Tenet Healthcare Corp (THC) 2026 Q2 法說會逐字稿

Welcome to Tenet Healthcare second-quarter 2026 earnings conference call. After the speaker's remarks, there will be a question-and-answer session for industry analysts. (Operator Instructions)

歡迎參加 Tenet Healthcare 2026 年第二季財報電話會議。在講者致詞後，將為產業分析師安排問答環節。(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.

現在我把電話交給本次會議主持人 Will McDowell 先生。投資人關係副總裁。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 second-quarter 2026 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. Our webcast this morning includes a slide presentation, which has been posted to the Investor Relations section of our website, tenethealth.com.

各位早安，感謝各位參加今天的電話會議。我是 Will McDowell，投資人關係副總裁。我們很高興各位加入，一同討論 Tenet 2026 年第二季業績，以及我們的財務展望。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。今天上午的網路直播包含投影片簡報，已發布於我們網站 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. 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.

提醒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所形成的預期。實際結果與計畫可能存在重大差異。Tenet 無義務因後續資訊而更新任何前瞻性陳述。投資人應留意今日簡報中所包含的警示性聲明投影片，以及我們最近一期 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。

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

接下來，我把電話交給 Saum。

Thank you, Will, and good morning, everyone. We continue to deliver results exceeding our goals based on the fundamental performance of our business. Hospital volumes and same-store revenue growth in both segments are strong, reflecting our commitment to higher acuity and value for payers. Margin strength is supported by timely execution on our technology-enabled expense management plans that we described at the very start of the year.

謝謝你，Will，各位早安。我們持續交出超越目標的成果，這建立在我們業務的基本面表現之上。兩大事業部的醫院量能與同店營收成長皆強勁，反映我們致力於提供更高病情複雜度（higher acuity）的服務並為付款方創造價值。利潤率的強勁表現，來自我們在年初即提出的科技賦能費用管理計畫之及時落實。

Second-quarter net operating revenues were $5.6 billion, and consolidated adjusted EBITDA was $1.304 billion, which represented an adjusted EBITDA margin of 23.2%. Consolidated adjusted EBITDA grew 16.3% over prior year. Year-to-date, our fundamental outperformance totals approximately $97 million across both segments. Adjusted diluted earnings per share increased 52% to $6.12 in the second quarter of 2026 compared to prior year.

第二季淨營運收入為 56 億美元，合併調整後 EBITDA 為 13.04 億美元，調整後 EBITDA 利潤率為 23.2%。合併調整後 EBITDA 較去年同期成長 16.3%。年初至今，我們在兩大事業部的基本面超預期表現合計約 9,700 萬美元。2026 年第二季調整後稀釋每股盈餘較去年同期增加 52% 至 6.12 美元。

As we noted last year, we are operating in a dynamic environment characterized by payer mix shifts and insurance enrollment uncertainty in both the exchanges and Medicaid. Despite these challenges, the growth and expense initiatives that we had planned and have implemented and continue to focus on enabled us to deliver a clean quarter. We are optimistic about the rest of the year and are increasing our revenue, adjusted EBITDA and cash flow guidance for 2026.

如同我們去年所提到的，我們正處於一個動態環境，特徵包括付款方組合變化，以及交易所與 Medicaid 的投保不確定性。儘管面臨這些挑戰，我們已規劃並落實、且持續聚焦的成長與費用措施，使我們得以交出一個乾淨俐落的季度表現。我們對今年剩餘時間保持樂觀，並上調 2026 年的營收、調整後 EBITDA 與現金流指引。

USPI generated $542 million in adjusted EBITDA, which represents 9% growth over second-quarter 2025 and 25% of our full-year 2026 adjusted EBITDA guidance for USPI. We are pleased with USPI's continued outperformance as we set an aggressive EBITDA target as a percent of the full year for the second quarter that we were able to exceed. Same-facility revenues grew 5% as our high acuity strategy continues to yield benefits and is highlighted by 10% same-store volume growth in total joint replacements in the ASCs over prior year.

USPI 產生 5.42 億美元的調整後 EBITDA，較 2025 年第二季成長 9%，並占我們 USPI 2026 全年調整後 EBITDA 指引的 25%。我們對 USPI 持續超越預期感到滿意；我們為第二季設定了相對於全年占比的積極 EBITDA 目標，而我們也成功超越。同設施營收成長 5%，高病情複雜度策略持續帶來效益，其中亮點為 ASC 的全關節置換手術同店量能較去年同期成長 10%。

We have a robust pipeline of partnerships interested in joining USPI this year. USPI is the premier ambulatory surgical asset in the space and the leading provider of low-cost, high-quality care that benefits all stakeholders across the healthcare ecosystem.

我們擁有強勁的合作夥伴管線，許多夥伴有意在今年加入 USPI。USPI 是該領域首屈一指的門診手術資產，也是提供低成本、高品質照護的領導者，能讓醫療照護生態系中的所有利害關係人受益。

Turning to our hospital segment, second-quarter 2026 adjusted EBITDA was $762 million, which was well above our expectations and represented 22% growth over second-quarter 2025. We reported 18% adjusted EBITDA margins in the quarter, which were driven by strong volume growth, disciplined expense management, benefits from growth initiatives, which were partially offset by the expected impact of reductions in exchange enrollment.

再看我們的醫院事業部，2026 年第二季調整後 EBITDA 為 7.62 億美元，顯著高於我們的預期，並較 2025 年第二季成長 22%。本季我們的調整後 EBITDA 利潤率為 18%，主要由強勁的量能成長、嚴謹的費用管理，以及成長計畫帶來的效益所驅動；部分則被交易所投保人數下降的預期影響所抵銷。

Again, these drivers were ahead of our core assumptions and contributed meaningfully to our outperformance in the quarter. Importantly, we continue to see attractive growth in our commercial managed care revenues. Regarding the exchange marketplace, exchange revenues have declined a significant 17% compared to second quarter of 2025. We are seeing highest impact in states like Florida, Arizona, Michigan, South Carolina and Texas.

同樣地，這些驅動因素均優於我們的核心假設，並對本季的超預期表現做出顯著貢獻。重要的是，我們持續看到商業管理式醫療（commercial managed care）收入具有吸引力的成長。就交易所市場而言，交易所收入較 2025 年第二季大幅下降 17%。我們在佛羅里達、亞利桑那、密西根、南卡羅來納與德州等州看到影響最大。

In light of the challenges that the decline in exchange enrollment presents, we are flexing our cost base and building an appropriate baseline on which to grow in the future with a focus on continued margin strength. Our consistent results are driven by a transformed portfolio of businesses, continued strategic focus on higher acuity specialty services, strong leadership at the local level and an ability to effectively manage through the current dynamic environment.

鑑於交易所投保下滑所帶來的挑戰，我們正調整成本結構，建立一個適當的基準，以便未來在持續維持利潤率強勁的前提下成長。我們穩健一致的成果，來自已轉型的事業組合、持續聚焦於更高病情複雜度的專科服務、地方層級的強力領導，以及在當前動態環境中有效管理的能力。

Additionally, it's important to note that year-to-date Conifer results are in line with our prior expectations, and we continue to manage through the conclusion of a third-party contract. We have also capitalized on our compelling valuation and deployed $1.36 billion to repurchase 7 million shares in the first half of 2026, with 5.7 million of those shares repurchased in the second quarter. The positive impact on EPS is significant as we look forward to the rest of the year.

此外，值得注意的是，年初至今 Conifer 的結果符合我們先前的預期，我們也持續管理一項第三方合約的到期結束。我們亦把握具吸引力的估值，上半年投入 13.6 億美元回購 700 萬股，其中第二季回購 570 萬股。展望今年剩餘時間，對 EPS 的正面影響相當顯著。

As we did note in our press release, the Board of Directors has authorized a $2 billion increase in our share repurchase program. We continue to be -- we expect to continue to be active in share repurchase over the balance of the year.

如同我們在新聞稿中所提到的，董事會已核准將我們的股票回購計畫額度增加 20 億美元。我們仍然—我們預期在今年剩餘期間將持續積極進行股票回購。

Turning to 2026, the guidance that we established at the beginning of the year was robust, given the dynamics the industry was facing, but so were our plans for realizing results from our recent growth investments and our expense and AI initiatives.

談到 2026 年，我們在年初所建立的指引在產業動態之下已相當穩健，而我們為實現近期成長投資成果，以及費用與 AI 計畫所制定的方案也同樣強而有力。

At this point in the year, we are raising our full-year 2026 adjusted EBITDA guidance to a range of $4.83 billion to $5.03 billion, which represents an increase of $295 million or 6% at the midpoint of the range over our prior guidance. The guidance increase is differentiated and primarily supported by fundamental strength in our businesses and our expectations for continued growth into the second half of the year.

