美國醫院公司 (HCA) 2022 Q1 法說會逐字稿

Welcome to the HCA Healthcare First Quarter 2022 Earnings Conference Call. Today's call is being recorded.

歡迎來到 HCA Healthcare 2022 年第一季度收益電話會議。今天的電話正在錄音。

At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

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弗蘭克摩根先生。請繼續，先生。

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

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。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, 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 in our various SEC filings.

在我將電話轉給 Sam 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提交給美國證券交易委員會的各種文件。

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，我們可能會參考調整後的 EBITDA 等指標，這是一項非公認會計原則的財務指標。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。

Good morning, and thank you for joining our call. The COVID-19 pandemic continued to influence our results in the first quarter with the Omicron surge which slowed in the middle of the quarter. More significantly, the challenging labor market pressured margins as the cost of labor increased more than we expected as compared to the first quarter of the prior year. In the face of these challenges, however, we had a number of positive volume and revenue indicators that were encouraging.

早上好，感謝您加入我們的電話。 COVID-19 大流行繼續影響我們第一季度的業績，Omicron 的激增在本季度中期放緩。更重要的是，與去年第一季度相比，勞動力成本的增長超過了我們的預期，因此充滿挑戰的勞動力市場給利潤率帶來了壓力。然而，面對這些挑戰，我們有一些令人鼓舞的積極數量和收入指標。

Compared to the first quarter of prior year, same-facility admissions increased 2%. During the quarter, we provided care to approximately 49,000 COVID-19 inpatients, which represented approximately 10% of total admissions, consistent with prior year. Non-COVID admissions grew 2.2%. This growth occurred in February and March. Inpatient surgeries grew approximately 1%. And across our inpatient business, acuity levels and payer mix continued to be strong.

與去年第一季度相比，同一設施的入學人數增加了 2%。在本季度，我們為大約 49,000 名 COVID-19 住院患者提供了護理，約佔總入院人數的 10%，與上一年一致。非 COVID 入學人數增長了 2.2%。這種增長發生在二月和三月。住院手術增長了大約 1%。在我們的住院業務中，敏銳度水平和付款人組合繼續保持強勁。

Outpatient volumes also rebounded strongly in the quarter. Same-facility emergency room visits grew 15%. Same-facility outpatient surgeries grew nearly 7%, and outpatient cardiac-related procedures grew by approximately 7%.

本季度門診量也強勁反彈。同一設施急診室就診人數增長了 15%。同一設施的門診手術增長了近 7%，與心臟相關的門診手術增長了約 7%。

We continue to believe that overall demand for health care remains strong in our markets across most categories with favorable population trends and other contributing factors that developed during the pandemic driving it.

我們仍然認為，在我們的大多數類別的市場中，對醫療保健的總體需求仍然強勁，其中有利的人口趨勢和在大流行期間發展的其他促成因素推動了這一趨勢。

Total revenues grew 6.9% compared to the first quarter 2021. Same-facility inpatient revenues grew 5.4%, and same-facility outpatient revenues grew 10.6%. Bill will provide more color on our revenues in his comments.

與 2021 年第一季度相比，總收入增長了 6.9%。同設施住院收入增長 5.4%，同設施門診收入增長 10.6%。比爾將在他的評論中為我們的收入提供更多的色彩。

I realize that our bottom line financial results were not what we expected, but these top line metrics were positive. Diluted earnings per share, excluding gains on sales of facilities, were $4.12, which was down $0.02 from the prior year.

我意識到我們的底線財務結果不是我們預期的，但這些頂線指標是積極的。攤薄後每股收益（不包括設施銷售收益）為 4.12 美元，比上年下降 0.02 美元。

In the quarter, we experienced higher levels of contract labor expenses than planned. As compared to the fourth quarter, we saw modest improvements in certain contract labor metrics. We expect further improvements in the remainder of the year as we align the workforce appropriately by reducing both the utilization of contract labor and the associated hourly rates for these contracts.

在本季度，我們的合同勞工費用水平高於計劃。與第四季度相比，我們看到某些合同勞工指標略有改善。我們預計今年剩餘時間將進一步改善，因為我們通過減少合同勞動力的使用和這些合同的相關小時費率來適當調整勞動力。

In some situations, the challenges in the labor market also constrained our capacity, preventing us from delivering hospital services to certain patients. By the end of the quarter, we were able to overcome some of these capacity constraints. And for the most part, our transfer centers were able to operate normally and move more patients to the proper setting in our networks.

在某些情況下，勞動力市場的挑戰也限制了我們的能力，使我們無法為某些患者提供醫院服務。到本季度末，我們能夠克服其中的一些產能限制。在大多數情況下，我們的轉運中心能夠正常運作，並將更多患者轉移到我們網絡中的適當位置。

It is important to understand we are doing what we absolutely have to do to take care of our patients, and we will always do that. This past quarter, our teams continued to show up and deliver on our promise to provide high-quality care to patients who need our services. I want to thank them for their commitment and hard work during these challenging times.

重要的是要了解我們正在做我們絕對必須做的事情來照顧我們的病人，我們將永遠這樣做。在過去的這個季度，我們的團隊繼續出現並兌現我們的承諾，為需要我們服務的患者提供高質量的護理。我要感謝他們在這些充滿挑戰的時期所做的承諾和辛勤工作。

We do, however, have numerous initiatives underway around retention, recruitment, capacity management and new care models that we believe will help offset some of these labor pressures. However, we now believe improvement in our labor cost will be slower than originally anticipated. This factor primarily influenced our revised outlook for 2022.

然而，我們確實在保留、招聘、能力管理和新的護理模式方面採取了許多舉措，我們認為這些舉措將有助於抵消其中一些勞動力壓力。然而，我們現在認為我們的勞動力成本的改善將慢於最初的預期。這一因素主要影響了我們修訂後的 2022 年展望。

We will continue to invest in our people, in our relationships and in our networks. We believe these investments are appropriate and should help us address the long-term opportunities for growth that exists in our markets.

我們將繼續投資於我們的員工、我們的關係和我們的網絡。我們相信這些投資是適當的，應該有助於我們把握市場中存在的長期增長機會。

At the end of the quarter, we had approximately 2,500 facilities or sites of care in HCA Healthcare networks. This represents a 15% increase over last year.

在本季度末，我們在 HCA 醫療保健網絡中擁有大約 2,500 個設施或護理場所。這比去年增加了 15%。

Recently, we published our annual Impact Report for 2021, which highlights the tremendous impact our colleagues had on the patients and communities we serve. You can find the details on our website.

最近，我們發布了 2021 年年度影響報告，其中強調了我們的同事對我們服務的患者和社區產生的巨大影響。您可以在我們的網站上找到詳細信息。

Before I turn the call over to Bill, let me end my comments with this. Over the past few years, we have demonstrated an ability to adjust effectively to whatever our realities are, and I'm confident we will do it again.

在我將電話轉給比爾之前，讓我以此結束我的評論。在過去的幾年裡，我們展示了有效適應現實的能力，我相信我們會再次做到這一點。

With that, I'll turn the call over to Bill. Thank you.

有了這個，我會把電話轉給比爾。謝謝你。

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

好的。謝謝你，山姆，大家早上好。我將就我們本季度的表現提供一些額外的評論，然後討論我們的 2022 年更新指南。

First, let me provide a little more commentary on our revenues in the quarter. We are encouraged with certain trends we saw in our non-COVID activity during the quarter. Same-facility non-COVID admissions grew 2.2% versus the prior year, and our non-COVID revenue per admission grew 2.4% as a result of maintaining our acuity levels and a slightly favorable payer mix as compared to the prior year.

首先，讓我對本季度的收入進行更多評論。我們對本季度在非 COVID 活動中看到的某些趨勢感到鼓舞。與上一年相比，同一設施的非 COVID 入院人數增長了 2.2%，由於保持了我們的敏銳度水平和與上一年相比略微有利的付款人組合，我們每次入院的非 COVID 收入增長了 2.4%。

Within our COVID activity, our same-facility COVID emissions were slightly above last year and represented approximately 10% of our total admissions, but we did see lower acuity and intensity with the Omicron variant this year. Our COVID inpatient revenue per admission was down approximately 15% from the first quarter of last year, which resulted in approximately $150 million less COVID revenue this year as compared to the first quarter of last year.

