Surgery Partners Inc (SGRY) 2023 Q4 法說會逐字稿

Greetings and welcome to the Surgery Partners fourth quarter 2023 earnings call. (Operator Instructions) As reminder, this conference is being recorded. I would now like to turn the conference over to your host, Mr. Dave Doherty, Chief Financial Officer of Surgery Partners. Thank you. You may begin.

歡迎參加外科合作夥伴 2023 年第四季財報電話會議。（操作員說明） 請注意，本次會議正在錄製中。現在我想將會議交給東道主，Surgery Partners 財務長 Dave Doherty 先生。謝謝。你可以開始了。

Good morning. My name is Dave Doherty, CFO of Surgery Partners. I'm joined today by Eric Evans, CEO; and Wayne DeVeydt, Executive Chairman.

早安.我叫 Dave Doherty，Surgery Partners 的財務長。今天，執行長 Eric Evans 也加入了我的行列。德維特（Wayne DeVeydt），執行主席。

During this call, we will make forward-looking statements. There are risk factors that could cause future results to be materially different from these statements. These risk factors are described in this morning's press release and the reports we file with the SEC, each of which are available on our website surgery partners.com. The company does not undertake any duty to update these forward-looking statements.

在本次電話會議中，我們將做出前瞻性陳述。存在可能導致未來結果與這些陳述有重大差異的風險因素。這些風險因素在今天早上的新聞稿和我們向 SEC 提交的報告中進行了描述，每一份報告都可以在我們的網站外科手術合作夥伴.com 上找到。該公司不承擔更新這些前瞻性陳述的任何責任。

In addition, we will reference certain financial measures that are considered non-GAAP, which we believe can be useful in evaluating our performance. The presentation of this information should not be considered in isolation or as a substitute for results prepared in accordance with GAAP. These measures are reconciled to the most applicable GAAP measure in this morning's press release.

此外，我們將參考某些被視為非公認會計原則的財務指標，我們認為這有助於評估我們的績效。此資訊的呈現不應被孤立地考慮或作為根據 GAAP 準備的結果的替代。這些措施與今天上午新聞稿中最適用的公認會計準則措施進行了協調。

With that, I will turn the call over to Wayne. Wayne?

這樣，我就把電話轉給韋恩。韋恩？

Thank you, Dave. Good morning and thank you all for joining us today. My remarks this morning will focus on our full year 2023 results and the positive catalysts we see as we head into 2024. I'll then turn the call over to Eric to provide further insights into our operating environment, along with details for the quarter. Finally, Dave will conclude with additional color on the quarter and an updated view related to the strength of our balance sheet and full year guidance associated with calendar year 2024.

謝謝你，戴夫。早安，感謝大家今天加入我們。我今天早上的演講將重點關注我們 2023 年全年業績以及我們在邁入 2024 年時看到的積極催化劑。然後，我會將電話轉給埃里克，以提供對我們的營運環境的進一步見解以及本季度的詳細資訊。最後，Dave 將對本季度進行補充說明，並提供與我們的資產負債表實力相關的最新觀點以及與 2024 日曆年相關的全年指導。

Starting with our 2023 results, we are extremely pleased with the substantial progress we achieved related to our strategic initiatives and how these initiatives further catalyze our growth engine as we enter into 2024. Specifically, our growth algorithm continued to deliver mid-teens growth, with full year adjusted EBITDA exceeding $438 million, representing 15% growth over the previous year.

從我們 2023 年的業績開始，我們對我們在策略舉措方面取得的實質進展以及這些舉措如何在進入 2024 年時進一步推動我們的成長引擎感到非常高興。具體來說，我們的成長演算法持續實現中雙位數成長，全年調整後 EBITDA 超過 4.38 億美元，比上年成長 15%。

Despite the macro headwinds faced by our industry over the past four years, including the inflationary impact on labor and supply costs and the global pandemic, the company has grown adjusted EBITDA at a compound annual growth rate of over 14% per annum and expanded margins by 210 basis points. These headwinds have slowly abated throughout 2023.

儘管過去四年我們的行業面臨宏觀阻力，包括勞動力和供應成本的通膨影響以及全球大流行，但該公司調整後的 EBITDA 複合年增長率超過 14%，利潤率擴大了210個基點。這些不利因素在 2023 年逐漸減弱。

Digging deeper into our results, the combination of our consolidated and unconsolidated facilities performed approximately 707,000 cases in 2023, 4% more than 2022, with all specialties growing in line or in excess of our expectations. When combined with our targeted increased acuity and contributions from recent acquisitions, net revenue grew 8% to $2.74 billion, inclusive of approximately $100 million of revenue divested early in the year, and adjusted EBITDA margins improved by 100 basis points, reflecting our cost discipline, acuity mix and enhanced rates. We anticipate our 2023 cost initiatives and pricing to represent tailwinds for 2024 as we continue to recognize the run rate benefits associated with our scale. Our 2023 growth was balanced with same-facility revenue growing more than 11%, representing case volume of approximately 4% and rate improvement of 7%, driven by acuity mix and enhanced managed care rates.

深入研究我們的結果，我們的合併和非合併設施在 2023 年共處理了約 707,000 例病例，比 2022 年增加了 4%，所有專科的增長符合或超出了我們的預期。結合我們目標敏銳度的提高和最近收購的貢獻，淨收入增長了8%，達到27.4 億美元，其中包括年初剝離的約1 億美元收入，調整後的EBITDA 利潤率提高了100 個基點，反映了我們的成本紀律，敏銳度組合和增強率。我們預計 2023 年的成本計劃和定價將代表 2024 年的順風車，因為我們繼續認識到與我們的規模相關的運行率優勢。在敏銳度組合和管理式照護率提高的推動下，我們 2023 年的成長與同設施收入成長超過 11% 相平衡，意味著病例量約為 4%，比率提高了 7%。

Rounding out our growth story, we continued our disciplined approach to sourcing and executing on strategically important acquisitions at attractive multiples. In 2023, we deployed approximately $165 million associated with 15 transactions at an aggregate sub-8 times multiple on a pre-synergized basis.

為了完善我們的成長故事，我們繼續採用嚴格的方法，以有吸引力的倍數尋找和執行具有戰略意義的收購。2023 年，我們在 15 項交易中部署了約 1.65 億美元，在協同前的基礎上總計低於 8 倍。

While this number is below our targeted goal of at least $200 million per year, we also closed an additional $60 million in transactions in early January that we had anticipated closing in the fourth quarter. The timing of our acquisitions had a nominal impact on our 2023 results as Dave will discuss and serve as a tailwind to 2024 earnings.

雖然這個數字低於我們每年至少 2 億美元的目標，但我們還在 1 月初額外完成了 6,000 萬美元的交易，預計將在第四季度完成。我們的收購時機對我們 2023 年的業績產生了名義上的影響，因為戴夫將討論並推動 2024 年的利潤。

Our business development team continues to manage a robust pipeline of attractive opportunities, and we remain committed to deploying at least $200 million annually. As of this morning's call, our team has a strong pipeline of transactions under LOI, and we continue to source new deals.

我們的業務開發團隊繼續管理大量有吸引力的機會，我們仍然致力於每年部署至少 2 億美元。截至今天早上的電話會議，我們的團隊在意向書下擁有強大的交易管道，我們將繼續尋找新的交易。

Similar to 2023, the timing of acquisitions and related activity can be difficult to predict. And we continue to use a midyear convention when providing our outlook for 2024. All in, we are pleased with the balanced approach to growth with all pillars of our long-term growth algorithm, either meeting or exceeding our expectations.

與 2023 年類似，收購和相關活動的時間可能難以預測。在提供 2024 年展望時，我們繼續採用年中慣例。總而言之，我們對平衡的成長方式以及長期成長演算法的所有支柱感到滿意，達到或超越了我們的預期。

Before I turn the call over to Eric, I want to highlight some additional accomplishments related to our balance sheet. The company was able to effectively refinance our term loan late in the year at favorable terms and pricing, extending the maturity of the majority of our outstanding debt to 2030. Associated with this refinancing, we support more banking syndicate. We were also able to increase our revolving credit facility to $700 million, reflecting the continued strength of our business model and confidence in our growth algorithm. Dave will elaborate further, but with this new term loan, our credit agreement defined leverage was 3.5 times at the end of the year.

在將電話轉給埃里克之前，我想強調一下與我們的資產負債表相關的一些其他成就。該公司能夠在今年稍後以優惠的條件和價格有效地為我們的定期貸款再融資，將我們大部分未償債務的期限延長至 2030 年。與此再融資相關的是，我們支持更多的銀行集團。我們還能夠將循環信貸額度增加到 7 億美元，反映了我們業務模式的持續優勢以及對我們成長演算法的信心。Dave 將進一步詳細說明，但透過這筆新定期貸款，我們的信貸協議規定的槓桿率在年底達到了 3.5 倍。

Together with my fellow Board members, we are encouraged by the continued focus of this management team to capture the benefits of the strong industry and company-specific tailwinds. Based on the recently completed 2024 budgeting process, we expect net revenue, adjusted EBITDA, and margin growth in line with our long-term growth algorithm. Specifically, we are providing initial guidance for net revenue of at least $3 billion and are reaffirming our previously provided adjusted EBITDA of greater than $495 million. We strive to provide you with guidance that balances our optimism for the company's growth with an appropriate amount of conservatism. We look forward to updating you on our progress as the year unfolds.

與我的董事會成員一起，我們對這個管理團隊持續專注於從強大的行業和公司特定有利因素中獲得的好處感到鼓舞。根據最近完成的 2024 年預算流程，我們預期淨收入、調整後 EBITDA 和利潤成長符合我們的長期成長演算法。具體來說，我們提供的淨收入至少為 30 億美元的初步指導，並重申我們先前提供的調整後 EBITDA 超過 4.95 億美元。我們努力為您提供指導，平衡我們對公司發展的樂觀態度和適當的保守態度。隨著這一年的展開，我們期待向您通報我們的最新進展。

With that, let me turn the call over to Eric to highlight some of our operational initiatives, industry trends, and recent investment activities. Eric?

接下來，讓我將電話轉給艾瑞克，重點介紹我們的一些營運舉措、產業趨勢和最近的投資活動。艾瑞克？

Thanks, Wayne, and good morning, everyone. I will echo Wayne's pride in the results for 2023 and our initial outlook for 2024. Importantly, for our investors and per my past comments, our performance remains consistent and predictable. Our unique partnership model and our approach to enabling our physician partners independence and strong community reputation allows us to naturally benefit from the continued site of care shift to our safe, high-quality, and cost-effective facilities.

