RadNet Inc (RDNT) 2017 Q4 法說會逐字稿

Good day, and welcome to the RadNet Inc. Fourth Quarter and Year-End Financial Results. Today's conference is being recorded. At this time, I'd like to turn the conference over to Mr. Mark Stolper, Executive Vice President and Chief Financial Officer of RadNet Inc. Please go ahead.

美好的一天，歡迎來到 RadNet Inc.。第四季和年終財務業績。今天的會議正在錄製中。現在，我想將會議交給 RadNet Inc. 執行副總裁兼財務長 Mark Stolper 先生。請繼續。

Thank you. Good morning, ladies and gentlemen, and thank you for joining Dr. Howard Berger and me today to discuss RadNet's fourth quarter and full year 2017 financial results.

謝謝。早安，女士們、先生們，感謝您今天與 Howard Berger 博士和我一起討論 RadNet 的 2017 年第四季度和全年財務業績。

Before we begin today, we'd like to remind everyone of the safe harbor statement under the Private Securities Litigation Reform Act of 1995. This presentation contains forward-looking statements within the meaning of the U.S. Private Securities Litigation Reform Act of 1995.

在今天開始之前，我們想提醒大家注意 1995 年《私人證券訴訟改革法案》中的安全港聲明。本簡報包含 1995 年美國私人證券訴訟改革法案意義內的前瞻性陳述。

Specifically, statements concerning anticipated future financial and operating performance, RadNet's ability to continue to grow the business by generating patient referrals and contracts with radiology practices, recruiting and retaining technologists, receiving third-party reimbursement for diagnostic imaging services, successfully integrating acquired operations, generating revenue and adjusted EBITDA for the acquired operations as estimated, among others, are forward-looking statements within the meaning of the safe harbor.

具體而言，有關預期未來財務和營運績效的陳述、RadNet 透過產生病患轉診和與放射科診所簽訂合約、招募和留住技術人員、接受診斷影像服務的第三方報銷、成功整合收購的業務、產生除其他外，估計的收購業務的收入和調整後的 EBITDA 均為安全港含義內的前瞻性陳述。

Forward-looking statements are based on management's current preliminary expectations and are subject to risks and uncertainties, which may cause RadNet's actual results to differ materially from the statements contained herein. These results and uncertainties include those risks set forth in RadNet's reports filed with the SEC from time to time, including RadNet's annual report on Form 10-K for the year ended December 31, 2017, to be filed shortly.

前瞻性陳述是基於管理階層目前的初步預期，並受到風險和不確定性的影響，這可能導致 RadNet 的實際結果與本文中包含的陳述有重大差異。這些結果和不確定性包括 RadNet 不時向 SEC 提交的報告中列出的風險，其中包括 RadNet 即將提交的截至 2017 年 12 月 31 日的年度 10-K 表格年度報告。

Undue reliance should not be placed on forward-looking statements, especially guidance on future financial performance, which speaks only as of the date it is made. RadNet undertakes no obligation to update publicly any forward-looking statements to reflect new information, events or circumstances after the date they were made or to reflect the occurrence of unanticipated events.

不應過度依賴前瞻性陳述，尤其是對未來財務表現的指導，該指導僅代表截至發布之日的情況。RadNet 沒有義務公開更新任何前瞻性陳述，以反映其作出後的新資訊、事件或情況，或反映意外事件的發生。

And with that, I'd like to turn the call over to Dr. Berger.

說到這裡，我想把電話轉給伯傑醫生。

Thank you, Mark. Good morning, everyone, and thank you for joining us today. On today's call, Mark and I plan to provide you with highlights from our fourth quarter and full year 2017 results, give you more insight into factors which affected this performance and discuss our future strategy. After our prepared remarks, we will open the call to your questions.

謝謝你，馬克。大家早安，感謝您今天加入我們。在今天的電話會議上，馬克和我計劃向您提供 2017 年第四季和全年業績的亮點，讓您更深入地了解影響這一業績的因素，並討論我們的未來策略。在我們準備好發言後，我們將開始電話詢問您的問題。

I'd like to thank all of you for your interest in our company and for dedicating a portion of your day to our conference call this morning.

我要感謝大家對我們公司的興趣，並感謝你們今天早上抽出部分時間參加我們的電話會議。

2017 was an active and very productive year for RadNet. We made progress on all strategic fronts, and I believe our performance demonstrated the power of the RadNet model and the multifaceted aspects to our business that make it unique in health care. I'd like to begin by highlighting some of the accomplishments of 2017.

2017 年對於 RadNet 來說是活躍且富有成效的一年。我們在所有策略方面都取得了進展，我相信我們的業績證明了 RadNet 模型的力量以及我們業務的多方面性，使其在醫療保健領域獨一無二。首先我想強調一下 2017 年所取得的一些成就。

First, our operations teams were successful in driving same-center growth. For the year, our same-center procedural volume growth in operations, including all joint ventures, exceeded 2%. When we are able to drive more patient volume and procedures through existing facilities, the incremental profitability is high since many of our costs are fixed. This contributed to our improved EBITDA and profitability through 2017. In addition, our contracting groups were successful in negotiating better reimbursement with several commercial health plans in key markets.

首先，我們的營運團隊成功地推動了同中心成長。今年，我們包括所有合資企業在內的同中心業務量成長超過2%。當我們能夠透過現有設施推動更多的患者數量和手術時，增量獲利能力就會很高，因為我們的許多成本都是固定的。這有助於我們 2017 年 EBITDA 和獲利能力的提高。此外，我們的簽約團隊成功地與主要市場的多個商業健康計劃進行了更好的報銷談判。

Second, the capital expenditures that we made during 2016 and 2017 added both capacity to see additional patients and new capabilities to our centers. In particular, our recent investments in 3D digital mammography is associated with increased reimbursement as compared with the traditional 2D mammography exams. Our ability to make capital investments further distances our centers and service offerings from those of our smaller competitors. We believe the medical communities that we serve recognize these differences that set RadNet apart.

其次，我們在 2016 年和 2017 年期間進行的資本支出增加了我們中心接待更多患者的能力和新能力。特別是，與傳統的 2D 乳房 X 光檢查相比，我們最近對 3D 數位乳房 X 光檢查的投資與報銷增加有關。我們的資本投資能力使我們的中心和服務產品與規模較小的競爭對手進一步拉開了距離。我們相信，我們所服務的醫療界認識到這些差異，而正是這些差異使 RadNet 與眾不同。

Our organic growth is also benefiting from the migration of outpatient services from hospitals into lower-cost, and in many cases, higher-quality ambulatory settings. On our last call, we were asked about the announcement that Anthem made several months ago regarding its commitment to direct outpatient imaging to freestanding centers and away from hospital settings. This announcement is representative of the thinking of not just Anthem but many of the larger regional and national health insurers. We have noted in our markets that hospital imaging rates are between 2x to 5x those of freestanding outpatient facilities. This simply is not sustainable. We believe we will continue to benefit from patients being directed to lower-cost facilities by their health plans, and patients in high deductible plans becoming more engaged in deciding where to get their health care services.

