Tenet Healthcare Corp (THC) 2025 Q2 法說會逐字稿

Good morning. Welcome to Tenet Healthcare second quarter 2025 earnings conference call. (Operator Instructions)

早安.歡迎參加 Tenet Healthcare 2025 年第二季財報電話會議。（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，您可以開始了。

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 second quarter 2025 results as well as a discussion of our financial outlook. Tenant 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.

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 年第二季的業績以及我們的財務前景。參加今天電話會議的租戶高級管理人員包括董事長兼首席執行官 Saumya Sutaria 博士和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. Tenet is under no obligation to update any forward-looking statements based on subsequent information.

我們今天早上的網路直播包含一份幻燈片演示，已發佈在我們網站 tenethealth.com 的投資者關係板塊。請收聽本次電話會議的聽眾注意，我們今天討論中的某些陳述具有前瞻性，代表了管理層基於現有資訊的預期。實際結果和計劃可能會有重大差異。Tenet 沒有義務根據後續資訊更新任何前瞻性聲明。

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.

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向美國證券交易委員會提交的 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. The second quarter continues our track record of strong outperformance in each of our businesses. We reported second quarter 2025 net operating revenues of $5.3 billion and consolidated adjusted EBITDA of $1.121 billion, which represents growth of 19% over 2024. Second quarter 2025 adjusted EBITDA margin of 21.3% represents a 280 basis point improvement over the prior year, driven by strong same-store growth and very efficient operating performance. .

謝謝你，威爾，大家早安。第二季度，我們各項業務持續保持強勁表現。我們報告 2025 年第二季淨營業收入為 53 億美元，合併調整後 EBITDA 為 11.21 億美元，比 2024 年成長 19%。2025 年第二季調整後的 EBITDA 利潤率為 21.3%，比上年同期提高了 280 個基點，這得益於強勁的同店成長和高效的營運表現。。

USPI continues to deliver. We generated $498 million in adjusted EBITDA, which represents 11% growth over second quarter 2024. Same-facility revenues grew 7.7% in the second quarter, highlighted by a 12.6% growth in total joint replacements in the ASCs over the prior year.

USPI 繼續提供服務。我們的調整後 EBITDA 為 4.98 億美元，比 2024 年第二季成長 11%。第二季同店營收成長了 7.7%，其中 ASC 的關節置換總量較上年增加了 12.6%。

We added eight new centers in the quarter, including facilities specializing in high acuity procedures such as spine, orthopedics, and neurosurgery. We continue to see a robust pipeline for M&A opportunities and expect to exceed our baseline intention for $250 million of M&A spend in 2025.

我們在本季增加了八個新中心，包括專門從事脊椎、骨科和神經外科等高敏銳度手術的設施。我們繼續看到強勁的併購機會，並預計 2025 年併購支出將超過我們 2.5 億美元的基本目標。

Turning to our hospital segment. Adjusted EBITDA grew 25% to $623 million in the second quarter of 2025. Same-store hospital admissions were up 1.6% in the quarter. Second quarter 2025 revenue per adjusted admission was up 5.2% over the prior year as payer mix and acuity remained strong.

轉向我們的醫院部門。2025 年第二季調整後 EBITDA 成長 25%，達到 6.23 億美元。本季同店住院人數增加了 1.6%。由於付款人結構和敏銳度保持強勁，2025 年第二季每張調整後入院收入比上年增長 5.2%。

We are making significant investments to expand our network to support growth in our markets and have confidence that the demographic trends are high acuity service line priorities and our efficient operating platform can generate ongoing returns in this segment. We have also reduced overhead given we downsized our hospital portfolio.

我們正在大力投資擴展網絡，以支持市場成長。我們堅信，人口結構趨勢是高風險族群服務線的優先事項，而我們高效的營運平台則能夠在這一領域持續創造回報。由於醫院組合規模縮減，我們的管理費用也隨之降低。

Our results in both segments exceeded our expectations and extend our track record of consistently strong fundamental execution. We continue to capitalize on our compelling valuation and have deployed $1.1 billion to repurchase 7.2 million shares in the first half of 2025. As we noted in our release, the Board of Directors has authorized a $1.5 billion increase to our share repurchase program.

我們在這兩個領域的業績超出了我們的預期，並延續了我們一貫強勁的基本執行記錄。我們繼續利用我們極具吸引力的估值，並已部署 11 億美元在 2025 年上半年回購 720 萬股股票。正如我們在新聞稿中指出的那樣，董事會已批准將我們的股票回購計畫增加 15 億美元。

Turning to our full year guidance. At this point in the year, we are raising our full year 2025 adjusted EBITDA guidance to a range of $4.4 billion to $4.54 billion which represents an increase of $395 million or 10% roughly at the midpoint of the range of our prior guidance. The guidance increase is supported by fundamental strength in our businesses and expectations for continued growth.

談到我們的全年指導。目前，我們將 2025 年全年調整後 EBITDA 預期上調至 44 億美元至 45.4 億美元之間，這相當於增加 3.95 億美元或 10%，大致處於我們先前預期範圍的中點。指導價的成長得益於我們業務的基本實力和持續成長的預期。

In summary, we continue to deliver on our commitment to a strong balance sheet and significantly improved free cash flow generation. Finally, in closing, we are committed to a culture of quality, transparency and compliance. This culture permeates our business and is reflected in the dedication of our colleagues and caregivers that go to work each day to care for our patients and communities that we serve. We are pleased that these are the values that we have instilled into our organization, which continue to drive results and outperformance.

總之，我們將繼續履行對強勁資產負債表和顯著改善自由現金流產生的承諾。最後，我們致力於打造優質、透明和合規的文化。這種文化滲透到我們的業務中，並體現在我們同事和護理人員的奉獻精神上，他們每天辛勤工作，照顧著我們服務的患者和社區。我們很高興這些價值觀已融入我們的組織，並持續推動我們取得成果和卓越績效。

And with that, Sun will provide a more detailed review of our financial results. Sun, turning it over to you.

屆時，Sun 將對我們的財務表現進行更詳細的回顧。現在輪到你了。

Thank you, Saum, and good morning, everyone. We delivered strong results in second quarter of 2025 with adjusted EBITDA 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. We generated total net operating revenues of $5.3 billion and consolidated adjusted EBITDA of $1.21 billion, a 19% increase over second quarter 2024. Second quarter adjusted EBITDA margin was 21.3%, a 280 basis point improvement over prior year.

謝謝你，Saum，大家早安。2025 年第二季度，我們取得了強勁的業績，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、有利的付款人組合以及有效的成本控制。我們創造了 53 億美元的總淨營業收入和 12.1 億美元的合併調整後 EBITDA，比 2024 年第二季成長 19%。第二季調整後的 EBITDA 利潤率為 21.3%，比去年同期提高了 280 個基點。

I would now like to highlight some key items for each of our segments, beginning with USPI, which again delivered strong operating results. In the second quarter, USPI's adjusted EBITDA grew 11% over last year, with adjusted EBITDA margin at 39.2%. USPI delivered a 7.7% increase in same-facility system-wide revenues, with net revenue per case up 8.3% and case volumes down 0.6%, reflecting our continued disciplined shift towards higher acuity services.