截至目前，我們將 2026 全年調整後 EBITDA 指引上調至 48.3 億至 50.3 億美元區間，較先前指引在區間中點增加 2.95 億美元，或 6%。此次上調具有差異化，主要由我們業務的基本面強勁表現，以及我們對下半年持續成長的預期所支撐。

As we noted in our adjusted EBITDA bridge in the investor deck, our guidance raise is supported by approximately $100 million of fundamental outperformance in the first half of the year and an additional $60 million through a continuation of those fundamental drivers into the second half of the year.

如同我們在投資人簡報中的調整後 EBITDA 橋接分析所述，本次指引上調，來自上半年約 1 億美元的基本面超預期表現，以及下半年在這些基本面驅動因素延續下的額外 6,000 萬美元。

Additionally, based on the ambulatory surgical acquisitions that we have made so far this year and the robust pipeline of deals that we see ahead, we now expect to exceed $300 million in full year M&A spend in 2026. We are confident in our ability to achieve our increased guidance as it is powered by continued strength in our core business drivers, same-store revenue growth, effective expense management and strong free cash flow.

此外，基於我們今年迄今完成的門診手術併購，以及我們所看到的強勁交易管線，我們目前預期 2026 年全年併購（M&A）支出將超過 3 億美元。我們有信心達成上調後的指引，因其動能來自核心業務驅動因素的持續強勁、同店營收成長、有效的費用管理，以及強勁的自由現金流。

For more details on our results in the quarter and our guidance looking ahead, I now turn it over to Sun.

如需了解本季業績以及我們對未來的指引之更多細節，接下來我把時間交給 Sun。

Thank you, Saum, and good morning, everyone. We delivered strong performance in the second quarter of 2026, generating total net operating revenues of $5.6 billion and consolidated adjusted EBITDA of $1.304 billion. Second-quarter adjusted EBITDA margin was 23.2%, driven by strong revenue performance and disciplined operating expense management, with continued progress on the growth and cost efficiency initiatives that we outlined at the beginning of the year.

謝謝你，Saum，各位早安。我們在 2026 年第二季交出強勁表現，合計淨營運收入達 56 億美元，合併調整後 EBITDA 為 13.04 億美元。第二季調整後 EBITDA 利潤率為 23.2%，主要受惠於強勁的營收表現與嚴謹的營運費用管理，同時我們也持續推進年初所提出的成長與成本效率計畫。

I would now like to highlight some key items for both of our segments, beginning with USPI. In the second quarter, USPI's adjusted EBITDA grew 8.8% over second quarter of '25 at $542 million, with adjusted EBITDA margin at 39%. USPI delivered a 5% increase in same-facility system-wide revenues, with net revenue per case up 6.3% and same-facility case volumes down 1.2%, reflecting our high acuity focus.

接下來我想重點說明我們兩個事業部門的一些關鍵事項，先從 USPI 開始。第二季 USPI 的調整後 EBITDA 較 2025 年第二季成長 8.8%，達 5.42 億美元，調整後 EBITDA 利潤率為 39%。USPI 同院（same-facility）系統整體營收成長 5%，其中每病例淨營收成長 6.3%，同院病例量下滑 1.2%，反映我們聚焦於高病情嚴重度（high acuity）的策略。

Turning to our hospital segment, second-quarter 2026 adjusted EBITDA grew 22% to $762 million, resulting in an adjusted EBITDA margin of 18%. Same-hospital inpatient adjusted admissions rose 2.6% in the quarter, a sequential improvement from first quarter and further validation that the demand environment remains healthy as we expected. Revenue per adjusted admissions increased 3.3% year over year in Q2, reflecting the work we do to grow acuity as well as an increase in supplemental Medicaid revenues, partially offset by the impact of reduced exchange volumes.

再看我們的醫院事業部門，2026 年第二季調整後 EBITDA 成長 22% 至 7.62 億美元，調整後 EBITDA 利潤率為 18%。本季同院住院調整後入院量（inpatient adjusted admissions）上升 2.6%，較第一季呈現連續改善，也進一步驗證如我們預期，需求環境仍然健康。第二季每調整後入院的營收年增 3.3%，反映我們提升病情嚴重度（acuity）的努力，以及補充性 Medicaid 收入增加；但部分被交易所（exchange）量縮的影響所抵銷。

Exchange revenues declined 17% from second quarter '25 and represented about 5.5% of consolidated net operating revenues in second quarter of 2026. Finally, we recognized $92 million of favorable out-of-period supplemental Medicaid revenues related to prior years in the second quarter. In the second quarter of '25, we had $70 million of favorable impact related to prior years.

交易所收入較 2025 年第二季下滑 17%，在 2026 年第二季約占合併淨營運收入的 5.5%。最後，我們在第二季認列 9,200 萬美元與前幾年度相關、屬於跨期（out-of-period）的有利補充性 Medicaid 收入。在 2025 年第二季，我們有 7,000 萬美元與前幾年度相關的有利影響。

We have not assumed any of this favorability in our initial guidance for 2026, and I would note that we had a clean beat in the quarter even without these incremental Medicaid revenues. We continue to demonstrate our ability to manage through a dynamic period for providers, delivering strong results despite the headwinds that the industry faces.

我們在 2026 年初始指引中並未假設這些有利因素；我也要指出，即使不計入這些額外的 Medicaid 收入，我們本季仍然是乾淨俐落地超出預期。我們持續展現穿越供應商所面臨之動態環境的管理能力，即便產業面臨逆風，仍能交出強勁成果。

Next, we will discuss our cash flow, balance sheet and capital structure. We generated $444 million of adjusted free cash flow in the second quarter, which brings us to $1.422 billion of adjusted free cash flow year-to-date. As of June 30, 2026, we had $2.1 billion of cash on hand, with no borrowings outstanding under our line of credit facility. And additionally, we have no significant debt maturities until late 2027.

接下來，我們將討論現金流、資產負債表與資本結構。第二季我們創造 4.44 億美元的調整後自由現金流，使年初至今調整後自由現金流達 14.22 億美元。截至 2026 年 6 月 30 日，我們手上現金為 21 億美元，且在循環信用額度（line of credit facility）下沒有任何未償借款。此外，我們在 2027 年底之前沒有重大到期債務。

And finally, during the second quarter, we repurchased 5.7 million shares of our stock or $1.04 billion. Year-to-date, we have repurchased almost 7 million shares of our stock for $1.36 billion. As Saum noted, the Board of Directors has authorized a $2 billion increase in share repurchase authorization, again, reflecting confidence in our strategy and our ability to execute over the long-term.

最後，在第二季我們回購了 570 萬股自家股票，金額為 10.4 億美元。年初至今，我們已回購將近 700 萬股自家股票，金額為 13.6 億美元。如 Saum 所提，董事會已核准將股票回購授權額度增加 20 億美元，再次反映對我們策略以及長期執行能力的信心。

Our leverage ratio as of June 30, 2026, was 2.33 times EBITDA or 2.9 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 continue to drive shareholder value.

截至 2026 年 6 月 30 日，我們的槓桿比率為 EBITDA 的 2.33 倍，或扣除 NCI 後 EBITDA 的 2.9 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，可支持資本配置優先事項並持續提升股東價值。

Let me now turn to our outlook for 2026. For fiscal '26, we now expect consolidated net operating revenues in the range of $21.9 billion to $22.5 billion, an increase of $300 million at the midpoint of the range over prior expectations. As Saum mentioned, we are raising our '26 adjusted EBITDA outlook range by $295 million at the midpoint to $4.83 billion to $5.03 billion, reflecting the strong fundamental performance of our businesses.

接下來談談我們對 2026 年的展望。就 2026 會計年度而言，我們目前預期合併淨營運收入將落在 219 億至 225 億美元區間，區間中點較先前預期上調 3 億美元。如 Saum 所提，我們將 2026 年調整後 EBITDA 展望區間的中點上調 2.95 億美元至 48.3 億至 50.3 億美元，反映我們各項業務強勁的基本面表現。

At USPI, we are now expecting '26 adjusted EBITDA of $2.16 billion to $2.22 billion. And in hospitals, we are raising our '26 adjusted EBITDA outlook range by $285 million at the midpoint to $2.67 billion to $2.81 billion. This increase is driven by fundamental improvements in our operations that benefited our results in the first half of the year and that we expect to continue into the back half of the year.

