Nutex Health Inc (NUTX) 2024 Q1 法說會逐字稿

Greetings and welcome to the Nutex Health first-quarter 2024 financial results earnings call. (Operator Instructions) As a reminder, this conference is being recorded.

歡迎參加 Nutex Health 2024 年第一季財務業績收益電話會議。（操作員指示）謹此提醒，本次會議正在錄製中。

It is now my pleasure to introduce your host, Jennifer Rodriguez. Thank you, Jennifer. You may begin.

現在我很高興向大家介紹你們的主持人珍妮佛羅德里格斯。謝謝你，詹妮弗。你可以開始了。

Hello and good morning. Welcome to the Nutex Health first-quarter 2024 earnings conference call. Today's call is being recorded. With me this morning is our Chairman and CEO, Dr. Tom Vo; CFO, Jon Bates; President, Dr. Warren Hosseinion; and COO, Josh DeTillio. Our team will provide some prepared remarks and then we'll take questions.

你好，早安。歡迎參加 Nutex Health 2024 年第一季財報電話會議。今天的通話正在錄音。今天早上和我在一起的是我們的董事長兼執行長 Tom Vo 博士；財務長喬恩‧貝茨；主席沃倫·侯賽尼恩博士；和營運長 Josh DeTillio。我們的團隊將提供一些準備好的評論，然後我們將回答問題。

Before I turn the call over to Dr. Vo, let me remind everyone that today's call may contain forward-looking statements that are based on management's current expectations, numerous risks, uncertainties, and other factors that may cause actual results to differ materially from those that might be expressed today. More information on forward-looking statements and these factors are listed on Wednesday's press release and in our various SEC filings.

在我將電話轉交給Vo 博士之前，請允許我提醒大家，今天的電話會議可能包含前瞻性陳述，這些陳述基於管理層當前的預期、眾多風險、不確定性以及其他可能導致實際結果與預期結果存在重大差異的因素。有關前瞻性陳述和這些因素的更多資​​訊列於週三的新聞稿和我們向 SEC 提交的各種文件中。

On this morning's call, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing the supplemental information on adjusted EBITDA and reconciling net loss attributable to Nutex Health Inc., is included in the press release and Form 10-Q filed earlier this week. This morning's call is being recorded and a replay of the call will be available later today.

在今天早上的電話會議上，我們可能會參考調整後 EBITDA 等指標，這是一項非 GAAP 財務指標。本週稍早提交的新聞稿和 10-Q 表格中包含了一張表格，提供了調整後 EBITDA 的補充資訊以及調節歸聯聯健康公司的淨虧損。今天早上的通話正在錄音，今天晚些時候將提供通話重播。

With that, I'll now turn the call over to Dr. Tom Vo, our Founder and Chief Executive Officer.

現在，我將把電話轉給我們的創辦人兼執行長 Tom Vo 博士。

Jennifer, thank you. And good morning, everybody, and thank you for joining the call. The past two years have been very challenging, both from a healthcare industry standpoint as well as from a macroeconomic standpoint. However, we remain committed to our core mission of providing improved accessibility as well as exceptional concierge level patient care.

詹妮弗，謝謝你。大家早安，感謝您加入通話。無論是從醫療保健產業的角度還是從宏觀經濟的角度來看，過去的兩年都非常具有挑戰性。然而，我們仍然致力於我們的核心使命，即提供更好的便利性以及卓越的禮賓級患者護理。

In fact, all of our hospitals are open 24/7 and we are the medical safety net for the communities that we serve. While we have faced many hurdles, I'm happy to report that our team have been very diligent in overcoming many of these hurdles.

事實上，我們所有的醫院都是 24/7 全天候開放，我們是我們服務的社區的醫療安全網。雖然我們遇到了許多障礙，但我很高興地向大家報告，我們的團隊非常努力地克服了其中的許多障礙。

We believe our effort over the past twelve months are beginning to pay off. This momentum has generated improved financial results driven by volume growth year over year, improved collections per visit, and solid operating margins. In 2023, we implemented several initiatives to increase ER volume, increase inpatient volume, and increase outpatient volume.

我們相信過去十二個月的努力已開始得到回報。在銷量逐年增長、每次訪問收藏量增加以及穩定的營業利潤的推動下，這種勢頭帶來了財務業績的改善。2023 年，我們實施了多項措施來增加急診量、增加住院量和門診量。

In addition, we opened four new hospitals in 2023, all of which have ramped up either faster than expectations or within expectations. System wide quarter over quarter from 2023 to 2024, ER volumes increased by 21%.