我們的有機成長也受益於門診服務從醫院轉移到成本較低、在許多情況下轉移到更高品質的門診環境。在我們最後一次通話中，我們被問及 Anthem 幾個月前發布的關於其承諾將門診成像直接轉移到獨立中心並遠離醫院環境的聲明。這項公告不僅代表了 Anthem 的想法，也代表了許多較大的地區和國家健康保險公司的想法。我們注意到，在我們的市場中，醫院影像率是獨立門診設施的 2 到 5 倍。這根本就是不可持續的。我們相信，我們將繼續受益於患者透過其健康計劃被引導到成本較低的設施，以及參加高免賠額計劃的患者更加積極地決定在哪裡獲得醫療保健服務。

During 2017, we furthered our hospital joint venture strategy by expanding existing joint ventures and established new JVs with 2 of the premier health systems in Southern California, Cedars-Sinai and MemorialCare. We expect 2018 will bring new joint venture opportunities as health systems seek affiliations and solutions to manage their radiology delivery and offerings.

2017 年，我們透過擴大現有合資企業以及與南加州兩家頂級醫療系統 Cedars-Sinai 和 MemorialCare 建立新的合資企業，進一步推進了我們的醫院合資策略。我們預計 2018 年將帶來新的合資機會，因為衛生系統尋求附屬關係和解決方案來管理其放射學服務和服務。

During 2017, we streamlined our business through divesting of noncore operations. In April, we completed the sale of 5 centers in Rhode Island to another operator in that market. The 5 centers were originally part of RadNet's acquisition completed in November 2011 of the U.S. operations of CML HealthCare. When we purchased the assets of CML, we were most interested in CML's operations in Maryland. Managing the Rhode Island region consumed time and resources in a marketplace that we felt was unlikely for us to grow.

2017 年，我們透過剝離非核心業務來精簡業務。4 月份，我們完成了將羅德島州的 5 個中心出售給該市場的另一家營運商的交易。這 5 個中心最初是 RadNet 於 2011 年 11 月完成的對 CML HealthCare 美國業務收購的一部分。當我們購買 CML 的資產時，我們最感興趣的是 CML 在馬裡蘭州的業務。管理羅德島地區消耗了我們在市場上的時間和資源，而我們認為我們不太可能發展這個市場。

Also in April, as part of the largest strategic relationship with Cedar Sinai, we sold to Cedars our medical oncology practices in the San Fernando Valley of Los Angeles. We originally purchased these oncology practices because of their connection with our Breastlink business and because they rely heavily on diagnostic imaging. Operating medical oncology practices was never our core business, and we were able to sell our ownership to Cedars who continues to utilize RadNet for the imaging needs of those patients.

同樣在四月，作為與 Cedar Sinai 最大戰略關係的一部分，我們將我們在洛杉磯聖費爾南多谷的腫瘤醫學業務出售給了 Cedars。我們最初購買這些腫瘤診所是因為它們與我們的 Breastlink 業務有聯繫，而且它們嚴重依賴診斷影像。經營腫瘤醫學實踐從來都不是我們的核心業務，我們能夠將我們的所有權出售給 Cedars，後者繼續利用 RadNet 來滿足這些患者的影像需求。

In September, we sold to Verity Health our interest in Breastlink California, our integrated Breast Disease Management operations. Like the San Fernando Valley oncology operations we created Breastlink partially to capture substantial imaging volumes resulting from breast cancer screening and treatment. By transferring the professional operations of Breastlink to Verity like Cedars, another strategic partner, we will remain the imaging provider of choice to these patients.

9 月，我們向 Verity Health 出售了我們在 Breastlink California（我們的綜合乳房疾病管理業務）中的權益。與聖費爾南多谷腫瘤學操作一樣，我們創建 Breastlink 的部分目的是捕捉乳癌篩檢和治療產生的大量影像量。透過將 Breastlink 的專業業務轉移給 Verity（如另一個策略合作夥伴 Cedars），我們將繼續成為這些患者的首選影像提供者。

During 2017, we also completed several strategic acquisitions in our core markets. The most notable one was the acquisition of Diagnostic Imaging Associates, RadNet's principal nonhospital outpatient competitor in Delaware. DIA has been a respected competitor of ours since we entered the Delaware marketplace in 2008. Through the combination of RadNet's existing 8 facilities with DIA's centers, we have become the clear leader of nonhospital outpatient imaging operators in Delaware. Through the integration of DIA with our existing operations in Delaware, we should benefit from unique consolidation and revenue opportunities.

2017年，我們也在核心市場完成了多項策略收購。最引人注目的是收購 Diagnostic Imaging Associates，這是 RadNet 在特拉華州的主要非醫院門診競爭對手。自 2008 年進入特拉華州市場以來，DIA 一直是我們備受尊敬的競爭對手。透過將 RadNet 現有的 8 個設施與 DIA 中心相結合，我們已成為特拉華州非醫院門診影像營運商的明顯領導者。透過將 DIA 與我們在特拉華州的現有業務整合，我們應該受益於獨特的整合和收入機會。

We made certain infrastructure investments to position ourselves to be an effective and scalable platform from which we will continue to grow. These investments were made to address challenges in our business, which should result in better future performance and more efficient operations. Most notably, we invested significantly in our revenue cycle operations. As we have discussed in the past, we are attempting to keep pace with the challenges in healthcare around effective billing and collection for services. Health plans have made the procedures and requirements more and more cumbersome to get reimbursed. We are forced to collect more money than ever from patients directly at the time of service and afterwards as a result of higher deductible health plans and more significant office visit charges and coinsurance. As a result, we have recruited and hired new senior management in this area, expanding customer service call center personnel and hours of operations; increased the size of our patient collection teams; and invested in new tools and technology to increase productivity. We are beginning to see benefits from these investments, and I expect to see performance enhancement in revenue cycle throughout 2018.

我們進行了某些基礎設施投資，將自己定位為一個有效且可擴展的平台，我們將在此基礎上持續發展。這些投資是為了應對我們業務中的挑戰，這應該會帶來更好的未來績效和更有效率的營運。最值得注意的是，我們在收入周期營運方面進行了大量投資。正如我們過去所討論的，我們正試圖跟上醫療保健領域圍繞有效服務計費和收款的挑戰。健康計畫使得報銷的程序和要求變得越來越繁瑣。由於更高的免賠額健康計劃以及更高的就診費用和共同保險，我們被迫在服務時和之後直接從患者那裡收取比以往更多的錢。因此，我們在該領域招募和聘用了新的高階管理人員，擴大了客戶服務呼叫中心的人員和營運時間；擴大我們的患者收集團隊的規模；並投資新工具和技術以提高生產力。我們開始看到這些投資的好處，我預期 2018 年營收週期的績效將會提升。

The last achievement of 2017 I'd like to discuss is our improved balance sheet and cash flow, which is a direct result of our operating performance in 2016 and 2017, and our commitment to deleveraging. In 2017, we produced over $50 million of free cash flow. This cash we generate after the deduction of our capital expenditures and cash interest expense. Essentially, this is cash we can use to repay debt or make strategic acquisitions. During 2017, we lowered our leverage from 4.8x net debt-to-EBITDA to 4x, and we ended the year with over $50 million on our balance sheet and undrawn on our $117 million revolving credit facility.

