Tenet Healthcare Corp (THC) 2025 Q3 法說會逐字稿

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

早安，歡迎參加 Tenet Healthcare 2025 年第三季財報電話會議。（操作說明）

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

現在我將把電話交給主持人，投資人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 third quarter 2025 results as well as a discussion of our financial outlook. Tenant senior management participating in today's call will be Dr. Saum Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer.

各位早安，感謝各位參加今天的電話會議。我是投資人關係副總裁威爾‧麥克道爾。我們很高興邀請您與我們一起探討 Tenet 2025 年第三季業績以及我們的財務展望。參加今天電話會議的租戶高階主管有：董事長兼執行長 Saum Sutaria 博士；以及執行副總裁兼財務長 Sun Park。

Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tenethealth.com. Listeners to this call are advised that certain statements made during our discussion today are forward-looking and represent management's expectations based on currently available information. Actual results and plans could differ materially. Tenet is under no obligation to update any forward-looking statements based on subsequent information. Investors should take note of the cautionary statement slide included in today's presentation as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission.

今天早上的網路直播包含一份幻燈片演示文稿，該文稿已發佈在我們網站 tenethealth.com 的投資者關係版塊。參與本次電話會議的聽眾請注意，我們今天討論中某些陳述屬於前瞻性陳述，代表管理層基於當前可用資訊所做的預期。實際結果與計劃可能有重大差異。Tenet公司沒有義務根據後續資訊更新任何前瞻性聲明。投資人應注意今天簡報中包含的警示聲明投影片，以及我們在最新的 10-K 表格和其他提交給美國證券交易委員會的文件中討論的風險因素。

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

接下來，我將把電話交給索姆。

All right. Thank you, Will, and good morning, everyone. We had another quarter of strong performance where we exceeded our expectations for revenue, adjusted EBITDA and margins. Third quarter 2025 net operating revenues were $5.3 billion, and consolidated adjusted EBITDA grew 12% over the third quarter 2024 to $1.1 billion. This represents an adjusted EBITDA margin of 20.8%, which is 170 basis points improvement over the prior year, driven by our strong same-store growth and continued operating efficiency.

好的。謝謝你，威爾，大家早安。我們又迎來了一個業績強勁的季度，營收、調整後 EBITDA 和利潤率都超乎預期。2025 年第三季淨營業收入為 53 億美元，合併調整 EBITDA 較 2024 年第三季成長 12%，達到 11 億美元。這代表調整後的 EBITDA 利潤率為 20.8%，比上年提高了 170 個基點，這主要得益於我們強勁的同店成長和持續的營運效率提升。

USPI continues to excel, and we generated $492 million in adjusted EBITDA, which represents 12% growth year over year. Same-facility revenues grew by 8.3% in the third quarter, highlighted by 11% growth in total joint replacements in the ASCs over the prior year. Our M&A and de novo activity remains robust as we acquired 11 centers and opened two de novo centers in the quarter, including facilities specializing in high acuity procedures such as spine and orthopedics. We have already spent nearly $300 million on M&A in this space year-to-date and expect to continue adding additional centers in the fourth quarter. The M&A and de novo pipelines remain strong.

USPI 繼續保持優異表現，我們實現了 4.92 億美元的調整後 EBITDA，年增 12%。第三季同店營收成長了 8.3%，其中門診手術中心 (ASC) 的關節置換手術總量比去年增加了 11%。我們的併購和新創業務依然強勁，本季我們收購了 11 個中心，並開設了兩個新中心，其中包括專門從事脊椎和骨科等高風險手術的機構。今年迄今為止，我們已在該領域的併購方面投入了近 3 億美元，並預計在第四季度繼續增加新的中心。併購和新項目儲備依然強勁。

Turning to our hospital segment. Adjusted EBITDA grew 13% to $607 million in the third quarter of 2025. Same-store hospital admissions, adjusted admissions were up 1.4% in the quarter. And third quarter 2025 revenue per adjusted admission was up 5.9% over the prior year as payer mix and acuity remains strong. In September, we opened our newest hospital facility in Port St. Lucie, Florida. This facility expands capacity in one of the fastest-growing areas in the country. The hospital will provide comprehensive emergency in specialty care and is focused on leveraging state-of-the-art technology, including robotics and advanced cardiac catheterization techniques.

接下來我們來看醫院板塊。2025年第三季調整後EBITDA成長13%，達6.07億美元。本季同店住院人數、調整後住院人數增加1.4%。2025 年第三季度，經調整後的每次入院收入比上年增長 5.9%，因為支付方組合和病情嚴重程度依然強勁。9 月，我們在佛羅裡達州聖露西港開設了最新的醫院設施。該設施擴大了該國成長最快地區之一的產能。該醫院將提供全面的專科急診服務，並致力於利用最先進的技術，包括機器人技術和先進的心臟導管介入技術。

Turning to our full year guidance. At this point in the year, we are once again raising our full year 2025 adjusted EBITDA guidance to a range of $4.47 billion to $4.57 billion. Building upon our substantial post second quarter guidance increase, indicating the confidence we have in our business this year, we have now increased our adjusted EBITDA guidance by $445 million or 11% at the midpoint of the range from our initial guidance.

接下來是我們的全年業績指引。截至目前，我們再次將 2025 年全年調整後 EBITDA 預期上調至 44.7 億美元至 45.7 億美元。繼第二季業績大幅上調之後，我們對今年的業務充滿信心，現在我們將調整後的 EBITDA 預期上調 4.45 億美元，增幅達 11%，達到我們最初預期範圍的中點。

Additionally, we are increasing our investments in capital expenditures in 2025 and now expect to invest $875 million to $975 million to fuel organic growth in the future, a $150 million increase at the midpoint over our prior expectations. In addition to this increased investment, we are also raising our expectations for full year 2025 free cash flow minus NCI to a range of $1.495 billion to $1.695 billion, an increase of $250 million at the midpoint from our previous guidance range. This increase is driven not only by the fundamental growth in adjusted EBITDA, but also by the strong cash collection performance of Conifer.

此外，我們將在 2025 年增加資本支出，目前預計將投資 8.75 億美元至 9.75 億美元，以推動未來的有機成長，比我們先前預期的中位數增加了 1.5 億美元。除了增加投資外，我們還將 2025 年全年自由現金流（扣除少數股東權益）的預期上調至 14.95 億美元至 16.95 億美元，比我們先前的預期範圍中位數增加了 2.5 億美元。這一成長不僅得益於調整後 EBITDA 的基本成長，也得益於 Conifer 強勁的現金回收表現。

Let me turn to 2026 with a few points. Uncertainty about the enhanced premium tax subsidies and the impact on reimbursement and enrollment in the exchanges still exists. Approvals for various increases in state directed payment programs for 2026 are still pending. Currently, in our hospital segment planning process, we see healthy patient demand that would support same-store volume growth and a stable operating environment supported by disciplined cost controls in 2026.

