美國醫院公司 (HCA) 2021 Q4 法說會逐字稿

Welcome to the HCA Healthcare Fourth Quarter 2021 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. Mark Kimbrough. Please go ahead, sir.

歡迎來到 HCA Healthcare 2021 年第四季度收益電話會議。今天的電話正在錄音。在這個時候，關於開場白和介紹，我想把電話轉給投資者關係副總裁 Mark Kimbrough 先生。請繼續，先生。

All right. Thank you, Chris. Good morning, and welcome to everybody on today's call. With me this morning is our CEO, Sam Hazen; and CFO, Bill Rutherford; along with our Chief Medical Officer, Dr. Michael Cuffe; and Frank Morgan, our new VP of IR. Welcome, Frank.

好的。謝謝你，克里斯。早上好，歡迎大家參加今天的電話會議。今天早上和我在一起的是我們的首席執行官 Sam Hazen；首席財務官比爾·盧瑟福；與我們的首席醫療官 Michael Cuffe 博士一起；以及我們新的 IR 副總裁 Frank Morgan。歡迎，弗蘭克。

Pleasure to be here.

很高興來到這裡。

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

山姆和比爾將提供一些準備好的評論，然後我們將回答問題。

Before I turn the call over to Sam and Bill, 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. More information on forward-looking statements and these factors are listed in today's press release and our various SEC filings.

在我將電話轉給山姆和比爾之前，讓我提醒大家，如果今天的電話中包含任何前瞻性陳述，它們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可能表達的結果大不相同。有關前瞻性陳述和這些因素的更多信息，請參見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.

在今天上午的電話會議上，我們可能會參考一些措施，例如調整後的 EBITDA，這是一項非公認會計原則的財務措施。今天發布的表格提供了關於調整後 EBITDA 的補充信息和調節 HCA Healthcare, Inc. 的淨收入。

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

正在錄製今天早上的通話，今天晚些時候將提供通話重播。

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

有了這個，我現在將把電話轉給 Sam。

All right. Thank you, Mark, and good morning, and thank you for joining us. As we begin this call, I want to reflect on 2021. Across many dimensions of our business, our teams demonstrated an impressive ability to adjust quickly and effectively to 3 different surges and deliver for our patients, deliver for our communities and deliver for each other. This steadfast resolve and sacrifice to serve others are what make health care workers special people in general. But specifically for HCA Healthcare, they are what make our company great. I want to thank our colleagues and physicians for their outstanding work this past year.

好的。謝謝你，馬克，早上好，感謝你加入我們。在我們開始本次電話會議時，我想回顧一下 2021 年。在我們業務的許多方面，我們的團隊展示了令人印象深刻的能力，可以快速有效地適應 3 種不同的激增並為我們的患者提供服務，為我們的社區提供服務，並為彼此提供服務.這種為他人服務的堅定決心和犧牲使衛生保健工作者成為特別的人。但特別是對於 HCA Healthcare，它們使我們的公司變得偉大。我要感謝我們的同事和醫生在過去一年中所做的出色工作。

In the fourth quarter, the COVID pandemic once again altered course with the omicron variant. As the Delta variant surge was slowing down at the end of the third quarter with some spillover into the fourth, the omicron surge started to influence our business in early December. Overall, our teams continued their tremendous response, and the effects of the pandemic's ever-changing conditions were managed well as reflected in our financial results for the fourth quarter, which were solid and in line with our most recent guidance.

在第四季度，COVID 大流行再次改變了 omicron 變體的進程。由於 Delta 變體激增在第三季度末放緩並在第四季度有所溢出，因此 omicron 的激增在 12 月初開始影響我們的業務。總體而言，我們的團隊繼續做出巨大的反應，大流行不斷變化的條件的影響得到了很好的管理，這反映在我們第四季度的財務業績中，這些業績穩健，符合我們最近的指導。

In the quarter, our hospitals provided care to 27,000 COVID-19 patients, approximately 5% of total admissions. This level is significantly below third quarter's 13%. Since the beginning of the pandemic, we have provided inpatient care to over 260,000 patients who contracted the virus. Currently, our hospitals continue to treat many patients with COVID-19. COVID-related census levels fortunately have begun to peak, and we anticipate they will decline over the next few weeks.

在本季度，我們的醫院為 27,000 名 COVID-19 患者提供了護理，約佔總入院人數的 5%。這一水平大大低於第三季度的 13%。自大流行開始以來，我們已為超過 260,000 名感染該病毒的患者提供住院治療。目前，我們的醫院繼續治療許多 COVID-19 患者。幸運的是，與 COVID 相關的人口普查水平已經開始達到頂峰，我們預計它們將在未來幾週內下降。

Same-facility revenues grew 6.4% in the quarter as compared to prior year. Inpatient revenue grew 2%, and outpatient revenue grew 13%. Same-facility volumes increased on a year-over-year basis across most major categories with the exception of inpatient surgeries, which were down 1%.

與去年同期相比，本季度同一設施的收入增長了 6.4%。住院收入增長 2%，門診收入增長 13%。除住院手術外，大多數主要類別的同一設施數量均同比增長，下降 1%。

In a challenging labor market, our teams adjusted well. Labor costs created some pressure on margins as compared to last year. But sequentially, there was no significant change in this metric as compared to the third quarter. Adjusted EBITDA margin for the quarter was strong. Diluted earnings per share, excluding gains on sales of facilities, increased 7% to $4.42 in the quarter.

在充滿挑戰的勞動力市場中，我們的團隊調整得很好。與去年相比，勞動力成本對利潤率造成了一定壓力。但是，與第三季度相比，該指標連續沒有顯著變化。本季度調整後的 EBITDA 利潤率強勁。本季度攤薄後每股收益（不包括設施銷售收益）增長 7% 至 4.42 美元。

As we move into 2022, our overall outlook for the year remains generally consistent with the early perspectives we provided in last quarter's call. While certain aspects of our business, including the impact of the pandemic, remain difficult to predict, we believe the guidance that we are providing today is reasonable. We also believe that the combination of our disciplined operating culture, plus our growth plan and the strong support from our capital deployment program, should help us deliver the results we are forecasting for the year and enhance long-term shareholder value.

隨著我們進入 2022 年，我們對今年的總體展望與我們在上一季度電話會議中提供的早期觀點大體一致。雖然我們業務的某些方面，包括大流行的影響，仍然難以預測，但我們相信我們今天提供的指導是合理的。我們還相信，我們嚴謹的運營文化，加上我們的增長計劃和資本部署計劃的大力支持，應該有助於我們實現我們對今年的預測結果並提高長期股東價值。

As I indicated previously, we believe demand for health care services will be strong in 2022 and comparable to historical growth rates in the 2% to 3% zone with COVID-related admissions representing between 3% and 5% of total. We expect this demand to be supported by a growing economy and more insurance coverage for people through their employer or the exchanges. We believe HCA Healthcare's strong and diversified portfolio of markets is differentiated across the industry and presents numerous long-term growth opportunities. Because of this, we plan to continue investing in our core strategy of developing our provider networks through our capital spending plan and also through acquisitions when available

正如我之前指出的，我們認為 2022 年對醫療保健服務的需求將強勁，與 2% 至 3% 區域的歷史增長率相當，與 COVID 相關的入院人數佔總數的 3% 至 5%。我們預計，這種需求將得到經濟增長和通過雇主或交易所為人們提供更多保險的支持。我們相信 HCA Healthcare 強大而多元化的市場組合在整個行業中具有差異化，並提供了許多長期增長機會。正因為如此，我們計劃繼續投資於我們的核心戰略，即通過我們的資本支出計劃以及在可用時進行收購來發展我們的供應商網絡

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care acquisition that we completed at the end of the year in South Florida.

我們於年底在南佛羅里達州完成的護理收購。

These investments continue to add depth to our networks and convenience for our patients, creating an easier and more cost-effective accessibility for our health care systems. Over the past year, we have increased the ambulatory care sites in our networks by 14%, bringing the total number to approximately 2,200. These sites support the 182 hospitals we operate today and will provide support in the future to the 8 new hospitals we recently announced in various Texas and Florida markets.

這些投資繼續為我們的患者增加網絡的深度和便利性，為我們的醫療保健系統創造更容易和更具成本效益的可及性。在過去一年中，我們網絡中的門診護理站點增加了 14%，使總數達到約 2,200 個。這些站點為我們今天運營的 182 家醫院提供支持，並將在未來為我們最近在德克薩斯州和佛羅里達州各個市場宣布的 8 家新醫院提供支持。

As I mentioned, we are operating in a difficult labor market. Over the past year, we have invested in our colleagues with increased pay, supplemental bonus programs and additional benefits. These investments, coupled with our efforts to improve operational support for providing care, should help us mitigate some of the difficulties caused by this environment. These past 2 years certainly have been a strain on our people. But through it all, they have demonstrated a level of excellence, compassion and resilience that has strengthened the company in many ways. They have accomplished this while simultaneously staying true to our mission and better positioning us for continued success.

正如我所提到的，我們在艱難的勞動力市場中運營。在過去的一年裡，我們通過增加工資、補充獎金計劃和額外福利對我們的同事進行了投資。這些投資，加上我們努力改善提供護理的運營支持，應該有助於我們減輕這種環境造成的一些困難。過去 2 年對我們的員工來說無疑是一種壓力。但通過這一切，他們表現出卓越、同情心和韌性的水平，這在許多方面增強了公司的實力。他們做到了這一點，同時忠於我們的使命，更好地定位我們以取得持續成功。

With that, I'll turn the call over to Bill for more details on the quarter's results, our '22 earnings guidance and capital deployment plan. Thank you.

有了這個，我將把電話轉給比爾，以獲取有關本季度業績、我們的 22 年收益指導和資本部署計劃的更多詳細信息。謝謝你。

Okay, great. Thank you, Sam, and good morning, everyone. I will provide some additional comments on our performance for the year then discuss our 2022 guidance.

