Select Medical Holdings Corp (SEM) 2023 Q4 法說會逐字稿

Good morning, and thank you for joining us today for Select Medical Holdings Corporation's earnings conference call to discuss the fourth-quarter 2023 results and the company's business outlook. Speaking, today are the company's Executive Chairman and Co-Founder, Robert Ortenzio; and the company's Senior Executive Vice President of Strategic Finance and Operations, Martin Jackson. Management will give you an overview of the quarter and then open the call for questions.

早安，感謝您今天參加 Select Medical Holdings Corporation 的財報電話會議，討論 2023 年第四季度業績和公司業務前景。今天發言的是公司執行主席兼聯合創辦人 Robert Ortenzio；以及公司策略財務和營運高級執行副總裁馬丁傑克遜 (Martin Jackson)。管理層將為您提供本季度的概述，然後開始提問。

Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or the future financial performance of the company, including, without limitation, statements regarding operating results, growth opportunities, and other statements that refer to Select Medical's plans, expectations, strategies, intentions, and beliefs.

在開始之前，我們想提醒您，本次電話會議可能包含有關未來事件或公司未來財務業績的前瞻性陳述，包括但不限於有關經營業績、成長機會的陳述以及其他有關未來事件的陳述。請參閱Select Medical 的計劃、期望、策略、意圖和信念。

These forward-looking statements are based on the information available to management of Select Medical today, and the company assumes no obligation to update these statements as circumstances change.

這些前瞻性陳述是基於 Select Medical 管理層目前掌握的信息，公司不承擔隨著情況變化而更新這些陳述的義務。

At this time, I will turn the conference call over to Mr. Robert Ortenzio.

此時，我將把電話會議轉給 Robert Ortenzio 先生。

Thanks, operator. Good morning, everyone. Welcome to Select Medical's earnings call for the fourth quarter of 2023. Before providing details on each of our four operating divisions, I will provide some updates and commentary on the business.

謝謝，接線生。大家，早安。歡迎參加 Select Medical 2023 年第四季的財報電話會議。在提供我們四個營運部門的詳細資訊之前，我將提供一些有關該業務的更新和評論。

As most of you know, on January 3, 2024, we announced that our Board of Directors has approved a plan to pursue the separation of Select Medical's wholly owned occupational health services business, Concentra. As I have previously stated, we are pursuing the separation of Concentra with the objective of enhancing shareholder value and the success of each business by creating two companies that will be leaders in their respective markets.

正如你們大多數人所知，2024 年 1 月 3 日，我們宣布董事會已批准一項計劃，尋求剝離 Select Medical 全資擁有的職業健康服務業務 Concentra。正如我之前所說，我們正在尋求 Concentra 的分離，目的是透過創建兩家將成為各自市場領導者的公司來提高股東價值和每項業務的成功。

The potential separation is intended to be effected in a tax-free manner to Select Medical and its stockholders and to be completed in 2024. We expect in the very near future to receive a private letter ruling from the US Internal Revenue Service with an opinion confirming the tax-free status of the potential separation of the Concentra business.

潛在的分拆計畫將以免以稅務方式對 Select Medical 及其股東進行，並將於 2024 年完成。我們預計在不久的將來會收到美國國稅局的私訊裁決，其中包含確認 Concentra 業務潛在剝離的免稅地位的意見。

The completion of the of the separation is still subject to customary conditions, including favorable market conditions, completion of necessary financing transactions, and final approval by Select Medical Board of Directors.

分拆的完成仍需滿足慣例條件，包括有利的市場條件、完成必要的融資交易以及 Select Medical 董事會的最終批准。

I will now provide commentary on our four business lines. Overall, we had a very successful fourth quarter and year. We experienced double-digit adjusted EBITDA growth over prior year in every quarter of this year. In the third quarter of 2023, adjusted EBITDA grew 21% and revenue grew by 5% with all four of our operating divisions again exceeding prior-year revenue and EBITDA.

我現在將對我們的四個業務線進行評論。總體而言，我們的第四季和今年非常成功。今年每季我們的調整後 EBITDA 均較去年達到兩位數成長。2023 年第三季度，調整後 EBITDA 成長 21%，營收成長 5%，我們的所有四個營運部門再次超過上年營收和 EBITDA。

For the quarter, total company adjusted EBITDA was $180.1 million compared to $148.9 million in the prior year. Our consolidated adjusted EBITDA margin was 10.9% for Q4 compared to 9.4% in the prior year. Our critical illness recovery hospital division continued to see margin improvement in Q4 with a 28% increase in adjusted EBITDA margin along with a 4% reduction in their salary wages and benefits to revenue ratio compared to the prior year.

本季度，公司調整後 EBITDA 總額為 1.801 億美元，而去年同期為 1.489 億美元。第四季我們的綜合調整後 EBITDA 利潤率為 10.9%，而去年同期為 9.4%。我們的重症復健醫院部門第四季度的利潤率持續改善，調整後 EBITDA 利潤率增加了 28%，而工資和福利收入比與前一年相比下降了 4%。

Consistent with prior quarters, Marty Jackson will provide additional detail regarding critical illness' continued progress with labor.

與前幾季一致，馬蒂傑克森將提供有關危重疾病隨分娩持續進展的更多細節。

Critical illness incurred $3.6 million of start-up losses related to new hospitals in this quarter compared to $3.1 million in the same quarter prior year. The opening of critical illness recovery hospital with a distinct part rehabilitation unit in Chicago with Rush University System for Health remains on target for Q2 this year.

本季與新醫院相關的重大疾病損失為 360 萬美元，而去年同期為 310 萬美元。與拉什大學健康系統一起在芝加哥開設具有獨立復健部門的危重疾病復健醫院仍是今年第二季的目標。

As we mentioned last quarter, we also have hospital expansions underway, which are expected to be completed in 2025, including in our Orlando market, which will also include a 48-bed rehab distinct part unit.

正如我們上季度提到的，我們還在進行醫院擴建，預計將於 2025 年完成，其中包括奧蘭多市場，其中還將包括一個擁有 48 個床位的康復中心。

On the inpatient rehab development front, we're excited to announce that we signed an agreement with CoxHealth system to construct a new freestanding 63-bed inpatient rehab hospital in Ozark, Missouri, in which we will have a majority interest.

在住院復健開發方面，我們很高興地宣布，我們與CoxHealth 系統簽署了一項協議，將在密蘇裡州奧扎克建造一座擁有63 個床位的新獨立住院復健醫院，我們將擁有該醫院的多數股權。

This hospital is projected to open early 2026. As previously noted, we have agreements with the University of Florida Health Shands to open a 48-bed hospital in Jacksonville, Florida in Q3 of 2024, and with the Cleveland Clinic to open a fourth inpatient rehab hospital, which is a 32-bed hospital scheduled to open in the first half of 2025.

