Tenet Healthcare Corp (THC) 2025 Q1 法說會逐字稿

Good morning, and welcome to Tenet Healthcare's first-quarter 2025 earnings conference call. (Operator Instructions)

早安，歡迎參加 Tenet Healthcare 2025 年第一季財報電話會議。 （操作員指示）

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

現在我將把電話轉給主持人、投資者關係副總裁威爾·麥克道爾先生。麥克道爾先生，你可以開始了。

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 first-quarter 2025 results as well as a discussion of our financial outlook.

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)。我們很高興您能與我們一起討論 Tenet 2025 年第一季的業績以及我們的財務前景。

Tenet senior management participating in today's call will be Dr. Saumya Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer.

參加今天電話會議的 Tenet 高級管理人員包括董事長兼首席執行官 Saumya Sutaria 博士；以及執行副總裁兼首席財務官 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. Actual results and plans could differ materially.

我們今天早上的網路廣播包括一份幻燈片演示，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具有前瞻性，代表了管理層根據當前可用資訊做出的預期。實際結果和計劃可能存在重大差異。

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 recently formed -- filed Form 10-K and other filings with the Securities and Exchange Commission.

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幻燈片以及我們最近提交給美國證券交易委員會的 10-K 表格和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，我將把電話轉給 Saum。

Thank you, Will, and good morning, everyone. We reported first-quarter 2025 net operating revenues of $5.2 billion and consolidated adjusted EBITDA of $1.163 billion, which represents growth of 14% over 2024. [Adjusted EBITDA margin of 22.3%] in first quarter 2025, a 320 basis point improvement over the prior year, demonstrates our strong growth and continued operating discipline.

謝謝你，威爾，大家早安。我們報告稱，2025 年第一季淨營業收入為 52 億美元，合併調整後 EBITDA 為 11.63 億美元，比 2024 年成長 14%。 2025 年第一季 [調整後 EBITDA 利潤率為 22.3%]，比前一年提高了 320 個基點，證明了我們強勁的成長和持續的經營紀律。

USPI had a nice start to the year as we generated $456 million in adjusted EBITDA, which represents 16% growth over first quarter 2024. Same-facility revenues grew 6.8% in the first quarter and were highlighted by a 12% growth in total joint replacements in the ASCs over the prior year.

USPI 今年開局良好，調整後 EBITDA 達到 4.56 億美元，比 2024 年第一季成長 16%。第一季同店營收成長了 6.8%，其中 ASC 的總關節置換手術量較上年同期成長了 12%。

Turning to our Hospital Segment, adjusted EBITDA grew 12% to $707 million in the first quarter of 2025. Same-store hospital admissions were up 4.4% as we continue to open up capacity to respond to the strong utilization environment. Acuity and payer mix remained strong, with first quarter 2025 revenue per adjusted admission up 2.8% over the prior year.

談到我們的醫院部門，調整後的 EBITDA 在 2025 年第一季成長了 12%，達到 7.07 億美元。由於我們繼續開放容量以應對強勁的利用率環境，同店住院人數上升了 4.4%。敏銳度和付款人組合依然保持強勁，2025 年第一季每張調整後入院收入比上年增長 2.8%。

In all, our first quarter results were above our expectations, driven by fundamental outperformance, continued strength in the same-store revenue growth due to customer demand, high acuity and effective cost management.

整體而言，我們的第一季業績超出預期，這得益於基本面的優異表現、客戶需求導致的同店營收成長持續強勁、高敏銳度和有效的成本管理。

Regarding our 2025 full-year guidance, we are not addressing the underlying outperformance in our business units during the first quarter. We're early in the year, and while we are very pleased with both our fundamental outperformance and the continued demand for our services and momentum we carry into the balance of the year, we'll address our full year expectations in the future.

關於我們的 2025 年全年指引，我們不會解決第一季業務部門的潛在優異表現。今年才剛開始，儘管我們對我們的基本面優異表現以及對我們服務的持續需求和我們在今年餘下時間所保持的勢頭感到非常滿意，但我們將在未來解決我們的全年預期。

Turning to capital deployment, we are well positioned to create value for shareholders through effective capital deployment of the cash flows that our portfolio of business generates. We've demonstrated an ability to flex our operations during challenging times, and our transformed portfolio is better positioned to handle economic stresses.

談到資本配置，我們有能力透過有效部署我們的業務組合產生的現金流量來為股東創造價值。我們已證明有能力在困難時期靈活調整運營，而且我們轉型後的投資組合能夠更好地應對經濟壓力。

We continue to see significant opportunity for M&A in the Ambulatory space and intend to invest a baseline of approximately $250 million towards this opportunity each year. During the quarter, we added six new centers, including a strategic partnership with Choice Care Surgery Center in Midland, Texas. Choice Care is a 16,000 square foot state-of-the-art multi-specialty surgery center with a focus on orthopedic surgery and urology, among other service lines.

我們繼續看到門診領域存在重大的併購機會，並打算每年為此機會投資約 2.5 億美元。本季度，我們增加了六個新中心，包括與德克薩斯州米德蘭的 Choice Care Surgery Center 建立戰略合作夥伴關係。Choice Care 是一家佔地 16,000 平方英尺的最先進的多專科手術中心，專注於骨科手術和泌尿外科等服務項目。

Our cash flows have enabled us to make incremental investments in capital expenditures to fuel organic growth, such as our expanded L&D department at our Abrazo West Campus in Arizona. Our top-tier medical professionals and latest medical technology reflect our commitment to delivering exceptional care to women and their families in one of the fast-growing communities in the United States.

我們的現金流使我們能夠在資本支出方面進行增量投資，以推動有機成長，例如我們在亞利桑那州 Abrazo West 校區擴建的 L&D 部門。我們擁有頂尖的醫療專業人員和最新的醫療技術，體現了我們致力於為美國快速發展的社區之一的女性及其家人提供卓越的護理。

We have significantly deleveraged our balance sheet with a net debt to EBITDA minus NCI ratio of 3:1 as of March 31, 2025, competitive with our leading peers. We remain committed to a deleveraged balance sheet as it provides us the flexibility to actively deploy capital to create value.

我們大幅降低資產負債表的槓桿率，截至 2025 年 3 月 31 日，淨負債與 EBITDA 減 NCI 的比率為 3:1，與領先的同業相比具有競爭力。我們仍然致力於去槓桿資產負債表，因為它為我們提供了積極部署資本以創造價值的靈活性。

We believe that our current valuation is disjointed relative to our growth prospects, strong operating capabilities and transformed portfolio of businesses. We see this as an opportunity that we can capitalize on via share repurchase.

我們認為，我們目前的估值與我們的成長前景、強大的營運能力和轉型的業務組合不符。我們認為這是一個可以透過股票回購來利用的機會。

We repurchased 2.6 million shares in the first quarter of 2025 for $348 million. And going forward, we plan to be active repurchasers of our shares, particularly at our current valuation multiple, leveraging the significant cash flow generation of our business.

我們在 2025 年第一季以 3.48 億美元回購了 260 萬股。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，利用我們業務產生的巨大現金流。

In summary, we've had a strong start to the year based on fundamental growth and cost management. We are executing effectively on our growth strategy with an intense focus on serving our patients and delivering value with our physician partners.

總而言之，憑藉基本面的成長和成本管理，我們今年取得了良好的開端。我們正在有效地執行我們的成長策略，重點關注為我們的患者提供服務並與我們的醫生合作夥伴一起創造價值。

Importantly, we are not altering our business strategy because of health care policy uncertainty that the industry is currently facing. We will steadily execute on our growth strategies with consistent capital investments and continued demonstration of our strong operating capabilities.