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。第二季度，USPI 的調整後 EBITDA 較去年同期成長 11%，調整後 EBITDA 利潤率為 39.2%。USPI 的同設施全系統收入增長了 7.7%，每例淨收入增長了 8.3%，病例數量下降了 0.6%，這反映了我們持續有紀律地轉向更高敏銳度的服務。

Turning now to our hospital segment. Second quarter adjusted EBITDA was $623 million, with margins up 300 basis points over last year at 15.6%. Same-hospital inpatient admissions increased 1.6% and revenue per adjusted admissions grew 5.2%. Our consolidated salary wages and benefits was 41% of net revenues, a 140 basis point improvement from the prior year. And our contract labor expense was 1.9% of consolidated SWB expense.

現在轉向我們的醫院部分。第二季調整後的 EBITDA 為 6.23 億美元，利潤率較去年同期上漲 300 個基點，達到 15.6%。同一家醫院的住院人數增加了 1.6%，每例調整後入院收入增加了 5.2%。我們的綜合薪資和福利佔淨收入的 41%，比前一年提高了 140 個基點。我們的合約勞務費用佔合併 SWB 費用的 1.9%。

This improvement has been driven by our data-driven approach to capacity and labor management and disciplined operating expense controls. Finally, we recognized a $79 million favorable pretax impact for additional Medicaid supplemental revenues related to prior periods in the second quarter of 2025. This includes the recently approved program in Tennessee. As a reminder, our second quarter 2024 results included a $30 million favorable pretax impact for additional Medicaid supplemental revenues related to prior year.

這項改進得益於我們以數據為驅動的產能和勞動力管理方法以及嚴格的營運費用控制。最後，我們確認，與 2025 年第二季前期相比，額外的醫療補助補充收入產生了 7,900 萬美元的稅前有利影響。其中包括田納西州最近批准的計劃。提醒一下，我們 2024 年第二季的業績包括與上一年相關的額外醫療補助補充收入的 3,000 萬美元稅前有利影響。

Next, we will discuss our cash flow, balance sheet, and capital structures. We generated $743 million of free cash flow in the second quarter. And as of June 30, 2025, we had $2.6 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.

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。我們在第二季產生了 7.43 億美元的自由現金流。截至 2025 年 6 月 30 日，我們手頭上有 26 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。

And finally, during the second quarter, we repurchased 4.6 million shares of our stock for $747 million. And year-to-date through June 30, we have repurchased 7.2 million shares or $1.1 billion. Our leverage ratio as of June 30, 2025, was 2.45 times EBITDA or 3.11 times EBITDA less NCI, driven by our outstanding operational performance and continued focus on financial discipline.

最後，在第二季度，我們回購了460萬股股票，價值7.47億美元。今年迄今截至 6 月 30 日，我們已回購 720 萬股，價值 11 億美元。截至 2025 年 6 月 30 日，我們的槓桿率為 EBITDA 的 2.45 倍或 EBITDA 減去 NCI 的 3.11 倍，這得益於我們出色的營運表現和對財務紀律的持續關注。

We are very pleased with our ongoing cash flow generation capabilities and remain committed to a deleveraged balance sheet. We believe we have significant financial flexibility to support our capital allocation priorities and drive shareholder value.

我們對持續的現金流產生能力感到非常滿意，並將繼續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. For 2025, we now expect consolidated net operating revenues in the range of $20.95 billion to $21.25 billion, an increase of $300 million over prior expectations. As Tom mentioned, we are raising our 2025 adjusted EBITDA outlook by $395 million at the midpoint to $4.4 billion to $4.54 billion, reflecting the strong fundamental performance of our business.

現在讓我談談我們對 2025 年的展望。對於 2025 年，我們目前預計合併淨營業收入將在 209.5 億美元至 212.5 億美元之間，比先前的預期增加 3 億美元。正如湯姆所提到的，我們將 2025 年調整後的 EBITDA 預期中位數上調 3.95 億美元，至 44 億美元至 45.4 億美元，這反映了我們業務強勁的基本表現。

At the midpoint of our range, we now expect our full year 2025 adjusted EBITDA to grow 12% over 2024. At USPI, we are now expecting 2025 adjusted EBITDA of $1.99 billion to $2.05 billion, a $70 million increase over prior expectations. In addition, we have increased our assumption for same-facility USPI revenue growth by 100 basis points to 4% to 7% for 2025. In hospitals, we are raising our '25 adjusted EBITDA outlook range by $325 million at the midpoint to $2.41 billion to $2.49 billion.

在我們的範圍中點，我們現在預計 2025 年全年調整後的 EBITDA 將比 2024 年成長 12%。在 USPI，我們現在預計 2025 年調整後的 EBITDA 為 19.9 億美元至 20.5 億美元，比之前的預期增加 7,000 萬美元。此外，我們將同設施 USPI 收入成長預期提高了 100 個基點，至 2025 年的 4% 至 7%。在醫院方面，我們將 25 年調整後的 EBITDA 預期範圍中位數上調 3.25 億美元，至 24.1 億美元至 24.9 億美元。

Additionally, we are lowering our assumption for same-hospital adjusted admissions growth by 50 basis points to 1.5% to 2.5% for 2025. Finally, we expect third quarter 25 consolidated adjusted EBITDA to be in the range of 22.5% to 23.5% of our full year consolidated adjusted EBITDA at the midpoint. We expect third quarter 2025 USPI EBITDA to be in the range of 23.5% to 24.5% of our full year USPI adjusted EBITDA at the midpoint.

此外，我們將同院調整入院人數成長預期下調 50 個基點，至 2025 年的 1.5% 至 2.5%。最後，我們預計第三季合併調整後 EBITDA 將介於全年合併調整後 EBITDA 的 22.5% 至 23.5% 之間。我們預計 2025 年第三季 USPI EBITDA 將處於我們全年 USPI 調整後 EBITDA 中位數的 23.5% 至 24.5% 之間。

Turning to our cash flows for 2025. We now expect free cash flows in the range of $2.025 billion to $2.275 billion. Distributions to noncontrolling interest in the range of $780 million to $830 million, resulting in free cash flow after NCI in the range of $1.245 billion to $1.445 billion, an increase of $195 million at the midpoint of our range from prior outlook.

轉向我們 2025 年的現金流。我們現在預計自由現金流將在 20.25 億美元至 22.75 億美元之間。分配給非控制權益的金額在 7.8 億美元至 8.3 億美元之間，導致非控制權益後的自由現金流在 12.45 億美元至 14.45 億美元之間，以我們先前預測的中位數計算，增加了 1.95 億美元。

Turning now to our capital deployment priorities, we are well positioned to create value for shareholders through the effective deployment of free cash flow and our priorities have not changed. First, we will continue to prioritize capital investments to grow USPI through M&A. Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings.

現在談談我們的資本部署重點，我們已做好準備，透過有效部署自由現金流為股東創造價值，我們的重點沒有改變。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，以推動有機成長，包括我們對更高敏銳度服務產品的關注。

Third, we will evaluate opportunities to retire and or refinance debt. And finally, we'll continue to have a balanced approach to share repurchases, depending on market conditions and other investment opportunities.

第三，我們將評估償還債務或再融資債務的機會。最後，我們將繼續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。

As Tom noted, our Board of Directors has recently authorized a $1.5 billion increase to our share repurchase program. We continue to deliver consistent growth and have disciplined operations, which has translated into outstanding financial results. We are confident in our ability to deliver on our increased outlook for 2025 as we continue to provide high-quality care for those in the communities we serve.