我想討論的2017年的最後一項成就是我們的資產負債表和現金流的改善，這是我們2016年和2017年經營業績以及我們致力於去槓桿的直接結果。2017 年，我們產生了超過 5,000 萬美元的自由現金流。我們產生的現金是在扣除資本支出和現金利息支出後產生的。從本質上講，這是我們可以用來償還債務或進行策略性收購的現金。2017 年期間，我們將槓桿率從 4.8 倍淨債務與 EBITDA 比率降低至 4 倍，到年底，我們的資產負債表上的餘額超過 5,000 萬美元，而我們的 1.17 億美元循環信貸額度尚未提取。

Our consistent deleveraging over the past 18 months as well as strong capital market conditions allowed us to amend our credit facility in August where we repaid in its entirety the second lien term loan we had outstanding, extended debt maturities and lowered our cost of capital. From a balance sheet perspective and in terms of our liquidity, we are in the best position we've ever been in, which allows us to continue to execute our strategic growth plan.

過去18 個月的持續去槓桿化以及強勁的資本市場狀況使我們能夠在8 月份修改我們的信貸安排，全額償還了我們未償還的第二筆留置權定期貸款，延長了債務期限，並降低了我們的資本成本。從資產負債表和流動性來看，我們處於有史以來的最佳位置，這使我們能夠繼續執行我們的策略性成長計劃。

At this time, I'd like to turn the call back over to Mark to discuss some of the highlights of our fourth quarter 2017 performance. When he's finished, I will have some closing remarks.

這次，我想將電話轉回給 Mark，討論我們 2017 年第四季業績的一些亮點。當他講完後，我將做一些結束語。

Thank you, Howard. I'm now going to briefly review our fourth quarter and full year 2017 performance and attempt to highlight what I believe to be some material items. I will also give some further explanation of certain items in our financial statements as well as provide some insights into some of the metrics that drove our fourth quarter and full year 2017 performance. I will also provide 2018 financial guidance levels, which were released in this morning's financial results press release.

謝謝你，霍華德。我現在將簡要回顧我們 2017 年第四季和全年的業績，並嘗試強調我認為的一些重要項目。我也會對我們財務報表中的某些項目進行進一步解釋，並對推動我們 2017 年第四季和全年業績的一些指標提供一些見解。我還將提供 2018 年財務指導水平，該水平已在今天上午的財務業績新聞稿中發布。

In my discussion, I will use the term adjusted EBITDA, which is a non-GAAP financial measure. The company defines adjusted EBITDA as earnings before interest, taxes, depreciation and amortization, and excludes losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishments and noncash equity compensation.

在我的討論中，我將使用調整後 EBITDA，這是一種非 GAAP 財務指標。該公司將調整後的 EBITDA 定義為息稅折舊攤銷前利潤，不包括設備處置損失或收益、其他收入或損失、債務清償損失和非現金股權補償。

Adjusted EBITDA includes equity and earnings in unconsolidated operations and subtracts allocations of earnings to noncontrolling interest in subsidiaries as adjusted for noncash or extraordinary and one-time items taking place during the period. A full quantitative reconciliation of adjusted EBITDA to net income or loss attributed to RadNet, Inc. common shareholders is included in our earnings release.

調整後的 EBITDA 包括未合併業務的股本和收益，並減去分配給子公司非控制權益的收益（根據該期間發生的非現金或非常規和一次性項目進行調整）。調整後 EBITDA 與 RadNet, Inc. 淨利潤或虧損的全面定量調節普通股股東已包含在我們的收益報告中。

With that said, I'd now like to review our fourth quarter and full year 2017 results. For the 3 months ended December 31, 2017, RadNet reported revenue and adjusted EBITDA of $235.6 million and $40.7 million, respectively. Revenue increased $10.6 million or 4.7% over the prior year same quarter and adjusted EBITDA increased $5.8 million or 16.6% over the prior year same quarter.

話雖如此，我現在想回顧一下我們 2017 年第四季和全年的業績。截至 2017 年 12 月 31 日的三個月，RadNet 報告的營收和調整後 EBITDA 分別為 2.356 億美元和 4,070 萬美元。營收比去年同季增加 1,060 萬美元，成長 4.7%，調整後 EBITDA 比去年同季增加 580 萬美元，成長 16.6%。

The vast majority of the revenue and EBITDA increase in the quarter is the result of increases in procedural volumes, mostly same-center increases and the effect of several payer increases we received in the latter half of 2017.

本季營收和 EBITDA 成長的大部分是由於程序量的增加（主要是同中心的成長）以及我們在 2017 年下半年收到的幾次付款人成長的影響。

For the fourth quarter of 2017 as compared with the prior year's fourth quarter and adjusting for the sale of our Rhode Island subsidiary, which we completed in April of 2017, aggregate MRI volume increased 4.7%, CT volume increased 8.1% and PET/CT volume increased 11.6%. Overall volume, taking into account routine imaging exams inclusive of x-ray, ultrasound, mammography and all other exams, increased 3.4% over the prior year's fourth quarter.

2017 年第四季與去年第四季相比，並根據我們於2017 年4 月完成的羅德島子公司的出售進行調整，總MRI 數量增加了4.7%，CT 數量增加了8.1%，PET/ CT 數量增加成長11.6%。考慮到包括 X 光、超音波、乳房 X 光檢查和所有其他檢查在內的常規影像檢查，總體數量比去年第四季度增加了 3.4%。

I will now discuss procedural volumes. Note that beginning in the second quarter of 2017, all procedural numbers I've been discussing includes all of our joint ventures, whether consolidated or unconsolidated from an accounting perspective. Our JVs have become a material part of our business and by including their procedural volumes, it provides a more accurate and complete picture of our operations.

我現在將討論程序卷。請注意，從 2017 年第二季開始，我一直在討論的所有程序資料都包括我們所有的合資企業，無論是從會計角度來看是合併的還是未合併的。我們的合資企業已成為我們業務的重要組成部分，透過納入其程序​​量，它可以更準確、更完整地描述我們的營運情況。

I will restate the prior period procedural volumes in the same manner to make meaningful comparisons.