讓我展望一下2026年，並提出幾點看法。提高保費稅收補貼及其對報銷和交易所參保的影響仍存在不確定性。2026 年各州定向支付計畫的各項增幅申請仍在審批中。目前，在我們的醫院業務規劃過程中，我們看到了健康的病人需求，這將支持同店銷售額的成長，並在嚴格的成本控制下，在 2026 年實現穩定的營運環境。

Our strategy, which is more focused on higher acuity services, has delivered a track record of improved margins and strong earnings growth over the past few years. The return on invested capital for this improved portfolio of hospital assets is such that we have confidently increased our CapEx per bed from prior levels to higher levels in both 2024 and 2025, and we should continue to see the benefits of that into 2026.

我們的策略更加重視高水準的醫療服務，在過去幾年中取得了利潤率提高和盈利強勁增長的良好記錄。由於醫院資產組合的改進帶來了豐厚的投資回報，我們有信心在 2024 年和 2025 年將每張床位的資本支出從之前的水平提高到更高的水平，並且我們應該會在 2026 年繼續看到這種做法帶來的好處。

At USPI, we expect same-store revenue growth in line with our long-term expectations, a continued focus on high acuity cases, operational efficiencies and disciplined cost controls. Additionally, we expect further contributions from M&A and de novo development. I would note that USPI is less exposed to Medicaid and the exchanges and our ASCs are on freestanding rates. We will continue to operate and invest in this attractive segment.

在 USPI，我們預計同店營收成長將符合我們的長期預期，並將繼續專注於高風險病例、營運效率和嚴格的成本控制。此外，我們預計併購和新開發將帶來更多貢獻。我想指出的是，USPI 對 Medicaid 和交易所的依賴程度較低，而且我們的 ASC 是以獨立收費標準運作的。我們將繼續在這個極具吸引力的領域開展業務並進行投資。

In summary, we continue to deliver our commitments for sustained growth, expanding margins, a delevered balance sheet, and improved free cash flow generation. Our strong execution is driving attractive EBITDA growth that we are converting into significant free cash flow and our transformed portfolio of businesses are well positioned to drive sustained performance in the future.

總而言之，我們繼續履行我們對持續成長、擴大利潤率、降低資產負債率和改善自由現金流的承諾。我們強大的執行力推動了可觀的 EBITDA 成長，我們正在將其轉化為可觀的自由現金流，我們轉型後的業務組合已做好充分準備，在未來推動業績持續成長。

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

接下來，Sun公司將為我們提供更詳細的財務績效分析。太陽，該你了。

Thank you, Saum, and good morning, everyone. We delivered strong results in third quarter 2025, with adjusted EBITDA above the high end of our guidance range, once again driven by strong 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 $1.1 billion, a 12.4% increase year over year. Our adjusted EBITDA margin in the quarter was 20.8%, a continuation of our improved margin performance over multiple quarters. I would now like to highlight some key items for both of our segments, beginning with USPI, which again delivered strong operating results.

謝謝你，Saum，大家早安。我們在 2025 年第三季取得了強勁的業績，調整後的 EBITDA 高於我們預期範圍的上限，這再次得益於同店收入的強勁增長、持續較高的患者病情嚴重程度、有利的支付方組合和有效的成本控制。我們實現了53億美元的淨營業收入，合併調整後的EBITDA為11億美元，較去年同期成長12.4%。本季調整後的 EBITDA 利潤率為 20.8%，延續了我們多個季度利潤率持續改善的勢頭。現在我想重點介紹我們兩個業務部門的一些關鍵事項，首先是 USPI，它再次取得了強勁的經營業績。

In the third quarter, USPI's adjusted EBITDA grew 12% over last year, with adjusted EBITDA margins at 38.6%. USPI delivered an 8.3% increase in same-facility system-wide revenues, with net revenue per case up 6.1% and same-facility case volumes up 2.1%. Turning to our hospital segment. Third quarter 2025 adjusted EBITDA was $607 million, with margins up 160 basis points over last year at 15.1%. Same-hospital inpatient adjusted admissions increased 1.4% and revenue per adjusted admissions grew 5.9%.

第三季度，USPI 的調整後 EBITDA 比去年同期成長了 12%，調整後 EBITDA 利潤率為 38.6%。USPI 的同店系統整體營收成長了 8.3%，每例淨收入成長了 6.1%，同店病例量成長了 2.1%。接下來我們來看醫院板塊。2025 年第三季調整後 EBITDA 為 6.07 億美元，利潤率比去年同期成長 160 個基點，達到 15.1%。同院住院調整入院人數增加 1.4%，每次調整入院收入增加 5.9%。

Our consolidated salary, wages and benefits was 41.7% of net revenues, a 160 basis points improvement from the prior year and our contract labor expense was 1.9% of consolidated SWB expenses. These improvements continue to be driven by our data-driven approach to capacity and labor management and disciplined operating expense controls. Finally, we recognized a $38 million pretax impact for Medicaid supplemental revenues related to prior years in the third quarter of 2025. As a reminder, in total, year-to-date, we have recorded $148 million of favorable pretax impacts associated with Medicaid supplemental revenues related to prior years.

我們的綜合薪資、薪資和福利佔淨收入的 41.7%，比前一年改善了 160 個基點；我們的合約工費用佔綜合薪資、薪資和福利支出的 1.9%。這些改進持續得益於我們以數據為導向的產能和勞動力管理方法以及嚴格的營運費用控制。最後，我們確認了 2025 年第三季與往年相關的 Medicaid 補充收入的稅前影響為 3,800 萬美元。提醒一下，截至目前，我們已記錄到與往年相關的醫療補助補充收入帶來的 1.48 億美元的有利稅前影響。

Next, we will discuss our cash flow, balance sheet and capital structure. We generated $778 million of free cash flow in the third quarter, amounting to $2.16 billion of free cash flow year-to-date, which is up 22% over the same nine month period in the prior year. As of September 30, 2025, we had $2.98 billion of cash on hand with no borrowings outstanding under our line of credit facility. Additionally, we have no significant debt maturities until 2027. And finally, during the third quarter, we repurchased 598,000 shares of our stock for $93 million. Year-to-date through September 30, we have repurchased 7.8 million shares for $1.2 billion.

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。第三季我們產生了 7.78 億美元的自由現金流，今年迄今的自由現金流達到 21.6 億美元，比去年同期成長了 22%。截至 2025 年 9 月 30 日，我們手頭上有 29.8 億美元現金，且在信貸額度下沒有未償還的借款。此外，我們在 2027 年之前沒有重大債務到期。最後，在第三季度，我們以 9,300 萬美元的價格回購了 598,000 股股票。今年截至 9 月 30 日，我們已回購 780 萬股股票，價值 12 億美元。

Our leverage ratio as of September 30, was 2.3 times EBITDA, or 2.93 times EBITDA less NCI driven by our outstanding operational performance and continued focus on financial discipline. We believe we have significant financial flexibility to support our capital allocation priorities, and drive shareholder value and are very pleased with our ongoing cash flow generation capabilities. We remain committed to a deleveraged balance sheet.

