Select Medical Holdings Corp (SEM) 2025 Q1 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 first quarter 2025 results at the company's -- and the company's business outlook.

早安，感謝您今天參加 Select Medical Holdings Corporation 的收益電話會議，討論公司 2025 年第一季度的業績以及公司的業務前景。

Presenting 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. Also on the conference line are the company's Executive Vice President and Chief Financial Officer, Michael Malatesta; and the company's Senior Vice President, Controller and Chief Accounting Officer, Christopher Weigl. Management will give you an overview of the quarter and open the call for questions.

今天出席的有該公司的執行主席兼聯合創始人羅伯特·奧滕齊奧 (Robert Ortenzio)；以及該公司戰略財務和運營高級執行副總裁馬丁·傑克遜 (Martin Jackson)。同時參加電話會議的還有該公司執行副總裁兼財務長 Michael Malatesta；以及公司資深副總裁、財務主管兼首席會計長克里斯多福‧韋格爾 (Christopher Weigl)。管理階層將向您介紹本季的概況並開放提問環節。

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 plans, expectations, strategies, intentions and beliefs.

在我們開始之前，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、成長機會和其他提及 Select Medical 計劃、期望、策略、意圖和信念的陳述。

These forward-looking statements are based on 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更新這些陳述的義務。

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

現在，我將把電話轉給羅伯特·奧滕齊奧先生。

Thank you, operator. Good morning, everyone. Welcome to Select Medical's earnings call for the first quarter of 2025. This was our first full quarter since our spin of Concentra this past November. As most of you know, we now have three remaining lines of business. Our inpatient rehab division had a very good first quarter and continues to exceed our expectations.

謝謝您，接線生。大家早安。歡迎參加 Select Medical 2025 年第一季財報電話會議。這是自去年 11 月我們剝離 Concentra 以來的第一個完整季度。正如你們大多數人所知，我們現在還剩下三條業務線。我們的住院復健部門第一季表現非常好，並且繼續超越我們的預期。

We are very excited about the significant growth of this business line for the foreseeable future. This past quarter presented challenges for both our outpatient and critical illness recovery hospital lines of business. Our outpatient division was impacted by severe weather events in the South and Central regions, along with a 3% reduction in Medicare reimbursement.

我們對可預見的未來該業務線的顯著成長感到非常興奮。過去一個季度，我們的門診和重症復健醫院業務都面臨挑戰。我們的門診部受到南部和中部地區惡劣天氣事件的影響，醫療保險報銷金額減少了 3%。

The outpatient division, however, had a strong finish to the quarter, which has carried over into the second quarter. The outpatient division would have exceeded prior year adjusted EBITDA performance for the quarter, if not for the impact of the severe weather events.

然而，門診部在本季表現強勁，並延續到了第二季。如果不是因為惡劣天氣事件的影響，門診部本季的調整後 EBITDA 業績將會超過去年同期。

We are confident in the outlook for outpatient as the division continues to focus on improving patient access, productivity and investing in technology. The Critical Illness Recovery Hospital division was impacted by a late start to the flu season, another increase in the high-cost outlier threshold, which has almost doubled over the last two years and the 20% transmittal rule.

我們對門診前景充滿信心，因為該部門將繼續致力於改善患者的就診機會、提高生產力和技術投資。重症復健醫院部門受到流感季節開始較晚、高成本異常值門檻再次提高（過去兩年幾乎翻了一番）以及 20% 傳輸規則的影響。

Approximately two-thirds of Critical Illness EBITDA missed to prior year was a result of the regulatory changes [comprised] of the increase to the outlier threshold and the 20% transmittal rule.

重大疾病 EBITDA 未達到上一年的約三分之二是由於監管變化造成的，包括異常值閾值的提高和 20% 的轉移規則。

In spite of these challenges, the division also had a strong finish to the quarter, which has carried into the second quarter. I'm very proud of how our operators were able to finish the quarter, which resulted in each division exceeding prior year adjusted EBITDA performance for the month of March.

