Nutex Health Inc (NUTX) 2024 Q4 法說會逐字稿

Greetings, and welcome to the Nutex Health fourth-quarter 2024 financial results call. (Operator Instructions) As a reminder, this conference is being recorded. I would now like to turn the call over to your host, Ms. Jennifer Rodriguez, Investor Relations for Nutex's Health. Please begin.

大家好，歡迎參加 Nutex Health 2024 年第四季財務業績電話會議。（操作員指示）提醒一下，本次會議正在錄音。現在，我想將電話轉給主持人、Nutex 健康投資者關係部門的 Jennifer Rodriguez 女士。請開始。

Good morning, everyone, and welcome to Nutex Health fourth-quarter and full-year 2024 earnings call. My name is Jennifer Rodriguez, and I'm happy to serve as your moderator today. We're truly grateful for your participation and your continued interest in our company as we share the highlights of an exceptional year.

大家早上好，歡迎參加 Nutex Health 2024 年第四季和全年財報電話會議。我叫珍妮佛羅德里格斯，很高興今天擔任你們的主持人。我們衷心感謝您的參與以及對我們公司的持續關注，讓我們共同分享這一特殊年份的亮點。

Please note that this call is being recorded for future reference. Joining me this morning are some of the key leaders driving Nutex Health forward, our Chairman and CEO, Dr. Tom Vo; our Chief Financial Officer, Jon Bates; our President, Dr. Warren Hosseinion; and our Chief Operating Officer, Josh DeTillio.

請注意，本次通話將被錄音以供日後參考。今天早上與我一起的還有推動 Nutex Health 向前發展的一些關鍵領導人，他們的包括我們的董事長兼首席執行官 Tom Vo 博士；我們的首席財務官喬恩·貝茨 (Jon Bates)；我們的總裁沃倫·侯賽尼翁博士；以及我們的首席營運官 Josh DeTillio。

Together, we'll provide prepared remarks to give you a comprehensive view of our performance, strategies and vision. After which we'll open the floor for your questions.

我們將共同提供準備好的評論，讓您全面了解我們的績效、策略和願景。之後我們將開始回答大家的提問。

Before I turn it over to Dr. Vo, I'd like to take a moment to address a few important points. Today's discussion may include forward-looking statements, which reflect management's current expectations about our future performance. These statements are based on what we know today, but they're subject to risks, uncertainties and other factors that could cause our actual results to differ from what we'll share. For a deeper dive into these forward-looking statements and the factors that might influence them, I encourage you to review the press release and the Form 10-K filed earlier this week as well as our various SEC filings.

在將問題交給 Vo 博士之前，我想花點時間討論幾個重要問題。今天的討論可能包括前瞻性陳述，反映了管理層對我們未來業績的當前預期。這些聲明是基於我們今天所了解的情況，但它們受到風險、不確定性和其他因素的影響，可能導致我們的實際結果與我們分享的結果不同。為了深入了解這些前瞻性陳述及其可能影響它們的因素，我建議您查看本週早些時候提交的新聞稿和 10-K 表格以及我們向美國證券交易委員會提交的各種文件。

You'll find all the details there. Additionally, we may reference non-GAAP financial measures such as adjusted EBITDA during the call. For those interested in how these metrics reconcile to GAAP standards, please refer to the press release and the Form 10-K, always included that information.

您將在那裡找到所有詳細資訊。此外，我們可能會在電話會議中參考非 GAAP 財務指標，例如調整後的 EBITDA。對於那些想知道這些指標如何與 GAAP 標準相協調的人，請參閱新聞稿和 10-K 表格，其中始終包含該資訊。

With those housekeeping items out of the way, it's my pleasure to hand the call over to Dr. Tom Vo, our Founder and Chief Executive Officer. Dr. Vo, the floor is yours.

處理完這些瑣事後，我很高興將電話交給我們的創始人兼執行長 Tom Vo 博士。Vo 博士，現在請您發言。

Thank you, Jennifer, and good morning to everybody, and thank you for joining us on our today's investors call. It is my pleasure to speak with you as we recap Nutex Health's fourth-quarter and full-year results for 2024.

謝謝你，詹妮弗，大家早安，謝謝你們參加我們今天的投資者電話會議。我很高興與您交談，回顧 Nutex Health 2024 年第四季和全年業績。

This has been a period of exceptional growth, operational refinements and innovation as we've worked to reshape how high quality concierge level health care is delivered across the communities we serve. Our entire organization is committed to our mission of providing concierge level care to the communities that we serve with a specific emphasis on patient-first values.

這是一個非凡成長、營運改善和創新的時期，我們致力於重塑我們服務的社區提供高品質禮賓級醫療服務的方式。我們整個組織致力於為我們服務的社區提供禮賓級護理的使命，特別強調病人至上的價值觀。

I'm excited to walk you through the details of our achievement, the strategies propelling us forward and the challenges we're navigating, particularly with a No Surprises Act and its arbitration process, where we've seen some positive developments.

我很高興向你們詳細介紹我們的成就、推動我們前進的策略以及我們正在應對的挑戰，特別是在《無意外法案》及其仲裁程序方面，我們已經看到了一些積極的進展。

So let's start with our financial performance. For the full year of 2024, our total revenue reached $479.9 million, up 94% from $247.6 million in 2023. Our adjusted EBITDA increased from $10.8 million in 2023 to $123.7 million in 2024, up over 1,000%.

那麼就讓我們從財務表現開始吧。2024 年全年，我們的總營收達到 4.799 億美元，較 2023 年的 2.476 億美元成長 94%。我們的調整後 EBITDA 從 2023 年的 1,080 萬美元成長至 2024 年的 1.237 億美元，增幅超過 1,000%。

Our full year of 2024 net income was $52 million for 2024 compared to a loss of $46 million for 2023. On the patient volume side, our total visit at our hospital increased by 17% from 144,000 in 2023 to 168,000 in 2024. Of that 17% growth in patient volume, 6.5% was from our mature hospitals.

我們 2024 年全年淨收入為 5,200 萬美元，而 2023 年虧損為 4,600 萬美元。在病患數量方面，我們醫院的總就診人數從 2023 年的 144,000 人次增加了 17% 至 2024 年的 168,000 人次。在患者數量增加的17%中，6.5%來自我們成熟的醫院。

On the debt side, even with the four new hospitals that we opened in 2024, the current portion of long-term debt increased only slightly from $10.8 million in 2023 to $14 million in 2024. While the net long-term debt actually decreased from $26 million in 2023 to $22 million in 2024, signifying our dedication to maintaining low debt and fiscal responsibility.

在債務方面，即使我們在 2024 年開設了四家新醫院，長期債務的當前部分也僅從 2023 年的 1080 萬美元略微增加到 2024 年的 1400 萬美元。而淨長期債務實際上從 2023 年的 2,600 萬美元減少到 2024 年的 2,200 萬美元，這表明我們致力於維持低債務和財政責任。

These figures reflect the success of our expansion strategy, the strength of our mature facilities and the tireless dedication of our entire team to achieve three key metrics: ER patient volume increase, inpatient volume growth and revenue per patient growth.

這些數字反映了我們擴張策略的成功、我們成熟設施的實力以及我們整個團隊為實現三個關鍵指標而做出的不懈奉獻：急診室患者數量的增加、住院患者數量的增長和每位患者收入的增長。

Now let's turn to a critical piece of our 2024 story. The No Surprises Act or the NSA. And the arbitration process, otherwise known as Independent Dispute Resolution Process or IDR. The NSA effective January 1, 2022, aimed to shield patients from surprise medical bills. A noble intent we fully support and fully adhere to.

現在讓我們來談談 2024 年故事的一個關鍵部分。無意外法案或國家安全局。仲裁程序，也稱為獨立爭議解決程序或 IDR。《國家安全法》將於 2022 年 1 月 1 日生效，旨在保護病患免受意外醫療費用的困擾。我們全力支持並全力遵守這項崇高意圖。

However, the flawed implementation of the NSA has hit providers like us very, very hard, and specifically on the revenue per patient reimbursement side. In 2022, our average insurer payments for emergency services dropped roughly 30%. The root issue is that insurers often pay below the qualifying payment amount or QPA, which was described and mandated in the NSA.

然而，國家安全法的缺陷實施給我們這樣的服務提供者帶來了極為嚴重的打擊，特別是在每位患者報銷收入方面。2022 年，我們的緊急服務保險平均賠償額下降了約 30%。根本問題在於，保險公司支付的金額通常低於 NSA 中描述和規定的合格支付金額或 QPA。

The QPA is the median contracted rate insurers recognize as of January 31, 2019, and for a similar service in a similar region adjusted manually by the consumer price index. So in essence, the QPA is the amount that the insurers are required to pay providers according to the law.

QPA 是保險公司截至 2019 年 1 月 31 日確認的類似地區類似服務的平均合約費率，並根據消費者物價指數進行手動調整。因此，從本質上講，QPA 是保險公司依法必須向提供者支付的金額。

If the providers find that the QPA payment by the insurers is consistently lower than the national benchmarks, the NSA has a provision where the providers can appeal through a formal process of mediation, sometimes referred to as open negotiation to resolve the dispute. However, if this nonbinding open negotiation still doesn't work, then the next step would be to escalate to arbitration or the IDR process to resolve the differences.

如果提供者發現保險公司支付的 QPA 始終低於國家基準，NSA 有一項規定，提供者可以透過正式的調解程序（有時稱為公開談判）提出上訴來解決爭端。然而，如果這種不具約束力的公開談判仍然不起作用，那麼下一步將是升級為仲裁或 IDR 程序來解決分歧。

And while we've been participating in the open negotiation process since 2022, we have only started the arbitration process on roughly around July 1, 2024. The main reason that we pivoted from primarily using open negotiation, which is nonbinding and continuing and moving on towards arbitration, which is binding in most cases was because of the low success rate of open negotiations, where we only achieved a roughly 10% increase in collections from the original low payment amount.

雖然我們自 2022 年以來就一直參與公開談判進程，但我們直到大約 2024 年 7 月 1 日才開始仲裁程序。我們之所以從主要使用不具約束力的公開談判轉向在大多數情況下具有約束力的仲裁，主要原因是公開談判的成功率很低，我們在最初的低付款金額上僅實現了約 10% 的收款增長。

Once the previous administration's made arbitration process more streamlined, more efficient and more cost effective, beginning in late 2023 and early 2024, we took advantage of this tool to leverage our positions with our insurers. However, compared to open negotiations, there are significant disadvantages to arbitration process. It's very costly, very labor intensive and takes a long time to collect from the insurance companies.

