Tenet Healthcare Corp (THC) 2026 Q3 法說會逐字稿

Good morning. Welcome to Tenet Healthcare's third quarter 2026 earnings conference call. (Operator Instructions)

早安。歡迎參加 Tenet Healthcare 2026 年第三季財報電話會議。（接線員指示）

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

我現在把電話交給本次會議主持人——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 are pleased to have you join us for a discussion of Tenet's third 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。我是投資人關係副總裁 Will McDowell。我們很高興各位參與本次會議，討論 Tenet 2026 年第三季業績，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. 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. With that, I will turn the call over to Saum.

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作的預期。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。接下來，我把電話交給 Saum。

Thank you, Will, and good morning, everyone. Third quarter net operating revenues were $5.6 billion, and consolidated adjusted EBITDA was $1.355 billion. Adjusted diluted earnings per share increased 80% to $6.64 in the third quarter of 2026 compared to the prior year. More importantly, after adjusting for one-time items related to contract transitions that generated adjusted EBITDA of $147 million that was not reflected in our previous guidance, the core business continued its strong growth trajectory in 2026 with an adjusted EBITDA margin of 21.8% and 10% growth in adjusted EBITDA over third quarter 2025.

謝謝你，Will，各位早安。第三季淨營運收入為 56 億美元，合併調整後 EBITDA 為 13.55 億美元。2026 年第三季調整後稀釋每股盈餘較去年同期成長 80%，至 6.64 美元。更重要的是，在剔除與合約移轉相關的一次性項目後——該等項目帶來 1.47 億美元的調整後 EBITDA，且未反映於我們先前的財測指引中——核心業務於 2026 年仍延續強勁成長軌跡，調整後 EBITDA 利潤率為 21.8%，且調整後 EBITDA 較 2025 年第三季成長 10%。

We continue to manage through payer mix shifts and enrollment declines in the exchanges and execute on our technology-enabled growth and expense management plans that support our margin strength. Our strong performance is driving significant free cash flow that we continue to deploy for the benefit of shareholders. Year- to- date, we have deployed over $1.6 billion for share repurchases. Turning to our segments. USPI generated $537 million in adjusted EBITDA, which represents 9% growth over third quarter 2025. Same-facility revenues grew 4.5% as our high acuity strategy continues to yield benefits and is highlighted by our strongest quarterly performance this year with 12.8% same-store growth in total joint replacements in the ASCs over prior year.

我們持續因應付款方組合變化與交易所（exchanges）投保人數下滑，同時推動以科技賦能的成長與費用管理計畫，以支撐我們的利潤率韌性。我們的強勁表現帶來可觀的自由現金流，我們持續將其用於股東利益。年初至今，我們已投入超過 16 億美元進行庫藏股回購。接著談各事業部門。USPI 產生 5.37 億美元的調整後 EBITDA，較 2025 年第三季成長 9%。同院（same-facility）營收成長 4.5%；我們的高重症（high acuity）策略持續帶來效益，並由今年最強單季表現所凸顯——門診手術中心（ASC）全關節置換（total joint replacements）同店（same-store）年增 12.8%。

USPI also had a very successful quarter in development, with over $100 million of investments in the third quarter alone. We remain the preferred acquirer of assets in this space and continue to have an attractive pipeline of partnerships interested in joining USPI. Additionally, we have commenced patient care at four de novo centers to date. Turning to our hospital segment. Our performance in the quarter was driven by 3.2% adjusted admissions growth and strong margin performance from sustained expense efficiencies.

USPI 在開發方面本季也非常成功，僅第三季就投資超過 1 億美元。我們仍是此領域資產的首選收購方，並持續擁有具吸引力的合作夥伴管線，對加入 USPI 表達興趣。此外，截至目前我們已在四家新設（de novo）中心開始提供病患照護。接著談醫院事業部門。本季表現主要由調整後入院量成長 3.2% 所帶動，並受惠於持續的費用效率所帶來的強勁利潤表現。

The investments that we have made in support of our high acuity strategy continue to pay dividends and drive incremental growth. Excluding the contract transition benefits that I mentioned, adjusted EBITDA grew a very attractive 11% over third quarter 2025, again, producing results ahead of our expectations. We are pleased with our performance in both operating segments, which continue to generate strong same-store revenue growth, attractive margins, and robust free cash flows. Turning to guidance for the rest of 2026. We began the year with attractive growth expectations and delivered an outsized and competitively differentiated increase to our guidance when we reported our second quarter results.

我們為支持高重症策略所做的投資持續帶來回報並推動增量成長。若排除我先前提到的合約移轉效益，調整後 EBITDA 較 2025 年第三季成長達 11%，相當亮眼，再次繳出超出我們預期的成果。我們對兩個營運事業部門的表現感到滿意，兩者持續帶來強勁的同店營收成長、具吸引力的利潤率，以及穩健的自由現金流。接著談 2026 年剩餘期間的財測指引。我們在年初即抱持具吸引力的成長預期，並在公布第二季業績時，對指引作出幅度更大且具競爭差異化的上修。

At this point in the year, we are raising our full year 2026 adjusted EBITDA guidance to a range of $5.05 billion-$5.2 billion, which represents an increase of $195 million, or 4% at the midpoint of the range, over our increased guidance after the second quarter. The guidance increase is supported by our continued expectations for strong fundamental performance, as well as the one-time items in the back half of the year. Notably, over 40% of our total guidance increase for this year is from fundamental outperformance. I'd like to now spend a few minutes discussing some early thoughts on 2027.

在今年此時點，我們將 2026 全年調整後 EBITDA 指引上調至 50.5 億至 52 億美元區間；相較於第二季後已上修的指引，在區間中點增加 1.95 億美元，或 4%。本次上修係基於我們對基本面持續強勁表現的預期，以及下半年的一次性項目。值得注意的是，今年指引上修總額中超過 40% 來自基本面優於預期。接下來我想花幾分鐘分享對 2027 年的一些初步想法。

After excluding the impact of the transition activities at Conifer, we expect our enterprise to deliver overall adjusted EBITDA growth in 2027. This assumes the current known regulatory frameworks. The value of our diversified business mix support our belief in this outcome for 2027. We are still conducting business planning, so details will come after the fourth quarter as usual. We are sizing further potential exchange headwinds and the estimated impact of Medicaid work requirements. USPI should not be materially impacted by these, and we expect same-store revenue growth, consistent margins, and further expansion of the asset portfolio in our ambulatory business.

在排除 Conifer 移轉活動的影響後，我們預期 2027 年整體企業將實現調整後 EBITDA 的整體成長。此預期係以目前已知的監管架構為前提。我們多元化的業務組合價值支撐我們對 2027 年達成此結果的信心。我們仍在進行營運規劃，因此細節將如往常在第四季之後提供。我們正在評估交易所可能進一步的不利因素，以及 Medicaid 工作要求的估計影響。USPI 應不會受到重大影響；我們預期門診業務將維持同店營收成長、穩定利潤率，並進一步擴張資產組合。

In the Hospital segment, we currently see healthy patient demand that would support same-store volume growth and a stable operating environment supported by disciplined cost controls in 2027. To help you bridge the years, we now expect various transition activities at Conifer to total $450 million of adjusted EBITDA in 2026. We do not expect these contributions to recur in 2027, and I will reiterate that this is an estimate depending on how the transitions proceed operationally. We will provide an update following our fourth quarter results.

在醫院事業部門方面，我們目前看到健康的病患需求，可支撐 2027 年同店量能成長；同時在嚴謹的成本控管支持下，營運環境可望保持穩定。為協助各位銜接年度比較，我們目前預期 Conifer 的各項移轉活動在 2026 年合計將貢獻 4.5 億美元的調整後 EBITDA。我們不預期這些貢獻會在 2027 年重複發生；我也再次強調，該數字為估計值，取決於移轉在營運層面的推進情況。我們將在公布第四季業績後提供更新。

We are pleased with the results of this highly attractive Conifer transaction, as the total value generated from the contract sale will now increase to approximately 15x 2025 adjusted EBITDA minus NCI. In summary, we have a transformed portfolio of businesses with strong underlying fundamentals, disciplined operations, and a business mix which is diversified from many of the reimbursement headwinds that are affecting the industry. Finally, I will again reiterate our commitment to returning free cash flow to shareholders via repurchases, especially at our attractive valuation multiple in light of recent comparable multiples for combination ASC hospital platforms. For more details on our results, I will now turn it over to Sun.

