Tenet Healthcare Corp (THC) 2026 Q1 法說會逐字稿

Good morning, and welcome to Tenet Healthcare's first quarter 2026 earnings conference call. (Operator Instructions)

各位早安，歡迎參加 Tenet Healthcare 2026 年第一季財報電話會議。（接線員指示）

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

現在我將把電話會議交給本次主持人——投資人關係副總裁 Will McDowell 先生。McDowell 先生，您可以開始。

Good morning, everyone, and thank you for joining today's call. I am Will McDowell, Vice President of Investor Relations. We're pleased to have you join us for a discussion of Tenet's first quarter 2026 results as well as a discussion of our financial outlook.

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 Will McDowell。我們很高興各位加入，一同討論 Tenet 2026 年第一季業績，以及我們的財務展望。

Tenet's 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.

參與今天電話會議的 Tenet 高階管理團隊包括：董事長兼執行長 Saum Sutaria 醫師；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.

今天上午的網路直播包含投影片簡報，已張貼於我們網站 tenethealth.com 的投資人關係專區。

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.

提醒收聽本次電話會議的聽眾，我們今天討論中所作的某些陳述屬於前瞻性陳述，代表管理層基於目前可得資訊的預期。實際結果與計畫可能有重大差異。Tenet 無義務因後續資訊而更新任何前瞻性陳述。

Investors should take note of the cautionary statement slide included in today's presentation as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission.

投資人應留意今日簡報中所載的警示性聲明投影片，以及我們最新的 Form 10-K 與其他向美國證券交易委員會提交之文件中所討論的風險因素。

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

接下來，我把電話會議交給 Saum。

All right. Thank you, Will, and good morning, everyone.

好的。謝謝你，Will，各位早安。

In the first quarter, we reported net operating revenues of $5.4 billion and consolidated adjusted EBITDA of $1.16 billion, which represents an adjusted EBITDA margin of 21.6%. We are pleased with the start to the year, performing above our previously provided expectations.

第一季我們公布的淨營運收入為 54 億美元，合併調整後 EBITDA 為 11.6 億美元，調整後 EBITDA 利潤率為 21.6%。我們對今年的開局感到滿意，表現優於先前提供的預期。

As anticipated towards the end of last year, the operating environment is dynamic. There are payer mix shifts, seasonal effects and insurance enrollment uncertainty in the exchanges and Medicaid that impact demand. Despite these challenges, we delivered a clean quarter characterized by disciplined operations, benefits from execution on our previously described expense opportunities, stable volumes despite headwinds and as a result, significant free cash flow generation.

如同我們在去年年底所預期，營運環境仍具動態變化。付款方組合轉移、季節性因素，以及交易所與 Medicaid 的投保不確定性，都會影響需求。儘管面臨這些挑戰，我們仍交出一個「乾淨」的季度：以嚴謹的營運紀律、落實先前所述費用改善機會所帶來的效益、在逆風下仍維持穩定的量能，並因此產生可觀的自由現金流。

USPI generated $484 million in adjusted EBITDA, which represents 6% growth over the first quarter of 2025 and a robust 22% of our full year 2026 adjusted EBITDA guidance. We are pleased with USPI's start to the year as we set an aggressive EBITDA target as a percent of the full year for the first quarter that we were able to exceed.

USPI 產生 4.84 億美元的調整後 EBITDA，較 2025 年第一季成長 6%，並占我們 2026 全年調整後 EBITDA 指引的強勁 22%。我們對 USPI 的年度開局感到滿意；由於我們為第一季設定了相對於全年目標的積極 EBITDA 目標，而我們也成功超越。

We have seen a pattern over the last few years with a modest shift towards an increased distribution of cases and, therefore, earnings into the first quarter. Given our focus on acuity, same-facility revenues grew 5.3% at USPI, highlighted by double-digit same-store volume growth in total joint replacements in the ASCs over prior year.

過去幾年我們觀察到一種趨勢：病例分布略為前移，因此獲利也更多集中在第一季。基於我們對高病情嚴重度（acuity）的聚焦，USPI 同院（same-facility）營收成長 5.3%，其中亮點包括 ASC 的全膝／全髖等全關節置換（total joint replacements）同店量能較去年同期呈現雙位數成長。

Our operations in the first quarter were somewhat impacted by two major winter storms and uncertainty from vendor cyber attacks, however, our operating teams managed through them and were able to reschedule many of the procedures lessening the overall impact in the quarter.

第一季營運在某種程度上受到兩場重大冬季風暴以及供應商網路攻擊所帶來不確定性的影響；不過，我們的營運團隊妥善因應，並重新安排了許多手術與處置，降低了本季整體影響。

We have a robust pipeline of assets interested in joining USPI this year. As such, we've had a particularly strong start to the year investing $125 million in the first quarter to acquire 7 ASCs. Additionally, we have commenced patient care at three de novo centers. This represents half of our targeted full year spend already completed in the first quarter.

今年我們有強勁的資產管線，對加入 USPI 表達興趣。因此，我們在年初即有特別強勁的投資動能：第一季投入 1.25 億美元收購 7 家 ASC。此外，我們也已在 3 家新設（de novo）中心開始提供病患照護。這代表我們原先規劃的全年投入金額，有一半已在第一季完成。

Turning to our Hospital segment. First quarter 2026 adjusted EBITDA was $678 million, which was nicely above our expectations and represented 27.5% of our full year 2026 adjusted EBITDA guidance. We reported 16.7% EBITDA margins in the quarter, which were driven by disciplined expense management and growth initiatives, which offset the expected impacts of unfavorable payer mix and reductions in exchange enrollment.

接著談醫院事業部。2026 年第一季調整後 EBITDA 為 6.78 億美元，明顯高於我們的預期，並占我們 2026 全年調整後 EBITDA 指引的 27.5%。本季 EBITDA 利潤率為 16.7%，主要由嚴謹的費用管理與成長計畫所帶動，抵銷了預期中的不利付款方組合影響以及交易所投保人數下降的影響。

The results in the quarter reflect no significant changes in supplemental Medicaid program revenues compared to our original expectations. We have seen declines in exchange coverage with same-store exchange admissions down about 10% compared to first quarter 2025, but not yet at the level we assumed as the average for the full year.

本季結果顯示，補充性 Medicaid 計畫收入相較我們原先預期並無重大變化。我們確實看到交易所保險覆蓋下降，同店交易所住院（admissions）較 2025 年第一季約下降 10%，但尚未達到我們假設的全年平均水準。

We continue to assess the overall environment for effectuation rates and the impact on future exchange volumes, but we believe we have the tools to manage this impact under a variety of scenarios.

我們持續評估整體環境中的保單生效率（effectuation rates）以及其對未來交易所量能的影響，但我們相信在多種情境下，我們都有工具可以管理這項影響。

We continue to make investments in technology to enable growth and streamline operations. We are executing on the expense initiatives that we discussed on our fourth quarter 2025 earnings call and are recognizing the benefits. These initiatives include engagement tools, which are improving recruitment and retention efforts, process automation to address length of stay and capacity controls, which improve our clinical throughput.

我們持續投資科技以支持成長並精簡營運。我們正執行在 2025 年第四季財報電話會議中討論的費用改善計畫，並已開始看到效益。這些計畫包括：提升招募與留任的員工互動工具、用於改善住院天數（length of stay）的流程自動化，以及提升臨床周轉效率的容量控管。

Among these things, we are executing on AI-related capabilities in our hospitals, physician practices and the global business center to drive further efficiencies, most of which have been useful for supporting extending the productivity metrics of our team.

在上述工作之中，我們也在醫院、醫師診所與全球業務中心推動與 AI 相關的能力，以進一步提升效率；其中多數已有效支持延伸團隊的生產力指標。

Importantly, we have learned that while all of these tools will not work in a pilot state, setting up a governance that either green lights for rapid scaling up or red lights for shutdown help us remain focused.

重要的是，我們了解到並非所有工具在試點階段都能奏效；建立一套治理機制，能夠對可快速擴大規模者「開綠燈」、對應停止者「亮紅燈」，有助於我們保持聚焦。

We have included third-party EMR integrated solutions, which will increase our clinician productivity, decrease administrative burden and improve patient access through programs such as ambient scribe, automated discharge summaries and autonomous professional fee coding in various pilot programs.

我們也納入第三方、可與 EMR 整合的解決方案，透過多項試點計畫提升臨床人員生產力、降低行政負擔，並改善病患可近性；例如環境式聽寫（ambient scribe）、自動化出院摘要，以及自主化專業費用編碼（autonomous professional fee coding）。

Additionally, we have increased back-office AI automation, which is improving productivity and consolidating third-party spend to reduce costs. For example, we have almost doubled or more the productivity of our Conifer analytics team.

