Select Medical Holdings Corp (SEM) 2025 Q2 法說會逐字稿

Good morning, and thank you for joining us today for Select Medical Holdings Corporation earnings conference call to discuss the second-quarter 2025 results and the company's business outlook.

早安，感謝您今天參加 Select Medical Holdings Corporation 收益電話會議，討論 2025 年第二季業績和公司業務前景。

Presenting today are the company's Executive Chairman and Co-Founder, Robert Ortenzio; the company's Executive Vice President and Chief Financial Officer; Michael Malatesta. Also on the conference line is 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.

今天出席的有公司執行主席兼聯合創始人羅伯特·奧滕齊奧 (Robert Ortenzio) 和公司執行副總裁兼首席財務官邁克爾·馬拉泰斯塔 (Michael Malatesta)。參加電話會議的還有該公司策略財務和營運高級執行副總裁馬丁傑克森 (Martin Jackson)。管理層將向您介紹本季度的概況，然後開始回答問題。

Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or 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.

在我們開始之前，我們想提醒您，本次電話會議可能包含有關公司未來事件或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 的計劃、期望、策略、意圖和信念的陳述。

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

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。現在，我將把電話會議交給羅伯特‧奧滕齊奧先生。

Thank you, operator. Good morning, everyone. Welcome to Select Medical's earnings call for the second quarter of 2025. I'd like to begin today's call by sharing that US News & World Report recently released its list of the nation's best rehabilitation hospitals. And I'm pleased to report that 8 of our hospitals, which operate across 15 locations, were recognized among the country's best.

謝謝您，接線生。大家早安。歡迎參加 Select Medical 2025 年第二季財報電話會議。今天電話會議開始，我想分享《美國新聞與世界報道》最近發布的美國最佳復健醫院名單。我很高興地報告，我們分佈在 15 個地點的 8 所醫院被評為全國最佳醫院。

Kessler Institute for rehabilitation at number 4 was once again ranked as one of the top 5 rehab hospitals in the nation, earning a spot on the list for the 33rd consecutive year. Our other rank hospitals include Baylor Scott & White Institute for Rehabilitation, Dallas, at number 8; Cleveland Clinic Rehab Hospital at number 20; California Rehab Institute at number 24; Banner Rehabilitation Hospital at number 26; and Ohio Health Rehabilitation Hospital at number 31.

排名第四的凱斯勒復健研究所再次被評為全美排名前五的復健醫院之一，連續第 33 年上榜。我們排名的其他醫院包括排名第 8 的達拉斯貝勒斯科特和懷特康復研究所；排名第 20 的克利夫蘭診所康復醫院；排名第 24 的加州康復研究所；排名第 26 的班納康復醫院；以及排名第 31 的俄亥俄健康康復醫院。

This year also marked the first recognition for Baylor Scott & White Institute for rehabilitation hospitals at Frisco at number 36 and Penn State Health Rehabilitation Hospital at number 47. These rankings underscore the strength and consistency of our services and reflect our ongoing commitment to delivering high-quality care to patients and the communities we serve.

今年，貝勒斯科特和懷特復健醫院研究所（弗里斯科，排名第 36 位）和賓州州立大學健康復健醫院（排名第 47 位）也首次獲得認可。這些排名強調了我們服務的實力和一致性，並反映了我們持續致力於為患者和服務社區提供高品質的照護。

I'm also pleased to report that we have continued success in executing our development strategy this past quarter. In our rehab division, we recently opened our second hospital with UPMC in Central Pennsylvania, adding a 12-bed acute rehab unit in Tallahassee, Florida and expanding our acute rehab hospital in Pensacola, Florida with 8 additional beds.

我還很高興地報告，我們在過去的一個季度繼續成功地執行了我們的發展策略。在我們的復健部門，我們最近與 UPMC 在賓州中部開設了第二家醫院，在佛羅裡達州塔拉哈西增加了一個擁有 12 張床位的急性復健病房，並擴建了位於佛羅裡達州彭薩科拉的急性復健醫院，增加了 8 張床位。

In addition, we launched a 12-bed neuro transitional care unit with SSM Health in Missouri. Within our outpatient rehab division, we continue to expand our footprint and grew our clinic count by 8 this past quarter. Looking ahead, we remain focused on advancing our development pipeline and growing our presence in key markets, particularly within the inpatient rehab division, where we continue to see growing demand for our services.

此外，我們還與密蘇裡州的 SSM Health 合作建立了一個擁有 12 個床位的神經過渡護理單元。在我們的門診復健部門，我們繼續擴大我們的覆蓋範圍，並在上個季度將診所數量增加了 8 家。展望未來，我們將繼續專注於推進我們的開發管道並擴大我們在主要市場的影響力，特別是在住院復健部門，我們繼續看到對我們服務的需求不斷增長。

We expect to add 382 rehab beds, which 294 will be consolidating and 88 non-consolidating and 30 critical illness beds between now and the end of the first half of 2027. This expansion will be achieved through a combination of new openings and bed additions in markets with strong volume and occupancy rates.

