Tenet Healthcare Corp (THC) 2025 Q4 法說會逐字稿

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

早安，歡迎參加 Tenet Healthcare 2025 年第四季財報電話會議。（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. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tenet's fourth quarter 2025 results as well as a discussion of our financial outlook. Tenet senior management participating in today's call will be Dr. Saum Sutaria, Chairman and Chief Executive Officer; and Sun Park, Executive Vice President and Chief Financial Officer.

早安.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 年第四季業績以及我們的財務展望。參加今天電話會議的 Tenet 高級管理人員包括董事長兼首席執行官 Saum 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. 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。

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

接下來，我將把電話交給索姆。

Thank you, Will, and good morning, everyone. We reported 2025 net operating revenues of $21.3 billion and consolidated adjusted EBITDA of $4.57 billion, which represents 14% growth over 2024. Full year adjusted EBITDA margin of 21.4% improved 200 over 200 basis points from the prior year. Our fourth quarter results were, again, above our expectations, driven by strong same-store revenue growth, high acuity and disciplined cost control. I would note that our full year adjusted EBITDA ended the year nearly $500 million higher than the midpoint of our initial expectations.

謝謝你，威爾，大家早安。我們公佈的 2025 年淨營業收入為 213 億美元，合併調整後 EBITDA 為 45.7 億美元，比 2024 年成長 14%。全年調整後 EBITDA 利潤率為 21.4%，比前一年提高了 200 個基點。第四季業績再次超越預期，這主要得益於同店營收的強勁成長、敏銳的洞察力和嚴格的成本控制。需要指出的是，我們全年調整後的 EBITDA 比我們最初預期的中位數高出近 5 億美元。

USPI continues to deliver attractive results. Volumes were strong and mix was good. Adjusted EBITDA grew 12% in 2025 to $2.026 billion. Same-facility revenues grew 7.5%, highlighted by double-digit same-store volume growth in total joint replacements in the ASCs over prior year. This performance was once again well above our long-term goal of 3% to 6% organic top line growth.

USPI持續取得令人滿意的業績。音量很大，混音也很好。經調整後的 EBITDA 預計到 2025 年將成長 12%，達到 20.26 億美元。同廠營收成長了 7.5%，其中 ASC 關節置換手術總量的同店銷量較上年實現了兩位數的成長。這項業績再次遠超過我們設定的3%至6%的長期有機營收成長目標。

We had an active year in the M&A and de novo activity lines as well, investing nearly $350 million in 2025 and adding 35 facilities to the portfolio, and the pipeline for both M&A and de novo development remains strong as we look into 2026. We remain the preferred acquirer and developer of assets in this space. Turning to our Hospital segment. Adjusted EBITDA grew 16% to $2.54 billion in 2025. Same-store revenues per adjusted admission was up 5.3% over the prior year as payer mix and acuity remains strong.

我們在併購和新建項目方面也度過了活躍的一年，2025 年投資近 3.5 億美元，並為投資組合增加了 35 個設施，展望 2026 年，併購和新建項目的儲備仍然強勁。我們仍然是該領域資產收購和開發的首選企業。接下來我們進入醫院板塊。2025年調整後EBITDA成長16%至25.4億美元。由於支付方組合和病情嚴重程度保持強勁，調整後入院人數的同店收入比上年增長了 5.3%。

We've continued to reinvest back in our business to further our capabilities stepping up our growth capital in 2025. And finally, over the past 3 years, we have been active repurchasers of our shares, retiring approximately 22% of our outstanding shares for around $2.5 billion since our share repurchase program began in the fourth quarter of '22. We expect to continue to deploy capital for share repurchase, particularly at our current valuation multiples. Our portfolio of businesses is now more predictable with consistently strong performance, both the Hospital segment and USPI. Our results represent a continuation of a multiyear track record of strong same-store revenue growth, improved margins and disciplined execution by our management team.

我們持續將資金再投資於我們的業務，以進一步提升我們的能力，並在 2025 年增加我們的成長資本。最後，在過去的 3 年裡，我們積極回購了我們的股票，自 2022 年第四季啟動股票回購計畫以來，我們已回購了約 22% 的流通股，總額約為 25 億美元。我們預計將繼續投入資金進行股票回購，尤其是在我們目前的估值倍數下。我們的業務組合現在更具可預測性，醫院業務和美國私人保險公司 (USPI) 都取得了持續強勁的業績。我們的業績延續了多年來強勁的同店收入成長、利潤率提高以及管理團隊嚴謹執行的良好勢頭。

We remain focused on driving further organic growth supplemented by accretive M&A at USPI. Turning to 2026 guidance. We are projecting full year 2026 adjusted EBITDA of $4.485 billion to $4.785 billion, driven by ongoing strength in demand and acuity, physician recruitment and service line expansion as well as additional sites of care joining the portfolio. We are also tackling expense management more structurally in anticipation of the next few years. We anticipate full year adjusted EBITDA for USPI of $2.13 billion to $2.23 billion.

我們將繼續專注於推動 USPI 的進一步內生成長，並輔以增值併購。接下來展望2026年的發展方向。我們預計 2026 年全年調整後 EBITDA 為 44.85 億美元至 47.85 億美元，主要得益於持續強勁的需求和疾病嚴重程度、醫生招聘和服務線擴張，以及更多醫療機構加入投資組合。為了因應未來幾年的發展，我們也從結構上更有效地管理費用。我們預計 USPI 全年調整後 EBITDA 為 21.3 億美元至 22.3 億美元。

The continued mix shift of services towards lower-cost sites of care will be furthered by the beginning of the phaseout of the inpatient-only list in 2026. We see this as a gradual tailwind for USPI that will play out over several years. In this first year, we see opportunities in areas such as high acuity spine and urology procedures. We have detailed tactical plans to capitalize on the opportunity and are actively operationalizing our capabilities to serve patients in 2026. USPI continues to be a high-growth, capital-efficient business that delivers high returns on capital expenditures.

隨著 2026 年住院治療名額逐步取消，醫療服務向低成本醫療場所的持續轉變將進一步推動這一趨勢。我們認為這將是 USPI 未來幾年逐步發展的有利因素。在第一年，我們看到了高難度脊椎手術和泌尿外科手術等領域的機會。我們制定了詳細的戰術計劃來抓住這一機遇，並正在積極落實我們的能力，以便在 2026 年為患者提供服務。USPI 持續維持高成長、資本效率高的企業形象，能夠帶來高資本支出回報。

Turning to our Hospital segment. We are expecting adjusted EBITDA in the range of $2.355 billion to $2.55 billion in 2026. Our plans reflect the headwind associated with the expiration of the enhanced premium tax credits on the exchange marketplace. We continue to closely monitor enrollment levels as well as the potential ramp off ramps for individuals to obtain coverage through a lower metal tier commercial plans or other options. We are assuming a 20% reduction in overall enrollment as we have more significant exposure in states such as Arizona, Michigan and California.

接下來我們進入醫院板塊。我們預計 2026 年調整後 EBITDA 將在 23.55 億美元至 25.5 億美元之間。我們的計劃反映了交易所市場上增強型保費稅收抵免到期帶來的不利影響。我們將繼續密切關注參保人數，以及個人透過較低級別的商業保險計劃或其他途徑獲得保險的潛在退出途徑。由於我們在亞利桑那州、密西根州和加利福尼亞州等州的業務規模較大，我們預計整體入學人數將減少 20%。

We recognize the uncertainty regarding effectuation rates as individuals make determinations if they can afford their premiums and the resultant expected increase in uninsured rates and have conservatively taken these matters into our initial guidance. Additionally, we are implementing cost savings plans to help mitigate this pressure and we'll continue to engage with our patients to ensure that they have good access to care. We are confident in our ability to achieve the strong core earnings growth we forecast for 2026. The significant margin improvements that we have made over the past few years provides us a strong foundation from which to grow our transformed portfolio of businesses. We carry momentum into this new year, and have many opportunities to expand our services and deliver value for patients, physician partners and in turn, our shareholders.