截至 9 月 30 日，我們的槓桿率為 EBITDA 的 2.3 倍，或 EBITDA 減去 NCI 後的 2.93 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。我們相信我們擁有相當大的財務靈活性來支持我們的資本配置優先事項，並提升股東價值，我們對我們持續的現金流量產生能力非常滿意。我們始終致力於降低資產負債比率。

Let me now turn to our outlook for 2025. For '25, we now expect consolidated net operating revenues in the range of $21.15 billion to $21.35 billion, an increase of $150 million over prior expectations. As Saum mentioned, we are raising our 2025 adjusted EBITDA outlook range by $50 million at the midpoint to $4.47 billion to $4.57 billion, reflecting our outperformance in the hospital business. This is in addition to the substantial $395 million guidance raise that we announced in the second quarter. At the midpoint of our range, we now expect our full year 2025 adjusted EBITDA to grow 13% over 2024.

現在讓我展望一下我們對2025年的展望。我們現在預計 2025 年合併淨營業收入將在 211.5 億美元至 213.5 億美元之間，比先前的預期增加 1.5 億美元。正如 Saum 所提到的，我們將 2025 年調整後 EBITDA 預期範圍的中點上調 5000 萬美元至 44.7 億美元至 45.7 億美元，這反映了我們在醫院業務方面的優異表現。此外，我們在第二季也宣布了大幅調高 3.95 億美元的業績預期。按照我們預測範圍的中點，我們現在預計 2025 年全年調整後 EBITDA 將比 2024 年成長 13%。

Turning to our cash flows for 2025. We now expect free cash flows in the range of $2.275 billion to $2.525 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 $1.495 billion to $1.695 billion, an increase of $250 million at the midpoint from our previous guidance range. This reflects our focus on strong free cash flow conversion from our EBITDA growth, the continued outstanding cash collection performance of Conifer and continued investment into high priority areas of our business.

接下來我們來看看2025年的現金流。我們現在預計自由現金流在 22.75 億美元至 25.25 億美元之間，向少數股東分配的利潤在 7.8 億美元至 8.3 億美元之間，因此，扣除少數股東權益後的自由現金流在 14.95 億美元至 16.95 億美元之間，比我們之前的指導範圍中值增加了 2.5 億美元。這體現了我們對 EBITDA 成長帶來的強勁自由現金流轉化的重視、Conifer 持續出色的現金回收表現以及對業務高優先領域的持續投資。

Now turning 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.

現在來談談我們的資金部署重點。我們有能力透過有效利用自由現金流為股東創造價值，我們的工作重點並沒有改變。首先，我們將繼續優先進行資本投資，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，以推動內生成長，包括我們專注於更高水準的護理服務。

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. We continue to deliver consistent growth and a 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 our patients.

第三，我們將評估償還和/或再融資債務的機會。最後，我們將繼續採取平衡的股票回購策略，具體取決於市場狀況和其他投資機會。我們持續保持穩定成長和嚴謹的運營，這轉化為優異的財務表現。我們有信心實現2025年更高的業績預期，並繼續為我們的患者提供高品質的醫療服務。

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

接下來，我們準備開始問答環節。操作員？

(Operator Instructions)

（操作說明）

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great. I wanted to ask you about the Q4 guidance and kind of the expectations for utilization. Are you guys building anything in there for higher utilization before these subsidies expire? And how do you think about the capacity, I guess, particularly within USPI to accommodate utilization there?

偉大的。我想問一下您關於第四季業績指引以及對產能利用率的預期。在這些補貼到期之前，你們有沒有在那裡建造什麼設施來提高利用率？那麼，您認為美國郵政署（USPI）的產能，特別是其內部的產能，該如何滿足那裡的使用需求呢？

And then I guess, secondly, you mentioned that USPI is insulated from the headwinds for next year, but just trying to understand a little bit where you do see that pressure. I guess can you talk a little bit about exchange exposure within USPI.

其次，您提到 USPI 明年不會受到不利因素的影響，但我只是想稍微了解一下您認為壓力來自哪裡。我想請您談談USPI的外匯風險敞口。

All right. There's a lot of questions in there, Kevin. So let me just tackle one by one. And Sun, we can kind of complement here. First of all, we haven't built in anything nor are we seeing any kind of rush to the office, if you will, with respect to the exchange subsidies.

好的。凱文，這裡面有很多問題。那我就逐一解決吧。而孫，我們可以在這裡起到互補作用。首先，關於外匯補貼，我們既沒有製定任何計劃，也沒有看到任何湧向辦公室的跡象。

We're not planning nor are we saying that we expect them to expire at this stage. I think much of what we're hearing is that it may take time, but a compromise will be achieved from our intelligence coming from Washington. So we're just sort of patiently waiting to see what happens there. From a capacity utilization standpoint, at USPI, we typically have, as you know, busier late November and certainly December and have planned for staffing and capacity stretch that happens in that time period every year. So the simplest way to look at it is we're not worried about our capacity to take on the demand that we would see in the typical end of the fourth quarter USPI.

我們既沒有計劃也沒有表示我們預期它們會在現階段到期。我認為我們聽到的大部分消息都表明，這可能需要一些時間，但根據我們從華盛頓獲得的情報，最終會達成妥協。所以我們現在只能耐心等待，看看那裡會發生什麼事。從產能利用率的角度來看，正如您所知，USPI 通常在 11 月下旬和 12 月會比較繁忙，因此我們已經為每年這段時間的人員配備和產能緊張情況做好了計劃。因此，最簡單的理解方式是，我們並不擔心我們是否有能力滿足美國第四季末期典型的市場需求。

We began planning for that every year, months in advance with a very well-established protocol of how we do things. And there should be no reason that's different this year, including if there happen to be more demand that came because of the -- any kind of change in the exchanges or whatever that may be ahead of us from that perspective. What we have said about exchange business at USPI is a couple of things.

我們每年都會提前幾個月開始為此做準備，並制定了一套非常完善的流程來處理此事。今年也應該不會有什麼不同，即使因為交易所的任何變化或其他任何可能出現的情況而導致需求增加。關於USPI的外匯業務，我們主要談了兩點。

One is there's a lot less exposure there on a per case or revenue basis than in the hospital segment. And the reason for that we have said is that we typically see the exchange business, especially newer exchange members behaving with consumption patterns that are more similar to, for example, Medicaid and that explains some of the difference.

一方面，以病例或收入計算，該領域的風險敞口比醫院領域小得多。原因在於，我們通常看到交易所業務，尤其是較新的交易所成員，其消費模式更類似於醫療補助計劃，這解釋了部分差異。

Sun, I don't know if there's anything you want to add here.