一旦上屆政府使仲裁程序更加精簡、高效和更具成本效益，從 2023 年底到 2024 年初開始，我們就會利用這項工具來鞏固我們與保險公司的地位。然而，與公開談判相比，仲裁程序存在明顯的劣勢。從保險公司收取賠款的成本非常高，需要耗費大量的人力，而且需要很長時間。

It also has a lot of upfront costs like Medicare administrative fees and arbitrator fees. To further add to the risk the loser of this arbitration process bears the IDR arbitration fee cost. So entering into arbitration process is not a decision that would take lightly at all whatsoever. However, if this results in a fair payment that is close to the QPA payment that the insurers are required to pay by law, then, of course, we will proceed and use any tools necessary.

它還有很多前期成本，例如醫療保險管理費和仲裁員費用。進一步增加風險的是，該仲裁程序的失敗者還需承擔 IDR 仲裁費用。因此，進入仲裁程序絕非一個可以輕易做出的決定。然而，如果這導致的公平賠償接近保險公司依法必須支付的 QPA 賠付，那麼，我們當然會繼續並使用任何必要的工具。

Since we have implemented the arbitration process, the results have been positive. As I mentioned earlier, while our volume -- our patient volume increased by about 30% in 2024 compared to 2023, our revenue increased by about 94%. And some of this, as a result -- some of this was a result of higher patient volume and acuity to our facility, but a lot of it also was directly from our arbitration initiative.

自從我們實施仲裁程序以來，取得了積極的成果。正如我之前提到的，雖然我們的患者數量在 2024 年與 2023 年相比增加了約 30%，但我們的收入卻增加了約 94%。其中部分原因是由於我們的設施患者數量增加和敏銳度增加，但很大一部分也直接來自於我們的仲裁措施。

Since 2024, we have submitted roughly between 60% to 70% of our billable visits to the IDR or arbitration portal. Of these claims submitted, we have achieved a roughly 80% win rate. Of these over 80%-plus arbitration wins once again, which are binding, we expect the insurers to pay 60% to 70% in the first 60 days and the rest later.

自 2024 年以來，我們已將約 60% 至 70% 的可計費造訪量提交至 IDR 或仲裁入口網站。在提交的這些索賠中，我們的勝訴率約為 80%。在這些具有約束力的超過 80% 的仲裁勝利中，我們預計保險公司將在前 60 天內支付 60% 到 70%，其餘的在以後支付。

In terms of revenue per visit increase from the IDR process, we typically find a 150% to 250% increase in reimbursement on the facility collection side compared to the initial payment. And once again, this is all consistent with the public data and consistent with the data that are published by other providers that are also doing arbitration like we are.

就 IDR 流程帶來的每次就診收入增加而言，我們通常會發現，與初始付款相比，設施收款方面的報銷金額增加了 150% 到 250%。再說一次，這一切都與公開數據一致，也與其他像我們一樣進行仲裁的提供者發布的數據一致。

Once again, the goal of arbitration really is just to get to the QPA payment level as outlined in the No Surprises Act. And so far, arbitration seems to be working as it was designed to do. Today, our network spans 24 hospitals across 11 states. In 2024, we hit our target of four new hospitals opening in Green Bay, Wisconsin, Post Falls, Idaho, Milwaukee, Wisconsin and our very first hospital in Florida and Tampa.

再次強調，仲裁的目的其實只是為了達到《無意外法案》所概述的 QPA 支付水準。到目前為止，仲裁似乎正在按照預期發揮作用。如今，我們的網路覆蓋 11 個州的 24 家醫院。2024 年，我們實現了在威斯康辛州格林貝、愛達荷州波斯特福爾斯、威斯康辛州密爾瓦基開設四家新醫院的目標，並在佛羅裡達州和坦帕開設了我們的第一家醫院。

We are already working on new hospital pipelines for 2025, 2026, 2027 and 2028. Each new facility is designed to deliver concierge level care eliminating emergency room wait times, easing patient stress and providing inpatient and outpatient services tailored to local needs.

我們已經在為 2025、2026、2027 和 2028 年制定新的醫院規劃。每個新設施都旨在提供禮賓級護理，消除急診室等待時間，減輕患者壓力，並提供根據當地需求量身定制的住院和門診服務。

Communities and doctors across the country still reach out to us weekly to open new hospitals in their areas. We target high demand growth markets, ensuring every new site aligns with our mission to serve where were needed the most. Meanwhile, our mature hospitals are continuing to grow, expanding their offerings to meet evolving demand.

全國各地的社區和醫生仍然每週與我們聯繫，希望在他們所在的地區開設新醫院。我們瞄準高需求成長市場，確保每個新站點都符合我們的使命，為最需要的地方提供服務。同時，我們成熟的醫院也在不斷發展，擴大其服務範圍以滿足不斷變化的需求。

On the corporate side, we are laser-focused on increasing hospital volume systems-wide, increasing inpatient admission to our hospitals, increasing our revenue per patient by implementing efficient revenue cycle processes such as arbitration and mediation and maintain low cost as well as aggressive debt management and debt payback.

在公司方面，我們專注於增加全系統的醫院數量，增加醫院的住院人數，透過實施仲裁和調解等有效的收入週期流程來增加每位患者的收入，並保持低成本以及積極的債務管理和債務償還。

And for those that have been in the health care industry for some time, you will know that every five to seven years, there's a major disruption to our industry. That disruption for us came in 2022 with a No Surprises Act. The great news is that we were able to pivot and adapt to the current environment.

對於那些已經在醫療保健行業工作了一段時間的人來說，你們會知道，每隔五到七年，我們的行業就會發生一次重大變革。對我們來說，這種幹擾發生在 2022 年推出的《無意外法案》之後。好消息是我們能夠轉變並適應當前的環境。

Our company is designed to operate and continually be adaptable, flexible and resilient to adjust to any future geopolitical, legislative or financial challenges just as we have done for the past 14 years. So we are very excited about the future of Nutex as we will begin 2025.

正如我們過去 14 年所做的那樣，我們公司旨在運作並持續保持適應性、靈活性和彈性，以應對未來的任何地緣政治、立法或金融挑戰。因此，我們對即將進入 2025 年的 Nutex 的未來感到非常興奮。

So with that, I'll pass to Jon Bates, our CFO, to dive further into the financials. Jon?

因此，我將把話題轉交給我們的財務長喬恩貝茨 (Jon Bates)，讓他進一步探討財務問題。喬恩？

Thanks, Tom, and good morning, everyone. I'm very excited to break down the financials for Nutex Health's fourth-quarter and full-year 2024, a year where we didn't just grow but we have begun delivering transformative financial performance. Tom has given you the big picture, and I'm going to zoom in on some more detail, beginning with the fourth-quarter of 2024, and their results and then taking -- been talking a little bit more about the full-year of 2024.

謝謝，湯姆，大家早安。我很高興能夠詳細分析 Nutex Health 第四季和 2024 年全年的財務狀況，這一年我們不僅實現了成長，而且開始實現變革性的財務表現。湯姆已經向你介紹了大概的情況，我將詳細介紹一下，從 2024 年第四季開始，討論他們的業績，然後再談談 2024 年全年的情況。

There is a lot to unpack. So let's start with the fourth-quarter ended December 31, 2024, and compare those results to the same period in 2023. So for the fourth-quarter of '24, our total revenue grew 270% or $187.9 million to $257.6 million versus $69.7 million for the fourth-quarter of 2023. Of this increase, the arbitration process resulted in $169.7 million more in revenue in the fourth-quarter compared to the same period in 2023, which amounted to approximately 90.3% of the $187.9 million increase in overall revenue.

有很多東西要解開。因此，讓我們從截至 2024 年 12 月 31 日的第四季開始，並將該結果與 2023 年同期進行比較。因此，在 2024 年第四季度，我們的總營收成長了 270%，即 1.879 億美元，達到 2.576 億美元，而 2023 年第四季的總營收為 6,970 萬美元。其中，仲裁程序導致第四季營收較 2023 年同期增加 1.697 億美元，約佔總營收 1.879 億美元增幅的 90.3%。

So of the $169.7 million arbitration revenue, $68.9 million related to dates of service for the fourth-quarter of '24, $70.5 million related to dates of service for the third-quarter of 2024 and $30.3 million related to dates of service for periods prior to the third-quarter of 2024.

因此，在 1.697 億美元的仲裁收入中，6,890 萬美元與 2024 年第四季的服務日期有關，7,050 萬美元與 2024 年第三季的服務日期有關，3,030 萬美元與 2024 年第三季之前的服務日期有關。

So of that total revenue increase, mature hospitals, which are hospitals are open prior to December 31, 2021, and therefore, they provided two full years of comparative results, they increased their revenue by 175.6% for the fourth-quarter '24 versus the fourth-quarter of '23.

因此，在總收入成長中，成熟醫院（即在 2021 年 12 月 31 日之前開業的醫院）提供了整整兩年的比較結果，與 23 年第四季相比，24 年第四季的收入成長了 175.6%。

For hospital division visits, we saw growth as well during the quarter as they increased by 9.8% or 4,063 visits to 45,444 visits in the fourth-quarter of '24 versus 41,381 visits in the same period in 2023, with the mature hospitals growing at 3.1% in the fourth-quarter '24 versus the fourth-quarter of '23. Additionally, the Population Health division revenue increased by just under $1 million or roughly about 11% to $7.9 million in the fourth-quarter of '24 from $7.1 million in a similar period in '23.

對於醫院部門的就診量，我們在本季度也看到了增長，2024 年第四季度的就診量增加了 9.8% 或 4,063 次，達到 45,444 次，而 2023 年同期為 41,381 次，其中成熟醫院在 2024 年第四季度與 2023 年第四季度相比增長了 3.1%。此外，人口健康部門的收入從 2023 年同期的 710 萬美元增加到 2024 年第四季的 790 萬美元，增幅略低於 100 萬美元，增幅約為 11%。

Now we discussed the growth in the hospital revenue and visits that we've seen in the fourth-quarter of '24. Now let's discuss the overall facility and corporate costs and the improvement in those areas. So total facility level operating costs and expenses increased $59.5 million during the period, but only represented about 45% or $116 million of total revenue for the fourth-quarter of '24 versus 81.1% or about $56.5 million for the same period in '23.

現在我們討論了 24 年第四季醫院收入和就診人數的成長。現在讓我們討論一下整體設施和公司成本以及這些領域的改進。因此，在此期間，設施級營運成本和費用總額增加了 5,950 萬美元，但僅佔 24 年第四季總收入的 45% 或 1.16 億美元，而 23 年同期則為 81.1% 或約 5,650 萬美元。

So of the $59.5 million increase, $57.6 million related to arbitration costs for the additional arbitration revenue booked during the period with cost of approximately $24 million related to the dates of service in the fourth-quarter of '24, another $24 million related to the dates of service for the third-quarter of '24, and then just about $9 million related to dates of service prior to the third-quarter of 2024.

