important to keep that in mind.

本，我只想說，就像這些程序一樣，我們總是談論它們的複雜性和多變性。在我們的項目組合中，您還會看到一些優點和缺點。因此，這三個州加上其他所有計劃的優缺點，實際上帶來了總計 2.4 億美元的淨收益。始終牢記這一點很重要。

Brian Tanquilut, Jeffries.

布萊恩·坦奎魯特，傑弗里斯。

Congrats on the quarter. Mike, I appreciate you're highlighting how you guys have done really well with expense management, labor and supplies. So just curious, as I think of supplies cost, you guys have done a great job over the last few years, keeping that fairly steady.

恭喜本季。麥克，我很欣賞你強調你們在費用管理、勞動力和供應方面做得非常出色。所以只是好奇，當我想到供應成本時，你們在過去幾年裡做得很好，並保持了相當穩定的水平。

At what point do those contracts reach that? And then maybe a follow-up question for me on cost too is, as we think about your efforts to mitigate Medicaid cuts from '28 forward, when do we start seeing those efforts come through the P&L? I mean I'm guessing a lot of that -- those initiatives will start way before '28.

這些合約什麼時候達到這個水準？然後，也許我還有一個關於成本的後續問題，當我們考慮您從 28 年開始減輕醫療補助削減的努力時，我們什麼時候才能開始看到這些努力透過損益表體現出來？我的意思是，我猜測很多這些舉措將在 28 年之前就開始實施。

On supplies, Brian, we have a robust ongoing effort with supplies that we communicated multiple times in the past. I mean, certainly, to help trust. A lot of effort in flight on our contract renewal cycles. We tend to run two-year cycles, some contracts as many -- and so those renewals flow as follows. And we spend a lot of effort in those contract negotiations, and that's certainly one component of our supply expense annual trends.

關於供應，布萊恩，我們正在大力持續努力，確保供應充足，過去我們曾多次溝通過這一點。我的意思是，當然是為了增強信任。我們在合約續約週期上付出了很多努力。我們傾向於採用兩年為一個週期，有些合約也是如此——因此續約流程如下。我們在合約談判上花費了大量精力，這無疑是我們供應費用年度趨勢的一個組成部分。

The second component would be mix of technology. And so as you're aware, every year, there's new technology coming in, and then there's management technology that goes through its maturation cycle that's a big part of our overall management retime.

第二個組成部分是技術混合。如您所知，每年都會有新技術出現，然後管理技術也會經歷成熟週期，這是我們整體管理調整的重要組成部分。

The third part of our resiliency plan is our efforts to manage utilization. And so we have a very active resiliency plan. Supplies is one of those areas that we are continuing to both enhance and accelerate our resiliency plans focused on appropriate management of supplies and the utilization supplies throughout the platform.

我們的彈性計畫的第三部分是管理利用率的努力。因此我們有一個非常積極的彈性計劃。供應是我們正在繼續加強和加速我們的彈性計劃的領域之一，重點是適當管理供應和整個平台的供應利用。

As I think about bridging into the future, the other component that we're keeping a close watch on our tariffs where our HealthTrust team continues to work through a very diligent effort to manage the tariff risk, both in terms of sourcing, the way that we negotiate with contract, our vendor partners on contracts and then also in terms of moving products and moving choices of products across the countries of words.

當我考慮展望未來時，另一個因素是我們密切關注我們的關稅，我們的 HealthTrust 團隊將繼續非常努力地管理關稅風險，包括採購方面、我們與合約談判的方式、我們的供應商合作夥伴在合約方面的談判，以及在跨國產品運輸和產品選擇方面的談判。

So a lot of work in flight with supplies that I think you've seen not only help us manage supplies over the last several years, but we believe we'll continue to give us a very strong platform moving forward and our ability to manage supplies.

因此，我想您已經看到了，在飛行過程中所做的大量供應工作不僅幫助我們在過去幾年中管理供應，而且我們相信，我們將繼續為我們提供一個非常強大的平台，讓我們能夠管理供應。

You asked about resiliency. And really, we had a long-standing resiliency effort in the company. As we've noted on the last couple of calls and noted again today, our work to both enhance and accelerate our resiliency plans continue as we prepare for the future. These are widespread across both our corporate platforms and our field platforms.

您詢問的是彈性。事實上，我們公司長期以來一直在努力提高復原力。正如我們在前幾次電話會議中提到的以及今天再次指出的那樣，我們在為未來做準備的同時，將繼續努力加強和加速我們的彈性計劃。這些在我們的企業平台和現場平台上廣泛傳播。

Really proud of the entire team at ACA, helping us to find additional opportunities to drive efficiencies. We're doing this through benchmarking. We're doing this through a robust focus on digital tools. Sam talks often about digital transformation, and it certainly applies to our resiliency and efficiency efforts, it's a big part of what we're doing.

真的為 ACA 的整個團隊感到自豪，他們幫助我們找到了更多機會來提高效率。我們透過基準測試來實現這一點。我們透過大力關注數位工具來實現這一目標。薩姆經常談論數位轉型，它當然適用於我們的彈性和效率努力，這是我們正在做的事情的重要組成部分。

And then third, we're focused on our shared service platforms and the strength that they give us and the ability to expand their influence across the company is comfortable as we continue to move forward. So a lot of good work going on with the resiliency as we get into our fourth quarter call, we'll intend to provide additional comments about our resiliency effort when we get 2026 full year guidance as well.

第三，我們專注於我們的共享服務平台，隨著我們繼續前進，它們賦予我們的力量以及擴大其在整個公司的影響力的能力是令人欣慰的。因此，當我們進入第四季度電話會議時，我們在彈性方面做了很多出色的工作，當我們獲得 2026 年全年指導時，我們也打算對我們的彈性工作提供更多評論。

And Mike, let me add to resiliency. I mean we think about resiliency holistically. There it's clearly a financial resiliency culture within HCA that Mike's alluded to, and it's not event driven. It's really a part of our culture. It's embedded within the discipline thinking the disciplined resource allocation and the disciplined execution.