重要的是，我們不會因為產業目前面臨的醫療政策不確定性而改變我們的經營策略。我們將透過持續的資本投入和不斷展示強大的營運能力，穩步執行我們的成長策略。

We see significant opportunity for growth, which we believe translates into attractive free cash flow generation that we can deploy across our discussed priorities to generate value for shareholders.

我們看到了巨大的成長機會，我們相信這將轉化為有吸引力的自由現金流，我們可以將其部署到我們討論的優先事項中，為股東創造價值。

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

屆時，Sun 將對我們的財務表現進行更詳細的回顧。太陽？

Thank you, Saum, and good morning, everyone. We're pleased to report another strong quarter to start off our fiscal 2025. We generated total net operating revenues of $5.2 billion and consolidated adjusted EBITDA of $1.163 billion, a 14% increase over first quarter 2024. Our first quarter adjusted EBITDA margin was 22.3% a 320 basis points improvement over last year.

謝謝你，Saum，大家早安。我們很高興地報告，2025 財年又迎來了一個強勁的季度。我們創造了 52 億美元的總淨營業收入，合併調整後 EBITDA 為 11.63 億美元，比 2024 年第一季成長 14%。我們第一季的調整後 EBITDA 利潤率為 22.3%，比去年同期提高了 320 個基點。

Adjusted EBITDA was well above the high end of our guidance range, driven by strong fundamentals, including same-store revenue growth, continued high patient acuity, favorable payer mix and effective cost controls.

調整後的 EBITDA 遠高於我們預期範圍的高端，這得益於強勁的基本面，包括同店收入增長、持續的高患者敏銳度、有利的付款人組合和有效的成本控制。

I would now like to highlight some key items for each of our segments, beginning with USPI, which again delivered strong operating results.

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經營業績。

In the first quarter, USPI's adjusted EBITDA grew 16% over last year, with adjusted EBITDA margin at 38%. USPI delivered a 6.8% increase in same-facility system-wide revenues, with net revenue per case up 9.1% and case volumes down 2.1%, reflecting our continued disciplined shift toward higher acuity services.

第一季度，USPI 的調整後 EBITDA 較去年同期成長 16%，調整後 EBITDA 利潤率為 38%。USPI 的同設施全系統收入增長了 6.8%，每例淨收入增長了 9.1%，病例數量下降了 2.1%，這反映了我們持續有紀律地轉向更高敏銳度的服務。

Turning to our Hospital segment. First quarter 2025 adjusted EBITDA was $707 million, with margins up 310 basis points over last year at 17.5%. Excluding the hospitals divested in 2024, our adjusted EBITDA grew 23% over the first quarter of 2024. Same-hospital inpatient admissions increased 4.4%, and revenue per adjusted admissions grew 2.8%.

轉向我們的醫院部門。2025 年第一季調整後 EBITDA 為 7.07 億美元，利潤率較去年同期成長 310 個基點，達到 17.5%。不包括 2024 年剝離的醫院，我們的調整後 EBITDA 比 2024 年第一季增加了 23%。同一醫院住院人數增加了 4.4%，每例調整後入院收入增加了 2.8%。

Our consolidated salary, wages and benefits in first quarter was 40.6% of our net revenues, a 260 basis point improvement from prior year. And our consolidated contract labor expense was 2% of SW&B.

我們第一季的綜合薪資、薪資和福利占我們淨收入的 40.6%，比去年同期提高了 260 個基點。我們的合併合約勞務費用為 SW&B 的 2%。

In the first quarter of '25, we recognized a $40 million favorable pre-tax impact for additional Medicaid supplemental revenues related to prior years. As a reminder, First quarter 2024 results included a $44 million favorable pre-tax impact for additional Medicaid revenues related to the prior year.

在 2025 年第一季度，我們確認了與前幾年相關的額外醫療補助補充收入的 4,000 萬美元稅前有利影響。提醒一下，2024 年第一季的業績包括與前一年相關的 4,400 萬美元額外醫療補助收入的稅前有利影響。

Next, we will discuss our cash flow, balance sheet and capital structure. We generated $642 million of free cash flow in the first quarter. And as of March 31, 2025, we had $3 billion of cash on hand, with no borrowings outstanding under our $1.5 billion line of credit facility. Additionally, we have no significant debt maturities until 2027. And finally, we repurchased 2.6 million shares of our stock for $348 million in the first quarter.

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。我們在第一季產生了 6.42 億美元的自由現金流。截至 2025 年 3 月 31 日，我們手頭上有 30 億美元現金，在 15 億美元的信貸額度下沒有未償還借款。此外，我們在 2027 年之前沒有重大債務到期。最後，我們在第一季以 3.48 億美元回購了 260 萬股股票。

Our leverage ratio as of quarter end was 2.46x EBITDA or 3.14x EBITDA less NCI, driven by our outstanding operational performance and continued focus on financial discipline. We are very pleased with our ongoing cash flow generation capabilities 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.

截至季末，我們的槓桿率為 2.46 倍 EBITDA 或 3.14 倍 EBITDA 減去 NCI，這得益於我們出色的營運表現和對財務紀律的持續關注。我們對持續的現金流量產生能力感到非常滿意，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. As Saum noted, we are not making any adjustments to our full-year '25 outlook at this time. While we had strong fundamental outperformance in the first quarter and have continued confidence in our ability to achieve our full-year targets, it is early in the year and we will revisit our full-year guidance as needed in subsequent quarters. As such, we are reaffirming the full year '25 guidance that we initially provided in February.

現在讓我來談談我們對 2025 年的展望。正如 Saum 所指出的，我們目前不會對 25 年全年展望做出任何調整。雖然我們在第一季的基本面表現強勁，並且仍然對我們實現全年目標的能力充滿信心，但現在才剛剛開始，我們將在隨後的幾個季度根據需要重新審視我們的全年指導。因此，我們重申我們在二月最初提供的 25 年全年指引。

A few items of note. Our outlook continues to assume $35 million of net revenues associated with the Tennessee supplemental Medicaid programs. which have not yet been fully approved. As such, we did not record any revenues associated with these programs in the first quarter of '25. We expect second quarter consolidated adjusted EBITDA and to be in the range of 24% to 25% of our full-year consolidated adjusted EBITDA at the midpoint.

有幾件值得注意的事情。我們的預測仍然假設與田納西州補充醫療補助計劃相關的淨收入為 3500 萬美元。尚未完全批准。因此，我們在 25 年第一季沒有記錄與這些項目相關的任何收入。我們預計第二季合併調整後 EBITDA 中位數將介於全年合併調整後 EBITDA 的 24% 至 25% 之間。

We expect USPI's EBITDA in the second quarter to be in the range of $24.2 million to 25.25% of our full year USPI adjusted EBITDA at the midpoint.

我們預計 USPI 第二季的 EBITDA 將在 2,420 萬美元至全年 USPI 調整後 EBITDA 中點的 25.25% 之間。

Turning to our cash flow for '25, we continue to expect free cash flows in the range of $1.8 billion to $2.05 billion, distributions to NCI in the range of $750 million to $800 million, resulting in free cash flow after NCI in the range of $1.05 billion to $1.25 billion, all consistent with our initial 2025 guidance.

談到我們 25 年的現金流，我們繼續預期自由現金流在 18 億美元至 20.5 億美元之間，分配給 NCI 的金額在 7.5 億美元至 8 億美元之間，導致 NCI 之後的自由現金流在 10.5 億美元至 12.5 億美元之間，所有這些都與我們最初的指引一致。

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 to 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，我們預計將繼續投資於關鍵的醫院成長機會，包括專注於更高敏銳度的服務產品。第三，我們將評估退休和再融資債務的機會。

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 continue to be active repurchasers of our stock 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 年繼續積極回購我們的股票。

We're pleased with our strong start to the year and are confident in our ability to deliver on our outlook for '25 as we continue to provide high-quality care for those and the communities we serve.