在我們的 COVID 活動中，我們同設施的 COVID 排放量略高於去年，約占我們總入院人數的 10%，但我們確實看到今年 Omicron 變體的敏銳度和強度較低。與去年第一季度相比，我們每次住院的 COVID 住院收入下降了約 15%，與去年第一季度相比，今年的 COVID 收入減少了約 1.5 億美元。

Let me transition to discuss some cash flow and balance sheet metrics. Our cash flow from operations was $1.345 billion as compared to $2 billion in the first quarter of 2021. We did pay $344 million of deferred payroll taxes from 2020 during this quarter, representing 50% of the total amount deferred.

讓我過渡到討論一些現金流和資產負債表指標。我們的運營現金流為 13.45 億美元，而 2021 年第一季度為 20 億美元。本季度我們從 2020 年開始支付了 3.44 億美元的遞延工資稅，佔遞延總額的 50%。

Capital spending was $860 million as compared to $650 million in the prior year period, and we completed just over $2.1 billion of share repurchases during the quarter.

資本支出為 8.6 億美元，而去年同期為 6.5 億美元，我們在本季度完成了超過 21 億美元的股票回購。

Our debt to adjusted EBITDA ratio at the end of the quarter was slightly below the low end of our target range, and we had just under $7.9 billion of available liquidity at the end of the quarter. We plan to use approximately $2.6 billion of this amount to redeem our 2023 bonds in the second quarter.

本季度末我們的債務與調整後 EBITDA 比率略低於我們目標範圍的低端，本季度末我們的可用流動性略低於 79 億美元。我們計劃在第二季度使用其中約 26 億美元來贖回我們的 2023 年債券。

Finally, I will mention, as noted in our release this morning, during March of this year, CMS approved the directed payment portion of the Texas Waiver Program. As a result, we recognized $385 million of revenue and $160 million of additional provider tax assessments related to this portion of the program from the period September 1, '21 through March 31, 2022. Of these amounts, approximately $244 million of the revenue and $90 million of the provider tax assessments related to the September through December of '21 period.

最後，我將提到，正如我們今天上午發布的內容所述，今年 3 月，CMS 批准了德州豁免計劃的定向付款部分。因此，在 2021 年 9 月 1 日至 2022 年 3 月 31 日期間，我們確認了與這部分計劃相關的 3.85 億美元收入和 1.6 億美元的額外供應商稅收評估。其中，大約 2.44 億美元的收入和與 21 年 9 月至 12 月相關的 9000 萬美元的提供商稅收評估。

As noted in our release this morning, we are adjusting our full year 2022 guidance as follows: We expect revenues to range between $59.5 billion and $61.5 billion. We expect net income attributable to HCA Healthcare to range between $4.95 billion and $5.34 billion. We expect full year adjusted EBITDA to range between $11.8 billion and $12.4 billion. We expect full year diluted earnings per share to range between $16.40 and $17.60, and we expect capital spending to remain at $4.2 billion for the year.

正如我們今天上午發布的內容所述，我們正在調整 2022 年全年指引如下：我們預計收入將在 595 億美元至 615 億美元之間。我們預計歸屬於 HCA Healthcare 的淨收入在 49.5 億美元至 53.4 億美元之間。我們預計全年調整後的 EBITDA 將在 118 億美元至 124 億美元之間。我們預計全年攤薄後每股收益將在 16.40 美元至 17.60 美元之間，我們預計今年的資本支出將保持在 42 億美元。

So let me provide some additional commentary on our adjusted guidance and 3 primary areas that we have considered. First, our cost of labor was higher than anticipated in the first quarter, primarily due to the utilization and cost of contract labor. We now believe the disruption of the labor market and the pressure this places on labor cost inflation will be slower to moderate than we originally anticipated.

因此，讓我對我們調整後的指南和我們考慮的 3 個主要領域提供一些額外的評論。首先，我們第一季度的勞動力成本高於預期，主要是由於合同勞動力的利用率和成本。我們現在認為，勞動力市場的混亂以及由此給勞動力成本通脹帶來的壓力將比我們最初預期的要慢到緩和。

Second, as I previously discussed, we saw reduced acuity and revenue from Omicron COVID patients in the quarter, and this lower acuity has been factored into our guidance as well.

其次，正如我之前所討論的，我們看到本季度 Omicron COVID 患者的敏銳度和收入有所下降，這種敏銳度降低也已納入我們的指導。

And lastly, we made assumption around increased inflationary pressures and expect that to have greater impact on us going forward, including for professional fees, energy procurement, cost of utilities and other purchase services.

最後，我們圍繞通脹壓力增加做出假設，並預計這將對我們未來產生更大的影響，包括專業費用、能源採購、公用事業成本和其他購買服務。

So let me close with a brief discussion on some of the initiatives we have underway to respond to these current market dynamics. We've spoken in the past of our resiliency efforts, which now include 3 main focus areas. First is around staffing and capacity, as Sam mentioned in his comments. We have teams working on and focused on multiple work streams in this category, these work streams in around investing in and enhancing employee recruitment and retention efforts and enhancing capacity management through new case management models and technology solutions. In addition, we are exploring new delivery models through our care transformation initiatives. All of these are focused on supporting our care teams and easing some of the current labor pressures.

因此，讓我簡要討論一下我們為應對當前市場動態而採取的一些舉措。我們過去曾談到我們的彈性工作，現在包括 3 個主要重點領域。正如 Sam 在評論中提到的那樣，首先是人員配備和能力。我們有團隊致力於並專注於這一類別的多個工作流，這些工作流圍繞著投資和加強員工招聘和保留工作，以及通過新的案例管理模型和技術解決方案加強能力管理。此外，我們正在通過我們的護理轉型計劃探索新的交付模式。所有這些都集中在支持我們的護理團隊和緩解當前的一些勞動力壓力上。

Second, we have our original resiliency programs that are continuing. Many of these are advancing efficiencies through our next generation of shared services. Examples of these include consolidation and alignment of laboratory operations, facility management, environmental and food and nutrition support areas.

其次，我們的原始彈性計劃仍在繼續。其中許多正在通過我們的下一代共享服務提高效率。這些例子包括實驗室運營、設施管理、環境和食品和營養支持領域的整合和調整。

And then the third major effort underway is an initiative around advancing our capability to benchmark key performance metrics across the organization. This is intended to identify variation and opportunity to see our best practices across several areas, such as supply utilization, provider support costs, discretionary spending and other similar cost area. Many of these were factored into our original planning assumptions, and we remain focused on these efforts to help offset some of the contract labor and inflationary cost pressures we are experiencing.

然後正在進行的第三項主要工作是圍繞提高我們對整個組織的關鍵績效指標進行基準測試的能力的舉措。這旨在確定差異和機會，以了解我們在多個領域的最佳實踐，例如供應利用率、供應商支持成本、可自由支配支出和其他類似成本領域。其中許多已被納入我們最初的規劃假設中，我們仍然專注於這些努力，以幫助抵消我們正在經歷的一些合同勞工和通貨膨脹成本壓力。

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

因此，我將把電話轉給弗蘭克以進行問答。

Thank you, Bill. (Operator Instructions) Emma, you may now give instructions to those who would like to ask a question.

謝謝你，比爾。 （操作員說明）艾瑪，您現在可以向想問問題的人發出指示。

(Operator Instructions) Your first question today comes from the line of A.J. Rice with Credit Suisse.

（操作員說明）您今天的第一個問題來自 A.J.瑞信的賴斯。

Maybe just to try to drill down a little bit more on -- I know within the range, you've changed your outlook for EBITDA by about $650 million at the high end, $750 million at the low end. There's a lot of moving parts in the first quarter with what's happening with Texas supplemental payments. Can you tell us how much of that adjustment was due to what you saw in the first quarter? And how much is changing in your thinking for the rest of the year? And particularly, maybe just drill down on the labor comments about maybe what you were thinking before versus what you're thinking today in terms of use of contract labor rates and so forth, if there's anything that can be shared there.

也許只是為了進一步深入研究——我知道在這個範圍內，你對 EBITDA 的展望在高端改變了大約 6.5 億美元，在低端改變了 7.5 億美元。第一季度，德克薩斯州的補充付款發生了很多變化。您能告訴我們調整有多少是由於您在第一季度看到的情況嗎？在今年餘下的時間裡，你的想法有多大變化？特別是，如果有什麼可以分享的話，也許只是深入了解勞工評論，可能是您之前的想法與您今天在使用合同勞工費率等方面的想法。

Yes, A.J. This is Bill. Let me give that a shot. So as we're looking forward and we're trying to take what we saw in the first quarter to make some assumptions and revision of our assumptions going forward, let's talk about the 3 areas. And first, as I mentioned, the pressure on the labor cost that what we're seeing is it's higher than we originally planned. It's primarily related to the use of contract labor. But we're also adjusting our base wages to be responsive to the market as well.