麥克，讓我補充一下彈性。我的意思是我們從整體上考慮彈性。正如 Mike 所提到的，HCA 內部顯然存在著財務彈性文化，而且它不是由事件驅動的。這確實是我們文化的一部分。它嵌入在紀律思維、紀律資源分配和紀律執行中。

But holistically, we also think about other aspects of resiliency across the organization. First is what we call organizational resiliency and I alluded to this in the fact that we had restructured, we're now embarking upon a more aggressive effort to develop our people, enhance the capabilities of our C-suite across our facilities and so forth, prepare for succession plan, all these things that go into having a very durable organization.

但從整體來看，我們也考慮整個組織彈性的其他面向。首先是我們所說的組織彈性，我提到這一點是因為我們已經進行了重組，現在我們正著手進行更積極的努力來培養我們的人才，增強我們各設施高管的能力等等，準備繼任計劃，所有這些都是為了建立一個非常持久的組織。

And we have great people in HCA. We want to make them greater through our development programs, and we've asked our human resource department to invest even more in ramping up capabilities there. The second aspect of resiliency that's beyond financial, it's something I'll call network resiliency.

HCA 擁有眾多優秀人才。我們希望透過我們的發展計劃使他們變得更強大，並且我們已經要求我們的人力資源部門投入更多資金來提升那裡的能力。彈性的第二個面向超越了財務範疇，我稱之為網路彈性。

Our organization within sort of the marketplace, it's also advancing resiliency with respect to adding more outpatient facilities, improving throughput within our facilities investing in very targeted ways to improve our overall competitive positioning and then just operating at an even more excellent level when it comes to quality, engagement, efficiency, patient satisfaction all these important fundamentals that help us endure through whatever cycles we have.

我們的組織在市場中也不斷提高彈性，增加更多的門診設施，提高設施的吞吐量，以非常有針對性的方式進行投資，以提高我們的整體競爭地位，然後在質量、參與度、效率、患者滿意度方面以更卓越的水平運營，所有這些重要的基礎都能幫助我們度過任何週期。

And so our resiliency agenda is broad. It's across these three dimensions. And it puts us in a very strong position, we believe, to navigate tailwinds, push through headwinds, compete on the ground and produce solid outcomes. And we've got a pattern of doing that and we're enhancing that now with technology. We're enhancing it with new capabilities within our shared service platform, as Mike alluded to, and we're further enhancing it with development of our people.

因此，我們的彈性議程非常廣泛。它跨越這三個維度。我們相信，這將使我們處於非常有利的地位，能夠順風而行，克服逆風，在實地競爭，並取得堅實的成果。我們已經有這樣做的模式，現在我們正在利用科技來增強它。正如麥克所提到的，我們正在透過共享服務平台中的新功能來增強它，並且我們正在透過人員的發展來進一步增強它。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

I was wondering how you guys are thinking about capital deployment for next year. Obviously, you have the capacity to increase buybacks or the dividend or what not. But I know you evaluate every year. So I just wanted to take your temperature on preliminary thoughts. And then I think what I mean is like, where do you think you will be spending differently versus prior years?

我想知道你們對於明年的資本部署有何考慮。顯然，你有能力增加回購或股利或其他。但我知道你每年都會進行評估。所以我只是想了解你的初步想法。然後我想我的意思是，您認為與前幾年相比，您的支出在哪些方面會有所不同？

So it's Sam. We're not ready to give you our financial plan for 2026 yet. I think it's a reasonable assumption to assume that plan is going to be somewhat consistent with the methodologies we've used in the past. And so we need to get through the planning process that we're in now see how some of the federal policies land. And from there, we will refine and define our capital allocation plan for 2026.

原來是薩姆啊。我們還沒有準備好向您提供 2026 年的財務計劃。我認為，假設該計劃將與我們過去使用的方法在某種程度上保持一致是一個合理的假設。因此，我們需要完成我們現在所處的規劃過程，看看一些聯邦政策如何實施。在此基礎上，我們將完善並確定 2026 年的資本配置計畫。

But just as much as the culture of HCA is around resiliency and cost discipline and so forth, we have the same culture around capital allocation and finding the most productive ways to allocate it to benefit our networks and benefit our patients, but also benefit our shareholders. And that thinking will permeate our plan in 2026 just as it's done this year and in past years.

但是，就像 HCA 的文化圍繞著彈性和成本紀律等一樣，我們在資本配置方面也有同樣的文化，並找到最有效的方法來分配它，以造福我們的網絡和患者，同時也造福我們的股東。正如今年和過去幾年一樣，這種想法將滲透到我們 2026 年的計劃中。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

A couple of things here. First, I think you mentioned payment dispute resolution is one of the drivers of revenue growth, pricing growth in the quarter. How much of a benefit there? And then another question on DPP. It sounds like your DPP number for 2025 benefit will be somewhere in the right, the $2.3 billion, $2.4 billion range this year.

這裡有幾件事。首先，我認為您提到支付糾紛解決是本季營收成長和定價成長的驅動力之一。那裡有多少好處？然後是關於 DPP 的另一個問題。聽起來，2025 年 DPP 福利數字應該在正確範圍內，今年在 23 億美元到 24 億美元之間。

Is that the right number? And before any of these additional data approvals come through, what's the right run rate that we should think about going into 2026 when we normalize for stuff that might have been at a period?

這個數字正確嗎？在這些額外的數據獲得批准之前，當我們對某個時期的情況進行正常化時，我們應該考慮在 2026 年達到什麼樣的正確運行率？

So let me walk through NRA real quick, and then we'll talk a little bit about supplementals. When I think about our net revenue per equivalent admission growth, in the third quarter to prior year, first thing I mentioned this in the comments, Justin, with the first thing is about half of the growth was related to state supplemental payment increases in revenue. And so that's a piece.