我們對這筆極具吸引力的 Conifer 交易成果感到滿意；合約出售所產生的總價值，現在將提高至約為 2025 年調整後 EBITDA（扣除 NCI）之 15 倍。總結而言，我們已打造出經轉型的業務組合，具備強勁的基本面、嚴謹的營運管理，以及能分散產業所面臨多項給付（reimbursement）逆風的多元化業務結構。最後，我再次重申我們將透過回購把自由現金流回饋股東的承諾，尤其是在我們目前具吸引力的估值倍數下，並考量近期可比的 ASC 與醫院平台組合之估值倍數。如需更多關於我們業績的細節，我現在把電話交給 Sun。

Thank you, Saum, and good morning, everyone. We again delivered strong performance in the third quarter of 2026, generating total net operating revenues of $5.6 billion and consolidated adjusted EBITDA of $1.355 billion. Third quarter adjusted EBITDA margins were driven by strong revenue performance and disciplined operating expense management with continued progress on the efficiency initiatives that we outlined at the beginning of the year, as well as favorable transition items as described in the earnings release. I would now like to highlight some key items for both of our segments, beginning with USPI.

謝謝你，Saum，各位早安。我們在 2026 年第三季再次交出強勁表現，總淨營運收入達 56 億美元，合併調整後 EBITDA 為 13.55 億美元。第三季調整後 EBITDA 利潤率主要受惠於強勁的營收表現與嚴謹的營運費用管理；同時，我們持續推進年初所說明的效率提升計畫，並如財報新聞稿所述，亦有利於移轉相關項目。接下來我想重點說明兩個事業部門的一些關鍵事項，先從 USPI 開始。

In the third quarter, USPI adjusted EBITDA grew 9.1% over third quarter 2025 at $537 million, with adjusted EBITDA margins at 39.2%. Same-facility system-wide revenues increased 4.5%, with net revenue per case up 6.1% and same-facility case volumes down 1.5%, reflective of our high acuity focus. Turning to our Hospital segment, same Hospital adjusted admissions rose 3.2% in the quarter as demand remained healthy. Revenue per adjusted admission increased 0.2% year-over-year in the quarter, primarily due to strength in commercial employer revenues offset by the impact of reduced exchange volumes.

在第三季，USPI 的調整後 EBITDA 較 2025 年第三季成長 9.1%，達 5.37 億美元，調整後 EBITDA 利潤率為 39.2%。同院系統整體營收成長 4.5%，其中每病例淨營收成長 6.1%，同院病例量下降 1.5%，反映我們聚焦高病情嚴重度（high acuity）的策略。接著看我們的醫院事業部（Hospital segment），本季同院調整後入院人次成長 3.2%，需求維持健康。本季每調整後入院人次營收年增 0.2%，主要來自商業雇主收入的強勁表現，但部分被交易所（exchange）量縮的影響所抵銷。

Exchange admissions and revenues declined 18% from third quarter of 2025 and represented about 5.5% of consolidated net operating revenues in third quarter of 2026. We recognized $32 million of out-of-period supplemental Medicaid revenues in the quarter. This compares to $38 million of out-of-period supplemental Medicaid revenues that we had in the third quarter of 2025. I would note that year-to-date, there is $124 million of favorable out-of-period supplemental Medicaid revenues related to prior years.

交易所入院人次與收入較 2025 年第三季下降 18%，並在 2026 年第三季約占合併淨營運收入的 5.5%。本季我們認列 3,200 萬美元的跨期（out-of-period）補充性 Medicaid 收入。相較之下，2025 年第三季我們的跨期補充性 Medicaid 收入為 3,800 萬美元。我也要指出，截至目前為止（year-to-date），與前期年度相關的有利跨期補充性 Medicaid 收入累計為 1.24 億美元。

Finally, we recognized a net benefit of $147 million associated with the timing of revenue recognition and various transition activities related to Conifer in the third quarter of 2026. This amount is comprised of two items. First, our net operating revenues increased by $97 million due to revenue recognition timing. It is important to note that this is simply a timing shift between the third and fourth quarters, and as such, does not impact our full year 2026 revenues associated with the transitioning contract. Second, we recognized $50 million of EBITDA from various transition activities, including expense reductions that took place earlier than we had originally anticipated.

最後，在 2026 年第三季，我們因 Conifer 相關的收入認列時點以及各項過渡（transition）活動，認列淨利益 1.47 億美元。此金額由兩個項目構成。第一，因收入認列時點因素，我們的淨營運收入增加 9,700 萬美元。需要強調的是，這僅是第三季與第四季之間的時點移轉，因此不影響 2026 全年與該過渡合約相關的收入。第二，我們自各項過渡活動認列 5,000 萬美元 EBITDA，其中包含較原先預期更早發生的費用降低。

All in all, our operating discipline and strategic focus enabled us to deliver another strong quarter despite the patient coverage challenges that the industry is facing. Next, we will discuss our cash flow, balance sheet, and capital structure. We generated $1.1 billion of adjusted free cash flow in the third quarter, which brings us to $2.5 billion of adjusted free cash flow year-to-date. As of September 30, 2026, we had $2.67 billion of cash on hand with no borrowings outstanding under our line of credit facility. As previously announced, we issued $2 billion of senior unsecured notes that mature in 2034.

總體而言，儘管產業正面臨病患保險覆蓋（patient coverage）方面的挑戰，我們的營運紀律與策略聚焦仍使我們再度交出強勁的一季。接下來，我們將討論現金流、資產負債表與資本結構。第三季我們產生 11 億美元的調整後自由現金流，使年初至今（year-to-date）的調整後自由現金流達到 25 億美元。截至 2026 年 9 月 30 日，我們手上現金為 26.7 億美元，且在循環信用額度（line of credit facility）下沒有任何未償借款。如先前公告，我們發行了 20 億美元、2034 年到期的無擔保優先票據（senior unsecured notes）。

We used the proceeds from the notes to retire $2 billion of notes that would have been due in 2027 and 2028. We now have no significant debt maturities until 2028. Finally, during the third quarter, we repurchased 970,000 shares of our stock for $255 million. Year-to-date, we have repurchased 8 million shares of our stock for $1.615 billion. Our leverage ratio as of September 30, 2026, was 2.11x EBITDA, or 2.58x EBITDA less NCI, driven by our strong operational performance and financial discipline. We remain committed to maintaining a de-leveraged balance sheet and believe that we have significant financial flexibility to support our capital deployment priorities and continue to drive shareholder value.

我們使用該票據募集資金償還原本將於 2027 年與 2028 年到期的 20 億美元票據。目前我們在 2028 年之前已無重大到期債務。最後，第三季我們以 2.55 億美元回購 97 萬股公司股票。年初至今，我們已以 16.15 億美元回購 800 萬股公司股票。截至 2026 年 9 月 30 日，我們的槓桿比率為 EBITDA 的 2.11 倍；若扣除 NCI（非控制權益），則為 EBITDA 的 2.58 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，並相信我們具備顯著的財務彈性，以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 2026, we now expect consolidated net operating revenues in the range of $22.05 billion- $22.45 billion, an increase of $50 million at the midpoint of the range over prior expectations. As Saum have mentioned, we are raising our 2026 adjusted EBITDA outlook range by $195 million at the midpoint to $5.05 billion- $5.2 billion, reflecting the increased EBITDA expectations associated with our transition activities, as well as the additional out-of-period supplemental Medicaid revenues that we recognized in the quarter.

接著我來談談我們對 2026 年的展望。對於 2026 年，我們目前預期合併淨營運收入介於 220.5 億至 224.5 億美元，區間中點較先前預期上調 5,000 萬美元。如 Saum 所提到的，我們將 2026 年調整後 EBITDA 展望區間中點上調 1.95 億美元至 50.5 億至 52 億美元，反映與過渡活動相關的 EBITDA 預期提高，以及本季認列的額外跨期補充性 Medicaid 收入。

Turning to our cash flow for 2026, we now expect adjusted free cash flow after NCI in the range of $1.925 billion- $2.155 billion, an increase of $100 million at the midpoint from our previous guidance range. This range includes the payment of about $150 million in tax payments this year for the Conifer transaction. Excluding these tax payments, this would represent $2.2 billion of adjusted free cash flow after NCI at the midpoint of our 2026 outlook. Our businesses continue to deliver strong free cash flow conversion from our EBITDA performance, while we continue to invest in high-priority areas to support future growth.

