Pediatrix Medical Group Inc (MD) 2022 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the Fourth Quarter 2022 Earnings Conference Call. (Operator Instructions) And as a reminder, this call is being recorded. I'd now like to turn the call over to our host, Mr. Charles Lynch. Please go ahead, sir.

女士們，先生們，感謝你們的支持，歡迎來到 2022 年第四季度收益電話會議。 （操作員說明）作為提醒，此通話正在錄音中。我現在想把電話轉給我們的主持人查爾斯·林奇先生。請繼續，先生。

Thank you, operator. Good morning, everyone. I'll quickly read our forward-looking statements, and then we'll get into the call. Certain statements and information during this conference call may be deemed to be forward-looking statements within the meaning of the Federal Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on assumptions and assessments made by Pediatrix's as management in light of their experience and assessment of historical risk -- historical trends, current conditions, expected future developments and other factors they believe to be appropriate.

謝謝你，運營商。大家，早安。我將快速閱讀我們的前瞻性聲明，然後我們將開始通話。本次電話會議中的某些陳述和信息可被視為 1995 年聯邦私人證券訴訟改革法案含義內的前瞻性陳述。這些前瞻性陳述基於 Pediatrix 作為管理層根據以下情況做出的假設和評估：他們的經驗和對歷史風險的評估——歷史趨勢、當前條件、預期的未來發展和他們認為合適的其他因素。

Any forward-looking statements made during this call are made as of today, and pediatrics undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the company's most recent annual report on Form 10-K, its quarterly reports on Form 10-Q and its current reports on Form 8-K, including the sections entitled Risk Factors.

本次電話會議期間作出的任何前瞻性陳述都是截至今天作出的，兒科不承擔更新或修改任何此類陳述的義務，無論是由於新信息、未來事件或其他原因。可能導致實際結果、發展和業務決策與前瞻性陳述存在重大差異的重要因素在公司最近的 10-K 表格年度報告、10-Q 表格季度報告和當前 8 表格報告中有所描述-K，包括標題為風險因素的部分。

In today's remarks by management, we will be discussing non-GAAP financial metrics. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures can be found in this morning's earnings press release, our quarterly reports on Form 10-Q and our annual report on Form 10-K and on our website at www.pediatrix.com.

在今天的管理層發言中，我們將討論非 GAAP 財務指標。這些非 GAAP 財務指標與最具可比性的 GAAP 指標的對賬可以在今天上午的收益新聞稿、我們的 10-Q 表格季度報告和 10-K 表格年度報告以及我們的網站 www.pediatrix 上找到.com。

With that, I'll turn the call to our Executive Chair, Mark Ordan.

有了這個，我將把電話轉給我們的執行主席 Mark Ordan。

Thanks, Charlie, and good morning, everyone. I'm here with Dr. Jim Swift, our Chief Executive Officer; and Marc Richards, our Chief Financial Officer. We announced in December my transition from CEO to Executive Chair; and Dr. Jim Swift's move from COO to CEO. This has been a naturally smooth transition since we had worked so closely on virtually all issues. It also capped a year-long process to sharply reduce executive leadership and other people-related overhead costs which has also enabled fully qualified and proven leaders to assume larger roles at Pediatrix.

謝謝，查理，大家早上好。我和我們的首席執行官 Jim Swift 博士一起來到這裡；和我們的首席財務官 Marc Richards。我們在 12 月宣布了我從 CEO 到執行主席的轉變；以及 Jim Swift 博士從首席運營官到首席執行官的轉變。這是一個自然而然的平穩過渡，因為我們在幾乎所有問題上都密切合作。它還結束了為期一年的流程，以大幅減少行政領導和其他與人員相關的間接費用，這也使完全合格和經過驗證的領導者能夠在 Pediatrix 擔任更大的角色。

Over the course of 2022, we saw overall stable volumes and payer mix, both of which ended the year on a strong note. We reduced leverage and improved on our sector-leading financial position. Our revenue cycle transition process, as we have reported, has been very difficult and remains a key operational priority. Within our fourth quarter results, the revenue headwinds caused by our RCM vendors delays in billing activities and extended AR persisted, but were largely offset by negotiated direct financial support provided by the vendor.

在 2022 年期間，我們看到總體穩定的交易量和付款人組合，這兩者都以強勁的勢頭結束了這一年。我們降低了槓桿率並改善了我們行業領先的財務狀況。正如我們所報告的那樣，我們的收入周期過渡過程非常困難，並且仍然是關鍵的運營優先事項。在我們第四季度的業績中，由我們的 RCM 供應商延遲計費活動和延長 AR 造成的收入逆風持續存在，但在很大程度上被供應商提供的協商直接財務支持所抵消。

Marc Richards will detail these offsetting factors in his discussion of the quarter. Since this poor performance persists today, just as in the latter part of 2022, we expect our vendor to provide all necessary support to repair this situation as they knew was necessary in Q4. We believe the plans we discussed on our last call to address the shortfall are the right ones, and Jim will detail where we are today with those plans.

馬克·理查茲 (Marc Richards) 將在他對本季度的討論中詳細說明這些抵消因素。由於這種糟糕的表現一直持續到今天，就像 2022 年下半年一樣，我們希望我們的供應商提供所有必要的支持來修復這種情況，因為他們知道在第四季度是必要的。我們相信我們在上次電話會議上討論的解決短缺的計劃是正確的，Jim 將詳細說明我們目前在這些計劃方面的進展情況。

Lastly, we continue to be overwhelmingly in network with constructive dialogue with payers in places where we're not. We, along with our government relations team and outside advisers continue to work hard to help defend against improper rules applied to what we viewed as CARES and bipartisan No Surprises Act.

最後，我們繼續以壓倒性優勢與我們不在的地方的付款人進行建設性對話。我們與我們的政府關係團隊和外部顧問一起，繼續努力幫助抵禦適用於我們認為是 CARES 和兩黨合作的《無意外法案》的不當規則。

Now I'll turn the call over to our Chief Executive Officer, Jim Swift.

現在我將把電話轉給我們的首席執行官吉姆斯威夫特。

Thanks, Marc, and good morning, everyone. I'm pleased to speak to you today as the CEO of Pediatrix, a company I joined almost 15 years ago. I've had the privilege of serving and expanding roles during my tenure here, which has allowed me the honor of working closely with our great position and clinical leaders, our operating team and, of course, our leadership team and Board of Directors. For many of you, I hope I'm also a familiar face and voice having participated in these calls as well as other events over the past several years, touching on our strategy and growth.

謝謝，馬克，大家早上好。我很高興今天作為 Pediatrix 的首席執行官與您交談，我在將近 15 年前加入了這家公司。在我任職期間，我有幸服務和擴大角色，這讓我有幸與我們的重要職位和臨床領導、我們的運營團隊，當然還有我們的領導團隊和董事會密切合作。對於你們中的許多人，我希望我也是一個熟悉的面孔和聲音，在過去幾年中參與了這些電話會議以及其他活動，涉及我們的戰略和發展。

This morning, I'm pleased to announce that following my appointment, we have named Dr. Curt Pickert, formerly our Chief Physician Executive as Chief Operating Officer, and Lee Wood, formerly our Senior Vice President of National Operations as Executive Vice President of National and Market Operations. I want to congratulate Curt and Lee, both long-standing Pediatrix leaders in their new roles for our operating team.

今天早上，我很高興地宣布，在我被任命後，我們已任命我們的前首席醫師執行官 Curt Pickert 博士為首席運營官，並任命我們的前全國運營高級副總裁 Lee Wood 為全國執行副總裁和市場運作。我要祝賀 Curt 和 Lee，他們都是 Pediatrix 的長期領導者，他們在我們的運營團隊中擔任新角色。

I'll speak plainly about our outlook for 2023, which reflects the continued burden from our RCM transition activities. Marc Ordan has spoken during the past few years of our view that Pediatrix has fundamental earnings power, which we define as adjusted EBITDA of $250 million and above. We believe that we're not for the shortfall from the RCM transition, we would today be reaffirming this position for 2023.