是的，A.J.這是比爾。讓我試一試。因此，當我們展望未來並試圖利用我們在第一季度看到的情況來做出一些假設並修改我們的假設時，讓我們談談這三個領域。首先，正如我所提到的，我們所看到的勞動力成本壓力高於我們最初的計劃。它主要與使用合同工有關。但我們也在調整我們的基本工資以適應市場。

As I would think about it, our original plans was to kind of manage our overall cost per FTE somewhere between that 3% and 3.5% level. What we saw in the first quarter is our cost per FTE was about 1.5% higher than we expected. So as we forecast this going forward for the balance of the year, it could have a $400 million to $500 million impact. So we factored that into our guidance.

正如我所想的那樣，我們最初的計劃是將每個 FTE 的總成本控制在 3% 到 3.5% 的水平之間。我們在第一季度看到的是我們的每 FTE 成本比我們預期的高出約 1.5%。因此，正如我們預測今年餘下時間的情況一樣，它可能會產生 4 億至 5 億美元的影響。因此，我們將這一點納入了我們的指導。

The second area is regarding the Omicron variant, the less acuity in revenue, not only that we saw in the first quarter. But to the extent that we continue to see some COVID at a reduced level than what we saw in the first quarter, we factored that in.

第二個領域是關於 Omicron 變體，收入的敏銳度較低，不僅是我們在第一季度看到的。但是，如果我們繼續看到一些 COVID 的水平低於我們在第一季度看到的水平，我們將其考慮在內。

And then lastly, as I mentioned, just some inflationary increases above what we originally anticipated.

最後，正如我所提到的，只是比我們最初預期的通脹增加了一些。

So I think the way I would characterize it, approximately 2/3 of our revision I would apply to kind of our wage and inflationary cost pressures and 1/3 of that due to the revenue acuity, primarily to the COVID patients.

因此，我認為按照我的描述方式，我們將大約 2/3 的修訂應用於我們的工資和通脹成本壓力，其中 1/3 是由於收入敏銳度，主要應用於 COVID 患者。

Your next question comes from the line of Pito Chickering with Deutsche Bank.

您的下一個問題來自德意志銀行的 Pito Chickering。

Embedded on the guidance reductions, can you walk us through the contract labor percent of nursing hours in fourth quarter, in the first quarter and how you assume that rolls off throughout the year? And then the same question on the rates for contract labor. And just because stocks had a big move today, any chance you guys can give us sort of a range for how we should be modeling 2Q EBITDA?

在指導減少的基礎上，您能否告訴我們第四季度、第一季度的合同工時護理時間百分比，以及您如何假設全年減少？然後是關於合同工費率的相同問題。僅僅因為今天股票有很大的變動，你們有沒有機會給我們一個關於我們應該如何建模第二季度 EBITDA 的範圍？

Yes. Pito, let me give a shot at that. I think we talked about on our fourth quarter call, our contract labor as a percent of nursing hours was around 11%. In the first quarter, it's about that level, too. We were 11.4% specifically in the fourth quarter, about 11.6% in the second quarter. We are experiencing elevated cost per hour of that contract labor, principally, we believe, related to the COVID surges. Our plans going forward are to continue to reduce the utilization of that contract labor and eventually moderate the average hourly rate that we're having to spend for that contract labor. But we think that moderation will be slower than we originally anticipated. So that's what's based in our assumptions, and it's basically influenced with what we saw in the fourth quarter.

是的。皮托，讓我試一試。我想我們在第四季度的電話會議上談到了，我們的合同工佔護理時間的百分比約為 11%。在第一季度，也差不多是這個水平。我們在第四季度具體為 11.4%，在第二季度約為 11.6%。我們認為，該合同工的每小時成本正在上升，我們認為這主要與 COVID 激增有關。我們未來的計劃是繼續減少該合同工的使用，並最終降低我們為該合同工所花費的平均時薪。但我們認為緩和會比我們最初預期的要慢。這就是我們假設的基礎，它基本上受到我們在第四季度看到的影響。

Yes. And let me add to that, Pito. This is Sam. I think as we have gone through 2 years of up and down periods with surges, short-cycle normal period surges, another short-cycle normal period, we saw in the surges an acceleration in both turnover and the use of contract labor. As I mentioned on my prepared comments, we do what we got to do to take care of our patients.

是的。讓我補充一下，皮托。這是山姆。我認為，隨著我們經歷了 2 年的暴漲和暴跌期，短週期的正常期暴漲，又一個短週期的正常期，我們在暴漲中看到了營業額和合同工使用的加速。正如我在準備好的評論中提到的那樣，我們盡我們所能來照顧我們的病人。

What we're anticipating is no more significant surges as we move through the rest of this year. And we -- that gives us some opportunity and some level of confidence that we can moderate the use of contract labor. And some of our other initiatives should provide support, recruitment, some of our retention efforts and so forth, giving us an opportunity to wean ourselves off the high levels of contract labor. And we saw that in the short cycles, to a certain degree, but we never were able to sustain it simply because it was just that, a short cycle.

我們預計在今年剩下的時間裡不會出現更大的激增。我們——這給了我們一些機會和一定程度的信心，我們可以緩和合同工的使用。我們的一些其他舉措應該提供支持、招聘、我們的一些保留工作等等，讓我們有機會擺脫高水平的合同工。我們在一定程度上在短週期中看到了這一點，但我們從未能夠僅僅因為它只是一個短週期而能夠維持它。

So as we go through the rest of this year, we think the cycle will be longer with respect to those surge, and that will give us an opportunity to gain some traction with some of these initiatives. Our teams are working diligently across the facilities to make this happen. And again, I'm confident, just as we've done in the past, that we can make these adjustments over time and get us to where we need to be.

因此，當我們度過今年剩下的時間時，我們認為這些激增的周期會更長，這將使我們有機會通過其中一些舉措獲得一些牽引力。我們的團隊正在各個設施中努力工作以實現這一目標。再一次，我有信心，就像我們過去所做的那樣，我們可以隨著時間的推移做出這些調整，讓我們到達我們需要的地方。

Your next question comes from the line of Justin Lake with Wolfe Research.

您的下一個問題來自 Justin Lake 與 Wolfe Research 的合作。

First, just a quick follow-up on Pito's question. Can you give us a number as to where you expect to end the year on contract labor as a percentage? And just to confirm, does that sit in operating expense or other operating? Because that was the line item that looks like was a bit off.

首先，快速跟進 Pito 的問題。您能否給我們一個數字，說明您預計年底合同工的百分比？只是為了確認一下，這屬於運營費用還是其他運營費用？因為那是看起來有點偏離的訂單項。

And then my actual question is, Sam, just as you take a step back, right, there was a huge improvement in margins during COVID. Looks like they take a step back here. I'm just curious, do you think this is a sustainable margin or a sustainable EBITDA level to kind of think about jumping off for next year? Or do you think some of those improvements could help you close the gap versus where you were when you guided the year originally?

然後我的實際問題是，山姆，就像你退後一步一樣，對，在 COVID 期間利潤率有了巨大的提高。看起來他們在這裡退了一步。我只是好奇，你認為這是一個可持續的利潤率還是一個可持續的 EBITDA 水平，可以考慮明年跳槽？還是您認為其中一些改進可以幫助您縮小與您最初指導這一年時的差距？

Justin, this is Bill. Let me start with the first part of that. Without giving any specific numbers, you've heard us talk about, we expect to decrease the utilization. If I look before COVID, we would be hovering around 9% to 10% of ours. I don't know exactly. There are so many uncertainties, but we expect it to sequentially improve going forward.

賈斯汀，這是比爾。讓我從第一部分開始。在沒有給出任何具體數字的情況下，您已經聽到我們談論過，我們希望降低利用率。如果我在 COVID 之前查看，我們將徘徊在我們的 9% 到 10% 左右。我不確切知道。有很多不確定性，但我們預計它會在未來逐步改善。

That does come through the SWB line, not the other operating. You did mention the other operating. It was primarily influenced with the provider tax assessments that I mentioned in my prepared remarks.

