美國醫院公司 (HCA) 2025 Q4 法說會逐字稿

Ladies and gentlemen, welcome to HCA Healthcare fourth quarter 2025 earnings conference call. Today's call is being recorded.

女士們、先生們，歡迎參加 HCA Healthcare 2025 年第四季財報電話會議。今天的通話將會被錄音。

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.

此時此刻，我謹將電話轉交給投資人關係副總裁法蘭克‧摩根先生，由他來致開幕詞及介紹各位嘉賓。請繼續，先生。

Good morning, and welcome to everyone on today's call. With me this morning is our CEO, Sam Hazen; and CFO, Mike Marks. Sam and Mike will provide some prepared remarks, and then we'll take questions.

早安，歡迎各位參加今天的電話會議。今天早上陪同我的是我們的執行長 Sam Hazen 和財務長 Mike Marks。Sam 和 Mike 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 can take any forward-looking statements that are based on management's current expectations. Numerous risks, uncertainties, and other factors may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed in today's press release and in our various SEC filings.

在將電話交給 Sam 之前，我想提醒大家，今天的電話會議可能會包含任何基於管理層當前預期的前瞻性陳述。諸多風險、不確定因素和其他因素可能導致實際結果與今天所表達的結果有重大差異。有關前瞻性聲明和這些因素的更多信息，請參閱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。

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

在今天早上的電話會議上，我們可能會提到調整後的 EBITDA 等指標，這是一個非 GAAP 財務指標。今天的新聞稿中包含一張表格，提供了有關調整後 EBITDA 的補充資訊以及歸屬於 HCA Healthcare, Inc. 的淨收入的調節資訊。今天早上的通話已被錄音，稍後將提供通話回放。

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

接下來，我將把電話交給薩姆。

Good morning, and thank you for joining the call. We closed out the year with strong results that were mostly consistent with the previous quarters in 2025. We delivered our 19th straight quarter of volume growth, reflecting continued solid demand across our markets, the benefit of network investments and improved results in capacity management, quality patient outcomes, and stakeholder engagement.

早安，感謝各位參加電話會議。我們以強勁的業績結束了這一年，這些業績與 2025 年前幾季的業績基本一致。我們連續第 19 個季度實現了銷售成長，這反映了我們各個市場持續強勁的需求、網路投資帶來的益處以及在產能管理、高品質的病患治療效果和利害關係人參與方面取得的進步。

Revenue increased 6.7% compared to the prior year quarter. and with disciplined expense management, margins improved both sequentially and year over year.

與上年同期相比，營收成長了6.7%。透過嚴格的費用控制，利潤率環比和年比均有所提高。

For the quarter, net income attributable to HCA Healthcare increased almost 31%. Diluted earnings per share as adjusted increased 29%, and adjusted EBITDA increased around 11% versus the prior year period.

本季度，HCA Healthcare 的淨利潤成長了近 31%。經調整後的稀釋每股盈餘成長了 29%，調整後的 EBITDA 比去年同期成長了約 11%。

Reflecting on 2025, this was another successful year for HCA Healthcare. Throughout the year, our teams executed at a high level. We gained ground with our strategic agenda, and we stayed focused on the fundamentals. Additionally, we invested significantly in network expansion, workforce development, and clinical capabilities. These investments helped deliver positive outcomes across the HCA Healthcare system. As a result, our networks had approximately 47 million patient encounters during the year, representing a record level of patient care activity for the company.

展望2025年，對HCA Healthcare來說，這又是成功的一年。全年，我們的團隊都保持了高水準的執行力。我們在策略議程方面取得了進展，並且始終專注於基本面。此外，我們也對網路擴張、員工隊伍發展和臨床能力進行了大量投資。這些投資幫助HCA醫療保健系統取得了積極的成果。因此，我們的網路在這一年中大約有 4700 萬次患者就診，這代表了該公司患者護理活動的最高紀錄。

I want to thank my colleagues for their outstanding work, their dedication to our patients, and their unyielding commitment to our mission.

我要感謝我的同事們，感謝他們出色的工作、對病人的奉獻以及對我們使命的堅定承諾。

Now let me transition to the policy environment. We continue to monitor several policy matters, including the expired enhanced premium tax credits, the ongoing developments related to Medicaid supplemental payment programs, and the rural health transformation program. These matters continue to evolve. As we learn more, we will provide updates at the appropriate time. That said, we believe our core business remains strong with forecasted volumes in our long-term 2% to 3% growth range.

現在讓我來談談政策環境。我們將繼續關注幾項政策事項，包括已到期的增強保費稅收抵免、與醫療補助補充支付計劃相關的持續發展以及農村衛生轉型計劃。這些情況仍在不斷變化。隨著我們了解更多信息，我們將在適當的時候提供最新消息。儘管如此，我們相信我們的核心業務依然強勁，預計銷量將保持在我們長期 2% 至 3% 的成長範圍內。

This past year, we strengthened the company's resiliency program in three important areas, and this gives us confidence that we can navigate effectively through these policy dynamics. The first was organizational. In this area, we added new capabilities that were aligned around the company's operating imperatives. Next, we strengthened the management systems to enhance execution. And lastly, we ramped up a leadership development.

過去一年，我們在三個重要領域加強了公司的韌性計劃，這讓我們有信心能夠有效地應對這些政策變化。首先是組織方面的問題。在這個領域，我們增加了與公司營運要務一致的新功能。接下來，我們加強了管理體係以提高執行力。最後，我們加強了領導力發展。

The second area relates to competitive positioning. We increased hospital capacity, clinical service offerings, and outpatient facilities across our networks to create greater patient access and address the needs of our communities.

第二個面向與競爭定位有關。我們增加了醫院容量、臨床服務項目和門診設施，以方便患者就診並滿足我們社區的需求。

The third was financial. Here, we advanced our cost management agenda and improved our balance sheet with strong cash flow and disciplined capital allocation. These results allowed us to invest significantly in our networks, our people, and our AI and tech agenda.

第三個問題是財務方面的。在這裡，我們推進了成本管理計劃，並透過強勁的現金流和嚴格的資本配置改善了資產負債表。這些成果使我們能夠對我們的網路、員工以及人工智慧和技術議程進行大量投資。

In closing, we are well positioned to move forward as we begin 2026. We continue to believe the HCA way of combining high-quality local provider networks with the distinct capabilities, talent, and scale of a national healthcare system creates sustained value for our stakeholders and allows us to deliver more effectively on our mission.

總之，我們已做好充分準備，迎接2026年的到來。我們始終相信，HCA 將高品質的本地醫療服務網絡與國家醫療保健系統的獨特能力、人才和規模相結合的方式，能夠為我們的利益相關者創造持續的價值，並使我們能夠更有效地履行我們的使命。

With that, I will turn over the call to Mike for more details on the quarter and our outlook for 2026.

接下來，我將把電話交給麥克，讓他詳細介紹本季業績以及我們對 2026 年的展望。

Thank you, Sam, and good morning, everyone. We were pleased with the results of the fourth quarter of 2025, which reflected strong operational performance combined with disciplined capital allocation. Let me note some same-facility volume comparisons for the fourth quarter of 2025 versus fourth quarter of 2024.

謝謝你，山姆，大家早安。我們對 2025 年第四季的業績感到滿意，這反映了強勁的營運表現以及嚴格的資本配置。讓我指出 2025 年第四季與 2024 年第四季同一工廠的產量對比情況。

Admissions increased 2.4%, and equivalent admissions increased 2.5%, in line with our expectations of 2% to 3% growth. Inpatient surgeries were flat, and outpatient surgical volume is down slightly. ER visits increased 50 basis points. Overall respiratory volumes had no material impact on year-over-year volume.

入學人數增加了 2.4%，等效入學人數增加了 2.5%，符合我們 2% 至 3% 的成長預期。住院手術量維持平穩，門診手術量略為下降。急診就診量增加了 50 個基點。整體呼吸量對年比呼吸量沒有實質影響。

Regarding payer mix for the quarter, same-facility total commercial equivalent admissions increased 1.1% over the prior year, with exchanges growing 2.5% and commercial, excluding exchanges, increasing approximately 1%.

就本季的支付方組成而言，同店商業等效入院總人數比上年增長了 1.1%，其中交易所增長了 2.5%，不包括交易所的商業入院人數增長了約 1%。

Medicare increased 3.5%, and Medicaid increased 2.2%. Same facility net revenue per equivalent admission increased 2.9% versus prior year quarter. The 80 basis point improvement in adjusted EBITDA margin in the quarter was driven primarily by solid revenue growth, good results in labor management, and improvements in other operating expenses. Adjusted EBITDA grew approximately 11% compared to the prior year quarter, primarily due to strong operating performance and an approximate $150 million increase in our hurricane markets.

聯邦醫療保險成長了 3.5%，聯邦醫療補助成長了 2.2%。同店每等效入院人數淨收入較上年同期成長 2.9%。本季調整後 EBITDA 利潤率提高了 80 個基點，主要得益於穩健的收入成長、良好的勞動力管理成果以及其他營運費用的改善。經調整的 EBITDA 比上年同期成長約 11%，主要得益於強勁的營運表現以及颶風市場約 1.5 億美元的成長。

As we've said in the past, Medicaid supplemental payment programs are complex, variable in timing, and do not fully cover our cost to treat Medicaid patients. Due to a retro payment from Virginia in the fourth quarter, the net impact of supplemental payments was approximately flat versus prior year quarter.

正如我們過去所說，醫療補助補充支付計畫很複雜，時間安排不固定，而且不能完全涵蓋我們治療醫療補助患者的成本。由於維吉尼亞州在第四季度進行了補發，補充付款的淨影響與去年同期基本持平。

Now let me discuss full-year results for 2025, which reflected good demand growth in our markets. On a same facility basis, we posted growth in revenue of 6.6%, equivalent admissions of 2.4%, and net revenue per equivalent admission of 4.1% versus prior year. Consolidated adjusted EBITDA increased 12.1% over prior year, and we delivered a 90 basis point improvement in adjusted EBITDA margin.