儘管面臨這些挑戰，該部門在本季度仍取得了強勁的業績，並且這種勢頭一直延續到了第二季度。我對我們的營運商能夠完成本季的業績感到非常自豪，這使得每個部門 3 月份的調整後 EBITDA 業績都超過了去年同期。

Our development pipeline remains strong, primarily in our inpatient rehab division. In January, we opened a rehab unit in Madison, Wisconsin, with 18 beds. In April, we opened a 12-bed unit in Tallahassee, Florida, and our second rehab hospital, UPMC in Central Pennsylvania comprised of 20 beds.

我們的開發管道依然強勁，主要是在我們的住院復健部門。一月份，我們在威斯康辛州麥迪遜市開設了一個擁有 18 張床位的復健中心。4 月份，我們在佛羅裡達州塔拉哈西開設了一個擁有 12 個床位的病房，並在賓州中部開設了第二家復健醫院 UPMC，該醫院擁有 20 張床位。

We have additional development projects in various stages for the inpatient rehab division, which I will summarize. Later in Q2, we plan on opening a 45-bed rehab hospital in Temple, Texas. In the last half of this year, we will open our fourth rehab hospital with the Cleveland Clinic in Fairhill, Ohio with 32 beds and a rehab unit in Orlando, Florida, also with 32 beds.

我們針對住院復健部門還有處於不同階段的額外開發項目，我將進行總結。在第二季後期，我們計劃在德州坦普爾開設一家擁有 45 張床位的復健醫院。今年下半年，我們將與俄亥俄州費爾希爾的克利夫蘭診所合作開設第四家復健醫院，擁有 32 張床位，並在佛羅裡達州奧蘭多開設復健病房，同樣擁有 32 張床位。

In Q1 of 2026, we plan to open our fourth rehabilitation hospital as part of our joint venture with Banner in Tucson, Arizona, and a new freestanding 63-bed rehab hospital in Ozark, Missouri, with Cox Health Systems. In Q4 2026, our 60-bed rehab hospital in Southern New Jersey, branded as Atlantic Care Rehabilitation Hospital, is scheduled to open as well as a 76-bed facility in Jersey City, New Jersey, branded as Kessler.

2026 年第一季度，我們計劃與 Banner 在亞利桑那州圖森合資開設第四家復健醫院，並與 Cox Health Systems 在密蘇裡州歐扎克合資開設一家擁有 63 張床位的全新獨立復健醫院。2026 年第四季度，我們計劃在新澤西州南部開設一家擁有 60 張床位的復健醫院（品牌為大西洋護理復健醫院），同時在新澤西州澤西市開設一家擁有 76 張床位的復健醫院（品牌為凱斯勒）。

Between the specific projects just mentioned as well as some other smaller expansions and new rehabilitation units in existing hospitals, we plan to add 440 additional beds to our operations from Q2 2025 through the end of 2027.

除了剛才提到的具體項目以及現有醫院的一些其他小型擴建和新復健病房外，我們計劃從 2025 年第二季到 2027 年底增加 440 張病床。

The additional beds primarily consist of rehab hospital beds, which include 68 non-consolidating beds. There are also a number of opportunities under evaluation that would further increase our Select Specialty Hospital footprint.

新增床位主要為復健醫院床位，其中包括 68 張非合併床位。目前還有許多機會正在評估中，這些機會將進一步擴大我們的精選專科醫院的影響力。

This quarter, our outpatient division added 10 de novo clinics. This was offset by the strategic closure or consolidation of 13 locations, further optimizing our existing resources and clinical capacity. This activity aligns with our strategic vision to identify areas of opportunity, serving our patient population and targeted demographics.

本季度，我們的門診增加了 10 個新診所。透過策略性地關閉或合併 13 個地點，我們抵消了這一影響，進一步優化了我們現有的資源和臨床能力。這項活動符合我們的策略願景，即找出機會領域，為我們的患者群體和目標群體提供服務。

Now turning to our first-quarter financial results and highlights. On a consolidated basis, our revenue increased over 2%, while adjusted EBITDA declined by 9% from $165.8 million to $151.4 million. Earnings per common share from continuing operations increased by 33% to $0.44 for the first quarter, compared to $0.33 per share in the same quarter prior year.