我們對今年的強勁開局感到高興，並有信心我們有能力實現 25 年的願景，因為我們將繼續為我們服務的個人和社區提供高品質的護理。

And with that, we're ready to begin the Q&A.

好了，我們準備開始問答環節了。

Operator?

操作員？

Thank you. At this time, we'll be conducting a question and answer session.

謝謝。這次，我們將進行問答環節。

(Operator Instructions)

（操作員指示）

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hey, good morning. Just a couple of quick ones here. I just wanted to ask you, specifically to understand the posture you're adopting on guidance. But I guess as we think about the first quarter itself, is there anything that you would kind of call out maybe the size of the $40 million of incremental Medicaid supplemental that you frame as potentially as an out-of-period item, that we should think about bridging from Q1 to Q2?

嘿，早安。這裡僅簡單介紹幾個。我只是想問你一下，具體了解你對指導採取的立場。但我想，當我們考慮第一季本身時，您是否可以提及一些事情，例如 4000 萬美元的增量醫療補助補充金，您將其定義為可能超出期外的項目，我們應該考慮將其從第一季度過渡到第二季度？

And then just on USPI, revenue per case growth, the highest we've seen for quite some time in a normal operating environment, despite the total joint case growth being a little bit lower than it was this time last year. Anything you kind of call out there is the driver of sort of the higher acuity, higher revenue intensity and potentially backfilling the total joint growth?

然後僅從 USPI 來看，每例案件的收入增長是我們在正常運營環境下相當長一段時間以來看到的最高水平，儘管總體聯合案件增長比去年同期略低。您所說的任何東西都是提高敏銳度、提高收入強度以及潛在填補整體聯合成長的驅動因素嗎？

Thank you.

謝謝。

Hi, Steve, Saum here. Thanks for the question -- or questions. Number -- on the first point, no, there's nothing else. I mean we're just not addressing guidance this early in the year. We recognize the fundamental outperformance.

你好，史蒂夫，我是山姆。感謝您的提問。數字——關於第一點，沒有，沒有其他了。我的意思是我們不會在今年年初就給予指導。我們認識到基本面的優異表現。

So there are no other items there. On the USPI side, from a revenue per case growth standpoint, three factors, obviously, our contracting platform, acuity, and we continue to take strategic opportunities, in particular, accelerating some of what we've been working on for the last year or two on low-acuity work.

所以那裡沒有其他物品。在 USPI 方面，從每例收入成長的角度來看，顯然有三個因素，我們的承包平台、敏銳度，以及我們繼續抓住策略機遇，特別是加速我們過去一兩年在低敏銳度工作方面所做的一些工作。

And I mean, look, the growth rates on joints and things like that, I mean as the platform gets bigger and bigger, obviously, on a percentage basis, the growth rates will come down a bit. But we're pleased with the joint -- the growth, the continued ongoing march forward in moving the joints into the outpatient setting. As we've said, we think that's a big opportunity this decade.

我的意思是，看看關節和類似東西的成長率，我的意思是，隨著平台越來越大，顯然，從百分比來看，成長率會下降一點。但我們對該關節的發展以及將關節移至門診環境的持續不斷的進步感到滿意。正如我們所說，我們認為這是未來十年的一個巨大的機會。

Craig Hettenbach, Morgan Stanley Investment.

摩根士丹利投資公司的克雷格‧赫滕巴赫（Craig Hettenbach）。

Thank you. For USPI, can you just talk about the pipeline of potential acquisitions and just your confidence of being able to deploy the $250 million in investment?

謝謝。對於 USPI，您能否談談潛在收購的管道以及您對部署 2.5 億美元投資的信心？

Yeah. The pipeline looks good. I mean, $250 million is always kind of a goal range that we put. Obviously, we have been -- well, we've certainly been spending on average, a lot more than that, almost double that because of some of the platforms over the past five, six years.

是的。管道看起來不錯。我的意思是，2.5億美元始終是我們設定的目標範圍。顯然，在過去五、六年裡，由於一些平台的緣故，我們的平均支出肯定遠高於這個數字，幾乎是這個數字的兩倍。

But yes, that's still our goal, and the pipeline looks healthy. The number of de novos look healthy in terms of syndicated centers that will stand up from the ground up. Corollary question that often comes is the multiples aren't really changing very much from where they've been.

但是，是的，這仍然是我們的目標，而且管道看起來很健康。從聯合中心的角度來看，從頭開始建立的新生數量看起來很健康。常出現的必然問題是，倍數其實並沒有太大的變化。

Obviously, our focus is a little bit more on some centers that have the potential for USPI to deploy its service-line diversification capabilities and add things like ortho and whatnot that may not be necessarily part of those centers.

顯然，我們的重點更多地放在一些有潛力讓 USPI 部署其服務線多樣化能力的中心，並添加諸如正畸之類的可能不一定是這些中心的一部分的東西。

But yeah, we feel pretty good. I mean the USPI environment looks great. And again, I'm sure it will come up. But I'll remind you that we don't have as much exposure in that environment to certainly Medicaid. And while the exchanges are certainly relevant there, they're less relevant than the Hospital segment.

但是是的，我們感覺很好。我的意思是 USPI 環境看起來很棒。而我確信它一定會出現。但我要提醒你，在那種環境下，我們對醫療補助的接觸並不多。儘管交易所在那裡確實具有相關性，但它們的相關性不如醫院部分。

Got it, appreciate the call.

明白了，感謝您的來電。

Thanks.

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 question. So maybe I guess I want to follow up actually the first question around just the strength in the quarter. I understand that you want to be conservative and you don't want to [update] all the elements early in the year.

嗨，早安。非常感謝您回答這個問題。所以也許我想我實際上想跟進第一個問題，即本季的實力。我理解您想保守一點，並且不想在年初就更新所有元素。

But just walk us through because the Hospital Segment, where in particular, those margins were much better. And even if you exclude the exclude the $40 million call-out period. So is there something else in that segment that came in much better than internal expectations? Thank you.

但請您向我們介紹一下，因為醫院部門的利潤率尤其高得多。即使排除 4000 萬美元的出診期。那麼，該部分中還有其他內容比內部預期更好嗎？謝謝。

It's Saum again, and Sun can comment just so that we're both consistent on this. I mean we had a good quarter. I mean we had a bunch of things in motion from last year regarding expense management. You can -- maybe you can review some of those statistics. Obviously, as we started to think about various policy changes and other things that could be out there or could be part of the discussion, we were thinking about expense management very carefully coming into 2025.

又是 Saum，Sun 可以發表評論，以便我們雙方對此保持一致。我的意思是我們度過了一個美好的季度。我的意思是，從去年開始我們就在費用管理方面進行了許多工作。您可以—也許您可以查看一些統計數據。顯然，當我們開始考慮各種政策變化以及其他可能出現或可能成為討論一部分的事情時，我們正在非常謹慎地考慮 2025 年的費用管理。

The growth environment has been good. We've been able to accommodate volume without adding a lot of contract labor, where we have been expanding capacity. Our recruiting of staff and nursing has been good. Our retention rates have improved.

成長環境良好。我們已經能夠在不增加大量合約工的情況下滿足產量，並且一直在擴大產能。我們對員工和護理人員的招募一直都很好。我們的保留率已經提高。

Yeah, I don't -- I mean, I know -- I understand the question, is there something else in there? But there's not. It's just we put together three or four good things together in the same quarter, and it ended up generating better results than we might have expected.

