美國醫院公司 (HCA) 2026 Q1 法說會逐字稿

Ladies and gentlemen, welcome to HCA Healthcare's first-quarter 2026 earnings conference call. Today's call is being recorded.

各位女士、先生，歡迎參加 HCA Healthcare 2026 年第一季財報電話會議。今天的會議將被錄音。

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.

此刻，為了開場致詞與介紹，我想把電話交給投資人關係副總裁 Frank Morgan 先生。先生，請開始。

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.

各位早安，歡迎各位參加今天的電話會議。今天早上與我一同出席的有我們的執行長 Sam Hazen，以及財務長 Mike Marks。Sam 與 Mike 將先發表準備好的談話，之後我們將進行問答。

Before I turn the call over to Sam, let me remind everyone that should today's call contain any forward-looking statements, they're 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.

在我把電話交給 Sam 之前，提醒各位，若今天的電話會議包含任何前瞻性陳述，皆係基於管理階層目前的預期。眾多風險、不確定性及其他因素可能導致實際結果與今日所表達者有重大差異。關於前瞻性陳述及相關因素的更多資訊，已列於今日新聞稿以及我們向 SEC 提交的各項文件中。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling to 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中，我們可能會提及如調整後 EBITDA 等指標，該等指標屬於非 GAAP 財務衡量。今日發布內容中包含一份提供調整後 EBITDA 補充資訊並與歸屬於 HCA Healthcare, Inc. 的淨利進行調節的表格。今天早上的電話會議將被錄音，並將於今日稍晚提供重播。

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

那麼，我現在把電話交給 Sam。

Good morning, and thank you for joining the call. First, I want to recognize our colleagues for continuing to demonstrate a remarkable ability to adapt to changing conditions and deliver positive results for our patients, communities and stakeholders. The start of the year presented a dynamic environment for HCA Healthcare.

各位早安，感謝各位加入本次電話會議。首先，我要肯定我們的同仁持續展現出卓越的適應能力，能因應變動的環境，並為我們的病患、社區與利害關係人交出正向成果。新年伊始，HCA Healthcare 所面臨的環境相當多變。

From a volume perspective, we did not experience the typical lift related to seasonal respiratory conditions. Compared to the first quarter of last year, our respiratory-related admissions were down 42%, and our respiratory-related emergency room visits were down 32%. Additionally, winter storm that hit a few of our markets adversely impacted our volumes in the quarter. On the positive side, however, we experienced a greater net benefit than anticipated from state supplemental programs. As a reminder, these programs are complex, they're variable and difficult to predict.

就量能而言，我們並未出現與季節性呼吸道狀況相關的典型增長。與去年第一季相比，我們呼吸道相關住院人次下降 42%，呼吸道相關急診就診人次下降 32%。此外，影響我們部分市場的冬季風暴也在本季對量能造成不利影響。不過，正面的是，我們從州級補充性計畫獲得的淨效益高於原先預期。提醒各位，這些計畫相當複雜、具變動性且難以預測。

This benefit mostly offset impacts from the shortfall in volumes.

此項效益大致抵銷了量能不足所帶來的影響。

Regarding payer mix for the quarter, the underlying shifts resulting from the changes in the health insurance exchanges were generally in line with our expectations. This area remains fluid. As we stated in our fourth quarter call, we have considered a range of potential scenarios as the effects continue to evolve. As mentioned over the last several quarters, our teams have been focused on a broad resiliency plan designed to generate cost savings where appropriate, enhance network execution and strengthen organizational capabilities. I am pleased with our resiliency efforts to date, and we expect they will continue to help offset some of the expected impact from the payer mix shift.

就本季的付款方組合（payer mix）而言，因健康保險交易所變動所造成的結構性移轉，整體大致符合我們的預期。此領域仍在變動中。如同我們在第四季電話會議所述，隨著影響持續演變，我們已考量多種可能情境。過去幾季我們也提到，我們的團隊一直專注於一項廣泛的韌性計畫，旨在於適當之處創造成本節省、強化網路執行力並提升組織能力。我對目前的韌性成果感到滿意，並預期這些措施將持續協助抵銷付款方組合移轉所帶來的部分預期影響。

Additionally, we were pleased with the volume results exiting the quarter. The reparatory related and winter storm impacts were mostly contained to January, with February and March volumes rebounding nicely. For the first quarter, revenue increased 4.3% compared to the first quarter last year. Adjusted EBITDA increased almost 2% and diluted earnings per share, as adjusted, increased approximately 11% versus the prior year period.

此外，我們也對本季末的量能表現感到滿意。呼吸道相關與冬季風暴的影響多集中在 1 月，2 月與 3 月的量能則明顯回升。第一季營收較去年第一季成長 4.3%。調整後 EBITDA 成長接近 2%，而調整後稀釋每股盈餘較去年同期約成長 11%。

We continue to deliver for our patients and important metrics including improved quality measures, increased patient satisfaction and reductions in the average length of stay. I remain excited about our digital transformation program and AI agenda. They progressed during the quarter with rollout of some key initiatives to more facilities. Our clinical teams continue to advance efforts to enhance quality, safety and services to our patients, with progress on broad initiatives across nursing care, hospital-based physician services and support functions. We continue to invest significantly in network development with our capital spending and with selective outpatient facility acquisitions.

我們持續為病患提供服務，且多項重要指標表現改善，包括品質衡量提升、病患滿意度提高，以及平均住院天數下降。我仍對我們的數位轉型計畫與 AI 議程感到振奮；本季隨著若干關鍵計畫擴大推行至更多院所而持續推進。我們的臨床團隊持續推動提升品質、安全與病患服務的工作，並在護理照護、院內醫師服務及支援功能等多項廣泛計畫上取得進展。我們也持續透過資本支出與選擇性門診設施併購，大幅投資於網路發展。

As compared to the first quarter last year, our networks expanded their overall sites of care by more than 4%, increased hospital beds through capital spending by almost 1% and added 4% to emergency room capacity.

與去年第一季相比，我們的網路整體照護據點（sites of care）擴增超過 4%，透過資本支出使醫院病床數增加近 1%，並使急診容量增加 4%。

To summarize, we view the respiratory-related volume shortfall and the increase in supplemental payment net benefits as first quarter events. As such, we believe our assumptions for the remainder of the year related to volumes, payer mix and costs continue to remain in line with our original guidance. HCA Healthcare has an impressive capability to remain disciplined in dynamic environments. This is a resounding strength of our teams and what they have built over time. It is rooted in our culture and it helps us to execute on our mission to provide high-quality care to our patients while delivering strong financial results.

總結而言，我們將呼吸道相關量能不足以及補充性支付淨效益增加視為第一季的事件。因此，我們認為今年剩餘期間在量能、付款方組合與成本方面的假設，仍與我們原先的指引一致。HCA Healthcare 具備在多變環境中維持紀律的卓越能力，這是我們團隊及其長期建立成果的顯著優勢。這根植於我們的文化，並協助我們在提供病患高品質照護的同時，交出強勁的財務表現。

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

接下來，我把電話交給 Mike，請他提供本季更多細節。

Thank you, Sam, and good morning, everyone. Let me start by providing same-facility volume comparisons for the first quarter of 2026 versus the first quarter of 2025. Admissions increased 0.9%, equivalent admissions increased [1.3%], inpatient surgeries were down 0.3% and outpatient surgeries declined 1.7%. ER visits increased 0.3%.

謝謝你，Sam，各位早安。首先我提供 2026 年第一季相較 2025 年第一季的同院（same-facility）量能比較。住院人次增加 0.9%，等效住院人次增加 [1.3%]，住院手術下降 0.3%，門診手術下降 1.7%。急診就診人次增加 0.3%。

As Sam mentioned, we had a much milder respiratory season in the quarter. This produced a drag on our quarterly volume growth in admissions and ER visits, up 70 basis points and 140 basis points, respectively. In addition, the winter storm in January impacted a wide swath of our markets, including Texas, Tennessee, North Carolina and Virginia, reducing admissions and ER visits by an estimated 30 basis points and 50 basis points, respectively. The impact of these two factors was consistent across all payer categories, and in total, adversely impacted adjusted EBITDA by an estimated $180 million.

如 Sam 所提，本季呼吸道季節明顯較為溫和，對本季住院人次與急診就診人次的量能成長造成拖累，分別約 70 個基點與 140 個基點。此外，1 月的冬季風暴影響我們多個市場，包括德州、田納西州、北卡羅來納州與維吉尼亞州，使住院人次與急診就診人次分別估計減少 30 個基點與 50 個基點。這兩項因素的影響在所有付款方類別中一致，合計估計使調整後 EBITDA 減少約 1.8 億美元。

Regarding payer mix, commercial equivalent admissions, excluding exchanges, increased 0.6%. Medicare increased 1.9% and Medicaid increased 0.3%. We believe the variance in volume relative to our expectations was almost entirely driven by the respiratory season and winter storm. We view these factors as being temporal and not structural. Overall, taking all of this into consideration, our volume growth in the quarter was generally in line with our 2% to 3% volume growth assumption for the year, albeit at the lower end of the range.