這確實來自 SWB 線，而不是其他操作。您確實提到了其他操作。它主要受到我在準備好的評論中提到的提供者稅收評估的影響。

Yes. This is Sam, Justin. With respect to the margins in the first quarter, I think the margins in the first quarter were clearly pressured, as we've indicated here, with somewhat unprecedented levels of cost on the labor side. Again, those costs were driven in some respects by the surge that we were reacting to and that pressured OM in a very significant way. I do believe, over time, we can recover some of that lost margin as we continue to appropriately align our workforce with more permanent workforce or more efficient workforce coming from the contract labor category.

是的。這是山姆，賈斯汀。關於第一季度的利潤率，我認為第一季度的利潤率顯然受到了壓力，正如我們在這裡所指出的那樣，勞動力方面的成本處於前所未有的水平。同樣，這些成本在某些方面是由我們正在應對的激增推動的，這給 OM 帶來了非常重要的壓力。我確實相信，隨著時間的推移，我們可以恢復部分損失的利潤，因為我們將繼續適當地將我們的勞動力與來自合同工類別的更長期的勞動力或更高效的勞動力相結合。

As -- setting a target, we don't necessarily have a target for contract labor. Obviously, in 2019, we were maybe half of what we're running today, somewhere in that zone. I don't know if that's realistic in the short run. But I'm hopeful in the intermediate run, with the number of initiatives that we have, plus our Galen College of Nursing expansion program, that we can start to get back to those kind of levels. But I do think the first quarter was uniquely pressured from a margin standpoint, simply because of the elevated levels of contract labor and the costs thereof.

作為——設定目標，我們不一定有合同工的目標。顯然，在 2019 年，我們可能是我們今天運行的一半，在那個區域的某個地方。我不知道這在短期內是否現實。但我希望在中期，隨著我們擁有的舉措數量以及我們的蓋倫護理學院擴展計劃，我們可以開始回到那種水平。但我確實認為，從利潤率的角度來看，第一季度的壓力是獨一無二的，這僅僅是因為合同工水平及其成本的提高。

Your next question comes from the line of Kevin Fischbeck with Bank of America.

您的下一個問題來自美國銀行的 Kevin Fischbeck。

Just want to maybe follow up on that question there. I think last quarter, you were talking about something like a 20% to 21% margin as kind of ultimately being sustainable. Is that the right way to think about it? Or have some of these things changed your view? And it sounds like, for the most part, you talked about recapturing margin, you're talking about cost savings. Is there anything on the rate side that is part of that equation? And if so, does that take a couple of years to play out? Or is that something that we can think about more normalized margins as soon as next year?

只是想在那裡跟進那個問題。我認為上個季度，你說的是 20% 到 21% 的利潤率最終是可持續的。這是正確的思考方式嗎？或者其中一些事情改變了你的看法？聽起來，在大多數情況下，您都在談論重新獲得利潤，您在談論節省成本。利率方面有什麼是該等式的一部分嗎？如果是這樣，這需要幾年時間才能完成嗎？還是我們可以在明年考慮更多標準化的利潤率？

Well, Kevin, if you look at our guidance, I think it would imply close to those 20% margin levels. Obviously, we've had to adjust some of our thinking given kind of these inflationary cost pressures that we're seeing. So we're doing everything we can to operate the company as efficiently as possible. There's a lot of variables that we know go into margin: volume, acuity, payer mix, continuing to manage our cost structures appropriately. So I would use that 19% to 20% level in the short run. And over time, we're going to continue to find ways to continue to operate efficiently.

好吧，凱文，如果你看看我們的指導，我認為這意味著接近 20% 的利潤率水平。顯然，鑑於我們所看到的這些通脹成本壓力，我們不得不調整一些想法。因此，我們正在盡一切努力盡可能高效地運營公司。我們知道利潤率有很多變量：數量、敏銳度、付款人組合、繼續適當地管理我們的成本結構。所以我會在短期內使用 19% 到 20% 的水平。隨著時間的推移，我們將繼續尋找繼續有效運營的方法。

On the payer contract, we are having more discussions. Obviously, the payers understand the inflationary pressures that providers have. And there's early discussions. It doesn't change our revenue mix in the 2022 period because we're largely contracted for 2022. But as we move into 2023 and 2024, Kevin, we have opportunities to utilize our payer contracts to get some relief from the inflationary pressures. And as we further our discussions with those commercial payers, I'm optimistic that we can gain some escalators that are more in line with the inflationary pressures of today versus the inflationary pressures of the past.

關於付款人合同，我們正在進行更多討論。顯然，付款人了解供應商所面臨的通脹壓力。並且有早期的討論。它不會改變我們在 2022 年期間的收入組合，因為我們在很大程度上是在 2022 年簽訂的。但是隨著我們進入 2023 年和 2024 年，凱文，我們有機會利用我們的付款人合同來緩解通脹壓力。隨著我們與這些商業支付方進一步討論，我樂觀地認為，我們可以獲得一些更符合當今通脹壓力與過去通脹壓力的自動扶梯。

Your next question comes from the line of Whit Mayo with SVB Securities.

您的下一個問題來自 SVB 證券的 Whit Mayo。

Bill, what are you assuming in your algorithm this year for the guidance around COVID and non-COVID? I think you were assuming non-COVID was going to be, I don't know, 2% to 3% of the total. How has that shifted? And is there anything that you can share on how non-COVID, either inpatient, outpatient or anything, is tracking through April that might just give us a sense of the run rate?

比爾，你在今年的算法中假設關於 COVID 和非 COVID 的指導是什麼？我認為您假設非 COVID 將佔總數的 2% 到 3%，我不知道。情況如何轉變？您有什麼可以分享的關於非 COVID（無論是住院病人、門診病人還是其他任何東西）在 4 月份的追踪情況，這可能會讓我們對運行率有所了解？

I can't say April, Whit, at this point. But we said in our prepared remarks, non-COVID was up 2.2%, and that was really in February and March. In February and March, we were seeing 4.5% to 5%, potentially in those levels. So again, that's why I said we're encouraged by those trends. I don't think really what we saw in the fourth quarter really in broad terms affect our volume outlook. We still see good volume demand in the marketplaces. So originally, we said 2% to 3% volume growth, COVID still being between that, maybe 3% to 5% of our total admissions. And I think right now, I think that's mostly in line with our current expectations.

我不能說四月，惠特，在這一點上。但我們在準備好的評論中說，非 COVID 上漲了 2.2%，而這實際上是在 2 月和 3 月。在 2 月和 3 月，我們看到 4.5% 到 5%，可能處於這些水平。再說一次，這就是為什麼我說我們對這些趨勢感到鼓舞。從廣義上講，我認為我們在第四季度看到的情況並不會真正影響我們的銷量前景。我們仍然看到市場上的大量需求。所以最初，我們說數量增長 2% 到 3%，但 COVID 仍在這之間，可能占我們總入學人數的 3% 到 5%。我認為現在，我認為這主要符合我們目前的預期。

Your next question comes from the line of Ben Hendrix with RBC Capital Markets.

您的下一個問題來自 RBC Capital Markets 的 Ben Hendrix。

Just a real quick follow-up on the comment you made just a second ago, Sam, about improving efficiency of contract labor. We've always kind of characterized this as kind of the labor backdrop as the contract being the kind of transitory piece and wage inflation being more permanent. Is that -- can we read that kind of improving efficiency comment as maybe your expectation that contract labor utilization at higher rates is more of a permanent construct now going forward in the labor market?

山姆，您只是對您一秒鐘前發表的關於提高合同工效率的評論進行了真正的快速跟進。我們一直將其描述為一種勞動力背景，因為合同是一種暫時性的東西，而工資膨脹則更為持久。那是 - 我們是否可以閱讀那種提高效率的評論，因為您可能期望更高的合同勞動力利用率在勞動力市場上更像是一種永久性結構？

Well, I think it's hard than it was in 2019. I don't think it will be hard than it was in the fourth quarter or the first quarter. I think rates will naturally come down as the surges subside and as workforce is aligned with more permanent staff and so forth. And so we're dealing in the first quarter and the fourth quarter and a little bit in the third quarter as well very high cost per hour for contract labor, and we do not believe that is sustainable. And so we're anticipating improvements in that.