我們認識到，由於個人需要決定是否能夠負擔得起保費，因此保費生效率存在不確定性，並且預計無保險率也會因此上升，因此我們在最初的指導意見中謹慎地考慮了這些因素。此外，我們正在實施成本節約計劃，以幫助緩解這種壓力，我們將繼續與患者保持溝通，以確保他們能夠獲得良好的醫療服務。我們有信心實現我們預測的2026年強勁的核心獲利成長。過去幾年我們取得的顯著利潤率提升，為我們轉型後的業務組合發展奠定了堅實的基礎。我們帶著這股勢頭進入新的一年，有很多機會可以擴大我們的服務，為患者、醫生合作夥伴以及我們的股東創造價值。

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

接下來，Sun公司將為我們提供更詳細的財務績效分析。太陽？

Thank you, Saum, and good morning, everyone. We are very pleased with the performance in 2025 and which again demonstrated robust same-store revenue growth in both the hospitals and USPI segments and adjusted EBITDA that exceeded our expectations each quarter driven by continued high patient acuity favorable payer mix and effective expense management. In the fourth quarter, we generated total net operating revenues of $5.5 billion and consolidated adjusted EBITDA of $1.183 billion, a 13% increase over last year. Our adjusted EBITDA margin in the quarter was 21.4%, a continuation of our improved margin performance over multiple quarters. For full year 2025, net operating revenues were $21.3 billion, and consolidated adjusted EBITDA was $4.566 billion, a 14% increase over '24.

謝謝你，Saum，大家早安。我們對 2025 年的業績非常滿意，醫院和 USPI 部門的同店收入再次實現了強勁增長，調整後的 EBITDA 每個季度都超出了我們的預期，這得益於持續高水平的患者病情、有利的支付方組合和有效的費用管理。第四季度，我們實現了55億美元的淨營業收入，合併調整後的EBITDA為11.83億美元，比去年同期成長了13%。本季調整後的 EBITDA 利潤率為 21.4%，延續了我們多個季度利潤率持續改善的勢頭。2025 年全年，淨營業收入為 213 億美元，合併調整 EBITDA 為 45.66 億美元，比 2024 年成長 14%。

Adjusted EBITDA margins in '25 was 21.4%, up 210 basis points from the prior year. I would now like to highlight some key items for both of our segments, beginning with USPI. In the fourth quarter, USPI's adjusted EBITDA grew 9% over last year, with adjusted EBITDA margins at 40.5%. USPI delivered a 7.2% increase in same-facility system-wide revenues, with net revenue per case up 5.5% and same-facility case volumes up 1.6%. Turning to our Hospital segment.

2025 年調整後 EBITDA 利潤率為 21.4%，比前一年成長 210 個基點。現在我想重點介紹我們兩個部門的一些關鍵事項，首先是 USPI。第四季度，USPI 的調整後 EBITDA 比去年同期成長了 9%，調整後 EBITDA 利潤率為 40.5%。USPI 的同店系統總收入成長了 7.2%，每例淨收入成長了 5.5%，同店病例量成長了 1.6%。接下來我們進入醫院板塊。

Fourth quarter adjusted EBITDA was $603 million, a 16% increase over fourth quarter of '24. Same-hospital inpatient adjusted admissions were flat and revenue per adjusted admissions grew 7.5% year-over-year. Our consolidated salary, wages and benefits was 40.2% of net revenues in the quarter, a 110 basis point improvement from the prior year, and our contract labor expense was 2.1% of consolidated SW&B expenses. Next, we will discuss our cash flow, balance sheet and capital structure. We generated $367 million of free cash flow in the fourth quarter and $2.53 billion of free cash flow for full year '25.

第四季調整後 EBITDA 為 6.03 億美元，比 2024 年第四季成長 16%。同院住院調整入院人數持平，每次調整入院收入年增 7.5%。本季度，我們的綜合薪資、薪資和福利佔淨收入的 40.2%，比去年同期改善了 110 個基點；我們的合約工費用佔綜合薪資、薪資和福利費用的 2.1%。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。我們在第四季產生了 3.67 億美元的自由現金流，2025 年全年自由現金流為 25.3 億美元。

As of December 31, 2025, we had $2.88 billion of cash on hand with no borrowings outstanding under our line of credit facility. Additionally, we have no significant debt maturities until late 2027. And finally, during the fourth quarter, we repurchased 943,000 shares of our stock for $198 million. We repurchased 8.8 million shares for $1.386 billion in 2025. Our leverage ratio as of December 31 was 2.25x EBITDA or 2.85x EBITDA less NCI driven by our strong operational performance and financial discipline.

截至 2025 年 12 月 31 日，我們手頭上有 28.8 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 年底之前沒有重大債務到期。最後，在第四季度，我們以 1.98 億美元的價格回購了 94.3 萬股股票。2025年，我們以13.86億美元的價格回購了880萬股股票。截至 12 月 31 日，我們的槓桿率為 EBITDA 的 2.25 倍，或 EBITDA 減去 NCI 的 2.85 倍，這得益於我們強勁的營運績效和財務紀律。

We remain committed to a deleveraged balance sheet, and believe that we have significant financial flexibility to support our capital deployment priorities and drive shareholder value. Let me now turn to our outlook for 2026. Our 2026 outlook assumes continued growth in same-store volumes and effective pricing as well as strong operational efficiencies and disciplined cost controls. Additionally, we anticipate further contributions from M&A and de novo center openings at USPI. In addition, we're also assuming same hospital admission growth of 1% to 2%, adjusted admissions growth of 1% to 2%, in same facility, USPI revenue growth of 3% to 6% for 2026.

我們仍然致力於降低資產負債率，並相信我們擁有相當大的財務靈活性，可以支持我們的資本部署重點並提升股東價值。現在讓我展望一下我們對2026年的展望。我們對 2026 年的展望假設同店銷售持續成長，定價有效，營運效率高，成本控制嚴格。此外，我們預計 USPI 的併購和新中心開設將帶來進一步的貢獻。此外，我們也假設 2026 年同一醫院的入院人數增加 1% 至 2%，調整後的入院人數增加 1% 至 2%，USPI 的收入增加 3% 至 6%。

Importantly, our outlook does not assume any contributions from potential increases in supplemental Medicaid programs that have not yet been approved. Also, we believe that the expiration of the enhanced exchange tax credits will result in lower volume growth and a less favorable payer mix. We estimate that this represents a $250 million impact to our 2026 adjusted EBITDA primarily in the Hospital segment. Clearly, there are a wide range of potential outcomes here, and we will continue to monitor enrollment levels and effectuation rates. We will also leverage Conifer's capabilities to assist our patients with their insurance coverage.

重要的是，我們的展望並未考慮尚未獲得批准的補充醫療補助計劃可能增加帶來的任何貢獻。此外，我們認為，增強型交易所稅收抵免政策的到期將導致交易量成長放緩和支付方結構惡化。我們估計這將對我們 2026 年調整後的 EBITDA 造成 2.5 億美元的影響，主要影響醫院業務部門。顯然，這裡存在著多種可能的結果，我們將繼續監測參與人數和效果實現率。我們也將利用 Conifer 的能力來幫助我們的患者處理保險事宜。

Based on all those items, we expect consolidated net operating revenues for 2026 in the range of $21.5 billion to $22.3 billion and consolidated adjusted EBITDA for 2026 in the range of $4.485 billion to $4.785 billion. There are 2 normalizing items that I would like to call out when comparing 2026 adjusted EBITDA to the prior year. First, we reported $148 million of prior year supplemental Medicaid payments in 2025. Second, in the first quarter of 2026, we will recognize a onetime $40 million favorable revenue adjustment as a result of the completed Conifer transaction. After normalizing for these items and excluding the headwind from the expiration of the enhanced premium tax credits, our 2026 adjusted EBITDA is expected to grow 10% at the midpoint of our range.