此外，我們在 2023 年開設了四家新醫院，所有醫院的擴張速度要麼快於預期，要麼在預期之內。從 2023 年到 2024 年，整個系統的 ER 數量較上季增加了 21%。

Of this 21% increase, 5.3% are from mature hospital growth, defined as hospitals being opened by December 31, 2022, to provide one full year or more of comparable results. Most of the remaining increases are from our ramping hospitals, defined as being open for less than one year.

在這 21% 的成長中，5.3% 來自成熟醫院的成長，即在 2022 年 12 月 31 日之前開業的醫院，以提供一整年或更長的可比結果。其餘的成長大部分來自我們不斷擴張的醫院，也就是開業時間不到一年的醫院。

From a revenue per patient perspective, we have also made some gains. Selection percentages have consistently increased monthly since January 1, 2022, when the No Surprises Act was implemented, and we are making great strides in understanding as well as navigating through all the nuances of the No Surprises Act.

從每位患者的收入角度來看，我們也獲得了一些收益。自 2022 年 1 月 1 日《無驚喜法案》實施以來，選擇百分比逐月持續增加，我們在理解和應對《無驚喜法案》的所有細微差別方面取得了巨大進步。

On the population health side of the business, we are also seeing growth. In addition to our IPA in Los Angeles, which has been consistently profitable, we have recently added an IPA in South Florida as well as an IPA in Houston. As a result, the number of MA lives, or Medicare Advantage lives, have increased by 78% quarter over quarter.

在人口健康業務方面，我們也看到了成長。除了一直獲利的洛杉磯 IPA 業務外，我們最近還在南佛羅裡達州和休士頓增加了 IPA 業務。因此，MA 生命（即 Medicare Advantage 生命）數量較上季增加了 78%。

From a cost perspective, our operating costs across most categories have started to come down due mainly to our cost cutting measures, which we have announced earlier this year. As we move through the remainder of the year, we will maintain our disciplined approach of managing our cost while continuing to invest appropriately in our strategic growth areas, which we believe should position the company favorably to meet our long-term objectives of being a long-term, sustainable, and profitable company.

從成本角度來看，我們大多數類別的營運成本已開始下降，這主要歸功於我們今年稍早宣布的成本削減措施。在今年剩下的時間裡，我們將保持嚴格的成本管理方法，同時繼續在策略成長領域進行適當投資，我們相信這將使公司處於有利地位，以實現我們成為長期供應商的長期目標。 、可持續且獲利的公司。

With that, I will turn the call over to Jon Bates, our CFO, or Chief Financial Officer, for more financial information for the first quarter. Jon?

接下來，我將把電話轉給我們的財務長喬恩貝茨 (Jon Bates)，以獲取第一季的更多財務資訊。喬恩？

Thanks, Tom, and good morning, everyone. So we believe our first quarter performance represents a strong start to the year and we continue to combine solid operational performance with a disciplined and balanced allocation of capital to increase shareholder value over time. We had very strong top-line growth in total revenue and visits for the first quarter of 2024 compared to the first quarter of 2023.

謝謝，湯姆，大家早安。因此，我們相信我們第一季的業績代表了今年的強勁開局，我們將繼續將穩健的營運業績與嚴格且平衡的資本分配相結合，以隨著時間的推移增加股東價值。與 2023 年第一季相比，2024 年第一季的總營收和訪客量出現了非常強勁的成長。

Regarding total revenue, we had an increase of 20%, or $11.2 million, to $67.5 million for the first quarter of 2024 versus $56.3 million for the first quarter of 2023. Of the total revenue increase, mature hospitals, which are hospitals that were opened prior to December 31, 2021, and therefore provided one full year of comparative results, increased its revenue by 6.7% for the first quarter 2024 versus the first quarter 2023.

就總營收而言，2024 年第一季我們的總營收成長了 20%，即 1,120 萬美元，達到 6,750 萬美元，而 2023 年第一季為 5,630 萬美元。在總收入成長中，成熟醫院（即 2021 年 12 月 31 日之前開業的醫院，因此提供了一整年的比較結果）2024 年第一季的收入較 2023 年第一季度增長了 6.7%。

Additionally, the population health division revenue grew by 5.4% in the first quarter of 2024 from $7 million in the first quarter of 2023 to $7.4 million in the first quarter of 2024. With regard to those hospital division visits, we also grew, as Tom mentioned earlier, had a solid increase of 21% quarter over quarter, with those mature facilities growing at 5.3% for the first quarter 2024 to first quarter 2023.