該醫院預計將於 2026 年初開幕。如前所述，我們與佛羅裡達大學Health Shands 達成協議，將於2024 年第三季在佛羅裡達州傑克遜維爾開設一家擁有48 個床位的醫院，並與克利夫蘭診所達成協議，開設第四家住院復健醫院，這是一家擁有32 個床位的醫院計劃於2025年上半年開業。

In the latter half of 2024, we plan to begin construction on a new inpatient rehab hospital in southern New Jersey, the Bacharach Institute for Rehab in partnership with AtlantiCare. We anticipate that our inpatient rehab division will continue their strong performance and have a successful 2024.

2024 年下半年，我們計劃與 AtlantiCare 合作，開始在新澤西州南部建造新的住院復健醫院—巴哈拉赫復健研究所。我們預計我們的住院復健部門將繼續保持強勁表現，並在 2024 年取得成功。

Overall, I am pleased with the development results and pipeline for our specialty hospital divisions. In 2023, we developed or acquired and put in operation 128 inpatient rehab beds and 227 critical illness recovery hospital beds. In 2024, we plan to be under construction or complete construction of 533 inpatient rehab facility beds and 70 critical illness recovery hospital beds that will begin operations in the current year or 2025.

總的來說，我對我們專科醫院部門的發展成果和管道感到滿意。2023年，開發或收購並投入使用住院復健床位128張，重症復健床位227張。2024年，我們計畫在建或竣工住院復健設施病床533張，重症復健病床70張，並於當年或2025年投入營運。

Concentra continued their strong performance, exceeding prior-year revenue, EBITDA, and patient volumes. As we mentioned on the last call, Concentra had significant development activity in October with the acquisition of three occupational medicine centers in Delaware and Maryland and the opening of three de novos in Norfolk, Virginia; Columbus, Ohio; and Fort Myers, Florida.

Concentra 持續保持強勁的業績，收入、EBITDA 和患者數量均超過上年。正如我們在上次電話會議中提到的，Concentra 在10 月進行了重大開發活動，收購了特拉華州和馬裡蘭州的三個職業醫學中心，並在弗吉尼亞州諾福克開設了三個de novo 中心；俄亥俄州哥倫布；和佛羅裡達州邁爾斯堡。

We have five signed leases for de novo slated to open in 2024 and two signed leases for de novo expected to be opened in Q1 2025. There is a strong pipeline of acquisitions, including one currently under a letter of intent, and other de novos that we continue to evaluate.

我們有五份已簽署的 de novo 租約預計於 2024 年開業，兩份已簽署的 de novo 租約預計將於 2025 年第一季開業。有大量收購，包括目前正在簽署意向書的收購，以及我們繼續評估的其他從頭開始收購。

This quarter, our outpatient rehab division generated a 41% increase in adjusted EBITDA and an 11% increase in visits per day. The division added seven clinics this quarter via de novos, which offset the closure of 12 underperforming clinics and the fold in of eight clinics into existing operations as their leases expire.

本季度，我們的門診復健部門調整後 EBITDA 成長了 41%，每日就診量增加了 11%。該部門本季透過 de novos 新增了 7 家診所，抵消了關閉 12 家表現不佳的診所以及因租約到期而將 8 家診所併入現有業務的影響。

The pipeline for future growth remains strong, with 19 executed leases for de novo clinics, of which 10 are scheduled to open in the first half of 2024. There are also many additional opportunities for acquisitions and de novo development that are under consideration.

未來的成長管道依然強勁，已有 19 個 de novo 診所簽署了租賃合同，其中 10 個計劃於 2024 年上半年開業。還有許多其他收購和從頭開始開發的機會正在考慮中。

At this point, I'll provide some further data points on each of our operating divisions. Our critical illness recovery hospital division experienced increases of 1% in net revenue and 29% in adjusted EBITDA. While our occupancy was down from same quarter last year, an increase in our case mix index and favorable payer contract negotiations contributed to an increase in our revenue per patient day. We've experienced very nice volume increases thus far in the first quarter of 2024 and are now at levels that exceed prior year.

此時，我將提供有關我們每個營運部門的一些進一步的數據點。我們的重症復健醫院部門的淨收入成長了 1%，調整後 EBITDA 成長了 29%。雖然我們的入住率較去年同期有所下降，但病例組合指數的增加和有利的付款人合約談判促進了我們每個患者日收入的增加。到目前為止，2024 年第一季我們的銷售成長非常好，目前的水準超過了去年。

Our adjusted EBITDA margin was 10.1% for the quarter compared to 7.9% in the prior year, Q4. The reduction in labor costs contributed to the improvement of our EBITDA margin with a 4% reduction in our salary wages and benefit to revenue ratio. Both nursing agency rates and utilization decreased 24% when compared to prior-year Q4.

本季調整後的 EBITDA 利潤率為 10.1%，而去年第四季為 7.9%。勞動成本的降低導致我們的 EBITDA 利潤率提高，我們的工資和福利收入比降低了 4%。與去年第四季相比，護理機構率和使用率均下降了 24%。

Orientation hours decreased 10% compared to prior-year Q4 and decreased 26% compared to Q3 of 2023. Nursing sign-on incentive bonus dollars decreased 36% from prior-year Q4 and 5% from the prior sequential quarter.

與去年第四季相比，迎新活動時間減少了 10%，與 2023 年第三季相比，減少了 26%。護理簽約激勵獎金較上年第四季下降 36%，較上一季下降 5%。

Our inpatient rehab hospital division experienced 9% increase in net revenue and a 19% increase in adjusted EBITDA. Patient volumes increased 7% and our rate per patient day increased 3%. Our occupancy of 85% was consistent with prior year. The adjusted EBITDA margin for inpatient rehab was 25.5% for Q4, higher than the prior year of 23.6%.

我們的住院復健醫院部門的淨收入增加了 9%，調整後 EBITDA 增加了 19%。患者數量增加了 7%，每位患者每天的收費增加了 3%。我們的入住率為 85%，與去年持平。第四季住院復健的調整後 EBITDA 利潤率為 25.5%，高於前一年的 23.6%。

Concentra experienced an increase of 6% in net revenue, driven primarily by rate. Our workers' comp volume increased 6% that was offset primarily by a decrease in employer base visits, which are reimbursed at lower rates that resulted in an overall visit increase of 1%. Concentra's adjusted EBITDA margin increased to 15.5% for the quarter compared to 15% for the same quarter prior year.