那麼，讓我快速介紹 NRA，然後我們再來談談補充內容。當我想到我們第三季與去年同期相比的每單位入場費淨收入增長時，賈斯汀，我在評論中首先提到的是，大約一半的增長與國家補充支付收入的增加有關。這就是其中的一部分。

Also mentioning it's the next biggest driver is payer mix. I mean, as we noted, with very strong paper base in the quarter, and that's the next biggest dropper for sure in our overall growth in net revenue per unit. Case-mix index was pretty consistent. It was just up a tick about 30 basis points to prior year. And then we are -- as we've noted in past calls, we continue to work on our speed resolution activities, and they did provide some support in the quarter.

也提到下一個最大的驅動因素是付款人組合。我的意思是，正如我們所指出的，本季的紙張基礎非常強勁，這肯定是我們單位淨收入整體成長的第二大下降因素。病例組合指數相當一致。與去年同期相比，僅上漲了約 30 個基點。然後我們——正如我們在過去的電話會議中提到的那樣，我們繼續致力於我們的速度解決活動，並且它們確實在本季度提供了一些支持。

So those combined really drove the net revenue per unit growth. I think on -- as I think about for the year in the state of our payments at this point, just keep in mind that we noted that we expect and part of what drove the earnings guidance is the net benefit from tax supplemental payment programs.

因此，這些因素的結合確實推動了單位淨收入的成長。我認為——當我思考我們今年的付款狀況時，請記住，我們注意到我們的預期以及推動盈利預測的部分因素是稅收補充支付計劃的淨收益。

We're going to be about $250 million better for the quarter. And so you would just apply that now if you just think about kind of the walk up on step supplemental payment programs, and you apply that to our full year guidance. I think that gives you a sense that now we're expecting it to be $250 million to $350 million favorable full year '25 to full year '24.

本季我們的營業額將增加約 2.5 億美元。因此，如果您只是考慮逐步增加補充支付計劃，那麼您現在就可以應用它，並將其應用於我們的全年指導。我認為這讓你感覺到，現在我們預計 2025 年全年至 2024 年全年的利潤將達到 2.5 億至 3.5 億美元。

And that gives you a sense of our -- kind of our early thinking as we kind of finish guidance right here. This is where we think the year will come in at this point. I did note, and there's a lot of volatility here. That guidance update does not include any additional impact from any other state supplemental payment programs that may get approved by CMS in 2025 once the government will be opened. So just keep that in mind as well.

這讓您了解我們的早期想法，因為我們在這裡完成了指導。我們認為今年的到來將會發生在此時。我確實注意到，這裡存在著很大的波動性。該指導更新不包括 2025 年政府開門後可能獲得 CMS 批准的任何其他州補充支付計劃的額外影響。所以也請記住這一點。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Last quarter, you called out a few underperforming regions outside the hurricane markets. Can you give us an update on those markets? And how addressable those issues are near term?

上個季度，您指出了颶風市場之外的一些表現不佳的地區。能向我們介紹一下這些市場的最新情況嗎？這些問題近期能得到怎樣的解決？

So we did mention that we had 2 of our 16 geographic divisions that had some challenges in the second quarter. One of those, I'm happy to say has recovered. But within our portfolio, we're fortunate that we have a very diversified geographical base and a very diversified service base. And we've seen, again, very strong portfolio performance across the company in the third quarter.

因此，我們確實提到，我們 16 個地理部門中的 2 個在第二季遇到了一些挑戰。我很高興地告訴大家，其中一人已經康復了。但在我們的投資組合中，我們很幸運，我們擁有非常多樣化的地理基礎和非常多樣化的服務基礎。我們再次看到，第三季整個公司的投資組合表現非常強勁。

So one of the divisions recovered the second one. It's still working its way through some of the challenges, and we're confident that we'll be where we need to be as we push into 2026. The -- I think an important point here is the third quarter over the second quarter is always a challenging period. You got summer dynamics with vacations, physician movement during the summer months and so forth. And in this particular third quarter, we performed sequentially really well.

因此其中一個師收回了第二艘。我們仍在努力克服一些挑戰，並且有信心在邁向 2026 年時達到我們需要的目標。我認為這裡的一個重要觀點是，第三季相對於第二季始終是個充滿挑戰的時期。您可以了解夏季假期的動態、夏季醫生的活動情況等等。在第三季度，我們的表現連續表現非常好。

And our core operations were managed very effectively. From a cost standpoint, we saw a good mix of volume from the second quarter. So that's an encouraging seasonality aspect to this particular year versus some of the other years that we've seen. And I'm really proud of our teams and how they push through that. And again, with a large portfolio, you always have movements inside of it.

我們的核心業務管理非常有效。從成本角度來看，我們看到第二季的銷售組合良好。因此，與我們見過的其他年份相比，今年的季節性令人鼓舞。我為我們的團隊以及他們如何克服困難感到非常自豪。再說了，有了龐大的投資組合，裡面總是會有變動。

But for the most part, none of them are material in and of themselves individually because we have other divisions that are outperforming our expectations and tend to provide cover for those that may have a struggle in the short term or what have you.

但在大多數情況下，這些因素本身並不是實質的，因為我們還有其他部門的表現超出了我們的預期，並且傾向於為那些可能在短期內陷入困境的人提供保障。

Matthew Gillmor, KeyBank.

馬修·吉爾摩（Matthew Gillmor），KeyBank。

I thought I might ask about the growth in surgeries. There was a little bit of an improvement this quarter versus last quarter. Sam just mentioned some of the seasonal dynamics. Can you give us a sense for some of the service lines that are maybe doing a little bit better? Just anything to highlight there?