此外，我們也提高後勤（back-office）的 AI 自動化程度，以提升生產力並整合第三方支出以降低成本。舉例來說，我們幾乎將 Conifer 分析團隊的生產力提升到接近倍增或更高。

As we look forward, we are actively identifying and piloting agentic workflows to transform further business processes. So far, our work has enabled us to more than offset the expected and unexpected headwinds that arose in the quarter.

展望未來，我們正積極辨識並試點具代理能力（agentic）的工作流程，以進一步改造業務流程。迄今為止，我們的工作已使我們得以大幅抵銷本季出現的預期與非預期逆風。

Regarding full year 2026 guidance, as in prior years, at this time, we are not addressing the underlying outperformance in our business units during the first quarter. We're pleased with our year-to-date performance, we're reaffirming our full year guidance, and we'll address our expectations for the full year in the future.

關於 2026 全年指引，如同以往年度，在此時點我們不會針對第一季各事業單位的超預期表現進行調整。我們對年初至今的表現感到滿意，並重申全年指引；未來我們將再更新對全年表現的預期。

As a reminder, after normalizing for the non-recurring items that were reported in 2025, in the f irst quarter of '26 and excluding the headwind from the expiration of the premium tax credits, our 2026 adjusted EBITDA is expected to grow at 10% at the midpoint of our range.

提醒各位，在將 2025 年所揭露的一次性項目正常化後，且在 2026 年第一季並排除因保費稅額抵免（premium tax credits）到期所帶來的逆風影響下，我們預期 2026 年調整後 EBITDA 於區間中點將成長 10%。

And finally, we continue to see significant opportunity to utilize share repurchase at our current valuations. We repurchased 1.35 million shares for $318 million in the first quarter of 2026 and expect to continue to deploy capital for share repurchase over the balance of the year.

最後，我們仍認為在目前估值水準下，運用庫藏股回購具有顯著機會。我們在 2026 年第一季以 3.18 億美元回購 135 萬股，並預期在今年剩餘期間持續配置資本進行股票回購。

In conclusion, we adapt to the environment, focus on strong clinical quality, recommit to helping our doctors have an easier environment to operate in and focus on delivering reliable earnings in this transitionary period. Our balance sheet is strong, and our diversified asset mix with a focus on ambulatory care gives us a significant strategic advantage in the market as we look ahead.

總結而言，我們將因應環境變化、專注於卓越的臨床品質、再次致力於協助醫師在更容易運作的環境中執業，並在此過渡期聚焦於提供穩健可靠的獲利表現。我們的資產負債表強健，而以門診照護為重點的多元化資產組合，讓我們在展望未來時於市場上具備顯著的策略優勢。

And with that, I will turn it over to Sun for more details. Sun?

接下來，我把電話會議交給 Sun 提供更多細節。Sun？

Thank you, Saum, and good morning, everyone.

謝謝你，Saum，各位早安。

We had a nice start to the year in the first quarter of 2026, generating total net operating revenues of $5.4 billion and consolidated adjusted EBITDA of $1.162 billion. First quarter adjusted EBITDA margin was 21.6%, driven by disciplined operating expense management, including good progress on the expense initiatives that we outlined last quarter.

我們在 2026 年第一季有個不錯的開局，總淨營運收入達 54 億美元，合併調整後 EBITDA 為 11.62 億美元。第一季調整後 EBITDA 利潤率為 21.6%，主要受惠於嚴謹的營運費用管理，包括我們在上季所概述的費用改善計畫取得良好進展。

I would now like to highlight some key items for both of our segments, beginning with USPI. In the first quarter, USPI's adjusted EBITDA was $484 million, with adjusted EBITDA margin at 36.7%. USPI delivered a 5.3% increase in same-facility system-wide revenues with net revenue per case up 5.6%, and same facility case volumes down 0.3%.

我現在想要針對我們兩個事業部門的幾個關鍵項目做重點說明，先從 USPI 開始。第一季，USPI 的調整後 EBITDA 為 4.84 億美元，調整後 EBITDA 利潤率為 36.7%。USPI 的同設施（same-facility）全系統營收成長 5.3%，每病例淨營收成長 5.6%，而同設施病例量下滑 0.3%。

As Saum noted, volumes were impacted by the winter storms early in the quarter, and while we were able to reschedule many of the procedures, there was an overall impact.

如 Saum 所提到，季度初期的冬季風暴影響了量能；雖然我們能夠重新安排許多手術，但整體仍受到影響。

Turning to our Hospital segment. First quarter 2026 adjusted EBITDA was $678 million, resulting in an adjusted EBITDA margin of 16.7%. This represents 27.5% of our expected full year '26 adjusted EBITDA. Same-hospital inpatient adjusted admissions rose 0.6% in the quarter and were impacted by a decline in respiratory admissions of 41% compared to first quarter of '25. This driver represented a 90 basis point reduction in admissions growth in the quarter.

接著看我們的醫院事業部門。2026 年第一季調整後 EBITDA 為 6.78 億美元，調整後 EBITDA 利潤率為 16.7%。這相當於我們預期 2026 全年調整後 EBITDA 的 27.5%。本季同院（same-hospital）住院調整後入院量成長 0.6%，但受到呼吸道入院量較 2025 年第一季下降 41% 的影響。此因素使本季入院成長率減少 90 個基點。

Revenue per adjusted admissions declined 1.5% year-over-year in the first quarter of '26 due to the impact of reduced exchange volumes within our overall payer mix and the year-over-year impact of the $40 million favorable out-of-period supplemental Medicaid revenues that we reported in the first quarter of 2025.

2026 年第一季每調整後入院的營收年減 1.5%，主要因整體付款人組合中交易所（Exchange）量能下降的影響，以及我們在 2025 年第一季認列的 4,000 萬美元有利的跨期（out-of-period）補充性 Medicaid 營收所造成的年對年比較影響。

Exchange revenues represented about 6% of consolidated revenues in the first quarter of '26, a 9% decline from first quarter of '25.

2026 年第一季，交易所（Exchange）營收約占合併營收的 6%，較 2025 年第一季下降 9%。

Our consolidated salary, wages and benefits was 40.5% of net revenues in the quarter, consistent with our performance from the prior year despite the net revenue headwinds, demonstrating our ability to flex our operating model. Overall, operating expenses per adjusted admissions were also favorable to our expectations, which contributed to our outperformance in the quarter.

本季合併薪資、工資與福利占淨營收的 40.5%，儘管面臨淨營收逆風，仍與去年表現一致，展現我們調整營運模式的能力。整體而言，每調整後入院的營運費用也優於我們的預期，促成我們本季的超預期表現。

In the first quarter of '26, we recognized a onetime approximate $40 million favorable revenue adjustment as a result of the completed Conifer transaction. This amount was included in our original guidance. And I would also note that this adjustment is not included in our revenue per adjusted admission calculations.

在 2026 年第一季，因 Conifer 交易完成，我們認列一次性約 4,000 萬美元的有利營收調整。該金額已包含在我們原先的指引中。另外我也要說明，這項調整未納入我們每調整後入院營收的計算。

We recorded supplemental Medicaid revenues of $304 million in the first quarter of '26, consistent with what we assumed in our guidance. Importantly, we did not benefit from out-of-period supplemental Medicaid revenues related to prior years in this quarter.

2026 年第一季我們認列補充性 Medicaid 營收 3.04 億美元，與我們在指引中的假設一致。重要的是，本季我們並未受益於與前幾年度相關的跨期補充性 Medicaid 營收。

We're pleased with our ability to manage through the various dynamics throughout our first quarter and feel we have the ability to deliver on our commitments over the balance of the year.

我們對於第一季在各種動態因素下的管理能力感到滿意，並認為我們有能力在今年剩餘期間達成我們的承諾。

Next, we will discuss our cash flow, balance sheet and capital structure. We generated $978 million of adjusted free cash flow in the first quarter.

接下來，我們將討論現金流、資產負債表與資本結構。第一季我們產生 9.78 億美元的調整後自由現金流。

And as of March 31, 2026, we had $2.97 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.

截至 2026 年 3 月 31 日，我們手上現金為 29.7 億美元，且在我們的循環信用額度（line of credit facility）下沒有任何未償借款。此外，在 2027 年底之前我們沒有重大到期債務。

And finally, during the first quarter, we repurchased 1.35 million shares of our stock for $318 million.

最後，在第一季期間，我們以 3.18 億美元回購了 135 萬股公司股票。

Our leverage ratio as of March 31, '26 was 2.24 times EBITDA or 2.83 times EBITDA less NCI, driven by our strong operational performance and financial discipline. We remain committed to maintaining a deleveraged balance sheet and believe that we have significant financial flexibility to support our capital deployment priorities and drive shareholder value.

