Tenet Healthcare Corp (THC) 2024 Q4 法說會逐字稿

Good morning. Welcome to Tenet Healthcare's fourth-quarter 2024 earnings conference call. (Operator Instructions)

早安.歡迎參加 Tenet Healthcare 2024 年第四季財報電話會議。（操作員指令）

I'll now turn the call over to your host, Mr. Will McDowell, Vice President of Investor Relations. Mr. McDowell, you may begin.

現在我將電話轉給主持人、投資人關係副總裁威爾·麥克道爾先生。麥克道威爾先生，你可以開始啦。

Good morning, everyone, and thank you for joining today's call. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tenet's fourth-quarter 2024 results as well as a discussion of our financial outlook. Tenet senior management participating in today's call will be Dr. Saum Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer.

大家早安，感謝大家參加今天的電話會議。我是投資者關係副總裁威爾麥克道爾 (Will McDowell)。我們很高興您能加入我們討論 Tenet 2024 年第四季的業績以及我們的財務前景。參加今天電話會議的 Tenet 高階主管包括董事長兼執行長 Saum Sutaria 博士；以及執行副總裁兼財務長 Sun Park。

Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tenethealth.com. Listeners to this call are advised that certain statements made during our discussion today are forward-looking and represent management's expectations based on currently available information.

我們今天早上的網路廣播包括一個幻燈片演示，該演示已發佈到我們網站 tenethealth.com 的投資者關係部分。請收聽本次電話會議的聽眾注意，我們今天討論中所做的某些陳述是前瞻性的，代表了管理層根據當前可用的信息所做出的期望。

Actual results and plans could differ materially. Tenet is under no obligation to update any forward-looking statements based on subsequent information. Investors should take note of the cautionary statement slide included in today's presentation, as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission.

實際結果和計劃可能存在重大差異。Tenet 沒有義務根據後續資訊更新任何前瞻性聲明。投資者應注意今天的簡報中包含的警告聲明投影片，以及我們最近的 10-K 表格和向美國證券交易委員會提交的其他文件中討論的風險因素。

And with that, I'll turn the call over to Saum.

說完這些，我會把電話轉給索姆。

Thank you, Will, and good morning, everyone. We delivered outstanding performance in 2024, characterized by strong same-store revenue growth, disciplined operations, and effective capital deployment. In addition, the year was highlighted by portfolio transactions that have transformed our franchise to be well positioned for long-term growth with strategic flexibility and a deleveraged balance sheet.

謝謝你，威爾，大家早安。2024年，我們取得了出色的業績，同店營收成長強勁、營運規範、資本配置有效。此外，今年的亮點是投資組合交易，這些交易使我們的特許經營權能夠透過策略靈活性和去槓桿資產負債表為長期成長做好準備。

We reported 2024 net operating revenues of $20.7 billion and consolidated adjusted EBITDA of $4 billion, which represents 13% growth over 2023. Full-year adjusted EBITDA margin of 19.3% improved over 200 basis points from prior year.

我們報告 2024 年淨營業收入為 207 億美元，合併調整後 EBITDA 為 40 億美元，比 2023 年成長 13%。全年調整後 EBITDA 利潤率為 19.3%，較前一年提高 200 個基點以上。

Our fourth-quarter results were above our expectations, driven by continued same-store revenue strength, high acuity growth, as well as effective cost management. Our disciplined approach has enabled us to consistently exceed our performance expectations each quarter this year, furthering our track record. I would note that our full-year adjusted EBITDA ended the year over $600 million higher than the midpoint of our initial expectations, driven by strong growth and operational performance.

我們的第四季業績超出預期，這得益於同店收入持續強勁、敏銳度成長以及有效的成本管理。我們嚴謹的方法使我們今年每季都能夠持續超越業績預期，進一步提升我們的業績記錄。我要指出的是，在強勁成長和營運績效的推動下，我們全年調整後的 EBITDA 比我們最初預期的中位數高出 6 億美元。

USPI had a fantastic year in 2024. We generated $1.81 billion in adjusted EBITDA, which represents 17% growth over 2023 and adjusted EBITDA margins of 4%. Same-facility revenues grew 7.8% in 2024, another year substantially above our long-term goals.

2024 年是 USPI 輝煌的一年。我們實現了 18.1 億美元的調整後 EBITDA，比 2023 年成長 17%，調整後的 EBITDA 利潤率為 4%。2024 年同店營收將成長 7.8%，比我們的長期目標高出許多。

High acuity volume growth was highlighted by total joint replacements in the ASCs, up 19% over prior year. Importantly, customer service levels in our centers remain quite high as we earned a 96.6 overall patient experience score in 2024.

ASC 的總關節置換量突顯出高敏銳體積的成長，比前一年增長了 19%。重要的是，我們中心的客戶服務水準仍然很高，因為我們在 2024 年獲得了 96.6 的整體患者體驗評分。

Turning to our hospital segment. Despite the sale of 14 hospitals during the year, we generated $2.185 billion of adjusted EBITDA in 2024, which represents 9% growth over prior year. Same-store hospital admissions were up 4.7%, as we continue to open up capacity to respond to a strong utilization environment. Acuity and payer mix were strong throughout 2024 and drove a 4.6% increase in same-store revenue per adjusted admission over prior year.

談到我們的醫院部門。儘管今年出售了 14 家醫院，但我們在 2024 年的調整後 EBITDA 仍為 21.85 億美元，比前一年增長了 9%。由於我們持續開放診療容量以應對強勁的利用率環境，同店住院人數上升了 4.7%。2024 年全年，敏銳度和付款人組合表現強勁，推動同店每張調整後入院收入較上年增長 4.6%。

This was an important year for Tenet, as we transformed our portfolio of businesses through the multiple high-multiple sales of 14 hospitals and related operations, generating $5 billion in gross proceeds and enabling significant balance sheet deleveraging. In addition, we added nearly 70 ambulatory surgical centers to the portfolio in 2024 as we were very active in both M&A and de novo development.

今年對 Tenet 來說是重要的一年，我們透過 14 家醫院及相關業務的多次高倍數銷售實現了業務組合轉型，產生了 50 億美元的總收益，並實現了資產負債表的大幅去槓桿。此外，由於我們在併購和全新開發方面非常活躍，我們在 2024 年為投資組合中增加了近 70 個門診手術中心。

And finally, over the past two years, we have returned capital to shareholders via share repurchase, retiring approximately 14% of our outstanding shares for $1.12 billion since our repurchase program began in the fourth quarter of 2022.

最後，在過去兩年中，我們透過股票回購向股東返還了資本，自 2022 年第四季開始回購計畫以來，我們以 11.2 億美元的價格回購了約 14% 的流通股。

Going forward, we plan to be active repurchasers of our shares, particularly at our current valuation multiples. These actions have resulted in a portfolio of businesses that is more predictable, capital efficient, and able to operate in a variety of environments with better margins and ample free cash flow for the benefit of shareholders. In summary, we're very pleased with our team's performance in 2024, and we believe that we will carry this momentum into the new year.

展望未來，我們計劃積極回購我們的股票，特別是在我們目前的估值倍數下。這些措施使得業務組合更加可預測、資本效率更高，能夠在各種環境下運營，獲得更高的利潤率和充足的自由現金流，從而為股東謀福利。總而言之，我們對團隊在 2024 年的表現感到非常滿意，我們相信我們會將這種勢頭帶入新的一年。

Turning to 2025 guidance. We are projecting full-year 2025 adjusted EBITDA of $3.975 billion to $4.175 billion, which is an attractive 7% growth rate at the midpoint on a normalized basis. We anticipate adjusted EBITDA growth at USPI of approximately 8.5% at the midpoint of our guidance for '25 based on our expectation of 3% to 6% growth in same-facility revenue, fueled by ongoing strength in demand and acuity, continuing effective operational execution, and additional sites of care joining the portfolio.

轉向2025年指導。我們預計 2025 年全年調整後 EBITDA 為 39.75 億美元至 41.75 億美元，以標準計算，中間值成長率為 7%，頗具吸引力。我們預計，在 25 年指引中位數下，USPI 的調整後 EBITDA 成長率約為 8.5%，這基於我們對同店收入成長 3% 至 6% 的預期，這得益於需求和敏銳度的持續強勁、持續有效的營運執行以及更多護理站點加入投資組合。

We intend to invest approximately $250 million each year towards M&A in the ambulatory space. And the pipeline of opportunities remain strong. We anticipate adding 10 to 12 de novo centers in 2025. Our ability to consistently scale our platform to create additional low-cost sites of care for patients and physicians continues to pay dividends, as it improves our overall growth, profitability, capital efficiency, and resiliency in this regulatory environment.

我們打算每年投資約 2.5 億美元用於門診領域的併購。機遇通路依然強勁。我們預計到 2025 年將增加 10 至 12 個 de novo 中心。我們能夠不斷擴展我們的平台，為患者和醫生創建額外的低成本護理站點，這將持續帶來回報，因為它提高了我們在這種監管環境下的整體成長、獲利能力、資本效率和彈性。

Turning to our hospital segment. We are expecting adjusted EBITDA growth of approximately 5.7% on a normalized basis at the midpoint for 2025. This projected is going to be driven by 2% to 3% adjusted admissions growth and the strong operating discipline that our team has now demonstrated for many years.