正如湯姆所指出的，我們的董事會最近批准將我們的股票回購計畫增加 15 億美元。我們繼續保持持續成長並嚴格運營，這轉化為出色的財務表現。我們有信心，我們有能力實現我們對 2025 年更高展望的目標，因為我們將繼續為我們服務的社區提供高品質的照護。

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

好了，我們現在可以開始問答環節了。操作員？

(Operator Instructions)

（操作員指示）

AJ Rice, UBS.

瑞銀的 AJ Rice。

Hi everybody, I might just ask about two aspects of the backdrop in Washington. The proposed rule on outpatient hospital care as the elimination of potentially of the inpatient-only rule. Can you just comment on what you think that might mean for your hospital and ASC business if that were to go through?

大家好，我可能只想問華盛頓背景的兩個面向。關於門診醫院護理的擬議規則可能會取消僅限住院的規則。您能否評論一下，如果這項計劃得以實施，這對您的醫院和 ASC 業務意味著什麼？

And then just any updated figures on the public exchange volumes, how that contributed to the quarter, what you're seeing year-to-year? And do you have any updated thoughts on what the outlook for next year might be if the enhanced subsidies go away?

那麼，有沒有關於公共交易量的最新數據，這對本季有何貢獻，與去年同期相比又有何變化？如果取消增強型補貼，您對明年的前景有何最新看法？

AJ, it's Saum. So thanks for the questions. The first one, obviously, enabling additional innovation in the ASCs is positive for the USPI business. I think about it this way, which is one is the reimbursement -- allowable reimbursement and certainly, this move is positive.

AJ，我是 Saum。感謝您的提問。第一個顯然是，在 ASC 中實現更多創新對 USPI 業務有利。我是這樣想的，一個是報銷──允許的報銷，當然，這項措施是正面的。

At the same time, it takes work and experience in higher acuity ASC procedures to actually be able to successfully move those things from an inpatient setting to an outpatient setting. And as you know, the patient selection criteria and expertise makes a big difference there so that you're doing the right things clinically. Those are all areas in which we're pretty advanced as an ASC operator and platform.

同時，需要具備更高敏銳度的ASC手術經驗和工作經驗，才能成功地將這些手術從住院環境轉移到門診環境。如你所知，患者的選擇標準和專業知識至關重要，這樣才能確保你在臨床上採取正確的措施。作為 ASC 營運商和平台，我們在這些領域都處於相當先進的水平。

So I think it plays to our advantages. I think it represents an opportunity for the future for sure. And I also think it gives us a platform to work with physicians to build the right protocols for many of these things to move into that more freestanding setting with the right patient selection.

所以我認為這對我們有利。我認為這肯定代表著未來的一個機會。而且我還認為它為我們提供了一個平台，讓我們可以與醫生合作，為這些事情建立正確的協議，並透過正確的患者選擇進入更獨立的環境。

Sun, do you want to comment on the update on our exchange volumes?

孫先生，您想對我們的交易量更新發表評論嗎？

I would say just as a summary statement there, AJ, obviously, the efforts to lobby for their extension. And importantly, the critical role they play in supporting small businesses and employees of small businesses in America is an added benefit of the exchanges that is obviously part of the discussion today.

我想說的是，AJ，顯然，他們正在努力遊說延長他們的延期。重要的是，他們在支持美國小型企業和小型企業員工方面發揮的關鍵作用是交流的額外好處，這顯然是今天討論的一部分。

Yeah, thank you, Sun. Just to add, obviously, health care exchange remains an important part of our business. For second quarter of '25, we saw about a 23% increase in admissions year over year, and we saw about a 28% increase in revenues from exchange year over year. In the second quarter, our exchange volume now represents about 8% of our total admissions and about 7% of total consolidated tenant revenues.

是的，謝謝你，Sun。補充一下，顯然醫療保健交易仍然是我們業務的重要組成部分。2025 年第二季度，我們的入場人數年增了約 23%，而交換收入較去年同期成長了約 28%。在第二季度，我們的交易量目前約佔總入場人數的 8% 和合併租戶總收入的 7%。

Okay, thanks a lot.

好的，非常感謝。

Josh Raskin, Nephron Research.

Josh Raskin，腎元研究。

Hi, thanks. Good morning. I was wondering if you could just give some more specifics on the outperformance in the core results, and I'm specifically looking at the incremental $70 million on the USPI side, the increase in guidance.

你好，謝謝。早安.我想知道您是否可以提供一些有關核心業績優異表現的更多細節，我特別關注 USPI 方面的增量 7000 萬美元，即指導金額的增長。

And then within that, is there anything Tenet has done specifically to improve your ability to sort of document categorize patients as you submit claims? Are there new systems, new technologies, new vendors or partners and obviously, anything relating to AI. I'd be curious if there's new things that you're doing within there.

那麼在此範圍內，Tenet 是否採取了哪些具體措施來提高您在提交索賠時對患者進行文件分類的能力？是否有新系統、新技術、新供應商或合作夥伴，以及顯然與人工智慧相關的任何內容。我很好奇你在那裡是否做了新的事情。

Josh, well, going -- kind of going backwards, we have -- there -- USPI has its own significant revenue cycle capability. We think it's an industry-leading capability. It's an environment that mostly serves our own ASCs, but certainly serves ASCs beyond that. We're pretty busy in advancing a lot of those capabilities.

喬希，好吧，有點倒退，我們有——那裡——USPI 有其自身顯著的收入周期能力。我們認為這是業界領先的能力。該環境主要服務於我們自己的 ASC，但肯定也服務於其他 ASC。我們正忙於推進許多此類能力。

I mean, it is not difficult for me to say that some of the improvement in our results over the last few years has been related to real standardization, technology deployment, better reporting, and certain advanced analytical tools that we have deployed into the ASC environment.

我的意思是，我可以毫不費力地說，過去幾年我們業績的改善與我們在 ASC 環境中部署的真正標準化、技術部署、更好的報告以及某些先進的分析工具有關。

Not surprising, given our focus in revenue cycle as a company that we have done that. And it's certainly paying dividends in terms of how we work in that environment, both on the retail collection side, as you can imagine, these are elective procedures. But also on the wholesale collection side, all the way from authorization back through document accurate documentation and more efficient management of the AR through technology and offshore capabilities. So we're really pleased with the platform that's being built for ASC revenue cycle within USPI.

考慮到我們公司專注於收入週期，我們這樣做並不奇怪。而且，就我們在這種環境下的工作方式而言，這無疑帶來了回報，無論是在零售收款方面，正如您所想，這些都是可選的程序。在批發收款方面，從授權到文件記錄的精準記錄，以及透過技術和離岸能力更有效率地管理應收帳款，也同樣如此。因此，我們對在 USPI 內為 ASC 收入周期構建的平台感到非常滿意。

Sun, do you want to comment on the nature of the guide?

孫先生，您想評論一下該指南的性質嗎？

Yeah, sure. Josh, in the first half and the second quarter, I think both consistent themes, we've seen high acuity, good case mix, good payer mix, good growth in some of our key case lines service lines, including ortho and total joints. So all the trends that we've discussed previously, I think, continue in USPI for second quarter. That's why you saw the strong net revenue overall growth of 7.7%. And as well as a strong net revenue per case.