此外，人口健康部門營收在 2024 年第一季成長了 5.4%，從 2023 年第一季的 700 萬美元增至 2024 年第一季的 740 萬美元。至於醫院部門的就診量，正如Tom 之前提到的，我們的就診量也有所增長，季度環比增長了21%，其中那些成熟的設施在2024 年第一季至2023 年第一季增長了5.3% 。

So in addition to that revenue improvement we have seen year over year, the company's focused operating cost control efforts that were started toward the end of 2023 continued to be a focus in the first quarter of 2024, and began to see a positive impact from these initiatives during the quarter.

因此，除了我們看到的收入逐年改善之外，該公司於 2023 年底開始的重點營運成本控制工作繼續成為 2024 年第一季的重點，並開始看到這些措施產生的正面影響。 。

One of those areas where we see this is in the 2024 first-quarter gross profit as it grew to $10.2 million, or 15.1% of total revenue as compared to $4.8 million, or 8.6% of total revenue in the first quarter of 2023, which is a 113% increase quarter over quarter.

我們看到這一情況的一個領域是2024 年第一季的毛利，其成長至1,020 萬美元，佔總營收的15.1%，而2023 年第一季為480 萬美元，佔總營收的8.6% ，季增 113%。

Additionally, first-quarter 2024 operating income was a positive $1.4 million compared to an operating loss of a negative $4.4 million in the same quarter of 2023. So net loss attributable to Nutex Inc., improved by $4.8 million from a loss of negative $5.1 million in the first quarter of 2023 to only a very small loss of a negative $364,000 in the first quarter of 2024.

此外，2024 年第一季的營業收入為正 140 萬美元，而 2023 年同一季度的營業虧損為負 440 萬美元。因此，Nutex Inc. 的淨虧損從 2023 年第一季的負虧損 510 萬美元減少到 2024 年第一季的負虧損 36.4 萬美元，減少了 480 萬美元。

Adjusted EBITDA increased $2.2 million, or 92%, from $2.4 million in the first quarter of 2023 to $4.6 million in the first quarter of 2024. With regard to cash flow, you will see that the net cash from operating activities was $3.1 million in the first quarter of 2024, which is an increase of $2.1 million from the first quarter of 2023.

調整後 EBITDA 增加了 220 萬美元，即 92%，從 2023 年第一季的 240 萬美元增至 2024 年第一季的 460 萬美元。關於現金流，你會看到2024年第一季經營活動產生的淨現金為310萬美元，比2023年第一季增加了210萬美元。

Finally, on our balance sheet, cash and cash equivalents at March 31 of 2024, was $30 million, up $8 million from $22 million at December 31, 2023. And on the liability side, we have long-term debt of $26.3 million, which is a relatively reasonable amount for a company that has 21 separate hospital locations. And a majority of this debt is related to, as you would imagine, equipment loans related at our hospitals for such things as MRIs, X-rays, ultrasounds, and CT machines.

最後，在我們的資產負債表上，截至 2024 年 3 月 31 日的現金和現金等價物為 3,000 萬美元，比 2023 年 12 月 31 日的 2,200 萬美元增加了 800 萬美元。在負債方面，我們的長期債務為 2,630 萬美元，對於一家擁有 21 個獨立醫院地點的公司來說，這是一個相對合理的金額。正如您想像的那樣，大部分債務與我們醫院的 MRI、X 光、超音波和 CT 機等設備貸款有關。

So with that, I will turn the call over to Jennifer to open it up for Q&A, as we look forward to your questions.

因此，我會將電話轉給 Jennifer，以進行問答，我們期待您的提問。

Thank you, Jon. We will now open the call to take questions.

謝謝你，喬恩。我們現在開始接受提問。

Bill Sutherland, The Benchmark Company.

比爾·薩瑟蘭，基準公司。

Thank you and good morning, everybody. Nice work in the first quarter. I just appreciate you taking the questions. So, Tom, to date, I think you added one hospital on April 1. How are you thinking about additional growth in terms of hospital facilities?

謝謝大家，早安。第一季的工作不錯。我只是感謝你提出問題。Tom，到目前為止，我認為您在 4 月 1 日增加了一家醫院。您如何看待醫院設施的進一步成長？

No, thank you, Bill, for the question. No, we believe in future growth. And for 2024, we do have a pipeline of four hospitals that we can open any time after the third quarter of this year. I am sorry, during the third quarter or after the third quarter of this year.

