Nutex Health Inc (NUTX) 2024 Q2 法說會逐字稿

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

您好，歡迎您參加 Nutex Health 2024 年第二季財務業績電話會議。（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, Jennifer Rodriguez. Thank you. You may begin.

現在我想將會議交給主持人珍妮佛羅德里格斯 (Jennifer Rodriguez)。謝謝。你可以開始了。

Welcome to the Nutex Health second-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 will take questions.

歡迎參加 Nutex Health 2024 年第二季財報電話會議。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 Jon Bates；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發言，然後回答問題。

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 in Thursday's press release and in our various SEC filings.

在我將電話轉交給Vo 博士之前，讓我提醒大家，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、不確定性和其他因素，這些因素可能導致實際結果與預期結果存在重大差異。有關前瞻性陳述和這些因素的更多資​​訊列於週四的新聞稿和我們向 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 supplemental information on adjusted EBITDA and reconciling net loss attributable to Nutex Health, Inc., is included in the press release and Form 10-K 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-K 表格中包含了一份表格，提供了調整後 EBITDA 的補充資訊以及對 Nutex Health, Inc. 的淨虧損進行調節的表格。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. Good morning to everyone, and thank you for joining the call. We are very excited to present our second quarter financials to our esteemed investors. At Nutex, everyone in the organization believes in the business model and is fully engaged and aligned to make the company even more successful.

詹妮弗，謝謝你。大家早安，感謝您加入通話。我們非常高興向尊敬的投資者介紹我們第二季的財務數據。在 Nutex，組織中的每個人都相信業務模式，並充分參與和協調，以使公司更加成功。

Before we dive into the financials, I'd like to take a step back to describe what Nutex Health is, our value proposition, where we came from, as well as how we see the future of health care. Nutex Health was founded in 2011 in Houston, Texas. It was founded based on the premise that Americans around the country need better accessibility to health care on a concierge level. We were one of the very first micro hospital companies in the country to provide this service. We started out serving emergency needs in Houston and eventually expanded our footprint throughout Texas in response to popular demand from consumers across the state.

在我們深入了解財務狀況之前，我想先回顧一下 Nutex Health 是什麼、我們的價值主張、我們來自哪裡，以及我們如何看待醫療保健的未來。Nutex Health 於 2011 年在德州休士頓成立。它的成立是基於這樣一個前提：全國各地的美國人需要更好地獲得禮賓等級的醫療保健。我們是全國最早提供這項服務的微型醫院公司之一。我們首先在休士頓滿足緊急需求，並最終將我們的足跡擴展到整個德州，以滿足全州消費者的普遍需求。

Around 2015, we started expansion into other states with our first hospital outside of Texas in Oklahoma City. We have continued the growth. Today, we have 21 micro hospitals located in 9 states. We continue to be among the leaders in the micro hospital segments in the United States.

2015 年左右，我們開始向其他州擴張，在德州以外的俄克拉荷馬城開設了第一家醫院。我們持續成長。如今，我們在 9 個州擁有 21 家微型醫院。我們仍然是美國微型醫院領域的領導者之一。

Let me take a moment to describe to our investors what a micro hospital is. A micro hospital is, essentially, a small licensed hospital with many of the ancillary capabilities of a large hospital. Our micro hospitals generally have an emergency room between 4 to 20 inpatient beds, an in-house pharmacy, an in-house laboratory, and an in-house radiology suite consisting of MRI, CT, ultrasound, and x-ray, all of which is enclosed in a roughly 20,000 to 30,000 square foot facility. This is compared to a traditional large hospital, which typically has anywhere between 100 to 500 plus inpatient beds. Our much smaller footprint allows us to build new facilities quicker and more efficiently in strategic locations around the country compared to constructing larger traditional hospitals.

讓我花點時間向我們的投資者描述什麼是微型醫院。微型醫院本質上是一家小型執照醫院，具有大型醫院的許多輔助能力。我們的微型醫院通常設有 4 至 20 張住院床位的急診室、內部藥房、內部實驗室以及由 MRI、CT、超音波和 X 射線組成的內部放射科室，所有這些佔地約20,000 至30,000 平方英尺的設施內。相比之下，傳統的大型醫院通常擁有 100 至 500 多個住院床位。與建造更大的傳統醫院相比，我們的佔地面積小得多，使我們能夠在全國各地的戰略地點更快、更有效率地建造新設施。

The services that we provide in these micro hospitals include emergency services, medical, surgical inpatient stays, outpatient imaging, outpatient labs and outpatient procedures. The vast majority of our patients come through the emergency room, which has historically been our main line of service. Out of every 100 patients that come through our ER, we can treat and discharge roughly 95% of those patients. Of that 95%, an average of 90% will be discharged from the ER and 5% will be admitted into our own hospital. The remaining 5% will be transferred to a larger hospital system.