孫，我不知道你還有什麼要補充的。

Yeah. Just a couple of metrics, Saum. I would also just note for USPI, our implied Q4 guidance is about an increase of $80 million roughly from Q3 into Q4, which is fairly standard, if you look at our historical pacing and change into Q4. So I think we remain confident in our -- both our capacity as well as our ability to take care of those patients. And then in exchange, I would just note that for Q3, exchange was 8.4% of our total admissions and 7% of our total consolidated revenues. So a slight increase in total as a percent of admissions from Q2 and reasonable relatively flat in terms of total percent of consolidated revenue. So we do see continued strong exchange performance, but at this point, no significant increase in Q3. So we'll see in Q4.

是的。Saum，就幾個指標而已。我還要指出，對於 USPI，我們隱含的第四季業績指引比第三季成長約 8,000 萬美元，這與我們以往第四季的業績成長速度和變化趨勢相當一致。所以我認為我們仍然對我們照顧這些患者的能力和規模充滿信心。另外，我想指出的是，第三季度，交換收入占我們總入場人數的 8.4%，占我們總合併收入的 7%。因此，總入院人數佔第二季的百分比略有上升，而總合併收入佔總收入的百分比則相對持平。因此，我們看到交易所表現持續強勁，但就目前而言，第三季沒有顯著成長。所以，我們第四季就會見分曉。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Wanted to hopefully just draw a little bit more to the CapEx inputs for the year, including the increase in the CapEx guidance. Maybe if you can talk about specific allocation of capital related to the increase and then maybe bucket some of the key larger investments that you're making within the CapEx for the full year?

希望能夠稍微增加今年的資本支出投入，包括提高資本支出預期。或許您可以談談與成長相關的具體資金分配情況，然後將您在全年資本支出中進行的一些關鍵性較大投資進行分類？

Scott, I appreciate the question. So I would just characterize the increased capital expenditure as more investment in both program or clinical program infrastructure, service line support and various other growth strategies in the hospitals. I mean, obviously, our CapEx plan for the year included the residual capital that was required to open up the Port St. Lucie Hospital. So this is capital expenditure that has extended above and beyond that where we see opportunities for growth.

斯科特，感謝你的提問。因此，我會將增加的資本支出描述為對醫院項目或臨床項目基礎設施、服務線支援以及各種其他成長策略的更多投資。我的意思是，很顯然，我們今年的資本支出計畫包括開設聖露西港醫院所需的剩餘資金。所以，這筆資本支出已經超出了我們認為有成長機會的範疇。

Look, as I indicated, the demand environment continues to be very healthy and we see opportunities. And the efficiency with which we operate, our focus on service levels to the physician community, we see the opportunity for them to choose our site as a location of care for their patients more and more. Obviously, the way in which we tend to deploy this capital is focused more on our high acuity strategy, so things that are relevant to the cardiac care unit, intensive care unit, cath labs, high-end imaging, et cetera, surgical programs. But that's really how we're making the investments around the country. And as we reviewed them, through this business planning cycle, we felt it was a good time, given the demand that we continue to see through the third quarter to go ahead and make those investments and raise our guidance.

正如我之前所說，市場需求環境依然非常健康，我們看到了許多機會。我們高效的運作方式，以及我們對服務醫生群體的重視，讓我們看到了他們越來越多地選擇我們的診所作為其患者就診地點的機會。顯然，我們部署這筆資金的方式更著重於我們的高風險策略，也就是與心臟護理室、重症監護室、導管室、高端影像、外科手術計畫等相關的事項。但這正是我們在全國各地進行投資的方式。在本次業務規劃週期中，我們回顧了這些投資，鑑於第三季持續的需求，我們認為現在是進行這些投資並提高業績預期的好時機。

Craig Hettenbach, Morgan Stanley.

克雷格‧赫滕巴赫，摩根士丹利。

Yeah. I want to just extend that just focused on free cash flow here, the increase to guidance. You mentioned kind of improved cash collections at Conifer. You also have margins coming up. So any other context around kind of free cash flow and importantly, just the sustainability of those trends as you see it?

是的。我想進一步強調一下，這裡只關注自由現金流，也就是提高預期。你提到Conifer的現金回收情況有所改善。你還有一些利潤空間要利用。那麼，關於自由現金流，更重要的是，您認為這些趨勢的可持續性，還有其他什麼背景資訊嗎？

Sun, go ahead.

太陽，繼續前進吧。

Craig, thanks. Yeah, as mentioned, this has been a long-term focus of ours, making sure not only EBITDA growth and EBITDA margins come through, through strong operational performance also then making sure that converts through free cash flow. And we listed some of the key drivers there. Obviously, the continued improving and a fantastic performance by Conifer on cash collections.

克雷格，謝謝。是的，正如前面提到的，這一直是我們的長期關注點，我們不僅要確保 EBITDA 成長和 EBITDA 利潤率的實現，還要透過強勁的營運業績，確保這些成長和利潤轉化為自由現金流。我們列出了一些關鍵驅動因素。顯然，Conifer 在現金回收方面持續改進並表現出色。

Obviously, growth in EBITDA comes through. And then probably a couple of other things that I'd point out. More broadly, in terms of working capital management, we have spent a lot of time and focus on making sure we're optimizing all components of there. And then obviously, one of the additional benefits of our continued deleveraging is improvement in interest expenses, which also helps our free cash flow generation. We believe these operational efficiencies that we've implemented similar to our margin performance, whether it's Conifer or working capital management or continued EBITDA generation, we obviously will work hard to make these sustainable over a long period of time.

顯然，EBITDA成長了。然後可能還有幾點要指出。更廣泛地說，在營運資金管理方面，我們投入了大量時間和精力，確保優化其中的所有組成部分。顯然，我們持續去槓桿化帶來的額外好處之一是利息支出的改善，這也有助於我們產生自由現金流。我們相信，我們實施的這些營運效率提升措施，無論是針葉樹種植、營運資本管理還是持續的 EBITDA 成長，都與我們的利潤率表現類似，我們顯然會努力使這些措施在很長一段時間內保持永續性。

Jason Cassorla, Guggenheim Securities.

Jason Cassorla，古根漢證券。

Great. I just wanted, Sun, to go back to your commentary around the implied 4Q guidance on USPI. At the midpoint, it would imply year over year growth, a little over 8%, which is still strong, marks a little bit of a deceleration from like the low to mid-teens you've done this year. Just any thoughts around that? Is it conservatism? Anything from a timing perspective, like the pace of development coming online that's impacting that? Just any further detail around the implied fourth quarter guidance for USPI would be helpful.

偉大的。孫先生，我只是想回到您之前對USPI第四季業績指引的評論。中點意味著同比增長略高於 8%，這仍然很強勁，但與今年早些時候的 15% 到 25% 的增速相比，增速略有放緩。大家對此有什麼想法嗎？這是保守主義嗎？從時間安排的角度來看，例如開發上線的速度，有沒有什麼因素會影響這一點？任何關於USPI第四季業績指引的更多細節都將有所幫助。

Well, Sun, we can -- let me start. I don't think anything we're saying about the business demand, organic performance really changes. I mean, obviously, we have certain assets at a larger scale and various other pricing elements that begin to lap year-over-year from that perspective. And so if anything, it's just math, basically. But there's really no -- I mean we don't there's no implication. We're not looking at this fourth quarter at USPI really any differently than in prior fourth quarter. As I said, we're intensely just focused on the ramp-up of business that we typically would see. Sun?