不，謝謝比爾提出這個問題。不，我們相信未來的成長。到 2024 年，我們確實有四家醫院正在籌備中，我們可以在今年第三季之後的任何時間開業。抱歉，今年第三季期間或第三季之後。

However, as previously disclosed, we have placed a delay on the opening of any further new hospitals in 2024 until certain financial metrics have been achieved. So in particular, we're slowing down openings until we could fund new hospitals, either through internal cash collections or through alternative financing that is not prohibitively expensive nor dilutive.

然而，如同先前所揭露的，我們已推遲在 2024 年開設更多新醫院，直到達到某些財務指標。因此，特別是，我們正在放慢開業速度，直到我們能夠透過內部現金籌集或透過既不昂貴也不稀釋的替代融資來為新醫院提供資金。

So on a weekly basis, we continue to evaluate our cash and potential timing for opening new hospitals this year. As far as looking forward to -- oh, go ahead, Bill.

因此，我們每週都會繼續評估我們的現金和今年開設新醫院的潛在時機。至於期待——哦，繼續吧，比爾。

No, you finish, sorry.

不，你說完了，抱歉。

And I was just going to say that beyond '24, looking forward to '25 and beyond that, we do get a fair number of requests from all over the country weekly to open these micro hospitals in their community. And so we'll continue to evaluate these opportunities and balance the high cost of developing these hospitals versus the big need and demand for accessible healthcare. The good news, though, is that there is no lack of demand for our services. These micro hospitals are very popular around the country.

我只是想說，在 24 年後，期待 25 以及之後，我們每週都會收到來自全國各地的相當多的請求，要求在他們的社區開設這些微型醫院。因此，我們將繼續評估這些機會，並平衡開發這些醫院的高成本與對可近醫療保健的巨大需求和需求。不過，好消息是對我們服務的需求並不缺乏。這些微型醫院在全國都很受歡迎。

Sorry, Bill, go ahead.

對不起，比爾，繼續吧。

Oh, no, I was just going to say to follow on to, you've also done some pruning of some underperforming hospitals. Is that process largely complete? Or is there more to go?

哦，不，我只是想說接著說，你們也對一些表現不佳的醫院進行了一些修剪。這個過程基本上完成了嗎？或者還有更多的事情要做嗎？

Oh, there's more to go. And so we're a portfolio company, as you know, and we are constantly reviewing every single hospital in our portfolio on a monthly basis to make sure that they are performing. Currently, there are a few hospitals that are not performing as expected.

哦，還有更多的事情要做。因此，如您所知，我們是一家投資組合公司，我們每月都會不斷審查投資組合中的每家醫院，以確保它們表現良好。目前，有一些醫院的表現未達預期。

And so what happened with the No Surprises Act was that with the decrease in reimbursements, the hospitals that were performing well three years ago may not be performing as well this year. And so we are always looking to improve the performance of these hospitals.

因此，《不出意外法案》的結果是，隨著報銷金額的減少，三年前表現良好的醫院今年可能會表現不佳。因此，我們一直在尋求提高這些醫院的績效。

And so our plans for these hospitals are to initiate all the revenue growth protocol, which I could go into later, as well as all of the cost cutting measures that I could go into later also and give them a period of time to turn around. And so if that still doesn't work, then the next step would be to do an analysis to either sell that facility to another operator or shut the facility down. So this -- so once again, this is a continuing process, not just for the underperforming hospitals, but for all our hospitals in our portfolio.

因此，我們對這些醫院的計劃是啟動所有收入成長協議（我可以稍後討論）以及所有成本削減措施（我也可以稍後討論），並給他們一段時間來扭轉局面。因此，如果這仍然不起作用，那麼下一步將是進行分析，要么將該設施出售給另一家運營商，要么關閉該設施。所以，再次強調，這是一個持續的過程，不僅對於表現不佳的醫院，而且對於我們投資組合中的所有醫院都是如此。

Just a continual process of optimization. It sounds like it doesn't sound like you've got like a list that you're concerned about to not continue with for the foreseeable future.

只是一個持續優化的過程。聽起來你似乎並沒有擔心在可預見的未來不會繼續使用一個清單。

That's right. Of the 21 hospitals, I would say that there are a few that we're trying to turn around. But for the most part, most of the hospitals are doing well.

這是正確的。在這 21 家醫院中，我想說的是，我們正在努力扭轉其中一些醫院的局面。但總的來說，大多數醫院都表現良好。

Got it. Warren, maybe over to you. In terms of the population health side, how do you see the growth outlook there for the remainder of the year and into next year?