我們在這些微型醫院提供的服務包括急診服務、醫療、外科住院、門診影像、門診實驗室和門診手術。我們的絕大多數患者都是透過急診室來的，這歷來是我們主要的服務範圍。每 100 名透過我們急診室就診的患者中，我們可以治療並出院約 95% 的患者。在這 95% 的患者中，平均 90% 會從急診室出院，5% 會住進我們自己的醫院。剩下的5%將被轉移到更大的醫院系統。

Another way to think about our model is the spectrum of care that we provide. As we all know, there are a lot of primary care physicians, urgent care centers and retail clinics around the country. Walgreens, CVS, Walmart, are a few national low-acuity retail clinics that come to mind. On the other hand of the spectrum, there are a lot of large major hospital systems around the country that provide high acuity, intensive trauma-level care. We are neither a clinic nor are we a large hospital. We position ourselves right in the middle of the acuity care spectrum between the low-acuity clinics and the high-acuity major hospital systems. This is a very unique niche in the health care ecosystem that we operate in. There are very few companies around the country that provide care in the mid-acuity spectrum like we do.

思考我們的模式的另一種方式是我們提供的照護範圍。眾所周知，全國各地有許多初級保健醫生、急診中心和零售診所。沃爾格林 (Walgreens)、CVS、沃爾瑪 (Walmart) 是我想到的一些全國性低風險零售診所。另一方面，全國有許多大型醫院系統提供高風險、重症創傷級護理。我們既不是診所，也不是大型醫院。我們將自己定位在急性度照護範圍的中間，介於低度診所和高度主要醫院系統之間。這是我們所在的醫療保健生態系統中非常獨特的利基市場。全國很少有公司像我們一樣提供中等視力範圍的護理。

While our hospital may be small, our patient satisfaction is extremely high in every community that we are located in, as evidenced by our online review and ratings. For example, if you research every one of our hospitals online, you will see that our Google reviews are consistently 4.8% or above. This is very unusual in health care. In essence, our patients are very happy with our service. A primary reason for our great patient satisfaction is the culture of our physicians and staff. We partner with local physicians at every one of our hospitals and work in conjunction with them to operate the hospital. This alignment with the local community physicians and staff ensures our patients receive concierge care from a doctor with little or no wait time. Our philosophy is that if your physicians and staff are happy, then your patients are happy.

雖然我們的醫院可能很小，但我們所在的每個社區的病患滿意度都非常高，我們的線上評論和評級就證明了這一點。例如，如果您在線上研究我們的每一家醫院，您會發現我們的 Google 評論始終為 4.8% 或以上。這在醫療保健領域是非常不尋常的。本質上，我們的患者對我們的服務非常滿意。我們病患滿意度高的主要原因是我們的醫生和員工的文化。我們與每一家醫院的當地醫生合作，並與他們共同經營醫院。與當地社區醫生和工作人員的這種協調確保我們的患者在很少或根本沒有等待時間的情況下獲得醫生的禮賓護理。我們的理念是，如果您的醫生和工作人員快樂，那麼您的患者也會快樂。

Across the entire company, we consistently have very low employee turnover and rarely have staffing issues. Our physicians and staff engagement are extremely high, and our team often comments that working at Nutex Health is the best job they have ever had. Once again, this is very rare among the large hospital systems, where staffing is a major issue among hospitals around the country today. So basically, we have a very simple formula, create a recipe of engaged, aligned and incentivized physicians and staff to provide concierge-level patient care and experience. This leads to repeat visits and word-of-mouth advertising, which further increases patient volumes, which increases revenue, which ultimately leads to what we have now, a profitable and growing company.

在整個公司，我們的員工流動率一直很低，很少有人員配置問題。我們的醫生和員工敬業度非常高，我們的團隊經常評論說，在 Nutex Health 工作是他們有過的最好的工作。這在大型醫院系統中再次非常罕見，人員配備是當今全國醫院的一個主要問題。所以基本上，我們有一個非常簡單的公式，創建一個由敬業、一致和激勵​​的醫生和工作人員組成的配方，以提供禮賓級的患者護理和體驗。這會帶來重複就診和口碑廣告，從而進一步增加患者數量，從而增加收入，最終使我們成為一家盈利且不斷發展的公司。

We believe that there are multiple indicators about the increased demand for hospitals and emergency services is not slowing down anytime soon. With the graying of the population and the so-called silver tsunami that is expected to hit health care, we feel that we are in a very good position to help meet this demand for more concierge-level accessibility for a long time.

我們認為，有多項指標顯示對醫院和緊急服務的需求增加不會很快放緩。隨著人口老化以及預計將衝擊醫療保健的所謂“銀色海嘯”，我們認為我們處於非常有利的地位，可以在很長一段時間內幫助滿足這種對更多禮賓級無障礙設施的需求。

Now to the second quarter. Overall, company-wide hospital visits were up 28% versus prior year for all of our hospitals. Our same-store mature hospital volumes were up an average of 10.3%, in total, billable visits over the prior year. Observation visit volumes were up 34% versus the second quarter of the prior year. Inpatient volumes were up 52% versus the prior year.

