Assure Holdings Corp (IONM) 2022 Q4 法說會逐字稿

Good morning, everyone, and welcome to the Assure Holdings Fourth Quarter and Full Year 2022 Earnings Call. (Operator Instructions) Please note this call may be recorded.

大家早上好，歡迎來到 Assure Holdings 第四季度和 2022 年全年收益電話會議。 （操作員說明）請注意，此通話可能會被錄音。

It is now my pleasure to turn today's program over to Brett Maas, Investor Relations Manager. Please go ahead.

現在我很高興將今天的計劃轉交給投資者關係經理 Brett Maas。請繼續。

Hello, everyone. Thank you for participating in today's conference call to discuss Assure Holdings' financial results for the fourth quarter and full year 2022. On the call today are Executive Chairman and CEO, John Farlinger; and CFO, John Price. Pre-market this morning, the company issued a press release announcing its results. The release is available on the Investor section of our website.

大家好。感謝您參加今天的電話會議，討論 Assure Holdings 第四季度和 2022 年全年的財務業績。今天參加電話會議的有執行董事長兼首席執行官 John Farlinger；首席財務官 John Price。今天上午盤前，公司發布了一份新聞稿，公佈了業績。該新聞稿可在我們網站的投資者部分獲得。

Before we begin the prepared remarks, I'd like to remind that some of the statements made will be forward-looking and are made under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those projected or implied due to a variety of factors. We refer you to Assure's recent filings with the SEC, including our annual report on Form 10-K for the full year for a more detailed discussion of the risks that could impact the company's future operating results and financial condition.

在我們開始準備好的評論之前，我想提醒一下，一些陳述將是前瞻性的，並且是根據 1995 年的《私人證券訴訟改革法案》做出的。實際結果可能與預期或暗示的結果大不相同，原因是各種因素。我們建議您參考 Assure 最近向美國證券交易委員會提交的文件，包括我們全年的 10-K 表格年度報告，以更詳細地討論可能影響公司未來經營業績和財務狀況的風險。

Also on today's call, management will reference certain non-GAAP financial measures which we believe provide useful information to investors. For a reconciliation of these non-GAAP measures, please consult the most recently filed 8-K associated with the filing of the earnings release for the year ended December 31, 2022, which is available on SEC's website.

同樣在今天的電話會議上，管理層將參考某些非 GAAP 財務指標，我們認為這些指標可為投資者提供有用的信息。如需對這些非 GAAP 措施進行核對，請查閱最近提交的與截至 2022 年 12 月 31 日止年度的收益發布備案相關的 8-K，該報告可在 SEC 網站上獲取。

Finally, I would like to remind everyone who have dialed into the call by telephone, you may want to join our webcast, and this call will be recorded and made available for replay via link and on the company's website. Now I'd like to turn the call over to the Executive Chairman and CEO of Assure Holdings, John Farlinger. John?

最後，我想提醒所有通過電話撥入電話的人，您可能想加入我們的網絡廣播，這個電話將被記錄下來，可以通過鏈接和公司網站重播。現在我想把電話轉給 Assure Holdings 的執行主席兼首席執行官約翰法林格。約翰？

Thank you, Brett. Hello, everyone, and thanks for joining us today. We're obviously disappointed by year-end results. However, a lot more elaboration is needed to get clarity on the position of our business at the current time.

謝謝你，布雷特。大家好，感謝今天加入我們。我們顯然對年終結果感到失望。但是，需要進行更多的闡述才能弄清楚我們當前的業務狀況。

We finished 2022 with a managed case volume of 21,557, well within our guidance and expectations for between 21,000 and 22,000 managed procedures. This represents an increase of 24% in managed case volume over last year, a compelling metric for the underlying strength of our business. During 2022, we provided oversight to over 14,000 surgeries. There continues to be strong demand for our services.

到 2022 年，我們的管理案例數量為 21,557 個，完全符合我們對 21,000 到 22,000 個管理程序的指導和預期。這表明管理案例數量比去年增加了 24%，這是衡量我們業務潛在實力的一個令人信服的指標。 2022 年期間，我們監督了超過 14,000 次手術。對我們服務的需求持續強勁。

Interoperative neuromonitoring is essential for invasive surgeries that place the nervous system at risk. It is a standard of care and surgeons agree it is a vital resource in the operating room. Importantly, our business remains highly scalable with compelling unit economics despite what have been significant reimbursement challenges that are plaguing not only the interoperative neuromonitoring industry, but the larger health care industry in general.

術中神經監測對於將神經系統置於危險之中的侵入性手術至關重要。這是一種護理標準，外科醫生認為它是手術室的重要資源。重要的是，儘管重大的報銷挑戰不僅困擾著術間神經監測行業，而且困擾著整個更大的醫療保健行業，但我們的業務仍然具有很高的可擴展性和令人信服的單位經濟效益。

We are taking the actions necessary to counterbalance a challenging reimbursement landscape by exiting the shared revenue MSA model, utilizing our internal RCM function and greatly accelerating our cash collections from commercial payers, facilities and patients. And further, we are continuing to reduce our cost of delivery by leveraging our tele-neurology services.

我們正在採取必要的行動，通過退出共享收入 MSA 模型、利用我們的內部 RCM 功能並大大加快我們從商業付款人、設施和患者那裡收取現金來平衡具有挑戰性的報銷環境。此外，我們正在通過利用我們的遠程神經病學服務繼續降低交付成本。

On the revenue side, we made the prudent decision to implement a new accounts receivable accrual and reserve strategy during 2022. Our new accounting estimation practice reserves and writes down claims earlier in the accounts receivable aging process. This led to a much higher accounts receivable reserve in 2022, which negatively impacted our net revenue.