我將以同樣的方式重述前期程序卷，以進行有意義的比較。

In the fourth quarter of 2017, we performed 1,779,246 total procedures. The procedures were consistent with our multi-modality approach whereby 75.9% of all the work we did by volume was from routine imaging. Our procedures in the fourth quarter of 2017 were as follows: 241,191 MRIs compared with 230,389 MRIs in the fourth quarter of 2016; 177,970 CTs as compared with 164,697 CTs in the fourth quarter of 2016; 9,241 PET/CTs as compared with 8,281 PET/CTs in the fourth quarter of 2016; and 1,350,844 routine imaging exams, which include nuclear medicine, ultrasound, mammography, x-ray and all other exams, as compared with 1,317,736 exams in the fourth quarter of 2016.

2017 年第四季度，我們總共執行了 1,779,246 例手術。這些程序與我們的多模態方法一致，我們所做的所有工作中有 75.9% 來自常規成像。我們在 2017 年第四季的程序如下： 241,191 次 MRI 掃描，而 2016 年第四季為 230,389 次 MRI 掃描； 177,970 輛 CT，而 2016 年第四季為 164,697 輛； PET/CT 數量為 9,241 例，而 2016 年第四季 PET/CT 數量為 8,281 例；常規影像檢查 1,350,844 次，其中包括核醫、超音波、乳房 X 光檢查、X 光和所有其他檢查，而 2016 年第四季為 1,317,736 次檢查。

Net income adjusted for a onetime $13.5 million noncash increase to our income tax expense in the quarter as a result of the Tax Cut and Jobs Act of 2017 and the revaluation of our deferred tax asset for the fourth quarter of 2017 was $6.3 million or $0.13 per share compared to net income of $3.7 million or $0.08 per share in 2016. This is based upon weighted average number of shares outstanding of 47.9 million and 46.4 million for these periods in 2017 and 2016, respectively.

由於2017 年減稅和就業法案的影響，本季所得稅費用一次性增加1,350 萬美元，調整後的淨利潤為630 萬美元，2017 年第四季遞延稅資產重估為630 萬美元，即0.13美元。相較之下，2016 年淨利為 370 萬美元，即每股 0.08 美元。這是基於 2017 年和 2016 年期間已發行股票的加權平均數分別為 4,790 萬股和 4,640 萬股計算的。

With respect to the one-time tax adjustment, many of you are aware that the Tax Cut and Jobs Act was enacted on December 22, 2017. The act reduces the U.S. federal corporate tax rate from 34% to 21%, along with adopting a number of tax provisions related to foreign entities. As part of our work for the fourth quarter, we made a reasonable estimate of the effects of our existing deferred tax balances. As a result of these analyses, during the quarter, we recognized a onetime noncash provisional amount of $13.5 million to our income tax expense and we'll continue to make and refine our calculations as additional work is completed.

關於一次性稅收調整，很多人都知道《減稅與就業法案》於2017年12月22日頒布。該法案將美國聯邦企業稅率從 34% 降至 21%，並採用了多項與外國實體相關的稅收規定。作為第四季度工作的一部分，我們對現有遞延稅項餘額的影響進行了合理估計。根據這些分析，在本季度，我們確認了 1,350 萬美元的一次性非現金預繳所得稅費用，隨著額外工作的完成，我們將繼續進行和完善我們的計算。

Going forward, we anticipate a benefit to our earnings from the lower corporate federal tax rate. We expect our effective corporate tax rate, which is inclusive of both federal and state taxes, to be reduced from approximately 41% to approximately 29%. I will report more on this matter on our first quarter financial results call after we've completed additional work.

展望未來，我們預計較低的企業聯邦稅率將使我們的收益受益。我們預計我們的有效企業稅率（包括聯邦稅和州稅）將從約 41% 降至約 29%。完成額外工作後，我將在第一季財務業績電話會議上報告有關此事的更多資訊。

Other than the one-time tax adjustment to the tax provision, affecting adjusted net income in the fourth quarter of 2017 were certain noncash expenses and nonrecurring items, including the following: $944,000 of noncash employee stock compensation expense resulting from the vesting of certain options and restricted stock; $255,000 of severance paid in connection with headcount reductions related to cost savings initiatives; $314,000 loss on the disposal of certain capital equipment; and $974,000 of amortization and write-off of deferred financing costs and loan discounts related to our existing credit facilities.

除了對稅項準備金的一次性稅收調整外，影響2017 年第四季度調整後淨利潤的還有某些非現金費用和非經常性項目，其中包括： 因授予某些期權而產生的944,000 美元非現金員工股票補償費用以及限制性股票；因與成本節約措施相關的裁員而支付的遣散費為 255,000 美元；處置某些固定設備造成 314,000 美元的損失； 974,000 美元的攤銷和沖銷遞延融資成本以及與我們現有信貸安排相關的貸款折扣。

With regards to some specific income statement accounts, overall GAAP interest expense for the fourth quarter of 2017 was $9.9 million. This compares with GAAP interest expense in the fourth quarter of 2016 of $10.6 million. For the fourth quarter of 2017, bad debt expense was 5.2% of our service fee revenue compared with 5.5% for the fourth quarter of 2016. We are pleased with a slight decrease in our bad debt percentage as we are being required to collect more dollars from patients directly in the form of copayments and coinsurance. The controls and procedures we put in place at the centers to become more effective in collecting money from patients are enabling us to keep bad debt from increasing relative to our service fee revenue. Additionally, investments we made in our customer service and collection teams are also paying dividends and positively impacting bad debt, DSOs and cash flow.

對於某些特定損益表帳戶，2017 年第四季 GAAP 利息支出總體為 990 萬美元。相比之下，2016 年第四季 GAAP 利息支出為 1,060 萬美元。2017 年第四季度，壞帳費用佔服務費收入的 5.2%，而 2016 年第四季為 5.5%。我們對壞帳百分比略有下降感到高興，因為我們被要求以共付額和共同保險的形式直接向患者收取更多的錢。我們在中心實施的控制和程序旨在更有效地向患者收款，這使我們能夠防止壞帳相對於服務費收入的增加。此外，我們對客戶服務和催收團隊的投資也帶來了紅利，並對壞帳、DSO 和現金流量產生了積極影響。

For the full year of 2017, the company reported $922 million of revenue and adjusted EBITDA of $142.5 million and adjusted net income of $13.6 million. Revenue increased $37.7 million or 4.3%, and adjusted EBITDA increased $9.5 million or 7.1% over 2016.

2017 年全年，該公司報告營收為 9.22 億美元，調整後 EBITDA 為 1.425 億美元，調整後淨利潤為 1,360 萬美元。與 2016 年相比，收入增加了 3,770 萬美元，即 4.3%，調整後的 EBITDA 增加了 950 萬美元，即 7.1%。

As Dr. Berger mentioned in his prepared remarks, the improved performance relative to 2016 was the result of same center-procedural and revenue growth, contribution from several tuck-in acquisitions, expansion of our JV strategy and containment on our cost structure. One thing to note that in 2017, for the first time in our company's history, we instituted a 401(k) match program for our employees. We accrued throughout the year $2.4 million of additional salaries and wages as a result of this program. Although our EBITDA and profitability was impacted, we are proud to recognize the hard work and dedication of our employee base.