現在到第二季。總體而言，我們所有醫院的全公司範圍內的醫院就診量比去年增加了 28%。我們同店成熟醫院的收費總就診量比前一年平均增加了 10.3%。觀察訪問量比去年第二季增加了 34%。住院人數比去年增加了 52%。

On the de novo hospital growth side, we have four new hospitals that are under construction that we anticipate opening in the next 6 to 12 months, barring any unforeseen setbacks. New hospital openings include Post Falls, Idaho; Tampa, Florida; Milwaukee, Wisconsin; and San Antonio, Texas. Beyond 2025, we have modified our annual growth projection slightly to project one to three new hospitals per year. We remain disciplined and only consider locations where the demand for small hospitals vastly outweighs the supply side. On the billing and collection side, we continue to see growth monthly on the revenue per patient metric. From the end of 2022 to the end of 2023, based on an adjudicated date of service data, we achieved a 7% increase in revenue per patient. 2024 numbers are still being adjudicated and we will report the results when ready.

在新醫院成長方面，我們有四家新醫院正在建設中，預計在未來 6 至 12 個月內開業，除非有任何不可預見的挫折。新開設的醫院包括愛達荷州波斯特福爾斯 (Post Falls)；佛羅裡達州坦帕；威斯康辛州密爾瓦基；和德克薩斯州聖安東尼奧。2025 年之後，我們稍微修改了年度成長預測，預計每年新增一到三家醫院。我們仍然遵守紀律，只考慮小型醫院需求遠超過供應方的地區。在計費和收款方面，我們繼續看到每位患者的收入指標每月都在增加。從2022年底到2023年底，根據服務數據判定日期，我們實現了每位患者的收入成長了7%。 2024 年的數字仍在裁決中，我們將在準備好後報告結果。

We have also already begun to engage in the arbitration process of the independent dispute resolution, whereas previously, we have stopped at the open negotiation process. We believe that there is a lot of potential incremental value and revenue to be gained from arbitration as we believe that the insurers typically pay us very low the first time. Arbitration is a tool provided by the No Surprises Act to ensure providers receive fair treatment. In recent articles and public data, we are seeing that providers are prevailing 70% to 80% of the time in arbitration. We started this process in July 2024, and we will have more data in the fourth quarter on the success rate of these arbitration claims with the insurance carriers.

我們也已經開始參與獨立爭議解決的仲裁程序，而此前我們一直停留在公開談判程序上。我們相信，仲裁可以帶來許多潛在的增量價值和收入，因為我們相信保險公司通常在第一次時向我們支付的費用非常低。仲裁是《無意外法案》提供的一種工具，旨在確保提供者獲得公平待遇。在最近的文章和公開數據中，我們發現提供者在仲裁中勝訴的機率為 70% 到 80%。我們於 2024 年 7 月開始這項流程，我們將在第四季度獲得更多有關保險公司仲裁索賠成功率的數據。

On the population health side, we are also making some adjustments. We have divested our MSO in California ProCare and are in the process of selling Clinigence, our health care analytics and data company. Jon and Warren will go over these details later in the presentation. We believe that these portfolio changes, we can focus on more profitable assets and continue to perform financially and reinvest these sellers into new markets. As we move through the remainder of the year, we will maintain our disciplined approach of managing our costs 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 sustainable and profitable company.

在人口健康方面，我們也在做一些調整。我們已經剝離了加州 ProCare 的 MSO，並正在出售我們的醫療保健分析和數據公司 Clinigence。喬恩和沃倫將在稍後的演示中討論這些細節。我們相信，透過這些投資組合的變化，我們可以專注於更有利可圖的資產，並繼續在財務上表現出色，並將這些賣家再投資到新市場。在今年剩下的時間裡，我們將保持嚴格的成本管理方法，同時繼續在我們的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，以實現我們可持續發展和可持續發展的長期目標。

With that, I will turn the call over to Jon Bates, Nutex's Chief Financial Officer, for more financial information for the second quarter. Jon?

接下來，我將把電話轉給 Nutex 財務長 Jon Bates，以獲取第二季的更多財務資訊。喬恩？

Thanks, Tom, and good morning, everyone. Our second-quarter 2024 results continue to trend, we saw in the first quarter, with increased success in top-line growth and with our disciplined cost control effort company-wide. But let's talk about the second quarter ended June 30, 2024, first and compare those results to the same quarter of 2023. So for the second quarter of 2024, our total revenue grew 29% or $17.2 million to $76.1 million versus $58.9 million for the second quarter of 2023.