在 USPI 方面，我們目前預期 2026 年調整後 EBITDA 為 21.6 億至 22.2 億美元。而在醫院事業部門，我們將 2026 年調整後 EBITDA 展望區間的中點上調 2.85 億美元至 26.7 億至 28.1 億美元。此一上調主要來自營運面的基本改善，這些改善已在上半年帶動我們的成果，且我們預期將延續至下半年。

In addition, we now expect a contribution of $140 million from recently approved increases in certain supplemental Medicaid programs, plus the out-of-period revenues from prior year that I already mentioned. Of this $140 million, about $20 million is expected in the second half of our fiscal year.

此外，我們目前預期，近期核准的部分補充性 Medicaid 計畫調升將貢獻 1.4 億美元，再加上我先前提到的前一年度跨期收入。在這 1.4 億美元中，約有 2,000 萬美元預期將在本會計年度下半年認列。

Finally, we expect third-quarter '26 consolidated adjusted EBITDA to be in the range of 23% to 24% of our full-year consolidated adjusted EBITDA at the midpoint, and we expect third-quarter '26 USPI EBITDA to be in the range of 24% to 25% of our full-year USPI adjusted EBITDA at the midpoint.

最後，我們預期 2026 年第三季合併調整後 EBITDA 在區間中點將約占全年合併調整後 EBITDA 的 23% 至 24%；同時我們預期 2026 年第三季 USPI EBITDA 在區間中點將約占全年 USPI 調整後 EBITDA 的 24% 至 25%。

Turning to our cash flows for '26, we now expect adjusted free cash flow after NCI in the range of $1.825 billion to $2.055 billion, an increase of $225 million at the midpoint from our previous guidance range. This guidance range includes the payment of about $150 million in tax payments this year from the Conifer transaction. Excluding these tax payments, this would represent $2.1 billion of adjusted free cash flow after NCI at the midpoint of our '26 outlook.

再看 2026 年的現金流，我們目前預期扣除 NCI 後的調整後自由現金流將落在 18.25 億至 20.55 億美元區間，較先前指引區間的中點上調 2.25 億美元。此指引區間包含今年因 Conifer 交易而需支付約 1.5 億美元的稅款。若排除這些稅款，在 2026 年展望的中點，扣除 NCI 後的調整後自由現金流將為 21 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. Turning to our capital deployment priorities. We are well positioned to create value for shareholders through the effective deployment of free cash flow.

我們仍聚焦於將 EBITDA 表現有效轉換為強勁的自由現金流，包括 Conifer 持續出色的現金收款表現，同時也持續投資於業務的高優先領域。接下來談資本配置優先事項。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。

First, we will continue to prioritize capital investments to grow USPI through M&A. And as Saum noted, we have made good progress so far this year and have a number of future opportunities to support our expectations for USPI M&A in '26. Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on the higher acuity service offerings. Third, we'll continue to be active in share repurchases as we continue to see significant opportunities.

第一，我們將持續把資本投資優先用於透過併購（M&A）推動 USPI 成長。如 Saum 所提，我們今年迄今已取得良好進展，且仍有多項未來機會可支持我們對 2026 年 USPI 併購的預期。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（organic growth），包括聚焦於更高病情嚴重度的服務項目。第三，鑑於我們仍看到顯著機會，我們將持續積極進行股票回購。

And finally, we will continue to evaluate opportunities to retire and/or refinance debt. We are pleased with our continued effective execution and remain confident in our ability to deliver on our increased outlook for '26. Our transformed portfolio of businesses is delivering more predictable results and our capital efficiency is enabling us to create shareholder value through effective capital deployment.

最後，我們將持續評估提前償還及／或再融資債務的機會。我們對持續有效的執行感到滿意，並仍有信心能達成我們上調後的 2026 年展望。我們已轉型的業務組合正帶來更可預測的成果，而資本效率的提升也使我們能透過有效的資本配置為股東創造價值。

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

那麼，接下來我們準備開始問答環節。接線員？

(Operator Instructions)

(接線員指示)

Craig Hettenbach, Morgan Stanley.

Craig Hettenbach，摩根士丹利。

Saum, I wanted to dig into the work that you've done on the cost structure that's driving this margin expansion despite some of the industry headwinds, including the exchange. So if you can just provide some examples of some of the things that are kind of playing out in the margins, that would be great.

Saum，我想深入了解你們在成本結構方面所做的工作；在面臨一些產業逆風（包括交易所）之下，這些工作仍在推動利潤率擴張。所以如果你能提供一些例子，說明利潤率中有哪些因素正在發酵，那就太好了。

Sure. Thanks, Craig. I think there's three or four things that are probably important to consider here. One is just traditional search for efficiencies that one would imagine including our more traditional productivity strategies, contract renegotiations on purchase services, supply standardization, right, things that are part of our toolkit that we're doing all the time that, as I indicated at the start of the year, about a year ago, June, July of last year, we began planning so that we could hit the ground running, executing on January 1 of this year.

當然。謝謝你，Craig。我認為這裡大概有三到四件事值得考量。第一個是傳統的效率提升尋找，你可以想像包含我們較傳統的生產力策略、對採購服務的合約重新談判、供應標準化等，這些都是我們工具箱的一部分，我們一直在做。正如我在今年年初所提到的，大約一年前、去年6月到7月，我們就開始規劃，讓我們能在今年1月1日就立即展開執行。

The second category is what I would describe as more clinical operations, cost improvement. And we really didn't feel that Category 1 would be adequate -- and adequate to sustain us through the next few years. And so we put increased effort in the length-of-stay management, service level management, for example, in the emergency department throughput in the hospital scheduling efficiencies and better utilization of our operating room and cath lab assets, both in the hospitals and the ASC business.

第二類是我會稱之為更偏臨床營運的成本改善。我們確實覺得第一類不足以——不足以支撐我們度過未來幾年。因此我們加大投入在住院天數管理、服務水準管理，例如急診部門的流量（throughput）、院內排程效率，以及更好地運用我們的手術室與心導管室資產，這些涵蓋醫院端以及ASC業務。

As an additional initiative, more complex, frankly, requires more behavior change and process redesign, but very important to what we're doing. The secondary benefit of that work, of course, is that it supported the service levels for patients and physicians, especially in the important emergency department area so that it's easier for them to gain access.

作為另一項倡議，這更複雜，坦白說，需要更多行為改變與流程再設計，但對我們正在做的事情非常重要。當然，這項工作的次要效益是，它也支援了病患與醫師的服務水準，尤其是在關鍵的急診部門領域，讓他們更容易取得就醫服務。

And then the third area is more what I would describe as the technology-driven, both automation, AI type work, combined with what we are doing in our global business center. The deployment of these technologies has been both domestic and in the global business center. It helps to improve productivity. It, in some cases, can literally automate or replace work. And over time, we are seeing the benefit in our core cost structure in those areas, not just in the payments arena, but also in some of our support overhead structures at the facility or the corporate level.

第三個領域則更偏我所說的科技驅動，包括自動化、AI類型的工作，並結合我們在全球業務中心所做的事情。這些技術的部署同時在國內以及全球業務中心進行。它有助於提升生產力。在某些情況下，它甚至可以真正自動化或取代工作。隨著時間推進，我們在這些領域的核心成本結構中看到效益，不僅是在支付（payments）領域，也包括在院區或公司層級的一些支援性間接費用結構。

So really, all three of those areas were things that we had planned or spent time planning last year. And I think the benefit we're seeing is we were just able to hit the ground running on execution in January. And so it is accrued into the business over these first two quarters.

所以，這三個領域其實都是我們去年已經規劃或花時間規劃的事情。我認為我們現在看到的好處是，我們在1月就能立即開始執行。因此，這些效益在前兩個季度逐步反映到業務中。

Benjamin Rossi, JPMorgan.

Benjamin Rossi，摩根大通。

Great. I just wanted to turn to the ambulatory segment for a moment. So given the strength of cost revenue per case to start of the year, I appreciate some of the in pieces in your 3% to 6% top-line growth expectation. I know the press release stated the can service mix, but could you just walk us through puts and takes going into expectations for that segment?

很好。我想先把話題轉到門診（ambulatory）部門。鑑於年初每病例成本收入（cost revenue per case）的強勁表現，我希望你能拆解一下你們對營收年增3%到6%的預期中，各項因素的貢獻。我知道新聞稿提到了病例組合（service mix），但你能否帶我們走一遍，這個部門的預期有哪些利多與利空因素？

How are you thinking about service line expansion opportunities this year and some of the more promising specialty areas on your radar? And then with the inpatient-only list, are you seeing any lift to start the year across either volumes or pricing from this first tranche of MSK procedures rolling off?