因此，在 5,950 萬美元的增幅中，5,760 萬美元與仲裁費用有關，這是期間內確認的額外仲裁收入，其中約 2,400 萬美元與 2024 年第四季的服務日期有關，另外 2,400 萬美元與 2024 年第三季的服務日期有關，然後約 900 萬美元與 202 年第三季的服務日期有關，然後約 9002 年第三季的服務日期有關，然後約 2024 年第三季有關

As a result of the revenue and facility cost improvement, our 2024 fourth-quarter gross profit was $141.6 million or 55% of total revenue as compared to $13.2 million or just 18.9% of total revenue in '23, which is a whopping 973% improvement in the fourth-quarter of '24 over '23.

由於營收和設施成本的改善，我們 2024 年第四季的毛利為 1.416 億美元，佔總營收的 55%，而 23 年為 1,320 萬美元，僅佔總營收的 18.9%，24 年第四季比 23 年成長了 973%。

From a corporate and other cost perspective, the general and administrative expenses as a percentage of total revenue for the fourth-quarter of '24 decreased to 4.9% compared to 12.2% for the fourth-quarter of '23. When you look at operating income, which, as you can see, includes a negative impact of $14.7 million of noncash stock-based compensation expense, for the fourth-quarter that operating income was $114.2 million compared to an operating loss of $26 million in the fourth-quarter of '23, representing a $140 million improvement quarter-over-quarter.

從公司和其他成本角度來看，24 年第四季的一般及行政費用佔總收入的百分比從 23 年第四季的 12.2% 下降至 4.9%。當您查看營業收入時，您會發現，其中包括 1,470 萬美元的非現金股票薪酬費用的負面影響，第四季度的營業收入為 1.142 億美元，而 23 年第四季度的營業虧損為 2,600 萬美元，環比改善了 1.4 億美元。

So net income attributable to Nutex Health was $61.7 million for the fourth-quarter of '24, again, including that negative impact from the stock comp expense. And the comparative net loss attributable to Nutex was $31.6 million for the fourth-quarter of '23, showing a $93.3 million improvement fourth-quarter '24 over the same period in '23. And we're out referencing adjusted EBITDA attributable to Nutex, it did increase $90.5 million from $3.1 million in the fourth-quarter of '23 to $93.6 million in the fourth-quarter of '24.

因此，24 年第四季歸屬於 Nutex Health 的淨收入為 6,170 萬美元，這再次包括了股票補償費用的負面影響。23 年第四季歸屬於 Nutex 的比較淨虧損為 3,160 萬美元，與 23 年同期相比，24 年第四季改善了 9,330 萬美元。我們參考了歸屬於 Nutex 的調整後 EBITDA，它確實從 23 年第四季的 310 萬美元增加了 9,050 萬美元，達到 24 年第四季的 9,360 萬美元。

Now on to the 12 months ended December of '24 compared to the 12 months ended December 31, 2023. Total revenue for the full year of '24 grew by 93.8% or $232 million to $479.9 million versus $247.6 million for the full year of '23. As mentioned previously, the arbitration process resulted in $169.7 million more in revenue in '24 versus '23, which amounted to approximately 73.1% of the $232 million of revenue increase.

現在來看看截至 24 年 12 月的 12 個月，與截至 2023 年 12 月 31 日的 12 個月進行比較。24 年全年總營收成長 93.8%（即 2.32 億美元），達到 4.799 億美元，而 23 年全年為 2.476 億美元。如前所述，仲裁程序導致24年的收入比23年增加了1.697億美元，約佔2.32億美元收入增幅的73.1%。

And as mentioned before, the $169.7 million arbitration revenue, $68.9 million related to dates of service in the fourth-quarter, just over $70 million related to dates of service for the third-quarter and just over $30 million related to dates of service for periods prior to the third-quarter of 2024. So of the total revenue increase, mature hospitals increased their revenue by 56.6% for the year of '24 versus the same period in 2023.

如前所述，1.697 億美元的仲裁收入中，6,890 萬美元與第四季度的服務日期有關，略高於 7,000 萬美元與第三季的服務日期有關，略高於 3,000 萬美元與 2024 年第三季之前的服務日期有關。因此，在總收入成長中，成熟醫院 24 年的收入與 2023 年同期相比成長了 56.6%。

Talking about visits. Visits increase, as Tom mentioned earlier, by roughly 17% or 24,330 visits, up to 168,388 visits in '24 versus 144,058 visits in the same period in '23, with mature hospital visits growing at 6.5% in 2024 versus the same period in '23. Additionally, in the Population Health side, it grew by 4.4% to $30.9 million in the first 12 months of '24 from $29.6 million in the same period in 2023.

談論訪問。正如湯姆之前提到的，就診次數增加了約 17% 或 24,330 次，2024 年達到 168,388 次，而 2023 年同期為 144,058 次，2024 年成熟醫院就診次數將比 2023 年同期增加 6.5%。此外，在人口健康方面，從 2023 年同期的 2,960 萬美元成長了 4.4%，達到 2024 年前 12 個月的 3,090 萬美元。

So in addition to the revenue and visit growth noted above, facility and corporate costs also showed improvement for the 12 months of '24 relative to '23. Total facility level operating costs and expenses increased $70.8 million during the period, but only represented about 59% or $283 million of total revenue for the 12 months ended December of '24 versus 86% or $212 million for the same period in 2023, a decrease of 26.9%.

因此，除了上述的收入和訪問量成長之外，24 年 12 個月的設施和公司成本相對於 23 年也有所改善。在此期間，設施級總營運成本和費用增加了 7,080 萬美元，但僅佔截至 12 月 24 日的 12 個月總收入的 59% 或 2.83 億美元，而 2023 年同期為 86% 或 2.12 億美元，下降了 26.9%。

So of that $70.8 million for the period, as mentioned previously, $57.6 million related to arbitration costs for the additional arbitration revenue booked during the period with cost of approximately $24 million related to the dates of service for the fourth-quarter, $24 million related dates for service for the third-quarter and then roughly $9 million related to dates of service for the third-quarter or prior.

因此，如前所述，在本期間的 7080 萬美元中，5760 萬美元與仲裁費用有關，這是本期間確認的額外仲裁收入，其中約 2400 萬美元與第四季度的服務日期有關，2400 萬美元與第三季度的服務日期有關，然後約 900 萬美元與第三季度或之前的服務日期有關。

So the gross profit for the 12 months for the full year of 2024 was $196.3 million, or just under 41% of total revenue as compared to $34.8 million or 14% of total revenue in the same period in '23. A very large 464% increase for the 12 months into '24 for the same period in '23.

因此，2024 年全年 12 個月的毛利為 1.963 億美元，佔總營收的 41% 以下，而 2023 年同期的毛利為 3,480 萬美元，佔總營收的 14%。與 2023 年同期相比，2024 年 12 個月內成長了 464%，增幅非常大。

From a corporate and other cost perspective, the G&A expenses as a percentage of total revenue for the 12 months of '24 decreased to 8.7% or $41.9 million from 13.4% or $33.2 million for the same period in '23. Operating income for the 12 months ended December '24 was a positive $130.6 million compared to an operating loss of just under $32 million for the 12 months ended '23.

從公司和其他成本角度來看，24 年 12 個月的一般及行政費用佔總收入的百分比從 23 年同期的 13.4% 或 3,320 萬美元下降至 8.7% 或 4,190 萬美元。截至 24 年 12 月的 12 個月的營業收入為正 1.306 億美元，而截至 23 年 12 個月的營業虧損略低於 3,200 萬美元。

Net income attributable to new tax was $52.2 million for 2024 compared to that loss of $45.8 million for '23, which was a $98 million positive increase. Adjusted EBITDA attributable to Nutex increased $112 million or just over 1,000% from $10.8 million in the first 12 months of '23 to $123.7 million in the first 12 months of '24.

2024 年歸因於新稅的淨收入為 5,220 萬美元，而 2023 年的虧損為 4,580 萬美元，增幅為 9,800 萬美元。歸屬於 Nutex 的調整後 EBITDA 從 23 年前 12 個月的 1,080 萬美元增加 1.12 億美元，增幅略高於 1,000%，達到 24 年前 12 個月的 1.237 億美元。

Now as Tom stated previously, we started the independent dispute resolution arbitration process in July of '24. As part of the arbitration process, we first went through the required 30 business day open negotiation process for each claim that we believe we were paid less than the qualified payment amount on. And that QPA is defined as the median of the contracted rates the insurance plans recognized for similar services or same or similar services, services provided by a provider in the same or similar specialty and then services provided in the same geographic area as the service at issue.

正如湯姆之前所說，我們於 24 年 7 月啟動了獨立爭議解決仲裁程序。作為仲裁程序的一部分，對於我們認為獲得的付款少於合格付款金額的每項索賠，我們首先進行了為期 30 個工作日的公開談判程序。QPA 定義為保險計劃針對類似服務或相同或類似服務、由相同或類似專業的提供者提供的服務以及在與相關服務相同的地理區域內提供的服務所認可的合約費率的中位數。

All of this, of course, is inflation adjusted. So if we're unsuccessful in open negotiations and still believe we were being paid below the QPA, then we enter until the arbitration process. And with the entire process, from entering open negotiations to getting arbitration to actually getting paid by the payer, taking on average at least three to five months, we did not begin to see the wins in ultimate payments from the payers from this effort into the early part of the fourth-quarter of '24.

當然，所有這些都是經過通貨膨脹調整的。因此，如果我們在公開談判中失敗，並且仍然認為我們獲得的報酬低於 QPA，那麼我們就會進入仲裁程序。整個過程，從進入公開談判到獲得仲裁，再到實際從付款人那裡獲得付款，平均需要至少三到五個月的時間，直到 2024 年第四季度初，我們才開始看到付款人最終從這項努力中獲得付款。

So as we finished out the year and the whole close process, we use our most recent results from the arbitration process to accrue revenue for all visits that have begun the open negotiations process at the end of the year. And as communicated previously, we have been submitting claims on the arbitration process for approximately 60% to 70% of our billable visits and achieving over an 80% win rate and that's factoring in a 70% collection rate on each win, and we continue to refine our process each period based upon the most recent detail that we have.

因此，當我們結束這一年並完成整個結束過程時，我們將使用仲裁過程的最新結果來累積所有在年底開始公開談判過程的訪問的收入。正如之前所傳達的，我們已經在仲裁過程中提交了大約 60% 到 70% 的可計費訪問的索賠，並取得了超過 80% 的勝訴率，其中每次勝訴的收集率為 70%，並且我們會根據所掌握的最新細節，繼續完善每個時期的流程。

And finally, and I'll talk about our balance sheet a little bit, it remains very strong with cash and cash equivalents at December at just under $44 million, up from just under $22 million from 2023, a 98.2% increase.

最後，我稍微談一下我們的資產負債表，它仍然非常強勁，12 月份的現金和現金等價物略低於 4,400 萬美元，高於 2023 年的略低於 2,200 萬美元，增幅為 98.2%。

The other sizable increase at the end of the year is the accounts receivable balance, which was at $232 million compared to $58.6 million at the end of '23. And as discussed previously, the major increase for that relates to the arbitration process that we began back in July of 2024.