謝謝，湯姆，大家早安。我們在第一季看到，2024 年第二季的業績持續保持趨勢，營收成長取得更大成功，並且我們在全公司範圍內嚴格控製成本。但我們首先討論截至 2024 年 6 月 30 日的第二季度，並將這些結果與 2023 年同一季度進行比較。因此，2024 年第二季度，我們的總營收成長了 29%，即 1,720 萬美元，達到 7,610 萬美元，而 2023 年第二季為 5,890 萬美元。

Of the total revenue increase, our mature hospitals, which are hospitals that were opened prior to December 31, 2021, and therefore provided two full years of comparative results, increased their revenue by 13.2% for the second-quarter 2024 versus the second-quarter 2023. For hospital division visits, we saw a similar growth during the quarter as they increased by 28% or 9,205 visits to 41,208 visits in the second quarter of '24 versus 32,183 visits in the same period of '23, with the mature hospitals growing at 10% in that second-quarter '24 versus '23.

在總收入成長中，我們的成熟醫院（即 2021 年 12 月 31 日之前開業的醫院，因此提供了整整兩年的比較結果）在 2024 年第二季度的收入較上一季度增長了 13.2% 2023年。對於醫院科室就診，我們在本季度看到了類似的增長，24 年第二季度的就診次數增加了28%，即9,205 次，達到41,208 次，而2023 年同期的就診次數為32,183 次，其中成熟醫院的成長速度為10 24 年第二季與 23 年第二季的百分比。

Additionally, the population health division had revenue growth of 15.9% to $8.5 million in the second quarter of '24 from $7.3 million in the similar period in '23 despite the divestiture of those two small entities within the division, as mentioned by Dr. Vo previously. In addition to the revenue and visit improvement we have seen in the second quarter of '24, we have continued to see an improvement in the overall facility and corporate cost structure.

此外，正如 Vo 博士所提到的，儘管該部門內的這兩個小實體被剝離，但人口健康部門的收入從 23 年同期的 730 萬美元增長到 24 年第二季的 850 萬美元。除了我們在 2024 年第二季度看到的收入和訪問量改善之外，我們還繼續看到整體設施和公司成本結構的改善。

Total facility-level operating costs and expenses represented only 70.3% or $53.5 million of total revenue for the second quarter of 24 versus 83.6% or $49.3 million for the same period in '23. As a result of the revenue and facility cost improvement, our 2024 second-quarter gross profit was $22.6 million or 29.7% of revenue as compared to only $9.6 million or 16.4% of total revenue in '24, a 134% increase in the second quarter of '24 over '23.

24 年第二季度，設施層面的總營運成本和支出僅佔總收入的 70.3%（即 5,350 萬美元），而 2023 年同期則佔總收入的 83.6%（即 4,930 萬美元）。由於營收和設施成本的改善，我們2024 年第二季的毛利為2,260 萬美元，佔營收的29.7%，而2024 年僅為960 萬美元，佔總營收的16.4%，第二季成長了134 % '24 超過 '23。

From a corporate and other cost perspective, the G&A expenses, as a percentage of total revenue for the second quarter of '24, decreased to 14% or $10.7 million from 16.6% or $9.8 million for the second quarter of '23. Now additionally, as mentioned previously, we did divest two smaller population health entities in the second quarter of '24, that had very little impact on the operational side of the population health business as we move forward. But the effect of these two transactions led to a noncash impairment of assets and noncash impairment of goodwill of $3.5 million and $3.2 million, respectively, during the second quarter of 24%.

從企業和其他成本的角度來看，G&A 費用佔 24 年第二季總收入的百分比從 23 年第二季的 16.6%（即 980 萬美元）下降至 14%（即 1,070 萬美元）。此外，正如前面提到的，我們確實在 2024 年第二季度剝離了兩個較小的人口健康實體，隨著我們的前進，這對人口健康業務的運營方面影響很小。但這兩筆交易的影響導致第二季的非現金資產減損和非現金商譽減損分別為350萬美元和320萬美元，達24%。

Operating income for the second quarter of 2024 was a positive $5.3 million compared to an operating loss of a negative $400,000 in the second quarter of '23. Net loss attributable to Nutex income improved by $3.1 million in the second quarter of 2024, from a loss of a negative $3.5 million in the second quarter of '23, to a very small loss of negative $364,000 in the second quarter of '24 and adjusted EBITDA attributable to Nutex, which removed the effect of the two noncash impairment items noted above, increased $8 million or 200% from $4 million in the second quarter of 2023, to $12 million in the second quarter of 2024.

2024 年第二季的營業收入為正 530 萬美元，而 2023 年第二季的營業虧損為負 40 萬美元。2024 年第二季度，Nutex 收入帶來的淨虧損改善了 310 萬美元，從 2023 年第二季度的負虧損 350 萬美元，到 24 年第二季度的負虧損 364,000 美元（經調整）扣除上述兩在非現金減損項目的影響後，歸屬於Nutex 的EBITDA 從2023 年第二季的400 萬美元增加到2024 年第二季的1,200 萬美元，增幅為800 萬美元，即200%。

Now on to the six months ended June 24 compared to six months ended June of '23. Total revenue for the first six months of 2024 grew by 25% or $28.2 million to $143.5 million versus $115.3 million for the previous period. Of the total revenue increase, mature hospitals increased our revenue by 10% for the first six months of 2024 versus the same period in '23. Hospital division visits saw similar growth as they increased by 24.6% or 16,032 visits to 81,276 visits in the first six months of '24 versus 65,244 visits in the same period of '23, with mature hospital visits growing at me at 9.7% in the six months ended June '24 versus the same period in '23.