基於上述所有因素，我們預計 2026 年合併淨營業收入將在 215 億美元至 223 億美元之間，2026 年合併調整後 EBITDA 將在 44.85 億美元至 47.85 億美元之間。在將 2026 年調整後的 EBITDA 與前一年進行比較時，我想指出兩個需要調整的項目。首先，我們報告稱，2025 年將有 1.48 億美元的上一年補充醫療補助金支付。其次，由於 Conifer 交易的完成，我們將在 2026 年第一季確認一次性 4000 萬美元的有利收入調整。在剔除這些項目的影響並排除增強保費稅收抵免到期帶來的不利影響後，我們預計 2026 年調整後的 EBITDA 將成長 10%，達到我們預期範圍的中點。

Finally, we would expect first quarter 2026 consolidated adjusted EBITDA to be 24% of our full year consolidated adjusted EBITDA at the midpoint. We anticipate that USPI's EBITDA in the first quarter will be 22% of our full year 2026 USPI EBITDA at the midpoint. Turning to our cash flows. From 2026, we expect adjusted cash flow from operations in the range of $3.2 billion to $3.6 billion. Capital expenditures in the range of $700 million to $800 million resulting in adjusted free cash flows in the range of $2.5 billion to $2.8 billion.

最後，我們預期 2026 年第一季合併調整後 EBITDA 為全年合併調整後 EBITDA 的 24%（取中間值）。我們預計 USPI 第一季的 EBITDA 將占我們 2026 年全年 USPI EBITDA 中位數的 22%。接下來我們來看看現金流。從 2026 年起，我們預計調整後的營運活動現金流將在 32 億美元至 36 億美元之間。資本支出在 7 億美元至 8 億美元之間，由此產生的調整後自由現金流在 25 億美元至 28 億美元之間。

And adjusted free cash flow after NCI in the range of $1.6 billion to $1.83 billion. This range includes about $150 million in tax payments for the Conifer transaction. Excluding these tax payments, this would represent $1.865 billion of adjusted free cash flow less NCI at the midpoint of our 2026 outlook. We remain focused on strong free cash flow conversion from our EBITDA performance, including the continued outstanding cash collection performance at Conifer, while continuing to invest in high priority areas of our businesses. Turning to our capital deployment priorities.

扣除 NCI 後的調整後自由現金流在 16 億美元至 18.3 億美元之間。該金額包括 Conifer 交易中約 1.5 億美元的稅款。除去這些稅款，在我們 2026 年展望的中點，這將代表 18.65 億美元的調整後自由現金流減去 NCI。我們將繼續專注於將 EBITDA 業績轉化為強勁的自由現金流，包括 Conifer 持續出色的現金回收業績，同時繼續投資於我們業務的高優先領域。接下來談談我們的資金部署重點。

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. And as Saum noted, we see a strong pipeline to support our $250 million annual target for USPI M&A in 2026. Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings. Third, we'll continue to have a balanced approach to share repurchases and depending on market conditions and other investment opportunities.

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。正如 Saum 指出的那樣，我們看到了強勁的發展前景，這將支持我們在 2026 年實現 USPI 併購 2.5 億美元的年度目標。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。第三，我們將繼續採取平衡的股票回購方式，並視市場狀況和其他投資機會而定。

And finally, we will continue to evaluate opportunities to retire and/or refinance debt. In conclusion, we had another outstanding year in 2025 with strong revenue growth disciplined operations and very attractive free cash flow generation. We are confident in our ability to deliver on our outlook for 2026 and can continue to drive value for patients, physician partners and shareholders.

最後，我們將繼續評估償還和/或再融資債務的機會。總之，2025 年我們又取得了卓越的成績，營收成長強勁，營運嚴謹，自由現金流非常可觀。我們有信心實現 2026 年的展望，並能持續為病患、醫師合作夥伴和股東創造價值。

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) Stephen Baxter, Wells Fargo.

（操作員說明）史蒂芬‧巴克斯特，富國銀行。

I was hoping that perhaps you could expand a little bit on the same-store hospital volume performance in the quarter and any moving parts there that looked like it was a little bit weaker than the trend? And then just as you're thinking about hospital volumes in 2026, it looks like at the midpoint, you might be looking for that to potentially improve a little bit versus the 2025 performance. So just I guess help us think about the moving pieces there with the exchanges and their core performance.

我希望您能詳細介紹一下本季同店醫院銷售額的表現，以及其中有哪些因素看起來比趨勢略微疲軟？然後，當你考慮 2026 年的醫院就診量時，看起來在中期，你可能會希望它比 2025 年的表現略有改善。所以，我想請您幫我們思考交易所及其核心表現中的各個變動因素。

Yes. I mean, obviously, our acuity was good, which is what we're really focused on in the fourth quarter. Flu. I mean, I would just say from our standpoint, the respiratory season was probably a little weaker than otherwise might have expected. And that's probably the basic explanation.

是的。我的意思是，很顯然，我們的敏銳度很好，這也是我們在第四季真正關注的重點。流感。我的意思是，從我們的角度來看，呼吸道疾病季可能比預期的要弱一些。這大概就是最基本的解釋。

In 2026, understanding all the moving pieces, as I indicated in my comments, we had invested significantly in growth capital during the year, and we expect to see returns from some of those investments into 2026, and that's the improvement that you pick up on.

正如我在評論中指出的那樣，考慮到所有變動因素，我們在2026年對成長資本進行了大量投資，我們預計到2026年將看到其中一些投資的回報，而這正是你們所看到的進步。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

When you say, Saum, that you're tackling expense management more structurally, what do you mean by that? And can you elaborate on what's incremental about the cost efficiencies that you expect to see this year?

Saum，你說你正在從結構上更有效地處理費用管理問題，這是什麼意思呢？您能否詳細說明您預計今年在成本效益方面有哪些改進？

Yes. Structurally, what really refers to the notion that we are looking as opposed to what I would describe as more traditional annual expense management. We're looking, as we've talked about over the past year, more thoroughly at the deployment of technology, basically that allows us more expense reduction opportunities, and that includes application of those technologies in our global business center. That's a little bit of a different pathway than before, more sustainable, more what I would describe as modernization of the business given some of the new tools and technologies available to us. It's not just AI, which is I think become kind of the central buzzword for this, but there's a lot more that can be done in automation.

是的。從結構上看，這實際上指的是我們正在研究的概念，而不是我所描述的更傳統的年度費用管理。正如我們過去一年來一直在討論的那樣，我們正在更全面地研究技術的部署，這基本上可以為我們帶來更多降低成本的機會，其中包括在我們全球業務中心應用這些技術。這和以前的道路略有不同，更永續，更符合我所說的業務現代化理念，因為我們現在擁有了一些新的工具和技術。不只是人工智慧，我認為人工智慧已經成為這個領域的核心流行語，自動化領域還有許多其他方面可以改進。

And then the other thing is just as we look at our clinical throughput, application of those technologies ramping up in our clinical throughput, we believe, is another area to take things to the next level. So whether that's areas like length of stay management or throughput in some of the more high-value portions of the hospitals, real estate, et cetera, ORs, ERs, et cetera, those kinds of things become more structural in nature. That's what I meant by that.

另一方面，正如我們審視我們的臨床吞吐量時所看到的，我們認為，在臨床吞吐量中應用這些技術是另一個可以提升到更高水平的領域。因此，無論是住院時長管理還是醫院一些高價值部分的吞吐量，例如房地產、手術室、急診室等等，這些事情的性質都變得更加結構化。我的意思就是這個。

Ben Hendrix, RBC Capital Markets.

Ben Hendrix，加拿大皇家銀行資本市場。

Apologies for getting cut off earlier. I just wanted to get a little more color on the hospital admission growth guide, the 1% to 2%. Just wanted to talk a little bit about the slowdown from last year, the degree to which if we can parse out that slowdown between exchange expiry, between kind of investments toward higher acuity and higher margin capabilities in the hospital setting and then also just a general slowdown of admissions that we've been seeing across the acute sector to begin with. So just any commentary you can offer there.