就付款方組合而言，商業保險等效住院人次（不含交易所）增加 0.6%。Medicare 增加 1.9%，Medicaid 增加 0.3%。我們認為相較於預期的量能差異幾乎完全由呼吸道季節與冬季風暴所驅動。我們將這些因素視為短期而非結構性因素。整體而言，綜合考量上述因素後，本季量能成長大致符合我們對全年 2% 至 3% 的量能成長假設，但落在區間的較低端。

Adjusted EBITDA margin decreased 50 basis points versus prior year quarter. Salaries and benefits as a percentage of revenue improved 30 basis points and supplies improved 20 basis points. Other operating expenses as a percentage of revenue increased 90 basis points, primarily due to an increase in cost related to the Medicaid state supplemental payments, professional fees and technological investments. As Sam noted in his comments, volumes continued to improve throughout the quarter, and we noted a similar progression of operating leverage and cost trends.

調整後 EBITDA 利潤率較去年同期下降 50 個基點。薪資與福利占營收比重改善 30 個基點，耗材改善 20 個基點。其他營運費用占營收比重增加 90 個基點，主要因 Medicaid 州級補充性支付相關成本增加、專業費用以及科技投資所致。如 Sam 在談話中所述，量能在本季持續改善，我們也觀察到營運槓桿與成本趨勢呈現類似的逐步改善。

Regarding Medicaid supplement payment programs. While we expected an increase in net benefit of $80 million, we realized an increase in net benefits of approximately $200 million to adjusted EBITDA versus the prior quarter. This was primarily due to the grandfathered approval of Georgia, the reinstatement of the Atlas program in Texas and the year-over-year benefit of the Tennessee program that was approved in the third quarter of 2025.

關於 Medicaid 補充性支付計畫。雖然我們原先預期淨效益增加 8,000 萬美元，但相較前一季，我們實際上對調整後 EBITDA 的淨效益增加約 2 億美元。這主要是因喬治亞州既有（grandfathered）核准、德州 Atlas 計畫恢復，以及田納西州計畫在 2025 年第三季獲核准所帶來的年對年效益。

We are adjusting our full year range to reflect the decline in supplemental payment program net benefit between $50 million to $250 million versus prior year. This updated guidance does not include any potential impacts from additional approvals of grandfathered applications. We continue to monitor the ongoing developments related to these programs, and particularly Florida. We continue to feel positive about the prospects for the approval of the Florida program, which covers the period of October 1, 2024, to September 30, 2025. If approved, we believe it should result in additional revenues, which may be significant.

我們正在調整全年區間，以反映補充性支付計畫淨效益相較去年將下降 5,000 萬至 2.5 億美元。此更新後的指引未納入任何額外既有申請（grandfathered applications）獲核准的潛在影響。我們將持續監控這些計畫的最新進展，特別是佛羅里達州。我們對佛州計畫獲核准的前景仍持正面看法；該計畫涵蓋 2024 年 10 月 1 日至 2025 年 9 月 30 日期間。若獲核准，我們認為將帶來額外營收，且可能相當可觀。

Now let me provide additional information regarding the exchange environment. As we stated in our fourth quarter call, the complexity of the exchanges is significant, and we're tracking several areas within the company. For the quarter, we estimate our same facility exchange equivalent adjusted admissions declined approximately 15% versus prior year quarter. This represents our comprehensive evaluation of patients that presented with exchange coverage that ultimately will not be covered for their episodes of care.

接著我補充交易所環境的更多資訊。如同我們在第四季電話會議所述，交易所的複雜性相當高，我們在公司內部追蹤多個面向。本季我們估計，同院交易所等效調整後住院人次較去年同期下降約 15%。此數據反映我們對就診時呈現交易所保險、但最終其照護事件（episodes of care）將不被承保之病患所做的全面評估。

Using the same analysis, we estimate same facility uninsured equivalent admissions increased approximately 16% versus prior year quarter. Over half of this implied increase relates to the movement from exchanges and normal uninsured growth. The remaining portion reflects a slowdown of conversions to Medicaid from patients who were not willing to fill out applications.

採用相同分析方法，我們估計同院無保險等效住院人次較去年同期增加約 16%。其中超過一半的推估增幅與從交易所移轉以及正常的無保險成長有關。其餘部分則反映部分病患不願填寫申請，導致轉換至 Medicaid 的速度放緩。

We estimate the adjusted EBITDA impact from the exchanges to be approximately $150 million in the first quarter of 2026 versus the prior year quarter. Given our experience to date, we still believe our full year range of $600 million to $900 million expected impact on adjusted EBITDA is appropriate. However, the exchange environment remains dynamic and has not fully settled. We will continue to track the fluid nature of this reform and will provide further commentary on our second quarter call.

我們估計，交換所改革對調整後 EBITDA 的影響，在 2026 年第一季相較於去年同期約為 1.5 億美元。根據我們迄今的經驗，我們仍認為全年預期對調整後 EBITDA 影響 6 億至 9 億美元的區間是適當的。然而，交換所環境仍具動態性，尚未完全穩定。我們將持續追蹤此項改革的變動性，並會在第二季電話會議中提供進一步評論。

Moving to capital allocation. Capital expenditures totaled $1.1 billion in the quarter. Additionally, we purchased $1.57 billion of our outstanding shares, and we paid $183 million in dividends for the quarter. Cash flow from operations was $2 billion in the quarter, representing a 22% increase in the first quarter of 2026 versus the prior year quarter. Our debt-to-adjusted EBITDA leverage remains in the lower half of our stated target range, and we believe our balance sheet is strong and well positioned for the future.

接著談資本配置。本季資本支出合計 11 億美元。此外，我們回購了 15.7 億美元的流通在外股份，並於本季支付 1.83 億美元股利。本季營運活動現金流為 20 億美元，較去年同期的 2026 年第一季成長 22%。我們的淨負債對調整後 EBITDA 槓桿比率仍位於我們所述目標區間的下半部，我們認為資產負債表強健，且已為未來做好良好布局。

As noted in our release, we are reaffirming our estimated guidance ranges for 2026.

如同我們在新聞稿中所述，我們重申 2026 年的估計指引區間。

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

我現在把電話交回給 Frank Morgan 進行提問。

Thank you, Mike. Andy, you may now give instructions to those who would like to ask a question.

謝謝你，Mike。Andy，現在請你向想要提問的人說明指示。

(Operator Instructions)

（接線員指示）

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，RBC Capital Markets。

I appreciate the color on the respiratory, SDP and other components. Maybe you could just give us a rundown broadly of how your results compare to your internal expectations for the quarter?

感謝你對呼吸道、SDP 以及其他組成項目的補充說明。也許你可以概括說明一下，本季的結果與你們內部預期相比如何？

Thanks, Ben. This is Mike. I mean our results were a bit short in terms of adjusted EBITDA to our internal expectations. Besides our internal expectations is being pretty consistent with the midpoint of our guidance in terms of growth, pretty consistent actually with consensus coming into the call. Really two main drivers in terms of the shortfall to internal expectations.

謝謝你，Ben。我是 Mike。我的意思是，我們的結果在調整後 EBITDA 方面略低於我們的內部預期。除此之外，就成長而言，我們的內部預期其實與指引中位數相當一致，也確實與電話會議前的市場共識相當一致。就低於內部預期而言，主要有兩個驅動因素。

The first one is this kind of shortfall in the seasonal volume uplift from respiratory in the winter storms, which was mostly offset by the net benefit from the supplemental payment programs.

第一個是冬季風暴期間，呼吸道業務的季節性量增幅度不足，而這一點大多被補充支付計畫的淨受益所抵銷。

A little detail here on seasonal volumes (inaudible). I've already kind of quantified the volume side of that. So let me talk about the expense side. As we were coming into January, our respiratory season was actually strong at the beginning of the year. However, later in January, it became apparent that the respiratory season was actually ending abruptly.

這裡補充一些季節性量的細節（聽不清）。我已經大致量化了其中的量的部分。那我來談談費用端。進入 1 月時，我們的呼吸道季節在年初其實表現強勁。然而到了 1 月下旬，很明顯呼吸道季節其實是突然結束的。

And we were then hit with a significant January winter storm across several of our states. Both the quick ramp down of the respiratory volume as well as the winter storm delayed our ability to flex down our seasonal cost in the quarter. We were ultimately able to do so as we move through the quarter, but there was a delay.

接著我們在多個州遭遇 1 月一場顯著的冬季風暴。呼吸道量的快速下滑以及冬季風暴，都延後了我們在本季調降季節性成本的彈性調整能力。我們最終在本季進行過程中做到了，但確實有延遲。

So let me switch now to the supplemental payment program activity. As noted, Medicaid supplement payments net benefits was better than expected. As we came into the quarter, we did anticipate an increase in the supplemental payment net benefit in Q1 of $80 million, largely due to the increase in the Tennessee program that was approved in Q3 of 2025. So the $200 million of net benefit in the first quarter was about $120 million higher than our internal expectations in the quarter, and again resulted from the approval of the grandfathered Georgia program as well as the reinstatement of the Atlas program in Texas.

那我現在切換到補充支付計畫的活動。如前所述，Medicaid 補充支付的淨受益優於預期。進入本季時，我們確實預期第一季補充支付淨受益會增加 8,000 萬美元，主要是因為 2025 年第三季核准的田納西州計畫增加。因此，第一季 2 億美元的淨受益比我們本季內部預期高出約 1.2 億美元，而這同樣來自於喬治亞州既有（grandfathered）計畫的核准，以及德州 Atlas 計畫的恢復。

So in summary, Ben, when I think about first quarter, largely, we were just a bit short in total. But when you take the temporal factors of the lack of the seasonal volume uplift and the pickup in net benefit supplemental payments, those are really the main drivers in the quarter.