我將坦率地談談我們對 2023 年的展望，這反映了我們 RCM 過渡活動帶來的持續負擔。 Marc Ordan 在過去幾年中談到了我們的觀點，即 Pediatrix 具有基本的盈利能力，我們將其定義為調整後的 EBITDA 為 2.5 億美元及以上。我們認為，我們不是因為 RCM 過渡帶來的不足，我們今天將重申 2023 年的這一立場。

Marc Richards will give additional details underpinning our preliminary 2023 outlook, but at a high level, this outlook contemplates a similar headwind to the adjusted EBITDA that we experienced in 2022 related to our RCM transition activities or roughly $15 million.

馬克·理查茲 (Marc Richards) 將提供更多細節來支持我們 2023 年的初步展望，但在較高的水平上，該展望考慮了與我們在 2022 年經歷的與 RCM 過渡活動相關的調整後 EBITDA 類似的逆風或大約 1500 萬美元。

The key difference is in 2022, we bore the brunt of that impact in the latter part of the year, while in 2023, it is far heavily weighted in the first half of the year, followed by expected improvements in the second half. Since last fall, we have added meaningful internal RCM staffing, some at a seen corporate level, more at a regional level and in some instances, our practice level. Our primary focus is to ensure full continuity throughout the RCM functions, particularly at the front end where we identified the most prominent root causes of documentation and billing delays, avoidable denials and other critical steps that have extended our AR cycle.

關鍵區別在於 2022 年，我們在下半年首當其沖地受到了這種影響，而在 2023 年，它在上半年的權重非常大，隨後預計下半年會有所改善。自去年秋天以來，我們增加了有意義的內部 RCM 人員配置，一些在可見的公司級別，更多在區域級別，在某些情況下，我們的實踐級別。我們的主要重點是確保整個 RCM 功能的完全連續性，特別是在前端，我們確定了文檔和計費延遲、可避免的拒絕和其他延長 AR 週期的關鍵步驟的最突出根本原因。

Just as important, we've been able to isolate those areas where we've identified underperformance in order to validate that they are indeed gaps on the part of our and our vendors' operations and not driven by external forces.

同樣重要的是，我們已經能夠隔離那些我們發現表現不佳的領域，以驗證它們確實是我們和我們供應商運營方面的差距，而不是由外部力量驅動的。

To be clear, as of today, our overall RCM performance has not yet improved on a sustained basis. However, we have been able to demonstrate that additional staffing properly deployed, can correct the front-end efficiencies, we identified in the areas we first targeted, we've seen performance improvement in the form of reduced backlogs, better connectivity through the step functions of the front-end processes.

需要明確的是，截至今天，我們的整體 RCM 性能尚未持續改善。但是，我們已經能夠證明，正確部署的額外人員可以糾正前端效率，我們在我們首先瞄準的領域中確定了，我們已經看到性能改進的形式是減少積壓，通過步驟功能實現更好的連接的前端進程。

Moving from these early positive steps to full sustained improvement at scale is taking time, but we believe we are on the right track, and our vendor is committed to the increased operational support required to improve the process. As a result of this work, we are confident that we can enable a highly functional RCM infrastructure as we and our vendors continue to push our improvement plans, our goal is that this progress translates to our reported results over the coming several quarters.

從這些早期的積極步驟轉變為大規模的全面持續改進需要時間，但我們相信我們走在正確的軌道上，我們的供應商致力於提供改進流程所需的更多運營支持。作為這項工作的結果，我們有信心在我們和我們的供應商繼續推動我們的改進計劃時啟用功能強大的 RCM 基礎設施，我們的目標是將這一進展轉化為我們在未來幾個季度報告的結果。

Turning from our focus on urgent efforts on revenue cycle, I'll back up and speak at a higher level. I am enthusiastic about the opportunities we have to build on the core fundamental strengths of our organization, which deserves mention. Demand for the services that our affiliated clinicians provide has been strong. For 2022, our same-unit patient volume increased by approximately 2%, highlight by acceleration in the fourth quarter. Same [unit report] across the hospitals where we provide services rose moderately over -- for the year despite a difficult comparison in 2021.

從我們對收入周期的緊急努力的關注轉向，我會支持並在更高層次上發言。我對我們必須建立在我們組織的核心基礎優勢之上的機會充滿熱情，這值得一提。對我們附屬臨床醫生提供的服務的需求一直很強勁。到 2022 年，我們的同病房患者數量增加了約 2%，突出表現在第四季度的加速增長。儘管與 2021 年進行了艱難的比較，但我們提供服務的醫院的同一 [單位報告] 在今年略有上升。

We have successfully removed a major layer of executive level overhead as well in other targeted and important to note, nonclinical areas. We don't have the crystal ball on the ultimate effects of the No Surprises Act, but we do continue to be overwhelmingly in-network. And as Marc mentioned, we are in constructive discussions to be back in network in certain instances where we are not in network today.

我們已經成功地消除了主要的行政級別開銷以及其他有針對性且需要注意的非臨床領域的開銷。我們沒有關於《無意外法案》最終效果的水晶球，但我們確實繼續以壓倒性優勢進入網絡。正如 Marc 提到的，我們正在進行建設性的討論，以便在我們今天不在網絡中的某些情況下回到網絡中。

We also continue to look closely at the labor market and possible challenges we may face. But volatility in our cost has been muted compared to other areas of health care. We have a strong balance sheet. We repaid substantially all of our borrowings on our revolving credit facility in the fourth quarter, and we began 2023 with a conservative and durable debt structure with low leverage, significant borrowing capacity and extended maturities following last year's refinancings. We believe our hospital and clinician relationships are strong, and combined with this financial strength, offer us the opportunities for both organic and inorganic growth.

我們還繼續密切關注勞動力市場和我們可能面臨的挑戰。但與其他醫療保健領域相比，我們成本的波動性較小。我們擁有強大的資產負債表。我們在第四季度償還了我們循環信貸額度的大部分借款，並且在去年的再融資之後，我們以保守和持久的債務結構、低杠桿、強大的借貸能力和延長的期限開始了 2023 年。我們相信我們的醫院和臨床醫生關係牢固，結合這種財務實力，為我們提供了有機和無機增長的機會。

We are focused directly on these hospital relations and on a very close working relationship with our world-class affiliated clinicians. And most important, our mission, take great care of the patient. It's a clear one, and the commitment to that mission spans our entire organization, both clinical and nonclinical. As a physician, I know firsthand that this is vital and it informs all of our decision-making. Our passion for our patients, clinicians, hospital partners, coupled with our adherence to strong and conservative business principles gives us real confidence in turbulent times.

我們直接關注這些醫院關係，並關注與我們世界級附屬臨床醫生的非常密切的工作關係。最重要的是，我們的使命是照顧好病人。這是一個明確的使命，對這一使命的承諾涵蓋了我們整個組織，包括臨床和非臨床組織。作為一名醫生，我直接知道這是至關重要的，它會影響我們所有的決策。我們對患者、臨床醫生、醫院合作夥伴的熱情，加上我們對堅定而保守的商業原則的堅持，使我們在動蕩的時代充滿信心。

This also provides the foundation of careful growth. We are in promising discussions with a number of health systems on ways we can expand what we do. We believe there are opportunities for targeted, acquisitive growth in our core, and we continue to expand and refine our pediatric primary and urgent care platform.

這也為精心成長奠定了基礎。我們正在與許多衛生系統就擴大我們所做工作的方式進行有希望的討論。我們相信有機會在我們的核心領域實現有針對性的、收購性的增長，我們將繼續擴大和完善我們的兒科初級和緊急護理平台。

As noted in our press release this morning, we believe that our outlook for the coming year represents a realistic achievable near-term financial profile for our company, and it is both my privilege and priority to build on that outlook as we look beyond 2023.

正如我們在今天上午的新聞稿中指出的那樣，我們認為，我們對來年的展望代表了我們公司近期可實現的現實財務狀況，在我們展望 2023 年之後，以這一展望為基礎是我的榮幸和優先事項。

To summarize, we have many strengths and many opportunities. We believe that once we can look back on our current RCM challenges, we can have a platform that's stronger and more efficient than anything we could have done on our own. Working with Curt, Lee and our senior team alongside our affiliated clinicians and support team, I am confident and excited by what's ahead.

總而言之，我們有很多優勢和很多機會。我們相信，一旦我們能夠回顧當前的 RCM 挑戰，我們就能擁有一個比我們自己所能做的任何事情都更強大、更高效的平台。與 Curt、Lee 和我們的高級團隊以及我們附屬的臨床醫生和支持團隊一起工作，我對未來充滿信心和興奮。

With that, I'll turn the call over to Marc Richards.

