RadNet Inc (RDNT) 2024 Q2 法說會逐字稿

Good morning, and welcome to the RadNet, Inc. second-quarter 2024 financial results conference call. (Operator Instructions) Please note this event is being recorded. I would now like to turn the conference over to Mark Stolper, Executive Vice President and Chief Financial Officer. Please go ahead.

早安，歡迎參加 RadNet, Inc. 2024 年第二季財務業績電話會議。（操作員說明）請注意此事件正在被記錄。我現在將會議交給執行副總裁兼財務長馬克‧斯托爾珀 (Mark Stolper)。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 second-quarter 2024 financial results. 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 US Private Securities Litigation Reform Act of 1995.

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 2024 年第二季度財務業績。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.

具體來說，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、招募和保留技術人員、接受診斷影像服務的第三方報銷、成功整合收購的業務、產生除此之外，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 materially differ from the statements contained herein. These risks 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, 2023. 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.

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。這些風險和不確定性包括 RadNet 不時向 SEC 提交的報告中列出的風險，包括 RadNet 截至 2023 年 12 月 31 日的年度 10-K 表格年度報告。不應過度依賴前瞻性陳述，尤其是有關未來財務績效的指導，該指導僅代表截至發布之日的情況。

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

RadNet 不承擔公開更新任何前瞻性聲明以反映其作出後的新資訊、事件或情況或反映意外事件發生的義務。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 planned to provide you with highlights from our second quarter 2024 results, give you more insight into factors which affected the performance and discuss our future strategy. After our prepared remarks, we will open the call to your questions. I'd like to thank all of you for your interest in our company and for dedicating a portion of your day to participate in our conference call this morning.

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 2024 年第二季業績的亮點，讓您更深入地了解影響業績的因素，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。我要感謝大家對我們公司的興趣，並感謝你們花一天的時間參加我們今天早上的電話會議。

Let's begin. Our performance in the second quarter was highlighted by the strongest quarter in our company's history with record revenue and adjusted EBITDA. Relative to last year's second quarter, total company revenue increased 13.9%, Imaging Center revenue increased 13.2% and Digital Health revenue increased 36.4%. Imaging Center revenue growth was driven by heavy demand in virtually all of our markets, benefiting from the increasing utilization of diagnostic imaging within health care as well as the shift of procedural volumes away from the more expensive hospital alternatives to ambulatory freestanding imaging centers like the ones RadNet operates.

讓我們開始吧。我們第二季度的業績突顯了我們公司歷史上最強勁的季度，營收和調整後 EBITDA 創歷史新高。相較於去年第二季度，公司總營收成長13.9%，影像中心營收成長13.2%，數位健康收入成長36.4%。成像中心收入的成長是由幾乎所有市場的強勁需求推動的，受益於醫療保健中診斷成像的使用不斷增加，以及程序量從更昂貴的醫院替代方案轉向像這樣的門診獨立成像中心RadNet 運行。

Also contributing to the strong revenue performance was the positive impact of improved reimbursement from commercial and capitated payers who recognize the important role we play as a lower-priced alternative to hospital-based imaging. Lastly, our top line is benefiting from a continuing shift in modality mix towards advanced imaging, particularly MRI, CT and PET/CT, where our revenue per scan is substantially higher than with routine imaging.

商業和按人頭付款人的報銷改善也帶來了積極影響，這對強勁的收入表現做出了貢獻，他們認識到我們作為醫院成像的低價替代品所發揮的重要作用。最後，我們的收入受益於模式組合向先進影像的持續轉變，特別是 MRI、CT 和 PET/CT，我們每次掃描的收入大大高於常規影像。

Relative to last year's second quarter, our advanced imaging increased by 149 basis points as a percentage of our procedural volume mix. This is both a function of an overall industry trend as well as the significant capital investment we have made in the last few years in advanced imaging equipment for growth and replacement. Driving the revenue growth within Digital Health was the artificial intelligence, AI, businesses, including our EBCD breast cancer screening AI-powered initiative, which grew 136.6% quarter over last year's same quarter.

與去年第二季相比，我們的高階影像佔程式量組合的百分比增加了 149 個基點。這既是整體產業趨勢的結果，也是我們過去幾年在先進影像設備方面進行的大量資本投資的結果，以實現成長和更新換代。推動數位健康領域營收成長的是人工智慧業務，包括我們的 EBCD 乳癌篩檢人工智慧計劃，該計劃比去年同期成長了 136.6%。

Adjusted EBITDA was also a quarterly record. In conjunction with the strong revenue results, which I just discussed, our focus on operational efficiency, improved management and utilization of labor, investments in information technology and effective cost control contributed to a total company adjusted EBITDA, which increased 19.7% from last year's second quarter. Another contributing factor to adjusted EBITDA growth was a disproportionate growth in the higher profit margin Digital Health businesses.

調整後 EBITDA 也創下季度紀錄。In conjunction with the strong revenue results, which I just discussed, our focus on operational efficiency, improved management and utilization of labor, investments in information technology and effective cost control contributed to a total company adjusted EBITDA, which increased 19.7% from last year's second四分之一.調整後 EBITDA 成長的另一個影響因素是利潤率較高的數位健康業務的不成比例的成長。

Cumulatively, these factors drove a 76 basis point increase in our adjusted EBITDA margin as compared with last year's second quarter. While we are pleased with this margin expansion, I remain convinced we have further opportunity to improve the margins in this future. The strong operating results in the second quarter relative to our internal budget resulted in our decision to increase 2024 full year guidance ranges for revenue, adjusted EBITDA and free cash flow, which we also increased after reporting our first-quarter financial results.

與去年第二季相比，這些因素累積推動我們調整後的 EBITDA 利潤率成長了 76 個基點。雖然我們對利潤率的擴大感到滿意，但我仍然相信我們未來還有進一步提高利潤率的機會。相對於我們的內部預算，第二季度的強勁營運業績導致我們決定提高 2024 年全年收入、調整後 EBITDA 和自由現金流的指導範圍，在報告第一季度財務業績後我們也提高了指導範圍。

Mark will discuss this in more detail in his prepared remarks. We continue a multifaceted approach to accelerate growth. With respect to acquisitions, we completed the two previously announced Houston, Texas Center acquisitions of 13 centers from Houston Medical Imaging and American Health Imaging. We are now in the beginning process of integrating these acquisitions with each other and on to the RadNet operating clinical and IT systems.

馬克將在他準備好的發言中更詳細地討論這一點。我們繼續採取多方面的方法來加速成長。在收購方面，我們完成了先前宣布的兩次德州休士頓中心對休士頓醫學影像公司和美國健康影像公司 13 個中心的收購。我們現在正處於將這些收購相互整合並整合到 RadNet 營運臨床和 IT 系統的過程中。

We are confident there are further opportunities in Houston for acquisitions, de novo buildouts, health system partnerships and other means of expansion, which include bringing our artificial intelligence and leading-edge clinical and operating digital health solutions to the Houston patient and referring physician communities. We also completed an expansion of our Ventura County joint venture with Dignity Health System through the recent acquisition of four imaging centers and the addition of Community Memorial Health System in Ventura as a second partner to our RadNet in that JV.

我們相信休士頓還有更多收購、從頭擴建、醫療系統合作夥伴關係和其他擴張方式的機會，其中包括將我們的人工智慧和領先的臨床和營運數位健康解決方案帶給休士頓患者和轉診醫生社區。我們也完成了文圖拉縣與 Dignity Health System 合資企業的擴張，最近收購了四個成像中心，並在文圖拉增加了社區紀念衛生系統，作為該合資企業中 RadNet 的第二個合作夥伴。

2024 continues to be a year of reinvestment in our business. Year-to-date, we have opened 5 de novo facilities, and we have 6 additional scheduled openings for the remainder of this year, which are in substantial construction as we speak. Moreover, we have 15 additional projects in development, which we intend to open during 2025. These de novo facilities are almost equally split between wholly owned and joint venture centers and are located in markets where we have patient backlogs require additional capacity or where we currently lack access points to serve identified patient populations.

2024 年仍然是我們業務再投資的一年。今年迄今為止，我們已經開設了 5 個全新設施，我們還計劃在今年剩餘時間內開設另外 6 個設施，目前這些設施正在大量建設中。此外，我們還有 15 個項目正在開發中，計劃在 2025 年開放。這些從頭開始的設施幾乎均等地分佈在獨資中心和合資中心之間，並且位於我們有患者積壓需要額外容量或我們目前缺乏為確定的患者群體提供服務的接入點的市場。

While these projects are requiring us to make capital investments above our normal spending, we are confident that these centers will be material contributors as have the others that we've already opened to our long-term performance and growth. We continue to grow our hospital and health system joint venture businesses. Currently, 149 of our 398 centers or 37.4% are held within health system partnerships. Our partners are some of the largest and most successful health systems in our geographies. Partners include RWJBarnabas Memorial Healthcare, Dignity Health, Cedars-Sinai Health system, University of Maryland Medical System, Adventist and others.

雖然這些項目要求我們進行高於正常支出的資本投資，但我們相信這些中心將像我們已經開放的其他中心一樣為我們的長期業績和成長做出實質貢獻。我們繼續發展我們的醫院和衛生系統合資業務。目前，我們 398 個中心中有 149 個（佔 37.4%）屬於衛生系統合作夥伴。我們的合作夥伴是我們所在地區一些最大、最成功的衛生系統。合作夥伴包括 RWJBarnabas Memorial Healthcare、Dignity Health、Cedars-Sinai Health 系統、馬裡蘭大學醫療系統、Adventist 等。

These and other health systems are seeking long-term strategies around outpatient imaging and have recognized that cost-effective and efficient freestanding centers will continue to capture market share from hospitals as payers and patients migrate their site of care towards lower-cost, high-quality solutions. Our hospital and health system partners have been instrumental in increasing our procedural volumes with their physician relationships.

這些和其他衛生系統正在尋求圍繞門診成像的長期策略，並認識到，隨著支付者和患者將其護理地點轉向低成本、高質量，具有成本效益和高效的獨立中心將繼續從醫院奪取市場份額解決方案。我們的醫院和衛生系統合作夥伴透過他們的醫生關係在增加我們的手術量方面發揮了重要作用。

And as I have indicated in the past, our anticipation and hope is that close to 50% of our centers will be in joint ventures within the next two to three years. We continue to make progress in Digital Health. As some of you remember, we announced earlier this year the formation of the RadNet Digital Health financial reporting segment that was effective January 1, 2024, which combines the eRAD and DeepHealth OS software businesses into what was our clinical AI reporting segment during 2023.

正如我過去所指出的，我們的預期和希望是，我們近 50% 的中心將在未來兩到三年內成為合資企業。我們在數位健康領域不斷取得進展。你們中的一些人還記得，我們​​今年稍早宣布成立RadNet 數位健康財務報告部門，該部門於2024 年1 月1 日生效，該部門將eRAD 和DeepHealth OS 軟體業務合併到我們2023 年的臨床人工智能報告部門中。

The financial impact of these digital health businesses has great potential for RadNet and the health care space in general, both as a customer of the DeepHealth OS and AI solutions and, of course, as the owner of these businesses, which sell the solutions to customers outside of RadNet. Software businesses and in particular, SaaS-based models, can operate at significantly higher margins than RadNet's core Imaging Center segment and require less capital investment.

這些數位健康業務的財務影響對於 RadNet 和整個醫療保健領域來說具有巨大潛力，無論是作為 DeepHealth 作業系統和人工智慧解決方案的客戶，當然還是作為向客戶銷售解決方案的這些企業的所有者RadNet 之外。軟體業務，特別是基於 SaaS 的模型，可以比 RadNet 的核心成像中心部門獲得更高的利潤，並且需要更少的資本投資。

Within Digital Health, we continue to sell service and support eRAD solutions to new and existing customers, while we focus on the ongoing development of the next-generation DeepHealth OS cloud-based operating system and generative AI modules. We continue to believe that DeepHealth OS can have a major impact on lowering costs and increasing efficiency in the areas of patient scheduling, preauthorization, insurance verification, revenue cycle management and reporting.

在數位健康領域，我們持續向新舊客戶銷售服務並支援 eRAD 解決方案，同時我們專注於下一代 DeepHealth OS 基於雲端的作業系統和產生人工智慧模組的持續開發。我們仍然相信 DeepHealth OS 可以在患者安排、預先授權、保險驗證、收入週期管理和報告等領域對降低成本和提高效率產生重大影響。

We will begin testing some of these AI-powered automation tools of DeepHealth OS in the third and fourth quarters of this year and aim to have commercially available solutions as early as the first half of 2025. Our Enhanced Breast Cancer Diagnostic mammography, or EBCD, offering is virtually complete with the exception of the newly entered Houston marketplace. Adoption rates continue to rise and now exceed over 40% on the East Coast and are averaging close to 30% on the West Coast, where we have more recently implemented the program.

我們將於今年第三季和第四季開始測試 DeepHealth OS 的部分人工智慧自動化工具，並計劃最早在 2025 年上半年推出商用解決方案。除了新進入的休士頓市場外，我們的增強型乳癌診斷乳房 X 光檢查 (EBCD) 產品幾乎已經完成。收養率持續上升，目前東海岸超過 40%，西海岸平均接近 30%，我們最近在西海岸實施了該計劃。

Our lung AI and prostate AI tools and as well as neuro AI solutions are also expanding their customer base, predominantly in Europe. This has been highlighted in the UK, where our lung AI solution is the partner of choice for a four-country rollout of the national health care systems targeted health check lung cancer screening program. Finally, we continue to improve liquidity and financial leverage. We ended the second quarter with a cash balance of $741.7 million and a net debt to adjusted EBITDA ratio of just slightly more than one.