在收入方面，我們謹慎地決定在 2022 年實施新的應收賬款應計和準備金策略。我們新的會計估計實踐在應收賬款賬齡過程中更早地準備和減記索賠。這導致 2022 年的應收賬款準備金大幅增加，對我們的淨收入產生了負面影響。

We recorded gross revenue of approximately $28.9 million. A bad debt charge of $17.9 million resulted in net revenues of $11 million for the year ending December 31, 2022.

我們記錄的總收入約為 2890 萬美元。 1790 萬美元的壞賬支出導致截至 2022 年 12 月 31 日止年度的淨收入為 1100 萬美元。

A number of factors led to this reserve. During 2022, we experienced a more than 60% decrease in the Texas state arbitration rate beginning in October, which not only negatively impacted our accrual rate but also increased our accounts receivable reserve. Additionally, collections on the COVID period during 2020, these claims were negligible, also increasing our bad debt expense.

許多因素導致了這種儲備。在 2022 年期間，從 10 月開始，德克薩斯州仲裁率下降了 60% 以上，這不僅對我們的應計利率產生了負面影響，還增加了我們的應收賬款準備金。此外，在 2020 年 COVID 期間的收款中，這些索賠微不足道，也增加了我們的壞賬費用。

All the while, the company continued to experience accelerated cash receipts collecting $21 million in 2022 compared to $13 million in 2021 and reducing our days to collect to 105 in 2022 compared to 209 in 2021. We're taking a pragmatic approach to accounts receivable reserves, given the challenges associated with collecting certain receivables and persistent industry headwinds. Using this approach, we've increased visibility and substantially reduced our risk of future write-downs for uncollectible accounts going forward.

與此同時，公司的現金收入繼續加速增長，從 2021 年的 1300 萬美元增加到 2022 年的 2100 萬美元，並將我們的收款天數從 2021 年的 209 天減少到 2022 年的 105 天。我們對應收賬款準備金采取務實的態度，鑑於與收取某些應收賬款和持續的行業逆風相關的挑戰。使用這種方法，我們提高了可見性，並大大降低了未來因無法收回的賬戶而減記的風險。

The reimbursement environment was challenging in 2022 to say the least and serves a significant negative factor for our financial results. It impacted our top line revenue, our profitability per case and our margins.

至少可以說，2022 年的報銷環境充滿挑戰，對我們的財務業績構成重大負面影響。它影響了我們的收入、每箱利潤和利潤率。

For federal reimbursements, the time from submission to resolution continues to be extremely long. The federal No Surprises legislation, which went into effect in January of 2022, was passed with the best of intentions: to protect consumers and provide health care providers with the ability to arbitrate claims, where service was performed, but a fair rate was not paid. However, implementation of the legislation has been an other failure on the part of the federal governments as the federal agencies have faced numerous operational challenges, including a significantly higher number of claims than anticipated, which has led to lengthy times to resolve outstanding claims. And this is ramping across the entire health care industry.

對於聯邦報銷，從提交到解決的時間仍然非常長。於 2022 年 1 月生效的聯邦 No Surprises 立法以最佳意圖獲得通過：保護消費者並為醫療保健提供者提供仲裁索賠的能力，其中提供了服務，但未支付公平費用.然而，立法的實施是聯邦政府的另一個失敗，因為聯邦機構面臨著許多運營挑戰，包括索賠數量明顯高於預期，這導致解決未決索賠的時間很長。這正在整個醫療保健行業蔓延。

To date, we have filed nearly 400 claims under this legislation. Just last month, we had our first case adjudicated. While the results were positive, it's anecdotal until we process more cases through the federal bottleneck. While the time from submission to resolution is consistently longer in the 90 days prescribed by the legislation, 7 months was what it took for our first case.

迄今為止，我們已根據該立法提出近 400 項索賠。就在上個月，我們對第一起案件進行了裁決。雖然結果是積極的，但在我們通過聯邦瓶頸處理更多案件之前，這只是軼事。雖然在立法規定的 90 天內，從提交到解決的時間一直更長，但我們的第一個案例只用了 7 個月。

We are encouraged by this first win. We expect to file an increasing number of federal arbitration cases in 2023. The resolution of these claims in a timely manner will have an impact on future profitability and cash flow.

我們對這首場胜利感到鼓舞。我們預計 2023 年將提交越來越多的聯邦仲裁案件。及時解決這些索賠將對未來的盈利能力和現金流產生影響。

For state reimbursements, there was a significant reduction in benchmark reimbursement rates that went into effect in October. And there have been a number of challenging technical issues surrounding the inbound filing of claims. We believe the commercial insurance companies are lobbying in certain states to secure reduced reimbursement rates causing downward pressure on our accrual rates.

對於國家報銷，10 月份生效的基準報銷率大幅降低。圍繞入境索賠提出了許多具有挑戰性的技術問題。我們認為商業保險公司正在某些州遊說以確保降低報銷率，從而對我們的應計利率造成下行壓力。

The gamesmanship that surrounds provider reimbursement is a cloud over the entire industry. Just recently, one of our private equity-backed competitors was forced to show its stores. This was a competitor that had been in business for much longer than Assure. Reimbursement environment further supports our decision to develop internal revenue cycle management resources, which continue to be critical to our business.

圍繞提供商報銷的遊戲技巧是籠罩整個行業的陰雲。就在最近，我們的一家私募股權支持的競爭對手被迫展示其門店。這是一個比 Assure 經營時間長得多的競爭對手。報銷環境進一步支持我們開發內部收入周期管理資源的決定，這對我們的業務仍然至關重要。

Smaller competitors that rely on third-party billing companies are vulnerable to the current turmoil surrounding federal and state reimbursements, primarily because they don't have a framework or the tools to analyze the data or arbitrate like we do. We have developed a more data-driven analytical approach to understanding and managing our revenue cycle and reimbursement per case. We believe that this remains a key differentiator in our business.