就 2026 年現金流而言，我們目前預期扣除 NCI 後的調整後自由現金流介於 19.25 億至 21.55 億美元，區間中點較先前指引上調 1 億美元。此區間包含今年因 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 年展望的區間中點，扣除 NCI 後的調整後自由現金流將為 22 億美元。我們的業務持續將 EBITDA 表現有效轉化為強勁的自由現金流，同時我們也持續投資於高優先領域以支持未來成長。

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. Second, we expect to continue investing in key hospital growth opportunities to fuel organic growth, including our focus on higher acuity service offerings. Third, we will continue to be active in share purchases.

談到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。第二，我們預期將持續投資於關鍵的醫院成長機會以帶動內生成長（organic growth），包括聚焦於更高病情嚴重度的服務項目。第三，我們將持續積極進行股票回購。

We continue to see significant opportunity at our current valuation, continued operating performance, and strong leverage position. 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 2026. With that, we are ready to begin the Q&A. Operator?

在目前的估值水準、持續的營運表現以及強健的槓桿水位下，我們仍看到顯著機會。最後，我們也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，並對達成上調後的 2026 年展望仍具信心。接下來，我們準備開始問答環節。接線員？

(Operator Instructions) Jason Cassorla, Guggenheim.

(接線員指示) Jason Cassorla，Guggenheim。

Great. Thanks. Good morning. I wanted to ask about commercial pricing. It is an area you have called out a couple of times, or at least the past couple of quarters. Maybe can you just unpack what you are realizing on the commercial rate side, how you are working with payers as a partner to increase revenue yields, reduce administrative costs, and the like, and how you are thinking about the sustainability of this commercial pricing favorability as you look out into the future. Thanks.

很好。謝謝。早安。我想詢問商業定價（commercial pricing）。這是你們提到過幾次的領域，至少在過去幾個季度是如此。能否請你們拆解一下：在商業費率（commercial rate）方面你們實際看到的情況、你們如何與付款方（payers）以夥伴關係合作以提高收入收益率（revenue yields）、降低行政成本等，以及當你們展望未來時，如何看待這種商業定價有利因素的可持續性。謝謝。

Hey, Jason. Good morning. It is Sun. Yeah. I think our relationship with our commercial payers and commercial pricing overall has not changed very much at all from our prior commentary, right? We still are seeing good renewals, a lot of them at the 3%-5% range. We are obviously fully contracted for this year and are basically over 90% contracted for next year as well, so we have good visibility. The only other thing I would note is from a net revenue per just admissions rate, we said 0.2% this year or this quarter, excuse me. A lot of that is driven by, as expected, good pricing mix across our categories, and then obviously offset by exchange headwinds.

嗨，Jason。早安。我是 Sun。是的，我認為我們與商業付款方的關係以及整體商業定價，與我們先前的評論相比並沒有太大改變，對吧？我們仍看到不錯的續約，很多都在 3%–5% 的區間。我們今年的合約當然都已完整簽訂，而明年也基本上已完成超過 90% 的簽約，所以能見度良好。另外我想補充的是，就每調整後入院人次的淨營收（net revenue per adjusted admission）而言，我們說的是本年或更正，本季年增 0.2%。其中很大一部分如預期所致，來自我們各類別之間良好的定價組合（pricing mix），同時也被交易所的不利因素所抵銷。

The exchange headwinds represented about 1.8% headwind on our net revenue stat. From an operational basis, look, we try to have a win-win relationship with all our payers. We obviously have to be very diligent from our Conifer business operations on our revenue yield as we respond to different requests and candidly denial activity from the payers.

交易所的不利因素對我們的淨營收指標約造成 1.8% 的逆風。從營運角度來看，我們希望與所有付款方建立雙贏關係。在回應付款方不同要求、坦白說也包括付款方拒付（denial）活動時，我們顯然必須在 Conifer 的業務營運上，對收入收益率（revenue yield）保持高度嚴謹。

We perform very well, I think, from a revenue yield basis, and that really has not changed over the last several years in our commentary. We think given Conifer's capabilities and the investments we continue to make in technology and Conifer overall, that we will be able to sustain that. I am wondering if you have any other comments on that. All right, thank you for your question.

我認為，從營收收益率的角度來看，我們表現得非常好，而這一點在過去幾年我們的評論中其實並沒有改變。我們認為，鑑於 Conifer 的能力以及我們持續在科技與 Conifer 整體上所做的投資，我們將能夠維持這樣的表現。我想請問您對此是否還有其他評論。好的，謝謝您的提問。

(Operator Instructions) Ryan Langston, TD Cowen.

(接線員指示) TD Cowen 的 Ryan Langston。

This is Brill for Ryan. I just have a quick question on the state-directed payments. You disclose a number in your filings about Medicaid supplemental payments. I was wondering if you could ballpark what percentage of those will not be subject to reductions under H.R.1? Thanks.

我是代替 Ryan 的 Brill。我想就州指導支付（state-directed payments）的狀況快速問一個問題。你們在申報文件中揭露了 Medicaid 補充支付（supplemental payments）的數字。我想請問，這些補充支付中，大約有多少百分比不會在 H.R.1 之下受到削減？謝謝。

Hey, thanks for your question. We disclose our overall state-directed supplemental Medicaid payments, excuse me, and for this quarter, you will see in our 10-Q, it will be $356 million total of supplemental payments. That being said, we do not disclose the proportion of which would be subject to H.R.1 activity going forward.

嗨，謝謝你的提問。我們揭露的是整體的州指導 Medicaid 補充支付（state-directed supplemental Medicaid payments），不好意思；就本季而言，你會在我們的 10-Q 中看到，補充支付總額為 3.56 億美元。話雖如此，我們不會揭露其中有多少比例在未來會受到 H.R.1 相關措施的影響。

Fair enough. If I could just ask a quick follow-up then on just work requirements and thinking about that for next year. When you think about your total adjusted admissions, what percentage come from Medicaid expansion individuals? Thanks.

了解。那我再追問一個關於工作要求（work requirements）以及明年影響的問題。當你們看總調整後入院量（total adjusted admissions）時，其中有多少百分比來自 Medicaid 擴張（expansion）的個人？謝謝。

When you look at our admissions, I would say there's about 60% of our admissions that are from expansion states. I think that's about it. I think, you know, that we have markets like Michigan where there's a lot of activity and we're important providers in that expansion state as an example. It's about 60%.

如果看我們的入院量，我會說大約有 60% 的入院來自擴張州（expansion states）。我想大概就是這樣。我想，你知道，我們在像密西根這樣的市場有很多活動，我們也是該擴張州的重要提供者，這是一個例子。大約是 60%。

Thanks.

謝謝。

Kevin Fischbeck, Bank of America.

美國銀行（Bank of America）的 Kevin Fischbeck。

Great, thanks. Just one clarification before I ask the question. When you said that you think you're going to be able to grow EBITDA next year, ex Conifer, is that the only adjustment, the $450 million? Or do we also have to take out the prior year Medicaid supplemental payments? Then I guess, the real question is just about your view on surgeries broadly. There's been a lot of talk about a weaker surgery backdrop, and I'd like to hear what you're seeing on that respect. Thanks.

很好，謝謝。在我提問之前先澄清一點。你剛才說你們認為明年在不含 Conifer 的情況下仍能成長 EBITDA，那唯一的調整就是 4.5 億美元嗎？還是我們也需要扣除前一年的 Medicaid 補充支付？那我真正的問題是你們對手術（surgeries）整體的看法。市場上一直在談手術環境轉弱，我想聽聽你們在這方面看到的情況。謝謝。

Yeah, let me start with the second question, I'll pass to Sun. I think the surgical environment, look, from an industry perspective in terms of what we're seeing, we're pleased with our results. Obviously, there are two components, the Hospital segment and the ASC segment, both of which I think are generally consistent or better than what we're seeing in the general industry. Remember, on the USPI side, as I noted, we're still so focused on our strategy of acuity that you have to take those results in light of that.