有了這個，我會把電話轉給馬克理查茲。

Thanks, Jim. Good morning, everyone. I'll start with certain components of our fourth quarter results. Our same-unit volumes were strong and payer mix was stable. Within the pricing component of our same unit revenue, we detailed in our press release the impact of the funds received from the CARES program, which were significant in the prior year. Underlying RCM performance presented a similar headwind to what we discussed in Q3, but was largely offset by an advance against older AR provided by our RCM vendor.

謝謝，吉姆。大家，早安。我將從我們第四季度業績的某些組成部分開始。我們的同單位銷量強勁，付款人組合穩定。在我們同一單位收入的定價部分中，我們在新聞稿中詳細說明了從 CARES 計劃收到的資金的影響，這些資金在前一年非常重要。潛在的 RCM 性能帶來了與我們在第三季度討論的類似的逆風，但在很大程度上被我們的 RCM 供應商提供的針對舊 AR 的進步所抵消。

On the cost side, this incremental Q4 revenue largely flowed through variable comp within practice, salaries and benefits. And our malpractice expense was also elevated, which we view as specific to the quarter and not an ongoing trend. As a result, adjusted EBITDA was within our expected range for the quarter.

在成本方面，第四季度增加的收入主要來自實踐、薪水和福利中的可變薪酬。我們的醫療事故費用也有所增加，我們認為這是本季度特有的，而不是持續的趨勢。因此，調整後的 EBITDA 在我們本季度的預期範圍內。

Turning to 2023, we expect net revenue of $2 billion to $2.1 billion and G&A expense as a percent of revenue should be comparable to '22 or just under 12%. Our preliminary outlook for adjusted EBITDA of $235 million to $245 million contemplates a rough $15 million RCM headwind, which, as Jim discussed, is expected to be heavily weighted towards the first half of the year. For reference, we estimate that the headwinds resulting from our RCM transition activities totaled roughly $15 million to $20 million in adjusted EBITDA in 2022.

談到 2023 年，我們預計淨收入將達到 20 億至 21 億美元，而 G&A 費用佔收入的百分比應與 22 年相當或略低於 12%。我們對 2.35 億美元至 2.45 億美元的調整後 EBITDA 的初步展望考慮了大約 1500 萬美元的 RCM 逆風，正如 Jim 所討論的那樣，預計將在今年上半年佔很大比重。作為參考，我們估計 2022 年我們的 RCM 過渡活動帶來的不利影響在調整後的 EBITDA 中總計約為 1500 萬至 2000 萬美元。

In terms of our quarterly earnings progression, we anticipate that our first quarter adjusted EBITDA will represent 16% to 18% of full year adjusted EBITDA, which is largely due to the normal seasonality of our financial results but also to our outlook for the impact of ongoing RCM transition activities.

就我們的季度收益進展而言，我們預計第一季度調整後的 EBITDA 將佔全年調整後 EBITDA 的 16% 至 18%，這主要是由於我們財務業績的正常季節性以及我們對影響的展望正在進行的 RCM 過渡活動。

Finally, we do not anticipate any additional CARES funds in '23, which in 2022 contributed $6.7 million in adjusted EBITDA, mostly in the first quarter of last year.

最後，我們預計 23 年不會有任何額外的 CARES 資金，這些資金在 2022 年為調整後的 EBITDA 貢獻了 670 萬美元，主要是在去年第一季度。

Turning finally to our balance sheet. We were paid substantially all remaining revolver borrowings and ended the year with net debt of just under $640 million, leverage of 2.6x.

最後轉向我們的資產負債表。我們幾乎支付了所有剩餘的循環借款，年底淨債務略低於 6.4 億美元，槓桿率為 2.6 倍。

With that, now I will turn the call back over to Jim.

有了這個，現在我將把電話轉回給吉姆。

Thank you, Marc. Operator, let's now open up the call for questions.

謝謝你，馬克。接線員，現在讓我們打開問題電話。

(Operator Instructions) It looks like we'll go to Ryan Daniels with William Blair.

（操作員說明）看來我們會和威廉·布萊爾一起去瑞安·丹尼爾斯。

This is Jack Senft on for Ryan Daniels. Just wanted to start off and touch on the margin expectations. Just kind of curious how we should be kind of thinking about margins heading into 2023, especially as it relates to the AR reserves. Just given that you kind of expect the headwinds to subside more in the second half, I just kind of wanted to make sure that your expectation -- or what your expectations are for the second half of this year? And just kind of wanted to see if you're on track to still kind of see the margins improve in the second half.

這是瑞恩丹尼爾斯的傑克森夫特。只是想開始並觸及利潤率預期。只是有點好奇我們應該如何考慮進入 2023 年的利潤率，尤其是與 AR 儲備相關的利潤率。鑑於您預計下半年逆風會更多地消退，我只是想確定您的期望——或者您對今年下半年的期望是什麼？只是有點想看看你是否有望在下半場看到利潤率有所提高。

Jack, it's Marc Richards. I would expect margin trends in '23 to continue very similar to what we saw in '22, certainly with our expected ramp relative to our RCM transaction activities. We'd expect those to marginally improve towards the second half of the year. But entering into '23, I'd expect similar margins as we saw in '22.

傑克，我是馬克·理查茲。我預計 23 年的利潤率趨勢將繼續與我們在 22 年看到的非常相似，當然與我們相對於 RCM 交易活動的預期增長。我們預計這些情況會在今年下半年略有改善。但進入 23 年，我預計利潤率將與 22 年相似。

Okay. Awesome. Just as a quick follow-up too. Just kind of curious how the recovery efforts have trended this quarter. I mean, I think it was a cumulative $20 million prior to this quarter. Before I know it seems that it was -- the recovery efforts were a tad lower than you originally expected and that this is an area that you're monitoring and addressing. So just kind of curious how those efforts have progressed and if the success rates have increased.

好的。驚人的。就像快速跟進一樣。只是有點好奇本季度的恢復工作趨勢如何。我的意思是，我認為在本季度之前累計達到 2000 萬美元。在我知道它似乎是之前 - 恢復工作比你最初預期的要少一點，這是你正在監控和解決的一個領域。所以有點好奇這些努力是如何取得進展的，以及成功率是否有所提高。

Recovery efforts relative to our RCM activity?

與我們的 RCM 活動相關的恢復工作？

Yes, correct.

是，對的。

Yes. I'd say they remained relatively unchanged moving from the third quarter into the fourth quarter in terms of our core RCM activity.

是的。我想說，就我們的核心 RCM 活動而言，從第三季度到第四季度，他們保持相對不變。

Okay. Awesome. And then just a quick last question here. Just kind of curious how labor has trended this quarter and kind of what your expectations are for 2023?

好的。驚人的。然後這裡只是一個快速的最後一個問題。只是有點好奇本季度勞動力的趨勢如何以及您對 2023 年的期望是什麼？

Yes. We've seen labor trends in the quarter with respect specifically to clinical compensation in the 5% range, kind of quarter-over-quarter. Jim's got some more details in terms of...

是的。我們已經看到本季度的勞動力趨勢，特別是在 5% 範圍內的臨床補償，有點環比。吉姆在……方面有更多細節。

Yes. And a fair amount of that is related to our contract labor as we brought new programs on organic programs on -- in the last quarter, so again, we don't see that necessarily as a trend going forward. And we really have not seen material effects of the volatility, as I stated.

是的。當我們在上個季度推出有關有機計劃的新計劃時，其中相當一部分與我們的合同工有關，所以我們再次認為這不一定是未來的趨勢。正如我所說，我們確實沒有看到波動的實質影響。

And next, we go to A.J. Rice with Credit Suisse.

接下來，我們去 A.J.瑞士信貸的大米。

Just because you mentioned a couple of times in the prepared remarks, are you seeing any more activity on the part of payers to try to move you out of that work and then go to arbitration? Or is it still steady state? I couldn't really tell from the prepared remarks.

僅僅因為你在準備好的評論中提到了幾次，你是否看到付款人有更多的活動試圖讓你退出那項工作然後去仲裁？或者它仍然處於穩定狀態？從準備好的評論中我真的看不出來。

Yes, A.J., this is Jim. No, it's steady state. We really have not seen additional activity or change in behavior by payers where we are in network. And again, as stated, we're working on certainly right now with some of those out-of-network issues, and we have -- we feel very strongly that we're going to be successful. So no material changes.