依賴第三方計費公司的較小競爭對手很容易受到當前圍繞聯邦和州報銷的動蕩的影響，主要是因為他們沒有像我們這樣的框架或工具來分析數據或進行仲裁。我們開發了一種更加數據驅動的分析方法來理解和管理我們的收入周期和每個案例的報銷。我們相信，這仍然是我們業務的關鍵差異化因素。

Consistent success in arbitration is essential and you need the data and analytics to win cases and be successful. We believe the arbitration process will ultimately lead to in-network contractual agreements with commercial insurance payers, which in turn will speed up cash flow and improve participation ranks. There was a strengthening case for industry consolidation in the near term, and we expect to selectively pursue M&A opportunities that will help us to expand our managed case volume in 2023.

仲裁的持續成功至關重要，您需要數據和分析來贏得案件並取得成功。我們相信仲裁過程最終將導致與商業保險付款人達成網絡內合同協議，這反過來將加快現金流並提高參與排名。近期行業整合的情況有所加強，我們預計將有選擇地尋求併購機會，這將有助於我們在 2023 年擴大我們的管理案例數量。

2022, we extended our geographical reach to include the State of New Jersey, which historically has had a strong reimbursement profile being among the top 5 in the United States. 2023, we are looking to add business in this new market as well as expand in high-performing markets like Texas and Colorado, where we already have a significant footprint.

到 2022 年，我們將地理範圍擴大到包括新澤西州，該州歷來擁有強大的報銷概況，在美國排名前 5 位。到 2023 年，我們希望在這個新市場增加業務，並在德克薩斯州和科羅拉多州等我們已經擁有重要足蹟的高性能市場擴張。

On the cost side, in February this year, we initiated an incremental cost reduction plan that targets a further $2 million reduction in annualized operating costs. The elements of this plan include a reduction in salaries for current staff and a reduction in headcount. We expect the impact of this plant will become more evident in our financial results beginning in the second quarter of fiscal 2023. This plan is an addition to the more than $4 million in salary and workforce reductions as well as other costs that was introduced earlier in 2022.

在成本方面，今年 2 月，我們啟動了一項增量成本削減計劃，目標是將年度運營成本進一步削減 200 萬美元。該計劃的要素包括降低現有員工的薪水和裁員。我們預計從 2023 財年第二季度開始，該工廠的影響將在我們的財務業績中變得更加明顯。該計劃是對超過 400 萬美元的工資和勞動力削減以及 2023 年早些時候推出的其他成本的補充。 2022.

While the industry is facing a number of challenges, we are optimistic we will overcome all these hurdles in 2023. We have a robust infrastructure of professionals, capital equipment and processes that serve the interoperative neuromonitoring space well and data analytics on the back end to help us manage and improve our revenue cycle management process.

雖然該行業面臨著許多挑戰，但我們樂觀地認為，我們將在 2023 年克服所有這些障礙。我們擁有強大的專業人員基礎設施、資本設備和流程，可以很好地服務於互操作神經監測空間和後端數據分析，以幫助我們管理和改進我們的收入周期管理流程。

Through cost cutting and the use of analytics, we are positioned to withstand the industry challenges around reimbursement and achieve sustained profitability and cash flow from operations during the second half of 2023. We are rightsizing our business to be a self-sustaining operation. Again, interoperative neuromonitoring is essential for invasive surgeries that place the nervous system at risk and is a vital resource in the operating room. The demand is still there.

通過削減成本和使用分析，我們有能力應對報銷方面的行業挑戰，並在 2023 年下半年實現持續的盈利能力和運營現金流。我們正在調整我們的業務，使其成為一個自我維持的業務。同樣，術中神經監測對於將神經系統置於危險之中的侵入性手術至關重要，並且是手術室中的重要資源。需求仍然存在。

I want to point out that notwithstanding the issues around the reserve, our total cash collected has steadily increased into the trailing 6-, 12- and 24-month period basis. We continue to experience strong cash collections and collected $21 million in 2022 compared to $13.4 million in 2021. Total cash collections, including MSA collections, were $27.5 million in 2022 compared to $22.7 million in 2021.

我想指出，儘管儲備金存在問題，但我們收集的現金總額在過去 6 個月、12 個月和 24 個月期間穩步增加。我們繼續經歷強勁的現金收款，2022 年收款 2100 萬美元，而 2021 年為 1340 萬美元。2022 年現金收款總額（包括 MSA 收款）為 2750 萬美元，而 2021 年為 2270 萬美元。

We would further benefit from in-network agreements, which we anticipate to achieve during 2023. Additionally, we are no longer supporting managed service agreements that require revenue shares with our surgeon partners. And we have exited the majority of these business agreements and expect to fully exit by the second quarter of 2023.

我們將進一步受益於我們預計在 2023 年實現的網絡內協議。此外，我們不再支持需要與我們的外科醫生合作夥伴分享收入的託管服務協議。我們已經退出了這些業務協議中的大部分，預計將在 2023 年第二季度之前完全退出。

As a result, we anticipate achieving and collecting an additional $200,000 or more of incremental cash receipts per month as a result of controlling all of that cash flow that was currently shared under MSAs. Importantly, we are driving higher participation rates, shortening our cash cycle and achieving better collections.

因此，由於控制了目前在 MSA 下共享的所有現金流，我們預計每月會實現並收取額外 200,000 美元或更多的增量現金收入。重要的是，我們正在推動更高的參與率，縮短我們的現金周期並實現更好的收款。

We have built a sophisticated data-driven revenue cycle management function that is continuing to improve collections and improve our visibility into the market. We're off to an encouraging start in 2023, with first quarter revenue collections better than our internal forecast and headed toward what we believe will be measurable improvement.