是的，當然。喬希，我認為上半年和第二季度的主題都是一致的，我們看到了高敏銳度、良好的病例組合、良好的付款人組合，以及一些關鍵病例線服務線的良好增長，包括正畸和全關節。因此，我認為我們之前討論過的所有趨勢都將在第二季的 USPI 中繼續延續。這就是為什麼您看到淨收入整體成長 7.7% 的原因。且每箱淨收入都很高。

So -- and then I think good operating expense management. So we demonstrated a 39.2% EBITDA margins in second quarter as well. So I think all those trends probably for both Q1 and Q2, which is ultimate about a $50 million increase versus our prior guidance. And then our general expectation is for those trends to continue into the second half, which is part of the guidance raised for the remaining full year.

所以——我認為營運費用管理很好。因此，我們在第二季也實現了 39.2% 的 EBITDA 利潤率。因此，我認為所有這些趨勢可能都適用於第一季和第二季度，與我們先前的預期相比，最終將增加約 5,000 萬美元。我們總體預期這些趨勢將持續到下半年，這也是對全年剩餘時間的預測的一部分。

I think we also remain positive on our M&A activity in terms of contribution. As Tom noted in his opening statement, we expect to exceed our $250 million baseline assumption for USPI M&A. So I think all those things contribute to the guidance raise.

我認為，就貢獻而言，我們對我們的併購活動也保持樂觀態度。正如湯姆在開場白中指出的那樣，我們預計 USPI 併購金額將超過 2.5 億美元的基準假設。所以我認為所有這些因素都有助於提高指導價。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. I Just wanted to ask about the volumes. There's a little bit of a deceleration there in both the inpatient and adjusted admissions in the quarter. You took down the guidance by, I think, 50 basis points were volumes impacted by any discrete items in the quarter or anything else to kind of call out driving some of the deceleration for the quarter and the full year? Thanks.

嗨，早安。我只是想問一下卷數。本季住院人數及調整後入院人數均略有下降。我認為，您下調了 50 個基點的預期，是因為本季度的任何單項項目或其他因素影響了銷量，從而導致本季度和全年銷量有所下降嗎？謝謝。

Hey, well, first of all, I think the the guidance is just simply reflecting the math that would play out for the rest of the year. Now it was a strong quarter. I mean we had strong volumes, the right acuity and mix and very much reflects the focus on our service lines as we have prioritized them. So I don't think there's anything particularly unusual other than seasonality.

嘿，首先，我認為該指導只是簡單地反映了今年剩餘時間的數學計算結果。現在這是一個強勁的季度。我的意思是，我們擁有強大的業務量、正確的敏銳度和組合，並且很大程度上反映了我們對服務線的關注，因為我們已將其列為優先事項。所以我認為除了季節性之外，沒有什麼特別不尋常的事情。

Matthew Gillmor, KeyBanc Capital Markets.

馬修‧吉爾摩 (Matthew Gillmor)，KeyBanc 資本市場。

Hey, thanks for the question. I wanted to ask about payer contracting. There's a lot of different dynamics creating pressure on payers. Has there been any discernible shift in terms of your negotiations with payers? Are you still getting the normal updates you'd expect? And is there anything to report with respect to any activity?

嘿，謝謝你的提問。我想詢問有關付款人合約的問題。有很多不同的因素會給付款人帶來壓力。您與付款人的談判是否有任何明顯的變化？您是否仍能獲得所期望的正常更新？對於任何活動有什麼需要報告嗎？

Yeah, well, a couple of things. First of all, obviously, different parts of the sector at various times, certainly go through their ups and downs. And I think our philosophy, most importantly, with the health plans, both the national plans and state-based plans is to work consistently to create value in what we do in our level of pricing in our negotiations and also to create predictability for both sides over a multiyear period. I mean, I think that's ultimately what's probably most important on both sides so that each party can then manage their own operations.

是的，嗯，有幾件事。首先，顯然，該行業的不同部分在不同時期肯定會經歷起伏。我認為，對於健康計劃（包括國家計劃和州計劃），我們的理念最重要的是不斷努力在談判的定價水平上創造價值，並為雙方在多年期間創造可預測性。我的意思是，我認為這最終對雙方來說可能是最重要的，以便各方能夠管理自己的營運。

And we have extended that philosophy over the last few years into the next wave of contracts. I think most people were aware that there are a number of contracts that are coming up, and we're not seeing anything unusual and certainly no change in our guidance with respect to the way that we have been negotiating our contracts.

在過去幾年裡，我們將這一理念延伸到了下一波合約。我想大多數人都知道即將簽訂多份合同，我們沒有看到任何異常情況，當然，我們在合約談判方式方面的指導也沒有發生任何變化。

But again, I think that's because we're committed to the value that we provide there, both from the standpoint of our highly efficient ambulatory business, but also working in an environment with reasonable and predictable rate increases so that we can focus on managing our own operations. Look, the denials activity, and it's really not just denial, it's kind of the disputes, documentation requests, denials, et cetera have ramped up over the past few years post COVID to levels that are, I would argue, not acceptable in some cases.

但我再次認為，這是因為我們致力於在那裡提供的價值，不僅從我們高效的門診業務的角度來看，而且還在合理且可預測的費率增長環境中工作，以便我們能夠專注於管理我們自己的營運。你看，拒絕活動，實際上不僅僅是拒絕，還有爭議、文件要求、拒絕等等，在過去幾年裡，在新冠疫情之後，這些活動已經增加到了我認為在某些情況下是不可接受的水平。

And we have adapted. Obviously, this is part of Conifer's job is to adapt and learn to respond to those things. In the early days, the responses were driving up expenditures. Today, as we have evolved and realized this is a new normal, we have, of course, deployed more technology, more automation, trained up more offshore staff and other things to be able to respond to those types of requests and activities in a more efficient and I would argue more effective manner. We track things like our yield relative to the volume or dollars that were disputed or denied.

我們已經適應了。顯然，這是 Conifer 工作的一部分，即適應並學會應對這些事情。在早期，這些回應導致支出增加。今天，隨著我們不斷發展並意識到這是一種新常態，我們當然部署了更多的技術、更多的自動化、培訓了更多的離岸員工並採取了其他措施，以便能夠以更有效率、更有效的方式回應這些類型的請求和活動。我們追蹤諸如我們的收益相對於有爭議或被拒絕的交易量或金額的情況。

And I think Conifer is doing well there for both ourselves and for our clients relative to the overall industry. You can see it in our results, and I think that translates across the board. And so this is a constant battle with respect to what's appropriate there. And obviously, we welcome both regulation and other things that would support a reduction of some of that what we consider inappropriate activity.

我認為，相對於整個行業而言，Conifer 對我們自己和我們的客戶來說都表現良好。您可以在我們的結果中看到這一點，我認為這是全面的。因此，這是一場關於什麼是合適的持續鬥爭。顯然，我們歡迎監管和其他措施，以減少我們認為不適當的活動。

Got it, thank you.

明白了，謝謝。

Justin Blake, Wolfe Research.