今年你們如何看待服務線擴張的機會，以及有哪些更具前景的專科領域在你們的雷達上？另外，隨著「僅限住院」清單（inpatient-only list）的調整，第一批MSK程序移出後，你們在年初是否看到不論是量或價方面的任何提升？

Yeah. Well, I think from a service line standpoint, we continue to focus on pushing the envelope of clinical appropriateness in the ambulatory surgery setting and doing it safely. So orthopedics, but expanding the range of orthopedics, that is obviously supported by some of the changes in the inpatient-only list. Those programs continue to scale. As we've indicated, we have seen success with our physician partners in urology.

是的。我想就服務線而言，我們仍然專注於在門診手術環境中推進臨床適切性的邊界，並且安全地進行。所以是骨科，但也在擴大骨科的範圍；這顯然也受到「僅限住院」清單部分變更的支持。這些計畫持續擴大規模。如我們所指出的，我們與醫師夥伴在泌尿科方面也看到成功。

Our robotics program continues to expand significantly. And when I say robotics here, I'm not just referring at all to orthopedics. I'm talking about core general surgical type robotics work that we see as important. We see increased activity in bariatrics. And again, as we've indicated over time, just kind of a steady -- slow, but steady march into the cardiovascular space, which will take some time. The other thing that we have done after really studying the spaces over the last couple of years, is started to increase the acuity in some of the more core legacy service lines.

我們的機器人手術計畫持續顯著擴張。我在這裡說的機器人手術，不只是指骨科。我指的是我們認為重要的核心一般外科類型的機器人手術工作。我們看到減重手術（bariatrics）的活動增加。而且再次，如我們長期以來所提到的，我們正以穩定——緩慢但穩定的步伐進入心血管領域，這需要一些時間。另外一件事是，在過去幾年深入研究這些領域之後，我們開始在一些更核心、傳統的服務線中提高病情複雜度（acuity）。

So in particular, GI and ophthalmology, we've started to push further into higher acuity procedures, right? So duodenal endoscopy and associated procedures and biopsies, retinal work or retinal specialization in the ambulatory surgery center, things that begin to improve or increase the acuity and expand the array of services in some of those core service lines in addition to what I described as more of the surgical frontier service lines that have a lot of growth in front of them.

特別是在腸胃科（GI）與眼科方面，我們開始進一步推進到更高複雜度的處置，對吧？例如十二指腸內視鏡及相關處置與切片檢查、在門診手術中心進行的視網膜相關手術或視網膜專科化服務；這些都開始提升或增加複雜度，並在這些核心服務線中擴大服務範圍，此外也包括我所描述的、較偏外科前沿（surgical frontier）的服務線，這些在未來仍有很大的成長空間。

Matthew Gillmor, KeyBanc Capital Markets.

Matthew Gillmor，KeyBanc Capital Markets。

I wanted to ask about the exchange performance. I appreciate you didn't change the guide. I was just curious how things played out relative to your expectations in terms of the decline in the revenues and the volumes patient shifting over to commercial coverage are becoming unassured. Any commentary there would be great.

我想問一下交易所（exchange）的表現。我理解你們沒有調整指引。我只是好奇，實際情況相對於你們的預期如何：包括營收與量的下滑，以及病患從交易所轉向商業保險或變成無保險（uninsured）的情況。如果能分享一些看法就太好了。

Yeah. Go ahead, Sun, do you want to --

是的。Sun，你要不要先--

Yeah. Matthew, it's Sun. So first of all, just on resetting on the metrics, I may have said in my prepared remarks about exchange volume. I meant exchange revenues in the quarter were down about 17%. And exchange volume admissions, down about 13.5%. So I would say both of these metrics were roughly in line with our expectations, both for the quarter.

好。Matthew，我是Sun。首先，先把指標重新釐清一下：我可能在事先準備的發言中提到的是交易所量（exchange volume），但我指的是本季交易所營收（exchange revenues）約下降17%。而交易所量的住院入院（admissions）約下降13.5%。所以我會說，這兩個指標在本季大致都符合我們的預期。

As we exited Q1 into Q2, we expected after the grace periods for exchange erosion to increase, obviously, from Q1 to Q2. And then we expect the overall market trends that we saw in Q2 to roughly continue into Q3 and Q4 rest of the year, which is why we didn't change our guidance.

從Q1結束進入Q2時，我們預期在寬限期（grace periods）結束後，交易所的流失（erosion）會明顯從Q1到Q2加劇。然後我們預期在Q2看到的整體市場趨勢，會大致延續到Q3與Q4，也就是今年剩餘期間；這也是我們沒有調整指引的原因。

This all resulted in about a $65 million revenue headwind on exchanges in our Q2 numbers, which we were able to pivot both from an OpEx standpoint as well as other growth initiatives and deliver results. And then the only other thing I would add is I think we are roughly seeing a pretty consistent conversion from exchange patient volume into uninsured on a pretty much one-to-one basis. So we did see a proportionately equal increase in uninsured volumes in our Q2 as well. And we expect that to continue as well in the second half.

這些因素在我們Q2數字中，對交易所造成約6,500萬美元的營收逆風；我們能夠從營運費用（OpEx）面以及其他成長倡議上做出調整並交出成果。另外我想補充的是，我們大致看到交易所病患量轉為無保險（uninsured）的轉換相當一致，幾乎是一比一。因此我們在Q2也看到無保險量按比例相當等幅地增加。我們也預期下半年會持續如此。

Stephen Baxter, Wells Fargo.

Stephen Baxter，富國銀行。

I wanted to ask about the revenue per adjusted admission trend in the second quarter. It improved a lot from where it was in the first quarter, the software number that you posted then. Can you help us unpack the factors that are driving the improvement? And then in the release, you cited strength in the commercial book as a call out. Is there something happening there kind of above and beyond the normal type rate increases you've come to expect in that part of the business?

我想詢問第二季每次經調整入院（adjusted admission）的收入趨勢。相較於第一季，你們當時公布的那個數字，第二季改善了很多。你能否協助我們拆解一下，哪些因素在推動這項改善？另外在新聞稿中，你們特別提到商業保險業務（commercial book）的強勁表現。那邊是否有什麼超出你們在該業務中通常預期的常態性費率上調之外的情況？

Go ahead, Sun. I don't think there's anything abnormal there.

Sun，你先說。我不認為那裡有任何不尋常的情況。

Yeah, on the NRAA, we did see softness in Q1, which, at that point, we said we thought it was a temporary Q1 artifact and that we thought our long-term acuity strategy would play out. And I think in Q2, it did. I think the only moving pieces we would highlight NRAA stat is two things. One is we did have out-of-period supplemental payments, like I said, of $92 million, but we had $70 million in the prior Q2 of '25. So relatively small net impact.

是的，關於NRAA，我們在第一季確實看到一些疲軟；當時我們說過，我們認為那是第一季的暫時性因素，而且我們認為長期的病患嚴重度（acuity）策略會逐步展現效果。我想在第二季確實如此。我認為在NRAA這個指標上，我們要強調的變動因素主要有兩點。第一，我們確實有跨期（out-of-period）的補充付款，如我所說為9,200萬美元，但在2025年第二季我們有7,000萬美元。所以淨影響相對不大。

And then probably the largest headwind in our NRAA was obviously the exchange revenue movement, and that represented almost 2% of NRAA headwind in the quarter. So we were very pleased with our overall acuity. It goes right in line with the commercial volume increases. And as Saum mentioned, I don't know that there's anything special to call out there. Thanks for your question.

另外，對我們NRAA最大的逆風，顯然是交易所（exchange）收入的變動，這在本季約造成NRAA將近2%的逆風。因此我們對整體病患嚴重度表現非常滿意。這也與商業保險量（commercial volume）的增加完全一致。如Saum所提到的，我不確定那裡有什麼特別需要額外點出的。謝謝你的提問。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Looking at the ASC volume weakness this quarter, how much is tied to HICs and slower electives versus your focus on higher acuity procedures? Did you see any geographical differences in electives across your portfolio depending upon the HICS exchanges? Has the overall demand sort of still there across your portfolio as you think about your broad based? And then last part of this multipart question here, looking at inpatient surgeries, how much of that did you capture in your ASCs versus weakness in inpatient?

就本季ASC（門診手術中心）量能偏弱來看，其中有多少與HICs以及選擇性手術（electives）放緩有關，相較之下又有多少是因為你們聚焦於更高嚴重度的手術？在你們的組合中，依不同地區、取決於HICS交易所的情況，你們是否看到選擇性手術存在任何地理差異？就你們對整體組合的廣泛布局來看，整體需求是否仍然存在？最後一個多段式問題：就住院手術而言，其中有多少被你們的ASC承接，或是反映為住院端的疲弱？

Yeah. Well, I don't -- I mean, from our perspective, the ASC volumes were strong because we're focused on the growth that we see in our high acuity service line priorities, just like I highlighted in joint replacements. I mean, 10% year-over-year growth, given how large our portfolio has become is outstanding growth from my perspective. So the vast majority of the impact there continues to be a migration of lower acuity quick pain procedures and other things into the office space setting or just deliberate migration of those sorts of cases.

