環球健康 (UHS) 2024 Q3 法說會逐字稿

Good day, and thank you for standing by. Welcome to the Third Quarter 2024 Universal Health Services earnings conference call.

您好，感謝您的支持。歡迎參加 2024 年第三季全民健康服務收益電話會議。

(Operator Instructions)

（操作員指令）

Please be advised that today's conference is being recorded.

請注意，今天的會議正在錄音。

I would now like to hand the conference over to your speaker today, Steve Filton. Executive Vice President and CFO. Please go ahead, sir.

現在，我想將會議交給今天的發言人史蒂夫·菲爾頓。執行副總裁兼財務長。先生，請繼續。

Thank you. Good morning, and welcome to this review of Universal Health Services results for the third quarter ended September 30, 2024. During the conference call, I'll be using words such as believes, expects, anticipates, estimates and similar words that represent forecasts, projections and forward-looking statements. For anyone not familiar with the risks and uncertainties inherent in these forward-looking statements, I recommend the careful reading of the section on Risk Factors and forward-looking Statements and Risk Factors in our Form 10-K for the year ended December 31, 2023, and our Form 10-Q for the quarter ended June 30, 2024.

謝謝。早安，歡迎閱讀截至 2024 年 9 月 30 日第三季的全民健康服務業績回顧。在電話會議期間，我將使用相信、預期、預計、估計等詞語以及代表預測、預期和前瞻性陳述的類似詞語。對於不熟悉這些前瞻性陳述所固有的風險和不確定性的任何人，我建議仔細閱讀我們截至 2023 年 12 月 31 日的 10-K 表中的風險因素和前瞻性陳述和風險因素部分，以及截至2024 年6 月30 日季度的10-Q 表。

I'd like to highlight just a couple of developments and business trends before opening the call up to questions. As discussed in our press release last night, the company recorded net income attributable to UHS per diluted share of $3.80 for the third quarter of 2024. After adjusting for the impact of the items reflected on the supplemental schedule, as included with the press release, our adjusted net income attributable to UHS per diluted share was $3.71 for the quarter ended September 30, 2024.

在開始提問之前，我想先強調一些發展和商業趨勢。正如我們昨晚的新聞稿中所討論的那樣，該公司 2024 年第三季歸屬於 UHS 的每股攤薄淨利潤為 3.80 美元。在調整新聞稿中補充時間表所反映的項目的影響後，截至 2024 年 9 月 30 日的季度，我們歸屬於 UHS 的調整後每股攤薄淨利潤為 3.71 美元。

As we anticipated, acute care volumes have moderated somewhat and have gradually begun to resemble the patterns we experienced before the pandemic. Adjusted admissions to our acute hospitals increased 1.5% year-over-year with surgical growth slowing. Overall, revenue growth was still a solid 8.6%, excluding the impact of our insurance subsidiary. Meanwhile, expenses were well controlled. Specifically, the amount of premium paying in the third quarter was $60 million, reflecting a 12% decline from the prior year quarter.

正如我們預期的那樣，急性護理量有所緩和，並逐漸開始類似於大流行之前我們所經歷的模式。我們急診醫院的調整後入院人數較去年同期增加 1.5%，但手術成長放緩。整體而言，除去保險子公司的影響，收入成長仍穩定達到 8.6%。同時，費用也得到了很好的控制。具體來說，第三季的保費支付金額為 6,000 萬美元，較去年同期下降 12%。

Included in our operating results during the third quarter of 2024, where aggregate net incremental reimbursements of approximately $20 million recorded in connection with various state supplemental Medicaid programs approximately half of which was earned by our acute care hospitals. These net reimbursements were in excess of the supplemental program projections included in our earnings guidance for the full year of 2024 as revised on July 24, 2024.

包括在我們 2024 年第三季的經營業績中，與各州補充醫療補助計劃相關的累計淨增量報銷約為 2000 萬美元，其中約一半由我們的急診醫院獲得。這些淨報銷金額超過了我們於 2024 年 7 月 24 日修訂的 2024 年全年獲利預測中包含的補充計畫預測。

On a same-facility basis, EBITDA at our acute care hospitals increased 36% during the third quarter of 2024. As compared to the comparable prior year quarter, and the increase was 17% when excluding the impact of the incremental Medicaid supplemental payments earned in Nevada during the third quarter of 2024. The increase in operating income comparison to last year's third quarter for our acute hospitals is a further step towards a more extended margin recovery we hope to sustain for the next several periods. In our acute segment, physician expense, which was a significant headwind in 2023, has stabilized at approximately 7.2% of revenues thus far in 2024. During the third quarter, same facility revenues at our behavioral health hospitals increased by 10.5%, primarily driven by an 8.5% increase in revenue per adjusted patient day.

以相同設施計算，我們急診醫院的 EBITDA 在 2024 年第三季成長了 36%。與去年同期相比，若不包括 2024 年第三季內華達州獲得的增量醫療補助補充付款的影響，則增幅為 17%。與去年第三季相比，我們急診醫院的營業收入有所增加，這朝著我們希望在接下來的幾個時期內維持的更大範圍的利潤率復甦邁出了一步。在我們的急性病領域，醫生費用是 2023 年的一個重大阻力，但到 2024 年為止已穩定在收入的 7.2% 左右。第三季度，我們行為健康醫院的同類設施收入成長了 10.5%，主要得益於調整後病患每日收入成長 8.5%。

Even after adjusting for Medicaid supplemental payments not included in our original 2024 guidance, facility revenues increased 8.3% and say facility EBITDA increased 9.6% in the third quarter of 2024 as compared to the comparable prior year period.

即使在調整了我們最初的 2024 年指引中未包括的醫療補助補充支付後，與去年同期相比，2024 年第三季的設施收入仍增長了 8.3%，設施 EBITDA 增長了 9.6%。

As a result of unfavorable trends experienced during the last several years, during the third quarter of 2024, we recorded a $30 million increase to our reserves for self-insured professional and general liability claims. Our cash generated from operating activities was $1.4 billion during the first nine months of 2024, as compared to $815 million during the same period in 2023. In the first nine months of 2024, we spent $698 million on capital expenditures and acquired $1.7 million of our own shares at a total cost of approximately $350 million.

由於過去幾年的不利趨勢，在 2024 年第三季度，我們的自保專業和一般責任索賠準備金增加了 3000 萬美元。2024 年前 9 個月，我們的經營活動產生的現金為 14 億美元，而 2023 年同期為 8.15 億美元。2024 年頭九個月，我們花了 6.98 億美元的資本支出，並以總成本約 3.5 億美元收購了 170 萬美元的自有股份。

Since 2019, we have repurchased approximately 31% of the company's outstanding shares. As of September 30, 2024, we had $1.01 billion aggregate available borrowing capacity pursuant to our $1.3 billion revolving credit facility. In our acute care segment, we continue to develop additional inpatient and ambulatory care capacity. Construction continues on our de novo acute care hospitals, consisting of the 150-bed West Henderson Hospital in Las Vegas, Nevada, which is expected to open shortly the 136 Fed Cedar Hill Regional Medical Center in Washington, D.C., which is expected to open in the spring of 2025 and the 150-bed Alan B. Miller Medical Center in Com Beach Gardens, Florida, which is expected to open in the spring of 2026.

自2019年以來，我們已回購了該公司約31%的流通股。截至 2024 年 9 月 30 日，根據我們的 13 億美元循環信貸安排，我們擁有 10.1 億美元的總可用借款能力。在我們的急性護理領域，我們繼續開發額外的住院和門診護理能力。我們的新生急診醫院建設仍在繼續，包括位於內華達州拉斯維加斯的擁有150 個床位的西亨德森醫院，預計不久將開業；位於華盛頓特區的擁有136 個床位的聯邦雪松山地區醫療中心，預計位於佛羅裡達州康比奇花園 (Com Beach Gardens) 的 150 張床位的艾倫·B·米勒醫療中心 (Alan B. Miller Medical Center) 預計將於 2026 年春季開放。

In our behavioral health segment, we recently opened the 128-bed River Vista Behavioral Health Hospital in Madera, California, and we are developing the 96th Egg Southridge Behavioral Hospital in West Michigan, a joint venture with Trinity Health, Michigan, which is expected to open in the spring of 2025. The approval processes continue in connection with new Medicaid supplemental payment programs in Tennessee and Washington, D.C. as well as the proposed funding increase to the existing program in Nevada.

在我們的行為健康領域，我們最近在加州馬德拉開設了擁有128 張床位的River Vista 行為健康醫院，並且我們正在與密西根州Trinity Health 合資建設位於密西根州西部的第96 家Egg Southridge 行為健康醫院，該醫院預計將於2025年春季開放。田納西州和華盛頓特區新的醫療補助補充支付計劃以及內華達州現有計劃的資金增加提案的審批流程仍在繼續。

Although we cannot provide assurance that any or all of these programs program changes will ultimately be approved by CMS, with the timing of such approvals, which may not occur until 2025, if approved in their current forms, the Tennessee program with estimated annual net benefit of $40 million to $56 million would be effective July 1, 2024. The Washington D.C. program with estimated an annual net benefit of approximately $85 million with the effect of October 1, 2024. We and the funding increase to the existing Nevada program with estimated annual net incremental benefit of approximately $56 million with the effective July 1, 2024. Our previously provided earnings guidance for the full year of 2024 as revised on July 24, 2024, did not include the estimated incremental net benefit related to any of these programs.

