Pediatrix Medical Group Inc (MD) 2023 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by.

女士們先生們，謝謝你們的支持。

Welcome to the 2023 fourth quarter earnings conference call.

歡迎參加 2023 年第四季財報電話會議。

(Operator Instructions) As a reminder, this conference is being recorded.

（操作員指示）謹此提醒，本次會議正在錄製中。

I would now like to turn the conference over to your host, Charles Lynch.

現在我想把會議交給主持人查爾斯·林奇。

Please go ahead.

請繼續。

Thank you, operator, and good morning, everyone.

謝謝接線員，大家早安。

I'll quickly read our forward-looking statements and then turn the call over to Jim.

我將快速閱讀我們的前瞻性聲明，然後將電話轉給吉姆。

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.

本次電話會議期間的某些陳述和資訊可能被視為 1995 年聯邦私人證券訴訟改革法案意義內的前瞻性陳述。

These forward-looking statements are based on assumptions and assessments made by Pediatrix's management in light of their experience and assessment of historical trends, current conditions, expected future developments and other factors they believe to be appropriate.

這些前瞻性陳述是基於 Pediatrix 管理層根據其經驗以及對歷史趨勢、當前狀況、預期未來發展和他們認為適當的其他因素的評估而做出的假設和評估。

Any forward-looking statements made during this call are made as of today, and Pediatrix undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise.

本次電話會議期間所做的任何前瞻性陳述均截至今日，Pediatrix 不承擔更新或修改任何此類陳述的義務，無論是由於新資訊、未來事件或其他原因。

Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the Company's filings with the SEC, including the sections entitled Risk Factors.

本公司向 SEC 提交的文件中描述了可能導致實際結果、發展和業務決策與前瞻性陳述存在重大差異的重要因素，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.

在今天管理階層​​的演講中，我們將討論非公認會計準則財務指標。

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. With that, I'll turn the call over to our CEO, Dr. Jim Swift.

這些非 GAAP 財務指標與最具可比性 GAAP 指標的調整表可在今天早上的收益新聞稿、我們的 10 Q 表季度報告和 10 K 表年度報告以及我們的網站 www.Pediatrix.com 中找到。 。接下來，我會將電話轉給我們的執行長吉姆·斯威夫特博士。

Thank you, Charlie, and good morning everyone.

謝謝你，查理，大家早安。

Also with me today is Marc Richards, our Chief Financial Officer.

今天和我在一起的還有我們的財務長馬克理查茲 (Marc Richards)。

Our fourth quarter results were within the revised expectations we provided in November.

我們第四季的業績符合我們 11 月提供的修訂後的預期。

Our overall same unit volumes reflected strength within our office-based maternal-fetal medicine services, partially offset by lower volumes in our hospital-based services.

我們總體上相同的單位數量反映了我們以辦公室為基礎的母胎醫學服務的實力，部分被我們以醫院為基礎的服務數量的減少所抵消。

Notably, these comparisons are against very strong volumes in the prior year quarter.

值得注意的是，這些比較是針對去年同期非常強勁的銷售量進行的。

Our underlying same unit pricing was also stable, absent certain distortions from last year's fourth quarter that Marc will detail.

我們的基本相同單位定價也很穩定，沒有馬克將詳細介紹的去年第四季的某些扭曲。

Turning to 2024, we provided this morning our preliminary outlook for adjusted EBITDA of between 202 hundred and $20 million.

談到 2024 年，我們今天早上提供了調整後 EBITDA 的初步展望，預計為 2,020 萬至 2,000 萬美元。

This outlook reflects clear progress in three priorities, effectively transitioning to a strong sustainable revenue cycle management program, generating continued efficiencies across our support structure and maintaining strong payer relationships and a high in-network status.

這一前景反映了三個優先事項的明顯進展，即有效過渡到強大的可持續收入周期管理計劃、在我們的支持結構中持續提高效率以及保持牢固的付款人關係和較高的網絡內地位。

It assumes also stabilizing our practice level margin profile against the headwinds we face.

它還假設我們能夠穩定我們的實踐水準利潤狀況，以應對我們面臨的逆風。

I'll give details on each of these priorities.

我將詳細介紹每個優先事項。

First, we have moved forward with our transition to a hybrid RCM model.

首先，我們已經向混合 RCM 模型過渡。

We've continued the expansion of our internal team and expect that we will soon be fully staffed, and we have worked closely with a new vendor under an interim transition engagement that we intend shortly to shift to a long-term relationship.

我們繼續擴大內部團隊，預計很快就會配備齊全，並且我們在臨時過渡協議下與新供應商密切合作，我們打算很快轉變為長期合作關係。

Thanks to this combination of robust resources, we have not encountered any significant disruptions to our RCM activities for the fourth quarter and to date in 2024.

由於強大的資源組合，我們從第四季到 2024 年迄今的 RCM 活動沒有遇到任何重大中斷。

Second, while this hybrid RCM model does this state additional internal staffing within our G&A line, we continue to identify efficiencies within our nonclinical infrastructure, such that in 2024, our expected total G&A expense will remain at a comparable percent of revenue as compared to 2023.