截至 2026 年 3 月 31 日，我們的槓桿比率為 EBITDA 的 2.24 倍，或扣除非控制權益（NCI）後 EBITDA 的 2.83 倍，主要受惠於強勁的營運表現與財務紀律。我們仍致力於維持去槓桿化的資產負債表，並相信我們具備相當的財務彈性，以支持資本配置優先事項並提升股東價值。

Let me now turn to our outlook for 2026. As Saum noted, we are not making any adjustments to our full year '26 outlook at this time. While we had strong fundamental outperformance in the first quarter, have continued confidence in our ability to achieve our full year targets, it is early in the year, and we will plan to revisit our full year guidance as needed in subsequent quarters.

接著談我們對 2026 年的展望。如 Saum 所提到，我們目前不對 2026 全年展望做任何調整。雖然第一季基本面表現強勁、超出預期，且我們對達成全年目標仍具信心，但現在仍是年初，我們將視需要在後續季度重新檢視全年指引。

As such, we are reaffirming the full year '26 guidance that we initially provided in February. Our outlook continues to exclude any contributions from potential increases in supplemental Medicaid programs that have not yet been approved and finalized by CMS.

因此，我們重申 2 月初次提供的 2026 全年指引。我們的展望仍排除尚未獲 CMS 核准並最終定案之補充性 Medicaid 計畫可能增加所帶來的任何貢獻。

For second quarter '26, we expect consolidated adjusted EBITDA to be 24% to 25% of our full year consolidated adjusted EBITDA at the midpoint. We expect that USPI's EBITDA in the second quarter will also be 24% to 25% of our full year '26 USPI EBITDA at the midpoint.

就 2026 年第二季而言，我們預期合併調整後 EBITDA 在中位數將約占全年合併調整後 EBITDA 的 24% 至 25%。我們也預期 USPI 第二季 EBITDA 在中位數將約占 2026 全年 USPI EBITDA 的 24% 至 25%。

Turning to our cash flows for '26. We continue to expect adjusted free cash flow after NCI in the range of $1.6 billion to $1.83 billion. This range includes the payment of about $150 million in tax payments for the Conifer transaction this year. Excluding these tax payments, this would represent $1.865 billion of adjusted free cash flow after NCI at the midpoint of our '26 outlook.

接著看 2026 年的現金流。我們仍預期扣除非控制權益（NCI）後的調整後自由現金流介於 16 億至 18.3 億美元之間。此區間包含今年因 Conifer 交易所需支付約 1.5 億美元的稅款。若排除這些稅款，以我們 2026 年展望的中位數計算，扣除 NCI 後的調整後自由現金流將為 18.65 億美元。

We remain focused on strong free cash flow conversion from our EBITDA performance, including the continued outstanding cash collection performance of Conifer, while continuing to invest in high-priority areas of our businesses.

我們仍專注於將 EBITDA 表現有效轉換為強勁的自由現金流，包括 Conifer 持續出色的現金回收表現，同時也持續投資於業務中的高優先領域。

Turning to our capital deployment priorities. We are well positioned to create value for shareholders through the effective deployment of free cash flow. First, we will continue to prioritize capital investments to grow USPI through M&A. And as Saum noted, we have had a strong start to the year and have a number of future opportunities to support our $250 million annual target for USPI M&A.

接著談我們的資本配置優先事項。我們具備良好條件，能透過有效運用自由現金流為股東創造價值。第一，我們將持續優先投入資本，透過併購（M&A）推動 USPI 成長。如 Saum 所提到，我們今年開局強勁，且有多項未來機會可支持 USPI 每年 2.5 億美元的併購目標。

Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings.

第二，我們預期將持續投資於關鍵的醫院成長機會，以推動內生成長，包括聚焦於更高病情嚴重度（higher acuity）的服務項目。

Third, we'll continue to be active in share repurchases. We continue to see significant opportunity at our currently compressed valuation multiple.

第三，我們將持續積極進行股票回購。我們仍認為在目前被壓縮的估值倍數下，存在顯著機會。

And f inally, we will continue to evaluate opportunities to retire and/or refinance debt.

最後，我們將持續評估提前償還及／或再融資債務的機會。

We are pleased with our strong start to the year and remain confident in our ability to deliver on our outlook for 2026. We continue to execute our strategy across our transformed portfolio of businesses, resulting in a more predictable, more capital-efficient company that is well positioned to drive value through effective capital deployment.

我們對今年強勁的開局感到滿意，並對達成 2026 年展望仍具信心。我們持續在已轉型的業務組合中執行策略，使公司更具可預測性、資本效率更高，並具備良好條件可透過有效的資本配置來驅動價值。

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

接下來，我們準備開始問答。接線員？

Thank you. At this time, we'll be conducting a question-and-answer session. (Operator Instructions)

謝謝。現在我們將進行問答環節。（接線員指示）

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Great. Thank you. Payer denials this year appear to be broadly accelerating across the industry. Are you seeing this activity increase in your business? And maybe is it more MA versus commercial? And is the rise in uninsured or uncompensated care you're seeing primarily related to the exchange subsidy expiration? Or is there anything else you'd call out there?

很好，謝謝。今年付款方拒付（denials）看起來在整個產業普遍加速。你們在業務中是否也看到這類活動增加？另外，是否更多發生在 Medicare Advantage（MA）相較於商業保險？以及你們看到的無保險或無償照護（uncompensated care）上升，是否主要與交易所補貼到期有關？或還有其他你會特別指出的因素？

Yeah, thanks for the question. Payer -- I mean, denials, I would say, payer disputes, many of which can result in denials and back and forth are high. They have been high, as I've said before, they're too high for what is appropriate, especially when comparing back to kind of pre-pandemic periods just as a marker.

是的，謝謝你的問題。付款方——我是說拒付，我會說付款方爭議（payer disputes），其中很多會導致拒付以及來回往返的處理，確實偏高。它們一直都很高，正如我之前說過的，與合理水準相比偏高，尤其是回頭與疫情前的期間相比作為一個參考。

I don't think that in our business, we have seen a net impact of disputes and denials changing in this quarter relative to before, so meaning last year. So look, they're high, they have been too high, but we don't see a meaningful trend this quarter that's different.

我不認為在我們的業務中，本季相較於之前（也就是去年），爭議與拒付的淨影響有出現變化。也就是說，它們很高、也一直過高，但我們沒有看到本季有任何與以往不同的顯著趨勢。

We can only guess obviously with the slight increase in uncompensated care that some of it has to do with the expiration of the exchange subsidies.

我們當然只能推測，無償照護略有上升，其中一部分可能與交易所補貼到期有關。

A.J. Rice, UBS.

A.J. Rice，UBS。

Thanks. Hi, everybody. If I look at the last number of quarters, there's been consistency of outperformance in the Hospital segment overall. I wonder if you could talk maybe broadly because we haven't talked about markets in a general sense.

謝謝。大家好。如果我看過去幾個季度，醫院事業部門整體的超預期表現相當一致。我想請你們從更宏觀的角度談談，因為我們一般而言還沒有特別討論各市場（markets）的情況。

Is there -- are there some markets where you've implemented strategies that you'd call out that have been particularly successful? And as you look across the portfolio, maybe discuss some markets that still have an opportunity for significant improvement as you deploy new strategies to improve their performance.

是否有——是否有一些市場，您已經實施了您會特別點名、且成效特別顯著的策略？另外，當您檢視整體投資組合時，是否也能談談一些仍有顯著改善空間的市場，隨著您部署新策略以提升其表現？

Thanks, A.J., and I appreciate you calling out the strength of the hospital business over the last few years.

謝謝你，A.J.，也感謝你特別提到過去幾年醫院業務的強勁表現。

We have been focused on a broad strategy of obviously increasing acuity, focusing on our ability to succeed with our transfer centers, adding new surgical programs and increasing our emergency-related services, especially trauma programs and other things.

我們一直聚焦於一個廣泛的策略：很明顯地提升病患病情嚴重度（acuity）、著重於我們透過轉診中心（transfer centers）取得成功的能力、增加新的外科手術項目，並提升與急診相關的服務，特別是創傷（trauma）計畫以及其他項目。

And in a combined sense, that is a -- it's a global strategy. I mean, implemented locally, but we have opportunities and are implementing in every market that we have. As you're aware, based upon the portfolio shifts that we made, we remained in markets in which we thought the execution of our overall strategy would be successful.

而從整體來看，這是一個——這是一個全域性的策略。也就是說，在地方層面落地執行，但我們在每一個所處市場都有機會，且正在推行。正如你所知，基於我們所做的投資組合調整，我們保留在那些我們認為能成功執行整體策略的市場。

No, look, there are things like, for example, enrollment in the exchanges that differ state to state and what the impact will be. So there are some differences there in terms of what's happening, in terms of throughput and other things that it may impact even the uninsured piece.

不過你看，確實有一些事情，例如交易所（exchanges）的投保/參保（enrollment）在各州之間不同，以及其影響會是什麼。因此在發生的情況上會有一些差異，包含就醫量（throughput）等可能受到影響的因素，甚至也可能影響到無保險（uninsured）那一塊。

But if you step back and now sort of with my commentary today, which is that we're in this transitionary period, where there's some coverage changes that are occurring. We'll see how all that settles out.