很抱歉剛才被打斷了。我只是想更詳細地了解醫院入院人數成長指南，也就是 1% 到 2% 的成長情況。我想稍微談談去年的經濟放緩情況，如果我們能把這種放緩程度從交易所到期、醫院環境中對更高水平和更高利潤能力的投資，以及我們一開始就在整個急性護理領域看到的入院人數普遍放緩等因素中區分開來，那麼這種放緩的程度究竟有多大。所以，歡迎大家提出任何意見。

Ben, it's Sun. Saum already commented on kind of the Q4 mission, including sort of the flu respiratory season being sort of not material for us. And then as we get into 2026, a lot of it has to do with this CapEx and technology investment that we've made in creating some volume momentum coming into '26. On your question about the exchange, as we said in our comments, there's a pretty wide range of potential outcomes here. As Saum mentioned, we're assuming about 20% decrease in enrollment.

本，是太陽。Saum 已經對第四季度的任務發表了評論，包括流感季對我們來說並不重要。而到了 2026 年，很多事情都與我們在資本支出和技術方面的投資有關，這些投資旨在為 2026 年創造一些銷售成長動能。關於您提出的交易問題，正如我們在評論中所說，這裡存在相當廣泛的潛在結果。正如 Saum 所提到的，我們預計入學人數將減少約 20%。

But we'd have to then -- there's lots of areas where what happens to those volumes, right? Do they -- those people find -- do those patients find alternate coverage, [I mean,] other plans, alternative plans. Certainly, a big majority of them could become uninsured. But that volume will still show up at our hospitals, obviously, and USPI. It's just the question then becomes, can we optimize our cost and efficiency.

但那樣我們就不得不這麼做了——有很多領域，這些數量會發生什麼變化，對吧？這些人能找到其他保險嗎？ （我的意思是，）其他計劃、替代方案呢？當然，他們中的絕大多數人可能會失去醫療保險。但很顯然，這些數量仍然會出現在我們的醫院和美國郵政服務 (USPI) 上。那麼問題就變成了，我們能否優化成本和效率。

So our range anticipates some impact of lost volumes, but I think our EBITDA range, and as we discussed, our lost EBITDA range is quantifying the exchange a little bit more.

因此，我們的預測範圍考慮到了銷售損失的一些影響，但我認為我們的 EBITDA 預測範圍，正如我們討論的那樣，我們損失的 EBITDA 預測範圍，對匯率的影響進行了更量化的調整。

Matthew Gillmor, KeyBanc Capital Markets.

Matthew Gillmor，KeyBanc Capital Markets。

Maybe following up on the cost efficiencies. Are you able to quantify what you're able to pull through this year. I was also curious about the timing building throughout the year such that you'll get a year-over-year benefit in future periods? Or do they take place earlier in the year, so they're all captured in '26?

或許可以進一步研究成本效益。你能量化一下今年能達成的成就嗎？我也很好奇，如何透過全年的時間積累，才能在未來的時期獲得逐年成長的收益？或者這些事件發生在年初，所以都被記錄在 2026 年？

Yes. No, we're not providing specific guidance between that. I mean if you think about our guidance core growth of EBITDA standpoint. I would just expect that embedded in there is both the value of the initiatives that we have invested in through capital and growth strategies for this year and expense management strategies that would be more -- as I said, more structural over and above what we might have done in a typical year. And as I indicated, the thought process behind those isn't just about 2026, it's about being prepared for the years ahead.

是的。不，我們不會就此提供具體指引。我的意思是，如果你從 EBITDA 核心成長的角度來看我們的指導目標。我希望其中既包含我們今年透過資本和成長策略投資的各項措施的價值，也包含費用管理策略的價值——正如我所說，這些策略比我們在往年可能採取的措施更具結構性。正如我所指出的，這些想法背後的考量不僅僅是關於 2026 年，而是為了未來幾年做好準備。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Yes. I guess I just want to follow up on that point. I guess, when we think about that type of growth, I mean, is this the type of growth that you think is sustainable in out years as we think about offsets because 10% is a pretty big number to be thinking about. And so I just want to understand, is this new focus on expense management replicatable? Or are you -- is it kind of -- this is what we're doing in year 1, and that's it?

是的。我想就這一點再補充一點。我想，當我們考慮這種成長類型時，我的意思是，當我們考慮抵銷措施時，你認為這種成長類型在未來幾年是否可持續，因為 10% 是一個相當大的數字。所以我想知道，這種新的費用管理重點是否可以複製？或者說——大概是這樣——這就是我們第一年要做的事情，僅此而已？

Or is this is what we're doing in year 1? And we should be thinking about similar types of opportunity in the out years because it is a little hard to bridge what would normally be viewed as a hospital business that might grow 3% to 5%. Now you're saying it's 10%, like, is that sustainable?

還是說這就是我們一年級要做的事？我們應該考慮未來幾年類似的機遇，因為要將通常被視為醫院業務、成長率可能只有 3% 到 5% 的業務連接起來有點困難。現在你說只有 10%，這可持續嗎？

Well, Kevin, I mean, I think 2 things. One is we've built up a track record of acuity growth in net revenue per case growth ahead of ahead of generally what the market does. Our margin expansion over the past, not just 2 years, as I indicated, but even beyond that in the Hospital segment itself has been significant above and beyond the asset sales that we did, which obviously helped some of that margin improvement. We said all along that we kept the markets where we felt like we had the best opportunities for growth and leadership. And as we look ahead to the environment that may be coming in '28, '29, et cetera, with OBBB and other things, now is the time to take on the challenge of really being well prepared for that.

嗯，凱文，我的意思是，我想到兩件事。其一是我們在每例淨收入成長方面已經建立了領先於市場整體水準的良好記錄。正如我之前提到的，過去兩年，甚至更長時間以來，我們在醫院業務領域的利潤率擴張都非常顯著，遠遠超過了我們出售資產所帶來的利潤率提升，而資產出售顯然也對利潤率的提高起到了一定的幫助作用。我們一直強調，我們會保留那些我們認為具有最佳成長和領導地位機會的市場。展望 2028 年、2029 年等可能出現的環境，以及 OBBB 和其他因素，現在正是迎接挑戰、做好充分準備的時候。

And so look, we understand what the core growth guidance is. We think it's very attractive guidance. We think there's a lot of work that's going to be required to get there and creativity. But on the other hand, that's exactly the work we should be doing given the platform that we've built. And so that's what we're going after.

所以你看，我們明白了核心成長指導是什麼。我們認為這是一條非常有吸引力的指導方針。我們認為要實現這個目標，需要付出很多努力，也需要創造力。但另一方面，鑑於我們已經建立的平台，這正是我們應該做的工作。所以這就是我們努力的目標。

Josh Raskin, Nephron Research.

Josh Raskin，腎單位研究。

I want to stay on the same topic, and Saum, appreciate what you just said. I sort of looked at it, margins were up 680 basis points since 2019 and the Hospital segment is up 660 basis points. So it's not really mix. Seems as though we've heard a lot about process improvement and optimization at Tenet for a couple of years, and now we're hearing about this new focus on expense management.

我想繼續討論這個話題，Saum，感謝你剛才所說的話。我大致了解了一下，自 2019 年以來，利潤率提高了 680 個基點，醫院業務部門提高了 660 個基點。所以它其實不算混合。似乎在過去的幾年裡，我們一直聽到 Tenet 公司在流程改善和優化方面投入了大量精力，而現在我們又聽到了他們對費用管理的新關注。

I'd just be curious to get your view on just the broader technology agenda, specifically, including AI and overall business, including revenue cycle management. And just do you think there's additional step function improvements in margins. I guess that's the main question. Do you think we're going to see continued margin improvement like we've seen in the past?