談到我們的醫院部門。我們預計，2025 年中期調整後的 EBITDA 成長率約為 5.7%。這項預測將受到 2% 至 3% 的調整後招生成長率和我們團隊多年來表現出的強大營運紀律的推動。

The hospital segment's performance will be enhanced by strategic capital deployment, expanded service lines, and further contributions from the new Westover Hills facility, which opened in the third quarter of 2024. Additionally, as we have noted, we have expanded the relationships that Conifer has with acquirers of hospitals we've sold, and this should contribute to growth in 2025.

戰略資本部署、擴大服務線以及 2024 年第三季開業的 Westover Hills 新設施的進一步貢獻將提升醫院部門的表現。此外，正如我們所指出的，我們擴大了 Conifer 與我們所出售的醫院的收購者之間的關係，這將有助於 2025 年的成長。

Finally, we acknowledge that there is currently a great deal of focus on the impact of potential regulatory changes in our space. We have demonstrated an ability to perform well in a variety of operating environments, and believe we are differentiated from our peer set as we navigate potential changes going forward. For example, our ASCs operate with freestanding ASC rates, which insulates that important part of our business from potential changes in site neutrality rules.

最後，我們承認，目前人們非常關注我們所在領域的潛在監管變化的影響。我們已證明自己有能力在各種營運環境中表現良好，並且相信，在應對未來潛在變化的過程中，我們將與同行有所區別。例如，我們的 ASC 採用獨立的 ASC 費率運作，這使得我們業務的重要部分免受站點中立規則潛在變化的影響。

In summary, we had an outstanding year in 2024 and believe that we are in a great position for another strong year in 2025. Our guidance reflects the opportunities before us and the momentum that we carry into the new year. Our established management team stands ready to execute our focused strategy and deliver value for patients, physician partners, and in turn, shareholders.

總而言之，2024 年是我們出色的一年，我們相信，2025 年我們一定能再創佳績。我們的指導反映了我們面臨的機會和我們在新的一年所取得的進展。我們現有的管理團隊隨時準備好執行我們的重點策略，為病患、醫師合作夥伴以及股東創造價值。

And with that, Sun will now provide a more detailed review of our financial results. Sun?

現在，Sun 將對我們的財務表現提供更詳細的回顧。太陽？

Thank you, Saum, and good morning, everyone. We are very pleased with the strong finish to the year. In the fourth quarter, we generated total net operating revenues of $5.1 billion and consolidated adjusted EBITDA of $1.048 billion, which represents an adjusted EBITDA margin of 20.7%, up almost 200 basis points from fourth quarter of '23.

謝謝你，Saum，大家早安。我們對今年的良好收官感到非常高興。第四季度，我們的總淨營業收入為 51 億美元，綜合調整後 EBITDA 為 10.48 億美元，調整後 EBITDA 利潤率為 20.7%，較 23 年第四季上漲近 200 個基點。

For full-year '24, we generated $20.7 billion of total net operating revenues and consolidated adjusted EBITDA of $3.995 billion. These results were driven by strong same-store revenue growth, continued high patient acuity, favorable payer mix, and effective cost controls.

24 年全年，我們的總淨營業收入為 207 億美元，綜合調整後 EBITDA 為 39.95 億美元。這些結果得益於強勁的同店收入成長、持續的高患者敏銳度、有利的付款人組合以及有效的成本控制。

Now I'd like to highlight some key items for each of our segments, beginning with USPI, which again delivered strong operating results. In the quarter, USPI's adjusted EBITDA grew 14% over last year with adjusted EBITDA margin at 42.1%. USPI delivered an 8.6% increase in same-facility system-wide revenues, driven by high acuity levels and favorable payer mix. Same-facility system-wide surgical case volume grew slightly over last year.

現在，我想重點介紹我們每個部門的一些關鍵項目，首先是 USPI，它再次取得了強勁的營運業績。本季度，USPI 的調整後 EBITDA 較去年同期成長 14%，調整後 EBITDA 利潤率為 42.1%。由於高敏銳度水準和有利的付款人結構，USPI 的同設施全系統收入成長了 8.6%。與去年同期相比，同一機構全系統的手術病例數略有增加。

And turning to our hospital segment. Fourth-quarter adjusted EBITDA was $518 million, with margins up 90 basis points over last year at 13.6%. Normalized for the divested hospitals, adjusted EBITDA grew 13% over fourth quarter of '23. Same-hospital inpatient admissions increased 5%, and revenue per adjusted admission grew 0.6%.

接下來談談我們的醫院部門。第四季調整後的 EBITDA 為 5.18 億美元，利潤率較去年同期上漲 90 個基點，達到 13.6%。對於剝離後的醫院而言，調整後的 EBITDA 較 23 年第四季增加了 13%。同一醫院的住院人數增加了 5%，每例調整後入院收入增加了 0.6%。

Our consolidated salary, wages, and benefits in fourth quarter of '24 was 41.3% of net revenues. And our consolidated contract labor expense was 2.1% of SWB, both substantially lower than the 43% and the 2.8%, respectively, that we reported in the fourth quarter of '23.

我們 24 年第四季的綜合薪資、薪資和福利佔淨收入的 41.3%。我們的合併合約勞務費用佔 SWB 的 2.1%，均大幅低於我們在 23 年第四季報告的 43% 和 2.8%。

Next, we will discuss our cash flow, balance sheet, and capital structure. Our cash flow performance was very strong in '24 with $1.1 billion of free cash flow for the year. This includes the payment of $855 million in income taxes related to our completed divestitures.

接下來，我們將討論我們的現金流量、資產負債表和資本結構。我們的現金流表現在 24 年非常強勁，全年自由現金流達到 11 億美元。這包括支付與我們已完成的資產剝離相關的 8.55 億美元所得稅。

Excluding these tax payments, this represents nearly $2 billion of free cash flow for the year or $1.3 billion of free cash flow after distributions to noncontrolling interests or NCI. For full-year 2024, we repurchased 5.6 million shares of our stock for $672 million. We finished the year with over $3 billion of cash on hand, with no borrowings outstanding under our $1.5 billion line of credit facility.

不包括這些稅款，這意味著全年自由現金流接近 20 億美元，或向非控制權益或 NCI 分配後自由現金流為 13 億美元。2024 年全年，我們以 6.72 億美元回購了 560 萬股股票。今年年底，我們的現金餘額超過 30 億美元，並且在我們的 15 億美元信用額度下沒有未償還借款。

Our year-end leverage ratio was 2.5 times EBITDA or 3.2 times EBITDA less NCI, a substantial improvement over the past year, reflecting the proceeds that we received from our hospital divestitures as well as our outstanding operational performance. We are very pleased with our ongoing cash flow generation and have a commitment to a deleveraged balance sheet. We believe we have significant financial flexibility to support our capital allocation priorities and drive shareholder value.

我們的年末槓桿率為 EBITDA 的 2.5 倍或 EBITDA 減去 NCI 的 3.2 倍，與去年相比有大幅改善，反映了我們從醫院資產剝離中獲得的收益以及我們出色的營運績效。我們對持續的現金流量產生感到非常滿意，並致力於去槓桿資產負債表。我們相信，我們擁有巨大的財務靈活性來支持我們的資本配置重點並推動股東價值。

Let me now turn to our outlook for 2025. We expect consolidated net operating revenues in the range of $20.6 billion to $21.0 billion. Our projected consolidated adjusted EBITDA is in the range of $3.975 billion to $4.175 billion. As a reminder, there are two normalizing items that I would call out when comparing our '25 adjusted EBITDA to the prior year.

現在我來談談我們對 2025 年的展望。我們預計合併淨營業收入在 206 億美元至 210 億美元之間。我們預計合併調整後 EBITDA 在 39.75 億美元至 41.75 億美元之間。提醒一下，在將我們的 25 年調整後 EBITDA 與前一年進行比較時，我會指出兩個標準化項目。

First, we reported $114 million of adjusted EBITDA from facilities that we divested in '24 and will not recur. Additionally, we reported $74 million of out-of-period supplemental Medicaid payments in Michigan and Texas in '24. After normalizing for these items, our '25 adjusted EBITDA is expected to grow 7% at the midpoint of our range.

首先，我們報告了 1.14 億美元的調整後 EBITDA，這些利潤來自我們在 24 年剝離的設施，並且不會再出現。此外，我們報告稱，1924年密西根州和德克薩斯州的超出期限的補充醫療補助支付金額為 7,400 萬美元。在對這些項目進行標準化之後，我們 25 年調整後的 EBITDA 預計將在我們範圍的中點成長 7%。

Our '25 outlook assumes continued growth in same-store volumes and effective pricing, as well as strong operational efficiencies and disciplined cost controls. Additionally, we anticipate further contributions from recent investments and partnerships in the hospital segment, as well as from M&A and de novo center openings at USPI. In addition, we are also assuming the following: same-hospital admissions growth of 2% to 3% and adjusted admissions growth of 2% to 3%; and for USPI, same-facility revenue growth of 3% to 6%.

我們對 25 年的展望假設同店銷售和有效定價將繼續成長，同時營運效率將強勁，成本控制也將嚴格。此外，我們預計醫院領域的近期投資和合作以及 USPI 的併購和新生中心開幕將帶來進一步貢獻。此外，我們也假設：同院入院人數成長率為 2% 至 3%，調整後入院人數成長率為 2% 至 3%；對於 USPI 來說，同一設施的收入增長了 3% 至 6%。

On a normalized basis, we expect adjusted EBITDA to grow 8.5% at USPI and 5.7% for our hospital segment at the respective midpoints of our guidance ranges. Our outlook also assumes $35 million of net revenues from the Tennessee supplemental Medicaid programs. About one-third of this increase is related to the second half of '24 and is expected to be recorded in the first quarter of this year.