好，太棒了。謝謝你，山姆，大家早上好。我將對我們今年的表現提供一些額外的評論，然後討論我們的 2022 年指導方針。

Our cash flow from operations was $2.4 billion as compared to a use of cash of $3.6 billion in the fourth quarter of 2020. In the prior year quarter, cash flow was affected by our returning or repaying early approximately $6 billion of CARES Act funding. For full year 2021, cash flow from operations was just under $9 billion. Capital spending was $1.2 billion for the quarter and was $3.6 billion for the full year 2021. In addition, we have approximately $4.1 billion of approved capital in the pipeline that is scheduled to come online over the next 3 years.

我們的運營現金流為 24 億美元，而 2020 年第四季度使用的現金為 36 億美元。在上一季度，現金流受到我們提前歸還或償還 CARES 法案資金約 60 億美元的影響。 2021 年全年，運營現金流略低於 90 億美元。本季度的資本支出為 12 億美元，2021 年全年的資本支出為 36 億美元。此外，我們還有大約 41 億美元的已批准資本正在籌備中，計劃在未來 3 年內上線。

We completed just over $2 billion of share repurchases during the quarter and $8.2 billion for the full year.

我們在本季度完成了超過 20 億美元的股票回購，全年完成了 82 億美元。

Our debt-to-EBITDA ratio was 2.7x at the end of the third quarter, and we had approximately $3.6 billion of available liquidity at the end of the quarter.

第三季度末，我們的債務與 EBITDA 比率為 2.7 倍，截至本季度末，我們擁有約 36 億美元的可用流動資金。

For full year 2021, we realized approximately $2.2 billion in proceeds from sales of facilities and health care entities and recognized approximately $1.6 billion in gains on these sales. We also executed on $1.1 billion of acquisitions on health care entities during the year.

2021 年全年，我們從設施和醫療保健實體的銷售中實現了約 22 億美元的收益，並確認了這些銷售的約 16 億美元收益。年內，我們還對醫療保健實體進行了 11 億美元的收購。

As noted in our release this morning, we are providing full year 2022 guidance as follows: We expect revenue to range between $60 billion and $62 billion. We expect net income attributable to HCA Healthcare to range between $5.55 billion and $5.835 billion. We expect full year adjusted EBITDA to range between $12.55 billion and $13.05 billion. We expect full year diluted EPS to range between $18.40 and $19.20, and we expect capital spending to approximate $4.2 billion during the year.

正如我們今天上午發布的內容所述，我們提供的 2022 年全年指引如下：我們預計收入將在 600 億美元至 620 億美元之間。我們預計歸屬於 HCA Healthcare 的淨收入將在 55.5 億美元至 58.35 億美元之間。我們預計全年調整後的 EBITDA 將在 125.5 億美元至 130.5 億美元之間。我們預計全年攤薄後每股收益將在 18.40 美元至 19.20 美元之間，我們預計今年的資本支出約為 42 億美元。

So let me provide some additional commentary on our guidance. The midpoint of our adjusted EBITDA guidance of $12.8 billion reflects a 1.2% increase over our 2021 adjusted EBITDA. In 2021, we recognized approximately $900 million in COVID support from the DRG add-ons, HRSA reimbursement for uninsured COVID patients and the impact of the delay in sequestration cuts. We do not have full line of sight into all of these programs for the full year, but we do expect some benefit continuing, and our guidance anticipates approximately $150 million of support in 2022.

因此，讓我對我們的指導提供一些額外的評論。我們調整後的 EBITDA 指引的中點為 128 億美元，比我們 2021 年調整後的 EBITDA 增長了 1.2%。 2021 年，我們認識到 DRG 附加項提供了大約 9 億美元的 COVID 支持、對未投保的 COVID 患者的 HRSA 報銷以及隔離削減延遲的影響。我們對全年的所有這些計劃沒有全面的看法，但我們確實預計會繼續獲得一些好處，我們的指導預計到 2022 年將提供大約 1.5 億美元的支持。

In addition, our divestitures contributed about $140 million of adjusted EBITDA in 2021. When you consider these items, along with an estimate of about $300 million of incremental cost for serving COVID patients in 2021, our growth in adjusted EBITDA is consistent with our historical expectations for growth over time of 4% to 6%. Within guidance, we expect our same-facility admissions to grow approximately 2% to 3% while revenue per admission to grow approximately 1%. We anticipate outpatient revenue to grow in the mid- to high single digits. We anticipate adjusted EBITDA margin to range between 20% and 21% for the full year. Depreciation is estimated to be about $3 billion, and interest expense is projected to be around $1.7 billion.

此外，我們的資產剝離在 2021 年為調整後的 EBITDA 貢獻了約 1.4 億美元。當您考慮這些項目時，再加上 2021 年為 COVID 患者服務的估計增加約 3 億美元的成本，我們調整後 EBITDA 的增長與我們的歷史預期一致隨著時間的推移增長4％至6％。在指導範圍內，我們預計同一設施的入場人數將增長約 2% 至 3%，而每次入場的收入將增長約 1%。我們預計門診收入將以中高個位數增長。我們預計全年調整後的 EBITDA 利潤率將在 20% 至 21% 之間。折舊估計約為 30 億美元，利息費用預計約為 17 億美元。

Finally, our fully diluted shares are expected to be about 303 million for the full year. Cash flow from operations is estimated to range between $9 billion and $9.5 billion.

最後，我們完全稀釋的股份預計全年約為 3.03 億股。來自運營的現金流估計在 90 億美元至 95 億美元之間。

As also noted in our release this morning, our Board of Directors has authorized a new $8 billion share repurchase program and declared an increase in our quarterly dividend from $0.48 to $0.56 per share.

正如我們在今天上午的新聞稿中所指出的，我們的董事會已授權一項新的 80 億美元股票回購計劃，並宣布將我們的季度股息從每股 0.48 美元增加到 0.56 美元。

So with that, I'll turn the call over to Mark to open it up for Q&A.

因此，我將把電話轉給馬克打開它進行問答。

All right. Thanks, Bill. Thank you, Sam. Chris, would you provide instructions on the queue for questions? (Operator Instructions)

好的。謝謝，比爾。謝謝你，山姆。克里斯，你能提供關於問題隊列的說明嗎？ （操作員說明）

(Operator Instructions) Our first question is from Ann Hynes with Mizuho Securities.

（操作員說明）我們的第一個問題來自瑞穗證券的 Ann Hynes。

Great. Just a couple of questions. So when I look at inpatient and outpatient versus 2009 (sic) [2019], they're down roughly 5%, which is a deterioration from prior quarters. Can you tell us what's driving that? Is it -- I mean, obviously, it's staffing issues. So maybe what's driving staffing issues versus COVID spikes and you're turning people away versus maybe a change in patient behavior?

偉大的。只是幾個問題。因此，當我比較住院和門診患者與 2009 年（原文如此）[2019] 時，它們下降了大約 5%，這比前幾個季度有所惡化。你能告訴我們是什麼驅動了它嗎？是嗎 - 我的意思是，顯然，這是人員配備問題。那麼，也許是什麼推動了人員配備問題與 COVID 高峰相比，您將人們拒之門外而不是患者行為的改變？

And then a quick clarification on your 2022 guidance. I think you said for 2021, you had about $300 million of incremental costs for COVID. Can you tell us what that is embedded in guidance for 2022? That would be great.

然後快速澄清您的 2022 年指導。我想您說過，對於 2021 年，您為 COVID 增加了大約 3 億美元的成本。您能告訴我們 2022 年指南中包含哪些內容嗎？那太好了。

Ann, you were breaking up a little bit on your first question. The second, I think we all understood. The first, did anyone get that? Can you repeat that, Ann, please?

安，你在第一個問題上有點分手。第二，我想我們都明白了。第一個，有人知道嗎？你能重複一遍嗎，安，好嗎？

Sure. So when I look at inpatient and outpatient trends in Q4 versus Q4 2019, they were down roughly by 5%, which is a slight deterioration from prior quarters. So can we just get some more color what's driving that? I mean, I know there's staffing issues. Are you not able to admit patients because of staffing issues? Or is it you're turning patients away because of COVID spikes? Or is it maybe a change in patient behavior? So if you can provide some color on that versus 2019.

當然。因此，當我查看第四季度與 2019 年第四季度的住院和門診趨勢時，它們下降了大約 5%，與前幾個季度相比略有惡化。那麼我們能不能得到更多的顏色是什麼驅動呢？我的意思是，我知道存在人員配備問題。由於人員配備問題，您無法接納患者嗎？還是因為 COVID 高峰而將患者拒之門外？或者可能是患者行為的改變？因此，如果您可以提供一些與 2019 年相比的顏色。

I think a couple of high-level observations that we believe are indicative of the fourth quarter of 2021 versus the fourth quarter of 2019. Obviously, we were carrying over into the fourth quarter a little bit of the Delta variant, and that was influencing some activity in some markets, and we think that had some impact on the 2019 comparison. The second item would be that, overall, we didn't see the same seasonality bump that we typically see in the fourth quarter. Again, we think that was influenced by the 2 different surges that were ramping down and ramping up. And then the third observation would be -- and then on our inpatient activity, we have seen some migration in inpatient orthopedic surgeries primarily into outpatient, and that did influence the inpatient stat and propped up the outpatient stat somewhat with respect to surgeries.

我認為我們認為有幾個高級別的觀察結果表明 2021 年第四季度與 2019 年第四季度的對比。顯然，我們將 Delta 變體的一點點延續到第四季度，這影響了一些一些市場的活動，我們認為這對 2019 年的比較產生了一些影響。第二項是，總體而言，我們沒有看到與第四季度通常看到的相同的季節性波動。同樣，我們認為這受到了兩種不同的激增的影響，它們正在下降和上升。然後第三個觀察結果是 - 然後在我們的住院患者活動中，我們看到住院骨科手術主要向門診患者遷移，這確實影響了住院患者的統計數據，並在一定程度上支撐了門診患者的手術統計數據。

So those will be the 3 main drivers, I think, of the comparisons. All in all, we did have to manage some capacity in certain situations, again, of the COVID markets. And we're hopeful, again, as we wind down the omicron variant, that we can get back to some normal period of business. Again, in 2021, as I've said on our third quarter call, we really haven't had a normal run of what our business trends would be. We've had a holiday variant at the end of 2020 carried into 2021. We had the Delta variant in the middle. We had maybe 3 to 4 months where we could see there was no COVID influence of any significance. So we're making some judgments around those variations, but that would be the 3-level observations we have on the 2019 comparisons.