雖然我們無法保證這些計劃的任何或所有變更最終都會得到 CMS 的批准，但考慮到批准時間，可能要到 2025 年，如果以目前的形式獲得批准，田納西州計劃的預計年度淨收益4000 萬美元至5,600 萬美元的削減將於2024 年7 月1 日生效。華盛頓特區計劃預計自 2024 年 10 月 1 日起每年淨收益約為 8,500 萬美元。我們增加了對現有內華達州計畫的資金投入，預計自 2024 年 7 月 1 日起，年度淨增量收益約為 5,600 萬美元。我們先前提供的 2024 年全年獲利預測（經 2024 年 7 月 24 日修訂）並未包括與任何這些計畫相關的預計增量淨收益。

I'd be pleased to answer your questions at this time.

我很樂意回答您的問題。

(Operator Instructions)

（操作員指令）

Josh Raskin, Nephron Research.

喬希‧拉斯金 (Josh Raskin)，腎元研究公司。

This is actually Marco on for Josh. I was just wondering if you could speak to any changes you may be seeing in the behavior of managed care plans during the quarter. including activity around patient denials or downgrades across both the acute and behavioral segments. And then it would also be helpful if you could just give some color on what trends you're seeing between commercial and MA plans and whether this activity is focused around any specific areas like Two-Midnight?

這實際上是 Marco 代替 Josh 上場。我只是想知道您是否可以談談本季度管理式醫療計劃行為中可能出現的任何變化。包括急性和行為階段的患者拒絕或降級活動。然後，如果您可以說明您在商業和 MA 計劃之間看到的趨勢，以及這項活動是否集中在任何特定領域（例如 Two-Midnight），這也會很有幫助嗎？

Sure. So I think if you go back and review some of our transcripts and other commentary from late in 2022 and early into 2023, we first began to note, I think, more aggressive behavior on the part of our managed care payers, especially coming off of the initial years of the pandemic 2021, '22, where clearly, we felt like payers had become less aggressive. I think in response to a large degree to the significant decreases in utilization during the early stages of the pandemic. So since then, since I would say late '22 or early '23, again, we've seen, I think, payer behavior become more aggressive as it relates to denials as it relates to patient status changes, length of stay management when patients are entered in the facility, et cetera. I don't believe that we saw a dramatic change in the current quarter.

當然。因此，我認為，如果你回顧一下我們在 2022 年底和 2023 年初的一些記錄和其他評論，我們首先開始注意到，我認為，我們的管理式醫療支付方的行為更加激進，尤其是在疫情爆發的最初幾年（2021 年和2022 年），我們明顯感覺到付款人變得不那麼積極了。我認為這在很大程度上是由於疫情初期利用率大幅下降所致。因此，從那時起，我想說在2022 年底或2023 年初，我們再次看到，我認為，付款人的行為變得更加激進，因為它與拒絕有關，與患者狀態變化有關，與患者住院時間管理有關進入設施等等。我認為我們在本季度並沒有看到顯著的變化。

I think, again, the more aggressive behavior that we've been citing, I think, has been ongoing for more like a year or four or six quarters.

我認為，我們一直提到的更具攻擊性的行為已經持續了一年或四個或六個季度了。

But wouldn't necessarily suggest that we saw a dramatic change in the current quarter. As far as weather and behavior is focused on any particular area because you specifically asked about the Two-Midnight rule. Again, I think we've made a comment that we've been focused on the Two-Midnight rule and the appropriate coding consistent with the Two-Midnight rule and appeals consistent with the Two-Midnight rule for several years. We've been using a third-party firm to help us properly code admissions. We've been using that same firm to help us with denial appeals, et cetera.

但這並不一定意味著我們在本季看到了巨大的變化。就天氣和行為而言，請專注於任何特定區域，因為您特別詢問了兩午夜規則。再次，我認為我們已經發表過評論，我們多年來一直專注於午夜兩點規則和與午夜兩點規則一致的適當編碼以及與午夜兩點規則一致的上訴。我們一直在利用第三方公司來幫助我們正確地編碼招生。我們一直在使用同一家公司來幫助我們處理拒絕上訴等等。

And so I don't think we've seen, again, some of the perhaps significant difference in how Two-Midnight rule -- Two-Midnight coding claims are being handled with our claims as maybe some of our peers have really changed their behavior as a result of the recent clarifications that CMS issued in terms of Two-Midnight rule.

因此，我認為我們並沒有看到 Two-Midnight 規則中可能存在的一些重大差異——Two-Midnight 編碼聲明的處理方式與我們的聲明相同，因為我們的一些同行可能確實改變了他們的行為這是CMS 最近針對午夜兩點規則發布的澄清說明的結果。

I appreciate all the color on that. And then just to squeeze in one more quick one. I was wondering if you could just give a quick update on physician recruitment and turnover trends in the acute behavioral segments, especially as it relates to opening up additional capacity and then whether you're seeing any more incremental competition in that area?

我很欣賞這一切的色彩。然後只需再擠進一個即可。我想知道您是否可以簡要介紹一下急性行為領域的醫生招聘和流動趨勢，特別是與開放額外能力相關的趨勢，以及您是否看到該領域的競爭加劇？

Yes. I think there's been much discussion about physicians and especially as it related to hospital-based physicians last year when there was a significant increase for almost all providers in the expense of hospital-based physicians in our case, especially emergency room physicians and anesthesiologists. I think that increased expense was more a result of billing changes, and I think specifically the, no Surprise billing Act and the constraints that, that put on those specialties emergency room anesthesiology in terms of their ability to build for out-of-network patients. So I think the pressures on those expenses were driven more by those billing changes than they were by a lack of or scarcity of those sort of physicians. I don't think that there is a dearth of physicians to what I think there's a glut necessarily in every market.

是的。我認為關於醫生的討論很多，特別是關於去年醫院醫生的討論，在我們這個案例中，幾乎所有醫療服務提供者的醫院醫生費用都大幅增加，特別是急診室醫生和麻醉師。我認為費用增加更多的是帳單變化的結果，特別是《無意外賬單法案》以及對急診室麻醉科專科為網絡外患者提供服務的能力的限制。因此，我認為這些費用的壓力更多的是由帳單方式的變化造成的，而不是由於缺乏或缺少這類醫生。我並不認為每個市場都存在醫生短缺的情況，相反，我認為每個市場都存在醫生過剩的情況。

different specialties are more challenging, et cetera. But I don't think we would describe physician recruitment as particularly difficult in the current period. I don't think it's changed much over the last several years.

不同的專業更具挑戰性，等等。但我不認為當前時期醫生招聘特別困難。我認為過去幾年它並沒有太大的改變。

Ann Hynes, Mizuho.

安海因斯（Ann Hynes）、瑞穗（Mizuho）。

Great, Heading into 2025, are there any maybe major headwinds and tailwinds you want to call out? And to that, I know it sounds like you're getting incremental provide stuff in 2024. Is there anything we should be on the lookout for 2025?

太好了，邁入 2025 年，您想指出哪些重大的逆風和順風呢？對此，我知道這聽起來像是你在 2024 年獲得了增量提供的東西。2025 年有什麼是我們應該關注的嗎？

So I think for us, Ann, as I mentioned in my prepared remarks, we'll have two new facilities open in 2025, our West Henderson facility in Las Vegas, which will open late this year. And then our hospital in the District of Columbia, which will open in the spring. I don't believe -- and we'll be more precise about this when we give our detailed 2025 guidance in February. But I don't believe that either of those facilities will create a significant drag on EBITDA. There will be some opening expenses and some ramp up, but I think both are well positioned so that, again, they should create much of a drag.

因此，安，我認為對我們來說，正如我在準備好的演講中提到的那樣，我們將在2025 年開設兩個新工廠，位於拉斯維加斯的西亨德森工廠將於今年晚些時候開業。我們位於哥倫比亞特區的醫院將於春季開業。我不相信——當我們在二月給出詳細的2025年指導時，我們會更加精確地說明這一點。但我不認為這兩項設施會對 EBITDA 造成重大拖累。會有一些開業費用和一些成長，但我認為兩家公司都處於有利地位，因此，它們應該會再次產生很大的阻力。

I think otherwise, for the two businesses, we are expecting the continued margin recovery that, again, I alluded to in my opening comments. And then finally, the major tailwinds are the ones that I mentioned again in my remarks, the specific ones in terms of Tennessee, issued of Colombia, Nevada.

我認為情況並非如此，對於這兩家企業來說，我們預計利潤率將繼續回升，我在開場白中再次提到了這一點。最後，主要的順風因素是我在演講中再次提到的，具體包括田納西州、哥倫比亞、內華達州。

These are either new or additional supplemental programs that have been submitted to CMS for approval. There's been some reporting and some -- things that have been written about programs, either new or expanded programs in California and Florida that could be effective next year, but those, I think, are in sort of earlier stages of development. So I think broadly, there are some significant potential tailwinds in the Medicaid supplemental area, some of which we've disclosed in some detail, others, which I think are a little bit more or not quite as precise at this point. But those for me seem to be the big puts and takes for 2025 at this point.