在正常化基礎上，我們預計調整後的 EBITDA 在 USPI 將成長 8.5%，在醫院部門將成長 5.7%，分別位於我們指導範圍的中點。我們的展望也假設田納西州補充醫療補助計劃的淨收入為 3500 萬美元。其中約三分之一的成長與24年下半年有關，預計將在今年第一季實現。

Finally, we would expect first-quarter 2025 consolidated adjusted EBITDA to be in the range of 24% to 25% of our full-year consolidated EBITDA at the midpoint. We anticipate that USPI's EBITDA in the first quarter of this year will be 21% to 22% of our full-year USPI EBITDA at the midpoint.

最後，我們預計 2025 年第一季合併調整後 EBITDA 中間值將介於全年合併 EBITDA 的 24% 至 25% 之間。我們預計今年第一季 USPI 的 EBITDA 將占我們全年 USPI EBITDA 的 21% 至 22%。

Turning to our cash flows for '25. We expect cash flow from operations in the range of $2.5 billion to $2.85 billion, capital expenditures in the range of $700 million to $800 million, resulting in free cash flows in the range of $1.8 billion to $2.05 billion. In addition, we're also assuming distributions to NCI in the range of $750 million to $800 million, which would result in free cash flow after NCI in the range of $1.05 billion to $1.25 billion.

轉向我們25年的現金流。我們預計經營現金流在 25 億美元至 28.5 億美元之間，資本支出在 7 億美元至 8 億美元之間，產生 18 億美元至 20.5 億美元的自由現金流。此外，我們還假設分配給 NCI 的金額在 7.5 億美元到 8 億美元之間，這將導致 NCI 之後的自由現金流在 10.5 億美元到 12.5 億美元之間。

And finally, as a reminder, our capital deployment priorities have not changed. First, we will continue to prioritize capital investments to grow USPI through M&A. Second, we expect to continue to invest in key hospital growth opportunities, including our focus on higher acuity service offerings. Third, we will evaluate opportunities to retire and/or refinance debt.

最後，提醒一下，我們的資本部署重點沒有改變。首先，我們將繼續優先考慮資本投資，透過併購來發展 USPI。其次，我們希望繼續投資關鍵的醫院成長機會，包括我們對更高敏銳度服務產品的關注。第三，我們將評估償還和/或再融資債務的機會。

And finally, we'll have a balanced approach to share repurchases, depending on market conditions and other investment opportunities. Given our attractive free cash flow profile and current valuations, we plan to be active repurchasers of shares in 2025.

最後，我們將根據市場狀況和其他投資機會，採取平衡的方式進行股票回購。鑑於我們具有吸引力的自由現金流狀況和當前估值，我們計劃在 2025 年積極回購股票。

In conclusion, we had an outstanding year in 2024, with effective operational execution, robust growth, and a transformed portfolio of businesses. We're confident in our ability to deliver on our outlook for '25 and continue to drive value for patients, physician partners, and shareholders.

總而言之，2024 年是我們的出色一年，我們擁有有效的營運執行、強勁的成長和轉型的業務組合。我們有信心實現25年的願景，並繼續為患者、醫生合作夥伴和股東創造價值。

And with that, we're ready to begin our Q&A. Operator?

現在，我們就可以開始問答了。操作員？

(Operator Instructions) Pito Chickering, Deutsche Bank.

（操作員指示） 德意志銀行 Pito Chickering。

Good morning, guys. Thanks for taking my question. So looking at Tenet sort of in the last few years, the biggest change has been the cash flows and your deleveraging. Your cash flow guidance for this year is up 90% year over year or nearly $1 billion more cash flow from operations.

大家早安。感謝您回答我的問題。所以回顧過去幾年的 Tenet，最大的變化是現金流和去槓桿。您今年的現金流預期比去年同期成長了 90%，或者說營運現金流增加了近 10 億美元。

So looking at your cash flow guidance for this year after NCI, it's about $1.15 billion at the midpoint. If we pull out $250 million for M&A, it's about $900 million left to deploy with a leverage at sort of 3.2 times EBITDA less NCI. Can you refresh us on what your ideal target leverage ratios are? And should we be modeling the rest of that going to share repo at this point? Thank you.

因此，請查看今年 NCI 之後的現金流指導，中間值約為 11.5 億美元。如果我們拿出 2.5 億美元用於併購，那麼剩下大約 9 億美元可供部署，槓桿率約為 EBITDA 減去 NCI 的 3.2 倍。您能否向我們介紹一下您理想的目標槓桿率是多少？那麼，我們現在是否應該對剩餘的股票回購進行建模呢？謝謝。

Hey, Pito. It's Saum. First of all, I appreciate reiterating the improvements that we've made in generating free cash flow from this business from operations. It's obviously been a very important part of our goal over the last few years and getting to this point probably earlier than we thought.

嘿，皮托。是索姆。首先，我很高興重申我們在從該業務運營中產生自由現金流方面所取得的進步。顯然，這是我們過去幾年來目標中非常重要的一部分，而且達到這一點可能比我們想像的要早。

We're very comfortable with the leverage that we operate at today. And importantly, it gives us -- we look at it and say it gives us significant strategic flexibility with respect to the business, both in terms of activity that we may pursue in growing and scaling USPI, as I noted in my comments, but also from the perspective, especially, as I said, at these valuation multiples in terms of share repurchase.

我們對目前運用的槓桿非常滿意。重要的是，它為我們提供了——我們認為它為我們的業務提供了顯著的戰略靈活性，不僅在我們可能開展的擴大和擴大 USPI 規模的活動方面，正如我在評論中提到的那樣，而且從這個角度來看，特別是，正如我所說的，在股票回購方面的估值倍數方面。

And both Sun and I noted that we would plan to be active repurchasers of our shares at these multiples, makes complete sense. We don't have debt coming due for a couple of years, right? I mean, so we're not in any situation of urgency there regardless. And I think the return on share repurchase at this point would be higher anyway.

孫正義和我都指出，我們計劃以這些倍數積極回購我們的股票，這是完全合理的。我們幾年內都不會有債務到期，對吧？我的意思是，無論如何我們都不會面臨任何緊急情況。而且我認為此時股票回購的報酬率無論如何都會更高。

So our thinking is relatively clear about that in the coming years. Obviously, we need to continue executing operationally with the track record that we've built to generate that free cash flow. But as we've talked about in the last couple of years, we've really hardwired our approach there.

所以我們對未來幾年的思考比較清晰。顯然，我們需要繼續利用我們已經建立的業績記錄來執行運營，以產生自由現金流。但正如我們在過去幾年中所談論的那樣，我們確實在那裡堅定地實施了我們的方法。

The last thing I would point out, in addition to what I said about USPI in my comments, we don't -- USPI does not have a tremendous amount of Medicaid exposure. So when you think about utilization of our cash flows and regulatory risk that may be out there, I mean, the reality is half our EBITDA is generated in the segment that isn't really facing risk from any scenario out there related to Medicaid programs.

我最後要指出的是，除了我在評論中提到的 USPI 的內容之外，USPI 並沒有大量的醫療補助風險。因此，當您考慮到我們的現金流利用率和可能的監管風險時，我的意思是，現實情況是，我們的一半 EBITDA 是在沒有真正面臨與醫療補助計劃相關的任何情境風險的部分中產生的。

And that's very helpful. It's very different than it might have looked five or six years ago. So we feel confident about the valuation opportunities for the company.

這非常有幫助。它與五、六年前的面貌截然不同。因此，我們對該公司的估值機會充滿信心。

Jamie Perse, Goldman Sachs.

高盛的傑米·珀斯 (Jamie Perse)。

Hey, good morning. Thanks for taking the question. Can you maybe spend a minute on just the volume environment that you're seeing today?

嘿，早安。感謝您回答這個問題。您能否花一點時間介紹一下您今天看到的音量環境？

Obviously, 2023 and 2024 were pretty strong years. Some of that just recovery and normalization post the pandemic. Where do you think we're at from a volume perspective today? And how do you expect volumes to progress throughout the course of the year?

顯然，2023 年和 2024 年是相當強勁的一年。其中一些只是大流行後的復甦和正常化。您認為從交易量來看我們目前處於什麼位置？您預計全年銷售量將如何成長？

Yeah, thanks, Jamie. I mean, the simple statement I would make right now is that we've anticipated the volume environment continuing to be strong coming into 2025. I mean, that's the simplest summary statement I would make.

是的，謝謝，傑米。我的意思是，我現在要簡單地說的是，我們預計到 2025 年，銷售環境將繼續保持強勁。我的意思是，這是我能做出的最簡單的總結。

We don't -- there aren't obvious trends from December 31 to January 1 that appear to have changed. I mean, the coverage environment looks good. The employment environment looks good. Demographics, both in terms of areas where, at least, our portfolio is now positioned relative to where it was, has attractive demographics.

我們沒有——從 12 月 31 日到 1 月 1 日，沒有明顯的趨勢似乎發生了變化。我的意思是，覆蓋環境看起來不錯。就業環境看起來良好。人口統計數據，至少從我們目前的投資組合相對於先前的定位來看，都具有吸引力。

And as we've noted, we've had opportunity to expand capacity and take on that capacity without excessive cost to do so. And we're doing it in a deliberate way. So we -- I mean, our guidance reflects that. We feel pretty good about going into 2025.

正如我們所指出的，我們有機會擴大產能，並且不需要花費過高的成本來承擔這些產能。我們正在以慎重的方式這麼做。所以我們—我的意思是，我們的指導反映了這一點。我們對進入 2025 年感到十分樂觀。

Okay. Thank you.