是的。嗯，我不——我的意思是，從我們的角度來看，ASC量能其實很強，因為我們聚焦在高嚴重度服務線優先事項所帶來的成長，就像我提到的關節置換一樣。我的意思是，在我們的組合已經變得如此龐大的情況下，年增10%是非常出色的成長。因此，那裡影響的絕大部分，仍然是較低嚴重度、快速止痛的處置以及其他項目，移轉到診所（office）場域，或是這類病例的刻意移轉。

We're very pleased that we continue to be able to deliver strong revenue growth, 5% quarter over quarter in this environment, consistent with our strategy. I couldn't tell if the question on geography was for the ambulatory surgery business or just surgeries overall I will answer the latter. I would say that surgical business overall, at least where we saw pressure on the elective side, primarily in the hospitals, tracked with some of the states that I described in my prepared remarks about where we're seeing the highest impact from the exchange enrollment declines.

我們很高興在這樣的環境下，仍能依照策略交出強勁的營收成長，本季較上季成長5%。我不太確定你問的地理問題是針對門診手術業務，還是整體手術；我先回答後者。我會說，整體手術業務方面，至少在我們看到選擇性手術端承壓的地方，主要是在醫院端，且與我在事先準備的發言中所描述的某些州相一致——那些州正是我們看到交易所投保人數下滑影響最大的地區。

And I -- look, we had strong emergency department volumes, strong emergency department inpatient surgeries. Our elective surgery book was under more pressure on the inpatient side, but elective outpatient surgeries in the hospital or hospital patient-based department were actually quite strong.

而且我——你看，我們的急診量能很強，急診帶動的住院手術也很強。我們的選擇性手術在住院端承受較大壓力，但醫院內的選擇性門診手術，或醫院病患部門（hospital patient-based department）的選擇性門診手術，其實相當強勁。

And that, I attribute largely to the fact that over the past couple of years in these hospitals, especially as we've been doing more work at USPI, we have been investing in hospital-based outpatient surgical programs, and I think that's probably the driver of why the elective outpatient surgeries continue to look strong in this current environment. It was offset to what impact you might have seen from the exchanges, right, the investments we made there. That's the way I would think about it.

我認為這主要歸因於過去幾年在這些醫院裡，尤其是我們在USPI投入更多工作之際，我們一直在投資醫院型門診手術計畫；我想這大概就是為什麼在目前環境下，選擇性門診手術仍然看起來很強的驅動因素。這些投資抵消了你可能從交易所那邊看到的影響，對吧——我們在那裡所做的投資。我會這樣看待。

Whit Mayo, Leerink Partners.

Whit Mayo，Leerink Partners。

You guys are going to have a lot of cash in the next few years. The leverage is pretty low. You've upped the buyback. Just any comments around targets for buybacks this year, other areas for capital deployment that we should expect? And maybe thoughts on where your head is around a potential dividend?

你們未來幾年會有很多現金。槓桿也相當低。你們也提高了回購規模。能否談談今年回購的目標，以及我們應該預期的其他資本配置方向？另外也想聽聽你們對於可能發放股利的想法。

Yeah. Thanks, Whit. I mean, just at a high level, I'll reinforce the commentary that Sun made. I mean, we do think at compelling valuations -- multiple valuations that given our growth prospects into the future, given the continued expansion of our USPI portfolio that share buybacks are an attractive use of our free cash flow generation, which, as we indicated, is also improving for this year.

好的。謝謝，Whit。我先從高層次再強調一下Sun的評論。我們確實認為，在具吸引力的估值——以倍數估值來看——考量我們未來的成長前景，以及USPI組合持續擴張，股票回購是我們自由現金流運用的一個具吸引力的選項；而且如我們所指出的，今年自由現金流也在改善。

Our hospital business, we continue to see good returns, as you can see, from both our margin improvements and our volumes in our strategic growth initiatives. We will continue down that path. I think the only thing we've said there is that we're a bit more cautious on large-scale hospital builds until we understand market environment and expansion opportunities there.

在醫院業務方面，從我們的毛利率改善以及策略性成長計畫的量能表現，你可以看到我們持續獲得良好回報。我們會持續沿著這條路走下去。我們唯一提到的是，在我們更了解市場環境與擴張機會之前，對於大型醫院新建案我們會稍微更謹慎一些。

We've kind of been focused on one to two per year, as you know, recently, and we're a little bit more cautious on that to just make sure that the market conditions are right. But otherwise, our investments in the segment continue to be strong; and then obviously, the deployment and increase in our guidance for deployment of capital into the USPI segment this year. Sun, do you want to -- I don't know if there's anything you want to add to that here?

如你所知，最近我們大致聚焦於每年一到兩個案子；我們在這方面會更謹慎一點，以確保市場條件合適。除此之外，我們在該事業部門的投資仍然強勁；而且很明顯地，我們也提高了今年投入USPI事業部門的資本配置指引。Sun，你要不要——我不確定你是否還想補充什麼？

I would maybe add two things. One is, as we look forward into our debt position, I mean, I think it's very well managed. We have maturities spread over the next several years. I think are well within our ability to either refinance and/or pay down. So we're very comfortable there. And then when you mentioned our free cash flow generation, even if when we look at ourselves and a free cash flow yield metric, we feel our shares are still very well discounted based on the free cash flow yield. So I would just point that out.

我可能補充兩點。第一，展望我們的負債狀況，我認為管理得非常好。我們的到期日分散在未來幾年。我認為這些都在我們可負擔的範圍內，可以選擇再融資和／或償還。所以我們在這方面非常放心。第二，你提到我們的自由現金流產生能力，即使以自由現金流殖利率（free cash flow yield）的指標來看，我們仍覺得公司股價相對於自由現金流殖利率而言折價幅度很大。我只是想指出這一點。

A.J. Rice, UBS.

A.J. Rice，瑞銀。

Maybe two things real quick. I appreciate the bridge in the slide deck. It's helpful. There's a lot of focus on core growth. If I'm looking at the slide that has the normalized performance for '25 at about $2.39 billion, and you've got a line growth and cost efficiencies of $388 million, that looks like you're seeing about 16% year-to-year growth in that -- on that area. Is there anything you'd call out is unusual cost efficiencies? What would you say is the sort of underlying core growth?

也許很快兩點。我很感謝簡報中的橋接（bridge）分析。很有幫助。大家很關注核心成長。如果我看那張投影片，2025年的常態化表現約為23.9億美元，而你們有一條「量能成長與成本效率」為3.88億美元，看起來那一塊年對年成長約16%。有沒有什麼不尋常的成本效率項目是你們會特別點出的？你們會說其背後的核心成長大概是多少？

And if I might slip in one thing, Saum, you mentioned the states where you've had the unusual HICs hit, Florida, Arizona, Michigan, South Carolina and Texas. I don't think we're surprised by Florida and Texas, but I'm a little surprised by the expansion states, Arizona and Michigan, that they are seeing big disenrollment. Any thoughts about that? I think the feeling has been that most of this would be targeted at non-expansion states, but there's a big drop off there, too. Any thoughts on that?

另外如果我可以補充一點，Saum，你提到你們出現異常 HICs 衝擊的州：佛羅里達、亞利桑那、密西根、南卡羅來納以及德州。我想佛州和德州我們不意外，但對於擴張州——亞利桑那和密西根——也出現大幅退保，我有點意外。你有什麼看法嗎？大家原本的感覺是，這大多會集中在非擴張州，但那裡也出現很大的下滑。你對此有什麼想法？

Well, why don't I start there and then I'll -- for the last question, and I'll pass it back to Sun for the first question. Yeah, it's interesting the -- and you can see the enrollment numbers publicly. It had been impacted in those states. I mean, unfortunately, these states, which are swing states, really, must have had a lot of members with needing the support of premium tax credits in order to continue to acquire product.

好，那我先從這裡開始回答最後一個問題，然後我會把第一個問題交回給 Sun。是的，這很有意思——而且你可以在公開資訊中看到投保人數。那些州確實受到了影響。我的意思是，不幸的是，這些州其實是搖擺州，可能有很多會員需要依賴保費稅額抵免（premium tax credits）的支持，才能繼續購買產品。

And we haven't dug into it deeply enough to understand if the issue is that there just isn't enough coverage from a bronze metal product standpoint that's attractive enough versus other states, or if the issue has been that eligibility for Medicaid for those at the lowest levels of income who would have required the highest premium support is just -- they're just not qualifying for that Medicaid.