這些是已提交給 CMS 批准的新計劃或附加補充計劃。目前已經有一些報導和文章提到了這些計劃，無論是加州和佛羅裡達州的新計劃還是擴大的計劃，這些計劃可能會在明年生效，但我認為，這些計劃還處於發展的早期階段。因此，我認為，總體而言，醫療補助補充領域存在一些重大的潛在推動因素，其中一些我們已經詳細披露，其他一些，我認為目前還不夠精確或過於詳細。但對我而言，目前這些似乎是 2025 年的重大挑戰。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I wanted to focus on the acute volumes. Maybe if you just take a step back and comment on the volume progression in that business. And now that we've established a more normal baseline for volumes, like what's the outlook in the acute care segment for volume growth?

我想集中精力於急性量。也許如果您只是退一步並評論一下該業務的銷量增長。現在我們已經為銷量建立了更正常的基礎，那麼急性護理領域銷售成長的前景如何？

Andrew, I think we've been pretty clear and consistent in our commentary in this regard, and that is we've been saying for some time that we expected broadly acute care growth to return to sort of more normal, I'll call them, pre-COVID levels. So same-store revenue growth in the 6% to 7% range, that would be split pretty evenly between price and volume. I think if you actually look at our year-to-date metrics in acute care, I think our adjusted admissions are up 3%. I think our pricing per -- revenue per adjusted admission is up 5%. I think if you adjust that for the Nevada Medicaid supplemental, you're sort of in that range of 6% to 7% revenue growth split pretty evenly between price and volume.

安德魯，我認為我們在這方面的評論非常明確和一致，也就是說，我們一段時間以來一直在說，我們預計廣泛的急性護理增長將恢復到更正常的狀態，我稱之為，回到新冠疫情之前的水平。因此同店收入成長在 6% 到 7% 之間，價格和銷量之間的分配相當均勻。我認為，如果您實際查看我們今年迄今為止的急診護理指標，我們會發現我們的調整後入院人數增加了 3%。我認為我們的調整後門票價格——每張門票收入上漲了 5%。我認為，如果針對內華達州醫療補助補充計劃進行調整，收入增長將處於 6% 到 7% 的範圍內，價格和數量之間的分配相當均勻。

I think that's been our view for a while. I know that some of the commentary from our peers have been a little bit more bullish about what acute care volume may look like and suggesting that there have been some structural changes in the business that would result in elevated acute care volume growth for the foreseeable future. We haven't seen that yet. And obviously, I think if there are these structural changes, we would benefit from them as would the average acute care hospital. We just haven't seen really evidence of that just yet.

我想這是我們一直以來的觀點。我知道，我們的一些同行對急性護理量可能的情況持更樂觀的態度，並認為業務中已經發生了一些結構性變化，這將導致可預見的未來急性護理量的增長。我們還沒看到這一點。顯然，我認為如果進行這些結構性變化，我們將像一般的急診醫院一樣從中受益。只是我們還沒看到真正的證據。

The other issue, which I kind of alluded to earlier, is I think a number of acute care hospitals are anticipating a fairly significant benefit from the Two-Midnight rule change and a consequent change in the way they are coding these things, et cetera. As I've indicated again, I think pretty clearly and consistently for a while now, we think we've been focused on that issue for several years now. And as a consequence, don't necessarily anticipate an incremental benefit from that. So again, I think we view acute care volumes or the future of acute care volume growth and I think broadly, acute care revenue growth is something that should be solid, et cetera, but that some of the really elevated acute care volume growth that we've seen over the last several years has been a result of the catch-up in postponed and deferred procedures or procedures that have been postponed before and during the pandemic. And by definition, I think those were sort of a onetime thing, and I think we're largely past that at this point.

另一個問題，我之前提到過，我認為許多急診醫院都預計從午夜兩點規則的改變以及隨之而來的編碼方式的改變等方面獲得相當大的利益。正如我再次指出的那樣，我認為我們已經非常清楚並且持續地關注這個問題好幾年了。因此，不一定能從中預期到增量利益。因此，我認為我們再次看待急性護理量或急性護理量增長的未來，我認為從廣義上講，急性護理收入增長應該是穩固的，等等，但我們過去幾年來我們看到的這種情況，是由於追趕被推遲和延期的程序，或在疫情之前和疫情期間被推遲的程序的結果。從定義上來說，我認為這些都是一次性的事情，我認為我們現在基本上已經度過了這個階段。

Great. And then your corporate expenses tracked a bit higher than our estimates in the quarter. Can you help us understand any onetime items there are other drivers of the increase in the corporate segment?

偉大的。然後，您的公司費用在本季略高於我們的預期。您能否幫助我們了解一次性專案以及企業部門成長的其他驅動因素？

Yes. We had a $5 million loss on the extinguishment of debt related to our refinancing that we did during the quarter. We probably had another $5 million settlements of miscellaneous smaller lawsuits. So that $10 million of corporate expense, I would clearly characterize as nonrecurring in the quarter.

是的。我們本季因再融資而清償債務，損失了 500 萬美元。我們可能也因其他一些小額訴訟而支付了 500 萬美元的和解金。因此，我會明確地將這 1000 萬美元的公司費用定性為本季的非經常性費用。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

This is Dylan on for Justin. Just had a couple of quick ones for you. Is there any color you can provide on the trajectory of volumes in the behavioral business in the quarter? And then second, behavioral pricing clearly remains a strength. Are you expecting to see similar opportunities heading into 2025?

這是 Dylan 為 Justin 表演的。我只想告訴你幾個簡單的問題。您能否提供本季行為業務量的變化趨勢？其次，行為定價顯然仍是一個優勢。您是否預期 2025 年還會出現類似的機會？

Or do you expect that to moderate?

或者您預計這種情況會有所緩和？

So as far as the trajectory of behavioral volumes, again, I think for the last several quarters, we've been talking about our sense that while we originally guided to 3% same-store patient day growth for behavioral for the full year -- that growth was occurring more slowly than we originally anticipated, and we sort of revised that view to -- we'd be able to exit the year at that sort of 3% level. We were able to exit the third quarter at that 3% level, and that's despite a little bit of drag from the hurricane impact in South Carolina and Georgia on some of our facilities at the very end of the quarter, Hurricane Lene. I think we remain confident that we should be able to exit the fourth quarter at that at least 3% patient day growth rate and we remain confident that we can do so.

至於行為量的發展軌跡，我想在過去幾個季度裡，我們一直在談論我們的感覺，雖然我們最初預計全年同店患者日增長率為 3%——經濟增長速度比我們最初預期的要慢，我們將這種觀點修改為——我們將能夠以3% 左右的增速結束今年。我們能夠以 3% 的水平結束第三季度，儘管在本季度末，颶風萊恩 (Hurricane Lene) 襲擊了南卡羅來納州和喬治亞州，對我們的一些設施造成了一點拖累。我認為，我們仍然有信心在第四季度結束時實現至少 3% 的患者日增長率，而且我們仍然有信心可以做到這一點。

As far as behavioral pricing. Behavioral pricing, as people know, has been quite strong for several years now throughout most of the pandemic. We attribute that to some degree to our efforts to leverage better pricing from some of our lower paying payers, particularly managed Medicaid payers. And I think in an environment where there's not a great deal of excess capacity in the behavioral industry at large. That's been an effective sort of strategy.

就行為定價而言。眾所周知，行為定價在整個疫情期間一直表現強勁。我們認為這在一定程度上要歸功於我們努力向一些低付費者，特別是管理型醫療補助付費者爭取更優惠的價格。我認為，在整個行為產業中，不存在太多的過剩產能。這是一種有效的策略。

we've been suggesting for some time that paper pricing is likely to moderate at some point, and we continue to believe that. But to be fair, it is staying in there very robustly and very strongly. At the current time. And obviously, we're not doing anything to try and reduce that. But we do believe that behavioral pricing which has been running at historically high levels will moderate at some point, but still should track in sort of that 4% to 5% range for the foreseeable future.

我們一直在暗示，紙張價格可能在某個時候會趨於平穩，我們仍然相信這一點。但公平地說，它仍然非常穩健、堅強地存在著。在當前時間。顯然，我們並沒有採取任何措施來減少這種情況。但我們確實相信，一直處於歷史高點的行為定價將在某個時候緩和，但在可預見的未來仍應保持在 4% 至 5% 的範圍內。

Sarah James, Cantor.

莎拉詹姆斯（Sarah James），領唱者。

This is Gaby on for Sarah. You had a nice beat on acute revenue per admission. Could you just walk us through the drivers there? And was any of that related to the extra day in the quarter?

這是 Gaby 為 Sarah 主持的節目。您的每張門票收入都取得了不錯的成績。您能向我們簡單介紹一下那裡的司機嗎？這些是否與本季的額外一天有關？

Yes. I mean, the extra day, I think is a mechanical sort of thing. We tend not to really focus on that. largely because I think in the end, obviously, the longer the period, if you look at the full year, all that comes out in the wash. I think more importantly, we had a difficult acute care comparison.