是的，A.J.，這是吉姆。不，它是穩定的狀態。我們確實沒有看到我們在網絡中的付款人的額外活動或行為變化。再一次，如前所述，我們現在肯定正在處理其中一些網絡外問題，而且我們有 - 我們非常強烈地認為我們會成功。所以沒有實質性的變化。

Okay. Usually -- the [last time, I recall] the pediatric urgent care effort has been a topic of discussion and you didn't really spend any time on that. Any update on what's happening there?

好的。通常 - [我記得最後一次] 兒科緊急護理工作一直是討論的話題，你並沒有真正花任何時間在這上面。關於那裡發生的事情的任何更新？

Yes. We're continuing to open up locations in parts of the country in certain geographies, and we have a team of folks working on that, inclusive of a new physician that we brought on board who is going to be leading our primary care initiatives with those clinics. So the activity continues.

是的。我們將繼續在該國某些地區的部分地區開設分店，我們有一個團隊正在為此工作，其中包括我們聘請的一名新醫生，他將領導我們的初級保健計劃診所。於是活動繼續。

Okay. And then maybe my last one. You called out -- well, 2 expense items, I think in the quarter, a little step-up in malpractice, I wondered if that was just a normal year-end true-up? Or is there anything else going on there? And then the incremental labor that's been taken on to deal with the revenue cycle management issue, is that on your books? Is that going to continue to be on your books? Or is that part of -- as well as getting the revenues, right, but part of why the outlook improves in the back half of the year that some of that will go away.

好的。然後也許是我的最後一個。你叫了 - 好吧，我認為在這個季度有 2 個費用項目，有點不當行為，我想知道這是否只是正常的年終調整？或者還有其他事情發生嗎？然後，為處理收入周期管理問題而採取的增量勞動，在您的賬簿上嗎？這會繼續出現在你的書上嗎？或者是 - 以及獲得收入的一部分，對，但部分原因是今年下半年前景有所改善，其中一些將會消失。

A.J., it's Marc. With respect to the incremental staffing efforts that both we and our RCM vendor have made some of that additional cost is -- will be borne by us and some of it will be borne by the vendor.

A.J.，是馬克。關於我們和我們的 RCM 供應商所做的增量人員配置工作，一些額外成本將由我們承擔，其中一些將由供應商承擔。

Okay. And does that fade down at some point? Or is that a permanent step-up on labor?

好的。那會在某個時候消失嗎？或者這是對勞動力的永久性提升？

I'd say that remains unknown at this point.

我想說這在這一點上仍然未知。

Okay. And then on your malpractice comment, anything there?

好的。然後關於你的瀆職評論，有什麼嗎？

With respect to the spike in the fourth quarter, this is really related to normal year-end activity and settlements related to that activity.

關於第四季度的激增，這確實與正常的年終活動和與該活動相關的結算有關。

And next, we'll go to Pito Chickering with Deutsche Bank.

接下來，我們將與德意志銀行一起前往 Pito Chickering。

Just a follow-up to A.J. question there. You talked about making sure that your commercial payers are following proper rules for the No Surprise Act. I guess a couple of questions here. What percent of our commercial cases are going to arbitration? Is your [win ratio is still] 75%? And can you quantify the revenues lost in these cases, what the revenue contraction was in those cases?

只是 A.J. 的後續行動。那裡的問題。您談到要確保您的商業付款人遵守《毫不意外法案》的適當規則。我想這裡有幾個問題。我們的商業案件中有百分之幾要進行仲裁？你的【勝率還是】75%嗎？您能否量化這些案例中的收入損失，這些案例中的收入收縮是多少？

Yes, I think from our standpoint, one thing on the IDR process, we feel that we have a very robust process for the claims that we submit. And it's a very small number of claims that we've entered into that process. And I would say that we've been largely successful in doing that. We've won over 80% of the time with our packet that's submitted in the IDR. So we're fairly confident, and we think that's the message to the payers, by the way, that they see that -- with that success rate that -- they're going to move through to have us come back in network. So I think, again, we've been largely successful there.

是的，我認為從我們的角度來看，關於 IDR 流程的一件事，我們認為我們有一個非常強大的流程來處理我們提交的索賠。我們已經進入該過程的索賠數量非常少。我會說我們在這方面取得了很大的成功。我們在 IDR 中提交的數據包贏得了超過 80% 的時間。所以我們相當有信心，我們認為這是給付款人的信息，順便說一下，他們看到了——以這樣的成功率——他們將繼續努力讓我們回到網絡中。所以我再次認為，我們在那裡取得了很大的成功。

Okay. Second question on the transformational costs here. They spiked to almost $20 million in the fourth quarter. that's a pretty big jump versus we have seen these levels since 2020, we're doing a lot of the consulting fees. So can you give us details of sort of what was in that number and what you're seeing for transformational costs for 2023?

好的。關於轉型成本的第二個問題。他們在第四季度飆升至近 2000 萬美元。與我們自 2020 年以來看到的這些水平相比，這是一個相當大的飛躍，我們正在收取大量諮詢費用。那麼，您能否向我們詳細說明該數字中的內容以及您看到的 2023 年轉型成本是多少？

Sure. It's Marc Richards again. That number represented exit costs associated with those executives that were terminated at the end of the year. There were a significant amount of executives in that pool. And going into '23, we do not expect any transition in restructuring expenses.

當然。又是馬克·理查茲。該數字代表與那些在年底被解僱的高管相關的退出成本。該池中有大量高管。進入 23 年，我們預計重組費用不會有任何轉變。

Okay. Great. And then last question here. Just looking at the net leverage ratio, I think it was 2.6, with EBITDA sort of flattish or down the last couple of years, what's the right leverage that you guys would be running at? And does the leverage ratios on the '23 EBITDA guidance change how you look at acquisitions for next year?

好的。偉大的。然後是最後一個問題。看看淨槓桿率，我認為它是 2.6，EBITDA 在過去幾年持平或下降，你們應該運行的正確槓桿率是多少？ 23 年 EBITDA 指南中的槓桿率是否會改變您對明年收購的看法？

No, I don't think so. We've said in the past that we're very comfortable in the 3x range. Certainly, our leverage will move from quarter-to-quarter as we make draws on our credit facility, but I would say, as a general rule of thumb, we like 3x.

不，我不這麼認為。我們過去曾說過，我們對 3 倍的範圍感到非常滿意。當然，隨著我們利用信貸額度，我們的槓桿率會逐季變化，但我想說，根據一般經驗，我們喜歡 3 倍。

Yes. And we also have plenty of cash flow in order to do transactions such as acquisitions. I will say, as we've talked about in previous quarters that we're being prudent with regard to No Surprises Act and how we look at targeted acquisitions. And that kind of principle will continue through. We do think there's opportunity, but we'll be wise and conservative in that regard.

是的。而且我們也有充足的現金流來進行收購等交易。我要說的是，正如我們在前幾個季度所討論的那樣，我們對《無意外法案》以及我們如何看待有針對性的收購持謹慎態度。這種原則將持續下去。我們確實認為有機會，但在這方面我們會保持明智和保守。

And next, we can go to Whit Mayo with SVB Securities.

接下來，我們可以和 SVB 證券一起去 Whit Mayo。

You guys have made some material progress reducing G&A in '22 or 2022. I feel like you communicated previously that the target for 2022 was $250 million for G&A, and it came in around $230 million. I know there's some natural inflation inside that number offset by whatever you took out. So I'm trying to kind of circle a number like what the permanent G&A savings that you found in 2022? And also, is there another savings number that you're targeting this year?

你們在 22 年或 2022 年在減少 G&A 方面取得了一些實質性進展。我覺得你們之前曾說過，2022 年的 G&A 目標是 2.5 億美元，實際收入約為 2.3 億美元。我知道這個數字中有一些自然通貨膨脹被你取出的任何東西抵消了。所以我想圈出一個數字，例如您在 2022 年發現的永久性 G&A 節省是多少？此外，您今年還有其他目標儲蓄數字嗎？

Whit, it's Marc Richards. Yes, you are right. We made significant progress in reducing overhead throughout all of '22. We think, and as we indicated in our guidance for '23, we think that a lot of that progress has been made and that as a result, we're probably looking at a similar G&A load in '23 to that in '22 in the sub 12% -- 11.5% to 12% range of total revenue.