是的，我不知道──我的意思是，我知道──我明白這個問題，這裡面還有其他東西嗎？但沒有。我們只是在同一季度將三、四件好事結合在一起，最終產生了比我們預期更好的結果。

Sun?

太陽？

Yeah. I'll just add. Look, the $40 million of out-of-period you mentioned, obviously, that's balanced with about the same amount, $44 million of out-of-period adjustments we had in Q1 of last year. So that's kind of even.

是的。我僅補充一點。你看，你提到的 4000 萬美元的期外調整，顯然與我們去年第一季的 4400 萬美元的期外調整數額大致相等。所以這還算公平。

And then as Saum said, I think it really was operational strength. Our acuity, our payer mix remains strong. Our net revenue per adjusted admissions of 2.8% compares very favorably to our OpEx per adjusted admissions of about 50 bps, I believe, it was.

正如索姆所說，我認為這確實是一種營運實力。我們的敏銳度和付款人組合依然強勁。我認為，我們每調整入院人數的淨收入為 2.8%，與每調整入院人數的營運支出（約 50 個基點）相比非常有利。

And then as Saum said, we are very focused on operating discipline, especially labor. We had an over 200 basis point improvement in SWB in the Hospital segment between Q1 of last year and Q1 of this year. That reflects not only the contract labor discipline, but just a stable wage environment overall as well as other operating discipline from our field force.

正如索姆所說，我們非常注重營運紀律，尤其是勞動力。從去年第一季到今年第一季度，我們在醫院部門的 SWB 提高了 200 多個基點。這不僅反映了合約勞動紀律，也反映了整體穩定的工資環境以及我們現場人員的其他營運紀律。

And then I would say, finally, we remain very focused on our other lines as well. If you look at our supplies, if you look at our other OpEx line items, we've demonstrated some incremental improvement there as well, not just this quarter versus Q1 of last year, but if you look at results, we've been working hard at this quarter-by-quarter making some incremental improvements. So I think all those things have contributed to a very strong Q1.

最後我想說的是，我們仍然非常關注我們的其他產品線。如果您查看我們的供應品，如果您查看我們的其他營運支出項目，我們也已經展示了一些漸進式的改進，不僅僅是本季度與去年第一季度相比，但如果您查看結果，我們一直在努力逐季度取得一些漸進式的改進。所以我認為所有這些因素都促成了第一季的強勁表現。

No, great, thank you.

不，太好了，謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Great. Thanks. Good morning. Yeah, You mentioned a couple of times, obviously, in the first quarter, we saw really tight labor management. I guess, how much more room do you think you can actually improve that labor performance? And then maybe just give us a sense on what types of initiatives you guys have put in place and/or are working on to kind of keep up that level of performance.

偉大的。謝謝。早安.是的，您提到過幾次，顯然，在第一季度，我們看到了非常嚴格的勞動力管理。我想，您認為實際上還能在多大程度上提高勞動績效？然後也許請讓我們了解一下你們已經採取了哪些措施和/或正在努力維持這種績效水準。

Well, if I improve we're referring specifically to the narrow issue of the percentage of contract labor, I'm not sure that necessarily decreasing that further is an improvement, right, because, obviously, there are times where you would utilize contract labor in order to open up capacity for things that you may be doing, which are accretive.

好吧，如果我改進的話，我們指的是合約工比例這個狹隘的問題，我不確定是否有必要進一步降低這一比例才算是一種改進，對吧，因為很明顯，有時候你會利用合約工來為你可能正在做的事情開闢產能，而這些事情是增值的。

So I think what we've said all along was that our strategy was to reduce contract labor, have our full-time employees that provide good care, leverage all the nursing school and other relationships, techs and other things that we built during COVID in order to help train graduates that they might choose to stay within our system and positively impact our retention rates because there's a degree of familiarity there.

因此，我認為我們一直在說的是，我們的策略是減少合約工，讓我們的全職員工提供良好的護理，利用我們在 COVID 期間建立的所有護理學校和其他關係、技術和其他東西，以幫助培訓畢業生，使他們可能選擇留在我們的系統中，並對我們的保留率產生積極影響，因為那裡有一定程度的熟悉度。

And of course, the net consequence of all that is that we can return to following our overall SWB inflation rather than just being focused on the narrow topic of contract labor expenses. So that's kind of the journey that we've been on, as you can imagine and appreciate from our comments over the past couple of years.

當然，所有這些的最終結果是，我們可以重新關注整體的 SWB 通膨，而不是僅僅關注合約工費用這個狹隘的話題。這就是我們所經歷的旅程，正如您可以從我們過去幾年的評論中想像和體會到的那樣。

So I think, look, the important in the next year or two is really on recruiting and retention of the staff necessary to build and grow the business. I think the contract labor is fine where it is.

所以我認為，未來一兩年內最重要的事情是招募和留住建立和發展業務所需的員工。我認為合約工在現有情況下是可以的。

Brian Tanquilut, Jefferies.

傑富瑞的布萊恩‧坦奎魯特 (Brian Tanquilut)。

Good morning guys. This is Meghan Holtz on for Brian. And congrats on the quarter. I guess just picking off Joanna's question on the Hospital business, can you provide some color in the acuity, the payer mix? What drove that revenue per adjusted admission? Some of your peers have spoken to exchange volume growth.

大家早安。我是 Meghan Holtz，為 Brian 報道。恭喜本季取得佳績。我想我只是回答喬安娜關於醫院業務的問題，您能否提供一些關於敏銳度和付款人組合的詳細資訊？是什麼推動了每張調整門票的收入？一些同行談到了交易量的成長。

Are you seeing the same growth? And can you quantify that growth?

您是否看到了相同的成長？您能量化這種成長嗎？

Meghan, thanks for the question. Yes, I think a couple of pieces. I'll repeat our statement that we saw continued acuity strength as well as a strong payer mix. I think if you look at our stats in terms of total managed care as a percent of our net patient revenues, it remains around 70%, very consistent with kind of what we had last year. And then our acuity strategy is, again, very consistent with last year.

梅根，謝謝你的提問。是的，我想有幾件。我重申我們的聲明，我們看到了持續的敏銳度以及強大的付款人組合。我認為，如果您查看我們的統計數據，以整體管理醫療占我們淨患者收入的百分比來看，它仍然保持在 70% 左右，與去年的水平非常一致。我們的敏銳度策略與去年的策略非常一致。

On the exchange growth, we agreed that was a continued strength for us. In Q1 of '25, we saw a 35% increase in exchange admissions. And at this point, our revenues from exchange is about 7% of total consolidated revenues. So a little higher, I think, than fiscal -- where we ended in fiscal '24. And we'll see for the rest of the year, we think the environment continues to be strong across our different payer areas.

關於匯率成長，我們一致認為這是我們持續的優勢。2025 年第一季度，我們的交換生入學人數增加了 35%。目前，我們的交易收入約佔總合併收入的 7%。因此，我認為，這個數字比 24 財年末的水平要高一點。我們將在今年剩餘時間內看到，我們認為不同付款人地區的環境將繼續保持強勁。

And we'll update our guidance as we go.

我們將隨時更新我們的指導。

Justin Blake. Wolf Research.

賈斯汀·布萊克。沃爾夫研究。

Thanks, good morning. Just wanted to follow up on the SWB discussion. It certainly kind of jumped off the page on the Hospital side. Is -- beyond the contract labor, is there anything else special going on in the quarter? And if not, is this a reasonable kind of run rate to be thinking about, whether it's SWB per adjusted admission or the ratio itself?