謝謝，韋恩，大家早安。我會同意韋恩對 2023 年業績的自豪感以及我們對 2024 年的初步展望。重要的是，對於我們的投資者來說，根據我過去的評論，我們的業績保持一致且可預測。我們獨特的合作夥伴模式以及使我們的醫生合作夥伴具有獨立性和強大的社區聲譽的方法使我們能夠自然地從持續的護理地點轉移到我們安全、高品質和具有成本效益的設施中受益。

We work every day to bring the benefits of a professional scaled management company while keeping the invaluable local feel and connection that differentiate our surgical facilities. This approach preserves the strong reputation our partners have earned. Allowing them to focus on their patients, knowing their preferences and input will remain an integral part of the facility they help build. Together, our partners win, our payers win, and most importantly, our patients get the best care possible for their surgical care needs. When this happens, we deliver consistent, high-quality results as we have done over the past four years despite managing through a global pandemic and a challenging inflationary macro environment.

我們每天都致力於帶來專業規模管理公司的優勢，同時保持寶貴的本地感覺和聯繫，使我們的手術設施與眾不同。這種方法保留了我們合作夥伴贏得的良好聲譽。讓他們專注於患者，了解他們的喜好和意見將仍然是他們幫助建造的設施的一個組成部分。在一起，我們的合作夥伴獲勝，我們的付款人獲勝，最重要的是，我們的患者獲得了滿足其手術護理需求的最佳護理。當這種情況發生時，我們將像過去四年一樣，儘管經歷了全球大流行和充滿挑戰的通膨宏觀環境，但仍能提供一致、高品質的結果。

As we finished 2023 and begin 2024, let me provide some highlights. Our organic growth initiatives translated into a strong full year 2023 top line same-facility growth of just over 11%. Our same-facility cases grew 3.9% in 2023, and rates grew 7.1%.

在 2023 年即將結束、2024 年即將開始之際，讓我提供一些要點。我們的有機成長計畫轉化為 2023 年全年同設施營收強勁成長，略高於 11%。2023 年，我們同一設施的病例數增加了 3.9%，比率增加了 7.1%。

As we consistently demonstrated, the rate improvements we are seeing in our existing facilities are benefiting from the strategic focus on recruiting physicians, specializing in higher acuity procedures such as total joints. We now perform orthopedic procedures in over 70% of our short-stay surgical facilities and total joint procedures in over 35% of our ASCs.

正如我們一貫所證明的那樣，我們在現有設施中看到的手術率的提高得益於招募醫生的戰略重點，這些醫生專門從事全關節等更高敏銳度的手術。現在，我們在超過 70% 的短期手術設施中進行骨科手術，在超過 35% 的 ASC 中進行全關節手術。

In our ASC facilities alone, we've seen a 50% increase in total joint procedures in 2023, which is a contributing factor in our same-facility rate growth. As recent acquisitions and de novos are fully integrated into our portfolio, the majority of which are orthopedic based. We expect to see this rate improvement remain at or above our long-term growth assumptions in 2024.

光是在我們的 ASC 設施中，到 2023 年，我們的聯合手術總數就增加了 50%，這是我們相同設施速度成長的一個促成因素。隨著最近的收購和從頭開始完全融入我們的投資組合，其中大部分是基於骨科的。我們預計 2024 年這一成長率的改善將保持在或高於我們的長期成長假設。

Net revenue of $2.74 billion grew 8% in 2023, with our organic same-facility growth de novos and consolidating acquisitions combining to overcome the impact of divestitures. In addition, in 2023, nearly half of our acquisitions were facilities that do not consolidate under accounting rules but generate significant revenue on a deconsolidated basis. Revenue growth in our non-consolidated entities exceeded 60% in 2023 as compared to the prior year, and we expect continued growth in 2024. Our underlying growth story remains consistent, and we continue to position our portfolio of assets to earn market share in each of our core specialties.

2023 年，我們的淨收入將達到 27.4 億美元，成長 8%，我們的同設施有機成長和合併收購相結合，克服了資產剝離的影響。此外，到 2023 年，我們近一半的收購都是根據會計規則未合併的設施，但在取消合併的基礎上產生了大量收入。與前一年相比，2023 年我們非合併實體的營收成長超過 60%，我們預期 2024 年將持續成長。我們的基本成長故事保持一致，我們繼續定位我們的資產組合，以在每個核心專業領域贏得市場份額。

Moving to our physician recruiting efforts. Our recruiting team had another banner year of new recruits with an increased focus on physicians that perform in MSK-related procedures. Their efforts are a core competency, helping our facilities create long-term value by recruiting physicians that are interested in a long-term relationship with our facilities and those that bring strategically important capabilities to our portfolio. We added nearly 700 new positions in 2023 across all specialties. And the average net revenue per case of these recruited positions is 27% higher than those physicians recruited in the prior year and 44% higher than 2021 recruiting class.

轉向我們的醫生招募工作。我們的招募團隊又迎來了新招募的輝煌一年，他們更專注於從事 MSK 斯隆相關手術的醫生。他們的努力是一項核心能力，透過招募有興趣與我們的機構建立長期關係的醫生以及那些為我們的產品組合帶來具有戰略意義的重要能力的醫生，幫助我們的機構創造長期價值。2023 年，我們在所有專業領域新增了近 700 個職位。這些招聘職位的平均每例淨收入比上一年招聘的醫生高27%，比2021年招聘類別高出44%。

Based on our experience, there is a compounding multiyear growth factor that recently recruited physicians bring, giving us increased confidence in our 2024 growth. As you know, we are in the early innings regarding migration of total joints into the highest-value settings of our short-stay surgical facilities. Such cases initially started with the transition of total knees in 2020 and total hips in 2021.

根據我們的經驗，最近招募的醫生帶來了複合多年成長因素，使我們對 2024 年的成長更有信心。如您所知，我們正處於將全關節遷移到我們短期手術設施的最高價值環境的早期階段。此類病例最初是從 2020 年全膝關節置換和 2021 年全髖關節置換開始的。

Since being removed from the inpatient only list, these procedures have experienced a three-year CAGR of 77%. We do not see this growth slowing nor are we seeing cases returning to the inpatient setting. In 2024, we're working with our orthopedic surgeons who are excited to bring additional joint programs to our ASCs with new focus on Medicare total shoulder and ankle surgeries that are now operated to be done in ASC setting for the first time. These procedures have been done safely in our ASCs for commercial patients for a number of years. And we're excited about the growth opportunities in both the near and future term as additional procedures continue to be removed from the inpatient only list.

自從從僅限住院患者名單中刪除以來，這些手術的三年複合年增長率為 77%。我們沒有看到這種增長放緩，也沒有看到病例返回住院治療。2024 年，我們正在與骨科醫生合作，他們很高興為我們的 ASC 帶來更多的聯合項目，新的重點是醫療保險全肩部和腳踝手術，這些手術現在首次在 ASC 環境中進行。多年來，我們的 ASC 一直在為商業患者安全地實施這些手術。隨著額外手術繼續從僅限住院患者的清單中刪除，我們對近期和未來的成長機會感到興奮。

Moving to the business development front. We are excited about our fast-growing de novo portfolio, of which 8 opened in 2023 and 12 are syndicated and currently under development, scheduled for openings in 2024 and early 2025. We remain selective in partnership opportunities with other health systems. While multiple opportunities exist, we are focused on forming long term, highly aligned partnerships with like-minded organizations that deliver high quality at sustainable cost to the system and are accretive to our earnings.

轉向業務發展前沿。我們對快速成長的 de novo 投資組合感到興奮，其中 8 個於 2023 年開業，12 個是聯合項目，目前正在開發中，計劃於 2024 年和 2025 年初開業。我們仍然選擇性地選擇與其他衛生系統的合作機會。雖然存在多種機會，但我們致力於與志同道合的組織建立長期、高度一致的合作夥伴關係，以可持續的成本為系統提供高品質的服務，並增加我們的收入。

Last week, we announced a partnership with Parkview Health, a premier community-based health system, as we look to expand our capabilities in my home state of Indiana. This partnership joins similar partnerships we announced last year as we accelerate our de novo capabilities with like-minded partners who will share in the development efforts with us.

上週，我們宣布與 Parkview Health 建立合作夥伴關係，Parkview Health 是一家一流的社區健康系統，我們希望擴大我們在我的家鄉印第安納州的能力。這項合作是我們去年宣布的類似合作關係的一部分，我們將與志同道合的合作夥伴一起加速我們的從頭能力，這些合作夥伴將與我們分享開發工作。

In similar vein, our integration with Intermountain Health managed-only facilities in Utah is progressing as planned, and we are actively working with them on syndicated de novos. Although these won't be a material contributor to our 2024 growth, the long-term prospects are incredibly attractive. As we expand our focus on de novo opportunities, we are positioning our team to manage at least 10 de novo centers in development annually.

同樣，我們與猶他州 Intermountain Health 託管設施的整合正在按計劃進行，並且我們正在積極與他們合作進行聯合專案。儘管這些不會對我們 2024 年的成長做出實質貢獻，但長期前景非常有吸引力。隨著我們擴大對 de novo 機會的關注，我們將我們的團隊定位為每年管理至少 10 個正在開發的 de novo 中心。

In addition to our de novo development, as Wayne mentioned, we deployed approximately $225 million on 16 transactions in the past 13 months. These transactions were bought at attractive multiples, averaging less than 8 times historic learnings. We continue to rapidly integrate our acquisitions into core operations, bringing the full benefit of our revenue cycle, procurement, managed care, and physician recruiting teams to yield significant synergies within the first 18 months of ownership. We remain committed to our annual capital deployment goal of at least $200 million, which will be in addition to the $60 million support in January of this year.

正如 Wayne 所提到的，除了我們的從頭開始開發之外，我們在過去 13 個月的 16 筆交易中部署了約 2.25 億美元。這些交易的買入倍數頗具吸引力，平均不到歷史教訓的 8 倍。我們繼續將我們的收購快速整合到核心業務中，充分發揮我們的收入週期、採購、管理式醫療和醫生招聘團隊的優勢，在所有權的前 18 個月內產生顯著的協同效應。我們仍然致力於實現至少 2 億美元的年度資本部署目標，這是在今年 1 月提供的 6,000 萬美元支援之外的。

In closing, I'm proud of our management team and our many talented physician partners and colleagues for effectively managing through inflationary labor and supply pressures over the past few years. Additionally, we have effectively managed challenges related to anesthesia costs which, as a reminder, is not a material expense within our structure.