現在來看看我們的第一季財務業績和亮點。綜合來看，我們的營收成長了 2% 以上，而調整後的 EBITDA 則從 1.658 億美元下降了 9% 至 1.514 億美元。第一季度，持續經營每股收益成長 33% 至 0.44 美元，而去年同期為每股 0.33 美元。

We are extremely pleased with the first quarter performance of our Inpatient Rehab Hospital division with increases of 16% in revenue, 15% in adjusted EBITDA, and 6% in average daily census when compared to the first quarter of last year. The adjusted EBITDA margin was 23%, which was in line with the prior year same quarter.

我們對住院復健醫院部門第一季的業績感到非常滿意，與去年第一季相比，營收成長了 16%，調整後 EBITDA 成長了 15%，平均每日人口普查成長了 6%。調整後的 EBITDA 利潤率為 23%，與去年同期持平。

Our rate per patient day increased by 7%. Our occupancy was 82%, was 5% lower than prior year of 87%, which was primarily the result of new hospitals. Same-store occupancy was 87%. In April, CMS issued their proposed rule for fiscal year 2026. And if adopted, we would see an increase of 2.4% in the standard federal payment rate. The final rule is expected in late July, early August after the required comment period.

我們每位病人每天的費率增加了 7%。我們的入住率為 82%，比去年的 87% 低 5%，這主要是因為新建了醫院。同店入住率為87%。今年 4 月，CMS 發布了 2026 財年的提案規則。如果實施，聯邦標準支付率將增加 2.4%。最終規則預計將在必要的評論期結束後於 7 月底或 8 月初出台。

As previously mentioned, our Outpatient Rehab division had a challenging quarter due to winter storms in the South and Central regions. The estimated impact of these events is approximately $4 million. Notwithstanding the weather events and one less workday for the first quarter compared to prior year, revenue increased 1%, driven by an increase in our net revenue per visit compared to the first quarter of prior year.

如前所述，由於南部和中部地區的冬季風暴，我們的門診復健部門度過了一個充滿挑戰的季度。預計這些事件的影響約為400萬美元。儘管第一季受到天氣因素影響且工作日較上年同期減少一天，但由於每次訪問的淨收入較上年同期第一季度有所增加，收入仍增長了 1%。

Net revenue per visit increased from $99 prior year Q1, up to $102 in Q1 of this year with continued improvements in managed care commercial rates, which was offset by the decline in our Medicare rate. The decrease in the Medicare fee schedule was 3.2% to our outpatient division or approximately $2.6 million in the first quarter.

每次就診淨收入從去年第一季的 99 美元增加到今年第一季的 102 美元，管理式醫療商業費率持續提高，但被醫療保險費率的下降所抵銷。第一季度，我們門診部的醫療保險費用減少了 3.2%，約 260 萬美元。

Total visits declined by 1% from prior year same quarter due to the one less workday. However, there was an increase of 1% in visits per day. Adjusted EBITDA declined 3% from Q1 of prior year, and the division's adjusted EBITDA margin decreased from 8.2% to 7.9%.

由於工作日減少一天，總訪問量與去年同期相比下降了 1%。然而，每日訪問量增加了1%。調整後的 EBITDA 較去年第一季下降 3%，該部門調整後的 EBITDA 利潤率從 8.2% 下降至 7.9%。

Our Critical Illness Recovery hospitals, as previously noted, had a challenging quarter, primarily related to the large increase in the high-cost outlier threshold for the second year in a row and the 20% transmittal rule as previously noted. The impact of the regulatory changes in the first quarter were especially challenging when this is when we treat our highest acuity patient population during respiratory season.