Concentra 的淨收入成長了 6%，這主要是受費率的推動。我們工人的補償金額增加了 6%，這主要被雇主基礎訪問量的減少所抵消，雇主訪問量的減少導致總體訪問量增加了 1%。本季 Concentra 調整後 EBITDA 利潤率增至 15.5%，去年同期為 15%。

Outpatient rehab division experienced an increase of 6% in net revenue, with patient volumes increasing by 11%, offset by a decrease in rate from $102 net revenue per visit to $100. Organizational activities focusing on improving clinical productivity via patient access contributed to additional volume, where the decline in rate was due to a decline in the outpatient Medicare fee schedule, payer mix, and variable discounts.

門診復健部門的淨收入增加了 6%，患者數量增加了 11%，但費用從每次就診的 102 美元淨收入下降到 100 美元，抵消了這一影響。專注於透過患者訪問提高臨床生產力的組織活動貢獻了額外的數量，其中比率下降是由於門診醫療保險費用表、付款人組合和可變折扣的下降。

The outpatient division adjusted EBITDA increased by 40.9% compared to prior year with a 33% increase in EBITDA margin to 7.5% from 5.7%. Earnings per fully diluted share were $0.36 in the fourth quarter compared to $0.22 per share in the same quarter prior year.

門診部門調整後的 EBITDA 與前一年相比增長了 40.9%，EBITDA 利潤率從 5.7% 增長了 33% 至 7.5%。第四季完全稀釋每股收益為 0.36 美元，去年同期為每股 0.22 美元。

For the full year, earnings per fully diluted share were $1.91 compared to $1.23 per share in the prior year. Adjusted earnings per fully diluted share were $1.99 this year, which excludes the loss from early retirement of debt and its related costs and tax effects.

全年完全稀釋每股收益為 1.91 美元，而前一年為每股 1.23 美元。今年調整後的每股完全攤薄收益為 1.99 美元，其中不包括提前償還債務造成的損失及其相關成本和稅務影響。

In regards to our allocation and deployment of capital, our Board of Directors declared a cash dividend of $0.125 payable on March 13th, 2024, to stockholders of record as of the close of business on March 1, 2024. This past quarter, we did not repurchase shares under our Board-authorized share repurchase program, and we will continue to evaluate stock repurchases, reduction of debt, and development opportunities.

關於我們的資本分配和部署，我們的董事會宣佈於 2024 年 3 月 13 日向截至 2024 年 3 月 1 日收盤時在冊的股東支付 0.125 美元的現金股利。上個季度，我們沒有根據董事會授權的股票回購計畫回購股票，我們將繼續評估股票回購、減少債務和發展機會。

This concludes my remarks, and I'll turn the call over to Marty Jackson for some additional financial details and commentary before we open the call up for questions.

我的演講到此結束，在我們開始提問之前，我會將電話轉給馬蒂傑克遜，以獲得一些額外的財務細節和評論。

Thanks, Bob. Good morning, everyone. I would like to first provide additional details with the progress we continue to make regarding labor costs within the critical illness recovery hospital division. Overall, our salaries, wages, and benefits as a percentage of revenue decreased from 59.8% in Q4 prior year down to 57.6% this past quarter.

謝謝，鮑伯。大家，早安。我想首先提供更多詳細信息，介紹我們在危重病康復醫院部門的勞動力成本方面繼續取得的進展。總體而言，我們的薪水、薪資和福利佔收入的百分比從去年第四季的 59.8% 下降到上一季的 57.6%。

Our SW&B as a percentage of revenue improved as the quarter progressed. Our year-to-date basis, with regards to SW&B as a percentage of revenue, decreased from 63.4% in '22, down to 57.2% in '23. Thus far in 2024, our SW&B as a percentage to revenue has continued to trend favorably, and we expect to finish at or below 55% in Q1.

隨著本季的進展，我們的SW&B 佔營收的百分比有所改善。年初至今，SW&B 佔營收的比例從 22 年的 63.4% 下降到 23 年的 57.2%。2024 年迄今為止，我們的 SW&B 佔收入的百分比持續保持良好趨勢，我們預計第一季將達到或低於 55%。

This past quarter, we had a sequential reduction from Q3 to Q4 in RN agency costs with a decrease in both utilization and agency rates. The reductions realized were 17% in RN agency costs, a drop in RN utilization from 15% to 14% and a decrease in agency rate from $78 to $70. RN agency utilization decreased throughout the quarter from 14.4% in October, 13.8% in November, and 13% in December. Nursing sign-on and incentive bonuses dollars also in decreased by 5%. And we had a 26% decrease in orientation hours.

上個季度，我們的 RN 代理成本從第三季到第四季連續下降，利用率和代理率均下降。RN 代理成本降低了 17%，RN 利用率從 15% 下降到 14%，代理費率從 78 美元下降到 70 美元。RN 機構利用率在整個季度有所下降，分別為 10 月的 14.4%、11 月的 13.8% 和 12 月的 13%。護理師簽約和激勵獎金也減少了 5%。我們的迎新時間減少了 26%。

Moving on to our financials, in Q4, equity and earnings of unconsolidated subsidiaries was $10.2 million compared to $6.8 million in the same quarter prior year. Net income attributable to non-controlling interests was $15.5 million compared to $10.2 million in the same quarter prior year.

轉向我們的財務數據，第四季度，未合併子公司的股本和收益為 1,020 萬美元，而上年同期為 680 萬美元。歸屬於非控制權益的淨利為 1,550 萬美元，而上年同期為 1,020 萬美元。

Interest expense was $50.8 million in the fourth quarter. This compares to $47.3 million in the same quarter prior year. The increase in interest expense was attributable to an increase in interest rates. This was offset by a decrease in our revolving credit facility when compared to Q4 of '22. At the end of the quarter, we had $3.7 billion of debt outstanding and $84 million of cash on the balance sheet.

第四季利息支出為 5,080 萬美元。相比之下，去年同期為 4,730 萬美元。利息支出增加是由於利率上升所致。與 22 年第四季相比，我們的循環信貸額度減少抵消了這一影響。截至本季末，我們的資產負債表上有 37 億美元的未償債務和 8,400 萬美元的現金。

Our debt balance at the end of the quarter included $2.1 billion in term loans, $280 million in revolving loans, $1.2 billion in our 6.25% senior notes, and $68.2 million of other miscellaneous debt. We ended the quarter with net leverage for our senior secured credit agreement of 4.54 times. As of December 31, we had $434 million of availability on our revolver. The interest rate on $2 billion of our term loans is capped at 1% SOFR plus 300 basis points through September 30 of 2024.