最後，我為我們的管理團隊以及許多才華橫溢的醫生合作夥伴和同事感到自豪，他們在過去幾年中有效地應對了通貨膨脹的勞動力和供應壓力。此外，我們有效地應對了與麻醉費用相關的挑戰，提醒一下，麻醉費用並不是我們結構中的物質費用。

With inflationary pressures abating, coupled with how well our teams are effectively executing on our initiatives across business development, recruiting, managed care, procurement, revenue cycle, and operations, we are confident that we will achieve our 2024 goals. I've never been more optimistic regarding our future and the number of tailwinds impacting our business. The desire and need to move more procedures to purpose-built, short-stay surgical facilities has never been greater. And our company is positioned to deliver industry-leading growth associated with these tailwinds.

隨著通膨壓力的減弱，加上我們的團隊有效執行業務開發、招募、管理式醫療、採購、收入週期和營運方面的舉措的情況，我們有信心實現 2024 年的目標。我對我們的未來以及影響我們業務的有利因素從未如此樂觀。將更多手術移至專門建造的短期手術設施的願望和需求從未如此強烈。我們公司的定位是在這些有利因素的推動下實現領先業界的成長。

This, coupled with an existing and growing M&A pipeline and a talented, deep, and experienced leadership team, provides further optimism for long-term sustainable mid-teens adjusted EBITDA growth.

再加上現有且不斷成長的併購管道以及才華橫溢、深厚且經驗豐富的領導團隊，為長期可持續的中雙位數調整後 EBITDA 成長提供了進一步的樂觀情緒。

With that, I will now turn the call over to Dave Doherty to provide additional color on our financial results as well as the 2024 outlook. Dave?

現在，我將把電話轉給戴夫·多爾蒂 (Dave Doherty)，為我們的財務業績以及 2024 年前景提供更多資訊。戴夫？

Thanks, Eric. I will first talk about our 2023 financial results and liquidity before providing detail on our outlook for 2024. Starting with the top line, we performed nearly 606,000 surgical cases in our consolidated facilities and over 153,000 in the fourth quarter alone.

謝謝，埃里克。我將首先討論我們 2023 年的財務表現和流動性，然後詳細介紹我們對 2024 年的展望。從營收開始，我們的綜合設施中實施了近 606,000 例手術，僅在第四季度就實施了超過 153,000 例手術。

On a same-facility basis, we grew cases 1.4% in the quarter and 3.9% for the full year. This marks the 12th consecutive quarter of same-facility case growth and the third consecutive year. This growth has been above our long-term target growth rate. The combined case growth in higher acuity specialties, specific managed care actions, and the continued impact of acquisitions supported consolidated revenue growth of 4% in the fourth quarter and 8% for the year, inclusive of approximately $100 million of revenue headwinds associated with facilities we divested in early 2023.

在相同設施的基礎上，我們本季的病例數增加了 1.4%，全年成長了 3.9%。這標誌著同一設施案例連續第 12 個季度增長，也是連續第三年增長。這一成長高於我們的長期目標成長率。較高敏銳度專業的病例成長、具體的管理式醫療行動以及收購的持續影響支持第四季度綜合收入增長4%，全年增長8%，其中包括與我們的設施相關的約1 億美元的收入逆風。

On a same-facility basis, total revenue increased 8.1% in the fourth quarter and 11.3% for the year. Same-facility rate growth was 6.7% and 7.1% for these periods, respectively. We have seen this rate growth all year, primarily driven by higher acuity procedures. Our strong revenue growth was equally reflected in our adjusted EBITDA growth, which was $142.3 million in the fourth quarter, 17.8% higher than last year. This gives us a margin of 19.4%, 230 basis points higher than 2022.

以同等設施計算，第四季總營收成長 8.1%，全年成長 11.3%。這些時期的同設施成長率分別為 6.7% 和 7.1%。我們全年都看到這種成長率，主要是由更高的敏銳度手術推動的。我們強勁的營收成長同樣反映在調整後 EBITDA 成長上，第四季為 1.423 億美元，比去年成長 17.8%。這使我們的利潤率為 19.4%，比 2022 年高出 230 個基點。

As Wayne and Eric mentioned, our full year adjusted EBITDA was $438.1 million, marking another year of mid-teens growth at just over 15%, with a margin that has expanded 100 basis points to 16.0%. Margins benefited from revenue growth, effective cost management, and contributions from our equity method investments, which we sometimes reference as minority partnerships.

正如 Wayne 和 Eric 所提到的，我們全年調整後 EBITDA 為 4.381 億美元，標誌著另一個年中青少年成長率略高於 15%，利潤率擴大了 100 個基點，達到 16.0%。利潤率得益於收入成長、有效的成本管理以及我​​們的權益法投資（我們有時稱之為少數合夥企業）的貢獻。

Moving to our balance sheet, as Wayne mentioned, we completed a significant refinancing of our term loan in December, extending the maturity to 2030 with more favorable terms. Concurrent with this refinancing, we increased and extended our revolving credit facility. We are fortunate to have a strong banking syndicate supporting a revolver that has a borrowing capacity in excess of $700 million.

轉向我們的資產負債表，正如韋恩所提到的，我們在 12 月完成了定期貸款的重大再融資，以更優惠的條件將期限延長至 2030 年。在進行再融資的同時，我們增加並擴大了循環信貸額度。我們很幸運有一個強大的銀行財團支持左輪手槍，其借貸能力超過 7 億美元。

As we have demonstrated, we will be opportunistic in approaching the capital markets. We will have that same discipline as we manage the two relatively smaller notes that come due over the next three years and look to hedge future interest rate exposures. I look forward to sharing more about our opportunities here in the coming quarters.

正如我們所證明的，我們將在進入資本市場時採取機會主義態度。當我們管理未來三年到期的兩張相對較小的票據時，我們將遵循相同的紀律，並尋求對沖未來的利率風險。我期待在未來幾季分享更多有關我們的機會的資訊。

Our corporate debt at the end of 2023 was approximately $1.9 billion with an average fixed interest rate of 6.7%. Our full year 2023 ratio of total net debt to EBITDA, as calculated under our new credit agreement, was 3.5 times. Under the terms of the new credit agreement, there was a change in the definition of net debt used in that calculation, with asset-backed finance leases now treated consistently with other asset-backed operating leases and excluded from the calculation of net debt.

截至 2023 年底，我們的企業債務約為 19 億美元，平均固定利率為 6.7%。根據新信貸協議計算，2023 年全年淨債務總額與 EBITDA 比率為 3.5 倍。根據新信貸協議的條款，計算中使用的淨債務定義發生了變化，資產支持融資租賃現在與其他資產支持經營租賃一致處理，並排除在淨債務計算之外。

This revised calculation is more reflective of the fundamental nature of assets and liabilities and conforms to market practice and definition as the prior language dated back to documents constructed over six years ago. Relative to the former term loan definition, this change benefited the calculation by approximately 0.4 turns. With the earnings growth we expect, we are confident this ratio will continue to decline, although the timing of acquisitions could temporarily pressure this calculation.

這項修訂後的計算更能反映資產和負債的基本性質，並且符合市場慣例和定義，因為先前的語言可以追溯到六年多前建構的文件。相對於先前的定期貸款定義，這項變更使計算受益約 0.4 圈。隨著我們預期的獲利成長，我們有信心這一比率將繼續下降，儘管收購的時機可能會暫時對此計算造成壓力。

In the fourth quarter, we generated free cash flow of approximately $19 million, giving us full year free cash flow of $110 million. Although we are incredibly proud to have turned this company into a positive cash flow position, I must acknowledge that this amount is lower than we previously messaged. The difference is primarily due to two timing related matters. The first was the timing of collections for paper-based billings and related insurance recoveries associated with this cyber threat we experienced in Idaho in 2023. And the second being amounts we earned in 2023 related to certain new state-based government programs that will settle in 2024. Neither of these factors affect the positive trajectory that we are experiencing, but our original projections did not reflect the delayed collections on these items.

第四季度，我們產生了約 1,900 萬美元的自由現金流，全年自由現金流為 1.1 億美元。儘管我們對將這家公司轉變為正現金流狀況感到非常自豪，但我必須承認這筆金額低於我們之前發布的資訊。差異主要是由於兩個與時間相關的問題造成的。第一個是與 2023 年我們在愛達荷州經歷的網路威脅相關的紙本帳單和相關保險追償的催收時間。第二個是我們在 2023 年賺取的與某些新的州政府計劃相關的金額，這些計劃將於 2024 年解決。這些因素都不會影響我們正在經歷的正面軌跡，但我們最初的預測並未反映這些物品的延遲收集。

Having said that, our pride comes from the fact that business the company's first year turning our free cash flow positive in a sustainable way. As growth in free cash flow is closely linked to the growth in our adjusted EBITDA, a trend we expect to continue to meaningfully enhance the company's liquidity position. Our updated view for 2024 free cash flow was in the range of $140 million to $160 million. This view reflects a more conservative view to reflect our core value of setting and exceeding expectations.

話雖如此，我們的自豪來自於公司第一年就以可持續的方式將我們的自由現金流轉為正值。由於自由現金流的成長與調整後 EBITDA 的成長密切相關，我們預期這一趨勢將繼續顯著增強公司的流動性狀況。我們對 2024 年自由現金流的最新預測在 1.4 億美元至 1.6 億美元之間。這一觀點反映了更保守的觀點，以反映我們設定並超越期望的核心價值。

We ended the quarter with $195.9 million in consolidated cash and an untapped revolver of $704 million. When combined with the free cash flow we are projecting, we believe our current and future liquidity positions us well while giving us flexibility to maintain our long-term acquisition posture of deploying at least $200 million annually for M&A.

本季末，我們擁有 1.959 億美元的合併現金和 7.04 億美元未動用的左輪手槍。結合我們預測的自由現金流，我們相信我們當前和未來的流動性使我們處於有利地位，同時使我們能夠靈活地維持每年至少部署 2 億美元用於併購的長期收購態勢。

We are carrying the momentum of a strong finish to 2023 into 2024 with all of our growth engines operating effectively. As a result, we are reaffirming our guidance for 2024 adjusted EBITDA to greater than $495 million, representing at least 13% growth over 2023. Additionally, we are setting 2024 revenue guidance to be greater than $3 billion. We expect to deploy at least $200 million of capital and M&A in addition to the $60 million we deployed in January, with additional spend depending on the timing of any portfolio management opportunities underway.