謝謝，早安。只是想跟進 SWB 討論。它確實在醫院方面引起了關注。除了合約工之外，本季還有其他特殊情況嗎？如果不是，這是否是一個合理的運作率，無論是每次調整入院的 SWB 還是比率本身？

And just to follow up on that, like if it is, what would have to go wrong for you not to materially outperform? I mean it certainly seems like -- I guess the question would be, if you're -- is this ratio what you embedded in your Hospital EBITDA guidance? Or is it running materially better? Thanks.

再進一步問一下，如果是的話，什麼情況會導致你的表現無法大幅超越？我的意思是，這看起來確實像是——我想問題是，如果你——這個比率是你在醫院 EBITDA 指導中嵌入的嗎？或者說它的運作品質是否有所提升？謝謝。

Justin, I mean a couple of things. I mean, we're not really updating guidance, right? I mean there's a few things. Obviously, the more we diversify the business into the Ambulatory side, that helps in terms of the USPI component and in particular, the impact on salary, wages and benefits.

賈斯汀，我指的是幾件事。我的意思是，我們實際上並沒有更新指導，對吧？我的意思是有幾件事。顯然，我們越是將業務多元化到門診方面，就越有助於 USPI 部分的發展，特別是對工資、薪資和福利的影響。

So look, I think, without some discontinuity in the environment, we feel pretty good about the various aspects of labor management that we are undertaking in this environment.

所以，我認為，在環境沒有出現一些不連續性的情況下，我們對在這種環境下進行的勞動力管理的各個方面感覺相當良好。

And at the same time, again, I can't emphasize enough from my perspective, the importance of having our own workforce that knows our physicians and knows our environment. And doing better and better on retention of that staff is a really important part of our strategic goal to expand capacity in a high-quality way. And that's kind of the balance that we're looking for right now.

同時，從我的角度來看，我再一次強調擁有了解我們的醫生和我們的環境的員工隊伍的重要性。越來越好地留住這些員工是我們高品質擴大產能策略目標中非常重要的一環。這就是我們現在尋求的平衡。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Hey guys, Great job this quarter. I guess you're going to see a trend here. I'm going to hit the SMB leverage maybe a slightly different way here. Your average length of stay was down sort of 2.3 days -- percent on a same-store basis. Is that due to flu?

嘿，大家好，本季表現很棒。我想你會在這裡看到一種趨勢。我將在這裡以稍微不同的方式來利用 SMB 槓桿。您的平均停留時間減少了 2.3 天——以同店計算的百分比。那是因為流感嗎？

Or is that just better productivity? As you think about where average length of stay can trend, where do you think we can exit the year?

或者這只是更高的生產力？當您思考平均住院時間的趨勢時，您認為今年的結局會是什麼樣子？

Or is this leverage due to uncompensated care, which looks to be down this quarter, despite revenues going up? It looks like this is due to implicit price concessions and charity write-offs down. So any thoughts around uncompensated care reductions down this year and how that impacts your margins? Thanks.

或者這種槓桿是因為無償照護造成的？儘管收入上升，本季無償照護費用似乎有所下降？看起來這是由於隱性價格優惠和慈善減免造成的。那麼，您對今年無償照護費用的減少有何看法，以及這會對您的利潤產生什麼影響？謝謝。

Well, let's go in reverse order. The uncompensated care piece is not same store, right? I mean, remember, we divested a bunch of assets in many cases that were in markets with less favorable payer mix. So I don't think you can look at that decline necessarily on a same-store type of basis if that helps. Yeah.

好吧，讓我們按相反的順序來。無償照護件不是同一家商店，對嗎？我的意思是，記住，在許多情況下，我們剝離了大量位於付款人結構不太有利的市場的資產。因此，如果有幫助的話，我認為你不一定能從同店類型的角度來看待這種下降。是的。

Sun, you want to take the other--

孫先生，你想拿另一個——

Yeah. So on some of your other questions, look, I mean, on the length of stay, yes, there probably was some flu impact. But I think overall, again, it comes back down to operating discipline and trying to make sure we balance the right patient care as well as our workflows and efficiency, right? So we're working hard on that.

是的。因此，關於您的其他一些問題，看，我的意思是，關於住院時間，是的，可能存在一些流感影響。但我認為總的來說，這又歸結為操作紀律，並試圖確保我們平衡正確的患者護理以及我們的工作流程和效率，對嗎？所以我們正在努力實現這一點。

And then I think your general question around kind of sustainable -- sustainment of kind of the pieces. Look, I think it all comes back on to two things that we mentioned. It's a stable external environment in terms of wages and fees. And then we focused a lot on our operating discipline, which is showing up in our metrics.

然後我認為你的一般性問題是關於永續性——維持某種部分。瞧，我認為這一切都歸結於我們提到的兩件事。從薪資、費用等方面來看，外部環境比較穩定。然後，我們非常注重我們的營運紀律，這體現在我們的指標中。

One final kind of footnote to Saum's answer on the uncompensated care number. I think you're absolutely -- I think Saum's right, it's not same store, so I think that distorts the comparison.

這是對 Saum 關於無償照護數字的回答的最後一種註腳。我認為你完全正確——我認為 Saum 是對的，這不是同一家商店，所以我認為這扭曲了比較。

And then I think, obviously, if you look at the individual line items, while some are going up and some are going down versus '24, you kind of have to take that all together. And if you look at the total uncompensated care percentage as revenues, we've been pretty consistent, '24 to '25. So I don't think that's driving the margins.

然後我認為，顯然，如果你看一下各個項目，你會發現與 24 年相比，有些項目正在上升，有些項目在下降，你必須把它們全部放在一起。如果你將無償照護費用佔總收入的百分比視為收入，那麼從 24 年到 25 年，我們的收入一直相當穩定。所以我不認為這會影響利潤率。

Ben Hendrix, RBC Capital Markets.

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

Great, thank you very much. Just a quick question back to Ambulatory rate growth, the strong 9.1% growth. I appreciate the commentary about the continued mix shift in the M&A towards higher acuity specialties. But just I noticed that one of your ASC peers have started to see in the last couple of quarters a more balanced mix of rate and volume growth overall in the Ambulatory. I'm just wondering, just based on your M&A plans and based on the shift you're seeing towards higher acuity, how persistent do you think this rate momentum is over the next couple of years? Thanks.

太好了，非常感謝。我只想快速問一下門診率的成長，強勁的 9.1% 的成長。我很欣賞關於併購中繼續向更高敏銳度專業領域轉變的評論。但我注意到，您的一位 ASC 同行在過去幾個季度中開始看到門診部的整體費率和數量增長更加均衡。我只是想知道，僅根據您的併購計劃以及您所看到的向更高敏銳度的轉變，您認為這種利率勢頭在未來幾年內會持續多久？謝謝。

Well, I mean, projecting out over the next couple of years on ASC rates is a little bit tough. I mean, I think that if you think about what we have been doing, and it's a fair criticism, by the way, if that's what it is, that our rate guidance has been under what we have been actually achieving for a couple of years, that's fair; our guidance obviously is much more long term in terms of the revenue growth, combination of volume and rate.

嗯，我的意思是，預測未來幾年的 ASC 利率有點困難。我的意思是，我認為如果你想想我們一直在做的事情，這是一個公平的批評，順便說一句，如果情況確實如此，我們的利率指導一直低於我們幾年來實際實現的水平，這是公平的；就收入增長、銷量和利率的組合而言，我們的指導顯然更為長期。

Our near-term impact is driven a lot by what we have been doing around not only growing higher acuity, but at the same time, working actively to create capacity to re-syndicate some of our partnerships and other things with certain low acuity business moving out of the ASC environment. And it took us a while to get that balance right. But I think we've got that balance a lot better.