正如 Berger 博士在他準備好的演講中提到的，相對 2016 年業績的改善是由於相同的中心程序和收入增長、幾次收購的貢獻、合資企業策略的擴展以及成本結構的控制。值得注意的是，2017 年，我們公司歷史上首次為員工製定了 401(k) 匹配計劃。由於該計劃，我們全年增加了 240 萬美元的薪水和工資。儘管我們的 EBITDA 和盈利能力受到了影響，但我們很自豪地認識到我們員工的辛勤工作和奉獻精神。

For the year ended December 31, 2017, as compared with 2016, and adjusting for the sale of our Rhode Island centers in April, MRI volume increased 4.8%; CT volume increased 6.7%; and PET/CT volume increased 7.4%. Overall volume, taking into account all the routine imaging exams, increased 3.1% for the 12 months of 2017 over 2016.

截至 2017 年 12 月 31 日的年度，與 2016 年相比，並根據 4 月份羅德島中心的銷售情況進行調整，MRI 數量增長了 4.8%； CT體積增加6.7%； PET/CT 體積增加了 7.4%。考慮到所有常規影像檢查，2017 年 12 個月的總數量比 2016 年增加了 3.1%。

In 2017, again adjusting for the sale of Rhode Island and restating prior period numbers to include our JV operations, we performed 7,101,086 total procedures. The procedures were consistent with our multi-modality approach whereby 76.1% of all the work we did by volume was from routine imaging. Our procedures in 2017 were as follows: 957,752 MRIs as compared with 913,971 MRIs in 2016; 706,164 CTs as compared with 661,890 CTs in 2016; 35,428 PET/CTs as compared with 32,988 PET/CTs in 2016; and 5,000 -- excuse me, 5,401,742 routine imaging exams as compared with 5,276,426 of all these exams in 2016.

2017 年，再次對羅德島州的出售進行調整併重述前期數據以將我們的合資企業業務納入其中，我們總共執行了 7,101,086 項程序。這些程序與我們的多模態方法一致，我們所做的所有工作中 76.1% 來自常規成像。我們 2017 年的程序如下： 957,752 次 MRI 掃描，而 2016 年為 913,971 次 MRI 掃描； 706,164 台 CT，而 2016 年為 661,890 台； PET/CT 數量為 35,428 例，而 2016 年為 32,988 例； 5,000 例－對不起，常規影像檢查為 5,401,742 例，而 2016 年所有這些檢查為 5,276,426 例。

Adjusted net income for 2017 was $0.29 per diluted share compared to adjusted net income of $0.15 per diluted share in 2016. This is based upon weighted average number of diluted shares outstanding of 47.4 million in 2017 and 46.7 million shares in 2016.

2017 年調整後攤薄後每股淨利為 0.29 美元，而 2016 年調整後稀釋後每股淨利為 0.15 美元。這是根據 2017 年 4,740 萬股和 2016 年 4,670 萬股稀釋後流通股的加權平均數計算的。

Affecting adjusted net income in 2017 were certain noncash and nonrecurring items including the following: $6.8 million of noncash employee stock compensation expense resulting from divesting of certain options and restricted stock; $1.8 million of severance paid in connection with headcount reductions related to cost savings initiatives; and $1.1 million loss on the disposal of certain capital equipment; $3.1 million gain on the sale of imaging centers; $3.2 million of expenses related to divested and closed operations; and $3.5 million of amortization and write-off of deferred financing fees and discount on issuance of debt related to our existing credit facilities and refinancing transaction.

影響 2017 年調整後淨利潤的是某些非現金和非經常性項目，包括：因剝離某些選擇權和限制性股票而產生的 680 萬美元非現金員工股票補償費用；因與成本節約措施相關的裁員而支付 180 萬美元的遣散費；處置某些固定設備造成的 110 萬美元損失；出售成像中心獲得 310 萬美元收益；與剝離和關閉業務相關的 320 萬美元費用； 350 萬美元的遞延融資費用攤銷和沖銷以及與我們現有信貸安排和再融資交易相關的債務發行折扣。

With regards to some specific income statement accounts, overall GAAP interest expense for 2017 was $40.6 million. Adjusting for noncash impacts of items such as amortization of financing fees and accrued interest, cash interest expense for the year was $34.2 million. This compares with GAAP interest expense in 2016 of $43.5 million and cash paid for interest in 2016 of $37.5 million.

對於某些特定損益表帳戶，2017 年 GAAP 利息支出總額為 4,060 萬美元。在調整融資費用攤提和應計利息等項目的非現金影響後，本年度現金利息支出為 3,420 萬美元。相較之下，2016 年 GAAP 利息支出為 4,350 萬美元，2016 年利息支付現金為 3,750 萬美元。

For 2017, bad debt expense was 5.4% of our service fee revenue compared with an overall blended rate of 5.5% for the full year of 2016.

2017 年，壞帳費用占我們服務費收入的 5.4%，而 2016 年全年的總體綜合比率為 5.5%。

With regards to our balance sheet as of December 31, 2017, unadjusted for bond and term loan discounts, we had $576.3 million of debt, which is our total par value of debt less our cash balance. This compares with $634.9 million of debt at December 31, 2016. Thus, we reduced net debt during 2017 by $58.6 million.

截至 2017 年 12 月 31 日，我們的資產負債表未經債券和定期貸款折扣調整，我們的債務為 5.763 億美元，這是我們的債務面值總額減去現金餘額。相較之下，截至 2016 年 12 月 31 日的債務為 6.349 億美元。因此，我們在 2017 年減少了 5,860 萬美元的淨債務。

As of the end of 2017, we were undrawn on our $117.5 million revolving line of credit and had a cash balance of $51.3 million. As Dr. Berger mentioned earlier, we reduced our debt-to-EBITDA leverage ratio by over 0.8 turns of leverage in 1 year from 4.8x net debt-to-EBITDA at the end of 2006 down to 4.0x net debt-to-EBITDA at the end of 2017.

截至 2017 年底，我們尚未提取 1.175 億美元的循環信貸額度，現金餘額為 5,130 萬美元。正如伯傑博士先前提到的，我們在一年內將債務與 EBITDA 槓桿比率降低了 0.8 倍以上，從 2006 年底的 4.8 倍淨債務與 EBITDA 降至 4.0 倍淨債務與 EBITDA 2017年底。

At December 31, 2017, our accounts receivable balance was $155.5 million, a decrease of $8.7 million from the year-end of 2016. The decrease in accounts receivable is mainly from additional efforts and resources dedicated to patient collections. Our DSO or days sales outstanding was 57.1 days at December 31, 2017, lower by 4.1 days when compared to 61.2 days as of that date one year ago. This is mainly due to improved collections.