是的。我的意思是，額外的一天，我認為是一種機械的事情。我們往往不會真正關注這一點。主要是因為我認為最終顯然時間越長，如果從全年來看，所有這些都會浮出水面。我認為更重要的是，我們進行了一次艱難的急性護理比較。

I think our same-store adjusted admissions in last year's third quarter were up close to 7%. But I think even more importantly, if you go back and you listen to or -- read our commentary from last year's third quarter, we attribute a lot of that to again, this catch-up in the deferred and postponed procedures and those procedures that have been postponed or deferred during the pandemic.

我認為我們去年第三季的同店調整後入院率成長了近 7%。但我認為更重要的是，如果你回去聽或讀我們去年第三季的評論，我們會把這很大程度上歸因於延期和推遲程序的追趕，以及那些在疫情期間被推遲或延期。

And as a consequence, if you go back while our volumes, both admissions and surgical volumes were strong in the third quarter, of last year, they tended to be skewed towards those lower acuity kind of more discretionary procedures that people have the ability to defer during the pandemic. And so when you're looking at now that comparison with '24 to '23, you see volumes sort of look unfavorable. They have come down some, but acuities come up because so much of that activity last year's quarter was due to the lower acuity, lower revenue sorts of procedures.

因此，如果你回顧一下，去年第三季度我們的入院量和手術量都很高，但它們往往傾向於那些低危險、更自由裁量的手術，人們可以推遲這些手術在疫情期間。因此，當您現在將 24 年與 23 年進行比較時，您會發現交易量看起來不太樂觀。雖然數量有所下降，但敏銳度卻有所上升，因為去年季度的大部分活動都是由於敏銳度較低、收入較低的程序造成的。

Okay. Awesome. And then any color on the inpatient surgical trends?

好的。驚人的。那麼住院手術趨勢有什麼變化嗎？

Yes. As I noted in my prepared remarks, surgeries were soft and they were probably down slightly in the quarter. And again, I think it's a lot of the same dynamic that surgeries were quite strong in the third quarter of last year, but that was skewed towards a lot of what I'll describe as sort of catch-up lower acuity, more discretionary, more elective sorts of procedures.

是的。正如我在準備好的發言中指出的那樣，手術量很低，本季的手術量可能略有下降。再次，我認為去年第三季的手術量相當強勁，但這種趨勢偏向於我所描述的那種追趕式的低敏銳度、更自由裁量的手術，更多可選的程序。

AJ Rice with UBS.

瑞銀的 AJ Rice。

Maybe just to ask about the labor. You commented that your use of premium pay was down to $60 million, 12% down year-to-year. Any more broad comments on what you're seeing in both business lines and labor? Are we sort of at a stable point at this point? And you can sort of hold your SWB ratios as a percent of revenues going forward?

也許只是想詢問一下勞動力的狀況。您評論說，您的加班費使用額下降到了 6000 萬美元，比去年同期下降了 12%。您對業務線和勞動力方面看到的情況還有什麼更廣泛的評論嗎？我們目前是否處於穩定的階段？您可以將 SWB 比率保持在收入的百分比範圍內嗎？

Or do you think there's still further opportunities?

或者您認為還存在更多機會？

Yes. What I think has happened, AJ, is that, again, we're in sort of now this post pandemic environment in which wage inflation, I think, has stabilized. It is clearly lower than it was at the height of the pandemic. Obviously, our use of premium pay has diminished dramatically, although it is also, I think, starting to stabilize and sort of flatten out. And I think that should continue that's benefiting us obviously, in an environment where the revenue growth in both businesses has been quite robust.

是的。AJ，我認為現在發生的情況是，我們現在又處於一種後疫情時代的環境中，我認為薪資通膨已經穩定下來。這一數字明顯低於疫情最嚴重時期的水準。顯然，我們對加班費的使用已大幅減少，儘管我認為它也開始趨於穩定和趨於平穩。我認為這種情況應該會持續下去，在兩項業務的收入成長都相當強勁的環境下，這顯然會為我們帶來好處。

It's contributing to the margin recovery that salaries are somewhat stable. And I will say people have noted to me that, on the behavioral side, salaries as a percentage of revenue did sequentially increase from Q2 to Q3.

工資相對穩定有助於利潤率的回升。我想說的是，人們已經注意到，從行為來看，薪資佔收入的百分比從第二季到第三季確實連續增加。

And I've asked about whether that's kind of emerging trend. And I would say not. I think that that's a function probably of the impact of the hurricane that we saw at the very end of the quarter where a number of our facilities, particularly in the Georgia, South Carolina market, saw diminished volumes but also it's a double whammy because we see diminished volumes, but we're also paying overtime, et cetera, to keep people in the facility and make sure it's properly staffed. But I think outside of that, I would say that labor trends have stabilized substantially in both business segments.

我曾問過這是否是一種新興趨勢。但我會說不是。我認為這可能是受本季末颶風的影響，我們的一些工廠，特別是喬治亞州和南卡羅來納州的工廠，銷量下降，但這也是雙重打擊，因為我們我們看到產量減少了，但我們也會支付加班費等，以留住設施內的人員並確保配備適當的人員。但除此之外，我認為兩個業務領域的勞動趨勢都已基本穩定。

Okay. And maybe just thinking about growth, development capital deployment, et cetera. Any comment on the behavior side, the JV pipeline, you paid some new bed additions as you start to think about '25 and then obviously, to the extent there is free cash flow beyond any of that, whether there's M&A opportunities? Or should we think that most of that cash flow is going to go to stock buybacks from the year?

好的。也許只是考慮成長、發展資本部署等等。對行為方面、合資管道、您開始考慮'25 時支付了一些新床位增加的費用，您有什麼評論嗎？或者我們應該認為大部分現金流將用於今年的股票回購？

Yes. I mean we continue with a pretty aggressive and robust capital expenditure program. I talked about some of the big spends in my prepared remarks, but we've started or maybe more properly, I would say we restarted to add that to our behavioral business. We've been doing that pretty consistently prior to the pandemic -- during the pandemic, we paused many of those expansion activities with the sort of logic being, we were struggling to staff the existing beds we had there was no point in building new beds. But now that, again, the labor market has stabilized, we're looking in those markets where there is an opportunity to increase volumes by adding beds.

是的。我的意思是我們將繼續實施相當積極和強勁的資本支出計劃。我在準備好的演講中談到了一些大筆支出，但我們已經開始，或者更確切地說，我想說，我們已重新開始將其添加到我們的行為業務中。在疫情爆發之前，我們一直在這樣做。但現在勞動市場已經穩定下來，我們正在尋找那些有機會透過增加床位來增加數量的市場。

Now to be fair, our overall occupancy in behavioral stands on the low 70s. So there are plenty of facilities where we should have the potential for upside volume without having to add any new beds, but there are some facilities that are running at higher occupancies than that.

公平地說，我們的行為總體佔用率在 70% 以下。因此，有許多設施都有潛力在不增加新床位的情況下提高入住率，但有些設施的入住率卻高於這個數字。

And in those facilities, we are, again, either resurrecting or entertaining new programs to build beds and we'll continue to do that. As far as opportunities for M&A, I think we often comment that we are presented with opportunities reasonably regularly -- we have found, if you look at our last five, seven years, not a great deal of those opportunities to be very compelling, although we'll continue to look at them. And so my guess, because this is M&A, I think, would be hard to predict, but my guess is that -- as you think about it, our capital deployment will remain focused probably on capital expenditures and on share repurchase, much as it has been for the last five to seven years.

在這些設施中，我們再次恢復或考慮建造床位的新計劃，我們將繼續這樣做。至於併購機會，我認為我們經常說，我們經常會遇到併購機會——但如果你回顧我們過去五、七年，你會發現，這些機會並不多，儘管我們會繼續關注。因此，我的猜測是，因為這是併購，所以很難預測，但我的猜測是——正如你所想的那樣，我們的資本配置仍將集中在資本支出和股票回購上，就像已經持續了五到七年。

Pito Chickering, Deutsche Bank.

德意志銀行的 Pito Chickering。

Looking at same-store occupancy here, that's a fun metric because it probably underestimates the busier days on Monday through Wednesday for neglected procedures. So my question is, what is the max occupancy for the portfolio before it impacts same-store mission growth. And as you think about hospital occupancy, if you can't sort of expand beds fast enough, does this sort of create a more aggressive conversations with your low yielding payers like you did a few years ago when you're a max capacity in behavior?

從同店入住率來看，這是一個有趣的指標，因為它可能低估了周一至週三較為繁忙的日子裡被忽視的程序。所以我的問題是，在影響同店任務成長之前，投資組合的最大佔用率是多少。考慮到醫院的入住率，如果你不能足夠快地擴大床位，這是否會像幾年前醫院容量達到最大容量時那樣，與低收益的付款人進行更激烈的對話？

Yes. So Pito, I'm not sure if your question was specific to one or both of the segments. So I'll try and answer for both. I think on the acute side, occupancy over the years has become somewhat less relevant metric. Obviously, it measures your occupied inpatient beds.