我想我可以詢問一下手術的增長。與上一季相比，本季的情況略有改善。薩姆剛才提到了一些季節性動態。您能否向我們介紹哪些服務項目可能會表現得更好一些？有什麼需要強調的嗎？

Well, when we look at our outpatient surgery, we had strong general surgery activity. Our urological service line was very strong on the outpatient side. On the inpatient side, our neurosciences surgical capabilities, our orthopedic surgical capabilities, cardiac all of these were up and had very good performance on a year-over-year basis.

嗯，當我們看我們的門診手術時，我們發現我們的普通外科手術活動很活躍。我們的泌尿科門診服務線非常強大。在住院方面，我們的神經科學手術能力、骨科手術能力、心臟手術能力都提高，且比去年同期表現非常好。

So again, diversification is a powerful element for us diversification amongst these service lines, different mill use for delivering care to our patients all of it sort of works as a system to create, again, the enterprise performance that we're able to produce. But those are some of the categories that moved favorably.

因此，多樣化是我們在這些服務線之間實現多樣化的強大因素，不同的工廠用於為患者提供護理，所有這些都像一個系統一樣運作，再次創造我們能夠產生的企業績效。但這些都是表現良好的類別。

We had a couple that weren't as positive. Again, that's par for the course from one quarter to the other and not really indicative of anything structural, our gynecology business on an outpatient in the third quarter was slightly down. So that's one item that was down, but it was covered by some of these other areas. And then within the inpatient side, our neurosurgery business was down modestly, and that impacted the inpatient business, but it was overcome by some of these other areas.

我們有幾個人不太積極。再次強調，這是從一個季度到另一個季度的正常現象，並不代表任何結構性的變化，我們第三季的婦科門診業務略有下降。這是被忽略的一項，但它被其他一些領域所覆蓋。在住院方面，我們的神經外科業務略有下降，這對住院業務產生了影響，但其他一些領域克服了這一影響。

Matthew, I might also mention on outpatient surgery that payer mix continues to be solid. Actually Medicaid and self-pay volumes continue to be below prior year, which obviously implies that our commercial and Medicare business continues to be really strong. So we're seeing that in really good growth in overall net revenue in outpatient surgery and the translation to earnings.

馬修，我可能還會提到，關於門診手術，付款人組合仍然保持穩固。實際上，醫療補助和自付費用額持續低於去年，這顯然意味著我們的商業和醫療保險業務持續保持強勁。因此，我們看到門診手術的整體淨收入和收益都出現了良好的成長。

One of the things we talked about at our investor conference back in November of '23 with what I termed the staying power of HCA Healthcare. And that staying power is really connected to 3 points. One, the relevance our systems within the communities that they serve. The second thing is the scale across the company when it comes to just the sheer size of HCA Healthcare.

我們在 2023 年 11 月的投資者會議上討論過的事情之一就是我所說的 HCA Healthcare 的持久力。而這種持久力其實與 3 點有關。第一，我們的系統與其所服務的社區的相關性。第二件事是整個公司的規模，僅就 HCA Healthcare 的規模而言。

The third aspect to that is the diversification. And so you're hearing about how the diversification provides I call staying power for our organization, allowing us to push forward with our agenda, produce solid returns on our capital and create better outcome for our stakeholders.

第三個面向是多樣化。所以，您聽到的是，多元化如何為我們的組織提供持久力，使我們能夠推進我們的議程，為我們的資本帶來可觀的回報，並為我們的利害關係人創造更好的結果。

Scott Fidel, Goldman Sachs.

高盛的史考特·菲德爾。

I was hoping if you could maybe drill a bit more into the Medicare volumes in the quarter. And break those down for us between Medicare Advantage and then fee-for-service year-over-year and sequentially? And then just observations on case mix or acuity that you're seeing in and the volume trends within those two categories in Medicare?

我希望您能更深入地了解本季的醫療保險額度。並為我們逐年和連續地細分一下醫療保險優勢計劃和按服務收費的情況嗎？然後，您觀察到的病例組合或敏銳度以及醫療保險中這兩個類別的數量趨勢是什麼？

So Medicare Advantage was up 4.8% in the quarter over prior year. And then I think. Look what was -- you have traditional over there --

因此，本季醫療保險優勢計畫比去年同期成長了 4.8%。然後我想。看看那邊有什麼——你們那裡有傳統--

90 bps.

90個基點。

Yes. Traditional was up 90 bps Case Mix Index, the traditional Medicare case mix index was actually up a bit, and Medicare Advantage was pretty flat to prior year. So those would be the two components of Medicare in the quarter. I think one of the things that we noted, I'll go kind of more of a macro statement here is the improvement in our volume trends in third quarter to prior year versus second quarter of the prior year.

是的。傳統醫療保險病例組合指數上漲了 90 個基點，傳統醫療保險病例組合指數實際上略有上漲，而醫療保險優勢指數與前一年相比基本持平。因此，這些就是本季醫療保險的兩個組成部分。我認為我們注意到的一件事，我將在這裡更多地從宏觀角度進行闡述，那就是與去年同期第二季相比，我們第三季的銷售趨勢有所改善。

We saw that in Medicare. Medicare combined was up 3.4% on adjusted admissions. Medicaid was up 1.4% after being down for several quarters. And then as we noted, we saw good movement in our overall commercial business as well with self-pay being down 6%. So overall, really good operational good demand growth across our payer categories, really with the one exception of being sell time.

我們在醫療保險中看到了這一點。調整後的醫療保險入院人數上漲了 3.4%。醫療補助在連續幾季下降後上漲了 1.4%。然後，正如我們所注意到的，我們的整體商業業務也出現了良好的進展，自付費用下降了 6%。因此，總體而言，我們的付款人類別的營運需求成長確實很好，除了銷售時間之外。

Ryan Langston, TD Calin.

瑞安·蘭斯頓，TD Calin。

We've heard a lot of news on the pickup of hospital usage in AI, particularly in revenue cycle. Can you give us a sense on how your initiatives there are progressing? And how much runway you see with the advances of technology in the future?