截至2017年12月31日，我們的應收帳款餘額為1.555億美元，較2016年底減少870萬美元。應收帳款的減少主要是由於專門用於患者催收的額外努力和資源。截至2017年12月31日，我們的DSO或應收帳款天數為57.1天，比一年前該日期的61.2天減少了4.1天。這主要是由於館藏的改善。

Throughout 2017, we had total capital expenditures, net of asset dispositions and sale of imaging center assets and joint venture interests, of $57.6 million. Approximately $61.3 million was paid for in cash, approximately $5.5 million was financed with capital leases, and we recognized $9.3 million in proceeds from the sale of equipment and imaging and medical practice assets.

2017 年全年，扣除資產處置以及成像中心資產和合資企業權益的出售後，我們的資本支出總額為 5,760 萬美元。大約 6,130 萬美元以現金支付，約 550 萬美元透過資本租賃融資，我們確認了出售設備、影像和醫療實踐資產的收益 930 萬美元。

I will now discuss how RadNet performed relative to 2017 guidance levels, which we released first upon our fourth quarter and full year 2016 financial results. Our guidance level for revenue for 2017 was $895 million to $925 million. Our actual results were $922.2 million.

我現在將討論 RadNet 相對於 2017 年指導水準的表現如何，我們在 2016 年第四季和全年財務業績中首次發布了該指導水準。我們對 2017 年收入的指導水準為 8.95 億美元至 9.25 億美元。我們的實際業績為 9.222 億美元。

Our adjusted EBITDA guidance was $135 million to $145 million. Our actual results were $142.5 million. Our capital expenditure guidance level was $55 million to $60 million. Our actual results were $57.6 million. Our cash interest expense guidance level was $35 million to $40 million. Our actual results were $34.2 million. Our free cash flow generation guidance level was $40 million to $50 million. Our actual results were $50.7 million. Thus, we met or exceeded our 2017 guidance levels in all categories. Our revenue and adjusted EBITDA were at the high end of the guidance ranges, and our strong adjusted EBITDA performance, controlled capital spending and lower interest expense than projected, contributed to our exceeding free cash flow guidance.

我們調整後的 EBITDA 指引值為 1.35 億美元至 1.45 億美元。我們的實際業績為 1.425 億美元。我們的資本支出指導水準為 5,500 萬至 6,000 萬美元。我們的實際業績為 5760 萬美元。我們的現金利息支出指導水準為 3,500 萬至 4,000 萬美元。我們的實際結果是 3420 萬美元。我們的自由現金流產生指導水準為 4,000 萬至 5,000 萬美元。我們的實際業績為 5,070 萬美元。因此，我們在所有類別中均達到或超過了 2017 年指導水準。我們的收入和調整後 EBITDA 處於指導範圍的高端，我們強勁的調整後 EBITDA 業績、受控的資本支出和低於預期的利息支出，促成了我們超越自由現金流指導。

At this time, I'd like to review our 2018 financial guidance levels, which we released this morning in our financial results press release. For total net revenue, our guidance level for 2018 is $950 million to $975 million. For adjusted EBITDA, our guidance levels are $145 million to $155 million. For capital expenditures, our guidance levels are $50 million to $55 million. For cash interest expense, our guidance levels are $33 million to $38 million. And for free cash flow generation, our guidance level is between $50 million and $60 million.

此時，我想回顧一下我們今天早上在財務業績新聞稿中發布的 2018 年財務指導水準。對於總淨收入，我們 2018 年的指導水準為 9.5 億至 9.75 億美元。對於調整後的 EBITDA，我們的指導水準為 1.45 億至 1.55 億美元。對於資本支出，我們的指導水準為 5,000 萬至 5,500 萬美元。對於現金利息支出，我們的指導水準為 3,300 萬美元至 3,800 萬美元。對於自由現金流的產生，我們的指導水準在 5,000 萬至 6,000 萬美元之間。

This guidance assumes no acquisitions and is derived from a true same-center model. It is built from a budgeting process that is completed at the center level and takes into account all opportunities and risks facing each center. We are projecting that capital expenditures will be lower in 2018 relative to last couple of years as a result of having substantially completed our transition to 3D mammography and the upgrade of our x-ray systems. Our cash interest expense guidance reflects the amendment and repricing of our senior credit facilities, partially mitigated by our expected higher LIBOR rate relative to 2017.

本指南假設沒有收購，且源自於真實的同中心模型。它是根據在中心層級完成的預算流程建構的，並考慮到每個中心面臨的所有機會和風險。我們預計，由於基本完成了向 3D 乳房 X 光攝影的過渡以及 X 射線系統的升級，2018 年的資本支出將低於過去幾年。我們的現金利息支出指引反映了我們高級信貸安排的修改和重新定價，部分緩解是由於我們預期倫敦銀行同業拆借利率相對於 2017 年較高。

I'd now like to turn the call back over to Dr. Berger, who'll make some closing remarks.

我現在想將電話轉回伯傑博士，他將做一些總結演講。

Thank you, Mark. The lines in health care are blurring. The roles of traditional health care insurers, hospitals and providers are changing in dynamic ways. Nobody might have predicted that Aetna and CVS would combine or that United through its Optum subsidiary would be purchasing physician practices, surgery centers and urgent care locations, hence, themselves becoming a provider, or that Humana would purchase Kindred and get into the nursing home, home health and rehabilitation or even most unlikely, that Berkshire Hathaway, Amazon and JPMorgan would form a health care alliance designed to address their rising health care spend.

謝謝你，馬克。醫療保健領域的界線正在變得模糊。傳統醫療保險公司、醫院和醫療服務提供者的角色正在動態變化。沒有人會預料到 Aetna 和 CVS 會合併，或者 United 透過其 Optum 子公司購買醫生診所、手術中心和緊急護理地點，從而成為醫療服務提供者，或者 Humana 會收購 Kindred 並進入療養院，家庭健康和康復，甚至最不可能的是，波克夏海瑟威、亞馬遜和摩根大通將組成一個醫療保健聯盟，旨在解決其不斷增長的醫療支出問題。

Add to that, today's announcement of Cigna buying Express Scripts. What is for certain, however, is that RadNet's positioned well to play an important role in delivery of health care in this country. Diagnostic imaging is necessary and irreplaceable in its ability to diagnose disease quickly and accurately and with relatively low cost that are more than recouped in the form of earlier and more effective treatment.

除此之外，今天也宣布 Cigna 收購 Express Scripts。但可以肯定的是，RadNet 已做好充分準備，將在該國提供醫療保健方面發揮重要作用。診斷影像是必要且不可替代的，因為它能夠快速、準確地診斷疾病，且成本相對較低，而且可以透過更早、更有效的治療來彌補。

We have positioned ourselves to be relevant to the insurance companies, physician practices, hospitals and virtually all the medical disciplines that rely on imaging as a diagnostic tool. Through our capitation model, we are participating in and furthering alternative payment models and risk taking. We are aligning payers with providers. With our eRAD solution, we are participating in the transition to the digital medical record and to electronic health care information systems.