我們預計從現在到 2027 年上半年末將增加 382 張復健床位，其中 294 張將合併，88 張將非合併，以及 30 張重症病床。此次擴張將透過在客流量和入住率較高的市場開設新酒店和增加床位來實現。

In Q3, we plan to open a 45-bed hospital in Temple, Texas and add a 30-bed Critical Illness Recovery Hospital in Memphis, Tennessee. Later this year, we plan to open our fourth Cleveland Clinic rehab hospital as well as a 32 bed acute rehab unit in Orlando, Florida, and complete a 10-bed expansion in one other of our existing rehab hospitals.

第三季度，我們計劃在德州坦普爾開設一家擁有 45 張床位的醫院，並在田納西州孟菲斯市增設一家擁有 30 張床位的重症復健醫院。今年晚些時候，我們計劃在佛羅裡達州奧蘭多開設第四家克利夫蘭診所復健醫院以及一個擁有 32 張床位的急性復健病房，並在另一家現有的復健醫院完成 10 張床位的擴建。

We anticipate opening an additional 3 rehab hospitals during 2026, including our fourth in partnership with Banner Health in Tucson, Arizona; 58 beds and a new freestanding 63-bed rehab hospital in Ozark, Missouri with Cox Health Systems; and a 60-bed rehab hospital branded as Atlanta Care Rehabilitation Hospital in New Jersey.

我們預計在 2026 年再開設 3 家復健醫院，包括與亞利桑那州圖森市 Banner Health 合作開設的第四家復健醫院；與 Cox Health Systems 合作在密蘇裡州歐扎克開設的擁有 58 張床位和一家擁有 63 張床位的全新獨立復健醫院；以及位於新澤西州的一家名為 Atlanta Care Rehabilitation Hospital 的擁有 Rehab60 張床位的擁有復健醫院。

We also intend to add another acute rehab unit and 2 neuro transitional units in 2026. And in 2027, we plan to open a 76-bed facility in Jersey City, which will operate under the Kessler brand and expand one of our existing hospitals. We expect to continue to fill our pipeline with additional growth opportunities as our inpatient rehab pipeline remains very strong with many opportunities currently under evaluation.

我們也計劃在 2026 年增加另一個急性復健單元和 2 個神經過渡單元。2027 年，我們計劃在澤西市開設一家擁有 76 張床位的醫療機構，該機構將以凱斯勒品牌運營，並擴大我們現有的一家醫院。由於我們的住院復健管道仍然非常強勁，並且許多機會目前正在評估中，因此我們期望繼續為我們的管道注入更多的成長機會。

In parallel with our growth initiatives, we remain committed to delivering value to our shareholders. This quarter, we repurchased over 5.7 million shares of our stock at an average price per share of $14.86 under our Board authorized stock repurchase program for a total purchase price of $85.1 million.

在推動成長計畫的同時，我們依然致力於為股東創造價值。本季度，我們根據董事會授權的股票回購計畫以每股平均 14.86 美元的價格回購了超過 570 萬股股票，總購買價為 8,510 萬美元。

In addition, our Board of Directors have also declared a cash dividend of $0.0625 per share is payable on August 28, 2025, to stockholders of record as of close of business on August 13, 2025. Looking forward, we will continue to evaluate the most effective uses of capital to support strong operational performance and shareholder value, including strategic investments for growth, debt reduction, additional share repurchases and cash dividends.

此外，我們的董事會也宣布，將於 2025 年 8 月 28 日向 2025 年 8 月 13 日營業結束時登記在冊的股東派發每股 0.0625 美元的現金股利。展望未來，我們將繼續評估最有效的資本用途，以支持強勁的營運績效和股東價值，包括成長策略投資、債務削減、額外股票回購和現金分紅。

Turning to our second quarter financial results. On a consolidated basis, our revenue grew nearly 5% to $1.3 billion, and our adjusted EBITDA increased to $125.4 million from $124.7 million in the prior year. Earnings per common share from continuing operations rose 88% to $0.32 from $0.17 per share in the same quarter prior year.

談談我們第二季的財務表現。綜合來看，我們的營收成長近 5%，達到 13 億美元，調整後的 EBITDA 從上年的 1.247 億美元增至 1.254 億美元。持續經營每股收益從去年同期的每股 0.17 美元成長 88% 至每股 0.32 美元。

I'd now like to highlight key financial results by segment, starting with our Inpatient Rehab Hospital division, which delivered another exceptional quarter. Revenue rose 17% year over year to $313.8 million with adjusted EBITDA increasing nearly 15% to $71 million, and our adjusted EBITDA margin declining slightly to 22.6% from 23.1% in the prior year. Our occupancy rate was lower than prior year at 82% and is reflective of the early-stage operations of our new hospitals.