如前所述，我們的重症復健醫院經歷了一個充滿挑戰的季度，主要與連續第二年高成本異常值門檻大幅提高以及如前所述的 20% 傳輸規則有關。第一季監管變化的影響尤其具有挑戰性，因為此時正值呼吸道疾病高發生率季節，我們治療的患者數量最多。

Revenue decreased from the first quarter of prior year by 3%, driven by a 2% decline in rate per patient day, coupled with a 1% decline in patient days. While our occupancy rate increased from 71% to 73% and our average daily census was consistent with prior year Q1, the volume decline was primarily a function of one less calendar day compared to prior year. The decrease in net revenue per patient day was driven by a decrease in our Medicare rate, which was primarily a function of the increase in the high-cost outlier threshold.

收入較去年同期第一季下降 3%，原因是每位病人每天的費率下降 2%，加上病人天數下降 1%。雖然我們的入住率從 71% 上升至 73%，且日均客流量與去年第一季持平，但客流量的下降主要是因為與去年相比，日曆日減少了一天。每位病人每天淨收入的下降是由於我們的醫療保險費率下降所致，而這主要是由於高成本異常閾值的提高。

Critical illness salary wage and benefit to revenue ratio was 54% compared to 53% in prior year Q1. Adjusted EBITDA declined by 25% from prior year, and our adjusted EBITDA margin was 14% for the quarter compared to 18% in the prior year Q1. In April, CMS issued their LTAC proposed rule for fiscal year '26. And if adopted, we would see an increase of 2.7% in the standard federal payment rate and an increase in the high-cost outlier threshold. The final rule is expected in late July or early August after the required comment period.

重大疾病薪資福利與收入比率為 54%，而去年第一季為 53%。調整後的 EBITDA 較上年下降了 25%，本季調整後的 EBITDA 利潤率為 14%，而上年第一季為 18%。今年 4 月，CMS 發布了 26 財年的 LTAC 擬議規則。如果實施，我們將看到標準聯邦支付率增加 2.7%，高成本異常值門檻也會提高。最終規則預計將在必要的評論期結束後於七月底或八月初出台。

During the quarter, we repurchased almost 650,000 shares of our stock at an average price per share of $17.52 under our Board authorized stock repurchase program for a total of $11.4 million. In regards to our deployment of capital, the Board of Directors declared a cash dividend of $0.0625 per share payable on May 29, 2025, to stockholders of record as of the close of business on May 15, 2025.

在本季度，我們根據董事會授權的股票回購計畫以每股 17.52 美元的平均價格回購了近 65 萬股股票，總計 1,140 萬美元。關於我們的資本部署，董事會宣布向截至 2025 年 5 月 15 日營業結束時登記在冊的股東派發每股 0.0625 美元的現金股息，派發日期為 2025 年 5 月 29 日。

Going forward, we will continue to evaluate stock repurchases, reduction of debt and development opportunities.

展望未來，我們將持續評估股票回購、減少債務和發展機會。

This concludes my formal remarks. I'll turn the call over to Marty Jackson for additional financial detail before we open the call up for questions.

我的正式發言到此結束。在我們開始提問之前，我會將電話轉給馬蒂傑克遜 (Marty Jackson) 以了解更多財務細節。

Thank you, Bob, and good morning, everyone. At the end of the quarter, we had $1.8 billion of debt outstanding and $53.2 million of cash on the balance sheet. Our debt balance at the end of the quarter included $1.05 billion in term loans, which are due 2031, $180 million in revolving loans, $550 million of 6.25% senior notes due 2032 and $37 million of other miscellaneous debt.

謝謝你，鮑勃，大家早安。截至本季末，我們的未償債務為 18 億美元，資產負債表上有 5,320 萬美元現金。本季末的債務餘額包括 10.5 億美元的定期貸款（2031 年到期）、1.8 億美元的循環貸款、5.5 億美元的 2032 年到期的 6.25% 優先票據以及 3,700 萬美元的其他雜項債務。

We ended the quarter with net leverage for our senior secured credit agreement of 3.4 times. As of March 31, we had $377.5 million of availability on our revolving loans. The interest rate on our term loan is SOFR plus 200 basis points. Interest expense was $29.1 million in the first quarter. This compares to $40.7 million in the same quarter prior year. The decrease in interest expense was due to the reduction of Select's debt resulting from the Concentra IPO and related debt transactions last year.