年末另一個顯著成長是應收帳款餘額，從 23 年末的 5,860 萬美元增加至 2.32 億美元。如同先前所討論的，這一金額的大幅增加與我們於 2024 年 7 月開始的仲裁程序有關。

Regarding cash flow, net cash from operating activities has increased to $21.9 million for the 12 months ended December of '24, all the way to $23.2 million as compared to just over $1 million for the same period in 2023. On the liability side, our total bank and equipment debt decreased by $1 million to $41.4 million, down from $42.4 million in December of '23, and again, with the majority of that debt relating to equipment loans in our hospitals for such things as MRIs, x-rays, ultrasounds, CT machines, et cetera.

就現金流而言，截至 24 年 12 月的 12 個月內，經營活動產生的淨現金已增加至 2,190 萬美元，而 2023 年同期僅為 100 萬美元，一路飆升至 2,320 萬美元。在負債方面，我們的銀行和設備債務總額減少了 100 萬美元，從 23 年 12 月的 4,240 萬美元降至 4,140 萬美元，而且，其中大部分債務與我們醫院的設備貸款有關，例如 MRI、X 光片、超音波、CT 機等。

So outside of this normal $40 million-plus of bank debt type items, the only other items of material look like that on the balance sheet are liabilities related to financing and operating lease liabilities. And we talked about this a little bit in the third-quarter, I wanted to reemphasize again. And so those liabilities are really just future lease payments due to our landlords on our hospital facilities.

因此，除了正常的 4000 多萬美元的銀行債務類型項目外，資產負債表上唯一類似的其他重要項目是與融資和經營租賃負債相關的負債。我們在第三季討論過這個問題，我想再次強調。因此，這些負債實際上只是我們醫院設施未來應向房東支付的租賃費用。

And they're reflected on the balance sheet because the accounting rules require us to aggregate all these lease payments that we pay to a landlord for the entirety of its lease, which might be 15 to 20 years of payments and then present value that back for each to the inception of that lease and record both a right-of-use asset and a corresponding of right to use liability on the balance sheet.

它們之所以反映在資產負債表上，是因為會計規則要求我們將整個租賃期間支付給房東的所有租賃付款加起來，這些付款可能是 15 到 20 年的付款，然後計算出租賃開始時每筆付款的現值，並在資產負債表上記錄使用權資產和相應的使用權負債。

As a result, on our balance sheet at December 31, of '24, the net asset balance for the operating and financing of our used assets amounted to $247 million, which is roughly 38% of total assets. And the net liability balance for the operating and financing Rouse liabilities amounted to just under $300 million, which is 66% of total liabilities.

因此，在我們 24 年 12 月 31 日的資產負債表上，我們所用資產的營運和融資的淨資產餘額為 2.47 億美元，約佔總資產的 38%。而 Rouse 經營和融資負債的淨負債餘額略低於 3 億美元，佔總負債的 66%。

Now most investors and analysts don't view these right-of-use liabilities is real operating debt. So I just wanted to clarify that for everybody. With all that said, our balance sheet remains very solid, and we have provided our company great flexibility that should allow us to execute on all of our growth plan in 2025 and beyond.

現在大多數投資者和分析師並不認為這些使用權負債是真正的經營債務。所以我只是想向大家澄清這一點。儘管如此，我們的資產負債表仍然非常穩健，並且我們為公司提供了極大的靈活性，這使我們能夠在 2025 年及以後執行所有成長計劃。

Now on to Warren Hosseinion, our President for Population Health update. Warren?

現在請我們來聽聽人口健康更新總裁 Warren Hosseinion 的發言。沃倫？

Thank you, John, and good morning, everyone. It's great to be with you today to discuss how Nutex Health is advancing population health management, a cornerstone of our mission to deliver sustainable, impactful health care.

謝謝你，約翰，大家早安。很高興今天能與大家一起討論 Nutex Health 如何推進人口健康管理，這是我們提供可持續、有影響力的醫療保健使命的基石。

In 2024, we made strides in this area, and I'm excited to share the progress, the strategies driving it and our plans to keep pushing forward. This isn't just about numbers or operations, it's about improving patient care, reducing disparities and creating a health care model that works for everyone, patients, providers and communities alike.

2024 年，我們在這一領域取得了長足進步，我很高興與大家分享這項進展、推動這項進程的策略以及我們繼續前進的計畫。這不僅涉及數字或操作，還涉及改善患者護理、減少差異並創建適合每個人（患者、提供者和社區）的醫療保健模式。

Let's start with where we are today. Our Population Health division currently manages over 40,000 patients across our platform. That's a broad reach, and it's growing because of the trust we've built through our independent physician associations or IPA. Revenue for the division hit $30.9 million in 2024, up slightly from $29.6 million in 2023. That growth might seem modest, but it's intentional.

讓我們從現在的情況開始。我們的人口健康部門目前在我們的平台上管理超過 40,000 名患者。其影響範圍很廣，而且由於我們透過獨立醫師協會（IPA）建立的信任，其影響範圍還在不斷擴大。該部門的收入將在 2024 年達到 3,090 萬美元，略高於 2023 年的 2,960 萬美元。這種成長可能看起來並不大，但卻是有意為之。

We divested two smaller entities that were unprofitable in 2024 to sharpen our focus on core operations, ensuring every dollar and effort aligns with our long-term vision. Our strategy revolves around building physician networks both primary care physicians and specialists around our hospitals. Building strong partnerships with local doctors is critical.

我們剝離了兩家在 2024 年未獲利的小型實體，以更加專注於核心業務，確保每一分錢和每一分錢都符合我們的長期願景。我們的策略是圍繞在我們醫院周圍建立初級保健醫生和專家的醫生網絡。與當地醫生建立牢固的合作關係至關重要。

These relationships create a web of care that's seamless for patients whether they're seeing a specialist getting diagnostics or managing a chronic illness, it's all coordinated and connected. Our vision is that our hospitals and IPAs working hand-in-hand, amplify our reach and effectiveness.

這些關係建構了一個無縫的護理網絡，無論患者是去專科醫生處進行診斷還是治療慢性病，一切都是協調且互聯的。我們的願景是我們的醫院和 IPA 攜手合作，擴大我們的影響力和效力。

We're not just adding doctors. We're fostering collaboration, sharing best practices and ensuring every provider is aligned with our patient-first culture. We're growing our IPA strategically focusing on areas near our hospitals to leverage existing relationships and infrastructure.

我們不只是增加醫生。我們正在促進合作、分享最佳實踐並確保每個提供者都符合我們的以患者為先的文化。我們正在策略性地擴大我們的 IPA，重點關注我們醫院附近的地區，以利用現有的關係和基礎設施。

In 2024, we laid the groundwork for new IPAs in Phoenix, Arizona and Dallas, Texas, with one or two more markets in the pipeline. Why Phoenix and Dallas? They are growing regions with health care gaps we can fill, and our hospital presence there gives us a head start. This isn't random expansion.

2024 年，我們為亞利桑那州鳳凰城和德克薩斯州達拉斯的新 IPA 奠定了基礎，並且還有一兩個市場正在籌備中。為什麼是菲尼克斯和達拉斯？這些地區正在發展，我們可以填補其醫療保健方面的缺口，而我們在那裡設立的醫院使我們佔據了先機。這不是隨機擴張。

It's deliberate building on our strengths to maximize impact. By 2026, these new IPAs will broaden our patient base and deepen our influence on local health care delivery. Coordinating large physician networks takes effort aligning incentives, standardizing care and managing data across systems. There's a lot of competition, and we're up against bigger players in some markets, but our edge is our integration, hospitals and IPAs feeding each other.

我們刻意發揮自己的優勢，以最大限度地發揮影響力。到 2026 年，這些新的 IPA 將擴大我們的患者基礎並加深我們對當地醫療保健服務的影響力。協調大型醫生網絡需要努力調整激勵措施、標準化護理並管理跨系統的數據。競爭非常激烈，在某些市場我們還要面對更大的競爭對手，但我們的優勢在於整合，醫院和 IPA 之間相互促進。

Our 2024 progress, 40,000 members and $30.9 million in revenue shows we're not just talking the talk. In 2026, we plan to scale this, refine it and keep proving the population health management continues to be a vital service for us.

我們在 2024 年取得的進展、40,000 名會員和 3,090 萬美元的收入表明我們不僅僅是說說而已。2026 年，我們計劃擴大規模、完善服務，並繼續證明人口健康管理仍然是我們的重要服務。

With that, I'll turn it over to Josh DeTillio, our Chief Operating Officer, to dive into our operations. Josh?

說完這些，我將把話題交給我們的營運長 Josh DeTillio，來深入了解我們的營運。喬許？

Thanks, Warren. As Tom and Jon mentioned on volume, overall, Q4 hospital visits were 45,444, up 9.8% from last year. For the whole year of 2024, total patient visits were 168,388 versus 144,058 in 2023, an increase of 16.9%. We've been very intentional about growth in 2024 with our hospital leadership and business development teams and have added a lot of specialists at our hospitals to take care of more acute patients. The volume numbers also include a shift in service mix and acuity to more observation patients and inpatients.

謝謝，沃倫。正如湯姆和喬恩所提到的數量，總體而言，第四季度醫院就診人數為 45,444 人次，比去年增加了 9.8%。2024 年全年，患者就診總數為 168,388 人次，而 2023 年為 144,058 人次，增加了 16.9%。我們與醫院領導層和業務發展團隊一起，非常有意識地實現 2024 年的成長，並在我們的醫院增加了許多專家來照顧更多的急性患者。數量變化還包括服務組合和敏銳度向更多觀察患者和住院患者的轉變。

This service shift just isn't about volume. It's about meeting the community and patient demand to stay at our hospital instead of being transferred when appropriate. Keeping patients under observation helps avoid unnecessary admissions and admitting them when they meet criteria helps foster a great continuum of care.

這種服務轉變不僅與數量有關。這是為了滿足社區和病人在適當的時候留在我們醫院而不是轉院的需求。對患者進行觀察有助於避免不必要的入院，而當患者符合標準時接收他們有助於促進良好的連續護理。

Cost management continues to be a very good story for us at Nutex. Inflation has hit labor and supplies hard across the health care industry. We've worked very hard to stay lean this year. We don't struggle with the staffing challenges and turnover that large hospitals do. Our employees love working with us.

成本管理對 Nutex 來說仍然是一件好事。通貨膨脹嚴重打擊了整個醫療保健產業的勞動力和供應。今年我們非常努力地保持精簡。我們不會像大型醫院那樣面臨人員配備和人員流動的難題。我們的員工喜歡與我們一起工作。

We have a great culture, a better pace and are totally focused on our patients and their experience. It's about delivering excellent care without burning out and exhausting our teams, and our model works extremely well.