現在讓我來談談 2025 年的全年業績，這反映了我們市場良好的需求成長。與前一年相比，在同等設施的基礎上，我們的收入增加了 6.6%，等效入院人數增加了 2.4%，每次等效入院的淨收入增加了 4.1%。綜合調整後 EBITDA 比上年增長 12.1%，調整後 EBITDA 利潤率提高了 90 個基點。

The net benefit from supplemental payments increased by $420 million. Hurricane-impacted markets contributed approximately $125 million in adjusted EBITDA growth. Diluted earnings per share as adjusted increased 28.5%.

補充支付帶來的淨收益增加了4.2億美元。受颶風影響的市場因素貢獻了約 1.25 億美元的調整後 EBITDA 成長。經調整後的稀釋每股收益成長了28.5%。

Moving to capital allocation. Capital expenditures totaled $1.5 billion in the quarter and $4.9 billion for the year. Additionally, we purchased $2.6 billion of our outstanding shares during the quarter and $10 billion in the year. We paid $162 million in dividends for the quarter and $679 million for the year.

接下來討論資本配置。本季資本支出總額為 15 億美元，全年資本支出總額為 49 億美元。此外，本季我們回購了價值 26 億美元的流通股，全年回購了價值 100 億美元的流通股。本季我們支付了 1.62 億美元的股息，全年支付了 6.79 億美元的股息。

Cash flow from operations was $2.4 billion in the quarter and $12.6 billion for the year. This represents a 20% increase in operating cash flow in 2025 over full year 2024. Our debt to adjusted EBITDA leverage remained at the low end of our target range. Given our strong balance sheet, we are well positioned for the future.

本季經營活動產生的現金流量為 24 億美元，全年經營活動產生的現金流量為 126 億美元。這意味著 2025 年的營運現金流比 2024 年全年成長 20%。我們的債務與調整後 EBITDA 比率保持在目標範圍的低端。鑑於我們強勁的資產負債表，我們已為未來做好了充分準備。

So with that, let me speak to our 2026 guidance. We expect revenues to range between $76.5 billion and $80 billion. We expect adjusted EBITDA to range between $15.55 billion and $16.45 billion. We expect net income attributable to HCA Healthcare to range between $6.5 billion and $7 billion. We expect diluted earnings per share to range between $29.10 and $31.50.

那麼，接下來我將談談我們2026年的指導方針。我們預計營收將在765億美元至800億美元之間。我們預計調整後 EBITDA 將在 155.5 億美元至 164.5 億美元之間。我們預計 HCA Healthcare 的淨利潤將在 65 億美元至 70 億美元之間。我們預計稀釋後每股收益將在 29.10 美元至 31.50 美元之間。

Further, we continued to see opportunities to deploy capital and drive organic growth in our markets through investing in high acuity programs, increasing our network through new access points, and building new inpatient capacity. As a result of these opportunities, we have increased our capital spending range from $5 billion to $5.5 billion.

此外，我們繼續看到透過投資高風險項目、透過新的接入點擴大我們的網路以及建立新的住院容量來部署資本並推動市場有機成長的機會。由於這些機遇，我們將資本支出範圍從 50 億美元增加到 55 億美元。

Our 2026 guidance includes the following assumption. Growth in equivalent admissions between 2% and 3%, an adverse impact on adjusted EBITDA between $600 million and $900 million related to the health insurance exchanges. This includes impact from administrative reforms enacted in 2025, the One Big Beautiful Bill Act, and the expiration of the enhanced premium tax credits.

我們的 2026 年指導方針包含以下假設。等效入院人數增加 2% 至 3%，與醫療保險交易相關的調整後 EBITDA 將受到 6 億美元至 9 億美元的不利影響。這包括 2025 年頒布的行政改革、《一項偉大的美麗法案》以及增強型保費稅收抵免到期帶來的影響。

We expect an offset to this exchange headwind of approximately $400 million through resiliency initiatives designed to generate efficiencies throughout the organization. We anticipate decline in supplemental payment programs' net benefit between $250 million and $450 million.

我們預計，透過旨在提高整個組織效率的韌性舉措，可以抵消約 4 億美元的匯率不利影響。我們預計補充支付計畫的淨收益將減少 2.5 億美元至 4.5 億美元。

The expected decline in net benefit is driven primarily by Tennessee's program reverting back to four quarters of net benefit versus six quarters in 2025, a pause on one specific program in Texas, and a onetime retro payment from Virginia. This guidance does not include any potential impact in 2026 from additional approvals of grandfathered applications.

預計淨收益下降的主要原因是田納西州的計劃在 2025 年將淨收益週期從六個季度恢復到四個季度，德克薩斯州的一個特定計劃暫停，以及弗吉尼亞州的一次性追溯付款。該指南並未考慮 2026 年因額外批准已獲豁免申請而可能產生的任何影響。

We do not anticipate any significant growth to adjusted EBITDA from our hurricane-impacted markets over prior year. We expect full-year margins to be slightly above 20%, consistent with 2025 and cash flow from operations to range between $12 billion and $13 billion. Lastly, we plan to continue investing in our technology and digital innovation strategies, which we expect will deliver long-term value and help position the company for the future.

我們預計受颶風影響的市場調整後 EBITDA 不會比前一年有顯著成長。我們預計全年利潤率將略高於 20%，與 2025 年的水準一致，經營活動產生的現金流將在 120 億美元至 130 億美元之間。最後，我們計劃繼續投資我們的技術和數位創新策略，我們期望這些策略能夠帶來長期價值，並幫助公司為未來做好準備。

Considering these factors, our overall 2026 adjusted EBITDA guidance reflects strength and momentum in operations, increased investment in strategic initiatives, consistent business fundamentals, and a disciplined approach to capital allocation. Given what we see today, including the demand in our markets, our resiliency program, and our digital transformation initiatives, we remain comfortable that we will perform within our long-term plan over time.

考慮到這些因素，我們對 2026 年調整後 EBITDA 的整體預期反映了營運的強勁勢頭、對戰略舉措的加大投資、穩定的業務基本面以及嚴謹的資本配置方法。鑑於我們目前所看到的，包括市場需求、我們的韌性計劃和數位轉型舉措，我們仍然有信心，隨著時間的推移，我們將實現我們的長期計劃目標。

As noted in our release this morning, our Board of Directors have authorized a new $10 billion share repurchase program. We currently anticipate completing a majority of the existing authorization in 2026, subject to market conditions and other factors. In addition, our Board declared an increase in our quarterly dividend from $0.72 to $0.78 per share.

正如我們今天早上發布的公告中所述，我們的董事會已批准一項新的 100 億美元股票回購計畫。我們目前預計將在 2026 年完成大部分現有授權，但具體時間取決於市場狀況和其他因素。此外，董事會宣布將季度股息從每股 0.72 美元提高到 0.78 美元。

In conclusion, 2025 marked another year of solid operational performance for HCA, and we believe that we are well positioned for continued progress and success in 2026.

總之，2025 年是 HCA 營運表現穩健的另一年，我們相信，我們已做好充分準備，在 2026 年繼續取得進步和成功。

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

接下來，我將把電話交給弗蘭克，讓他回答問題。

(Event Instructions)

（活動須知）

(Operator Instructions) AJ Rice, UBS.

（操作說明）AJ Rice，瑞銀集團。

I wondered maybe the focus is on the top line, of course, in your comments. Can you talk about the expense items, SWB, supplies, other operating expenses, professional fees, et cetera? What are you -- what are your underlying assumptions there that are embedded in the guidance? Is there margin improvement opportunities on any of those lines in '26?

我懷疑你們的評論重點是不是放在了第一行。您能談談費用項目、SWB、用品、其他營運費用、專業費用等等嗎？你的指導原則中隱含著哪些潛在假設？2026年，這些產品線中是否有任何利潤率提升的機會？

When I look at the margin, and I noted this in my comments, but yeah, the midpoint of our revenue and adjusted EBITDA guidance range suggests expectations for pretty stable margins in '26 versus '25. As we noted on our third-quarter call, we continue to expect mostly stable trends in our operating costs, consistent with the last couple of years.

當我查看利潤率時，我在評論中也提到了這一點，是的，我們收入和調整後 EBITDA 指導範圍的中點表明，預計 2026 年的利潤率將與 2025 年相比相當穩定。正如我們在第三季電話會議上提到的那樣，我們預計營運成本將繼續保持相對穩定的趨勢，與過去幾年的情況一致。

I might note that we do see and expect continued physician cost pressures and believe that those could even be maybe in the high single digits growth in '26 versus '25. So those would be kind of some comments on the cost side of our guidance.

我注意到，我們確實看到並預期醫生成本壓力將持續存在，並且認為 2026 年的醫生成本增長甚至可能達到個位數高位，而 2025 年則不然。以上就是我們對成本方面的一些看法。

Okay. In the contract labor and just general labor that's steady year-to-year underlying assumptions?

好的。合約工和普通工人的薪資水平，其基本假設是逐年穩定的嗎？

It is. I mean, the only thing I might mention is that contract labor as a percent of SWB, we came in at about 4.2% for the fourth quarter, and that feels like kind of our run rate now as we come into 2026. But other than that, I mean, the resiliency plan is reflected in our guidance, as I noted in my comments.

這是。我的意思是，我唯一想提的是，合約工佔SWB的比例，第四季約為4.2%，這感覺就像我們進入2026年時的運作水準。但除此之外，我的意思是，正如我在評論中提到的，我們的指導方針中體現了復原力計劃。

And largely, the resiliency plan is there to help us offset as much of the adverse impact of the exchange headwinds as possible. And you see that in our guidance as well. And I think it reflects really strong cost and operating leverage as we head into 2026.