總結來說，Ben，當我回顧第一季時，整體而言我們只是總體略低一些。但若把呼吸道季節性量增不足，以及補充支付淨受益的提升這些時間性因素納入考量，這些確實是本季的主要驅動因素。

Appreciate that color. And then kind of just a quick follow-up. Can you just give us an update on the moving pieces that kind of get you back to the initial guide? Maybe walk us through the components of the EBITDA bridge as you see them today after such a dynamic first quarter?

感謝這些補充說明。接著快速追問一下：你能否更新一下，哪些變動因素讓你們回到最初的指引？在第一季如此動態之後，能否帶我們走一遍你們目前看到的 EBITDA 橋接（bridge）各項組成？

Sure. If you go back to the release, the really only change to our key assumptions for the 2026 guidance relates to the supplemental payment programs. We estimate that the Georgia approval and the reinstated Atlas program I previously discussed, will provide approximately $200 million of incremental net benefit for the full year that was not originally included in our guidance.

當然。如果你回到新聞稿，我們對 2026 年指引的關鍵假設中，唯一的變動與補充支付計畫有關。我們估計，我先前提到的喬治亞州核准以及恢復的 Atlas 計畫，全年將帶來約 2 億美元的額外淨受益，而這原本並未納入我們的指引。

I would note that the $120 million for Georgia and Texas that we talked about for the first quarter had a prior period impact in it. And so the component that applied the first quarter and for the full year of '26 really make up that $200 million. And so that's why we're adjusting our assumption for full year net benefit to now be a decline of $50 million to $250 million. And just to note, that assumption does not include any additional approvals of grandfathered applications.

我想指出，我們談到第一季喬治亞州與德州的 1.2 億美元，其中包含了前期（prior period）的影響。因此，適用於第一季以及適用於 2026 全年的部分，合計才構成那 2 億美元。也因此，我們把全年淨受益的假設調整為現在將下降 5,000 萬至 2.5 億美元。並補充說明，這項假設不包含任何額外既有（grandfathered）申請案的核准。

When I think about the rest of our assumptions, Ben, if you think about the impact of the exchanges, we still believe that, that $600 million to $900 million range is appropriate based on what we've learned in first quarter. Our resiliency assumptions that were in guidance also, we believe, are still reasonable and appropriate. And so at the end of the day, we just felt like that it was appropriate not to change our total guidance range, even with the $200 million improvement in first quarter.

至於其餘假設，Ben，如果你看交換所的影響，基於我們在第一季的學習，我們仍認為 6 億至 9 億美元的區間是適當的。我們在指引中所列的韌性（resiliency）假設，我們也認為仍然合理且適當。歸根結底，即使第一季改善了 2 億美元，我們仍覺得不調整整體指引區間是合適的。

A chunk of that really goes back to this temporal nature of the headwinds that we saw in first quarter being related to the seasonal volume impacts in the winter storm and the related cost impacts. And so as we think about how we progress through the quarter, Sam mentioned that as we exited the quarter in March, there are volumes were improving largely back to our original plan. We also saw the same thing in our cost structure. As we got through March, our cost trends really reflected good performance in March, and we're largely on plan. And so that's the walk-through on guidance.

其中很大一部分回到我們在第一季看到的逆風具有時間性，主要與冬季風暴造成的季節性量影響及其相關成本影響有關。因此，當我們思考本季的推進時，Sam 提到我們在 3 月季末時，量已大致改善並回到原先計畫。我們在成本結構上也看到同樣情況。進入 3 月後，我們的成本趨勢確實反映出 3 月的良好表現，且大致符合計畫。以上就是對指引的說明。

AJ Rice, UBS.

AJ Rice，UBS。

Just to put a fine point on what we're just going on the numbers flying back and forth. Is the right way -- am I hearing you say, you basically had $180 million of negative impact from flu and weather in the first quarter? You picked up $120 million of benefit from DPPs in the first quarter that was not expected. So the net was a $60 million drag net of the unusual items or weather and flu. And then on the $180 million versus the $200 million of DPP in the full year impact.

我想把剛才數字來回的部分講得更精準一些。正確的理解方式是——我聽到你們說，第一季因流感與天氣造成約 1.8 億美元的負面影響；第一季你們從 DPP 帶來了 1.2 億美元原本未預期的受益。因此，扣除這些異常項目（天氣與流感）後，淨額是 6,000 萬美元的拖累。然後關於全年 DPP 影響的 1.8 億美元對比 2 億美元。

So you're ending up roughly $20 million if you maintain your guidance for Q2, Q3, Q4 better because of the incremental impact of DPP over the course of the year. I just want to make sure that's the right take from what you're saying.

所以，如果你們維持指引不變，因為 DPP 在全年帶來的額外影響，你們在第二、三、四季大概會多出約 2,000 萬美元的改善。我只是想確認，這是否是你們剛才說法的正確解讀。

Yes. I think you're generally in the zone. I mean we view the $180 million headwind in the quarter as being temporal and not structural. So we don't think that will repeat. The $200 million improvement for the full-year '26 from supplemental payment benefits reflect Georgia and Texas.

是的。我認為你的理解大致在正確範圍內。我們把本季 1.8 億美元的逆風視為時間性而非結構性，因此我們不認為它會重複發生。2026 全年因補充支付受益帶來的 2 億美元改善，反映的是喬治亞州與德州。

And then just broadly, we're not changing our full year guidance on earnings. And I think that's the way to read that. I think I would acknowledge there's a little bit of softness (inaudible) consensus. It may be not fully explained, but it's pretty close from the moving factors in the first quarter.

然後更廣泛地說，我們不會調整全年獲利指引。我認為應該這樣解讀。我也會承認，共識預期中有一點疲弱（聽不清），可能沒有被完全解釋，但就第一季的變動因素而言，已經相當接近了。

And then AJ, when we look at the rest of the year, and we think about the demand that we're seeing in the marketplace, we believe that we will be able to run between 2% to 3% volume growth in the next three quarters of prior year. Our original assumption around the exchanges, around revenue and our cost trends, we think that the balance of the year is another way of saying is largely back on our original plan.

另外 AJ，當我們看今年剩餘時間，並思考我們在市場上看到的需求時，我們相信接下來三個季度相較去年同期，我們能維持 2% 到 3% 的量成長。我們原先對交換所、對營收以及成本趨勢的假設，我們認為換句話說，今年剩餘時間大致回到原先計畫。

Okay. And maybe a follow-up -- go ahead.

好的。那也許再追問一下——你先說。

It's Sam. I mean, we do, I'll call it, a business analysis of the company in the first quarter. It's pretty much where we expected, save the respiratory dynamic. So we believe the business outcomes of the company in the first quarter are in line with the guidance we provided just 90 days ago. And so we're at a point where we're judging that.

我是 Sam。我的意思是，我們在第一季對公司做了，我稱之為，業務分析。除了呼吸道的動態之外，基本上都在我們預期之內。因此，我們認為公司第一季的業務結果與我們 90 天前提供的指引一致。所以我們現在就是在這個基礎上做判斷。

We're trying to influence what we can on the edges and put ourselves in a position where we get to where we need to be by the end of the year. I mean that's sort of the short story on what happened here. There's always puts and takes with the supplemental program. We've talked about that for years. What we're trying to judge is the business functioning and performing as we thought. And generally, that case, save the one item associated with the respiratory activity.

我們正試著在邊際上影響我們能影響的部分，並讓自己處於一個位置，使我們在年底能達到需要達到的目標。這大概就是這裡發生了什麼的簡短版本。補充計畫一直都有利有弊，我們多年來一直在談這件事。我們想要判斷的是，公司的業務運作與表現是否如我們所想。整體而言是如此，除了與呼吸道活動相關的那一項。

Okay. Could I just, as a follow-up, your $400 million resiliency program, I know you've got a lot of AI initiatives, but some of that is other stuff. Can you just sort of update us on where you're at with the AI initiatives? And is that $400 million a pretty firm number? Is there a range around that as to what you might ultimately realize this year?

好的。我想追問一下，你們的4億美元韌性計畫，我知道你們有很多AI倡議，但其中也包含其他項目。你能否更新一下目前AI倡議的進度？另外，這4億美元是一個相當確定的數字嗎？還是說可能有一個區間，代表你們今年最終可能實現的金額？

This is Sam, AJ. In the quarter, as Mike indicated, we get operating leverage. When we get volume, whether it's respiratory volume or surgical volume, we get operating leverage. So we lost a little bit of that in the first quarter. But again, when you sort of normalized for that, as we exited the quarter, we felt good about the leverage we were seeing in the subsequent months.

AJ，我是Sam。就本季而言，如Mike所指出的，我們能取得營運槓桿。當我們有量的時候，不論是呼吸道量或手術量，我們都能取得營運槓桿。所以第一季我們少了一點這部分。但同樣地，當你把這些因素做了某種程度的常態化調整後，隨著我們走出本季，我們對於後續幾個月所看到的槓桿表現感到不錯。

And so when you merge that with the maturing of our resiliency program over the course of the year, we think we can get where we need to be with our cost objectives for 2026. Are there opportunities on maybe more possibly? Could we fund pressures that we haven't anticipated? Of course. I mean, that's what a dynamic business environment represent.

因此，當你把這點與我們韌性計畫在全年逐步成熟結合起來，我們認為我們可以在2026年的成本目標上達到需要的水準。是否在某些面向上還有更多機會、可能更好？我們是否可能需要承擔一些未預期的壓力？當然。我的意思是，這就是動態商業環境所代表的情況。

I will tell you that our artificial intelligence agenda is getting implemented. We have productivity with our physicians, with our ambient listening capabilities and the documentation associated with that. We're rolling out our nurse handoff program, as I mentioned. We've got new initiatives that are rolling out to more facilities. That's got more patient safety and nurse engagement, some productivity to it.