好的，我先回答第二個問題，然後交給 Sun。我認為手術環境——你看，從產業角度、就我們所看到的而言，我們對自己的結果感到滿意。顯然有兩個組成部分：醫院（Hospital）事業部與 ASC 事業部，我認為兩者的表現大致與整體產業一致或更好。請記得，在 USPI 這邊，如我提到的，我們仍然非常專注於「高病情嚴重度（acuity）」的策略，因此你必須在這個背景下解讀這些結果。

But again, I think competitively differentiated results there as well, both on revenue and volume. So we're pleased with that. That said, I would not say this is a gangbusters surgical environment right now, right? You just have to take both of them together, and the importance of our strategy is probably the critical point here in terms of what's driving our confidence in the earnings growth going forward into 2027.

但再說一次，我認為我們在那裡的表現也具有競爭差異化，無論是營收或量（volume）。所以我們對此感到滿意。話雖如此，我不會說現在是一個手術大爆發（gangbusters）的環境，對吧？你必須把兩者一起看，而我們策略的重要性，可能才是這裡的關鍵點——也就是推動我們對未來、一路到 2027 年獲利成長有信心的原因。

Yeah. Kevin, this is Sun. Just on your clarification question, yeah, we do believe we'll grow total EBITDA next year once you normalize for the $450 million of one-time transition items that we called out this year.

是的。Kevin，我是 Sun。就你剛才的澄清問題，是的，我們確實相信，明年在把我們今年提到的 4.5 億美元一次性轉換項目（one-time transition items）正常化（normalize）之後，總 EBITDA 會成長。

Stephen Baxter, Wells Fargo.

Wells Fargo 的 Stephen Baxter。

Hi, thanks. I was hoping you could update us a little bit on what you're seeing on uncompensated care trends. It looks like in the third quarter, there was some uptick in both unpaid admissions and also, I think a little bit more so, unpaid outpatient visits when compared to the second quarter. Does that go beyond what you're seeing on the exchanges? Any kind of update just on the exchange trajectory throughout the year? Thank you.

嗨，謝謝。我希望你們能更新一下目前看到的無償照護（uncompensated care）趨勢。看起來在第三季，未付費入院（unpaid admissions）以及未付費門診就診（unpaid outpatient visits）相較第二季都有些上升，尤其是未付費門診就診似乎更明顯一些。這是否超出你們在交易所（exchanges）所看到的情況？能否更新一下今年以來交易所的走勢？謝謝。

First of all, the primary comment I would make is that largely Q3 is a stabilization message from Q2, right? If Q1 started with what would have been under the basic run rate of impact, and Q2 accelerated, Q3 is a stabilization message, is our main takeaway there. Then you're right about the slight changes there. I don't know, Sun, if you have any other comments, but that's how we're viewing it.

首先，我主要想說的是，第三季基本上是相較第二季的「穩定」訊號，對吧？如果第一季是從低於基本運行率（run rate）的影響開始，而第二季加速，那第三季的主要結論就是趨於穩定。然後你說的那些小幅變化也沒錯。我不確定 Sun 是否還有其他補充，但我們是這樣看待的。

Nothing further to add, Saum. It's really exchange volume reductions that we discussed and the commensurate increase in uncompensated care numbers that you're seeing. I don't think there's anything beyond that, Stephen.

沒有其他補充，Saum。主要就是我們討論過的交易所量（exchange volume）下降，以及你所看到相應的無償照護數字上升。我不認為除此之外還有其他因素，Stephen。

Whit Mayo, Leerink Partners.

Leerink Partners 的 Whit Mayo。

Thanks. Is there a revenue headwind that we should be aware of as we think about the Hospital segment for the fourth quarter with CommonSpirit now gone? Is the $450 million headwind next year ratably across each of the quarters or does it have a different slope to it? Thanks.

謝謝。在 CommonSpirit 現在已經不在之後，我們在思考第四季醫院事業部時，是否有需要注意的營收逆風（revenue headwind）？另外，明年 4.5 億美元的逆風是平均分攤到每一季（ratably across each of the quarters），還是會呈現不同的斜率（slope）？謝謝。

Yeah. Hey, Whit, this is Sun. The only revenue headwind we will call out is the timing piece that we explicitly said, the $97 million that came into Q3 from a timing basis that otherwise would have been in Q4 instead. I think that is the only material one that I would call out from a Hospital segment perspective.

是的。嗨，Whit，我是 Sun。我們要特別指出的唯一營收逆風，是我們明確提到的時間點因素（timing piece）：有 9,700 萬美元因時間點關係在第三季入帳，否則本來會在第四季入帳。我認為，從醫院事業部的角度來看，這是我會點出的唯一重大項目。

For next year, the $450 million, I would say a big portion of that would be spread ratably throughout the year, and that is the overall contribution of the CommonSpirit contract that we saw this year. Then there is a portion, and we call that about $160 million total between Q3 and Q4. That is going to be more, obviously, second half weighted, given that some of the efficiency and transaction activities took place in the second half of the year versus the first half. I think those are the major moving pieces.

至於明年那 4.5 億美元，我會說其中很大一部分會在全年平均分攤，這部分是我們今年看到的 CommonSpirit 合約整體貢獻。另外還有一部分——我們說大約總計 1.6 億美元，落在第三季與第四季之間——這部分顯然會更偏向下半年，因為部分效率與交易相關活動是在下半年發生，而不是上半年。我想這些就是主要的變動因素。

Okay, thanks.

好的，謝謝。

Brian Tanquilut, Jefferies.

Jefferies 的 Brian Tanquilut。

Hey, good morning, guys. Sun, as I think about the salaries line, I see it down both sequentially and a year-over-year basis. Is this largely driven by the Conifer transition, or is there anything to think about, in terms of the efforts that you guys have put in on SWB, and is this the right baseline to basically adjust and build off of going forward? Thanks.

嗨，早安，各位。Sun，當我看薪資（salaries）這一行時，我看到無論是季比（sequentially）或年比（year-over-year）都在下降。這主要是由 Conifer 轉換所驅動的嗎？還是說，從你們在 SWB 上所做的努力來看，還有其他需要考量的因素？另外，這是否就是未來用來調整並作為基礎往上建立（adjust and build off of）的正確基準？謝謝。

Yeah, I would actually say it's the other way around. Most of the efficiency you're seeing in our SWB line is from all the things that we just talked about over the course of the year, where we obviously have spent a lot of time and energy and effort and have shown performance on cost controls, in the face of Ex, exchange reductions and other challenges. There are a lot of moving pieces, obviously, in that line item. But a majority of that is from our efficiency efforts. As you get into Q3 and Q4, as again said, there are some additional efficiency initiative impact that we'll see as we transition activities. But by and large, SWB is from our efficiency efforts overall across Tenet Healthcare.

是的，我其實會說是反過來。你在我們 SWB 這一行看到的大部分效率改善，來自於我們今年一路以來剛剛談到的各項作為；我們顯然投入了大量時間、精力與努力，並且在成本控管上展現了成果，以因應交易所（Ex，exchange）縮減及其他挑戰。當然，那個科目裡有很多變動因素。但其中大多數來自我們的效率提升努力。進入第三季與第四季時，如同剛才所說，隨著我們進行轉換活動，還會看到一些額外的效率專案影響。但整體而言，SWB 主要來自我們在 Tenet Healthcare 全面推動的效率提升努力。

Thank you.

謝謝。

Pito Chickering, Deutsche Bank.

Pito Chickering，德意志銀行。

Hey. Good morning, guys, and thanks for taking my questions. Just looking at the ASC growth engine, for the next few years, ortho, has obviously been a big one. But should we be thinking about other areas like urology, bringing in used da Vinci, used Xi, urology, and as you look past ortho, which again, will continue for another couple of years, where's the next sort of big growth engine that we should be thinking about within ASCs?