其次，雖然這種混合RCM 模型在我們的G&A 業務範圍內增加了內部人員配置，但我們繼續確定我們的非臨床基礎設施內的效率，這樣到2024 年，我們的預期總G&A 費用將保持在與2023 年相當的收入百分比。

Third, although our in-network status has typically been above 95%, we entered this year with an even higher in network position following successful negotiations with two payers in three states where we previously had been out of network.

第三，雖然我們的網路內狀態通常高於 95%，但在與我們之前不在網路外的三個州的兩個付款人成功談判後，我們今年的網路地位甚至更高。

As we've discussed in the past, we believe that these renegotiations were made possible by our ability to effectively navigate the arbitration process for out-of-network claims under the No Surprises Act through which we've been able to demonstrate the value of the critical services, our affiliated clinicians provide to their patients.

正如我們過去所討論的，我們相信，這些重新談判之所以成為可能，是因為我們能夠根據《無意外法案》有效地引導網絡外索賠的仲裁程序，通過該程序，我們能夠證明我們的附屬臨床醫生為患者提供的關鍵服務。

We are very pleased that patients and their families now have in network access to these services.

我們非常高興患者及其家人現在可以透過網路存取這些服務。

And we are gratified to have a broad recognition by payers of our essential role in the market.

我們很高興得到付款人對我們在市場中的重要角色的廣泛認可。

Finally, as I noted last quarter, we are also focusing on narrowing the range of financial performance across individual practices in our organization.

最後，正如我上季指出的那樣，我們也致力於縮小組織中各個業務的財務績效範圍。

We have identified and initiated specific plans for a wide range of affiliated practices.

我們已經為廣泛的附屬實踐確定並啟動了具體計劃。

And these plans themselves encompass an array of structural, tactical and strategic steps.

這些計劃本身包含一系列結構、戰術和戰略步驟。

And as we have been executing on these plans, we expect that activity will accelerate through the year.

隨著我們一直在執行這些計劃，我們預計這項活動將在今年加速。

As a result, we believe that the financial impact of these improvements will build cumulatively through 2024.

因此，我們相信這些改善的財務影響將持續累積到 2024 年。

Overall, I'm confident that our focus on the operating priorities that are critical critical to our success will benefit all stakeholders.

總的來說，我相信，我們對對我們成功至關重要的營運優先事項的關注將使所有利害關係人受益。

And I firmly believe that this focus in no way detracts from our mission to take great care of the patient, and we look forward to executing on these priorities throughout the remainder of the year.

我堅信，這種關注絕不會減損我們精心照顧患者的使命，我們期待在今年剩餘時間內執行這些優先事項。

Before turning the call over to Mark, I want to emphasize that above all else, we are a clinically focused organization and we take very seriously the critical role we play in the improvement and quality of patient care for the most fragile patients this week.

在將電話轉交給馬克之前，我想強調的是，最重要的是，我們是一個以臨床為重點的組織，我們非常認真地對待本週在改善最脆弱患者的護理品質和品質方面發揮的關鍵作用。

Pediatrics will be hosting two concurrent conferences, our 12th Annual specialty review and neonatology at our 45th.

兒科將同時舉辦兩場會議：第 12 屆年度專業審查會議和第 45 屆新生兒學會議。

And you will know the conference for neonatology is a testament to our mission that we have hosted these important events for so long with strong attendance that goes well beyond pediatrics affiliated clinicians.

您會知道，新生兒學會議證明了我們的使命，我們長期以來一直主辦這些重要活動，出席人數遠遠超出了兒科附屬臨床醫生的範圍。

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

這樣，我會將電話轉給馬克理查茲。

Thank you, Jim, and good morning, everyone.

謝謝吉姆，大家早安。

I'll provide some details for the quarter.

我將提供本季的一些細節。

Our same unit volumes were mixed in the quarter with hospital-based volumes declining somewhat offset by strong office-based volumes, specifically maternal-fetal medicine.

本季我們相同的單位銷售量參差不齊，醫院銷售量的下降在一定程度上被辦公室銷售的強勁（特別是母胎醫學）所抵銷。

Notably, these comparisons were against strong volumes in the prior year fourth quarter.

值得注意的是，這些比較是與去年第四季的強勁銷售進行的。

On the pricing side, there are two key items to call out for you to make an appropriate year-over-year comparison.

在定價方面，有兩個關鍵項目需要您進行適當的同比比較。

First, in the fourth quarter of 22, we recorded revenue from our prior RCM vendor for financial support related to aged receivables, which did not recur in the 2023 fourth quarter.

首先，在 22 月第四季度，我們記錄了先前的 RCM 供應商為與陳舊應收帳款相關的財務支援提供的收入，該收入在 2023 年第四季度沒有重複出現。

This reduced our same-unit pricing growth by roughly 2% in Q4 of 23.

這使得 23 年第四季的同單位定價成長下降了約 2%。

Additionally, we recorded a modest amount of CARES dollars in Q4 of 22, which also did not recur reducing our same-unit pricing growth in Q4 of 23 by an additional 40 basis points.