我們的短期影響很大程度上取決於我們一直以來所做的事情，不僅在於提高敏銳度，而且在於同時積極努力創造能力，重新聯合我們的一些合作夥伴關係和其他事物，將某些低敏銳度業務從 ASC 環境中轉移出來。我們花了一段時間才找到正確的平衡。但我認為我們已經取得了更好的平衡。

And then when you add on top of that the fact that most of what we're doing in the ASC costs 30% to 50% less than the same acute care setting, our contracting strategies have been helpful because there is a desire by all stakeholders to move things into a lower-cost setting, including providing fair rates in the ASC environment, which we've been able to achieve.

然後，如果您再加上這樣一個事實：我們在 ASC 中所做的大部分工作的成本比相同的急性護理環境低​​ 30% 到 50%，我們的承包策略就很有幫助，因為所有利益相關者都希望將事情轉移到更低成本的環境中，包括在 ASC 環境中提供公平的費率，而我們已經實現了這一目標。

So when you put all that together, I don't disagree with the premise at all that we should see momentum on the net revenue per case in the ASC environment for some time to come, and that's a good thing. And that's -- and the ASC should be the leading edge of innovation of getting appropriate higher acuity care into a lower-cost setting.

因此，當你把所有這些放在一起時，我完全不反對這樣的前提，即我們應該在未來一段時間內看到 ASC 環境中每箱淨收入的成長勢頭，這是一件好事。這就是 — — ASC 應該成為創新的前沿，以更低成本的環境提供適當的更高敏銳度的護理。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

Hey, thanks. Saum, when you talked about opening up capacity on the acute care side, just any numbers around this to frame maybe what the year-over-year increase was from those initiatives?

嘿，謝謝。Saum，當您談到開放急性照護方面的能力時，是否有任何數字可以說明這些措施帶來的同比增長？

Well, I think the numbers -- what I was referring to is specifically the same-store hospital growth numbers, included capacity expansion as one of the reasons that they were so robust. I mean, we haven't quantified -- if you're asking how many beds or something like that, we haven't quantified that. Although, to be honest with you, I'm not even sure I can tell you sitting here right now exactly how many beds we opened up.

嗯，我認為這些數字——我指的是同店醫院的成長數字，其中包括容量擴張，這是它們如此強勁的原因之一。我的意思是，我們還沒有量化——如果你問有多少床位或類似的東西，我們還沒有量化。不過，說實話，我現在坐在這裡甚至不確定我能準確地告訴你我們到底開放了多少床位。

Right. Maybe just another question just around USPI and the commentary around physician additions, recruiting efforts. You talked about re-syndication efforts as well. Just wondering if there's anything there share about what those numbers mean in terms of a year-over-year increase versus maybe history?

正確的。也許這只是有關 USPI 以及有關醫生增加和招募工作的評論的另一個問題。您也談到了重新聯合的努力。我只是想知道，就年成長與歷史相比而言，這些數字意味著什麼？

I would say that the physician activity is, on a numbers basis, gross numbers basis; very similar to in the past. I mean the ASC environment is an environment where you have to be constantly engaged in renewing, refreshing and re-syndicating partnerships.

我想說的是，醫生的活動是基於數字、基於總數的；與過去非常相似。我的意思是 ASC 環境是一個你必須不斷參與更新、刷新和重新聯合合作夥伴關係的環境。

What I was referring to before on the re-syndication piece directly tied to the commentary about net revenue per case is that sometimes, that's a specialty shift, right? I mean, in many ASCs, you're renewing, refreshing, et cetera, the same specialties. But if you're making service line shifts and transitions towards higher acuity, you may be re-syndicating with different specialists than were in the ASCs before, and that's what I was referring to.

我之前提到的重新聯合發布部分與關於每箱淨收入的評論直接相關，有時這是一種專業轉變，對嗎？我的意思是，在許多 ASC 中，您正在更新、刷新相同的專業等等。但是，如果您正在進行服務線的轉變並向更高的敏銳度過渡，您可能會與先前 ASC 中的不同專家重新聯合，這就是我所指的。

And that obviously takes a lot more work to get done. You have to identify new individuals, perhaps new practices that join an existing ASC versus simply working with your existing practices to add doctors when they may have retirements or departures or whatever the case may be.

顯然，這需要做更多的工作才能完成。您必須找到新的人員，也許是加入現有 ASC 的新診所，而不是簡單地與現有診所合作，在醫生退休或離職或出現其他情況時增加醫生。

So it's -- the service line transition work that we've undertaken in the last few years, it's a lot of work. And it's -- and again, as you know, we -- took us a while to get admittedly the balance right and how we've been doing it.

所以，我們在過去幾年中所進行的服務線轉型工作非常艱鉅。而且 — — 而且正如你所知，我們 — — 花了一段時間才找到正確的平衡，以及我們是如何做到這一點的。

We feel much better about it now. It's been much more consistent for the last couple of years, and it's driving earnings growth above our expectations and above USPI's long-term trends, which is terrific because it's a momentum driver for that business.

現在我們感覺好多了。過去幾年，這種趨勢更加穩定，推動獲利成長超出了我們的預期，也超出了 USPI 的長期趨勢，這非常棒，因為它是該業務的動力驅動力。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

Hi, good morning, thank you. Again, I want to focus on the Q1 beat because it was so meaningful. I know you said that it was better than your internal expectations. Can you just go through what was the main driver, what surprised you most about the quarter internally? And also, I get this question a lot. Just because the macroeconomic environment is very volatile, people are concerned about a recession.

你好，早安，謝謝。再次強調，我想專注於第一季的業績，因為它意義重大。我知道您說這比您內心的預期要好。能否簡單介紹一下主要的驅動因素是什麼？本季最讓您感到驚訝的是什麼？而且，我常被問到這個問題。正是因為宏觀經濟環境非常不穩定，人們才會擔心經濟衰退。

Do you think there is any type of, like, front-loading of volumes if people are worried that they may lose their jobs? Thanks.

如果人們擔心自己可能會失去工作，您認為是否有任何形式的預先加載？謝謝。

Do you want to take the first part and then--

你想先看第一部分，然後──

Ann, I'll take the first part and then hand off to Saum. On the Q1 beat, listen, I mean, I think we've covered a lot of the dynamics that we talked about in terms of what we assumed in our guidance versus where we're showing up. I mean, obviously, we mentioned before the strength in exchange patients growing 35% admissions. We weren't quite sure how -- what that number would be in Q1. We figured it would be relatively strong. But again, compared to last year, we expect it to go down.

安，我先負責第一部分，然後交給索姆。關於第一季的進展，聽著，我的意思是，我認為我們已經涵蓋了許多我們所討論的動態，包括我們在指導中假設的情況以及我們所出現的情況。我的意思是，顯然，我們之前提到過，交換病患的入院人數增加了 35%。我們不太確定第一季的數字會是多少。我們認為它會相對強勁。但與去年相比，我們預計這一數字還會下降。

So we weren't quite sure how that would turn up, but we were very pleased to see that. And I think that's reflective of not only the coverage and payer environment, but also of our continued networking strategy of being brought access to the east exchange population. So I think we're pleased to see that. Other than that, I don't know that we have anything else that we haven't covered already.

所以我們不太確定結果會怎樣，但我們很高興看到這一點。我認為這不僅反映了覆蓋範圍和付款人環境，也反映了我們持續的網路策略，即為東部交易所的人口提供存取服務。所以我認為我們很高興看到這一點。除此之外，我不知道我們還有什麼尚未涉及的內容。

So I'll hand off back to Saum on the other questions.