我可以告訴你，我們的人工智慧議程正在落地執行。我們透過環境聆聽（ambient listening）能力以及相關的文件紀錄，提升了醫師端的生產力。如我提到的，我們正在推行護理交班（nurse handoff）計畫。我們也有新的倡議正在擴展到更多院所，這些帶來更多病人安全與護理人員投入度，也帶來一些生產力提升。

We're really excited about what the artificial intelligence program can do to complement our caregivers in our company and help us provide better care, do it more cost effectively and run the business better. We're seeing it in case management. We had good outcomes with case management, as we talked about with average length of stay.

我們對人工智慧計畫能如何補強公司內照護人員、協助我們提供更好的照護、以更具成本效益的方式執行，以及把企業經營得更好，感到非常振奮。我們在個案管理上也看到了成效。如同我們談到平均住院日（average length of stay）時所說，我們在個案管理方面取得了良好結果。

So all of this is coming together. Does it have some upside in some areas? Yes. Could there be some pressures in other areas?

所以這一切正在整合到一起。它在某些領域是否有上行空間？有。其他領域是否可能出現一些壓力？

Of course. So when we put it together, we feel like we're on the program that we estimated at the beginning of the year.

當然。所以綜合來看，我們覺得目前的進度符合我們在年初所估計的計畫。

Ann Hynes, Mizuho Securities.

Ann Hynes，瑞穗證券（Mizuho Securities）。

I just had a quick follow-up from a comment you made in the prepared remarks, and then I have a question. Just on the Florida DPP, I do think there are some anxiety in the market because it's taking so long to approved. Do you have any color on maybe from a timing perspective when that could be approved?

我先就你在事先準備的發言中提到的一點做個簡短追問，然後我還有一個問題。關於佛羅里達DPP，我確實認為市場上有些焦慮，因為核准時間拖得很久。你能否就時程面提供一些資訊，可能何時會獲得核准？

And then my real question is just on ACA, just with the increasingly uninsured and the bad debt, is that coming in line with your initial expectations? And can you remind us, does your guidance assume a deterioration in the collectibles of co-pays and deductibles of the insured? And what change is embedded in your guidance?

然後我真正的問題是關於ACA：隨著無保險人口增加以及壞帳上升，這是否符合你們最初的預期？另外也請你提醒我們，你們的指引是否假設已投保者的自付額（co-pays）與自負額（deductibles）的可收回性（collectibles）會惡化？你們的指引中內含了什麼樣的變化？

That is a multipart question, Ann. It was impressive. So when I think about -- let me start with Florida. And I do think that the size of the Florida program as such, the enhanced size that CMS is thoroughly reviewed this program, as you noted. But based on our sense of things as we sit here today, we do feel positive about the prospects of approval for the Florida program.

Ann，這是一個多段式問題，很厲害。那我先從佛羅里達開始。我確實認為佛羅里達計畫的規模本身、以及其擴大的規模，使得CMS如你所說正在非常徹底地審查這個計畫。但就我們今天此刻的理解而言，我們對佛羅里達計畫獲得核准的前景仍感到正面。

And if approved, as I noted in my prepared comments, we believe it would result, not only in additional revenues, but those that may be significant. So that's a quick update on Florida. And obviously, we'll be watching this just like you will, and we'll keep you informed as that moves.

而且如果獲得核准，如我在事先準備的評論中所提到，我們相信這不僅會帶來額外收入，而且可能是相當可觀的收入。以上是對佛羅里達的快速更新。當然，我們會像你們一樣持續關注，也會在進展推進時向各位更新。

As it relates to the exchanges and what we're seeing related to patient amounts do, I would say like this, as we came into our modeling, our models included some shift from silver, bronze. And what we're seeing is we study our patients so far is that there has been a bit of a shift from silver to bronze in the patient selection of metal tier. I wouldn't say, however, that, that shift is significant at this point, but there is some.

至於交易所（exchanges）以及我們看到與病人應付金額（patient amounts due）相關的情況，我會這樣說：在我們建模時，模型已納入一些從銀級（silver）轉向銅級（bronze）的變化。而我們目前對病人的研究顯示，在金屬層級（metal tier）的選擇上，確實出現了一些從銀級轉向銅級的情況。不過我不會說這個轉移在目前階段很顯著，但確實有一些。

We're also noting that even within silver, if you compare the benefit designs in 2025 to 2026, that the amount patients to within silver are also increasing as we are studying the 2026 activity. And so all this is leading us to conclude that we are seeing a growth in patient amounts due on the exchanges. And as we've noted in the past, we see a lower collection rate on patient balances from the exchange plans as compared to traditional managed care patients in this shift. I do think we'll have an impact on patient collections on uncompensated care.

我們也注意到，即便是在銀級內部，如果你比較2025與2026的給付設計（benefit designs），在我們研究2026的活動時，病人在銀級內的自付金額也在增加。因此，這些因素讓我們得出結論：我們正在看到交易所病人應付金額的成長。正如我們過去所提到的，相較於傳統管理式醫療（traditional managed care）病人，交易所計畫的病人餘額（patient balances）收款率較低；在這樣的轉移下，我確實認為這會對病人收款與無償照護（uncompensated care）產生影響。

But from a context standpoint, I don't think that the impact of the shift and the growth in the patient out dues is going to be overly material, given the relatively minor portion of our patient cash collections that relate to exchange patients. We did include in our original estimate of $600 million to $900 million, this increase in patient amount due on the exchanges. It's within the range of our models based on what we're seeing.

但從整體脈絡來看，鑑於與交易所病人相關的病人現金收款在我們總體中占比相對較小，我不認為這種轉移以及病人應付金額的成長會造成過度重大的影響。我們在最初估計的6億至9億美元中，已納入交易所病人應付金額上升的因素。就我們目前看到的情況而言，仍在我們模型的區間之內。

On the broader part with the exchanges, to your point, we did anticipate movement out of the exchanges to uninsured. And so if I think about the kind of the payer mix implications within the model, as you go back to that discussion, we thought that we would lose about 15% to 20% of volume, of people leaving the exchanges. And we think we saw about a 15% decline in first quarter, so at the lower end of that. You may recall that our assumption was about 15% to 20% of beds who lost coverage on the exchanges would migrate to employee-sponsored insurance and the rest who uninsured. As we're studying the patients during the first quarter that previously had exchange coverage, we are noting that the patients converting to employee-sponsored insurance or generally within the estimated range that we built into our guidance model.

至於交易所更廣泛的部分，如你所說，我們確實預期會有人從交易所轉為無保險。因此，如果我從模型中的付款方組合（payer mix）影響來看，回到那段討論，我們認為會有約15%到20%的量（volume）流失，也就是人們離開交易所。我們認為第一季大約看到15%的下降，落在區間的低端。你可能還記得，我們的假設是：在交易所失去保障的人當中，約15%到20%會轉移到雇主贊助保險（employee-sponsored insurance），其餘則轉為無保險。當我們研究第一季先前有交易所保障的病人時，我們注意到轉為雇主贊助保險的比例大致落在我們納入指引模型的估計範圍內。

Interestingly, patients migrating to uninsured are just a little bit less than expected as we are seeing some individuals converting to Medicare or Medicaid due to the age or to changes in life circumstances. But I would note that this is a slight improvement and was not significant. And overall, that the payer mix deterioration from the exchanges is generally in line with our expectations for the quarter. (inaudible), and obviously, this is going to continue to mature. So we'll have more mature insights.

有趣的是，轉為無保險的病人比預期略少一些，因為我們看到部分個人因年齡或生活情況改變而轉為Medicare或Medicaid。但我要指出，這只是些微改善，且並不顯著。整體而言，本季交易所帶來的付款方組合惡化大致符合我們的預期。（聽不清楚），而且很明顯，這還會持續發展成熟，所以我們之後會有更成熟的洞見。

So I'll just end with this. I mean if you think about the growth in the uninsured that I highlighted in my prepared comments, a little more than half of that 16% growth was from the movement from exchanges, and that's in line generally, with our expectations. The other factor that did show up as growth in uninsured volume was the slow down in Medicaid conversions that we highlighted. Broadly, those are the components that I would say that are in our uncompensated care results for the quarter and largely are in line with our expectations and plans.

所以我最後補充一下：如果你回想我在事先準備的評論中提到的無保險成長，其中16%的成長有一半多一點來自交易所的轉移，這大致符合我們的預期。另一個推升無保險量成長的因素，是我們所強調的Medicaid轉換（conversions）放緩。整體來說，這些就是我會說反映在本季無償照護結果中的組成，且大致符合我們的預期與規劃。

Brian Tanquilut, Jefferies.

Brian Tanquilut，Jefferies。

Maybe, Mike, just a quick view, maybe to follow up with your comments on Ann's question to you. How do you want us to think about the sequential move then from Q1 EBITDA to Q2, factoring in the recovery in volumes and then your expectations on HICS and how that's all going to play out?

Mike，也許快速請教一下，延續你對Ann問題的回應。你希望我們如何看待從第一季EBITDA到第二季的季對季變動（sequential move），把量的回升以及你對HICS的預期都納入考量後，整體會如何發展？

Yes. We don't generally give guidance by quarter, other than just kind of pointing back to normal seasonality, Brian. Clearly, as you noted from our comments, and we do view the volume shortfall in first quarter as being temporal and not structural. So I mean that's an important note.