惠特，是馬克·理查茲。是的你是對的。在整個 22 年期間，我們在減少開銷方面取得了重大進展。我們認為，正如我們在 23 年的指導中指出的那樣，我們認為已經取得了很多進展，因此，我們可能會看到 23 年的 G&A 負載與 22 年的類似低於 12%——總收入的 11.5% 至 12% 範圍。

Okay. Okay. So there are no additional initiatives to further reduce that G&A this year? I feel like there was a number that I had in my head, maybe like a $13 million number that you had previously communicated.

好的。好的。那麼今年沒有進一步減少 G&A 的額外舉措嗎？我覺得我腦子裡有一個數字，可能就像你之前交流過的 1300 萬美元的數字。

Well, we had savings over the course of '22, which are permanent savings of over $25 million. An offset to that is obviously we pay fees to our RCM vendor and other things that hit the overhead line item. But the savings that we achieved over the course of the last -- over the last year are permanent savings, and they're concentrated at the executive level and on the people side.

好吧，我們在 22 年的過程中節省了超過 2500 萬美元的永久性儲蓄。對此的抵消顯然是我們向我們的 RCM 供應商支付費用以及其他影響間接費用的事情。但我們在過去一年中實現的節省是永久性節省，它們集中在行政層面和人員方面。

Okay. Got it. So $25 million is kind of the number that you took out of the organization that should be recurring going forward. Okay. That's helpful.

好的。知道了。所以 2500 萬美元是你從組織中取出的數字，應該在未來重複出現。好的。這很有幫助。

I'm a little confused on the malpractice comments. I mean looking at your 10-K, the end-period malpractice costs were actually lower year-over-year. It was like $53 million versus $56 million last year. And there was another $4 million favorable prior year development. So I don't know, Marc, can you maybe flesh that out just a little bit more, maybe there was just something elevated in the fourth quarter, but not necessarily in the full year.

我對醫療事故的評論有點困惑。我的意思是看看你的 10-K，期末醫療事故成本實際上比去年同期要低。這相當於 5300 萬美元，而去年為 5600 萬美元。並且還有另外 400 萬美元的有利前一年發展。所以我不知道，馬克，你能不能再充實一點，也許第四季度只是有所提升，但不一定是全年。

Yes, that's correct. So it was 1 event, and we don't see that going forward. There's no pattern, and we haven't seen that in the past. We don't anticipate that, but you never know in terms of malpractice. So that was just 1 event in the fourth quarter.

對，那是正確的。所以這是 1 個事件，我們看不到它會繼續發展。沒有模式，我們過去從未見過。我們沒有預料到這一點，但您永遠不會知道是否存在醫療事故。所以那隻是第四節的一場比賽。

Okay. And 1 last one here, sorry. I'm still a little confused on this. It's just the AR write-down in the fourth quarter. I presume there was one and did R1 absorbed that for you. They make you [hold], and what are you assuming in terms of perhaps a headwind in 2023?

好的。抱歉，這裡是最後一個。我對此仍然有些困惑。這只是第四季度的 AR 減記。我假設有一個，R1 是否為您吸收了它。他們讓你 [hold]，你假設 2023 年可能會出現逆風？

Well, in terms of the headwind, we said that we expect the headwind in '23 to be approximately $15-plus million in adjusted EBITDA related to continued rate erosion. Looking at the fourth quarter of '22, our net patient service revenue, of course, reflects all the ins and outs -- related to write-downs and the associated billings in the quarter. So that's all contemplated both in the rate discussion and in what we saw in total revenue for the quarter. So I'm not sure there's no real direct write-off related to that. It's just our revenue recognition relative to our aging policies.

好吧，就逆風而言，我們說我們預計 23 年的逆風與持續利率下降相關的調整後 EBITDA 約為 15 多萬美元。看看 22 年第四季度，我們的患者服務淨收入當然反映了所有細節——與本季度的減記和相關賬單有關。因此，在費率討論和我們看到的本季度總收入中都考慮到了這一點。所以我不確定是否有與此相關的真正直接註銷。這只是我們相對於我們的老齡化政策的收入確認。

In the fourth quarter, R1 backstopped our vendor back a portion of our receivables. And that was a onetime event, which directly supported our numbers because they realized that they had been very deficient coming into the fourth quarter.

在第四季度，R1 支持我們的供應商償還了我們的部分應收賬款。那是一次性事件，它直接支持了我們的數據，因為他們意識到進入第四季度時他們的實力非常不足。

Okay. Sorry, 1 last follow-up, and I'll get all off -- sorry. I just -- with any of the AR that you've already previously written off, are you making any progress to collect any of that or all of the initiatives focused on the bills going out the door today?

好的。抱歉，最後一次跟進，我會全力以赴 - 抱歉。我只是 - 對於您之前已經註銷的任何 AR，您是否在收集任何一項或所有針對今天開出的賬單的舉措方面取得了任何進展？

A couple of things on that. Certainly, there's a lot of initiatives on the bills going out today, as I mentioned earlier, with respect to the revenue that we recognized in '22, we believe any difference in bad debt expense is appropriately recognized and therefore, reflected in our P&L.

有幾件事。當然，正如我之前提到的，關於我們在 22 年確認的收入，今天有很多關於賬單的舉措，我們認為壞賬費用的任何差異都得到了適當的確認，因此反映在我們的損益表中。

And next, I go to Kevin Fischbeck with Bank of America.

接下來，我會去美國銀行拜訪 Kevin Fischbeck。

Great. Yes. I guess it's still not 100% clear to me how this R1 payment is working. Is it -- is it flowing through your revenue number? Or is it -- where does it show up, I guess, in the P&L?

偉大的。是的。我想我仍然不是 100% 清楚這個 R1 付款是如何運作的。它是 - 它是否流經您的收入數字？或者它是——我猜它在損益表中出現在哪裡？

It's in revenue.

它在收入中。

Okay. So your pricing includes the R1 impact. So I'm just trying to think about like what -- what do you think ex CARES, ex R1, but with normal performance on collections, what do you think pricing would have looked like in the quarter?

好的。因此，您的定價包括 R1 影響。所以我只是想想想——你認為 ex CARES，ex R1 是什麼，但是如果系列表現正常，你認為本季度的定價會是什麼樣子？

Down about 200 basis points, ex those factors.

除去這些因素，下跌約 200 個基點。

Ex those factors, even though commercial was up in the quarter. So like what else, I guess, that's on a mix basis. So what else was causing a down 20 basis points?

除這些因素外，儘管本季度商業業務有所增長。所以就像其他什麼一樣，我猜，這是混合的。那麼還有什麼原因導致下跌 20 個基點？

Yes, Kevin, it's Charlie. For the fourth quarter, that's predominantly the comparison of CARES dollars as they flow through, which was pretty significant in the fourth quarter of '21 digging through all of those variable pieces, whether it is the impact of the rev cycle process, the CARES dollars and the like, we're still looking at an underlying price trend in the range of, call it, 1% to -- between 1% and 2%. And that's a function of normal pricing trends across managed care and governmental payers as well as, as I think you know, we account for our admin fee revenue -- our contract and admin fee revenue within pricing, and that usually has some increase to it in the fourth quarter, it was fairly modest.

是的，凱文，我是查理。對於第四季度，這主要是 CARES 美元流動時的比較，這在 21 年第四季度挖掘所有這些可變部分非常重要，無論是 rev 週期過程的影響，CARES 美元等等，我們仍在關注 1% 至 1% 至 2% 範圍內的潛在價格趨勢。這是管理式醫療和政府付款人之間正常定價趨勢的函數，而且我想你知道，我們在定價中考慮了我們的管理費收入——我們的合同和管理費收入，通常會有一些增加在第四季度，它相當溫和。

Okay. So you think underlying pricing is 1% to 2% is kind of a go-forward way of thinking about it once this is all stabilized.

好的。所以你認為基礎定價是 1% 到 2% 是一種前瞻性的思考方式，一旦這一切都穩定下來。

Yes. I don't see any reason for it to be different from that.

是的。我看不出有任何不同之處。

And then just to understand maybe go back to the other question for this. Because when we think about companies that would go through these types of disruptions, I guess there's 2 potential implications going forward. One is that you get back to the right run rate. And then the second one is that you collect on things that you didn't collect. So there's actually a period of outperformance, I guess, as you start collecting on old receivables. Is that the right way to think about it? Or is the fact that R1's backstop things kind of taken away some of that catch-up opportunity? I mean is there -- how should we be thinking about what this looks like when it's -- we get the other side of it?