現在，我想重點介紹各部門的主要財務業績，首先是我們的住院復健醫院部門，該部門又取得了一個出色的季度業績。營收年增 17% 至 3.138 億美元，調整後 EBITDA 成長近 15% 至 7,100 萬美元，調整後 EBITDA 利潤率從上年的 23.1% 小幅下降至 22.6%。我們的入住率低於前一年的 82%，這反映了我們新醫院的早期運作。

Our same-store occupancy rate remained stable at 86%. In April, CMS issued the proposed rule and if adopted, would see an increase of 2.4% in the standard federal payment rate. We expect the final rule to be posted in early August.

我們的同店入住率維持穩定在86%。今年 4 月，CMS 發布了擬議規則，如果通過，標準聯邦支付率將增加 2.4%。我們預計最終規則將於八月初公佈。

In our Outpatient Rehabilitation division, revenue increased 3.8%, which was driven by a corresponding 3.8% in patient volume when compared to prior year. Our net revenue per visit remains stable at $100. And while we continue to see improvements in our commercial managed care rates, these improvements are offset by a 3.2% reduction in Medicare physician fee schedule rates.

在我們的門診復健部門，收入增加了 3.8%，這是由於與前一年相比患者數量增加了 3.8%。我們每次訪問的淨收入保持穩定在 100 美元。儘管我們的商業管理醫療費率持續有所改善，但這些改善卻被醫療保險醫師收費標準 3.2% 的降低所抵消。

Reduction in Medicare rate caused a $3 million decrease in our revenue during the quarter and adjusted EBITDA increased 6.1% year over year with the division's adjusted EBITDA margin increasing to 9.3% from 9.1%.

醫療保險費率的降低導致我們本季的營收減少 300 萬美元，調整後的 EBITDA 年成長 6.1%，該部門的調整後 EBITDA 利潤率從 9.1% 上升至 9.3%。

Before speaking to the performance of the Critical Illness Recovery Hospital division, I wanted to address the headwinds we are continuing to face with LTAC reimbursement system. The goals of the 2013 LTAC criteria policy, which we supported focused on carrying for high-acuity patients, those with a minimum three-day ICU stay with lower acuity patients being treated in lower cost setting.

在談到重症復健醫院部門的表現之前，我想先談談我們在 LTAC 報銷制度方面繼續面臨的阻力。我們支持的 2013 年 LTAC 標準政策的目標重點是照顧高風險患者，即那些在 ICU 住院時間至少為三天的患者，以及在較低成本環境中接受治療的低風險患者。

Since the enactment of the criteria, the LTAC industry has seen a 56% reduction in Medicare spend. The enactment of criteria at additional regulatory changes has resulted in the closure of over 100 LTAC hospitals, which represents a 24% closure rate. The high-cost outlier threshold targets established more than 20 years ago at 8% receded the implementation of LTAC criteria and was developed using a significantly different and less acute patient population than the industry is caring for today. This has resulted in a significant reduction in reimbursement for the higher acuity patients and the high-cost outlier status has been further magnified by the 20% transmittal.

自該標準頒布以來，LTAC 行業的醫療保險支出減少了 56%。附加監管變化標準的頒布已導致 100 多家 LTAC 醫院關閉，關閉率高達 24%。20 多年前設立的 8% 高成本異常閾值目標推遲了 LTAC 標準的實施，並且制定該標準時所針對的患者群體與當今行業所照顧的患者群體有顯著不同，且病情不那麼嚴重。這導致高風險患者的報銷金額大幅減少，而 20% 的傳輸率進一步放大了高成本異常狀態。

We are committed to engaging in dialogue with regulators regarding potential short- and long-term policy reforms. We're hopeful these discussions will lead to positive changes that will enable us to continue to provide excellent care to high-acuity patients with complex medical needs.

我們致力於與監管機構就潛在的短期和長期政策改革進行對話。我們希望這些討論將帶來積極的變化，使我們能夠繼續為具有複雜醫療需求的重症患者提供優質護理。

Moving on to the financial results for the Critical Illness Recovery Hospitals division. Revenue was $601.1 million this quarter, which is a decline of 1% from the same quarter last year. The decrease continues to reflect the impact of the increase in high-cost outlier threshold and the implementation of the 20% transmittal rule.

接下來介紹重症復健醫院部門的財務表現。本季營收為 6.011 億美元，較去年同期下降 1%。這一下降繼續反映了高成本異常值門檻提高和 20% 傳輸規則實施的影響。

Patient volumes remained relatively stable year-over-year, with our occupancy rate improved to 69% from 67% in the prior year. Our salary wage and benefit to revenue ratio rose slightly to 58% and our adjusted EBITDA declined 22% year over year, which was primarily due to the regulatory changes I mentioned earlier. Our adjusted EBITDA margin was 9.4% for the quarter compared to 11.9% in the prior year.

患者數量較去年同期保持相對穩定，入住率從去年的 67% 提高到 69%。我們的薪資福利與收入比率小幅上升至 58%，調整後的 EBITDA 年減 22%，這主要是由於我之前提到的監管變化。本季我們的調整後 EBITDA 利潤率為 9.4%，而去年同期為 11.9%。

Yesterday afternoon, CMS issued the final LTAC rules for fiscal year 2026. These rules, which become effective October 1, include an increase in the standard federal rate of 2.9%, which is higher than the 2.7%, which was within the proposed rule in April.