而我們還沒有深入到足以理解：問題究竟是從青銅級（bronze metal）產品的角度來看，缺乏足夠有吸引力的保障、相較其他州不夠具競爭力；還是問題在於，對於收入最低、需要最高保費補助的族群，其 Medicaid 資格——他們就是不符合 Medicaid 的資格。

So I mean, you can see it in our numbers. Our exchange -- the exchange admissions are down, uninsured is up. It's not quite one to one, but it's certainly in that 80% to 100% of that range. And so you can see that is happening. And it's bigger in numbers in those states that I called out. Sun, the first part of the question on the rates?

所以我的意思是，你可以在我們的數字裡看到。我們的交易所——交易所投保人數下降，未投保人口上升。雖然不是完全一比一，但大概落在 80% 到 100% 的區間。所以你可以看到這確實正在發生。而且在我點名的那些州，數字更大。Sun，關於費率的問題第一部分？

Yeah. I mean, A.J., I don't know that there's anything unique or abnormal that I would point out, right? I mean, it's an aggregation of a lot of the themes that we mentioned, our acuity focus, the growth investments that we've made to help grow the acuity and the volumes in our hospitals. Obviously, OpEx management, both from a kind of a planned looking-ahead standpoint that we did last year into this year as well as being nimble on a side-by-side facility-wise facility base, just depending on how things are going.

是的。我的意思是，A.J.，我不覺得有什麼特別獨特或異常之處需要特別指出，對吧？這其實是我們提到的許多主題的綜合：我們對高病情嚴重度（acuity）的聚焦、我們為了在醫院提升高病情嚴重度與量能所做的成長投資。當然還有營運費用（OpEx）管理，既包括我們去年到今年做的前瞻性規劃，也包括在各個院區、逐一設施層級上保持彈性，視情況而定。

Commercial rates, as we've talked about, have been as expected this year. We've managed through some of the operating expense pressures around professional fees. It has grown about 10% since last year, which was per our expectations, and we've managed it. And then we've also called out separately the supplemental Medicaid revenues that were either out of period or not in our original guidance from a change standpoint. So yes, I think those are the only things that I would call out.

商業保險費率如我們先前所談，今年符合預期。我們也因應了專業費用（professional fees）相關的一些營運費用壓力。該項自去年以來成長約 10%，符合我們的預期，而且我們已經管理住了。另外，我們也另外指出補充性 Medicaid 收入（supplemental Medicaid revenues），其中有些是跨期（out of period）或因變動而未納入我們原先的指引。所以，是的，我想我能補充的大概就這些。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

I wanted to dig in on your strong year-over-year revenue growth in the quarter. So from your disclosures, it looks like it's being driven by this commercial and Medicaid. So maybe you could tell us what your commercial employer group revenue growth -- what that looked like in the quarter? Give us some idea there.

我想深入了解你們本季強勁的年對年營收成長。從你們的揭露來看，似乎是由商業保險與 Medicaid 所帶動。所以也許你們可以告訴我們，本季商業雇主團體（employer group）營收成長——看起來是什麼樣子？請給我們一些概念。

And then on Medicaid, your revenue was up about $125 million year over year. I know you had this $90 million of out-of-period. But last quarter, the second quarter of '25, you had $70 million. So really, that's only $20 million of the $125 million year over year increase. So I'm curious what drove the other $100 million plus in Medicaid revenue growth year over year and how we should think about that going forward?

另外在 Medicaid 方面，你們的營收年對年增加約 1.25 億美元。我知道其中有 9,000 萬美元是跨期（out-of-period）。但上一季，也就是 2025 年第二季，你們有 7,000 萬美元。所以嚴格來說，在年對年增加的 1.25 億美元裡，只有 2,000 萬美元來自這部分。因此我很好奇，還有其他超過 1 億美元的 Medicaid 營收年對年成長是由什麼驅動的，以及我們未來應該如何看待？

Well, let me address some of the Medicaid piece. And then Sun, if you want to go back on the commercial part of the question, the first half of the question will go in reverse order again. I mean, I think two things here around Medicaid. First of all, we are very much committed in our markets. And as you know, we have some very large markets in trauma -- multiple trauma centers in environments with a heavy Medicaid population.

我先回應 Medicaid 的部分。然後 Sun，如果你願意，可以再回到商業保險那一段，也就是問題的前半段——我們再一次用相反順序來回答。我想 Medicaid 這裡有兩點。首先，我們對我們所在市場非常投入。如你所知，我們在創傷（trauma）領域有一些非常大的市場——在 Medicaid 人口占比高的環境中，擁有多個創傷中心。

It's not just Southeast Michigan where we've been very committed to that mission for a long time, but it's certainly in other states, Memphis and Tennessee, the central part of California, the desert part of California where there is significant need for high acuity Medicaid-related services. I mean, this is why -- and we have been focused on growing those service lines. And of course, we receive all patients from that standpoint.

不只是我們長期以來非常投入這項使命的密西根東南部；在其他州也是如此，例如孟菲斯與田納西、中加州、加州沙漠地區，那些地方對高病情嚴重度、與 Medicaid 相關的服務有顯著需求。我的意思是，這也是為什麼——我們一直專注於擴大這些服務線。當然，從這個角度來看，我們接收所有病患。

In addition, Justin, our continued efforts to be a trauma-receiving center for outlying hospitals that simply can't take care of the sickness level of the patients they're seeing extends to all payers as well. We accept all payers in the community when we're providing those services. And of course, those types of cases, combined with our investments in our neonatal intensive care unit business, drive revenue growth. And so that's largely what it is.

此外，Justin，我們持續努力成為周邊醫院的創傷收治中心，因為那些醫院根本無法照護他們所看到病患的病情嚴重度；這也同樣適用於所有付款方（all payers）。當我們提供這些服務時，我們在社區中接受所有付款方。而且當然，這類病例再加上我們對新生兒加護病房（neonatal intensive care unit, NICU）業務的投資，推動了營收成長。所以大致上就是這些因素。

And look, I've said this all along, this whole notion that somehow state-directed payment program monies, assuming you accept the construct, are not monies that are earned doesn't make a lot of sense to me. Because you really do have to put in place the services, make capital investments, work with physicians or attract them to build some of these sophisticated service lines for the sickest of Medicaid patients who also deserve access to good quality healthcare.

而且你看，我一直都這麼說：這種認為州指導支付計畫（state-directed payment program）的資金——如果你接受這個架構——不是「賺來的」資金，對我來說不太合理。因為你確實必須建立相應服務、進行資本投資、與醫師合作或吸引他們，來打造一些精密的服務線，服務最重症的 Medicaid 病患，而他們也同樣應該獲得高品質醫療的可近性。

And we do that, and we consider that some of those payments that help support those investments are things that we earn and should be part of our core as opposed to not. But nevertheless, we sort of describe what's happening in the core separate from SPPs given the way we talk about things today. But make no mistake, we will continue to invest and grow and build those services for all payers in the hospitals.

而我們確實這麼做；我們也認為，部分用來支持這些投資的支付，是我們賺取的，應該屬於我們的核心，而不是相反。但無論如何，鑑於我們目前談論事情的方式，我們會把核心業務中發生的情況與 SPPs 分開描述。但請不要誤會，我們會持續投資、成長並建置這些服務，讓醫院能服務所有付款方。

In terms of forecasting out what that implication is for Medicaid revenue growth going forward, I'll be honest. I'm not going to do that today only because I haven't looked at that in the way that you asked the question. So I'm not sure I could provide a very well-informed answer. But conceptually, the reasons for it are what I described in addition to the state-directed payment program portion that you called out from Q2 of last year to this year. Sun, do you want to take the commercial portion of the question?

至於要預測這對未來 Medicaid 營收成長的意涵，老實說，我今天不會這麼做，因為我還沒有用你提問的方式去看這件事。所以我不確定我能提供一個非常有根據的答案。但在概念上，原因就是我所描述的那些，再加上你提到的州指導支付計畫部分，也就是從去年第二季到今年第二季的變化。Sun，你要回答商業保險那一部分的問題嗎？

Yeah. Well, I think when you look at our disclosures, you'll see our managed care category down about 2.7% in terms of mix proportion of revenues that it represents. Now obviously, that downward trend is driven by exchange, as we talked about. If we look at outside of exchange, other commercial payer classes, I can tell you from a -- both from a volume and a patient revenue standpoint, it's up low single digits quarter over quarter. So I think we're pleased with that.