總體而言，此應急計劃旨在幫助我們盡可能抵消匯率逆風帶來的不利影響。這一點在我們的指導原則中也有體現。我認為這反映了我們在邁向 2026 年之際，成本和營運槓桿作用非常強勁。

Ann Hynes, Mizuho.

安海恩斯，瑞穗。

So it sounds like the net negative headwind from HCA subsidies is in the $200 million to $500 million range. Can you just go into more of the resiliency programs provide some more detail on what's making up that $400 million and obviously, the confidence in executing throughout the year just from a timing perspective and when you expect to lose potential volume?

因此，HCA 補貼帶來的淨負面影響似乎在 2 億至 5 億美元之間。您能否詳細介紹一下韌性計劃，詳細說明這 4 億美元的具體構成，以及從時間安排的角度，以及您預計何時會損失潛在業務量，來說明您對全年執行計​​劃的信心？

Sure. I'll start with resiliency, and I'll pick up the second part, end of your question related to the exchanges. But as we've talked about over the last really year plus, we have been implementing steps to try to mitigate the impact of this health insurance exchange headwind. We've been working to both enhance and accelerate our financial resiliency program. I would make a couple of contextual notes related to our program.

當然。我先從韌性說起，然後再回答你關於交易所問題的後半部。但正如我們在過去一年多的時間裡一直在討論的那樣，我們一直在採取措施，試圖減輕醫療保險交易市場逆風的影響。我們一直在努力加強和加快我們的財務韌性計劃。我會做一些與我們專案相關的背景說明。

The first is that our program has four key areas of focus: revenue integrity, variable and fixed cost efficiencies, and capacity management. We are leveraging three primary capabilities in driving our financial resiliency program: first, internal and external benchmarking and advanced analytics; second, digital transformation with AI and automation; and third, expanding and leveraging our shared service platforms.

首先，我們的計劃有四個重點領域：收入完整性、變動成本和固定成本效率以及產能管理。我們在推動財務韌性計劃方面主要利用了三項能力：第一，內部和外部基準測試和高級分析；第二，利用人工智慧和自動化進行數位轉型；第三，擴展和利用我們的共享服務平台。

Our 2026 plan includes significant efforts at corporate, in our large shared service platforms and in our hospital operations. We have planned elements to drive better capacity management, including managing throughput and length of stay in our inpatient settings and our emergency rooms and our operating rooms.

我們的 2026 年計畫包括在公司層級、大型共享服務平台和醫院營運方面做出重大努力。我們已製定計劃，以推動更好的容量管理，包括管理住院部、急診室和手術室的吞吐量和停留時間。

On the cost side, we have robust plans to drive labor efficiency, supply cost actions and operating costs covering both variable and fixed costs. We're proud of our teams, and I think they have done a wonderful job embracing resiliency as a strategic imperative. And we have confidence that we'll be able to execute on this $400 million of incremental cost savings in '26 versus '25. A little bit more on your question related to HICS. And let me just say this.

在成本方面，我們制定了強有力的計劃，以提高勞動效率、降低供應成本並降低營運成本，涵蓋變動成本和固定成本。我們為我們的團隊感到自豪，我認為他們在將韌性作為策略性要務方面做得非常出色。我們有信心在 2026 年實現比 2025 年節省 4 億美元的額外成本。關於您提出的HICS問題，我再補充一點。我只想說一句。

Our estimated range, as I noted in my comments, of $600 million to $900 million adverse impact to EBITDA includes the potential impacts from administrative reforms that were passed as part of the One Big Beautiful Bill Act and enacted through rulemaking as well as expiration of the EPTCs. And so as a reminder, our health exchange volumes represent approximately 8% of admissions and 10% of revenue in 2025. And the estimate impact centers around some key variables that are included in our calculations. First, how many people lose exchange coverage. And what form of coverage, if any, do those lives migrate to?

正如我在評論中提到的，我們估計對 EBITDA 的不利影響範圍為 6 億美元至 9 億美元，其中包括作為《一項偉大的法案》的一部分通過並通過規則制定實施的行政改革的潛在影響，以及 EPTC 到期的影響。因此，再次提醒大家，到 2025 年，我們的健康交易量約佔入院人數的 8% 和收入的 10%。估算結果主要圍繞著我們計算中包含的一些關鍵變數。首先，有多少人失去了健保。那麼，這些患者最終會獲得何種形式的醫療保險（如果有的話）？

And for those retaining coverage, is there a change in metal tier or utilization? As you can imagine, assumptions around the variables are informed through our own data and experience as well as incorporating external studies and analysis. These variables are difficult to predict and require significant judgments. Our model contemplates a 15% to 20% decline in our HICS volumes for 2026. We assume this volume will migrate to either employee-sponsored insurance or to uninsured.

對於那些繼續享有保險的人來說，金屬等級或使用率會改變嗎？您可以想像，我們對變數的假設是透過我們自己的數據和經驗，以及結合外部研究和分析而得出的。這些變數難以預測，需要做出大量判斷。我們的模型預測，到 2026 年，我們的 HICS 銷售量將下降 15% 至 20%。我們假設這部分業務量要麼轉移到員工提供的醫療保險範圍內，要麼會轉移到沒有保險的人群中。

Of the decline in our HICS volumes, we assume approximately 15% to 20% will move to employee-sponsored coverage, which carries a benefit with the remaining migrating to uninsured, which includes a decline in utilization from those individuals no longer having coverage. From a timing perspective, we are watching the enrollment figures carefully. As you know, they were released recently by CMS. But these recently released enrollment data include a couple of key areas that will dictate the timing of the impact. And the first one is whether people can pay and sustain their premiums, given the significant increase they are facing from EPTC expiration.

我們預計，HICS 業務量的下降中，約有 15% 至 20% 將轉為雇主提供的保險，這會帶來好處；而其餘的人則會轉為無保險狀態，這會導致那些不再有保險的人的保險使用率下降。從時間安排的角度來看，我們正在密切關注招生人數。如您所知，它們是CMS最近發布的。但最近公佈的這些入學數據包含幾個關鍵領域，這些領域將決定影響的時間。第一個問題是，鑑於 EPTC 到期後保費大幅上漲，人們是否能夠支付並維持保費。

The second one is if there will be a metal tier shift from silver to bronze and the impact on utilization and collectibility of our patient due balances. So we're watching these trends carefully as we go through the opening days, weeks and months of 2026, and we will keep you informed as they play out during 2026 on our quarterly calls.

第二個問題是，金屬等級是否會從銀級降至銅級，以及這會對我們病患應收帳款的使用率和回收率產生什麼影響。因此，在 2026 年的最初幾天、幾週和幾個月裡，我們將密切關注這些趨勢，並在 2026 年的季度電話會議上隨時向您通報這些趨勢的發展。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

2026 guidance question here, just are there any one-timers we should be adjusting out for 2025? But if you take the baseline of '25, to pull out, I think, $450 million to $900 million from HCA supplemental payments offset by the resiliency programs, I just want to make sort of calculating the core growth of what HCA is doing at sort of 3% to 12%, the 7% at the midpoint versus just your long-term guidance of 4% to 6%, so you're still guiding core above your long-term guidance?

這裡有個關於 2026 年指導意見的問題，是否有任何一次性因素我們應該在 2025 年進行調整？但如果你以 2025 年為基準，從 HCA 的補充付款中提取 4.5 億至 9 億美元，並抵消韌性計劃的影響，我只是想計算一下 HCA 的核心增長，大約在 3% 到 12% 之間，中間值為 7%，而你們的長期指導值為 4% 到 6%，所以你們仍然高於長期的指導值？

Let me say, I think from a range perspective, I would just reiterate two or three of the moving parts for clarity. We've noted the range of potential adverse impact from the exchanges of $600 million to $900 million. We've noted that we believe that the supplemental payments could have a $250 million to $450 million decline in net benefit and that that decline in net benefit does not include any potential new approvals of grandfathered applications by CMS. And lastly, resiliency, we are confident that we'll be able to execute on our plans for 2026, given the $400 million target.

讓我說一下，從範圍的角度來看，為了更清楚地說明，我只想重申其中兩個或三個組成部分。我們注意到，這筆交易可能帶來的不利影響範圍在 6 億美元至 9 億美元之間。我們注意到，我們認為補充支付可能會導致淨收益減少 2.5 億美元至 4.5 億美元，而且淨收益的減少還不包括 CMS 對已獲批准的申請可能進行的任何新的批准。最後，關於韌性，我們有信心實現 2026 年的計劃，達到 4 億美元的目標。

So I think in taking those kind of swing factors into account -- PO, we do agree, and we're pleased with the strength and the performance of the company and the momentum of the company as we go into 2026.

所以我認為，考慮到這些波動因素——PO，我們同意，我們對公司的實力和業績以及公司在進入 2026 年的發展勢頭感到滿意。

And then you can size out the potential DFL approvals come through, how much that could add to '26 EBITDA?

然後，你可以估算一下如果民主黨-農民-勞工黨（DFL）獲得批准，會給 2026 年的 EBITDA 增加多少？

Yeah, we're not sizing the due approvals until we get a sense of the actual approval from CMS and what changes, if any, they make through their review and approval processes. So not quite sizing that yet.

是的，在了解 CMS 的實際批准情況以及他們在審查和批准過程中做出的任何更改之前，我們不會估算需要批准的金額。所以尺寸還沒完全確定。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

This is Anna on for Justin. Just wanted to ask, the $400 million of resiliency benefit in '26 is impressive. Can you talk about how much of that comes from ramping AI initiatives and how we should think about further resiliency opportunities beyond 2026 as some of the Medicaid cuts begin in the out years?