好的，Sun，我們可以——讓我先開始。我認為我們所說的關於業務需求、自然成長表現的任何內容都不會真正改變什麼。我的意思是，很顯然，我們有一些規模較大的資產，以及其他各種定價因素，從這個角度來看，這些因素開始逐年遞減。所以說，歸根究底，這只是數學問題。但其實並沒有——我的意思是，我們沒有——沒有任何暗示。我們對USPI第四季的看法與以往的第四季並無太大不同。正如我所說，我們目前正全力以赴地推進業務成長，這與我們通常的情況類似。太陽？

Yeah, I don't think I have anything further to add, Saum. Thanks.

是的，我想我沒什麼要補充的了，Saum。謝謝。

Ann Hynes, Mizuho.

安海恩斯，瑞穗。

Great. Just looking at the -- obviously, margins and cash flows have been very strong. Costs have been very good. going into 2026, especially the labor environment, I think that's better than expectations in 2025. Do you expect that to continue into 2026 on the labor side? And then any other inflationary pressure you would call out as we do our models, that would be great.

偉大的。單從這一點來看——顯然，利潤率和現金流都非常強勁。成本控制得非常好。展望2026年，尤其是勞動市場環境，我認為這將比2025年的預期更好。您預期勞動市場方面的這種趨勢會持續到2026年嗎？此外，如果您在建立模型時指出任何其他通膨壓力因素，那就太好了。

Go ahead, Sun.

太陽，繼續吧。

Sure. And while we're not commenting specifically on '26 yet, we'll note a couple of things. You're right. Our labor environment has generally been very strong and conducive to our operations. whether it's full-time labor expenses, whether it's our management of contract labor and other premium labor, whether it's pro fees, I think they've all been to our expectations.

當然。雖然我們目前還不打算對 26 年的情況進行具體評論，但有幾點需要說明。你說得對。我們的勞動力環境整體上非常穩健，有利於我們的營運。無論是全職勞動成本，或是我們對合約工和其他優質勞動力的管理，亦或是專業服務費，我認為都符合我們的預期。

And in the current environment, as we sit here today, don't see any meaningful changes coming. In terms of other inflationary pressures, again, not commenting specifically on '26, but obviously, the other topic that we've talked about is tariffs, we've said that for 2025, we've been able to manage that fairly well due to both our sourcing optimization exercises, whether it's contracting, whether it's working with our vendors, whether it's picking the right products, as well as through efforts through our GPO. So we remain confident based on our contract structure that we have a couple more cycles where we'll be able to manage this. But obviously, as we get into the future years, we'll have to remain nimble on the tariff dynamic.

就目前的情況來看，我們今天看不到任何實質的改變。至於其他通膨壓力，同樣，我不打算具體評論 2026 年的情況，但顯然，我們討論過的另一個話題是關稅，我們說過，對於 2025 年，由於我們的採購優化措施，無論是簽訂合同、與供應商合作、選擇合適的產品，還是通過我們的集團採購組織 (GPO) 所做的努力，我們已經能夠很好地應對這個問題。因此，基於我們的合約結構，我們仍然有信心在未來幾個週期內能夠應對這種情況。但很顯然，隨著我們進入未來幾年，我們必須在關稅動態方面保持靈活。

Benjamin Rossi, JPMorgan Chase.

班傑明‧羅西，摩根大通。

I guess just checking in on Conifer, how did Conifer's contribution within the Hospital Operations segment shake out during 3Q? And then you've previously mentioned Conifer's ability to sit with patient eligibility and enrollment services during things like Medicaid redeterminations. I guess should the ACA exchange subsidies expire, do you think Conifer could have a similar utility for you in helping identify patients with lost coverage and to be eligible for coverage elsewhere?

我只是想了解一下 Conifer 的情況，Conifer 在第三季醫院營運部門的貢獻如何？而且您之前也提到過，Conifer 有能力在 Medicaid 重新認定等事項中為病患資格和註冊服務提供支援。我想，如果 ACA 交易所補助到期，您認為 Conifer 能否在幫助識別失去保險並有資格在其他地方獲得保險的患者方面發揮類似的作用？

Well, I mean, that's a very good insight about some of the capabilities that we have in Conifer. And by the way, I would flip it the other direction as well. Given the time frame we're at, but the likelihood -- the positive likelihood of a compromise that we keep hearing, it will also be important that we have invested in the right capacity and capabilities to utilize Conifer's ability to help with enrollment and enrollment in our markets in our clients' markets on the exchanges if the exchange enrollment time line gets delayed or extended. So yes, obviously, the capabilities to help enroll in other products is there, but we're also ramping up our investments and approach to support what might be a little bit of a dislocated enrollment time line on the exchanges given the potential for a later compromise.

嗯，我的意思是，這讓我們對 Conifer 的一些能力有了非常好的了解。順便說一句，我也會把它反過來裝。鑑於我們所處的時間框架，以及我們不斷聽到的達成妥協的可能性——積極的可能性，同樣重要的是，我們已經投資了適當的能力和資源，以便在交易所註冊時間表被推遲或延長時，利用 Conifer 的能力來幫助我們的客戶在交易所的市場進行註冊。所以，是的，顯然，我們有能力幫助用戶註冊其他產品，但考慮到以後可能會有妥協方案，我們也正在加大投入並改進方法，以應對交易所註冊時間線可能出現的一些偏差。

So it will work well on both dimensions, and we have been investing up in both our staffing and field deployment in preparation for that already. Conifer is performing well according to our expectations within the segment, not a lot else to comment on there. I mean obviously, we are really happy with the way it's performing in the market for us and our base of clients from a cash collection standpoint that I noted before.

因此，它在兩個方面都能很好地發揮作用，我們已經在人員配備和現場部署方面加大了投入，為此做好了準備。根據我們的預期，Conifer 在該細分市場中表現良好，除此之外沒有其他值得評論的。我的意思是，很顯然，從我之前提到的現金回收角度來看，我們對它在市場上的表現以及我們客戶群的表現都非常滿意。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Nice to see the ASC volumes positive. Any particular service lines or maybe even geographies driving this? And maybe same thing for the acute side, any hospital service line stronger or weaker than you expected in the third quarter?

很高興看到ASC交易量呈現上升趨勢。是否有特定的服務線或地理因素在推動此趨勢？急性醫療方面可能也存在同樣的問題，第三季有哪些醫院服務線比您預期的更強或更弱？

Yeah. No, I appreciate the question. A couple of things. I mean we said this at the start of the year when we gave guidance that we kind of saw the environment USPI picking up later in the year just given -- we look very carefully, obviously, at how busy our positions are. And as we looked at that, we saw it ramping up in the latter part of the year.