是的。我們一般不會按季度提供指引，Brian，除了大致回到正常的季節性（seasonality）來看。很明顯，如你從我們的評論中所注意到的，我們確實把第一季的量缺口視為暫時性的（temporal），而非結構性的（structural）。所以我的意思是，這是一個重要的註記。

Broadly on the exchanges, you get a sense for what we saw in the first quarter, it is dynamic community. I think about what we're going to learn on the exchanges. I mean, we're going to continue to learn more as we go along. I think what that looks like is studying how much of the anticipated 2026 full year volume decline like came through during the first quarter, which is a bit difficult to today.

就交易所整體而言，你已經大致了解我們第一季看到的情況，這是一個動態的社群。我在想我們接下來會在交易所學到什麼——我們會隨著時間推進持續學到更多。我認為接下來要做的是研究：預期2026全年量下滑中，有多少其實已在第一季就反映出來；而就今天而言，這點有些難以判斷。

As we studied this, we know that certain individuals were in their grace period throughout the quarter, and they may drop coverage after the first quarter. We made an estimate for those patients in both our equivalent admission statistics and our financials. But I still think based on the data we've seen to date, we do believe that our assumption of a 15% to 20% volume decline continues to be reasonable. So those would be the thoughts that I can give you now related to the progression through the year.

在我們研究時，我們知道有些人在整個季度都處於寬限期（grace period），他們可能在第一季之後才會失去保障。我們在等效入院（equivalent admission）統計與財務數字中，都對這些病人做了估計。但我仍認為，基於目前為止看到的數據，我們相信15%到20%的量下滑假設仍然合理。以上就是我目前能提供、關於全年進程的看法。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

So the health plans are all on an organized campaign today on prior authorization. I just was wondering if you could talk about any payer behavior changes, particularly post discharge denials? Anything new that you saw emerge within the quarter or year-to-date? And I know you've been working with a number of plans to sort of streamline all this back and forth stuff. So just any color would be helpful.

所以今天各家健康保險計畫都在有組織地推動「事前授權」。我想請教您是否能談談付款方行為的任何變化，特別是出院後拒付（post discharge denials）？在本季或年初至今，您是否看到任何新的趨勢出現？另外我知道你們一直在與多家保險計畫合作，試圖把這些來回往返的流程更精簡一些。所以若能提供一些補充說明會很有幫助。

Sure. Thanks, Whit. We continue to experience increased activity levels with our payers on denials and underpayments pretty broadly across payers and across products. I mean I might continue to call out Medicare Advantage as being a specific driver within the product mix.

當然。謝謝你，Whit。我們持續看到付款方在拒付與少付（underpayments）方面的活動量增加，而且相當普遍，涵蓋多數付款方與多種產品。我想我仍會特別點名 Medicare Advantage（聯邦醫療保險優勢計畫）是產品組合中的一個特定驅動因素。

As you know, we've been working really hard over the last several years to strengthen our revenue cycle. We've added resources, technologies and a lot of capabilities around speed resolution to really go after the root cause of the denials. That work has continued to pay dividends.

如你所知，過去幾年我們非常努力強化營收循環（revenue cycle）。我們增加了資源、技術，以及許多圍繞「加速解決」（speed resolution）的能力，真正去追溯拒付的根本原因。這些工作持續帶來成效。

Given the results of the work of the company, I think as you look at first quarter even with the pretty significant increase in activity around denials and under payments that we are seeing, our recoveries, our work around speed resolution, our work around appeals and getting these overturned or such that we were able to mitigate and not see a lot of year-over-year impact to earnings. But the denials and underpayments are still really high. And so it's a key part for our industry to continue to work together on.

考量公司這些工作的成果，我認為你看第一季，即便我們看到拒付與少付的活動量顯著增加，我們的追回款（recoveries）、加速解決的工作、申訴（appeals）以及把案件推翻（overturned）等作為，使我們得以緩解影響，沒有看到太多對獲利的年對年衝擊。但拒付與少付仍然非常高。因此，這是我們產業需要持續共同努力的一個關鍵議題。

As you noted, we have launched over the last really 18 months now, a series of partnerships with many of our strategic payer partners. These partnerships really focus on digital integration to try to share more digital and structured data back and forth between us and our payers, eliminate faxes, eliminate paper. A lot of work around administrative simplifications for both us and our payers to deal with the really significant administrative cost burdens that are associated with kind of the health care in America.

如你所提到的，過去大約 18 個月，我們與許多策略性付款方夥伴啟動了一系列合作。這些合作主要聚焦在數位整合，嘗試在我們與付款方之間更有效地雙向分享數位化與結構化資料，消除傳真、消除紙本。也做了很多行政簡化的工作，讓我們與付款方都能因應與美國醫療體系相關、相當可觀的行政成本負擔。

And then lastly, management of disputes. I would say that those are good in early work products, but we have a long way to go as we continue to move that forward. So that's a bit of an update on denials and underpayments [improvement].

最後是爭議管理（management of disputes）。我會說這些在早期的工作成果上是正面的，但要持續推進仍有很長的路要走。以上是關於拒付與少付（改善）的最新進展。

Andrew Mok, Barclays.

Andrew Mok，Barclays。

Wanted to follow up on the slower conversion to Medicaid. Just curious which states you're seeing that slow down, whether you view that as a temporary or issue or durable trend? And when you take a step back on the broader uninsured ACA population this year, did you make any changes to your bad debt accrual process?

我想追問一下 Medicaid 轉換（conversion）變慢的情況。想請教你們看到哪些州的速度放緩？你們認為這是暫時性的問題，還是較為持久的趨勢？另外，從更宏觀的角度看今年更廣泛的未投保 ACA 人口，你們是否對壞帳提列（bad debt accrual）流程做了任何調整？

Thank you. So when I think about Medicaid and the slowdown in the conversions, we think, and it's still early, there can be potentially some other contributing factors. But we largely think about this as people, who, this year, are less willing to fill out Medicaid applications. And so we suspect that, that could be driven a bit by concerns around immigration and like. So we're studying that.

謝謝。談到 Medicaid 以及轉換放緩，我們認為——而且目前仍偏早——可能還有其他因素在影響。但我們主要的看法是，今年人們較不願意填寫 Medicaid 申請。因此我們推測，這可能部分受到移民等相關疑慮的驅動。我們正在研究這點。

I'm not quite sure if that's the full reason why. But that is a piece of the story here in terms of the year-over-year growth in the slowdown in Medicaid conversions that's impacting our uninsured volume increases.

我不太確定這是否就是全部原因。但就年對年 Medicaid 轉換成長放緩、進而影響我們未投保量增加而言，這確實是其中一部分的解釋。

Broadly, yes, our plans for 2026 reflected the payer mix shifts and the patient amount due collections that we anticipated being impacted by the exchanges. And so that was reflected both in what we anticipated related to uninsured volume growth and related to the potential impacts in terms of patient due collection. So that was built into generally our models for 2026.

整體而言，是的，我們對 2026 年的規劃已反映我們預期由交易所（exchanges）帶來的付款方組合（payer mix）變化，以及病患應付金額（patient amount due）收款可能受到的影響。因此，這同時反映在我們對未投保量成長的預期，以及對病患應付收款潛在影響的預期上。這些都已大致納入我們 2026 年的模型之中。

Matthew Gillmor, KeyBanc.

Matthew Gillmor，KeyBanc。

I wanted to ask about the hurricane-impacted markets. I think guidance didn't assume any continued improvement from those markets. Can you just give us an update in terms of how things are playing out and if there's any signs that those markets are improving, particularly in North Carolina?

我想問一下受颶風影響的市場。我認為指引並未假設這些市場會持續改善。你能否更新一下目前的進展情況，以及是否有任何跡象顯示這些市場正在改善，特別是在北卡羅來納州？

So this is Sam. North Carolina, here's the short story. Demand is above our expectation. It's costing us more to serve that demand because Western North Carolina has a significant workforce deficit. We're having to bring in labor, nursing, nonnursing to support the demand.

我是 Sam。北卡羅來納州，簡短說明如下：需求高於我們的預期。為了服務這些需求，我們的成本更高，因為北卡西部存在顯著的人力缺口。我們必須引進人力，包含護理與非護理人員，以支援需求。

We have a very aggressive recruitment campaign and compensation program to service that demand, and we're hopeful, over time, we can mitigate the cost. So we've seen more volume. It's cost us more to serve it. So we're a little bit behind our expectations in North Carolina on the bottom line.

我們有非常積極的招募活動與薪酬方案來服務這些需求，我們希望隨著時間推進能降低成本。因此我們看到更多量，但服務這些量的成本也更高。所以在北卡羅來納州的獲利表現（bottom line）上，我們略低於原先預期。

The other thing, Sam, that we're seeing is the payer mix change. In North Carolina, it clearly has been disrupted in terms of that workforce disruption is also impacted in a less favorable overall payer mix.

另外一點，Sam，我們看到的是付款方組合的變化。在北卡羅來納州，顯然已受到干擾；這種人力中斷也導致整體付款方組合變得較不利。

Broadly, when we think about the hurricane-related markets, in our guidance, we indicated that we did not think that we would see any kind of material improvement in year-over-year earnings from the hurricane markets. I mean, our Tampa facility [Argo] Medical Center has largely recovered in (inaudible) but we don't think we're going to see any net material increase in year-over-year earnings from the hurricane markets due to the reason that Sam articulate.