因此，我認為這些將是比較的 3 個主要驅動因素。總而言之，在 COVID 市場的某些情況下，我們確實必須管理一些容量。我們再次希望，當我們結束 omicron 變體時，我們可以回到正常的業務時期。同樣，在 2021 年，正如我在第三季度電話會議上所說的那樣，我們的業務趨勢確實沒有正常運行。我們在 2020 年底有一個假期變體，到 2021 年。我們在中間有 Delta 變體。我們可能有 3 到 4 個月的時間，我們可以看到沒有任何重大的 COVID 影響。因此，我們正在圍繞這些變化做出一些判斷，但這將是我們對 2019 年比較的 3 級觀察。

Yes. Ann, this is Bill. On your second question regarding the $300 million of incremental costs, that would be above and beyond what we're anticipating next year. We wanted to highlight the fact that we are seeing some decline in COVID support and acknowledge that we would also expect to see some decline of some of that direct incremental costs. So that is above and beyond what we would expect.

是的。安，這是比爾。關於您關於 3 億美元增量成本的第二個問題，這將超出我們明年的預期。我們想強調一個事實，即我們看到 COVID 支持有所下降，並承認我們也希望看到其中一些直接增量成本有所下降。所以這超出了我們的預期。

And that includes drug-related PP&E and other related costs associated with treatment of COVID patients.

這包括與藥物相關的 PP&E 以及與治療 COVID 患者相關的其他相關費用。

Great. And congratulations on your retirement, Mark.

偉大的。祝賀你退休，馬克。

Thank you, Ann. Appreciate it.

謝謝你，安。欣賞它。

Our next question is from Kevin Fischbeck with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

Great. Yes. It seems like HCA feels a little bit more controversial today than I'm used to it being, predominantly around where the margin should be normalizing out to. Obviously, this year, you're looking for lower margins than last year, but it's still nicely up from where 2019 was. Can you just level-set for us where do you think ultimately those margins normalize into 2023 and beyond? And to the extent that it's above the 19.5% in 2019, can you help us bridge what has gotten better sustainably from where you were pre-COVID?

偉大的。是的。似乎 HCA 今天感覺比我習慣的更具爭議性，主要是在邊距應該正常化的地方。顯然，今年你正在尋找比去年更低的利潤率，但它仍然比 2019 年的水平高很多。您能否為我們設定水平，您認為這些利潤率最終會在 2023 年及以後正常化嗎？如果它高於 2019 年的 19.5%，您能否幫助我們彌合您在 COVID 之前的可持續發展情況？

Thanks, Kevin. Yes, Kevin, this is Bill. I'll make a shot at that. So as you heard in our commentary, we expect margins to land between 20% and 21%. Obviously, as we know, we've talked about during this COVID period of time, obviously when you compare it to pre-COVID, we've seen a growth in acuity as we've seen people return to have higher intensity of services. And we've lost a little bit of the lower acuity business during this period of time.

謝謝，凱文。是的，凱文，這是比爾。我會試一試。因此，正如您在我們的評論中所聽到的，我們預計利潤率將在 20% 到 21% 之間。顯然，正如我們所知，我們在這段 COVID 時期已經討論過，很明顯，當您將其與 COVID 之前進行比較時，我們已經看到敏銳度有所增長，因為我們看到人們返回以獲得更高強度的服務。在這段時間裡，我們失去了一些低敏銳度的業務。

And we've enjoyed a favorable payer mix as we've seen a full employment effort, the activity in the health insurance exchanges. And so we saw obviously significant growth over the past, call it, 6 quarters since the middle of 2020. We expect those trends to remain positive but maybe not at the same level. And that's helping drive some of the margins that we're seeing currently. And I think our view is that, that, coupled with other efforts HCA [has made], that we should be able to land within the ranges we provided.

我們享受了有利的支付組合，因為我們看到了充分的就業努力，健康保險交易所的活動。因此，我們在過去看到了明顯的顯著增長，稱之為自 2020 年中期以來的 6 個季度。我們預計這些趨勢將保持積極，但可能不會處於同一水平。這有助於推動我們目前看到的一些利潤。我認為我們的觀點是，再加上 HCA [已經做出的] 其他努力，我們應該能夠在我們提供的範圍內著陸。

Is that the right long-term amount as well?

這也是正確的長期金額嗎？

Well, based on what we know today, there's no reason to presume we can't stay somewhere in that range. But obviously, there's a lot of variables to our business, and we'll have to advance our perspectives on those when we get those variables, I'll say, better understood over the course of this next year and so forth. But that's our thing.

好吧，根據我們今天所知道的，沒有理由假設我們不能停留在那個範圍內的某個地方。但顯然，我們的業務存在很多變數，當我們得到這些變數時，我們將不得不推進我們對這些變數的看法，我會說，在明年的過程中更好地理解等等。但那是我們的事。

We've had a number, Kevin, financial resiliency initiatives, and we have ongoing initiatives that we think are positive to margin, all things equal, but we'll have to wait and see how some of these other components of our business develop over the course of 2022.

凱文（Kevin），我們已經制定了許多財務彈性計劃，並且我們正在進行一些我們認為對利潤率有利的計劃，在所有條件相同的情況下，但我們必須拭目以待，看看我們業務的其他一些組成部分如何發展2022年的課程。

Our next question is from Andrew Mok with UBS Technology.

我們的下一個問題來自瑞銀科技的 Andrew Mok。

I just wanted to echo congratulations to Mark on your retirement.

我只是想對你退休表示祝賀。

On the 2022 guide, I want to make sure I understand the progression and development of the guide since the 3Q earnings call. Are you saying that since 3Q, you're now expecting more COVID patients? And because government relief only gives us line of sight through April, you're planning for a significantly higher level of COVID costs in 2022 but only 1 quarter of extended government relief, such that there's somewhat of a mismatch in COVID costs and COVID relief in 2022?

關於 2022 年指南，我想確保我了解自第三季度財報電話會議以來指南的進展和發展。您是說自第三季度以來，您現在期待更多的 COVID 患者？而且由於政府減免只能讓我們看到 4 月之前的情況，因此您計劃在 2022 年大幅提高 COVID 成本，但僅延長政府減免的 1/4，因此 COVID 成本和 COVID 減免在某種程度上不匹配2022 年？

Yes. I mean, I think our guidance is very consistent with what our third quarter commentary is. I mean, there's obviously a lot of moving parts. I think the COVID volume we're anticipating now, as Sam mentioned, between 3% to 5% is consistent with where we thought COVID volume would be when we provided our third quarter. The COVID support programs that we mentioned, I think, are pretty close to what we anticipated during that discussion. So without talking about the progression of those occurring during the year, I think, overall, our guidance is very consistent with what -- our commentary and what our beliefs were at the end of the third quarter.

是的。我的意思是，我認為我們的指導與我們第三季度的評論非常一致。我的意思是，顯然有很多活動部件。正如 Sam 所說，我認為我們現在預期的 COVID 數量在 3% 到 5% 之間，這與我們在提供第三季度時認為的 COVID 數量一致。我認為，我們提到的 COVID 支持計劃與我們在那次討論中的預期非常接近。因此，在不談論這一年發生的那些進展的情況下，我認為總體而言，我們的指導與我們的評論以及我們在第三季度末的信念非常一致。

Our next question is from Justin Lake with Wolfe Research.

我們的下一個問題來自 Wolfe Research 的 Justin Lake。

Obviously, first, Mark, thanks for everything over 20 years. Enjoy your retirement. You'll be missed.

顯然，首先，馬克，感謝 20 年來所做的一切。享受你的退休生活。你會被想念的。

Then from a question perspective, maybe you can talk a little bit about the -- 2 things, right? So one, your view -- we think you got some dollars, at least there were some articles out there, that you might have got about $250 million from Florida in terms of extra Medicaid payments. Can you talk a little bit about that? Was it recognized in the fourth quarter? Is it in the guidance for 2022? Or because you -- maybe you haven't gotten it yet, so you didn't recognize it yet. So that's number one.

然後從問題的角度來看，也許您可以談談-- 2 件事，對吧？所以一個，你的觀點 - 我們認為你得到了一些美元，至少有一些文章在那裡，你可能從佛羅里達州獲得了大約 2.5 億美元的額外醫療補助付款。你能談談嗎？是否在第四季度得到認可？它在 2022 年的指導中嗎？或者因為你——也許你還沒有得到它，所以你還沒有認出它。所以這是第一名。

And then number two, just in terms of your pricing assumption in terms of revenue per admit. Is it fair to say then that the -- versus the typical 2% to 3% you're saying, one, you're assuming maybe about 1% of that is kind of a headwind from government dollars that are going to be down materially, and then the other 1% is a little bit of -- the extra 1% is maybe a little bit of payer mix deterioration? Is that a reasonable way to think about it?

然後是第二個，僅就您在每次承認收入方面的定價假設而言。那麼公平地說 - 與你所說的典型的 2% 到 3% 相比，你假設其中大約 1% 是政府資金的逆風，這將大幅下降，然後另外 1% 是一點點——額外的 1% 可能是支付者組合的一點點惡化？這是一種合理的思考方式嗎？

So let me try to address that. So let me talk about Florida and the other supplemental programs that we have during the quarter, and I know there's been a lot of discussion. We are participating in the Florida DPP program. And in the fourth quarter, we did recognize a net benefit of approximately $130 million related to that program. We do expect to recognize a similar benefit in the latter half in 2022 as well.