我們擁有良好的文化、更快的節奏，並且完全專注於我們的患者及其體驗。這是為了提供優質的護理，而不會讓我們的團隊精疲力竭，我們的模式非常有效。

In terms of supply chain savings, as stated previously, we continue to be on target for 2025 with the GPO realignment we completed back in Q3 of 2024. We continue to work on corporate contracts for services, with corporate discounts and we'll keep at it in 2025. We held costs essentially flat except for the arbitration expenses on higher volume throughout 2024 while also opening four new hospitals.

在供應鏈節約方面，如前所述，我們將繼續按照 2024 年第三季完成的 GPO 重新調整來實現 2025 年的目標。我們將繼續致力於企業服務合同，並提供企業折扣，並將在 2025 年繼續這樣做。除了 2024 年全年因業務量增加而產生的仲裁費用外，我們的成本基本上保持不變，同時我們還開設了四家新醫院。

In 2024, we also incorporated several new software packages, including HR and procurement software. For 2025, we want to expand our technology with more software and AI to save costs and provider and back office time. Some of the new AI tools are showing increased promise and our better cash flow position will allow us to pilot some of these AI agents.

2024 年，我們也整合了幾個新的軟體包，包括人力資源和採購軟體。到 2025 年，我們希望透過更多的軟體和人工智慧來擴展我們的技術，以節省成本以及供應商和後台辦公室的時間。一些新的人工智慧工具顯示出越來越大的前景，我們更好的現金流狀況將使我們能夠試行其中一些人工智慧代理商。

The latest AI for health care promises faster check-ins, predictive staffing, note writing for doctors and nurses, which can free them up to see more patients, optimize coding and personalized treatment and care plans. It can also predict supply usage and optimize schedules, freeing resources for patient care and providing further cost savings.

最新的醫療保健人工智慧有望為醫生和護士提供更快的登記、預測人員配置和筆記書寫，使他們能夠看更多的病人，優化編碼和個性化的治療和護理計劃。它還可以預測供應使用情況並優化時間表，釋放資源用於患者護理並進一步節省成本。

We believe we're just in the early stages of AI in health care and hospitals, but we believe this transition will happen fast, and we want to be an early adopter. Lastly, one of our big competitive advantages and differentiators besides our concierge care model is that we are deeply integrated into our communities and markets.

我們相信，我們才剛剛處於醫療保健和醫院人工智慧的早期階段，但我們相信這種轉變將會很快發生，我們希望成為早期採用者。最後，除了禮賓服務模式之外，我們的一大競爭優勢和差異化因素是我們深入融入社區和市場。

In 2024, we ramped up outreach and business development, including more health fairs, school and clinic collaborations, community events and patient education. This visibility builds trust and relationships. When patients have an emergency and their family, they pick us because they know and trust will take excellent care of them. We also get a lot of repeat visits.

2024 年，我們加強了外展和業務開發，包括更多的健康博覽會、學校和診所合作、社區活動和病患教育。這種可見性可以建立信任和關係。當患者和家人遇到緊急情況時，他們會選擇我們，因為他們知道並相信我們會為他們提供優質的照護。我們也收到了很多回頭客。

We have great doctors, leaders and employees who are some of the best in health care. As you know, health care is all about people, and we believe we have the very best people, which is why our model and service to continue to shape the future of health care. Thank you. Back to you, Jen.

我們擁有優秀的醫生、領導和員工，他們都是醫療保健領域的佼佼者。如您所知，醫療保健的一切都以人為本，我們相信我們擁有最優秀的人才，這就是為什麼我們的模式和服務將繼續塑造醫療保健的未來。謝謝。回到你身邊，Jen。

Thank you, Josh, and team for those updates. I will now turn it over to our operator, Melissa, who will begin the Q&A portion of the call.

感謝 Josh 和團隊提供的更新。現在我將把電話交給我們的接線生梅麗莎，她將開始電話會議的問答部分。

(Operator Instructions)

（操作員指示）

Bill Sutherland, Benchmark Company

比爾‧薩瑟蘭（Bill Sutherland），Benchmark公司

Thank you and good morning everybody. Great, great work in the year just ended. So I think on top of everyone's mind is trying to think about your -- prospectively about the arbitration process and just trying to get a handle on kind of what is -- what's a realistic way to think about what you can realize in the coming quarters?

謝謝大家，早安。剛剛過去的一年，我做得非常好。因此，我認為每個人首先要考慮的是仲裁過程，並試圖了解什麼是現實的，即如何實際思考未來幾季可以實現什麼？

Yeah, hi Bill, this is Tom. Great for you to join us and thank you. So our philosophy on arbitration and Jon, feel free to chime in. But our philosophy and arbitration is that it is a tool that we can use from the NSA, and the tool allows for us to collect a fair rate. And really, that is the main reason why we use it.

是的，嗨，比爾，我是湯姆。非常感謝您加入我們。因此，我們對仲裁和喬恩的理念是，請隨意發表意見。但我們的理念和仲裁是，這是我們可以從國家安全局使用的工具，而該工具可以讓我們收取公平的費率。事實上，這正是我們使用它的主要原因。

And a fair rate is, as Jon stated, is defined as the QPA or essentially median in network. And really, all we want to do is just get to a median in network, which is basically right in the middle of where we should get paid. And that's basically it. And so as long as the No Surprises Act is still in effect, as long as arbitration is within the rules and confines of NSA, we will continue to use it.

正如喬恩所說，公平利率被定義為 QPA 或網路中位數。實際上，我們想要做的只是達到網路的中間值，這基本上就是我們應該得到報酬的中間值。基本上就是這樣。因此，只要《無意外法案》仍然有效，只要仲裁符合國家安全局的規則和範圍，我們就會繼續使用它。

And hopefully, long term, the insurance company will start paying us better and closer to the QPA or the median work rate so that we don't have to do arbitration. But it's -- that's something that we're going to have to watch very closely month by month, quarter by quarter. Jon, do you have anything else to add?

並且希望，從長遠來看，保險公司能夠開始向我們支付更好的報酬，並更接近 QPA 或平均工作率，這樣我們就不必進行仲裁了。但這是我們必須逐月、逐季密切關注的事情。喬恩，你還有什麼要補充的嗎？

Absolutely. And Bill, great question. What I would say is, and we've talked about this when we were finishing up, say, the third-quarter, we were early, early stage in this process, not knowing exactly where we would land. And as we started to see some of these benefits happen and come through in the latter part of the fourth-quarter, we're getting a better picture at least what's happening currently. But I'll still say this is very much in the early stages of this process.

絕對地。比爾，這個問題問得好。我想說的是，我們在第三季收尾時就討論過這個問題，當時我們還處於這個過程的早期階段，不知道我們究竟會落到什麼地步。當我們開始看到其中一些好處在第四季度後半段出現並發揮作用時，我們至少對當前的情況有了更好的了解。但我還是要說，這個過程還處於早期階段。

If you think about it, when it takes three to five months or more to get paid on something, you have to go through a pretty long process to get there. So we're watching and identifying and trying to determine what the realization will be. And I feel like, certainly, as we finished out the year and the financials you're seeing, we feel pretty confident in what we have in there.

如果你仔細想想，當需要三到五個月甚至更長時間才能獲得報酬時，你必須經歷一個相當漫長的過程才能實現。因此，我們正在觀察、識別並試圖確定最終結果。而且我覺得，當然，當我們結束這一年並看到財務狀況時，我們對我們所擁有的一切非常有信心。

But as things progress, just like our business prior to even getting into the arbitration business, we were always watching and seeing or estimating what we ultimately get paid. And then when cash came in, we would adjust accordingly. And I think our ability to predict was very, very good in previous years because we didn't have a lot more history.

但隨著事情的發展，就像我們進入仲裁業務之前一樣，我們一直在觀察或估計我們最終獲得的報酬。然後，當現金到帳時，我們會進行相應的調整。我認為我們前幾年的預測能力非常非常好，因為我們沒有太多的歷史記錄。

And so now we're getting some history, and I think now we finished out the year and rolling into the first quarter. I think we'll have even more data as we go through each quarter this year, so we hope that it will -- the trend that we have would continue, but there's no guarantee of that. But the good news is we feel solid about where we were at the end of the year, and we're very bullish on making sure that we're getting paid what would be the qualified payment amount, and we're watching to see if that will happen. It's a great question.

現在我們了解了一些歷史，我想現在我們已經結束了今年的工作並進入了第一季。我認為，隨著今年每季的推進，我們將獲得更多的數據，因此我們希望這種趨勢能夠持續下去，但這並不能保證。但好消息是，我們對年底的狀況感到滿意，我們非常有信心確保我們能夠獲得合格的付款金額，我們正在觀察這是否會發生。這是一個很好的問題。

So Jon, so just to clarify a little bit more, the file size, if you will, that you have in the arbitration is -- was it like a catch-up process that occurred? Or is this -- or we should think of it more just an ongoing process? I know you can't talk to whatever success rates will be. But just in terms of the claims that you're going to be moving into arbitration, is it going to be at a similar pace on a go-forward basis, assuming they don't step up and start negotiating more fairly?

那麼喬恩，為了進一步澄清一下，如果你願意的話，你在仲裁中擁有的文件大小是 - 這是否像是一個發生的追趕過程？或者這是——或者我們應該認為這只是一個持續的過程？我知道你無法談論成功率是多少。但是，就您將要進入仲裁程序的索賠而言，假設他們不站出來並開始進行更公平的談判，那麼未來是否會以類似的速度進行？

Yeah, that's a very -- that's a loaded question, a great question. And I think we'll better understand that in these next couple of months as well. But we still take the same approach on -- as we look at its visit by visit, if we don't believe that we're getting paid equitably then we're working through the process and going through what we described as being the arbitration process in those cases.

是的，這是一個非常──這是一個引導性很強的問題，也是一個很好的問題。我認為在接下來的幾個月裡我們也會更好地理解這一點。但我們仍然採取相同的方法——當我們逐一查看訪問情況時，如果我們認為我們得到的報酬不公平，那麼我們就會通過整個流程，並在這些案件中通過我們所描述的仲裁程序。

And we -- as we mentioned back even in the end of the third-quarter and in the press release that we did a month or two ago, and that 60% to 70% of the visits -- billable business that we have seems to be in line with what we're consistently so far seeing that can go into this process. So that piece for now is pretty consistent as it changes, we would certainly let you know.

正如我們在第三季末和一兩個月前發布的新聞稿中提到的那樣，60% 到 70% 的訪問量——我們的可計費業務似乎與我們迄今為止看到的可以進入這一流程的情況一致。因此，目前該部分內容相當一致，當它發生變化時，我們一定會通知您。

But I think that's all -- that's one of the independent variables, right? Then you also have how many business come in, in general that drive up or down and then different acuities, et cetera, that come into place. So the answer is we see it being somewhat consistent at this point, and we'll adjust as necessary.