但如果你退一步看，並結合我今天的評論，也就是我們正處於一個過渡期，保險覆蓋（coverage）正在發生一些變化。我們會看看這些最終會如何落定。

But when you look at the opportunity to find efficiencies, you look at the support services for the hospitals, and you look at some of the automation opportunities that I described. Once again, those are available in each market.

但當你看尋找效率提升的機會、看醫院的支援服務，以及看我所描述的一些自動化機會時，再次強調，這些在每個市場都存在。

Of course, some markets are bigger than other markets. So at a dollar level, you might get more impact in one market than another, but they're scaled appropriately and are available in each of the markets.

當然，有些市場比其他市場更大。因此以金額層面來看，你可能在某個市場看到更大的影響，但它們會按規模適當配置，而且在每個市場都可推行。

So if you look at our earnings in the first quarter this year, they were driven by consistency across our markets in terms of the efficiency opportunities.

所以如果你看我們今年第一季的獲利表現，它是由各市場在效率機會上的一致性所驅動的。

Look, the other thing I would point out is just good old fashioned discipline around flexing our cost structure. We kind of knew early in the year by the time we had given guidance that one of the winter storms that already come through, and we were able to maintain our SWB as a percentage of our top line by flexing even though the revenues were going to be a little bit more challenged.

另外我想指出的是，就是傳統的成本結構彈性調整（flexing）紀律。我們在年初、也就是給出指引時就大致知道，已經有一場冬季風暴來襲，而我們能夠透過彈性調整來維持 SWB 佔營收（top line）的比例，即使營收會稍微更具挑戰。

So some of this is just continuing to maintain the old fashioned discipline of anticipating and flexing intra-quarter, which, of course, is also an opportunity available in all markets.

所以其中一部分就是持續維持這種傳統紀律：預先判斷並在季度內（intra-quarter）彈性調整；當然，這也是所有市場都具備的機會。

I hope that helps.

希望這能有所幫助。

Okay. Yes, no, thanks a lot.

好的。是的，沒有，真的非常感謝。

Jason Cassorla, Guggenheim Partners.

Guggenheim Partners 的 Jason Cassorla。

Great, thanks. Good morning. I wanted to go back to your prepared remarks around your efforts around length of stay and throughput improvements. You're clearly seeing the benefits there given length of stay has been down about 3% in each of the past six quarters by our math.

很好，謝謝。早安。我想回到你在事先準備的談話中提到、關於住院天數（length of stay）與就醫量/流轉（throughput）改善的努力。很明顯你們已經看到效益，因為按我們的計算，過去六個季度每一季住院天數都下降了約 3%。

But that improvement is coming despite your high acuity service line focus, which would naturally carry a higher length of stay. I guess could you just delve a little bit more on the length of stay opportunity for you and what that run rate looks like as you move through the rest of the year and beyond?

但這樣的改善是在你們聚焦高病情嚴重度（high acuity）服務線的情況下發生的，而那通常會帶來更長的住院天數。我想請你再多談一點你們在住院天數上的改善空間，以及當你們走過今年剩餘時間乃至更長期時，這個運行水準（run rate）大概會是什麼樣子？

Yes. No, I appreciate the question.

是的。沒有，我很感謝這個問題。

And you're right that the two are actually coupled in an interesting way, which is in order to maintain available capacity to always service the high acuity needs that arise in the community, whether from direct arrival at our hospitals or for outlying hospitals that might need help or support, which we always try to say yes to, you have to make sure that your throughput and capacity management is good enough to have the availability of beds to be able to say, yes, for those things.

你說得對，這兩者其實以一種有趣的方式相互連動：為了維持可用容量，隨時能服務社區中出現的高病情嚴重度需求——不論是病患直接到我們醫院，或是周邊醫院可能需要協助或支援，而我們也總是盡量說「可以」——你必須確保你的就醫量流轉（throughput）與容量管理足夠好，才能有可用病床，對這些需求說「可以」。

And so we see the two being very intricately linked in terms of a requirement to succeed in the high acuity strategy.

因此我們認為，若要在高病情嚴重度策略上成功，兩者在要求層面是非常緊密相連的。

Now look, you're right that as the acuity goes up, there's a length of stay headwind that does come with it because the cases are more complex and and longer.

現在你看，你說得對，隨著病情嚴重度上升，確實會帶來住院天數的逆風，因為病例更複雜、也更耗時。

But look, we're pleased with the fact that we are managing that overall length of stay to something better than even breakeven in terms of our reported length of stay because that's creating capacity in our hospitals.

但我們很高興的是，我們在整體住院天數的管理上，表現甚至優於打平（breakeven）的水準（以我們對外揭露的住院天數來看），因為這正在為我們的醫院釋放容量。

And I would remind everybody that part of the strategy, of course, is capital avoidance on additional capacity that's really not necessary when you can improve productivity that way.

我也想提醒大家，策略的一部分當然是避免資本支出（capital avoidance）去新增其實不必要的容量，因為你可以透過這種方式提升生產力。

So again, for us, all these things are intricately linked and look, we're pleased that some of these new tools that we're trying out are helping to add to our more traditional length of stay management that we've talked about over the last four or five years.

所以再說一次，對我們而言，這些事情都緊密相連；而且我們也很高興，我們正在試行的一些新工具，正在幫助我們在過去四、五年一直談到的較傳統住院天數管理之外，帶來額外的改善。

Great. Thank you.

很好，謝謝你。

Brian Tanquilut, Jefferies.

Jefferies 的 Brian Tanquilut。

Hey, good morning, Saum. This is a tough quarter, so congrats on beating that EBITDA line.

嗨，早安，Saum。這一季很艱難，所以恭喜你們 EBITDA 超出那條線。

Maybe just on the Medicaid side, a lot of your peers have spoken about Medicaid trends, whether it's immigrants [not filling out] paperwork. And just curious, what are you seeing in the Medicaid book?

想請教一下 Medicaid 方面，你們很多同業都談到 Medicaid 的趨勢，例如移民（immigrants）[沒有填寫]文件等。想了解你們在 Medicaid 組合（book）上看到了什麼？

And as we've seen uncompensated care step up here, which was also here across the space, right? How much of that is Medicaid versus maybe exchange members versus other dynamics? Thanks.

另外，隨著我們看到無償照護（uncompensated care）在這裡上升，而整個產業也都有這種情況，對吧？其中有多少是 Medicaid 的因素，還是可能來自交易所成員（exchange members）或其他動態？謝謝。

Yes. No, I appreciate it.

是的。沒有，我很感謝。

And obviously, it's somewhat speculation. But I guess we sort of speculate based on our markets. So I'll be a little bit careful of how sure I am in my answers, but I would say that, look, Medicaid is down a little bit, and we see a little bit more of that in places like California, so that does suggest that some of what's happened is either disenrollment or lack of renewal of enrollment with populations that may not have been qualified to begin with based upon at least federal regulations, so that's one fact point that we see.

而且很明顯，這在某種程度上是推測。但我想我們是基於自身市場來做推測。所以我會稍微謹慎一點，避免把答案講得太篤定。不過我會說，Medicaid 的確小幅下降，而我們在像加州這樣的地方看到更多一些；這確實暗示，發生的情況可能是退保（disenrollment）或未續保（lack of renewal），而且涉及的族群可能一開始就不符合資格——至少依聯邦法規來看——這是我們看到的一個事實點。

The second question that has been out there, especially because we are in a lot of important [border] communities where we do a lot of work for the broader communities that are there.

第二個外界一直在問的問題，特別是因為我們在許多重要的[邊境]社區（[border] communities）有業務，我們也為那裡更廣泛的社區做了很多工作。

Look, we do see a little bit of hesitation at times with those populations. We partner a lot with the important FQHCs in those markets. And there's just kind of this tone of hesitation.

你看，我們確實有時會看到那些族群有一點猶豫。我們在那些市場與重要的聯邦合格健康中心（FQHCs）有很多合作。整體氛圍就是有點猶豫。

The impact at the end of the day has been on the hospitals minimal because obviously, we're there taking care of people who are sick and have needs.

但最終對醫院端的影響很小，因為很明顯，我們在那裡照護生病且有需求的人。

But on the outpatient side, for people who are doing more primary care and other things in the community, we're hearing about a little bit more impact and certainly hesitation from coming into consume care.

但在門診端，對於在社區做更多基層醫療（primary care）及其他服務的人，我們聽到影響稍微更大一些，且確實聽到他們對於進來接受照護（consume care）有更多猶豫。

Scott Fidel, Goldman Sachs.

Goldman Sachs 的 Scott Fidel。

I think my question probably ties in to the last two, but I wanted to ask it from just the -- from the acuity and case mix perspective overall for the -- for both the hospital and the USPI, how those rates look year-over-year?