截至本季末，我們的債務餘額包括 21 億美元的定期貸款、2.8 億美元的循環貸款、12 億美元的 6.25% 優先票據以及 6,820 萬美元的其他雜項債務。本季結束時，我們的優先擔保信貸協議的淨槓桿率為 4.54 倍。截至 12 月 31 日，我們的左輪手槍可用價值為 4.34 億美元。截至 2024 年 9 月 30 日，我們 20 億美元定期貸款的利率上限為 1% SOFR 加 300 個基點。

For the fourth quarter, operating activities provided us with $179.4 million in cash flows. Our days sales outstanding or DSO was 52 days as of December 31, 2023. This is compared to 55 days at December 31 of 2022 and 52 days at September 30, 2023. Investing activities used $69.6 million of cash in the fourth quarter. This includes $60.6 million in purchases of property, equipment, and other assets and $9 million in acquisition and investment activity.

第四季度，經營活動為我們提供了 1.794 億美元的現金流。截至 2023 年 12 月 31 日，我們的應收帳款天數或 DSO 為 52 天。相較之下，2022年12月31日為55天，2023年9月30日為52天。第四季投資活動使用了 6,960 萬美元現金。其中包括 6,060 萬美元的不動產、設備和其他資產採購以及 900 萬美元的收購和投資活動。

Financing activities used $103.3 million of cash in the fourth quarter. This was primarily due to $60 million in net payments on our revolving line of credit; $16 million in dividends on our common stock; $13.4 million net payments on other debt, which included $5.3 million of term loan payments; and $12.5 million in net payments and distributions to non-controlling interest.

第四季融資活動使用現金 1.033 億美元。這主要是由於我們的循環信貸額度淨付款為 6,000 萬美元； 1600 萬美元的普通股股息；其他債務淨支付額為 1,340 萬美元，其中包括 530 萬美元的定期貸款支付；向非控制權益支付和分配的淨額為 1,250 萬美元。

As stated previously, we did not purchase any shares under our Board-authorized repurchase program this quarter. Last quarter, the Board approved a two-year extension of the share repurchase program, which now remains in effect until December 31, 2025, unless further extended or earlier terminated by the Board.

如前所述，本季我們沒有根據董事會授權的回購計畫購買任何股票。上季度，董事會批准將股票回購計畫延長兩年，該計畫目前有效期至 2025 年 12 月 31 日，除非董事會進一步延長或提前終止。

We are issuing our business outlook for 2024 and expect revenue to be in the range of $6.9 billion to $7.1 billion. Adjusted EBITDA is expected to be in the range of $830 million to $880 million. And finally, our expected range for earnings per fully diluted common share is $1.88 to $2.18. We expect capital expenditures to be in the range of $225 million to $275 million for 2024.

我們正在發布 2024 年業務展望，預計營收將在 69 億至 71 億美元之間。調整後 EBITDA 預計在 8.3 億美元至 8.8 億美元之間。最後，我們預計完全稀釋後的每股普通股收益範圍為 1.88 美元至 2.18 美元。我們預計 2024 年的資本支出將在 2.25 億美元至 2.75 億美元之間。

This concludes our prepared remarks. And at this time, we'd like to turn it back over to the operator to open up the call for questions.

我們準備好的演講到此結束。此時，我們想將其轉回給接線員以打開提問電話。

(Operator Instructions) Justin Bowers, Deutsche Bank.

（操作員指示）Justin Bowers，德意志銀行。

Hi, good morning, everyone. Could you talk about some of the moving parts in the guide? And then any additional color you can give us by segment would be appreciated as well. How are you thinking about some of the segments playing out for the year?

嗨，大家早安。您能談談指南中的一些活動部分嗎？然後，您可以按段向我們提供任何其他顏色，我們也將不勝感激。您如何看待今年播出的一些片段？

Yes, Justin. This is Marty. The outlook that we provided is really a function of taking a look at the four business segments, taking a look at some of the headwinds as well as the tailwinds. Obviously, the inpatient rehab is doing quite well. Concentra is doing quite well. But we did have some headwinds, though, in the -- both our critical illness recovery hospitals with regards to the high-cost outlier. And we had cuts on the Medicare portion of our outpatient rehab.

是的，賈斯汀。這是馬蒂。我們提供的前景實際上是對四個業務部門、一些逆風和順風的考察的結果。顯然，住院復健工作進展順利。Concentra 的表現相當不錯。但我們的兩家危重病復健醫院確實遇到了一些關於高成本異常情況的阻力。我們削減了門診復健的醫療保險部分。

All of that's reflected in the outlook, so I think you can expect that the critical illness recovery hospitals and outpatient rehab were a little bit muted because of that. But both inpatient rehab and Concentra continues to do quite well, both in tough in terms of revenue growth and EBITDA growth.

所有這些都反映在前景中，所以我認為你可以預料到，重症復健醫院和門診復健中心因此而有些平靜。但住院復健中心和 Concentra 都繼續表現良好，但在收入成長和 EBITDA 成長方面都表現不佳。

Okay, understood. And then I just wanted to ask one about -- a couple about LTAC and then one on outpatient rehab. So I think you said that LTAC is tracking towards 55% SWB in first quarter. I just want to clarify that I heard that correctly. And then is that sort of the implication there that the volumes are up sequentially?

好的，明白了。然後我只想問一個關於 LTAC 的問題，然後一個關於門診復健的問題。所以我認為您說過 LTAC 第一季的 SWB 目標是 55%。我只是想澄清一下我沒聽錯。那麼這是否意味著卷是按順序增加的？

And then just one more. Do you have another LTAC coming online in 2024 this year? I guess that's a bit of a three-parter.

然後還有一個。今年還有另一個 LTAC 將於 2024 年上線嗎？我想這有點像三人組。

Sure. The first part of the question with the 55% -- and yes, you did hear that correctly. We are trending towards 55%. We have seen volumes up in the first quarter, and we do have a hospital coming on as critical illness recovery hospital in Q2.

當然。問題的第一部分是 55%——是的，你沒有聽錯。我們正朝著 55% 的方向發展。我們看到第一季的數量增加，並且我們確實有一家醫院在第二季度成為危重疾病康復醫院。

Okay, got it. And then just on outpatient rehab, I know that there's -- obviously, there's been some headwinds with Medicare too, but you guys have been chopping somewhat operationally as well over the last, I think, four to six quarters. Is that segment likely -- are you expecting margins to improve in that segment this year? And any thoughts on the trajectory to get back to that low to mid-teens margin that you guys target?

好，知道了。然後就門診復健而言，我知道醫療保險也存在一些阻力，但我認為，在過去的四到六個季度裡，你們在營運上也有所削減。該細分市場有可能嗎？您預計今年該細分市場的利潤率會提高嗎？對於回到你們目標的低至中青少年利潤率的軌跡有什麼想法嗎？

Yes. As I mentioned before, we did have the cuts from Medicare and that had -- that muted the growth there. We do expect -- we're seeing clinical efficiencies improve. And we expect within -- probably within the next two, three years that we will be in that low to mid-range teens as far as margins are concerned.