嗯，我認為這比 2019 年更難。我認為不會比第四季度或第一季度更難。我認為隨著激增的消退以及勞動力與更長期的員工保持一致等，費率自然會下降。因此，我們在第一季度和第四季度以及在第三季度的一點點進行交易，以及非常高的每小時合同工成本，我們認為這是不可持續的。因此，我們期待這方面的改進。

Additionally, I think we will see reductions in the number of contract labor personnel that we use. Again, as our initiatives gain traction, we've invested heavily in our recruiting function and really improve the candidate experience inside of that. We have some improving retention efforts and compensation programs that we think are going to support that component of our set of initiatives. So all of that leads us to believe that we can get the cost per FTE down from where it was in the fourth quarter and the first quarter. And so that's our thinking.

此外，我認為我們將看到我們使用的合同工人數減少。再次，隨著我們的計劃獲得牽引力，我們在招聘功能上投入了大量資金，並真正改善了其中的候選人體驗。我們有一些改進的保留工作和薪酬計劃，我們認為這些計劃將支持我們一系列舉措的組成部分。因此，所有這些都讓我們相信，我們可以將每 FTE 的成本從第四季度和第一季度的水平降低。這就是我們的想法。

Your next question comes from the line of Ann Hynes with Mizuho.

你的下一個問題來自 Ann Hynes 和 Mizuho 的台詞。

Can you tell us -- when I look at inpatient admissions and adjusted admissions versus 2019, they're still down about 3%. Can you tell us what's embedded in guidance for 2022 versus the 2019 baseline trends, please?

你能告訴我們——當我查看與 2019 年相比的住院人數和調整後的住院人數時，它們仍然下降了約 3%。請您告訴我們 2022 年與 2019 年基線趨勢相比，指南中包含哪些內容？

Ann, this is Bill. So as I mentioned before, we still believe we'll end up seeing 2% to 3% admissions for the full year '22. You're right. We are down a little on '19. I'd have to take a moment to see what that represents in '19. It's about 1% is what I think that would be our '21 number versus the baseline '19, would be down about 1%.

安，這是比爾。所以正如我之前提到的，我們仍然相信我們最終會在 22 年全年看到 2% 到 3% 的錄取率。你是對的。 19 年我們有點失望。我得花點時間看看這在 19 年代表什麼。大約 1% 是我認為我們的 '21 數字與基線 '19 相比，將下降約 1%。

Yes. Let me color that, Ann, a little bit more, Bill, if I may, please. I think a couple of things when it comes to our same-store 2019 versus our same-store 2021. Our uninsured volumes are down 11% from 2019. So that's a very significant point.

是的。讓我給它上色，安，再多一點，比爾，如果可以的話，請。當談到我們 2019 年的同店與 2021 年的同店時，我認為有幾件事。我們未投保的數量比 2019 年下降了 11%。所以這是一個非常重要的點。

The second point I would say is we've had a fairly significant shift of orthopedic total joint surgeries go from inpatient to outpatient from 2019 to 2022. Again, that's put pressure on the admissions. Our surgeries were actually up over 2019. And then again, with our emergency room visits, if you look at the categories that are the paying categories were slightly up, but our uninsured activities were way down.

我要說的第二點是，從 2019 年到 2022 年，我們的骨科全關節手術發生了相當大的轉變，從住院病人轉為門診病人。這再次給入院帶來了壓力。我們的手術實際上比 2019 年增加了。再說一次，我們的急診室就診，如果你看一下付費類別的類別略有上升，但我們的無保險活動卻大幅下降。

So I think you got to look at the components of the business and understand the different components. And so the mix, slightly better shift, inpatient to outpatient, which we've talked about over the last couple of years, and that influences the 2022 to 2019 comparison.

因此，我認為您必須查看業務的組成部分並了解不同的組成部分。因此，我們在過去幾年中討論過的混合，稍微好一點的轉變，住院病人到門診病人，這影響了 2022 年到 2019 年的比較。

Your next question comes from the line of Gary Taylor with Cowen.

您的下一個問題來自 Gary Taylor 和 Cowen。

Wanted to think about seasonality of revenue and EBITDA if you can here. Do we go back to sort of pre-COVID and think about first quarter, fourth quarter EBITDA always being higher? Or do we think about J&J and some of the other device companies have said, all-time high cancellations in January, things really started improving in March and April? And then obviously, you've got some anticipation that labor cost could ease a bit sequentially. So are we back to normal EBITDA seasonality yet? Or is the year still more complex? And can you help us a little?

如果可以的話，想考慮收入和 EBITDA 的季節性。我們是否回到 COVID 之前的狀態並考慮第一季度、第四季度的 EBITDA 總是更高？或者我們是否考慮一下強生和其他一些設備公司所說的，1 月份的取消量創歷史新高，而 3 月和 4 月情況真的開始好轉？然後很明顯，你有一些預期，勞動力成本可能會依次降低。那麼我們是否恢復到正常的 EBITDA 季節性呢？還是年份更複雜？你能幫我們一點忙嗎？

I think a couple of things, Gary. Thank you for that question. The seasonality, we talked about this in the fourth quarter call, was really difficult for us to discern because, again, we were weaning ourselves off the Delta variant and then ramping up on the Omicron variant.

我想了幾件事，加里。謝謝你的問題。我們在第四季度的電話會議中談到了季節性，我們真的很難辨別，因為我們再次放棄了 Delta 變體，然後開始使用 Omicron 變體。

I think the seasonality, again, with our volume is a bit uncertain to us right now. My sense is this could be a more normal period on seasonality for volume in 2022 than any that we've had over the last 2 years, obviously.

我認為現在我們的交易量的季節性對我們來說有點不確定。我的感覺是，這可能是 2022 年成交量季節性的一個更正常的時期，顯然比過去 2 年的任何時期都更正常。

But the seasonality on our costs, as we've indicated, I think are going to be different. And they're going to be different because we're at a high watermark on labor cost per FTE in the first quarter. And typically, our costs would go up seasonally. But we think as we work through the initiatives and the alignment of our workforce, we'll have a different pattern to our cost in 2022 than what we've had in previous years. And then hopefully, 2023 gets back to normal.

但正如我們所指出的，我認為我們成本的季節性會有所不同。而且它們將有所不同，因為我們在第一季度的每 FTE 勞動力成本處於高水位。通常，我們的成本會隨季節增加。但我們認為，隨著我們通過舉措和員工隊伍的調整，我們在 2022 年的成本模式將與前幾年不同。然後希望 2023 年恢復正常。

So that's how we're thinking about it. Obviously, there's still months to come here for us to understand, in fact, if that does play out, but that's our thinking at this point.

所以我們就是這麼想的。顯然，我們還有幾個月的時間來了解，事實上，如果這確實發生了，但這是我們目前的想法。

Your next question comes from the line of Brian Tanquilut with Jefferies.

您的下一個問題來自 Brian Tanquilut 與 Jefferies 的對話。

Sam, just to follow up some questions on labor rate? So one question we're getting asked is, why now? Like you guys have done a great job managing through labor over the last 1.5 years. And maybe any color you can share on what you're thinking in terms of turnover on your perm nurses.

山姆，只是為了跟進一些關於人工費率的問題？所以我們被問到的一個問題是，為什麼是現在？就像你們在過去的 1.5 年里通過勞動管理做得很好一樣。也許你可以分享你對燙髮護士營業額的想法的任何顏色。

And then I guess for Bill, to follow up to that, is you called out acuity as a driver of the revenue guidance cut. But as we pull back on temp staff, is there going to be an impact in labor -- or on volumes that we should be thinking about?

然後我猜比爾，為了跟進這一點，你是否將敏銳度稱為收入指導削減的驅動力。但是當我們撤回臨時員工時，是否會對勞動力產生影響 - 或者我們應該考慮的數量？

So the first half of last year, our costs were not in what I call an elevated state from the labor. And we mentioned this on our third quarter call. We also mentioned it again on the fourth quarter call, and now we're mentioning it on the first quarter call. So we're working ourselves out of some comparisons, number one.

所以去年上半年，我們的成本並沒有處於我所說的勞動力成本上升的狀態。我們在第三季度的電話會議上提到了這一點。我們還在第四季度電話會議上再次提到它，現在我們在第一季度電話會議上提到它。所以我們正在努力進行一些比較，第一。

But our costs of labor were dramatically disrupted in the Delta variant for a couple of reasons. One, we jumped our census from the second quarter to the third quarter by 8.5%. We had record census levels in the company in the third quarter -- not for the third quarter but forever. And that forced us to respond to those patients in an appropriate way.