然後只是為了理解也許回到另一個問題。因為當我們考慮將經歷這些類型的中斷的公司時，我想未來有兩個潛在的影響。一是您恢復到正確的運行率。然後第二個是你收集你沒有收集的東西。所以我猜，當你開始收取舊的應收賬款時，實際上有一段時間表現出色。這是正確的思考方式嗎？還是 R1 的後備功能剝奪了一些追趕機會？我的意思是那裡 - 我們應該如何考慮它的樣子 - 我們得到它的另一面？

I think our forecast is that we're going to get back to the right level over the coming quarters. And there may be some bump from additional collections. But in our forecast and the numbers that we're forecasting, we are working hard, as Jim detailed to get back to a proper functioning process and get back to the levels that -- where we should be.

我認為我們的預測是我們將在未來幾個季度回到正確的水平。並且可能會有一些來自其他集合的顛簸。但在我們的預測和我們預測的數字中，我們正在努力工作，正如吉姆詳細描述的那樣，以恢復正常的運作流程並恢復到我們應該達到的水平。

Okay. And then just to try and round out this 1 payment dynamic. You guys mentioned that you're putting extra costs into improved collections, some of which you're taking, some of which they are taking. And the $15 million includes those costs that you're undertaking and that may or may not be permanent?

好的。然後只是嘗試完善這個 1 付款動態。你們提到你們正在將額外成本投入到改進的收藏中，有些是你們拿的，有些是他們拿的。 1500 萬美元包括您正在承擔的那些費用，這些費用可能是永久性的，也可能不是永久性的？

No. That is solely related to our expectation of the flow-through of revenue impact of the AR process, as we've talked about the last few quarters, the -- any kind of incremental costs that we're incurring or believe we might incur, additional staffing is embedded within our outlook for G&A for this year that sub-12% G&A that Marc referenced.

不，這僅與我們對 AR 流程對收入影響的流動的預期有關，正如我們在過去幾個季度所討論的那樣，我們正在承擔或認為我們可能會產生的任何類型的增量成本因此，我們對今年 G&A 的展望中包含了額外的人員配置，即 Marc 提到的低於 12% 的 G&A。

But we're still in discussions with our vendor, if there are additional labor costs that are needed on how we share those costs because they stepped up properly and helped cover a lot of the costs that we incurred from additional labor in Q4, and we have talked to them about the need to continue that bolstering by them for cost that we need to get back on track.

但我們仍在與我們的供應商討論，是否需要額外的勞動力成本來分攤這些成本，因為他們適當地加強並幫助支付了我們在第四季度因額外勞動力而產生的大量成本，我們已經與他們討論了需要繼續支持他們的成本，我們需要回到正軌。

Okay. And then just last clarification on a question on the question that was asked earlier. I think you said you're not seeing any change in behavior from payers that are in network. I just want to make sure I understand 2 things. One is rate updates from payers in network are consistent as what you're saying that you're not trying to squeeze more out of you to stay in network? And then two, you say you're overwhelmingly in network, has that percentage changed at all during the last couple of years. You could still be overwhelmingly but have it go from 4% to 6%. So I just want to make sure we're not missing anything there.

好的。然後是對之前提出的問題的最後一次澄清。我想你說過你沒有看到網絡中付款人的行為發生任何變化。我只想確保我了解兩件事。一個是來自網絡中付款人的費率更新與您所說的一致，即您沒有試圖從您身上榨取更多以留在網絡中？然後兩個，你說你在網絡中佔據壓倒性優勢，在過去幾年中這個百分比是否發生了變化。你仍然可以壓倒性地從 4% 到 6%。所以我只想確保我們沒有遺漏任何東西。

Yes. This is Jim. No, it hasn't changed. Again, we've had a few of the payers where we've been out of network. And as I said, we've been very successful in the IDR process and we have not seen a trend of payers coming to us to look to move us out of network. It's very stable.

是的。這是吉姆。不，它沒有改變。同樣，我們有一些付款人已經脫離了網絡。正如我所說，我們在 IDR 過程中非常成功，我們沒有看到付款人來找我們尋求將我們移出網絡的趨勢。它非常穩定。

I'd say that there was a fear in the market over the last, say, 18 months that payers would use this as a weapon, and we haven't seen that. What we've seen is the normal proper discussions with payers about being in network and in many cases, renewing in rates in line with what we've had in the past. So if you're asking relative to a big concern that everybody had, we said we have not seen that materialize. As Jim said in his remarks, we don't have a crystal ball about the future, but we continue to have constructive relationships.

我想說的是，在過去的 18 個月裡，市場一直擔心付款人會將其用作武器，而我們還沒有看到這一點。我們所看到的是與付款人就加入網絡進行正常的適當討論，並且在許多情況下，根據我們過去的情況更新費率。因此，如果你問的是每個人都關心的一個大問題，我們說我們還沒有看到它成為現實。正如吉姆在發言中所說，我們沒有關於未來的水晶球，但我們繼續保持建設性關係。

We have not had a change in more out-of-network situations. And in fact, in some areas where we've been at a network, even though there were a few, we're having very constructive dialogue. What's clear is that payers want us in network. We are the premier provider of these necessary services from mothers and babies. And I think people know that if you want to have subscribers you want to have Pediatrix physicians and clinicians providing care.

在更多的網絡外情況下，我們沒有發生變化。事實上，在我們參與網絡的某些領域，儘管有一些，但我們正在進行非常有建設性的對話。很明顯，付款人希望我們進入網絡。我們是母嬰必要服務的主要提供者。而且我認為人們知道，如果你想擁有訂閱者，你就會希望 Pediatrix 醫生和臨床醫生提供護理。

And next, we go to Rishi Parekh with JPMorgan.

接下來，我們將與摩根大通一起前往 Rishi Parekh。

One, going back on the NSA. I think you said that you're winning 80% of your cases, I believe or I assume, you're winning at a rate that is above the QPA. So a couple of things. One, can you confirm that you are winning above the rate -- above the QPA rate and what that multiple looks like? And then two, can you just give us an idea as to how many claims you're running through arbitration and what the DSOs are on these claims?

一，回到國家安全局。我想你說過你贏得了 80% 的案件，我相信或我假設，你以高於 QPA 的比率獲勝。所以有幾件事。第一，你能確認你贏得的利率高於 QPA 利率嗎？這個倍數是什麼樣的？然後兩個，你能告訴我們你有多少索賠是通過仲裁進行的，以及這些索賠中的 DSO 是什麼？

Yes, it's Jim. Listen, we're actually winning those well above the QPA, and we see that as a barometer in terms of our ability to contract back in network at relatively good rates. And the process, as everybody has heard the process has been a bit disjointed. We, however, feel that we've had a great team and or same vendor has been -- one of those people on that team. So process of submitting the claims into the IDR has gone very smoothly for us.

是的，是吉姆。聽著，我們實際上贏得了那些遠高於 QPA 的人，我們將其視為我們以相對較好的速度在網絡中收縮的能力的晴雨表。這個過程，正如每個人都聽說的那樣，這個過程有點脫節。然而，我們覺得我們擁有一支優秀的團隊，或者同一家供應商曾經是——該團隊中的其中一員。因此，將索賠提交到 IDR 的過程對我們來說非常順利。

On that, has the R1 situation in any way affected your ability to collect on those claims?

就此而言，R1 情況是否以任何方式影響了您收取這些索賠的能力？

No, not at all. Actually, that's been a bright spot in the relationship.

一點都不。事實上，這是這段關係中的一個亮點。

And then the TMA summary judgment with regards to the QPA. Just curious as to how you guys think it will affect you?

然後是關於 QPA 的 TMA 簡易判決。只是想知道你們認為這會對您產生怎樣的影響？

Well, I think the -- we all can look at the effect that they're shutting down -- the claims going in after February 6, we look for resolution to that issue and hopeful that there'll be a more judicious view of what should be considered in the IDR process and not just the QPA. So we remain vigilant, and we remain very positive that there will be an outcome there. But none of us can know HHS and CMS what they're going to do with that. So we're waiting to hear following that court case.