嗨。各位早安，謝謝讓我提問。我想就 ASC 的成長引擎來看，未來幾年骨科顯然一直是很大的動能。但我們是否也該思考其他領域，例如泌尿科，引進二手的達文西（da Vinci）、二手 Xi，用於泌尿科？以及當你們把視角放到骨科之後（骨科當然還會再持續成長幾年），ASC 內下一個我們應該關注的主要成長引擎會是什麼？

Yeah. Thanks, Pito. For sure, orthopedics and the expansion of orthopedics cases beyond the current case mix is an important driver. But in addition for us, as you know, we have been pursuing growth in urology, in general surgery, in advanced body robotics, in spine. There are a number of areas, standing up some new cardiac centers, as I've always said, slower process, but still opportunity. So the diversification into higher acuity areas while maintaining and growing our base are both important drivers of that future.

是的。謝謝你，Pito。當然，骨科，以及將骨科手術案例擴展到目前病例組合之外，是一個重要的驅動因素。但此外，如你所知，我們也一直在推動泌尿科、一般外科、進階軀幹機器人手術、脊椎等領域的成長。另外也有一些領域，例如建立新的心臟中心——我一直說這是較慢的過程，但仍然有機會。因此，在維持並擴大我們基本盤的同時，向更高急性度領域多元化，兩者都是未來的重要驅動因素。

And really, the combination of that strategy with the regulatory framework and support for moving surgical care into safe, lower-cost settings are both things that I think will benefit us over a multi-year period. In this environment, and look, the regulatory environment is somewhat known and somewhat uncertain based upon what happens from an election standpoint. But I would say and reiterate what I noted in my comments, which is having the diversified platform at the scale we have it is a really important driver of our ongoing ability to build and grow this business at an enterprise level.

而且我認為，這項策略與監管架構及其對將外科照護移轉到安全、低成本場域的支持相結合，將在多年期間為我們帶來助益。在這樣的環境下——監管環境某種程度上是已知的，但也會因選舉結果而存在一定不確定性。不過我想重申我在評論中提到的：我們擁有目前這樣規模的多元化平台，是推動我們在企業層級持續打造並擴張這項業務能力的一個非常重要的因素。

Great, and then a follow-up here. You raised the core EBITDA growth by sort of three million versus last quarter. I assume there's a lot of moving pieces within that three million. So can you sort of talk about the good guys and bad guys within that, as it seems pretty solid considering the volatility we're seeing in the markets today? Thank you.

很好，接著一個追問。你們把核心 EBITDA 成長相較上季提高了大約 300 萬。我猜這 300 萬裡面有很多變動因素。所以你能否談談其中的正面與負面因素？考量到我們今天在市場上看到的波動，這看起來相當穩健。謝謝。

Yeah, Pito, I think, as we kind of said in our prepared comments, the change in our estimates and guidance ranges was pretty mechanical this quarter, where it was virtually all to do with the one-time items as well as the revenue recognition piece that we already mentioned, plus the out-of-period Medicaid. Without those, I would say, from a core fundamental performance basis, we had a very significant raise last quarter, both for the first half of the year and the second half of the year. And we think we obviously delivered to our increased expectations in Q3. So I would say those are probably the moving pieces I would point out.

是的，Pito，我想如同我們在事先準備的發言中提到的，本季我們對估計與指引區間的調整相當「機械式」，幾乎全部都與一次性項目，以及我們先前提到的收入認列事項，再加上跨期的 Medicaid 有關。如果不考慮這些，我會說，從核心基本面表現來看，我們上季已經做了非常顯著的上修，涵蓋上半年與下半年。而我們也認為第三季顯然達成了我們提高後的預期。所以我會說，這些大概就是我會指出的主要變動因素。

Yeah, we're reiterating the belief in the strength of the business today and also our ability to manage that into the fourth quarter at the elevated levels that we've provided. And we think we have the foundation in place and the tactics for the fourth quarter in place, given the demand we're seeing right now for a successful end to the year.

是的，我們重申對當前業務強勁表現的信心，也重申我們有能力在第四季把這樣的表現維持在我們所提供的較高水準。基於我們目前看到的需求，我們認為我們已具備基礎與第四季所需的策略，以在年底交出成功的成績。

Great. Thanks so much. Appreciate it.

很好。非常感謝。感激不盡。

(Operator Instructions) A.J. Rice, UBS.

（接線員指示）A.J. Rice，瑞銀。

Hi, everybody. We have had now, with the announcement over the last week, two major deals where non-profit health systems are buying surgery center assets, paying significantly higher premiums than what your business is being valued in the market. USPI has generally been viewed in the industry as probably the premium surgery center asset. I wonder, with that backdrop, can you comment on, is this having any impact in the market on deals, the smaller deals, in terms of how people are thinking about pricing?

各位好。隨著上週的公告，我們現在看到兩筆重大交易：非營利醫療體系正在收購手術中心資產，支付的溢價顯著高於市場目前對你們業務的估值。在業界，USPI 一般被視為可能是最優質的手術中心資產。在這樣的背景下，我想請你們評論：這是否對市場上的交易、尤其是較小型交易的定價思維產生任何影響？

Is it changing the competition for ASC assets in any way? Maybe these guys are out of the market because they are in the process of selling, or maybe the nonprofit systems are gearing up to be more active acquirers. Does it do anything to make you think about being more proactive in trying to get recognition for the value that is obviously there at USPI, but does not seem to be recognized by the market?

它是否以任何方式改變了對 ASC 資產的競爭？也許這些人因為正在出售而退出市場，或是非營利體系正準備成為更積極的收購方。這是否會讓你們考慮更主動地爭取市場對 USPI 明顯存在、但似乎未被市場認可之價值的認同？

Well, thanks, A.J. Let's start with the last part of it. As I commented, at the end, I think from a practical perspective, the two things that we can do are continue to deliver differentiated earnings growth. I believe that USPI has delivered differentiated earnings growth versus any other ASC platform in the industry, both recently and over a long period of time. I think the facts would support that pretty easily. The second thing is, with our free cash flow generation, recognizing the attractive valuation of our equity, relative to what are some reasonable valuations of, in this case, more recently, ASC hospital combination platforms, as I noted.

好的，謝謝你，A.J. 我先從最後一部分開始。如我在結尾所評論的，從務實角度來看，我們能做的兩件事是：第一，持續交出具差異化的獲利成長。我相信，無論是近期或長期，USPI 相較於業界任何其他 ASC 平台，都交出了具差異化的獲利成長。我認為事實很容易支持這一點。第二，憑藉我們的自由現金流產生能力，並考量到我們股權的吸引人估值，相對於一些合理估值——例如我提到的、近期較常見的 ASC 與醫院結合平台的估值。

So those are the two practical things. Look, we believe in continuing to build this business and do it in a differentiated manner. In terms of the M&A market, look at the third quarter again, right? A very successful third quarter in acquisitions, the vast majority of which were not competitive processes, but came exclusively to USPI, in those processes. We have a terrific pipeline looking ahead. I know we keep saying that, but the reality is our acquisitions every year continue to confirm that pipeline translates to actual acquisition activity and successful ramp-up of our ability to deliver synergies into those assets.

所以，這就是兩個務實的作法。我們相信持續以具差異化的方式打造這項業務。就併購市場而言，再看第三季，對吧？第三季的收購非常成功，其中絕大多數並非競標流程，而是在那些流程中專屬地來到 USPI。展望未來，我們有非常強勁的案源管線。我知道我們一直這麼說，但事實是，我們每年的收購都持續證明：這些管線會轉化為實際的收購活動，並且我們能成功加速導入協同效益到這些資產中。

De novo development, new tools in the toolkit about how we think about those de novo developments, a heavier focus of those de novo developments into some of the higher acuity service lines where we've built a differentiated reputation in the marketplace with physician and physician groups and MSOs, that are investing in those specialties. So I think that's another important feature of what we are able to do, looking forward.

至於新設（de novo）開發，我們在工具箱中也有新的工具，來思考如何進行這些新設開發；並且更聚焦把這些新設開發導向一些更高急性度的服務線——在這些領域，我們已在市場上、在醫師與醫師團體以及投資這些專科的 MSO（醫師管理服務組織）之間，建立了具差異化的聲譽。因此，我認為這也是我們展望未來能做到的一個重要特點。

Finally, because of the value that we are providing health plans in the ASC sector and the government, candidly, our ability to move into new markets and new states with our contracting platform and move surgical care into lower cost settings without having to own more acute care hospitals is another important differentiator in what we are able to do with respect to expanding USPI's scope and activity. So again, as you can imagine, we spend a lot of time on this and how we remain competitively differentiated, going forward, not just where we are today.