我們的肺部人工智慧和前列腺人工智慧工具以及神經人工智慧解決方案也在擴大其客戶群，主要是在歐洲。這一點在英國得到了強調，我們的肺部人工智慧解決方案是在四個國家推出全國醫療保健系統針對性健康檢查肺癌篩檢計畫的首選合作夥伴。最後，我們持續提高流動性和財務槓桿。第二季結束時，我們的現金餘額為 7.417 億美元，淨債務與調整後 EBITDA 的比率略高於 1。

On April 18, we opportunistically refinanced our debt facilities. With this financing, we are able to reduce our cost of capital, extended maturities and add additional approximately $168 million to RadNet's cash balance. With all of this, RadNet is in the best financial condition in its history and is poised for accelerated growth.

4 月 18 日，我們機會主義地為債務融資進行了再融資。透過這筆融資，我們得以降低資本成本、延長期限，並為 RadNet 的現金餘額增加約 1.68 億美元。憑藉所有這些，RadNet 處於歷史上最好的財務狀況，並準備好加速成長。

At this time, I'd like to turn the call back over to Mark to discuss some of the highlights of our second-quarter 2024 performance. When he is finished, I will make some closing remarks.

此時，我想將電話轉回給 Mark，討論我們 2024 年第二季業績的一些亮點。當他講完後，我將做一些結束語。

Thank you, Howard. I'm now going to briefly review our second-quarter 2024 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 second quarter performance. I will also provide an update to the 2024 financial guidance levels, which were released in conjunction with our 2023 year-end results in March of this year and revised in May in conjunction with our first-quarter 2024 results.

謝謝你，霍華德。我現在將簡要回顧我們 2024 年第二季的業績，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，並對推動我們第二季業績的一些指標提供一些見解。我還將提供 2024 年財務指導水準的更新，該指導水準於今年 3 月與我們的 2023 年年終業績一起發布，並於 5 月與我們的 2024 年第一季度業績一起修訂。

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. Adjusted EBITDA includes equity and earnings of unconsolidated operations and subtracts allocations of earnings to noncontrolling interest in subsidiaries and is adjusted for noncash or extraordinary and onetime events taking place during the period.

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。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分配，並針對該期間發生的非現金或特殊和一次性事件進行調整。

A full quantitative reconciliation of adjusted EBITDA to net income or loss attributable to RadNet, Inc. common shareholders is included in our earnings release. With that said, I'd now like to review our second-quarter 2024 results. For the second quarter of 2024, we reported total company revenue of $459.7 million and adjusted EBITDA of $72.3 million. Revenue increased $56 million or 13.9% and adjusted EBITDA increased $11.9 million or 19.7% as compared with the second quarter of 2023.

我們的收益報告中包含了調整後 EBITDA 與歸屬於 RadNet, Inc. 普通股股東的淨利潤或虧損的完整定量調節。話雖如此，我現在想回顧一下我們 2024 年第二季的業績。2024 年第二季度，我們報告的公司總收入為 4.597 億美元，調整後 EBITDA 為 7,230 萬美元。與 2023 年第二季相比，營收增加了 5,600 萬美元，即 13.9%，調整後的 EBITDA 增加了 1,190 萬美元，即 19.7%。

Breaking this performance down to the individual operating segments, our Imaging Center segment reported revenue of $443.9 million and adjusted EBITDA of $69.1 million. This was an increase of $51.8 million or 13.2% in revenue and an increase of $10 million or 16.9% in adjusted EBITDA as compared with the second quarter of 2023. Driving this performance were strong aggregate and same-center procedure volumes, the impact of higher reimbursement we are receiving from commercial and capitated payers, the gradual movement towards advanced imaging and tight expense control.

將這項績效細分到各個營運部門，我們的影像中心部門報告營收為 4.439 億美元，調整後 EBITDA 為 6,910 萬美元。與 2023 年第二季相比，營收增加了 5,180 萬美元，即 13.2%，調整後 EBITDA 增加了 1,000 萬美元，即 16.9%。推動這一業績的因素包括強勁的總體和同中心手術量、我們從商業和按人頭付款人獲得的更高報銷額的影響、先進成像的逐步發展和嚴格的費用控制。

The Digital Health segment reported revenue of $15.8 million and adjusted EBITDA of $3.3 million. Revenue increased to $4.2 million or 36.4% and adjusted EBITDA increased $1.9 million or 135.2% as compared with the second quarter of 2023. Digital Health significant growth was due in part from a $3.2 million increase in AI revenue, which climbed to $5.6 million during the second quarter of 2023. Total company net loss for the second quarter of 2024 was $3 million as compared with a total company net income of $8.4 million for the second quarter of 2023.

數位健康部門報告收入為 1580 萬美元，調整後 EBITDA 為 330 萬美元。與 2023 年第二季相比，營收增加至 420 萬美元，即 36.4%，調整後的 EBITDA 增加了 190 萬美元，即 135.2%。數位健康的顯著成長部分歸因於人工智慧收入增加了 320 萬美元，該收入在 2023 年第二季攀升至 560 萬美元。2024 年第二季公司淨虧損總額為 300 萬美元，而 2023 年第二季公司淨利總額為 840 萬美元。

Net loss per share for the second quarter of 2024 was negative $0.04 compared with net income per share of $0.12 in the second quarter of '23 based upon a weighted average number of diluted shares outstanding of 73.4 million shares in 2024 and 60.9 million shares in 2023. There were a number of unusual or onetime items impacting the second quarter, including the following: $1.9 million of noncash loss from interest rate swaps; $5.6 million of noncash interest expense related to extraordinary interest rate swap; other comprehensive income amortization; $809,000 expense related to leases for de novo facilities under construction that have yet to open their operations; $8.8 million of debt restructuring and extinguishment expenses related to the April 2024 successful debt refinancing transaction; and $3.3 million of noncapitalized R&D expenses related to the DeepHealth cloud OS and generative AI development.

2024 年第二季的每股淨虧損為負0.04 美元，而2023 年第二季的每股淨利為0.12 美元，基於2024 年和2023 年稀釋後流通股的加權平均數分別為7,340 萬股和6,090 萬股。有許多不尋常或一次性的項目影響了第二季度，其中包括： 利率掉期造成 190 萬美元的非現金損失；與特別利率掉期相關的 560 萬美元非現金利息支出；其他綜合收益攤銷； 809,000 美元的費用與正在建造但尚未開業的 de novo 設施的租賃有關；與 2024 年 4 月成功的債務再融資交易相關的 880 萬美元債務重組和清償費用；與 DeepHealth 雲端作業系統和生成式人工智慧開發相關的 330 萬美元非資本化研發費用。

Adjusting for the above items, total company adjusted earnings was $12 million and diluted adjusted earnings per share was $0.16 per share during the second quarter of 2024. This compares favorably with total company adjusted earnings of 2023 of $5.9 million and diluted adjusted earnings per share of $0.10 during last year's second quarter. For the second quarter of 2024, as compared with the prior year second quarter, MRI volume increased 16%, CT volume increased 14.8% and PET/CT volume increased 20.4%. Overall volume, taking into account all routine imaging exams, including inclusive of x-ray, ultrasound, mammography and all other exams, increased 9.2% over the prior year second quarter.

在上述項目進行調整後，2024 年第二季公司調整後總收益為 1,200 萬美元，稀釋調整後每股收益為 0.16 美元。相比之下，2023 年公司調整後總收益為 590 萬美元，去年第二季稀釋後調整後每股收益為 0.10 美元。2024年第二季度，與去年第二季度相比，MRI檢查量增加了16%，CT檢查量增加了14.8%，PET/CT檢查量增加了20.4%。考慮到所有常規影像檢查（包括 X 光、超音波、乳房 X 光檢查和所有其他檢查）的總數比去年第二季度增加了 9.2%。

On a same-center basis, including only of those centers which were part of RadNet for both the second quarters of 2024 and 2023, MRI volume increased 11.7%, CT volume increased 9.9% and PET/CT volume increased 13.7%. Overall same-center volume, taking into account all routine imaging exams, increased 6.1% over the prior year's same quarter. In the second quarter of 2024, we performed 2,785,804 total procedures. The procedures were consistent with our multi-modality approach, whereby 73.5% of all the work we did by volume was from routine imaging.

在同一中心基礎上，僅包括 2024 年第二季和 2023 年第二季 RadNet 的中心，MRI 數量增加了 11.7%，CT 數量增加了 9.9%，PET/CT 數量增加了 13.7%。考慮到所有常規影像檢查，同中心的總體數量比去年同期增加了 6.1%。2024 年第二季度，我們總共執行了 2,785,804 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 73.5% 來自常規成像。

Since we now have a table of our aggregate procedure volumes broken down my modality in our earnings release, I won't go through the numbers, but we'll make the following point. In his remarks, Dr. Berger mentioned that we are experiencing a slow shift to higher acuity procedures or what we call advanced imaging. In the second quarter, 26.5% of our procedures were from MRI, CT and PET/CT. In last year's second quarter, this metric was 25%, which represents a shift of 1.5% of all of our procedure volume this year towards advanced imaging.

由於我們現在有了一張匯總程序量表，詳細說明了我在收益發布中的方式，因此我不會詳細說明這些數字，但我們將提出以下觀點。伯傑博士在演講中提到，我們正在經歷向更高敏銳度手術或我們所說的高級影像的緩慢轉變。第二季度，我們 26.5% 的手術來自 MRI、CT 和 PET/CT。去年第二季度，這項指標為 25%，這意味著今年我們所有手術量的 1.5% 轉向了高階影像。

The higher pricing and the better margins that the more advanced imaging procedures have improves our financial results, including our operating margins. Overall GAAP interest expense for the second quarter of 2024 was $26.1 million as compared with $16 million during last year's second quarter. In the second quarter of 2024, cash interest expense, which includes payments to and from counterparties on interest rate swaps and net interest income from our cash balance, was $3.8 million. This compares with $12.4 million in the second quarter of 2023.

更先進的成像程序帶來的更高的定價和更好的利潤改善了我們的財務業績，包括我們的營業利潤。2024 年第二季的整體 GAAP 利息支出為 2,610 萬美元，去年第二季為 1,600 萬美元。2024 年第二季度，現金利息支出為 380 萬美元，其中包括向交易對手支付和從交易對手支付的利率互換費用以及我們現金餘額的淨利息收入。相比之下，2023 年第二季的銷售額為 1,240 萬美元。

The lower cash interest this quarter is primarily the result of significantly more interest income on the larger cash balances as well as the timing of cash interest paid on our term loan. With regards to the balance sheet, as of June 30, 2024, unadjusted for bond and term loan discounts, we had $301.6 million of net debt, which is our total debt at par value less our cash balance. Note that this debt balance includes New Jersey Imaging Network's debt of $140.6 million for which RadNet is neither a borrower nor a guarantor, and it includes NJIN's cash balance of $86.5 million.

本季現金利息較低的主要原因是較大現金餘額的利息收入顯著增加以及定期貸款支付現金利息的時間。就資產負債表而言，截至 2024 年 6 月 30 日，未經債券和定期貸款折扣調整，我們的淨債務為 3.016 億美元，這是我們按面值計算的總債務減去現金餘額。請注意，該債務餘額包括新澤西成像網絡 1.406 億美元的債務（RadNet 既不是藉款人也不是擔保人），還包括 NJIN 的 8,650 萬美元現金餘額。

This company-wide net debt compares with $518.9 million of net debt as of June 30, 2023. As of March 31, 2024 -- excuse me, as of June 30, 2024, we were undrawn on our $282 million of revolving credit line, and we had a cash balance of $741.7 million. At June 30, 2024, our accounts receivable balance was $195.3 million, an increase of $31.6 million from year-end 2023. The increase in accounts receivable is primarily the result of increased business, some collection delays resulting from the cyber attack unchanged health care and the normal effect of cash collections from the resetting of patient deductibles each year in January.

截至 2023 年 6 月 30 日，該公司範圍內的淨債務為 5.189 億美元。截至 2024 年 3 月 31 日——對不起，截至 2024 年 6 月 30 日，我們的循環信貸額度尚未動用，金額為 2.82 億美元，現金餘額為 7.417 億美元。截至2024年6月30日，我們的應收帳款餘額為1.953億美元，比2023年底增加3,160萬美元。應收帳款的增加主要是由於業務增加、網路攻擊導致醫療保健不變而導致的一些收款延遲以及每年一月份重新設定患者免賠額而產生的現金收款的正常影響。

Our DSOs, or days sales outstanding, was 34.9 days at June 30, near a historic low and flat from the end of the first quarter of 2024. Through June 30, 2024, we had total capital expenditures net of proceeds from the sale of imaging equipment of $98.6 million. This total includes $6.9 million spent under equipment notes and the remainder spent in cash and excludes $12.4 million of New Jersey Imaging Network capital expenditures.

截至 6 月 30 日，我們的 DSO（即應收銷售天數）為 34.9 天，接近歷史低點，與 2024 年第一季末持平。截至 2024 年 6 月 30 日，扣除銷售影像設備收益後的總資本支出為 9,860 萬美元。這一總額包括 690 萬美元的設備票據支出和其餘的現金支出，不包括 1,240 萬美元的新澤西成像網路資本支出。

Note that each year, we front-load the majority of our capital decisions into the first part of the year and have been spending extraordinarily on growth CapEx to fund the de novo facilities in construction. At this time, I'd like to update and revise our 2024 fiscal year guidance levels, which we released in conjunction with our fourth quarter and year-end 2023 results and which we amended after reporting our first quarter 2024 financial results in May.