但我認為這就是全部——這只是獨立變數之一，對嗎？然後你還會知道有多少業務進來，通常是上升或下降，然後是不同的敏銳度等等。所以答案是，我們看到它目前是有些一致的，我們會根據需要進行調整。

Okay, that's good. I'll pass it along. Thanks a lot guys.

好的，很好。我會傳達的。非常感謝大家。

Thank you, Bill.

謝謝你，比爾。

Carl Byrnes, Northland Capital Markets.

卡爾‧伯恩斯 (Carl Byrnes)，北國資本市場 (Northland Capital Markets)。

Thanks for the question and congratulations on the quarter in the year. I'm wondering if you can maybe help me out a little bit with the hospital division and how you're currently recognizing revenue at the time of service? And then are you subsequently adjusting it after the IDR adjudication process is finalized? And then I have a follow-up as well.

感謝您的提問，並祝賀本季取得的成績。我想知道您是否能幫我一下醫院部門的情況，以及您目前如何在提供服務時確認收入？那麼，在 IDR 裁決過程結束後，您是否會對其進行後續調整？然後我還有一個後續行動。

Thanks. Okay, thank you Carl. Yeah, Jon go ahead, yeah.

謝謝。好的，謝謝你，卡爾。是的，喬恩繼續，是的。

Yeah, great question, Carl. So we absolutely, as we see visits, every visit that comes in, just like we did even pre arbitration, we would go back and analyze that specific visit and look back its similarities to that visit with adjudicated claims in previous periods and see what average reimbursement would be based on the acuity, the payer and the location. And so we're continuing that exact same process even adding this kind of new twist to it with the arbitration piece.

是的，問得好，卡爾。因此，我們絕對會在看到訪問時，看到每次訪問，就像我們在仲裁前所做的那樣，我們會回過頭來分析那次特定的訪問，並回顧它與之前時期裁決的索賠的訪問的相似之處，並根據敏銳度、付款人和地點來查看平均報銷金額。因此，我們將繼續同樣的進程，甚至在仲裁部分中添加這種新的變更。

And so we are doing our best to guesstimate exactly what will be realizable down the road today with a visit that walks in the door based on its similarities to a claim -- similar claim in the past and how it ultimately would get realized.

因此，我們正在盡最大努力，根據與過去類似主張的相似性以及最終如何實現，準確估計今天的訪問將如何實現。

So as that continues to prove itself out and that continues to feed sort of the engine and the model, and so it will adjust up or down based on the realization that happens. It just takes a little bit of time for that to prove itself out. But -- so through the end of the year, to answer your question falls that process was in place and to the best of our data that we have at that point, which is all the information on the wins, losses, et cetera, through the end of December, we were able to go back and say, okay, for every visit that might not necessarily have gotten through the arbitration process if it was going there.

因此，隨著這一點不斷得到證明，並繼續為引擎和車型提供動力，它將根據實際情況進行向上或向下調整。只是需要一點時間來證明這一點。但是——所以到年底，回答你的問題，這個過程已經到位，並且根據我們當時掌握的最佳數據，也就是截至 12 月底的所有勝利、失敗等信息，我們能夠回過頭來說，好吧，對於每次訪問，如果它去那裡，可能不一定能通過仲裁程序。

But yet, we believe it will go there or maybe it's in one stage of that process. We used our most recent data by location, as I mentioned, by acuity, by payer and then try to do our best to estimate exactly what we believe will happen when the ultimate realization of that receivable happens, whether it's a month, two months or three months down the road.

但我們相信它會實現這一目標，或者可能它正處於這個過程的一個階段。正如我所提到的，我們使用了按地點、按敏銳度、按付款人劃分的最新數據，然後盡力準確估計我們認為當應收帳款最終實現時會發生什麼，無論是一個月、兩個月還是三個月後。

Got it. That's very helpful. And then just sort of on that line, just as a follow-up. You had adjusted EBITDA in the fourth-quarter, let's just call it, $94 million. I think it was $93.7 million.

知道了。這非常有幫助。然後就這樣繼續下去，只是作為後續。你們在第四季調整了 EBITDA，我們就稱之為 9,400 萬美元吧。我認為是 9,370 萬美元。

And for the year, it was $123.7 million. So it's very loaded in the fourth-quarter. How much of that would be attributable to IDR adjudication awards? Or to kind of phrase it differently, how might we look at what would a normalized adjusted EBITDA number potentially be or look like? Thanks.

全年收入為 1.237 億美元。因此第四季的負荷非常大。其中有多少可歸因於 IDR 裁決？或者換一種說法，我們如何看待標準化調整後的 EBITDA 數字可能會是什麼或是什麼樣子？謝謝。

Yeah, so I know we described and I talked about it in my prepared comments, talking to you a little bit about how the revenue side of things played out. And I would say that our best scenario or best situation right now that we would anticipate that would follow a similar trajectory. So you have even of that arbitration revenue that we recorded in the fourth-quarter and have provided how, from a data service perspective, it related back to the third-quarter, it's really -- most of it was third and fourth-quarter, and there was some that was prior to that period.

是的，我知道我們描述過，我也在準備好的評論中談論過這個問題，和你稍微談了一下事情的收入方面是如何發展的。我想說的是，我們目前預期的最佳情境或最佳情況將遵循類似的軌跡。因此，您甚至可以了解我們在第四季度記錄的仲裁收入，並且從數據服務的角度來看，它與第三季度的關係是怎樣的，事實上 - 其中大部分是第三季度和第四季度的，也有一些是在該時期之前的。

So I think on a similar percentage basis, I would -- if I were projecting, which I'm not yet, but that would be where I would see it. I don't have any other data that tells me differently, but I think based on that trending, that would be where you would see the adjusted EBITDA whether it's for the year of next year or whether it's quarter-by-quarter.

因此我認為，在類似的百分比基礎上，如果我進行預測的話，雖然我還沒有進行預測，但那就是我所看到的情況。我沒有其他數據可以告訴我不同的情況，但我認為基於這種趨勢，您將會看到調整後的 EBITDA，無論是明年的還是逐季度的。

Got it, thanks. I'll jump back in the queue.

明白了，謝謝。我將重新回到隊列中。

Thanks, Carl.

謝謝，卡爾。

Anthony Vendetti, Maxim Group.

安東尼·文德蒂（Anthony Vendetti），馬克西姆集團（Maxim Group）。

Thank you. Just a couple of questions. Just one more on the IDR and then a couple on the hospitals. So this independent dispute resolution, this amount was all accounted for here in the fourth-quarter. Do you expect it to be as you roll through this process in '25, do you expect it to be spread more over the quarters? Or is it likely that you do this kind of calculation at the end of the year when you do the full year audit and it's likely to be a fourth-quarter event again?

謝謝。僅有幾個問題。再說一個關於 IDR 的問題，然後再說幾個關於醫院的問題。因此，這個獨立的爭議解決金額全部在第四季度得到了核算。您是否預計在 25 年完成此過程時，它會在各個季度中進一步蔓延？或者您有可能在年底進行全年審計時進行這種計算，並且它很可能再次成為第四季度的事件？

Anthony, great question. And it's not a backloaded scenario. Of course, it is in 2024 only based on the data that we had and the timing that we were able to work through it. So now as we get better and get more data, so now we're working that into the models every single month. So our intent is we're doing that every single month, first quarter, second quarter, third-quarter.

安東尼，這個問題問得好。這不是一個後期加載的情況。當然，這只是根據我們掌握的數據和我們能夠解決的時間來確定的，即 2024 年。現在，隨著我們不斷進步並獲得更多數據，我們每個月都會將這些數據納入模型中。因此，我們的目的是每個月都這樣做，第一季、第二季、第三季。

So it's not going to be necessarily at all in a backloading scenario in 2025 -- or excuse me, 2025. It will be progressively updated throughout the year based on data that we have, just like we had really started to accumulate at the end of the fourth-quarter.

因此，在 2025 年（抱歉，是 2025 年），根本不會必然出現後期加載的情況。它將根據我們掌握的數據在全年逐步更新，就像我們在第四季末真正開始累積一樣。

Okay, great. No, that's helpful. Yeah, thanks, Jon. And then just on the hospital. So you opened four in 2024. Can you talk about how that is ramping up? I know some of them aren't. They haven't hit the mature date in terms of gauging that. But can you talk about how patient volume is ramping in those hospitals? Is it fairly evenly? Is one hospital doing much better than the others? Can you talk about how that's playing out so far?

好的，太好了。不，這很有幫助。是的，謝謝，喬恩。然後就去醫院了。所以你們在 2024 年開設了四家店。能談談進展如何嗎？我知道其中一些不是。從衡量這一點來看，他們還沒有到達成熟的日期。但是您能談談這些醫院的病患數量是如何增加的嗎？是否比較均勻？一家醫院的表現是否比其他醫院好很多？能談談目前進展如何嗎？

Yeah, hi Anthony, this is Tom. So yes, absolutely. So the four hospitals that we opened up were in Green Bay, Wisconsin; Milwaukee, Wisconsin; Tampa, Florida; and Post Falls, Idaho. And as you know, medicine is local every facility is slightly different.

是的，嗨，安東尼，我是湯姆。是的，絕對是。我們開設的四家醫院位於威斯康辛州格林貝；威斯康辛州密爾瓦基；佛羅裡達州坦帕；以及愛達荷州的波斯特福爾斯。如你所知，醫療是地方性的，每個機構都略有不同。

But I would say that two of those hospitals are performing up to par and even better than expected. And then the other two are a little bit newer, like, for example, Tampa opened late December, so we don't have a lot of data on that yet. But I would say half of them are performing better than expected and the other two are performing as expected.

但我想說，其中兩家醫院的表現達到標準，甚至比預期更好。另外兩個則稍微新一些，例如坦帕於 12 月下旬開業，因此我們還沒有太多相關數據。但我想說，其中一半的表現比預期，另外兩家的表現符合預期。

Okay. Great. And then can you provide a little more color at this point on the planned openings in '25 as we roll through this year, what's the schedule look like for the planned '25 openings?

好的。偉大的。然後，您能否在此時提供更多關於 25 年計劃開業的信息，隨著我們今年的推進，25 年計劃開業的時間表是怎樣的？

Yeah. So we have three hospitals that are currently under development and under construction as we speak. And all three of them are scheduled to be open either third-quarter or fourth-quarter of this year assuming that construction and everything else goes well. And then '26, we have probably four more after that. And then '27, I think we have a couple more and then we're already working on hospital pipelines for 2028.