好的。謝謝。

Brian Tanquilut, Jefferies.

傑富瑞 (Jefferies) 的 Brian Tanquilut。

Hey, good morning, guys, and congrats on the quarter. Maybe, Saum, as I think about your comments on Medicaid and USPI, just curious how you're thinking about the risk overall for the company from all the political headlines that are out there and what the Republicans are trying to do with changes to healthcare policy, and what you're doing to prepare for that just for that potential change, whether it's Medicaid or health insurance exchanges across both business lines. Thanks.

嘿，大家早上好，恭喜本季取得佳績。也許，Saum，當我想到您對 Medicaid 和 USPI 的評論時，我只是好奇您如何看待公司面臨的總體風險，因為所有的政治頭條新聞以及共和黨試圖通過改變醫療保健政策來做什麼，以及您為應對這種潛在的變化做了哪些準備，無論是 Medicaid 還是跨兩個業務線的健康保險交易。謝謝。

Yeah, thanks, Brian. A few things. So I mean, first of all, the fundamental underpinnings of success in an environment with any kind of uncertainty, in our view, is operating discipline in what we do, right? And the other important underpinning is having a clear understanding of the economics of our business internally; meaning, we understand clearly our service lines, our markets, et cetera, that may have greater dependency or less dependency upon certain types of supplemental payments where, for example, the strength in the exchanges has contributed to earnings, et cetera.

是的，謝謝，布萊恩。有幾件事。所以我的意思是，首先，在我們看來，在任何不確定的環境中取得成功的根本基礎是我們所做事情的紀律，對嗎？另一個重要的基礎就是要清楚了解我們業務內部的經濟狀況；意思是，我們清楚地了解我們的服務線、我們的市場等等，它們可能對某些類型的補充支付有更大或更小的依賴性，例如，交易所的實力有助於盈利等等。

So the combination of the operating discipline and the insights about the business probably give us an opportunity to manage and pivot as needed depending on what happens. You're right; the segments are different.

因此，營運紀律和對業務的洞察相結合可能會為我們提供一個機會，讓我們根據實際情況進行管理和調整。你說得對;各個部分都不同。

I mean, we've taken the opportunity over the past few years to create resiliency in USPI by making sure that the ambulatory surgery centers as a part of USPI are on freestanding rates. The Medicaid exposure is de minimis in that business, and that's very helpful from that perspective. And the exchange business there has had less impact than it had on the acute care segment in terms of the exchange growth from that perspective.

我的意思是，過去幾年來，我們抓住機會，透過確保作為 USPI 一部分的門診手術中心實行獨立收費，增強了 USPI 的彈性。業務中的醫療補助風險極小，從這個角度來看，這非常有幫助。從這個角度來看，那裡的交易所業務對交易所成長的影響小於對急診護理領域的影響。

So from a USPI perspective, look, this is all about an important tailwind of moving things into a lower-cost setting in an expensive portion of the healthcare industry, which is surgical care, right, and doing so in a way where we're constantly increasing the acuity of the work at USPI because it creates more value for the purchaser.

因此，從 USPI 的角度來看，這一切都是為了將醫療行業昂貴部分（即外科護理）轉移到低成本環境中的重要順風，同時我們也會不斷提高 USPI 的工作敏銳度，因為這可以為購買者創造更多價值。

On the acute care hospital side, I think it's important to continue to search for efficiencies that allow us to generate margins. We always talk about the concept of Medicare profitability, right? Can you generate margins on Medicare reimbursement in order to have a metric out there for efficiency goals that you would create? Because it's important to be able to operate in that type of environment.

在急診醫院方面，我認為繼續尋求能讓我們產生利潤的效率非常重要。我們總是談論醫療保險盈利能力的概念，對嗎？您能否在醫療保​​險報銷上產生利潤，以便為您所創建的效率目標提供衡量標準？因為能夠在那種環境中運作非常重要。

Specifically on the acute care side, the number one adaptive action today is helping the regulators understand the importance that these programs provide for basic access for people that wouldn't otherwise have access to care. And that's really important because if that shapes -- or is a factor in shaping policy, I think that what comes out of that policy will likely be manageable for us and something that we can get behind.

具體來說，在急性照護方面，當今最重要的適應性行動是幫助監管者認識到這些計劃為那些原本無法獲得醫療服務的人提供基本醫療服務的重要性。這真的很重要，因為如果它能夠形成——或者成為影響政策的一個因素，我認為該政策的結果可能是我們可以控制的，也是我們可以支持的。

I'm not sure that right now taking a bunch of actions to restructure the business is the right thing to do. I think there's a very strong case to be made that many of these things are really critical to providing access. And it happens to be that that access is also being provided in states with voters that really matter to this administration. And that's an important supporting factor as well.

我不確定現在採取一系列行動來重組業務是否正確。我認為有充分理由證明，其中許多事情對於提供存取權限確實至關重要。而實際上，這些選民對本屆政府來說非常重要的州也提供了這種機會。這也是一個重要的支持因素。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. When I look at the ASC case mix from '23 to '24, it doesn't look like there are significant mix changes. We actually see MSK down 1 percentage point; in ophthalmology, up 1 percentage point.

嗨，早安。當我查看 23 年到 24 年的 ASC 病例組合時，看起來並沒有顯著的變化。我們實際上看到 MSK 下降了 1 個百分點；眼科方面，漲了1個百分點。

But you're increasing acuity significantly to the point where you're seeing high single-digit same-store revenue growth without meaningful case growth. So can you speak to the types of cases driving acuity higher? Because it's not obvious from the case mix disclosures. Thanks.

但是，你的敏銳度正在大幅提高，以至於你看到同店收入以個位數高增長，而案例數量卻沒有顯著增長。那麼您能談談導致敏銳度上升的案例類型嗎？因為從病例組合揭露來看這並不明顯。謝謝。

Yeah, no problem. I mean, just to clarify, the orthopedics line item has a lot of things in there. That's why we call out the highest acuity work in joint cases, for example, which is where you have the hips, knees, obviously, the shoulder expansion. That's where the acuity is actually growing.

是的，沒問題。我的意思是，只是為了澄清一下，骨科計畫裡面有很多東西。這就是為什麼我們在關節病例中呼籲最高級別的敏銳度工作，例如臀部、膝蓋，顯然還有肩部擴張。這就是敏銳度實際上不斷增長的地方。

I mean, remember, when you look at certain low acuity procedures that we may do in ASCs, the revenue per case is an eighth or ninth of a single joint case, total joint case from that perspective. So I mean, we're doing exactly what we wanted with the business, which is we're growing the acuity.

我的意思是，請記住，當您查看我們可能在 ASC 中執行的某些低敏銳度程序時，從這個角度來看，每個案例的收入是單一聯合案例、總聯合案例的八分之一或九分之一。所以我的意思是，我們正在做我們想要做的事情，那就是提高敏銳度。

We're growing the net revenue per case. We are reducing exposure to high-volume, low-revenue cases; in some cases, things that could also be done in offices that further strengthen the resiliency and value of what USPI is building.

我們正在增加每箱的淨收入。我們正在減少接觸高數量、低收入的案件；在某些情況下，也可以在辦公室中完成一些事情，以進一步增強 USPI 所建立內容的彈性和價值。

So that orthopedics line item has a lot of things in there from high acuity to low-acuity cases. And it's the reason we call out the really high acuity work. That's a fundamental driver of the net revenue per case strength, which you're seeing.

因此，骨科計畫包含許多內容，從高度敏銳度到低度敏銳度的病例。這就是我們呼籲進行真正高強度工作的原因。正如您所看到的，這是每案淨收入成長的根本驅動因素。

Great. Thanks for the call.

偉大的。感謝您的來電。

Sure.

當然。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

Thanks. Good morning. A couple of things just numbers-wise. Maybe you could tell us -- you've mentioned Tennessee as a tailwind, that $35 million. You mentioned, for instance, Michigan is not going to -- you're going to have a little bit of a one-time headwind there.

謝謝。早安.從數字上看，有幾件事。也許您可以告訴我們——您提到田納西州是順風，即 3500 萬美元。例如，您提到密西根州不會——您將在那裡遇到一點一次性的逆風。

But when you think about ex those issues kind of core DPP dollars year over year, can you tell us what's assumed in the guidance? And then the same for exchanges, like what kind of exchange growth do you kind of expect in your markets, exchange volume growth within that guidance? Thanks.

但是當您考慮這些問題時，核心 DPP 資金逐年增加，您能告訴我們指導意見中的假設是什麼嗎？對於交易所來說也是一樣，您預期您所在的市場會出現什麼樣的交易所成長，交易所交易量會在該指導範圍內成長嗎？謝謝。

Hey, Justin. It's Sun, and thanks for the question. On your question about supplemental payments, yeah, I think you called out the kind of the one-timers that we've referenced. The other point, in fiscal '24, is we still had a little bit of value from hospitals that were divested during the course of the year. But that's mostly in Q1. So there are a couple of those moving factors.

嘿，賈斯汀。我是 Sun，感謝您的提問。關於補充付款的問題，是的，我認為您提到了我們提到的那種一次性付款。另一點是，在 24 財年，我們仍然從當年剝離的醫院中獲得了一些價值。但這主要發生在第一季。因此，有幾個令人動容的因素。

But in fiscal '24, we generated about $1.16 billion of Medicaid supplemental payments. Going into '25, our guidance assumes something pretty consistent with that. You mentioned the Tennessee one-time. But excluding that, we're pretty consistent year over year.