我們聽到了很多關於醫院人工智慧使用率上升的消息，特別是在收入週期方面。您能告訴我們您在那裡的舉措進展如何嗎？您認為未來科技進步的前景如何？

So you're right. I mean, there's been a lot of commentary around the size of utilization intensity and maybe coding intensity and the like. And I think it's important to note we can't speak to all of the dynamics that the payers see across their various geographies and line of insurance.

所以你是對的。我的意思是，關於利用強度的大小以及編碼強度等已經有很多評論。我認為需要注意的是，我們無法談論付款人在不同地區和保險範圍內看到的所有動態。

We've already noted from a pure volume perspective, what we're seeing volume-wise, I do think that both Medicare Advantage, the exchanges, you are seeing pretty good volumes this year at leaks from HCA, and that's really to the extent that we can speak to.

我們已經從純交易量角度注意到，就交易量而言，我確實認為，無論是醫療保險優勢計劃 (Medicare Advantage) 還是交易所，今年從 HCA 洩漏的交易量都相當可觀，這就是我們可以談論的程度。

As it relates to coding intensity, we think about that as case mix index. And from a case mix index perspective, it's pretty consistent with prior year and the trends, I think it was up 30 basis points in third quarter '25 versus third quarter of '24 and actually down a little bit sequentially from second quarter.

由於它與編碼強度有關，我們將其視為病例組合指數。從病例組合指數的角度來看，它與去年和趨勢非常一致，我認為 2025 年第三季比 2024 年第三季上漲了 30 個基點，實際上比第二季略有下降。

As we look at the individual lines of insurance, whether it's Medicare Advantage, Medicaid exchanges and commercial. We're really not seeing any material changes in case mix index compared to prior year at the detailed line level as well. It's always important to note our coding practices remain consistent and ACURATE is verified by multiple layers of audits.

當我們查看單獨的保險項目時，無論是醫療保險優勢計劃、醫療補助交換計劃還是商業保險。與去年相比，我們在詳細線路層面上確實沒有看到病例組合指數有任何實質變化。始終要注意的是，我們的編碼實踐保持一致，並且 ACURATE 經過多層審核的驗證。

Specifically related to the AI, we do, as Sam mentioned, we're deep into our efforts around digital transformation across our company. including in our revenue cycle. Our focus in terms of AI and automation in our revenue cycle right now is really specifically focused on working to respond to the growing denial and underpayment activities from the payers.

具體到人工智慧，正如 Sam 所提到的，我們確實深入致力於整個公司的數位轉型，包括我們的收入週期。我們目前在收入週期中對人工智慧和自動化的關注實際上主要集中在努力應對付款人日益增多的拒絕和少付行為。

We have noted before, we are also both piloting and rolling out ambient AI documentation tools designed to help our physicians be more complete, more accurate and more timely in completing their clinical documentation. So that's a quick update on what we're seeing in the utilization space.

我們之前已經提到，我們也在試行和推出環境 AI 文件工具，旨在幫助我們的醫生更完整、更準確、更及時地完成他們的臨床文件。這是我們對於利用空間所見內容的快速更新。

Raj Kumar, Stephens Inc.

Raj Kumar，Stephens 公司

Just kind of maybe focusing on the expense side and Pro fees. Just maybe kind of any color on how that trended year-over-year -- and as a sense, if we kind of bridge towards '26 and think about Alesco and how that's historically been a drag of $40 million to $50 million in the past for EBITDA on a quarterly basis kind of -- how do you expect that to trend in 4Q in 2026? And what kind of opportunity is still there to maybe potentially achieve breakeven in '26?

可能只是專注於費用方面和專業費用。也許只是對同比趨勢的任何一種顏色進行某種程度的描述——從某種意義上說，如果我們展望 26 年並考慮 Alesco 以及它在過去每季度對 EBITDA 造成 4000 萬至 5000 萬美元的拖累——您預計 2026 年第四季度的趨勢會如何？還有什麼樣的機會可能在 26 年達到收支平衡？

So our same-facility professional fees increased 11% over the prior year in third quarter '25 versus third quarter '24. I'll note, it's about a 1% sequential increase to second quarter of 2025. So professional fees continue to run hotter than just average inflationary levels across the rest of -- if you think about our cost structure, I might note that this is a bit more related to anesthesia and radiology this year. And so that's a bit of an update on both these professional fees on an as-reported basis, still represent about 24% of total other operating expenses.

因此，與 2024 年第三季相比，2025 年第三季我們的同設施專業費用比去年同期成長了 11%。我要指出的是，到 2025 年第二季度，這一數字將環比增長約 1%。因此，專業費用繼續高於其他地區的平均通膨水平——如果你考慮我們的成本結構，我可能會注意到這與今年的麻醉和放射學更相關。因此，根據報告，這兩項專業費用都有更新，仍佔其他營運費用總額的 24% 左右。

Remember, Velasco was an acquisition. It's in part of our employee base, so we don't really call that out separately other than just say generally, and Sam might note additional commentary to hear, but we're pleased with our work around integrating Velesco and really making Valesco a strategic asset for the company.

請記住，Velasco 是一次收購。這是我們員工基礎的一部分，所以我們不會單獨提到這一點，只是一般地說，Sam 可能會注意到更多的評論，但我們對整合 Velesco 的工作感到滿意，並真正使 Valesco 成為公司的戰略資產。

As we're thinking about not only the ability to manage the cost structure of emergency physician management and hospital medicine. It also really helps us with our strategic work around things like case management to improve our length of stay and the ability to manage our emergency rooms to drive really good emergency room efficiency. So the work around Valesco continues to mature and really proud of our operating and our physician management team for the really good work around Valesco. Sam I would.