賈斯汀·布萊克，沃爾夫研究公司。

Thanks. Good morning. First, I just wanted to follow up on AJ's question. I do understand that the industry is lobbying for an extension of these subsidies and how important that could be to a lot of folks. But is there a framework that company can share with us in terms of how to think about the potential impact to 2026 earnings if those subsidies do go away and then sticking with that DC stuff.

謝謝。早安.首先，我想跟進一下AJ的問題。我確實明白該行業正在遊說延長這些補貼，這對許多人來說非常重要。但是，如果這些補貼確實消失，並且繼續使用 DC 政策，那麼公司是否可以與我們分享一個框架，說明如何考慮對 2026 年收益的潛在影響？

Maybe you can give us an update on the provider tax run rate you're seeing in 2025 versus I think the previous guidance was about $1.1 billion. And have you analyzed and have anything to share with us in terms of the impact of if that the bill that just passed, it does get rolled out what the impact to DPP could be over time a provider taxes. Thanks.

也許您可以向我們介紹一下您所看到的 2025 年提供者稅率的最新情況，而我認為之前的指導價格約為 11 億美元。您是否分析過，如果剛通過的法案真的實施，對DPP的影響會是什麼？供應商稅會怎樣？有什麼可以分享的嗎？謝謝。

Yeah, hey, Justin. So we don't have any comments about 2026 at this stage. And certainly, all of the work and effort is focused on helping stakeholders realize again how important the exchanges are for families who utilize them, including those that came off of Medicaid from a Medicaid redetermination standpoint over the last few years.

是的，嘿，賈斯汀。目前我們對2026年還沒有任何評論。當然，所有的工作和努力都集中在幫助利害關係人再次認識到交易所對使用它們的家庭的重要性，包括那些在過去幾年中從醫療補助重新確定的角度退出醫療補助的家庭。

It's very much my belief that because of the existence of the exchanges and the subsidies for the people who don't have very high income levels as Medicaid redetermination proceeded, the exchanges were a critical safety net for the individuals who needed health care insurance to have a landing spot, and it created what I consider a pretty smooth Medicaid redetermination process because of the availability of those insurance options for individuals and families that needed it.

我堅信，由於交易所的存在以及在醫療補助重新確定過程中為收入水平不太高的人群提供的補貼，交易所對於需要醫療保險的個人來說是一個重要的安全網，並且由於有需要的個人和家庭可以獲得這些保險選擇，它創造了一個我認為相當順利的醫療補助重新確定過程。

And so that, in addition to the fact that the exchanges represent critical support for small businesses that are unable to provide broad-based insurance coverage options to their employees, which supports, obviously, a very large part of the economy represents two of the most important prongs of the conversation around why it's important to extend these subsidies, not the least of which is that it affects red states more than Blue states, given the nature of the administration in Congress today, that's also an important fact.

因此，除了交易所為無法為其員工提供廣泛保險覆蓋選項的小型企業提供關鍵支持之外，這顯然支撐了經濟的很大一部分，也代表了關於為什麼延長這些補貼很重要的討論的兩個最重要的方面，其中最重要的是它對紅州的影響大於藍州，考慮到當今國會政府的性質，這也是一個重要的事實。

So look, I think the work is ongoing in that area. I think it's important, and I think it's important to more than just our industry. It affects other parts of our sector, but it also affects the macro economy through the support for small businesses, which helps to make them more competitive in the US economy at large.

所以，我認為該領域的工作正在進行中。我認為這很重要，而且我認為這不僅對我們的行業很重要。它不僅影響我們行業的其他部分，還透過對小型企業的支持影響宏觀經濟，這有助於提高小型企業在整個美國經濟中的競爭力。

The current situation in Bill that passed a lot of the impacts, as you know, have been pushed out pretty far into the very, very end of '27 or really '28 from that standpoint. And we really don't have any insight into how this will be implemented.

如你所知，比爾的當前情況已經受到很大影響，從這個角度來看，這種情況已經推遲到 27 年末或 28 年末。我們確實不知道這將如何實施。

There are new legislative proposals that have already come up attempting to resin some parts of [OBBB], which are in play in Congress. And I think it's just -- it remains an area of significant uncertainty. And we don't have any sort of projections to provide from that standpoint, especially because we're talking about, again, as I said, out to 2028.

已經有一些新的立法提案提出，試圖廢除國會正在審議的[OBBB]的某些部分。我認為這只是——它仍然是一個存在很大不確定性的領域。從這個角度來看，我們沒有提供任何預測，特別是因為我們談論的是到 2028 年的情況，正如我所說的。

Sun, do you want to cover there was a question in there about the DPP programs

孫先生，你想談談關於民進黨計畫的問題嗎？

Yeah, let me just clarify that, Justin. So for Q2 of '25, we recorded about $350 million of total Medicaid supplemental payments. So for the first half of this year, we're at about $675 million range. Now we have pointed out some one-timers. So once you normalize for that in the first half of the year, our run rate for the full year is right around the $1.1 billion, $1.2 billion range that we previously discussed.

是的，讓我澄清一下，賈斯汀。因此，在 2025 年第二季度，我們記錄的醫療補助補充支付總額約為 3.5 億美元。因此，今年上半年我們的營收約為 6.75 億美元。現在我們已經指出了一些一次性事件。因此，一旦上半年的業績正常化，我們全年的營運率大約在我們之前討論過的11億美元到12億美元之間。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，康托費茲傑拉。

Thank you. I just wanted to circle back to what went on with the volume guide down. I understand seasonality and just the mass of the quarter impact on the year, but what actually changed in this quarter or in your view of the area? Are there certain, segments or any kind of deeply?

謝謝。我只是想回顧一下音量指南下降時發生的情況。我了解季節性以及季度對全年的影響，但本季或您認為該地區實際上發生了哪些變化？是否存在某些特定的片段或任何類型的深度？

Well, the most important thing that we would be focused on that happened in the second quarter was, as I said earlier, the strength and success of our high acuity strategy that has been in place for multiple years, continuing to demonstrate in this market, the ability to generate revenue and earnings across our hospital portfolio. I mean that's really, at the end of the day, that's the most notable and important trend in the second quarter, which is that, that strategy continues to deliver results.

嗯，正如我之前所說，第二季度我們要關注的最重要的事情是，我們實施多年的高敏銳度戰略的優勢和成功，繼續在這個市場上展示我們在整個醫院組合中創造收入和收益的能力。我的意思是，歸根結底，這是第二季度最值得注意和最重要的趨勢，即該策略繼續取得成果。

Yes, thank you.

是的，謝謝。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Yeah, hi, thanks. Just to follow up on Justin's question. I just wanted to ask about the jump-off point for EBITDA this year. Is it as simple as we're moving the out-of-period Medicaid supplemental EBITDA, I think it's $70 million -- $79 million this quarter and $40 million with the first quarter. Or are there any other meaningful areas to consider whether they're Medicaid supplemental payments sort of onetime contributors that you should think about as for bridging into 2026.Thank you.

是的，你好，謝謝。只是想跟進一下賈斯汀的問題。我只是想問一下今年 EBITDA 的起點。這是否像我們將期外醫療補助補充 EBITDA 轉移一樣簡單，我認為是 7000 萬美元 - 本季為 7900 萬美元，第一季為 4000 萬美元。或者還有其他有意義的領域需要考慮，它們是否是醫療補助補充支付之類的一次性捐助者，您應該考慮將其過渡到 2026 年。謝謝。

We're not making any comments about 2026 nor are we commenting on headwinds and tailwinds yet for the following year.