我想我的問題可能和前兩個問題有關，但我想從——從整體病情嚴重度（acuity）與病例組合（case mix）的角度來問：就醫院端與 USPI 端而言，這些比率（rates）年對年看起來如何？

And maybe you could layer in on the tailwind side, the proactive service line expansions and investments that you've made on higher acuity and then on the headwind side, obviously, some of these dynamics or dynamics relating to the dynamic environment that we saw in some of the end markets in the first quarter.

另外也許你可以補充一下：在順風面，你們主動擴張服務線、並在更高病情嚴重度上所做的投資；而在逆風面，顯然第一季在部分終端市場（end markets）看到的這些動態，或與動態環境相關的因素。

Sure. Well, let's start with USPI.

當然。那我們先從 USPI 開始。

I mean there's no question there about the increase in acuity. I mean, I called out -- I mean, we've had -- we obviously are on the outpatient side, probably the largest single provider of outpatient joint replacements when you collectively look at almost 570 assets at USPI, many of which do orthopedics.

我的意思是，病情嚴重度提升這件事毫無疑問。我是說，我特別提到——我們在門診端，若把 USPI 近 570 個資產（assets）整體來看，其中許多都有骨科（orthopedics），我們可能是單一最大的門診關節置換（outpatient joint replacements）提供者。

And we're still posting double-digit growth in total joint replacement surgeries within the ASCs and off of a pretty high base. So it just suggests that demand is out there, right?

而且我們在ASC中的全關節置換手術總量仍然維持兩位數成長，而且是在相當高的基期之上。所以這只是在說明需求確實存在，對吧？

If you create the right operating environment for these surgeons and give them an efficient safe way to do the work, the demand is out there. And so we continue pushing in our high acuity strategy.

如果你為這些外科醫師打造合適的執業環境，並提供他們一個高效率且安全的方式來完成工作，需求就會在那裡。因此我們持續推進我們的高急重症策略。

I mean you can see it in the revenues, and when you add to that as you asked for other service lines, the types of things we're doing in urology, the types of things we're doing in robotics, we're probably up to over 150 robotic surgery programs in the ASCs that are general surgery based.

我的意思是，你可以從營收看得出來；再加上你問到的其他服務線，我們在泌尿科所做的事情、在機器人手術所做的事情——我們在ASC中以一般外科為基礎的機器人手術計畫，可能已經超過150個。

Those types of things are growing quickly. I mean the only services that are declining are the high-volume, low acuity areas, which is, as we've said, we're less focused on in this diversification path.

這類業務成長很快。我的意思是，唯一在下滑的服務是高量、低急重症的領域；正如我們所說，在這條多元化路徑上，我們對那部分的聚焦較少。

So again, in summary, on the USPI side, the acuity is growing. The case mix is improving in the direction we want to.

所以再次總結，在USPI這邊，急重症程度在提升，病例組合正朝我們希望的方向改善。

We have a good number of service line starts and physician additions. The assets that we're acquiring are also supportive more of the service line strategies that we're interested in. And our de novos that we open will also have the opportunity to do this type of higher acuity work.

我們有相當多的服務線啟動以及醫師加入。我們正在收購的資產也更能支持我們感興趣的服務線策略。而我們新設（de novo）開出的據點，也將有機會承接這類較高急重症的工作。

So I would say that, that looks very good.

所以我會說，這看起來非常好。

On the hospital side, the journey that we've been on is obviously -- I mean, we made this decision in the very early part of the pandemic. It's been five years that we've been really pushing this high acuity strategy.

在醫院端，我們走過的這段旅程顯然——我的意思是，我們在疫情非常早期就做了這個決定。到現在已經五年了，我們一直在大力推動這個高急重症策略。

And you see it in the CMI, the margins, the net revenue per case, all of that.

你可以從CMI、利潤率、每例淨營收等各方面看得出來。

This quarter obviously has some differences that Sun can go into in terms of the comp to the first quarter last time with a bunch of onetime items.

本季顯然有一些差異，Sun可以進一步說明，主要是相較於上次第一季的比較基期中有一堆一次性項目。

And look, the CMI for the first time, was down a little bit, but this is temporary, right? We had some weather-related issues. We had some -- we certainly had a decline in the intensity and volume of the respiratory business.

而且你看，CMI第一次出現小幅下滑，但這是暫時的，對吧？我們有一些與天氣相關的問題。我們也——呼吸道業務的強度與量確實下滑了。

But as I said, we made up for that significantly by flexing and also by focusing more on some of our other type of work in the hospitals.

但如我所說，我們透過彈性調整（flexing）以及在醫院端更聚焦於其他類型的工作，在很大程度上彌補了這個缺口。

And I think the quarter ended up fine. Like I don't think anything changes going forward just because there was one quarter with significant respiratory impact.

我認為這一季最終表現還不錯。就像我不認為未來會因為某一季呼吸道影響顯著就有任何改變。

Craig Hettenbach, Morgan Stanley.

Craig Hettenbach，摩根士丹利。

On the back of the $125 million invested in USPI in Q1, really strong start to the year. Saum, can you just talk about the M&A engine, what's working, and also just context of why Tenet might be a preferred acquirer of choice out there in the marketplace?

在第一季對USPI投資1.25億美元之後，今年開局非常強勁。Saum，你能談談併購（M&A）引擎嗎？哪些在奏效？另外也請提供一些背景，為什麼Tenet在市場上可能會成為首選的收購方？

Yes. Well, I mean, I think what's working -- fundamentally what's working is that USPI has just got a multiyear track record of acquiring assets, adding value to them, both clinically, our quality performance is consistent.

可以。嗯，我的意思是，我認為奏效的——根本上奏效的是，USPI在收購資產並為其增值方面有多年可驗證的紀錄；不論在臨床面，我們的品質表現一向穩定。

Our ability to bring these facilities in network and do well is consistent. Our broad-based an ongoing supply chain and purchase services agenda helps to reduce costs and create efficiencies.

我們把這些機構納入網路並把營運做好的能力也很一致。我們廣泛且持續的供應鏈與採購服務議程，有助於降低成本並創造效率。

And then our business development team is terrific in helping these centers oftentimes go from single specialty to multispecialty or help them design their OR operations if they're already multi-specialty to be able to do those more efficiently, as I've always talked about, right, the ability to do kind of dirty and clean surgery in the same center with the right protocols and the right scheduling.

此外，我們的業務發展團隊非常出色，能協助這些中心很多時候從單一專科轉為多專科；或者如果它們已經是多專科，也能協助它們設計手術室（OR）作業以更有效率地運作——就像我一直談到的，對吧？也就是在同一個中心、在正確的流程與正確的排程下，同時進行所謂「污染」與「潔淨」手術的能力。

I mean all of these things are things that we work on consistently, but we're just ahead in the market when it comes to executing on these things.

我的意思是，這些都是我們持續在做的事情，但在市場上就執行這些事項而言，我們確實走在前面。

And I think physicians know that, I think many of the MSOs that we partner with know that, the health systems that we partner with not only know that, but because of the expertise of some of these health systems, they contribute actively to our quality improvement agenda and other things.

我認為醫師知道這一點；我認為許多與我們合作的MSO也知道；與我們合作的醫療體系不僅知道，而且因為其中一些醫療體系具備專業能力，他們也會積極貢獻於我們的品質改善議程以及其他事項。

I mean Baylor, Memorial Hermann, I mean these guys are experts in many of these areas, and they contribute actively to the partnership in USPI to make those improvements.

我的意思是，Baylor、Memorial Hermann——這些夥伴在許多領域都是專家，他們會積極投入USPI的合作關係，來推動這些改善。

So look, I think all of those things has created a nice virtuous cycle of reputation enhancement as we do these things, and we deliver on what we say we're going to do.

所以你看，我認為所有這些因素，讓我們在做這些事情並兌現我們所承諾的同時，形成了一個良性的聲譽提升循環。

So we're still very selective. Our diligence processes are robust. We still say no to more centers than we say yes to. And that's fine because we still think that the opportunity for high-quality ASCs supports USPI's growth algorithm.

所以我們仍然非常挑選。我們的盡職調查流程很扎實。我們拒絕的中心仍然比同意的多。這沒問題，因為我們仍然認為，高品質ASC的機會能支撐USPI的成長算法。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

Just a couple of numbers questions for me. First, your guidance assumes $250 million of exchange impact for the year. I apologize if I missed it, but do you have a number for the quarter maybe relative to what we would have thought maybe is a $60 million, $65 million run rate?

我這邊有幾個數字問題。第一，你們的指引假設全年有2.5億美元的匯兌影響。若我沒聽漏的話，你們是否有本季的數字？相較於我們原本可能以為的每季6,000萬到6,500萬美元的run rate？

And then on DPP, in your slides, you talked about $22 million -- the DPP down $22 million for the year. I'm curious, does this include the $40 million decline because of out-of-period so that you're actually up $18 million ex that. Thanks.