知道了。沃倫，也許該輪到你了。在人口健康方面，您如何看待今年剩餘時間和明年的成長前景？

Yeah, thank you for the question, Bill. We are continuing to grow the side of the business. We currently have three IPAs that are operational. One in Los Angeles, one in Houston, and one in South Florida. All three of these had a strong annual enrollment period at the end of 2023, resulting in Nutex Health almost doubling our Medicare Advantage lives under management. Looking forward, we are launching our IT in Phoenix, Arizona this year, and then we plan to launch one to two more new IPAs each year going forward around our other facilities.

是的，謝謝你的提問，比爾。我們正在繼續發展業務。我們目前有三個正在運行的 IPA。一間在洛杉磯，一間在休士頓，一間在南佛羅裡達。所有這三個機構在 2023 年底都有強勁的年度投保期，導致 Nutex Health 管理的 Medicare Advantage 壽命幾乎翻了一番。展望未來，我們今年將在亞利桑那州鳳凰城推出 IT，然後我們計劃每年在我們的其他設施周圍推出一到兩個新的 IPA。

Got it. So you provided a same store number this quarter, which is helpful. What -- how are you focusing on expanding that the same-store number going forward? Because I think there's some service enhancements that you guys have started to put in place.

知道了。因此，您本季提供了相同的商店編號，這很有幫助。未來你們將如何專注於擴大同店數量？因為我認為你們已經開始實施一些服務增強措施。

Yeah. So, Bill, absolutely. So we definitely believe in growth both internally as well as externally with new locations. So internally, over the past 12 months, we have put several initiatives that we think will be very beneficial to the company. So we have protocols in place for all the hospitals in our network to, number one, increase ER volumes, and that's through marketing and patient referral, physician referral, so on and so forth.

是的。所以，比爾，絕對是。因此，我們絕對相信新地點的內部和外部成長。因此，在過去的 12 個月裡，我們在內部提出了幾項我們認為對公司非常有利的措施。因此，我們為網路中的所有醫院制定了協議，第一，增加急診室的數量，這是透過行銷和病患轉診、醫生轉診等方式實現的。

Number two, is once a patient goes into our ER, we want to keep them at our hospital. So we want to increase the observation status of those patients. And then from there, increase the inpatient as well, because we want to maximize the use of our inpatient service lines. And then we also have outpatient service lines such as imaging, so CT, X-ray, MRI, ultrasound, labs. So we want to increase those service lines also.

第二，一旦病人進入我們的急診室，我們希望將他們留在我們的醫院。所以我們希望增加這些患者的觀察狀態。然後從那裡開始增加住院病人，因為我們希望最大限度地利用我們的住院服務線。我們還有影像、CT、X 光、MRI、超音波、實驗室等門診服務線。所以我們也想增加這些服務線。

For about six of the hospitals, we actually have a pretty robust initiative for medical treatment of behavioral health conditions. So conditions such as alcohol intoxication, alcohol detoxification, or benzodiazepine addiction as an example of these treatments.

對於大約六家醫院，我們實際上有一個相當強大的措施來治療行為健康狀況。因此，酒精中毒、酒精戒毒或苯二氮平成癮等病症就是這些治療的一個例子。

And then for about four hospital, we're starting to do some outpatient procedures, such as interventional pain procedures or interventional radiology procedures. And so far we're seeing some positive results from a lot of the initiatives. And so hence, that's why you see the 5% to 6% quarter-over-quarter growth from both a volume as well as a revenue side.

然後，我們開始在大約四家醫院進行一些門診手術，例如介入性疼痛手術或介入性放射手術。到目前為止，我們看到許多舉措取得了一些正面成果。因此，這就是為什麼銷量和收入方面都出現了 5% 到 6% 的季度環比增長。

So that’s on the revenue side. On the expense side, we have also implemented a few cost cutting initiatives. And with that, I’d like to ask our Chief Operating Officer, Josh, to describe some of the things that he’s working on, and we’re working on both from a hospital level as well as a corporate level. Josh, are you on?

這就是收入方面的情況。在費用方面，我們也實施了一些成本削減措施。說到這裡，我想請我們的營運長喬許描述他正在做的一些事情，我們正在從醫院層級和公司層面進行工作。喬什，你在嗎？

Yes. Good morning, everyone. Yes. So, as Tom said, on the cost side, we’ve been working very hard in the last number of months, both at the hospitals and at corporate. Our three biggest costs are our labor costs, our contract services, and our supplies. For labor, we’ve worked very hard with our teams to maximize productivity at the hospitals as well as corporate, and we’ve leaned down in certain areas.