我們不會對 2026 年發表任何評論，也不會對接下來一年的逆風和順風發表評論。

Ben Hendrix, RBC Capital Markets.

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

Thank you very much. Just a quick follow-up on the acuity trends that you're seeing. Appreciate that the revenue per show strong acuity trends there, and that's consistent with your strategy. But also I just wanted to square that with the hospital inpatient surgeries being down. Just a little more detail on where you're seeing that stronger case mix and how that's kind of translating into the stronger rates on the hospital side? Thanks.

非常感謝。只是對您所看到的敏銳度趨勢進行快速跟進。很高興看到那裡的收入呈現出強勁的敏銳趨勢，這與您的策略一致。但我也只是想說明醫院住院手術量下降的情況。您能否更詳細地說明一下，您在哪裡看到了更強的病例組合，以及這如何轉化為醫院方面的更高比率？謝謝。

Yeah, I mean our strength in cardiovascular, orthopedics, spine, neurosurgery, broad-based general surgery robotics. I mean those are all the areas that we continue to focus on in terms of our work. Now I would add to that emergency driven trauma in trauma surgery. As you know, we have a lot of very large urban emergency departments that have built trauma capabilities in order to service patients in need of trauma.

是的，我的意思是我們在心血管、骨科、脊椎、神經外科、廣泛的一般外科機器人方面的優勢。我的意思是，這些都是我們在工作中繼續關注的領域。現在我想補充一下創傷外科中緊急驅動的創傷。如您所知，我們有許多非常大型的城市急診科，它們都具備創傷治療能力，以便為需要創傷的患者提供服務。

And finally, as we have indicated over the past few years, our transfer strategy always being willing to accept any patient from any outlying hospital as long as we have the services available to help them, we have been committed to providing that help. And obviously, many of those patients tend to be sicker and may require more complex surgery. So all of those things have been contributors to the results from what we describe as the high acuity strategy.

最後，正如我們在過去幾年中所指出的，我們的轉院策略始終是願意接受來自任何偏遠醫院的任何患者，只要我們有能力為他們提供服務，我們一直致力於提供這種幫助。顯然，許多患者的病情更加嚴重，可能需要更複雜的手術。因此，所有這些因素都對我們所說的高敏銳度策略的結果有所貢獻。

Thank you.

謝謝。

Whit Mayo, Leerink Partners.

惠特·梅奧 (Whit Mayo)，Leerink Partners。

Yeah, thanks. Just one quick clarification. I was wondering if you could comment briefly on how much your medical case mix did increase in the quarter, and if it changed much from prior trends. But my real question is looking at the EBITDA growth at USP. Is there any way to quantify the contribution that you may still be seeing from continued synergies, whether from SCD covenant. Just wondering if those are contributing to any of the growth still.

是的，謝謝。只需簡單澄清一下。我想知道您是否可以簡單評論本季您的醫療病例組合增加了多少，以及與先前的趨勢相比是否有很大的變化。但我真正的問題是看 USP 的 EBITDA 增長。有沒有什麼方法可以量化您可能仍然看到的持續協同效應的貢獻，無論是來自 SCD 契約。只是想知道這些是否仍然有助於成長。

Well, case mix security was up. I'm not sure exactly what you're asking, Sun, you may want to comment more specifically on that question. I mean -- but consistent with what we're saying about acuity case mix index was up. That's referring to the hospital segment.

嗯，病例組合安全性提高了。我不確定你到底想問什麼，孫，你可能想更具體地評論一下這個問題。我的意思是——但與我們所說的敏銳度病例組合指數上升一致。這是指醫院部分。

On the USPI side, the revenue growth that we see, obviously, in a very dynamic business comes from all sorts of things, including same-store growth, volume growth, our payer contract, annual escalators, rostering of new facilities on to our managed care contracts as part of our network strategy of having an alliance of high-quality, reliable centers, all of that contributes to the revenue growth.

在 USPI 方面，我們在一個非常活躍的業務中看到的收入增長顯然來自各種各樣的因素，包括同店增長、銷量增長、我們的付款人合同、年度自動升級、將新設施列入我們的管理式醫療合同，這是我們建立高質量、可靠中心聯盟的網絡戰略的一部分，所有這些都有助於收入增長。

But that's why we provide the total revenue growth and also the same-store revenue growth so that one can differentiate between those. And I think all of that data is consistent both with success of the high acuity strategy, but also we're consistently performing in revenue growth above our long-term trend, which has been very positive for USPI.

但這就是我們提供總收入成長和同店收入成長的原因，以便人們能夠區分它們。我認為所有這些數據都與高敏銳度策略的成功相一致，而且我們的收入成長也一直高於長期趨勢，這對 USPI 來說非常有利。

Yeah, Saum, just your -- I'm sorry, your question on case mix. We're up about 1% year over year in Q2. And obviously, if you look at a longer period of time, that growth would be more significant based on acuity.

是的，Saum，只是你的——抱歉，你的問題是關於病例組合的。我們第二季的銷售額年增了約 1%。顯然，如果從更長的時間來看，從敏銳度來看，這種成長會更加顯著。

Peter Chickering, Deutsche Bank.

彼得‧奇克林，德意志銀行。

Hey, good morning, guys. Thanks for taking my questions. Nice quarter here. DSOs trended down nicely even the lowest that I've ever seen with you guys. Can you talk about cash collections and what have you done differently? Or are the payers doing some differently?

嘿，大家早安。感謝您回答我的問題。這裡很不錯。DSO 趨勢良好，甚至達到了我所見過的你們的最低水平。能談談現金收取狀況嗎？您做了哪些不同的事情？或是付款人的做法有所不同？

And from a cash flow perspective, should we continue to model sort of the bulk of the cash going into repo with some M&A in there. So you can buy back around 10-plus percent of your market cap each year while still delevering. Is that the right way to think about it?

從現金流的角度來看，我們是否應該繼續將大部分現金用於回購，並進行一些併購？這樣，你每年就可以回購約10%以上的市值，同時還能繼續去槓桿。這是正確的思考方式嗎？

Well, okay, so just two separate things. Sun, do you want to start with the second one and then we'll back into the revenue cycle question.

好的，所以這只是兩件獨立的事情。孫先生，你想先從第二個問題開始，然後再回到收入週期的問題。

Yeah, sure. So Pito, yeah, we obviously very strong free cash flow performance, have increased our guidance for free cash flow after NCI up $195 million. I would say the other notable piece, obviously, is the amount of share repurchases we completed in the second quarter of this year. It was a substantial increase from our normal trends.

是的，當然。所以 Pito，是的，我們的自由現金流表現顯然非常強勁，在 NCI 之後，我們提高了 1.95 億美元的自由現金流指引。我想說的另一個值得注意的顯然是我們今年第二季完成的股票回購數量。與我們的正常趨勢相比，這是一個大幅的成長。

I would say, looking forward, our capital allocation priorities haven't changed, right? USPI, M&A, hospital CapEx for high acuity strategy and then maintaining our deleveraged balance sheet and a balance share repurchase approach.