最後，坦白說，因為我們在 ASC 領域為健康保險計畫以及政府所提供的價值，我們能夠憑藉合約平台進入新市場與新州，並在不必擁有更多急性照護醫院的情況下，把外科照護移轉到更低成本的場域——這也是我們在擴大 USPI 規模與活動方面的一個重要差異化優勢。所以如你所想像，我們在這方面投入很多時間，思考如何在未來維持競爭上的差異化，而不僅僅是停留在今天的狀態。

Hopefully that gives you a little bit of a flavor of it. Look, in terms of the two recent ASC acquisitions, I've personally extended my congratulations to both new owners. This is an important part of the market, and we have a lot of work to do together from an advocacy perspective in order to support and build the growing interest in ambulatory surgery, maintain high quality and safety, and also ensure that regulators understand the benefits that this portion of the surgical sector is providing to the cost of healthcare going forward. I look forward to those collaborations with those leaders.

希望這能讓你稍微了解一些。至於近期兩筆 ASC 收購案，我本人已向兩位新所有者致上祝賀。這是市場中很重要的一部分；從倡議（advocacy）的角度，我們也有很多工作需要一起合作，以支持並建立門診手術日益增加的市場興趣、維持高品質與安全，同時也確保監管機關理解：這一部分外科領域在未來對醫療成本所帶來的效益。我期待與這些領導者展開合作。

Okay. Thanks a lot.

好的。非常感謝。

Justin Lake, Wolfe Research.

Justin Lake，Wolfe Research。

Thanks. Good morning. You guys have done an incredible job of managing costs and improving margins at the Hospital segment in particular. Wanted to see if you can give us any color on where you see yourself in terms of the life cycle of that margin trajectory. Effectively asking whether you still see meaningful opportunity here, or should we expect core growth going forward in the hospital business to look more like top-line growth, X items like DPP, exchanges, work requirements that are going to be transitioning?

謝謝。早安。你們在成本管理與提升利潤率方面做得非常出色，尤其是在醫院事業部。想請你們分享一些看法：就利潤率走勢的生命週期而言，你們認為目前處於什麼階段？換句話說，你們是否仍看到顯著的改善空間？或者我們應該預期，未來醫院業務的核心成長會更接近營收端成長（排除像 DPP、交易所、工作要求等正在轉換的項目）？

Hey, Justin. Thanks for the question. We have spent a lot of time and energy making sure that our total business, including hospitals, as you noted, is running efficiently and we are finding cost opportunities wherever we can. That has been a longstanding campaign for Tenet, obviously. This year, as we have talked about several times, we accelerated those efforts, including adoption of different technologies and AI tools, for obvious reasons in the face of some headwinds that we had in Exchange as well as other dynamics.

嗨，Justin。謝謝你的提問。我們投入了大量時間與精力，確保我們的整體業務（包括你提到的醫院）運作高效，並且在任何可能的地方尋找成本機會。這顯然一直是Tenet長期以來的行動。今年，如同我們多次談到的，我們加速了這些努力，包括採用不同的技術與AI工具，原因很明顯，是為了因應我們在Exchange以及其他動態上所面臨的一些逆風。

Going forward, it is tough to say where in the life cycle we are, right? I think it is reasonable to assume that we will have access to even more improved technologies and other solutions as we go that we may not be aware of today, but that we can adopt as we go in the future. I think Tenet's shown the ability to do that. From a more operational basis, the operating environment, I think, is pretty stable, as we've said many times. From a labor standpoint, from our ability to manage our suppliers other medical professional providers. I think, there remains opportunity, and we will continue to work on those, but I think we've managed that pretty significantly.

展望未來，很難說我們正處於生命週期的哪個階段，對吧？我認為可以合理假設，隨著時間推進，我們將能接觸到更多改良的技術與其他解決方案，其中有些我們今天可能還不知道，但未來可以逐步採用。我認為Tenet已展現出這樣做的能力。從更偏營運的角度來看，我認為營運環境相當穩定，正如我們多次所說。就勞動力而言，以及我們管理供應商與其他醫療專業服務提供者的能力而言。我認為仍然存在機會，我們也會持續推進，但我認為我們已經在這方面做了相當顯著的管理。

So listen, I think Tenet's been showing the ability to kind of dial up, dial down, as the situation requires. We'll see as we get through our planning for 2027 what all the headwinds and tailwinds are. Obviously, managing our operating expenses will be a big part of how we deliver our commitments. So hopefully that answers the question. Thanks, Justin.

所以我想說，Tenet一直展現出能夠依情勢需要來調高或調低的能力。等我們完成2027年的規劃後，我們會再看看有哪些逆風與順風。顯然，管理我們的營運費用將是我們兌現承諾的重要一環。希望這回答了你的問題。謝謝你，Justin。

The only thing I'd add is that our commentary about 2027 is probably a reflection of how positively we feel about our controllable activities, looking forward into the coming year.

我唯一想補充的是，我們對2027年的評論，可能反映了我們對可控活動的正向感受，並將視角延伸到明年。

Agree.

同意。

Great. Thanks.

很好。謝謝。

Thank you.

謝謝。

Andrew Mok, Barclays.

Andrew Mok，Barclays。

Good morning. Total joints have been a strong category for quite some time, but it looks like that category re-accelerated at USPI this quarter. Is there anything to call out driving that re-acceleration of total joint growth? And do you believe that share is still coming from hospitals? Thanks.

早安。全關節置換（total joints）長期以來一直是強勢類別，但看起來本季在USPI該類別又再度加速。有沒有什麼因素可以說明，推動全關節置換成長再加速？你是否認為市占仍然是從醫院端移轉過來的？謝謝。

Yes. I think when you say, is that share coming from hospitals, I think it's coming from migration of cases from probably an HOPD to a freestanding outpatient setting. I think the driver of that is the continued efforts that we make in helping surgeons realize that they have a service-differentiated site of care that, as they get comfortable with it, they can continue to grow their activity in that environment, right? It's more convenient for them, it's more convenient for their patients.

是的。我想你問市占是否來自醫院，我認為是病例從可能的HOPD（醫院門診部）移轉到獨立的門診場域。我認為驅動因素是我們持續努力協助外科醫師意識到，他們有一個具服務差異化的照護地點；當他們對此更熟悉後，就能在那個環境中持續擴大其業務量，對吧？對他們更方便，對病患也更方便。

One of the important things that we have, I think I've talked about before, is the ability to help these surgeons, who are pretty smart about opportunity and risk with their patients, to use frameworks we've established to give them more predictability in terms of which cases are safe in the ASC environment, likely to be successful, and which conditions they may want to think about that would drive them to continue for patient success and safety standpoint in the hospital.

我認為我們有一個很重要的能力，我之前也談過：協助這些外科醫師——他們在病患的機會與風險判斷上相當精明——運用我們建立的框架，讓他們在判斷哪些病例在ASC環境中是安全的、成功機率高，以及哪些狀況可能需要考量回到醫院以確保病患成功與安全方面，能有更高的可預測性。

Those protocols, I think, are very helpful to growing the confidence in the surgical community of what they can achieve in a USPI ASC, and that's helping to drive the organic growth. It's a matter of really expanding the access to those protocols, which is really about how many surgeons trial an environment in the USPI setting. One of the things we do in this service line is give surgeons an opportunity to trial USPI centers without having to be joint venture partners or equity owners or other things. So that's a really important feature of what we create capacity to do in our environment, because those could be future partners, in perhaps new de novo and other centers.

我認為這些流程（protocols）非常有助於提升外科社群對於在USPI ASC能達成什麼的信心，並推動內生成長。關鍵在於擴大這些流程的可及性，而這實際上取決於有多少外科醫師在USPI的環境中試用。我們在這條服務線做的一件事，是讓外科醫師有機會試用USPI中心，而不必成為合資夥伴、股權持有人或其他身分。因此，這是我們在自身環境中所打造之產能的一個非常重要特點，因為這些人未來可能成為合作夥伴，或許在新的de novo及其他中心。

Great. Thank you.