請注意，每年，我們都會將大部分資本決策提前到今年上半年，並在成長資本支出上投入大量資金，為建設中的從頭設施提供資金。目前，我想更新和修改我們的 2024 財年指導水平，該指導水平是我們與 2023 年第四季度和年底業績一起發布的，並在 5 月份報告 2024 年第一季度財務業績後進行了修改。

Given the positive trends we are experiencing in virtually all aspects of our business and the strong financial performance of the first and second quarters, we are revising upwards certain guidance levels in anticipation of financial results that we believe will exceed our original and revised expectations. We amended our previously announced guidance levels as follows: For revenue, we increased our guidance ranges by $10 million at the low and the high end; for EBITDA, we increased our -- and that range is now $1.685 billion to $1.735 billion. We increased our EBITDA guidance range by $2 million at the low and the high ends to $257 million to $260 million in the Imaging Center segment; we also increased our capital expenditures in the Imaging Center segment by $5 million to $135 million to $145 million; we lowered our cash interest expense as a result of the refinancing transaction and the higher cash balance to $32 million to $37 million, which is a lowering of $5 million of cash interest expense; and we increased our free cash flow guidance range by $4 million to $72 million to $80 million in the Imaging Center segment.

鑑於我們業務的幾乎所有方面都經歷了積極的趨勢，以及第一季和第二季的強勁財務業績，我們正在上調某些指導水平，以期我們相信財務業績將超出我們最初和修訂後的預期。我們對先前公佈的指導水準進行瞭如下修改：對於收入，我們將低端和高端指導範圍提高了 1000 萬美元；對於 EBITDA，我們提高了——目前該範圍為 16.85 億美元至 17.35 億美元。我們將影像中心部門的 EBITDA 指引範圍從低端和高端提高了 200 萬美元，達到 2.57 億至 2.6 億美元；我們也將影像中心部門的資本支出增加了 500 萬美元，達到 1.35 億至 1.45 億美元；由於再融資交易和現金餘額增加至 3,200 萬至 3,700 萬美元，我們降低了現金利息支出，即減少了 500 萬美元的現金利息支出；我們將影像中心部門的自由現金流指引範圍提高了 400 萬美元至 7,200 萬美元至 8,000 萬美元。

For the Digital Health segment, our guidance ranges all remain the same, and we are on track to meet the originally anticipated projections. I'll now take a few minutes to give you an update on 2025 Medicare reimbursement. As a reminder, Medicare reimbursement represents about 22% of our business mix. With respect to Medicare reimbursement several weeks ago, we received a matrix for proposed rates by CPT code, which is typically part of the physician fee schedule proposal that is released about this time every year.

對於數位健康領域，我們的指導範圍均保持不變，並且我們有望實現最初預期的預測。現在我將花幾分鐘時間向您介紹 2025 年 Medicare 報銷的最新情況。提醒一下，醫療保險報銷約占我們業務組合的 22%。關於醫療保險報銷，幾週前，我們收到了一個以 CPT 代碼列出的建議費率矩陣，該矩陣通常是每年這個時候發布的醫生費用表提案的一部分。

We have completed an initial analysis and compared those rates to 2024 rates. We volume weighted our analysis using expected 2025 procedural volumes. As you may recall, four years ago, CMS moved forward with increased reimbursement for evaluation and management CPT codes, which favor certain physician specialties that regularly bill for these services, particularly primary care doctors. CMS proposed doing so with budget neutrality, meaning that it proposed to reallocate reimbursement from physicians who rarely bill for E&M codes to physicians who regularly bill for these codes.

我們已經完成了初步分析，並將這些比率與 2024 年的比率進行了比較。我們使用預期的 2025 年程序數量對我們的分析進行了數量加權。您可能還記得，四年前，CMS 加大了對評估和管理 CPT 代碼的報銷力度，這有利於定期為這些服務付費的某些專業醫生，尤其是初級保健醫生。CMS 建議在預算中立的情況下這樣做，這意味著它建議將很少按 E&M 代碼計費的醫生的報銷重新分配給經常按這些代碼計費的醫生。

As a result, radiology and most other specialties experienced cuts in reimbursement from 2021 through 2024, which was an intentional phase-in of the reimbursement cuts to pay for the reimbursement benefit being provided to primary care physicians. The cuts we are currently facing in 2024 were substantially mitigated by congressional legislation that was passed in March of this year as part of the Consolidated Appropriations Act. In the proposed rule, we received several weeks ago governing 2025 reimbursement, Medicare appears to effectively be phasing in the remainder of the E&M code related cut avoided last year and this year.

因此，從 2021 年到 2024 年，放射科和大多數其他專業的報銷費用都被削減，這是有意分階段削減報銷費用，以支付向初級保健醫生提供的報銷福利。今年 3 月作為《綜合撥款法》一部分通過的國會立法大大緩解了我們目前面臨的 2024 年削減。在幾週前我們收到的關於 2025 年報銷的擬議規則中，醫療保險似乎實際上正在分階段實施去年和今年避免的 E&M 法規相關削減的剩餘部分。

The cut proposed for 2025 results from a decrease in the conversion factor in the Medicare fee schedule by about 2.8% from $33.29 down to $32.36, along with certain minor changes to the RVUs of certain radiology CPT codes. Our initial analysis of the proposal for next year implies that RadNet on roughly $1.8 billion in revenue would face an approximate $6 million to $8 million revenue hit in 2025 from its Medicare business. Because the proposed decrease in the conversion factor affects all physicians, not just radiologists, there are many lobbying groups from the various medical specialties aggressively opposing the cut, including radiology's two main lobbying forces, the Association for Quality Imaging, or AQI, and the American College of Radiology, the ACR.

2025 年擬議的削減是由於醫療保險費用表中的轉換係數降低了約 2.8%，從 33.29 美元降至 32.36 美元，以及某些放射科 CPT 代碼的 RVU 進行了一些微小的變化。我們對明年提案的初步分析表明，收入約為 18 億美元的 RadNet 到 2025 年將面臨醫療保險業務收入約 600 萬至 800 萬美元的打擊。由於擬議的轉換係數降低影響到所有醫生，而不僅僅是放射科醫生，因此來自各個醫學專業的許多遊說團體強烈反對削減，其中包括放射學的兩個主要遊說力量，質量成像協會（AQI）和美國醫學會放射學院，ACR。

At this time, our experts believe there is a high probability that the final rule governing next year's Medicare payments will be less severe than the current proposal as a result of congressional action that could take place later this year. In November of this year, during our third quarter financial results call, we hope to have a more fulsome update on this matter. While the $6 million to $8 million cut to RadNet's revenue next year is not insignificant, we have reimbursement increases scheduled from capitated and commercial payers that will fully mitigate this Medicare reduction should it go into effect as currently (technical difficulty). I'd like now to turn the call back over to Dr. Berger, who will make some closing remarks.

目前，我們的專家認為，由於國會可能在今年稍後採取行動，明年醫療保險支付的最終規則很可能不會像當前提案那麼嚴格。今年 11 月，在我們的第三季財務業績電話會議上，我們希望就此事獲得更全面的更新。雖然 RadNet 明年的收入削減 600 萬至 800 萬美元並非無關緊要，但我們已計劃增加按人頭付款和商業付款人的報銷金額，如果目前生效，這將充分緩解醫療保險的減少（技術難度）。現在我想將電話轉回伯傑博士，他將做一些總結演講。

Thank you, Mark. As we progress through the second half of the year, we continue to be excited about the future opportunities in RadNet. Our core imaging business, which we are experiencing continuing trends that we believe are sustainable for the foreseeable future. The shift from more expensive hospital imaging to more cost-effective outpatient imaging should continue. We also expect the growing demand for advanced imaging to continue well into the future.

謝謝你，馬克。隨著下半年的進展，我們繼續對 RadNet 的未來機會感到興奮。我們的核心成像業務正在經歷持續的趨勢，我們相信在可預見的未來是可持續的。從更昂貴的醫院影像向更具成本效益的門診影像的轉變應該繼續下去。我們也預計，對先進成像的需求將在未來持續成長。

This is being driven by technology advances in equipment, contrast materials, radioactive pharmaceuticals, post-processing software and artificial intelligence, all of which drive new applications for utilizing diagnostic imaging, particularly in the population health and screening tools.

這是由設備、造影材料、放射性藥物、後處理軟體和人工智慧方面的技術進步所推動的，所有這些都推動了診斷成像的新應用，特別是在人口健康和篩檢工具方面。

Prostate, Alzheimer's, coronary cardiac angiography, lung cancer screening, just to name a few, will be opportunities for more advanced imaging utilization. Furthermore, our health system partnership model continues to gain traction as we are engaged in discussions with several new health systems to establish partnerships and work with existing partners to expand joint ventures, which we are already in operation.

前列腺癌、阿茲海默症、冠狀動脈造影、肺癌篩檢等將成為更先進影像技術應用的機會。此外，我們的衛生系統合作夥伴模式繼續受到關注，因為我們正在與幾個新的衛生系統進行討論以建立合作夥伴關係，並與現有合作夥伴合作擴大我們已經在運營的合資企業。

While Digital -- within Digital Health, we are making significant progress with initiatives that are poised to help us drive more revenue, reduce costs and increase margins. We continue to work towards the commercial launch of our new DeepHealth operating system technology platform in the fourth quarter of 2024. DeepHealth OS will be the delivery platform for solutions that automate business processes and more effectively manage patient and clinical data, including automating patient scheduling, clinical reporting, medical coding, sales and marketing and clinical workflow. The end result will be an improved patient experience.

在數位健康領域，我們正在透過旨在幫助我們增加收入、降低成本和增加利潤的措施取得重大進展。我們持續致力於在 2024 年第四季推出新的 DeepHealth 作業系統技術平台。DeepHealth OS 將成為自動化業務流程並更有效管理患者和臨床數據的解決方案的交付平台，包括自動化患者調度、臨床報告、醫療編碼、銷售和行銷以及臨床工作流程。最終結果將是改善患者體驗。

In parallel to the DeepHealth operating system development, we are continuing to grow revenue from clinical AI solutions for breast, lung and prostate cancer screening. Our breast AI is improving the productivity and accuracy of our radiologists while improving a valuable benefit -- while providing a valuable benefit to our patients for which they are willing to self-pay.

在開發 DeepHealth 作業系統的同時，我們也持續增加乳癌、肺癌和攝護腺癌篩檢臨床人工智慧解決方案的收入。我們的乳房人工智慧正在提高放射科醫生的工作效率和準確性，同時提高寶貴的效益，同時為我們願意自付費用的患者提供寶貴的效益。

We are formulating similar screening programs for prostate, lung and other chronic diseases for both domestic and international markets as we firmly believe that health care needs to shift towards prevention and early detection and not just focus on treating patients who are already presenting with serious symptomatology. We are also working with imaging equipment manufacturers in efforts to make their technology smarter and more capable.

我們正在為國內和國際市場制定類似的前列腺、肺部和其他慢性疾病篩檢計劃，因為我們堅信醫療保健需要轉向預防和早期發現，而不僅僅是專注於治療已經出現嚴重症狀的患者。我們也與成像設備製造商合作，努力使他們的技術更聰明、更強大。

Operator, we are now ready for the question-and-answer portion of the call.

接線員，我們現在已準備好進行通話的問答部分。

(Operator Instructions) Brian Tanquilut, Jefferies.

（操作員說明）Brian Tanquilut，Jefferies。

Hey, good morning, guys, and congrats on a solid quarter. Maybe, Howard, as I think about AI made to start, I know there's a lot of moving pieces there. You guys are working on a lot of things. So for investors on the call for us, what are the catalysts or the developments that we need to watch out for? What are you working on that we need to keep an eye out for, for the next 6 to 12 months on the AI front?

嘿，早安，夥計們，祝賀本季業績穩定。霍華德，也許，當我想到人工智慧的開始時，我知道那裡有很多移動的部分。你們正在做很多事。那麼，對於我們的投資者來說，我們需要關注哪些催化劑或發展？未來 6 到 12 個月，在人工智慧領域，我們需要密切關注您的哪些工作？

Good morning, Brian. Hope you're well. I think the main focus, which hopefully will be reflected in our results, is the deployment of the DeepHealth operating system internally to the RadNet-owned centers. That's probably the place where we're going to get the first indications of how these new tools will better improve the patient experience as well as the clinical adoption. And that, I think, will drive improved margins in our business.

早安，布萊恩。希望你一切都好。我認為主要焦點（希望能夠反映在我們的結果中）是將 DeepHealth 作業系統內部部署到 RadNet 擁有的中心。這可能是我們將獲得有關這些新工具如何更好地改善患者體驗以及臨床採用的第一個跡象的地方。我認為，這將提高我們業務的利潤率。

But the importance of this is that we can implement these tools make them ready for prime time, if you will, and improve the likelihood of success in the external implementation and commercialization of these, which we expect to begin in 2025. What is unique about RadNet maybe as much as any other single facet is the enormous amount of data that we own that is helping drive the development of these new tools and which others outside are recognizing the value of our tapping into RadNet to further collaborate on development of products, both for RadNet and the commercial market.

但這一點的重要性在於，如果您願意的話，我們可以實施這些工具，讓它們為黃金時段做好準備，並提高這些工具的外部實施和商業化的成功可能性，我們預計將於2025 年開始。RadNet 的獨特之處可能與其他任何單一方面一樣，是我們擁有的大量數據正在幫助推動這些新工具的開發，而外部其他人也認識到我們利用 RadNet 進一步合作開發的價值產品，適用於RadNet 和商業市場。

So I think in the early stages of this, which are already beginning and which I hope to be able to report on more substantively, certainly at the end of the third quarter, but more particularly with the end of the year's results, we see great opportunity, which was the primary reason why we developed this interest in not only the clinical side of artificial intelligence but the generative side, which will address not only improving our margins but addresses the continuing issue we have with challenges in hiring and recruiting and therefore, leading to automation that will make all of our current employees that much more efficient and comfortable.