是的。正如我之前提到的，我們確實削減了醫療保險，這削弱了那裡的成長。我們確實期望——我們看到臨床效率有所提高。我們預計，就利潤率而言，可能在未來兩三年內，我們將處於中低水準。

Okay, thanks. I'll jump back in queue.

好的謝謝。我會插回隊列。

Thanks, Justin.

謝謝，賈斯汀。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. Maybe just to get back to the guidance, the range I guess for percentage perspective looks a little wide. What are the things that you think are kind of the things that could push you to the high end or the low end of the guidance range?

萬分感謝。也許只是回到指導，我認為百分比視角的範圍看起來有點寬。您認為哪些事情可以將您推向指導範圍的高端或低端？

I think the primary item for us, Kevin, is the potential impact on the high-cost outliers on the critical illness recovery hospitals. And that's why we were pretty wide on the rate.

凱文，我認為我們的首要任務是對重症復健醫院的高成本異常值的潛在影響。這就是為什麼我們的利率相當廣泛。

Okay. And then I guess the improvement you made in the Q4 on the labor side of things happened with volume being a little bit weak. I just want to see -- it seems you should be easier to staff when order volumes are a little bit light. It sounds like you're expecting volumes to kind of come back. Is there anything you need to do on the hiring side or any trends you could point to on the hiring side that say as volumes normalize, you'll still be able to make progress on the temp staffing side of things?

好的。然後我猜你在第四季在勞動力方面取得的進步是在成交量有點弱的情況下發生的。我只是想看看——當訂單量有點少時，你似乎應該更容易配備人員。聽起來你預計銷量會回升。在招聘方面您需要做些什麼，或者您可以指出招聘方面的任何趨勢，即隨著數量正常化，您仍然能夠在臨時人員配置方面取得進展？

For us, what we've seen is we are back to pre-pandemic with regards to our staffing. If you recall, we talked about, on average, pre-pandemic what our -- different buckets of nurses are in. So we have our full-time nurses that's pretty much back to where we've been pre-pandemic. We think we're seeing PRN actually increase, which is a good thing. And historically, we've been in that 15% to 18% as far as agency nursing, and we're down to 13%, 14%. (Multiple speakers)

對我們來說，我們所看到的是我們的人員配置回到了大流行前。如果你還記得的話，我們討論過，平均而言，大流行前我們的不同類別的護士處於什麼狀態。所以我們的全職護理師幾乎回到了疫情前的狀態。我們認為 PRN 實際上有所增加，這是一件好事。從歷史上看，我們的機構護理比例一直在 15% 到 18%，現在已經下降到 13%、14%。（多位發言者）

But then if you said you are back from a staffing level, what's the lever to get further down as a percentage of SW&B? Is it just occupancy and leverage from that, or is it rates?

但如果你說你已經從人員配置水準恢復過來，那麼進一步降低 SW&B 比例的槓桿是什麼？只是入住率和槓桿率，還是利率？

Yeah, it really is -- it's volume. Volume will do wonders to get that percentage down. Yeah, I mean, volume is going to increase your top line.

是的，確實是——這是音量。成交量將創造奇蹟來降低這一百分比。是的，我的意思是，成交量會增加你的收入。

Okay. And then maybe -- the Concentra spin-off sounds really interesting. I was wondering if you could just maybe provide us -- remind us how you're thinking about the growth of Concentra and what that company might look like as a standalone company.

好的。也許——Concentra 的衍生產品聽起來真的很有趣。我想知道您是否可以向我們提供——提醒我們您如何看待 Concentra 的發展以及該公司作為獨立公司可能會是什麼樣子。

You've done a really good job bringing the margins up in that business. Is there still room on the margin side or is it more about organic growth, de novos, and tuck-in acquisitions? Or how should we think about the growth of that business as a separate company?

你們在提高該業務的利潤方面做得非常好。利潤率方面是否仍有空間，還是更專注於有機成長、從頭開始和收購？或者我們應該如何考慮作為獨立公司的該業務的成長？

It's Bob. I think Concentra is just a fabulous company because that because of their dominance in that occupational medicine space and their various levers they have to grow. I mean, they can grow by de novo. They can grow by acquisitions, either in new markets or existing markets. So they have a lot of levers that they can press, and I think that they enjoy solid margins now.

是鮑伯。我認為 Concentra 是一家出色的公司，因為他們在職業醫學領域佔據主導地位，並且擁有各種手段，因此他們必須成長。我的意思是，它們可以從頭開始生長。他們可以透過收購來實現成長，無論是在新市場還是現有市場。因此，他們有很多可以利用的槓桿，我認為他們現在享有可觀的利潤。

I'm not sure that I could sit here and project that their margins are going to go very much higher than they are right now, but they do have a lot of opportunities for growth. So we're pretty excited to have Concentra, as you know, all these years that we've had it, and I'm pretty enthusiastic about their prospects as a stand-alone company.

我不確定我是否可以坐在這裡預測他們的利潤率會比現在高很多，但他們確實有很多成長機會。因此，我們非常高興能夠擁有 Concentra，正如您所知，這些年來我們一直擁有它，而且我對他們作為獨立公司的前景充滿熱情。

Great. Thank you.

偉大的。謝謝。

Ben Hendrix, RBC Capital Markets.

本‧亨德里克斯，加拿大皇家銀行資本市場部。

Thank you very much. You guys are continuing to deliver a really impressive margin in the inpatient rehab business despite what looks like a fairly aggressive development strategy.

非常感謝。儘管看起來相當積極的發展策略，你們仍在住院復健業務中繼續提供令人印象深刻的利潤。

I'm just wondering if you could kind of go in a little bit more into your development pipeline, how you're thinking about that, and if there's any risk that we could see some drag on the margin over the next several quarters given the expansion? Thanks.

我只是想知道您是否可以更多地了解您的開發流程，您是如何考慮這一點的，以及考慮到未來幾季我們可能會看到利潤率受到一些拖累的風險擴張？謝謝。

As you point out, we are -- feel pretty good about the development pipelines for inpatient rehab, given our strategy. And our strategy is -- our new development is in partnership with a large acute care system. So in some regards, we don't have complete control over the cadence of when those hospitals come on.

正如您所指出的，考慮到我們的策略，我們對住院復健的開發管道感到非常滿意。我們的策略是－我們的新開發是與大型急診系統合作。因此，在某些方面，我們無法完全控制這些醫院的開診節奏。

Now, as you know that we -- our policy is not to announce our rehab projects until they're signed and commenced. But we did go a little bit further on disclosure today when I talked about the hospitals in 2024 that we had hoped to have under construction are complete. So that's 533 rehab beds and a much smaller number of critical illness beds in 2024.