因此我將把其他問題交還給 Saum。

Yeah, I don't -- I mean, I don't know -- how can one tell honestly if there's a surge in demand that's coming? I mean we don't necessarily see in our, for example, our physician practice offices or other things. significant changes. Sometimes you see changes at USPI and cancellation rates and other things. We haven't really seen much of a difference there.

是的，我不知道——我的意思是，我不知道——如何誠實地判斷未來是否會出現需求激增？我的意思是，我們不一定能在例如我們的醫生診所或其他地方看到。重大變化。有時您會看到 USPI 和取消率以及其他方面的變化。我們確實沒有看到太大的差異。

I don't know that there's anything I could point to, to affirmatively say that people are trying to utilize their coverage out of a fear of losing it. I don't -- we probably have to think a little bit more about how to track some things that might give us a sense that, that's happening.

我不知道我能指出什麼來肯定地說人們試圖利用他們的保險是因為害怕失去它。我不知道——我們可能需要多想如何追蹤一些可能讓我們感覺到正在發生的事情。

Benjamin Rossi, JP Morgan Chase.

摩根大通的班傑明‧羅西。

So I appreciate the unknown here. But regarding tariffs, we've been getting some commentary from your peers on framing exposure on finished goods supply spend, particularly outside of the US. Do you have any additional context on framing there? And maybe how much of your supply spend would be off-contract or direct manufacturers? And then beyond scope of supply, are there any differences in your procurement setup between Ambulatory and Hospital?

所以我很欣賞這裡的未知。但關於關稅，我們從您的同行那裡得到了一些關於構建成品供應支出風險敞口的評論，特別是在美國以外。您對此框架還有什麼補充資訊嗎？也許您的供應支出中有多少是來自合約外或直接製造商？那麼，除了供應範圍之外，門診和醫院的採購設定有什麼區別嗎？

Yes. No. Thanks for the question. And I think just -- I mean, remember, we are active members of HealthTrust, and that's true not just on the Hospital business, but you can imagine at our scale where the anchor client on the ambulatory surgery side as well and well engaged with the other peers and partners, who also are in the ASC business.

是的。不。謝謝你的提問。我認為——我的意思是，請記住，我們是 HealthTrust 的活躍成員，這不僅適用於醫院業務，而且你可以想像，在我們的規模下，門診手術方面的主要客戶也與 ASC 業務中的其他同行和合作夥伴保持著良好的互動。

So there is no separation between Tenet and USPI and our engagement with HealthTrust. And no, we don't have any commentary to add. I mean, the numbers that you have heard are -- in terms of the supply spend base, the location of where it's coming from, the pharmaceuticals points, all the same, no different.

因此，Tenet 與 USPI 以及我們與 HealthTrust 的合作之間沒有任何區別。不，我們沒有任何要添加的評論。我的意思是，您聽到的數字——就供應支出基數、來源地、藥品點而言，都是一樣的，沒有什麼不同。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Hi everybody, thanks. I make, I understand that you don't want to sort of quantify things that are unknown, that are being discussed in Washington. But as I think about and see commentary from nonprofit peers, we see some nonprofits saying they're putting in hiring freeze, so they get clarity. Others are saying they're looking at their capital budgets.

大家好，謝謝。我知道，我明白你不想量化那些未知的事情，那些正在華盛頓討論的事情。但當我思考並看到非營利組織同行的評論時，我們看到一些非營利組織表示他們正在凍結招聘，因此他們得到了明確的答案。其他人則表示他們正在審視資本預算。

I wondered if you could comment -- obviously, you've got the public exchange, the supplemental payment questions related to provider tax, even some discussion about site-neutral payments. Are there contingency plans that you make at this point? Do you sort of just have to sit back and see what happens? Or how do you guys think about getting in front of any of that? Or is it affecting in any way your business?

我想知道您是否可以發表評論——顯然，您有公開交流、與提供者稅相關的補充付款問題，甚至一些關於網站中立付款的討論。您目前有訂定應急計畫嗎？您是否只需要坐下來看看會發生什麼？或者你們如何看待解決這些問題？或者它以某種方式影響了您的業務？

And then I will throw in there specifically in managed care contracting. Do you approach that differently? Do they approach it differently? I know you typically do three year deals. Is there any thought that maybe we should take a little more narrow focus until there's some clarity?

然後我將特別討論管理式醫療承包。您對此有何不同看法？他們採用不同的方法嗎？我知道你們通常簽三年合約。有沒有想過，也許我們應該把焦點再縮小一點，直到問題變得明朗？

Any thoughts along those lines would be helpful.

任何類似的想法都會有幫助。

Sure, A.J. Thanks for the question. So let's just -- I mean, I'll just say let's just step back, right? Our -- coming into this year, regardless of the policy uncertainty, I think the best way to frame the answer to this question is, have we changed our priorities or have we added to our priorities? And I would argue it's the latter.

當然，A.J.謝謝你的提問。所以讓我們——我的意思是，我只想說讓我們退一步，對吧？進入今年，無論政策如何不確定，我認為回答這個問題的最佳方式是，我們是否改變了我們的優先事項，還是增加了我們的優先事項？我認為是後者。

And our number one priority going into this year was to build off of what was a strong utilization environment in 2024 with us having significant outperformance of our expectations and carrying that into 2025, both through our capital initiatives, our growth prospects and acquisitions at USPI and the capacity expansion in the markets where we thought we still had beds that we could open up as we could accommodate that without excessive contract labor. So that still remained priority 1, okay?

我們今年的首要任務是鞏固 2024 年強勁的利用率環境，目前我們的業績遠超預期，並將這種勢頭延續到 2025 年，這包括透過資本計劃、USPI 的成長前景和收購，以及在我們認為仍有床位可以開放的市場進行產能擴張，因為我們可以在不增加合約工的情況下滿足這些需求。所以這還是第一要務，好嗎？

Priority 2 was the cost control. And in particular, it had to do with what I've talked about earlier, which is labor. And now, I would say, what we've added to that is a much tighter look and initiation of some actions on the supply side to tighten up our utilization, where it's possible to do so in advance of any theoretical tariff business or whatever may come to pass. And that's kind of priority number two.

第二要務是成本控制。具體來說，這與我之前談到的勞動力有關。現在，我想說，我們在此基礎上進行了更嚴格的審查，並在供應方面採取了一些行動來提高我們的利用率，我們可以在任何理論關稅業務或任何可能發生的情況之前這樣做。這是第二要務。

Priority number 3 has been engaging as constructively as possible in the discussion in Washington, both through our various agencies that we work with, but more importantly, in my view, directly, as myself and selected other leaders have been doing in order to shape the dialogue about the potential impact of cuts.

第三大優先事項是盡可能建設性地參與華盛頓的討論，這既透過我們合作的各個機構進行，但更重要的是，我認為，直接參與，就像我和其他一些領導人所做的那樣，以引導有關削減潛在影響的對話。

I mean I've said this publicly before, and I'll do so a little bit more in the coming weeks, in other forums, the polling is very clear about how the public all over the country feels about the importance of the exchange tax subsidy extensions and Medicaid. And when I -- others are sharing it, I'll share it here in a couple of weeks, that what we found in our work, it's really important insight about how much support there is for these programs and for health care coverage for people. So that's been priority number three.

我的意思是，我之前已經公開說過這一點，並且在接下來的幾週內，我會在其他論壇上更多地談論這一點，民意調查非常清楚地表明了全國各地的公眾對延長稅收補貼和醫療補助的重要性的看法。當我——其他人分享它時，我會在幾週後在這裡分享，我們在工作中發現，關於這些項目和人們的醫療保險獲得了多少支持，這是一個非常重要的見解。所以這是第三要務。

So priority number 4 has been contingency planning. We haven't really moved that up the list yet. Of course, we're contingency planning. Look, we did a good job during COVID, which was a shock to the system, and we'll do it again if we need to.