我很想了解您對更廣泛的技術議程的看法，特別是包括人工智慧和整體業務（包括收入週期管理）的看法。你認為利潤率還有進一步提升的空間嗎？我想這才是關鍵問題。你認為我們會像過去一樣繼續看到利潤率提升嗎？

Yes. I mean I don't -- obviously, we're giving guidance in a year where there happens to be a headwind that we've done our best to quantify with respect to the exchange premium tax credits. Stated a different way, if those headwinds weren't there, we've been saying all along that we continue to believe there's margin expansion opportunity in the hospital segment the urgency with respect to much of what we're talking about doing is enhanced because of the -- what's happened on the exchange marketplace or what hasn't happened on the exchange marketplace, as the case may be. The other thing I'm mindful of is that there are -- what happens with respect to many of these reimbursement items might change over the next couple of years, right? So we're not really planning out to that level of specificity for '27, '28, et cetera.

是的。我的意思是，顯然，我們是在一年中恰逢不利因素（我們已盡力量化了與交易所溢價稅收抵免相關的不利因素）的情況下給出指導意見的。換句話說，如果沒有這些不利因素，我們一直都認為醫院領域有利潤擴張的機會。我們所談論的許多事情的緊迫性，是因為交易所市場發生的事情，或者說交易所市場沒有發生的事情（視情況而定）。我注意到的另一點是，未來幾年內，許多報銷項目的情況可能會發生變化，對吧？所以我們並沒有為 2027 年、2028 年等製定如此具體的計畫。

There are elections that happened between now and then that could alter, modify or just transform policy from where it is today. But I think this gets back to the first part of your question, which is, as we look around the environment, we've done a lot in this organization to improve reliability, accountability, the types of efficiencies we've taken as we've scaled the company down in the Hospital segment, reliably moving our overhead structure in line with that, all the things you would expect from an organization that is attempting to be best-in-class in what it does. And now with the advent of many of these technologies in AI and automation, the ability to actually begin to deploy those and see if we can drive the next level of improvement, we're better set up for that now because we have more standard processes. We have more standard workflows. We have labor standards and supply standards that have been uniformly disseminated across the company, it's much harder to do those things when every market is doing something very different versus having established those standards.

從現在到那時之間已經舉行過一些選舉，這些選舉可能會改變、調整甚至徹底改變當前的政策。但我認為這又回到了你問題的第一部分，那就是，當我們環顧四周，我們在這個組織中做了很多工作來提高可靠性、問責制，以及在縮減醫院業務規模的過程中所採取的各種效率提升措施，並可靠地調整了我們的管理費用結構，所有這些都是一個力求在其所從事的領域做到一流的組織所應做的一流。現在，隨著人工智慧和自動化領域許多此類技術的出現，我們能夠真正開始部署這些技術，看看我們能否推動下一階段的改進，我們現在為此做好了更充分的準備，因為我們有了更多標準化的流程。我們採用的是更標準化的工作流程。我們有勞動標準和供應標準，這些標準已在公司內部統一推廣。如果每個市場的做法都大相逕庭，那麼執行這些標準就比建立標準困難得多。

And we've done that, and we've consistently demonstrated that establishing those standards have improved our business. So now it's about taking that to the next level, and that's really what we're talking about.

我們已經做到了這一點，我們不斷證明，制定這些標準改善了我們的業務。所以現在我們要做的就是將這一切提升到一個新的水平，而這才是我們真正要討論的。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Wanted to follow up on some of the guidance stuff. I appreciate all the details. You mentioned -- obviously, the DPP, you gave us the onetime benefit there last year that comes out. I'm just curious if you could specify is DPP other than that flat year-over-year? Or any change within that core guidance?

想就一些指導性內容進行後續跟進。感謝您提供的所有細節。你提到了——顯然，DPP，你去年給了我們一次性的好處。我只是好奇，除了同比持平之外，您能否具體說明DPP還有哪些方面？或者核心指導原則有任何改變嗎？

Maybe you could also give us the run rate of DPP. And then I thought your estimate of the impact of the subsidy expirations was towards the higher end of my expectations at least. And I'm curious how you treated at least your thoughts on the potential shift of some of these enrollees back to employer commercial. What you've assumed there versus, let's say, I think UHS or one of your peers is assuming none and one of your peers is assuming 15% to 20%.

或許您還可以提供一下DPP的運作率。然後我認為你對補貼到期影響的估計至少比我的預期要高一些。我很想知道，對於部分受保人員可能會重新轉回雇主商業保險的情況，您有什麼看法。假設你假設的情況與此不同，比如說，我認為 UHS 或你的同儕假設的情況為零，而你的同儕假設的情況為 15% 到 20%。

Justin, it's Sun. Thanks for your question. On your question about the Medicaid supplemental payments. Yes, as you pointed out, so a couple of numbers here. We finished 2025 with $1.34 billion in total supplemental payments.

賈斯汀，我是太陽。謝謝你的提問。關於您提出的有關醫療補助補充支付的問題。是的，正如你所指出的，這裡有一些數字。截至 2025 年底，我們共發放了 13.4 億美元的補充支付款項。

And obviously, we pointed out about $148 million of that is out of period payments. So let's call it [$1.2 billion] effective run rate for 2025. In '26, our guidance assumes effectively a pretty consistent number with our '25 normalized baseline. So hopefully, that helps. And then on your question about exchange.

顯然，我們指出其中約有 1.48 億美元是逾期付款。所以，我們姑且稱之為 2025 年的 [12 億美元] 有效運作率。2026 年，我們的指導意見假設與 2025 年的標準化基準基本保持一致。希望這能有所幫助。然後是關於你提出的匯率問題。

Yes. I mean, like we said, we assume about 20% overall reduction of enrollment. I would say on your question about our assumptions for people finding alternative plans, including commercial, we're about 10% to 15% as our internal assumption. Now all of that, again, depends on what we've seen in Q1 and what run rates we see, but that's our assumption embedded in our guidance.

是的。我的意思是，就像我們之前說的，我們預計入學人數總體上會減少約 20%。關於您提出的「人們尋找替代方案（包括商業方案）的假設」的問題，我們的內部假設是 10% 到 15%。當然，這一切還要取決於我們在第一季看到的情況以及我們看到的運行速度，但這是我們在業績指引中隱含的假設。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Can I ask about sort of the first quarter guidance, normally, you guys are getting more than 24% of EBITDA in the first quarter. I think in the script, you said that 21% for the company ASCs, which is normal. So it means that the change is actually in the Hospital segment. So is this something fundamental like the flu or lower [circle] demand? Or is this just the $40 million of prior period from last year or something else?

請問一下第一季的業績指引嗎？通常情況下，你們第一季的 EBITDA 佔比會超過 24%。我認為你在劇本中提到，公司ASC的比例為21%，這是正常的。所以這意味著改變實際上發生在醫院領域。所以這是像流感一樣的根本性問題，還是需求下降的問題？或者這只是去年同期的 4000 萬美元，還是其他原因？

And then just a quick clarification. Can you quantify the DPP that you received in the fourth quarter of '25?

最後再簡單澄清一下。你能量化一下你在 2025 年第四季收到的 DPP 嗎？

Peter, it's Sun. Just to be clear, our USPI Q1 guidance is 22% of our full year guidance in Q1 for USPI. And then for our Hospital, you're right. I think the $40 million onetime benefit in Q1 kind of skews the total rates. Other than that, we see pretty standard annual Q1 percentages as a percent of full year. And then for your question on DPP Q4, we had $315 million.

彼得，是太陽。需要明確的是，我們對 USPI 第一季業績的預期佔全年第一季業績預期的 22%。至於我們醫院，你說得對。我認為第一季的 4000 萬美元一次性收益在某種程度上扭曲了總利率。除此之外，我們看到的是相當標準的年度第一季百分比，以佔全年百分比表示。至於你問的 DPP 第四季的情況，我們有 3.15 億美元。

Andrew Mok, Barclays Bank.