現在，如您所知，我們的政策是在簽署並開始之前不會宣布我們的康復項目。但今天，當我談到我們原本希望在建的醫院在 2024 年竣工時，我們確實在披露方面走得更遠。因此，到 2024 年，復健床位數量將達到 533 個，而重症床位數量將少得多。

Any drag on earnings as a result of that development you can assume is factored into the guidance. So I think that we're of a size, and the platform there is that we feel we can bring these on and not really compromise our growth rate in that division.

您可以假設的這種發展對收益造成的任何拖累都已納入指導中。因此，我認為我們的規模和平台使我們認為我們可以實現這些目標，而不會真正影響我們在該部門的成長率。

Thanks. And just if I may ask a different question here, we're getting into questions about the recently announced subpoena in California for Concentra. And I know these types of things pop up from time to time, but is there anything unique or notable about the subpoena? And is there any potential for it to delay your timeline on the spend? Thanks.

謝謝。如果我可以在這裡問一個不同的問題，我們正在討論最近在加州宣布的 Concentra 傳票的問題。我知道這類事情時不時​​就會出現，但是傳票有什麼獨特或值得注意的地方嗎？它是否有可能延遲您的支出時間表？謝謝。

Now we do not believe that it will have any delay on the on the separation of Concentra. These subpoenas you can get for all kinds of reasons. This one comes from the California State Department of Insurance, and you can have -- I think investors in healthcare are used to the various (inaudible) that are oftentimes announced because of whistle-blower suits, and that could happen in state agencies as well as well as federal.

現在我們認為Concentra的分離不會有任何拖延。您可以出於各種原因獲得這些傳票。這個來自加州保險部，你可以——我認為醫療保健領域的投資者已經習慣了由於舉報人訴訟而經常宣布的各種（聽不清），而且這也可能發生在州機構中以及聯邦。

We never like to get them. And [I wouldn't want to] say that these are routine, but they have become routine over the years. And so we disclosed it as we feel is our obligation. But beyond that, I really can't predict the outcome, but I can tell you that we will vigorously defend our business practices in California with Concentra.

我們從來不喜歡得到它們。[我不想]說這些都是例行公事，但多年來它們已經成為例行公事。因此，我們披露了這一點，因為我們認為這是我們的義務。但除此之外，我真的無法預測結果，但我可以告訴你，我們將與 Concentra 一起大力捍衛我們在加州的商業行為。

Thank you.

謝謝。

Bill Sutherland, the Benchmark Company.

比爾·薩瑟蘭，基準公司。

Thank you. Good morning, guys. Hey, Bob, you mentioned that volumes were starting to improve quarter to date for critical illness. Can you just give some more color on that and maybe how you think about the sustainability?

謝謝。早上好傢伙。嘿，鮑勃，您提到本季迄今為止，重症疾病的治療量開始有所改善。您能否就此提供更多資訊以及您如何看待永續性？

Well, I can't give you much more color on that. I mean, you know we are trying to give a little bit more disclosure. And us to give how the first quarter is shaping up is, as you know, probably a little unusual for us. But we were pleased that volumes are up.

好吧，我不能給你更多的資訊。我的意思是，你知道我們正在努力提供更多資訊。如您所知，我們提供第一季的情況對我們來說可能有點不尋常。但我們很高興銷量增加。

Now it is -- seasonally, this is the time -- and I those volumes can be affected by lots of things, but it was pretty broad based across the country for our critical illness hospital.

現在是——從季節性來看，是時候了——我認為這些數量可能會受到許多因素的影響，但對於我們的重症醫院來說，它在全國範圍內的影響相當廣泛。

So I thought that was noteworthy. I mean, it's hard to say without more current data, whether it's because you have more respiratory cases or whether there's COVID or other acute illnesses that are driving that volume. Normally our critical illness volumes go up when the ICUs at acute care hospitals volumes go up.

所以我認為這是值得注意的。我的意思是，如果沒有更多的最新數據，很難說是因為呼吸道病例增多，還是因為新冠病毒或其他急性疾病導致了這一數量的增長。通常情況下，當急診醫院的 ICU 數量增加時，我們的重症數量也會增加。

So when we look at our volumes, I think you can assume that in large measure, it's because volumes at our referral hospitals and their ICUs are up as well.

因此，當我們查看我們的數量時，我認為您可以假設在很大程度上，這是因為我們的轉診醫院及其 ICU 的數量也在增加。

So sustainable, I'd like to think so. I mean, I don't think there's anything to suggest that there has been an outbreak of health in the United States. I think we'll continue to see patients that, particularly with an aging population, that have the kind of respiratory conditions that land them in ICUs and make them appropriate for our level of care.

如此可持續，我想是這樣。我的意思是，我認為沒有任何跡象表明美國爆發了健康疫情。我認為我們將繼續看到患有呼吸系統疾病的患者，特別是人口老化的患者，他們會被送入重症監護室，並適合我們的護理水平。

So I'd like to think so. But as you've seen over the years, that census can go up and down, and Q1 is seasonally one of the better quarters because of the because of the winter and the colder months.

所以我想是這樣認為的。但正如您多年來所看到的，人口普查可能會上下波動，而且由於冬季和寒冷的月份，第一季是季節性較好的季度之一。

Yeah, it was interesting on a year-over-year basis because you were kind of flattish side here last year. At Concentra, I'm curious if you could give us a little more color on the blend of the business and why the employer visit side is not as strong, and what might be the outlook for that? I know it helps the mix, but just curious about that.

是的，與去年同期相比，這很有趣，因為去年你們的表現有些平淡。在 Concentra，我很好奇您能否給我們更多關於業務融合的信息，以及為什麼雇主訪問方面不那麼強大，以及前景如何？我知道這有助於混合，但只是對此感到好奇。

Yeah, Bill, this is Marty. The employer side, there's different things that they have there and the different activities they perform. It's pre-employment, physicals, drug testing. To a certain extent, it has to do with the drug testing is down a little bit. And I think that may have to do with some of the -- we've increased some of our pricing. And there is a lot of price elasticity associated with that product.

是的，比爾，這是馬蒂。雇主方面，他們有不同的東西，他們進行不同的活動。這是就業前、身體檢查、藥物測試。一定程度上跟藥檢下降一點有關。我認為這可能與我們提高了一些定價有關。該產品具有很大的價格彈性。

But it has a pretty standard -- I mean, steady demand side, the drug testing.

但它有一個相當標準的標準——我的意思是，穩定的需求方，藥物測試。

Yeah, there is. But as you probably know, the Department of Transportation requires drug testing for all truck drivers. So that's certainly been good. And there is some -- as far as the employment, employment has been pretty steady.

是的，有。但您可能知道，交通部要求對所有卡車司機進行藥物測試。所以當然很好。還有一些——就就業而言，就業一直相當穩定。

Okay. I'm thinking about outpatient rehab for a second and the revenue per visit. And I know the pressure there from Medicare. How do you think things could go this year for that number?