但在24財年，我們產生了約11.6億美元的醫療補助補充支付。進入25年，我們的指導假設與此非常一致。您曾經提到過田納西州。但除此之外，我們的業績逐年相當穩定。

On your question about exchange, as we've said multiple times, total admissions and revenues from exchange population was a strong growth driver in 2024. We expect that to continue, per Saum's earlier comments around the overall volume environment.

關於您所提到的交換問題，正如我們多次所說的，交換人口的總入場人數和收入是 2024 年強勁的成長動力。根據 Saum 先前關於整體交易量環境的評論，我們預計這種情況將會持續下去。

The enrollment -- the renewal cycle seems to have been positive. We'll see how much of that turns into actual admissions. But we certainly won't see the 40%, 50% growth that we saw in '24, but we still continue to see a strong environment.

入學－更新周期似乎是正面的。我們將看看其中有多少能夠轉化為實際的錄取。但我們肯定不會看到24年那樣的40%、50%的成長，但我們仍然看到強勁的環境。

Just as an example, we're -- our strategy -- long-term strategy has always to be in broad networks from a contracting standpoint as an example. So we see good things for '25. Thanks for the question.

舉個例子，我們的長期策略一直是從承包的角度建立廣泛的網絡。因此我們認為25年會有好結果。謝謝你的提問。

Benjamin Rossi, JPMorgan Chase.

摩根大通的班傑明‧羅西 (Benjamin Rossi)。

Hey, good morning. Thanks for the question here. So just across supplies where -- seem some pressure here as a percentage of revenue with that category increase in about 100 bps year over year to 18.3. How would you characterize your current supply dynamics exiting the quarter?

嘿，早安。感謝您在此提問。因此，僅在供應方面——這似乎存在一些壓力，因為該類別的收入百分比比去年同期增長了約 100 個基點，達到 18.3。您如何描述本季目前的供應動態？

Is there anything discrete occurring within there? Is this largely a byproduct of your push in the higher acuity? Just kind of curious where you're seeing that number settling out in the steady state during 2025. Thanks.

其中是否發生了什麼離散的事情？這主要是您推動更高敏銳度的副產品嗎？我只是有點好奇，您認為 2025 年這個數字會穩定下來嗎？謝謝。

Yeah. Hey, Ben. Yeah, I think it's what you said on the latter piece. It is a just kind of part and parcel with our acuity strategy. So the supplies will go up as a percentage a little bit in Q4. But over the year, we've been pretty well balanced. And we expect it to be, again, balanced in '25.

是的。嘿，本。是的，我認為這就是你在後一篇文章中所說的。這只是我們的敏銳策略的一部分。因此第四季的供應量百分比將略有上升。但一年來，我們的狀況一直相當平衡。我們預計到25年它將再次達到平衡。

Got it. Thanks.

知道了。謝謝。

Thank you.

謝謝。

Joanna Gajuk, Bank of America.

美國銀行的喬安娜‧加朱克 (Joanna Gajuk)。

Hi, good morning. Thanks so much for taking the questions. So on the guidance element -- and both are same-store revenue 3% to 6%, right? That seems to be sort of more like a normalized growth because, clearly, you grew very nicely in '24, almost 8%. So is it just conservatism? Could you maybe also break down volumes versus pricing that's included in that range? Thank you.

嗨，早安。非常感謝您回答這些問題。那麼就指導要素而言 - 兩者都是同店收入的 3％ 到 6％，對嗎？這似乎更像是一種正常化成長，因為顯然，24 年的成長非常好，幾乎成長了 8%。那麼這只是保守主義嗎？您能否將該範圍內的銷售量與價格進行細分？謝謝。

Yeah, hey, it's Saum. Look, a couple of things there. First of all, long term, as we've learned with USPI -- and I think we've shared this data before. We've looked at 10 years' worth of USPI's performance, and same-store growth rates of around 4% to 6% is what we guide to.

是的，嘿，這是 Saum。看，那裡有幾件事。首先，從長遠來看，正如我們從 USPI 了解到的情況——我想我們之前已經分享過這些數據。我們研究了 USPI 過去 10 年的業績，預計同店成長率約為 4% 至 6%。

Now history suggests over that 10-year period, we've performed at the upper end of that range, 6%. That has looked better strengthened over the last five, six years, actually over that average period, okay? So you point out -- this year, almost -- or this year, past year, '24, 7.8%. The prior year was 9.2% growth rate.

歷史表明，在這 10 年期間，我們的表現處於該範圍的上限，即 6%。在過去五、六年裡，實際上在平均時期內，這一情況似乎得到了更好的加強，好嗎？所以你指出 - 今年，差不多 - 或者今年，去年，'24，7.8％。上年的成長率為9.2%。

So we're running very hot from that perspective in terms of long-term averages with respect to USPI. So our guide just comes -- brings us right back to what our long-term growth rate is. In terms of the year to year, as you've seen, it can be lumpy, right? '23, huge volume growth; '24 more growth in acuity and intensity.

因此，從 USPI 的長期平均值來看，我們的表現非常出色。所以我們的指導方針就是——讓我們回到我們的長期成長率。從逐年來看，正如您所看到的，情況可能會不盡相同，對嗎？'23、銷量大幅成長； '24 敏銳度和強度進一步增長。

And part of what we're signaling for '25 is it's definitely our plan to continue the shift to higher acuity procedures. I started to point out some of the factors driving that in terms of the revenue intensity of some of these cases, how efficiently we're able to do them in our operating rooms now and generate margin, how we are scaling those programs into more centers.

我們在 25 年發出的信號是，我們肯定計劃繼續轉向更高敏銳度的程序。我開始指出推動這些病例收入強度的一些因素，即我們現在能夠在手術室中多高效地進行這些手術並產生利潤，以及我們如何將這些項目擴展到更多中心。

We now have robots in almost 150 of our programs around the country. This is the direction in which we're taking the organization. So yeah, the guidance reflects kind of our long-term average. But we've obviously been running quite a bit above that.

目前，我們在全國近 150 個項目中都使用了機器人。這就是我們帶領組織前進的方向。是的，該指引反映了我們的長期平均值。但顯然我們的運行速度已經遠遠超出了這個水準。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Hi, everybody. Saum, I would ask you maybe on where you're at with managed care contracting. I know we've been in a period where you've been getting a little bit toward the high end of historical rate updates to pay for some of the labor challenges in the last few years.

大家好。Saum，我可能想問您在管理式醫療承包方面的情況。我知道我們已經處於這樣一個時期：為了應對過去幾年的一些勞動力挑戰，你們的利率已經略微接近歷史最高水準。

Is '25 a year in which you'll still type of dynamic, maybe where are you at in terms of signing up contracts? And then also on the managed care side, any update on thoughts about denial activity, prior authorization challenges, and other term changes that you're dealing with?

25 年裡您是否還會保持活力，從簽訂合約的角度來看您處於什麼位置？那麼在管理式醫療方面，對於拒絕活動、事先授權挑戰以及您正在處理的其他術語變更的想法有什麼更新嗎？

Yeah, why don't we take those in reverse. The -- I mean, I would say that the environment is no different than it has been. I mean, there's a constant back and forth of administrative costs that goes into adjudicating claims that probably is unnecessary. But obviously, both sides have a point of view on that.

是的，我們為什麼不反過來做呢？——我的意思是，我想說環境與以前沒有什麼不同。我的意思是，在裁決索賠時總是需要不斷花費行政費用，而這可能是不必要的。但顯然雙方對此都有自己的看法。

What I would say, more importantly than anything else from our perspective, is the work that Conifer does in driving initial disputes to a very, very attractive low rate of denials is critical. And our skill set in doing that in both working collaboratively with the payers and adversely where needed on the basis of solid documentation, appropriate coding, compliant coding, and efficient revenue cycle operations, has made a big difference.

我想說，從我們的角度來看，最重要的是，Conifer 在將初始爭議推向非常非常有吸引力的低拒絕率方面所做的工作至關重要。我們在與付款人合作以及在有需要時以可靠的文件、適當的編碼、合規的編碼和高效的收入周期運作為基礎進行工作時所具備的技能發揮了巨大的作用。

We're seeing a gap in what we generate in terms of lower denial rates than the industry from what we are seeing with respect to initial dispute rates. And that's good because that means we're doing things right in generating the appropriate cash flow from the work we're doing.

就初步爭議率而言，我們發現，我們所創造的拒絕率低於行業平均水平，存在差距。這很好，因為這意味著我們正在做正確的事情，從我們所做的工作中產生適當的現金流。

Sun, maybe you want to comment on the managed care side.

孫先生，也許您想就管理式醫療方面發表評論。

Yeah. Thanks, Saum. AJ, for your first part of the question, as we've said historically, we are continuing to see commercial rates increases in the 3% to 5% range. And some of the contracts have been at or slightly above the high end of that range, with respect to the inflationary pressures that you've mentioned.

是的。謝謝，Saum。AJ，對於您問題的第一部分，正如我們歷史上所說，我們繼續看到商業利率在 3％ 至 5％ 的範圍內上漲。就您所提及的通膨壓力而言，一些合約的價格已經處於或略高於該範圍的高端。

So I think the overall situation there is pretty consistent. And then in terms of contracting, going to '25, we're over 90% contracted for '25 and probably about over 50% contracted for '26 as well. So we have great visibility into '25 and beyond. Thanks for your question.

所以我認為那裡的整體情況是相當一致的。就合約而言，到 25 年，我們的 25 年合約簽訂率已超過 90%，26 年合約簽訂率可能也超過 50%。因此，我們對25年及以後的情況有很清晰的認識。感謝您的提問。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi, thanks. I wanted to come back to the same-store hospital volume guidance for 2025. I appreciate you're still expecting exchange growth inside of that number to some degree.