因此，第四大優先事項是應急計劃。我們還沒有真正將其提升到清單的頂部。當然，我們正在製定應急計劃。你看，我們在 COVID 期間做得很好，這對系統是一個衝擊，如果需要的話，我們會再做一次。

But we're not moving that up to priority number one, number two or number three right now because we still believe that our operating platform can receive and accept all patients that need care and do it in an accretive manner. And so the growth is still an important way to go. If there is some shock that comes out of Washington, obviously, priority 4 may move up in terms of our list, but it is not there right now.

但我們現在不會將其提升為第一、第二或第三優先事項，因為我們仍然相信我們的營運平台可以接收所有需要護理的患者，並以累積的方式進行。因此，成長仍然是一條重要的道路。如果華盛頓出現一些令人震驚的事情，那麼顯然，第四個優先事項可能會在我們的名單上上升，但目前它還不在那裡。

On your other question about managed care, look, I think in -- it's -- the contract renewal cycles come up in various sequences. They tend to be, as you said, three year potential deals. I don't see a whole lot of reason if you're negotiating fair contracts and partnerships with the plans to be looking at different time frames to create a [bunch] of uncertainty every year from that perspective.

關於您關於管理式醫療的另一個問題，我認為—合約續約週期有各種不同的順序。正如您所說，它們往往是三年的潛在交易。從這個角度來看，如果你正在談判公平的合約和合作夥伴關係，並且計劃考慮不同的時間框架以每年製造大量不確定性，那麼我認為沒有太多理由。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, You delivered another quarter of double-digit same-store growth in total joints. I think you've done that almost every quarter since you started disclosing that a few years ago. Can you give us a sense for how that market has evolved over the last five years or so in terms of eligible population or penetration of total seniors? And where do you think those numbers can go? Thanks.

您好，您在本季再次實現了同店銷售額兩位數的成長。我認為自從幾年前開始披露這項資訊以來，幾乎每個季度你都會這樣做。您能否向我們介紹一下過去五年來該市場在符合條件的人口或老年人整體滲透率方面是如何發展的？您認為這些數字將會如何改變？謝謝。

Yeah. Well, there's still a lot of HOPD work that goes on there, that isn't really due to comorbidities or other sorts of things, right? It's -- I mean there are people that have active HOPD strategies, and then they're just physicians that are less comfortable in a non-hospital environment. And then you have, of course, in some markets more than others; high quantities of employed orthopedic surgeons that aren't really allowed to invest in ambulatory surgery platform.

是的。嗯，那裡仍然有很多 HOPD 工作在進行，這並不是因為合併症或其他原因，對嗎？我的意思是，有些人有積極的 HOPD 策略，但他們只是在非醫院環境中不太適應的醫生。當然，在某些市場，你的收入會比其他市場更高；大量受僱的骨科醫生實際上不允許投資門診手術平台。

So there's still a lot of runway here to move these kinds of procedures into lower-cost settings. Obviously, combining that with getting trainees in orthopedics more exposed to same-day type of settings is an important piece of this. And obviously, the insurers creating incentives to do so is important from that perspective as well. And part of that incentive is you've got to compensate adequately for that outpatient care because it's so much lower cost than a hospital setting.

因此，我們仍有很大的發展空間將這些類型的程序轉移到成本較低的環境。顯然，將這一點與讓骨科實習生更多地接觸當日類型的環境結合起來是其中的一個重要部分。顯然，從這個角度來看，保險公司創造激勵措施也很重要。而這種激勵措施的一部分就是你必須對門診護理進行充分的補償，因為它的成本比醫院低得多。

So I think when the issues move from all of these various things in the [milieu] to only the clinical care considerations, which is who's appropriate for what setting, we'll know that the shift is complete. We're not there yet right? We're kind of halfway through that process, and there's still runway to go.

因此，我認為，當問題從[環境中]的各種事物轉移到僅有臨床護理考慮因素（即誰適合什麼環境）時，我們就會知道轉變已經完成。我們還沒到那裡吧？我們已經完成了一半的流程，但仍有很長的路要走。

Josh Raskin, Nephron Research.

Josh Raskin，Nephron Research。

Thanks for fitting me in. I guess I want to take the margins from maybe a more optimistic view. So even excluding the $40 million retro payment, the Hospital margins were, call it, 17%; so do you think there's additional room for margin expansion there on the acute care side? I mean, you've seen almost a doubling over the last decade. And maybe what sort of volumes would you need to get there? And what areas do you still think there's operating leverage?

謝謝你幫我安排。我想我想從更樂觀的角度來看利潤。因此，即使不包括 4000 萬美元的追溯支付，醫院的利潤率也只有 17%；那麼，您認為急性護理方面還有額外的利潤增長空間嗎？我的意思是，在過去十年裡，這數字幾乎翻了一番。也許你需要什麼樣的數量才能到達那裡？您認為哪些領域仍有經營槓桿？

Yeah, Josh, thanks for the question. I mean look, we always operate with a mindset that there's margin expansion potential. The drivers of the margin expansion, obviously, in the Hospital segment as a whole entity are multifield, right? One is just we've instituted in Tenet and hardwired now significantly more operating discipline over the last few years than existed prior, that helps.

是的，喬希，謝謝你的提問。我的意思是，我們始終以利潤率有擴大潛力的心態來經營。顯然，醫院部門整體利潤率擴大的驅動因素是多領域的，對嗎？一是我們在 Tenet 中製定並嚴格執行了比以前更加嚴格的營運紀律，這很有幫助。

Our controls around utilization and other things are much, much more data driven. So while we started them top down during COVID, based upon that data-driven environment, just the operators have a chance to react much more quickly and nimbly.

我們對利用率和其他方面的控制更多是由數據驅動的。因此，雖然我們在 COVID 期間自上而下地啟動了這些工作，但基於數據驅動的環境，操作員才有機會更快、更靈活地做出反應。

Payer mix over the last few years has improved. You can't escape the fact that the exchanges have been a supportive environment. We didn't know what would happen with redetermination. It ended up being accretive to revenue and margins from that perspective. And of course, we've also had the benefit of portfolio transformation on the Hospital business, where on average, slightly lower-margin facilities were divested versus the remaining portfolio.

過去幾年付款人結構有所改善。你無法逃避這樣一個事實：交易所一直是一個支持性的環境。我們不知道重新確定後會發生什麼事。從這個角度來看，它最終會增加收入和利潤。當然，我們也受惠於醫院業務的投資組合轉型，平均而言，與剩餘的投​​資組合相比，利潤率略低的設施被剝離。

And then the operating leverage in the future comes from better cost structure in labor, better standardization of the supply environment. And as I've said all along for many years, we have had a focus on asset utilization, which continuing to build and grow the business to improve our asset utilization will continue to improve, hopefully, margins, all other things being equal. And so that's kind of what we focus on.

未來的經營槓桿來自於更好的勞動成本結構、更好的供給環境標準化。正如我多年來一直所說的那樣，我們一直專注於資產利用率，在其他條件相同的情況下，繼續建立和發展業務以提高我們的資產利用率將繼續提高利潤率。這就是我們所關注的重點。

And again, that gets back to also, Josh, just to A.J.'s question around priorities. That's why our priorities right now are still in this environment to continue to build and grow the business rather than of any kind of retreat yet.

再一次，這又回到了喬希 (Josh) 提出的關於 A.J. 優先事項的問題。這就是為什麼我們目前的首要任務仍然是在這種環境下繼續建立和發展業務，而不是採取任何形式的撤退。

That's perfect. Thanks.

那很完美。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。現在您可以斷開線路，感謝您的參與。