Andrew Mok，巴克萊銀行。

This is Thomas Walsh on for Andrew. Conifer services to the CommonSpirit concluding at the end of this year, could you frame the current plan to redeploy existing resources to growth opportunities and otherwise reduce expenses to rightsize the cost structure?

這裡是托馬斯·沃爾什，他代替安德魯發言。Conifer 為 CommonSpirit 提供的服務將於今年年底結束，您能否概述一下目前的計劃，即重新部署現有資源以抓住成長機會，並透過其他方式減少開支來調整成本結構？

Well, I mean, we have a full year of service that we have to execute with respect to Conifer and our client this year. So we're not expecting to take cost reductions this year from that perspective. If anything, we may both increase revenue and cost if we end up doing more from a transition service standpoint, and that may come with a margin. After that, we've talked about the fact that we have other growth opportunities that are already locked in starting in and around that will allow us to redeploy talent in that direction. So we can see that we'll be rebasing a bit the business at Conifer and preparing it for future growth.

嗯，我的意思是，今年我們還有整整一年的時間要為 Conifer 和我們的客戶提供服務。因此，從這個角度來看，我們預計今年不會削減成本。如果從過渡服務的角度來看，我們最終可能會增加收入和成本，但這可能會帶來利潤。之後，我們討論了這樣一個事實：我們還有其他一些成長機會，這些機會已經確定，將在周邊地區啟動，這將使我們能夠將人才重新部署到那個方向。因此我們可以看到，我們將對 Conifer 的業務進行一些調整，並為未來的成長做好準備。

I mean, I don't know, I would kind of just go back to the core of what actually happened here in what we did. I mean if I were to be very simple about this, we had an expiring contract for which the cash flow that we would have taken in between 2026 and 2032, was basically breakeven at best because at the end of that period, we would have significant obligations to the client in terms of payments that would need to be made and equity that we'd have to buy back. I mean one thing that may not have been so clear, we haven't made cash distributions from that joint venture in the last decade, and that resulted in a pretty significant buildup of redeemable noncontrolling interest and other liabilities. So what we did was we retired $885 million of those obligations on the balance sheet and got back 23.8% of the equity that was in the joint venture for $540 million. And then if you look at the remaining 6 years of the transaction of the contract that got dealt with in the transaction, we received $1.9 billion in accelerated cash flow over 3 years that would have come over 6 years in the contract and the present value of those 2 things was roughly double what we would have got by running off the contract.

我的意思是，我不知道，我還是會回到我們實際所做的事情的核心問題。我的意思是，簡單來說，我們有一份即將到期的合同，從 2026 年到 2032 年，我們所能獲得的現金流充其量只能勉強收支平衡，因為到那時，我們將對客戶承擔重大的付款義務，以及我們必須回購的股權。我的意思是，有一點可能不太清楚，那就是在過去的十年裡，我們沒有從該合資企業進行現金分配，這導致了可贖回少數股東權益和其他負債的大量積累。因此，我們償還了資產負債表上 8.85 億美元的債務，並以 5.4 億美元的價格收回了合資企業 23.8% 的股權。然後，如果你看一下交易中處理過的合約剩餘的 6 年期限，我們會發現，我們在 3 年內獲得了 19 億美元的加速現金流，而這筆錢原本需要在合約規定的 6 年內才能到賬。這兩筆錢的現值大約是我們履行完合約所能獲得的兩倍。

So I mean, we've gone back for what it's worth and done the math, if you just look at this on an NPV basis after tax, the incremental value from actually running out the contract that we've created, again, post-tax present value was north of $1 billion. We calculate $1.1 billion. I mean this was absolutely the right path to go down in addition to getting complete control of the strategic future of Conifer. How we deal with that in 2027 and beyond, including growth opportunities, investments that we can now control in reducing the cost to collect and positioning Conifer to be more competitive, is the work of 2026 that we have in this asset. But maybe that kind of bottom line calculation now that we've had a chance to look at what the earnings will look like in the out years based on what we know today is helpful in framing what we did in this transaction.

所以我的意思是，我們已經回過頭來計算了一下，如果只從稅後淨現值 (NPV) 的角度來看，我們實際履行這份合約所帶來的增量價值，同樣，稅後現值超過 10 億美元。我們計算得出是11億美元。我的意思是，除了完全掌控康尼弗的戰略未來之外，這絕對是正確的道路。我們如何應對 2027 年及以後的挑戰，包括成長機會、我們現在可以控制的投資（例如降低收集成本和使 Conifer 更具競爭力），是我們在 2026 年需要在這個資產方面完成的工作。但或許，既然我們現在有機會根據我們目前所掌握的資訊來展望未來幾年的收益情況，那麼這種底線計算有助於我們理解我們在此次交易中所做的一切。

Again, after-tax NPV of about $1 billion to $1.1 billion is what we calculate. We're pleased with the outcome.

我們再次計算得出，稅後淨現值約為 10 億至 11 億美元。我們對結果很滿意。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

I was hoping maybe you could elaborate a bit on -- for the ASC business. How you're thinking about and planning for investments, they can be either around the new facilities in terms of organic or de novo expansion. From a case mix and procedure perspective, just interested in where you see underlying demand the strongest where you see the best opportunities to continue to drive the trend that you've had of favorable case mix and profitable sort of acuity procedure growth in some of these specialty areas of the ASC business?

我希望您能詳細闡述一下—關於ASC業務。你對投資的思考和規劃，可以是圍繞新設施的有機成長或全新擴張。從病例組合和手術流程的角度來看，您認為哪些領域的潛在需求最強勁，哪些領域最有機會繼續推動您在 ASC 業務的某些專業領域中取得的有利病例組合和盈利性高風險手術增長的趨勢？

Yes. No, thanks for the question. I guess I would make 3 comments. One is that I alluded earlier to the inpatient-only list and additional opportunities there. I think that will be a slow tailwind going forward as there are more things that qualify in that area?

是的。不，謝謝你的提問。我想提三點意見。其一是我之前提到的僅限住院病人的名單以及那裡的其他機會。我認為隨著更多符合該領域條件的事物出現，這將會是一個緩慢的順風？

I think USPI is well known to be kind of at the leading edge of the innovation in higher acuity procedures in that area. We continue to build on our urology platform, looking forward to doing more spine work there. A lot of the robotics capabilities that we have brought into the ASCs continue to allow us to find new avenues of expansion. And obviously, the large ongoing opportunity that we continue to see double-digit growth in our joint programs across the network, all those areas are, I think, attractive looking forward. We had a big M&A year and a lot of the value that USPI brings after we acquired the assets and get into those settings is the planning for service line diversification and whatnot.

我認為USPI在該領域，尤其是在高精度手術操作方面，一直處於創新前沿，這一點眾所周知。我們將繼續完善泌尿科平台，並期待在那裡進行更多脊椎手術。我們引入 ASC 的許多機器人技術能力，使我們能夠不斷找到新的發展途徑。顯然，我們看到整個網路中的聯合專案持續保持兩位數成長，這是一個巨大的持續機遇，我認為所有這些領域在未來都很有吸引力。我們經歷了併購豐收的一年，USPI 在收購資產並進入這些環境後所帶來的許多價值在於服務線多元化等方面的規劃。

So we have a big cohort this year that -- usually it takes about a year to start to work on new physician entry and restructuring of the operating schedules, where possible to bring some of that higher acuity in sometimes as we've talked about in the past, it removes lower acuity procedures in the context of doing that. When you get new centers, usually takes a year or so to kind of get that done. So we have a lot of work to do in that regard. And then the last point I would make is that Q4, as we expected about a year ago, we said that we saw a ramp going forward. Q4 had a nice pickup in GI case recovery as well.