因此，我認為在這個階段的早期階段，已經開始，我希望能夠更實質地報告，當然在第三季末，但更特別的是在今年年底的結果中，我們看到了很好的結果機會，這是我們不僅對人工智慧的臨床方面而且對生成方面產生興趣的主要原因，這不僅可以提高我們的利潤，還可以解決我們在招聘和招聘方面面臨的持續挑戰，因此，實現自動化將使我們所有現有員工變得更有效率和舒適。

So it's perhaps a little longer answer, Brian, than you wanted. But I think looking at -- continuing to look at expanding margins and deployment internally of RadNet, which as I want to emphasize, has already begun will be where I think we'll see the early results of the investment and expertise that we have.

所以布萊恩，這個答案可能比你想要的還要長。但我認為，繼續專注於擴大 RadNet 的利潤和內部部署，正如我想強調的那樣，這已經開始，我認為我們將看到我們所擁有的投資和專業知識的早期結果。

That's awesome. And then maybe, Mark, as I look at the balance sheet, obviously, you're sitting on a good chunk of cash. I'm guessing you're looking to deploy that at some point. So I'm just curious how you're thinking about capital deployment and what you're seeing in the market for acquisitions today?

太棒了。然後，馬克，當我查看資產負債表時，顯然，你坐擁大量現金。我猜您希望在某個時候部署它。所以我只是好奇您如何考慮資本部署以及您在當今的收購市場上看到了什麼？

Yes. Maybe that's something better that I can answer (inaudible) at this point. But we're very carefully assessing deploying that capital in both segments of the company, the Digital Health division as well as the Imaging Center segment. We have -- as we've always had in the past, a number of acquisitions constantly that we're looking at, most of those in the past have, as you well know, Brian, been more of our tuck-in acquisitions, which we tend to try to accomplish in the 3 to 5 times EBITDA range.

是的。也許這是我現在可以回答的更好的問題（聽不清楚）。但我們正在非常仔細地評估在公司的兩個部門（數位健康部門和成像中心部門）部署這些資本。正如我們過去一直在進行的那樣，我們正在不斷地進行一些收購，正如你所知道的，布萊恩，過去的大多數收購更多的是我們的收購，我們傾向於嘗試在EBITDA 的3 到5 倍範圍內實現此目標。

But there may be other larger acquisitions that could stretch that multiple for what we would call very strategic investments that we would be looking at that would expand our geographic presence in the Imaging Center division. But we need to also be mindful of the opportunities that we have in the Digital Health division to improve the tools that we're working on and add other tools that I believe will complement the opportunity to roll out a broader artificial intelligence platform.

但可能還有其他更大規模的收購，可以擴大我們所說的非常策略性投資的倍數，我們將考慮這些投資，以擴大我們在成像中心部門的地理影響力。但我們也需要注意數位健康部門所擁有的機會，以改善我們正在開發的工具，並添加其他工具，我相信這些工具將補充推出更廣泛的人工智慧平台的機會。

At the end of the day, I think artificial intelligence on both the clinical and the generative side will be transformative for radiology, perhaps more than any other specialty. And I think people will be looking for two important tools in making their decisions as to who they want to be their provider. The first one will be cloud adoption. I think there's no way to avoid having the functionality that health systems and large-scale operators like RadNet will require in order to create the efficiencies that only cloud technology will provide along with what we believe will be improved cybersecurity to protect this data from cyber terrorists, if you will, or hackers.

歸根結底，我認為臨床和生成方面的人工智慧都將為放射學帶來變革，也許比任何其他專業都更具變革性。我認為人們會尋找兩個重要的工具來決定他們希望誰成為他們的提供者。第一個是雲的採用。我認為，沒有辦法避免擁有衛生系統和像RadNet 這樣的大型營運商所需的功能，以創造只有雲端技術才能提供的效率，以及我們認為將改進的網路安全性，以保護這些數據免受網路恐怖分子的侵害。

The other part of this, though, is that there's going to be hundreds, I probably would be comfortable saying of artificial intelligence clinical tools that will be useful in various parts of the health care industry. A lot of them, as I mentioned before, could be related to population health and screening tools, which we're already experiencing a huge growth in, not just in cancer screening, but also cardiac screening, which I believe will be a big part of AI and screening in the future.

然而，另一部分是，我可能會輕鬆地說，將有數百種人工智慧臨床工具將在醫療保健產業的各個領域發揮作用。正如我之前提到的，其中許多可能與人口健康和篩檢工具有關，我們已經在這方面經歷了巨大的增長，不僅在癌症篩檢方面，而且在心臟篩檢方面，我相信這將是一個重要組成部分未來的人工智慧和篩檢。

But other specific targeted AI tools that will help improve the accuracy of diagnosis, both on the hospital side as well as the outpatient side that will need to be incorporated. And the breadth of all of these AI tools will benefit from or, let's say, the people that offer this will benefit if they can consolidate this onto a single platform rather than putting the burden on either the hospital or the imaging centers to try to integrate from multiple different sources.

但其他有針對性的人工智慧工具將有助於提高診斷的準確性，無論是在醫院方面還是在門診方面，都需要納入其中。所有這些人工智慧工具的廣度都將從中受益，或者說，如果提供此工具的人能夠將其整合到一個平台上，而不是給醫院或成像中心增加嘗試整合的負擔，那麼他們將受益來自多個不同的來源。

So you've probably already seen in the marketplace where there are companies that talk about doing that integration or platform for AI. And I assure you, RadNet will be in the pick of that, whether we own those AI tools or whether we simply provide them on some license basis for our customers.

因此，您可能已經在市場上看到有些公司正在談論為人工智慧進行整合或平台。我向您保證，無論我們是否擁有這些人工智慧工具，還是我們只是在某種許可的基礎上為我們的客戶提供它們，RadNet 都會做出選擇。

David MacDonald, Truist.

大衛麥克唐納，真理主義者。

Good morning, guys. A couple of quick questions. I wanted to just briefly come back to the volume strength in the quarter. You guys talked a little bit about the de novo development activity. I'm wondering if you could also just touch on your remote capabilities, equipment efficiency and what you're seeing on throughput, access to labor to meet these -- meet the demand that you guys are seeing? Just any additional detail there would be helpful.

早安，夥計們。幾個簡單的問題。我想簡單回顧一下本季的成交量強度。你們談論了一些從頭開始開發活動。我想知道您是否也可以談談您的遠端能力、設備效率以及您所看到的吞吐量、勞動力獲取以滿足這些需求——滿足您所看到的需求？只要有任何額外的細節都會有幫助。

I'll be happy to take that. Thanks, Dave. Well, you brought up a point which I have failed to mention earlier, but we have talked about it in the past. And that is smart technology, if you will, to help address both the efficiency and labor shortages that we have. We currently use a product called the remote center operations to manage a lot of the MRs that we do daily that are overseen by technologists who are not necessarily on site.

我很樂意接受。謝謝，戴夫。嗯，你提出了一個我之前沒有提到的觀點，但我們過去已經討論過。如果你願意的話，這就是智慧技術，可以幫助解決我們的效率和勞動力短缺問題。目前，我們使用一種稱為遠端中心操作的產品來管理我們每天執行的大量 MR，這些操作由不一定在現場的技術人員進行監督。

That technology, which we have in the past been purchasing, we are now developing and beginning to implement ourselves a product and an implementation that we call tech live.

我們過去一直在購買這項技術，現在我們正在開發並開始實施我們稱之為「tech live」的產品和實施。

And that, as I mentioned, has just begun implementation here in this second quarter and which we will accelerate towards the end of the year. But the importance of this is that we believe that the same tools are capable of being implemented -- designed and implemented for basically all of the imaging modalities that we operate. So not just MR, but CT, PET/CT, x-ray, ultrasound, nuclear medicine, and that is the future, if you will, not only because of the efficiencies that it creates and improved quality, but also, as I've stressed over and over again, the limitations that are the band of the existence for everybody in health care, but particularly in imaging of available staffing.

正如我所提到的，這一點剛剛在第二季開始實施，我們將在年底加速實施。但這一點的重要性在於，我們相信相同的工具能夠被實施——為我們操作的基本上所有成像模式設計和實施。因此，不僅僅是 MR，還有 CT、PET/CT、X 射線、超音波、核醫學，如果你願意的話，這就是未來，不僅因為它創造的效率和提高的質量，而且正如我所說我們一再強調，醫療保健領域每個人都存在局限性，特別是在現有人員配置方面。

If I were able to flip a switch and open all of our rooms for all the demand that we are currently getting, you would see a large increase in our revenues and subsequently in our profitability. But this is not an overnight process. It's one that we're working both internally and externally with other partners, both on the technology side and on the recruiting and staffing and educational side of this, if you will. But that is the future smart technology I want to introduce that term because you'll be hearing more of it in the very near future from us about how we're working with the OEMs in trying to enhance the productivity of their equipment by putting these kinds of tools, which we uniquely have onto their equipment or integrating with their equipment.

如果我能夠打開開關並打開我們所有的房間來滿足我們當前收到的所有需求，您會看到我們的收入大幅增加，隨後我們的盈利能力也會大幅增加。但這不是一朝一夕的過程。我們正在與其他合作夥伴在內部和外部進行合作，無論是在技術方面還是在招募、人員配置和教育方面（如果你願意的話）。但這就是未來的智慧技術，我想介紹這個術語，因為在不久的將來，您會從我們這裡聽到更多關於我們如何與原始設備製造商合作，透過將這些各種工具，我們獨特地將其安裝在他們的設備上或與他們的設備整合。

So all of that will fall into a broadened effort in our Digital Health division, which we're all extremely excited here, again, not only because of what it represents in terms of the future for health care, but a new avenue for continued growth of RadNet in a different area other than just the Imaging Center segment by itself. So I think these future tools will take up more and more of our close call conferences as well as announcements that we'll be making.

因此，所有這些都將屬於我們數位健康部門的更廣泛的努力，我們再次對此感到非常興奮，不僅因為它代表了醫療保健的未來，而且因為它是持續增長的新途徑RadNet 在不同領域的應用，而不僅僅是成像中心領域本身。因此，我認為這些未來的工具將佔據我們越來越多的千鈞一發的會議以及我們將要發布的公告。

But we intend to be very aggressive in investing in both sides of our business because they really -- they're really synergistic. And the more centers they have, the better that we can develop the new tools, and the more tools we create, the bigger market opportunity that there is for us.

但我們打算非常積極地投資我們的業務雙方，因為它們確實具有協同作用。他們擁有的中心越多，我們就越能更好地開發新工具，而我們創造的工具越多，我們的市場機會就越大。

Okay. And then, guys, just two others. Just on the de novos, given that these are being added in markets where you have demand backlogs, can you just talk about the profitability ramp and the return on invested capital of these relative to where it was maybe a couple of years ago? And then the other question I had was just any early learnings or feedback from the Houston market, whether that's incoming calls from other practices, potentially hospital JV partners or just any high-level observations from Houston?

好的。然後，夥計們，還有另外兩個人。就從頭開始，考慮到這些產品是在有需求積壓的市場中添加的，您能否談談相對於幾年前的盈利能力提升和投資資本回報率？然後我的另一個問題是來自休士頓市場的任何早期經驗或回饋，無論是來自其他診所、潛在的醫院合資夥伴的來電，還是來自休士頓的任何高層觀察？

Yes, sure. So I'll take the de novo portion of the question first, Dave. Because the de novo centers have been focused in areas where we have heavy patient demand, including significant backlogs or in the case of about half of the de novo centers that we have in development today, which are in hospital joint ventures, these are situations where we believe we can fill the patient -- the new centers patient volume very quickly faster than historically we've been able to do.

是的，當然。所以我將首先回答問題的從頭部分，戴夫。因為 de novo 中心一直集中在我們病患需求量大的領域，包括大量積壓，或者我們目前正在開發的大約一半的 de novo 中心位於醫院合資企業，這些情況我們相信我們能夠比以往更快地容納新中心的患者數。

Although de novos have always been part of our business, historically, the pace at which we're opening them today exceeds that pace that we've ever done in the past. And that's because of these patient volumes. So typically, historically, we've seen that it could take several quarters to a year for a de novo center to ramp up and start contributing positively to our EBITDA. What we're seeing with the recent de novos and what we expect with the de novos that we have under construction currently is that they're ramping up much more quickly.

儘管從頭開始一直是我們業務的一部分，但從歷史上看，我們今天開放它們的速度超過了我們過去的速度。這是因為患者數量龐大。因此，從歷史上看，我們通常會看到，從頭開始中心可能需要幾個季度到一年的時間才能擴大規模並開始為我們的 EBITDA 做出積極貢獻。我們從最近的 de novo 中看到的以及我們對目前正在建設中的 de novo 的預期是，它們的增長速度要快得多。

And within a quarter or two, they're already starting to have a positive EBITDA contribution. So if you go back 20, 30 years in this industry, Dave, there was a point where there existed overcapacity in the industry as a whole on the outpatient side with 6,000 to 7,000 imaging centers that has existed for now a couple of decades.

一、兩個季度內，他們就已經開始產生正的 EBITDA 貢獻。所以，戴夫，如果你回顧這個行業 20、30 年前，整個行業在門診方面就存在產能過剩的情況，有 6,000 到 7,000 個影像中心，而這些中心已經存在了幾十年。

And what happened is that as the industry has steadily grown each year, the industry itself has grown into that overcapacity, where today, that overcapacity doesn't exist. And so in order for us to create the capacity that we need to service the patient volumes, we either have to buy somebody that has capacity that we could then fill which is less available today than in the past or we have to build it ourselves. And so that's what we've been doing. And the ramp-up that we're seeing in these de novo centers is happening much more quickly.