整體來看，談到颶風相關市場，我們在指引中已表示，我們不認為颶風市場的年對年獲利會出現任何實質改善。我的意思是，我們坦帕的設施 [Argo] Medical Center 大致已在（聽不清）中恢復，但基於 Sam 所說的原因，我們不認為颶風市場會帶來任何淨額、實質的年對年獲利增加。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

On the impact from winter weather, should we expect any loss procedures in January to come back through the year? I think you said February, March volumes more in line or just wondering if you picked those January volumes up already. I'm sorry if I missed this, but can you quantify the impact from weather to the same-store inpatient and outpatient surgery growth?

關於冬季天氣的影響，我們是否應預期 1 月流失的手術量會在今年其他時間回補？我記得你說 2 月、3 月的量更接近正常，只是想確認你們是否已經把 1 月的量補回來了。若我漏聽了很抱歉，但你能否量化天氣對同店住院與門診手術成長的影響？

So when I think about the winter storm specifically, in my prepared comments, we indicated that, that was 30 basis impact on year-over-year volume growth on admissions and a 50 basis impact on year-over-year ER visits. So just to keep that in mind.

談到冬季風暴本身，在我事先準備的發言中，我們提到它對年對年住院入院量（admissions）成長的影響是 30 個基點，對年對年急診（ER）就診的影響是 50 個基點。請先記住這點。

From a recovery standpoint, we do believe that from the winter storm, that we largely recovered the surgical component of that with the end of the quarter. What was not recovered and what drove the net volume impact here was really the emergency visits and the related emergency admissions, where there was really not a second chance to recapture that volume. And so I don't think that the winter storm was really an impact on our surgical volumes in the corporate and material.

就回補而言，我們確實認為冬季風暴造成的手術部分，到季末基本上已經回補。沒有回補、並導致這裡淨量影響的，主要是急診就診以及相關的急診入院，因為那部分基本上沒有第二次機會把量追回來。因此我不認為冬季風暴在公司層面對我們的手術量造成了重大且具實質性的影響。

Yes, it's not going to be notable over the rest of the year, and we'll likely recover some volume, but it will be sprinkled into our mix in a fashion that we won't be able to really discern it.

是的，這在今年剩餘時間不會很顯著；我們可能會回補一些量，但會以分散的方式混入我們的組合中，以致我們很難真正辨識出來。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

I wanted to follow up on your comments around exchange patients sitting in the grace period in February and March that you might not get paid for. My understanding is that managed care will let you know who these patients are in real time and that their coverage is suspended. Is that right? And just to be clear, how do you treat these patients within the exchange volume decline of 15% in the first quarter? And maybe share a little more color on how you accounted for this utilization during the quarter from an accounting revenue recognition perspective.

我想追問你們提到 2 月與 3 月交易所病患處於寬限期（grace period），你們可能收不到款的情況。我的理解是，管理式醫療（managed care）會即時告知你哪些病患屬於這種情況，而且他們的保險給付已被暫停。是這樣嗎？另外請明確說明，在第一季交易所量下滑 15% 的統計中，你們如何處理這些病患？也請多分享一些你們在本季從會計收入認列（revenue recognition）角度，如何把這些使用量納入的細節。

Sure, Justin. So if you think about the verification process that we have with our payers, we have some payers where we do receive some premium status information through our verification process. But the information that we are able to access is not consistent and is not standardized across exchange payers. As a result, we generally do not have reliable third-party visibility at the time of service whether a premium has been paid. When the information is available, it certainly helps us inform further patient engagement to encourage these patients to maintain their coverage.

當然，Justin。若你從我們與付款方的資格核驗（verification）流程來看，有些付款方確實會在核驗過程中提供一些保費狀態（premium status）資訊。但我們能取得的資訊在不同交易所付款方之間並不一致，也沒有標準化。因此，一般而言，在提供服務當下，我們並沒有可靠的第三方可視性來確認保費是否已繳。當資訊可得時，確實能幫助我們進一步與病患互動，鼓勵他們維持保險保障。

Generally, though, I would not characterize the eligibility and verification information we received at the time surface as comprehensive consistent are largely accurate as the verifiable data.

但整體而言，我不會把我們在服務當下收到的資格與核驗資訊描述為全面、一致且大致準確、可驗證的資料。

Let's talk a minute, Justin, about the grace period and how that's flowing through. Patients that received premium assistance, whether they are auto reenrollees, new exchange enrollees or switching plans, generally have a three-month grace period after the coverage is effectuated. For the first month of the grace period, the payer is required to cover the care. For the remaining two months, the payer is not required to cover any care episodes, unless the premium was called out by the enrollee.

Justin，我們再花點時間談寬限期以及它如何反映。獲得保費補助（premium assistance）的病患，不論是自動續保者（auto reenrollees）、新的交易所投保者，或是更換方案者，在保險生效後通常都有三個月的寬限期。寬限期的第一個月，付款方必須給付醫療費用。剩下兩個月，除非投保人補繳保費，否則付款方不需要給付任何照護事件（care episodes）。

So our work, as we studied the quarter, was to first look at every patient that came in with exchange coverage and try our best to understand whether or not they had an attrition during the quarter, at which point we recognize that revenue impact during the quarter, or to make an estimate of those that we believe will lose and come out of the grace period with attrition, where we will not get paid for that, and we'll know that in second quarter and beyond as they get past their grace period.

因此，我們在研究本季時的作法，首先是檢視每一位以交易所保險就醫的病患，盡力判斷他們是否在本季內發生退保／流失（attrition）；若有，我們就在本季認列該收入影響。或者，我們會對那些我們認為將會流失、並在寬限期結束後退保、導致我們收不到款的個案做出估計；我們會在第二季及之後、當他們走完寬限期後確認這些情況。

For that last part, we've made an accounting evaluation and a business evaluation that we included in our analysis about equivalent admissions and revenue. And so when we articulate that 15% drop in equivalent admissions, it contains both of those components and same thing with the impact on our revenue and earnings.

至於最後那一部分，我們做了會計層面的評估以及業務層面的評估，並把它們納入我們對等值入院量與營收的分析中。因此，當我們表述等值入院量下降15%時，這個數字同時包含這兩個構成要素；對我們營收與獲利的影響也是同樣的道理。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛。

If you could talk about what you saw with acuity and case mix in the quarter. Maybe putting aside the lighter respiratory, which we know when probably drive a lower case mix. And then maybe in terms of patients and then some of the types of procedures and service lines, how that impacted the Q&A in case make as well.

能否談談本季你們在病患嚴重度（acuity）與病例組合（case mix）方面看到的情況？也許先把呼吸道病例偏少這個因素先放一邊，因為我們知道那可能會拉低病例組合。接著從病患端以及一些手術類型與服務線的角度，談談這些如何也影響到病例組合。

So this is Sam. We saw increased acuity as reflected in our case mix. It was modestly up on a year-over-year basis. Inside of that, we did have the respiratory dynamic that we alluded to. But within the respiratory dynamic, we had a fairly acute component last year that was more pace mix driven than maybe we've seen in the past. But yes, we still jumped over that.

我是Sam。我們看到病患嚴重度上升，這也反映在我們的病例組合上；以年對年來看是小幅上升。在這之中，確實有我們提到的呼吸道動態。不過在呼吸道這個動態裡，去年其實有一個相當急重的組成，更多是由病例組合所驅動，可能比我們過去看到的更明顯。但對，是的，我們仍然超越了那個影響。

So when you look inside of our business, in the first quarter this year, we had really strong cardiac activity. So our cardiac procedures grew significantly. Trauma was up 2.5%, also driving acuity. We had rehab services grow at a very good pace. So a lot of the elements that we've had momentum and from a service line standpoint, over the past few years, continued into the first quarter, again, influenced somewhat in total by these other factors that we alluded to.

再看我們業務內部，今年第一季心臟科活動非常強勁，因此心臟相關手術量大幅成長。創傷（trauma）也成長了2.5%，同樣推升了嚴重度。我們的復健服務也以非常不錯的速度成長。所以，過去幾年我們在服務線面向累積的動能，很多元素都延續到第一季；當然，整體仍在某種程度上受到我們提到的其他因素影響。

So we continue to find opportunities in the market to develop more comprehensive programs as our communities grow and service our communities more effectively closer to home. That will continue to be a part of our journey here.

因此，我們持續在市場中尋找機會，隨著社區成長，發展更完整的方案，並在更靠近家鄉的地方更有效率地服務我們的社區。這也會持續成為我們旅程的一部分。

One other metric that I think is important with respect to case mix is our receiving of patients through our patient logistics centers grew by 2.4%. That tends to have a higher acuity level as well as rural hospitals, other community-based hospitals are using the deeper service offerings that we have in some of our tertiary and quaternary facilities. So all in all, we were generally satisfied with our case mix.

另外一個我認為與病例組合相關的重要指標是：透過我們病患物流中心（patient logistics centers）轉入的病患量成長了2.4%。這類病患通常嚴重度較高；同時，鄉村醫院與其他社區型醫院也在使用我們部分三級與四級醫療機構（tertiary and quaternary facilities）更深的服務供給。總體而言，我們對病例組合大致感到滿意。

And can I just ask a follow-up, just around the payer buckets on acuity (inaudible). Were they relatively consistent or would the exchange sort of disruption, did you see any sort of movement around the different payer --

我可以追問一下嗎？關於不同支付方（payer）類別在嚴重度（inaudible）方面的分布。它們是否相對一致？或者交易所（exchange）那邊的擾動，你們是否看到不同支付方之間有任何變動——

What's interesting, the case mix was pretty consistent. The respiratory effects were pretty consistent. So we had consistency across all aspects of our payer classes when it came to sort of the overall story for the company.