所以今年我們迎來了一群新醫生——通常需要大約一年的時間才能開始著手新醫生的入職和手術安排的重組，盡可能地引入一些高危險手術，正如我們過去所討論的那樣，這樣做有時會減少一些低危險手術。新建中心通常需要一年左右的時間才能完成。所以，我們在這方面還有很多工作要做。最後我想說的是，正如我們大約一年前預期的那樣，第四季度我們看到了成長勢頭。第四季GI案件回收率也有不錯的回升。

And that was an important driver of that performance. So I think it's the same this year. We expect the year to build over the year stronger and stronger. The first quarter last year was an incredibly strong quarter for us because of a lot of the synergies that dropped on the covenant transaction, the CPP transaction in Q1 of '25. But as we kind of overcome that this first quarter, we expect to see growing momentum in the business looking ahead.

而這正是促成那場出色表現的重要因素。所以我覺得今年也是一樣。我們預計今年的經濟狀況會逐年改善。去年第一季對我們來說是一個非常強勁的季度，因為契約交易和 2025 年第一季的 CPP 交易帶來了許多協同效應。但隨著我們基本上克服了第一季遇到的問題，我們預計未來業務將呈現成長動能。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Can you tell us where exchange volumes and revenues tracked in the fourth quarter? And I know you don't assume any pickup from the supplemental programs that aren't approved, but do you have any insight into where we're at in the approval process for the pending programs like Florida, Arizona, California?

能否告知我們第四季的交易量和收入狀況？我知道您不會指望從未經批准的補充項目中獲得任何收益，但是您對佛羅裡達州、亞利桑那州、加利福尼亞州等待審批項目的審批流程目前進展如何有任何了解嗎？

Ryan, on Q4 for exchanges, we were about almost 7 -- I'm sorry, 7.5% of total admissions for HICS. And then a little over 6%, 6.5%, somewhere in there of our total consolidated revenues was from exchange. On your question about Medicaid supplement payments, yes, we're obviously tracking all these sort of the pending submissions and approvals in some of the states that you mentioned. We don't -- I don't know that we have any specific updates to provide at this time. We'll obviously continue to monitor.

Ryan，第四季交換生人數佔 HICS 總錄取人數的近 7%——抱歉，是 7.5%。然後，我們合併總收入中略高於 6% 或 6.5% 的部分來自外匯交易。關於您提出的醫療補助補充付款問題，是的，我們顯然正在追蹤您提到的某些州的所有待處理提交和批准的申請。目前我們——我不知道我們是否有任何具體的最新消息可以提供。我們當然會繼續關注。

Yes. I mean I think it's just worth reemphasizing we haven't put anything in our guidance about programs that haven't yet received approval for '26. Anything incremental, sorry, I should be clear. Anything incremental in our guidance.

是的。我的意思是，我認為有必要再次強調，我們的指導方針中沒有包含任何關於尚未獲得 2026 年批准的項目的內容。任何漸進式的改變，抱歉，我應該說清楚了。我們指導方針的任何改進。

A.J. Rice, UBS.

A.J. Rice，瑞銀集團。

Maybe just some comments on what you're seeing with managed care contracting. Obviously, that sector continues to be under pressure with some of the government programs, et cetera, and I wondered is there any change in discussion in terms of the pace of new contract or contract renegotiations or terms or just general update and rates?

或許您可以就您在醫療管理合約中看到的情況發表一些看法。顯然，由於一些政府項目等原因，該行業仍然面臨壓力，我想知道在新合約的簽訂速度、合約重新談判、條款或一般更新和費率方面，討論是否有任何變化？

Yes. A.J., it's Sun. No real change in our commentary. Look, I think we have very positive and successful conversations with payers in general based on Tenet's overall service lines and what we bring to the table, including USPI as part of the overall package as well. Our commentary on rates is pretty consistent as we see 3% to 5% range from payers.

是的。A.J.，是Sun。我們的評論沒有實質改變。我認為，基於 Tenet 的整體服務範圍以及我們所能提供的服務（包括 USPI 作為整體方案的一部分），我們與支付方之間的對話總體上都非常積極和成功。我們對費率的評論相當一致，我們看到付款方的費率在 3% 到 5% 之間。

And overall, from a contracting standpoint, we're virtually contracting in 2026, I would say high 90s. And then even for '27, we're about 80% contracted. So I think we're in a very good spot. Thanks for your question.

總的來說，從合約的角度來看，我們實際上在 2026 年就實現了合約簽訂，我認為合約簽訂時間會接近尾聲（90% 左右）。即使是 2027 年，我們也已經完成了大約 80% 的合約。所以我覺得我們現在處境非常好。謝謝你的提問。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，坎托費茲傑拉。

Can you elaborate a little bit more about what you saw in payer mix in 4Q for USPI and then unpack what you're assuming for Hospital and USPI as far as the [sale] of change in '26 between 1Q '26 and 4Q '26?

您能否詳細說明您在 USPI 第四季觀察到的支付方組合情況，然後解釋一下您對醫院和 USPI 在 2026 年第一季和第四季之間變化的假設？

I'll take the second half of it. I don't think we're anticipating any different -- if you're asking the question about are we anticipating any sort of a different mix quarter-to-quarter than we saw in the amount of EBITDA that we generate in the Hospital segment or USPI proportionally, I don't think we're saying that at all. I mean this is always the case where you could have movement of 1 percentage point or something like that up or down depending on we deal with winter weather, we deal with hurricanes, we deal with. But we rebook those things and attempt to deal with them. Sometimes that's intra-quarter, sometimes it's at a quarter.

我選後半部分。我認為我們預計不會有任何不同——如果你問的是我們是否預計每個季度醫院業務或美國私人保險公司 (USPI) 產生的 EBITDA 金額的比例會與我們之前看到的有所不同，我認為我們根本沒有這樣說過。我的意思是，這種情況總是會發生，價格可能會上下波動 1 個百分點左右，這取決於我們應對冬季天氣、颶風以及其他各種情況。但我們會重新安排這些事宜並嘗試處理它們。有時是季度內的變化，有時是季度性的變化。

So I'd personally focus on the overall guide and our message in terms of the percentages for Q1 aren't meant to imply that we're changing our proportions for Q2, 3 and 4. Yes...

因此，我個人會專注於整體指南和我們的訊息，即第一季的百分比並不意味著我們將改變第二、三、四季的比例。是的...

Got it. I guess I was thinking more in terms of as effectuation takes place if you would expect the payer mix to change at the end of the year and to what degree compared to your assumptions on [1Q]?

知道了。我當時想的更多的是，隨著政策生效，您是否預期年底支付方組成會發生變化，以及與您的假設相比，變化程度如何。[1Q]？

Yes, I would say that -- I mean, there's a reason why the guidance range is wider than it normally is. I mean we don't know, right? I mean we're tracking it. We have a unique vantage point with Conifer because we do enrollment work as well. So we get a bit of a view into what that enrollment work is yielding in terms of where are people going, what reaction are they having to their premiums as they get exposure to them.

是的，我會這麼說——我的意思是，導引範圍比通常情況要寬是有原因的。我的意思是，我們不知道，對吧？我的意思是，我們正在追蹤此事。由於我們也從事招生工作，因此我們在康尼弗學院擁有獨特的優勢。因此，我們可以大致了解參保工作取得了哪些成果，例如人們的去向，以及他們在了解保費後有何反應。

So I think we'll have some leading-edge insights there. But let's be honest, it's not perfect at this stage. It's very early in the year. And I think the guidance is appropriately broad in the Hospital segment because we really don't know exactly how that's going to translate. We've been transparent with our assumptions with you all so that you can see where that's going to run relative to what actually happens.

所以我認為我們會在那裡獲得一些前沿見解。但說實話，它目前還不完美。現在才年初。我認為醫院領域的指導意見範圍足夠廣泛，因為我們真的不知道這將如何轉化。我們已經向大家坦誠地說明了我們的假設，以便大家能夠了解這些假設與實際發生的情況之間的差距。

And Sarah, this is Sun. On your question about payer mix on USPI. I would say it's been very consistent. As Saum mentioned, we have some GI that came back. So that will tweak the overall mix a little bit from a payer standpoint, but nothing substantive.