因為我們考慮的不僅僅是管理急診醫生管理和醫院醫學的成本結構的能力。它也確實幫助我們進行個案管理等方面的策略工作，以改善我們的住院時間，並提高急診室的管理能力，從而提高急診室的效率。因此，圍繞 Valesco 的工作不斷成熟，我們為我們的營運和醫生管理團隊在 Valesco 方面所做的出色工作感到非常自豪。山姆，我願意。

The only thing I would add there, Mike, is I would say generally, we do expect continued financial improvement as we carry forward into 2026. We haven't finalized their budgets yet either. And so we don't have a number specific to that, but we are seeing progression favorable progression and the financial performance of Valesco.

麥克，我唯一想補充的是，總的來說，我們確實預計，隨著我們進入 2026 年，財務狀況將繼續改善。我們還沒有最終確定他們的預算。因此，我們沒有具體的數字，但我們看到了 Valesco 的良好進展和財務表現。

And beyond even operational improvements, as Mike was alluding to, we expect clinical improvement patient engagement improvement and other clinical efficacy, if you will, from the opportunity that we have with Valesco being part of our organization now. So we're excited about what the prospects are.

正如 Mike 所暗示的，除了營運方面的改進之外，我們還希望透過 Valesco 成為我們組織的一部分這一機會，實現臨床改善、患者參與度改善和其他臨床療效。因此，我們對前景感到興奮。

Ben Rossi with JP Morgan.

摩根大通的本‧羅西 (Ben Rossi)。

Regarding maybe the capacity for incremental volumes. I appreciate your commentary regarding the stable operational backdrop and some of your existing efforts and patient throughput. I guess just as you think about 4Q and the typical seasonal uptick in utilization, how would you characterize the incremental cost to manage additional throughput or free up additional capacity? And then are you seeing any variance across your markets and being able to ramp up this capacity and cost manner?

可能涉及增量容量。我很欣賞您對穩定的營運背景以及您現有的一些努力和患者吞吐量的評論。我想，正如您考慮第四季度和利用率的典型季節性上升一樣，您會如何描述管理額外吞吐量或釋放額外容量的增量成本？那麼，您是否看到各個市場之間存在任何差異，並且能夠提高這種產能和成本方式？

Well, the short answer is we don't see any significant capacity constraints at this particular point in time. If you recall, a couple of years ago, we had capacity constraints that were driven mostly by staffing and not having the workforce that we needed to take care of the patients who desired service in our facilities, we don't have that issue today.

嗯，簡短的回答是，我們目前沒有看到任何重大的容量限制。如果您還記得的話，幾年前，我們的容量限制主要是由於人員配備不足，而我們沒有足夠的勞動力來照顧那些希望在我們的設施中接受服務的患者，但今天我們已經不再有這個問題了。

We've improved the net headcount of the company, and we believe we have good programmatic efforts in place today to put us in a position to carry forward the workforce necessary to meet the demand that we expect in the fourth quarter.

我們已經提高了公司的淨員工人數，我們相信，我們今天已經採取了良好的計劃措施，使我們能夠保留必要的勞動力，以滿足我們預期的第四季度的需求。

And really on into next year, we're excited about some of the other operational initiatives that are being put forward with our emergency rooms. We have very specific surge planning that we're preparing for and learning from past years to improve our preparation in anticipation of demand surges in whatever periods we have -- so we feel much better about our capacity on the labor side.

進入明年，我們對急診室將採取的一些其他營運措施感到非常興奮。我們有非常具體的激增計劃，我們正在為此做準備，並從過去幾年的經驗中學習，以改進我們的準備工作，以應對任何時期的需求激增——因此，我們對勞動力方面的能力感覺好多了。

We're also encouraged about the fact that we have more capital coming online in 2026 than we had this year. And that will add physical capacity and align with the capacity that we're creating and put the company in an even better position to accommodate the demand that we anticipate.

我們也對 2026 年投入的資本將比今年更多這一事實感到鼓舞。這將增加物理容量並與我們正在創建的容量保持一致，並使公司處於更好的位置來滿足我們預期的需求。

I might add as well that the work that we've been putting forth to manage length of stay has also been very helpful. Third quarter showed really good performance around length of state management. Those efforts continue, not only into the fourth quarter but into 2026. That also gives us the ability to make additional room for volume growth as we head into the future.

我還要補充一點，我們為管理住院時間所做的工作也非常有幫助。第三季在狀態管理長度方面表現非常出色。這些努力不僅會持續到第四季度，而且會持續到 2026 年。這也使我們有能力在未來為銷售成長騰出更多空間。

So I really want to call out to our operating teams and our case management teams for really good work this year to help us prepare for volume growth in the future.

因此，我真的想呼籲我們的營運團隊和案例管理團隊今年做出真正的出色工作，以幫助我們為未來的數量成長做好準備。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great. Just wanted to ask about the hurricane-impacted facilities. I know you let that the same in guidance. There's a big step up in the fourth quarter. But how should we think about the ability to recover the remaining $150 million or so headwind versus the $250 million total headwind back in 2024?

偉大的。只是想詢問受颶風影響的設施的情況。我知道您在指導中也說過同樣的話。第四季取得了很大的進步。但是，我們該如何看待收回剩餘約 1.5 億美元逆風與 2024 年 2.5 億美元總逆風的能力呢？

Would you expect to recover the majority of that remaining headwind next year? Or how do we think about growth off that?

您是否預計明年能夠克服剩餘的大部分逆風？或者我們如何看待成長？

Yes. So first, let me walk back to you just quickly the way the hurricane markets is kind of transfers this year. As you may recall, as we started the year, we actually thought that our 2025 full year EBITDA would be about flat with '24. And '24 had this $250 million hit from the hurricanes. And really that $250 million hit was a hit to our pre-storm run rate of earnings.

是的。首先，讓我快速回顧一下今年颶風市場的轉移方式。您可能還記得，當我們開始新的一年時，我們實際上認為 2025 年全年 EBITDA 將與 24 年持平。2024 年颶風對經濟造成了 2.5 億美元的損失。事實上，這 2.5 億美元的損失確實對我們風暴前的盈利率造成了打擊。

So think about them to $23 million. As we're now updating guidance, we're -- we believe that we'll recapture, call it, $100 million of that in 2025. The real impact here now is just the continued and lingering effects of that storm and mostly in our North Carolina markets. While volumes have recovered in North Carolina, the payer mix has deteriorated, and we're having to use a significant amount of premium labor to staff those facilities. And so that's the that's the driver there.