是的。大家，早安。是的。因此，正如湯姆所說，在成本方面，過去幾個月我們在醫院和公司都非常努力地工作。我們最大的三大成本是勞動成本、合約服務成本和供應成本。在勞動力方面，我們與我們的團隊非常努力地工作，以最大限度地提高醫院和企業的生產力，並且我們在某些​​領域進行了傾斜。

We put in some new tools like staffing matrices, and we’re looking at implementing some new scheduling and productivity software. And it’s always a balance and with the significant volume growth that we’ve had over the last several months to ensure that we’re staffing appropriately.

我們引入了一些新工具，例如人員配置矩陣，並且正在考慮實施一些新的調度和生產力軟體。這始終是一種平衡，過去幾個月我們的銷售量顯著成長，以確保我們配備適當的人員。

I would also add that we’ve not experienced the staffing shortages or turnover or increased labor costs like other health systems, as our teams are highly engaged and love our model and love their jobs. Contract services has also been a big improvement for us in cost, and there’s a lot more to come.

我還要補充一點，我們沒有像其他衛生系統那樣經歷人員短缺、人員流動或勞動成本增加，因為我們的團隊高度敬業，熱愛我們的模式，熱愛他們的工作。合約服務對我們的成本也有很大的改善，而且還有更多的改進。

We’re really working hard to leverage our size and scope with vendors. Historically, we’ve had 21 different contracts for certain vendors where we’re shifting to larger corporate contracts to take advantage of bulk purchasing and discounts.

我們確實正在努力與供應商充分利用我們的規模和範圍。從歷史上看，我們與某些供應商簽訂了 21 份不同的合同，現在我們正在轉向更大的公司合同，以利用批量採購和折扣。

On the corporate side, we’ve had a number of consultants that we’ve eliminated, insurances that we’ve renegotiated, and we’ve continued to whittle down spending on temporary employees, staffing agencies, and our legal spend.

在公司方面，我們已經取消了一些顧問，我們重新談判了保險，並且我們繼續削減臨時僱員、人事代理機構的支出以及我們的法律支出。

On the supply side, we’ve been working very closely with our distributors and GPOs to ensure we’ve got the right contracts with the most advantageous pricing for medical supplies and pharmaceuticals. And again, in supplies, we’re leveraging our size versus 21 individual hospitals. The supply savings have begun, but there’s a lot more to come and it will continue to be material.

在供應方面，我們一直與分銷商和 GPO 密切合作，以確保我們以最優惠的價格獲得正確的醫療用品和藥品合約。在供應方面，我們再次利用我們的規模來對抗 21 家獨立醫院。供應節約已經開始，但還會有更多的節約，而且將繼續是實質的。

We’re working closely with our corporate team and hospital teams, and they’re very familiar with our operational planning and cost saving initiatives that we put in place. And we’re very fortunate to have some of the best leaders in the industry and our hospitals, and they’re doing a great job executing on the cost side. Thank you.

我們正在與公司團隊和醫院團隊密切合作，他們非常熟悉我們實施的營運規劃和成本節約措施。我們非常幸運，擁有業界和醫院中一些最優秀的領導者，他們在成本方面執行得非常出色。謝謝。

Awesome. Thanks, Josh. Thanks, Tom. If you don’t mind, I’ll sneak in one or two more questions. And because I’m curious about revenue per visit, patient revenue per visit bounced back dramatically last year. Pretty steady right now. Is that a -- is it a steady state number going forward?

驚人的。謝謝，喬許。謝謝，湯姆。如果您不介意的話，我會再偷偷地問一兩個問題。由於我對每次就診的收入感到好奇，去年每次就診的患者收入大幅反彈。目前還算穩定。這是一個－未來的穩定數字嗎？

Yeah. No. No. We’re continuing to make progress with the NSA, and as you know, and this is industry wide, is that when the NSA was implemented back in 2022, we saw roughly a [$30 million to $35 million] decrease in revenue. And that’s just not us, that’s everybody else. And so we had to make some serious adjustment very, very fast. And so over the past two years, we have learned a great deal about the process and have put together a very competent team to work these claims.

是的。不。不。我們正在繼續與 NSA 合作取得進展，正如您所知，這是整個行業的情況，當 NSA 在 2022 年實施時，我們看到收入大約減少了 [3000 萬至 3500 萬美元]。這不僅僅是我們，而是其他所有人。所以我們必須非常非常快地做出一些認真的調整。因此，在過去的兩年裡，我們對這個過程有了很多了解，並組建了一支非常有能力的團隊來處理這些主張。

And what we’re finding is that, unfortunately, we have to resubmit about two thirds of our claims back to the NSA portal in order to get a better payment. So, in other words, insurers are paying us below market on two thirds of those claims. And so, as you can imagine, that’s a lot of claims that we have to reprocess, which requires a lot more work, but however we’re doing it.