這是安娜替賈斯汀發言。我想問一下，2026 年 4 億美元的韌性效益令人印象深刻。您能否談談其中有多少來自於人工智慧計畫的加速推進，以及隨著一些醫療補助計畫的削減將在未來幾年開始，我們應該如何考慮2026年以後的進一步增強韌性的機會？

Yeah. And we've mentioned this before. But I think the way to think about our resiliency program is that it's a multiyear program. The $400 million came from our assessment of implementation status of the long list of opportunities that we're working on. And based on that assessment of our implementation status, it gave us confidence to include $400 million of savings in '26 versus '25 in our overall guidance.

是的。我們之前也提到過這一點。但我認為，看待我們的韌性計劃應該把它看作是多年計劃。這 4 億美元來自我們對正在推進的眾多專案實施情況的評估。基於對我們實施情況的評估，我們有信心將 2026 年比 2025 年節省 4 億美元納入我們的整體指導方針中。

As we move forward, we continue to work on our resiliency plan. It's a program, and I mentioned on the previous question, components that we're working on. But we're really pleased with the depth and breadth of our resiliency program and believe that it gives us good support here as we move through the back half of the decade.

展望未來，我們將繼續完善我們的應對能力提升計劃。這是一個程序，我在上一個問題中提到過，是我們正在開發的元件。但我們對韌性計畫的深度和廣度感到非常滿意，並相信它將在我們進入本十年後半段時為我們提供良好的支持。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

You guys have been working on some digital efforts with payers recently, I think at least some of the large national ones around data and disputes. Can you maybe talk about that and how it's manifesting into revenue cycle, yield collections, or pricing or maybe just reduce payer friction?

我認為你們最近一直在與支付方合作進行一些數位化項目，至少包括一些圍繞數據和爭議解決的大型全國性項目。您能否談談這一點，以及它如何影響收入週期、收益收取或定價，或只是減少付款方的摩擦？

Sure. Hey, Whit. Thank you. We have, over the last year, have launched a series of engagements with many of our major payers. And these engagements kind of focus on digital integration. So think about electronic data exchange, think about the kinds of activities that HCA and our payers can partner on to produce administrative simplification.

當然。嘿，惠特。謝謝。過去一年，我們與許多主要付款方進行了一系列合作。這些合作項目主要著重於數位化整合。因此，請考慮電子資料交換，考慮HCA和我們的付款方可以合作進行哪些活動以簡化行政管理。

And I think they also include dispute resolution and trying to do -- find better ways to resolve disputes between the parties. We're pleased with these engagements. And I think it gives us strength in our overall relationships with payers. And frankly, we continue to work with our payers to find ways to make things better for their members and our patients and to digitize the whole workflow between ourselves and our payer partners.

我認為它們還包括爭端解決，以及努力尋找更好的方法來解決各方之間的爭端。我們對這些合作感到滿意。我認為這增強了我們與付款方的整體關係。坦白說，我們將繼續與支付方合作，尋找改善其會員和我們患者體驗的方法，並實現我們與支付方合作夥伴之間整個工作流程的數位化。

So I think overall, these engagements have produced good progress with the relationship between us and our payers. And so we're excited as we head into 2026 to continue to work with these -- with our payers on these initiatives.

所以總的來說，我認為這些互動在我們與付款方的關係方面取得了良好的進展。因此，我們非常高興地展望 2026 年，並繼續與我們的支付方合作開展這些計劃。

And Mike, speak to the working capital improvement this year, which are part and parcel to some of that, not entirely all of it, but I think that is reflected in the cash flow production that the company had and then our working capital improved this year.

麥克，請談談今年的營運資金改善情況，這與上述情況有一定關係，但並非全部，但我認為這體現在公司的現金流產生情況上，而且我們今年的營運資金也得到了改善。

For sure. I mean, we had a nice reduction in net days in AR, especially in the fourth quarter. And that really reflects the benefits of sharing data and exchanging data from payers digitally and certainly is a part of what's driving those enhancements. So I think the efforts here are clearly on administrative simplification. I do think they have impacts on our revenue cycle, both in terms of getting claims paid more timely, but also through potential mitigation of denials and disputes, which is beneficial for both us and our payers.

一定。我的意思是，我們的應收帳款淨天數大幅減少了，尤其是在第四季。這確實體現了與支付方進行數位化資料共享和交換的好處，當然也是推動這些改進的部分原因。所以我認為，這裡的努力顯然是為了簡化行政程序。我認為它們確實對我們的收入週期產生了影響，不僅體現在更及時地支付索賠方面，還體現在潛在地減少拒付和爭議方面，這對我們和我們的付款方都有好處。

And Mike, let me add to just the whole resiliency agenda. This is not an episodic event for us. It just happens to be a maturation of what in my estimation is cultural within HCA, and that is being cost effective in finding ways to leverage scale, utilize best practices. Now we have tools, as Mike alluded to, that are in front of us as opportunities to create even more consistency, efficiencies and transparency in the company's overall cost. And that's why the program is lining up in a well-timed manner with some of the enhanced premium tax credit challenges.

麥克，我想就整個韌性議程補充一點。對我們來說，這不是一件偶發事件。在我看來，這恰好是 HCA 內部文化的一種成熟體現，即在利用規模優勢和最佳實踐方面追求成本效益。正如麥克所暗示的那樣，我們現在擁有了一些工具，這些工具為我們提供了機會，可以進一步提高公司整體成本的一致性、效率和透明度。正因如此，該計劃的推出與一些加強保費稅收抵免的挑戰在時間上恰到好處地契合。

But we see this program continuing to mature. And as we get more capable at using these tools, it's going to help us find even more opportunities. But this is not a onetime event. It's a cultural dynamic in our company around being cost effective, being high quality and finding ways to improve from a process standpoint and a leverage standpoint with our overall scale.

但我們看到這個項目正在不斷成熟。隨著我們越來越熟練地使用這些工具，這將幫助我們發現更多機會。但這並非一次性事件。我們公司內部的文化氛圍是，注重成本效益、追求高品質，並從流程和規模效益的角度尋找改進的方法。

Brian Tanquilut, Jefferies.

Brian Tanquilut，傑富瑞集團。

Mike, as I think about the rural benefit from One Big Beautiful Bill, curious if you have any updated thoughts they finalized the rules there. And then just any call out in Q1 that we think about other than sort of the tough comp that we should be contemplating?

麥克，我一直在思考《大而美好的法案》對農村地區的益處，想知道你對他們最終確定相關規則是否有任何最新的想法。那麼，除了我們應該考慮的比較激烈的競爭之外，我們在第一季還會考慮哪些其他的競標機會呢？

On the Rural Health Transformation program under the One Beautiful Bill Act, all 50 states have been allocated their program funding, but these are largely state-driven programs, and most of the details have not yet been released. We do not yet know the timing, the structure or the size of any state level awards, or how much of the funding will be distributed within each state. So our approach, Brian, has been to really stay actively engaged with our state and federal partners regarding both the program design and then our response to program design to ensure that once the applications are open, that we will participate in a way that's meaningful.

根據《一個美好法案》的農村衛生轉型計劃，所有 50 個州都已獲得計劃資金，但這些計劃主要由各州主導，大部分細節尚未公佈。我們目前還不清楚各州級獎項的頒發時間、結構或規模，也不清楚各州將分配多少資金。布萊恩，所以我們的做法是，積極與州和聯邦合作夥伴就專案設計以及我們對專案設計的回應保持密切聯繫，以確保一旦申請開放，我們就能以有意義的方式參與其中。

At this stage, we do view the Rural Health Transformation Fund as a potential opportunity, but it's not something that we have reflected in our guidance given the remaining uncertainty. When I think about the quarter, we had a strong quarter.

現階段，我們確實將農村衛生轉型基金視為潛在的機會，但鑑於仍有許多不確定因素，我們尚未將其反映在我們的指導方針中。回顧這個季度，我們表現非常出色。

We noted that there's maybe one part of that that was a little different than we anticipated when we gave our third quarter update, and that's the state supplemental payments. You may recall that on our third quarter update, we thought we would finish the full year at $300 million net benefit in state supplemental payment programs for the quarter -- for the year of 2025 because we were anticipating a year-over-year decline in fourth quarter, given some known headwinds from the prior year. We ended up getting a retro payment from Virginia in the fourth quarter, which kind of pushed us flat in the quarter and led us up to a $420 million net benefit for the full year.

我們注意到，在發布第三季更新報告時，可能有一部分情況與我們預期的略有不同，那就是州政府的補充付款。您可能還記得，在我們的第三季更新中，我們認為 2025 年全年各州補充支付計劃的淨收益將達到 3 億美元，因為我們預計第四季度將同比下降，考慮到上一年的一些已知不利因素。第四季度，我們收到了弗吉尼亞州的一筆追溯付款，這使得我們該季度的業績基本持平，並使我們全年的淨收益達到了 4.2 億美元。

So that's about the -- that's the only thing I can think of, Brian, that would be a little different than we anticipated when we gave our update for guidance in our third quarter call. I mean volumes came in largely where we anticipated. Our rates were stable, a stable operating environment with rates. And our expense management, I thought was really good in the quarter. So overall, we deem our fourth quarter performance as being strong.

所以，布萊恩，我能想到的唯一一點就是，這可能與我們在第三季財報電話會議上給出的業績指引更新預期略有不同。我的意思是，銷售量基本上符合我們的預期。我們的費率保持穩定，營運環境穩定。我認為本季我們的費用管理做得非常好。整體而言，我們認為第四季的業績表現強勁。

Mike, let me add to the rural discussion, just one minute here. Roughly 15% of our hospitals, we believe, are rural hospitals of some sort. And so that's a large footprint that we have that's complementary to the networks across the company. And so we have a number of assets in rural communities.