我們將在 2023 年強勁結束的勢頭下進入 2024 年，所有成長引擎均有效運作。因此，我們重申 2024 年調整後 EBITDA 的指引值將超過 4.95 億美元，比 2023 年成長至少 13%。此外，我們將 2024 年的收入指引設定為超過 30 億美元。除了 1 月部署的 6,000 萬美元之外，我們預計還將部署至少 2 億美元的資本和併購，額外支出取決於正在進行的任何投資組合管理機會的時間表。

There are always puts and takes to our early guidance with risks we track and opportunities we pursue. Generally, we feel we have built a conservative outlook for 2024, subject to the timing of our capital deployment. As Wayne mentioned, the pipeline is strong with over $200 million already under LOI, with the majority of the transactions representing consolidating entities. As a reminder, we are agnostic to the accounting treatment if the deal is right for the company and our shareholders.

我們的早期指導總是包含我們追蹤的風險和我們追求的機會。總體而言，我們認為我們對 2024 年的前景持保守態度，這取決於我們的資本部署時間。正如韋恩所提到的，管道很強大，意向書已超過 2 億美元，其中大部分交易代表合併實體。提醒一下，我們不知道該交易是否適合公司和股東的會計處理。

Our guidance implies continued margin expansion, reflecting our ongoing and accretive progress in procurement and revenue cycle, as well as the integration benefits from recent acquisitions and contributions from de novos we expect to open this year. We have high confidence in these growth levers based on our historical experience and the compounding effect of activity that has already occurred in areas like physician recruiting and managed care contracting. Once again, our well-established and proven growth algorithm is firing on all cylinders and enables the company to confidently guide to double-digit adjusted EBITDA growth and margin expansion in 2024 and beyond.

我們的指導意味著利潤率的持續擴張，反映了我們在採購和收入週期方面持續不斷的進步，以及我們預計今年將開業的近期收購和貢獻帶來的整合效益。根據我們的歷史經驗以及醫生招募和管理式醫療承包等領域已經發生的活動的複合效應，我們對這些成長槓桿充滿信心。我們完善且經過驗證的成長演算法再次全速運轉，使公司能夠自信地在 2024 年及以後實現兩位數的調整後 EBITDA 成長和利潤率擴張。

With that, I would like to turn the call back over to the operator for questions. Operator?

因此，我想將電話轉回給接線員詢問問題。操作員？

(Operator Instructions) Brian Tanquilut, Jefferies.

（操作員說明）Brian Tanquilut，Jefferies。

Hey, good morning, guys, and congrats on the solid year. I guess my first question, maybe Wayne or Eric, the comment you made about the ankles and shoulders, anything you can share with us in terms of understanding the economics of that business and also the relative sizing of that opportunity because, obviously, we added knees and hips? It was a little different from the legacy businesses in terms of the margin profile and the contribution to the P&L. So just curious what you can share with us on ankles and shoulders.

嘿，早上好，夥計們，恭喜你度過了堅實的一年。我想我的第一個問題，也許是韋恩或埃里克，你對腳踝和肩膀的評論，你可以與我們分享的任何關於理解該業務的經濟學以及該機會的相對規模的內容，因為顯然，我們補充說膝蓋和臀部？就利潤狀況和對損益的貢獻而言，它與傳統業務略有不同。所以只是好奇你能在腳踝和肩膀上與我們分享什麼。

Hey, Brian, good morning. I'm going to have Eric give a few more details on this. But one thing I do want to highlight for all of our investors and one of the reasons we enjoy seeing these continued programs expand from the inpatient only list is while we consistently talk about the total joint programs, and in this case, the total joints that we will get from ankles and shoulders, what is important to recognize is that it also expands the ecosystem of other procedures in which we get to capitalize on.

嘿，布萊恩，早安。我將讓埃里克提供更多有關此事的細節。但我確實想向我們所有的投資者強調一件事，我們喜歡看到這些持續項目從僅限住院患者的名單中擴大的原因之一是，我們一直在談論總聯合項目，在這種情況下，總聯合項目我們將從腳踝和肩膀上得到好處，重要的是要認識到它還擴大了我們可以利用的其他程序的生態系統。

So as an example, if you were just to look at total orthopedic growth, so ignore joints -- like include joints, but what other growth comes with those surgeons that bring their joints over? We've got over the last three years of CAGR of over 8% in just absolute orthopedic procedures. And so from our perspective, first and foremost, the joints are going to obviously bring a great economic value to us, and Eric can talk about that. But what's even more important is it actually opens up our facilities to additional surgeons that historically may not have even considered us due to the lack of the ability of doing the total joints.

舉個例子，如果你只是為了觀察骨科的整體生長，那麼就忽略關節——例如包括關節，但是那些將關節移過來的外科醫生還會帶來什麼其他生長呢？過去三年，我們在絕對骨科手術的複合年增長率超過 8%。因此，從我們的角度來看，首先也是最重要的是，關節顯然將為我們帶來巨大的經濟價值，而艾瑞克可以談論這一點。但更重要的是，它實際上向更多外科醫生開放了我們的設施，而這些外科醫生在歷史上可能甚至沒有考慮過我們，因為我們缺乏全關節手術的能力。

But Eric, anything you want to elaborate on regarding that?

但是艾瑞克，你想詳細說明一下嗎？

Sure. And thanks for the question, Brian, and the comments. We're really excited about ankles and shoulders getting taken off the inpatient only list. As you probably remember, we talked about this during COVID. We had a hospital without walls, ASCs that were able to safely do these procedures. And so the evidence has been apparent for a while that we're the best place to do this.

當然。感謝布萊恩的提問與評論。我們對腳踝和肩膀從僅限住院患者的名單中刪除感到非常興奮。您可能還記得，我們​​在新冠疫情期間討論過這個問題。我們有一家沒有圍牆的醫院，ASC 能夠安全地進行這些手術。因此，一段時間以來，證據已經很明顯，表明我們是做到這一點的最佳場所。

There are thousands of cases amongst our existing surgeons they can't bring today, so it is a meaningful opportunity. As Wayne mentioned too, when surgeons have to schedule those cases at a hospital, they tend to take their day. And so we see that as a real opportunity just for convenience.

我們現有的外科醫生中有數千個病例他們今天無法帶來，所以這是一個有意義的機會。正如韋恩也提到的，當外科醫生必須在醫院安排這些病例時，他們往往會休息一天。因此，我們認為這是一個真正的機會，只是為了方便。

And again, our existing doctors who use us have a lot of cases. We know exactly where those cases are going. We're already working to move those over in January. And February, we're working hard on that. And then there's obviously shoulder specialists in our markets that now fall right into our recruitment pipeline.

再說一次，我們現有的使用我們的醫生有很多病例。我們確切地知道這些案件的去向。我們已經在努力在一月將這些轉移。二月，我們正在為此努力。然後，顯然我們市場上的肩部專家現在就屬於我們的招募管道。

So we were excited about the opportunity. It certainly reinforces our confidence in total joint growth. And just one more example is as things get added to the ASC list, the opportunity to create value for the system and to create value for Surgery Partner shareholders is tremendous.

所以我們對這個機會感到很興奮。這無疑增強了我們對全面共同增長的信心。再舉一個例子，隨著 ASC 清單中的內容不斷增加，為系統創造價值並為外科手術合作夥伴股東創造價值的機會是巨大的。

Yeah, it's awesome. And then maybe my follow-up, Eric or so for Dave, as I think about the remaining debt pieces out there that you can either call or refinance, as I think about the opportunities there and then in terms of what that does to your cash flow outlook for 2025, I know in the past you've talked about a goal hitting $200 million of free cash in '25, just maybe any thoughts you can share with us in those things. Thanks.

是的，太棒了。然後也許是我的後續行動，埃里克或戴夫的其他人，當我想到你可以打電話或再融資的剩餘債務部分時，當我想到那裡的機會，然後就這對你的現金產生什麼影響時2025 年的流量展望，我知道您過去曾談到在 25 年實現 2 億美元自由現金的目標，也許您可以與我們分享有關這些事情的任何想法。謝謝。

Yeah. Thanks, Brian. You're right. I'll just give you a reminder of where we sit on our balance sheet. First off, we did mention that term loan refinance in December, which took that debt out to 2030. And as you can see with our leverage, it gave us some pretty favorable terms as we modernize that for current situations.

是的。謝謝，布萊恩。你說得對。我只是提醒您我們在資產負債表上的位置。首先，我們確實在 12 月提到了定期貸款再融資，該計劃將債務延長至 2030 年。正如你所看到的，我們的槓桿作用在我們針對當前情況進行現代化改造時，它給了我們一些相當有利的條款。

The rates I think were also pretty well. But as you know, we do have to address the interest rate that's currently protected by the hedges, which we'll do over the course of this year.

我認為價格也相當不錯。但如您所知，我們確實必須解決目前受對沖保護的利率問題，我們將在今年完成這項任務。

We also have two senior notes that sit out there. They're both small. One is about $180 million due in 2025, carries a very favorable coupon rate of 6.75%. So that one looks better than rates you can get in the market right now. So you're probably going to hold onto that until it makes sense for us to look at that again.

我們還有兩篇高級筆記。他們倆都很小。其中一筆約 1.8 億美元，將於 2025 年到期，票面利率非常優惠，為 6.75%。因此，這個價格看起來比您現在在市場上可以獲得的價格要好。所以你可能會堅持下去，直到我們有理由再次審視它。

The other is $320 million related to a 2027 note that carries a coupon of 10%. That one steps down to par in middle of April. That does represent a fantastic opportunity for us to create interest savings on that. But in both of those two things, they're relatively small on our balance sheet, easy for us to address.

另一項是 3.2 億美元，與 2027 年票據相關，票息率為 10%。這個數字會在四月中旬下降到標準水準。這確實為我們提供了一個絕佳的機會來節省利息。但這兩件事在我們的資產負債表上都相對較小，我們很容易解決。

So we will remain opportunistic when we address both the interest rate hedge for the term loan and the refinancing of that 10% coupon note. And I think as you've seen us do over the past several years, Brian, we'll be judicious about when we enter the market and really tried to take advantage the best environment that we possibly can. But that will be an area of focus that I look forward to talking to you about as we go through the year.