不幸的是，我們發現，我們必須將大約三分之二的索賠重新提交給 NSA 入口網站，以獲得更好的付款。因此，換句話說，保險公司對三分之二的索賠向我們支付的費用低於市場價格。因此，正如您可以想像的那樣，我們必須重新處理大量索賠，這需要做更多的工作，但無論我們正在做什麼。

And so when we resubmit these claims, there are two ways to do it through the -- what’s called the IDR or the independent dispute resolution. You could either negotiate with the insurers directly through what’s called an open negotiation, or you could go through a little bit more of a formal process called arbitration.

因此，當我們重新提交這些索賠時，有兩種方法可以透過所謂的 IDR 或獨立爭議解決來實現。您可以透過所謂的公開談判直接與保險公司進行談判，也可以透過更正式的程序（稱為仲裁）進行談判。

So historically, we’ve been doing mainly open negotiation, and we’re getting good results, as you can tell from our previous financials. However, at the end of 2023, the arbitration portal was actually upgraded, thanks to the current administration, to make it a lot more streamlined as well as cost effective. And so we are basically ramping up to start to process more claims through the arbitration process of the NSA in 2024.

因此，從歷史上看，我們一直在進行主要是公開談判，並且我們取得了良好的結果，正如您從我們先前的財務數據中可以看出的那樣。然而，在 2023 年底，仲裁門戶實際上進行了升級，這要歸功於現任政府，使其更加精簡且更具成本效益。因此，我們基本上正在加緊努力，在 2024 年開始透過 NSA 仲裁程序處理更多索賠。

And so really, our goal is to get the insurance company to pay us fairly. That’s it. That’s our goal. We don’t need any more than that. However, we don’t have any data yet on the arbitration process because we’re just starting that process. However, based on public data that we see out there, we see that the providers win about 70% or 80% of the time when they go through the arbitration process.

事實上，我們的目標是讓保險公司公平地向我們付款。就是這樣。這就是我們的目標。除此之外我們不需要更多。然而，我們還沒有關於仲裁過程的任何數據，因為我們剛剛開始這個過程。然而，根據我們看到的公開數據，我們發現提供者在進行仲裁過程時勝訴的機率約為 70% 或 80%。

So we’re hopeful for a good outcome. So, in addition to the arbitration, you may know this already, but in 2024, the insurers, through the NSA, are mandated to increase their payment by about 5% to adjust for cost of living increase.

因此，我們希望有一個好的結果。因此，除了仲裁之外，您可能已經知道這一點，但到 2024 年，保險公司將透過 NSA 被強制將其付款增加約 5%，以適應生活成本的增加。

So, in summary, we're closely monitoring our collections, but we remain very optimistic about both the 5% cost of living increase as well as the arbitration process to help increase our collections. So more to come as we get more results over the next few quarters.

因此，總而言之，我們正在密切關注我們的藏品，但我們對 5% 的生活成本增長以及有助於增加我們藏品的仲裁程序仍然非常樂觀。隨著我們在接下來的幾個季度獲得更多結果，還會有更多結果。

So just to follow up, Tom, on that, I think that in May or this month, I should say, the payers are now using a higher, what's called qualifying payment amount, the QPA. Is that the 5% increase you're talking about or is that separate?

湯姆，我想跟進一下，我認為在 5 月或本月，我應該說，付款人現在使用更高的、所謂的合格付款金額，即 QPA。您所說的是 5% 的成長還是單獨的成長？

No, that's separate. That's separate. The QPA basically stands for qualified payment amount, and essentially tied to what's called the median in-network. And so the median in-network is based on the median in network rates of the hospitals around our hospital. And so this is -- there's a fair amount of controversy remaining about this so called QPA, or median in-network.

不，那是分開的。那是分開的。QPA 基本上代表合格的支付金額，並且本質上與所謂的網路中位數相關。因此，網路內中位數是基於我們醫院周圍醫院的網路費率中位數。因此，關於所謂的 QPA（即網路內中位數）仍存在相當多的爭議。

And so, unfortunately, there has been a lack of clarity on what the insurance company used as a median in-network. And so there's been several court cases that's been challenging this median in-network. But so far, it looks like the court has sided with the providers on this calculation of the median in-network. And you could definitely read about it if you do a search.