本季結束時，我們的優先擔保信貸協議的淨槓桿率為 3.4 倍。截至 3 月 31 日，我們的循環貸款可用金額為 3.775 億美元。我們的定期貸款利率為 SOFR 加 200 個基點。第一季利息支出為 2,910 萬美元。相比之下，去年同期為 4,070 萬美元。利息支出的減少是由於去年 Concentra 首次公開募股和相關債務交易導致 Select 債務減少。

For the quarter, operating activities used $3.5 million in cash flows. Our days sales outstanding on DSO for continued operations was 60 days at March 31, 2025. This compares to 62 days as of March 31, 2024, and 58 days as of December 31, 2024. Investing activities used $52.3 million of cash in the first quarter for purchases of property and equipment. Financing activities provided $49.3 million of cash in the first quarter.

本季度，經營活動使用了 350 萬美元的現金流。截至 2025 年 3 月 31 日，我們持續經營的 DSO 未償銷售額天數為 60 天。相較之下，截至 2024 年 3 月 31 日為 62 天，截至 2024 年 12 月 31 日為 58 天。第一季投資活動使用了 5,230 萬美元現金購買財產和設備。第一季融資活動提供了4930萬美元的現金。

This includes $75 million in net borrowings on our revolving line of credit and $3.2 million in net borrowings on the other debt.

其中包括循環信用額度中的 7,500 萬美元淨借款和其它債務中的 320 萬美元淨借款。

This activity was offset by $11.4 million in common stock repurchases, $8.1 million in dividends of our common stock, $6.8 million in net distributions and purchases of non-controlling interest and a $2.6 million payment on our term loan. We are slightly adjusting our business outlook for 2025 and now expect revenue to be in the range of $5.3 billion to $5.5 billion.

這項活動被 1,140 萬美元的普通股回購、810 萬美元的普通股股息、680 萬美元的淨分配和購買非控制權益以及 260 萬美元的定期貸款支付所抵消。我們正在稍微調整 2025 年的業務前景，目前預計營收將在 53 億至 55 億美元之間。

Adjusted EBITDA is expected to be in the range of $510 million to $530 million. And finally, adjusted earnings per common share is still expected to fall in the range of $1.09 to $1.19. Capital expenditures are expected to be in the range of $160 million to $200 million.

調整後的 EBITDA 預計在 5.1 億美元至 5.3 億美元之間。最後，調整後每股普通股收益預計仍將在 1.09 美元至 1.19 美元之間。預計資本支出將在1.6億美元至2億美元之間。

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

我們的準備好的演講到此結束。現在，我們想將電話轉回給接線員，以便大家提問。

(Operator Instructions) Justin Bowers, Deutsche Bank.

（操作員指示）德意志銀行的賈斯汀·鮑爾斯。

So in IRF, you had very strong results and a nice sequential increase in occupancy. Is that -- like how should we be thinking about occupancy for the rest of the year with the new capacity coming online?

因此，在 IRF，您獲得了非常強勁的業績，並且入住率連續大幅增長。那是不是說——隨著新容量的投入使用，我們該如何考慮今年剩餘時間的入住率？

Justin, I think it's just stay around in that 85%-plus capacity even with the new business coming online. As the new business comes online, we still have some other business that's still maturing. But again, on our mature hospitals have all been in that 85%-plus range.

賈斯汀，我認為即使有新業務上線，它的產能也能維持在 85% 以上。隨著新業務的上線，我們還有一些其他業務仍在成熟中。但同樣，我們成熟的醫院都處於 85％ 以上的範圍內。

And then on LTAC, you mentioned that two-thirds of the miss was related to regulatory and some of the outlier stuff. Was that versus like your internal expectations? Or consensus? Just trying to get a sense of what the magnitude there was and maybe you can quantify for us.

然後關於 LTAC，您提到三分之二的失誤與監管和一些異常因素有關。這和你內心的期望相符嗎？還是共識？只是想了解那裡的規模，也許您可以以為我們量化一下。

Yeah, Justin. The -- it was higher than what we had anticipated. So for example, if you take a look at the high-cost outlier impact from Q1 '25 versus Q1 of '24 there was about 100% increase in the cost to high-cost outlier. We thought it was going to be a little bit less than that. And the 20% impact, it was 480% from Q4 of '24. That 20% impact didn't go -- that wasn't around Q1 of '24. First quarter, we had it was actually in Q4 of last year.