此外，我們在第四季度記錄了 22 美元的少量 CARES 美元，這也沒有再次導致我們第四季度 23 的同單位定價增加額外 40 個基點。

These items clouded what we view as a stable and positive pricing comparison, which included favorable payer mix and growth in contract and administrative fees.

這些項目為我們認為穩定和積極的定價比較蒙上了陰影，其中包括有利的付款人組合以及合約和管理費用的增長。

On the cost side, our practice level expenses declined slightly year over year, largely reflecting lower incentive compensation and malpractice expense, partially offset by increases in salaries and group insurance expenses.

在成本方面，我們的執業水準費用較去年同期略有下降，主要反映了激勵薪酬和醫療事故費用的減少，部分被工資和團體保險費用的增加所抵消。

As Jim noted, underlying pricing level salary growth remained elevated in the mid single digits.

正如吉姆指出的那樣，基本定價水準的薪資成長仍然保持在中等個位數的高位。

Lastly, G&A increased slightly year over year, partially reflecting staffing increases as we continue to build our internal RCM team.

最後，一般行政費用較去年同期略有增加，部分反映了我們繼續建立內部 RCM 團隊而導致的人員編制增加。

We generated $73 million in operating cash flow for the fourth quarter, resulting in full year operating cash flow of $146 million.

第四季我們產生了 7,300 萬美元的營運現金流，全年營運現金流為 1.46 億美元。

As Jim noted, we're pleased that our RCM transition did not cause any material disruptions in billing and collections in the fourth quarter and our DSOs were basically flat at year end compared to the end of Q3.

正如吉姆指出的那樣，我們很高興我們的 RCM 過渡沒有對第四季度的計費和收款造成任何重大干擾，並且與第三季度末相比，我們的 DSO 到年底基本持平。

We ended the year with total borrowings of $628 million and cash of $73 million for net leverage at year end of just under 2.8 times.

截至年底，我們的總借款為 6.28 億美元，現金為 7,300 萬美元，年末淨槓桿率略低於 2.8 倍。

As a reminder, we are a user of cash in the first quarter of each year as we pay out incentive compensation and other benefits.

提醒一下，我們在每年第一季都是現金用戶，因為我們支付激勵薪資和其他福利。

And this cash balance will reduce any potentially borrowings needed before we turn to ExpressJet free cash flow generation in Q2 and beyond.

在我們在第二季及以後轉向 ExpressJet 自由現金流產生之前，這種現金餘額將減少所需的任何潛在藉款。

I'll add some details to our '24 outlook.

我將在我們的 24 年展望中添加一些細節。

We expect net revenue of $2 billion to $2.1 billion or modest growth over '23.

我們預計 2023 年淨收入將達到 20 億至 21 億美元，或略有成長。

And as Jim touched on, we anticipate that our G&A expense as a percentage of revenue will be comparable in '24 versus '23, with additions to our RCM team offset by continued efficiencies across our corporate infrastructure.

正如吉姆所說，我們預計 24 年和 23 年的一般管理費用將佔收入的百分比將相當，我們的 RCM 團隊的增加將被我們公司基礎設施的持續效率所抵消。

Finally, in terms of quarterly earnings progression, we anticipate that our first quarter adjusted EBITDA will represent 17% to 19% of full-year adjusted EBITDA, largely reflecting the normal seasonality of our financial results.

最後，就季度獲利進展而言，我們預計第一季調整後 EBITDA 將佔全年調整後 EBITDA 的 17% 至 19%，這在很大程度上反映了我們財務表現的正常季節性。

With that, I'll turn the call back over to Jim.

這樣，我會將電話轉回給吉姆。

Thank you, Marc.

謝謝你，馬克。

Operator, let's now open the call for questions.

接線員，現在讓我們開始提問。

(Operator Instructions) Brian Tanquilut, Jefferies.

（操作員說明）Brian Tanquilut，Jefferies。

Okay.

好的。

We'll move on.

我們會繼續前進。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Hi, this is Andrew on for A.J. On the company previously sized around a 50 million RCM headwind in the first half of 23.

大家好，我是 A.J. 的安德魯。該公司此前預計 23 年上半年的 RCM 逆風約為 5,000 萬。

Would that be a tailwind in 24 for pricing in the first half?

這會成為24年上半年定價的順風車嗎？

No, I don't think so.

不，我不這麼認為。

We are in the midst of a transition from an end to end vendor to a hybrid solution.

我們正處於從端到端供應商向混合解決方案的過渡之中。

I would say, as we progress through this transition, which is staged in various components throughout 24 weeks back to maintain stable pricing through this transition.

我想說的是，隨著我們在整個 24 週內分階段進行的過渡，以在過渡期間保持穩定的價格。

I be a continuance of what we saw the fourth quarter of '23.

我是 23 年第四季的延續。

Got it.

知道了。

Thanks.

謝謝。

And then a quick question on arbitration.

然後是關於仲裁的快速問題。

Cms reopened the arbitration portal in December.

Cms 於 12 月重新開放仲裁入口網站。

The Company previously talked about having around a 75% success rate in arbitration cases versus the industry average of 71%.

該公司先前曾表示，仲裁案件的成功率約為 75%，而業界平均為 71%。

Are there any updates on this win rate?