實際情況是，隨著該行業每年穩步增長，該行業本身已經出現了產能過剩，而如今，這種產能過剩已經不存在了。因此，為了讓我們能夠創造出為患者提供服務所需的能力，我們要么必須購買具有我們可以填補的能力的人，而今天的能力比過去少，要么我們必須自己建造它。這就是我們一直在做的事情。我們在這些從頭中心看到的成長速度要快得多。

With respect to the second part of your question, with Houston, I'll let Dr. Berger comment.

關於休士頓問題的第二部分，我將讓伯傑博士發表評論。

Okay. Yes, I think we've -- the fact that we entered the Houston market has already presented itself with other opportunities. One of which the second acquisition that we did, we closed this quarter and then there's other operators that are talking to us. So we expect to make announcements about continued expansion in the Houston market and potentially look at de novos that might be appropriate there. In that regard, I just want to amplify one thing that Mark mentioned.

好的。是的，我認為我們進入休士頓市場的事實已經為我們帶來了其他機會。其中之一是我們進行的第二次收購，我們在本季度完成了收購，然後還有其他營運商正在與我們交談。因此，我們預計將宣布休士頓市場的持續擴張，並可能考慮在那裡可能合適的從頭開始。在這方面，我只想強調馬克提到的一件事。

And with the validation, I think, of doing de novos is really looking at that, even though about 3/8 of our centers are in joint ventures with hospital systems, 50% of the de novos are in those joint ventures.

我認為，經過驗證，從頭開始確實是在考慮這一點，儘管我們大約 3/8 的中心是與醫院系統的合資企業，但 50% 的從頭開始是在這些合資企業中。

And I think the significance of that is that all of the systems that we're dealing with are experiencing the same issues that RadNet's wholly owned centers are, and that is capacity either to take on the shift away from the hospital's outpatient work as well as the increasing demand for outpatient imaging. As Mark highlighted, I think what was our -- Mark, our year-over-year same-store growth? 6.5%?

我認為這一點的重要性在於，我們正在處理的所有系統都遇到了與 RadNet 全資中心相同的問題，即承擔從醫院門診工作轉移的能力以及門診成像的需求不斷增加。正如馬克所強調的那樣，我想我們的——馬克，我們的同店同比增長是多少？6.5%？

6.1%.

6.1%。

6.1%, which I believe was about what it was last quarter or somewhere in there, maybe even in that ballpark. But the fact of the matter is these are the benchmarks by which we're using the decision-making as to where we're deploying capital. And in a way, the market should almost look at our de novo centers as really in lieu of acquisitions. And so rather than paying higher multiples, what we're doing is building out these in areas where we know we have that capacity and demand.

6.1%，我相信這大約是上個季度的水平，或者是那個季度的水平，甚至可能是這個水平。但事實是，這些是我們在部署資本的決策中所依據的基準。在某種程度上，市場幾乎應該將我們的從頭中心視為真正取代收購的。因此，我們所做的不是支付更高的倍數，而是在我們知道擁有這種能力和需求的領域建立這些設施。

And again, I'll point out that half of those are coming from our hospital joint venture partners who would not be giving their approval for this expansion. If they did not have the same sense of need to add this capacity in a market, meaning the imaging market, which is growing at 2 times to 3 times the rate that it has in the past.

再次，我要指出，其中一半來自我們的醫院合資夥伴，他們不會批准這次擴張。如果他們沒有同樣的意識需要在市場中增加這種容量，這意味著成像市場的成長速度是過去的 2 倍到 3 倍。

Okay. Thanks very much.

好的。非常感謝。

Thanks, Dave.

謝謝，戴夫。

John Ransom, Raymond James.

約翰·蘭塞姆，雷蒙德·詹姆斯。

So a question I am getting is just on margin flow-through. So on our model, I mean, you guys were well ahead on revenue, about $20 million, but the EBITDA flow-through was a bit less. So the margin was maybe 50 bps less than we would have guessed even -- and we were at lower revenues. Is there anything with the margin flow-through in the quarter? Is it the de novos? Or is there something else going on?

所以我收到的一個問題就是關於保證金流通。因此，在我們的模型中，我的意思是，你們的收入遙遙領先，大約為 2000 萬美元，但 EBITDA 流量要少一些。因此，利潤率可能比我們的預期低 50 個基點，而且我們的收入也較低。本季的利潤流入有什麼變化嗎？是從頭開始嗎？還是還有其他事情發生？

Yes, John, let me take that. First of all, we were happy and proud to show margin expansion in this quarter relative to last year. Our total company EBITDA margin was up about 76 basis points, which is a function of a number of things. On the Imaging Center side, it's a function of the focus and the growth in the higher acuity exams or what we call advanced imaging, and there was about 150 basis point shift towards advanced imaging and away from routine imaging relative to last year's second quarter.

是的，約翰，讓我接受。首先，我們很高興也很自豪地看到本季的利潤率較去年有所增長。我們公司的 EBITDA 總利潤率成長了約 76 個基點，這是多種因素共同作用的結果。在影像中心方面，這是焦點和更高敏銳度檢查或我們所說的高級成像的增長的函數，與去年第二季度相比，向高級成像和遠離常規成像的轉變約為 150 個基點。

It's also a function of the fact that we have been successful in getting price increases, both from capitated as well as commercial payers. And it's been a focus of tight cost control as well as the growth in our Digital Health businesses because our Digital Health businesses have the promise and the capability of driving much higher margins, particularly the SaaS-based software businesses. So we are showing margin expansion.

這也是因為我們成功地從資本支付者和商業支付者那裡獲得了價格上漲。它一直是嚴格成本控制以及我們數位健康業務成長的重點，因為我們的數位健康業務有希望並有能力推動更高的利潤率，特別是基於 SaaS 的軟體業務。因此，我們正在展示利潤率擴張。

What I will tell you on the Imaging Center segment side is that our continued point of pain is on the labor front. We -- although we have been much more successful in the last 1.5 years in terms of recruiting and retaining talent, it has become simply more expensive to hire and retain talent. And so some of the growth -- the excellent growth that you're seeing on the top line is going towards higher salary benefits and wages in order to appropriately staff our centers and meet the heavy demand that we have. So that's what you are seeing on the flow-through is that a bigger portion of that flow-through is being allocated towards salary benefits and wages.

在影像中心領域，我要告訴您的是，我們持續的痛點是在勞動力方面。儘管我們在過去 1.5 年在招募和留住人才方面取得了更大的成功，但招募和留住人才的成本卻變得更高。因此，一些增長——您在營收上看到的出色增長將轉向更高的工資福利和工資，以便為我們的中心配備適當的人員並滿足我們的大量需求。因此，您在流動資金中看到的情況是，流動資金的很大一部分被分配給薪資福利和薪資。

Okay. And then likewise for the year, I mean, you bumped the revenue by 10% and the EBITDA by 2%. So it's just building in more for labor absorption of that incremental revenue.

好的。我的意思是，今年也是如此，您將收入提高了 10%，將 EBITDA 提高了 2%。因此，它只是為增加收入的勞動力吸收而增加更多的資金。

That's right. And just so you know, the way we -- our philosophy on guidance and revising guidance is that we look at the actual quarters, meaning the quarters that have already been reported and compare that relative to our initial budget. And if we're significantly -- and then what we do is we add the remaining quarters just at budget. So to the extent that we've overachieved the existing -- the already reported quarters and then we add the new budget, if that now takes us into a new guidance range, that's when we'll revise guidance ranges.

這是正確的。如您所知，我們對指導和修訂指導的理念是，我們查看實際季度，即已經報告的季度，並將其與我們的初始預算進行比較。如果我們顯著 - 那麼我們所做的就是按照預算添加剩餘的季度。因此，如果我們已經超額完成了現有的目標——已經報告的季度，然後我們添加新的預算，如果現在將我們帶入新的指導範圍，那麼我們就會修改指導範圍。

We don't generally reforecast the future quarters. So to the extent that we significantly beat the third and the fourth -- see that we beat in the third quarter, we could potentially adjust guidance thereafter. So we try to take a fairly conservative approach.

我們通常不會重新預測未來幾季。因此，如果我們顯著擊敗了第三季和第四季——看到我們在第三季擊敗了，我們可能會在此後調整指引。所以我們嘗試採取相當保守的方法。

John, let me just amplify one thing. I believe some of the slowing, if you will, of margin expansion may be partially attributed to the slower-than-anticipated implementation of our de novo centers. Here, we are in the midpoint of the year, where we're looking at, initially, I think, 12 imaging centers to be added. We still have six or seven more to go. These are large centers.

約翰，讓我強調一件事。我認為，如果你願意的話，利潤擴張的放緩可能部分歸因於我們的從頭中心的實施速度慢於預期。現在，我們正處於今年年中，我認為最初我們會考慮增加 12 個影像中心。我們還有六、七個任務要走。這些都是大型中心。

Many of the regions that we are building these out in have been compromised in terms of the people who approve construction plans, the regulatory issues that we have, getting radioactive material licenses, et cetera.

我們正在建造這些設施的許多地區在批准建設計劃的人員、我們面臨的監管問題、獲得放射性材料許可證等方面都受到了損害。

So I think it really underscores the importance of the de novo center growth because with the return that Mark described, those will significantly contribute to better margins than what we might experience -- what we might otherwise have achieved if we had just stretched to buy a bunch of centers that may not have had the same margins that we know we can build ourselves with the new centers.

因此，我認為這確實強調了從頭中心增長的重要性，因為隨著馬克所描述的回報，這些將大大有助於比我們可能經歷的更好的利潤——如果我們只是竭盡全力購買一個中心，我們可能會取得更好的利潤。

So Howard, that was a perfect segue. So Mark, one more number question. If we think about jumping off point in fourth quarter, and I know we already have to think about 2025. I mean you've highlighted the Medicare cuts potentially. I would imagine there's a good guy in terms of de novos running at fuller margins next year than this year as you're wrapping it up. But what are the puts and takes we should think of next year versus this year as we start refining our models?

霍華德，這是一個完美的延續。馬克，還有一個數字問題。如果我們考慮第四季的起點，我知道我們已經必須考慮 2025 年了。我的意思是你已經強調了醫療保險的潛在削減。我想在你即將結束的時候，明年會有一個從頭開始運行的好人，其利潤率會比今年更高。但是，當我們開始完善我們的模型時，與今年相比，明年我們應該考慮哪些看跌期權和看跌期權？

Yes, sure. And we'll talk much more about this as we get into the third and fourth quarters and produce those quarterly results. But yes, so we will have a $6 million to $8 million Medicare headwind. That will be fully mitigated and then some based upon pricing increases that we're getting from commercial insurance companies and capitated payers.

是的，當然。當我們進入第三和第四季度並產生這些季度業績時，我們將更多地討論這一點。但是，是的，因此我們將面臨 600 萬至 800 萬美元的醫療保險逆風。這將得到充分緩解，然後一些基於我們從商業保險公司和按人頭付費的付款人那裡獲得的定價上漲。

There obviously will be the additional contribution of the six de novo centers that we intend to open by year-end. We've opened three de novo centers already in the first two quarters of this year. Those will be fully operational for the entire year of 2025. Additionally, we have 15 de novo centers that are currently slated for opening in 2025. So if we're successful in opening all 15 or some portion thereof, those will already be additional contributing factors.

顯然，我們計劃在年底前開設的六個從頭中心將做出額外貢獻。今年前兩個季度我們已經開設了三個 de novo 中心。這些設施將於 2025 年全年全面投入營運。此外，我們還有 15 個 de novo 中心，目前計劃於 2025 年開幕。因此，如果我們成功開放全部 15 個或其中的一部分，那麼這些就已經是額外的影響因素。

Additionally, the Houston acquisitions, which we did this year on April 1 and June 1, those 13 centers will now be contributing for the entire year of 2025. And we also expect improvement in their financial results from integrating those operations onto the RadNet clinical and operating and IT systems. We're in the midst or really the beginnings of integrating those into the RadNet systems right now. There will be further tuck-in acquisitions that will be announcing and completing between now and year-end.

此外，我們於今年 4 月 1 日和 6 月 1 日進行的休士頓收購，這 13 個中心現在將為 2025 年全年做出貢獻。我們也預計，透過將這些業務整合到 RadNet 臨床、營運和 IT 系統中，他們的財務表現將會得到改善。我們現在正處於或真正開始將這些整合到 RadNet 系統中。從現在到年底，也將宣布並完成更多的收購活動。

And there will be additional health system joint ventures with both new partners -- for new partnerships as well as expansions of existing joint ventures that will -- that we're working on currently that hopefully will announce by year-end and will be major contributors next year. And then in addition to that, obviously, the further growth and maturity and progress in the Digital Health side, both on the AI front in terms of getting greater penetration of the EBCD program, both on the East Coast and the West Coast, bringing that EBCD program to the Houston marketplace, which we haven't started implementing, further growth with Aidence and Quantib on lung and prostate licensing, particularly with the NHS in the UK as that targeted lung health check program rolls out, we expect to see significant growth there on the lung side.

我們目前正在努力，將與新合作夥伴建立更多的衛生系統合資企業——新的合作夥伴關係以及現有合資企業的擴張，希望能在年底前宣布，並將成為主要貢獻者明年。除此之外，很明顯，數位健康方面的進一步成長、成熟和進步，無論是在人工智慧方面，還是在東海岸和西海岸，EBCD 計劃都得到了更大的滲透，這帶來了休士頓市場的EBCD 計劃（我們尚未開始實施）與Aidence 和Quantib 在肺部和前列腺許可方面的進一步增長，特別是隨著針對性肺部健康檢查計劃的推出，英國NHS 的合作，我們預計將看到顯著增長在肺的一側。

We are also intending to launch a self-pay prostate screening program here in America, which we've started selling the seeds for along the lines of what we're doing with breast cancer, the EBCD program. And then as Howard mentioned, launching the DeepHealth OS and doing a full commercial scale launch to external customers in 2025. So that's a big laundry list of things that we have on our plate, but they're all very exciting, and I think they're all potential for having significant growth in the coming years.