因此，當我們解決定期貸款的利率對沖和 10% 息票票據的再融資問題時，我們將保持機會主義。我認為，正如您在過去幾年中看到的那樣，布萊恩，我們在進入市場時會保持明智，並真正嘗試利用我們可能的最佳環境。但這將是我期待在這一年中與您討論的一個重點領域。

Awesome. Thank you.

驚人的。謝謝。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. I wanted to focus on the revenue per case in the quarter, which was strong again. I think you mentioned as far as a cash flow dynamic, the state supplemental payments. I was wondering if you could maybe flesh out how much that was as far as revenue benefit in the quarter and then I guess also as far as the cash flow drag for the year? And then just trying to understand if you think about breaking out that revenue per case, how much is mix versus rate?

萬分感謝。我想重點關注本季度每個案例的收入，該收入再次強勁。我想你提到了現金流動態，即國家補充付款。我想知道您是否可以具體說明本季的收入收益有多少，然後我想還有今年的現金流拖累？然後試著了解一下，如果您考慮細分每個案例的收入，那麼混合與費率是多少？

Hey, Kevin, good morning.

嘿，凱文，早安。

Maybe I'll take that. (multiple speakers)

也許我會接受。（多個發言者）

Thanks for the question. I'm going to let Dave and Eric a little bit deeper on the specifics. But just at a very, very high level, I want to remind everyone that these upper payment limit programs are fairly de minimus to our operating earnings as a whole and happened throughout the year. But we've got more and more state programs that are actually expanding to these, and we continue to try to capture these.

謝謝你的提問。我將讓戴夫和埃里克更深入地了解具體細節。但只是在非常非常高的水平上，我想提醒大家，這些支付上限計劃對我們的整體營業收入來說相當微不足道，而且是全年發生的。但我們有越來越多的國家計劃實際上正在擴展到這些領域，我們將繼續努力抓住這些目標。

So in terms of the specifics of the quarter, not an overall material impact but rather a reflection of many of the initiatives that the company has been doing throughout the year to continue to just expand. And as you know, fourth quarter is a very heavy commercial quarter for us, typically, due to deductibles. So we continue to get that.

因此，就本季的具體情況而言，這並不是整體的實質影響，而是反映了該公司全年為繼續擴張而採取的許多舉措。如您所知，第四季度對我們來說是一個非常繁忙的商業季度，通常是由於免賠額的原因。所以我們繼續得到這一點。

And then the last thing I would highlight is that we have these investments we've made in these non-majority-owned, non-consolidating facilities. And if we again -- the run rate of those now start to ramp up, we get more of an impact of that in the fourth quarter. You'll start to see that smooth out more though as we go into the new year because now we'll start getting the run rate impact of that in Q1 and Q2 as well.

我要強調的最後一件事是，我們對這些非多數股權、非合併設施進行了投資。如果我們再次——這些設備的運行率現在開始上升，我們將在第四季度受到更大的影響。當我們進入新的一年時，您會開始看到這種情況更加平滑，因為現在我們也將開始了解第一季和第二季的運行率影響。

But Dave or Eric, anything you want to elaborate on?

但是戴夫或埃里克，你想詳細說明一下嗎？

Yeah. Before I hand over to Dave to talk about that program a little more specifically, I would just -- on the mix and rate question, it's primarily mix. Like we had success obviously in rate, but most of what drives that is our increased acuity and focus around recruitment and higher acuity service lines.

是的。在我交給戴夫更具體地談論該計劃之前，我只想 - 關於混合和評級問題，它主要是混合。就像我們在比率上顯然取得了成功一樣，但推動這一成功的主要原因是我們對招募和更高敏銳度服務線的敏銳度和關注度的提高。

But Dave, I'll turn it over to you on his specific question.

但是戴夫，我會將他的特定問題轉交給你。

Yeah, and thank you. But first off, again, it is good to reiterate that point on the rate growth really coming from the change in acuity. And that's what we've seen all year. Brian, I know you've -- we've talked about this before. And the impact of those non-consolidating is pretty significant as we've been really focusing that de novo engine on those high acuity procedures, which is going to, obviously, be a big benefit to us as we go through that going forward. So that is by far the biggest driver that sits inside there.

是的，謝謝你。但首先，重申利率成長真正來自於敏銳度變動的觀點是有好處的。這就是我們這一整年所看到的情況。布萊恩，我知道你已經──我們之前討論過這個問題。這些非整合的影響非常重大，因為我們一直在真正將重頭引擎集中在那些高敏銳度程序上，這顯然對我們未來的發展有很大好處。所以這是迄今為止最大的驅動因素。

As Wayne mentioned, the state-based programs, it's something that we've always had in our portfolio. There was a new program that came through in one of the states that we operate in this year. That one did create some issues with us in terms of projecting cash flow, the reimbursement rates. The timing of when those reimbursements happened was more in '24 and a little bit in '25, but it wasn't what we expected. We expect that to come through, or I think, a little bit earlier in the process.

正如韋恩所提到的，基於州的計劃是我們的投資組合中一直有的東西。今年我們開展業務的一個州實施了一項新計劃。這確實為我們帶來了一些在預測現金流、報銷率方面的問題。這些報銷發生的時間更多是在 24 年，有一點是在 25 年，但這不是我們預期的。我們希望這一點能夠實現，或者我認為，能夠在這個過程中更早實現。

As Wayne mentioned, the driver of rate was not coming through exclusively from there. In fact, we've seen those rate base programs over the course of the year. We're only talking about that because of the pressure it created for us on the cash flow piece.

正如韋恩所提到的，利率的驅動因素並不完全來自那裡。事實上，我們在這一年中已經看到了這些費率基礎方案。我們之所以談論這個只是因為它給我們帶來了現金流方面的壓力。

How much was that in the cash flow?

現金流量中有多少？

About half of the [miss]. Maybe a little bit -- somewhere around half of that miss versus the $140 million we've been talking about before. And again, just to reiterate, I don't want to leave any doubt on this. This is just timing of when those cash flows are coming. There's no concern about the recovery of that.

大約有一半[錯過]。也許有一點——大約是我們之前討論過的 1.4 億美元的失誤的一半左右。再次重申，我不想對此留下任何疑問。這只是這些現金流到來的時機。不用擔心恢復情況。

Okay. And then maybe just a second question. You guys have seen some margin expansion, looking for margin expansion again this year. Could you just talk a little bit about where exactly you think that's coming from. And then can you just remind us with the growth in orthopedics. Is that a headwind to margin that you're overcoming, or is that a tailwind to margin and part of the reason why we should be seeing margin expansion? Thanks.

好的。然後也許只是第二個問題。你們已經看到了一些利潤率的擴張，希望今年能再次實現利潤率的擴張。能簡單談談您認為這到底來自哪裡嗎？然後你能提醒我們骨科的發展嗎？這是您正在克服的利潤率逆風，還是利潤率的順風車，也是我們應該看到利潤率擴張的部分原因？謝謝。

(multiple speakers) Yeah, go ahead, Dave.

（多個發言者）是的，繼續，戴夫。

Yeah, thank you. So margin expansion is going to come naturally to us for a couple of key reasons. One, if we're doing our job right on the rate side of the equation, that should naturally create margin as we really tried to focus on cost control, which we've done pretty effectively over the past couple of years, if you look at those high-level metrics that we've continued to improve upon. So if you look back over this past year, plus 50 basis points of improvement on both the supply and SG -- I'm sorry, and on the SWB, salaries, wages, and benefits.

是的，謝謝。因此，由於幾個關鍵原因，利潤率擴張對我們來說將是自然的。第一，如果我們在等式的費率方面做好我們的工作，那自然會創造利潤，因為我們確實試圖專注於成本控制，如果你看的話，我們在過去幾年中做得非常有效我們不斷改進這些高級指標。因此，如果你回顧過去的一年，再加上供應和SG方面的50個基點的改善——我很抱歉，以及SWB、工資、工資和福利方面的改善。

So you're going to get a driver of that, which is what you should count on. We get margin expansion also from the acquisitions that we've done and being able to take a turn off of those things as we integrate those into our facilities. And importantly, the equity method investments, those minority interest holding don't come with revenue. So a lot of that growth will just come through as pure margin for us.

所以你會得到一個驅動程序，這是你應該指望的。我們也透過收購來實現利潤率的擴張，並且當我們將這些收購整合到我們的設施中時，我們能夠關閉這些收購。重要的是，權益法投資，那些持有少數股權的投資不會帶來收入。因此，大部分成長將作為我們的純利潤來實現。

And when you look at the rate on the change in acuity, you're going to see some of that acuity coming through those minority interest holders. So you're not actually going to see the pressure on margin that you were referring to.

當你觀察敏銳度的變化率時，你會發現其中一些敏銳度來自那些少數股東。因此，您實際上不會看到您所指的利潤壓力。

But where those come through on our consolidated cases? You're 100% right. There is margin pressure. And the margin pressure is not as you would think. It really just arrests the rate of growth a little bit. It doesn't take our margins backwards as we have modeled them as this mix changes. So we're still able to outgrow that with the revenue growth that we see and the contributions from our minority interest partners.

但這些在我們的合併案例中體現在哪裡呢？你是100%正確的。存在保證金壓力。而且利潤壓力並不像你想像的那樣。它實際上只是稍微抑制了成長率。它不會使我們的利潤率倒退，因為我們隨著這種組合的變化而對它們進行了建模。因此，憑藉我們所看到的收入成長以及少數股東權益合作夥伴的貢獻，我們仍然能夠超越這一點。

Great. Thanks.

偉大的。謝謝。

Jason Cassorla, Citi.

賈森·卡索拉，花旗銀行。

Great, thanks. Good morning. I just wanted to follow up on the free cash flow commentary, Dave, just to be clear on this. The total dollar value of those two items you flagged, the people insurance plus the state program, the two miss there, was that a $30 million difference between your $140 million of free cash flow target? And would you expect to recoup those two items completely in '24? And then maybe just from that point, help us bridge to that [150] midpoint for free cash flow for '24? Just anymore color there would be great to start things.

萬分感謝。早安.我只是想跟進自由現金流評論，戴夫，只是為了澄清這一點。您標記的這兩個項目（人民保險加上國家計劃）的總價值，這兩項都沒有達到，您的 1.4 億美元自由現金流目標之間是否存在 3000 萬美元的差異？您希望在 24 年完全收回這兩項費用嗎？然後也許就從那時起，幫助我們過渡到 24 年自由現金流的 [150] 中點？只要有更多的顏色就可以很好地開始。

Yeah, happy to. So first off, let me just say, it's worth noting, this company has never generated free cash flow before. This is our first year doing so. And we went from negative last year, $210 million. But the year over year change that we see is remarkable, kind of worth a pause as we look through this.