好吧，我認為 - 我們都可以看看他們關閉的影響 - 2 月 6 日之後提出的索賠，我們尋求解決該問題並希望對什麼有更明智的看法應該在 IDR 過程中考慮，而不僅僅是 QPA。所以我們保持警惕，我們仍然非常樂觀地認為那裡會有結果。但我們都不知道 HHS 和 CMS 他們將用它做什麼。因此，我們正在等待聽取該法庭案件的消息。

Right now, claims can go into the IDR process, but they can't come out. So it's going to increase the backlog, which is very unfortunate. Fortunately for us, because we're overwhelmingly in network, it doesn't affect us the way it does many other people. but we certainly hope that the government clarifies the rules so the IDR process can restart.

現在，索賠可以進入 IDR 流程，但不能出來。所以它會增加積壓，這是非常不幸的。對我們來說幸運的是，因為我們絕大多數都在網絡中，所以它不會像影響其他許多人那樣影響我們。但我們當然希望政府澄清規則，以便重啟 IDR 流程。

So this is the second time that the courts have said that the rulings have been inappropriate and don't mirror the bipartisan legislation. But now this stall, which is unfortunate. Again, fortunately for Pediatrix, we are overwhelmingly in network. And we win -- we have won overwhelmingly in the cases that have gone to arbitration. So I think it is, again, a signal that if you look at all the factors that were in the bipartisan legislation, it favors a group like ours.

因此，這是法院第二次表示裁決不當，沒有反映兩黨立法。但現在這個攤子，倒是倒霉。同樣，對 Pediatrix 來說幸運的是，我們絕大多數都在網絡中。我們贏了——在提交仲裁的案件中，我們以壓倒性優勢獲勝。所以我認為這再次表明，如果你看看兩黨立法中的所有因素，它有利於像我們這樣的團體。

And just a last question on the NSA. As it relates to the percentage that is out of network. Can you just remind me as to what that percentage is? And then I think you had stated earlier that you think that there's a high probability that you could move some of that in to an in-network agreement. And I was hoping that maybe you could quantify of that amount that is out of network, where do you think there's a high probability or what is the amount that could actually move in network over the course of '23?

關於國家安全局的最後一個問題。因為它與網絡外的百分比有關。你能提醒我這個百分比是多少嗎？然後我想你之前曾說過，你認為很有可能將其中的一些內容轉移到網絡內協議中。我希望也許你可以量化網絡外的數量，你認為哪裡有很高的可能性，或者在 23 年的過程中實際可以在網絡中移動的數量是多少？

I think roughly, we have about 5% where we're out of network, and that's kind of held traditionally along those lines over the last number of years. Obviously, anybody had the concern that with the NSA and payer behavior that could get worse. To Marc's point, where we are out of network, we feel very, very good about what we're able to do with that. And again, we may be in a good position to be back in network.

我粗略地認為，我們有大約 5% 的人不在網絡中，而且在過去幾年中，這種情況傳統上是沿著這些路線進行的。顯然，任何人都擔心國家安全局和付款人的行為會變得更糟。對於 Marc 的觀點，我們在網絡之外的地方，我們對我們能夠用它做的事情感覺非常非常好。再一次，我們可能處於重新回到網絡中的有利位置。

And just the last question for '23, can you just walk us through your capital allocation policies.

還有 23 年的最後一個問題，你能告訴我們你的資本分配政策嗎？

Sorry for that. This is Jim. Listen, I think what -- again, as I referenced on the call is that we are going to be very careful about our strategic acquisitions and deployment of capital in that regard. I think we are with the balance sheet where it is, we have plenty of cash flow in order for us to do transactions. At this time, we're coming off the heels of having the stock buyback. We thought that was an original allocation that we took in 2022. And right now, I think we, again, have the balance sheet to look at some acquisitions in our core areas that may be attractive.

對不起。這是吉姆。聽著，我想——再次，正如我在電話會議上提到的那樣，我們將非常謹慎地對待我們在這方面的戰略收購和資本部署。我認為我們的資產負債表就在那裡，我們有足夠的現金流來進行交易。目前，我們即將結束股票回購。我們認為這是我們在 2022 年進行的最初分配。現在，我認為我們再次擁有資產負債表，可以查看我們核心領域的一些可能具有吸引力的收購。

And I will say that one of the behaviors we've seen change with groups is instead of us having to do prospecting and call the groups, we have people who have been reaching out to us about interest in being a part of Pediatrix.

我要說的是，我們看到的一種行為隨著團體而改變，而不是我們必須進行勘探並打電話給團體，我們有一些人一直在聯繫我們，表示有興趣成為 Pediatrix 的一部分。

And next, we go to Tao Qiu with Stifel.

接下來，我們和 Stifel 一起去陶秋。

Could you talk about the expectation in terms of potential impact on either payer mix shift or patient volume from Medicaid redetermination that's expected to start in the second quarter? And how much of that is baked into your guidance?

您能否談談預計將在第二季度開始的醫療補助重新確定對付款人組合轉變或患者數量的潛在影響的預期？您的指導中包含了多少內容？

Tao, it's Charlie. We haven't given that a huge priority in our outlook. We tend in all the changes that have occurred, whether it was additional support during the pandemic and even going back a long time ago to some of the rules within the original affordable CARES Act. The nature of the services are affiliated physicians provide for expecting mothers and newborns. Virtually, I think, completely across the country has a higher eligibility threshold as a percent of property for Medicaid eligibility. So that has tended not to create any movement in our Medicaid mix as a part of our payer mix based on those changes and indeed, we did not see that in any material fashion through the course of the pandemic.

陶，是查理。在我們的展望中，我們沒有把它放在首位。我們關注已發生的所有變化，無論是在大流行期間的額外支持，還是很久以前的原始負擔得起的 CARES 法案中的一些規則。服務的性質是附屬醫生為準媽媽和新生兒提供的服務。實際上，我認為，整個國家都有更高的資格門檻作為醫療補助資格的財產百分比。因此，這往往不會在我們的醫療補助組合中產生任何變化，作為我們基於這些變化的付款人組合的一部分，事實上，在大流行的過程中，我們沒有看到任何實質性的變化。

Got you. And then, you called out the $15 million expected revenue headwind from R1, what was the level in fourth quarter? Could you kind of give us the cadence of the expectation through the next 4 quarters on the $15 million.

明白了然後，您提出了 R1 的 1500 萬美元預期收入逆風，第四季度的水平是多少？你能否給我們在接下來的 4 個季度中對 1500 萬美元的預期節奏。

I think Marc referenced that in the fourth quarter, the impact embedded within our results, although it's difficult to see in the fourth quarter, it was comparable to what we experienced in the third quarter of last year. And if you're asking about '23, as Mark said, we just -- we think that the $15 million drag in '23 will be largely in the first half of the year and ramp up as we approach the end of the second quarter into the third and fourth quarter.

我認為馬克在第四季度提到了我們的結果中嵌入的影響，雖然在第四季度很難看到，但它與我們去年第三季度的經歷相當。如果你問的是 23 年，正如馬克所說，我們只是 - 我們認為 23 年 1500 萬美元的拖累將主要出現在今年上半年，並隨著我們接近第二季度末而增加進入第三和第四節。

Okay. Got you. Mostly in the first half. So then when we think about the DSO, when -- where do you think that might stabilize that in 2023 or once the R1 transition is complete?

好的。明白了主要集中在上半場。那麼當我們考慮 DSO 時，您認為它可能在 2023 年或 R1 過渡完成後穩定在哪裡？

We don't know. We saw a positive movement in the DSO from the third and the fourth quarter, but it is a slow recovery to normal. So we would expect that once again, probably weighted towards the latter half of '23 when we see our DSO come back in line.

我們不知道。從第三季度和第四季度開始，我們看到 DSO 出現了積極的變化，但它正在緩慢恢復到正常水平。因此，當我們看到我們的 DSO 回歸時，我們會再次期望，可能會在 23 年下半年加權。

And we'll continue to report on that in the coming quarters.

我們將在未來幾個季度繼續對此進行報告。

Yes. So when you talk about normal, right, are we talking about kind of pre-pandemic level DSO? Or do you expect to be a little bit elevated?

是的。因此，當您談論正常時，我們是在談論某種大流行前水平的 DSO 嗎？還是您希望提高一點？

Correct. Pre-pandemic levels.

正確的。大流行前的水平。

And next, we have a follow-up from Pito Chickering with Deutsche Bank.