我們已經建立了一個複雜的數據驅動的收入周期管理功能，該功能將繼續改進收款並提高我們對市場的知名度。我們在 2023 年開局令人鼓舞，第一季度的收入好於我們的內部預測，並朝著我們認為可衡量的改善方向邁進。

The percentage of first pass payment rates has been increasing. Days to pay have been reduced and commercial payers are paying at a higher rate versus last year. While still early in the year, reimbursement rates appear to be stabilizing and possibly rebounding from 2022. And we are moving closer toward receiving a fair rate for the services we provide.

首次通過支付率的百分比一直在增加。付款天數已經減少，商業付款人的付款率高於去年。雖然還在今年年初，但報銷率似乎正在穩定並可能從 2022 年開始反彈。我們正朝著我們提供的服務獲得公平費率的目標邁進。

Looking ahead, we are focused on aligning our costs with updated management case, revenue expectations and adding scale in favorable markets and fixing, controlling and reducing the cost of delivering our services.

展望未來，我們專注於使我們的成本與更新的管理案例、收入預期保持一致，並在有利的市場中擴大規模，並固定、控制和降低提供我們服務的成本。

Next, John Price will walk us through the full year financials. John?

接下來，John Price 將向我們介紹全年的財務狀況。約翰？

Thanks, John, and thank you, everyone, for joining us today. We continue to grow our procedure count, performing approximately 5,400 managed cases during the fourth quarter, an increase over the prior year's fourth quarter and bringing our total for the year to 21,557.

謝謝約翰，謝謝大家今天加入我們。我們繼續增加我們的程序數量，在第四季度執行了大約 5,400 個管理案例，比去年第四季度有所增加，使我們全年的總數達到 21,557 個。

The fourth quarter is typically a seasonally strong quarter in our business, and we had experienced a more beneficial revenue mix with a higher proportion of patients utilizing more profitable commercial insurance programs relative to the proportion of facility patients. As a reminder, we exited the underperforming markets of Louisiana and Nevada during 2022.

第四季度通常是我們業務的季節性強勁季度，我們經歷了更有利的收入組合，相對於設施患者的比例，使用更有利可圖的商業保險計劃的患者比例更高。提醒一下，我們在 2022 年退出了表現不佳的路易斯安那州和內華達州市場。

For the full year, we reported gross revenue of $28.9 million and net revenue of $11 million. Net loss was $30.7 million. Adjusted EBITDA loss was $18.5 million. Our gross revenue was negatively impacted by implicit price concessions of $17.9 million related to aged claims and a change in accrual rates from downward pressure on reimbursement. Based on our historical experience, claims generally become uncollectible once they are aged greater than 24 months.

全年，我們報告的總收入為 2890 萬美元，淨收入為 1100 萬美元。淨虧損為 3070 萬美元。調整後的 EBITDA 虧損為 1850 萬美元。我們的總收入受到與老年索賠相關的 1790 萬美元隱性價格優惠以及報銷下行壓力導致的應計利率變化的負面影響。根據我們的歷史經驗，索賠一旦超過 24 個月就無法收回。

As such, our implicit price concessions include an estimate of the likelihood that a portion of our accounts receivable may become uncollectible due to age. As John discussed, we refined our accounts receivable reserve process that now takes a more conservative approach to AR reserves.

因此，我們的隱性價格優惠包括對我們的一部分應收賬款可能因賬齡無法收回的可能性的估計。正如約翰所討論的，我們改進了我們的應收賬款準備金流程，現在對應收賬款準備金采取更保守的方法。

As a result, we begin to build a valuation reserve against claims earlier in the aging process. This process led to a significantly higher AR reserve in 2022, which negatively impacted our financial results and made for a challenging comparison to the prior year.

因此，我們開始為老化過程中較早的索賠建立估值儲備。這一過程導致 2022 年應收賬款準備金顯著增加，這對我們的財務業績產生了負面影響，並與上一年相比具有挑戰性。

At December 31, 2022, the total accounts receivable reserve was approximately $14 million and represents nearly 50% of our outstanding gross accounts receivable. Looking ahead, we expect a more normalized cadence to our accounts receivable reserve and are forecasting less than $2 million of reserves for the first quarter of 2023.

截至 2022 年 12 月 31 日，應收賬款準備金總額約為 1400 萬美元，占我們未清應收賬款總額的近 50%。展望未來，我們預計應收賬款準備金的節奏將更加正常化，並預測 2023 年第一季度的準備金將低於 200 萬美元。

As John mentioned, we began to experience a decline in our reimbursement rate starting in October '22 due to a revision in the Texas State benchmark, which negatively impacted revenue by $3.7 million for the year. This led to a lower expectation in payments in our largest market and lower accrual rate, hence driving down revenue.

正如 John 所提到的，由於德克薩斯州基準的修訂，我們從 22 年 10 月開始經歷了報銷率的下降，這對當年的收入產生了 370 萬美元的負面影響。這導致我們最大市場的付款預期降低，應計利率降低，從而導致收入下降。

Cost of revenues for 2022 were $15.2 million compared to $14.3 million for 2021, an increase of 6%. Importantly though, the number of managed cases increased 24% year over year. Through our cost-cutting measures, benefit of scale in the business from the growth in volume in tele-neurology services, we reduced our cost of delivery. In 2023, we are focused on further reducing our average cost of delivery and drive further improvement in gross margin.