好的。我正在考慮門診復健和每次就診的收入。我知道來自醫療保險的壓力。您認為今年這個數字會如何？

I think we're going to see net revenue per visit increase -- our expectation is to see that increase at least a couple of dollars, whether it's $2 or $3 by the end of the year.

我認為我們將看到每次訪問的淨收入增加——我們的預期是到年底增加至少幾美元，無論是 2 美元還是 3 美元。

Right. And then just kind of a more high-level question, Bob, I'm looking at this big expansion plan for beds for rehab hospital relative to critical illness. And I'm wondering if this is just timing or is this kind of a Board and management view of capital allocation, relative to -- given the margin profile of rehab hospitals and the, I think, the market growth opportunities relative to -- critically on this?

正確的。然後是一個更高級別的問題，鮑勃，我正在考慮一項針對重症疾病的康復醫院床位的大型擴張計劃。我想知道這是否只是時機，還是董事會和管理層對資本配置的看法，相對於——考慮到康復醫院的利潤狀況以及我認為相對於——關鍵的市場成長機會關於這個？

Yeah, it's a good question about how we think about allocating capital, which is truly an allocation of capital assessment. The rehab, the critical illnesses have historically been our largest division. We have a footprint of over 107 hospitals. I see that there are -- there will always be, I think, opportunities there, although we have brought some reimbursement headwinds in the critical illness. And this high-cost outlier threshold issue that we've talked about is certainly a headwind.

是的，這是一個關於我們如何考慮資本分配的好問題，這實際上是資本評估的分配。復健、危重疾病歷來是我們最大的部門。我們的足跡遍佈超過 107 家醫院。我認為，儘管我們在危重疾病方面帶來了一些報銷阻力，但我認為，那裡永遠存在著機會。我們討論過的這種高成本異常值閾值問題無疑是一個阻力。

That's not to say that rehab hospitals will not have headwinds in the future. But I think the way we look at it is as we work with the kind of large partners of the type that we have signed, when you have those opportunities to do those deals, I think those are the ones that become a priority for our capital.

這並不是說復健醫院未來不會遇到阻力。但我認為我們看待這個問題的方式是，當我們與我們已經簽署的那種大型合作夥伴合作時，當你有機會進行這些交易時，我認為這些是我們資本的優先事項。

And typically, they involve using capital to build new hospitals, which are not inexpensive. The critical illness opportunities do come about, and we tend to [triage]. Those are the ones that are absolutely the most compelling. So we will continue to do that and add new hospitals to critical illness. But when we have an opportunity to work with a great partner as the profile -- the ones that we have for inpatient rehab, we certainly want to move on those.

通常，它們涉及利用資金建造新醫院，而這些醫院並不便宜。危重疾病的機會確實出現了，我們傾向於[分類]。這些絕對是最引人注目的。因此，我們將繼續這樣做，並增加新的重症醫院。但是，當我們有機會與一個優秀的合作夥伴合作時——我們為住院康復所擁有的合作夥伴，我們當然希望繼續努力。

And our development pipeline that we've been working for years and years and years is just very robust right now. And there are some great opportunities to sign some rehab deals with some great partners. And what we've seen over the history of the company is these partnership deals and returns and growth within the partnerships is absolutely compelling.

我們多年來一直在努力的開發管道現在非常強大。並且有一些很好的機會與一些優秀的合作夥伴簽署一些康復協議。我們在公司的歷史中看到的是這些合作夥伴關係交易以及合作夥伴關係中的回報和成長絕對是引人注目的。

And I think because of the way we structured those with the partners, they tend to have a larger moat around them and give you the comfort that even in the face of perhaps some reimbursement headwinds, if and when they come, you'll be able to navigate them better with a very large system.

我認為，由於我們與合作夥伴構建這些機制的方式，他們往往有更大的護城河，讓你感到安慰，即使面對一些報銷逆風，如果它們來了，你將能夠通過一個非常大的系統更好地導航它們。

And I think the other thing that's not particularly well recognized is not only the signing of the new partnerships, but the growth within the partnerships. And I mentioned today that we are getting underway with the construction of our fourth inpatient rehab facility in partnership with the Cleveland Clinic in their market.

我認為另一件沒有特別充分認識的事情不僅是新夥伴關係的簽署，還有合作關係內部的成長。我今天提到，我們正在與克利夫蘭診所合作在其市場上建造第四個住院復健設施。

And so these opportunities just are really compelling. And sometimes building replacement facilities or taking units out of hospitals and partnership and building those are just really great deals. So I think you'll continue to see growth in both, but perhaps a bit more of an acceleration of the inpatient rehab. And with the planned separation of Concentra, as we look at the growth rate for the company, we'll see it in outpatient rehab, inpatient, and in the critical illness. But the rehab is a good opportunity.

因此，這些機會確實非常引人注目。有時建造替代設施或將單位從醫院中取出並建立夥伴關係確實是很棒的交易。因此，我認為您將繼續看到兩者的增長，但住院康復的速度可能會加快。隨著 Concentra 的計劃分離，當我們觀察公司的成長率時，我們將在門診康復、住院和危重疾病中看到它。但康復是一個很好的機會。

Thanks, Bob.

謝謝，鮑伯。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Hi, everybody. A couple of questions, maybe. I just want to make sure I understand, on the tough couple of times in response to questions about the outlier threshold increasing on the critical access facilities or critical illness facilities, what -- that went into effect, I think, October 1. Do you get a pretty good read right away as to how that impact is? I guess I'm trying to figure out why it still is a big swing factor in the guidance if you've got a quarter's experience already.

大家好。也許有幾個問題。我只是想確保我理解，在回答有關關鍵通道設施或重大疾病設施異常閾值增加的問題時，我認為這會在 10 月 1 日生效。您是否立即就了解了這種影響如何？我想我正在試圖弄清楚，如果你已經有了四分之一的經驗，為什麼它仍然是指導中的一個很大的搖擺因素。

Hey, A.J. It really takes some time to evaluate something that significant with regards to the high-cost outlier. I mean, we went from $38,000 -- a little bit north of $38,000 up to $59,000. And remember, the length of stay of our patients is not five to six days. It's over 30 days.

嘿，A.J.對於高成本異常值來說，評估一些重要的事情確實需要一些時間。我的意思是，我們的價格從 38,000 美元（略高於 38,000 美元）升至 59,000 美元。請記住，我們患者的住院時間不是五到六天。已經30多天了。

I think the other thing, A.J., is it's not hard for us. But our robust systems and data collection to understand the impact, we understood the impact way in advance of it going into effect. It's a question of how your mitigation strategies are going to work.