是的。不，我很感謝你的提問。有幾件事。我的意思是，我們在年初給出指導意見時就說過，我們大致看到了 USPI 在今年晚些時候的環境有所好轉——顯然，我們會非常仔細地觀察我們的持倉情況。我們觀察發現，這種情況在下半年愈演愈烈。

I would say probably the biggest driver of that growth in addition to the core of the higher acuity services that we're investing in, ortho, spine, some of the things we're doing in robotics and other things. Those things continue to go strong. We saw just based upon the numbers, healthier GI recovery into the third quarter which is kind of what we were expecting, given what the volumes and business of our physicians look like in the first half. So that was probably an outsized driver of the USPI volume contribution. On the hospital side, and you can tell from the city net revenue per case, et cetera, I mean, that environment continues to be strong.

我認為，除了我們正在投資的高端醫療服務（如骨科、脊椎科）以及我們在機器人技術和其他領域所做的一些工作之外，推動這一增長的最大因素可能是…這些事情依然進展順利。從數據來看，第三季胃腸道狀況有所好轉，這與我們上半年醫生的業務量和工作情況的預期基本一致。所以這可能是 USPI 交易量貢獻的一個主要驅動因素。從醫院方面來看，從城市每例病例的淨收入等數據可以看出，我的意思是，醫院的營運環境依然強勁。

Obviously, things like trauma and high acuity emergency visits and stuff. There's less elasticity there, right, with market conditions, given the nature of that. The only thing I would note on the hospital side is that especially outpatient visits, which contribute to adjusted admissions, the respiratory and infectious disease volumes were a little bit lower than perhaps expectations. And that just may signal some sort of a slower start to the respiratory season. The numbers certainly seem to indicate that.

顯然，例如創傷和危重症急診之類的情況。鑑於市場狀況的性質，那裡的彈性較小，對吧？我唯一想指出的是，醫院方面，特別是門診就診量（這會影響入院人數），呼吸道疾病和傳染病的病例數可能比預期要低一些。這或許預示著呼吸道疾病流行季的開始會比較緩慢。這些數字似乎確實表明了這一點。

But again, we're talking about the third quarter, right? So it's less of a harbinger than one would say. But factually speaking, the infectious disease respiratory areas are the only areas I would call out on a proportional basis.

但是，我們說的是第三季度，對吧？所以它與其說是某種預兆，不如說是人們通常所說的預兆。但事實上，傳染病呼吸系統疾病領域是我唯一會按比例重點提及的領域。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

I might have missed it, but I was hoping to get an update on total contribution from DPP provider taxes in the third quarter and your updated estimate on that benefit for the year. And then I appreciate you pointing out the $148 million of prior year DPP that we should think about as being kind of onetime, I assume. Any other items we should consider for 2026 in terms of that bridge year over year versus kind of typical growth?

我可能錯過了，但我原本希望得到第三季度 DPP 提供者稅收總貢獻的最新信息，以及您對該年度福利的最新估計。另外，感謝您指出上一年的 1.48 億美元 DPP，我認為我們應該將其視為一次性支出。就2026年而言，在實現同比增速與典型成長相比方面，還有其他需要考慮的因素嗎？

Yeah. Justin, on the DPP in Q3, we had about -- recorded almost $350 million, $346 million of supplement Medicaid programs, of which we noted $38 million of that was prior year. So that brings us to about a little over $1 billion of -- $1.02 billion for year-to-date in fiscal '25, then of that $148 million was out of period. So I think we're on track. It's right in the middle of kind of our expectations once you normalize for the out of period prior year payments.

是的。賈斯汀，關於第三季的 DPP，我們記錄了近 3.5 億美元，其中 3.46 億美元是補充醫療補助計劃，我們注意到其中 3800 萬美元是去年的。因此，截至 2025 財年，累計金額略高於 10 億美元，為 10.2 億美元，其中 1.48 億美元屬於非當期金額。所以我覺得我們一切進展順利。扣除往年同期付款後，這個結果基本上符合我們的預期。

And then in terms of normalization. I would say from a technical math basis, the $148 million of Medicaid supplemental payments that we pointed out are the largest normalization factor for '25 and '26, obviously, there are a lot of other dynamics that we -- that Saum touched on in his opening comments around reimbursement and other dynamics that we'll have to take into consideration as we get deeper into guidance in our next earnings call.

然後是歸一化方面。從技術數學的角度來看，我們指出的 1.48 億美元的醫療補助補充付款是 2025 年和 2026 年最大的正常化因素，顯然，還有很多其他因素，正如 Saum 在開場白中提到的，關於報銷和其他因素，我們將在下次財報電話會議上更深入地探討業績指引時予以考慮。

Brian Tanquilut, Jefferies.

Brian Tanquilut，傑富瑞集團。

Just a question on capital allocation. Obviously, you've set goals for USPI's acquisition spend, and you've already exceeded that. And then how should we be thinking about that and then the buyback in terms of how you're thinking about your thrown capital to buyback since you've hit your M&A targets already?

關於資本配置方面有個問題。顯然，你們已經為 USPI 的收購支出設定了目標，而且已經超額完成了目標。那麼，既然你們已經實現了併購目標，我們該如何考慮回購問題，以及你們如何考慮將投入的資金用於回購呢？

Yeah. I mean the M&A targets every year are obviously guidance that we go into the year with respect to expectations of what we're going to do. We're responsive to a marketplace, as you can imagine. And we're very careful about our diligence in maintaining our high bar for acquisitions. This year, we have found more opportunities, a broader pipeline certain processes that may have been competitive in addition that we want and just continued momentum on our de novo strategy.

是的。我的意思是，每年的併購目標顯然是我們進入新年時對我們未來發展方向的預期指引。正如您所想，我們對市場需求反應迅速。我們非常謹慎地進行盡職調查，以保持我們對收購的高標準。今年，我們發現了更多機會，拓展了某些可能具有競爭力的流程，這是我們想要的，我們繼續推動我們的全新策略。

So mean the kind of cash flow that USPI generates, we can fund those increases. Now obviously, if you go back historically, with the platform deals that we have done, we've also outspent our typical guidance. So yes. Look, we try to update that as we go quarter to quarter based upon what we're seeing in the environment and what we're bringing on board. Obviously, having these additional assets on board is positive for the organization going into the following year.

所以，就USPI產生的現金流而言，我們可以為這些成長提供資金。顯然，回顧歷史，在我們達成的平台交易中，我們的支出也超過了我們通常的預期。是的。你看，我們會根據每個季度的市場環境和我們引入的新事物，努力對這個計劃進行更新。顯然，擁有這些額外的資源對公司來年的發展是有利的。

And as I noted, we also continue to see some more opportunity in the fourth quarter. So we'll see how that all plays out. I mean we just remain focused on executing the M&A and de novo strategy. And if we do it with the appropriate diligence and onboarding, we're just updating what the spend looks like in a given year.