現在將截至 6 月 24 日的六個月與截至 2023 年 6 月的六個月進行比較。2024 年前六個月的總收入成長了 25%，即 2,820 萬美元，達到 1.435 億美元，而上一時期的總收入為 1.153 億美元。在總收入成長中，成熟醫院 2024 年前 6 個月的營收比 2023 年同期成長了 10%。醫院科室就診次數也出現了類似的成長，24 年前六個月增加了24.6%，即16,032 次就診，達到81,276 次，而23 年同期為65,244 次就診，成熟醫院就診次數在這六個月中成長了9.7%截至 2024 年 6 月的月份與 2023 年同期相比。

Now additionally, the population health division had revenue growth of 10.8% to $15.9 million in the first 6 months of 2024 from $14.4 million in the same period in '23 despite the divestiture of those 2 smaller entities within the division during the second quarter, '24, as mentioned previously. So facility and corporate-level costs continued to show improvement for the first six months of 2024, relative to the same period in '23. And the total facility-level operating costs and expenses represented 77.5% or $110 million of total revenue for the six months ended June versus 87.4% or $100.8 million for the same period in '23, a decrease of 9.9%.

此外，儘管第二季剝離了該部門內的這兩個較小實體，但人口健康部門的收入從2023 年同期的1,440 萬美元增長到2024 年前6 個月的1,590 萬美元，增長了10.8% 。因此，與 2023 年同期相比，2024 年前六個月的設施和企業層面成本持續改善。截至6 月的六個月，設施層面的總營運成本和支出佔總收入的77.5%（即1.1 億美元），而2023 年同期則佔總收入的87.4%（即1.008 億美元），下降了9.9 %。

The gross profit for the six months ended June 2024 was $32.7 million or 22.8% of total revenue as compared to only $14.5 million or 12.6% of total revenue in the same period in '23, a 126% increase for the six months ended June versus the six months ended June '24 versus six months ended June '23. And so from a corporate and other cost perspective, the G&A expenses, as a percentage of total of revenue for the six months ended June decreased to 13.5% or $19.3 million from 14.7% or $16.9 million for the same period in '23.

截至2024 年6 月的六個月的毛利為3,270 萬美元，佔總收入的22.8%，而2023 年同期僅為1,450 萬美元，佔總收入的12.6%，截至6 月的六個月比去年同期成長了126%截至 2024 年 6 月的六個月與截至 2023 年 6 月的六個月相比。因此，從企業和其他成本的角度來看，截至6 月的六個月，G&A 費用佔總收入的百分比從2023 年同期的14.7%（即1,690 萬美元）下降至13.5%（即1,930 萬美元） 。

Operating income for the six months ended June 24 was a positive $6.7 million compared to an operating loss of a negative $4.8 million for the six months ended June of '23. The net loss attributable to Nutex improved by $7.9 million from a loss of $8.6 million for the first six months of 2023, to a very small loss of just a negative $728,000 in the first six months of '24. Adjusted EBITDA attributable to Nutex, which removed the effect of those two noncash impairment items noted above, increased $10.2 million or 159% from $6.4 million in the first six months of '23 to $16.6 million in the first six months of 2024.

截至6月24日的六個月的營業收入為正670萬美元，而截至2023年6月的六個月的營業虧損為負480萬美元。Nutex 的淨虧損改善了 790 萬美元，從 2023 年前六個月的虧損 860 萬美元，減少到 2024 年前六個月的負 728,000 美元。歸屬於Nutex 的調整後EBITDA 消除了上述兩個非現金減損項目的影響，從2023 年前六個月的640 萬美元增加到2024 年前六個月的1660 萬美元，增幅為1020 萬美元，即159%。

Finally, we want to talk about our balance sheet. It remains very strong with cash and cash equivalents at the end of June of '24, $40.8 million, up $18.8 million or 85.5% from the $22 million as of the end of the year 2023. With regard to cash flow, net cash from operating activities increased by $15.2 million for the six months ended June of '24 to $16.3 million as compared to $1.1 million for the same period in 2023. And on the liability side, our total debt, true debt decreased by $1.5 million to $40.9 million in June of '24, down from $42.4 million at December of '23, with the majority of this debt related to equipment loans at our hospitals for such normal items as MRIs, x-rays, ultrasound, and CT machines.