是的，賈斯汀。這比我們預期的要高。例如，如果您查看 2025 年第一季與 2024 年第一季的高成本異常值影響，您會發現高成本異常值的成本增加了約 100%。我們以為會比這少一點。而 20% 的影響，從 24 年第四季開始就達到了 480%。20% 的影響並沒有消失——那不是在 2024 年第一季左右。第一季度，實際上是去年第四季。

Understood. Go ahead.

明白了。前進。

Yes. So Justin, from a quantification standpoint, we have -- we basically quantified that in the revised guidance.

是的。所以賈斯汀，從量化的角度來看，我們基本上在修訂後的指南中對此進行了量化。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

Congrats on the IRF performance. But just going back to LTAC, just wondering if you could provide any update or if you're having any changing thoughts on mitigation strategies with regard to high-cost outlier in the transmittal rule, kind of anything you can do to kind of head off those headwinds operationally?

恭喜 IRF 的出色表現。但回到 LTAC，只是想知道您是否可以提供任何更新，或者您是否對傳輸規則中高成本異常值的緩解策略有任何改變的想法，您可以做些什麼來在操作上避免這些阻力？

And then second, just based on your flu commentary and guidance, is there a reason to expect maybe an easing of that year-over-year headwind as we kind of get into some of the lower acuity quarters?

其次，僅根據您的流感評論和指導，隨著我們進入一些低嚴重程度的季度，是否有理由預期這種同比逆風可能會有所緩解？

Yes Ben, to your -- and there's two questions there to both questions. I think when you talk about high-cost outliers, typically, our Q1 is higher than the balance of the year just because the acuity of the patient, it's pulmonary patients that we're dealing with. So it's typically higher during that period of time. So we should see that drop. So it's part and parcel the same answer to your two questions.

是的，本，對於你的這兩個問題，都有兩個疑問。我認為，當您談論高成本異常值時，通常我們的第一季高於全年餘額，只是因為患者的敏銳度，即我們正在處理的肺部患者。因此，在那段時期內，其價格通常較高。所以我們應該會看到這種下降。因此，對於您的兩個問題，答案基本上是一樣的。

Okay. And then anything that you can do just strategically? Or is there -- is it just something you have to ride out? Or is there anything maybe from a legislation perspective, any conversations in Washington that could help kind of cure this or get traction with revised regulations?

好的。那麼您可以從策略上做些什麼呢？或者說——這只是你必須克服的事情？或者從立法角度來看，華盛頓有任何對話可以幫助解決這個問題或推動修訂法規？

Yes. Ben, this is Bob. Yes, we are constantly having conversations both on the regulatory side with the new CMS administration and on the legislative side. So that's always ongoing. But I think that, that has been stepped up and a little bit narrowed to this high-cost outlier impact because from a policy standpoint, with the criteria for LTACs that encourages taking the higher acuity patients and not taking what they call the site neutral or the patients that are excluded by the criteria that was put in place some years ago, it is going to logically have more patients that reach high-cost outlier status.

是的。本，這是鮑伯。是的，我們一直在與新的 CMS 管理部門就監管方面以及立法方面進行對話。所以這一直在持續進行。但我認為，這個問題已經得到加強，並且已經稍微縮小到高成本異常值的影響，因為從政策角度來看，LTAC 的標準鼓勵接收病情更嚴重的患者，而不是接收所謂的「中立地點」患者或被幾年前製定的標準排除在外的患者，從邏輯上講，會有更多的患者達到高成本異常值的狀態。

So we are trying to have the kind of conversations that explain that and look for ways that we might be able to propose some ideas and some changes on some of the policies that would help mitigate some of the severe impacts that we're seeing.