因此，想想它們的價值是 2300 萬美元。由於我們現在正在更新指導，我們相信我們將在 2025 年重新獲得其中的 1 億美元。現在真正的影響只是這場風暴的持續和揮之不去的影響，而且主要影響到我們的北卡羅來納州市場。雖然北卡羅來納州的業務量已經恢復，但付款人結構卻惡化了，我們不得不使用大量優質勞動力來為這些設施配備人員。這就是那裡的驅動因素。

It's too early to get 2026 guidance. But just to give you a sense of kind of how it's moved through the first three quarters of the year, first quarter of 2025 was about flat to prior year. Second quarter was a bit negative, modestly negative. And third quarter, '25 to '24 combined for our hurricane markets on EBITDA was again about flat. So that's why we said in fourth quarter, we do expect that all plus that $100 million improvement in year-over-year EBITDA will happen in the fourth quarter.

現在獲得 2026 年的指導還為時過早。但只是為了讓您了解今年前三個季度的走勢，2025 年第一季與去年同期基本持平。第二季的情況有點消極，略微消極。2025 年至 2024 年第三季度，我們颶風市場的 EBITDA 總體而言再次持平。所以這就是為什麼我們在第四季度說，我們確實預計所有這些加上 1 億美元的年比 EBITDA 成長都將在第四季度實現。

We will give more guidance on our fourth quarter call when we give full year 2026 guidance about the hurricane markets, but hopefully, that helps as it relates to the movement through the year.

當我們給予 2026 年全年颶風市場指導時，我們將在第四季度電話會議上提供更多指導，但希望這對全年的走勢有所幫助。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

I appreciate the early commentary on 2026. So I'm wondering if there's something you can speak to that gives you confidence in achieving the long-term volume range at this point. I guess the question would really be without exchange growth, you'd be below the range this year. So I'm sure you thought about the even with an extension, you change volumes could potentially be flat to down next year. But wondering how you're thinking about what the other moving parts are, whether that could be more normal levels of Medicaid or self-pay growth in there, too?

我很欣賞對 2026 的早期評論。所以我想知道您是否可以談談一些事情，讓您有信心在此時實現長期的銷售範圍。我想真正的問題是，如果沒有匯率成長，今年的匯率就會低於這個範圍。因此，我相信您考慮過，即使延期，明年的交易量也可能會持平或下降。但想知道您如何看待其他活動部分，這是否也可能是醫療補助或自付費用成長的更正常水平？

I realize the past is not prolonged here, but we've had 18 consecutive quarters of volume growth. So that gives us a pretty confident foundation that we can continue to navigate through different dynamics within our markets. As I mentioned, we have more capital coming online next year we have more outpatient facilities, or our ambulatory outreach is growing. We're building new relationships with physicians. All of that's woven into our thinking around 2026 volume.

我知道過去並不長，但我們已經連續 18 個季度實現了銷量成長。因此，這為我們提供了非常有信心的基礎，讓我們能夠繼續應對市場中的不同動態。正如我所提到的，明年我們將有更多的資金投入使用，我們將擁有更多的門診設施，或者我們的門診服務範圍正在擴大。我們正在與醫生建立新的關係。所有這些都融入了我們對 2026 年銷量的思考中。

We continue to believe that population is growing in many of our markets as it has, and there's going to be this consistent level of demand. the exchange piece of it is a small component of the overall gain diversification that we have as a company. And so when you add all that up, we feel pretty confident that the range will accommodate some of the movement our overall demand equation.

我們仍然相信，我們許多市場的人口都在成長，而且需求水準也將保持穩定。其中，交易部分只是我們公司整體收益多樣化的一小部分。因此，當你把所有這些加起來時，我們非常有信心，這個範圍將適應我們整體需求方程式的一些變化。

Craig Hettenbach, Morgan Stanley.

摩根士丹利的克雷格·赫滕巴赫。

On the $600 million to $800 million resiliency program you laid out a few years ago, can you just give us a sense on kind of how you're tracking to that? And then how you think about any additional levers to extend that further over time, whether that's technology or increased AI adoption?

關於您幾年前提出的 6 億至 8 億美元的復原力計劃，您能否向我們介紹一下您目前是如何實施該計劃的？那麼，您如何看待任何額外的槓桿來隨著時間的推移進一步擴大這一範圍，無論是技術還是增加人工智慧的採用？

Yes. So at our Investor Day back in 2023, we highlighted our resiliency plan, including that target of $600 million to $800 million. We've been working hard on that. And -- but the other thing that we highlighted, so yes, some of those dollars helped us to '24 and '25. But as we've gone through really in the last 12 to 18 months, we've been focused at both enhancing and accelerating our development of our resiliency program and our execution of our resiliency program.

是的。因此，在 2023 年的投資者日上，我們強調了我們的彈性計劃，包括 6 億至 8 億美元的目標。我們一直在為此努力。而且 — — 但我們強調的另一件事是，是的，其中一些資金幫助我們實現了 24 年和 25 年的成就。但正如我們在過去 12 到 18 個月中所經歷的那樣，我們一直致力於加強和加速我們的彈性計畫的發展和執行。

And that development piece is key. We think about this as a program. In other words, as we have work streams that we identified, we work those through, we pilot them, we execute on them, and then we roll them out to scale. And then literally, every day, we're hunting for new ideas.

而開發部分是關鍵。我們將其視為一個程序。換句話說，當我們確定了工作流程後，我們就會對其進行研究、試行、執行，然後將其推廣到更大範圍。事實上，我們每天都在尋找新的想法。

And our teams are really attuned to this idea of the pipeline on resiliency and identifying new ideas and as the new ideas come into our resiliency work stream efforts, those ideas again are piloted. They are verified within our markets, and then we try to roll them out at scale.