是的，很高興。首先，我想說，值得注意的是，這家公司以前從未產生過自由現金流。這是我們這樣做的第一年。我們從去年的負數變成 2.1 億美元。但我們看到的逐年變化是顯著的，在我們審視這一點時值得停下來。

Most of that comes from, hey, the lack of some unusual items and just pure growth of the underlying operations of the company. So this is a strong, repeatable foundation that we have out there. But I must acknowledge, as you pointed out, that we missed how collections were going to come through, particularly in this fourth-quarter revenue that was there and as a result of the cyber event that took place in the beginning of the year and just the complexity of doing paper-based billings and how that impacts our payers as we go through those.

其中大部分來自，嘿，缺乏一些不尋常的項目，而只是公司基礎業務的純粹增長。因此，這是我們擁有的強大、可重複的基礎。但我必須承認，正如您所指出的，我們錯過了收款的方式，特別是在第四季度的收入中，以及由於年初發生的網絡事件而產生的結果。我們處理這些帳單時它如何影響我們的付款人。

We attribute a large majority, predominant majority of that miss to the $140 million that we had talked about before to those two items. We do expect the majority of that to come back within 2024. But some of those state programs could take as long as '25. Again, we're trying to be prudent as we give our guidance going into next year. So certainly, you're going to see a benefit from those collections going through.

我們將這一失誤的很大一部分歸因於我們之前討論過的這兩項的 1.4 億美元。我們確實預計其中大部分將在 2024 年內恢復。但其中一些州計劃可能需要長達 25 年的時間。同樣，我們在給予明年的指導時會盡量保持謹慎。所以當然，您會從這些收集中看到好處。

But as we mentioned earlier, those state-based programs continue for us. They're part of just the natural underlying source of business that we have, so those cash flows won't come in. So there will be some natural offsetting that happens on that piece of the pie.

但正如我們之前提到的，這些基於國家的計劃對我們來說仍在繼續。它們只是我們擁有的自然潛在業務來源的一部分，因此這些現金流不會進來。因此，在這塊餡餅上會發生一些自然的抵消。

And hey, listen, first time doing that metric last year, we're going to be prudent in what we included in our outlook for 2024. And so I look forward to giving an updated guidance as we go through the year. I would say in answer to your question more specifically on what's driving that year-over-year growth, it's the growth in the underlying operations of the organization implied in our guide of $495 million. This company will now have a predictable path on converting earnings into cash flows.

嘿，聽著，去年第一次進行該指標，我們將謹慎對待 2024 年展望中的內容。因此，我期待在這一年中提供更新的指導。我想說的是，在回答你的問題時，更具體地說是什麼推動了同比增長，那就是我們的 4.95 億美元指南中隱含的組織基礎運營的增長。該公司現在將有一條可預測的將收益轉化為現金流的路徑。

Great. Thanks for all the clarity on that. And maybe just want to hop over to the hospital partnerships. Could you just delve in a bit more on those partnerships? You flagged that those would be minimal contribution for '24, but maybe just how you're thinking about the timing of development and attribution. If there's any way to help size or frame the opportunity within these partnerships would be helpful

偉大的。感謝您對此的澄清。也許只是想跳到醫院夥伴關係。您能更深入地探討一下這些合作關係嗎？您指出，這些對於 24 年來說是最小的貢獻，但也許只是您對開發時間和歸因的考慮。如果有任何方法可以幫助確定或框架這些合作夥伴關係中的機會，將會有所幫助

Okay, Eric, do you want to elaborate on that? I know you recently just finished the fourth partnership with Parkview last week. But this would probably be a good way to highlight how you see the maturity of these partnerships evolving some, which I know, like Intermountain, which are occurring rapidly in terms of us taking over the management of existing facilities, but other than these that are more of the de novo focus.

好的，艾瑞克，你想詳細說明一下嗎？我知道您上週剛完成了與 Parkview 的第四次合作。但這可能是一個好方法，可以強調您如何看待這些夥伴關係的成熟度，其中一些正在發展，我知道，例如Intermountain，在我們接管現有設施的管理方面，這些夥伴關係正在迅速發生，但除此之外更多的是從頭開始的焦點。

Sure. Happy to talk about that, and we're excited about our health system partners. I should reiterate, we have a lot of inbounds. On health system partnerships, we're very selective on choosing like-minded partners or choosing markets where otherwise our entry has either been constrained or it's been states that have been hard to enter.

當然。很高興談論這一點，我們對我們的衛生系統合作夥伴感到興奮。我應該重申一下，我們有很多界外球。在衛生系統合作夥伴關係方面，我們非常有選擇性地選擇志同道合的合作夥伴或選擇我們的進入受到限製或難以進入的市場。

All of those partnerships are actually moving along quite nicely. When we think about the partnerships that we have entered, we're looking for partners that will allow us to get to double digit ASCs over a three to five year period. So these are meaningful partnerships.

所有這些合作夥伴關係實際上都進展順利。當我們考慮我們已經建立的合作夥伴關係時，我們正在尋找能夠讓我們在三到五年內達到兩位數 ASC 的合作夥伴。因此，這些都是有意義的合作關係。

The timing of that, we obviously have within our guidance this year the timing we expect for 2024. But because so much of this is de novo, there will be some acquisitions. I think it's hard to say when exactly the timing will happen over a three- to five-year period. But I think you should be thinking when we sign a health system partner, our goal is to get to double-digit centers with that partner within a three- to five-year window. And we're super excited about each of our four partners we've announced, and they are long-term strategic partners who are like-minded with us on the transition of surgical cases to the right side of care to create value for the system.

顯然，我們今年的指導中已經包含了 2024 年的預期時間。但由於其中大部分都是從頭開始，因此將會有一些收購。我認為，在三到五年的時間內，很難說出具體的時機是什麼時候發生。但我認為，當我們與衛生系統合作夥伴簽約時，您應該考慮一下，我們的目標是在三到五年的時間內與該合作夥伴一起達到兩位數的中心數。我們對我們宣布的四個合作夥伴中的每一個都感到非常興奮，他們是長期戰略合作夥伴，在將手術病例轉變為正確的護理方式以為系統創造價值方面與我們志同道合。

Great. Thanks.

偉大的。謝謝。

Lisa Gill, J.P. Morgan.

麗莎·吉爾，摩根大通。

Thanks very much. Good morning. I just want to go back to your 2024 guidance. I'm just wondering if you could maybe just give us a little more color on what you're expecting for case growth in 2024.

非常感謝。早安.我只想回顧一下您對 2024 年的指導。我只是想知道您是否可以給我們更多關於 2024 年病例增長預期的資訊。

And you start with the first question talking about ankle and shoulders. I'm just also wondering if maybe you can talk about the type of cases that you're expecting as we think about '24?

從第一個問題開始，討論腳踝和肩膀。我還想知道您是否可以談談我們在考慮“24”時您所期待的案件類型？

Hey, Lisa, let me start with, as the team builds the plan annually, we generally target our base growth algorithm, which is the 2% to 3% in volume that we believe is table stakes. Like from our perspective, if you just look at the normal growth that you should be able to expect to GI, ophthalmology, and of course, what we see with orthopedics, we generally create baselines of two to three. And we do it at the facility level so that we really understand if there's any unique changes in the market or its demographics.

嘿，麗莎，首先，隨著團隊每年制定計劃，我們通常以基本成長演算法為目標，即我們認為賭注的 2% 到 3% 的交易量。就像從我們的角度來看，如果你只看胃腸道、眼科，當然還有我們在骨科方面看到的正常生長，我們通常會創建兩到三個基線。我們在設施層面進行操作，以便我們真正了解市場或其人口統計數據是否有任何獨特的變化。

That being said then, we obviously will pursue these higher acuity procedures first. As you know, due to the higher acuity, this procedures in many cases have a great rate with them. But they require a little more of the OR time. Of course, there still a better converter per minute of OR time in terms of cash flow.

話雖這麼說，我們顯然會先追求這些更高敏銳度的程式。如您所知，由於敏銳度較高，這種手術在許多情況下都有很高的成功率。但他們需要更多的手術時間。當然，就現金流而言，每分鐘 OR 時間仍然有更好的轉換器。

But what I would say is, at an aggregate level, think about the volume of -- we still target two to three. The goal is always to outperform the high end of that range as we've done the last several years. And so ultimately, the budget says we ought to be able to do at least the high end maybe slightly better than that.

但我想說的是，從整體水準來看，我們的目標仍然是兩到三個。正如我們過去幾年所做的那樣，我們的目標始終是超越該範圍的高端。因此最終，預算表明我們至少應該能夠做得比高端產品略好一些。

Dave, anything you want to add to that in terms of how we're building our outlook?

戴夫，關於我們如何建立我們的前景，您還有什麼要補充的嗎？

Yeah. I mean, to reiterate everything that you said, the budget is built at the facility level. So we have good line of sight as we said through there. Case growth is fairly predictable for a couple of reasons for us. One, as we saw all year and as we've been talking about, quite frankly, for the past two solid years, the business doesn't change rapidly.

是的。我的意思是，重申你所說的一切，預算是在設施層面製定的。所以正如我們所說的那樣，我們通過那裡有良好的視線。對我們來說，病例增長是可以預測的，原因有幾個。第一，正如我們一整年所看到的，坦白說，正如我們一直在談論的那樣，在過去的兩年裡，業務並沒有迅速變化。

So there's no -- unless you have a Covid pandemic, which we've long since passed in our business. Our power relationship with our physicians is long-standing. Their block time or their practices are very strong. So we have an underlying base that we think is fairly predictable.

所以沒有——除非有新冠大流行，而我們的業務早已通過了這種流行病。我們與醫生的權力關係由來已久。他們的封鎖時間或他們的做法非常強。因此，我們有一個我們認為相當可預測的基礎。

Our recruiting pipeline from 2023 has been really strong, as you guys know, that compounds in a very predictable pattern for us. And so you will see confidence in that underlying rate growth -- sorry, case growth, that's at least in line with that guide that Wayne mentioned.

如你所知，我們從 2023 年開始的招募管道非常強勁，這對我們來說是一種非常可預測的模式。因此，您將看到對基本利率增長的信心 - 抱歉，病例增長，這至少與韋恩提到的指南一致。

It will be across all of our specialties because we focus very hard on those. However, you will see us trying to take advantage of ankles and shoulders, particularly in those where we already have relationships. And as our minority interest partnerships continue to mature, you'll see a continued upward pressure on there. So those cases should continue to be positive.