麥克，讓我補充一下關於鄉村的討論，就一分鐘時間。我們認為，我們醫院中大約有 15% 是某種類型的鄉村醫院。因此，我們擁有如此龐大的業務覆蓋範圍，與公司內部的各種網路形成互補。因此，我們在農村社區擁有許多資產。

Secondly, we have a number of programs where our health systems from one community to the other provide services in rural communities, whether it's telemedicine, transport systems, satellite clinic with our physicians, urgent care, whatever. And so that's another vehicle.

其次，我們開展了許多項目，讓我們的醫療系統從一個社區到另一個社區為農村社區提供服務，無論是遠距醫療、運輸系統、由我們醫生坐鎮的衛星診所、緊急護理等等。所以，那又是另一輛車了。

The third piece for us is workforce. Our graduate medical education programs, even our nursing rotations with our Galen College of Nursing programs create opportunities for us to, we believe, participate in the programs. But as Mike said, we're having to work through roughly 20 different programs in our company to understand how those funds are going to be applied. But we do think we have elements of the company that are in rural America in a way that deserves funding through these programs.

對我們來說，第三個要素是勞動。我們相信，我們的研究生醫學教育項目，甚至我們與蓋倫護理學院合作的護理輪調項目，都為我們創造了參與這些項目的機會。但正如麥克所說，我們公司需要研究大約 20 個不同的項目，才能了解這些資金將如何被使用。但我們認為，我們公司的一些業務與美國農村地區有著某種聯繫，值得透過這些計畫獲得資助。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，加拿大皇家銀行資本市場。

I was wondering if you could provide some thoughts on the potential for a transition to a health savings account construct for enhanced subsidies. Assuming those funds go directly to customer HCAs, is there any initial thoughts you have on how it would impact your current assessment of the EPC expiry headwinds? And then how should we think about the impact on uncompensated care patients have access to the funds but may not be purchasing insurance.

我想請您就過渡到健康儲蓄帳戶模式以加強補貼的可能性提供一些看法。假設這些資金直接用於客戶的 HCA，您初步認為這將如何影響您目前對 EPC 到期不利因素的評估？那麼，我們該如何看待未獲得補償的醫療服務對病患的影響呢？患者可以獲得資金，但可能沒有購買保險。

So I think as you think about President Trump's healthcare plan announcement last week, I think the plan, as we understand it, was really aimed at approving a forbid. The themes seem to be, including insurance plan, account -- pharmaceutical prices increasing price transparency. And to your point, potentially changing the way that the set of exchanges with tax credits, maybe a little bit more related to cash coming into healthcare savings accounts. It's a little early to get a sense for what aspects of that plan will come to fruition. We're monitoring, as you can imagine, closely, is Congress pick those up and decide how they will react.

所以，我認為，當你思考川普總統上周宣布的醫療保健計劃時，我認為，據我們了解，該計劃實際上是為了批准一項禁令。主題似乎是，包括保險計劃、帳戶——藥品價格提高價格透明度。正如您所說，這可能會改變稅收抵免的交易方式，或許與現金流入醫療保健儲蓄帳戶的關係更為密切。現在判斷該計劃的哪些方面能夠實現還為時過早。正如您所想，我們正在密切關注國會是否會審議這些法案，以及他們將如何應對。

So at this point, it's a little early to try to size potential impacts related to those kinds of potential changes. We're just going to see how they flow through Congress and see what comes. But obviously, we're monitoring it just like you are. And we'll update we know more.

因此，目前要評估這些潛在變化可能帶來的影響還為時過早。我們只想看看這些法案在國會如何通過，以及最終結果如何。但很顯然，我們和你們一樣都在密切關注著這件事。如果有更多信息，我們會及時更新。

Matthew Gillmor, KeyBanc.

Matthew Gillmor，KeyBanc。

I want to follow up on the exchange discussion for '26. Can you give us a sense for how the exchange reforms and subsidy expirations will impact the volume outlook? I'm curious if there's a drag that's being absorbed within the 2% to 3% volume outlook from the exchange expiration. And can you also give us a sense for how you're thinking about the decline in utilization from folks that moved to uninsured within your outlook?

我想跟進一下關於 2026 年交流活動的討論。您能否預測匯率改革和補貼到期將如何影響交易量前景？我很好奇，交易所到期導致的 2% 到 3% 的交易量預期是否吸收了部分拖累。另外，您能否談談您如何看待那些失去醫療保險的人導致醫療服務使用率下降的問題？

Sure. So if you just think about the modeling, and again, I think it's important to always start with context. This modeling, these judgments are significant, and they're early. And so part of our work as we go through the next days, weeks and months will be to test these assumptions against our actual experience. And so we're going to know more, Matthew, at the end of first quarter into second quarter, and we will keep you updated as we learn more.

當然。所以，如果你仔細想想建模，我認為始終從背景開始非常重要。這種建模和判斷意義重大，而且現在還處於早期階段。因此，在接下來的幾天、幾週和幾個月裡，我們的部分工作就是根據我們的實際經驗來檢驗這些假設。所以，馬修，我們會在第一季度末進入第二季度時了解更多信息，我們會隨時向您報告最新情況。

But yeah, I do think that the overall volume of the company, although it's within that range of 2% to 3% has an impact here on exchanges. And if you think about the walk-through of the math, and so I'll just go back through it because I think it's instructive, we contemplate a 15% to 20% decline in our HICS volumes in 2026. And that this volume will migrate to either employee-sponsored insurance or to uninsured. Of the decline in our volume, we assume approximately 15% to 20% of those people will end up with employee-sponsored insurance coverage, which does carry a benefit. But the remaining will go to uninsured.

但是，我確實認為，儘管公司的整體交易量在 2% 到 3% 的範圍內，但它確實會對交易所的交易產生影響。如果你仔細想想數學計算的過程，所以我再回顧一下，因為我認為這很有啟發性，我們預計到 2026 年，我們的 HICS 業務量將下降 15% 到 20%。而這部分業務量要麼轉移到員工提供的保險範圍內，要麼會轉移到沒有保險的範圍內。我們預計，在我們業務量下降的情況下，大約有 15% 到 20% 的人最終會獲得雇主提供的保險，這確實有好處。但剩餘部分將分配給沒有保險的人。

And for the ones that go to uninsured, we do anticipate a decline in utilization from those individuals no longer having coverage. And we believe that that decline is somewhere in the 30% range compared to their utilization of the health care services when they had health care insurance through the exchanges.

對於那些失去保險的人來說，我們預計他們的醫療服務使用率會下降，因為他們不再有保險保障。我們認為，與他們透過交易所獲得醫療保險時相比，這種下降幅度在 30% 左右。

The only other thing I might mention with the exchange population is we find that they tend to utilize the emergency room in a way that's heavier than our traditional managed care or commercial population. And so clearly, that's -- the folks that become uninsured, even with the slight decline of utilization, that population as well almost entirely uses the emergency room. So those will be some additional comments on the impact on volume.

關於醫療保險交換人群，我唯一想提的是，我們發現他們使用急診室的頻率往往比我們傳統的醫療保險或商業保險人群要高。因此很明顯，即使醫療服務利用率略有下降，失去醫療保險的人幾乎全部依賴急診室。以上就是一些關於銷量影響的補充說明。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Outpatient surgeries declined year-over-year on a negative comp and moderated from the previous quarter. Can you elaborate on what you saw there and if there are any payer categories you would call out driving some of that volume pressure?

門診手術量較去年同期下降，基數較低，較上一季收窄。您能否詳細說明您在那裡看到的情況，以及您認為哪些支付方類別導致了交易量的成長壓力？

Hey, Andrew. Yeah, absolutely. If I pull (inaudible) just outpatient surgery, let me just talk about outpatient in general first, and then we'll touch surgery. But overall, on the outpatient side, we were pleased with our outpatient revenue growth, which actually grew at a rate higher than our inpatient revenue growth. As a reminder, we kind of characterize our outpatient revenue into four categories: emergency services, outpatient surgery, which includes both hospital-based and ASCs, our ambulatory platforms, which include physician clinics, and urgent care clinics and other hospital-based outpatient services, including cardiology, diagnostics and the like. All four categories experienced solid revenue growth over prior year in the quarter.

嘿，安德魯。是的，絕對的。如果我把（聽不清楚）只拿出來，那就讓我先談談門診手術的一般情況，然後再談談手術。但總體而言，在門診方面，我們對門診收入的成長感到滿意，其成長速度實際上高於住院收入的成長速度。提醒一下，我們將門診收入大致分為四類：急診服務、門診手術（包括醫院門診和門診手術中心）、我們的流動平台（包括醫生診所、急診診所和其他醫院門診服務，例如心臟病學、診斷等）。本季度所有四個類別的收入均較上年同期實現了穩健成長。

A couple of notes on outpatient surgery specifically. Our same facility cases were down about 50 basis points in fourth quarter over prior year, with hospitals being about flat and ASCs down about 1.5%. Payer mix, though, continued to be solid with declines to prior year primarily driven by Medicaid. In addition to the payer mix environment, we saw a decline in lower intensity cases like ENT. So as a result, we had good growth in net revenue and earnings in our outpatient surgery business overall, inclusive of both the hospitals and the ambulatory surgery center platform.

關於門診手術，有幾點需要說明。與去年同期相比，我們同一機構的病例數在第四季度下降了約 50 個基點，其中醫院病例數基本持平，而門診手術中心病例數下降了約 1.5%。不過，支付方組成依然穩健，與前一年相比的下降主要由醫療補助計劃推動。除了支付方組合環境的變化，我們也看到耳鼻喉科等低強度病例減少。因此，我們的門診手術業務（包括醫院和門診手術中心平台）的淨收入和利潤整體上都實現了良好的成長。

And Mike, let me just add to just the whole outpatient discussion. We continue to invest significantly in outpatient facility development. Just this past year, we added roughly 100 business units to our outpatient footprint across the company. And we find ourselves heading into 2026 and 2027 with significant capital in the pipeline that's geared toward, yeah, some inpatient capacity and inpatient capabilities, but also quite a bit of outpatient development.