是的。我想當你看我們的揭露時，你會看到我們的受管理式照護（managed care）類別，在其所代表的營收組合占比方面下降約 2.7%。當然，這個下滑趨勢如我們所談，是由交易所（exchange）所驅動。如果我們看交易所以外的其他商業付款方類別，我可以告訴你，無論從量（volume）或病患收入（patient revenue）的角度，季對季都是低個位數成長。所以我想我們對此感到滿意。

And then, Justin, just the only other bridge I would give you in terms of the Medicaid delta. You're right, quarter over quarter, '25 into '26, our supplemental payments are up. The out-of-period numbers explain roughly $20 million to $25 million of that.

然後，Justin，就醫療補助（Medicaid）差異（delta）而言，我想再補充一個銜接點給你。你說得對，按季比較，從'25到'26，我們的補充性付款（supplemental payments）是增加的。跨期（out-of-period）數字大約解釋了其中約2,000萬到2,500萬美元。

There are two other components that are sort of mechanical in nature. One is additional programs that were outside of our guidance for this fiscal year, and the increase in Florida program would be a good example of that versus our original guidance. And then as Saum said, the rest of it is through the care we provide, the volume growth, some program adjustments and some timing items. So hopefully, that helps.

另外還有兩個組成部分，性質上算是比較機械性的。其中一個是本財年指引之外新增的計畫，例如佛羅里達計畫的增加，相較於我們原先的指引就是一個很好的例子。然後如Saum所說，其餘部分來自我們提供的照護、量的成長、一些計畫調整以及一些時點因素。所以希望這能有所幫助。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

I want to isolate the growth, not the efficiency aspect, but the growth on the hospital segment earnings guide bridge. Earlier, you listed off some contributors. They all sounded sustainable around rate negotiations and other aspects. But then the guide sounds like you're assuming the second half benefit is just over about half of what you recognized in first half. When I take the $100 million versus the $60 million as a proxy, I know that's total company, and I'm focusing on hospital here. But is that delta just conservatism? Or is there a good portion of the year-to-date hospital segment non-efficiency growth drivers that's transitory?

我想把成長單獨拉出來看，不談效率面，而是看醫院事業部獲利指引銜接表中的成長部分。先前你列出了一些貢獻因素。聽起來它們在費率談判和其他面向都具有可持續性。但指引聽起來你假設下半年帶來的效益，只有上半年認列的大約一半多一點點。我用1億美元對6,000萬美元作為一個代理指標，我知道那是全公司層級，而我這裡聚焦在醫院。但這個差異只是出於保守嗎？還是說，今年迄今醫院事業部那些非效率的成長驅動因素，有相當一部分是短暫性的？

Well, I think it's more that we're prudent about the fact that from Q1 to Q2, obviously, the exchange or HICs impact accelerated significantly. And it's very possible that even though the rate of growth and the negative impact won't be the same as it was from Q1 to Q2, it could get a little bit worse, right?

我想更多是因為我們審慎看待：從Q1到Q2，顯然交易所（exchange）或HICs的影響加速得很明顯。而且很有可能，即便成長率與負面影響不會像Q1到Q2那樣，但它仍可能再稍微變糟，對吧？

I mean, we're not blind to the trends. And as I indicated, the most important thing is we were prepared for them and continue to be prepared for them. So I think it's very consistent with our overall guide. Sun, I don't know if you want to add to that?

我的意思是，我們並非看不到這些趨勢。而且如我所說，最重要的是我們已為此做好準備，並且會持續做好準備。所以我認為這與我們整體指引是非常一致的。Sun，你要不要補充一下？

I would just say, Sarah, listen, if you look at our full-year '25 versus '26 growth on a normalized basis, right, it's very heavy, right? It's about 14% if you look at our IR deck. Now we did have a difference in growth factors just driven off of a '25 baseline difference in Q1 versus Q2 of our first half.

我只想說，Sarah，你看我們在常態化（normalized）基礎上，全年'25對'26的成長，其實非常強勁。如果你看我們的IR簡報，大約是14%。不過我們在成長因素上確實有差異，主要是因為上半年Q1相較Q2的'25基期不同所致。

As we get into the second half, I think we're projecting, if my math is roughly correct, about 11% growth in the second half versus last year while overcoming the expected exchange headwinds. So we feel that's still very much in line with our original fairly aggressive guidance into this environment. So we feel good about it.

進入下半年後，我想我們預估（如果我算得大致正確）在克服預期的交易所逆風之下，下半年相較去年仍約有11%的成長。所以我們認為這仍非常符合我們在這個環境下原先相當積極的指引。因此我們對此感覺良好。

Scott Fidel, Goldman Sachs.

Scott Fidel，Goldman Sachs。

Now, I guess. I was hoping you could maybe talk about the OPPS proposal and walk through some of the more significant, I guess, sort of reform elements to 340B that they proposed in terms of the increase in the facility reimbursement while cutting the drug reimbursement and ultimately hoping how that sort of translates or transmits from like hospital outpatient to ASC? And ultimately, how you think that proposal, what the key effects should be for the ASC business from a pricing, from a volume and from a sort of a margin perspective?

那我想……我希望你可以談談OPPS提案，並帶我們梳理一下他們提出的、較重要的340B改革要素：例如提高機構端（facility）給付、同時下調藥品給付，並且最終希望這如何從醫院門診傳導到ASC？最後，你認為這個提案對ASC業務在定價、量以及利潤率等面向的關鍵影響會是什麼？

Yeah. I mean, the -- obviously, the outpatient rule -- proposed rule at this point was a little -- it had a few curve balls in it and was a little bit different than in the past. So we're obviously still studying that. I mean, the 340B reallocation could be material. At the same time, they accelerated the recruitment, which fundamentally we're not even sure of the legal basis of.

是的。我的意思是——顯然，這次門診規則（outpatient rule）的擬議規則（proposed rule）目前看起來有點——裡面有幾個出乎意料的變化，跟過去有些不同。所以我們當然還在研究中。340B的重新分配（reallocation）可能會是重大的。同時，他們也加速了所謂的recruitment，而就其根本而言，我們甚至不確定其法律依據是什麼。

So there's a lot of moving pieces here that we're still looking at. And I think as we move ahead into the year, at the right time, we'll have synthesized those various moving pieces into what we think the math looks like and share that when we talk about the following year.

所以這裡有很多變動因素，我們仍在評估。我想隨著今年往前推進，在適當的時間點，我們會把這些不同的變動因素整合起來，形成我們認為的數學影響，並在我們談到下一年度時分享。

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，Bank of America。

Great. I guess when I look at that guidance assumption that the exchanges are going to be relatively similar in Q3 and Q4 relative to Q1. I guess, historically, you've kind of seen exchange enrollment drop off year over year and last year didn't happen as much. So I would have thought that, that number would ramp a little bit more in the back half. So just curious on your thoughts about that and then kind of how to think about exchange as a potential headwind into next year? Should it be something similar to what you're seeing this year, less thoughts there?

很好。我想當我看你們指引假設：Q3和Q4的交易所影響相對於Q1會大致相近。我想，歷史上你們通常看到交易所投保人數會逐年下滑，而去年並沒有那麼明顯。所以我原本以為下半年那個數字會再爬升一些。所以想請教你對此的看法，以及該如何看待交易所對明年的潛在逆風？會是跟今年看到的類似，還是更小？你的想法是什麼？

Yeah. I mean, I really don't want to guess about exchange enrollment in the following year without the data point seeing what happens in the next two quarters. As I indicated a few moments ago, we have thought about the fact that in our view, our estimates were about right. We knew that from Q1 to Q2 would be the big data point about how much it increased. It did, in fact, increase substantially.

是的。我的意思是，在沒有看到接下來兩季會發生什麼、沒有那個數據點之前，我真的不想去猜測下一年度的交易所投保情況。如我剛才提到的，我們已經考慮到：以我們的觀點，我們的估計大致是正確的。我們知道從Q1到Q2會是關鍵數據點，用來衡量增加了多少。而事實上，它確實大幅增加。

And we planned for that to really moderate into Q3 and Q4 based upon what we would imagine the trend line would look like, and we've built that into our guidance. I mean, it's -- this is not a game of perfect forecasting. It's a game of using the available data, which often lags a little bit, and what we're seeing in our business and what we're seeing with Conifer doing enrollment work in terms of how much of that enrollment work is related to patients who were prior on exchanges versus Medicaid or something like that. It's been mostly exchanges becoming uninsured. And that's how we've made our forecast looking forward.

而我們的規劃是：基於我們想像的趨勢線，到了Q3和Q4會明顯趨緩，並已把這點納入指引。我的意思是——這不是一場完美預測的遊戲。這是一場運用可得數據的遊戲，而這些數據往往會稍微落後；同時也要看我們在業務中看到的情況，以及Conifer在做投保登記（enrollment）工作時所觀察到：這些登記工作有多少是與原本在交易所的病人、相對於Medicaid或其他來源相關。目前多數情況是交易所投保者轉為無保險（uninsured）。這就是我們用來做前瞻預測的方式。

Ann Hynes, Mizuho.