因此，我們正嘗試進行某種對話來解釋這一點，並尋找方法提出一些想法並對某些政策做出一些改變，以幫助減輕我們所看到的一些嚴重影響。

William Sutherland, The Benchmark Company.

威廉‧薩瑟蘭 (William Sutherland)，基準公司。

What do startup costs look like this year and then versus last year, that would be helpful.

今年的啟動成本與去年相比如何，這將會很有幫助。

Bill, this is Marty. Good morning. The start-up losses are relatively the same from last year to this year.

比爾，這是馬蒂。早安.今年的開工損失與去年基本持平。

Okay. And nothing special in the quarter though. Okay.

好的。但本季並沒有什麼特別之處。好的。

Yes.

是的。

And then on -- I'm a little confused on the impact high-cost outlier and transmittal rule in the sense that in terms of how it's impacting guidance. So you had this big impact, particularly in the first two months of the quarter.

然後——我對高成本異常值和傳輸規則的影響有點困惑，不知道它如何影響指導。因此，您受到了巨大的影響，尤其是在本季度的前兩個月。

Then I think, Bob, you said that March was -- you were finishing up the year in March was -- I mean, the quarter with March even a little ahead of plan. So is this guidance change just reflect really the first two months of the year, particularly for LTAC?

然後我想，鮑勃，你說三月是 - 你在三月結束了這一年 - 我的意思是，三月份的季度甚至比計劃提前了一點。那麼，這項指導變化是否僅僅反映了今年前兩個月的情況，特別是對於 LTAC 而言？

Yeah Bill, the first two -- it was actually like the first six weeks. We saw a slow first six weeks versus what we typically see as far as the flu is concerned. We saw that pick up the balance of the quarter. That's basically what we were talking about. As far as the high-cost outlier, high-cost outlier, as I mentioned earlier, on a year-over-year basis, there was about a 100% increase in the high-cost outlier.

是的，比爾，前兩週——實際上就像是前六週。與流感通常出現的情況相比，我們看到前六週疫情發展較為緩慢。我們看到本季的餘額有所回升。這基本上就是我們所談論的。至於高成本異常值，正如我之前提到的，與去年同期相比，高成本異常值增加了約 100%。

So that's --

這就是--

And again, if you take a look, what we've seen, right, we've seen an increase of almost 100% from '23. We saw an increase from $38,000 to $57,000, I believe, $59,000. And then we saw an increase from the $59,000 up to $77,000. We did a pretty good job with this last year, and we're going through that right now. Our operators, again, doing a very good job, the best job that they can. But those increases are very, very significant.

再說一次，如果你看一下我們所看到的，對吧，我們看到從 23 年開始成長了近 100%。我們看到從 38,000 美元增加到 57,000 美元，我相信是 59,000 美元。然後我們看到它從 59,000 美元增加到了 77,000 美元。去年我們在這方面做得非常好，現在我們正在經歷這個過程。我們的操作員再次表現出色，並盡了他們所能做到最好。但這些增長非常非常顯著。

Right. No, I get it. Okay. And then lastly, in outpatient rehab, update us, if you can, on some of the initiatives you got in place to improve the margins of the business?

正確的。不，我明白了。好的。最後，在門診復健方面，如果可以的話，您能向我們介紹一下您為提高業務利潤率所採取的一些舉措嗎？

The initiatives -- I mean, a couple of those -- we've talked, I think, over the last two or three quarters about the change that we're making in our technology. And we have rolled that out in the first quarter. We are seeing some benefits from that. We continue to have additional releases on that software. We think we'll continue to see those benefits expand throughout the year.

我認為，在過去的兩三個季度裡，我們已經談論過其中的幾項舉措，即我們在技術方面所做的改變。我們已經在第一季推出了這項計劃。我們從中看到了一些好處。我們將繼續發布該軟體的附加版本。我們認為，這些好處將在全年持續擴大。

And from a contracting perspective, we continue to see some nice increases in the range of 4% to 6%, so on the commercial side.

從合約角度來看，我們繼續看到商業方面的 4% 至 6% 範圍內的良好成長。

Okay. So you've got these progressive -- these steady improvements kind of baked into your expectations then in the guide.