最後，我們想談談我們的資產負債表。截至 2024 年 6 月底，現金和現金等價物仍然非常強勁，為 4,080 萬美元，比 2023 年底的 2,200 萬美元增加了 1,880 萬美元，增幅為 85.5%。在現金流方面，截至 2024 年 6 月的六個月，經營活動產生的淨現金增加了 1,520 萬美元，達到 1,630 萬美元，而 2023 年同期為 110 萬美元。在負債方面，我們的總債務，即真實債務，從2023 年12 月的4,240 萬美元減少到24 年6 月的4,090 萬美元，減少了150 萬美元，其中大部分債務與我們醫院的設備貸款有關。

So with that, I'll turn the call over to Josh DeTillio, our Chief Operating Officer, to discuss more about our operations.

因此，我將把電話轉給我們的營運長 Josh DeTillio，以討論有關我們營運的更多資訊。

Thanks, Jon. Good morning, everyone. On the operational side, we've been very focused on both volume growth and service line growth in our mature hospitals as well as a continued focus on cost and becoming a leaner organization. On the volume and revenue growth side, we've made some adjustments in our business development and marketing team, which I'm happy to say have resulted in the impressive second quarter performance that you heard about.

謝謝，喬恩。大家早安。在營運方面，我們非常關注成熟醫院的數量成長和服務線成長，並持續關注成本並成為一個更精簡的組織。在銷售和收入成長方面，我們對業務開發和行銷團隊進行了一些調整，我很高興地說，這導致了您聽說過的令人印象深刻的第二季業績。

An additional contributing factor has been the implementation of our new CRM software, HubSpot. Our business development efforts at Nutex Health continue to focus on community events, calling on local primary care and specialist physicians, schools, urgent care centers, large local employers, while simultaneously using Google Ads, social media and billboards as our primary marketing mediums. Ultimately, key for our hospitals is to grow and continue to provide concierge-level access and care for our patients and to be a resource in the communities and markets in which we serve.

另一個影響因素是我們新的 CRM 軟體 HubSpot 的實施。我們在 Nutex Health 的業務開發工作繼續關注社區活動，呼籲當地初級保健和專科醫生、學校、緊急護理中心、當地大型雇主，同時使用 Google Ads、社交媒體和廣告看板作為我們的主要行銷媒介。最終，我們醫院的關鍵是發展並繼續為我們的患者提供禮賓級的服務和護理，並成為我們所服務的社區和市場的資源。

Excellent patient care is our best marketing through word of mouth and our reputation in our markets continues to grow. In addition to our focus on increasing ER volumes, which began towards the end of 2023, one of our major initiatives has been to shift our service mix to increase inpatient and observation volumes in our hospitals. As part of this initiative, our hospitals did a lot of work locally, partnering with local hospitals and specialists to provide additional care to our existing patients versus transferring them out to other hospital systems. We're starting to see the financial benefits of this changing service mix of becoming more inpatient-centric. This shift will continue to benefit us going forward.

卓越的患者護理是我們最好的口碑行銷，我們在市場上的聲譽不斷提高。除了我們從 2023 年底開始專注於增加急診室數量之外，我們的主要措施之一是改變我們的服務組合，以增加醫院的住院和觀察量。作為該計劃的一部分，我們的醫院在當地做了很多工作，與當地醫院和專家合作，為我們現有的患者提供額外的護理，而不是將他們轉移到其他醫院系統。我們開始看到這種不斷變化的服務組合所帶來的經濟效益，即變得更加以住院患者為中心。這種轉變將繼續使我們受益匪淺。

At Nutex Health, we're also very focused on our costs. As you heard, our largest costs are labor, supplies and contract services in that order. We continue to manage labor very closely with all of our hospitals. We have a new HR software, Workday, which has helped us streamline approvals and physician control, and we're planning to implement a new labor management software in the coming quarters to help us staff even more efficiently. In the medical supplies and pharmaceutical areas over the last several months, we've gone through the process of aligning our pricing with supply vendors with our primary GPO, HPG. Based on our previous purchasing history, we're projecting an annual cost savings of several million dollars over the next 12 months with these contracted pricing reductions.

在 Nutex Health，我們也非常關注我們的成本。正如您所聽到的，我們最大的成本依次是勞動力、供應品和合約服務。我們繼續與所有醫院密切管理分娩。我們有一個新的人力資源軟體 Workday，它幫助我們簡化了審批和醫生控制，我們計劃在未來幾季實施新的勞動力管理軟體，以幫助我們的員工更有效率。在過去的幾個月裡，在醫療用品和製藥領域，我們經歷了與供應商和我們的主要 GPO HPG 協調定價的過程。根據我們先前的採購歷史，我們預計透過這些合約價格下調，在未來 12 個月內每年可節省數百萬美元的成本。

In contract services, we continue to renegotiate contracts and, whenever possible, eliminate overlapping contracts at both hospitals and at corporate and negotiate larger corporate contracts with better pricing to take advantage of our size and scope. For 2025, we began our business planning, which is going to occur in the third and fourth quarter. Our focus this year for our hospitals is really, as you've heard, an observation and inpatient focus, as well as creating some incremental service lines as well.