我們還打算在美國推出一項自費前列腺篩檢計劃，我們已經開始出售該計劃的種子，就像我們針對乳癌所做的 EBCD 計劃一樣。然後，正如 Howard 所提到的，推出 DeepHealth 作業系統，並於 2025 年向外部客戶進行全面的商業規模發布。這是我們要做的一長串清單，但它們都非常令人興奮，而且我認為它們都有可能在未來幾年內顯著成長。

And just lastly for me. I mean, you talked about the 150 basis point mix shift to higher revenue scans. Is that just -- in your opinion, is that a permanent structural feature that you'll continue to see that? And I've asked you this before, but we should think about like maybe 70% of that dropping to the margin line. So if it's up 150, then maybe that's 100 points of margin, all else being equal?

最後對我來說。我的意思是，您談到了 150 個基點混合轉向更高的收入掃描。在您看來，這是否是您將繼續看到的永久結構特徵？我之前問過你這個問題，但我們應該考慮一下，其中 70% 可能會下降到利潤線。那麼，如果上漲 150，那麼在其他條件相同的情況下，也許這就是 100 點的利潤？

I think that's something that's going to continue fairly substantially. I think at the end of the day, it's a demand -- it's a combination of current demand as well as new applications. I would point very proudly to the growth that we've seen in MR and CT, but -- which is dwarfed by the growth that we're seeing in PET/CT finally coming into its own, if you will, and the use of PET/CT, which I believe is just going to continue to grow, maybe a function not so much of the demand that we have, but our ability to put more PET/CT scanners and replace older ones, which are now really capable of improved scanning time and throughput as well as quality is it's a remarkable shift.

我認為這種情況將會相當持續地持續下去。我認為歸根結底，這是一種需求——它是當前需求和新應用程式的結合。我非常自豪地指出我們在 MR 和 CT 領域看到的增長，但是，與我們在 PET/CT 領域最終實現的增長（如果你願意的話）以及使用我相信PET/CT 將會繼續增長，也許這一功能與我們的需求無關，但我們有能力放置更多PET/CT 掃描儀並替換舊的掃描儀，這些掃描儀現在確實能夠得到改進掃描時間、吞吐量以及品質是一個顯著的轉變。

And I believe over the last two quarters, I'm doing this from memory, our PET/CT volume is quarter-over-quarter and almost all of it's organic growth, is about 20% if I combine these two quarters or somewhere in that area. That is coming from adoption of prostate and now a much more rapid adoption of PET/CT for Alzheimer's disease. I should also note that by the end of this year, we will have in place for the first time three PET MR systems, which I believe will make us the largest provider of that service and which I think will be transformative in the future for adding additional capabilities, not only in diseases that we're looking at today, but in new applications for this.

我相信在過去兩個季度中，我憑記憶做到這一點，我們的PET/CT 數量是季度環比增長，而且幾乎所有增長都是有機增長，如果我將這兩個季度或其中某個季度合併起來，大約是20%區域。這得益於前列腺的採用，以及現在針對阿茲海默症的 PET/CT 的更快採用。我還應該指出，到今年年底，我們將首次擁有三個 PET MR 系統，我相信這將使我們成為該服務的最大提供商，並且我認為這將在未來帶來變革，因為增加額外的功能，不僅在我們今天關注的疾病中，而且在新的應用中。

So the notion of technology driving imaging cannot be underestimated. I think it's something which is now accelerating both because of improved equipment that all the OEMs are producing as well as artificial intelligence and developing new tools to be able to accomplish these, particularly in the PET area. So I think you can build those. Those all should come in with higher margins for a number of reasons, not just because they are more expensive test, but because we -- with the equipment that we've put in that now can do these exams more efficiently, we're able to drive more revenue per unit time.

因此，技術驅動成像的概念不容小覷。我認為，由於所有原始設備製造商生產的設備得到改進，人工智慧以及開發新工具來實現這些目標，尤其是在 PET 領域，這一趨勢現在正在加速發展。所以我認為你可以建造這些。出於多種原因，所有這些都應該獲得更高的利潤，不僅是因為它們的測試更昂貴，而且因為我們 - 使用我們現在投入的設備可以更有效地進行這些檢查，我們能夠以增加單位時間的收入。

So lastly for me, I keep saying lastly, and I keep lying. The two things I think people are looking for: one, being large-scale M&A; and secondly, being a major payer stepping up and paying for the AI. So if you were a betting person, would either of those -- is there a greater than a 50-50 chance that either one of those or both might occur by the end of the year?

所以最後對我來說，我一直說最後，但我一直在說謊。我認為人們正在尋找兩件事：一是大規模併購；二是大規模併購。其次，成為人工智慧的主要支付者並為其付費。因此，如果您是博彩人士，那麼到今年年底，其中之一或兩者都發生的可能性是否大於 50-50？

Well, fortunately for you, John, I am a betting person. So I think it's a very good. I've been doing this for 40 years, John. So I've been betting a long time on imaging, as you well know. But I would say that there's a very good chance that both of those will occur within the next 6 to 12 months.

好吧，對你來說幸運的是，約翰，我是一個打賭的人。所以我認為這是非常好的。約翰，我已經這樣做了 40 年。所以，正如你所知，我長期以來一直把賭注押在成像上。但我想說，這兩種情況很有可能在未來 6 到 12 個月內發生。

At one time, I believe it would take longer for the AI to get reimbursed.

一度，我相信人工智慧需要更長的時間才能得到報銷。

At this point, our focus is not necessarily CMS, but perhaps one or two or maybe even three of the major payers who are talking to us because the results that we're showing them for artificial intelligence, right now, primarily in breast as you are well aware of, but the value proposition for it is overwhelmingly positive and obvious right now. So those discussions are taking place. I think we have a great team that's able to both scientifically as well as from a business standpoint made compelling arguments.

在這一點上，我們的重點不一定是CMS，但可能是一兩個甚至三個正在與我們交談的主要付款人，因為我們現在向他們展示人工智慧的結果，主要是在乳房中，就像您一樣眾所周知，但它的價值主張目前是極其積極和明顯的。所以這些討論正在進行中。我認為我們擁有一支出色的團隊，能夠從科學角度以及商業角度提出令人信服的論點。

I think as Mark pointed out, we're going to see MR become the bellwether for early prostate cancer detection, which will also have to be incorporated with prostate AI, which we own that tool ourselves. We're working on pilot projects to further demonstrate that, although even as early as today, there was an (inaudible) in radiology with a pilot study done by the Mayo Clinic that showed the efficacy of prostate MR as a far better screening tool than anything else. So all of these things seem to be accelerating. And I'm a betting man, and I think RadNet is a good bet.

我認為，正如馬克指出的那樣，我們將看到 MR 成為早期前列腺癌檢測的領頭羊，這也必須與前列腺人工智慧相結合，我們自己擁有該工具。我們正在進行試點項目，以進一步證明，儘管早在今天，梅奧診所在放射學領域進行的一項試點研究（聽不清楚）表明，前列腺MR 作為一種比前列腺MR 更好的篩檢工具的功效。所以所有這些事情似乎都在加速。我是一個賭徒，我認為 RadNet 是一個不錯的選擇。

All right. Thank you, sir.

好的。謝謝您，先生。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. Wanted to better understand the composition of the Digital Health segment EBITDA expectations for the year. I think the non-AI revenue within Digital Health makes up about 2/3 of the revenue today. So is that have a similar EBITDA contribution? And then relatedly, how should we think through the net impact of the EBCD program so far in the runway from here? What's the latest adoption rate for the program? And what does that actually translate into from a procedure standpoint?

嗨，早安。希望更了解數位健康部門今年 EBITDA 預期的組成。我認為數位健康領域的非人工智慧收入約佔當今收入的 2/3。那麼這是否有類似的 EBITDA 貢獻呢？與此相關的是，我們應該如何思考 EBCD 計劃迄今為止在跑道上的淨影響？該計劃的最新採用率是多少？從程式的角度來看，這實際上意味著什麼？

So for instance, if you've done 956,000 mammograms in the first half of this year, how many are actually Saige-Dx procedures within that, that you're able to collect an incremental $40 out of pocket on?

舉例來說，如果您在今年上半年進行了 956,000 次乳房 X 光檢查，其中有多少實際上是 Saige-Dx 程序，您可以從口袋中收取 40 美元的增量費用？

Sure. Andrew, it's Mark. I'll answer the first question regarding the composition of the EBITDA of the Digital Health business. So there's two businesses in the Digital Health segment, one of which, as you correctly pointed out, is the AI business. The other is the software business.

當然。安德魯，是馬克。我將回答關於數位健康業務 EBITDA 構成的第一個問題。因此，數位健康領域有兩項業務，其中之一，正如您所指出的，是人工智慧業務。另一個是軟體業務。

The software business has historically been a very profitable business. And last year, that eRAD business, which is now being morphed into what we call, DeepHealth OS. That eRAD business last year did about $37 million of revenue and $20 million of EBITDA.

軟體業務歷來都是一項非常有利可圖的業務。去年，eRAD 業務現已轉變為我們所說的 DeepHealth OS。eRAD 業務去年的營收約為 3,700 萬美元，EBITDA 約為 2,000 萬美元。

So when we move that very profitable business into the Digital Health business -- or Digital Health segment, that certainly is driving more of the revenue and the profitability in the Digital Health operating segment. We are expecting this year the Digital Health operating segment to do about $60 million to $70 million of revenue. I would say, close to $40 million of which, again, will be software sales -- software licensing sales of eRAD. And then the remainder will be, let's call it, $25 million-ish, give or take, will be AI revenue.

因此，當我們將這項利潤豐厚的業務轉移到數位健康業務（或數位健康部門）時，這肯定會推動數位健康營運部門的更多收入和獲利能力。我們預計今年數位健康營運部門的收入約為 6,000 萬至 7,000 萬美元。我想說，其中接近 4000 萬美元將再次用於軟體銷售——eRAD 的軟體授權銷售。然後剩下的，我們稱之為 2500 萬美元左右，無論給予或接受，都將是人工智慧收入。

AI runs -- right now our cost structure at AI, given the teams at Aidence, Quanta, DeepHealth, all the developers, the machine learning folks, the AI scientists, the FDA people, marketing, sales, you name it, is running close to about $25 million, if not a little bit more than that. We are expecting our quarterly revenue of the DeepHealth business to be somewhere north of $6 million as we're exiting this year. And so our AI business by itself will turn profitable sometime in the fourth quarter of this year. So that when we look forward to 2025, we're going to have two profitable businesses as part of Digital Health.

人工智慧運作－目前我們在人工智慧方面的成本結構，考慮到Aidence、Quanta、DeepHealth 的團隊、所有開發人員、機器學習人員、人工智慧科學家、FDA 人員、行銷、銷售，凡是你能想到的，都非常接近。隨著我們今年退出，我們預計 DeepHealth 業務的季度收入將超過 600 萬美元。因此，我們的人工智慧業務本身將在今年第四季的某個時候實現盈利。因此，當我們展望 2025 年時，我們將擁有兩項獲利業務作為數位健康的一部分。

Bulk being the software business and then the AI business. And of course, we're expecting to have growth in the AI business, which leads into your second question about adoption rates for EBCD. What we're currently seeing, and I'm going to bifurcate it between East Coast rates and West Coast rates because we started the implementation of EBCD on the East Coast going back to the fourth quarter of 2022. We're seeing about a 42% adoption rate on the East Coast for women electing to be part of the EBCD program, which means that they're desiring to have their scan read by -- the initial scan read by AI.

主要是軟體業務，然後是人工智慧業務。當然，我們預期人工智慧業務將會成長，這引出了關於 EBCD 採用率的第二個問題。我們目前所看到的情況，我將把它分為東海岸費率和西海岸費率，因為我們從 2022 年第四季開始在東海岸實施 EBCD。我們發現，在東海岸，選擇加入 EBCD 計畫的女性採用率約為 42%，這意味著她們希望由人工智慧讀取最初的掃描結果。

And on the West Coast, which we have much more recently adopted, we're close to a 30% rate in terms of adoption. And the last report, we all received was about 28%. So the -- what we're really encouraged about that on the West Coast is that it took many months on the East Coast to get anywhere near a 30% adoption rate. And what we've done is we've taken a lot of the learnings from the East Coast, such as the marketing collateral, pricing, how we train our schedulers and front office people to communicate the benefits of the services.

在我們最近採用的西海岸，我們的採用率接近 30%。我們收到的上一份報告約為 28%。因此，令我們真正感到鼓舞的是，在西海岸，東海岸花了好幾個月的時間才達到接近 30% 的採用率。我們所做的是，我們從東海岸吸取了很多經驗，例如行銷材料、定價，以及我們如何培訓調度員和前台人員來傳達服務的好處。

All of that benefit and pain that we had to go through on the East Coast adoption, we've been able to adopt as best practices on the West Coast to be able to drive a much higher adoption rate. I don't see any reason why the adoption rates on the West Coast should be any different, ultimately, than the East Coast adoption rates, and we're still seeing growing adoption rates on the East Coast. So we think that there's more to come in terms of the success of this program as we move later on into this year and into 2025. I don't know, Howard, do you have anything more to add?