我們將自己定位為與保險公司、醫生診所、醫院以及幾乎所有依賴影像作為診斷工具的醫學學科相關。透過我們的按人頭付費模式，我們正在參與並推動替代支付模式和風險承擔。我們正在使付款者與提供者保持一致。借助我們的 eRAD 解決方案，我們正在參與向數位醫療記錄和電子醫療保健資訊系統的過渡。

Through our joint venture model, we are affording health systems the opportunity to transform from being inpatient providers to having a broader, more distributed reach into the communities in which they serve.

透過我們的合資模式，我們為衛生系統提供了從住院提供者轉型為更廣泛、更分散地覆蓋其服務社區的機會。

Radiology and imaging will continue to evolve as a result of technological advances from both equipment and software development. RadNet will adapt to these changes not merely as a consumer but through strategic investments and alignments, which are now possible due to our improved financial position. An example of this is the recent announcement of our investment into Turner Imaging Systems.

由於設備和軟體開發的技術進步，放射學和成像將繼續發展。RadNet 不僅將作為消費者，還將透過策略投資和調整來適應這些變化，由於我們財務狀況的改善，這些現在已經成為可能。這方面的一個例子是我們最近宣布投資特納成像系統公司。

Our results in 2017 demonstrated the power of our core operating model. As we move into 2018, our focus will continue to be executing on our multifaceted operating strategy to include driving same-center growth and efficiencies; making tuck-in acquisitions; expanding our health system joint venture model; designing innovative IT capabilities such as artificial intelligence and computer-aided diagnostics; and furthering alternative payment models. What's most gratifying to me is that we have never been better positioned as a company competitively or financially to accomplish all of this than we are today.

我們 2017 年的業績證明了我們核心營運模式的力量。進入 2018 年，我們的重點將繼續執行多方面的營運策略，包括推動同中心成長和效率；進行大量收購；擴大我們的衛生系統合資模式；設計創新的IT功能，例如人工智慧和電腦輔助診斷；並進一步推廣替代支付模式。最令我欣慰的是，作為一家公司，我們從來沒有像今天這樣在競爭或財務上處於更好的地位來實現這一切。

I look forward to updating you on the many initiatives we've discussed on our call today during our first quarter financial results call in May. Operator, we are now ready for the question-and-answer portion of the call.

我期待向您介紹我們在五月第一季度財務業績電話會議上今天討論的許多舉措的最新情況。接線員，我們現在已準備好進行通話的問答部分。

(Operator Instructions) And we'll go first to Brian Tanquilut with Jefferies.

（操作員指示）我們將首先與 Jefferies 一起去找 Brian Tanquilut。

Mark, first question for you. So as I think about just clarifying on Q4. I know you gave the volume same store, but if you don't mind just giving like total same-store revenue. I think in the past, you had given that.

馬克，第一個問題給你。所以當我想澄清第四季時。我知道你給了同店的銷量，但如果你不介意的話，只給同店總收入。我想在過去，你已經給了這一點。

Yes. You'll see that in the K, when we release it in the MD&A section, Brian. But our same-store revenue exceeded our same-store procedural volume growth pretty significantly this quarter. And most of it was due to some payer increases that we received both on the West Coast and the East Coast. And so we saw some pricing benefit in several of our different markets. So you'll see same-store revenue growth over double-exceeding our procedural volume growth.

是的。Brian，當我們在 MD&A 部分發布它時，您會在 K 中看到這一點。但本季我們的同店營收大大超過了同店程式銷售的成長。其中大部分是由於我們在西海岸和東海岸收到的一些付款增加。因此，我們在幾個不同的市場中看到了一些定價優勢。因此，您將看到同店收入成長超過我們程式銷量成長的兩倍。

Okay. That's good to know. And as I think about your guidance for 2018, as I back into it, after analyzing Q4, it seems like you're assuming like 2% same-store revenue? Is that the right ballpark? And given the price increases that you just mentioned, how should we be thinking about the moving parts on same-store for 2018?

好的。很高興知道這一點。當我思考你們對 2018 年的指引時，當我回顧第四季後，你們似乎假設同店收入為 2%？這是正確的球場嗎？鑑於您剛才提到的價格上漲，我們該如何考慮 2018 年同店的變動情況？

Sure. I mean, typically, the low end of our range assumes pretty modest 0% to 1% same procedural volume growth in -- which is no different in 2018, and the high end is about 3%. And we're projecting to be somewhere in that range given some of the early indications that we saw at the end of last year and earlier on in this year, as well as some of the growth will come from some small tuck-in acquisitions that will be -- we'll have the full year benefit here in 2018 as well as some of the expansions of our JVs both on the East Coast and the West Coast and then the new joint venture out here on the West Coast with the Memorial health system, which we began operations on January 1. So I would -- we're hard pressed to put in a lot of organic growth, although that we -- the last few years we have been kind of comping in the 1% to 3% range and we're still comfortable with that going forward.

當然。我的意思是，通常情況下，我們範圍的低端假設 2018 年的相同程序量增長相當適度，為 0% 到 1%，這在 2018 年沒有什麼不同，而高端約為 3%。考慮到我們在去年底和今年早些時候看到的一些早期跡象，以及一些增長將來自一些小型的收購，我們預計會在這個範圍內。我們將在2018 年享受全年福利，以及我們在東海岸和西海岸的合資企業的一些擴張，然後在西海岸與紀念健康中心建立新的合資企業系統，我們於1 月1 日開始運營。所以我會——我們很難投入大量的有機增長，儘管我們— —過去幾年我們一直在1% 到3% 的範圍內進行比較% 範圍，我們仍然對未來感到滿意。

That's good. And then, Mark, as I think about that and it appears that your margin outlook guidance is essentially flat, right? But in a positive same-store environment, kind of like you just described, is that just conservatism or do you think there's opportunity to drive margins up this year?

那挺好的。然後，馬克，當我想到這一點時，您的利潤率前景指導似乎基本持平，對吧？但在積極的同店環境中，就像您剛才描述的那樣，這只是保守主義還是您認為今年有機會提高利潤率？

Yes. I think there is opportunity to drive margins. I mean, we have and are continuing to make some investments in our infrastructure. We talked about a little bit in our prepared remarks some significant investments we've made on the revenue cycle area of our company. And so as we make those investments, there is some sort of -- some lag before we see improved financial results from those investments. For instance in revenue cycle, we hired some additional senior management to help with controls around self-pay, controls around special group bills. We beefed up our call center, customer service support center in Dallas. We invested in some technology regarding an automated dialer system for our collection team in Dallas. And we're outsourcing some more of the difficult older AR to some strategic partners. And so all of this, it's starting to show through in our DSOs. It's starting to show through on our cash flow. But these types of investments take a while to run through our P&L before they create margin enhancements. But we believe that our margin for 2018 will be flat with some upside possibilities.