但是由於幾個原因，我們的勞動力成本在 Delta 變體中受到了極大的影響。一，我們從第二季度到第三季度的人口普查增加了 8.5%。第三季度，我們公司的人口普查水平創歷史新高——不是第三季度，而是永遠。這迫使我們以適當的方式回應這些患者。

The market -- the labor market was being tremendously impacted during the summer of 2021, and we had to use more contract labor at that time than we had in previous periods. Well, that's continued into the fourth quarter and then to the first quarter. Again, we think some of that is influenced significantly by the surges. So that's part of what reoccurred.

市場——勞動力市場在 2021 年夏天受到了巨大影響，當時我們不得不使用比以往更多的合同工。嗯，這一直持續到第四季度，然後到第一季度。同樣，我們認為其中一些受到激增的顯著影響。所以這是再次發生的一部分。

As Bill alluded to it, the Delta variant was the most intense revenue patient population that we had. So the third quarter covered a lot of that cost because the revenue intensity of the Delta patients was quite high.

正如比爾所暗示的那樣，Delta 變體是我們擁有的收入最高的患者群體。所以第三季度支付了很多成本，因為 Delta 患者的收入強度非常高。

The fourth quarter had a blend of Delta and Omicron, and it still was higher than the first quarter. And so the labor costs really haven't changed per FTE in 3 quarters. I'm considering that to be a good thing. And I'm also considering it to be the opportunity because we're using too much contract labor, and it's still at elevated, outsized rates.

第四季度混合了 Delta 和 Omicron，但仍高於第一季度。因此，每個 FTE 的勞動力成本在 3 個季度內確實沒有變化。我認為這是一件好事。而且我也認為這是一個機會，因為我們使用了太多的合同工，而且它仍然處於高昂的、超大的速度。

And so our rate trend has continued in the quarter to be reduced. I think our contract labor cost per hour in the first quarter was down 5% from the fourth quarter. And within the quarter -- within the first quarter, it was better each month, month over month. Again, it gives us some confidence that the assumptions we're making for the remainder of the year are reasonable. So that's part of why it doesn't look like we manage through it in historical ways.

因此，我們的利率趨勢在本季度繼續下降。我認為我們第一季度的每小時合同勞動力成本比第四季度下降了 5%。在這個季度內——在第一季度內，每個月都在變好，月復一月。再次，它讓我們相信我們對今年剩餘時間所做的假設是合理的。所以這就是為什麼它看起來不像我們以歷史方式管理它的部分原因。

Our productivity is at a very efficient level when it comes to employees per patient. So we're managing on that front as well as we possibly can. And as, again, we get these other underlying initiatives into a normal period hopefully of no COVID surges, we're going to gain ground on the pressure that we've experienced over the past 3 quarters.

就每位患者的員工人數而言，我們的生產力處於非常高效的水平。因此，我們正在盡我們所能在這方面進行管理。而且，我們再次將這些其他潛在舉措納入正常時期，希望不會出現 COVID 激增，我們將在過去 3 個季度所經歷的壓力中取得進展。

Yes. Brian, you have a follow-up question. As I think Sam mentioned, too, in his comments, there's always the potential where the labor pressures could affect your volume. What we've seen that is in COVID surges as we manage through transfers. Again, I think as Sam alluded in his comments, at the end of the quarter, we were really back to our normal levels, but we're continuing to manage through that dynamic.

是的。布賴恩，你有一個後續問題。正如我認為山姆在他的評論中提到的那樣，勞動力壓力總是有可能影響你的產量。當我們通過轉移進行管理時，我們看到的是 COVID 激增。同樣，我認為正如 Sam 在他的評論中提到的那樣，在本季度末，我們真的回到了正常水平，但我們正在繼續管理這種動態。

Your next question comes from the line of Scott Fidel with Stephens.

您的下一個問題來自 Scott Fidel 和 Stephens 的對話。

So we just had the Medicare IPPS proposed to come back for 2023 and certainly had a couple of different moving pieces on that. So I thought it would be helpful if you can give us the gross versus net sort of projection for your rates from that proposal. And then just more broadly, how you feel about CMS sort of factoring in this inflationary pressure and ultimately if you think that CMS will start to factor that in more accurately as we look out maybe to FY '24 and beyond.

因此，我們剛剛提議將 Medicare IPPS 計劃在 2023 年回歸，並且在這方面肯定有幾個不同的推動因素。因此，我認為如果您可以向我們提供該提案中您的費率的總額與淨額預測，這將是有幫助的。然後更廣泛地說，您對 CMS 的看法如何考慮這種通脹壓力，最終如果您認為 CMS 將開始更準確地考慮這一因素，因為我們可能會展望 24 財年及以後。

Yes, Scott. This is Bill. I mean, obviously, we're still assessing it. But I think on first blush, we thought kind of the gross increase we saw would be hovering just under 2%, and that's pretty consistent with what we've seen. But I think to your point, it does get netted out when we see the delay in the sequestration cuts out there. So we'll still assess that. So it may move it closer to flat net-net all-in, but we're seeing at the top line just under 2% growth on that. And so we'll see how the final rule comes out as we go through comments.

是的，斯科特。這是比爾。我的意思是，顯然，我們仍在評估它。但我認為乍一看，我們認為我們看到的總增長將徘徊在 2% 以下，這與我們所看到的非常一致。但我認為就你的觀點而言，當我們看到隔離的延遲被削減時，它確實會被淘汰。所以我們仍然會評估。因此，它可能會使其更接近於平淨淨全押，但我們看到頂線的增長率略低於 2%。因此，我們將在查看評論時看到最終規則是如何產生的。

Yes. And in forward years, typically, it takes a little bit for the wage index to be adjusted to reflect what's going on in the industry. So I think as '21 and '22 start to get baked into the formula for inflation around the wage indexes of the hospital industry will start to influence the reimbursement in slightly different ways.

是的。在未來幾年，通常需要對工資指數進行一些調整以反映該行業的情況。因此，我認為隨著 21 年和 22 年開始被納入圍繞醫院行業工資指數的通脹公式，將開始以略有不同的方式影響報銷。

Your next question comes from the line of Andrew Mok with UBS.

您的下一個問題來自瑞銀的 Andrew Mok。

Just wanted to follow up on the revenue commentary. Can you take us through the components of the lower revenue guidance in more detail, maybe help bucket the $500 million decline between volume, acuity and mix. And are there any other government-related items that you would call out in that revenue decline?

只是想跟進收入評論。您能否更詳細地向我們介紹較低收入指導的組成部分，也許有助於解決銷量、敏銳度和組合之間 5 億美元的下降。在收入下降的情況下，您還會提到其他與政府相關的項目嗎？

Yes, Andrew. This is Bill. I would tell you it's principally related to the drop in the COVID acuity that I mentioned in my comments, and we're estimating it to be approximately $150 million in the quarter. COVID, obviously, was higher at 10% of our admissions than we expect in the full year. But if you run that out, I would say the vast majority of that revenue decline would be due to the lower acuity that we're seeing with the Omicron variant and expect to see going forward. And outside of that, there's no other really major item that I would call out, just the ebb and flow of kind of normal volume patterns.

是的，安德魯。這是比爾。我會告訴你，這主要與我在評論中提到的 COVID 敏銳度下降有關，我們估計本季度約為 1.5 億美元。顯然，COVID 占我們入學人數的 10% 比我們全年預期的要高。但如果你用完了，我會說收入下降的絕大部分是由於我們看到的 Omicron 變體的敏銳度較低，並且預計會繼續發展。除此之外，沒有其他真正重要的項目我會提到，只是正常音量模式的潮起潮落。

Your next question comes from the line of Stephen Baxter with Wells Fargo.

您的下一個問題來自富國銀行的斯蒂芬·巴克斯特（Stephen Baxter）。

Just wanted to ask another one on the labor market. So I'm sure part of your process around this issue involves a great degree of competitive intelligence about what's going on in your markets. Was hoping you could share a little bit about what you're seeing from your local market competitors and whether there are strategies around contract labor or employed labor for us or even maybe potentially putting certain service lines on pause or maybe exacerbating some of the pressures you're feeling. I guess, big picture, do you think they're being as disciplined as you are? And if not, how should we think about the longer-term implications of that?