麥克，我只想補充一下關於門診治療的討論。我們將繼續大力投資門診設施建設。光是去年，我們就為公司門診業務新增了約 100 個業務部門。我們發現，進入 2026 年和 2027 年，我們有大量資金正在籌備中，這些資金不僅用於一些住院容量和住院能力，還用於相當多的門診開發。

Moreover, I would suggest that we have a better pipeline for acquisition opportunities inside of our outpatient footprint than we've seen in a few years, again, allowing us to complement the existing networks that we have.

此外，我認為我們在門診業務範圍內擁有比過去幾年更好的收購機會管道，這將使我們能夠補充我們現有的網路。

And so when we look at overall revenue production of the company, I think, Mike, in the fourth quarter, our outpatient revenue as a percent of total was actually up on a year-over-year basis. Some of that is due to the components that Mike laid out, but it's also due to the fact that we're adding units at a greater pace than we are, obviously, our inpatient hospitals.

因此，當我們審視公司的整體收入時，我認為，麥克，在第四季度，我們的門診收入佔總收入的百分比實際上同比增長了。部分原因是由於麥克提出的那些因素，但也因為我們增加單位的速度明顯比我們住院醫院的速度要快。

And so the combination of that, we think, is important to our overall network resiliency. And by that, we mean creating an environment where patients have easier access into the HCA Healthcare system and our payers actually have better price points for their members such that they can get into the system with urgent care or physician clinic or an ambulatory surgery center in a manner that is most productive for them as a patient, but also for their insurance company. So we're pretty excited about the overall construct that's evolving for our company.

因此，我們認為，這兩者的結合對我們整體網路的彈性至關重要。這意味著要創造一個環境，​​讓患者更容易進入 HCA 醫療保健系統，同時我們的支付方也能為他們的會員提供更優惠的價格，使他們能夠以最有利於患者自身以及保險公司的方式，透過急診護理、醫生診所或門診手術中心進入該系統。因此，我們對公司正在發展的整體架構感到非常興奮。

I think today, we have about 2,700 outpatient facilities or so. That continues to grow, and we see that pushing toward our targets of 18 to 20 outpatient facilities per hospital as we finish out this decade. And that, again, will come through capital development in greenfield projects, but also acquisitions that make sense for us strategically.

我認為目前我們大約有2700家門診機構。這一趨勢仍在持續增長，我們看到，到本十年末，我們將朝著每家醫院擁有 18 至 20 個門診設施的目標邁進。而這，同樣將透過綠地專案的資本開發來實現，同時也將透過對我們具有戰略意義的收購來實現。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，坎托費茲傑拉。

It's Gaby on for Sarah. I just wanted to double click on the payer mix. And if you can share any color on how it played out compared to your internal expectations, specifically in Medicaid inflecting positively for the first time in 2025? And if that's something you expect to present.

加比代替莎拉上場。我只是想雙擊一下付款組合。如果您能分享實際情況與您內部預期相比如何，特別是醫療補助計劃在 2025 年首次出現積極變化的情況，那就太好了？如果你打算展示這個內容的話。

Yeah, good question. So when I think about fourth quarter volume and the composition, and I mentioned this in the call, I think on the exchange side, we had a 2.5% growth. We were actually down a smidge sequentially from third quarter to fourth quarter. I think that really reflects a couple of things. One, and this also impacted Medicaid is just the timing of the Medicaid redetermination process in the prior year.

嗯，問得好。所以，當我考慮第四季的交易量和組成時，我在電話會議中也提到過，我認為在交易所方面，我們實現了 2.5% 的成長。實際上，從第三季度到第四季度，我們的成績略有下滑。我認為這反映了兩件事。第一，這也對醫療補助計劃產生了影響，那就是前一年的醫療補助計劃重新確定流程的時間表。

So we think we have fully sunsetted that time line in prior year. And so you saw less exchange growth and you also saw a bit more Medicaid volume and Medicaid of 2.2% growth over prior year. It seems to be now back to kind of a normal growth rate more consistent with our overall volume growth rate for Medicaid.

所以我們認為，去年我們已經徹底結束了那個時間表。因此，我們看到交易所的成長減少，同時醫療補助業務量略有增加，醫療補助業務量比前一年增長了 2.2%。現在看來，成長率似乎已經恢復到正常水平，與我們整體的醫療補助業務量成長率更加一致。

And the healthcare exchanges, clearly, we did not see a pull forward of demand as people were anticipating premium increases, but the 2.5% growth, we do believe reflects that timing of the Medicaid redetermination process in prior year. Otherwise, I think we were generally pleased with our payer mix in the quarter and our overall volume growth. I mean, Medicare up 3.5% and total equivalent admissions up 2.5%, I think, really reflects a solid demand for the company as we finish the year.

顯然，在醫療保健交易所方面，我們沒有看到人們預期保費上漲而導致需求提前出現，但我們認為 2.5% 的增長反映了前一年 Medicaid 重新評估過程的時間安排。除此之外，我認為我們對本季的支付方組成和整體交易量成長總體上感到滿意。我的意思是，Medicare 成長了 3.5%，總入院人數增加了 2.5%，我認為這確實反映了年底時公司強勁的需求。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

I guess with the balance sheet in a pretty good place and maybe fair to expect smaller hospitals and health systems seeing more detrimental impact from subsidy expiration and impact of the One BBB. I guess now that the subsidies are expired, can you give us a sense on your M&A opportunities if that pipeline is bigger, smaller, size of the assets? And then maybe kind of touch on capital budget priorities for 2026?

我想，鑑於資產負債表狀況良好，或許可以合理預期，規模較小的醫院和醫療系統會因補貼到期和「一個BBB」計畫的影響而受到更大的不利影響。我想既然補貼已經到期，您能否根據現有併購專案規模（是更大、更小，還是資產規模）向我們介紹您的併購機會？然後或許可以簡單談談2026年的資本預算優先事項？

So as I just mentioned -- this is Sam. We have seen some acceleration in the outpatient space in our pipeline through acquisitions is a little greater than it's been in past years. And we continue to execute on those appropriately, assuming we can get to a reasonable deal, and we've been able to accomplish that in certain circumstances. So from that standpoint, that's been what we've seen mostly in the market is in-market type transactions that are complementary to the network and again, create a better patient offering for us overall.

正如我剛才提到的——這位是山姆。我們看到，透過收購實現的門診業務成長速度比往年略快。我們將繼續適當地執行這些措施，前提是我們能夠達成合理的協議，而且在某些情況下，我們已經能夠做到這一點。所以從這個角度來看，我們在市場上看到的主要是市場內的交易，這些交易與網路互補，並再次為我們整體上創造了更好的患者服務。

With respect to hospitals and tax-exempt hospitals specifically, we just haven't seen it yet that there is a significant opportunity for the company that makes sense from a financial standpoint. We continue to be well positioned, as you just mentioned, with our balance sheet being in a great position, the capabilities of the company as a scaled player allows us to assimilate individual hospitals or hospital systems synergistically, but we haven't seen it. And so, we obviously are open to those type of transactions if and when they present themselves.

就醫院，特別是免稅醫院而言，我們還沒有看到從財務角度來看，公司有值得投資的重大機會。正如您剛才提到的，我們仍然處於有利地位，我們的資產負債表狀況良好，公司作為一家規模較大的企業，其能力使我們能夠協同整合單一醫院或醫院系統，但我們還沒有看到這種情況發生。因此，如果這類交易出現，我們顯然會持開放態度。

We're fortunate, as we've mentioned in the past, that we do have great markets within HCA's portfolio overall. And the opportunities to invest in those markets organically is compelling. And we've been able to do that, again, in our outpatient space, but also with our hospitals.

正如我們之前提到的，我們很幸運，HCA 的整體投資組合中確實擁有許多優秀的市場。在這些市場中進行有機投資的機會非常誘人。而且，我們在門診和醫院都再次做到了這一點。

Our hospitals are running 73%, 74% occupancy. We have many strategic positioned hospitals that need capital. I think our capital is at an all-time high for approved projects that will come online in '26, '27, maybe early '28. It's almost $7 billion of capital that's in the pipeline. Mike alluded to the fact that we're lifting our capital spending because of those circumstances to somewhere between $5 billion and $5.5 billion, and we will continue to evaluate that.

我們的醫院入住率分別為 73% 和 74%。我們有很多地理位置優越的醫院需要資金。我認為，我們用於已批准專案（將於 2026 年、2027 年，甚至可能在 2028 年初投入使用）的資金已經達到了歷史最高水準。目前正在籌備中的資金總額接近70億美元。麥克暗示，由於這些情況，我們將資本支出增加到 50 億至 55 億美元之間，我們將繼續對此進行評估。

So we're finding ways to invest productively as well as use our assets productively with acquisitions where appropriate, investing in our networks and then looking for out -- in-market opportunities if, in fact, they do present themselves in an appropriate way.

因此，我們正在尋找有效投資和有效利用資產的方法，在適當的時候進行收購，投資於我們的網絡，然後尋找市場機會——如果它們確實以適當的方式出現的話。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Curious if you can talk a bit about your expectations for growth in terms of specialties and procedures and 2026. Maybe talk about some of the areas where you're expecting outsized procedure growth around some of the categories that we've certainly seen the company investing in and then also just underlying growth due to different trends that we're seeing in the market.

能否請您談談您對2026年在專科和手術方面的成長預期？或許可以談談您預計在某些領域（例如我們已經看到公司投資的某些類別）會大幅成長的情況，以及由於我們在市場上看到的不同趨勢而產生的潛在成長。

This is Sam. We said this in the past, and we have a geography that's diversified in the sense that no one division in HCA generates more than 10% of the profits of the company. We also have similar diversification, if you will, in services in that no specific service line generates any more than 15% of the revenue of the company. So given that, we haven't seen anything that's disproportionate vis-a-vis one other service line.