第二，關於DPP，你們在投影片中提到全年DPP下降2,200萬美元。我想確認，這是否包含因跨期（out-of-period）造成的4,000萬美元下滑，因此若排除該因素其實是增加1,800萬美元？謝謝。

No, good question. Sun, do you want to take those maybe in reverse order.

不，問得很好。Sun，你要不要先從後面那題開始回答。

Yes, Justin, it's Sun.

好的，Justin，我是Sun。

Yes, you're right on the DPP question. That includes the $40 million. So if you normalize for that for '25 out-of-period, then it would be a slight increase. So you're correct.

是的，你在DPP那題的理解正確。那個數字包含了4,000萬美元。所以如果把2025年的跨期因素正常化（normalize）掉，那就會是小幅增加。你說得沒錯。

On the HICS, we mentioned that exchange revenues in Q1 were about 6% of our consolidated revenues. As a comparator in Q1 of '25, it was about 6.5% of our consolidated revenues. So if you kind of do the algebra, it's about a 9% to 10% decrease in revenues versus Q1.

至於HICS，我們提到第一季的匯兌收入約占我們合併營收的6%。作為比較，2025年第一季約占我們合併營收的6.5%。所以如果你做一下計算，相較第一季，營收大約下降9%到10%。

So I would say it's roughly at half of kind of the overall one year kind of 20% reduction in volumes that we kind of talked about in February.

所以我會說，這大概相當於我們在2月談到的、全年整體量下滑約20%的一半左右。

And we do expect with all the dynamics around kind of the first quarter and the grace period with some of the enrollees or re-enrollees that I think our guidance range of kind of 20% reduction and $250 million overall impact is still pretty consistent.

而且我們確實預期，考量第一季的各種動態，以及部分投保人或重新投保人所處的寬限期（grace period），我們所給出的約20%下滑與總體2.5億美元影響的指引區間，仍然相當一致。

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，美國銀行。

Great, thanks. Yes, I guess two questions. One, maybe following up on that one. So the Q1 impact is lower. Is that how -- is it lower but in line with what you thought Q1 would be because you always assumed it would ramp? Or was that potential area of the outperformance?

很好，謝謝。是的，我想有兩個問題。第一，延續剛剛那題：第一季的影響較低。那是因為——它雖然較低但符合你們原本對第一季的預期，因為你們一直假設會逐步爬升（ramp）？還是說這可能是超預期表現的來源？

And then you talked a little bit earlier about f lu. I know one of your competitors had a pretty high margin, decremental margin on lost volume in Q1. It sounds like you did a better job flexing costs. Any way to kind of size what you think the EBITDA impact was to both USPI and the hospitals from the flu and the weather disruption?

第二，你們稍早提到流感。我知道你們的一位同業在第一季因量流失而出現相當高的遞減利潤率（decremental margin）。聽起來你們在成本彈性調整上做得更好。能否大致量化一下，你們認為流感與天氣干擾對USPI與醫院端的EBITDA影響各是多少？

Yes, it's Saum. I can take the latter part of it.

是的，我是Saum。我可以回答後半段。

I mean I don't know about flu specifically, but just I mean we look at respiratory ER traffic admissions and other things. And similar to what we've heard, for example, respiratory admissions were down like 40% in the quarter and it had an earlier effect.

我的意思是，我不確定是否專指流感，但我們會看呼吸道相關的急診（ER）就診量、住院收治以及其他指標。也跟我們聽到的類似，例如呼吸道住院在本季下滑了大約40%，而且影響出現得更早。

I mean, if I look at the quarter, January to February to March, things improved steadily month-over-month, week-over-week almost. So that by the time we were in March, in the early to middle part of March, we had a keen sense that the revenue and admission and volume intensity was increasing, but because we had kind of anticipated the impact early in the quarter, we had already done some of our cost flexing.

我的意思是，如果我看這一季，從1月到2月到3月，情況穩定地逐月改善，幾乎是逐週改善。所以到3月、3月上旬到中旬時，我們已經很清楚感受到營收、收治與量的強度正在回升；但因為我們在本季初就預先預期到影響，所以我們已經先做了一些成本彈性調整。

And then, of course, as we talked about and previewed on our fourth quarter call, we had developed a more systematic type of cost agenda in the second half of 2025 that we executed that added to our savings.

然後，當然，正如我們在第四季電話會議中討論並預告的那樣，我們在 2025 年下半年制定了一套更系統化的成本議程並加以執行，進一步增加了我們的節省。

And so just -- it created a situation in which the anticipation of the need to flex plus other cost improvements plus the month-over-month improvement during the quarter allowed us to outperform in the Hospital segment, what our expectations were despite some of these headwinds.

因此——這造成了一種情況：對需要彈性調整的預期，加上其他成本改善，以及本季內逐月改善的趨勢，使我們在醫院事業部門的表現能夠優於原先預期，儘管面臨其中一些逆風。

In terms of what our expectations were, I mean, we had sort of made a simple linear assumption. I would say that the outperformance in the quarter in the segment is a combination of the two things: one being the cost management and efficiencies and two being that the first quarter exchange impact was probably a little bit less than at least a simple linear assumption for the full year.

就我們的預期而言，我的意思是，我們先前大致做了一個簡單的線性假設。我會說，本季該事業部門的超預期表現是兩個因素的組合：其一是成本管理與效率提升；其二是第一季的交易所影響，可能比至少以全年簡單線性假設所推估的要小一些。

Ann Hynes, Mizuho.

Ann Hynes，Mizuho。

Maybe we can shift to the Washington outlook. Is there anything that you're paying attention to on the regulatory and legislative outlook, especially on the regulatory with the upcoming outpatient rule.

也許我們可以轉到華盛頓方面的展望。就監管與立法前景而言，你們有沒有特別關注的事項，尤其是即將發布的門診規則所涉及的監管面？

Is there anything that we -- that is on your radar screen that we should be aware of?

有沒有什麼——在你們雷達上、我們應該注意的事情？

Sure. I mean, obviously, the -- we're keenly awaiting the outpatient rule, especially given the type of policy commentary that's been coming out of CMS, HHS broadly, and CMS supporting care in lower cost settings.

當然。我的意思是，很明顯地——我們正密切等待門診規則，特別是考量到 CMS、HHS 更廣泛層面以及 CMS 支持在較低成本場域提供照護所釋出的政策評論。

And one of the ways to help that, of course, is to provide robust or more robust outpatient rate support relative to what was sort of as expected, but nothing incredibly positive on the IPPS side. So we're looking forward to seeing that.

而協助達成這點的方法之一，當然是相較於原先大致預期，提供更強或更強化的門診費率支持；但在 IPPS 方面並沒有什麼特別正面的訊息。所以我們很期待看到那份規則。

I would tell you, other than the commentary they're making, I don't have any proprietary insight to share. We, of course, have been following all of the discussion and commentary about the various parts of the sector.

我會告訴你，除了他們所做的評論之外，我沒有任何可分享的內部或專有洞見。我們當然一直在追蹤關於產業各個面向的所有討論與評論。

And look, from our perspective, we're just trying to stay on the right side of the value equation, having efficient health systems being accessible at all times, efficient in what we're doing and obviously providing surgical care at scale at half the cost sometimes of what it is to do the same work in a hospital.

而且你看，從我們的角度來看，我們只是努力站在價值方程式的正確一側：打造高效率、隨時可近用的醫療體系，在我們所做的事情上更有效率，並且顯然能以規模提供外科照護，有時成本僅為在醫院做同樣工作的一半。

So -- with USPI, I mean. So look, I think all of those things we feel like we're well positioned as we look ahead.

所以——我是指 USPI。總之，我認為展望未來，我們在這些方面都處於有利位置。

I mean if you really look at USPI, and I know this question was asked maybe as a sub-question earlier by Kevin, USPI had an even cleaner quarter despite all the noise because the weather impact was there, but you don't really see that much of an impact from the exchanges or Medicaid in that business, as we've pointed out before.

我的意思是，如果你真的看 USPI，而且我知道 Kevin 先前可能把這個問題當作子問題問過，USPI 在充滿雜音的情況下仍然交出更乾淨的一季，因為天氣確實有影響，但你在那個業務中其實看不到交易所或 Medicaid 帶來太多影響，正如我們之前指出的。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Hey, good morning, guys, and thanks for taking my questions. Looking at -- back to hospitals looking at the first quarter, I understand that there's $22 million less of loan payments, offset by recoveries of $40 million this quarter.

各位早安，謝謝回答我的問題。回到醫院業務看第一季，我理解本季貸款付款少了 2,200 萬美元，但被本季 4,000 萬美元的回收所抵銷。

But when we normalize sort of the margins, we sort of get to, I guess, the 15% range is generally where your guidance is. And if I think about margins for hospitals, generally, the year is better than just the first quarter because of the strong fourth quarter.