這個勝率有更新嗎？

And are you seeing more cases go through arbitration than previously?

您是否看到比以前更多的案件通過仲裁？

Thanks.

謝謝。

Wasn't it was not just started since we're back in network.

這不是自從我們回到網路後才開始的嗎？

Now with a number of the payers that we were having to contemplate arbitration, we haven't seen an increase related to our creation cases.

現在，我們不得不考慮仲裁的一些付款人，我們還沒有看到與我們的創造案件相關的增加。

I would say that the process and our internal process for this, we've continued to refine by having much of that capability in-house and you are on our win rate has improved over the course of the last several months, we're approaching at least on our most recent data.

我想說的是，我們的流程和我們的內部流程，我們透過內部擁有大部分能力來繼續完善，並且您知道我們的勝率在過去幾個月中有所提高，我們正在接近至少根據我們最新的數據。

We're approaching it almost 90% win rate when we are going to arbitration.

當我們進行仲裁時，我們的勝訴率已經接近 90%。

Thanks a lot.

多謝。

Ryan Daniels, William Blair.

瑞恩·丹尼爾斯、威廉·布萊爾。

Hey, good morning, guys.

嘿，早上好，夥計們。

This is Jack Sam on for Ryan Daniels.

我是瑞安·丹尼爾斯的傑克·薩姆。

Think Thanks for taking my question.

想想謝謝你提出我的問題。

First the adjusted EBITDA guide was admittedly wider for the first quarter was admittedly wider than what you've guided to in the past.

首先，第一季調整後的 EBITDA 指南無疑比您過去的指導更廣泛。

Can you just talk about the rationale for this and maybe the puts and takes that get you to the low end of the range versus the high end of the range things.

您能談談這樣做的基本原理嗎？也許是讓您達到範圍低端與高端的看跌期權和看跌期權。

Can you clarify?

你能澄清一下嗎？

I didn't catch it right.

我沒聽清楚。

It relates to the first quarter or the full year.

它涉及第一季或全年。

Sorry, the first quarter, I guess because I think the guide was a $20 million range versus what you've done in the past of about $10 million.\

抱歉，我猜是第一季度，因為我認為該指南的範圍是 2000 萬美元，而您過去所做的大約是 1000 萬美元。\

I think I did it for the full year.

我想我一整年都在這麼做。

That's a we've provided a $20 million range, which is give or take a 10% range around the midpoint of where we're at for the first quarter.

我們提供了 2000 萬美元的範圍，大約是第一季中點左右 10% 的範圍。

If you do the math on what Mark provided of 17% to 19% of full year EBITDA, that's a little bit narrower than $20 million.

如果你計算一下 Mark 提供的全年 EBITDA 的 17% 到 19%，這個數字比 2000 萬美元要窄一些。

Sorry, I definitely misspoke.

抱歉，我確實說錯了。

I meant before your sorry about that.

我的意思是在你對此感到抱歉之前。

And then as a quick follow-up here on last quarter, too, I know you mentioned that you're planning to tackle the labor cost challenges and growth in clinician comp.

然後，作為上季度的快速跟進，我知道您提到您計劃解決勞動力成本挑戰和臨床醫生薪酬的增長。

Curious if you can just give any additional color here and kind of what you've done or at least plan to do heading into 2024?

好奇您是否可以在這裡提供任何額外的資訊以及您已經做了什麼或至少計劃在 2024 年做什麼？

And then just maybe if we can just get your expectations here for 2024 with this initiative as well.

或許我們也能透過這項措施了解您對 2024 年的期望。

Thanks.

謝謝。

I can I can start off and let Jim add some color on that within our expectations for the full year, EBITDA is similarly an expectation of some moderation in underlying practice level expense growth.

我可以先讓吉姆在我們對全年的預期中添加一些色彩，EBITDA 同樣是對基本實踐水準費用成長放緩的預期。

And as we discussed in the previous quarter and Jim referenced this morning, we have fairly specific plans across a pretty broad spectrum of practices.

正如我們在上一季討論的和吉姆今天早上提到的，我們在相當廣泛的實踐中製定了相當具體的計劃。

It doesn't have any number of different focal points to them.

它沒有任何數量的不同焦點。

And a lot of that is geared toward a stabilization of gross margin across our practice spectrum.

其中很大一部分是為了穩定我們整個業務領域的毛利率。

And within that and obviously within our guidance for this year is some moderation in overall practice level expense growth versus what we experienced over the past year?

在此範圍內，顯然在我們今年的指導範圍內，與我們去年經歷的情況相比，整體實踐水平費用增長是否有所放緩？

Jim, you want to?

吉姆，你願意嗎？

Yes.

是的。

And we're looking at really what we're doing on the variable and fixed comp side to have more stability around that.

我們正在研究我們在可變和固定補償方面所做的事情，以提高穩定性。

Additionally, I think what we've seen along the way and starting up new practices is that the in some of the specialties, the harder challenge to recruit in and pay those physicians.

此外，我認為我們一路走來並開始新的實踐所看到的是，在某些專業中，招募和支付這些醫生的挑戰更加艱鉅。

I think we'll still see some of that.