有趣的是，病例組合相當一致；呼吸道的影響也相當一致。因此，當談到公司整體故事時，我們在各類支付方上都呈現一致性。

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，美國銀行。

Okay. Great. Can you just talk a little bit about the $150 million impact from the exchanges this quarter and how that compares to the $600 million to $900 million annual number? Did you guys assume that, that number would build as the year goes on? Or are you saying that you're kind of trending towards the lower end for the year on that dynamic?

好的。很棒。你們能否多談一點本季來自交易所的1.5億美元影響，以及這與全年6億到9億美元的數字相比如何？你們是否原本假設這個數字會隨著年度進行而逐步增加？還是說你們認為在這個因素上，全年可能更偏向區間下緣？

And then also on the Medicaid side, is this dynamic something that you just kind of started noticing in Q1? Or has it been building for a while? And is it a dynamic that you think is peaking in Q1 or will get better or worse from here?

另外在Medicaid方面，這個動態是你們在第一季才開始注意到的嗎？還是已經累積一段時間？你們認為它在第一季見頂，還是接下來會變好或變差？

Yes. Let's start with HICS, Kevin. If I think about the $150 million for the quarter, I mean, it's a quarter estimate. And obviously, that would put us a bit at the lower end of the full year range. But I think it's a bit early.

是的。我們先從HICS開始，Kevin。若我看本季的1.5億美元，我的意思是，這是一個季度估算。顯然，按此推算會讓我們更偏向全年區間的下緣，但我認為現在還有點早。

I mean, it's dynamic. You can imagine, as we've gone through the quarter and we're trying to understand and analyze all of the moving parts around the exchanges, it's probably a little early to declare that the full year would be at the lower end of the range. So I'm not quite ready to say that.

我的意思是，這是動態變化的。你可以想像，當我們在季度內一路走過來、試著理解並分析交易所周邊所有變動因素時，現在就斷言全年會落在區間下緣，可能還太早。所以我還不準備這麼說。

But I would say that we were pleased that in the quarter, we think that this $150 million reflects not only what we saw in the quarter, but our estimates of the attrition rate and a life that we've built in to our counter team. So a little early to try to give you a broader sense for the full year yet. But I would say, like we do think that this range of $600 million to $900 million is sort of a reasonable estimate for the year. So let me leave that there.

但我會說，我們對本季的結果感到欣慰：我們認為這1.5億美元不僅反映了本季實際看到的情況，也反映了我們對流失率（attrition rate）的估計，以及我們已納入對沖（counter）團隊的一些假設。因此，現在要給你更完整的全年判斷仍稍早。不過我會說，我們確實認為6億到9億美元這個區間，作為全年估計是合理的。我先說到這裡。

On the Medicaid conversion slowdown issue, it's pretty nascent. We maybe saw a smidge of it at the very end of last year as well, but it really popped up on us here in first quarter. Given its nascency, again, a little early to call whether it's a sustained trend or something that just popped in first quarter, and we're watching it, as you can imagine, and we'll keep you up to things as we go forward. So that would be the --

至於Medicaid轉換放緩的問題，這還相當初期。我們在去年年底可能也看到一點點跡象，但在今年第一季才明顯浮現。由於它仍屬初期階段，現在也還太早判斷這是持續趨勢，或只是第一季的短暫現象；我們正如你所想地密切觀察，並會在後續進展中持續向你們更新。所以這會是——

Yes. I would say, though, Mike, just adding to that, I mean, our Parallon teams have a robust process for qualifying patients who need support through our financial counselors and other efforts. And so those continue. We're just dealing with some dynamics here that we haven't experienced before. And it's like Mike said, too early to really suggest that it's peaked or not peaked. We just need a little bit more time to judge it.

是的。我會補充一下，Mike。也就是說，我們的Parallon團隊有一套健全流程，透過財務諮詢師與其他措施，來協助需要支持的病患完成資格認定。這些工作都持續進行。我們只是正在面對一些以前沒遇過的動態。正如Mike所說，現在要判斷是否已見頂或未見頂仍太早；我們需要多一點時間來評估。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

And I'm sorry to circle back on to it. But amidst that March volumes were recovering towards the range of 2% to 3%, is that (inaudible) possible for full year to hit the existing guide of 2% to 3% volume?

抱歉我再繞回來問一下。但在3月量能回升、接近2%到3%區間的情況下，全年要達到既有指引的2%到3%量能成長，是否（inaudible）仍有可能？

We couldn't hear what you were saying on the front end, but we think we know what you said, and that is how are volumes exiting the quarter and what does that do to our full year guidance.

我們沒聽清楚你前半段在說什麼，但我們想我們知道你的問題，也就是：季度末的量能表現如何，以及這對我們全年指引有何影響。

February and March were generally in line, when you put the two together, with our full year guidance. January was the month in the quarter where we saw a decline in activity. So when we're making a judgment about the rest of the year, we're judging what we think is going to happen in the last three quarters of the year. And we think our guidance around volume of 2% to 3% in the rest of the quarters is appropriate.

把2月與3月合在一起看，整體大致符合我們的全年指引。1月是本季中我們看到活動量下滑的月份。因此，當我們對今年剩餘時間做判斷時，我們是在判斷接下來三個季度會發生什麼。我們認為，在其餘季度維持2%到3%的量能指引是合適的。

And what we see with demand in the market, what we see with trends coming out of the quarter and what we see with capital projects and other initiatives to develop our networks, we feel that that's still a reasonable target. And so that's where we are at this point.

從我們看到的市場需求、季度結束後的趨勢，以及資本專案與其他用來發展我們網路的計畫來看，我們覺得這仍是合理的目標。因此，目前我們的立場就是如此。

Stephen Baxter, Wells Fargo.

Stephen Baxter，富國銀行。

Thank you for all the color on the moving parts in the quarter. If we think about -- I guess the only sort of year-over-year number you haven't given us yet is on resiliency. And I guess I'm wondering, is there any reason to think that just kind of a quarter of the full year impact that you talked about wouldn't be a reasonable placeholder for the first quarter?

感謝你們對本季各項變動因素提供的許多細節。如果我們來看——我想你們唯一還沒提供的年對年數字，可能是關於resiliency（韌性）這一塊。我在想，有沒有任何理由認為，你們所談到的全年影響，取其四分之一作為第一季的合理占位（placeholder），會不合理？

And then if we go through and kind of look at those moving parts, it does imply that the core growth in the quarter was probably closer to 2.5% or 3%. And I think you have a bit higher of a full year guide embedded here. Just wondering if you could help us understand what you think the shortfall was on the core kind of normalizing for all these moving parts?

另外，如果我們把這些變動因素逐一拆解來看，似乎暗示本季核心成長可能更接近2.5%或3%。而你們內含的全年指引似乎略高一些。想請你們協助我們理解：在把這些變動因素正常化之後，本季核心表現的短缺（shortfall）你們認為是什麼？

When I think about the resiliency plan, and we're still confident in the full year $400 million guidance. So I'll leave that there. I mean I think that's a good estimate for the full year. When I think about core growth, I mean, our first quarter's EBITDA growth was, call it, 1.9%. And the midpoint of our full 2026 year guidance is kind of, call it, 2.8%, 2.9%. And so that gives you a sense.

談到resiliency計畫，我們仍對全年4億美元的指引有信心，我就先說到這裡。我認為這是對全年的一個不錯估計。至於核心成長，我們第一季的EBITDA成長約為1.9%。而我們2026全年指引的中位數大概是2.8%、2.9%。這可以讓你有個概念。

I think we've articulated the drivers in the first quarter. And so we largely think that it indicates that -- we believe we're going to be largely on plan for the next three quarters in terms of the overall makeup of volume and revenue and earnings back to our original plan here over the next three quarters, and that's how we think about it.

我想我們已經闡述了第一季的驅動因素。因此，我們大致認為這表示——我們相信在接下來三個季度，就量能、營收與獲利的整體組成而言，我們將大致按計畫推進，回到我們原先的計畫軌道；這就是我們的看法。

Jason Cassorla, Guggenheim.

Jason Cassorla，Guggenheim。

Maybe just to follow-up on the outpatient side. Historically, you've talked about some of the pressures you saw on Medicaid, but you more than made up of that on the revenue side of the fence. It looks like revenue was up just shy of 3% in the quarter for outpatient compared to the 9% or so you did last year. Sorry if I missed this, but can you give us any impact on the weather on the outpatient side? And then maybe how trends, revenue and volume-wise trended in the quarter, I guess, compared to -- with your ASPs compared to your remaining outpatient footprint would be helpful.

也許只是跟進一下門診端。過去你們曾談到在 Medicaid 方面看到的一些壓力，但你們在收入端的表現已遠遠彌補了那部分。看起來本季門診收入年增接近 3%（略低於 3%），相較於去年你們做到約 9% 左右。若我有漏聽請見諒，但你們能否說明天氣對門診端的影響？另外，本季的趨勢（就收入與量而言）大概如何變化——我想，若能把你們的 ASP 與你們剩餘的門診版圖做比較，會很有幫助。

Sure. Let's start with the EV side the outpatient business. And yes, between respiratory and the winter storms, there was an impact on our ER volumes. And it's about 140 basis points impact on ER visits from respiratory, about 50 basis points of impact from the storm. If you think about that compared to the 23% growth in ER visits, it gives you a sense that you're back kind of a normal trends when considering things like the winter weather storm and in the respiratory season shortfall there on ER.