只是想問另一個關於勞動力市場的問題。因此，我敢肯定，您圍繞這個問題的流程的一部分涉及到關於您的市場正在發生的事情的大量競爭情報。希望您能分享一下您從當地市場競爭對手那裡看到的情況，以及我們是否有圍繞合同工或僱傭勞工的策略，甚至可能會暫停某些服務線，或者可能會加劇您的一些壓力感覺。我想，從大局來看，你認為他們和你一樣有紀律嗎？如果不是，我們應該如何考慮其長期影響？

So from a competitive standpoint, I mean, obviously, our wage programs have to be competitive. And that means different things in different circumstances. And we have made adjustments to our compensation programs, really starting back in the third quarter of '21, to respond to some of the market dynamics. We continue to be very fluid in that particular area of our business in responding to the different circumstances from one market to the other.

因此，從競爭的角度來看，我的意思是，很明顯，我們的工資計劃必須具有競爭力。這在不同的情況下意味著不同的事情。我們已經對我們的薪酬計劃進行了調整，實際上是從 21 年第三季度開始，以應對一些市場動態。在應對從一個市場到另一個市場的不同情況時，我們繼續在我們業務的特定領域非常靈活。

I would say that we think we're in a pretty good spot. We haven't seen any unusual maneuvers broadly. We are fortunate again to have competitors that tend to be only local and in 1 market or 2 markets at the most, so we don't see sort of patterns that permeate all 43 markets for HCA Healthcare. And so that's a positive on that front.

我會說我們認為我們處於一個非常好的位置。我們還沒有廣泛地看到任何不尋常的演習。我們再次幸運地擁有往往只是本地的競爭對手，並且最多在 1 個或 2 個市場中，所以我們看不到 HCA Healthcare 的所有 43 個市場都有某種模式。所以這在這方面是積極的。

But we haven't seen anything unique yet from the competitive landscape with contract labor and so forth, but I've got to believe that they are facing many of the same challenges as we do. And I believe over time we've been able to use our operating discipline, use our systems, use the learnings that we have across the company to create advantage for us. And I believe we will continue to do that.

但是我們還沒有從合同工等競爭格局中看到任何獨特的東西，但我必須相信他們面臨著許多與我們相同的挑戰。而且我相信，隨著時間的推移，我們已經能夠使用我們的運營紀律，使用我們的系統，利用我們在整個公司獲得的經驗為我們創造優勢。我相信我們會繼續這樣做。

Your next question comes from the line of Joshua Raskin with Nephron Research.

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

Quick follow-up on contract labor. How long are those typical contracts in place? And then my real question is, are you having any issues with discharges, post-acute discharges? Is that impacting length of stay, driving up cost and obviously the same DRG, the same payment?

快速跟進合同工。這些典型的合同執行了多長時間？然後我真正的問題是，您是否對出院、急性出院有任何問題？這是否會影響逗留時間、推高成本以及明顯相同的 DRG、相同的付款？

Yes, Josh. It's Bill. Typically, those contracts range around 13 weeks, so it takes time to adjust. But given the size, they're always flowing through our system on there.

是的，喬什。是比爾。通常，這些合同的期限約為 13 週，因此需要時間來調整。但考慮到規模，它們總是流經我們的系統。

And relative to post-acute and discharge planning, I would say yes. I think that's part of our case management initiatives that I spoke to in my prepared comments. I think the supply and demand dynamics in post-acute, whether it be skilled nursing or other post-acute settings, from time to time can cause a backup in our discharges. And that's why we're trying to advance and utilize some technologies, advance a common organizational structure around case management, so we can continue to focus on that and improve that length of stay when patients are ready to go home and there's appropriate levels of discharges. But that is a dynamic out there. There's no doubt about it. But I think we're focusing a lot of effort and energy and resources to try to continue to improve in that area.

相對於急性期和出院後的計劃，我會說是的。我認為這是我在準備好的評論中談到的案例管理計劃的一部分。我認為急性後的供需動態，無論是熟練的護理還是其他急性後環境，不時會導致我們的出院後備。這就是為什麼我們試圖推進和利用一些技術，推進圍繞病例管理的共同組織結構，這樣我們就可以繼續專注於這一點，並在患者準備回家並且出院水平適當時延長住院時間.但這是一個動態。毫無疑問。但我認為我們正在集中大量的精力、精力和資源來嘗試在該領域繼續改進。

Your next question comes from the line of Jason Cassorla with Citi.

您的下一個問題來自花旗銀行的 Jason Cassorla。

Great. I just want to go back to your comments around the initiatives for retention, recruitment, capacity management and new care models. Can you just help in terms of what is different with these initiatives today maybe compared to perhaps how you utilized these initiatives back in 3Q '21 when labor was picking up? Is it just more intensity there? Or are you leveraging incremental levers that maybe weren't considered or pretty utilized back then? And then if possible, can you help quantify the offset of these programs or initiatives related to the $400 million to $500 million net pressure regarding the higher wages and costs with the revised guidance?

偉大的。我只想回到您對保留、招聘、能力管理和新護理模式舉措的評論。您能否就今天的這些舉措與您在 21 年第三季度勞動力回升時利用這些舉措的方式相比有何不同？只是那裡的強度更大嗎？或者您是否正在利用當時可能沒有考慮或沒有充分利用的增量槓桿？然後，如果可能的話，您能否通過修訂後的指導來幫助量化這些與 4 億至 5 億美元的淨壓力相關的計劃或舉措的抵消？

Yes. I'll start and let Sam kick in. I think it's a mix of both escalating existing initiatives and new ones. One, I'll give an example, and Sam mentioned this earlier, around recruitment. We've increased our investment in recruiter significantly, and that's been a really intentional effort. Same around retention. We're putting common retention strategies across the organization on there.

是的。我將開始讓 Sam 加入。我認為這是不斷升級的現有計劃和新計劃的混合。第一，我舉個例子，山姆在前面提到過，關於招聘。我們已經顯著增加了對招聘人員的投資，這是一項非常有目的的努力。保留率也一樣。我們在整個組織中製定了通用的保留策略。

And then the case management that I mentioned in my comments, we recently approved an effort to really align organizationally around our case management strategies. And we're investing in new technologies to give us better predictive assessments of patients' needs at discharge. So it's a combination of accelerating and emphasizing existing efforts as well as implementing new ones. And it kind of touches all bases, if you will, between recruitment, retention, capacity management.

然後是我在評論中提到的案例管理，我們最近批准了一項真正在組織上圍繞我們的案例管理策略進行調整的努力。我們正在投資新技術，以便更好地預測患者出院時的需求。因此，這是加速和強調現有工作以及實施新工作的結合。如果你願意的話，它會觸及所有基礎，包括招聘、保留、能力管理。

And new care models, as you know, can we -- can we bring new support staff to support the care teams, whether it be through patient care techs, through patient safety attendants and the like. So we've got a number of initiatives to try to just, as I said in my comments, continue to support the team and ease those pressures.

如您所知，新的護理模式，我們能否帶來新的支持人員來支持護理團隊，無論是通過患者護理技術人員，還是通過患者安全服務員等。因此，正如我在評論中所說，我們採取了許多舉措來嘗試繼續支持團隊並緩解這些壓力。

I would say in our guidance, in our original guidance, we had already factored in some impact of those. And we're going to continue to focus on those to try to, I think, counter some of the market pressures that we are seeing.

我想說，在我們的指導中，在我們最初的指導中，我們已經考慮了這些影響。我認為，我們將繼續關注那些試圖應對我們所看到的一些市場壓力的產品。

Your next question comes from the line of Jamie Perse with Goldman Sachs.

您的下一個問題來自高盛集團的 Jamie Perse。

Question on volumes. Last year, the timing of the COVID wave was pretty similar to what it looked like this year. You had a really nice acceleration in 2Q last year in terms of volumes across the board. What are you seeing now in terms of volumes? And is last year's experience a good proxy for how we should be thinking about the acceleration into 2Q?

關於卷的問題。去年，COVID 浪潮的時間與今年的情況非常相似。就整體銷量而言，您去年第二季度的增長非常好。你現在看到的數量是多少？去年的經歷是否可以很好地代表我們應該如何考慮加速進入第二季度？

And then just one quick follow-up. Can you guys give us what percent of your managed care contracts are in place for 2023?