這是薩姆。我們過去也說過，我們的業務地理分佈是多元化的，HCA 的任何一個部門創造的利潤都不超過公司總利潤的 10%。我們也有類似的多角化經營模式，在服務領域，沒有任何一條單一的服務線能夠創造超過公司總收入 15% 的收入。因此，就目前而言，我們還沒有發現任何相對於其他服務線而言不成比例的情況。

I will tell you that we've seen reasonable demand for cardiac services. Some of that's technology-driven in electrophysiology. We continue to believe that that pattern will persist into 2026. Obviously, within our emergency room -- we continue to believe that our emergency room services are a very important component to community health and at the same time to our networks. And so we're investing in our emergency rooms, both from a patient care standpoint, an operational throughput standpoint as well as the supply standpoint to make sure we have sufficient resources in that particular area.

我可以告訴大家，我們看到心臟病服務的需求相當可觀。其中一些變化是由電生理學領域的技術所驅動的。我們仍然認為這種模式將持續到2026年。顯然，在我們的急診室裡——我們仍然認為，我們的急診室服務是社區健康以及我們醫療網絡的重要組成部分。因此，我們正在對急診室進行投資，從患者護理的角度、營運效率的角度以及物資供應的角度，以確保我們在該領域擁有充足的資源。

And then within surgeries, I mean we do have specific efforts afoot, but they're more generic, if you will. They're not necessarily specialty oriented. I will tell you that our case mix continues to grow, and that growth is driven, we believe, by the acuity of the patients in many instances in our medical space. So we see a lot of patients who have intense medical needs, creating more acute care requirements, whether it's intensive care or deeper med-surg capabilities, and that's part of what is going on in the communities that we serve as well.

而在外科手術方面，我的意思是，我們確實有一些具體的努力正在進行中，但它們更偏向一般性。它們不一定以專業領域為導向。我可以告訴大家，我們的病例組合持續成長，我們認為，這種成長是由我們醫療領域中許多患者的病情日益嚴重所驅動的。因此，我們看到許多患者有嚴重的醫療需求，這產生了更多的急診護理需求，無論是重症監護還是更深層次的內外科治療能力，這也是我們所服務的社區正在發生的事情的一部分。

So that's a bit of an overview. I don't have any other specifics for 2026 around different categories of growth that we expect, but we can try to get that to you if that's something that would be helpful.

以上就是簡要概述。對於 2026 年我們預期的不同成長類別，我還沒有其他具體數據，但如果這對您有幫助，我們可以嘗試提供給您。

Raj Kumar, Stephens.

Raj Kumar，史蒂芬斯。

Maybe just in line the kind of recent winter storm, maybe any operational disruptions to call out? And maybe kind of any considerations for the 1Q relative to annual guidance that we should be kind of thinking about related to any potential impacts there?

或許只是像最近這種冬季風暴造成的營運中斷？需要報告嗎？那麼，關於第一季業績與全年業績指引之間可能存在的任何潛在影響，我們應該考慮哪些因素？

Well, it looks like are getting out here in Nashville right now. So to say that we're aware of what the impacts are going to be at this point, we're not. I mean, we've had snowstorms before we had a massive storm in Texas a few years ago, and we were able to navigate through that.

看來我們現在正在納許維爾這邊活動。所以要說我們目前已經意識到這些影響會是什麼，答案是否定的。我的意思是，我們以前也遇到過暴風雪，幾年前德克薩斯州就發生過一場特大暴風雪，我們當時都挺過來了。

My sense is as we close out January, we'll have some sense of the impact of the storm here in Nashville as well as a few other markets for the company. But I don't think it's a in most other markets as we maybe are experiencing here. Having said that, we have plenty of opportunity, I think, to recover some of the challenges that are typical for these type of storms.

我的感覺是，到一月底的時候，我們就能大致了解這場風暴對納許維爾以及公司其他幾個市場的影響了。但我認為這種情況在其他大多數市場可能不會像我們這裡一樣普遍。話雖如此，我認為我們有很多機會來應對這類風暴通常會帶來的一些挑戰。

Steve Baxter, Wells Fargo.

史蒂夫‧巴克斯特，富國銀行。

Could you expand a little bit on the pause Texas Medicaid supplemental payment that was mentioned during the guidance color? I guess what exactly is happening there? And what needs to happen for that payment to come back online in 2026? And how much, I guess, of the year-over-year impact is that driving?

您能否詳細說明一下指導意見中提到的暫停德州醫療補助補充支付的問題？我想問那裡到底發生了什麼事？那麼，要讓這項支付在 2026 年恢復正常，需要滿足哪些條件？那麼，我想，這在同比變化的影響中佔多大比例呢？

So the paused program is called ATLIS, stands for Aligning Technology by Linking Interoperable Systems. There was a commissioner that issued a termination notice on that program on their way out as they were leaving office. The new Executive Commissioner that has -- is now in place has agreed to review that program, effectively putting it on pause versus terminating. We don't know yet the timeline for this review, but we are encouraged that the department is willing to review the program and consider a potential reinstatement.

所以暫停的程式叫做 ATLIS，全稱為 Aligning Technology by Linking Interoperable Systems（透過連接互操作系統來調整技術）。有一位委員在離任時，發布了終止該項目的通知。新上任的執行專員已同意審查該計劃，實際上是暫停該計劃，而不是終止該計劃。我們目前還不清楚此次審查的時間表，但我們感到鼓舞的是，該部門願意審查該項目並考慮是否有可能恢復該項目。

From a sizing standpoint, when I think about the overall guidance for '26, and we've highlighted a $250 million to $450 million decline in net benefit from state supplemental payments. This Texas pause is about a third of that decline. The other two that we noted that are the other two-thirds of that decline, one would be the retro payment from Virginia that we received in fourth quarter of 2025. And then second is the Tennessee program where we had six quarters of benefit in '25 and only four quarters of benefit in '26. So that's the -- each of those three items are about a third of that decline of $250 million to $450 million.

從規模角度來看，當我考慮 2026 年的整體指導方針時，我們已經強調了州政府補充支付的淨收益將減少 2.5 億美元至 4.5 億美元。德州的這次經濟放緩大約相當於先前下滑幅度的三分之一。我們注意到另外兩項，它們佔該下降幅度的三分之二，其中一項是我們在 2025 年第四季收到的維吉尼亞州的追溯付款。其次是田納西州項目，我們在 2025 年有六個季度的收益，但在 2026 年只有四個季度的收益。所以，這三個因素分別約佔下降 2.5 億美元至 4.5 億美元的三分之一。

Josh Raskin, Nephron Research.

Josh Raskin，腎單位研究。

I know it came up a little bit, but can you speak to your technology agenda and where you think the greatest opportunities are for HCA and specifically interested in areas where you think AI can help already looking at both the administrative costs but also as well as the revenue enhancement opportunities?

我知道這個問題之前已經稍微提過，但您能否談談貴公司的技術發展計劃，以及您認為HCA最大的發展機會在哪裡？特別是您認為人工智慧可以在哪些領域發揮作用，包括降低管理成本和提高收入的機會？

So we are investing, as Mike said, heavily in our tech agenda. And it's got multiple components to it. We're investing in our electronic health record transition from one system to another, and we're accelerating into that platform. That's a very important foundational piece for our company in that we're going to be able to standardize datasets across all of our hospitals.

正如麥克所說，我們正在大力投資科技發展。它由多個部分組成。我們正在投資將電子健康記錄系統從一個系統過渡到另一個系統，我們正在加速向該平台過渡。這對我們公司來說是一個非常重要的基礎，因為我們將能夠實現所有醫院資料集的標準化。

Heretofore, our hospitals had a variable dataset that created some challenges for us when we were using the big data. And big data for us, we believe, is the next scalable asset inside of HCA to produce better performance broadly. So we've organized ourselves into three domains. And we are extremely energized by the possibilities here in each of the domains.

在此之前，我們醫院的數據集各不相同，這給我們在使用大數據時帶來了一些挑戰。我們相信，大數據是 HCA 內部下一個可擴展的資產，能夠帶來更廣泛的更好績效。因此，我們把自己組織成三個領域。我們對各領域蘊藏的無限可能感到無比振奮。

The first domain is administrative, and you alluded to that. That is an area that's focused on revenue cycle, human resources, IT, supply chain in many instances and a few other areas that we think we can accelerate into because we're more consolidated in our operations.

第一個域是管理域，你之前也提到過這一點。這是一個專注於收入週期、人力資源、IT、供應鏈等領域，在許多情況下也專注於其他一些領域，我們認為我們可以加速進入這些領域，因為我們的營運更加集中化了。

And so we're implementing as we speak in our revenue cycle and supply chain and other areas to move through some transitions into artificial intelligence, supporting better functioning, more efficiencies, better interaction with payers and vendors and so forth. And we should start to see some value, and that's part of what Mike alluded to again in our resiliency agenda in 2026.

因此，我們正在收入週期、供應鏈和其他領域實施人工智慧，以推進向人工智慧的轉型，從而支援更好的運作、更高的效率、與付款方和供應商更好的互動等等。我們應該開始看到一些價值，這也是麥克在 2026 年的韌性計劃中再次提到的一部分。

The second domain for us is what we're calling operational. And that's where we're delegating operational responsibilities to each of our hospitals and facilities. Here again, we have areas of focus that we think are going to create incremental value for the company and allow us to be better at throughput, asset productivity, scheduling, and staffing our hospitals, scheduling and running our ORs and so forth.