昨天下午，CMS 發布了 2026 財年的最終 LTAC 規則。這些規則將於 10 月 1 日生效，其中包括將標準聯邦稅率提高 2.9%，高於 4 月提議的規則中的 2.7%。

The high-cost outlier threshold increased by $1,188 from $77,048 to $78,936, which is less than the $14,199 increase in the proposed rule. The MS LTAC DRG relative weight and expect the length of stays were also updated in the final rule.

高成本異常值門檻從 77,048 美元增加了 1,188 美元至 78,936 美元，低於擬議規則中的 14,199 美元增幅。最終規則中也更新了 MS LTAC DRG 相對權重和預期住院時間。

This concludes my remarks, and I'll now turn it over to Mike Malatesta for some additional financial details 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，我將把時間交給 Mike Malatesta 來詢問一些額外的財務細節。

Thank you, Bob, and good morning, everyone.

謝謝你，鮑勃，大家早安。

At the end of the quarter, we had $1.9 billion of debt outstanding and $52.3 million of cash on the balance sheet. Our debt balance at the end of the quarter included $1.04 billion in term loans, $250 million in revolving loans, $550 million 6.25% senior notes due 2032 and $33 million of other miscellaneous debt. We ended the quarter with net leverage for our senior secured credit agreement of 3.57. As of June 30, we had $319.1 million of availability on our revolving loans.

截至本季末，我們的未償債務為 19 億美元，資產負債表上有 5,230 萬美元現金。本季末的債務餘額包括 10.4 億美元的定期貸款、2.5 億美元的循環貸款、5.5 億美元 2032 年到期的 6.25% 優先票據以及 3,300 萬美元的其他雜項債務。本季末，我們的優先擔保信貸協議淨槓桿率為3.57。截至6月30日，我們的循環貸款可用餘額為3.191億美元。

The interest rate on our term loan is SOFR plus 200 basis points and matures on December 3, 2031. Interest expense was $30 million in the second quarter compared to $28 million in the same quarter prior year. For the second quarter, operating activities generated $110.3 million of cash flow. Our days sales outstanding, or DSO, for continuing operations was 62 days at June 30, 2025, compared to 60 days at June 30, 2024, and 58 days at December 31, 2024. Investing activities used $64.7 million of cash in the second quarter for purchases of property and equipment.

我們的定期貸款利率為 SOFR 加 200 個基點，到期日為 2031 年 12 月 3 日。第二季利息支出為 3,000 萬美元，而去年同期為 2,800 萬美元。第二季度，經營活動產生了1.103億美元的現金流。截至 2025 年 6 月 30 日，我們持續經營的應收帳款週轉天數（DSO）為 62 天，而 2024 年 6 月 30 日為 60 天，2024 年 12 月 31 日為 58 天。投資活動在第二季使用了 6,470 萬美元現金用於購買財產和設備。

Financing activities used $46.5 million of cash in the second quarter, which includes the $85.1 million of shares repurchased under our stock repurchase program, $7.9 million in dividends paid on our common stock, $12 million in net distributions and purchases of noncontrolling interests and a $2.6 million payment on our term loan. This was offset by $70 million in net borrowings on our revolving line of credit.

第二季的融資活動使用了 4,650 萬美元的現金，其中包括根據我們的股票回購計劃回購的 8,510 萬美元的股票、支付的 790 萬美元的普通股股息、1,200 萬美元的淨分配和購買非控股權益以及 260 萬美元的定期貸款付款。這被我們循環信用額度中的 7000 萬美元淨借款所抵消。

We are reaffirming our business outlook for 2025. We expect revenue to be in the range of $5.3 billion to $5.5 billion, adjusted EBITDA to be in the range of $510 million to $530 million and adjusted earnings per common share to be in the range of $1.09 to $1.19. We are narrowing our expectation of capital expenditures, which we now project to be in the range of $180 million to $200 million.

我們重申2025年的業務展望。我們預計營收將在53億美元至55億美元之間，調整後EBITDA將在5.1億美元至5.3億美元之間，調整後每股普通股收益將在1.09美元至1.19美元之間。我們下調了資本支出預期，目前預計在1.8億美元至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)

（操作員指示）

Ann Hynes, Mizuho.

安‧海因斯 (Ann Hynes)，瑞穗。

Right. I just want to talk about how the EBITDA per segment came in line versus your internal expectations, specifically with the critical illness, I guess I expected an improvement in the year-over-year decline in EBITDA. Did that come in line or worse than your expectations? And also with guidance, can you talk about -- I know you reiterated your adjusted EBITDA guidance, but maybe any changes within that guidance would be great.

正確的。我只想談談每個部門的 EBITDA 與您的內部預期相比如何，特別是對於重大疾病，我想我預計 EBITDA 的同比下降會有所改善。這符合你的預期還是比你預期的更糟？另外，您能否談談指導意見——我知道您重申了調整後的 EBITDA 指導意見，但也許該指導意見中的任何變更都會很棒。

Hi, Ann. Critical illness came in for our internal expectations, slightly lower. But then again, we continue to see inpatient rehab exceed our expectations. And then going forward, that's kind of built into our guidance. So overall, we're comfortable with our reform guidance.