2022 年的收入成本為 1520 萬美元，而 2021 年為 1430 萬美元，增長 6%。但重要的是，管理案例的數量同比增長了 24%。通過我們的成本削減措施，遠程神經病學服務量增長帶來的業務規模效益，我們降低了交付成本。 2023年，我們專注於進一步降低平均交付成本並推動毛利率進一步改善。

Operating expenses for 2022 were $23.6 million and include noncash goodwill impairment charge of $3.5 million. Additionally, we amended the useful life of certain intangible assets, resulting in an additional $3.1 million of noncash amortization expense. When excluding these charges, normalized operating expenses were $17 million, which is nearly flat compared to 2021.

2022 年的運營費用為 2360 萬美元，其中包括 350 萬美元的非現金商譽減值費用。此外，我們修改了某些無形資產的使用壽命，導致額外的 310 萬美元非現金攤銷費用。排除這些費用後，標準化運營費用為 1700 萬美元，與 2021 年相比幾乎持平。

Management will continue to evaluate our goodwill balance and anticipates a further impairment of goodwill of $1 million in the first quarter of 2023. We collected approximately $21 million of cash in 2022 compared to $13.4 million in 2021. Further, we continue to experience improvement in our average days to collect to 105 days in 2022 from 209 days in 2021, an important operating metric when measuring revenue cycle and use of working capital.

管理層將繼續評估我們的商譽餘額，並預計 2023 年第一季度商譽將進一步減值 100 萬美元。我們在 2022 年收取了大約 2100 萬美元的現金，而 2021 年為 1340 萬美元。此外，我們繼續改善我們的平均收集天數從 2021 年的 209 天減少到 2022 年的 105 天，這是衡量收入周期和營運資金使用的重要運營指標。

At December 31, 2022, 86% of our outstanding accounts receivable was aged 12 months or less from data service. In comparison, during the first quarter of 2022, just 68% of accounts receivable was part of the same category. A much larger portion of our accounts receivable are more current, which reduces our exposure and risk to future reserves.

截至 2022 年 12 月 31 日，我們 86% 的未清應收賬款的賬齡為 12 個月或更短，來自數據服務。相比之下，在 2022 年第一季度，只有 68% 的應收賬款屬於同一類別。我們的應收賬款中有很大一部分是流動性更強的，這降低了我們對未來儲備的敞口和風險。

I'll pass the call back over to John Farlinger for the first quarter and full year 2023 expectations. John?

關於 2023 年第一季度和全年的預期，我會將電話轉回給 John Farlinger。約翰？

Thank you, John. This is certainly a challenging business and a challenging industry. And notwithstanding the significant impact of downward reimbursement pressures, the company does have a number of things to be positive about. Firstly, cash collections exceeded $21 million in 2022 and we expect them to be strong in 2023. Total system-wide collections were a record $27.5 million.

謝謝你，約翰。這無疑是一項具有挑戰性的業務，也是一個具有挑戰性的行業。儘管向下報銷壓力產生了重大影響，但該公司確實有許多值得樂觀的事情。首先，2022 年現金收款額超過 2100 萬美元，我們預計 2023 年現金收款額將強勁。全系統收款總額達到創紀錄的 2750 萬美元。

Second, our plan is to be out of the MSA revenue-sharing agreements by the end of the second quarter of 2023, with over 70% of the remaining MSA volume becoming wholly owned by the end of the second quarter. Thirdly, we have shut down a number of unprofitable markets which will not be agreed on cash in 2023.

其次，我們的計劃是到 2023 年第二季度末退出 MSA 收入分成協議，到第二季度末，剩餘 MSA 量的 70% 以上成為全資擁有。第三，我們關閉了一些無利可圖的市場，這些市場不會在 2023 年達成現金協議。

Fourthly, the certainty of what we will recover on revenue being realized in the cash collections is now much more certain and there could be upside coming out of the federal arbitration process as it starts to take effect in 2023. Definitely, we're involving 2 pieces of outstanding litigation in Louisiana during the course of 2023, with the first going to trial in July. These could have a myriad of material impact on our cash position over the balance of the year.

第四，我們現在可以確定的是，我們將從現金收款中實現的收入中收回什麼，而且聯邦仲裁程序可能會在 2023 年開始生效時帶來好處。當然，我們涉及 2 2023 年期間路易斯安那州有許多未決訴訟，第一起將於 7 月開庭審理。這些可能會對我們今年餘下時間的現金狀況產生無數重大影響。

Further, we are finalizing our employer retention credit and expect a meaningful amount to be recovered from the IRS. This is a potential 7-figure recovery and will be filed over the next 10 days. We've historically been very successful in recovery, incentives and monies from the federal government over the past 3 years. We will continue to focus on driving our cost of delivery to less than $1,100 per patient including the cost of our RCM function so that we can meet the demands of lower reimbursement.

此外，我們正在最終確定我們的雇主保留信貸，並期望從美國國稅局收回一筆有意義的金額。這是一個潛在的 7 位數恢復，將在接下來的 10 天內提交。在過去的 3 年裡，我們在從聯邦政府那裡獲得的恢復、激勵和資金方面一直非常成功。我們將繼續專注於將我們的交付成本降低到每位患者 1,100 美元以下，包括我們的 RCM 功能的成本，以便我們能夠滿足較低報銷的需求。

And with that, I'll turn the call back over to the operator for Q&A. Thank you.

然後，我會將電話轉回給接線員進行問答。謝謝。

(Operator Instructions) The first question is coming from Jim Sidoti from Sidoti & Company.

（操作員說明）第一個問題來自 Sidoti & Company 的 Jim Sidoti。

So if you look at the $15 million of accounts receivables on the balance sheet today -- or I'm sorry, at the end of the year, how confident are you that you'll be able to collect those receivables?