所以讓我試著解決這個問題。因此，讓我談談佛羅里達州和我們在本季度擁有的其他補充計劃，我知道已經進行了很多討論。我們正在參與佛羅里達 DPP 計劃。在第四季度，我們確實確認了與該計劃相關的大約 1.3 億美元的淨收益。我們確實希望在 2022 年下半年也能看到類似的好處。

But I also want to talk about Texas for a moment. I think it's been reported that CMS has not yet approved the Medicaid directed payment program in Texas that was to go into effect September 1, '21. And as a result of this new program not being approved, we did not record any revenue anticipated with that -- this aspect of the waiver program in the latter 4 months of the year. So this equated to about $120 million reduction in our waiver revenue in the fourth quarter compared to what we had recognized in the 3 previous quarters, so it largely offset the impact of the Florida program in our consolidated results.

但我也想談談德克薩斯。我認為據報導 CMS 尚未批准將於 21 年 9 月 1 日生效的德克薩斯州醫療補助定向支付計劃。由於這個新計劃沒有獲得批准，我們沒有記錄任何預期的收入 - 在今年後 4 個月的豁免計劃的這方面。因此，這相當於我們在第四季度的豁免收入與我們在前三個季度中確認的相比減少了約 1.2 億美元，因此它在很大程度上抵消了佛羅里達計劃對我們綜合業績的影響。

We believe, eventually, the Texas program will be worked out, and we don't anticipate it being a headwind for 2022. But our full year guidance anticipates that we'll be able to recognize that annual historical level over time, even though it may take some time for the state of Texas and CMS to work that through.

我們相信，德州計劃最終會制定出來，我們預計它不會成為 2022 年的逆風。但我們的全年指導預計，隨著時間的推移，我們將能夠認識到這一年度歷史水平，儘管它德克薩斯州和 CMS 可能需要一些時間來解決這個問題。

On the pricing side, our revenue per admit, 1%. You're right. It's a little lower than maybe historically on there. When you adjust for the COVID, it does add about 1 point, so I think that's right. And then when you think our outpatient revenue growth, as I mentioned we expect to be in the mid- to high single digits, and you blend that, I think it would look relatively consistent when you look at revenue per equivalent admission. So we think it's generally in the range of what our historical trends would indicate.

在定價方面，我們每次承認的收入為 1%。你是對的。它比歷史上可能低一點。當您針對 COVID 進行調整時，它確實增加了大約 1 分，所以我認為這是正確的。然後，當您考慮我們的門診收入增長時，正如我所提到的，我們預計將達到中高個位數，並且您將其混合起來，我認為當您查看每次等效入院的收入時，它看起來會相對一致。所以我們認為它通常在我們的歷史趨勢所表明的範圍內。

Okay. Can I just ask a quick follow-up, Bill, on the Texas and Florida? So the way to think about them for 2022 is you're building in this extra, let's say, $130 million for Florida is in the '22 guidance. And then theoretically, you would also have a catch-up, right, from the fourth quarter of those last 4 months where there's an extra $130 million. So there's another $200 million and, let's say, $50 million of kind of extra dollars that are either at a period or probably may or may not continue from Florida and Texas in 2022. Is that the right way to think about it?

好的。比爾，我可以快速跟進德克薩斯州和佛羅里達州的情況嗎？因此，在 2022 年考慮它們的方式是，你正在增加這個額外的費用，比如說，佛羅里達州的 1.3 億美元在 22 年的指導中。然後從理論上講，從過去 4 個月的第四季度開始，你還會有一個額外的 1.3 億美元。因此，還有 2 億美元，比方說，5000 萬美元的額外資金要么在一段時間內，要么可能會或可能不會在 2022 年從佛羅里達州和德克薩斯州繼續下去。這是正確的思考方式嗎？

Well, Justin, I think in our guidance, we're anticipating an annual amount, a 12 month in our guidance. We're not anticipating a catch-up, just given the uncertainty of how that may settle out. So we're going to have to wait to see how that is developed. The state of Texas is testing that federal program. We're hoping that we get some understanding of that soon. So our guidance really reflects an annual amount, not necessarily a catch-up amount from this year. And so we'll just have to wait and see how that plays out.

好吧，賈斯汀，我認為在我們的指導中，我們預計每年的金額，在我們的指導中為 12 個月。我們不期待追趕，只是考慮到如何解決的不確定性。所以我們將不得不等待看看它是如何發展的。德克薩斯州正在測試該聯邦計劃。我們希望我們能盡快對此有所了解。因此，我們的指導確實反映了年度金額，不一定是今年的追趕金額。所以我們只需要等待，看看結果如何。

Our next question is from A.J. Rice with Credit Suisse.

我們的下一個問題來自 A.J.瑞信的賴斯。

Best wishes, Mark. I will say how long we've been interacting. But maybe I'll pivot and ask about -- you guys have talked about from time to time in the COVID crisis, there -- some of the downstream ability to discharge has been challenging home health, SNFs, whatever. And you also talked about that making -- maybe having some impact on your capital deployment priorities. Can you just give us your updated thoughts, as you see Delta moderate, omicron come -- surge, are you seeing issues with being able to discharge patients in the time frame you'd want? And any updated thoughts on having any of those areas, in particular new or increased capital priorities?

最好的祝愿，馬克。我會說我們已經互動了多久。但也許我會轉向並詢問——你們在 COVID 危機中不時談論過——一些下游排放能力一直在挑戰家庭健康、SNF 等。你還談到了這種做法——可能會對你的資本部署優先級產生一些影響。您能否告訴我們您的最新想法，因為您看到 Delta 溫和，omicron 來了 - 激增，您是否看到能夠在您想要的時間範圍內讓患者出院的問題？以及關於擁有任何這些領域的最新想法，特別是新的或增加的資本優先事項？

Thank you, A.J. One of the areas that we're focused on, and it's connected really to our labor agenda, it's connected to our overall business agenda for 2022 is managing capacity and throughput most effectively. So case management, length of stay management, discharge planning, post-acute and other settings is very important to our success, ER throughput. All of those elements are very important to our ability to manage capacity. And then, clearly, we have to execute on our labor agenda, and we have a robust labor agenda to respond to the issues that we face on the people side of our equation.

謝謝你，A.J.我們關注的領域之一，它與我們的勞工議程真正相關，與我們 2022 年的整體業務議程相關，是最有效地管理產能和吞吐量。因此，病例管理、住院時間管理、出院計劃、急性後和其他設置對我們的成功、ER 吞吐量非常重要。所有這些元素對於我們管理容量的能力都非常重要。然後，很明顯，我們必須執行我們的勞工議程，我們有一個強有力的勞工議程來回應我們在等式的人方面面臨的問題。

And as it relates to the surges, discharge planning during the surges has been a little bit more difficult. It's been more difficult in the omicron variant because the nursing home environment and even the home care environment has been suffering from employees who have been infected by the omicron variant. And so that's created a little bit of a contraction, we think, in some markets with overall post-acute capacity. And that has delayed our ability to execute on our discharge planning process as we ordinarily would.

由於它與浪湧有關，因此浪湧期間的排放計劃更加困難。在 omicron 變體中變得更加困難，因為療養院環境甚至家庭護理環境一直受到感染 omicron 變體的員工的影響。因此，我們認為，在一些具有整體急性後產能的市場中，這造成了一些收縮。這延遲了我們像往常一樣執行出院計劃流程的能力。

As it pertains, A.J., to our capital planning, as you know, we did acquire the home care and hospice business unit from Brookdale. We have been in the process of integrating that business into our company. And the first part of this year has been about integration. We sold non-overlap components to another home care company, and then we've been organizing ourselves around home care and hospice inside of the markets where we overlap. And so again, we're in the early stages of integration. We're looking for some significant strides on that front in '22.

正如您所知，A.J. 與我們的資本規劃有關，我們確實從 Brookdale 收購了家庭護理和臨終關懷業務部門。我們一直在將該業務整合到我們公司中。今年的第一部分是關於整合的。我們將非重疊組件出售給另一家家庭護理公司，然後我們一直在我們重疊的市場內圍繞家庭護理和臨終關懷組織自己。同樣，我們正處於整合的早期階段。我們正在尋找 22 年在這方面的一些重大進展。

Additionally, we're making significant investments in rehab, as we've mentioned on these calls in the past, particularly in Florida but also in other components of our business. And we think that will enhance our ability to manage the post-acute discharge process a little bit more efficiently. We also have preferred networks that we've evolved with our bundled payment programs over the years with certain providers in post-acute. We will continue to leverage and build on those relationships, allowing us, hopefully, to maintain efficient discharge planning process.

此外，正如我們過去在這些電話中提到的那樣，我們正在對康復進行大量投資，特別是在佛羅里達州，而且還包括我們業務的其他組成部分。我們認為這將提高我們更有效地管理急性出院後過程的能力。我們還擁有首選網絡，這些網絡多年來與我們的捆綁支付計劃一起發展，某些供應商處於後期急性期。我們將繼續利用和建立這些關係，希望我們能夠維持有效的出院計劃流程。

The last thing I would say on that front as well is our case management program is continuing to be advanced in our company. We are implementing technology. We are deploying certain shared services capabilities around utilization review and so forth, and we think those initiatives are going to yield benefits for us as it relates to capacity management. So a lot of components to this, A.J.

在這方面我要說的最後一件事是，我們的案例管理計劃正在我們公司繼續推進。我們正在實施技術。我們正在圍繞利用率審查等部署某些共享服務功能，我們認為這些舉措將為我們帶來與容量管理相關的收益。所以很多組成部分，A.J.

Overall capital spending, however, to sum it all up here, materially changing from what we previously indicated.

然而，總的資本支出在這裡總結起來，與我們之前指出的情況發生了重大變化。

Our next question is from Pito Chickering with Deutsche Bank.

我們的下一個問題來自德意志銀行的 Pito Chickering。

I want to echo everyone's comments. Mark, a big thank you. It's been a pleasure working with you over the years. And Frank, I look forward to working with you again in the future.