你好，安。重大疾病的發生對於我們的內部預期來說，略低一些。但話又說回來，我們繼續看到住院復健超出了我們的預期。然後，展望未來，這將融入我們的指導之中。總體而言，我們對我們的改革指導感到滿意。

All right. Okay. And then with inpatient rehab, I know there's a few states that might lift the inpatient rehab [CON] hopefully, over the next year in North Carolina being a big one. What is your strategy going forward in those states that will have a more favorable CON environment for inpatient rehab?

好的。好的。然後對於住院康復，我知道有幾個州可能會在明年取消住院康復 [CON]，希望北卡羅來納州是一個很大的州。對於那些對住院復健具有更有利的 CON 環境的州，您的未來策略是什麼？

Yes. As you point out, there are a few number of states that continue to have CON law. You'll recall that a year or so ago, Florida sunseted theirs which was really a big one, and you saw more growth. And we would expect the same thing to happen in North Carolina or other states that may remove their CON requirements.

是的。正如您所指出的，有少數州仍然實行 CON 法。你會記得，大約一年前，佛羅裡達州終止了他們的計劃，這確實是一個很大的舉措，你看到了更多的成長。我們預計北卡羅來納州或其他州也會發生同樣的事情，這些州可能會取消 CON 要求。

For us, it really won't change our strategy. We would spend more time in North Carolina, but we would continue to stay true to our joint venture strategy. So while if you see a sunset, for example, in North Carolina, you wouldn't expect us to see us go in, tie up, land and immediate at least start construction. We would probably follow our model of engaging with some of the major systems in that state that would be interested in growing their post-acute network with rehab potentially critical illness and outpatient.

對我們來說，這確實不會改變我們的策略。我們將在北卡羅來納州花更多時間，但我們將繼續堅持我們的合資策略。因此，當你看到北卡羅來納州的日落時，你不會期望看到我們進入、繫泊、著陸並立即開始施工。我們可能會遵循我們的模式，與該州的一些主要係統合作，這些系統有興趣擴大他們的急性後網絡，包括康復、潛在的重大疾病和門診。

Thank you.

謝謝。

Justin Bowers, Deutsche Bank.

德意志銀行的賈斯汀·鮑爾斯。

So an outpatient rehab, making some progress there, EBITDA up 6% year-over-year. Can you talk about how you expect that business to evolve throughout the rest of the year? And then in the midterm, where you think EBITDA margins consolid for that business?

門診復健取得了一些進展，EBITDA 年比成長 6%。您能談談您預計今年剩餘時間該業務將如何發展嗎？那麼在中期，您認為該業務的 EBITDA 利潤率會鞏固到什麼程度？

Hi, Justin. We continue to expect outpatient to improve. And I think we communicated before, that improvement will continue throughout the year. And our initiative with scheduling really should take off towards the end of the year and the early part of next year. And we should start exceeding that -- our approach that 10% EBITDA margin because right now, we're slightly below. I think a slight improvement from 9.1% to 9.3% this last quarter, but we should continue to see improvement.

你好，賈斯汀。我們繼續期待門診情況有所改善。我想我們之前已經溝通過了，這種改善將持續全年。我們的日程安排計劃應該會在今年年底和明年年初真正開始實施。我們應該開始超越這個目標——我們的目標是 10% 的 EBITDA 利潤率，因為現在我們略低於這個水平。我認為上個季度從 9.1% 略有改善至 9.3%，但我們應該會繼續看到改善。

Justin, it's Bob. I continue to be very bullish on the prospects for our outpatient division on a go-forward basis. We have been working on implementing some really good system upgrades in that platform. And with a platform that spans as many states as where we're in with 2,000-plus clinics, the incremental improvement that we can put over that platform through systems efficiencies can really drive performance margin and EBITDA growth. So I'm pretty bullish about our prospects there on a go-forward for the balance of this year and particularly into -- through 2026, even with the Medicare headwinds that we're seeing on the Medicare fee schedule.

賈斯汀，我是鮑伯。我對我們的門診部未來的前景仍然非常樂觀。我們一直致力於在該平台上實施一些非常好的系統升級。而且，我們的平台涵蓋了與 2,000 多家診所一樣多的州，透過系統效率對該平台進行的漸進式改進可以真正推動績效利潤率和 EBITDA 成長。因此，我對今年餘下時間，特別是到 2026 年的前景非常樂觀，即使我們看到醫療保險費用表上存在醫療保險阻力。

Understood. And then with the outlier threshold, can you help us understand the impact there in 2Q or maybe throughout the year? And then what some of those policy initiatives are that you think could maybe impact the CMS' approach to this longer term?