所以，如果你看看今天資產負債表上的 1500 萬美元的應收賬款——或者對不起，在年底，你對能夠收回這些應收賬款有多大信心？

John Price, do you want to answer that question?

John Price，你想回答這個問題嗎？

(inaudible) on the call we revised our practice of estimating the bad debt. And we have talked about this on some of the other calls over the course of 2022, where we started to reserve accounts receivable earlier in the process which ultimately, more expense rolled through the 2022 financials. And we think we're in a really good spot at this point to address the bad debt and potential write-offs as we go forward. And you can see that in the forecast for Q1, we're anticipating less than $2 million of bad debt. And we've really reduced our exposure on a go-forward basis.

（聽不清）在電話會議上，我們修改了估計壞賬的做法。我們在 2022 年期間的其他一些電話會議上也談到了這一點，我們開始在此過程的早期預留應收賬款，最終，更多的費用流經了 2022 年的財務報表。我們認為我們在這一點上處於一個非常好的位置，可以在我們前進的過程中解決壞賬和潛在的註銷問題。你可以看到，在第一季度的預測中，我們預計壞賬將少於 200 萬美元。而且我們確實在前進的基礎上減少了我們的風險敞口。

And Jim, I think the key issue from our standpoint, we've significantly reduced the amount per claim that we're going to obtain here. And it's -- you've got all the data points now. You've got state arbitrations. You're probably going to have federal claims coming through now. And we've written off so much that we don't think there's a lot of downside on the accrual rates now.

吉姆，我認為從我們的角度來看，關鍵問題是我們已經大大減少了我們將在這裡獲得的每項索賠的金額。它是——你現在已經獲得了所有的數據點。你有州仲裁。您現在可能會收到聯邦索賠。而且我們已經註銷了太多，以至於我們認為現在的應計利率不會有太大的下行空間。

So the only other issue is, and then can you collect the money on a per claim basis. So we're feeling pretty good about that. In fact, there may be some upside going forward.

因此，唯一的另一個問題是，您能否在每次索賠的基礎上收取款項。所以我們對此感覺很好。事實上，未來可能會有一些上行空間。

The other thing is on our accounts receivable, there is also an MSA accounts receivable number. That is going to go away. As we have struck deals with our surgeon partners, we will take over a meaningful amount of that accounts receivable as well to collect on a go forward.

另一件事是在我們的應收賬款上，也有一個 MSA 應收賬款編號。那將會消失。由於我們與我們的外科醫生合作夥伴達成了交易，我們將接管相當數量的應收賬款，並在未來收款。

Okay. Can you talk about what you expect for procedure rates in the first quarter and then to 2023?

好的。你能談談你對第一季度和 2023 年手術率的預期嗎？

Yes. I think, again, here's the one problem we have so far. We've got hundreds of claims in queue through the IVR process other than No Surprises Act. We have very little data on that. But based on the information we have, we think a commercial claim will be worth probably between $2,200 and $2,400. In some cases, higher, but that's probably in the range of where we are going to settle right now, down significantly from a year ago at this time and probably down by 50% from where we were 2 years ago.

是的。我想，這也是我們迄今為止遇到的一個問題。除了 No Surprises Act 之外，我們還有數百個通過 IVR 流程排隊的索賠。我們這方面的數據很少。但根據我們掌握的信息，我們認為商業索賠的價值可能在 2,200 美元到 2,400 美元之間。在某些情況下，更高，但這可能在我們現在要解決的範圍內，比一年前的這個時候顯著下降，可能比 2 年前下降 50%。

And that's forced us to run much, much leaner. And John talked about where we brought the cost of delivery down. And we brought it probably down by about 30% to 40% or more in most states. And we've shut down states where we are not making margin in an attempt to conserve cash and become profitable in the very short term.

這迫使我們跑得更瘦。約翰談到了我們在哪些方面降低了交付成本。在大多數州，我們可能將其降低了約 30% 至 40% 或更多。我們已經關閉了我們沒有賺取利潤的州，以試圖節省現金並在短期內實現盈利。

Okay. And then how about in terms of number of procedures? You did a little over [5 million] in the fourth quarter, and that's with exiting Louisiana and Arizona. How many procedures do you expect to have completed at the end of Q1? And how many for the year?

好的。那麼在程序數量方面又如何呢？你在第四季度做了 [500 萬] 多一點，那是在離開路易斯安那州和亞利桑那州的情況下。您希望在第一季度末完成多少個程序？一年有多少？

Yes. Q1 will be -- is always our softest quarter. It is every year. I think we're looking at about 15% to 20% growth. That's what we're targeting this year in terms of procedure growth.

是的。第一季度將是——永遠是我們最疲軟的季度。每年都有。我認為我們正在尋找大約 15% 到 20% 的增長。這就是我們今年在程序增長方面的目標。

Okay. And that's for the quarter and for the year.

好的。這是本季度和全年的情況。

For the quarter, it's probably going to be -- it will be similar to last year. The only thing I would say is we have the benefit of an acquisition that we made in the last day of December, adding about 1,400 surgeries annually. So that will certainly help us get off to a better start and a faster start in 2023 and give us additional volume.

對於本季度，它可能會與去年相似。我唯一要說的是，我們受益於我們在 12 月最後一天進行的收購，每年增加約 1,400 台手術。因此，這肯定會幫助我們在 2023 年有一個更好的開端和更快的開端，並給我們帶來更多的銷量。

And then how are you managing cash at this point? You ended the year, I believe, it was under $1 million. Do you have access to a line of credit? How are you funding the operations?