是的。目前我們有三家醫院正在開發和建設中。如果施工和其他一切進展順利，這三棟建築都計劃於今年第三季或第四季開業。然後是 26 年，之後我們可能還會有 4 年。然後是 27 年，我想我們還會再有幾家，然後我們已經在為 2028 年制定醫院管道計劃了。

Okay. Excellent. And then just in terms of the mature hospitals in your portfolio, I know it's hard to gauge. But what is your expectation based on trends you're seeing for growth? Is it mid-single digits? Do you think you can outperform that? Because I know the larger hospitals, they're lucky to get low single digits depending on what they're doing or if they're changing specialty, sometimes they can increase that. But what are you seeing? And what's your expectations for your mature hospitals?

好的。出色的。那麼就您投資組合中的成熟醫院而言，我知道這很難衡量。但是根據您所看到的成長趨勢，您的預期是什麼？是中等個位數嗎？您認為您能做到更好嗎？因為我知道較大的醫院，他們很幸運能得到低個位數的收入，這取決於他們正在做什麼，或者他們是否改變專業，有時他們可以增加這個數字。但是你看到了什麼？對於你們這些成熟的醫院有什麼期望？

Yeah, so great question, and I'll answer, and then Josh, maybe you could chime in also. So we're shooting for also single digits in our ER volume growth year-over-year. which I think is doable and achievable. However, on top of that, we're not just trying to get single-digit ER volume.

是的，這個問題問得很好，我會回答，然後喬希，也許你也可以插嘴。因此，我們也力爭使急診室數量較去年同期成長個位數。我認為這是可行且可以實現的。然而，最重要的是，我們不只是想獲得個位數的 ER 數量。

We're also growing our other service lines. So for example, we're actually ramping up our specialists. We're wrapping up our hospitalist so that we could admit more patients to our hospitals. So the idea of using all four walls of the hospital in order to bring as much patients through the ER and then after that, do as much observation as we can, and increase inpatient as much as we can. And the only way to do that is to increase staffing and expertise so that you could treat more people and more variety of illnesses.

我們也在拓展其他服務線。例如，我們實際上正在增​​加我們的專家數量。我們正在結束我們的住院治療，以便我們醫院可以接收更多的病人。因此，我們的想法是充分利用醫院的所有資源，讓盡可能多的病人通過急診室，然後盡可能多地進行觀察，並盡可能增加住院病人。而做到這一點的唯一方法就是增加人員和專業知識，以便可以治療更多的人和更多種類的疾病。

Josh, do you have anything else to add to that?

喬希，你還有什麼要補充的嗎？

No, Tom, that was very well said, increasing mature hospital ER visits, but then also the service mix is changing as well. So we're expecting a great year.

不，湯姆，你說得很好，成熟醫院急診室的就診人數不斷增加，但服務組合也在改變。所以我們期待這將會是美好的一年。

Okay, and then, sure, good.

好的，那麼，當然，很好。

I'm sorry. I was going to say one more thing that is very unique to us is that since we're small, we're able to pivot to a lot of different needs. And so what we do is we find what the community needs, and we try to pivot to solve that need. And so that's the beauty of having a hospital that has pretty much all the functions of a particular hospital. So I just want to say that.

對不起。我要說的另一件事對我們來說非常獨特，那就是由於我們的規模很小，因此我們能夠滿足許多不同的需求。因此，我們所做的就是找到社區的需求，並嘗試解決該需求。這就是擁有一家醫院的美妙之處，它幾乎具備某家特定醫院的所有功能。所以我只想說這一點。

And so every market is slightly different. And so we're sort of like tailor the need of that market for our hospital.

因此每個市場都略有不同。因此，我們有點像是根據該市場的需求來為我們的醫院量身定制。

Okay. And Tom, you touched on an important point, right, which is for hospitals hiring not just ER physicians, but hospitalists or intensivists that can continue to see the patients and continue to treat the patients once they're in your setting. Are those particular specialists hard to come by? And do you have an executive recruiter or someone that helps to staff your hospitals?

好的。湯姆，你提到了一個重要的觀點，對吧，那就是醫院不僅要雇用急診室醫生，還要雇用住院醫生或重症監護醫生，這樣一旦病人進入你的機構，他們就可以繼續看病並繼續治療病人。這些特定的專家很難找到嗎？你們是否有高階主管招募人員或幫助醫院配備人員的人員？

The answer is yes and no. So by that, what I mean is going back to the medicine is local kind of concept, a lot of the time, the specialists actually come to us because they are somehow either dissatisfied with their local hospital or they don't want to admit their patients to the local hospitals and so they admit their patients to us and we take care of them, right?

答案是肯定的，也是否定的。所以，我的意思是回到醫學是本地化的概念，很多時候，專家來找我們，是因為他們對當地醫院不滿意，或者他們不想讓他們的病人進入當地醫院，所以他們把病人送到我們這裡，由我們來照顧他們，對嗎？

So that's one. And then in terms of using a recruiter of some type, we do have an in-house recruiting team. However, the best way that we get specialists are through personal relationship with our local physicians. And so our local physicians are all sort of like superstars of the communities that they live in. And so they tend to know pretty much everybody in terms of the health care dynamics. And so through those relationships, we get a lot of specialists that want to send their patients to our hospital.

這就是其中之一。在使用某種類型的招募人員方面，我們確實有一個內部招募團隊。然而，獲得專家的最佳方式是透過與當地醫生建立個人關係。因此，我們當地的醫生都像是他們所居住社區的超級明星。因此，他們往往對醫療保健動態方面的每個人都很了解。透過這些關係，我們得到了許多願意將病人送往我們醫院的專家。

That's great. And then just lastly, I want to switch back for the last question to the IDR. So you've been -- in your commentary, you said you've been submitting about 60% to 70% of your claims to the IDR process and your win rate is about 80%.

那太棒了。最後，我想回到 IDR 的最後一個問題。所以您在評論中說過，您已經將大約 60% 到 70% 的索賠提交給 IDR 流程，並且您的勝率約為 80%。

As you've demonstrated to these insurance companies that you're willing to, a, go through this process and your win rate has been so high. Have the insurance companies come back and said, okay, you know what, going forward, we're going to start reimbursing, so we don't have to go through this process? Or are you expecting in '25 for it to be similar in that you're still expecting to submit about 60% or 70% of your claims to the IDR process?

正如您向這些保險公司證明的那樣，您願意經歷這個過程，而且您的勝率非常高。保險公司是否會回覆並表示，好吧，你知道嗎，從現在起，我們將開始償還，所以我們不必經歷這個過程？或者您是否預期 25 年的情況會類似，您仍預計將大約 60% 或 70% 的索賠提交給 IDR 流程？

Yeah, I think the answer is that if the insurance company pay better upfront and pay close to the QPA or the median in network, then we don't have to submit anything to the arbitration process. And by the way, the arbitration process was designed as sort of like the last ditch effort so that the providers like us could use it to get a fair payment.

是的，我認為答案是，如果保險公司預付的金額更高，並且支付金額接近 QPA 或網路中位數，那麼我們就不必向仲裁程序提交任何東西。順便說一句，仲裁程序被設計成一種最後的努力，以便像我們這樣的提供者可以利用它來獲得公平的賠償。

It wasn't designed to be the first form of payment, if that makes sense. But unfortunately, because of the way that this whole thing came about with a low payment upfront, we have to use it as a last ditch effort. But if the insurance company starts to pay better at the first time or in the beginning, then we wouldn't have to go through it.

如果說得通的話，它並不是被設計為第一種付款方式。但不幸的是，由於整個事情的預付款很低，我們不得不將其作為最後的努力。但如果保險公司在第一次或開始時就支付更好的賠償，那麼我們就不必經歷它了。

And so I think that in time, and we'll see how this whole process works. I think in time, the insurance company will come around and start to pay a little bit better because if they lose 80% of the time, then that means that the expenses associated with arbitrator is also borne by the insurance company or by the loser, right, unfortunately. And so I think that may be an incentive for them to come around. But we'll see. I mean, I think that this is very new, like Jon said, and there's a lot of things that is uncertain at this point.

所以我認為，隨著時間的推移，我們將看到整個過程如何進行。我認為隨著時間的推移，保險公司會轉變態度並開始支付更好的賠償，因為如果他們 80% 的時間都輸了，那麼這意味著與仲裁員相關的費用也要由保險公司或敗訴方承擔，對吧，不幸的是。所以我認為這或許可以成為他們轉變的動力。但我們會看到。我的意思是，我認為這是非常新的，就像喬恩所說的那樣，目前有很多事情尚不確定。

Understood. Hey, that was great caller. Thanks so much for all the information. I appreciate it, and I'll hop back in the queue.

明白了。嘿，那位來電者太棒了。非常感謝您提供的所有資訊。我很感激，我會重新回到隊列中。

Thank you, Anthony.

謝謝你，安東尼。

Gene Mannheimer, Freedom Capital Markets.

吉恩‧曼海默，《自由資本市場》。

Hey, thanks and good morning, everybody. Congratulations on the above average quarter. Nicely done. Following up on Anthony's line of questioning, it sounds like then, Tom, you're going to get -- you're going to collect the money one way or the other, right, either through dispute or through a blanket increase in reimbursement. So we shouldn't be viewing the dispute process as extraordinary or onetime event, but it will be in the course of business going forward.

嘿，謝謝大家，早安。恭喜本季業績超出平均水準。做得好。接著安東尼的問題，聽起來，湯姆，你會以某種方式收回這筆錢，對吧，要么通過爭議，要么通過全面增加報銷金額。因此，我們不應將爭議過程視為非典型或一次性事件，而應將其作為未來業務進程中的一部分。

Yeah, that's right. So the way to think about this is that -- and I think Jon spoke about this, is that the increase in the revenue for the fourth-quarter was actually spanned over the third and fourth-quarter when we started doing the arbitration.

是的，沒錯。所以思考這個問題的方式是——我認為喬恩談到了這一點，第四季度收入的增長實際上是在我們開始進行仲裁時跨越了第三季度和第四季度。

And so -- and I'm just going to put in a very layman's term is that we can't report it in the third-quarter because the arbitration process was not completed yet. And so we didn't know how much we were going to win. So the 80% win that was -- all that was in the fourth-quarter. And so once we saw that, then Jon obviously reported that in the fourth-quarter, right?

所以——我用一個非常外行的術語來說，我們不能在第三季度報告它，因為仲裁程序尚未完成。所以我們不知道我們能贏多少錢。所以80%的勝率——都是在第四節實現的。所以一旦我們看到這一點，喬恩顯然會在第四季度報告這一點，對吧？

So -- and so the other way to think about it is that, that revenue that is revenue that we should have gotten from day one had the insurance company paid a fair rate. And so that revenue in our opinion, should be the QPA because we went through a very expensive formal binding process where you have two sides or like arguing, using the letter of the law, according to the NSA.

所以 — — 另一種思考方式是，如果保險公司支付了公平的費率，那麼我們從第一天起就應該獲得這些收入。因此，我們認為，這筆收入應該是 QPA，因為我們經歷了一個非常昂貴的正式約束程序，在這個程序中，雙方都有自己的觀點，或者說，根據國家安全局的規定，使用法律條文進行爭論。

And so we feel confident that, that final payment is probably as close to the QPA as we think it should be, right? So going forward, to Jon's point, we are still going to continue to evaluate each patient and determine whether or not the payment is, we think it's fair, according to market value.