是的。我認為有機會提高利潤率。我的意思是，我們已經並將繼續對基礎設施進行一些投資。我們在準備好的演講中談到了我們在公司收入周期領域所做的一些重大投資。因此，當我們進行這些投資時，在我們看到這些投資帶來的財務表現改善之前，會有某種程度的延遲。例如，在收入週期中，我們聘請了一些額外的高階主管來幫助控制自付費用、特殊團體帳單的控制。我們加強了達拉斯的呼叫中心和客戶服務支援中心。我們為達拉斯的催收團隊投資了一些有關自動撥號系統的技術。我們正在將更多困難的舊 AR 外包給一些策略合作夥伴。所有這一切都開始在我們的 DSO 中顯現出來。它開始在我們的現金流上顯現出來。但這些類型的投資需要一段時間才能反映我們的損益表，然後才能提高利潤率。但我們相信 2018 年的利潤率將持平，但仍有一些上升的可能性。

Got it. And then last question for me, for Howard. As I think about the Memorial JV and some of the other JVs that you've done, 2 questions. Number one, how do you see the opportunity to grow those JVs? I mean, are these essentially new businesses that have a lot of runway to expand both on the top line and the margin side in terms of operational improvements you can put through? And then the second part of the question is, as you -- as Mark talked about price increases with managed care, is that a result of some of these joint ventures? Or is there another dynamic that's driving pricing growth?

知道了。最後一個問題是問我，問霍華德。當我想到紀念合資企業和您所做的其他一些合資企業時，有兩個問題。第一，您如何看待發展這些合資企業的機會？我的意思是，這些本質上是新企業，在營運改善方面是否有很大的空間可以在營收和利潤方面進行擴展？然後問題的第二部分是，正如馬克談到管理式醫療價格上漲時，這是其中一些合資企業的結果嗎？或者是否有其他動機推動價格成長？

Well, I'll try to take the first part of your question. Our strategy with the joint ventures should be noted that it's not with a single hospital, it's with a hospital system. So we're looking in each of our markets for a system that recognizes the value proposition that RadNet can bring, both in terms of its operating capabilities in the radiology and imaging space, as well as expanding the reach that, that hospital might have into the community that can help generate additional hospital visits for their systems as a result of the more encounters that we're likely to have on an outpatient basis. But it should also be noted that virtually every hospital system that we deal with is also in the market for consolidation and vertical alignment with primary care physicians. So as we contract with these hospitals through the joint ventures, we also get the benefit of the hospitals, physician groups and their ability to direct their imaging and keep it within their system, of which we now become a part of. So the growth opportunities are there. Also, as we mentioned in our remarks, most of these systems are aware of what is the inexorable movement of imaging out of the hospitals and into outpatient facilities. So we also expect to benefit along with them as our partner as that business continues to be directed away from hospitals and hospital licensed facilities. In regards to other opportunities, as we get larger and even more essential into the delivery of health care in these markets with our hospital partners, we have a better seat at the table in terms of negotiating not only, I think, better reimbursement but also in terms of really starting to craft alternative payment methods, maybe even bundling of services that allow radiology to fit with the other services that hospitals offer, not just hospitalization but layout in pharmacy, outpatient surgery centers, et cetera. The best example of this that I can give you has been an extremely successful negotiation with all of the major payers in New Jersey when we had our Barnabas Health System partner with us shoulder to shoulder in negotiating new rates. So all of the reasons that I believe are inherent in a joint venture with a hospital system, are capable for us to benefit from on a number of different levels. And I think that will be further recognized by other systems perhaps not just in the markets that we're in but in others where we can use this experience to potentially look for other joint venture partners that clearly need some kind of help with their radiology delivery and operations.

好吧，我會嘗試回答你問題的第一部分。值得注意的是，我們與合資企業的策略不是針對一家醫院，而是針對一個醫院系統。因此，我們正在每個市場中尋找一個能夠認識到 RadNet 可以帶來的價值主張的系統，無論是在放射學和成像領域的運營能力方面，還是擴大醫院可能進入的範圍方面。由於我們可能會在門診遇到更多的情況，因此社區可以幫助他們的系統增加更多的醫院就診次數。但也應該指出的是，幾乎我們處理的每個醫院系統也在市場上與初級保健醫生進行整合和垂直調整。因此，當我們透過合資企業與這些醫院簽訂合約時，我們也受益於醫院、醫生團體以及他們指導成像並將其保留在他們的系統內的能力，我們現在已經成為其中的一部分。所以成長機會就在那裡。此外，正如我們在評論中提到的，大多數這些系統都知道影像從醫院進入門診設施的不可阻擋的運動。因此，我們也希望作為我們的合作夥伴與他們一起受益，因為該業務繼續遠離醫院和醫院許可設施。至於其他機會，隨著我們與醫院合作夥伴在這些市場上提供醫療保健服務的規模越來越大，甚至變得越來越重要，我們在談判中擁有更好的席位，我認為，不僅可以更好地報銷，而且可以在談判中佔據更好的位置。就真正開始製定替代支付方式而言，甚至可能捆綁服務，使放射科能夠與醫院提供的其他服務相適應，不僅僅是住院治療，還包括藥局、門診手術中心等的佈置。我可以給您的最好的例子是與新澤西州所有主要付款人進行的非常成功的談判，當時我們有巴拿巴醫療系統合作夥伴與我們並肩談判新費率。因此，我認為與醫院系統合資所固有的所有原因都能夠使我們在許多不同層面上受益。我認為其他系統將進一步認識到這一點，也許不僅在我們所在的市場，而且在其他市場，我們可以利用這一經驗潛在地尋找其他合資夥伴，這些合作夥伴在放射學交付方面顯然需要某種幫助和操作。

(Operator Instructions) And we have no further questions at this time.

（操作員說明）目前我們沒有其他問題。

Okay, thank you, operator, and thank everybody for the opportunity to speak with you about our results. I'd like to take the opportunity to thank all of our shareholders for their continued support and the employees of RadNet for their dedication and hard work. Management will continue its endeavor to be a market leader that provides great services with an appropriate return on investment for all stakeholders. Thank you for your time today, and I look forward to speaking to you on our next call. Good day.

好的，謝謝您，操作員，也謝謝大家給我機會與您談論我們的結果。我想藉此機會感謝所有股東的持續支持以及 RadNet 員工的奉獻和辛勤工作。管理層將繼續努力成為市場領導者，為所有利害關係人提供優質服務和適當的投資回報。感謝您今天抽出寶貴的時間，我期待在下次通話中與您交談。再會。

And that does conclude today's conference. Thank you for your participation. You may now disconnect.

今天的會議到此結束。感謝您的參與。您現在可以斷開連線。