我想回應大家的評論。馬克，非常感謝。多年來與您合作非常愉快。還有弗蘭克，我期待在未來再次與您合作。

So guys, I'm asking a single sort of multipart question here. So labor is obviously a big topic these days. So the first question is how should we model the cadence of earnings in 2022 versus a pre-COVID year?

所以伙計們，我在這裡問一個單一的多部分問題。因此，勞動顯然是當今的一個大話題。所以第一個問題是，我們應該如何模擬 2022 年與 COVID 之前的收入節奏？

Number two, on [3.8%] of revenue growth guidance, you're only guiding to 50 basis points of margin compression despite these labor pressures. Can you give us any color on where salaries and benefits track in '22 versus '21? Any other color on supply and OpEx? And then finally, number three, what assumptions are you making on labor costs sort of throughout the year? Do you have a moderating, same levels? Any color you can give us there?

第二，在 [3.8%] 的收入增長指引中，儘管存在這些勞動力壓力，但您僅將利潤率壓縮至 50 個基點。你能告訴我們 22 年和 21 年工資和福利的軌跡嗎？供應和運營支出上的任何其他顏色？最後，第三點，你對全年的勞動力成本做出了什麼樣的假設？你有一個適度的，相同的水平？有什麼顏色可以給我們嗎？

This is Bill. Let me start with the quarterly case. Obviously, we don't give specific guidance. But I think when you consider the discussion I had around the Texas waiver program, we think that will take some time to settle out potentially even into the second half of the year. And then we think about labor, really the current trends, probably more pressured in the first half of the year. We think we can continue to manage through those in the second half of the year.

這是比爾。讓我從季度案例開始。顯然，我們沒有給出具體的指導。但我認為，當您考慮我圍繞德克薩斯州豁免計劃進行的討論時，我們認為這可能需要一些時間才能解決，甚至可能會持續到今年下半年。然後我們考慮勞動力，真正的當前趨勢，可能在今年上半年面臨更大的壓力。我們認為我們可以在下半年繼續管理這些問題。

I think it's reasonable to expect that our growth will be weighted in the second half of the year. We expect that as we've seen the utilization of some of our premium labor, especially around contract labor, that we can ease that as we go through the balance of the year as, hopefully, we get out of a COVID surge environment. And that will provide some relief as we progress through the second half of 2022.

我認為我們的增長將在下半年加權是合理的。我們預計，由於我們已經看到了一些優質勞動力的使用，尤其是合同勞動力的使用情況，我們可以在今年餘下的時間裡緩解這種情況，因為希望我們能夠擺脫 COVID 激增的環境。隨著我們在 2022 年下半年的進展，這將提供一些緩解。

On supplies and OpEx, our assumptions are really consistent with our trends. When I look at those 2 areas as a percentage of revenue, they stay pretty close in terms of the variability from period to period. So there's really no major tailwinds or headwinds that I would call out on those. I think our supply trends and our other operating trends would be consistent with, I think, what we've seen throughout most of this year.

在供應和運營支出方面，我們的假設與我們的趨勢非常一致。當我將這兩個領域視為收入的百分比時，它們在不同時期的可變性方面保持非常接近。所以我真的沒有什麼大的順風或逆風我會呼籲這些。我認為我們的供應趨勢和其他運營趨勢將與我們今年大部分時間所看到的一致。

Okay. Great. And actually, a follow-up question on the premium labor. Can you quantify how much premium labor you guys saw in the fourth quarter and what you're assuming in 2022?

好的。偉大的。實際上，關於優質勞動力的後續問題。你能量化一下你們在第四季度看到了多少溢價勞動力，以及你對 2022 年的假設嗎？

Well, I think it's -- we did obviously have to utilize higher contract labor. I think the impact was as much about the cost to procure that contract labor as it was the utilization. Our contract labor FTEs were up maybe 10% compared to where we ran in the first quarter. But the cost to procure that contract labor update was up significantly.

嗯，我認為是——我們顯然不得不使用更高的合同工。我認為影響與採購合同勞動力的成本和利用率一樣重要。與第一季度相比，我們的合同工 FTE 可能增加了 10%。但採購該合同工更新的成本顯著上升。

So we believe that as the COVID surges begin to dissipate, that the cost per contract labor, we'll be able to manage through that and manage that down. So those are basically the numbers right now.

因此，我們相信，隨著 COVID 激增開始消散，每個合同工的成本，我們將能夠度過難關並將其控制下來。所以這些基本上是現在的數字。

Our next question is from Whit Mayo with SVB Leerink.

我們的下一個問題來自 Whit Mayo 和 SVB Leerink。

Best wishes, Mark.

最好的祝愿，馬克。

Bill, my question is when I look at the framework that you've offered up for 2022, I may be off 1 point or so here. But if COVID is budgeted to be 3% to 5% of your total admissions, it does seem to imply that non-COVID admissions grow maybe somewhere in the high single-digit range, but that could be roughly flat versus 2019. So I'm just trying to see if you can put into context the growth in non-COVID and how that's been trending. And maybe any color around service lines, just to help us bridge that increase, and any views on maybe the first quarter could be helpful.

比爾，我的問題是，當我查看您為 2022 年提供的框架時，我可能會偏離 1 分左右。但是，如果將 COVID 預算佔總招生人數的 3% 到 5%，這似乎確實意味著非 COVID 招生人數的增長可能在高個位數範圍內，但這可能與 2019 年大致持平。所以我我只是想看看您是否可以將非 COVID 的增長以及趨勢如何。也許服務線周圍的任何顏色，只是為了幫助我們彌合這一增長，對第一季度的任何看法可能會有所幫助。

All right. Thank you, Whit. That -- if you look at COVID in discrete terms, you're probably not incorrect with some of your estimations. But I don't think we're viewing COVID completely discrete in the sense that some of those patients would still be entering the system, regardless of COVID, and that was especially true in the fourth quarter as we looked at some of our COVID patients and such that they were coming in for different reasons.

好的。謝謝你，惠特。那——如果您以離散的方式看待 COVID，您的某些估計可能並沒有錯。但我不認為我們認為 COVID 是完全離散的，因為其中一些患者仍會進入系統，無論 COVID 如何，在第四季度尤其如此，因為我們查看了一些 COVID 患者以至於他們出於不同的原因進來。

And then they were also COVID positive because many people didn't even know they had COVID. So I think you have to sort of look at it as a bit of a mixed bag there, and that's how we're judging it as well. I do believe that there was deferred demand, and it still showed itself in the quarter and will yield some recovery in the first part of 2022. I mean, literally, we had surgeons who were closing practices, canceling cases because they, themselves, contracted the omicron variant. So I think from that standpoint, there is the typical COVID impact on volumes in the quarter while we're experiencing a surge.

然後他們也是 COVID 陽性，因為很多人甚至不知道他們感染了 COVID。所以我認為你必須把它看作是一個混合包，這也是我們判斷它的方式。我確實相信存在延遲的需求，它仍然在本季度表現出來，並將在 2022 年上半年產生一些恢復。我的意思是，從字面上看，我們有外科醫生正在結束實踐，取消病例，因為他們自己已經簽約omicron 變體。因此，我認為從這個角度來看，當我們經歷激增時，本季度的銷量會受到典型的 COVID 影響。

But we believe, again, that strong job growth across our portfolio of markets, more people covered by the exchange, deferrals, some elective and transfer closures across our portfolio all bode well for our ability to recover volume in 2022. Again, as I mentioned to A.J., we have to manage capacity. We have to supply that capacity with labor, and we're working through all of those elements, as we speak, to put ourselves in the best position to receive that demand.

但我們再次相信，我們市場組合中的強勁就業增長、更多人被交易所覆蓋、延期、我們投資組合中的一些選修和轉移關閉都預示著我們有能力在 2022 年恢復交易量。再次，正如我提到的對於 A.J.，我們必須管理容量。我們必須用勞動力來提供這種能力，正如我們所說，我們正在處理所有這些因素，以使自己處於接受這種需求的最佳位置。

But we're very excited about the prospects for growth across the company. As I mentioned in my comments, we're investing in that. We've announced, as I mentioned, 8 new hospitals, recognized some of the overall growth that exists in these markets. We've had momentum. If you look at our market share at the end of 2019, it was north of 26.5%. It ended with the most recent data that we get, which is about 1.5 years later, right under 28%. So we gained share during COVID. We've positioned our organization, we believe, with our ambulatory network better. And when we bump that up to what we're judging to be some demand that's been dislocated by the COVID surges, we feel like our guidance is reasonable.

但我們對整個公司的增長前景感到非常興奮。正如我在評論中提到的，我們正在對此進行投資。正如我所提到的，我們已經宣布了 8 家新醫院，它們認識到這些市場中存在的一些整體增長。我們有動力。如果你看看我們在 2019 年底的市場份額，它超過了 26.5%。它以我們獲得的最新數據結束，大約 1.5 年後，略低於 28%。因此，我們在 COVID 期間獲得了份額。我們相信，我們已經通過我們的流動網絡更好地定位了我們的組織。當我們將其與我們認為因 COVID 激增而錯位的一些需求相提並論時，我們覺得我們的指導是合理的。

The next question is from Sarah James of Barclays.

下一個問題來自巴克萊的 Sarah James。

I echo the heartfelt comments to Mark.

我回應了對馬克的衷心評論。

How much of the wage inflation environment do you think of as a structural shift or a shift in how we think about the base wage range for nurses? And how does that impact your conversations with payers and how you think about CapEx or capital deployment mix?

您認為工資通脹環境在多大程度上是結構性轉變或我們對護士基本工資範圍的看法的轉變？這對您與付款人的對話以及您對資本支出或資本部署組合的看法有何影響？

Thank you, Sarah. Well, as Bill mentioned, the market has been significantly disrupted, the labor market that it, has been significantly disrupted with COVID. What we see during COVID surges is more opportunities for our nurses and other people's nurses to go into a traveler and get a really outsized rate. We think as COVID surges moderate, that is going to moderate the overall labor market, to some degree.