是的。所以 Pito，我不確定你的問題是針對其中一個部分，還是兩個部分。因此我會盡力回答這兩個問題。我認為，從嚴重的角度來看，多年來，入住率已經成為一個不太相關的指標。顯然，它衡量的是住院床位的佔用情況。

But my experience is I've been in a hospital penny a number of times that maybe at 2/3 occupancy from an inpatient bed perspective, but you walk through the emergency room and there are stretches in the hallway or you walk through the OR and have got a real busy schedule of the Cath lab, that sort of thing.

但我的經驗是，我去過醫院很多次，從住院床位的角度來看，可能只有2/3 的佔用率，但當你走過急診室時，走廊裡會有一些延伸，或者當你走過手術室時，在心臟導管室的日程安排非常繁忙，諸如此類。

So I think that acute care inpatient occupancy is not as relevant as sort of a metric as it used to be or onetime it was. There are, I think, a number of other equally important variables in measuring sort of the efficiency and the output of an acute care hospital -- I think in terms of the broader question, I don't know that we have too many hospitals that we're really at max capacity in any of those areas. We're certainly not there in terms of inpatient beds, but I don't think we're necessarily there in terms of emergency room capacity or Cath labs or ORs, et cetera.

因此，我認為急診住院病患佔用率不再像以前那樣具有相關性。我認為，在衡量急診醫院的效率和產出時，還有許多其他同樣重要的變數——我認為就更廣泛的問題而言，我不知道我們是否有太多醫院我們在任何一個領域的容量都已經達到了最大限度。就住院床位而言，我們肯定還沒有達到那個水平，但我認為，就急診室容量、心臟導管室或手術室等而言，我們也不一定達到那個水平。

And to the degree that we are, I think we're responding to that with capital improvement and expansion programs to address that. On the behavioral side, I do think that inpatient occupancy or an inpatient bed occupancy number is more relevant. There are sort of fewer ancillary sorts of procedures in a behavioral hospital. That account for that, although obviously, outpatient activity needs to be measured as well. But the same thing.

就我們目前的情況來看，我認為我們正在透過資本改善和擴張計劃來解決這個問題。從行為來看，我確實認為住院佔用率或住院床位佔用率更為相關。行為醫院的輔助治療程序比較少。儘管顯然門診活動也需要衡量，但這也說明了這一點。但都是一樣的。

I mean, as I said, for the most part, I don't think we have visible capacity constraints in our behavioral business, but there certainly our facilities and geographies where that is an issue. And those are the places where we're doing debt expansions or at least contemplating that expansion.

我的意思是，正如我所說的，在大多數情況下，我認為我們的行為業務沒有明顯的產能限制，但我們的設施和地理位置肯定存在問題。這些就是我們正在進行債務擴張或至少正在考慮擴張的地方。

Great. And then a follow-up here is on physician expenses. Like you talked about sort of that being stable at like 70% of revenue. Are there other areas like radiology and NICU which have not been pressure points in the past, which could be asking for subsidies going forward or pretty much across portfolio across all different groups of physicians at stable?

偉大的。接下來是醫生費用。就像您說的，這個比例穩定在收入的 70% 左右。是否還有其他領域，例如放射科和新生兒重症監護室(NICU)，在過去並不是壓力點，這些領域可能會要求在未來提供補貼，或者幾乎在所有不同的醫生群體中都提供穩定的補貼？

Yes. So the answer is yes. And I would tell you, in the portfolio, I can find examples in almost every specialty where we've had requests for greater subsidies or increased expense, et cetera. As I noted in my comments earlier, I think for us, the biggest pressure by far the most expansive has been in the emergency room and anesthesia areas. But yes, we have, I think, one-off situations where we've seen pressure from hospitalists or labors or radiologists as you asked about.

是的。所以答案是肯定的。我想告訴你，在投資組合中，我幾乎可以在每個專業領域找到例子，我們都要求增加補貼或增加開支等等。正如我之前在評論中提到的，我認為對我們來說，迄今為止最大的壓力是在急診室和麻醉區域。但是的，我認為，我們確實遇到過一次性的情況，正如您所問到的，我們看到了住院醫生、勞工或放射科醫生的壓力。

But for the -- but they clearly I think have accounted for much less pressure than ER and anesthesiology. And I think broadly, while we continue to sort of deal with those issues every day. I think that situation, which was such a headwind in 2023 has largely stabilized.

但是對於——但我認為他們顯然比急診室和麻醉科承受的壓力要小得多。我認為，從廣義上講，我們每天都在繼續處理這些問題。我認為，2023 年的不利情勢已基本穩定下來。

Joanna Gajuk, BofA Securities.

美國銀行證券的 Joanna Gajuk。

I just first to clarify the commentary around the outlook for SiC business into next year. So you sort of alluded to the idea of maybe pricing excluding supplementals growing 4%, 5%. And I guess you still expect to exit at 3% volume growth. So is that sort of the trajectory to expect next year in terms of growth for that segment?

我首先要澄清一下明年 SiC 業務前景的評論。所以您暗示了也許不包括補充劑的價格會增加 4% 或 5%。我想您仍然希望以 3% 的銷量成長率退出。那麼，就該領域明年的成長而言，預計會出現這樣的軌跡嗎？

Yes. So Joanna, I mean, we're not -- we're going to give sort of precise 2025 guidance on this call. We don't do that until our fourth quarter call in February. But I think we have broadly described our expected sort of trajectory of growth in the behavioral business is same-store revenue growth in the kind of mid- to upper single digits, 6%, 7%, 8%. And probably skewed a little bit more to pricing.

是的。所以喬安娜，我的意思是，我們不會——我們將在這次電話會議上給出精確的 2025 年指導。我們要等到二月的第四季電話會議時才會這麼做。但我認為，我們已經大致描述了行為業務預期的成長軌跡，即同店營收成長率將達到中等到高個位數，即 6%、7%、8%。並且可能對定價有更多偏差。

So 4% to 5% pricing 3% to 3.5% volume -- but I'm not suggesting that that's going to be our precise guidance for next year. But I think in terms of thinking about next year, that's, I think, how we start and then obviously to the degree that there's any significant Medicaid supplemental programs, et cetera, that would be sort of incremental to that.

因此，定價率為 4% 到 5%，交易量率為 3% 到 3.5%——但我並不是說這將是我們明年的準確指導。但我認為，就明年而言，這就是我們的開始，然後顯然，如果有任何重要的醫療補助補充計劃等等，這將是漸進的。

Right. And I guess on site, in terms of volumes, so this quarter maybe wasn't very close to 3%, but I guess you still expect to kind of exit that year. But as we think about those 3% tailwinds? So can you -- can you walk us through what you're seeing there in the market. So obviously, there's the mental hostility with a deal that has, I guess, more peak requiring to actually execute on this method parity and also sounds like states are adding more benefits.

正確的。我想，就現場交易量而言，本季可能沒有接近 3%，但我想你仍然預計那年會退出。但我們要怎麼考慮那 3% 的順風呢？那麼可以向我們介紹一下你在市場上看到的情況嗎？因此，顯然，人們對這項協議有心理敵意，我想，這項協議需要更多高峰來真正執行這種方法的平等，而且聽起來各州正在增加更多的利益。

So are you seeing higher demand I guess are you able to meet that demand, I guess, is there something to be said about increased rates to be able to then staff for that volume.

那麼，您是否看到了更高的需求？

Yes. So Joanna, I apologize because I'm not being a little trouble hearing you, but I think I got the crux question. I'll say this, we -- as I indicated in some earlier comments, I think our volume recovery in behavioral has -- I think we've been candid about saying it's taken a little bit longer than we expected. We've cited a number of issues that have been challenges labor scarcity issues in specific pockets and specific geographies has been one. We had a handful of residential facilities that struggled with some very sort of unique issues that they've been recovering from.

是的。喬安娜，我很抱歉，因為我聽不清楚你說什麼，但我想我已經抓住了關鍵問題。我想說的是，正如我之前的一些評論所指出的那樣，我認為我們的行為量恢復已經——我認為我們已經坦率地說，這比我們預期的要長一點。我們列舉了許多問題，其中之一就是特定領域和特定地區的勞動力短缺問題。我們有少數住宿設施正在努力解決一些非常獨特的問題，並且正在努力從中恢復。

And then I think over the last year or so, we've talked about the impact of Medicaid disenrollment and the sort of challenges that -- that's created even for those patients who have been able to reenroll or enroll in commercial exchange products.

然後我想在過去一年左右的時間裡，我們討論了醫療補助取消註冊的影響以及這給那些能夠重新註冊或註冊商業交易產品的患者帶來的挑戰。

Will that, I think, tends to be a benefit on the acute side. I don't think it tends to be as much what tenet on the behavioral side because the large copays and deductibles that generally come with those commercial plans have sort of been challenging. But I think for the most part, the recovery in our behavioral volumes and our optimism about being able to sustain that recovery in the fourth quarter is really about the improvement of all these issues. We continue to be able to hire more staff and have more adequate staff to allow us to take more patients. The residential facilities that have struggled are continuing to improve and the Medicaid disenrollment impact.

我認為，這從急性方面往往是有益的。我認為這與行為的原則關係不大，因為這些商業計劃通常附帶的巨額共付額和免賠額一直很有挑戰性。但我認為，在很大程度上，我們的行為量的恢復以及我們對能夠在第四季度維持這種復甦的樂觀態度實際上與所有這些問題的改善有關。我們能夠繼續僱用更多的員工，並擁有更充足的員工，以便接收更多的患者。陷入困境的住宿設施正在不斷改善，醫療補助取消的影響也隨之而來。

Continues to dissipate as either patients are able to reenroll in Medicaid or get commercial exchange coverage and they exhaust their co-pays and deductibles.