正如我之前提到的，我們在第四季也看到了更多的機會。所以，我們拭目以待。我的意思是，我們將繼續專注於執行併購和新業務拓展策略。如果我們以適當的盡職調查和入職流程來完成這項工作，我們只是更新了特定年份的支出情況而已。

Look, on the second point, we've been very active repurchasers of our shares this year. I would continue to reiterate at our trading multiples were long-term active repurchasers of our shares this quarter, obviously, was lower than the prior quarter. There's also a lot more uncertainty in the market. And we feel fine about what we've achieved this year in that regard.

關於第二點，今年我們一直在積極回購自己的股票。我將繼續重申，本季我們的交易倍數明顯低於上一季度，因為長期積極的股票回購者一直在回購我們的股票。市場上的不確定性也大大增加。我們對今年在這方面所取得的成就感到滿意。

AJ Rice, UBS.

AJ Rice，瑞銀集團。

As you start to think about 2026 budgeting together, et cetera, are there any particular areas on the expense management side. I know you've talked a little bit about some of the things you're seeing this year in labor. But whether it's labor supplies, other there are opportunities for incremental savings or programs to initiatives to move forward? And then obviously, there's a lot of discussion about AI, whether there's anything on AI that's worth calling out that you're focused on being able to deploy that.

當你們開始一起考慮 2026 年的預算等事宜時，在費用管理方面是否有任何特別需要關注的領域？我知道你已經稍微談到了今年在分娩過程中看到的一些情況。但無論是勞動力供應，還是其他方面，都存在逐步節省成本或推進相關計劃的機會嗎？然後，很顯然，關於人工智慧有很多討論，關於人工智慧是否有任何值得一提的進展，以及你是否專注於部署它。

AJ, so short, medium, long term, kind of all embedded in there. We have undertaken over the last few months and ongoing business transformation initiative that is designed to look for those opportunities and also do contingency planning given the uncertainty in the marketplace. Those opportunities would include how we think about all aspects of what I would call labor costs within the organization. Obviously, this year, as we have noted before, we have done some work to rightsize our corporate structure, given some of the asset divestitures that we've had in the past. It has very much been our philosophy to -- I think you know this, to use advanced analytics and where we have the ability to more automation and leveraging our global business center, which is continuing to perform well and scale up.

AJ，所以短期、中期、長期，都包含在其中。在過去的幾個月裡，我們開展了一項持續的業務轉型計劃，旨在尋找機遇，並鑑於市場的不確定性制定應急計劃。這些機會將包括我們如何看待組織內部我稱之為勞動成本的各個面向。顯然，正如我們之前提到的，今年我們做了一些工作來調整公司結構，因為我們過去進行了一些資產剝離。一直以來，我們的理念都是——我想您也知道——運用先進的分析技術，並在我們有能力的地方實現更多自動化，並充分利用我們全球業務中心，該中心目前表現良好，並且正在不斷擴大規模。

This will -- this year proportionately will be one of the larger scale up years in the last few years. within the global business center, which we feel very good about. So there are a lot of opportunities there. Sun already talked about supplies, I won't say a lot more there, and we continue to invest actively in improvement opportunities and our ability to drive more efficient and better collections in Conifer, some of which we've noted in earlier parts of this call. So very much comprehensively looking at these opportunities. But with the mindset of finding both shorter-term and longer-term opportunities that will impact the business.

今年將是近幾年來規模擴張幅度最大的一年，就全球業務中心而言，我們對此感到非常樂觀。所以那裡有很多機會。Sun 已經談到了供應問題，我不再贅述。我們將繼續積極投資於改進機會，提高我們在 Conifer 的收集效率和質量，其中一些我們已經在本次電話會議的前半部分中提到過。因此，我們正在非常全面地審視這些機會。但要抱著尋找短期和長期機會的心態，這些機會將對業務產生影響。

Josh Raskin, Nephron Research.

Josh Raskin，腎單位研究。

First was a quick clarification, I think, on Kevin's question. Did you see the contribution from exchanges, the revenue contribution was less than the percentage of adjusted admissions? And then my real question just sort of getting back to the M&A environment for the ASCs. There's been a couple more reports, media reports in terms of maybe a competitive landscape. And I'm just curious if that's been changing or if you're seeing anything on valuations yet? And as you speak to your conversations with physicians, maybe how they're evaluating opportunities in ASCs as well?

首先，我想快速澄清一下凱文提出的問題。你注意到交易所的貢獻了嗎？其收入貢獻低於調整後入場人數的百分比。然後，我真正的問題還是回到ASC的併購環境。還有一些關於競爭格局的媒體報導。我只是好奇這種情況是否有所改變，或者您已經觀察到估值方面的任何變化？在您與醫生的交流中，或許也可以了解他們是如何評估日間手術中心 (ASC) 的機會的？

I think the commentary, going back to the first question from Kevin was simply that the exposure to exchanges either on volumes or revenue is less than in the hospital business, USPI, the exposure whether you're looking at volumes of exchange patients or revenue from exchange patients proportionally in their business is less than the hospital business. That was what the comment was. I hope that helps clarify. The ASC opportunity, first of all, I would say it has so many different dimensions in terms of the growth platform that we have built at USPI, right? We're active in de novos.

我認為，回到 Kevin 的第一個問題，評論很簡單，無論是交易量還是收入，交易所業務的風險敞口都小於醫院業務。 USPI，無論從交易患者的數量或交易患者的收入比例來看，交易所業務的風險敞口都小於醫院業務。這就是評論的內容。希望這樣解釋清楚了。首先，ASC 的機會在於，就我們在 USPI 建立的成長平台而言，它具有許多不同的維度，對吧？我們積極參與從零開始的專案。

Those are more focused on higher-end specialties and partnerships with our more proactive health system partners. So there's really two threads there. We've worked hard to work with MSO organizations that are deploying capital and scaling their businesses to be the partner of choice on the ASC side. I think that has played out very nicely. And really there, the strategies are across multiple different service lines, GI, orthopedics, stuff that we do with MSOs in ophthalmology, obviously, our urology platform, et cetera.

這些更側重於高端專科以及與我們更積極主動的醫療系統合作夥伴的合作。所以這裡其實有兩個線索。我們一直努力與那些正在部署資本並擴大業務規模的MSO組織合作，力求成為ASC的首選合作夥伴。我認為結果非常好。實際上，這些策略涵蓋多個不同的服務領域，包括胃腸科、骨科、我們與眼科醫療服務組織 (MSO) 合作的計畫、我們的泌尿科平台等等。

So there are multiple avenues of growth that develop there. Of course, we talk about the acquisition market a fair amount. And in that acquisition market, we have been, for a long period of time, the partner of choice. It's the reason we've scaled so effectively. But physicians to get to your question of what are they looking for?