很好。謝謝。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

Thank you. You guys have talked positively about surgical results versus the industry. Are you gaining surgical share in 2026? Is it on the Hospital, USPI, or both? How are you thinking about the surgical versus medical mix heading into 2027?

謝謝。你們談到相較於產業，你們的手術結果表現更為正向。你們在2026年是否正在提升手術市占？是在醫院端、USPI端，還是兩者都有？你們如何看待進入2027年時，手術與內科（medical）組合的變化？

Yeah. So two things. I would reiterate our strategic focus. We're primarily focused on growing and succeeding in share capture in our higher acuity surgical areas and continuing to build more access points in some of the more foundational ambulatory surgery center environments, which is effectively share capture by growing the number of surgeons or number of doctors affiliated with USPI. In the high acuity areas, we're doing that, plus we are seeing growth that's based upon the question that we just answered around the migration from higher cost to lower cost settings. It's a combination of the two, which is why you see higher growth rates.

是的。兩點。我會重申我們的策略重點。我們主要聚焦於在較高病情嚴重度（higher acuity）的手術領域擴張並成功取得市占，同時在一些更基礎的門診手術中心環境中持續建立更多的可及點；這本質上是透過增加與USPI合作的外科醫師或醫師人數來取得市占。在高病情嚴重度領域，我們正在這麼做；此外，我們也看到成長來自於我們剛剛回答的問題——病例從高成本場域移轉到低成本場域。兩者結合，這也是你看到較高成長率的原因。

The summary from both of those is that we are increasing the proportional share that's happening in the lower cost ASC setting. In the acute care business, as I noted, this year has tilted a bit more towards both significant emergent and medical care on balance than surgical care, though both have been important drivers of our strategy.

這兩者的總結是：我們正在提高在低成本ASC場域發生的占比。在急性照護業務方面，如我所提，今年整體上相較於手術照護，稍微更偏向顯著的急診（emergent）與內科照護，儘管兩者都是我們策略的重要驅動因素。

Remember, for us, again, the focus on that higher acuity segment is very important in terms of what we're doing. That's what supports our revenue growth and case mix index growth and the ongoing opportunities for expense management we have with our length of stay platform and the things we're doing there. The mix of business gives us an opportunity to both grow revenue intensity and improve our expense management, which is why you see the margin strength that we're able to deliver.

請記得，對我們而言，再次強調，聚焦於較高病情嚴重度的區隔，對我們正在做的事情非常重要。這支撐了我們的營收成長、病例組合指數（case mix index）成長，以及我們透過住院天數（length of stay）平台與相關措施所持續擁有的費用管理機會。這樣的業務組合讓我們同時有機會提升營收強度並改善費用管理，這也是你看到我們能交付強勁利潤率的原因。

Thank you.

謝謝。

Ann Hynes, Mizuho Securities.

Ann Hynes，瑞穗證券（Mizuho Securities）。

Good morning. Thank you so much. Thanks on the visibility for able to be able to grow in 2027. Do you have any targets, meaning do you have a long-term target for each segment? And if you do you think you will be able to grow within those long-term targets for each segment? Thank you.

早安。非常感謝。謝謝你們提供對於2027年能夠成長的能見度。你們有任何目標嗎？也就是說，你們是否對各個事業部門有長期目標？如果有的話，你們認為各部門能在這些長期目標範圍內成長嗎？謝謝。

Yeah, Ann, we have not indicated any kind of long-term targets in the segments other than what we sort of repeat year- over- year when we give guidance until there is full clarity about what is going to happen vis-a-vis H.R.1, which we believe is very highly subject to modification based upon election outcomes over the next few years.

是的，Ann，我們尚未對各部門提出任何形式的長期目標；除了我們在提供財測時每年反覆提到的那些之外。原因是，在H.R.1相關事項完全明朗之前，我們不會這麼做；而我們認為，H.R.1在未來幾年的選舉結果影響下，非常可能會被修改。

Craig Hettenbach, Morgan Stanley.

Craig Hettenbach，Morgan Stanley。

Yes, thank you. Saum, in the hospital segment, the transfer program has been an important driver of higher acuity growth and margin performance. Can you just touch on the strategy behind that and the durability of that strategy?

是的，謝謝。Saum，在醫院事業部門，轉診/轉院（transfer）計畫一直是推動更高病情嚴重度成長與利潤率表現的重要驅動因素。你能否談談背後的策略，以及這項策略的持久性？

Yes. Thanks, Craig. Look, I think it's very important in this environment, coming out of COVID, this is more of a long-term strategy that urban and sort of larger suburban hospitals have an important role to play in providing access to more smaller suburban and certainly more rural communities, where the funding just hasn't been necessarily fully available to refresh capital physician specialty capacity and other things coming out of the COVID crisis. At the same time, there's still people that live there, need access, get very sick, and go to their hospitals.

是的，謝謝你，Craig。你看，我認為在這個環境下、在COVID之後，這是一個更長期的策略：都會區以及較大型的郊區醫院，在為較小型郊區、當然也包括更偏鄉的社區提供可近性方面，扮演著重要角色；因為在COVID危機之後，這些地區的資金未必能完全到位，用於更新資本、醫師專科量能以及其他事項。同時，仍然有人住在那裡、需要醫療可近性、會病得很重，並且會前往他們當地的醫院。

We have a very important to us transfer program strategy that is willing and able to receive all patients from these outlying locations when there are needs, and importantly, return them to their home communities as appropriate as early as possible as well. Our ability operationally to have built these successful partnerships have been sustainable, we've found over a number of years. In the end, if you're a good partner to more rural and smaller suburban communities, they remember that, and you're reliable, and you take their patients when they need it, and you return their patients to them when appropriate.

我們有一項對我們而言非常重要的轉診計畫策略：在有需求時，願意且有能力接收來自這些偏遠地區的所有病患；更重要的是，也會在適當情況下，盡可能及早將他們送回其原本的社區。我們在營運上建立這些成功夥伴關係的能力，經過多年驗證，我們發現是可持續的。歸根結底，如果你能成為較偏鄉與較小型郊區社區的好夥伴，他們會記得；你值得信賴、在他們需要時接收病患，並在適當時機把病患送回去。

They remember that. Those relationships that have been built through the back end of COVID, and all the way into today are an important part of our strategy. Look, we also have built a better expertise than the market in taking care of high acuity patients and transfers because it's the heart of our strategy. We save intensive care unit capacity for these types of patients. We are very good at stepping people down out of the intensive care unit when their care is safe in that manner in order to create that capacity.

他們會記得。這些在 COVID 後期一路延續到今天所建立的關係，是我們策略的重要一環。另外，我們在照護高病情嚴重度病患與轉診方面，也建立了比市場更強的專業能力，因為這正是我們策略的核心。我們會保留加護病房（ICU）量能給這類病患。當病患的照護狀況允許時，我們也非常擅長讓病患從加護病房降階照護，以釋出量能。

We also have emergency department contracts and physicians that understand we take this obligation to these communities very seriously. Therefore, we create and save capacity for those patients in the emergency environment as well. So it is a comprehensive approach that we do not think is very easy to replicate, in terms of what we have put in place. Yes, it is an important driver of our, in the end, to simplify our high acuity strategy.

我們也有急診部門的合約與醫師團隊，他們理解我們非常嚴肅看待對這些社區所承擔的責任。因此，我們也會在急診環境中為這些病患建立並保留量能。所以這是一套全面性的作法；就我們已經建置的內容而言，我們認為並不容易被複製。是的，這最終也是推動我們（簡化）高病情嚴重度策略的重要驅動因素。

Helpful context. Thank you.

這些背景資訊很有幫助。謝謝。

Ben Hendrix, RBC.

RBC 的 Ben Hendrix。

Great. Thank you very much. Just wanted to follow up on some of the joint procedure momentum discussion. I realize that the strength you are seeing reflects the high acuity focus, service line initiatives, share capture, et c. But just hoping to get a sense of some of the underlying demand trends in your markets. I think one of your peers had talked about a lull in high acuity ortho with clinic and imaging volume, not necessarily converting to procedures. Wanted to see what degree you are seeing delays build and if that is informing your growth expectations for 2027. Thanks.