明白了。然後，透過異常值閾值，您能幫助我們了解其對第二季或全年的影響嗎？那麼，您認為哪些政策措施可能會對 CMS 的長期做法產生影響？

Yeah. Well, I'll speak to the policy initiatives. As you know, the final rule for LTACs just came out yesterday and we saw an improvement -- a slight improvement, an improvement nonetheless on the rate, and we saw a pretty significant improvement on the high-cost outlier threshold, which was telegraphed under the last administration to go to over $90,000. And in the final rule here, it's in the $70,000.

是的。好吧，我將談談政策舉措。如你所知，LTAC 的最終規則昨天剛剛出台，我們看到了改善——略有改善，但無論如何在費率上有所改善，而且我們看到高成本異常值門檻有了相當顯著的改善，上屆政府曾宣布該門檻將超過 90,000 美元。這裡的最終規則是 70,000 美元。

So I'm encouraged by the willingness of the current CMS administration to be open to the feedback of providers and with us specifically, and we have submitted a number of comment letters and have work to engage with CMS.

因此，我很高興看到現任 CMS 管理部門願意接受供應商的回饋，特別是我們的回饋，我們已經提交了許多評論信，並致力於與 CMS 合作。

And the only thing that I can say is, I have found them much more open and transparent to discussion than I had found through the Biden CMS. So they're open to dialogue. And for us, that's the best that we can hope for. I mean success in our policy initiatives is not guaranteed, never has been. But I'm encouraged by the fact that there is an easier path to dialogue.

我唯一能說的是，我發現它們比我透過拜登 CMS 發現的討論更加開放和透明。所以他們願意對話。對我們來說，這是我們所能期待的最好的結果。我的意思是，我們的政策措施並不能保證一定成功，從來都不是。但令我感到鼓舞的是，對話之路變得更容易了。

And Justin, the impact on the quarter, it was around 60% of the impact it was in Q1. So as we expected, we're still going to face these headwinds throughout the year, but it wouldn't be as significant to Q1 when we have higher volume and higher acuity.

賈斯汀，本季的影響約為第一季的 60%。因此，正如我們預期的那樣，我們全年仍將面臨這些阻力，但當我們擁有更高的交易量和更高的敏銳度時，對於第一季來說，這些阻力不會那麼大。

Thank you. Appreciated it.

謝謝。非常感激。

Ben Hendrix, RBC Capital Markets.

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

Just to touch a little more on that last point there. If we could just give your take on kind of how we should think about seasonality with LTAC margins knowing that we did enter a lower acuity quarter, and we saw a sequential decrease in margin? And now that we've got kind of a more stable high-cost outlier backdrop going forward, any way that we should just generally think about margin seasonality going forward under the current rule?

我只是想稍微談談最後一點。如果我們能不能談談您對我們應該如何看待 LTAC 利潤率的季節性的看法，因為我們確實進入了一個較低敏銳度的季度，並且看到利潤率連續下降？現在我們已經有了更穩定的高成本異常值背景，我們是否應該在現行規則下普遍考慮未來的利潤季節性？

Well, I don't think there's a change in when we say margin seasonality, I mean Q1 is always going to be our strongest quarter, [it's the great is], last year, I think in 2024, we're around 17% margin. We finished this year at over 13%. Q2, we started seeing weakening as the quarter progresses. And in Q3, that's normally our most challenging quarter, and we started seeing census growth through the back end of that quarter. And in Q4, we started seeing a ramp back up during the colder months. So while we're going to have margin suppression from 2024, the seasonality aspect is relatively the same.

嗯，我認為利潤率的季節性不會發生變化，我的意思是第一季始終是我們表現最強勁的季度，去年，我認為到 2024 年，我們的利潤率將在 17% 左右。今年我們的成績超過了 13%。Q2，隨著季度的進展，我們開始看到疲軟現象。第三季度通常是我們面臨的最具挑戰性的季度，但我們在該季度末開始看到人口普查的成長。在第四季度，我們開始看到寒冷月份的回升。因此，雖然從 2024 年開始我們將抑制利潤率，但季節性因素相對相同。

Great. And then can you tell how much startup cost do you have included in the guidance for the IRF segment through the back of the year?

偉大的。然後，您能否告訴我們，今年年底 IRF 部門的指導包含了多少啟動成本？

It's probably slightly around or a little less than $10 million for the back of the year. I think year-over-year for Select Specialty hospitals, were pretty consistent from '25 through '24 around our per annum basis that $20 million level.

今年稍後的收入可能在 1000 萬美元左右或略低於 1000 萬美元。我認為，從 25 年到 24 年，精選專科醫院的年收入與前一年相比都相當穩定，維持在每年 2,000 萬美元的水平。

Thank you.

謝謝。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

This is Joaquin Arriagada on for Joanna. So for Q1, you flagged the 20% rule impact. The rule was issued as a surprise to the industry and there was some traction in Congress to pull back. What's been the progress on this? And what should we expect moving forward?