但當我們把利潤率做正常化後，我們大概會得到約 15% 的區間，這通常也是你們指引所在。而如果我思考醫院的利潤率，一般來說全年會比第一季更好，因為第四季通常很強。

So I guess, can you just walk me through how we should think about the hospital margins with 1Q, excluding the $40 million as a bridge into the rest of the year? Thank you.

所以我想請你們帶我走一遍：我們應該如何看待醫院利潤率——以第一季為起點、排除這 4,000 萬美元——作為銜接到今年剩餘期間的橋樑？謝謝。

Well, I'll start and Sun, if you want to add.

我先開始，Sun，如果你想補充的話。

I mean, look, I think that if you come back -- step back to our guidance for the year, which is in the Hospital segment, a 10% normalized year-over-year growth which there was obviously some discussion and dialogue about when we put it out there.

我的意思是，你看，我認為如果你回到——退一步看我們對全年醫院事業部門的指引，也就是 10% 的正常化年增成長，當我們提出這個指引時顯然也有一些討論與對話。

We feel very confident that we're on track to that.

我們非常有信心我們正朝著這個目標前進。

Now some of that's going to be margin improvement. Some of that is because we had visibility from our work in the second half of 2025, which was going to be expense management, execution of expense management initiatives that we were designing this year that we would see benefit this year from, and obviously those are margin enhancing. .

其中一部分會來自利潤率改善。一部分是因為我們從 2025 年下半年的工作中已具備能見度——那將是費用管理、執行我們今年設計的費用管理措施，而我們會在今年看到效益，顯然這些都有助於提升利潤率。.

So I don't know that the algorithm is exactly like it would be in a normal year.

所以我不確定這個演算法是否完全會像一般正常年度那樣運作。

The respiratory volume impact in Q1 is a headwind to margins because those tend to be capacity filling and margin accretive.

第一季呼吸道量的影響對利潤率是逆風，因為那類通常能填補產能並且增厚利潤。

We overcame that, and as we sort of return to normal operations, plus have a year where we are executing on a broader efficiency strategy, I would say that we think that this year's performance will support margin growth in the Hospital segment.

我們克服了這點；而當我們逐步回到正常營運，再加上今年我們正在執行更廣泛的效率策略，我會說我們認為今年的表現將支持醫院事業部門的利潤率成長。

Sun, I don't know if you want to add to that, but we feel very confident about the balance of the year.

Sun，我不知道你是否想補充，但我們對今年剩餘期間非常有信心。

Yes, I think that's right.

是的，我認為沒錯。

The only thing I would add, Pito, is if you kind of just look at our Q1 Hospital margin of 16.7%, you're right, we should normalize for the onetime [corner] for $40 million.

我唯一想補充的，Pito，是如果你看我們第一季醫院利潤率 16.7%，你說得對，我們應該把 4,000 萬美元的一次性[corner]做正常化調整。

And then the only other thing I would mention is, like we said, the exchange impact likely sort of grows over the rest of the year from what we had in Q1.

然後我還想提的另一點是，如同我們所說，交易所的影響很可能在今年剩餘期間相較於第一季會逐步增加。

So that probably damps down margin a little bit on a run rate basis.

因此在以運行率來看時，這可能會讓利潤率稍微受到抑制。

But when it's all said and done, as Saum said, if you look kind of at our full year guidance of sort of 15% implied margins, I think that's still run on our expectations.

但總結來說，正如 Saum 所說，如果你看我們全年指引所隱含的大約 15% 利潤率，我認為這仍符合我們的預期。

I mean on [the impact], I get the guidance that you gave in the first quarter, but the uninsured payer mix declined year-over-year in the first quarter, I thought that would have been increasing. So I guess, how does that fit within that HICS guidance you guys have provided?

我的意思是，就[影響]而言，我理解你們在第一季給的指引，但第一季無保險的付款方組合年比年是下降的，我原本以為會上升。所以我想，這如何與你們提供的 HICS 指引相吻合？

Well, I mean, look, I think we should watch and wait, right? I mean effectuation rates and other things are important to track. The first quarter often is a relief valve for payment premiums and other things.

嗯，我的意思是，你看，我認為我們應該觀察並等待，對吧？我的意思是，生效率（effectuation rates）以及其他事項都是重要的追蹤指標。第一季往往是支付保費與其他因素的一個釋壓閥。

So I would say we watch and wait.

所以我會說，我們觀察並等待。

From our perspective, the way we think about this year is anticipate that the challenge could increase and plan accordingly in a disciplined way to manage to the earnings guidance that we have given. I mean, if -- obviously, if the impact is less or if the uninsured impact doesn't increase as much, those are all opportunities for outperformance for us.

從我們的角度來看，我們對今年的思考方式是：預期挑戰可能會增加，並以有紀律的方式做相應規劃，以管理並達成我們所給出的獲利指引。我的意思是——顯然，如果影響較小，或無保險的影響沒有增加那麼多，這些都會成為我們超預期表現的機會。

I mean, I would just reiterate, we're not spending a lot of time thinking about downside risks right now. We're spending our time thinking about how the strategy in both segments plus our expense opportunities, plus how this exchange uninsured Medicaid market plays out could create upside opportunities for us.

我的意思是，我只想重申，我們現在沒有花很多時間去想下行風險。我們把時間用在思考：兩個事業部門的策略加上我們的費用機會，再加上這個交易所／無保險／Medicaid 市場的發展，如何為我們創造上行機會。

That's where our mindset is right now after this first quarter.

這就是我們在第一季之後目前的心態。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

Hey, thanks. I just wanted to hear more about the reserving and revenue recognition for the exchange patients, what the underlying estimates are for attrition and maybe what the exit rate on the decline in volumes was within March. Thanks.

謝謝。我想多聽一些關於交易所病患的準備金提列與收入認列：對流失（attrition）的基礎估計是什麼？另外，3 月份量下滑的退出率（exit rate）大概是多少？謝謝。

It's Sun.

我是 Sun。

Listen, I think on your first question, we obviously pay through Conifer, very close attention patient by patient, if we can, on their HICS coverage status, premium payment status, all those details that you would imagine.

聽著，我想就你的第一個問題，我們顯然透過 Conifer，盡可能以逐一病患的方式，非常密切地關注他們的 HICS 承保狀態、保費繳納狀態，以及你能想像到的所有那些細節。

And I think, again, we'll review this as the year develops and we get more data. But I think we're very appropriately reserved on our overall patient population, right, including HICS.

而且我想，再次強調，我們會隨著年度推進、取得更多數據後再檢視。但我認為我們對整體病患族群（包括 HICS）已做了非常適當的準備金提列，對吧。

And that sort of speaks to kind of the numbers that we shared in Q1, where admissions were down, as we said, 9% and if you do the algebra, I think revenues from HICS is down probably 9% to 10% as well. So it's sort of 1:1 is where we're sitting. .

而這也某種程度反映在我們第一季分享的數字上：如我們所說，住院人次下降 9%；如果你做一下代數推算，我認為 HICS 的收入大概也下降了 9% 到 10%。所以我們目前大致是 1:1 的關係。.

So I think we're in a very reasonable situation there. And then like we said, we'll continue to observe this as we go.

所以我認為我們目前處於一個非常合理的狀況。然後就像我們說的，我們會在推進過程中持續觀察。

From a month-over-month trend perspective, I mean, our overall volumes, not just HICS, but overall, improved through the course of Q1 coming into March, which again, I think, gives us some confidence into rest of your guidance.

從月對月的趨勢來看，我是說，我們的整體量，不只是 HICS，而是整體，在第一季的過程中一路改善並進入三月；這也再次讓我對你們其餘的指引更有信心。

On HICS, I don't know that there's any trends that we would point out. I think in January being sort of a grace period for a lot of the enrollees, I mean I think that did help January numbers somewhat.

就 HICS 而言，我不確定有沒有什麼趨勢是我們會特別指出的。我認為一月對許多投保人來說算是一段寬限期，我是說，我覺得那確實在某種程度上幫助了一月的數字。

But again, I think it's too early to kind of have any trend discussions.

但同樣地，我認為現在要談任何趨勢都還太早。

Okay, thanks.

好的，謝謝。

Thanks for your question.

謝謝你的提問。

Stephen Baxter, Wells Fargo.

Stephen Baxter，富國銀行（Wells Fargo）。

Hi, thanks. I wanted to ask about the same-store revenue per adjusted admission decline of 1.5 points in the first quarter.

嗨，謝謝。我想問一下第一季同店「每調整後入院」收入（same-store revenue per adjusted admission）下降 1.5 個點的問題。

I guess we do have a lot of moving parts with some of the Medicaid changes you discussed and also the exchanges. But on the other hand, you also have less flu, which I think would tend to push up some of those metrics.