我認為另一件事，A.J.，這對我們來說並不難。但是我們強大的系統和資料收集來了解影響，我們在其生效之前就了解了影響的方式。問題在於您的緩解策略將如何發揮作用。

And so it's not so much understanding the impact. But over the course of this year, how will -- how successful will the operators be in the mitigation? And that is -- it tends to play out and is not as easy as you would think because it's -- you want to keep your referral sources happy. But at the same time, you have to appreciate that the more high-cost outliers that you hit, the more are the losses you're going to sustain. So I think that is a reason why we've left ourselves some room on the guidance.

因此，人們還不太了解其影響。但在今年，營運商在緩解方面將取得怎樣的成功？也就是說，它往往會發揮作用，並且並不像您想像的那麼容易，因為您想讓您的推薦來源滿意。但同時，您必須認識到，遇到的高成本異常值越多，您承受的損失就越大。所以我認為這就是我們在指導上給自己留下一些空間的原因。

Okay. Can you -- probably have given this before. Can you just remind me what percentage of your admissions or your volume or however you want to describe it end up falling into that status? Typically, I know it will change with the increased threshold, but is there -- can we get an order of magnitude of how many -- what percentage of your patients are impacted in that business?

好的。你能——可能以前已經給過這個嗎？您能否提醒我您的錄取人數或數量或您想如何描述的百分比最終落入這種狀態？通常情況下，我知道它會隨著閾值的增加而改變，但是，我們能否得到一個數量級，您的患者在該業務中受到影響的比例是多少？

Yeah, A.J., it varies pretty significantly, hospital by hospital, and then on average also. So we really have not provided that because of that variation.

是的，A.J.，不同醫院的情況差異很大，而且平均情況也是如此。因此，由於這種變化，我們確實沒有提供這一點。

I can tell you that as we look over the entire industry, Select Medical probably has more higher cost outliers than the average of the rest of the industry because we take higher acuity patients. You'll recall that our strategy, long held, was not to take site-neutral patients and to only take the highest acuity patients.

我可以告訴你，當我們縱觀整個行業時，Select Medical 可能比其他行業的平均水平有更多更高的成本異常值，因為我們接受的是更高敏銳度的患者。您可能還記得，我們​​長期以來堅持的策略是不接受地點中立的患者，而只接受視力最高的患者。

We believed that that was the intent of the 2014 criteria we built our clinical programs around being able to take care of those very complex patients. And this has been part of our efforts with CMS is that the high-cost outlier increase of the threshold actually hurts those providers that are actually taking care of the very patients that the policy wants the LTACs to take care of. Ours tend to be higher, and so we're affected more.

我們相信，這就是 2014 年標準的目的，我們圍繞著能夠照顧那些非常複雜的患者制定了臨床計劃。我們在 CMS 所做的努力的一部分是，門檻的高成本異常增加實際上損害了那些實際上正在照顧政策希望 LTAC 照顧的患者的提供者。我們的水平往往更高，因此我們受到的影響更大。

Okay, that makes sense. And I think in the fourth quarter, you called out that you had about $3 million of start-up costs from development, and that's similar to what you had in the fourth quarter of '22. Can you talk about the total amount, given the development projects that are underway, joint ventures, et cetera, how much '24 start-up costs will be compared to what startup costs ended being up in '23? Is that a headwind tailwind, tailwind? How is the shakeout?

好吧，這是有道理的。我認為在第四季度，您稱您的開發啟動成本約為 300 萬美元，這與 22 年第四季的情況類似。您能否談談總金額，考慮到正在進行的開發項目、合資企業等，與 23 年最終的啟動成本相比，24 年的啟動成本是多少？這是逆風、順風、順風嗎？洗牌情況如何？

I think for '24, our projected start-up loss is $12.3 million, and that is reflected in the business outlook.

我認為 24 年，我們預計的啟動虧損為 1,230 萬美元，這反映在業務前景中。

And that is that -- off the top of your head, do you have how that compares with '23? Is it a similar amount?

那就是——你的腦海中浮現出這與'23'相比如何？是類似的金額嗎？

Yeah, it is similar amount in 2023.

是的，2023 年的數量也差不多。

Okay. All right. And then just a last question, Marty, you called out that obviously, some of these interest rate caps and swaps, et cetera, expire in September. What is your assumption? What do you think about your outlook as to what happens in the fourth quarter with respect to your borrowing costs, or what mitigation strategies are you thinking about or any comment on that?

好的。好的。最後一個問題，馬蒂，你顯然指出，其中一些利率上限和掉期等將在 9 月到期。你的假設是什麼？您對第四季度借貸成本的前景有何看法，或者您正在考慮哪些緩解策略或對此有何評論？

Yeah, A.J., we anticipate that we'll see probably about a $20 million increase in interest expense for the fourth quarter. On an EPS basis, that's about $0.12 a share.

是的，A.J.，我們預計第四季度的利息支出可能會增加約 2000 萬美元。以 EPS 計算，每股盈餘約為 0.12 美元。

Okay. And is there anything, any way to mitigate that in any way or not particularly? That's sort of it is -- rates are what rates are?

好的。有沒有辦法以任何方式或不是特別地減輕這種情況？就是這樣——利率是什麼？

Yeah, at this point in time, the way we've mitigated is that the indices come down, right?

是的，在這個時候，我們緩解的方法是指數下降，對嗎？

Okay. I will take it, maybe a pivot to paying down a retiring debt or something like that. I know you said you didn't do any buybacks this quarter. I don't know if anything like that was in the -- was under review or not.

好的。我會接受它，也許是償還退休債務或類似的東西的一個支點。我知道您說過本季沒有進行任何回購。我不知道類似的內容是否正在接受審查。

We will take any -- we will be very opportunistic as we always are, A.J., and take advantage of any opportunity we can to get that interest expense down.

我們將一如既往地抓住一切機會，A.J.，並利用一切可能的機會來降低利息支出。

Yeah, we're looking at it at this point in time. We've got a good six months for us to think about what opportunities they are. And that is -- as Marty pointed out, that's $0.12 off the EPS that we reflected in the guidance, which -- because of the cap going off. But we will find opportunities.

是的，我們現在正在考慮這個問題。我們有六個月的時間來思考它們是什麼機會。正如 Marty 指出的，這比我們在指導中反映的 EPS 低了 0.12 美元，因為上限已經取消。但我們會找到機會。

Okay. All right. Thanks a lot.

好的。好的。多謝。

Thank you. At this time, I would now like to turn the conference back over to Mr. Ortenzio for closing remarks.

謝謝。現在，我想將會議轉回奧滕齊奧先生致閉幕詞。

No closing remarks. Thank you, operator, and thanks, everybody, for joining us.

沒有結束語。謝謝運營商，也謝謝大家加入我們。

This concludes today's conference call. Thank you for participating. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。