由於患者能夠重新加入醫療補助計劃或獲得商業交易保險並且用盡了共同支付和免賠額，因此費用繼續消散。

So I think it's the improvement in those areas that's really contributing to the behavioral improvement. I think you specifically asked about whether we're seeing or anticipating a significant benefit from the Biden administration sort of tightening of rules on mental health parity mental health parity, which was implemented any number of years ago, so it's a great fanfare. And I think expectation that we would really benefit from that. I think we've benefited to some degree -- but I think the payers and the payer community broadly has been challenging in terms of really getting them to comply with, I think, both the spirit and the actual intent of mental health parity. I do think that the strength in government regulations are helpful, but I don't know that they're likely to really create a landscape change.

所以我認為這些領域的改善真正有助於行為的改善。我想你特別問的是，我們是否看到或預期拜登政府收緊心理健康平權規則會帶來重大好處，這項政策幾年前就已實施，因此備受矚目。我認為我們確實有望從中受益。我認為我們在某種程度上受益了——但我認為，付款人和付款人社區總體上在真正遵守心理健康平價的精神和實際意圖方面一直面臨著挑戰​​。我確實認為政府監管的力道是有幫助的，但我不知道它們是否真的能帶來格局的改變。

I think where they're helpful is as we appeal these things, as we appeal denials and that sort of thing, strength in government regulations are often helpful in that regard.

我認為它們的幫助在於，當我們對這些事情提出上訴時，當我們對拒絕和諸如此類的事情提出上訴時，政府監管的力度往往會在這方面有所幫助。

But I don't think that's going to drive a huge increase in behavioral volumes.

但我不認為這會推動行為量的大幅增加。

There are last, I guess, clarification question. I'll comment on the 2024 guidance or assuming no change so you put up $20 million, I guess, good guide in the quarter from supplemental that wasn't in there, but then there was a $10 million back, I guess, for debt and debt cost and -- I guess settlement, so roughly no change to your 2024 guidance? I just want to confirm that?

我想，這是最後一個需要澄清的問題。我將對2024 年的指導意見進行評論，或者假設沒有變化，所以你在本季度從沒有包含在內補充中拿出了2000 萬美元，我想這是一個很好的指導意見，但後來又有1000 萬美元的債務以及債務成本和——我猜是和解，所以您的 2024 年指引大致沒有變化？我只是想確認一下？

Yes, there is no change to our revised 2024 guidance.

是的，我們修訂後的 2024 年指引沒有改變。

Jamie Perse, Goldman Sachs.

高盛的傑米·珀斯 (Jamie Perse)。

I just wanted to go back to acute care volumes in the quarter at 1.5%. I appreciate you've been expecting some normalization, but that was just weaker than expected. And I want to get a sense of if you saw any change across the quarter any callouts by payer class, if you can give us any detail on how some of the larger payer classes grew relative to that? And then as we think about normalization, is this what new normal looks like? Or are there any dynamics in the third quarter that make this not representative of the go forward?

我只是想讓本季的急診護理量回到 1.5% 左右。我知道你一直期待某種正常化，但這比預期的要弱。我想了解的是，您是否看到本季度按付款人類別劃分的任何變化，您是否可以向我們詳細介紹一些較大的付款人類別相對於此的增長情況？然後，當我們思考正常化時，這就是新常態的樣子嗎？或者第三季度是否存在任何動態使得這不能代表前進的勢頭？

Yes. So on this one, Jamie, I think I'm just going to have to repeat comments that I've already made I think the most significant sort of dynamic in the quarter is the difficult comparison to last year. Which I will say we have clearly and consistently pointed out during the quarter and tried to manage people's expectations. But more importantly, is that difficult comparison to last year, I think, was really related to the fact, and I think if you go back and read or listen to our commentary from last year, it was this sort of exhaustion of deferred and postponed procedures, which we did view as kind of a onetime thing.

是的。因此，傑米，在這一點上，我想我只需要重複我已經發表過的評論，我認為本季最重要的動態是與去年的困難比較。我想說的是，我們在本季已經明確且持續地指出了這一點，並試圖管理人們的期望。但更重要的是，我認為，與去年相比，這種艱難的對比確實與事實有關，如果你回去閱讀或聽聽我們去年的評論，就會發現這種推遲和延期的疲憊我們確實將其視為一次性的事。

What I also said earlier was I thought that if you looked at the year-to-date performance of the acute business, 3% adjusted admission growth, 5% revenue per adjusted admission growth. And if you ex out the impact of the Nevada supplementals, you started to get you start to get an acute care model that in my mind, a was reflected or is reflective of our historical model, but also our expectations for the future, which is kind of mid-single digits, 6%, 7% same-store revenue growth. Split pretty evenly between price and volume.

我之前也說過，我認為，如果您看一下急性業務的年初至今的表現，調整後的入院人數增長率為 3%，調整後的入院人數增長率為 5%。如果你排除內華達州補充法案的影響，你就會開始得到一個急性照護模型，在我看來，這個模型既反映了我們的歷史模型，也反映了我們對未來的期望，也就是同店收入成長率約為個位數中等，分別為6% 和7%。價格和數量分配相當均勻。

Okay. That's helpful. And then maybe just a bit of a longer-term question. We've been in a pretty unique environment really for the last five years or so, a number of structural dynamics have either emerged or maybe intensified over that period, ASC utilization, aggressive payer tactics that probably impacts administrative burden, growth in MA and HICS. I guess just as you think about the next five years, can you level set us on strategy and in particular, internal investment priorities going forward?

好的。這很有幫助。這也許只是一個長期問題。在過去五年左右的時間裡，我們一直處於一個非常獨特的環境中，在此期間，許多結構性動態要么出現，要么可能加劇，ASC 利用率、積極的付款人策略可能會影響行政負擔、MA和HICS 的成長。我想，正如您對未來五年的展望一樣，您能否為我們制定未來的策略，特別是內部投資重點？

Yes. I mean, it's a pretty broad question and one that I'm sure we could speak for an extended period of time about sort of all the dynamics that you mentioned. I think broadly, the way I would answer the question, which seems to be an acute care center question is, we have a view that the care continuum has clearly been expanded and payers are looking to ensure that patients can be treated in the most cost-effective settings of care, which has resulted in a growth of ambulatory surgery facilities and freestanding imaging facilities and much greater access points. We've had great success with our penetration of freestanding emergency departments as an example.

是的。我的意思是，這是一個相當廣泛的問題，我相信我們可以就您提到的所有動態進行長時間的討論。我認為，從廣義上講，我回答這個問題的方式似乎是急性護理中心的問題，我們認為護理連續性顯然已經擴大，付款人正在尋求確保患者能夠以最經濟的方式得到治療- 有效的護理環境，這導致了門診手術設施和獨立影像設施的增長以及接入點的增加。例如，我們在滲透獨立急診室方面取得了巨大的成功。

But broadly, I think we are trying to participate in that and the investment in that broader continuum, whether it's, again, ASCs, freestanding imaging, freestanding EDs, et cetera. That's certainly one component of it. The other, I think, is a continued alignment with our physicians, whether that's through accountable care organizations. We have at least one of those in every single market in which we operate. Whether it's employee physicians, which we have in virtually all of our markets, et cetera.

但從廣義上講，我認為我們正試圖參與其中，並投資於更廣泛的領域，無論是 ASC、獨立成像、獨立 ED 等等。這當然是其中一個組成部分。另一個我認為是與我們的醫生保持持續的協調，無論是透過負責任的護理組織。在我們開展業務的每個市場中，我們都至少擁有其中一個。無論是僱員醫生（我們幾乎在所有的市場都有僱員醫生）等等。

But I think we view that as we sort of continue into a pretty challenging environment and where utilization is going to be viewed carefully by payers and by the government, we think being properly aligned with our physicians as sort of most -- most important dynamics.

但我認為，隨著我們繼續進入一個相當具有挑戰性的環境，並且利用率將受到付款人和政府的仔細審查，我們認為與我們的醫生保持適當的一致是最重要的動力。

So to me, I would cite those two issues, the continued emphasis on physician alignment in a bunch of different ways and the continued expansion of the care continuum as two of our major focuses as we think about the next five years.

因此對我來說，我會將這兩個問題、繼續強調以多種不同方式協調醫生以及繼續擴大護理範圍作為我們思考未來五年的兩個主要關注點。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Quick one and then maybe a more broad one. First, does the STP program benefit you called out for DC, does that include the new facility that you're opening?

先快速說一個，然後再說一個更廣泛的問題。首先，您所提到的 STP 計劃是否為 DC 帶來好處，其中是否包括您正在開設的新設施？

Yes, it does. Although I think for the most part, it's been difficult to predict what the impact on the new facility is because, obviously, we have no track record of utilization, et cetera. So the number that we've given is largely based on the historic performance of our acute care hospital in the district as well as we do have a behavioral hospital in district that would have a smaller benefit from this program. But the new hospital will participate in any new Medicaid supplemental program that's approved.