我想說，展望未來，我們的資本配置重點沒有改變，對嗎？ USPI、併購、高敏銳度策略的醫院資本支出，然後維持我們的去槓桿資產負債表和平衡股票回購方法。

It's hard to predict what our run rate share repurchase activity will be in the next quarter, the second half of this year into 2016. I think that will depend on facts and circumstances. But I do believe our free cash flow and financial performance and balance sheet flexibility will afford us to make the right decisions as those things come.

很難預測下一季、今年下半年甚至 2016 年我們的股票回購活動運行率會是多少。我認為這取決於事實和情況。但我確實相信，我們的自由現金流、財務表現和資產負債表靈活性將使我們在這些事情發生時做出正確的決定。

Yeah, look, in summary, on the first part of the question, as the industry has trended up overall in terms of denials and also the times to collect given some of the dispute and back and forth on documentation requests and other things. We remain very focused on trying to keep that as tight as possible using technology automation.

是的，總而言之，關於問題的第一部分，由於存在一些爭議以及在文件請求和其他事情上的反复，整個行業的拒絕率和收集時間總體呈上升趨勢。我們仍然非常專注於嘗試利用技術自動化盡可能地保持這種緊密聯繫。

I mean one of the advantages that Conifer has is an incredibly standardized workflow that is really critical to not only collections but also timely collections in an environment where those time frames have been increasing for a long period of time.

我的意思是，Conifer 的優勢之一是其高度標準化的工作流程，這不僅對於收集至關重要，而且對於在時間框架長期不斷增加的環境中及時收集也至關重要。

We're obviously, as we've talked about before, supplementing some of those capabilities that we have today that used to be manual with AI-enabled technologies that allow us to produce more rapid automated responses to various types of disputes based upon pattern recognition that you would see from various sources that allow us to do that more effectively. And that makes in the end what we're doing more reliable, but also as you're pointing out, sort of faster.

顯然，正如我們之前談到的，我們正在用人工智慧技術補充我們今天擁有的一些過去需要手動完成的功能，這些技術使我們能夠根據從各種來源看到的模式識別，對各種類型的爭議做出更快速的自動響應，從而使我們能夠更有效地做到這一點。這最終使我們所做的事情更加可靠，而且正如您所指出的，速度也更快。

The other thing I would say about this environment in which we talk a lot about the dispute denial activity. And as I said earlier, I think some of it is highly inappropriate. But it's also important that we spend our time being committed to very accurate documentation and coding.

關於這個環境，我想說的另一件事是，我們經常談論爭議否認活動。正如我之前所說，我認為其中一些內容非常不合適。但同樣重要的是，我們要花時間致力於非常準確的文件和編碼。

And I think one of the things that Conifer does well is produce accurate documentation and coding and that has a tendency to also reduce the dispute activity to some extent, from the health plans, right? I mean it is a two-way street in the end, and both parties have to perform in that and that speeds up collections to some extent.

我認為 Conifer 做得很好的一件事就是產生準確的文件和編碼，這在某種程度上也減少了健康計劃中的爭議活動，對嗎？我的意思是，這最終是一條雙行道，雙方都必須履行職責，這在一定程度上加快了收款速度。

So anyway, I said this earlier, and I'll let it be adapting to the current environment from a collection standpoint is a critical capability that we have developed, and that capability has moved from being manual when it first started to increase to much more technology-driven and workflow automation driven.

無論如何，我之前說過，我會讓它從收集的角度適應當前環境，這是我們開發的關鍵能力，而且這種能力已經從剛開始增加時的手動轉變為更加技術驅動和工作流自動化驅動。

Benjamin Rossi, JPMorgan Chase.

摩根大通的班傑明‧羅西。

Good morning. Thanks for the question here. Just as a follow-up on your ACA exchange volumes. With your reported hospital length of stay down call it, 3% year over year and ACA exchange lines up 28% during 2Q. Is there any additional detail you can provide on procedural mix or length of stay across those exchange-based volumes just been getting some comments from comment payers in recent weeks regarding the elevated trend there across that group. So just curious if there are any particular areas that were contributors to that 2Q growth figure? Or if it was more broad-based across all specialties for your ACA exchange book?

早安.感謝您在這裡提出的問題。只是作為對您的 ACA 交易量的後續跟進。由於您報告的住院時間較去年同期下降了 3%，而 ACA 交易所線路在第二季度上漲了 28%。您能否提供關於這些基於交易所的交易量的程序組合或停留時間的更多詳細資訊？最近幾週，我從評論者那裡得到了一些關於該群體上升趨勢的評論。所以我只是好奇是否有任何特定領域對第二季的成長數據做出了貢獻？或者，如果您的 ACA 交換書涵蓋所有專業，那麼它的適用範圍是否更廣泛？

Yeah, I don't think there's been anything unusual in this quarter versus prior quarters with respect to the exchange volumes. I mean, remember, the one thing I would say is the exchange business tends to behave similar to the Medicaid business more than the commercial business in the sense that a disproportionately larger amount of it is emergency department driven may still come with higher acuity, but it tends to be more emergency department driven.

是的，我認為本季與前幾季相比，交易量沒有什麼異常。我的意思是，請記住，我想說的一件事是，交易所業務的行為方式往往與醫療補助業務更相似，而不是商業業務，因為交易所業務中很大一部分是由急診科驅動的，雖然可能仍然具有更高的敏銳度，但它往往更多地是由急診科驅動的。

That's why the impact of the exchanges on our business is higher in the hospital segment versus the USPI segment, even though it's present in both. But I don't think that I noticed anything unusual about the nature of the exchange volumes this year this quarter.

這就是為什麼交易所對我們在醫院業務的影響比在 USPI 業務的影響更大，儘管它在兩個領域都存在。但我認為我沒有註意到今年本季交易量有什麼異常。

Sun, is there anything you would point out there?

孫先生，您還有什麼要指出的嗎？

I think you're right, it's pretty consistent with prior mix overall.

我認為你是對的，它總體上與之前的混合非常一致。

Okay, got it.

好的，明白了。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓 (Ryan Langston)，TD Cowen。

Thanks. Good morning. SWB continues to run pretty favorably. I mean I assume as you achieve these levels, this becomes kind of the new baseline expectation to your operators. But I guess the question is, how much more opportunity do you see on SWB? And I guess, what types of initiatives can you execute on to keep up sort of this level of performance?

謝謝。早安. SWB 的運作情況持續良好。我的意思是，我假設當你達到這些水平時，這將成為對你的操作員的一種新的基準期望。但我想問題是，您認為 SWB 上還有多少機會？我想，您可以採取哪些類型的舉措來維持這種績效水準？

Well, obviously, effective labor management has been a strength of our organization, not just recently, but over the last few years. We stay focused on the various parameters that drive demand, obviously, length of stay, the acuity, the day-to-day productivity and an accurate staffing needs that we have in our hospitals.

顯然，有效的勞動力管理一直是我們組織的優勢，不僅是最近，而且是過去幾年來的優勢。我們始終關注推動需求的各種參數，顯然包括住院時間、敏銳度、日常生產力以及我們醫院的準確人員配備需求。

But at the same time, from a supply standpoint, we've really, I think, benefited from improved recruiting strategies, relationships with some terrific nursing schools around the country, where we've created good opportunities for their students and graduates to work in our environment and also improving our retention rates as a result of what we've done.