那麼此時您如何管理現金？你年底，我相信，它不到 100 萬美元。您可以使用信用額度嗎？您如何為運營提供資金？

We've been -- we've pretty much been, over the last couple of months, staying roughly static on the cash position. And as I mentioned, there are a couple of things that we are working on. One is the stimulus program from the government, which we appear to qualify for. We've been successful in getting government funding back in the past through the PPP loans and other methods. And we're involved in 2 lawsuits, one of which wants to have a settlement discussion now. But obviously, it's more of a challenge for growth, Jim, in having limited working capital without doing something to continue to expand our business.

在過去的幾個月裡，我們一直 - 我們幾乎一直保持現金頭寸大致不變。正如我提到的，我們正在做幾件事。一個是來自政府的刺激計劃，我們似乎有資格獲得。過去，我們通過 PPP 貸款和其他方法成功地收回了政府資金。我們涉及 2 起訴訟，其中一起現在想進行和解討論。但顯然，吉姆，在沒有採取措施繼續擴大我們的業務的情況下，營運資金有限，這對增長來說更具挑戰。

Okay. But do you think with the cost-cutting initiatives that you have put in place that you'll have enough -- your cash flow is sufficient to sustain the current operations without any growth?

好的。但是，您是否認為通過實施的成本削減計劃，您的現金流足以維持當前的運營而無需任何增長？

We're not going to be able to hit our growth numbers without some additional capital, either through stimulus or equity or some additional debt on our line of credit.

如果沒有一些額外的資本，我們將無法達到我們的增長數字，無論是通過刺激或股票或我們信貸額度上的一些額外債務。

Okay. Okay. But -- okay. I think that's it for me.

好的。好的。但是——好吧。我想對我來說就是這樣。

(Operator Instructions) And the next question is coming from Bill Sutherland from Benchmark Company.

（操作員說明）下一個問題來自 Benchmark 公司的 Bill Sutherland。

The bad debt outlook now that you've got a much more improved current picture, well, and also the cleanup, what should we think about as far as gross versus net revenue for the year?

壞賬前景現在有了更好的改善，好吧，還有清理工作，就今年的總收入與淨收入而言，我們應該考慮什麼？

John, do you want to answer that question for our model?

約翰，你想為我們的模型回答這個問題嗎？

Bill, so for Q1, as we discussed on the call, it's -- we're forecasting it to be less than $2 million. And one of the topics where we attempted to tackle with the reserves is to just push most of that bad debt, address it in 2022 so that our gross revenue and net revenue really do start to align moving forward. I think that as you take a look over '23, we really should not have the same level of bad debt experience, obviously, that we saw in '22.

比爾，所以對於第一季度，正如我們在電話會議上討論的那樣，我們預測它會低於 200 萬美元。我們試圖用儲備解決的主題之一就是推動大部分壞賬，在 2022 年解決它，以便我們的總收入和淨收入真正開始保持一致。我認為當你回顧 23 年時，我們確實不應該有與 22 年相同水平的壞賬經歷。

Bill, one comment here. This was the first year where cash receipts even before the write-downs were approximating revenue. We're getting pretty close. And we see that continuing in the first quarter and the second quarter this year.

比爾，這裡有一個評論。這是第一年現金收入甚至在減記之前就接近收入。我們已經很接近了。我們看到今年第一季度和第二季度繼續如此。

So Jim, to your point, we're going to need to do something. But historically, revenue has far exceeded cash flow, and that was our problem. We weren't able to collect cash on a lot of these bad debts or a lot of the AR. And hence, it gained bad debt.

所以吉姆，就你的觀點而言，我們需要做點什麼。但從歷史上看，收入遠遠超過現金流，這就是我們的問題。我們無法從很多壞賬或很多應收賬款中收回現金。因此，它獲得了壞賬。

This is the first time where cash flow is either approximating or potentially exceeding revenue, which is helping us. And the other key data point is, as John pointed out, is the reduction in days to collect. And from the end of 2021 to the end of 2022, we cut those days in half. It went from approximately 200-plus days to 105. I think the numbers were 209 to 105.

這是現金流第一次接近或可能超過收入，這對我們很有幫助。正如約翰指出的那樣，另一個關鍵數據點是收集天數的減少。從 2021 年底到 2022 年底，我們將這些天數減少了一半。它從大約 200 多天變成了 105 天。我認為數字是 209 到 105。

So you're speeding up cash flow, and that is helping from a working capital standpoint. But our challenge is -- our goal is to continue to grow, consolidate and expand our business. That will be difficult to do without some additional capital. And so we've either got to expedite getting the money back from the federal government, so the lawsuit, or we're going to have to go back and raise some capital in the market.

所以你正在加速現金流，從營運資金的角度來看，這是有幫助的。但我們面臨的挑戰是——我們的目標是繼續發展、鞏固和擴大我們的業務。如果沒有一些額外的資金，這將很難做到。因此，我們要么必須加快從聯邦政府收回資金，即訴訟，要么我們將不得不回去在市場上籌集一些資金。

Right. And as you kind of hear about what's going on in the industry with the MSA negotiations at the federal level, do you sense that after this huge delay that the cases are going to start -- the filed cases are going to start to move through and be adjudicated?

正確的。當你聽說過聯邦層面的 MSA 談判在行業中發生的事情時，你是否感覺到在案件將開始的這種巨大延遲之後 - 已提交的案件將開始通過並且被判決？

We hope so. We've talked to the CEOs of most of our competitors, at least the larger competitors over the last month. We're all feeling the same frustration. I think we've been filibustered at the -- really rolling out of this No Surprises Act, but almost no claims paid to anybody.