它將涵蓋我們所有的專業，因為我們非常專注於這些專業。然而，你會看到我們試圖利用腳踝和肩膀，特別是在那些我們已經有關係的地方。隨著我們的少數股權合作夥伴關係不斷成熟，您將看到那裡持續的上行壓力。因此，這些病例應該繼續是正面的。

Those are a relatively small number of cases that have a very large impact on revenue. So we're pretty bullish on how that's going to look for next year.

這些案例數量相對較少，但對收入影響很大。因此，我們非常看好明年的情況。

And then --

進而--

And then, Lisa --

然後，麗莎--

I'm sorry, go ahead.

抱歉，請繼續。

No, Lisa, the only thing I was going to say, to the extent just as has been our track record that we exceed those expectations, then we'll raise guidance as we move throughout the year. So I think we'd like to tried to create a conservative thoughtful baseline. But then, again, as we've done historically, if we continue to outperform that baseline, you'll see that reflected then in our outlook each quarter.

不，麗莎，我唯一想說的是，只要我們的業績記錄表明我們超出了這些預期，那麼我們將在全年的行動中提高指導。所以我認為我們想嘗試創建一個保守的深思熟慮的基線。但話又說回來，正如我們歷史上所做的那樣，如果我們繼續超越該基準，你會看到這一點反映在我們每季的展望中。

No, that's very helpful. Just staying on the 2024 guidance just for one more minute. I just want to make sure I also understand what you have in there as far as acquisitions go. I think, Dave, in your comments you talked about some slipping from '23 into ''24, but if you can talk about how much you have in the revenue guidance for acquisitions.

不，這非常有幫助。僅在 2024 年指導上停留一分鐘。我只是想確保我也了解你們在收購方面所擁有的內容。我認為，戴夫，在您的評論中，您談到了從“23”滑入“24”的情況，但您是否可以談談您的收購收入指導中有多少。

Yeah. (multiple speakers)

是的。（多個發言者）

Dave, I'm sorry, let me just start with this, then I want to put this to you.

戴夫，對不起，讓我先從這個開始，然後我想把這個告訴你。

Just a reminder, the $60 million that we got done in early January, we view that as just finalizing what we were doing in '23. And so that is going to move forward. So everything that Dave is going to talk about is the incremental $200 million we believe we would get done this year.

只是提醒一下，我們在一月初完成了 6000 萬美元的工作，我們認為這只是敲定了我們在 23 年所做的事情。所以這將會向前發展。因此，戴夫要談論的一切都是我們相信今年會完成的 2 億美元增量。

I'm sorry, Dave, go ahead.

對不起，戴夫，繼續吧。

Okay.

好的。

Yeah, yeah. So our guide right now implies that we're going to do another $200 million just as we've talked about before using a midyear convention that is exclusive of the $60 million that Wayne just mentioned that we completed in early January. The lesson learned from the past and I would just encourage us all to think about this as we do our models, it's how much of that is going to come through and consolidated as that converts to revenue versus non-consolidated.

是啊是啊。因此，我們現在的指南暗示我們將再投入 2 億美元，就像我們在使用年中大會之前討論的那樣，這不包括韋恩剛剛提到的我們在一月初完成的 6000 萬美元。從過去學到的教訓，我只是鼓勵我們所有人在製作模型時考慮這一點，即當轉換為收入而不是非合併收入時，其中有多少會通過並合併。

Now as we look at the pipeline right now, majority of those are in consolidated facilities, but we manage a very strong pipeline that goes deeper than the $200 million that's currently under LOI. And so we'll look to see how those ultimately manifest. That's what we will continue to guide to as we look through the year. As we're looking at the divestiture side, which the other point that gave us some pressure points last year, we're not looking at anything as significant as we did last year that will create that type of headwind at least as we're talking on our portfolio level at this point.

現在，當我們查看管道時，其中大部分都在合併的設施中，但我們管理著一個非常強大的管道，其深度超過了目前意向書下的 2 億美元。因此，我們將看看這些最終如何體現。這就是我們在展望這一年時將繼續指導的方向。當我們關注資產剝離方面時，這是去年給我們帶來一些壓力的另一點，我們並沒有考慮像去年那樣重要的事情，至少會造成這種類型的逆風。

Okay. Great. Thanks for the comments.

好的。偉大的。感謝您的評論。

Bill Sutherland, The Benchmark Company.

比爾·薩瑟蘭，基準公司。

Thanks very much. Good morning, everybody. It does look a little bit harder at case growth in the quarter. I'm assuming that's just a matter of the mix into the higher acuity procedures taking more OR time, is that why it was below 2%?

非常感謝。大家早安。本季案件成長確實看起來有點困難。我假設這只是混合到更高敏銳度程序中需要更多手術時間的問題，這就是為什麼它低於 2% 嗎？

No, Bill. Actually, I'm really glad you asked this question, and I want to provide a little clarity. So first and foremost, remember that the last fourth quarters, we generated 4% case volume growth. So we continue to compound off of a very large growth rate in Q4.

不，比爾。事實上，我真的很高興你問這個問題，我想澄清一下。因此，首先也是最重要的是，請記住，去年第四季度，我們的案件量增加了 4%。因此，我們在第四季度繼續以非常大的成長率實現複合。

And the reason that's important to note is that the fourth quarter of this year, which was aligned with our expectations, had a very unique anomaly occur, which was that Christmas fell on a Monday. And as you know, for the vast majority of our procedures, while we are open Monday through Friday, the majority of them actually occur on Mondays and Tuesdays. And so in this particular year, many of our facilities were not only close for the Monday but were actually closed for the Tuesday as well. And so you get this year-over-year unique comp dynamic.

值得注意的原因是，今年第四季與我們的預期一致，但出現了一個非常獨特的異常情況，那就是聖誕節恰逢星期一。如您所知，對於我們的絕大多數程序，雖然我們在周一至週五開放，但其中大多數實際上是在周一和周二進行的。因此，在今年，我們的許多設施不僅在周一關閉，而且在周二實際上也關閉了。因此，您將獲得逐年獨特的競爭動態。

As we move into 2024, it actually becomes a tailwind for us because we have a leap year. Christmas is actually getting pushed to a Wednesday, which means we'll get the Monday, Tuesday back. And in addition to that, we have one additional day in the fourth quarter of this upcoming year. So it creates a little bit of an odd anomaly in terms of comps of last year and the year before versus this year. But no concerns in terms of what we think is the basic algorithm in achieving that 2% to 3% plus.

當我們進入 2024 年時，它實際上成為我們的順風車，因為我們有閏年。聖誕節實際上被推遲到星期三，這意味著我們將恢復星期一和星期二。除此之外，我們在即將到來的一年的第四季還有一天。因此，就去年和前年與今年的比較而言，這造成了一些奇怪的異常。但就我們認為實現 2% 到 3% 以上的基本演算法而言，無需擔心。

Got it. Thanks for that. And then I was also curious if you could look at -- looking at the de novos, what's the cadence of them impacting the top line as they come on?

知道了。感謝那。然後我也很好奇你是否可以看看——看看從頭開始，它們出現時影響營收的節奏是怎樣的？

Dave, do you want to highlight that?

戴夫，你想強調這一點嗎？

Yeah. happy to. And it's a great question because, again, it could be somewhat confusing. Most de novos, as they startup in their process, are going to come through as minority interest partnerships, especially those that are coming through with our new partners that we've announced over the past year.

是的。高興。這是一個很好的問題，因為它可能再次令人困惑。大多數從頭開始的項目，在啟動過程中，都會以少數股權合作夥伴的形式出現，尤其是那些與我們在過去一年宣布的新合作夥伴合作的項目。

And at some point in time, we'll look for the opportunity to buy up to a consolidating level. So the impact on revenue should be somewhat muted in the short run. Now, that's not an exclusive statement. There are some of our de novos that we look at that out of the gate we will be consolidating. And in that case, you won't see a huge impact in 2024.

在某個時間點，我們將尋找機會買入至盤整水平。因此，短期內對收入的影響應該會減弱。現在，這並不是一個獨家聲明。我們正在研究一些從頭開始的項目，我們將對其進行整合。在這種情況下，2024 年你不會看到巨大的影響。

When it becomes something that's a material contributor to our revenue guide, we'll probably give you a heads up on that. But the gestation period for de novos is a relatively long ramp. So the seeds we planted last year and the seeds reflecting this year will take another year or two before you start to see them provide the meaningful growth that we'll be talking about. As we sit here today, we're just excited about managing about 10 or so a year now.

當它成為我們收入指南的實質貢獻者時，我們可能會提醒您。但從頭開始的醞釀期是一個相對較長的過程。因此，我們去年播下的種子和今年反映的種子將需要一兩年的時間才能開始看到它們提供我們將要討論的有意義的增長。當我們今天坐在這裡時，我們對現在每年管理大約 10 個左右感到興奮。

Okay, great. Thanks, Dave.

好的，太好了。謝謝，戴夫。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Thank you. I wanted to go back to margins. I appreciate the mechanics of the minority interest assets lifting margins. But can you clarify if '24 you would also be guiding to margin expansion on your core book? And then on the drivers of that, you've been talking about improving RCM for a while, how much runway is left on that? And also, G&A came in well below consensus, anything you can point to as the driver there in the quarter and if that would continue into '24?

謝謝。我想回到邊緣。我很欣賞少數股東權益資產提高利潤率的機制。但您能否澄清一下，您是否也會在 24 年指導核心書籍的利潤擴張？關於其驅動因素，您已經談論改進 RCM 一段時間了，這方面還剩下多少跑道？此外，G&A 的表現遠低於共識，您能指出本季的驅動因素嗎？

Hey, Saraha, good morning. First and foremost, core book will be expanding margins as well as the minority interest. So no changes from that perspective.

嘿，莎拉哈，早安。首先也是最重要的，核心帳目將是擴大利潤率和少數股東權益。所以從這個角度來看沒有改變。

I think we continue to get the benefits of scale. And in many cases, we were overcoming headwinds that the industry was suffering over the last couple of years, both around labor and cost supply. And while we effectively managed it well, we've also been able to maintain a cost structure. That means we'll get the benefits of that as we return to a more normal environment. So feel very good from that perspective.