我是 Joaquin Arriagada，代替 Joanna 發言。因此，對於 Q1，您標記了 20% 規則的影響。該規定的發布令業界感到意外，國會也曾試圖收回這項規定。此事目前有何進展？我們對未來的發展應該抱持怎樣的期待？

I'm not sure that I could agree that there was traction in Congress to pull back on the 20% transmittal, if that's what your question was. I mean that -- the first part of your comment was, yes, the 20% transmittal came from what they call a sub regulatory -- and this was back in the last administration, kind of the outgoing CMS that was not put through formal rulemaking and it came through what they call a transmittal. So that was a surprise and a disappointment to many of us in the industry because it doesn't give you any opportunity to comment.

如果您的問題是這個的話，我不確定我是否同意國會已經採取行動來撤回 20% 的轉讓。我的意思是——您評論的第一部分是，是的，20% 的傳送來自他們所謂的子監管——這是在上屆政府時期，即將離任的 CMS 沒有經過正式的規則制定，而是透過他們所謂的傳送而來。因此，對於我們業內的許多人來說，這是一個驚喜和失望，因為它沒有給你任何評論的機會。

Normally, it would be very difficult for the Congress to fix that. And there really has not at least to this date, been much of a vehicle even though you had the reconciliation, that was what they call a pretty clean bill. So I think on that, working with CMS is probably going to be the only path that we have on that. But that's now been in place for close to six months. So while we can always hopeful, hope is not a strategy. So we are where we are right now. And we've baked that transmittal impact into our guidance, and we'll continue to look at all avenues to try to affect policy.

通常情況下，國會很難解決這個問題。至少到目前為止，儘管有對帳單，但實際上還沒有太多的手段，這就是他們所說的相當乾淨的帳單。因此我認為，與 CMS 合作可能是我們唯一的出路。但這項措施已實施近六個月了。因此，儘管我們總是充滿希望，但希望並不是策略。所以我們現在處於這樣的境地。我們已將這種傳輸影響納入我們的指導中，並將繼續尋找一切途徑來嘗試影響政策。

But I just want to point out that the 20% transmittal is just part of a bigger high-cost outlier challenge that the industry is facing, as I made in my comments, which is as the number of cases in the LTAC industry have overall gone down and those cases tend to have much higher CMI case mix index and higher measure of acuity, the 8% outlier pool is going to continue to be a challenging element of the reimbursement system. I hope that answers your question without getting too far in the weeds.

但我只想指出，20% 的傳輸只是該行業面臨的更大的高成本異常挑戰的一部分，正如我在評論中提到的那樣，由於 LTAC 行業的案件數量總體下降，而且這些案件往往具有更高的 CMI 案件組合指數和更高的敏銳度，8% 的異常池將繼續成為報銷系統的一個挑戰因素。我希望這能回答你的問題，而不會涉及太多細節。

No, yes, definitely. And then kind of changing it up on the final LTAC reg, you only called for the 2% increase in the outlier threshold. So it should be easier to manage than the 30% increase in full year '25. So are we assuming better margins in the critical illness business in 4Q '25?

不，是的，絕對是。然後在最終的 LTAC reg 上進行更改，您只要求將異常值閾值增加 2%。因此，這應該比 25 年全年 30% 的成長更容易管理。那麼，我們是否預期2025年第四季重大疾病業務的利潤率會更高？

Well, the reduction from the proposed 91,000 to 70,000 was certainly welcome, but I'm not sure I could agree with the characterization that it will make it easier in 2025, 2026. That's still a challenging number on the fixed loss threshold. So we didn't bake into our guidance the proposed rule nor do we ever provide guidance as proposed rules. So while we're very happy that it's not as punitive as the proposed rule, it is still represent a modest increase over where our current threshold limit is.

嗯，從提議的 91,000 人減少到 70,000 人當然值得歡迎，但我不確定我是否同意這樣的說法，即這會讓 2025 年、2026 年的情況變得更容易。對於固定損失閾值而言，這仍然是一個具有挑戰性的數字。因此，我們沒有將擬議規則納入我們的指導中，也沒有以擬議規則的形式提供指導。因此，雖然我們很高興它不像擬議的規則那樣嚴厲，但它仍然比我們目前的門檻限制略有增加。

Got it. Thank you, guys.

知道了。謝謝你們。

A.J. Rice, UBS.

瑞銀的 A.J. Rice。

Just to make sure I understand sort of the dynamics in the critical access hospital LTAC business. So some of the less intense patients are dropping off and now getting referred to LTAC. It sounds like maybe there's some contraction of the people that are providing the business. Can you just talk about -- I know there's a lot of focus on the outlier changes, et cetera, and how that's affected the dynamics.

只是為了確保我了解關鍵通道醫院 LTAC 業務的動態。因此，一些病情較輕的患者開始退出治療並被轉介至 LTAC。這聽起來好像提供業務的人員可能會減少。你能不能談談——我知道人們非常關注異常變化等等，以及這些變化如何影響動態。

But if you strip all that back, is the supply -- what is happening with the overall supply and demand picture in that business? Is there a meaningful reduction in capacity? Is there a steady flow of patients at least [the kind] that you want that is not even picked up maybe as you're one of the few outlets is hanging in there. Any thoughts on that?