謝謝你，莎拉。好吧，正如比爾提到的，市場已經被嚴重擾亂，它的勞動力市場已經被 COVID 嚴重擾亂。我們在 COVID 激增期間看到的是，我們的護士和其他人的護士有更多機會進入旅行者並獲得非常高的價格。我們認為，隨著 COVID 的溫和增長，這將在一定程度上緩和整個勞動力市場。

We have advanced our wages for our employees. We've advanced some of our benefits. We've provided certain shift bonuses throughout the year, and that has yielded in some increased rate of wage growth for our employee base. We think, however, moving into 2022 as we go through the moderation on the contract labor, we'll be able to absorb the wage trends that are built into our employee base over the course of '22 and land somewhere around 3% to 3.5%, possibly, on a composite basis for our cost per FTE. And that, we believe, is something that we can absorb in our guidance.

我們提高了員工的工資。我們已經提升了一些優勢。我們全年提供了一定的輪班獎金，這為我們的員工群帶來了一定的工資增長率。然而，我們認為，進入 2022 年，隨著我們對合同工進行適度調整，我們將能夠吸收 22 年期間建立在我們員工基礎中的工資趨勢，並降落在 3% 到 3.5 左右%，可能是我們每 FTE 成本的綜合基礎。我們相信，這是我們可以在指導中吸收的東西。

As it relates to our payer contracts, yes, we were talking to them about inflationary pressures and how that will influence future contracting. At this particular point in time, our book of business for 2022 is pretty much accomplished and part of '23 is accomplished. But we're building in some flexibility to reflect the inflationary pressures that might exist, and we'll continue to work through those as we work through our contract portfolio with the different payers.

因為它與我們的付款人合同有關，是的，我們正在與他們討論通貨膨脹壓力以及這將如何影響未來的合同。在這個特定的時間點，我們 2022 年的商業賬簿已經完成，23 年的一部分已經完成。但我們正在建立一些靈活性以反映可能存在的通脹壓力，我們將繼續解決這些問題，因為我們通過與不同付款人的合同組合進行工作。

But I think, in general, they understand the pressures that providers are facing on that front, and they have the unique ability to adjust their premiums on an annual basis in most instances, and that should line up with the need for us to get a fair cost increase related to inflation.

但我認為，總的來說，他們了解提供商在這方面面臨的壓力，並且在大多數情況下，他們具有每年調整保費的獨特能力，這應該符合我們獲得與通貨膨脹相關的公平成本增加。

Our next question is from Scott Fidel with Stephens.

我們的下一個問題來自 Scott Fidel 和 Stephens。

I will echo the thanks to Mark, and best wishes to Frank.

我將向馬克表示感謝，並向弗蘭克致以最良好的祝愿。

I had a question. Was interested to get a few more details on the 8 hospitals that you've announced that you're going to plan to build in aggregate in Florida and in Texas. And just specifically interested if you could talk about what the overall related CapEx would be for those facilities and the ROIC that you think you can generate on them. And then also maybe in aggregate sort of new beds that you'll think that you'll be able to add from the same facilities and when, in terms of timing, those are expected to come online.

我有一個問題。有興趣了解您宣布計劃在佛羅里達州和德克薩斯州共同建設的 8 家醫院的更多詳細信息。如果您可以談論這些設施的總體相關資本支出以及您認為可以在它們上產生的投資回報率，那麼您會特別感興趣。然後，您可能會認為您可以從相同的設施中添加新的床位，並且在時間方面，這些床位預計將在何時上線。

Well, I would submit that the 8 projects that we've announced is not going to materially change our capital thinking over the next 2 to 3 years. We believe we can absorb most of that in what will be a budget that's approximately what we're indicating for, for this year. The situation is this. I mean, some of these markets are growing significantly often. This, as everybody probably knows, is growing in a way that is creating opportunities for us, just like it's creating opportunities for others in that community.

好吧，我認為我們宣布的 8 個項目不會在未來 2 到 3 年內實質性地改變我們的資本思維。我們相信我們可以在今年的預算中吸收大部分費用，這大約是我們所指示的預算。情況是這樣的。我的意思是，其中一些市場經常顯著增長。正如每個人可能都知道的那樣，這正在以一種為我們創造機會的方式發展，就像它為該社區中的其他人創造機會一樣。

But with the growth in that market and with the occupancy that we currently run in Austin, Texas, as an example, it presents a nice platform for us to expand into some of these growing areas and add to our network.

但是，隨著該市場的增長以及我們目前在德克薩斯州奧斯汀運營的入住率，它為我們提供了一個很好的平台，可以擴展到其中一些增長區域並添加到我們的網絡中。

Most of these hospitals will be primary and secondary care type hospitals with basic inpatient services and many outpatient services. And then to the extent that these patients need deeper, more acute care, we obviously have those capabilities in or different markets. We have the same situation in Florida with the exception of 1 hospital that we're building in Fort Myers, which is a new market for us. And we're extending into that market because there's a need for more capacity and it's proximal to one of our West Florida markets in a way that we think we can create synergies.

這些醫院大部分將是初級和二級保健類型的醫院，提供基本的住院服務和許多門診服務。然後，就這些患者需要更深入、更緊急的護理而言，我們顯然在不同市場或不同市場擁有這些能力。除了我們在邁爾斯堡建造的 1 家醫院外，我們在佛羅里達州也有同樣的情況，這對我們來說是一個新市場。我們正在擴展到該市場，因為需要更多的產能，而且它與我們的西佛羅里達市場很接近，我們認為我們可以創造協同效應。

So I think with respect to returns, we have a pattern, we believe, of producing very solid projects. It's reflected in our return on capital overall, and we anticipate that these projects, over time, will yield the same kind of value that we've typically generate with capital programs.

所以我認為關於回報，我們相信，我們有一種模式，可以生產非常可靠的項目。這反映在我們的總體資本回報率中，我們預計隨著時間的推移，這些項目將產生與我們通常通過資本項目產生的相同價值。

So that's where we are with them. Again, most of them are going to be 50 to 75 beds starting out. They're not huge hospitals. They're complementary assets that, over time, will hopefully grow to more acute and more capable facilities with respect to service offerings.

這就是我們與他們在一起的地方。同樣，他們中的大多數一開始將有 50 到 75 張病床。他們不是大醫院。它們是互補的資產，隨著時間的推移，它們有望在服務產品方面發展為更先進、更有能力的設施。

Our next question is from Gary Taylor with Cowen.

我們的下一個問題來自 Gary Taylor 和 Cowen。

Mark, congrats. Not to make you feel old, but I think HCA had $2 billion of revenue in 1982 when you started, so you've come a long way.

馬克，恭喜。不是讓你覺得自己老了，但我認為 HCA 在 1982 年你剛開始的時候就有 20 億美元的收入，所以你已經走了很長一段路。

That's right. I remember. Thank you.

這是正確的。我記得。謝謝你。

One clarification and one question. I just want to clarify, the Utah hospital is not yet in the guide. And then my question, just going back to labor. I know you've covered a lot on it. I appreciate it. But Bill, on the 3Q, you had talked about contract labor, over time, shift differentials, and you had said 10% to 12% of FTEs were in those premium categories. And I think you -- I think all 3 of those were included in sort of the premium categories. So I just wanted to get a sense sequentially if you have that figure, if there's a sense that, that eased at all yet or we're still waiting to see that.

一個澄清和一個問題。我只是想澄清一下，猶他州醫院還沒有在指南中。然後我的問題，只是回去工作。我知道你已經介紹了很多。我很感激。但是比爾，在第三季度，您談到了合同工、隨著時間的推移、輪班差異，您曾說過 10% 到 12% 的 FTE 屬於這些優質類別。而且我認為您 - 我認為所有這三個都包含在高級類別中。所以我只是想按順序來了解一下，如果你有這個數字，如果有一種感覺，那已經緩解了，或者我們還在等著看。

This is Bill. To answer, yes, Utah is not in our guidance. We're still in a regulatory review process, so we've not included any of that in our guidance.

這是比爾。要回答，是的，猶他州不在我們的指導範圍內。我們仍處於監管審查過程中，因此我們的指導中沒有包含任何內容。

Regarding the contract labor and premium labor trends, we did see some improvement as we went through the fourth quarter. I think the number is closer to 11% of our nursing hours were contract hours in the fourth quarter, so there is some slight improvement going forward. And as we think about in my earlier commentary, we think in the first half of '22, we'll continue to see that pressure over time as the year goes on. As COVID dissipates, we'll be able to manage that process down.

關於合同工和優質勞動力的趨勢，我們在第四季度確實看到了一些改善。我認為這個數字接近 11% 的護理時間是第四季度的合同時間，因此未來會有一些輕微的改善。正如我們在我之前的評論中所考慮的那樣，我們認為在 22 年上半年，隨著時間的推移，隨著時間的推移，我們將繼續看到這種壓力。隨著 COVID 的消散，我們將能夠管理該過程。

Our next question is from Jamie Perse with Goldman Sachs.

我們的下一個問題來自高盛的 Jamie Perse。

I just wanted to ask one clarification first. On the COVID DRG and HRSA sequestration for 2021, if you can give a breakdown of that $900 million, and same thing for 2022, the $150 million that you're planning for.

我只是想先問一個澄清。在 2021 年的 COVID DRG 和 HRSA 隔離中，如果你能給出 9 億美元的明細，以及 2022 年的同樣情況，你計劃的 1.5 億美元。

And then my real question is just around, I think we're was getting to this question but the implied non-COVID volume in 2022. You're certainly not implying you'd get back to trend line, maybe back to 2019 levels. But really what is the bottleneck to get back to trend line growth? Is it discharge capacity, labor capacity? What are those bottlenecks that you would have to work through to see upside for your non-COVID volumes?