在合約服務方面，我們繼續重新談判合同，並儘可能消除醫院和企業的重疊合同，並以更優惠的價格談判更大的企業合同，以充分利用我們的規模和範圍。對於 2025 年，我們開始了業務規劃，這將在第三和第四季進行。正如您所聽到的，我們今年醫院的重點實際上是觀察和住院患者，以及創建一些增量服務線。

Our focus for 2025 is to continue to grow our mature hospitals and ER volume observation, inpatient and outpatient, as well as expand into new service lines that we are piloting at some hospitals now and quickly ramp up our new hospitals. We're very excited about the continued growth and future of Nutex and we're working with our stakeholders to strategically plan out the next five years. The second quarter was great for us returning our company to profitability, and we're expecting that trend to increase in subsequent quarters as we continue to grow organically in our existing hospitals and in our markets.

我們 2025 年的重點是繼續發展我們成熟的醫院和急診室觀察、住院和門診量，並擴展到我們目前在一些醫院試點的新服務線，並迅速擴大我們的新醫院。我們對 Nutex 的持續成長和未來感到非常興奮，我們正在與利益相關者合作，策略性地規劃未來五年。第二季度對於我們使公司恢復盈利來說非常有利，隨著我們在現有醫院和市場中繼續有機增長，我們預計這一趨勢將在接下來的幾個季度中增加。

With that, go back to Jennifer.

說完，回到珍妮佛。

Thank you, Josh. On the call, we have Bill Sutherland from Benchmark Company, who will now ask our team a question.

謝謝你，喬許。來自 Benchmark Company 的 Bill Sutherland 參加了電話會議，他現在將向我們的團隊提出一個問題。

Let me start with the population health side, and I'm wondering what other color you can provide there. I guess this will be for Warren.

讓我從人口健康方面開始，我想知道你們還可以在那裡提供什麼其他顏色。我想這將是給沃倫的。

Bill, thank you for the question. On the population health side of the business, we continue to build on our momentum this year with 10.8% year-over-year growth in the first half of 2024. Our Independent Physician Association, or IPA, in Los Angeles, California continues to perform well and is generating significant free cash flow. Our IPA in Houston had a strong start to the year, enrolling over 1,900 Medicare Advantage patients. However, we encountered attribution issues, which we are working our way through.

比爾，謝謝你的提問。在人口健康業務方面，我們繼續保持今年的勢頭，2024 年上半年年增 10.8%。我們位於加州洛杉磯的獨立醫師協會 (IPA) 繼續表現良好，並產生大量自由現金流。我們在休士頓的 IPA 今年開局良好，招募了 1,900 多名 Medicare Advantage 患者。然而，我們遇到了歸因問題，我們正在努力解決這個問題。

Essentially, many of these patients were erroneously assigned to competing IPAs in Houston. A batch of these patients were reassigned back to us on July 1 and another batch on August 1. We hope to recuperate the remaining patients over the next two months. Our new IPA in Florida is growing steadily. Looking forward, we intend to start one to two new IPAs around our facilities every year. For example, we did start an IPA in Phoenix, and we are still signing up primary care physicians and specialists and are gearing up for the Medicare annual enrollment period, which began in mid-October.

本質上，這些患者中的許多人被錯誤地分配到休士頓的競爭性 IPA。其中一批患者於 7 月 1 日重新分配回我們，另一批則於 8 月 1 日重新分配回我們。我們希望剩下的病人能在接下來的兩個月康復。我們在佛羅裡達州的新 IPA 正在穩步成長。展望未來，我們打算每年在我們的設施周圍啟動一到兩個新的 IPA。例如，我們確實在鳳凰城啟動了 IPA，我們仍在招募初級保健醫生和專家，並為 10 月中旬開始的 Medicare 年度註冊期做準備。

Finally, as Tom mentioned earlier, we divested one subsidiary already, which was burning cash. And by the end of this month, we'll have divested a second unit, which continues to burn cash. We expect that these two transactions will enhance our net income and [EBITDA] beginning in September.

最後，正如湯姆之前提到的，我們已經剝離了一家正在燒錢的子公司。到本月底，我們將剝離第二個部門，該部門將繼續燒錢。我們預計這兩項交易將提高我們 9 月開始的淨利潤和 [EBITDA]。

And then maybe moving over to the balance sheet. Jon, can you give us a little more detail on where debt sits right now?

然後也許會轉向資產負債表。喬恩，您能給我們更多關於目前債務狀況的詳細資訊嗎？

Sure. Great question, Bill. As you can see on our balance sheet and mentioned previously in my financial update, overall bank equity-type debt, both short and long term, went from $42.4 million at December of '23, down to $40.9 million at June of '24. It's a slight decrease from year-end, but the overall balance is a relatively small balance of true operating debt for a company of our size. I know that we get questions on why our overall liabilities, as you look on the balance sheet are, $340 million as that seems like a large number.