當然。我們先從門診業務的急診（ER）端開始。是的，呼吸道因素與冬季風暴之間，確實對我們的急診量造成影響。呼吸道因素對急診就診人次約有 140 個基點的影響，風暴約有 50 個基點的影響。若把這與急診就診人次 23% 的成長相比，你會感覺到，在把冬季風暴天氣與呼吸道季節不如預期等因素納入考量後，趨勢其實大致回到較正常的水準。

Sam mentioned this, but we did have good growth in year-over-year things like EMR, EMS visits and trauma visits. So that was good.

Sam 提到過這點，但我們在一些年對年項目上確實有不錯的成長，例如 EMR、EMS 就診以及創傷（trauma）就診。所以這點是好的。

On the surgery side, our outpatient surgeries declined 1.7%, and that was 2.1% in hospital-based outpatient and 1% in our ambulatory surgery centers. On the hospital side, we saw a little bit of weakness in our ortho-related cases.

在手術端，我們的門診手術量下滑 1.7%；其中以醫院為基礎的門診（hospital-based outpatient）下滑 2.1%，而我們的門診手術中心（ASC）下滑 1%。在醫院端，我們在骨科相關病例上看到一些偏弱。

On the ASC side, it was really more of the low acuity service lines like ophthalmology and ENT that drove the statistical decline. I would say, we were pleased with our revenue performance in our ASCs for sure. And when I think about payer mix for surgery, really for first quarter, the two big drivers of weakness on the payer side was Medicaid and of course, the exchanges, which we anticipated. So those would be kind of a run down.

在 ASC 端，主要是低複雜度（low acuity）的服務線，例如眼科與耳鼻喉科（ENT），帶動了統計上的下滑。我會說，我們對 ASC 的收入表現確實感到滿意。再談到手術的付款方組合（payer mix），就第一季而言，付款方端偏弱的兩個主要驅動因素是 Medicaid，當然還有交易所（exchanges），這是我們原先就預期的。所以大致就是這樣的概況。

Let me give a little backdrop here. When you look at our outpatient revenue and the composition of it, about one-third of it is emergency room. About one-third of it is outpatient surgery. And the other one-third is imaging, primarily driven by cardiac and so forth. And so when you think about the storm, it affects, obviously, the emergency room and our outpatient surgery and our imaging, all three categories.

我補充一些背景。當你看我們的門診收入及其構成時，大約三分之一來自急診室；約三分之一來自門診手術；另外三分之一是影像檢查，主要由心臟相關等所帶動。因此當你想到風暴時，它顯然會影響急診室、門診手術與影像檢查這三大類。

The respiratory is mainly the emergency room. So all of it sort of comes together in this composite view. And that's how we sort of dissect the outpatient business. So as we push into the rest of the year, we don't really have the implications of either of those for our outpatient platform, and we're confident that we'll be able to generate the revenue expectations for the balance of the year.

呼吸道因素主要影響的是急診室。所以這些因素在這個綜合視角下會一起反映出來，而這就是我們拆解門診業務的方式。隨著我們推進到今年剩餘時間，我們認為這兩項因素對我們門診平台不會再有同樣的影響，我們也有信心能在今年餘下期間達成預期的收入表現。

Benjamin Rossi, J.P. Morgan.

Benjamin Rossi，J.P. Morgan。

Across your network development efforts, I guess, what's your current cadence of ramping new beds in OR capacity? And how much of your 2026 growth is depending on projects already coming online versus future years?

就你們的網路發展（network development）工作而言，我想問一下，你們目前新增病床與手術室（OR）產能爬坡的節奏是如何？另外，你們 2026 年的成長有多少是仰賴已經上線中的專案，多少是仰賴未來年度的專案？

And then could you just give us an update on how you're generally thinking about M&A as a potential growth lever this year? And how inbound and outbound conversations with opportunities in your pipeline have developed to start the year?

另外，能否更新一下你們今年對併購（M&A）作為潛在成長槓桿的整體看法？以及年初至今，你們管線中機會的 inbound 與 outbound 對話發展得如何？

So as I mentioned in our prepared remarks, we did see a number of outpatient acquisitions closed in the first quarter. Those were primarily related to opportunities in urgent care and ambulatory surgery and in our freestanding emergency room business unit.

如同我在事先準備的發言中提到的，我們確實在第一季完成了多起門診收購案。這些主要與急診照護（urgent care）、門診手術，以及我們的獨立式急診室（freestanding emergency room）事業單位相關的機會有關。

We had a number of acquisitions there. If we think about the going-forward aspects of acquisition, we continue to believe that's where most of our opportunities will be. It's in the outpatient arena and that complementing our hospital networks. And so our pipeline has a number of promising projects in it. And I'm hopeful that we'll get to close those as we push into the balance of the year.

我們在那裡完成了多起收購。若談到未來的收購面向，我們仍然相信大多數機會會在那個方向——也就是門診領域，並用以補強我們的醫院網路。因此，我們的管線中有不少具前景的專案。我也希望在今年剩餘時間推進時，能完成這些案子的交割。

With respect to capital spending, we do have a significant pipeline of projects that have already been approved that are in development. That's almost $5.5 billion to $6 billion of approved projects that will come online over the next 24 to 30 months throughout sort of different periods within that time period. A lot of those projects are long-lived projects.

就資本支出而言，我們確實有一個相當可觀、已獲核准且正在開發中的專案管線。已核准、將在未來 24 到 30 個月內陸續上線的專案金額約為 55 億到 60 億美元，會在該期間內不同時點分批上線。其中許多是長期型專案。

And by that, I mean they're adding hospital capacity, which is difficult to do because they're big projects, they're disruptive projects to our facilities, and it takes a while to get them done. And then at the same time, we try to build those future growth that we anticipate in the markets.

我所謂的長期型，是指它們在增加醫院產能；這類專案很難做，因為它們規模大、對我們的設施具有干擾性，而且需要一段時間才能完成。同時，我們也會把我們預期市場未來的成長納入建置規劃。

So there is a component of our growth expectation in '26 that's related to projects that have come online in '24, '25 and '26. And so we sort of blend that into our expectations every year. And we do have a slightly accelerated expectation in '26 as compared to the previous two years related to capital projects that are coming online. So we remain encouraged with the opportunities to invest in our networks.

因此，我們對 2026 年的成長預期中，有一部分與 2024、2025 與 2026 年上線的資本專案相關。我們每年都會把這些因素融合進預期之中。相較於前兩年，由於將上線的資本專案，我們對 2026 年的預期略為加速。因此，我們仍對投資我們網路的機會感到鼓舞。

Our occupancy levels continue to be at high levels for us, and that presents opportunities for investment and growth. And as we build out our networks with outpatient facilities, as communities grow and as our overall hospital positioning increases, we think that gives us a good opportunity to grow our share and deliver positive returns. And we've had a tremendous pattern, I think, of producing positive returns on capital, and we still continue to believe we can deliver on that.

我們的住院率（occupancy）水準持續維持在對我們而言偏高的水準，這帶來投資與成長的機會。隨著我們以門診設施擴建網路、社區成長，以及我們整體醫院的市場定位提升，我們認為這讓我們有很好的機會提升市占並帶來正向報酬。我認為我們在資本報酬率方面一直有非常好的紀錄，而我們仍相信可以持續做到。

Andy, let's take one last question.

Andy，我們再接最後一個問題。

Craig Hettenbach, Morgan Stanley.

Craig Hettenbach，Morgan Stanley。

Yes. Just a question on kind of contracting just for this year, just kind of what you're seeing in the rate backdrop as well as any visibility into 2027?

是的。想問一下今年合約談判（contracting）的情況，你們在費率環境（rate backdrop）上看到什麼？以及對 2027 年是否有任何能見度？

This is Sam. For 2026, we're pretty much fully contracted at our targeted levels. As we push into '27 and '28, we're in a contracting cycle as typical with our payer contracts, and we're about one-third of the way through on '27 and modestly into '28. And right now, we're on target. We believe we're going to be able to get into a range that works for our business as we finalize these contracts with the payers.

我是 Sam。就 2026 年而言，我們基本上已在目標水準上完成合約簽訂。展望 2027 與 2028 年，我們正處於付款方合約的談判週期，這與以往一樣；目前 2027 年大約已完成三分之一的進度，2028 年也已小幅展開。而就目前來看，我們仍在軌道上。我們相信在與付款方完成這些合約定案時，能達到一個符合我們業務需求的區間。

As Mike alluded to, we got other issues that we're working with them on, that we think can be additive to them, additive to us, beneficial to our patients and their customers in a way that makes the system work better. And so we're confident that we'll get to the good answers on these contracts that we're in negotiations on currently.

如同 Mike 提到的，我們也有其他議題正與他們合作處理；我們認為這些議題可以對他們有加分、對我們也有加分，並以能讓系統運作更好的方式，讓病患與他們的客戶受益。因此，我們有信心能在目前正在談判的這些合約上取得好的結果。

That concludes our question-and-answer session. I will now turn the call back over to Mr. Frank Morgan for closing remarks.

問答環節到此結束。我現在把電話交回給 Frank Morgan 先生做結語。

Andy, thank you for your help today, and thanks to everyone for joining us on the call. We hope you have a great weekend. I'm (inaudible) this afternoon if we can answer additional questions. Have a great day.

Andy，謝謝你今天的協助，也感謝各位參與本次電話會議。祝大家週末愉快。如果今天下午我們能回答更多問題，我會（聽不清）在場。祝大家有美好的一天。

Ladies and gentlemen, this concludes today's call, and we thank you for your participation. You may now disconnect.

各位女士、先生，今天的電話會議到此結束，感謝各位的參與。您現在可以掛線。