然後我真正的問題就在附近，我認為我們正在解決這個問題，但隱含的非 COVID 數量在 2022 年。你當然不是暗示你會回到趨勢線，也許回到 2019 年的水平。但真正回到趨勢線增長的瓶頸是什麼？是排放能力，勞動能力？您必須克服哪些瓶頸才能看到非 COVID 交易量的上漲空間？

Yes. Let me take the first part of that, the breakdown of the COVID support. It was roughly $180 million from the DRG add-ons. The sequestration delay was about $200 million for us in '21, and then we had a little over $400 million of HRSA reimbursement and then a little bit of technology add-on payments after that. Regarding '22, we know we have some visibility into the sequestration being phased in. I would say it's roughly half of the $150 million we talked about and the rest being from the other programs.

是的。讓我談談第一部分，即 COVID 支持的細分。 DRG 附加組件大約為 1.8 億美元。在 21 年，我們的隔離延遲約為 2 億美元，然後我們有 4 億多美元的 HRSA 報銷，然後是一些技術附加付款。關於 22 年，我們知道我們對逐步實施的封存有一定的了解。我想說這大約是我們討論的 1.5 億美元的一半，其餘的來自其他項目。

I think on the capacity side of the equation, again, if you categorize how we're approaching, making sure we have adequate capacity, and we have to execute on these categories in order to achieve that, first is staffing. We have to retain the staff we have. We have to recruit new staff, and we have to manage that obviously cost effectively. And again, we have a number of initiatives in place to deal with that, and I'm encouraged by our hiring. We've advanced our recruiting agenda. We've got improvements in certain categories with turnover. And again, getting through COVID surges will be helpful to that.

我認為在等式的能力方面，再次，如果你對我們的接近方式進行分類，確保我們有足夠的能力，我們必須在這些類別上執行以實現這一目標，首先是人員配備。我們必須留住現有的員工。我們必須招募新員工，而且顯然我們必須以成本效益的方式進行管理。再說一次，我們有許多舉措來解決這個問題，我對我們的招聘感到鼓舞。我們已經推進了我們的招聘議程。我們在某些類別的營業額方面有所改進。再一次，度過 COVID 激增將對此有所幫助。

The second thing we're working on is something we're calling new models of care. We're exploring and experimenting with different approaches to staffing models that allow our nurses to be supported by different approaches and creating more capacity, if you will, for our nurse population in a way that delivers the patient outcomes we want and recognizes some of the market issues.

我們正在做的第二件事是我們稱之為新的護理模式。我們正在探索和試驗不同的人員配備模型方法，使我們的護士能夠得到不同方法的支持，並為我們的護士群體創造更多的能力，以提供我們想要的患者結果並認識到一些市場問題。

And then the final piece is what I had mentioned previously around throughput and capacity management. And again, case management is a piece of that. Telemedicine inside of our hospitals is a piece of that. Load balancing across all of our bed capacity market is a piece of that, so we have a lot of elements. Technology also factors into that and how we're using some new technology solutions to help us in throughput management. So those are the areas that we're focused on, and I've got confidence in our teams and our ability to execute around these categories and deliver the capacity that we're going to need in order to take care of the demand that's going to be in the communities.

最後一部分是我之前提到的關於吞吐量和容量管理的內容。再一次，案例管理是其中的一部分。我們醫院內的遠程醫療就是其中的一部分。我們所有床位容量市場的負載平衡就是其中的一部分，所以我們有很多元素。技術也影響了這一點，以及我們如何使用一些新技術解決方案來幫助我們進行吞吐量管理。所以這些是我們關注的領域，我對我們的團隊以及我們圍繞這些類別執行的能力以及提供我們將需要的能力以應對未來的需求充滿信心在社區。

Our next question is from Jason Cassorla with Citi.

我們的下一個問題來自花旗的 Jason Cassorla。

Great. I guess just on the payer mix side, can you help flush out volume growth in the quarter by payer cohort and how you're thinking about 2022 in context of that 2% to 3% overall volume growth embedded in guidance? I guess you suggested stability in payer mix for '22, but just wondering how you're thinking about the impact of any potential Medicaid reverification activity and especially the pickup in the marketplace enrollment in your bigger states, I think, particularly in Texas. So any help there would be great.

偉大的。我想僅在付款人組合方面，您能否幫助按付款人群組清除本季度的交易量增長，以及在指導中嵌入 2% 至 3% 的整體交易量增長的背景下，您如何看待 2022 年？我猜您建議 22 年付款人組合保持穩定，但只是想知道您如何考慮任何潛在的 Medicaid 重新驗證活動的影響，尤其是在您較大的州，尤其是在德克薩斯州，市場註冊人數的增加。所以那裡的任何幫助都會很棒。

Yes. I mean, in the quarter, we saw a continued favorable payer mix. Our managed care book for the quarter was up about 2.6% compared to our overall admissions that became favorable. That was partly driven, if not mostly driven, by the health insurance exchange volume. We continue to see that. We've talked about good enrollment going into that.

是的。我的意思是，在本季度，我們看到了持續有利的付款人組合。與我們變得有利的整體招生相比，我們本季度的管理式醫療書籍增加了約 2.6%。這部分是由健康保險交易量驅動的，如果不是主要驅動的話。我們繼續看到這一點。我們已經談到了良好的入學率。

As we go forward into '22, as I mentioned in my comments, I think we're expecting that our acuity and payer mix should continue to be positive trends, maybe not at the same pace we've seen over these past several quarters, but we expect some continued positive growth on that.

正如我在評論中提到的那樣，隨著我們進入 22 年，我認為我們期望我們的敏銳度和支付者組合應該繼續保持積極的趨勢，也許不會以我們在過去幾個季度中看到的相同速度，但我們預計在此基礎上會出現一些持續的正增長。

Relative to the Medicaid piece, we've seen some pluses and minuses of Medicaid. Medicaid growth is up a little higher than our average. In terms of expectations for next year, I think they would be mostly consistent with what our recent trends have been. I'm not so sure what else was tagged in on his question.

相對於 Medicaid 部分，我們已經看到了 Medicaid 的一些優點和缺點。醫療補助增長略高於我們的平均水平。就明年的預期而言，我認為它們與我們最近的趨勢基本一致。我不太確定他的問題還有什麼標籤。

That was it.

就是這樣。

Our next question is from Brian Tanquilut with Jefferies.

我們的下一個問題來自 Jefferies 的 Brian Tanquilut。

Mark, thanks again for all the help over the years. I guess my question, in your prepared remarks, you talked about how you saw the migration of inpatient ortho to outpatients. So just wondering how you're thinking about strategizing around that and how that plays out going forward. And maybe any color you can share on the difference in economics, maybe on an EBITDA basis, apples-to-apples, for procedures inpatient versus outpatient on ortho.

馬克，再次感謝多年來的所有幫助。我想我的問題是，在您準備好的發言中，您談到了您如何看待住院正畸患者向門診患者的遷移。所以只是想知道你是如何考慮圍繞這一點制定戰略的，以及這將如何發揮作用。也許你可以分享任何關於經濟差異的顏色，也許是在 EBITDA 的基礎上，蘋果對蘋果，對於手術住院和門診手術。

So our total orthopedic volume, surgical volumes were up when you look at inpatient and outpatient in total. We have a physician alignment strategy with our orthopedic community that we think is yielding value. We continue to iterate on that to respond to some of the individual needs from one market to the other.

所以當你看住院病人和門診病人時，我們的骨科總體積和手術體積都增加了。我們有一個與我們的骨科社區一致的醫生策略，我們認為這會產生價值。我們繼續對此進行迭代，以響應從一個市場到另一個市場的一些個人需求。

The second piece of our strategy is around our outpatient elements and how we manage our surgical space in the hospitals for outpatient cases and then also in our ambulatory surgery centers where we have orthopedic partners. So we have a multipronged approach to orthopedics, just like we do with most service lines, and it involves our quality agenda, our service agenda, our facility agenda and then our physicians. And so we have the same dynamic with orthopedics.

我們戰略的第二部分是圍繞我們的門診要素以及我們如何管理醫院的手術空間以處理門診病例，以及我們擁有骨科合作夥伴的門診手術中心。因此，我們對骨科採取了多管齊下的方法，就像我們對大多數服務線所做的那樣，它涉及我們的質量議程、服務議程、設施議程，然後是我們的醫生。所以我們在骨科方面也有同樣的動力。

The reimbursement per case is obviously less in an outpatient environment than it is in an inpatient, but I think the important thing about HCA Healthcare is we have such a diversification of services. And no one service provides a disproportionate amount of revenue or profits for the company. So when there's migration from one setting to the other, it doesn't necessarily change the overall equation for the company. And that's what we're seeing with orthopedics today. It's migrating. We've had other service lines over the years migrate from inpatient to outpatient, and we've been able to manage through that and actually create market share momentum around that transition, and we're believing that we have the right approach here with orthopedics as well.

在門診環境中，每個病例的報銷顯然比在住院環境中要少，但我認為 HCA Healthcare 的重要之處在於我們擁有如此多樣化的服務。沒有一項服務為公司提供不成比例的收入或利潤。因此，當從一種環境遷移到另一種環境時，並不一定會改變公司的整體等式。這就是我們今天在骨科中看到的。它正在遷移。多年來，我們已經有其他服務線從住院病人轉移到門診病人，我們已經能夠通過這種方式進行管理，並圍繞這種過渡實際創造市場份額勢頭，我們相信我們在骨科方面有正確的方法也是。

Our next question is from Calvin Sternick with JPMorgan.

我們的下一個問題來自摩根大通的 Calvin Sternick。

I just wanted to circle back to some of the Medicaid comments you made, specifically related to rate determinations. Just want to understand what's assumed in your guys' guidance with respect to the resumption of Medicaid rate determinations and whether or not you think that has a discernible impact on your numbers, particularly in the back half.

我只是想回顧一下您發表的一些 Medicaid 評論，特別是與費率確定有關的評論。只是想了解你們的指導中關於恢復醫療補助費率確定的假設，以及您是否認為這對您的數字有明顯的影響，尤其是在後半部分。

To be clear, when you say redeterminations, we talked about the supplemental programs.

需要明確的是，當您說重新確定時，我們談到了補充計劃。

Rate determinations.

費率確定。

Around eligibility..