我想我們仍然會看到其中的一些。

But I think in some of the specialties where we've largely had to use locums.

但我認為在一些專業中我們很大程度上不得不使用代理。

We think that there's expanding pool of clinicians where we are not going to have been really the contract labor is a headwind.

我們認為，隨著臨床醫生隊伍的不斷擴大，我們不會真正感受到合約工是一種阻力。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

I just want guys on on the revenue growth guidance are $2 billion to $2.1 billion.

我只是希望營收成長指引為 20 億至 21 億美元。

What are the components of the revenue growth split between volume and price?

銷售成長和價格成長的收入成長由哪些部分組成？

Hey, Peter, good morning.

嘿，彼得，早安。

We I wouldn't I would take out a couple of pieces.

我們我不會，我會拿出幾塊。

We're expecting stable volume throughout 2014.

我們預計 2014 年銷售量將保持穩定。

Our guidance on volume, of course, is a contributing factor to our top line range that we provided.

當然，我們對數量的指導是我們提供的頂線範圍的影響因素。

I would say also, as we indicated, we expect through our RCM transition rate to remain somewhat stable through '24.

我還要說，正如我們所指出的，我們預計透過我們的 RCM 過渡率，到 2024 年將保持一定程度的穩定。

Certainly, as we complete the various stages of the transition and we move over to our complete hybrid solution, there is opportunity for rate improvement as we approach the end of the year.

當然，隨著我們完成過渡的各個階段並轉向完整的混合解決方案，隨著年底的臨近，費率還有機會提高。

Okay.

好的。

So so basically stable volumes and stable rates arm.

因此，成交量和費率基本上穩定。

So I mean, as you brought on those out-of-network contracts into in-network was at a rate tailwind or a rate headwind.

所以我的意思是，當你將這些網路外合約引入網路內時，無論是順風還是逆風。

And that's that's generally we're going to move from an ad network to in network position that is generally favorable for us.

一般來說，我們將從廣告網路轉向通常對我們有利的網路地位。

Peter starts, I'll send a lag component of Pete over the last component of that of a top line revenue estimate is around organic growth and the opportunities there.

彼得開始，我將發送皮特的滯後部分，而頂線收入估計的最後一部分是關於有機增長和那裡的機會。

Okay, which which actually is a great segue you know, looking at your sort of guidance ranges with with contracting for pricing basically set and contracting with your doctor has basically said is the only variable between the high and the low end simply with the volumes and out or where the components are there between the high end are still low in the guidance.

好吧，這實際上是一個很好的延續，你知道，看看你的指導範圍，基本上確定了定價合同，並與你的醫生簽訂了合同，基本上說這是高端和低端之間的唯一變量，僅取決於數量和或高端之間的組件在指導中仍然較低。

But I mean, I would say that is certainly a component of that range on.

但我的意思是，我想說這肯定是該範圍的一部分。

I want to be clear that we have a lot of activity on the operational side, be it in the RCM transition in our practice level plans and our corporate plans.

我想澄清的是，我們在營運方面有很多活動，無論是在我們的實踐水平計劃還是我們的企業計劃中的 RCM 過渡。

So there is an execution component and each of those that we wanted to take into account within that guidance range.

因此，有一個執行組件，我們希望在該指導範圍內考慮其中的每一個組件。

Okay, sir, I have two more quick ones here.

好的，先生，我這裡還有兩個快的。

With your contracting with your physician, is there any change to sort of turnover has as contracts come up for renewal?

您與醫師簽訂合約後，隨著合約的續約，營業額是否會有所變動？

There been any change to the turnover of those docs on those contracts, or is it pretty stable?

這些合約上的文件營業額有什麼變化，還是相當穩定？

No, it's been pretty stable.

不，一直很穩定。

Our turnover is very, very low, as we've commented before.

正如我們之前評論的那樣，我們的營業額非常非常低。

And with most of these contracts.

其中大部分合約都是如此。

Again, some of them are renewed over three year period.

同樣，其中一些在三年內更新。

And in the specialties we're in, we really are the medical home for a lot of these specialties.

在我們所從事的專業領域，我們確實是許多專業領域的醫療之家。

So I think that really breeds confidence within the clinician pool to remain a part of the organization.

所以我認為這確實增強了臨床醫生群體的信心，讓他們繼續留在組織中。

It makes sense.

這說得通。

And then last quick one year free cash flow conversion for 24 should be pretty similar for you as it was at 23 now that now that RCM is pretty stable.

然後，去年 24 的自由現金流轉換對您來說應該與 23 非常相似，因為現在 RCM 相當穩定。

Thanks a lot.

多謝。

I would think so, Pito, if you look at 23, it was a little over 70% from adjusted EBITDA to operating cash flow from our general rule of thumb, rule of thumb has been in the range of maybe two quarters of adjusted EBITDA into operating cash flow.

我想是的，Pito，如果你看一下 23，根據我們的一般經驗法則，從調整後 EBITDA 到營運現金流的比例略高於 70%，經驗法則可能在調整後 EBITDA 的兩個季度的範圍內經營性現金流。

So that's a kind of a good baseline for you to think about.

所以這是一個值得你思考的良好基準。

Great.