但是如果你把所有這些都去掉，那麼供應——該行業的整體供需狀況如何？容量是否有所減少？是否有穩定的患者流量，至少是您想要的那種，甚至還沒有被接收，也許因為您是少數幾個堅持下去的門市之一。對此有什麼想法嗎？

Well, let me take a shot at that, A.J. You tell me if I'm being responsive to your question. the supply-demand dynamics for the Critical Illness Recovery Hospitals is very strong, and we think it will be even stronger. And that's driven by demographics. It's fueled by advances in medical technology. It's fueled by the need to decompress ICUs that are becoming increasingly crowded, particularly during those months where you see a lot of respiratory cases.

好吧，A.J，讓我來回答一下。你告訴我我是否回答了你的問題。重症復健醫院的供需動態非常強勁，我們認為它會更加強勁。這是由人口結構決定的。這是由醫療技術的進步所推動的。這是因為需要緩解日益擁擠的重症監護室的壓力，特別是在呼吸道病例較多的月份。

So we are not short of patient demand for our services. We, of course, struggle with the same things everybody else struggles with, which, as more and more patients -- Medicare patients go to Medicare Advantage, we still face what we consider being appropriate denials or preauthorization that delay or prevent admissions, but that is not a new problem, and that is a problem that we manage.

因此，我們並不缺乏患者對我們服務的需求。當然，我們也和其他人一樣面臨著同樣的問題，隨著越來越多的患者——醫療保險患者轉向醫療保險優勢計劃，我們仍然面臨著我們認為適當的拒絕或預授權，從而延遲或阻止入院，但這不是一個新問題，而是一個我們可以解決的問題。

We still have over 24%, 25% of our patient population in our Critical Illness Recovery Hospitals, our Medicare Advantage and 30%, probably Medicare fee-for-service. So that -- we see that demand going forward unabated. It's really -- our challenge has been the structure of the reimbursement system that for a company like ours that has one of the highest case mix indexes, we tend to see the higher acuity patients that are more likely to go through the fixed loss and end up in high-cost outlier status. If that's responsive. If not, please ask a follow-up question.

我們的重症復健醫院、醫療保險優勢計畫的患者人數仍超過 24% 至 25%，醫療保險按服務收費的患者人數可能為 30%。因此，我們看到這種需求將持續成長。確實，我們面臨的挑戰是報銷系統的結構，對於像我們這樣擁有最高病例組合指數的公司來說，我們傾向於看到病情較重的患者更有可能經歷固定損失並最終陷入高成本異常狀態。如果這是響應的話。如果沒有，請提出後續問題。

No, that's sort of what I'm looking for. Just generally speaking, again, we're talking about some of the top level revenue-driven things. What's happening with some of your expenses, I know mainly labor, I guess, but across the different business lines, a number of providers are showing improvement there margin-wise. But what's your trend across your major business lines?

不，這正是我所尋找的。一般來說，我們再次討論一些頂級的收入驅動的事情。您的一些開支情況如何？我知道主要是勞動成本，但在不同的業務線上，許多供應商的利潤率正在改善。但您主要業務線的趨勢是怎樣的？

A.J., our trend is at least on an employee rate perspective, we continue to see improvement. So I think during -- coming out of COVID or in the heart of COVID in our inpatient division for full-time employees, we're experiencing 5% per annum increases. That's migrated down to 3% and now even a little bit below 3%.

A.J.，至少從員工率的角度來看，我們的趨勢是繼續看到改善。因此，我認為在 COVID 疫情結束後或疫情最嚴重時期，我們住院部全職員工的年薪會增加 5%。這一比例已下降至 3%，現在甚至略低於 3%。

So from that aspect, it's improving. I don't think we have the headwinds or the challenges we had with agency and those elevated costs that we had in 2022 and part of 2023. We did have some slight deterioration in our critical illness, labor margin this quarter year-over-year, but that was a function of really the pressures that we have on revenue with the HCO threshold. So that's where you saw that modest tick up of 1%.

所以從這個方面來看，情況正在改善。我認為，我們不會遇到 2022 年和 2023 年部分時間在代理方面遇到的阻力或挑戰以及成本上漲。本季我們的重大疾病、勞動力利潤率與去年同期相比確實略有下降，但這實際上是由於 HCO 門檻對我們的收入帶來的壓力所致。這就是你看到的 1% 的小幅上漲。

Okay. That's great. Thanks so much.

好的。那太棒了。非常感謝。

I'm showing no further questions in queue. I will now turn the call back over to Mr. Ortenzio for any closing remarks.

隊列中沒有其他問題。現在我將把電話轉回給奧滕齊奧先生，請他做最後發言。

Great. Thank you, operator. Thanks, everybody, for joining us for the call. We look forward to updating you next quarter.

偉大的。謝謝您，接線生。感謝大家參加我們的電話會議。我們期待下個季度向您更新最新情況。

This concludes today's conference call. Thank you for your participation, and you may now disconnect.

今天的電話會議到此結束。感謝您的參與，您現在可以斷開連接。