好的。因此，您已經獲得了這些漸進式的——這些穩定的改進，這些改進已經融入了您在指南中的期望中。

Yes, we do.

是的，我們有。

Ann Hynes, Mizuho.

安‧海因斯 (Ann Hynes)，瑞穗。

Maybe we can shift to IRF. Obviously, that was a shining star in the quarter. I mean is there any plans to actually -- I know you're accelerating growth a lot. Is there any plans to even accelerate it more to further diversify your business away from LTAC given the regulatory challenges? And I guess, like internally, how much capacity can the organization support for that growth?

也許我們可以轉向 IRF。顯然，這是本季的一顆耀眼明星。我的意思是，實際上是否有任何計劃——我知道你們正在加速成長。考慮到監管方面的挑戰，是否有計劃進一步加快步伐，使您的業務從 LTAC 中進一步多元化？我想，就內部而言，該組織能夠支援多大容量的成長？

Yes. Thanks, Ann. On the development side, I think it's important to note that all the projects that we listed or that I talked about in my prepared remarks, those are projects that are signed under construction and are -- and will open. It doesn't include all the other projects that are in our pipeline that will be signed, will be committed to. And some of those could come in along those same time frames.

是的。謝謝，安。在開發方面，我認為值得注意的是，我們列出的所有項目或我在準備好的發言中談到的所有項目，都是已經簽約在建並且即將開放的項目。它不包括我們正在簽署和承諾的所有其他項目。其中一些可能會在相同的時間範圍內出現。

So the short answer to your question is yes. There is more of an acceleration going on than even that you would see to drive more robust growth on the rehab side.

所以對你的問題的簡短答案是肯定的。復原方面的加速發展速度比你想像的還要快，從而推動康復方面更加強勁的成長。

Okay. Great. And my second question would just be just on the CMS front. Obviously, for the industry, the outlier and the transmittal rule is a pressure point. What type of advocacy do you have with CMS just to help the industry to try to offset some of these pressures?

好的。偉大的。我的第二個問題只是關於 CMS 方面。顯然，對於產業來說，異常值和傳輸規則是一個壓力點。您對 CMS 有何建議，以幫助該行業緩解部分壓力？

Well, you got to remember that the new CMS team is just so recently installed. I mean the new CMS administrator was just confirmed a couple of weeks ago. So it's very early for them to be in place and to get their hands dirty on all the policies. And they have obviously a lot of things going on that we can assume are bigger issues than the LTAC space, not even including what's being talked about by Medicaid and all the issues with Medicare Advantage.

好吧，你必須記住，新的 CMS 團隊剛剛成立。我的意思是，新的 CMS 管理員幾週前才剛剛確認。因此，他們現在就位並著手製定所有政策還為時過早。顯然，他們有很多事情要做，我們可以假設這些問題比 LTAC 領域更大，甚至不包括醫療補助計劃所討論的問題以及醫療保險優勢計劃的所有問題。

And so it would be presumptuous of me to think that we could be moved to the top of their list. But we have a policy of always engaging with CMS. We did with the last CMS administration, not with a lot of great success on these policies. So I'm optimistic that maybe we can do better under the new administration.

因此，我認為我們可以成為他們名單上首位的候選人，這未免有些冒昧。但我們的政策是始終與 CMS 合作。我們在上一屆 CMS 管理中確實這樣做過，但這些政策並沒有取得很大的成功。因此我樂觀地認為，在新政府的領導下我們或許可以做得更好。

I'm not showing any further questions in the queue. I would now like to turn the call back over to Mr. Ortenzio for closing remarks.

我不會在隊列中顯示任何其他問題。現在我想把發言權交還給奧滕齊奧先生，請他作最後發言。

Yes. No closing comments. Thanks, everybody, for being with us and working through our quarter. Look forward to updating you next quarter.

是的。沒有結束語。感謝大家在本季與我們一起努力。期待下個季度向您更新。

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect. Everyone, have a great day.

感謝大家參加今天的會議。該計劃確實就此結束。您現在可以斷開連線。祝大家有個愉快的一天。