圍繞資格..

Yes. Eligibility rate determinations.

是的。合格率確定。

I don't think there's any material assumptions in terms of changes of that into our expectations going forward. We haven't heard any discussion of that impact in our Medicaid volume projections going forward. So I would tell you that I think for next year, it's built on our historical trends remaining pretty consistent.

我認為沒有任何實質性假設可以改變我們未來的預期。我們在未來的醫療補助數量預測中沒有聽到任何關於這種影響的討論。所以我會告訴你，我認為明年，它建立在我們保持相當一致的歷史趨勢之上。

Our next question is from Joshua Raskin with Nephron Research.

我們的下一個問題來自 Nephron Research 的 Joshua Raskin。

Great. And congrats, Mark, and welcome, Frank, as well.

偉大的。祝賀你，馬克，歡迎你，弗蘭克。

On the labor front, I'm curious if you're seeing competition for clinical labor, specifically physicians, nurses, et cetera. Is that mostly coming from other hospitals, competing hospitals or maybe staffing situations? Or are there trends where individuals, the clinical labor is going to other areas, other sites or maybe even leaving health care because we continue to see that in media reports?

在勞動力方面，我很好奇你是否看到臨床勞動力的競爭，特別是醫生、護士等。這主要來自其他醫院、競爭醫院還是人員配備情況？或者是否存在個人、臨床勞動力前往其他地區、其他地點甚至可能離開醫療保健機構的趨勢，因為我們繼續在媒體報導中看到這一點？

And then maybe just a comment on Galen and the impact that, that's having and how that may be a competitive advantage for HCA?

然後也許只是對 Galen 及其影響的評論，以及這如何成為 HCA 的競爭優勢？

Well, I think all of the above on labor. I mean, there's clearly competition for labor, not just in clinical labor, but non-clinical labor, too. The service side of our agenda, we have competitive dynamics on that labor front as well. So we're no different than any other industry when it comes to that.

好吧，我認為以上所有內容都是關於勞動的。我的意思是，顯然存在勞動力競爭，不僅在臨床勞動力方面，而且在非臨床勞動力方面也是如此。在我們議程的服務方面，我們在勞動力方面也有競爭動力。因此，在這方面，我們與任何其他行業沒有什麼不同。

I think, again, we have advanced our recruitment very significantly, and we're recruiting significant numbers of nurses. We have retention efforts that I think are going to pay off. The care transformation that I mentioned in capacity management, all that's connected to a staffing solution for our company. And we're competing very aggressive in this space, just like we compete for physicians, just like we compete for patients and so forth. So I'm confident in our competitive abilities on this particular agenda.

我認為，我們再次大大推進了招聘工作，並且正在招聘大量護士。我們有留住努力，我認為這些努力會得到回報。我在容量管理中提到的護理轉型，都與我們公司的人員配備解決方案有關。我們在這個領域競爭非常激烈，就像我們爭奪醫生，就像我們爭奪病人等等。所以我對我們在這個特定議程上的競爭能力充滿信心。

Galen is off to a great start. We acquired it, and we're limited to when we could start our expansions. We started our expansion this past year. I think we have 12 new schools in the pipeline, maybe 6 or 8 of them have actually opened, one in Austin and one in Nashville. We're both the fastest ramp-up in new enrollment history of Galen, their CEO told me. So we're very excited about the prospects.

蓋倫開了個好頭。我們獲得了它，而且我們僅限於何時可以開始我們的擴張。我們在去年開始了我們的擴張。我認為我們有 12 所新學校正在籌建中，其中可能有 6 或 8 所實際上已經開學，一所在奧斯汀，一所在納什維爾。他們的首席執行官告訴我，我們都是 Galen 新入學歷史上增長最快的。所以我們對前景感到非常興奮。

It will take us time to graduate these nurses, but we expect to have 12 to 18 new schools over the next 2 to 3 years, and that should yield a number of new students for us. We will integrate those students into our facilities in ways that hopefully secure an employment opportunity for them in an HCA facility when they graduate. We anticipate tripling the number of graduates over what they currently produce by 2026, which yield a reasonable growth in number of nurses in the communities that, again, hopefully, we can retain into our facilities.

我們需要時間讓這些護士畢業，但我們預計在未來 2 到 3 年內將有 12 到 18 所新學校，這應該會為我們帶來一些新學生。我們將把這些學生整合到我們的設施中，希望他們畢業後能在 HCA 設施中獲得就業機會。我們預計，到 2026 年，畢業生人數將比他們目前生產的人數增加三倍，這將使社區中的護士人數合理增長，再次，希望我們可以保留到我們的設施中。

We believe our faculty will be supported by HCA nursing leadership, and the externs programs that we'll use for students in the Galen school will be integrated into HCA procedures, systems and so forth. And we do think that creates some advantage in securing these graduates into our facilities.

我們相信我們的教師將得到 HCA 護理領導層的支持，我們將為 Galen 學校的學生使用的外部項目將被整合到 HCA 程序、系統等中。我們確實認為這在確保這些畢業生進入我們的設施方面創造了一些優勢。

Our final question is from Ben Hendrix with RBC Capital Markets.

我們的最後一個問題來自加拿大皇家銀行資本市場的 Ben Hendrix。

Congratulations to both Mark and Frank.

祝賀馬克和弗蘭克。

I think most of my questions have been answered, and you've touched on this. But just kind of get your inpatient care delivery efforts and then length of stay management, this is all a consistent theme we've heard from your competitors. Certainly, Tenet has talked about this and Community as well. But just wanted to get a little bit more color on what you think are your key differentiators, whether that be your scale, your approach, and kind of what might give HCA the competitive advantage in that endeavor.

我想我的大部分問題都已經得到解答，你也談到了這一點。但是，只是讓您的住院護理交付努力，然後是住院時間管理，這是我們從您的競爭對手那裡聽到的一致主題。當然，Tenet 也談到了這一點和社區。但只是想對您認為的主要差異化因素有更多的了解，無論是您的規模、您的方法，以及可能使 HCA 在該努力中獲得競爭優勢的某種因素。

And then a follow-on to that, kind of what inning are we in? How much room to run do we have on getting efficiency out of -- specifically the care delivery?

然後是一個後續，我們在哪一局？我們在提高效率方面還有多少空間——特別是在護理服務方面？

All right. Thanks, Ben. I don't know what the other companies are necessarily saying about this particular agenda. I think what we're trying to do is make sure we're using technology. We have training and visibility into the processes that make a difference in case management. And then we're ultimately using our capacity broadly across the markets to support better throughput and overall capacity management.

好的。謝謝，本。我不知道其他公司對這個特定議程的看法。我認為我們正在嘗試做的是確保我們正在使用技術。我們對在案例管理中產生影響的流程進行了培訓和了解。然後，我們最終將在整個市場廣泛使用我們的產能，以支持更好的吞吐量和整體產能管理。

And then, as I mentioned, we've advanced our capabilities in post-acute with our own acquisitions and development as well as relationships with others. And I think the combination of all of those elements create an opportunity for us to gain more efficiencies through our case management programs overall. And we think also that will help us with our receivables and our management of denials and so forth with the payers, and there's some yield on that front as well. So we're pretty excited about the developments in this area. How much more advantage we are than others, I can't really speak to that.

然後，正如我所提到的，我們通過自己的收購和發展以及與他人的關係提高了我們在急性後的能力。我認為所有這些元素的結合為我們創造了一個機會，通過我們的整體案例管理計劃來提高效率。而且我們認為這也將幫助我們處理我們的應收賬款和我們對付款人的拒絕管理等等，並且在這方面也有一些收益。因此，我們對這一領域的發展感到非常興奮。我們比其他人有多少優勢，我真的不能說。

That concludes the question-and-answer session. I will turn the call over to Mr. Hazen for any closing remarks.

問答環節到此結束。我將把電話轉給 Hazen 先生，讓其作最後的發言。

Yes. Well, thank you again for participating on our call, and I wanted to take this moment to thank Mark for his 39 years of service. He and I both have worked 39 years with the company. I'm not sure why he's retiring. But nonetheless, he has had a wonderful career and represented our company incredibly well with our shareholders and others, and I want to thank him for that. And again, welcome, Frank, to the team. Frank's going to do a wonderful job as well. So Mark, congratulations, and we wish you the best.

是的。好吧，再次感謝您參加我們的電話會議，我想藉此機會感謝馬克 39 年的服務。他和我都在公司工作了 39 年。我不確定他為什麼要退休。但是，儘管如此，他的職業生涯非常出色，並且代表我們公司與我們的股東和其他人相處得非常好，我要為此感謝他。再次，歡迎弗蘭克加入團隊。弗蘭克也會做得很好。所以馬克，恭喜你，我們祝你一切順利。

Appreciate it. Well, I wanted to say thanks, too. And finishing up our -- my final earnings call, I wanted to thank Sam and Bill and all the others I've known and worked alongside these past 39-plus years. I truly enjoyed working with everyone here at HCA and all of you listening on the call today, too. I also want to thank Dr. Frist for his vision in creating HCA and Vic Campbell for his years of mentoring and friendship to me over the past decades.

欣賞它。嗯，我也想說聲謝謝。在結束我們的最後一次財報電話會議後，我想感謝山姆和比爾以及我認識並在過去 39 多年裡與之共事的所有其他人。我真的很喜歡與 HCA 的每個人一起工作，而且你們今天也都在聽電話會議。我還要感謝 Frist 博士在創建 HCA 方面的遠見和 Vic Campbell 在過去幾十年中對我的指導和友誼。

Frank and I will be here to answer any further questions you might have following this call, so feel free to give us a shout this afternoon or the week. Thank you so much.

弗蘭克和我將在這裡回答您在本次電話會議後可能提出的任何其他問題，因此請隨時在今天下午或本週給我們留言。非常感謝。

Ladies and gentlemen, this concludes today's conference call. Thank you for participating, and you may now disconnect.

女士們，先生們，今天的電話會議到此結束。感謝您的參與，您現在可以斷開連接。