嗨，謝謝。我想回顧一下 2025 年同店醫院數量指引。我很欣賞您仍然期待匯率在這一數字內實現一定程度的增長。

I would also love to hear any quantification you can offer about how much hospital capacity you'll have online in 2025 compared to 2024? Trying to break out that 2% to 3% and maybe think about maybe what's the market level growth inside of that compared to how much of it is coming from capacity. Thank you.

我還想聽聽您能否提供關於 2025 年與 2024 年相比在線醫院容量的量化數字？試著突破 2% 到 3% 的成長速度，思考一下其中的市場水準成長與來自產能的成長相比如何。謝謝。

Yeah, hey, Stephen. It's obviously both. I mean, the majority of that is the market level demand that we're seeing versus the selective markets in which there's still capacity that we're bringing online. But it is a contributor which is why I called it out before. We haven't quantified what that looks like between the two numbers. But it is both, and the majority of it is market-based demand across the board.

是的，嘿，史蒂芬。顯然兩者兼而有之。我的意思是，我們看到的大部分是市場層面的需求，而我們仍在為那些仍有產能的選擇性市場提供上線服務。但它是一個貢獻者，這就是我之前指出它的原因。我們尚未量化這兩個數字之間的關係。但兩者兼而有之，而且絕大部分都是全面市場需求。

Some of this is also related to the service line choices we make, of course, which have higher growth rate. The things that we're doing that are taking care of people with multiple chronic illnesses that continue to grow in prevalence are continuing to create more demand than, perhaps, certain types of lower acuity work, which may be coming out of hospitals in our environment. And so that's really how we think about it in terms of the growth rates.

當然，這也與我們選擇的服務產品線有關，這些產品的成長率更高。我們為照顧患有多種慢性病且發病率不斷上升的患者所做的工作，正在持續產生比我們所在環境中的醫院可能出現的某些類型的低敏銳度工作更多的需求。這就是我們對成長率的看法。

Yeah, look, it's been a very busy year in the acute care environment. And as I said, I think the most important thing we're taking into the year from a mindset perspective is, we're not seeing changes in the demand patterns. It was a comment to Jamie's question earlier. We're not seeing changes in the demand pattern right now. And so I mean, I'm not going to go forecasting what we may see in the later part of the year, but we're not seeing that right now.

是的，你看，今年對於急性照護環境來說是非常忙碌的一年。正如我所說，我認為從思維方式的角度來看，我們今年要考慮的最重要的事情是，我們沒有看到需求模式的變化。這是對 Jamie 之前的問題的評論。我們目前沒有看到需求模式的改變。所以我的意思是，我不會去預測今年下半年會發生什麼，但我們現在還沒有看到這種情況。

Michael Ha, Baird.

麥可·哈，貝爾德。

Hi, thank you. Just a quick clarification first, and then my real one. And apologies if I missed it, but your USPI at 3% to 6% growth guide, what's the volume versus pricing split on that? And then my real question -- I'm sorry to add one more question on policy.

你好，謝謝。首先簡單澄清一下，然後是我的真實情況。如果我錯過了，請原諒，但您的 USPI 增長指南為 3% 至 6%，其中的銷量與價格比例是多少？然後我真正的問題是──很抱歉，我還要補充一個關於政策的問題。

And I understand USPI has minimal Medicaid exposure. But for your hospital and maybe taking a different approach, just given all the news flow, NIH cuts, DOGE's potential focus on Medicaid administrative cuts. If DOGE were to implement those cuts, it might not be overly impactful, but still, perhaps, a couple of percent of overall Medicaid spend.

據我了解，USPI 的醫療補助風險極小。但是對於您的醫院來說，也許採取不同的方法，考慮到所有的新聞流，NIH 削減，DOGE 可能關注醫療補助的行政削減。如果 DOGE 實施這些削減，可能不會產生太大影響，但仍可能占到整體醫療補助支出的幾個百分點。

So I'm curious to hear your view, if that were to happen, how do you think states might react? What's your view on the likelihood that states might potentially slow that Medicaid cut down to provider rates and impact kind in hospitals more broadly? Thank you.

所以我很好奇想聽聽您的看法，如果發生這種情況，您認為各州會如何反應？您認為各州可能放慢醫療補助計劃削減提供者費率的速度並對醫院產生更廣泛影響的可能性有多大？謝謝。

Yeah. A couple of different things. So let's just start with the business side of it first. With respect to USPI, as I indicated, there's no long-term deviation from our approach of thinking about half and half roughly managed care and volume at USPI. But because it's lumpy and it's proven to be lumpy, we're not guiding specifically for the year with respect to that.

是的。一些不同的事情。因此我們首先從商業方面開始。關於 USPI，正如我指出的那樣，我們對 USPI 大致管理的護理和數量各佔一半的思考方法並沒有長期偏差。但因為它是不穩定的，而且已被證明是不穩定的，所以我們沒有針對這一年做出具體的指導。

And you can understand that. I mean, we're successfully now two years in a row executing our strategy of increasing lower-volume, high-acuity cases. And in fact, as you can tell from our quarterly beats, consistently, we're exceeding what we expect from the standpoint of what we can do in same-store revenue growth in that environment.

你也可以理解這一點。我的意思是，我們已經連續兩年成功執行了增加低容量、高嚴重程度病例的策略。事實上，正如您從我們的季度業績中看到的那樣，從我們在這種環境下同店收入增長方面所能取得的成績來看，我們一直超出我們的預期。

And so we're pleased by that, that we can do that. We obviously had a little bit of fits and starts around that a few years ago in terms of how we were executing it. But we got it right, and it's working. And I'm really pleased with that.

我們很高興能夠做到這一點。顯然，幾年前我們在執行這項計劃時遇到了一些困難。但我們做對了，而且它正在發揮作用。我對此感到非常高興。

So the long-term algorithm is the same. But from a short-term standpoint, we're giving you the revenue guidance with, obviously, the track record of it being stronger. I don't -- on the policy side, I think to be clear, we don't have -- even in our academic medical center enterprises and affiliations, we don't have significant NIH or NSF indirect grant cost exposure in our business.

所以長期演算法是一樣的。但從短期角度來看，我們為您提供的收入指導顯然是基於更強勁的業績記錄。在政策方面，我認為需要明確的是，即使在我們的學術醫療中心企業和附屬機構中，我們的業務中也沒有顯著的 NIH 或 NSF 間接撥款成本風險。

So in particular, as you can imagine, when we saw that, we thought about that in our environment and where we had [RON] grants and other things within our environment. But we don't have that significantly in our environment.

因此，具體來說，你可以想像，當我們看到這一點時，我們會在我們的環境中考慮這一點，以及我們在我們的環境中擁有 [RON] 補助金和其他東西的地方。但在我們的環境中，這種情況並不明顯。

I think the broader question of Medicaid policy and other things is an important one. But, look, the focus on -- that is articulated -- and you can't tell what's going to happen. But the focus that's articulated on reducing fraud and abuse, including in some of the public comments made yesterday all the way in the Oval Office, I think one thing that people may find is that Medicaid redeterminations over the last couple of years have probably done a lot to reduce the number of people eligible or not eligible who happened to be on Medicaid.

我認為醫療補助政策和其他問題的更廣泛問題是一個重要議題。但是，你看，焦點已經明確了，你無法預知接下來會發生什麼事。但是，包括昨天在橢圓形辦公室發表的一些公眾評論在內的重點都集中在減少欺詐和濫用上，我認為人們可能會發現，過去幾年的醫療補助重新確定可能已經大大減少了符合條件或不符合條件但恰好享受醫療補助的人數。

And so I'm -- again, no way to predict, for sure. But I I'm somewhat comforted by the fact that some of that work has already been done through this redetermination process. So we'll see where this goes and what remains to be seen.

所以我—再說一遍，無法確定地預測。但讓我感到些許安慰的是，部分工作已經透過這個重新確定過程完成了。因此，我們將觀察此事將走向何方以及還有什麼需要觀察。

Finally, as to speculation -- speculating on what the state's responses may be, I think the states are going to be important allies across the board in advocating for the dollars that come through these Medicaid partnerships with the federal government. Because, again, I go back to -- this is the only way to create access for the people that need it that are on Medicaid.

最後，至於猜測——猜測各州的反應可能是什麼，我認為各州將成為全面的重要盟友，並爭取透過與聯邦政府的醫療補助合作獲得資金。因為，我再說一次——這是為有需要的醫療補助人們提供醫療服務的唯一途徑。

This is not some program that's generating incredible windfalls for health systems on that basis. The unit reimbursement is still below the cost of that care. And so I think that that's going to be an important balancing factor. The states will play an important role in this.

這並不是某個以此為基礎為醫療體系帶來驚人意外之財的計畫。單位報銷金額仍低於該項護理的費用。所以我認為這將是一個重要的平衡因素。各州將在其中發揮重要作用。

Ann Hynes, Mizuho.

安海因斯（Ann Hynes）、瑞穗（Mizuho）。

Hi, good morning. So I know there's some big surgery center assets out there in the market. Can you remind us, given your delivered balance sheet, what your appetite is versus larger-scale M&A in the surgery center business?

嗨，早安。所以我知道市場上有一些大型手術中心資產。您能否根據您提交的資產負債表，提醒我們一下，相對於手術中心業務的大規模併購，您的興趣是什麼？

Hey, Ann, it's Saum. Obviously, I'm not going to comment on any kind of M&A opportunities. We're very aware of everything that's available in the market. We've proven our ability over the last few years to deploy M&A capital both on a single-asset basis and large multicenter asset acquisitions.