當然。好問題，比爾。正如您在我們的資產負債表上看到的以及我之前在財務更新中提到的那樣，銀行股權型債務（無論是短期還是長期）從23 年12 月的4240 萬美元下降到24 年6 月的4090 萬美元。比年底略有下降，但對於我們這種規模的公司來說，整體餘額是真實營運債務的相對較小的餘額。我知道我們有人問為什麼我們的總負債（正如您在資產負債表上看到的那樣）是 3.4 億美元，因為這看起來是一個很大的數字。

The reality is the $241 million of that $340 million balance, roughly 71%, relates to operating and financing right-of-use liabilities, which are just future lease payments to a landlord on our hospital facilities. And these are reflected on the balance sheet because the accounting rules require us to aggregate all lease payments that we paid to a landlord for the entirety of each lease term, which might be 15 to 20 years of payments and then present-value back that total dollar amount of those lease payments to the inception of the lease and recorded right-of-use asset and a corresponding right-of-use liability on the balance sheet for that result, which amounts to the $241 million at June 30, of '24, you see in our balance sheet.

現實情況是，這 3.4 億美元的餘額中的 2.41 億美元（約 71%）與營運和融資使用權負債有關，這些負債只是我們醫院設施未來向房東支付的租金。這些都反映在資產負債表上，因為會計規則要求我們匯總在整個租賃期內向房東支付的所有租賃付款，這可能是 15 到 20 年的付款，然後用現值返回該總額到租賃開始時的這些租賃付款金額以及為此結果在資產負債表上記錄的使用權資產和相應的使用權負債，截至2024 年6 月30 日總計2.41 億美元，你可以在我們的資產負債表中看到。

So that is why you see such a large amount in both the financing and operating right-of-use asset accounts in the case of the right-of-use under the total assets and, of course, the right-of-use liability accounts under total liabilities, on the balance sheet. So most analysts and investors don't view these right-of-use liabilities as real operating [event]. So I wanted to clarify that to you and others who have that question. Great question.

因此，這就是為什麼您在總資產下的使用權以及使用權負債帳戶下的融資和經營使用權資產帳戶中看到如此大的金額在資產負債表上的總負債項下。因此，大多數分析師和投資者並不將這些使用權負債視為實際營運負債[事件]。所以我想向你和其他有這個問題的人澄清這一點。很好的問題。

Yes. Appreciate that color. And then last for me. I was thinking about the back half of the year. And maybe you can remind us as we try to think about it relative to the second quarter, any cadence or seasonality we should keep in mind.

是的。欣賞那個顏色。然後最後對我來說。我在想下半年的事情。也許您可以提醒我們，當我們嘗試相對於第二季度進行思考時，我們應該牢記任何節奏或季節性。

Yes, I could take that. Good question, Bill. So yes, our business does have a seasonality to it. Typically, as summer approach, volume goes down because people go on vacation and kids get out of school and so on and so forth. But as kids come back, which is right around now at this time of the year, we typically see an increase in volume from August going forward. So half second-quarter buy-in does drop, but then it picks up again around this time of the year.

是的，我可以接受。好問題，比爾。所以，是的，我們的業務確實有季節性。通常，隨著夏季的臨近，交易量會下降，因為人們去度假，孩子們放學等等。但隨著孩子們回來（每年的這個時候），我們通常會看到從八月開始數量會增加。因此，第二季的一半購買量確實下降了，但隨後在每年的這個時候又會回升。

And then looking into the fourth quarter, you would get also strength as you get into flu season, et cetera, right?

然後展望第四季度，當你進入流感季節等時，你也會獲得力量，對吧？

Yes, correct. Not just flu, but as you know, COVID is still around. And we're still seeing COVID even in the summertime, unfortunately. So in addition to the flu, COVID and whatever new strains of any pathogens that are out there this winter time, we should be in a good position to take care of our patients.

是的，正確。不僅僅是流感，如您所知，新冠病毒仍然存在。不幸的是，即使在夏天，我們仍然會看到新冠病毒。因此，除了流感、新冠肺炎以及今年冬天出現的任何新病原體之外，我們還應該處於有利地位來照顧我們的患者。

Thank you, Bill. All right, we're taking a moment to check the queue for any additional questions. Okay. If there are any additional questions, please send an e-mail to investor@nutexhealth.com, and we will do our best to answer in a timely manner.

謝謝你，比爾。好的，我們將花點時間檢查佇列中是否有任何其他問題。好的。如果還有其他問題，請發送電子郵件至investor@nutexhealth.com，我們將盡力及時解答。

On behalf of the Nutex management team, we appreciate everyone for dialing in and listening to our second quarter earnings report. A recording of this call will be available on our website for a limited time. Take care, everyone.

我們代表 Nutex 管理團隊感謝大家撥打並聆聽我們的第二季財報。我們的網站將限時提供本次通話的錄音。大家保重。

This concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

今天的會議到此結束。此時您可以斷開線路，我們感謝您的參與。