偉大的。

Thanks so much.

非常感謝。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Hey, good morning, guys, and sorry about the technical difficulties earlier.

嘿，早安，夥計們，對於之前的技術困難，我們深表歉意。

Jim, I guess my first question would in your prepared remarks, you talked about structural tactical and the strategic changes that you're making to the business.

吉姆，我想我的第一個問題是在您準備好的發言中，您談到了您正在對業務進行的結構性戰術和戰略變革。

Maybe if you can share with us what falls into each of those three buckets that you alluded to I suppose when we look at it at face value, one is and we've talked about volume in the past, we're looking at staffing associated with the practices to make sure that we have the right staffing mix in terms of personnel and within that is really are we using clinics, physicians versus other clinicians such as nurse practitioners or PAs.

也許您可以與我們分享您提到的這三個類別中的每一個類別，我想當我們從表面上看時，其中一個是我們過去討論過的數量，我們正在考慮相關的人員配備通過實踐來確保我們在人員方面擁有正確的人員配置組合，其中我們實際上是使用診所、醫生還是其他臨床醫生，例如執業護士或私人助理。

That's one piece to we know that we have contract revenue in our relationship with some of our hospital partners.

這是我們知道我們與一些醫院合作夥伴的關係中有合約收入的一部分。

And certainly that becomes an element in terms of rightsizing the support for those practices and making sure that we really are executing with our hospital partners in that regard.

當然，這成為調整對這些做法的支持規模並確保我們真正與我們的醫院合作夥伴在這方面執行的一個要素。

And we've had some favorable results thus far.

到目前為止，我們已經取得了一些有利的結果。

And I think as well as the issue that we've seen about being back in network in the case of our ambulatory practices that have been adversely affected because as opposed to the inpatient services where the patients do make it to the service largely in those other areas.

我認為，我們所看到的關於回到網路的問題，在我們的門診實踐中也受到了不利影響，因為與住院服務相反，患者確實主要在其他地方獲得服務。地區。

We are really those patients are directed elsewhere.

我們確實是那些被送到其他地方的病人。

So we feel that there's going to be a benefit as we get more of our marketing and execution around the patient volumes from a collective ambulatory standpoint.

因此，我們認為，從集體門診的角度來看，隨著我們圍繞患者數量進行更多的行銷和執行，將會帶來好處。

Got it.

知道了。

Okay.

好的。

And then maybe since you talked about inpatient, is there anything you're seeing in the hospital other than a tough comp from last year.

也許既然你談到了住院病人，除了去年的艱難比賽之外，你在醫院裡還看到了什麼嗎？

Have you kind of hinders the ability to drive growth?

您是否阻礙了推動成長的能力？

Is it your hospitals losing market share or is it just the birth rate altogether Just curious how you're thinking about volumes.

是你們的醫院失去了市場份額還是只是出生率下降了？只是好奇你們是如何考慮數量的。

Yes.

是的。

I think that part of the volume issue is, you know, take the Nik, you out for a moment.

我認為音量問題的一部分是，你知道，拿尼克，你出去一會兒。

We did not see the large amount of volume this year as last year that we saw in 22 related to the other inpatient services such as pediatric hospitalists, pediatric ER and pediatric ICU.

今年我們沒有看到像去年那樣大量的與其他住院服務（例如兒科住院醫師、兒科急診室和兒科 ICU）相關的 22 項治療量。

I think from the standpoint of our inpatient acute services, people talk a little bit about, you know, a higher degree of severe prematurity and increasing length of stays.

我認為，從我們住院急診服務的角度來看，人們談論了一些，你知道，嚴重早產率更高，住院時間更長。

And we've certainly seen that the some of the bread and butter around emissions into the mix.

我們當然已經看到一些麵包和黃油周圍的排放物混合在一起。

You have been variable across the country.

你在全國範圍內變化無常。

So but again, we anticipate volumes will remain kind of where we are for the time being, but we don't see any indication of volumes decelerating going forward.

因此，我們再次預計成交量將暫時保持在目前的水平，但我們沒有看到任何跡象表明成交量未來會減速。

And Brian, just a quick note on that.

布萊恩，請簡單說明一下。

We did highlight the fourth quarter had some pretty strong comps that we went against.

我們確實強調第四季度有一些我們反對的相當強大的競爭。

We look at our Nike days over a two year stack.

我們回顧了兩年來我們在耐吉的日子。

They were actually slightly positive versus the first two years ago.

與兩年前相比，他們實際上稍微積極一些。

So in our view, looking across as many states and practices from where we are providing neonatology services, we usually view it as more appropriate to look at a longer term timeframe to get a better sense of where things are going.

因此，在我們看來，縱觀我們提供新生兒學服務的許多州和實踐，我們通常認為更合適的是著眼於更長期的時間框架，以更好地了解事情的進展。

And as a result, as we look into 24 on, we're not anticipating within our within our outlook for the year, any meaningful movement in patient volumes, some of them at the rate.

因此，當我們展望 24 日時，我們預計今年的患者數量不會出現任何有意義的變化，其中一些變化是按比例變化的。

But then maybe last question for me.