我認為我們將繼續獲得規模效益。在許多情況下，我們正在克服過去幾年該行業在勞動力和成本供應方面所遭受的阻力。雖然我們有效地管理得很好，但我們也能夠維持成本結構。這意味著當我們回到更正常的環境時，我們將受益於此。所以從這個角度來說感覺非常好。

On the RCM front, I am continually amazed at the work that Dave and the team have done and where the opportunities continue to exist. Dave, do you want to elaborate on a bit more of what we see as runway? And I don't think we see this slowing down anytime soon.

在 RCM 方面，我一直對 Dave 和團隊所做的工作以及繼續存在的機會感到驚訝。戴夫，你想詳細說明一下我們所看到的跑道嗎？我認為這種情況不會很快放緩。

That's right. Yeah, thank you. And rev cycle is something that's probably a multiyear journey for us as we continue to get better in that front. And it happens both from bringing in the right teams and continuing to standardize across the portfolio as well as recent integrations as we bring the benefit of our rev cycle approach across the organization. So I think that there's still a long runway that sits in there that will be a contributing factor for both cash conversion as well as enhance revenue uptake.

這是正確的。是的，謝謝。隨著我們在這方面不斷進步，轉速週期對我們來說可能是一個多年的旅程。這是透過引入合適的團隊並繼續在整個產品組合中實現標準化以及最近的整合來實現的，因為我們在整個組織中帶來了我們的轉速週期方法的好處。因此，我認為仍然有很長的路要走，這將成為現金轉換和提高收入吸收的促成因素。

And your question on G&A, Sarah, it's really just the flex of the business as we go through the ups and downs of the quarter. Again, on that particular line, I would encourage folks to look at that on a longer-term basis. So to 6 months to 12 months view will help you to smooth out the impact of some of the flexing that sits underneath that G&A line item. As you can imagine, probably the biggest piece inside there is on your incentive comp viewpoint.

莎拉，你關於一般行政費用的問題，這實際上只是我們經歷本季的起起落落時業務的靈活性。再次，在這一點上，我鼓勵人們從更長遠的角度來看待這個問題。因此，6 個月到 12 個月的視圖將幫助您消除 G&A 訂單項目下方的一些調整的影響。正如您可以想像的那樣，其中最重要的部分可能是您的激勵補償觀點。

Got it. Thank you.

知道了。謝謝。

Gary Taylor, TD Cowen.

加里·泰勒，TD·考恩。

Hey, good morning. Most of my questions answered. I did have a couple questions just on the expense side. But maybe just following up on that G&A point, I guess given how strong the fourth quarter usually is, particularly with commercial, I guess it wasn't my sense that it would be a quarter you'd be looking or needing to flex G&A lower. So I just wanted to understand that comment just a little bit better.

嗨，早安。我的大部分問題都得到了解答。我確實有幾個關於費用的問題。但也許只是跟進G＆A點，我想考慮到第四季度通常有多強勁，特別是在商業方面，我想這不是我的感覺，你會尋找或需要降低G＆A較低的季度。所以我只是想更好地理解這個評論。

And then the other question was on other operating expense with the other way that seasonally doesn't tend to increase as much up a fair amount. So maybe there's a little bit of offset in terms of the impact between those two-line items, but a little more color would be helpful.

然後另一個問題是其他營運費用，以另一種方式，季節性往往不會增加相當多的金額。因此，這兩個項目之間的影響可能會有一點抵消，但多一點顏色會有所幫助。

Gary, I'm going to let Dave dive in. A couple of things to keep in mind, as we divested certain fully consolidated facilities early in the year, obviously, you'll start seeing the full impact to be comparing Q4 this year versus last year in the fourth quarter.

加里，我要讓戴夫深入了解。有幾件事需要記住，因為我們在今年年初剝離了某些完全整合的設施，顯然，您將開始看到今年第四季與去年第四季的比較所產生的全面影響。

It's also fair to recognize that our non-consolidated entities of which we started making those investments throughout the year, those are obviously going to show up in a single line. But you're not going to necessarily see the consolidated growth associated with those on the G&A front. But Dave, you want to elaborate a little bit further as well on any other anomalies or anything to point out?

公平地說，我們全年開始進行這些投資的非合併實體，這些實體顯然會出現在一條線上。但你不一定會看到與一般管理費用方面相關的綜合成長。但是戴夫，你想進一步詳細說明任何其他異常情況或需要指出的事情嗎？

Yeah, happy to. So you're right on how you flex up and down the business based on the overall strength. Inside the corporate G&A side, you will look at how this organization thinks about incentivizing our teams and driving strong performance. We have very, very high internal expectations. And so as a result of that, you'll see some movement inside that in any given quarter. Again, you got to look at that particular line item on a multi-quarter basis.

是的，很高興。因此，您根據整體實力調整業務的方式是正確的。在公司的 G&A 方面，您將了解該組織如何考慮激勵我們的團隊並推動強勁的績效。我們有非常非常高的內在期望。因此，您會在任何特定季度看到其中的一些變化。同樣，您必須在多個季度的基礎上查看該特定訂單項目。

The other operating expense question you have is a great one. It relates to provider taxes for the most part. So the taxes on some of the programs that exist at a state level in some of the states that we experienced in the latter part of the year.

您提出的另一個營運費用問題是一個很好的問題。它大部分與提供者稅有關。因此，我們在今年下半年經歷了一些州對州級計畫的稅收。

Thanks.

謝謝。

Dan Hendrix, RBC Capital Markets.

丹‧亨德里克斯，加拿大皇家銀行資本市場。

Hey, guys, thanks for squeezing me in. Just a quick question. We're hearing a lot of momentum around on the medtech side about the robotics geared towards the shoulder opportunity. Just wanted to see kind of how that factor into your CapEx plans for the next couple of years. And in general, how you're thinking about CapEx as we look towards the $140 million to $160 million in the $200 million for 2025. Thanks.

嘿，夥計們，謝謝你們讓我進來。只是一個簡單的問題。我們在醫療技術方面聽到了很多關於機器人技術面向肩部機會的勢頭。只是想看看這如何影響您未來幾年的資本支出計劃。總的來說，當我們展望 2025 年 2 億美元中的 1.4 億至 1.6 億美元資本支出時，您如何看待資本支出。謝謝。

Eric, do you want to highlight how you're seeing the robotics continue to evolve. And Dave, provide a little clarity around the numbers.

艾瑞克，你想強調一下你如何看待機器人技術的不斷發展嗎？戴夫，請澄清一下這些數字。

Yeah, happy to. Yeah, we've grown our robotics portfolio a lot. We've added quite a few in 2023; we're nearly 50 robots. I would say this that related just to shoulders and ankles, there might be a little bit of demand for robotics. We have a lot of those well covered.

是的，很高興。是的，我們的機器人產品組合已經大幅成長。2023 年我們增加了很多；我們有近 50 個機器人。我想說的是，這僅與肩膀和腳踝有關，對機器人來說可能有一點需求。我們有很多這樣的內容。

And I would also say that when we add robots, to remind you, those are financed locally. So not a huge CapEx impact. And actually, the ROI on those have been incredibly strong. And so we agree with the medtech enthusiasm on the opportunity to continue to grow robotics in our facilities. We do that ostensibly though.

我還要提醒您的是，當我們添加機器人時，這些機器人都是由當地提供資金的。因此資本支出影響不大。事實上，這些的投資報酬率非常高。因此，我們同意醫療技術的熱情，認為有機會繼續在我們的設施中發展機器人技術。但表面上我們是這樣做的。

So you think about this as really to attract new opportunities and to go into new service lines; we'll do that. It's a little bit different than some of our peers who often are upgrading our product just to keep our technology for the same book of business. For us, it's really a great offense at play, and we would share medtech enthusiast on that.

所以你認為這實際上是為了吸引新的機會並進入新的服務領域；我們會這麼做的。這與我們的一些同行有點不同，他們經常升級我們的產品，只是為了保持我們的技術適用於同一業務。對我們來說，這確實是一個很好的進攻，我們會與醫療技術愛好者分享這一點。

Dave, I don't know if you want to add anything.

戴夫，我不知道你是否想補充什麼。

Yeah. I'll just say one thing. What we've been able to see on the procurement side of the world is a stronger partnership with very like-minded medtech suppliers out there who see the same opportunity that we see. So we've seen this since that knees and hips came out, where they're working with us to capture this market shift.

是的。我只說一件事。我們在全球採購方面看到的是與志同道合的醫療技術供應商建立了更牢固的合作夥伴關係，他們看到了與我們相同的機會。因此，自從膝蓋和臀部問世以來，我們就看到了這一點，他們正在與我們合作，以抓住這個市場轉變。

They see the growth in ASC is following closely behind the availability of the right equipment. And so you're finding those favorable financing or more opportunistic financing opportunities. Now financing eventually will come round to paying cash. But for the most part, we only enter those if they're properly asset-backed and the ROI is strong.

他們認為 ASC 的成長緊跟著合適設備的可用性。因此，您正在尋找那些有利的融資或更機會主義的融資機會。現在融資最終將轉向支付現金。但在大多數情況下，我們只會進入那些有適當資產支持且投資報酬率很高的專案。

Thank you.

謝謝。

Thank you. Ladies and gentlemen, that concludes our question-and-answer session. I'll turn the floor back to Mr. Evans for final comments.

謝謝。女士們先生們，我們的問答環節到此結束。我將請埃文斯先生徵求最後意見。

Sure. Thank you. Before we wrap up, I would like to reiterate how proud I am of my colleagues and physician partners who collaborate to deliver on our mission to enhance patient quality of life through partnership. Their work and contributions allow us to deliver consistent and predictable results and drive sustained growth for all of our stakeholders. Most importantly, they also continue to serve our communities with the highest clinical care and a low-cost setting, with the convenience and professionalism all our facilities are known to provide.

當然。謝謝。在結束之前，我想重申，我對我的同事和醫生合作夥伴感到非常自豪，他們通力合作，實現我們透過合作提高病患生活品質的使命。他們的工作和貢獻使我們能夠提供一致且可預測的結果，並推動所有利害關係人的持續成長。最重要的是，他們也繼續為我們的社區提供最高水準的臨床護理和低成本環境，以及我們所有設施所提供的便利和專業精神。

Thank you all for joining our call this morning and have a great day.

感謝大家今天早上加入我們的電話會議，祝您有美好的一天。

Thank you. This concludes today's conference call. You may disconnect your lines at this time. Thank you for your participation.

謝謝。今天的電話會議到此結束。此時您可以斷開線路。感謝您的參與。