因此，不幸的是，保險公司使用的網路中位數缺乏明確性。因此，有幾個法庭案件一直在挑戰網絡內的中位數。但到目前為止，法院似乎在網路中位數的計算上站在了提供者一邊。如果你進行搜索，你肯定可以讀到它。

But going back to the QPA that you referenced, yes, this QPA is separate to this 5% cost of living increase. And in fact, because of the -- the NSA also mandates that if the insurance company had not done a cost of living increase since 2019, the actual cost of living increase in 2019 should be closer to 21%. So that 5% is only going from '23 to '24. And so we're monitoring our collection to see that if that has been done.

但回到你提到的 QPA，是的，這個 QPA 與這 5% 的生活成本成長是分開的。事實上，因為——美國國家安全局也規定，如果保險公司自 2019 年以來沒有增加生活費用，那麼 2019 年的實際生活費用增加應該會接近 21%。所以這 5% 只發生在 23 年到 24 年間。因此，我們正在監控我們的收藏，看看是否已經完成。

Okay.

好的。

So that is basically the law of the land (technical difficulty) -- mandate that.

這基本上就是法律（技術難度）——強制要求。

Are the payers now forced to -- not forced but I thought that whole QPA thing was going to improve because they were going to start out with a higher QPA. Is that in the works? I can't remember if that's happened or not.

付款人現在是否被迫——不是被迫，但我認為整個 QPA 事情將會改善，因為他們將從更高的 QPA 開始。那是在作品中嗎？我不記得是否發生過這種事。

Yeah. No, no. Basically, the whole premise of the QPA is that they have to use the median in-network calculation.

是的。不，不。基本上，QPA 的整個前提是他們必須使用網路內計算的中位數。

Yeah.

是的。

And in using the median in-network calculation, they have to exclude any hospitals or providers that do not provide a similar level of service.

在使用網路內中位數計算時，他們必須排除任何不提供類似服務等級的醫院或提供者。

And so, for example, and let's just say in a region, if there are, say, 10 hospitals and only three hospital provides emergency services, which is similar to our model, then they could only use the median in-network rate of those three hospitals that provide emergency services.

舉例來說，在一個地區，如果有 10 家醫院，而只有 3 家醫院提供緊急服務，這與我們的模型類似，那麼他們只能使用這些醫院的網絡內比率中位數三家提供緊急服務的醫院。

The other common hospitals may not provide emergency services, and so their payment may be a lot less. And so the court back in 2023 ruled that in calculation of the QPA or the media in-network, the insurers cannot use what they call the ghost rates, which are the inclusion of the rates for the seven hospitals that do not have emergency services.

其他普通醫院可能不提供急診服務，所以收費可能會少很多。因此，法院早在 2023 年就裁定，在計算 QPA 或網路內媒體時，保險公司不能使用他們所謂的“幽靈費率”，即包含七家沒有緊急服務的醫院的費率。

They could only use the three hospitals that provide emergency services. And so that's where I think there was a lack of clarity, and I think that's where the insurance company used to like cause that -- the reduction in revenue. So I think that --

他們只能使用三家提供緊急服務的醫院。所以我認為這就是缺乏清晰度的地方，我認為這就是保險公司過去喜歡的原因——收入減少。所以我認為--

So --

所以--

I'm sorry. Go ahead.

對不起。前進。

Yeah, so they're now abiding by that structure you just talked about with -- like-for-like to create the medium.

是的，所以他們現在遵守你剛才談到的那種結構——類似地創造媒體。

That's right.

這是正確的。

Yeah. Okay. That's good.

是的。好的。那挺好的。

That's a law. Whether or not the insurers follow that, hard to say.

這是一條法律。保險公司是否遵循這一點，很難說。

Okay. I think that's all I've got. Appreciate all the color, guys. Take care.

好的。我想這就是我所擁有的一切。欣賞所有的顏色，夥計們。小心。

Yeah. Thank you, Bill, for the. Excellent questions.

是的。謝謝你，比爾。很好的問題。

Thanks, Bill.

謝謝，比爾。

Great. Are there any additional questions for the Nutex team? Okay. On behalf of the Nutex management team, we appreciate everyone for dialing in and listening to our first-quarter earnings report.

偉大的。Nutex 團隊還有其他問題嗎？好的。我們代表 Nutex 管理團隊感謝大家撥打並聆聽我們的第一季財報。

A recording of this call will be available on our website for a limited time. If there are any additional questions, please send an email to investors@nutexhealth.com, and we will do our best to answer in a timely manner. Thank you for joining and take care.

我們的網站將限時提供本次通話的錄音。如果還有其他問題，請發送電子郵件至investors@nutexhealth.com，我們將盡力及時解答。感謝您的加入並照顧。

This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.

今天的會議到此結束。此時您可以斷開線路。感謝您的參與。