因此，在那裡發展出多種成長途徑。當然，我們經常談到收購市場。在併購市場中，我們長期以來一直是首選合作夥伴。這就是我們能夠如此有效率地擴大規模的原因。但是，醫生要回答你的問題，那就是他們在找什麼？

I mean they're looking for somebody who's delivered a consistent track record who has demonstrated the ability to grow, who has demonstrated the ability to take on new assets and find that other doctors tell them that it went well when onboarded. And they're looking -- many times, single specialty physicians are looking for somebody who has a proven track record to help them diversify their business to grow the center and make it multispecialty, which is, as you know, something that USPI has historically been very, very good at in terms of running larger multi-specialty type of centers that help these physicians get to the next level of maturity in their investments.

我的意思是，他們正在尋找一位業績穩定、有發展潛力、能夠接管新業務，並且其他醫生也反饋說他/她加入後發展順利的人。他們正在尋找——很多時候，單一專科醫生都在尋找有成功經驗的人來幫助他們實現業務多元化，發展中心，使其成為多專科中心。如您所知，USPI 一直以來都非常擅長經營大型多專科中心，幫助這些醫生在投資方面達到更高的成熟水準。

So when I look across the board on the way the market works, we continue to be the advantaged party in what it takes to build and grow this segment. And so that's what gives us the confidence to continue ahead to spend more than we had originally thought we would spend and look forward to a healthy pipeline in 2026.

因此，從整體來看，在建立和發展這一細分市場方面，我們仍然是具有優勢的一方。因此，這給了我們信心，讓我們能夠繼續前進，投入比我們最初設想的更多的資金，並期待在 2026 年擁有健康的業務儲備。

This is Sun. Josh, just to give you the numbers again. What we said was for Hicks, it represents 8.4% of our admissions in Q3 of '25 and 7% of our total consolidated revenues. So the admissions that is a little slightly higher than the revenue stat, and that's been consistent for us historically. Hopefully, that helps.

這是太陽。喬希，我再給你報一次數據。我們之前說過，對 Hicks 來說，它占我們 2025 年第三季入院人數的 8.4%，占我們合併總收入的 7%。所以，招生人數略高於收入統計數據，這在我們歷史上一直都是如此。希望這能有所幫助。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

So CMS is this new Wiser model in fee-for-surface Medicare that starts next year. Do you see any impact on prior for administrative work for USPI? I know it's only six states, but Texas is one of them and knee arthroscopy and certain implants. I think there are an area they're focused on. So just any thoughts or insight into how you're preparing for this.

所以，CMS 正在推行一種新的、更明智的按服務項目收費的醫療保險模式，該模式將於明年開始實施。您認為這對美國郵政署 (USPI) 的行政工作會有任何影響嗎？我知道只有六個州，但德克薩斯州是其中之一，那裡有膝關節鏡手術和某些植入物。我認為他們關注的領域是有的。所以，關於你如何準備這次活動，你有什麼想法或見解嗎？

Yeah. Well, there is some movement in the preauthorization space in fee-for-service Medicare. As you correctly note, the Wiser program still has some uncertainty about how and what scope of services that will be implemented for. But yes, we have taken into consideration what will be required there. There are really three threats to it.

是的。嗯，在按服務收費的聯邦醫療保險的預授權領域，確實出現了一些變化。正如您所指出的，Wiser 計劃在如何實施以及服務範圍方面仍然存在一些不確定性。是的，我們已經考慮到了那裡需要什麼。它實際上面臨三大威脅。

One is premiering documentation, understanding of documentation requirements for appropriate care. Two is actually consistently complying with those. And three is the operational element of managing our scheduling to be complemented by preauthorization having been achieved. So we're sort of prepared to do all of that. I mean we don't talk about it much, but we have a very capable revenue cycle function within USPI that deals with all of the end-to-end type of services that are required there.

一是首創性文件記錄，了解適當照護所需的文件記錄要求。實際上，二號始終遵守這些規定。第三點是營運方面的管理要素，即在獲得預先授權的情況下管理我們的日程安排。所以我們已經做好了做所有這些事情的準備。我的意思是，我們很少談論這件事，但USPI內部有一個非常強大的收入週期管理部門，負責處理所有需要的端到端服務。

And so we feel pretty good about that. Look, the other thing is that in any marketplace, when these types of things are introduced, there's an adjustment period. But also physicians have the opportunity to adjust different mix into the centers as they fill their -- especially the ones that have block time. And so I think part of the move here will also be to increase commercial mix and work with the physicians to increase their commercial mix in that process.

所以，我們對此感覺相當不錯。還有一點是，在任何市場中，當這類事物被引入時，都會有一個調整期。但醫生們也有機會在安排就診時間時調整中心的人員組成——尤其是那些有固定時段的就診中心。因此，我認為此舉的部分原因還在於增加商業產品組合，並與醫生合作，在此過程中增加他們的商業產品組合。

Andrew Mok, Barclays Bank.

Andrew Mok，巴克萊銀行。

This is [Thomas Wilson] on for Andrew. As we await the finalization of the hospital outpatient role, could you comment on whether the removal of the inpatient-only list is a net positive or net negative for the enterprise?

這是托馬斯威爾遜替補安德魯上場。在等待醫院門診角色最終確定之際，您能否評論一下，取消僅限住院患者的名單對企業來說是利大於弊還是弊大於利？

Okay. So that came through really garbled. I think the question was, is the inpatient only rule list going away? And is that a benefit to us. I don't know that it's going away. I think there's been discussion about the inpatient-only rule list and what that impact would be. I mean, obviously, for us, the benefit would be in the USPI segment and potentially a push for more in certain types of volumes that have been in the hospital setting into the outpatient setting.

好的。所以傳過來的聲音非常混亂。我認為問題是，僅限住院患者的規則清單是否會被取消？這對我們有好處嗎？我不知道它是否會消失。我認為之前已經討論過僅限住院患者的規則清單及其影響。我的意思是，很顯然，對我們來說，好處在於 USPI 領域，並且有可能推動某些類型的業務量從醫院環境擴展到門診環境。

In our acute care hospital segment, because of our greater focus on high acuity work, proportionally, and it's not to say that we don't have the business. But proportionally, those cases wouldn't be affected as much as maybe a typical general acute care facility. But we haven't done any quantification of that, that we've shared anywhere. I think this policy is still very much up in the air being discussed and not even at the point where I would say that we're engaging in rule-making discussions about it.

在我們的急診醫院領域，由於我們更加重視高風險疾病的治療，因此，按比例來說，這並不是說我們沒有這方面的業務。但從比例來看，這些病例受到的影響可能不會像典型的綜合急診護理機構那麼大。但我們還沒有對此進行任何量化分析，也沒有在任何地方分享過相關數據。我認為這項政策目前仍處於討論階段，尚未進入製定相關規則的討論階段。

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.

問答環節到此結束，今天的會議也到此結束。現在您可以斷開線路了，感謝您的配合。

Thank you.

謝謝。