但也許是我的最後一個問題。

Since you guys talked about in network, how much of the out of network is going to be left in the business, let's just say as we exit?

既然你們談到了網路內，那麼業務中將剩下多少網路外的業務，讓我們說當我們退出時？

Yes, it's a it's a good question because you're asking things that we don't know about how this year will unfold but where we stand right now, where our historical experiences five or less than 5% out-of-network position and were lower that as we entered, were lower than that as we entered this year, thanks to some of the recontracting we've done.

是的，這是一個很好的問題，因為你問的問題是我們不知道今年將如何展開，但我們現在所處的位置，我們歷史上經歷過5% 或不到5% 的網絡外位置，以及低於我們進入時的水平，低於我們今年進入時的水平，這要歸功於我們所做的一些重新簽約。

Got it.

知道了。

Thank you.

謝謝。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks.

萬分感謝。

I guess a couple of follow up questions on when you said that the that going in network is usually a positive for the Company.

當你說進入網路通常對公司有利時，我想有幾個後續問題。

We're talking about positive on the rate perspective.

我們談論的是利率角度的正面因素。

Are we talking about this dynamic with the with the outpatient volumes usually getting a boost once you go in network.

我們是否在談論這種動態，一旦進入網絡，門診量通常會增加。

I was referencing the rate our experience over the last several years is that we're in and when we are in and out of network position, some of the reimbursement we're receiving from payers tends to be quite low, hence the arbitration processes that we that we enter them.

我指的是我們過去幾年的經驗是，當我們進入和退出網絡位置時，我們從付款人那裡收到的一些報銷往往相當低，因此仲裁程序我們進入他們。

So we're generally fund favorably positioned when we are out of network from a from a rate standpoint, Jim?

因此，從利率的角度來看，當我們脫離網路時，我們通常會處於有利的位置，吉姆？

Yes, Kevin, it is volume to write.

是的，凱文，寫太多了。

It is volume on the ambulatory services, particularly in although we had strong numbers on a maternal-fetal medicine practices.

這是流動服務的數量，特別是儘管我們在母胎醫學實踐方面擁有大量的數量。

When you think about it when it is impacted in that outpatient setting, that doesn't impact that impacts from the inpatient, if that is the mother who's directed away from one of our practices that might not deliver with one of our facilities.

當你考慮一下，當它在門診環境中受到影響時，這不會影響住院病人的影響，如果那位母親被引導離開我們的一種做法，而這種做法可能無法透過我們的一種設施提供。

So again, that captures that volume back, which which we're very pleased with.

再次，這卷回了，我們對此非常滿意。

Okay.

好的。

And then if I just want to make sure I got the numbers right.

然後如果我只是想確保我得到的數字是正確的。

I think the reported same-store pricing in the quarter was minus 50 basis points and you're saying back 2% and then another 40 basis points you kind of look at overall pricing in the quarter is like a positive 1.9 and a normalized basis.

我認為本季報告的同店定價為負 50 個基點，你會說回 2%，然後再上升 40 個基點，你會看到本季的整體定價就像正 1.9 和標準化基礎。

Is that the right way to think about it that's right.

這是正確的思考方式嗎？

That's right.

這是正確的。

That's right.

這是正確的。

Okay.

好的。

So if you walk and walk through the pieces of same unit revenue quarter over quarter is down about 1.5%.

因此，如果你仔細查看相同單位的收入，季度環比下降了約 1.5%。

There's about 1% of that is attributed to volume, which brings same unit rate down to about a 50 basis point decline.

其中約 1% 歸因於交易量，這使得相同的單位利率下降約 50 個基點。

We've got some carriers in there.

我們那裡有一些運營商。

And then, of course, you referenced the other component related to the guarantee last year.

當然，您去年也提到了與擔保相關的其他組成部分。

Okay.

好的。

So so when you said that your revenue guidance assumes stable volumes and stable pricing.

當您說您的收入指導假設穩定的銷售和穩定的價格時也是如此。

And when you say stable, you mean flat year over year or you mean stable as in like still about 2% crisis?

當你說穩定時，你的意思是同比持平，還是指穩定，就像仍然有 2% 左右的危機？

No.

不。

But when I say stable, I mean effectively flat continuing off of the end of 23.

但當我說穩定時，我的意思是從 23 月底開始實際上持平。

So effectively the the rate the exit rate in 23 is what we anticipate driving 24%.

因此，我們預計 23 年的退出率將達到 24%。

Is there a reason why you're not getting rate update that you're in network, I would think that you should be getting some sort of cost of revenues or something else about payer mix assumptions or anything else that you're assuming?

是否有原因導致您沒有獲得網路中的費率更新，我認為您應該獲得某種收入成本或有關付款人組合假設或您假設的其他任何內容？

No, I mean, we assume our payer mix has been relatively flat year over year.

不，我的意思是，我們假設我們的付款人組合比去年同期相對持平。

If you look back in the 10 K, we're assuming that as well.

如果你回顧 10 K，我們也會假設這一點。

There are, of course, puts and takes in rate.

當然，還有看跌期權和買入利率。

Of course, despite the fact that we're anticipating a stable rate through 24 going to flat volume, there is a little bit of growth in the top line.