嘿，安，我是索姆。顯然，我不會對任何類型的併購機會發表評論。我們非常了解市場上的所有產品。過去幾年來，我們已經證明了我們有能力在單一資產和大型多中心資產收購中部署併購資本。

I would tell you that the first year post our acquisition early last year of the portfolio that we took on went better than we thought it would. So that's good news. And as I said early on in my comments, our balance sheet provides us plenty of flexibility to approach things.

我想說的是，自去年年初我們收購投資組合以來，第一年的表現比我們想像的還要好。這是個好消息。正如我在早些時候的評論中所說的那樣，我們的資產負債表為我們處理事情提供了充足的靈活性。

But, look, we're disciplined. We believe in growth businesses. We believe in areas in which we can add value. And we have a lot of flexibility given our cash flow generation and valuation multiple to deploy cash for the benefit of shareholders in multiple different avenues at this point.

但是，你看，我們是有紀律的。我們相信成長型企業。我們相信我們可以在某些領域增加價值。鑑於我們的現金流量產生和估值倍數，我們目前擁有很大的靈活性，可以透過多種不同途徑為股東利益部署現金。

Whit Mayo, Leerink Partners.

惠特·梅奧（Whit Mayo），Leerink Partners 合夥人。

Hey, good morning. Just to stick on USPI for a second. Are there any new health system partners that we may not be aware of in the last year? I know you've been selective and disciplined with the financial strength of the partners that you want to work with.

嘿，早安。只需在 USPI 上停留一秒鐘。去年是否存在我們可能不知道的新醫療系統合作夥伴？我知道您對合作夥伴的財務實力非常挑剔，並且嚴守紀律。

But I'm just not sure I've had an update or heard an update on anything new or any expanded relationships with any health systems in some time. And maybe just a broader comment on the de novo activity, the 10 to 12 this year. Any of those with new partners, or those are all existing partners? Thanks.

但我只是不確定我是否有收到或聽到任何新消息或與任何醫療系統擴展關係的最新消息。或許只是對今年 10 至 12 項新生活動的更廣泛的評論。其中有沒有新的合作夥伴，還是都是現有的合作夥伴？謝謝。

Yeah. Hey, Whit, it's Saum. No, we haven't provided any updates on health system partners and other things. And remember, I mean, our platform is such that we work just as effectively with partners as we do without partners because of our ability to generate contract synergies, managed care, supply chain, everything, right, in our management capacity for these assets.

是的。嘿，惠特，我是索姆。不，我們沒有提供有關醫療系統合作夥伴和其他事項的任何最新消息。請記住，我們的平台是這樣的，我們在有合作夥伴的情況下和沒有合作夥伴的情況下一樣有效地工作，因為我們有能力產生合約協同效應、管理式醫療、供應鏈等等，在我們管理這些資產的能力範圍內。

So we're growing the portfolio in both -- with both vectors. And I don't think that's going to change. I mean, I think the expansion of de novo assets can occur in many different ways. Some are in existing markets. Some are in new markets.

所以我們正在透過兩個管道擴大投資組合。我不認為這種情況會改變。我的意思是，我認為新資產的擴張可以透過多種不同的方式實現。有些在現有市場。有些是在新市場。

Some are with MSOs that are expanding their physician side footprint and as I've said in the past, have realized that there isn't a better operator of ASCs to generate margin from those investments for those doctors than USPI. So that's another vector of growth that is helping to create de novo activities. It's a multipronged growth strategy, and I don't think that's really going to change looking forward.

一些 MSO 正在擴大其醫生方面的足跡，正如我過去所說的那樣，他們已經意識到，沒有比 USPI 更好的 ASC 運營商來為這些醫生從這些投資中獲取利潤。所以這是另一個有助於創造新生活動的成長載體。這是一個多管齊下的成長策略，我認為未來這項策略不會改變。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

Hey, good morning. Saum, I predict you'll hate this question, but bear with me. So we've heard from a few folks that the fourth-quarter seasonal uptick is not quite what it used to be because just the fact that deductibles have gotten so high, particularly in commercial plans. Do you think there's any evidence of that?

嘿，早安。索姆，我猜你會討厭這個問題，但請忍耐一下。因此，我們從一些人那裡聽說，第四季度的季節性上漲並不像以前那樣，因為免賠額已經變得太高，特別是在商業計劃中。您認為有證據證明這一點嗎？

So, John, are you referring just care delivery overall or USPI specifically?

那麼，約翰，您指的是整體的醫療服務還是具體指 USPI？

I'm sorry, I meant electives. So electives either in the hospital or in the USPI.

抱歉，我的意思是選修課。因此，可以在醫院或 USPI 進行選修課程。

Yeah, elective work. Yeah. Well, it's -- I mean, again, I'm not sure that I'm going to be able to give you a statistically significant answer. But I would say that the seasonality in Q4 -- and especially that ramped into Q1 on elective surgery -- it has tempered a bit.

是的，選修課。是的。嗯，我的意思是，我不確定我是否能給你一個具有統計意義的答案。但我想說，第四季的季節性——尤其是第一季選擇性手術的季節性——已經有所緩和。

I mean, Q4 is still a more productive quarter. Our asset utilization in our USPI segment does go up still in Q4. But it has tempered a bit overall. And also -- and how much of it is the deductibles versus somewhat the impact of -- if you look at our Q4, the impact of just some of these weather events were relevant.

我的意思是，第四季仍然是一個生產力更高的季度。我們 USPI 部門的資產利用率在第四季確實有所上升。但整體來說已經有所緩和。而且，其中有多少是免賠額，有多少是天氣影響？

And so how much of it was a seasonality shift versus some of the weather events that we -- I don't know that we've really calculated that. But it is -- I mean, you're picking up on something that we've sort of said, intuitively, it feels a little bit different. But the general pattern hasn't changed.

那麼，相對於某些天氣事件而言，有多少是季節性變化造成的？但事實是——我的意思是，你直覺地感覺到了我們說過的某件事有點不同。但整體格局並未改變。

And so just a follow-up -- and thanks for that answer. If we look at '23 and '24, utilization was up for -- in '23. I'd say, electives in '24, there was a bunch of other stuff going on like two-midnight rule and cancer cases and what have you.

所以只是一個後續問題——感謝您的回答。如果我們看一下'23 和'24，就會發現'23 年的利用率有所上升。我想說，1924 年的選修課還有很多其他內容，像是兩夜規則、癌症病例等等。

Do you think -- again, probably, you can't answer this question. But it seems to us like '25 were kind of back to more kind of a normalized year, where maybe we've cleared out all the COVID backlog, and we're kind of clear all of these kind of wonky events in '23 and '24. Is that kind of your -- is that what's implied in your guidance? Is that's kind of where we are?

您認為—再說一次，很可能您無法回答這個問題。但在我們看來，25 年似乎已經回歸到了更正常的一年，也許我們已經清理了所有的 COVID 積壓，並且我們已經清除了 23 年和 24 年所有這些不穩定事件。這就是你的──這就是你的指導中所暗示的嗎？這就是我們所處的情況嗎？

I mean, that is kind of -- I mean, at some point, we have to get back to an environment where we're not explaining everything, either on the basis of COVID or post-COVID or whatever the case may be. No one ever gets that entirely right. But I do think that that is a little bit of what the guidance implies.

我的意思是，這有點——我的意思是，在某個時候，我們必須回到一個我們不會解釋一切的環境，無論是基於 COVID 還是後 COVID 或任何情況。沒人能完全正確地理解這一點。但我確實認為這有點符合指導意見中所暗示的意思。

And as I said, I think that's a fair way to plan for the year. And yet at the same time, I don't see shifts necessarily in the strength -- the strong demand environment that we saw in '24 yet, in particular. So we'll see how that plays out.

正如我所說，我認為這是製定年度計劃的合理方式。但同時，我認為強度——尤其是我們在 24 年看到的強勁需求環境——不一定會改變。我們將看看結果如何。

Thank you.

謝謝。

Thanks.

謝謝。

Josh Raskin, Nephron Research.

喬希‧拉斯金 (Josh Raskin)，腎元研究公司。

Thanks. I'm going to stick on the USPI topic. So can you speak maybe to the broader competitive landscape for ASC transactions? Are you seeing more competition? And if you could differentiate between larger sets of assets or even one-offs or even competitors developing de novos in your markets?

謝謝。我將堅持討論 USPI 主題。那麼您能談談 ASC 交易的更廣泛的競爭格局嗎？您是否看到了更多的競爭？您是否可以區分更大的資產集，甚至是一次性資產，甚至是您所在市場中新開發的競爭對手？

And then in your prepared remarks, Saum, you mentioned the de novo growth. Is that indicative of more, what we'll call, sort of organic center expansions as opposed to acquired centers?

然後，索姆，在您準備好的發言中，您提到了從頭開始生長。這是否意味著更多的是我們所說的有機中心擴張，而不是收購中心？

Well, let me go in reverse. Look, we think de novo development activity is really critical, and we've been focused on that and scaling that up. I mean, again, part of our thinking here, Josh, is that consistent with our move into more high-acuity ambulatory surgical work, de novos also represent a significant value shift in markets, right?