我們在東海岸採用時必須經歷的所有好處和痛苦，我們已經能夠在西海岸採用最佳實踐，從而能夠推動更高的採用率。我不認為西海岸的採用率最終會與東海岸的採用率有任何不同，而且我們仍然看到東海岸的採用率不斷增長。因此，我們認為，隨著今年稍後和 2025 年的到來，該計劃的成功還將取得更多成果。不知道霍華德你還有什麼要補充的嗎？

Yes. I would just want to point out that one of the reasons -- and we anticipated this that the adoption rate would be slower on the West Coast is that a substantial portion of our volumes on the West Coast and therefore, revenue come from our capitated contracts. And generally speaking, we cannot and do not do artificial intelligence for the EBCD on the patients who are capitated without our discussing this with the medical groups that essentially we sub capitate with.

是的。我只想指出，我們預計西海岸的採用率會較慢的原因之一是，我們在西海岸的銷售量很大一部分，因此，收入來自我們的人均合約。一般來說，如果沒有與我們本質上是按人頭付費的醫療團體進行討論，我們就不能也不會對按人頭付費的患者進行 EBCD 人工智慧。

We are beginning to have those conversations already with them and that there's a high degree of interest that they may want to change their plan design to include in the program, the artificial intelligence or breast because they even more readily see the long-term benefit of reducing some of their costs and improving outcomes, for which they become the responsible payer, if you will. We haven't done this yet because we've not had the East Coast implemented.

我們已經開始與他們進行這些對話，他們非常有興趣改變他們的計劃設計，將人工智慧或乳房納入計劃中，因為他們更容易看到人工智慧或乳房的長期好處。 ，如果你願意的話，他們將成為負責任的付款人。我們還沒有這樣做，因為我們還沒有實施東海岸。

But if we take out the capitated lives, which we don't have that discretion right now of offering that on a pay-for-service basis to those capitated lives. If we rule those out and reassessed, I will imagine that we would be in the mid- to high 30s for our fee-for-service patients on the West Coast. And in fact, I will instruct our teams to do that because I think it's an interesting exercise.

但如果我們去掉按人頭付費的生活，我們現在就沒有自由裁量權以按服務付費的方式向這些按人頭付費的生活提供服務。如果我們排除這些因素並重新評估，我想我們西海岸的收費服務患者的收入將在 30 多歲左右。事實上，我會​​指導我們的團隊這樣做，因為我認為這是一個有趣的練習。

But I think I just want to underscore one thing is that this will be the standard of care for doing mammography. And it's -- whether it happens tomorrow or next year or the year after, in our opinion here and that -- most people who have seen these results and understand the science behind artificial intelligence, particularly for breast imaging and breast cancer, it is the way to significantly improve the outcome and reduce cost.

但我想我只是想強調一件事，這將成為乳房X光檢查的護理標準。我們認為，無論是明天、明年還是後年，大多數看到這些結果並了解人工智慧背後科學的人，特別是在乳房影像和乳癌領域，顯著改善結果並降低成本的方法。

So we're just in the early stages of this ball game, but I'm happy to say we're the ones leading the way into this becoming adopted on a much larger scale. And I think with our initiative, this is something that could have taken 5 to 10 years. I'm very proud of our teams and the decisions that we've made over the years here to commit to the future of health care in radiology and imaging being driven by these kinds of sophisticated tools.

因此，我們正處於這項運動的早期階段，但我很高興地說，我們是引領這項技術得到更大規模採用的人。我認為如果是我們的倡議，這可能需要 5 到 10 年的時間。我為我們的團隊以及我們多年來所做的決定感到非常自豪，這些決定致力於由這些複雜工具驅動的放射學和成像醫療保健的未來。

Got it. Okay. And just to clarify, when you say adoption rate, is that within the facilities that are offering the program? And if so, do you have an offer rate then or what the coverage rate is?

知道了。好的。澄清一下，當你說採用率時，這是在提供該計劃的設施內嗎？如果是這樣，你們有報價嗎？

Yes. So the adoption rate is based upon -- the denominator of that is the number of mammography screening exams that we do. So we do about a little over 2 million mammography exams per year. That's our current run rate, of which about 1.6 million are screening mammography exams. And so those are the exams that we offer this service on.

是的。因此，採用率取決於——其分母是我們進行的乳房 X 光攝影篩檢檢查的數量。因此，我們每年進行約 200 萬次乳房 X 光檢查。這是我們目前的運行率，其中約 160 萬人正在接受乳房 X 光檢查。這些就是我們提供這項服務的考試。

So to the extent that someone schedules a screening mammography exam, now she's eligible for us to upsell the EBCD program. And so we're seeing 40% of all women on the East Coast who are scheduling their mammography screening exam to elect into this program in 28 -- to 30 on the West Coast. Is that clear?

因此，只要有人安排了乳房 X 光攝影篩檢檢查，現在她就有資格讓我們追加銷售 EBCD 計畫。因此，我們看到東海岸 40% 的女性計劃在 28 至 30 歲（西海岸）進行乳房 X 光檢查，以選擇加入該計劃。清楚了嗎？

Got it. Okay. Yes, that makes sense. And if I could just follow up with one more. I think the same center advanced imaging volumes were very strong in the quarter, up double digits, leading to the continued procedural mix shift that you talked about.

知道了。好的。是的，這是有道理的。如果我能再跟進一個就好了。我認為同一中心的高級成像量在本季度非常強勁，增長了兩位數，導致了您談到的持續的程序混合轉變。

But the revenue mix between routine advanced actually looks relatively flat sequentially. So just curious what's going on underneath the volume mix with respect to pricing or anything else that's keeping the revenue mix flat sequentially.

但常規高級產品之間的收入組合實際上看起來相對持平。因此，我只是好奇在定價或其他保持收入組合持平的因素方面，銷售組合背後發生了什麼。

Yes. The revenue mix that you're seeing in the report, it's based upon payments received, not accrued net revenue. So what we do is we apply the differential in those payments to the current accrued revenue and say, hey, 25% or 30% of our revenue is MRI and so on and so forth. So you'll see a lag. So I would expect in the coming quarters as we continue to see the increase towards higher acute exams, I would expect to see that those percentages will actually shift in terms of the revenue as well.

是的。您在報告中看到的收入組合是基於收到的付款，而不是應計淨收入。所以我們所做的就是將這些付款中的差額應用到當前的應計收入中，然後說，嘿，我們收入的 25% 或 30% 是 MRI 等等。所以你會看到一個滯後。因此，我預計在接下來的幾個季度，隨著我們繼續看到更高的急性考試的成長，我預計這些百分比實際上也會隨著收入的變化而變化。

Got it. And why is that because bad debt assumptions are different? What's the driver of that?

知道了。為什麼會因為壞帳假設不同而出現這種情況？其驅動因素為何？

Just the lag in terms of the DSO of the difference between payments received versus accrued net revenue. Accrued net revenue is an estimate based upon how many exams you do in the quarter. Payments are based upon payments that you're collecting from prior quarters.

只是就 DSO 而言，收到的付款與應計淨收入之間的差異存在滯後。應計淨收入是根據您在本季度參加的考試次數估算的。付款是基於您從前幾季收取的付款。

It might also be worth putting out, Mark, that in the case of advanced imaging, all of those procedures require an authorization from the payer. And therefore, it's a slower process of getting those patients done, submitting the bills with the authorization and ultimately getting paid, whereas on the routine imaging mammography -- those do not require authorization and those get paid as quickly as we can present the bills.

馬克，還值得指出的是，在高級成像的情況下，所有這些程序都需要付款人的授權。因此，讓這些患者完成手術、提交帶有授權的賬單並最終獲得付款是一個較慢的過程，而在常規乳房X光成像檢查中，這些不需要授權，並且我們可以在提交賬單後儘快獲得付款。

Got it. Okay. Thank you.

知道了。好的。謝謝。

Larry Solow, CJS Securities.

拉里·索洛，CJS 證券。

Good morning. A couple of follow-ups. I guess most of my questions have been answered. I guess, Mark, on the DeepHealth operating system sounds really exciting. I'm just curious, as you roll this out, would you expect to start even getting some benefit on margins, maybe just next year or in the first year? Or do you feel like it takes a little while? Is there some learning curve you think to incorporate systems across internally?

早安.一些後續行動。我想我的大部分問題已經得到解答。我想，Mark，關於 DeepHealth 作業系統聽起來真的很令人興奮。我只是很好奇，當你推出這個產品時，你是否期望開始獲得一些利潤收益，也許只是明年或第一年？或者你覺得需要一點時間嗎？您認為在內部整合系統是否有一些學習曲線？

And then the second question is, do you -- eventually, when you go external, do you think the external opportunity is actually bigger, greater than the internal opportunity? And then have you also -- third question there is, have there been thoughts to externalize, or have you been approached on the EBCD AI test as well from external parties?

然後第二個問題是，最終，當你走向外部時，你是否認為外部機會實際上比內部機會更大？然後，您是否也 - 第三個問題，是否有外部化的想法，或者外部各方是否也曾就 EBCD AI 測試與您接洽？

Sure. Okay. Let me take the first part of the question first, which is, do we expect to see any benefits with respect to -- in 2025 with the rollout --?

當然。好的。讓我先回答問題的第一部分，即，我們期望在 2025 年推出該技術後能看到任何好處嗎？——？

Rollout, right?

推出，對嗎？

Yes, of DeepHealth OS. And the answer to that question is yes, absolutely. What are -- the unique aspect of the DeepHealth OS relative to what we're currently using, which is our own eRAD (inaudible) technology platform is that the DeepHealth OS has a number of generative AI-powered modules as part of it that is focused on automating business functions that we perform on behalf of our centers in order to automate aspects of the business that today we rely heavily on labor and human capital for.

是的，DeepHealth 作業系統。這個問題的答案是肯定的。相對於我們目前使用的 eRAD（聽不清楚）技術平台，DeepHealth 作業系統的獨特之處在於 DeepHealth 作業系統擁有許多由 AI 驅動的生成模組作為其一部分專注於自動化我們代表中心執行的業務功能，以便實現當今我們嚴重依賴勞動力和人力資本的業務方面的自動化。

And these are in the areas around automating patient scheduling, preauthorization, insurance verification, customer call centers or patient call centers as well as certain revenue cycle functions. So we're already testing a couple of these modules internally. But when they have a full-scale rollout here, we expect that these automation tools will make our business much more efficient, which will have two benefits. One will be, I think, from a patient-facing standpoint, it's going to be better and more efficient to patients. They're going to be able to schedule their exams more efficiently and more expeditiously.

這些領域涉及自動化患者調度、預先授權、保險驗證、客戶呼叫中心或患者呼叫中心以及某些收入週期功能。所以我們已經在內部測試了其中幾個模組。但當它們在這裡全面推廣時，我們預計這些自動化工具將使我們的業務更加高效，這將帶來兩個好處。我認為，從面向患者的角度來看，這對患者來說會更好、更有效率。他們將能夠更有效、更迅速地安排考試。

We'll be able to take payments more -- on a more automated basis from an AR and collections standpoint. We're going to be able to get authorizations faster and more efficient from the insurance company.

從 AR 和收款的角度來看，我們將能夠以更自動化的方式接受更多付款。我們將能夠更快、更有效率地從保險公司獲得授權。

So all of these things should have the intended effect of reducing our reliance on expensive human capital. So we do expect to see benefits just from RadNet adopting it internally. And then, of course, as we launch the fully commercialized product and start selling and licensing that product to both our 200-plus existing eRAD customers as well as the rest of the industry, we expect and intend that this product is going to be very successful. I mean it's a cloud-based product. It's got all of the new and advanced bells and whistles, including these generative AI modules.

因此，所有這些事情都應該達到減少我們對昂貴人力資本依賴的預期效果。因此，我們確實希望看到 RadNet 在內部採用它所帶來的好處。當然，當我們推出完全商業化的產品並開始向 200 多家現有 eRAD 客戶以及行業其他客戶銷售和許可該產品時，我們預計並打算該產品將非常受歡迎。我的意思是它是一個基於雲端的產品。它具有所有新的和先進的功能，包括這些生成式人工智慧模組。

We're already talking to our existing customer base. We previewed a number of its capabilities and a demo last year at the big radiology show in November of last year called the RSNA, the Radiological Society of North America Show in Chicago. We're going to be doing that same customer outreach this November in the show this year. So we're very excited and think that this product is as good or better than anything else that's on the marketplace, particularly for outpatient freestanding imaging centers, where this workflow that we've built into it and the scalability of the product because we've had to make it scalable and work for RadNet internally, we think is going to be the best in the industry.

我們已經在與現有客戶群進行交談。去年 11 月，我們在芝加哥舉行的大型放射學展 RSNA（北美放射學會展）上預覽了它的一些功能和演示。我們將在今年 11 月的展會上進行同樣的客戶推廣活動。因此，我們非常興奮，並認為該產品與市場上的其他任何產品一樣好甚至更好，特別是對於門診獨立成像中心，我們在其中內置了此工作流程以及產品的可擴展性，因為我們“我們必須使其具有可擴展性並在內部適用於RadNet，我們認為它將成為業內最好的。

There was a third part of your question that I can't remember.

你問題的第三部分我不記得了。

Just on the thoughts about, are you've been approached at all about externalizing the Enhanced Breast Cancer Detection tool?

只是想一想，是否有人與您聯繫過將增強型乳癌檢測工具具體化？

So yes, we're going to continue to drive adoption rates internally, and we are having discussions with third parties about providing this technology and potentially even creating an EBCD like program for other customers. We haven't yet find any customer that hasn't been our focus. But that's certainly where we're headed. And I think as Dr. Berger mentioned, reimbursement is a big part of that because one of the -- or probably the main reason why AI solutions have not been adopted on a widespread basis in the industry is the lack of the ability for radiologists to bill and collect for the use of these AI tools.