因此，我們有信心，最終付款可能與我們認為的 QPA 盡可能接近，對嗎？因此，正如喬恩所說，我們仍將繼續評估每位患者，並根據市場價值確定付款是否公平。

And if it is fair that we accept it. If it is not fair, then we run it through the queue, first starting with open negotiation. And then if that doesn't work, then put in them through the arbitration. But once again, as I mentioned, arbitration is not cheap. It's not free.

如果公平的話我們就接受。如果不公平，那麼我們就會按照程序進行，先從公開談判開始。如果這不起作用，就透過仲裁來解決。但正如我再次提到的，仲裁並不便宜。這不是免費的。

It's very expensive, time consuming, lots of stress on our team to do it. But unfortunately, we have to do it. We're going to have to do it.

這項工作非常昂貴、耗時，並且給我們的團隊帶來很大壓力。但不幸的是，我們必須這麼做。我們必須這麼做。

Yes. No, that all makes sense, Tom. So I mean, as Jon pointed out, you recognized $70 million -- or $69 million from dates of service in Q4, $70 million in Q3. So is that kind of the ballpark number to think about going forward? Or could there be a lot of variation around that number?

是的。不，這一切都是有道理的，湯姆。所以我的意思是，正如喬恩指出的那樣，你確認了 7000 萬美元 - 或者說第四季度服務日期的 6900 萬美元，第三季度的 7000 萬美元。那麼，這是未來需要考慮的大概數字嗎？或者這個數字周圍會存在很大的變化嗎？

Jon, do you want to tackle this?

喬恩，你想解決這個問題嗎？

I can speak to that. I mean you know as well as I do, that there's always going to be variation in this in as early stage as it is. We do not know what is -- how it will translate into first or second quarter and beyond, but it's starting to show a trend. That's what I would say. And we're trying to look at it. And certainly, we're doing the calcs, the behind the scenes to come up with what the estimate should be now month by month by month as we really were able to kind of go through the process at the end of the year based on all of the data we had at that point.

我可以談一下這個。我的意思是，你和我一樣清楚，在早期階段，這種情況總是會改變。我們不知道這會對第一季、第二季及以後產生怎樣的影響，但它已開始顯示出一種趨勢。這就是我要說的。我們正在嘗試研究它。當然，我們正在進行計算，在幕後逐月計算出現在的估計值，因為我們確實能夠根據當時掌握的所有數據在年底完成整個過程。

Well, now we have data in January and February, and we'll have something in March shortly. So all of that will start to prove this out. But I mean the trend that we saw, as I described, the dates of service that those wins did relate to is starting to show kind of a trend, whether that will be up or down going forward. I cannot commit to that, of course. But I think it's starting to give us a pattern of what we should expect.

嗯，現在我們有了一月和二月的數據，很快我們就會得到三月的數據。所有這些都將開始證明這一點。但我的意思是，正如我所描述的，我們看到的趨勢是，這些勝利確實與之相關的服務日期開始顯示出一種趨勢，無論這種趨勢在未來是上升還是下降。當然，我不能承諾這一點。但我認為它開始給我們一個我們應該期待的模式。

Okay. No, that's fair, John. And just two more from me. So there was $30 million of dispute-related revenue for dates of service prior to Q3. How far back does that go? Was that in Q2?

好的。不，這很公平，約翰。我再說兩句話。因此，第三季之前的服務日期的爭議相關收入為 3000 萬美元。這能追溯到多久以前？那是在第二季嗎？

Most of that is Q2. But there are -- just to remind everybody, the process started in July, but you don't -- you can't go into the open negotiations, arbitration process until you get the first payment from the insurance provider or payer. In this case, so you have some that were, of course, second quarter as well.

其中大部分是第二季。但是——只是提醒大家，這個過程從 7 月就開始了，但你不能——在你從保險提供者或付款人那裡收到第一筆付款之前，你不能進入公開談判、仲裁程序。在這種情況下，當然也有一些是第二季的。

You even have a couple that were even in the early part of last year, one or two a very small piece that might have even been 2023 because it takes sometimes three, four, five months on some of these claims to get that first payment. And you can't start the process until then.

甚至有幾筆款項是在去年年初支付的，有一兩筆金額很小的款項可能要到 2023 年才能支付，因為對於某些索賠，有時需要三、四、五個月的時間才能獲得第一筆付款。直到那時你才能開始這個過程。

But predominantly third and fourth-quarter. Then you have a little trickle into the second quarter. Much past that, it's pretty small into the first quarter of last year and even prior to that. So it's predominantly third and fourth-quarter.

但主要集中在第三季和第四季。然後你就會進入第二季。在那之後，去年第一季甚至更早的時候，這一數字就相當小了。因此主要是第三季和第四季。

Got it, thank you. And lastly, these claims that you're disputing, do they tend to be specific to certain payers? Or are they across the board?

知道了，謝謝。最後，您所質疑的這些索賠是否針對特定的付款人？還是它們都是全面的？

Yeah, great question. There's not a specific payer. It's pretty across the board. And it's not -- we're really payer agnostic from that respect. It's more about what we believe to be the equitable QPA-type payment. And then just so happens if it happens to be one payer in one location or another, it honestly does not matter. And we're seeing it sort of across the board. There are some that pay a little bit better and a little bit more upfront. But generally, it's more of a pervasive situation than it is specific to one payer in one location.

是的，很好的問題。沒有特定的付款人。整體來說非常漂亮。事實並非如此——從這個方面來說，我們確實對付款人持不可知論。這更多的是關於我們認為公平的 QPA 類型的支付。那麼，如果碰巧是付款人，在某個地方，那真的無所謂了。我們在各個方面都看到了這一點。有些付款方式比較好一些，預付金額也比較高一些。但一般來說，這種情況更為普遍，而不是特定於某個地方的某個付款人的情況。

Very good. All right, thanks and congrats again.

非常好。好的，再次感謝並祝賀。

Thank you.

謝謝。

Carl Byrnes, Northland Capital Markets.

卡爾‧伯恩斯 (Carl Byrnes)，北國資本市場。

Thanks for the follow up. You've obviously had -- you're experiencing great success with increasing revenue on a per visit basis driven by acuity and specialists and hospitals and such. I'm wondering if you might be able to kind of quantify that in terms of a percent and year-over-year increase on a normalized basis? Thanks.

感謝您的跟進。顯然，您已經取得了巨大的成功，在敏銳度、專家和醫院等的推動下，每次就診的收入都在增加。我想知道您是否可以用百分比和同比增長來量化這一點？謝謝。

Let me make sure I understand your question, step back if you don't mind. So you're talking about year-over-year basis. Are we talking about the arbitration component relative to the non-arbitration component? What is your question again?

讓我確認一下我理解了你的問題，如果你不介意的話請你退後一步。所以你談論的是同比數據。我們談論的是相對於非仲裁部分的仲裁部分嗎？你又想問什麼問題？

No, I'm just -- I'm wondering if you're able to look at the revenue per visit on a normalized basis and quantify that at all in terms of what you've been able to achieve in terms of increased acuity that would drive revenue per visit? Forgetting about -- I'm just trying to look at it on a normalized basis because that's one of your initiatives is to drive acuity and various procedures that are high dollar volume?

不，我只是——我想知道您是否能夠以標準化的方式查看每次訪問的收入，並根據您在提高敏銳度方面所取得的成就來量化它，從而推動每次訪問的收入？忘了——我只是想從規範化的角度來看待它，因為這是你的舉措之一，是為了推動敏銳度和各種高額美元交易量的程序？

Okay. Well, I don't know that I can speak specifically to a number that is going to be as you move forward. But I mean, you can see within the financials that's presented kind of that progression of you're asking about revenue per visit. So I know it's a little backloaded into the fourth-quarter. But if you look at it compared to, say, '23, our revenue per visit, I think if you saw in the K that we filed at the end of last year was over $1,500, just maybe $1,514 a visit.

好的。嗯，我不知道我是否能具體說出未來將會達到的一個數字。但我的意思是，您可以在財務報表中看到您所詢問的每次訪問收入的進展。所以我知道這會拖累第四季的表現。但如果你將它與 23 年的每次訪問收入進行比較，我想如果你看到我們去年年底提交的 K 表，每次訪問的收入超過 1,500 美元，可能只有 1,514 美元。

And then if you go forward into, say, for the full year of '24 under this scenario, it's a little under -- it's around $2,600 or so. And I think you have still a muddied picture of what you're looking at when it comes in there. So I think as you look forward, it's going to be somewhere in between those numbers is my -- is how we look at it at this point. We don't know exactly where that will be. But it's somewhere between what you would see for the full year '24 and full year of '23 with, of course, arbitration starting midyear of '24.

然後，如果你展望未來，比如說，在這種情況下，24 年全年，這個數字會略低——大約 2,600 美元左右。我認為，當它出現時，你對所看到的東西仍然沒有清晰的認識。因此我認為，當你展望未來時，它會處於這兩個數字之間的某個位置，這就是我們現在的看法。我們不知道它具體在哪裡。但它介於 2024 年全年和 2023 年全年之間，當然，仲裁將於 2024 年中期開始。

Got it. Thanks. Congratulations again.

知道了。謝謝。再次恭喜。

Yeah, thank you. Great question.

是的，謝謝。好問題。

Thank you. Ladies and gentlemen, we've come to the end of our time allowed for questions. I'll turn the floor back to Mr. Rodriguez for any final comments.

謝謝。女士們、先生們，我們的提問時間已經結束。我將把發言權交還給羅德里格斯先生，請他發表最後的評論。

Thank you all for the valuable questions and answers. For all those joining us today, if you have more questions, please e-mail at investors@nutexhealth.com, and we'll get back to you promptly. On behalf of the Nutex management team, thank you all for joining us for our fourth-quarter and full-year 2024 earnings call. We've covered a lot, growth, strategy, challenges and our vision, and we appreciate your time and interest.

感謝大家提出的寶貴問題和答案。對於今天加入我們的所有人，如果您有更多問題，請發送電子郵件至investors@nutexhealth.com，我們會及時回覆您。我代表 Nutex 管理團隊感謝大家參加我們的 2024 年第四季和全年財報電話會議。我們已經討論了很多內容，包括發展、策略、挑戰和我們的願景，我們感謝您的時間和興趣。

A recording of this call will be available on our website for a limited time, so feel free to revisit it there. Take care, everyone, and we look forward to keeping you updated on our journey.

本次通話的錄音將在我們網站上限時提供，因此歡迎隨時再次造訪。大家保重，我們期待向您通報我們的旅程進展。

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

謝謝。今天的電話會議到此結束。現在您可以斷開您的線路。感謝您的參與。