接下來，我們有來自德意志銀行的 Pito Chickering 的後續行動。

This follow-up. Just a quick 1 here. excluding contract labor, what your practice as a benefits increase in fourth quarter?

這個後續。在這裡快速 1。不包括合同工，您在第四季度的福利增長是什麼？

It was right in the mid-single digits, Peter. Jim referenced, and we've given similar comments in the second and third quarters that underlying trend was a little bit elevated from what we expected, certainly not to the level of volatility we've seen elsewhere, but somewhat elevated primarily related to the standup of new practices on behalf of our hospital partners and the -- some of the difficulties in those expansions in new recruiting and the like and the need for locums and others as we get staffing right?

正好是中個位數，彼得。吉姆提到，我們在第二和第三季度給出了類似的評論，即潛在趨勢比我們預期的略高，當然沒有達到我們在其他地方看到的波動水平，但有所上升主要與站會有關代表我們的醫院合作夥伴的新實踐以及 - 在新招聘等方面的擴張中的一些困難以及我們在人員配置方面對 locums 和其他人的需求？

Yes. And it's not unusual in that time period because of the holidays that we have to have additional staffing opportunities or challenges of people taking time off. So that's probably baked in there as well.

是的。在那個時間段內，由於假期，我們必須有額外的人員配備機會或人們請假的挑戰，這並不罕見。所以那可能也在那裡烤了。

Okay. So actually let me ask it differently. Excluding sort of the sort of that -- the higher cost labor kind of in general, what was your core labor inflating in the fourth quarter.

好的。所以實際上讓我換個方式問。不包括那種——一般來說成本較高的勞動力，你的核心勞動力在第四季度膨脹了多少。

We still have the same kind of directional comment there, Pito, right kind of in that mid-single-digit range. And within our outlook for 2023, versus the historical norm, we're looking at somewhat elevated but not in a great fashion.

我們在那裡仍然有相同類型的定向評論，Pito，在那個中個位數範圍內是正確的。在我們對 2023 年的展望中，與歷史常態相比，我們看到的是有所提升，但不是很好。

Single digit. By mid-single digit, like 4% to 5%.

個位數。中個位數，比如 4% 到 5%。

Yes. Okay. So to Kevin's question, sort of normalized pricing sort of 1% or 2% labor inflating either low single digits or mid-single digits. Just what makes sort of this margin start increasing in 2024 and beyond? Is it the pricing gets better than 1% to 2%? Is it the labor comes down to like 1% to 2%? Or is it the amount of G&A leverage you can get off of the business in order to help negate the negative yield spread?

是的。好的。所以對於凱文的問題，標準化定價有點像 1% 或 2% 的勞動力膨脹低個位數或中個位數。究竟是什麼讓這種利潤率在 2024 年及以後開始增加？定價是否優於 1% 至 2%？是勞動力減少到 1% 到 2% 嗎？或者是您可以從業務中獲得的 G&A 槓桿數額，以幫助抵消負收益率利差？

There is a volume component in there as well, which carries operating leverage when it's positive. So that's just one thing to keep in mind in that equation. Jim, I don't know if you want to add further.

那裡也有一個數量組成部分，當它是積極的時候，它會產生經營槓桿。因此，這只是該等式中要記住的一件事。吉姆，我不知道你是否想進一步補充。

No.

不。

Next, we can to Brian Tanquilut with Jefferies.

接下來，我們可以與 Jefferies 一起訪問 Brian Tanquilut。

Jim, just trying to put on your former biz dev hat on. As I think about -- obviously, there's a lot of focus here on rev cycle near term. But once you get past that, how are you thinking about where your focus is from a growth perspective? And what do you think will be kind of like a good normalized growth rate to be thinking about maybe once we get to 2024.

吉姆，只是想戴上你以前的商業開發帽子。正如我所想 - 顯然，這裡有很多關注近期的轉週期。但是一旦你克服了這一點，你如何從增長的角度考慮你的重點在哪裡？你認為我們到 2024 年時可能會考慮一個良好的正常化增長率。

Yes. I think what we focused on in the last number of years, and you know that we reported on this is really around the build-out of our organic growth team, which really paid off in dividends in terms of sourcing opportunities with our hospital partners and also sourcing opportunities internal to us that were all around ambulatory services. What we've seen going forward now is that, and I mentioned on the call, really these relationships with the hospitals where we have had hospitals reach out to us. And instead of it being a 1 program they're looking for, there's a suite of programs that they want us to build out around women and children.

是的。我認為我們在過去幾年中關注的重點，你知道我們對此的報導實際上是圍繞我們的有機增長團隊的建設，這在與我們的醫院合作夥伴和還在我們內部尋找與門診服務相關的機會。我們現在看到的是，我在電話中提到過，與我們曾經有過醫院的醫院的這些關係確實與我們有聯繫。他們不是在尋找一個單一的項目，而是希望我們圍繞婦女和兒童建立一套項目。

So we always talk about the fact that we're not a staffing company. We're a program building company and those programs are in women and children's. So we've seen a significant uptick in that activity.

所以我們總是談論我們不是一家人力資源公司這一事實。我們是一家項目建設公司，這些項目是針對婦女和兒童的。因此，我們看到該活動顯著增加。

When you look at the core areas, I think there's a confluence of issues coming down the pike. I think there are succession issues and some of these practices on some of the hospitals where the hospitals are concerned about, do they have the right people as the population ages in the physician population. So I think we stand ready, both on an organic side, but I would also say on the acquisitive side, there's opportunity for us in multiple specialties and in the core. You have to remember, I think the core is going to be a big part of this when you talk about NICU, when you talk about MFM. And we're focused on that because that is really obviously key to what we do on the growth side. But I think it's going to be pretty measured. We'll keep our powder dry if we need to in terms of a big acquisition. But there's something out there that is material to what we're doing, we're going to go after it.

當你審視核心領域時，我認為問題匯集在一起。我認為醫院關注的一些醫院存在繼任問題和其中一些做法，隨著醫生人口老齡化，他們是否有合適的人選。所以我認為我們在有機方面做好了準備，但我也要說在收購方面，我們在多個專業和核心領域都有機會。你必須記住，當你談論 NICU 和 MFM 時，我認為核心將成為其中的重要部分。我們專注於此，因為這顯然是我們在增長方面所做工作的關鍵。但我認為這將是非常有分寸的。如果我們需要進行大型收購，我們會保持火藥乾燥。但有些東西對我們正在做的事情很重要，我們會去追求它。

Got it. And then I guess, Marc, as I think about just seasonality, and I know Q1 is always one of the issues here, but maybe if you can quantify for us how we should be thinking about payroll tax just for sequential modeling purposes?

知道了。然後我想，Marc，因為我只考慮季節性，而且我知道 Q1 始終是這裡的問題之一，但也許如果你能為我們量化我們應該如何考慮僅出於順序建模目的的工資稅？

I mean I would look at the first quarter of last year. We would expect a similar load in the first quarter of '23, which will tail off as those limits are met typically towards the end of the first quarter into the second quarter.

我的意思是我會看看去年第一季度。我們預計 23 年第一季度會有類似的負載，隨著這些限制通常在第一季度末到第二季度得到滿足，負載將會減少。

And currently, we have no further questions in queue.

目前，我們沒有其他問題在排隊。

Thank you very much, operator. Thank you all for joining the call.

非常感謝你，接線員。感謝大家加入電話會議。

Thank you very much. Ladies and gentlemen, this conference will be available for replay after 11:15 Eastern today and running through March 3 at midnight. You can access the AT&T replay system at any time by dialing 1 (866) 207-1041 and entering the access code 7838189. International participants may dial (402) 970-0847. Those numbers again are 1 (866) 207-1041 and International parties (402) 970-0847 with the access code 7838189. That does conclude our call for today. Thanks for your participation for using AT&T conferencing service. You may now disconnect.

非常感謝。女士們，先生們，今天東部時間 11 點 15 分之後並一直持續到 3 月 3 日午夜，可以重播本次會議。您可以隨時撥打 1 (866) 207-1041 並輸入接入碼 7838189 訪問 AT&T 重播系統。國際參與者可以撥打 (402) 970-0847。這些號碼還是 1 (866) 207-1041 和國際電話 (402) 970-0847，訪問代碼是 7838189。我們今天的電話會議到此結束。感謝您參與使用 AT&T 會議服務。您現在可以斷開連接。