很好。非常感謝。我想追問一下你們先前提到的關於關節手術動能的討論。我理解你們看到的強勁表現反映了對高病情嚴重度的聚焦、服務線（service line）計畫、份額取得（share capture）等等。但我希望了解一下你們市場中一些更底層的需求趨勢。我想你們某位同業曾提到，高病情嚴重度骨科出現一段低迷期：門診與影像量有，但不一定轉化為手術。想請教你們看到延遲累積到什麼程度，以及這是否影響你們對 2027 年成長的預期。謝謝。

Yeah. Obviously, we've thought a lot about this this year, and in various forums have kind of made comments about it. Again, I think what I said today was, it's not a gangbusters environment. On a differentiated basis, we're performing well, and I think that's good. I think secondarily, as I said, the commitment we have at USPI is to build and grow the revenues and earnings of the business and to be strategic rather than just kind of catchers of what's in the market. I think being strategic has consistently helped us over the last few years, in terms of how we've built the business. So look, we anticipate continuing to do both.

是的。顯然我們今年對此思考很多，也在不同場合發表過一些看法。再說一次，我今天的說法是，這不是一個「爆發式成長」的環境。但就差異化表現而言，我們做得不錯，我認為這是好事。其次，如我所說，我們在 USPI 的承諾是建立並成長該業務的營收與獲利，並以策略性方式推進，而不是只是被動承接市場上自然發生的量。我認為，過去幾年在建構業務的過程中，策略性做法一直持續幫助我們。所以我們預期兩者都會持續推進。

I think as the coverage environment settles, maybe this demand environment will, when I say settle, it'll at least become more predictable as we look ahead and hopefully that in combination with settling some of the uncertainty around the election will also help settle 2027. From our standpoint, as we've gone through our planning process to date, we couldn't see anything visible that suggested that we shouldn't be able to deliver another, as I called it, consistent year ahead, at USPI. On top of that, I think I indicated our M&A environment is tracking towards the raised guidance for this year that we gave earlier this year, in terms of our ability to have more affiliated centers at USPI. So we're looking forward to 2027 from the perspective of ambulatory surgery.

我認為，隨著保險給付／承保環境逐步穩定——我說的穩定，至少是指在往前看時會更可預測——再加上選舉相關不確定性逐漸消退，也將有助於讓 2027 年的環境更趨穩定。就我們而言，截至目前的規劃流程中，我們沒有看到任何明顯跡象顯示我們無法在 USPI 於未來一年再交出一個（如我所稱）一致性表現的一年。除此之外，我想我也提到，我們的併購（M&A）環境正朝向今年稍早我們上調的指引在推進，也就是我們有能力在 USPI 擁有更多的合作中心（affiliated centers）。因此，從門診手術的角度來看，我們對 2027 年感到期待。

Thank you.

謝謝。

Thank you.

謝謝。

Thanks.

謝謝。

Benjamin Rossi, JPMorgan.

JPMorgan 的 Benjamin Rossi。

Great. Thanks for squeezing me in here. I guess I will just end with following up on some of the surgical comments. Saum, you have discussed OR productivity a good deal when framing your high acuity strategy. Just with surgical growth in negative territory across segments year-to-date, can you give us an update on how OR dynamics and throughput are working, how clinics are managing through anesthesia coverage, and how you are approaching things like OR scheduling and physician recruitment as you take on these longer duration cases? Thanks.

很好。謝謝讓我插個問題。我想最後追問一下你們關於手術的幾點評論。Saum，你在闡述高病情嚴重度策略時，談了不少手術室（OR）生產力。在今年迄今各分部手術量成長落在負值的情況下，你能否更新一下手術室的運作動態與吞吐量（throughput）表現、門診如何因應麻醉人力覆蓋（anesthesia coverage），以及在承接這些手術時間更長的病例時，你們如何處理例如 OR 排程與醫師招募等事項？謝謝。

Yeah. Well, I think I have indicated before, one of the sort of just simple operational benefits of longer case times in higher acuity surgery is productive OR capacity utilization. Like anything else, it is a fixed asset. In the case of ambulatory surgery centers, it is a fixed asset that is only open for a certain number of hours every single day, or at least every weekday, generally. The importance of that OR utilization as a driver of our revenue growth is something that we track very carefully. To the point I think you are making, the improvements in those areas are helpful to us. Look, there are still operationally areas that we are working on improving.

是的。我想我之前提過，高病情嚴重度手術中較長的手術時間，帶來的一個相對簡單的營運面好處，就是手術室量能利用率更具生產力。和其他任何事情一樣，這是一項固定資產。以門診手術中心（ASC）而言，這項固定資產每天只在一定時數內開放，或至少通常是每個工作日。手術室利用率作為推動我們營收成長的驅動因素之一，其重要性我們追蹤得非常仔細。就你提到的重點而言，這些面向的改善對我們是有幫助的。當然，在營運上仍有一些領域是我們正在努力改善的。

Some of the new tools that we are working with trialing in patient outreach, including agentic solutions, with respect to improving case cancellations and reminders, could be important drivers over time. Some of the analytics that we are learning from with some of these new tools that help us think about how to organize better operating room schedules to maximize the utilization, short cases versus long cases, turnover times, what generates efficiency. Some of these things, in the past, you would have to rely on the intuition of center leaders who have just been so experienced doing it.

我們正在病患觸達（patient outreach）方面試行一些新工具，包括代理式（agentic）解決方案，用於改善手術取消率以及提醒通知；長期來看，這些可能成為重要的驅動因素。另外，透過部分新工具所帶來的分析洞見，也能幫助我們思考如何更好地安排手術室排程以最大化利用率——短手術與長手術的搭配、換台時間（turnover times）、以及哪些因素能帶來效率。過去，這些事情往往必須仰賴中心主管的直覺，因為他們在這方面累積了非常豐富的經驗。

Now, with the availability of analytics tools, you can actually put a lot of that retrospective data into algorithms that will help you decide better how to manage your OR scheduling even, from that perspective. So we are trying all of that stuff in the spirit of being better ASC operators and the way in which this organization embraces the use of many of these AI-based technologies. We will see what works, looking forward. But I hope that those things, in partnership with our doctors, continue to help us improve the efficiency and accuracy with which we run our operating rooms.

現在，隨著分析工具的可用性提升，你其實可以把大量回溯資料放進演算法中，從這個角度協助你更好地決定如何管理手術室排程。因此，我們正在嘗試這些作法，目標是成為更好的 ASC 營運者，也符合本組織擁抱多種 AI 為基礎技術的方式。未來我們會看看哪些有效。但我希望這些作法能與我們的醫師夥伴合作，持續幫助我們提升手術室運作的效率與準確性。

The other things that happen in that environment, of course, are all of the things related to accurately capturing charges, preparing pre-authorization. All of those areas have opportunity for technology to benefit the way that we're doing those things. I think your last question or part of your question in there that I'll wrap with here is, on the anesthesia side. I think largely that market, which hasn't been a favorable line item from an expenditure standpoint, has somewhat stabilized. And, I think it's well known in the industry that we focus our work with a preference on in-network anesthesia. And we do our best to make that clear across the board.

當然，在那樣的環境中，還有其他事情會發生，包括所有與正確擷取費用（charges）、準備事前授權（pre-authorization）相關的工作。在這些領域，科技都有機會為我們目前的作業方式帶來效益。我在這裡也回應你問題的最後一部分：麻醉方面。我認為整體而言，那個市場——從支出角度來看一直不是有利的費用項目——已經在某種程度上穩定下來。而且我想業界也很清楚，我們在麻醉合作上偏好使用網內（in-network）麻醉。我們也盡最大努力在各方面把這點說清楚。

Thank you. And ladies and gentlemen, we have reached the end of the question- and- answer session, and this also concludes today's conference, and you may disconnect your lines at this time. We thank you for your participation. Have a great day.

謝謝。各位女士先生，我們的問答環節到此結束，今天的會議也告一段落，您現在可以掛斷電話。感謝各位的參與。祝各位有美好的一天。