Ann Hynes，Mizuho。

I just want to focus on the surgery center. I don't think we've gotten a breakout of service line or procedures by modality in a while. Can you let us know how that's trending? How many of your procedures are orthopedic versus gastro? Maybe how is that trending versus the past three years? Is it maybe the growth rate within each modality? That would be great.

我想聚焦在手術中心。我覺得我們有一段時間沒有看到按服務線或按治療模式拆分的手術量/程序數據了。你能否告訴我們目前趨勢如何？你們的手術中有多少是骨科、多少是腸胃科？也許相較過去三年，趨勢如何？以及各模式內的成長率可能是怎樣？那就太好了。

Yeah. I don't -- I mean, I think that we generally have published that once a year in terms of the overall proportion. And I guess we can do that again at the end of the year. But I would tell you that the primary migration, if you will, or change is just a continuation of growth in the higher acuity service lines so that they continue to become a bigger and bigger proportion of the revenue in the business.

是的。我不——我的意思是，我想我們一般一年會公布一次整體占比。我想我們可以在年底再做一次。但我可以告訴你，主要的遷移（migration）或變化，就是高病情複雜度（higher acuity）服務線的成長持續進行，因此它們在業務收入中的占比持續變得越來越大。

The case counts -- again, as we've talked, the case counts are sometimes so skewed by high volume, low acuity cases. And unfortunately, other than what we're doing, there isn't really a good measure to compare a single orthopedic surgery versus seven procedures that are done in 15 minutes each in the same time frame in the way the case counts work.

案件數——再次如我們先前討論的，案件數有時會因為高量、低病情嚴重度的病例而被大幅扭曲。而且不幸的是，除了我們正在做的方式之外，並沒有一個真正好的衡量方法，能在案件數的運作方式下，於同一時間範圍內把一台單一骨科手術與七個各在15分鐘內完成的處置拿來做比較。

So we obviously focus on the revenues, focus on the growth rates of the important higher acuity frontier kind of service lines that were adapted working on. And then as I indicated today, we have started work a couple of years ago on looking for opportunities that are now starting to get built into the business of newer type of procedures in both GI and ophthalmology to see about moving them from the hospital setting to the ASC setting, and we'll see how that goes.

因此我們顯然會聚焦在營收，聚焦在那些重要、較高病情嚴重度、屬於前沿類型且我們正在調整與推進的服務線之成長率。然後如我今天所提到的，我們在幾年前就開始著手尋找機會；這些機會現在也開始被納入業務之中，針對腸胃科（GI）與眼科的較新型處置，評估是否能把它們從醫院場域移轉到ASC（門診手術中心）場域，我們會再看看進展如何。

Brian Tanquilut, Jefferies.

Brian Tanquilut，Jefferies。

Congrats on the quarter. Saum, maybe as I think about, yeah, just all the comments prior to your release here with all these KOL calls pointing to weakness in volumes, it obviously doesn't sound like you're facing that. So is this a share gain situation? Maybe more broadly speaking, you and I have in the past talked about your view that volumes are going to remain strong because of demographic trends and whatnot. So just curious where your mind is now in terms of volumes and what you're seeing in terms of share at the local level for your assets?

恭喜本季表現。Saum，當我回想，嗯，就是在你們這次發布之前，先前有很多KOL電話會議都指出量能疲弱，但顯然聽起來你們並沒有面臨那種情況。所以這是市占率提升的情境嗎？更廣泛地說，你我過去談過你對量能將因人口結構趨勢等因素而維持強勁的看法。所以想請教你目前對量能的想法，以及你在地方層級就你們資產所看到的市占變化是什麼？

Yeah. I mean, let me start -- first of all, I'll sort of move from what I'm most sure about to less sure about. And what I mean by that is when we look at our business, we have obviously migrated our hospital portfolio to markets that we thought we had better growth opportunities in and better return on invested capital opportunities in. We've stepped up our capital expenditure in those markets the last couple of years on growth initiatives, and we're seeing results from that.

是的。我的意思是，讓我先從——首先，我會大致從我最有把握的部分談到較沒那麼有把握的部分。我所說的是，當我們檢視我們的業務時，我們顯然已把醫院資產組合移轉到我們認為具有更好成長機會、以及更佳投入資本報酬機會的市場。過去幾年我們在這些市場提高了資本支出，用於成長計畫，而我們也看到了成果。

If you go back a couple of years, I think people would have asked the question, can tenants step up capital investments in hospital markets and see returns either from a growth or margin perspective? That was an open question. And our job was to test that post all the divestitures and demonstrate that what we did with the portfolio restructuring would, in fact, add value for our shareholders over time.

如果回到幾年前，我想大家會問：承租方是否能在醫院市場加大資本投資，並從成長或利潤率角度看到回報？那是一個未解的問題。而我們的工作是在完成所有資產剝離之後去驗證這件事，並證明我們透過資產組合重整所做的事情，確實會隨時間為股東創造價值。

And we're seeing evidence of that, which I'm pleased about, because it means that our work is paying dividends in those areas. And so I think what we're seeing, at least in our volume environment, is a good background environment, coupled with the benefits of the returns on the investments that we've made.

我們正在看到相關證據，這讓我很高興，因為這代表我們的努力在那些領域正在帶來成果。因此我認為，至少就我們的量能環境而言，我們看到的是良好的大環境背景，再加上我們所做投資帶來的報酬效益。

And then when you add on top of that the fact that we had planned so actively out of concern for what would happen with the exchanges in 2027 that we were able to hit the ground running in January on our expense initiatives, the combination of those things have supported earnings and happened to have supported earnings ahead of our expectations that we created.

再加上我們因擔心2027年交易所（exchanges）會發生什麼而做了非常積極的規劃，因此我們在1月就能立即啟動費用改善計畫；這些因素的組合支撐了獲利，而且也恰好使獲利表現超出我們原先建立的預期。

Now if I just step back, because I went through this exercise just reflecting on the past couple of weeks, where kind of our volumes look like and some of the reports that are out there about overall volumes. I mean, this is not an environment to be pessimistic about with respect to the acute care industry.

現在如果我退一步看，因為我在過去幾週做了這個回顧練習，看看我們的量能大概長什麼樣，以及外界一些關於整體量能的報告。我的意思是，就急性照護產業而言，這不是一個該悲觀的環境。

I mean, the fact is that these 2%-plus, 2.5%-plus type of volume numbers that we're seeing published from others in the industry and including us, when you look back over a few years or you go back pre-COVID, I mean, those are healthy years. And you see as many quarters or years where it's above that as it is below that. So this is not an environment that one would describe as negative. I do think some of that is general demographic trends, aging, chronic disease burden, and things of that nature. But it's also a reasonable environment. So I generally am more optimistic.

事實上，我們看到其他同業（也包括我們）公布的這種2%以上、2.5%以上的量能數字，當你回頭看幾年、或回到COVID之前，那些都是健康的年份。而且你會看到，高於這個水準的季度或年度，和低於這個水準的同樣多。所以這不是一個可以被形容為負面的環境。我確實認為其中一部分來自一般人口結構趨勢、老化、慢性疾病負擔等因素。但這同時也是一個合理的環境。因此我整體上更偏向樂觀。

We're not seeing -- in our business, we're not seeing some kind of consumer pullback occurring right now. Where we have pluses and minuses in the ASC business for the quarter, I would say it's more geographically based or exchange related after you get past the stuff that we're doing to get rid of low acuity in that setting, more than it is some systematic view that consumers are now deferring care.

我們沒有看到——在我們的業務中，我們目前沒有看到某種消費者縮手正在發生。至於本季ASC業務的正負面因素，我會說在排除我們正在做的、用以在該場域去除低病情嚴重度病例的措施之後，更多是地理因素或交易所相關因素所致，而不是因為我們認為消費者正在系統性地延後就醫。

I don't see that yet in the results that we have there. And I think we should continue to be optimistic that if we work on access, if we make it easy for doctors and patients to get in, if the service levels improve, I think the demand is there. And that's the assumption we're making with our guidance increase into the balance of the year that we will be able to manage that and deliver that based upon what we have achieved in the first half of the year.

我在我們目前的結果中還沒有看到那種情況。而且我認為我們應該持續保持樂觀：如果我們改善可近性、讓醫師與病患更容易進來、如果服務水準提升，我認為需求是存在的。這也是我們在上調全年剩餘期間指引時所採用的假設：我們將能夠管理並交付這些成果，基於我們在上半年所達成的表現。

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，今天的會議到此結束。您現在可以掛斷電話線，感謝各位的參與。

Thank you, everyone.

謝謝大家。