莎拉，這位是太陽。關於您提出的有關 USPI 付款方組合的問題。我認為它一直非常穩定。正如 Saum 所提到的，我們有一些 GI 患者回來了。因此，從付費者的角度來看，這將稍微調整整體組成，但不會有實質的變化。

So we're very pleased with our payer mix. In Q4, we reported at USPI, net revenue per case growth of 5.5% and total EBITDA margins above 40%. So I think all those metrics show very strong revenue acuity.

所以我們對我們的付款方組成非常滿意。第四季度，USPI 報告稱，每箱淨收入成長 5.5%，總 EBITDA 利潤率超過 40%。所以我認為所有這些指標都顯示出非常強大的營收洞察力。

Benjamin Rossi, JPMorgan.

班傑明‧羅西，摩根大通。

Just as a follow-up for the ambulatory side. For the $30 million EBITDA headwind across ambulatory from the [EAPTC] is expiring, how much of your payer mix for the ambulatory segment came from the ACA exchanges in 2024 and 2025? And then did you see any pull forward across that cohort here during the fourth quarter, given your typical seasonal dynamics for ambulatory?

作為門診方面的後續跟進。由於 [EAPTC] 到期，門診業務面臨 3000 萬美元的 EBITDA 逆風，那麼在 2024 年和 2025 年，您的門診業務支付方組合中有多少來自 ACA 交易所？那麼，考慮到門診治療的典型季節性變化，您是否在第四季度觀察到該群體有任何成長勢頭？

Yes, Ben, we don't disclose that information in terms of the segment. But we've been pretty clear all along that the HIC exposure at USPI is significantly less than the hospital segment. And no, we did not see any significant pull forward. We looked for it. Remember, we talked about this a quarter ago as well.

是的，本，我們不會就該細分市場揭露此類資訊。但我們一直以來都非常明確地表示，USPI 的高收入者風險敞口遠低於醫院部門。不，我們沒有看到任何明顯的成長勢頭。我們找過了。別忘了，我們三個月前也討論過這個問題。

We looked for it, but we did not see any significant pull forward.

我們尋找過，但沒有看到任何明顯的進展。

John Ransom, Raymond James.

約翰·蘭索姆，雷蒙德·詹姆斯。

Sorry. There's a big narrative over the past few months that providers are getting on top of payers with coding advances assisted by AI, particularly claims submissions are easier. Is that exaggerated? Are we -- what inning are we in? And just given that you're positioned on Conifer being a provider, what's your position on that debate?

對不起。過去幾個月來，一種普遍的說法是，醫療服務提供者藉助人工智慧輔助的編碼技術進步，在支付方面前佔據了優勢，尤其是理賠提交變得更加容易。這是否言過其實？我們現在──我們現在進行到第幾局了？既然您認為 Conifer 是一家供應商，那麼您對這場爭論的立場是什麼？

Yes. I mean, John, I can only comment for Tenet. And I guess, to some extent, for how we operate at Conifer. Our coding has always been appropriate, compliant. It's -- we audit carefully.

是的。約翰，我的意思是，我只能對《信條》發表評論。我想，在某種程度上，這也影響了我們在 Conifer 的運作方式。我們的編碼一直都是恰當的、合規的。我們會進行仔細審核。

We haven't changed our coding practices over the last few years, either for ourselves or necessarily for our clients. We aim for very high degrees of accuracy and we have not made changes in those areas. We have obviously been successful in increasing our acuity, which has supported our net revenue per case in terms of our pathway there. And finally, just to unpack a little bit the question earlier related to this with Sun's comments about our managed care contracting environment. We also don't have extremely heavy HOPD market drive from what we're doing.

過去幾年，我們並沒有改變我們的程式設計實踐，無論是為了我們自己，還是不一定是為了我們的客戶。我們力求達到非常高的準確度，而我們在這方面沒有做出任何改變。我們顯然已經成功提高了我們的診療水平，這提高了我們每個病例的淨收入。最後，為了更清楚地解釋一下先前與孫先生關於我們醫療管理合約環境的評論相關的問題。我們目前所做的事情並沒有對醫院門診部 (HOPD) 市場產生特別大的需求。

So we do a lot on the basis of freestanding outpatient in what we do, and that ends up being a value to the plans. We have not found ourselves in conflict over coding practices. We find ourselves in conflict over the nature of the amount of time and energy we put into disputes, denials, under payments and things of that nature. That have a process back and forth that you got to work through. But increasingly, we've been setting up systems with the health plans to have adjudication mechanisms to work with them on in order to resolve these things in a less resource-intensive way.

因此，我們在工作中很大程度上依賴獨立的門診服務，最終為醫療計劃帶來了價值。我們在編碼規範方面並沒有發生衝突。我們發現自己在投入到爭端、否認、少付款項以及類似事情上的時間和精力的性質上存在衝突。這需要一個來回反覆的過程，你需要一步一步地完成。但是，我們越來越多地與健康計劃建立系統，設立裁決機制，以便與他們合作，以資源消耗更少的方式解決這些問題。

Some payers have been better than others about doing that with us, but that's the path we're moving down.

有些付款方在這方面比其他付款方做得更好，但這正是我們努力的方向。

Craig Hettenbach, Morgan Stanley.

克雷格‧赫滕巴赫，摩根士丹利。

Appreciate all the details given the fluid backdrop in terms of puts and takes on this year. Saum, just keying off of your comment of taking an active approach to buybacks, especially at the current valuation multiple given the significantly stronger balance sheet, free cash flow generation and CommonSpirit kind of proceeds, how are you and the Board just thinking about kind of the right cadence here of buybacks?

鑑於今年市場波動劇烈，所有細節都值得讚賞。Saum，我剛才提到要積極主動地進行股票回購，尤其是在當前估值倍數下，考慮到公司資產負債表明顯更強、自由現金流更充裕以及CommonSpirit的收益，您和董事會是如何考慮合適的股票回購節奏的呢？

Well, yes, I mean I purposely indicated I purposely noted and indicated that -- I mean all these things linked together, right? I mean it's not just that we have significant cash on the balance sheet. We just described maybe in more detail today, the kind of value we just generated from the Conifer transaction, effectively, a portion of that transaction was like debt retirement, right? I mean it was an obligation on the balance sheet that was real coming up in the next few years. And so then the other proceeds from that go back into investing in the business, investing in USPI, and it gives us the opportunity for more share buybacks.

是的，我的意思是，我特意指出並表明了這一點——我的意思是，所有這些事情都是相互關聯的，對吧？我的意思是，不僅僅是我們資產負債表上有大量現金。我們今天可能更詳細地描述了我們從 Conifer 交易中產生的價值，實際上，該交易的一部分就像是償還債務，對吧？我的意思是，這是資產負債表上的一項實際債務，將在未來幾年內到期。因此，剩餘的收益將重新投入業務投資中，投資於 USPI，這讓我們有機會進行更多的股票回購。

And I would link this to our guidance for 2026 in terms of -- I know we've talked a little bit about our growth rates and core growth rates. I mean we attempt to operate and behave like a company that trades at a higher multiple. We will deploy our balance sheet like an organization that recognizes that the multiple has a valuation that's attractive to buy back shares. And I think we've done that over the last year. I mean that's our mindset, right?

我會將此與我們對 2026 年的指導方針聯繫起來——我知道我們已經討論過我們的成長率和核心成長率。我的意思是，我們努力像一家估值倍數較高的公司一樣運作和行事。我們將像一家認識到目前估值倍數具有吸引力、適合回購股票的機構一樣運用我們的資產負債表。我認為過去一年我們做到了這一點。我的意思是，這就是我們的想法，對吧？

We expect to perform at that level. We also expect to deploy our balance sheet in a way that demonstrates we have confidence in our ability to operate. That might be the easiest way to describe how we think about the two. They're interlinked for us.

我們期望能達到那個水準。我們也希望透過合理運用資產負債表，展現我們對自身營運能力的信心。這或許是描述我們如何看待這兩者最簡單的方法。對我們來說，它們是相互關聯的。

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。