然後只是一個快速的跟進。你們能告訴我們2023年管理式醫療合同的百分比嗎？

So February and March, which were obviously months post Omicron surge, behaved similarly to the holiday surge that occurred at the end of 2020 and on into the first part of 2021. Again, we had solid non-COVID admission growth in February and March, as Bill alluded to, in the mid-single digits. So we're encouraged by that. There's nothing to suggest that the patterns will be different. But again, we're learning, obviously, as we go through these patterns. And we're hopeful that we won't have any more surges, and we'll be able to judge some of these patterns more effectively.

因此，2 月和 3 月顯然是 Omicron 激增之後的幾個月，其表現與 2020 年底和 2021 年上半年發生的假期激增相似。同樣，我們在 2 月和 3 月實現了穩健的非 COVID 入學增長，正如比爾所暗示的那樣，在個位數中。所以我們對此感到鼓舞。沒有任何跡象表明模式會有所不同。但同樣，當我們經歷這些模式時，我們顯然正在學習。我們希望我們不會再出現任何激增，我們將能夠更有效地判斷其中一些模式。

With respect to our payer contracts, we're about 50% contracted for 2023 and about 30% contracted for 2024. Again, those capacities in each of those years give us opportunities to adjust some of the inflationary expectations to the realities that we have today.

關於我們的付款人合同，我們在 2023 年簽訂了約 50% 的合同，在 2024 年簽訂了約 30% 的合同。同樣，這些年的這些能力使我們有機會根據我們今天的現實調整一些通脹預期.

Your next question comes from the line of Sarah James of Barclays.

您的下一個問題來自巴克萊的 Sarah James。

You've been talking about the majority of the pressure being on temp labor, but I was hoping you could unpack that a little bit. Are you talking about 2/3, 1/3 temp labor to kind of the longer-tailed items like wage inflation and bonuses or a more extreme split?

你一直在談論臨時工的大部分壓力，但我希望你能解開一點。您是在談論 2/3、1/3 的臨時工與工資通脹和獎金等長尾項目，還是更極端的分裂？

And you guys are in a unique position owning a nursing school. So are you seeing any shift in what field students are selecting? And how is that influencing your strategy?

你們擁有一所護士學校，處於一個獨特的位置。那麼，您是否看到學生選擇的領域有任何變化？這對您的策略有何影響？

I don't know, Bill, if we -- if I have the split right in front of me to be able to answer the first question, but let me speak to the second question, and we can get back to you on that first question with a little bit more specificity if we can.

我不知道，比爾，如果我們 - 如果我面前有分裂能夠回答第一個問題，但讓我談談第二個問題，我們可以先回复你如果可以的話，問題更具體一點。

It's still early for us with the Galen College of Nursing programs and expansions. But just looking at some of the new schools that we've opened, Austin, Texas, Nashville, Tennessee, parts of South Carolina, the enrollment in a couple of those situations is record-level enrollment in nursing program in the Galen College of Nursing. So we've seen a really robust initial enrollment. That gives us confidence.

蓋倫護理學院的課程和擴展對我們來說還為時過早。但看看我們開辦的一些新學校，德克薩斯州奧斯汀、田納西州納什維爾、南卡羅來納州部分地區，其中一些情況的入學率是蓋倫護理學院護理項目的創紀錄水平.所以我們已經看到了一個非常強大的初始註冊。這給了我們信心。

We also believe that we have an opportunity to integrate those students into our organization to support current needs as well as hopefully create synergy as they graduate the program and want to come to work for HCA Healthcare. So we're really encouraged by the prospects. But again, that's more intermediate run kind of a gain, although there will be some short run with nurse externs and rotations and so forth that we can utilize hopefully effectively to support current day needs. But the initial enrollment in a number of these new schools would suggest that there's still a reasonable supply of students who want to go into nursing schools.

我們還相信，我們有機會將這些學生整合到我們的組織中，以支持當前的需求，並希望在他們畢業並希望為 HCA Healthcare 工作時產生協同效應。因此，我們對前景感到非常鼓舞。但同樣，這是更多的中期收益，儘管會有一些短期的護士實習和輪換等等，我們可以希望有效地利用這些來支持當前的需求。但是，這些新學校的初始入學人數表明，仍有合理的學生想要進入護士學校。

Maybe bill has an answer. I guess -- I think Bill has an answer to your second question.

也許比爾有答案。我想——我認為比爾已經回答了你的第二個問題。

No, no, I don't have an answer, Sarah. We'll have to get back with you. I think our overall labor market is a combination of the temporary labor and some of the base wage inflation. I can't split it for you exactly. We'll get back with you on that, but it's a combination of both.

不，不，我沒有答案，莎拉。我們得回去陪你。我認為我們的整體勞動力市場是臨時勞動力和一些基本工資通脹的結合。我不能準確地為你拆分它。我們會與您聯繫，但這是兩者的結合。

Just to clarify on the nursing school, I was trying to understand like the structural shift that's going on, if your graduating nurses are selecting one field like surgical versus home health versus like if you're seeing just like a structural shift in where graduating nurses are going.

只是為了澄清護士學校，我試圖理解正在發生的結構性轉變，如果你的即將畢業的護士正在選擇一個領域，比如外科手術與家庭健康，而不是你看到畢業護士的結構性轉變要去。

No, no, we're not.

不，不，我們不是。

Your next question comes from the line of Matt Borsch with BMO Capital Markets.

您的下一個問題來自 BMO Capital Markets 的 Matt Borsch。

Question is off-topic for the quarter, but there's -- I have been following this closely, but there's been obviously an ongoing dialogue around compliance with the price transparency regulations. And I know there's a lot of complexity to the implementation. But can you just address where, from your standpoint, you are with that? And what -- when you would expect to get, if not already, to full compliance on that?

問題是本季度的題外話，但有 - 我一直在密切關注這一點，但顯然圍繞遵守價格透明度法規進行了持續對話。而且我知道實施有很多複雜性。但是你能不能從你的角度談談你在哪裡？什麼 - 當你期望得到，如果還沒有，完全遵守？

Go ahead, Sam, if you want to.

來吧，山姆，如果你願意的話。

Well, I was going to say, we believe we are compliant with the CMS rules, which are tremendously complex and in many ways difficult to implement because of the variations that exist from one commercial contract to another and from one market to another. So we have, through an internal process, established a program that we believe and CMS has validated in certain circumstances is compliant. And we continue to try to refine those presentations in ways that, again, satisfy CMS' evolving interpretation as well as our ability to adjust some of our postings to meet the evolving requirements.

好吧，我想說的是，我們相信我們遵守 CMS 規則，這些規則非常複雜，並且在許多方面難以實施，因為從一個商業合同到另一個商業合同以及從一個市場到另一個市場存在差異。因此，我們通過內部流程建立了一個我們認為並且 CMS 已驗證在某些情況下合規的計劃。我們繼續嘗試以再次滿足 CMS 不斷變化的解釋以及我們調整某些帖子以滿足不斷變化的要求的能力的方式改進這些演示文稿。

Your last question today comes from the line of Ben Hendrix with RBC Capital Markets.

您今天的最後一個問題來自加拿大皇家銀行資本市場的 Ben Hendrix。

Just to get to that 1/3 of the guide down that's related to the lower acuity on COVID volume, is there any way to give us an idea of the margin differential between the lower-acuity patients you've seen through Omicron versus COVID patients historically and then versus a non-COVID inpatient admission?

只是為了達到與 COVID 體積的較低敏銳度相關的指南的 1/3，有沒有辦法讓我們了解您通過 Omicron 看到的低敏銳度患者與 COVID 患者之間的邊緣差異從歷史上看，然後與非 COVID 住院患者相比？

No. I think we'd have to follow up off-line on that. I don't have any specifics in front of me of the specific margins. But I do know when we have the acuity drop like we did, the revenue does flow through pretty much down to margin. But I don't have the exact percentages that I could share with you between these various variants that we've seen.

不，我認為我們必須對此進行離線跟進。我面前沒有任何關於特定邊距的細節。但我確實知道，當我們像以前一樣出現敏銳度下降時，收入確實會流向利潤率。但我沒有確切的百分比可以與您分享我們所看到的這些不同變體之間的百分比。

Okay. Emma, I think that's got it down.

好的。艾瑪，我想這已經解決了。

That concludes today's question-and-answer session.

今天的問答環節到此結束。

All right. Thank you, everyone.

好的。謝謝大家。

This concludes today's conference call. Thank you for attending. You may now disconnect.

今天的電話會議到此結束。感謝您的出席。您現在可以斷開連接。