所以，是的，我們將繼續提高內部採用率，並且我們正在與第三方討論提供這項技術，甚至可能為其他客戶創建類似 EBCD 的程序。我們還沒有找到任何不是我們關注的客戶。但這肯定是我們前進的方向。我認為正如 Berger 博士所提到的，報銷是其中的一個重要部分，因為人工智慧解決方案尚未在行業中廣泛採用的主要原因之一，或者可能是放射科醫生缺乏能力使用這些人工智慧工具進行計費和收取費用。

We believe that once radiologists can actually bill and collect for the use of these tools, then the whole industry is going to want to adopt these tools. Very similar to what happened many years ago when mammography equipment was shifting from 2D technology to 3D technology with tomosynthesis, there was a period of several years where Hologic had introduced the technology to the world, but it wasn't being adopted on a widespread basis because radiologists couldn't charge anything more for doing a 3D exam and therefore, they didn't want to make the capital investment to provide a service that they couldn't bill and collect for.

我們相信，一旦放射科醫生能夠真正對這些工具的使用進行計費和收費，那麼整個產業就會想要採用這些工具。與多年前發生的情況非常相似，當時乳房 X 光攝影設備從 2D 技術轉向採用斷層合成技術的 3D 技術，Hologic 曾在幾年內將該技術引入世界，但並未得到廣泛採用因為放射科醫生無法為3D 檢查收取更多費用，因此他們不想進行資本投資來提供無法計費和收費的服務。

And that's the problem with AI right now. We do believe that, that's just a matter of time. And once there is more widespread adoption for AI reimbursement, then that's the time that we're going to be able to have a successful AI licensing business.

這就是目前人工智慧的問題。我們確實相信，這只是時間問題。一旦人工智慧報銷得到更廣泛的採用，那麼我們就能夠擁有成功的人工智慧授權業務。

Got it. I appreciate that color. I guess just one last question. Just, Mark, with the increase in minimum wage in California and salaries, did that impact you guys at all?

知道了。我很欣賞那種顏色。我想只有最後一個問題。只是，馬克，隨著加州最低工資和工資的增加，這對你們有影響嗎？

It does. The minimum wage is being increased from $17.50 to, I think, it's $20 or $21. I can't remember. And that is built into our budget this year. The implementation of that was delayed. It was supposed to go into effect, I think it was either June 1 or July 1. Do you remember, Howard?

確實如此。最低工資將從 17.50 美元增加到 20 美元或 21 美元。我不記得了。這已納入我們今年的預算中。該計劃的實施被推遲了。它應該會生效，我想是6月1日或7月1日。你還記得嗎，霍華德？

Yes, June 1.

是的，6 月 1 日。

Yes. And that -- because of budgetary reasons and the impact on budget, particularly from the county facilities and the hospitals, all the health care workers that they employ, they've delayed that implementation to later this year. I think it did go into effect August 1. Is that right, Howard?

是的。而且，由於預算原因和對預算的影響，特別是來自縣設施和醫院以及他們僱用的所有醫護人員的影響，他們已將實施推遲到今年晚些時候。我認為它確實於8月1日生效。是這樣嗎，霍華德？

No, it's -- currently, it's scheduled to go in place, I believe, October 1, but there's still some doubt as to whether or not they're going to do it this year or kick that can down the road to January 1 of next year.

不，目前，我相信它計劃於 10 月 1 日實施，但對於他們是否會在今年實施或是否會在 1 月 1 日之前實施，仍然存在一些疑問。

Yes. So there's a little bit of a good guy or a cushion built into our guidance because we had anticipated that going into effect earlier on in the year.

是的。因此，我們的指導中包含了一些好人或緩衝，因為我們預計該指導將在今年早些時候生效。

Great. Okay, great. Thank you. Appreciate it.

偉大的。好的，太好了。謝謝。欣賞它。

Yuan Zhi, B.Riley.

袁志，B.Riley。

This is Brandon Carney on for Yuan. Congrats on another strong quarter. First, we're curious about the recent CMS update on the diagnostic radiopharmaceuticals and how that would affect your PET scan volume? The proposed reimbursement change was for outpatient setting in the hospital and the update was for a more favorable reimbursement. Does that mean that the hospital has more incentive to keep those scans within the outpatient department rather than sending those patients to freestanding centers like yours?

我是布蘭登·卡尼（Brandon Carney）代表袁徵發言。祝賀又一個強勁的季度。首先，我們很好奇最近 CMS 對診斷放射性藥物的更新以及這將如何影響您的 PET 掃描量？擬議的報銷變更是針對醫院門診設置，更新是為了更優惠的報銷。這是否意味著醫院更有動力將這些掃描保留在門診部，而不是將這些患者送到像您這樣的獨立中心？

Yes, sure. So that impacts, as you rightfully said, the hospitals and not us. Look, the hospitals are a big player in PET/CT business today and they're going to continue to try to keep as much of that business in-house. I think like all the other modalities, it's an inevitability that more and more of this business is going to move into the outpatient centers. And we're already demonstrating that with the growth of the prostate imaging and Alzheimer's imaging on the PET/CT side, where I think we are -- we've done more PSMA tests than anyone else whether on the hospital side or the outpatient side, we've done about 13,900 PSMA test since the beginning of time.

是的，當然。因此，正如您所說，這影響的是醫院，而不是我們。看，如今醫院是 PET/CT 業務的重要參與者，他們將繼續努力將盡可能多的業務保留在內部。我認為，與所有其他模式一樣，越來越多的業務將不可避免地轉移到門診中心。我們已經證明，隨著 PET/CT 方面前列腺成像和阿茲海默症成像的發展，我認為我們所做的 PSMA 測試比其他任何人都多，無論是在醫院方面還是在門診方面，從一開始我們就完成了大約13,900 個PSMA 測試。

This quarter alone, we've done over 2,100 PSMA tests. And the same thing that you're seeing in Alzheimer's, which is the other big growth area of PET/CT is that we're leading the way of these amyloid tests. We've done over 1,400 -- excuse me, over 1,500 of these tests in the last several quarters. In July, we did over 360 of these tests alone. So I think that regardless of what the hospitals are doing and regardless of how they're paying for these radioactive tracers, the fact of the matter is they're charging significantly more for the technical component of the PET/CT than we are.

僅本季度，我們就完成了 2,100 多項 PSMA 測試。與您在阿茲海默症（PET/CT 的另一個重要成長領域）中看到的情況相同，我們正在引領這些澱粉樣蛋白測試的發展方向。我們已經完成了 1,400 多次——對不起，在過去幾個季度中，我們已經完成了 1,500 多次這樣的測試。光是 7 月份，我們就進行了 360 多項此類測試。因此，我認為，無論醫院在做什麼，也無論他們如何支付這些放射性示蹤劑的費用，事實是他們對 PET/CT 技術組件的收費比我們高得多。

Generally, we're seeing that in the range of 2 times to 4 times what we're charging. So I think that although the hospitals will always be in the imaging business that -- more and more of this business is going to be captured in the outpatient landscape.

一般來說，我們看到的電量是我們充電的 2 倍到 4 倍。因此，我認為，儘管醫院將始終從事影像業務，但越來越多的業務將在門診領域中體現。

Great. Thanks for that, especially the numbers you've given, very helpful. It's great to see the 14% same-center growth on the PET scan volume. And just to follow up on what you were seeing on the Alzheimer's, can you give some context about like how that increase is going right now? We saw the approval of another amyloid agent.

偉大的。謝謝你，特別是你給的數字，非常有幫助。很高興看到 PET 掃描量的同中心增加 14%。為了跟進您在阿茲海默症方面所看到的情況，您能否提供一些背景信息，例如目前這種增長情況如何？我們看到另一種澱粉樣蛋白藥物獲得批准。

I think you mentioned that they saw a tripling of their sales for their amyloid imaging agent. What are you guys seeing on Alzheimer's specifically as it relates to the growth quarter-to-quarter?

我想你提到他們的澱粉樣蛋白顯影劑的銷售額增加了兩倍。你們對阿茲海默症有何特別看法，因為它與每季的成長有關？

Yes. So I'll start. So as I mentioned, we've done over 1,400 of these studies thus far. It's growing fast. And if I look at the last two months, in July, we did a little over 360 of these studies.

是的。那我就開始吧。正如我所提到的，迄今為止我們已經完成了 1,400 多項此類研究。它增長得很快。如果我看看過去兩個月，即 7 月份，我們做了超過 360 項此類研究。

In June, so the month prior to that, we did only 208 of these studies. So we're talking about over a 60% increase on a month-to-month basis. These are still relatively small numbers, given the fact that we do north of 75,000 PET/CTs or at least that's our current run rate in a year. But we're seeing a lot of growth. We are seeing that the regional MAX that we call them, these are the Medicare administrators, are starting to more freely authorize these initial studies.

6 月份，也就是之前的一個月，我們只做了 208 篇研究。所以我們談論的是每月超過 60% 的成長。考慮到我們執行的 PET/CT 數量超過 75,000 例，或至少這是我們目前一年的運行率，這些數字仍然相對較小。但我們看到了很大的成長。我們看到，我們所說的地區 MAX，即醫療保險管理者，開始更自由地授權這些初步研究。

We've seen others, as you mentioned, come in on the radioactive contrast side to make that more competitive, which will ultimately drive down the cost of the radioactive tracer. We think that, that's going to continue. And that -- as the cost goes down, that's going to drive more and more of these initial studies. I would also mention that as exciting as an opportunity as the Alzheimer's is on the PET/CT side, it's perhaps a more exciting opportunity on the MRI side.

正如您所提到的，我們已經看到其他人進入放射性對比劑方面，以使其更具競爭力，這最終將降低放射性示踪劑的成本。我們認為，這種情況將會持續下去。隨著成本的下降，這將推動越來越多的初步研究。我還要提到，與阿茲海默症在 PET/CT 方面的機會一樣令人興奮，在 MRI 方面這可能是一個更令人興奮的機會。

Most all of these patients need an initial MRI to establish a baseline and then every four to five months through the therapies once these patients go on these initial therapies, whether it's the Biogen therapy or the Eli Lilly or others in terms of these treatments, they're going to need additional MRIs every four to five months to monitor potential adverse side effects of these therapies. So the Alzheimer's opportunity, we remain excited about because it's going to be just another driver of advanced imaging, both on the PET/CT and the MRI side.

大多數這些患者都需要進行初始MRI 以確定基線，然後每四到五個月進行一次治療，一旦這些患者接受這些初始治療，無論是百健(Biogen) 療法、禮來(Eli Lilly) 療法或其他療法，他們每四到五個月需要進行一次額外的核磁共振檢查，以監測這些療法的潛在不良副作用。因此，我們對阿茲海默症的機會仍然感到興奮，因為它將成為先進成像的另一個驅動力，無論是在 PET/CT 方面還是在 MRI 方面。

Great. Very helpful. And then one last one. Just wondering if you can clarify what you mean by the patient backlog? Are these patients that have appointments on the calendar? Or is it some other measurement of incoming volume? And then how does that backlog really help to inform plans on expanding capacity?

偉大的。非常有幫助。然後是最後一張。只是想知道您是否可以澄清患者積壓的含義？這些患者在日曆上有預約嗎？或是輸入量的其他測量值？那麼，這些積壓的訂單如何真正有助於為擴大產能的計畫提供資訊呢？

Yes. The backlogs that we have are defined by, if somebody calls in for an exam today, what is the earliest time that we can fit them into our schedule. And we monitor those by the number of days that it takes to easily schedule a patient. That being said, if there is a more urgent need, we do keep a certain number of slots available for what we call add-ons. But the current circumstances we find ourselves in is that we probably have the capacity to do a lot more of the demand that we're currently being asked to provide.

是的。我們的積壓工作是這樣定義的：如果有人今天要求參加考試，我們最早可以將其納入我們的日程安排的時間是多少。我們透過輕鬆安排患者所需的天數來監控這些情況。話雖這麼說，如果有更緊急的需求，我們確實會保留一定數量的插槽用於我們所謂的附加元件。但我們目前所處的情況是，我們可能有能力滿足目前要求我們提供的更多需求。

But our limitation is not so much the equipment as it is the technologists that we need in order to staff, the facilities to do that. So we find ourselves having closed rooms, which just pushes the backlogs even higher. These are things that we're trying to really address by not only hiring -- or more aggressive recruiting and hiring, but really with technologies to upgrade equipment that gives us better capacity and throughput, and which then fundamentally would lower our backlog.

但我們的限制並不是設備，而是我們需要的技術人員和設施來做到這一點。因此，我們發現自己的房間已經關閉，這只會使積壓的訂單進一步增加。這些都是我們試圖真正解決的問題，不僅透過招募——或更積極的招募和聘用，而且透過技術升級設備，為我們提供更好的產能和吞吐量，從而從根本上減少我們的積壓。

So it is a nice problem to have, but not one that is optimally in the best interest of providing the level of care that we would otherwise like to. But this is the challenge that we're faced with, and it's better than sitting around and waiting for the phone to ring. But every aspect of what we can do to potentially accommodate the requests that we're getting are being pursued.

因此，這是一個很好的問題，但不是一個最符合我們原本希望提供的護理水平的最佳利益的問題。但這就是我們面臨的挑戰，比坐等電話鈴聲好。但我們正在盡一切努力來滿足我們收到的要求。

Great. Thanks again for taking our questions.

偉大的。再次感謝您提出我們的問題。

This concludes our question-and-answer session. I would like to turn the conference back over to Dr. Berger for any closing remarks.

我們的問答環節到此結束。我想將會議轉回給伯傑博士發表閉幕詞。

All right. Thank you. 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 our next call. Good day.

好的。謝謝。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，期待我們的下一次通話。再會。

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.

會議現已結束。感謝您參加今天的演講。您現在可以斷開連線。