好吧，讓我反過來說。看，我們認為從頭開始開發活動確實至關重要，我們一直專注於此並擴大其規模。我的意思是，喬希，我們在這裡的想法是，與我們進軍高敏銳度門診手術工作的舉措一致，de novos 也代表著市場價值的重大轉變，對嗎？

Because, usually, what you're doing is you're building from the ground up. You're moving things into a lower-cost setting. It's value for the consumers and payers in the markets to be focused on de novos, in addition to everything else that we may be doing to grow the portfolio and expand the high-acuity services. So that -- it's part of our value strategy there. And maybe that's why you're seeing more of it from the de novo side.

因為通常你要做的是從頭開始建造。您正在將事物轉移到成本較低的環境。除了我們為擴大產品組合和拓展高敏銳度服務所做的其他一切努力之外，關注 de novos 對市場上的消費者和付款人來說也是有價值的。所以—這是我們價值策略的一部分。也許這就是為什麼你會從新的角度看到更多的東西。

In terms of the competitive landscape, no, I don't think the competitive landscape has changed. I mean, the easiest way to assess the competitive landscape is to just count the center counts across different organizations. And some are scaling better than others. And that probably, more than anything, reflects competitive -- the output of whatever competitive intensity exists.

就競爭格局而言，不，我認為競爭格局沒有改變。我的意思是，評估競爭格局的最簡單方法就是計算不同組織的中心數量。有些企業的擴張速度比其他企業更快。這可能比任何事情都更能體現競爭——無論存在什麼競爭強度，其產出都是如此。

We've been pretty pleased with our ability to scale, win competitive situations and processes where we want them, and maintain high-quality high-profit margin centers. And we always assess that pipeline every year. The pipeline still looks good for doing that.

我們對我們的擴展能力、在競爭中取得勝利的能力和流程以及維持高品質、高利潤率的中心感到非常滿意。我們每年都會對該管道進行評估。該管道看起來仍然很好。

That's helpful. Is it fair to assume that the de novo long-term returns on capital are higher?

這很有幫助。假設從頭開始的長期資本報酬率更高是否公平？

Yes, of course. Yes. Because again, the -- it's not like building an acute care facility, right? The building costs are low. It's a shorter timeframe. Once the partnership is syndicated, there's work upfront in syndicating the partnership that takes time. But that's not a capital-intensive activity.

是的當然。是的。因為再說一遍，這不像是建造一個急診設施，對吧？建築成本低。這是一個較短的時間範圍。一旦合作關係建立，前期的工作就需要花費一些時間。但這並不是資本密集型活動。

Look, I think at the start of this, Pito pointed out one of the big changes in the organization around the generation of free cash flow. We also focus on measuring and following our overall return on invested capital within the organization.

看，我認為在一開始，皮托就指出了組織在產生自由現金流方面發生的重大變化之一。我們也著重於衡量和追蹤組織內投資資本的整體報酬率。

And obviously, the more we shift into this ambulatory segment, the more that gets better. And obviously, the more we do de novos, we see that that gets better in terms of what we're doing in the business when we're deploying our cash. So yeah, you're absolutely picking up on what we're doing for the right reasons.

顯然，我們越是轉向這個門診部分，情況就會越好。顯然，我們做的重新思考越多，我們發現，就我們在業務中部署現金而言，情況會越來越好。是的，您完全明白我們這麼做是出於正確的理由。

Thanks.

謝謝。

Matthew Gillmor, KeyBanc Capital Markets.

馬修·吉爾摩（Matthew Gillmor），KeyBanc 資本市場。

Hey, thanks. I wanted to follow up on the cost management and efficiency comments. The company has clearly made a lot of progress the last few years, and you noted the SWB and contract labor metrics. As you look ahead, are there any areas of particular focus that are going to continue to drive efficiency in 2025 and beyond that you'd highlight for us?

嘿，謝謝。我想跟進有關成本管理和效率的評論。公司在過去幾年顯然取得了很大進步，您注意到了 SWB 和合約工指標。展望未來，您是否可以向我們強調哪些需要特別關注的領域將在 2025 年及以後繼續推動效率提升？

Sure. I mean -- I think that the cost management agenda doesn't change in terms of managing labor, managing supplies, managing purchase services, active vendor consolidation, activities, scaling our service lines in which we've got a cost structure that we're comfortable with. Obviously, just that scale creates opportunity.

當然。我的意思是——我認為成本管理議程在管理勞動力、管理供應、管理採購服務、積極的供應商整合、活動、擴展我們的服務線方面不會改變，我們已經有一個滿意的成本結構。顯然，正是這種規模創造了機會。

I've said, in the acute care segment, I've said all along, we're really pleased with the improvements that we've made in so many of the metrics from the standpoint of cost, labor, overhead, supplies, purchase services, relative to our peer set in the industry. Obviously, we always continue to note that an area that we can improve is our asset utilization. And that's obviously in comparison to what we look at as kind of the gold standard out there.

我說過，在急性護理領域，我一直在說，相對於業內同行，從成本、勞動力、管理費用、供應品、採購服務等角度來看，我們對許多指標所取得的進步感到非常滿意。顯然，我們始終注意到我們可以改進的一個領域是資產利用率。這顯然與我們所認為的黃金標準有所差異。

So that's really an area that we're continuing to work on as we expand capacity and build volumes into some of the facilities that we took capacity offline during the pandemic from an efficiency standpoint. Our global business center has contributed significantly to our cost savings. If you think about the last four, five years the journey we've been on, of course, there's obvious unit cost savings that you see on an immediate basis.

因此，從效率的角度來看，這實際上是我們正在繼續努力的一個領域，我們正在擴大產能，並將一些在疫情期間下線的設施的產量增加到新水平。我們的全球業務中心為我們的成本節約做出了巨大貢獻。如果你回想過去四、五年我們走過的歷程，你會立刻看到明顯的單位成本節省。

But there's a lot of cash flow that goes into actually restructuring and building and scaling that enterprise. And what might have started with kind of commodity work in certain areas of finance or accounts receivable has expanded to 10, 12 different service lines that we are now running effectively in the global business center clinical areas, clinical analytics, physician credentialing a variety of things.

但實際上，重組、建造和擴大企業需要大量的現金流。我們最初可能只是在某些財務或應收帳款領域從事某種商品工作，現在已經擴展到 10 到 12 條不同的服務線，現在我們在全球業務中心的臨床領域、臨床分析、醫生資格認證等各種領域有效地運行這些服務線。

And that's an important part of our efficiency agenda as we look forward as well. And it's -- now that it's, obviously, well passed breakeven cash flow, those savings materially contribute to what we're doing.

這也是我們未來效率議程的重要組成部分。現在，顯然現金流已經遠遠超過了損益平衡，這些節省對我們的工作做出了實質的貢獻。

Got it. Very helpful. Thank you.

知道了。非常有幫助。謝謝。

Ben Hendrix, RBC Capital Markets.

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

Hi, this is Mike Murray, on for Ben. Thanks for taking my question. So ASC total joint procedures grew nicely in 2024. I wanted to hear your expectations for growth in 2025 and beyond.

大家好，我是麥克‧莫瑞 (Mike Murray)，代替本 (Ben)。感謝您回答我的問題。因此，ASC 總體聯合手術在 2024 年將達到良好成長。我想聽聽您對 2025 年及以後的成長期望。

And then cardiology procedures have been the latest slated to drive material growth in ASCs. Can you discuss any early progress there, and when do you see these procedures really accelerating? Thanks.

心臟病學手術是最新推動 ASC 物質生長的手術。您能討論一下那裡的一些早期進展嗎？謝謝。

Yeah, hey, it's Saum. We -- obviously, we anticipate continuing to focus on our orthopedics line of business going forward. We're not going to guide service line level volumes from that perspective. But we still think, obviously, there's a tailwind in ambulatory surgical growth from an orthopedic standpoint. And that's both the stuff we're doing today and expansion of the procedure set that could be done safely in ASC.

是的，嘿，這是 Saum。顯然，我們預計未來我們將繼續專注於我們的骨科業務線。我們不會從這個角度來指導服務線等級的銷售量。但我們仍然認為，從骨科的角度來看，門診手術顯然存在著增長的順風。這既是我們今天所做的事情，也是可以在 ASC 中安全完成的程序集的擴展。

Same with cardiac, I mean, as I've said all along, the opportunity in a wide variety of cardiovascular procedures is there. I've always been clear that I think that that opportunity will proceed more slowly than people anticipate because of important patient safety considerations and payer mix considerations. And also, the CapEx required to build a cardiac center is very different than building other types of ASCs given the equipment that you have to have in there.

心臟也是一樣，我的意思是，正如我一直說的，各種各樣的心血管手術都有機會。我一直很清楚，我認為由於重要的病人安全考慮和付款人組合考慮，這一機會的進展將比人們預期的要慢。此外，考慮到所需的設備，建造心臟中心所需的資本支出與建造其他類型的 ASC 有很大不同。

So the upfront investment for the physician partners and other things is much higher with potentially lower margin assets. And so from economic reasons and patient safety reasons, I think this market will evolve, but I think it will evolve slower than people like to think. And we'll, obviously, be participants in that as we are today. But we're also -- we're not going to try to rush it and sacrifice patient safety and quality in that regard.

因此，醫生合作夥伴和其他方面的前期投資要高得多，而利潤資產的潛在價值卻較低。因此，從經濟原因和病人安全原因來看，我認為這個市場將會發展，但我認為它的發展速度會比人們想像的要慢。顯然，正如今天一樣，我們將參與其中。但我們也不會急於求成，而犧牲病人的安全和品質。

That's helpful. Thank you.

這很有幫助。謝謝。

This concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

今天的會議到此結束。您現在可以斷開您的線路，我們感謝您的參與。