當然，儘管我們預計 24 日銷售量將保持穩定，但營收仍會有一些成長。

The timing of that I'd say is counterbalanced with both, you know, our CFO transition and the like.

我想說的時間安排與我們的財務長過渡等因素是平衡的。

Okay.

好的。

And then I guess as far as the guidance, it doesn't sound like it's assuming anything from a capital deployment perspective?

然後我想就指導而言，聽起來似乎沒有從資本部署的角度做出任何假設？

Or do you expect to be active on that front?

或者您希望在這方面積極參與嗎？

Well, we still we still are looking at and I think there was a we had a certain amount of caution while we were out of network, but now being back at network, largely in our bigger markets, we do have the opportunity to deploy capital in terms of acquisitions of practices.

好吧，我們仍在考慮，我認為在我們脫離網絡時我們有一定的謹慎態度，但現在回到網絡，主要是在我們更大的市場，我們確實有機會部署資本在實踐的獲取方面。

And we're certainly identifying in the core of those practices that would make sense for us to acquire.

我們當然正在確定那些對我們來說有意義的實踐的核心。

So yes, we still have an attitude of deploying capital in that regard.

所以是的，我們在這方面仍然有配置資本的態度。

Thank you.

謝謝。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Yes, hey, guys.

是的，嘿，夥計們。

Thanks.

謝謝。

Let me come back in.

讓我進來吧。

Just a quick modeling question.

只是一個快速建模問題。

As we're looking at the guidance for modeling salaries and benefits as a 30 basis point sort of headwind, is that generally how we should be thinking about 2024, where are you referencing that 30 basis points?

當我們將工資和福利建模指南視為 30 個基點的逆風時，我們通常應該如何考慮 2024 年，您在哪裡引用了 30 個基點？

Peter?

彼得？

Sorry.

對不起。

Sorry.

對不起。

Just looking at looking at your guidance from revenue, you saying that G&A is going to be flat on I mean, just you know, I guess let me ask it differently, like how do you view so it was embedded as a percent of revenue in 24 versus 23?

看看你對收入的指導，你說一般行政費用將持平，我的意思是，你知道，我想讓我以不同的方式問它，比如你如何看待它作為收入的百分比嵌入24對23？

Yes, I think you can partially solve for that.

是的，我認為你可以部分解決這個問題。

And I think I think you have within the range we provided on revenue and adjusted EBITDA at a high level.

我認為您的收入和調整後的 EBITDA 處於我們提供的高水準範圍內。

Our view and our goal is that '24 represents a stabilization of our margin profile as compared to 2023 following some of the headwinds we faced over the last year or two.

我們的觀點和目標是，在經歷了過去一兩年的一些不利因素之後，與 2023 年相比，24 年我們的利潤率狀況趨於穩定。

So that's by and large how we have formulated that outlook, if that's if that's helpful to you.

總的來說，這就是我們如何闡述這一觀點的，如果這對您有幫助的話。

Yes.

是的。

And then which you is at the most 25 and beyond what I understand your your G&A leverage, you guys have done a good job with that and excellent jobs are dealing with the RCM issues that have occurred.

然後，你們最多 25 歲，超出了我對你們 G&A 槓桿的理解，你們在這方面做得很好，而且在處理已經發生的 RCM 問題方面做得很好。

But as I think about sort of two, three years down the road, is there an ability to stabilize S&B from turning from a headwind into a tailwind?

但我想，未來兩三年，S&B 是否有能力穩定局面，避免從逆風轉變為順風？

Or is this sort of a permanent headwind that that could be offset with G&A leverage?

或者這種永久性的逆風可以透過一般行政費用槓桿來抵銷？

Thank you, sir.

謝謝你，先生。

No, I think that our goal and what we see is even though the second half of the year is where we would look that hopefully, we start to see improvement.

不，我認為我們的目標和我們所看到的是，儘管下半年我們希望看到我們開始看到進步。

And then looking into 25, really it will be a different story.

然後再看看25，真的會是個不同的故事。

We think in terms of the overall cost structure, both at the practice level on labor.

我們從整體成本結構的角度來考慮，無論是在勞動力的實踐層面。

But also again, I think what we referenced and is that we're looking at all the practice in terms of the efficiencies in those practices that will be benefit to the organization.

但同樣，我認為我們所提到的是，我們正在根據那些對組織有利的實踐的效率來審視所有實踐。

And on top of that is obviously what we're doing structurally, we with our overhead at the corporate level.

最重要的是，顯然我們在結構上正在做的事情，我們在公司層級的管理費用。

All right, great.

好吧，太好了。

Thanks so much.

非常感謝。

And at this time, there are no further questions.

而此時，已經沒有其他問題了。

Thank you, operator, and thank you, everyone, for joining our call today.

謝謝接線員，也謝謝大家今天加入我們的通話。

Ladies and gentlemen, that does conclude your conference for today.

女士們、先生們，今天的會議到此結束。

Thank you for your participation and for using AT&T Executive Teleconference.

感謝您的參與和使用 AT&T 高階主管電話會議。

You may now disconnect.

您現在可以斷開連線。