是的。儘管我認為在大多數情況下，很難預測對新設施的影響是什麼，因為顯然我們沒有利用率的記錄等等。因此，我們給出的數字主要是基於我們地區急診醫院的歷史表現，而且我們地區確實還有一家行為醫院，該醫院從該計劃中獲得的益處較小。但新醫院將參與任何獲得批准的新醫療補助補充計劃。

So that would just be some upside potentially to what you've ranged already, I guess, maybe modest?

因此，我猜，這可能只是對您現有的範圍的一些好處，也許是適度的好處？

Correct.

正確的。

Okay. And then maybe just more broadly, we've seen some, I guess, increase in frequency and legal headlines both on behavioral and the acute side. So just curious on your thoughts on -- is that just sort of the avalanche of C1 and now you're going to get 3 more? And if you think that might subside, I mean, it just seems like these are much higher at least frequency than pre-COVID. So just any kind of high-level thoughts on some of the legal news flow would be great?

好的。然後可能從更廣泛的角度來看，我想我們已經看到，無論是行為方面還是急性方面，頻率和法律頭條新聞都有所增加。所以只是好奇您的想法——這只是 C1 的雪崩，現在您還要再獲得 3 個嗎？如果你認為這種情況可能會消退，我的意思是，這種情況發生的頻率似乎至少比新冠疫情之前要高得多。那麼，對於一些法律新聞流，任何高層次的想法都是很好的嗎？

Yes. I mean, certainly, there have been some kind of headline grabbing verdicts in -- I think particularly in the behavioral space in the last year. I think as we've indicated, we believe that the two verdicts that we have disclosed are both subject to appealable issues. At least one of the verdicts has been substantially reduced just at the trial judge level. But again, I think there's a great deal more appeal activity to go on both of those cases.

是的。我的意思是，當然，確實有一些引人注目的判決——我認為特別是在去年的行為領域。我認為，正如我們所指出的，我們認為我們所揭露的兩項判決都存在可上訴的問題。至少有一項判決僅在審判法官層級就大幅減少。但我再次認為，這兩起案件還有大量的上訴工作要做。

I think it's hard to say whether those cases really reflect a significant change in the landscape. I think they were both extraordinary verdicts in terms of any sort of history in terms of facts of the case or the jurisdictions or whatever.

我認為很難說這些案例是否真的反映了情勢的重大變化。我認為，從歷史角度、案件事實、司法管轄權或其他方面來看，這兩個判決都是非同尋常的。

As I mentioned in my prepared remarks, we are increasing our reserves for malpractice expense to recognize, I think, just more broadly an increase, not so much in the frequency of cases, but in the severity of cases and the severity of settlements and verdicts, et cetera, but not necessarily really driven by the the two cases that we've been disclosing because I do think those are sort of extraordinary and are both likely to be significantly reduced.

正如我在準備好的發言中提到的那樣，我們正在增加醫療事故費用的儲備，我認為，更廣泛地說，這並不是因為案件發生頻率的增加，而是因為案件的嚴重程度以及和解和判決的嚴重程度的增加等等，但不一定是由我們披露的兩起案件所驅動，因為我確實認為這兩起案件有些特殊，而且都可能大幅減少。

Matthew Gillmor, KBCM.

馬修·吉爾摩（Matthew Gillmor），KBCM。

Steve. So the outlook for the Medicaid supplemental payments. I think we've heard you talk about Tennessee and D.C. in the past. I think today, you mentioned some additional funding for Nevada of $56 million.

史蒂夫。醫療補助補充支付的前景是如此。我想我們以前曾聽過您談論田納西州和華盛頓特區。我記得今天您提到了為內華達州提供 5600 萬美元的額外資金。

Did that be understood to be something new that's developed? Or was that already sort of baked in and understood previously?

這是否可以理解為某種新開發的東西？或者說這一點之前就已經根深蒂固並被理解了？

No, I think what gives rise to that incremental benefit is the state increasing the size of their Medicaid supplemental pool as a result of updating their Medicaid utilization, statistics and data and submitting that to CMS. So that is something that is sort of incrementally newsworthy to us. And then obviously, we're disclosing it now. But I think it's triggered by the increase in Medicaid utilization that the state is experiencing. And as a consequence is increasing their pool these Medicaid supplemental payments available.

不，我認為產生這種增量收益的原因是各州透過更新其醫療補助利用率、統計數據和數據並將其提交給 CMS，增加了其醫療補助補充資金池的規模。所以這對我們來說是有點新聞價值的事情。顯然，我們現在就披露它。但我認為這是由於該州醫療補助使用率的增加所引起的。這樣做的結果是增加了醫療補助補充支付的資金池。

Got it. And then, Steve, I wanted to see if you would be able to provide any comments on the hurricane dynamics. I think you mentioned some impacts around the edges with behavioral volumes. But -- any way to think about sort of any EBITDA impact? Or is it just small enough that it doesn't matter that much?

知道了。然後，史蒂夫，我想看看你是否能對颶風動態提供任何評論。我認為您提到了行為體積邊緣的一些影響。但是——有沒有什麼方法可以考慮一下 EBITDA 的影響？或者它只是足夠小以致於沒有那麼重要？

Yes. I mean I would say that we thought that probably on the behavioral side of the business, patient day volume would have been a 25, 30 basis points higher heading mapping for the impacts of the hurricane. I mentioned that I think there was a bit of a creep up in salary expense during the quarter as a result. I think broadly, we had the view that trying to quantify the impact of the hurricane in both of the segments. It was just not material enough to sort of call out as a discrete item.

是的。我的意思是，我想說，我們認為在業務的行為方面，患者日均治療量可能比颶風的影響高出 25 到 30 個基點。我提到，我認為本季的工資支出有所增加。我認為，從總體上講，我們試圖量化颶風對這兩個部分的影響。它不夠實質性，不足以被稱作一個獨立的項目。

It certainly was a bit of a drag during the quarter.

這對本季來說確實是個拖累。

But I think our point of view was it wasn't significant enough to call out as a discrete item.

但我認為我們的觀點是，它還不足以被視為一個獨立的專案。

Whit Mayo, Leerink Partners.

惠特·梅奧（Whit Mayo），Leerink Partners 合夥人。

I'll just keep it to one question. Steve, I was just looking for an update on some of the EMR investments you guys have been making within the behavioral segment. How many facilities now, any benefits that you're seeing on labor or other efficiencies? And then just maybe any new strategic initiatives within that segment that we should be mindful of as we enter 2025? Thanks.

我只問一個問題。史蒂夫，我只是想了解你們在行為領域進行的 EMR 投資的最新情況。現在有多少家工廠，您在勞動力或其他效率方面看到什麼好處嗎？那麼，當我們進入 2025 年時，我們應該注意該領域內的任何新策略舉措嗎？謝謝。

Yes. So I don't necessarily have the precise data in front of me with, but I think by early next year, we'll probably have 25 or 30 facilities live on the EMR and that implementation and installation process will continue -- I think we feel like it's generally been successful. And I think it tends to lend itself to greater efficiencies when you don't necessarily have a pay per record but also higher quality of care, different clinicians that are able to view a record more easily, et cetera, and that improves, I think the quality of the patient care that you can provide. I think the other technological development that we've talked about before in behavioral has to do with -- we describe as patient observation or patient rounding having eyes on behavioral patients, it's very, very frequently. It's a significant part of keeping patients safe and well.

是的。因此，我手上不一定有精確的數據，但我認為到明年年初，我們可能會有 25 或 30 個設施使用 EMR，並且實施和安裝過程將繼續——我認為我們感覺總體上是成功的。我認為，當你不需要按記錄付費時，它往往會提高效率，而且護理品質也會更高，不同的臨床醫生能夠更輕鬆地查看記錄等等，我認為這會有所改善您所能提供的患者護理的品質。我認為我們之前談到的行為方面的另一項技術發展與之有關——我們稱之為患者觀察或患者巡視，關注行為患者，這是非常非常頻繁的。這是保障病人安全與健康的重要一環。

And to date, that's been a physical exercise that literally someone is laying eyes on every patient, every 15 minutes or so. But to the degree that we can enhance that process technologically, have a patient where what looks like an Apple watch and then our clinicians carry, what looks like a tablet around and be able to know where patients are and whether they've been observed and keep tracking them more effectively that way. I think that's going to be a significant development that will help in the behavioral business in a great many ways in terms of quality of patient care and risk management, et cetera, in the next few years.

到目前為止，這已經是一次體力勞動了，每隔 15 分鐘左右就會有人照顧每位病人。但是，我們可以在技術上增強這一過程，讓患者佩戴類似蘋果手錶的設備，然後我們的臨床醫生隨身攜帶類似平板電腦的設備，這樣他們就能知道患者在哪裡，是否已經對他們進行了觀察，以此方式更有效地追蹤它們。我認為這將是一個重大的發展，在未來幾年裡，它將在病人護理品質和風險管理等方面在很大程度上幫助行為業務。

Michael Ha with Baird.