我想我們確實有很多變動因素，包括你們提到的一些 Medicaid 變化以及交易所（exchanges）。但另一方面，你們也遇到流感較少，我認為這通常會推升其中一些指標。

I would hope to just get a better sense of some of the moving parts that impacted that metric. And then maybe a direct comment on what you're seeing on commercial mix and whether that's a headwind in the quarter that you might assume gets better through the balance of the year.

我希望能更清楚了解有哪些變動因素影響了那個指標。然後也想請你們直接評論一下你們看到的商業保險組合（commercial mix）情況，以及這是否是本季的逆風、並且你們是否預期在今年剩餘期間會改善。

Yes. I mean, why don't we should probably just start with the comp from the prior year and then the math because it's -- for us, it really wasn't that worrisome. Sun, I don't know if you want to just walk through that perhaps.

是的。我是說，我們或許應該先從與去年同期的比較以及數學拆解開始，因為——對我們來說，這其實沒有那麼令人擔心。Sun，我不知道你是否願意帶大家走一遍。

Yes. I think just on a [periodic] basis, I mean, we said NRAA was down 1.5% in the Hospital segment.

是的。我想就[期間]基礎來看，我們說過在醫院事業部（Hospital segment）NRAA 下降了 1.5%。

A lot of that between the $40 million of out-of-period Medicaid we recognized in Q1 that we didn't have in Q1 of '26, and then the reduction in HICS that, as we talked about, presumably moved volume into uncompensated or other payer classes. Those two combined, I think, was worth 2% to 2.5% of NRAA headwind.

其中很大一部分來自兩點：第一，我們在第一季認列了 4,000 萬美元的跨期（out-of-period）Medicaid，但在 26 年第一季並沒有；第二，HICS 的減少——如我們所談到的，推測把部分量移轉到無償照護（uncompensated）或其他付款人類別。這兩項合計，我認為大約造成 NRAA 2% 到 2.5% 的逆風。

So once you normalize for that, we're sort of at 50 bps to 1%. Then I think there are some other moving parts that we talked about. Saum, I don't know if you want to comment directly on flu.

所以把這些因素正常化之後，我們大概是在 50 個基點到 1% 的區間。然後我認為還有一些我們談過的其他變動因素。Saum，我不知道你是否想直接評論一下流感。

But yes, I think flu impacted our emissions, but in the scheme of our total adjusted admissions base and our net revenue base, it's a relatively small component.

但對，是的，我認為流感影響了我們的入院量，但就我們的總調整後入院基礎以及淨營收基礎而言，它占比相對小。

So whether or not flu was there or not, I don't know that impacts NRAA that much.

所以不管流感有沒有出現，我不確定它對 NRAA 會有那麼大的影響。

Yes. I mean the only other thing I would add is clarifying point, but also the onetime Conifer $40 million that we announced, even though it was part of the Hospital segment, we excluded that in looking at the NRAA because that's appropriate. It wasn't related to the case volume.

是的。我是說，我唯一要補充的是一個釐清點：我們宣布的一次性 Conifer 4,000 萬美元，雖然它屬於醫院事業部的一部分，但我們在看 NRAA 時把它排除，因為那樣做是恰當的；它與病例量無關。

But just in case anybody is looking at the math that way.

只是以防有人用那種方式在看數學拆解。

So I mean, in summary, look, I would say the biggest driver was this out-of-period thing, and we had a very high NRAA in 2025.

所以總結來說，我會說最大的驅動因素是這個跨期項目，而且我們在 2025 年的 NRAA 非常高。

Back to my overall commentary, the acuity strategy is working very, very well, and we're not worried about it.

回到我整體的評論，重症度（acuity）策略運作得非常、非常好，我們並不擔心。

And obviously, it did not have an impact. In fact, it was the opposite, we outperformed on the earnings despite the revenue, which is just right now a marker of the flexibility and operating discipline, I think, that's required in this environment as things settle out.

而且很明顯，它並沒有造成影響。事實上是相反：儘管營收如此，我們在獲利上仍優於預期；我認為這正是目前在這種環境下、在各項因素逐步落定時，所需要的彈性與營運紀律的一個指標。

I suspect in the coming months and when we talk again, we'll probably have a lot more insight into how I sense that the desire for predictability, how the exchange market and uninsured and Medicaid will settle out for this year, which will give us a much better opportunity to kind of update our guidance for the year based upon the outperformance so far.

我猜在接下來幾個月、以及我們再次交流時，我們可能會對我所感受到的「對可預測性的渴望」有更多洞見——交易所市場、無保險以及 Medicaid 在今年會如何落定；這將讓我們有更好的機會，基於目前為止的超預期表現，來更新我們對全年指引的看法。

Andrew Mok, Barclays Bank.

Andrew Mok，巴克萊銀行（Barclays Bank）。

Hi, good morning. You mentioned that ACA volumes were down 10%, and you had expected unfavorable payer mix. But when I look at the managed care mix disclosure, it actually looks relatively stable year-over year. So can you help us understand what you saw on payer mix inside of that, including the moving parts on the government side. Thanks.

嗨，早安。你們提到 ACA 量下降了 10%，而且你們原本預期付款人組合（payer mix）不利。但當我看你們揭露的管理式照護（managed care）組合時，年對年看起來其實相對穩定。所以你們能否幫我們理解你們在其中看到的付款人組合變化，包括政府端的各項變動因素？謝謝。

Hey, Andrew, it's Sun.

嗨，Andrew，我是 Sun。

Sorry, go ahead, Saum.

抱歉，你先說，Saum。

No, you go ahead, please. Sorry.

不，你先請。抱歉。

Yes. Sorry. I was going to say, Andrew, yes, we did see the 10% reduction as we talked about. But I think your question on the rest of managed care sort of [absent] that. One reminder, when we report managed care, we also include managed Medicaid and managed Medicare in that component.

是的，抱歉。我本來要說，Andrew，對，我們確實如我們所談到的看到 10% 的下降。但我想你問的是除了那個之外，其餘管理式照護的情況。一個提醒：我們在報告 managed care 時，也把管理式 Medicaid 與管理式 Medicare 納入其中。

So I think we saw a reasonable strength in the rest of the payer mix, as to your point, it remained pretty stable as a percent of total revenues.

所以我認為其餘付款人組合的表現相當有韌性；如你所說，它占總營收的百分比仍相當穩定。

So I think that did offset the HICS impact a little bit.

所以我認為這也在一定程度上抵消了 HICS 的影響。

Again, we'll see. I think Q1 in terms of payer mix trends, we were happy with, but I think there's some more trending and data that we need to see into Q2 before we can make some more detailed comments.

同樣地，我們再觀察看看。我認為第一季就付款人組合趨勢而言，我們是滿意的，但我想在我們能做出更細緻的評論之前，還需要看到更多延伸到第二季的趨勢與數據。

Great.

很好。

Thank you.

謝謝。

And the only qualitative thing I was going to add there was just -- look, I think that as people come off the exchanges, they find different employment and other things, especially those that need health care have families they need to cover.

我唯一想補充的定性觀察是——我認為當人們離開交易所後，他們會找到不同的工作以及其他安排，特別是那些需要醫療照護、且有家庭需要保障的人。

We do think there's going to be some percentage of them that obviously pick up commercial coverage, and we've talked about that before. That's good. And then we did have strength in Medicare.

我們確實認為其中會有一定比例的人，顯然會轉而取得商業保險保障，我們之前也談過。這是好事。另外，我們在 Medicare 方面也有強勁表現。

I mean, we do a lot of work on appropriate utilization, appropriate admission rates from the ER, appropriateness of interfacing with these plans on Medicare Advantage.

我是說，我們在適當利用（appropriate utilization）、從急診（ER）適當入院率、以及與 Medicare Advantage 計畫在流程銜接的適切性方面做了很多工作。

And we have strength in the Medicare side in addition, which, again, is consistent with our acuity strategy given what these patients need. So I appreciate what you're seeing in those metrics. It does look better than I would have expected based upon the theory of the case of what could have happened with the exchanges.

而且我們在 Medicare 端也有額外的強勁表現；同樣地，考量這些病患的需求，這與我們的重症度策略一致。所以我理解你在那些指標上看到的情況；它看起來確實比我基於交易所可能發生狀況的「案例假設」所預期的還要好。

And again, it's just, for us, it just all goes to the point that the trend line in Q1 of the type of headwinds was more mitigated than the simple straight-line assumption for the year. And again, we're pleased that it helped drive outperformance rather than a headwind we couldn't catch up to.

再一次，對我們而言，這一切都指向同一點：第一季這類逆風的趨勢線，比起對全年做簡單的直線外推假設，受到的緩解更大。而且我們也很高興，它反而推動了超預期表現，而不是我們追趕不上的逆風。

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.

我們已到達問答環節的結束，今天的電話會議到此結束。您現在可以掛斷電話線，感謝各位的參與。