但同時，從供應的角度來看，我認為我們確實受益於改進的招聘策略，與全國一些優秀的護理學校建立的關係，我們為他們的學生和畢業生創造了在我們的環境中工作的良好機會，並且由於我們的努力，我們的保留率也得到了提高。

We found that making investments and we have made real investments in our nursing and overall hospital management director and other supervisory levels with special recognitions and other things that have been ongoing for multiple years because we see the value that they provide in terms of creating a stable and effective workforce for patient care.

我們發現，我們對護理和整體醫院管理主任以及其他監督級別的人員進行了真正的投資，並給予他們特殊認可和其他已經持續多年的投資，因為我們看到了他們在為患者護理創建穩定有效的勞動力方面所提供的價值。

That has been an important part of what we have done over the last few years and recognizing their efforts. I mean, I think, look, all of those things are sustainable strategies, and all of them contribute to the improvements that we've made both in our efficiencies and effectiveness there.

這是我們過去幾年所做工作的重要部分，也是對他們努力的認可。我的意思是，我認為，所有這些都是可持續的策略，所有這些都有助於提高我們的效率和效力。

John Ransom, Raymond James.

約翰·蘭塞姆、雷蒙·詹姆斯。

Hey, good morning. I'm going to ask Saum a question he's not going to answer one he answered and we'll ask them another question. Do you think that now that we've gotten the bill behind us and we know the nodes, is the environment if you were able to look to sell any more hospitals as the environment was such that that's more possible there?

嘿，早安。我要問索姆一個他不會回答的問題，他已經回答過了，然後我們再問他們另一個問題。您是否認為，既然我們已經獲得了賬單，並且知道了節點，那麼您是否能夠考慮出售更多的醫院，因為環境是這樣的，那裡更有可能這樣做？

John, I'm not sure how to answer that question. We don't comment on asset sales and anything that we may be looking at there. We're pretty happy with the portfolio. It's obviously performing based upon the last couple of years in the post transaction environment. I don't know how to comment on whether the broader industry has fully understood the implications for them of the OBBB or anything else that may come.

約翰，我不知道該如何回答這個問題。我們不對資產出售以及我們可能正在關注的任何事項發表評論。我們對投資組合非常滿意。顯然，這是根據過去幾年交易後環境的表現而定的。我不知道該如何評論整個行業是否已經完全了解 OBBB 或任何可能出現的其他事件對他們的影響。

I would take this opportunity to reiterate that our view from what we have seen so far in the external landscape related to legislation, regulation, et cetera, Washington essentially, we think about this pretty carefully, it has not changed our commitment to our core strategy as it stands right now. And so I feel good about that looking forward.

我想藉此機會重申，從我們迄今為止所看到的與立法、監管等相關的外部環境來看，華盛頓基本上已經非常仔細地考慮了這一點，它並沒有改變我們對目前核心策略的承諾。因此我對此充滿期待。

Yeah, so you let me write to my other question. What now that this bill is behind this, what are your current like legislative and lobbying priorities in DC and then where are you going to spend your time there?

是的，所以你讓我寫下我的另一個問題。現在這項法案已經通過，您目前在華盛頓特區的立法和遊說重點是什麼？您打算在那裡做些什麼？

The most important area right now, as I said, both for the health care industry, for the insurance industry. And importantly, we think now that we have an understanding of how important these exchanges are for small businesses and keeping and remaining a competitive workforce for small businesses in America is engaging in dialogue about mechanisms to extend the exchange subsidies.

正如我所說，目前最重要的領域是醫療保健產業和保險業。重要的是，我們認為現在我們已經了解了這些交易所對小型企業的重要性，並且正在就延長交易所補貼的機制進行對話，以保持和維持美國小型企業的競爭力。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

All right. Great. I guess I wanted to understand a little bit more of the commentary on hospital volumes and the payer mix. I guess how much of the payer mix improvement that you're seeing is because of the exchange growth if we took exchanges out? Would you still be talking about improved payer mix to the same degree?

好的。偉大的。我想更多地了解有關醫院數量和付款人組合的評論。我想，如果我們取消交易所，您所看到的付款人組合改善有多少是由於交易所的成長？您是否還會談論同等程度的付款人組合改善？

And then when we think about the volume outlook, the volume outlook being lower, you guys have always had a different view on volumes. It's hard to kind of tell what how much is this high acuity strategy versus underlying demand? Do you have a sense of what underlying demand growth was in the quarter? Was it consistent with where Q1 was? Or did it decelerate kind of similar to how your overall volumes decelerated from Q1 to Q2? Thanks.

然後，當我們考慮交易量前景時，交易量前景較低，你們對交易量一直有不同的看法。很難說清這種高敏銳度策略與潛在需求有多大關係？您是否了解本季的潛在需求成長？它與 Q1 的情況一致嗎？或者它的減速方式類似於你們整體銷售量從第一季到第二季的減速方式？謝謝。

Yeah, a couple of things. One is commercial mix was strong. And as I indicated earlier, maybe another way of describing that, I mean obviously, the growth that Sun described in the exchanges indicates that some of that mix strength is definitely on the payer mix side is definitely coming from the exchanges. And this is, again, going back to the importance of the exchanges, as a landing spot as Medicaid redetermination has worked its way through the overall system. It's been an important landing spot.

是的，有幾件事。一是商業組合強勁。正如我之前指出的，也許可以用另一種方​​式來描述這一點，我的意思是，孫宇晨描述的交易所的增長顯然表明，混合實力肯定在付款人混合方面，肯定來自交易所。這又回到了交易所的重要性，它是醫療補助重新確定在整個系統中發揮作用的著陸點。它一直是重要的著陸點。

And then finally, now I mean, I think, look, underlying demand in this environment is still strong on a macro basis. I mean it wouldn't be the case that we would be able to lose significant amounts of underlying what you would call general Med Surg, emergency department, et cetera, demand and exist solely on a high acuity strategy, right?

最後，現在我的意思是，我認為，從宏觀角度來看，這種環境下的潛在需求仍然強勁。我的意思是，我們不會損失大量所謂的普通外科、急診科等基礎需求，而只依靠高敏銳度策略生存，對嗎？

The high acuity strategy is meant to support the types of margin expansion and growth that we have seen on an efficient basis in the hospital segment. And the margin expansion in the hospital segment over the last 12 we were just looking over the last 12 months or even over the last three to four years, it's been significant.

高敏銳度策略旨在支持我們在醫院業務領域看到的利潤擴張和成長。過去12個月，甚至過去三、四年，醫院業務的利潤擴張都非常顯著。

And that's really what the strategy has helped support, but I don't think it's worth making anything of one single quarter, especially when you have seasonal trends and quarter-to-quarter trends and ramp on and ramp off of respiratory illness and other things. I think this will play itself out over time. The underlying demand environment when you compare it to a multiyear basis, still seems strong to me.

這確實是該策略所支持的，但我認為不值得對單一季度做出任何評價，尤其是當你有季節性趨勢和季度間趨勢以及呼吸道疾病和其他疾病的起伏時。我認為隨著時間的推移，這個問題會得到解決。與多年期基礎相比，潛在的需求環境在我看來仍然強勁。

We have reached the end of the question-and-answer session, and this concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

問答環節已經結束，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。