我們的團隊非常適應這種關於彈性管道的想法並確定新想法，並且隨著新想法進入我們的彈性工作流程工作，這些想法再次得到試行。它們在我們的市場內得到驗證，然後我們嘗試大規模推廣它們。

And so think about the resiliency program with all of our benchmarking work with all of our digital technology and development. We have a robust series of use cases that are in flight for AI, machine learning and automation. And then lastly, as I mentioned earlier, this notion of continuing to expand the impact of our shared service platforms.

因此，請考慮我們所有的基準測試工作以及我們所有的數位技術和開發的彈性計劃。我們擁有一系列適用於人工智慧、機器學習和自動化的強大用例。最後，正如我之前提到的，我們將繼續擴大共享服務平台的影響力。

All of those combined really give us encouraged that we are preparing for the future. And this resiliency program is not a static onetime event. It is a program that allows us to develop financial resiliency well into the future as well.

所有這些結合在一起確實給了我們鼓勵，讓我們為未來做好準備。而這個彈性計畫並不是一個靜態的一次性事件。該計劃也能讓我們在未來更能發展財務彈性。

I think, Mike, some of that's reflected. I mean if you just look back in 2023 when we gave the update on the resiliency program and you look at the core operating margin of the company at that particular point in time versus what it is now, it's improved.

我認為，麥克，其中一些已經反映出來了。我的意思是，如果你回顧一下 2023 年我們對彈性計畫進行更新的情況，並比​​較當時公司的核心營業利潤率與現在的情況，就會發現它已經有所改善。

And so we're experiencing some of that in the margin advancement that you're seeing in the results of the company. And we are continuing to, as Mike said, with technology, with best practices, with benchmarking, with finding other ways to deliver more efficient services, we see this as a growing agenda, not one that's static.

因此，我們在公司業績中看到的利潤率成長中也反映了這一點。正如麥克所說，我們將繼續利用技術、最佳實踐、基準測試，尋找其他方式來提供更有效率的服務，我們認為這是一個不斷發展的議程，而不是一成不變的議程。

Frey, let's take one more question. We're running at plus the end of the hour.

弗雷，我們再回答一個問題。我們正處於一個小時的末端。

Josh Raskin, Nephron Research.

Josh Raskin，腎元研究。

I appreciate that. So I wanted to ask about cash flow conversion. We've seen the ratio of EBITDA that converts to free cash flow sort of move from the 30% range into the 40s. And I think this year, you're on track to almost 50%.

我很感激。所以我想問現金流轉換的問題。我們已經看到，EBITDA 轉化為自由現金流的比率從 30% 左右上升到了 40% 左右。我認為今年你的目標將接近 50%。

So maybe talk about the factors that are driving that? Is that a shift to outpatient? Is there impact from the strong pricing, including the sub payments? And I guess, most importantly, do you think that's sustainable over the next couple of years?

那也許可以談談造成這種情況的因素？這是轉為門診了嗎？強勢定價（包括分期付款）會產生影響嗎？我想，最重要的是，您認為這種狀況在未來幾年內能夠持續下去嗎？

There's three or four things I would note that are driving our strong cash flow from operations as we think about it. One, certainly, is just we've had really solid adjusted EBITDA growth. And that strong operational performance that we continue to highlight as we think about the strength of our revenue cycle operations in the Parallon we turn that revenue into cash. And so that's a piece of that. And you're seeing that in kind of our working capital management plans.

我認為有三、四件事推動了我們強勁的營運現金流。首先，當然是我們的調整後 EBITDA 成長確實非常穩健。當我們考慮 Parallon 的營收週期營運實力時，我們繼續強調強勁的營運業績，我們將收入轉化為現金。這就是其中的一部分。您可以在我們的營運資本管理計畫中看到這一點。

We have a pretty robust working capital management a strategic plan that includes not only net days and ARR that includes inventory levels, prepaid levels. And that work around working capital continued to see good steps as we think about growing of cash flow.

我們有一個相當強大的營運資本管理策略計劃，它不僅包括淨天數和 ARR，還包括庫存水準、預付款水準。當我們考慮增加現金流時，圍繞營運資本的工作繼續取得良好的進展。

The other point -- and I made this on the call, but it's important to note, is that year-to-date, we have been able to defer $1.3 million -- $1.3 billion of estimated federal income tax payment for the fourth quarter. And so keep that in mind as well. But when I think about the long term, this idea of clearing out your revenue cash and the strength of Parallon in our revenue cycle operations and the strength of the working capital management financial of the company, I think, puts us in good stead for continued strong management and performance or our cash flow into the future.

另一點——我在電話會議上提到了這一點，但值得注意的是，今年迄今為止，我們已經能夠推遲繳納第四季預計 130 萬美元——13 億美元的聯邦所得稅。所以也請記住這一點。但是當我考慮長遠時，我認為，清理收入現金的想法以及 Parallon 在我們的收入周期運營中的實力以及公司營運資本管理財務的實力，將使我們在未來繼續保持強勁的管理和業績或現金流。

And that is all the time we have for questions. I would like to turn it back to Mr. Frank Morgan for some closing remarks.

這就是我們回答問題的全部時間了。我想請弗蘭克摩根先生作最後發言。

Pril, thank you for your help today, and certainly, good luck for the rest of the earnings season. If anybody has any questions, we're around today, give us a call. Thank you.

Pril，感謝您今天的幫助，當然，祝您在接下來的財報季中好運連連。如果有人有任何疑問，我們今天就在附近，請打電話給我們。謝謝。

Thank you, presenters. And ladies and gentlemen, this concludes today's conference call. Thank you all for joining. You may now disconnect.

謝謝各位主持人。女士們、先生們，今天的電話會議到此結束。感謝大家的加入。您現在可以斷開連線。