對我們來說，第二個領域就是我們所謂的營運領域。因此，我們將營運職責下放給旗下的每一家醫院和醫療機構。同樣，我們也有一些重點領域，我們認為這些領域將為公司創造增量價值，並使我們能夠在吞吐量、資產生產力、醫院排班和人員配備、手術室排班和運行等方面做得更好。

And so again, a lot of good ideas and a lot of tools that we think AI can bring to the operations of our hospital, allowing us to be a little bit more standardized, allowing us to be a little bit more consistent in performance and then giving our management teams greater tools to run their business even better than they do today, and they run it incredibly well currently.

因此，我們認為人工智慧可以為我們醫院的營運帶來許多好想法和工具，使我們能夠更加標準化，使我們的績效更加穩定，並為我們的管理團隊提供更強大的工具，讓他們比現在更好地經營業務，而他們目前已經做得非常出色了。

The third area is what we've called the Holy Grail. And the Holy Grail for us is really centered around clinical and what we can do to support our doctors with insights that come from the patterns that we know exist in the services that we offer because of our volume. We believe with HCA's proprietary database, that we have a wonderful opportunity to use those patterns to help our physicians in the moment, make better decisions, more informed decisions potentially for their patients in a way that will improve care.

第三個領域就是我們所說的聖杯。而對我們來說，真正的聖杯其實是圍繞著臨床展開的，以及我們如何利用我們從自身服務中了解到的模式來支持我們的醫生，因為我們的服務量很大。我們相信，憑藉 HCA 的專有資料庫，我們擁有絕佳的機會，可以利用這些模式來幫助我們的醫生在當下做出更好的決策，更明智的決策，從而改善患者的照護。

The second thing on the clinical side is nursing. The opportunity to support our nurses with tools that make it easier for them to do shift change, to have a safety net underneath their day-to-day activities so they can make the patient environment safer and more efficient is in front of us. And again, we have some solutions that we're implementing this year.

臨床方面的第二件事是護理。我們面前的機會是，為我們的護理人員提供工具，使她們更容易進行交接班，為她們的日常工作提供安全保障，從而使她們能夠使病人環境更安全、更有效率。此外，我們今年也將實施一些解決方案。

Our leadership challenge and our leadership responsibility is to help our facilities manage this change, get to the other side of it so that we can create value for our patients, value for our facilities, and ultimately, value for the organization. We are all in on the possibilities with artificial intelligence merging with what I call the human intelligence that exists within our facilities. And if we can put that together in an appropriate way, and we think we can, we see a lot of value potential across quality, efficiency and just management effectiveness.

我們面臨的領導挑戰和責任是幫助我們的機構應對這一變化，渡過難關，從而為我們的患者創造價值，為我們的機構創造價值，並最終為組織創造價值。我們都非常看好人工智慧與我們設施中存在的所謂「人類智慧」融合的可能性。如果我們能以適當的方式將這些要素結合起來（我們認為我們可以做到），我們​​就能在品質、效率和管理效能方面看到巨大的價值潛力。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Maybe asking the payer mix questions in a little bit of a different way. I know you've talked with the exchange enrollment kind of transitioning into uninsured. But can you give us a sense in terms of what 2026 guidance assumes for overall bad debt and uncompensated care and how that compares to 2025 levels? And perhaps if there's offsets at the external level in terms of state uncompensated care pools or programs that you could tap into as offsets there?

或許可以換個方式詢問有關支付方組合的問題。我知道你已經和健保交易平台談過如何過渡到無保險狀態。但您能否簡要說明一下，2026 年的指導意見對整體壞帳和未補償醫療費用做了哪些假設，以及與 2025 年的水準相比如何？或許可以利用州政府提供的無償醫療救助資金或計畫等外部資源來抵銷？

Well, I would say that our assumptions in our guidance certainly include this movement for the people who lose the exchange coverage. The ones who don't go to employee-sponsored insurance will likely become uninsured. And for the -- if you just think about kind of that component, when someone enters our hospitals and they're uninsured, we do anticipate it's inherent in our guidance that we'll see an increase in the amount of people who are entering our facilities with no insurance in '26 versus '25. And that is part of the math that I walked through earlier. As you know, when someone with that insurance comes into the hospital, I mean, largely, those patients are reserved right away, right? So that growth kind of immediately transitions into uncompensated care.

嗯，我認為，我們的指導方針中的假設當然包括了那些失去交易所保險保障的人的這種變化。那些不參加公司提供的醫療保險的人，很可能會失去醫療保險。至於——如果你仔細想想這方面，當有人進入我們的醫院而他們沒有保險時，我們預計，根據我們的指導方針，2026 年進入我們醫療機構的無保險人數將比 2025 年有所增加。而這正是我之前講解的數學原理的一部分。如你所知，當擁有這種保險的人來醫院就診時，我的意思是，基本上，這些病人都會立即被預留，對吧？因此，這種成長很快就過渡到了無償照顧。

The other component that we're studying carefully is the amount that patients owe when they do have insurance. And so within the exchanges, I think the potential impact here is when someone goes from silver to bronze. And if we see a significant movement in metal tiers from silver, I do think there is a potential for there to be a bit more due from patients. That's our past experience is that the folks on the exchanges owe a bit more than people with traditional managed care. And then when we think about collectability, the collectibility of patient balances within the metal tiers on the exchanges, the bronze enrollees have a lower collection rate than the silver.

我們正在仔細研究的另一個方面是，當患者有保險時，他們需要支付多少費用。因此，我認為在交易中，潛在的影響是當有人從銀牌降級到銅牌時。如果金屬等級從銀級大幅提升，我認為患者可能會因此獲得更多補償。根據我們過去的經驗，透過醫療保險交易平台投保的人比參加傳統醫療保險的人需要支付更多的費用。然後，當我們考慮可回收性，即交易所中不同金屬等級的患者餘額的可回收性時，青銅級參保人的回收率低於白銀級參保人。

And our modeling and based on our past experience with silver and bronze, I would say that the -- our belief is that the impact to patient balance collections appear to be relatively immaterial. And so overall, I think the bigger impact will be just the growth in the uninsured versus the uncollectibility of patient balances due as people go from silver to bronze. Again, lot of modeling assumptions in that, a lot of judgments in that, that we're going to have to test as we go through the first weeks, days and months of 2026, but that's our current thinking.

根據我們的模型以及我們過去在銀級和銅級方面的經驗，我認為——我們認為，對患者餘額催收的影響似乎相對微不足道。因此總的來說，我認為更大的影響將是無保險人數的增長，而不是隨著人們從銀級升至銅級而導致的病人欠款無法收回。同樣，這其中包含許多建模假設和判斷，我們需要在 2026 年的前幾週、幾天和幾個月裡對這些假設和判斷進行檢驗，但這是我們目前的想法。

Coby, let's take one more question for almost an hour.

科比，我們再花將近一個小時回答一個問題吧。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Maybe just one clarification on that last point. And then -- so what is the collection rate on like a bronze versus a silver just so that we can think about it? But then I guess, more importantly, you guys have been over 20% margin last year, this year, even though you've got these headwinds coming in. We kind of think about 20% margin is kind of the high end for you guys, but you're outcompeting that even with pressure.

關於最後一點，或許還需要補充一點。那麼──銅牌和銀牌的收藏率分別是多少呢？這樣我們就可以思考一下了。但我想，更重要的是，儘管面臨這些不利因素，你們去年和今年的利潤率都超過了 20%。我們認為 20% 的利潤率對你們來說算是比較高的了，但即便麵臨壓力，你們的利潤率仍然超過了這個水準。

So how do you think about what kind of margin HCA can point to? You sound pretty bullish about cost savings going forward. Should we be thinking about something north of 20% as a sustainable margin for HCA?

那麼，您認為HCA能帶來什麼樣的利潤率呢？聽起來你對未來的成本節約前景相當樂觀。我們是否應該將 20% 以上的利潤率視為 HCA 的可持續利潤率？

Well, let's start with '26. I mean, I think given the headwinds from the exchanges and from supplemental payments and the fact that we've been able to develop and implement a resiliency program that has allowed us to offset as much of that as we can, we're really pleased with the guidance around margin, which we've been able to get pretty consistent with where we landed 2025. That obviously reflects a ton of hard work in our resiliency plan, our ability to drive operating leverage through our volume growth and our overall cost management activities as a company.

好，我們就從 26 年開始吧。我的意思是，考慮到交易所和補充支付帶來的不利影響，以及我們已經制定並實施了一項恢復計劃，使我們能夠盡可能地抵消這些影響，我們對利潤率的預期非常滿意，我們已經能夠使其與我們2025年的目標相當一致。這顯然反映了我們在韌性計劃方面付出的大量努力，我們透過銷售成長來推動營運槓桿的能力，以及我們作為一家公司的整體成本管理活動。

It's a little premature to talk about what could happen in the future other than to just point you back to my comments, Kevin, where we noted that given the demand in our marketplaces, our resiliency programs, and the digital transformation that Sam just talked about that we are comfortable that we will be able to maintain our long-term plan over time. And so I think that's a good sense of the confidence we have in the company and our performance.

現在談論未來可能發生的事情還為時過早，凱文，我只想提醒你回顧一下我之前的評論，我們指出，鑑於我們市場的需求、我們的彈性計劃以及薩姆剛才提到的數位轉型，我們有信心能夠長期維持我們的長期計劃。所以我認為這很好地體現了我們對公司和自身業績的信心。

So I think we'll end there. Frank?

所以我想我們就到此為止吧。坦率？

Okay. Thank you, Coby, for your help today, and thanks to everyone for joining us on the call. We hope you have a good earnings season. We are around this afternoon if we can answer any additional questions. Thank you.

好的。謝謝Coby今天提供的協助，也謝謝所有參加電話會議的各位。祝您財報季一切順利。今天下午我們都有空，可以解答任何其他問題。謝謝。

This concludes today's conference call. You may now disconnect.

今天的電話會議到此結束。您現在可以斷開連線了。