邁克爾·哈和貝爾德。

Steve, I think last quarter, you mentioned a lot of cost management in your acute care business. in preparation for that sort of eventual return to pre-pandemic volume? And then basically, the aim of being able to continue EBITDA margin expansion even when things moderate. So now that volumes appear to be moderating and acuity seems to be picking up. It feels like it might be materializing faster than most expected.

史蒂夫，我想上個季度你提到了急診護理業務中的許多成本管理。為最終恢復到疫情前的水準做準備？基本上，即使情況緩和，我們的目標也是能夠繼續擴大 EBITDA 利潤率。因此現在交易量似乎正在放緩，而敏銳度似乎正在上升。感覺它可能比大多數人預期的要快得多。

So I wanted to revisit this topic ask about those cost management efforts, how it's been tracking -- how has it been tracking? And at this point in time, if volumes do continue to moderate, what's your confidence level that you're right now in the right position to drive that EBITDA and margin expansion in the Q?

所以我想重新討論這個主題，詢問那些成本管理工作，它是如何追蹤的 - 它是如何追蹤的？目前，如果銷售量繼續放緩，您認為自己目前處於正確的位置來推動 Q 中的 EBITDA 和利潤率擴大，對此您有何信心？

Yes. I mean I think the point that I tried to make in the last quarter, maybe in the last couple of quarters is the sort of idea that some of the traditional kind of blocking and tackling that we have done from a productivity standpoint was, if not suspended may be pause temporarily during the pandemic. We were so challenged in finding an adequate workforce and keeping an adequate workforce during the pandemic there were -- we're definitely sort of -- that was over leptin to manage to what we would sort of consider peak efficiency. I think as we emerge from the pandemic, we're willing to do those sort of things that I think we've always historically done, including adjusting to volumes as they moved up and down.

是的。我的意思是，我認為我在上個季度，也許在過去幾個季度試圖表達的觀點是，我們從生產力角度所做的一些傳統的阻止和處理措施，如果不是的話，疫情期間，暫停的活動可能會暫時停止。在疫情期間，我們面臨的挑戰是尋找足夠的勞動力並保持足夠的勞動力——我們肯定是——這超出了我們認為的最高效率。我認為，隨著我們擺脫疫情，我們願意採取一些我們過去一直在做的事情，包括根據銷售的上下波動進行調整。

And I think you saw that last quarter and I think you saw that this quarter as well, where salaries as a percentage of revenues has been coming down and coming down pretty steadily, and I think is really one of the main contributors to that margin recovery. I think that's continuing. And I think the point being, I don't exactly know where acute care volumes will move, and I don't think anybody really knows for certain. But I think we're in a position where we're much more flexible about reacting to that and reacting to that in an efficient way than we were at the height of the pandemic, we faced so many more staffing challenges.

我想你們在上個季度和本季都看到了這一點，薪資佔收入的比例一直在下降，而且下降得相當穩定，我認為這確實是利潤率回升的主要原因之一。我認為這種情況還會持續下去。我認為關鍵在於，我並不確切知道急性護理量將如何變化，而且我認為沒有人真正知道確切答案。但我認為，與疫情最嚴重的時候相比，我們現在對此的反應更加靈活，也更加有效，當時我們面臨更多的人員配備挑戰。

And then follow-up. California and New Mexico, supplemental payments for '25, we're hearing it could be potentially $70 million to $80 million for California, $30 million for New Mexico to UHS. I was wondering if you have any sort of additional clarity on sizing. And then with all the recent discussion around state proposals and CMS raising those payments to average commercial rates for next year. I was wondering if you could talk more about those proposals the potential tailwind, not just California and Florida, which everyone has been focused on, but across all your states, I guess, how real a potential tailwind is this?

然後進行跟進。加州和新墨西哥州對 25 年的補充支付，我們聽說加州可能會向 UHS 支付 7,000 萬至 8,000 萬美元，新墨西哥州向 UHS 支付 3,000 萬美元。我想知道您是否對尺寸有任何其他的澄清。然後，根據最近關於州提案和 CMS 的討論，明年這些付款將提高到平均商業費率。我想知道您是否可以更多地談論這些提案的潛在順風，不僅僅是每個人都關注的加利福尼亞州和佛羅裡達州，而是在所有州，我想，這個潛在的順風有多真實？

Yes. So just responding to the specific questions you asked, New Mexico, I don't think is a significant upside for us. We have one small behavioral facility in New Mexico. California, we obviously have a much bigger presence both for acute and behavioral. I think the challenge in terms of sizing the potential benefit in California is that the state has not created a formal plan or an allocation methodology, et cetera.

是的。因此，僅回答您提出的特定問題，新墨西哥州，我認為對我們來說不是一個顯著的優勢。我們在新墨西哥州有一個小型行為設施。在加州，我們顯然在急性和行為治療方面都有更大的影響力。我認為，確定加州潛在利益規模方面的挑戰在於該州尚未制定正式計劃或分配方法等等。

So even though we understand that the potential benefit in total could be quite significant. We really have no way of knowing exactly how that would impact specific hospitals, how will be allocated among specific hospitals until the state issues a more specific plan, which at least we understand is not likely to happen until sometime maybe next year, early next year.

因此，儘管我們知道整體潛在利益可能相當可觀。我們真的無法確切知道這將如何影響具體醫院，如何在具體醫院之間分配，直到州政府發布更具體的計劃，至少我們知道這可能要到明年某個時候，也許明年年初。

Your broader question about are more states likely to increase their programs or develop new programs, increase their funding to average commercial rates. It really varies by state. And we've sort of had this practice of really only disclose them when the states have a formal plan they submitted to CMS and are waiting approval. But we certainly, like others are aware that other states are contemplating this in earlier stages, et cetera. And so we continue to believe that the potential benefit could be significant beyond just the ones that we've disclosed, which are significant, I think, in and of themselves.

您更廣泛的問題是，是否有更多州可能增加其項目或開發新項目，增加其對平均商業利率的資助。這確實因州而異。我們實際上只有當各州向 CMS 提交正式計劃並等待批准時才會披露這些資訊。但我們和其他人一樣，當然也知道其他州正在早期階段考慮這個問題，等等。因此，我們仍然相信，潛在的利益可能遠遠超出我們已經披露的利益，我認為，這些利益本身就意義重大。

But difficult to size that opportunity in any sort of precise way until the states develop their plans and submit them to CMS.

但是在各州制定計劃並將其提交給 CMS 之前，很難以任何精確的方式衡量這個機會。

Bin Hendrix with RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Bin Hendrix。

Just a quick follow-up on some of the psychiatric questions, especially in residential site, and I think I've asked this before, but just wanted to get any updates or any updated thoughts on your strategic initiatives around SIC. I know you mentioned the higher liability reserves and some very specific issues at some of your facilities. Is there any thoughts on kind of changing strategic direction or evolving strategy there? And could we potentially emit this heightened security -- could there be consolidation opportunities in residential? Thanks.

只是對一些精神病學問題進行快速跟進，特別是在住宅區，我想我以前問過這個問題，但只是想獲得有關 SIC 周圍戰略舉措的任何更新或更新想法。我知道您提到了更高的責任準備金以及您們某些設施的一些非常具體的問題。您對改變策略方向或發展策略有什麼想法嗎？我們是否有可能提高安全性—住宅領域是否有整合機會？謝謝。

Yes. I mean, I was asked kind of a more strategic question earlier, while that focus was on acute care. But then I think in some ways, the -- my answer on behavioral and my outlook is similar in the sense that we see an expanding continuum in which outpatient care is likely to play a greater role and there will be more demand for access to outpatient care, and we're expanding our outpatient footprint in response to that. I think we continue to expand our services to military members because that seems to be a growing and significant part of the business. The SD or addiction business continues to grow and demand is increasing there.

是的。我的意思是，之前我被問到了一個更具策略性的問題，而重點是急性護理。但我認為，在某種程度上，我對行為的回答和我的觀點是相似的，因為我們看到一個不斷擴大的連續體，其中門診護理可能會發揮更大的作用，對門診治療的需求也會增加護理，為此我們正在擴大我們的門診覆蓋範圍。我認為我們將繼續向軍人擴大我們的服務，因為這似乎是業務中不斷增長的重要部分。SD 或成癮業務持續成長，需求也在增加。

And I think we're increasing our exposure there.

我認為我們正在增加在那裡的曝光率。

So, yes, I don't know that it's particularly an acute residential sort of issue of paying attention or focusing on one more than the other. As much as it is these other service lines, which we think are growing in it. And I would add to sort of the outpatient dynamic continuing expansion of telehealth capabilities as well.

所以，是的，我不知道這是否是一個特別嚴重的住宅問題，需要更加關注或重視其中一個問題。我們認為，其他服務線也正在不斷成長。我想補充的是，門診遠距醫療能力的持續擴展也具有動態性。

And I'm showing no further questions at this time. And I would like to hand the conference back over to Steve Filton for any closing remarks.

我現在沒有其他問題了。現在我想將會議交還給史蒂夫·菲爾頓，請他做最後發言。

Yes. We'd just like to thank everybody for their time and look forward to speaking with people at the end of next quarter. Thank you.

是的。我們只想感謝大家的時間，並期待下季末與大家交談。謝謝。

This concludes today's conference call. Thank you for participating. You may now disconnect. Everyone, have a great day.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。祝大家有個愉快的一天。