我們希望如此。我們已經與大多數競爭對手的首席執行官進行了交談，至少在上個月是較大的競爭對手。我們都感到同樣的沮喪。我認為我們一直在阻撓 - 真正推出這個“無意外法案”，但幾乎沒有向任何人支付任何索賠。

Anecdotally, our team has been working really hard on the RCM side to get claims pushed through. We did get our first claim paid. Results were very optimistic, but it's anecdotal information. We don't have enough data yet. At a state level, we're pretty sure what we're going to get, and it's almost working like clockwork now in the states where we are arbitrating. But Bill, it's not, there isn't a certainty to that.

有趣的是，我們的團隊一直在 RCM 方面非常努力地工作，以推動索賠。我們確實得到了第一次索賠。結果非常樂觀，但這是軼事信息。我們還沒有足夠的數據。在州一級，我們非常確定我們會得到什麼，現在在我們仲裁的州，它幾乎像發條一樣運轉。但是比爾，這不是，這並不確定。

The other thing I will say is the financial statements don't reflect any upside through all these claims that are in queue to be arbitrated. And we believe there is some upside there, and there will be increased upside as this process starts, at least as it starts -- as it's intended to be used going forward. So there is some upside there. I think the feeling from the competitors that have been at this for 20 years is this is probably the toughest that they've seen it right now in that period. But most are optimistic that things are going to turn as the year goes on.

我要說的另一件事是，財務報表並未反映所有這些排隊等待仲裁的索賠的任何好處。我們相信那裡有一些好處，而且隨著這個過程的開始，好處會增加，至少在它開始的時候——因為它打算在未來使用。所以那裡有一些好處。我認為已經從事這項工作 20 年的競爭對手的感覺是，這可能是他們在那個時期看到的最艱難的一次。但大多數人樂觀地認為，隨著時間的推移，情況將會發生轉變。

Right. And then last one on the -- now that you've gotten your cost on a per patient basis down to $1,100 given the reimbursement mix that you're looking at, is that a decent margin at this point?

正確的。然後最後一個 - 考慮到您正在考慮的報銷組合，現在您已經將每位患者的成本降至 1,100 美元，此時這是一個不錯的利潤率嗎？

We want to go lower. We're going to strive to get this closer to $1,000. That's our goal in the first 6 months of this year. It won't be easy.

我們想走得更低。我們將努力使它接近 1,000 美元。這是我們今年前 6 個月的目標。這並不容易。

But at those numbers, I think we're -- we'll be feeling much better about the business. And we've taken a number of steps in the first quarter to reduce the cost of delivery and even looked at the financials from '21 to '22. You can see our cost of delivery, certainly on a cost of goods basis, has reduced.

但根據這些數字，我認為我們——我們會對這項業務感覺好得多。我們在第一季度採取了一些措施來降低交付成本，甚至研究了 21 年到 22 年的財務狀況。你可以看到我們的交付成本，當然是在商品成本的基礎上，已經降低了。

Certainly, we've made some good progress on the remote neurology side in getting additional margin there. We will pick up additional margin by getting out of the MSA business. It's going to be several hundred thousand dollars a month in margin that we will pick up going into Q2.

當然，我們在遠程神經病學方面取得了一些良好的進展，在那裡獲得了額外的利潤。我們將通過退出 MSA 業務獲得額外利潤。我們將在第二季度獲得每月數十萬美元的保證金。

I think those headwinds are going to work well for us. But the focus has got to be to continue to drive and run leaner going forward.

我認為這些不利因素會對我們有利。但重點必須是繼續推動和運行更精簡的前進。

There were no other questions in queue at this time. I would now like to hand the call back to the Assure management team for closing remarks.

此時隊列中沒有其他問題。我現在想將電話轉回給 Assure 管理團隊以作結束語。

It's John Farlinger. Obviously, myself and the team are disappointed with certainly the reserves and the challenges of the interoperative neuromonitoring industry. At the same time, there are some tremendous data points that show that we are making significant improvement in our business. Among those, making a significant dent in reducing the days to collect, making improvements in our cash flow, and improving our corporate cash flow by almost 50% over the prior year, and total cash collections continuing to improve significantly.

是約翰·法林格。顯然，我本人和團隊對術間神經監測行業的儲備和挑戰感到失望。與此同時，有一些巨大的數據點表明我們的業務正在取得顯著改善。其中，收款天數明顯減少，現金流改善，企業現金流比上年提高近50%，現金收款總額繼續顯著改善。

I think we're going to very tightly monitor the accruals going forward. We did last year. We just did not have -- I don't think many people have visibility into the change in the arbitration rates that are going to happen at the end of the year nor the rapid reduction in reimbursement as we saw it from '21 to '22. But we -- I think we are very optimistic now. We've hit a trough. We're stabilizing and our first quarter 2023 numbers were actually ahead of target in terms of cash flow and improving cash flow.

我認為我們將非常嚴格地監控未來的應計費用。我們去年做過。我們只是沒有——我認為很多人都沒有看到年底將要發生的仲裁費率的變化，也沒有看到我們從 21 年到 22 年看到的報銷的快速減少.但是我們——我認為我們現在非常樂觀。我們遇到了低谷。我們正在穩定，我們 2023 年第一季度的數據實際上在現金流和改善現金流方面超過了目標。

So I want to leave really the call with the fact that it was a tough year, but we are seeing improvement. And we're going to continue to work to drive our costs lower and to be able to meet the challenges of a changing market. Thank you very much. Have a great day.

所以我真的想留下一個事實，那就是這是艱難的一年，但我們看到了進步。我們將繼續努力降低成本，並能夠應對不斷變化的市場帶來的挑戰。非常感謝。祝你有美好的一天。

Thank you. This does conclude today's conference. You may disconnect your lines at this time, and have a wonderful day. Thank you for your participation.

謝謝。今天的會議到此結束。此時您可以斷開線路，度過美好的一天。感謝您的參與。