環球健康 (UHS) 2025 Q1 法說會逐字稿

Good day, and thank you for standing by. Welcome to the UHS 2025 conference call here. (Operator Instructions). Please be advised that today's conference is recorded.

您好，感謝您的支持。歡迎參加 UHS 2025 電話會議。（操作員指令）。請注意，今天的會議已被錄音。

I would like to now hand the conference over today's speaker, Steve Filton, Executive Vice President and Chief Financial Officer. Please go ahead.

現在，我想將會議交給今天的演講者，執行副總裁兼財務長史蒂夫·菲爾頓 (Steve Filton)。請繼續。

Good morning. Thank you. Marc Miller is also joining us this morning. We both welcome you to this review of Universal Health Services results for the first-quarter March 31, 2025. During the conference call, we'll be using words such as believes, expects, anticipates, estimates and similar words that represent forecast projections and forward-looking statements.

早安.謝謝。馬克米勒 (Marc Miller) 今天早上也將加入我們。我們歡迎您閱讀 2025 年 3 月 31 日第一季全民健康服務業績的審查。在電話會議期間，我們將使用相信、預期、預期、估計等詞語以及代表預測預測和前瞻性陳述的類似詞語。

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, 2024. We would like to highlight just a couple of developments and business trends before opening the call up to questions.

對於不熟悉這些前瞻性陳述中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 2024 年 12 月 31 日的 10-K 表中有關風險因素和前瞻性陳述和風險因素的部分。在開始提問之前，我們想強調一些發展和商業趨勢。

As discussed in our press release last night, the company reported net income attributable to UHS per diluted share of $4.80 for the first quarter of 2025. 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 $4.84 for the quarter ended March 31, 2025.

正如我們昨晚的新聞稿中所討論的，該公司報告 2025 年第一季歸屬於 UHS 的每股攤薄淨收入為 4.80 美元。在根據新聞稿中附上的補充時間表所反映的項目的影響進行調整後，截至 2025 年 3 月 31 日的季度，我們歸屬於 UHS 的每股攤薄淨收入為 4.84 美元。

During the first quarter of 2025, on a same facility basis, adjusted admissions to our acute care hospitals increased 2.4% over the first quarter of the prior year. Same facility net revenues in our acute care hospital segment increased by 5.0% during the first quarter of 2025 as compared to last year's first quarter after excluding the impact of our insurance subsidiary.

2025 年第一季度，以相同設施計算，我們急診醫院的調整入院人數比去年同期第一季度增加了 2.4%。在剔除保險子公司的影響後，2025 年第一季我們急診醫院部門的同類設施淨收入與去年第一季相比成長了 5.0%。

Meanwhile, operating expenses continued to be well managed. Other operating expenses on a same facility basis increased by 2.6% over last year's first quarter after excluding the impact of our insurance subsidiary. For the first quarter of 2025, our solid acute care revenues, combined with effective expense controls, resulted in a 21% increase in EBITDA after excluding the impact of Medicaid supplemental payments.

同時，營運費用持續得到良好管理。剔除保險子公司的影響後，以相同設施計算的其他營運費用比去年第一季增加了 2.6%。2025 年第一季度，我們穩健的急性照護收入加上有效的費用控制，在排除醫療補助補充支付的影響後，EBITDA 成長了 21%。

During the first quarter of 2025, same-facility net revenues at our behavioral health hospitals increased by 5.5%, driven by a 5.8% increase in revenue per adjusted day. Adjusted patient days were relatively flat compared to the prior year quarter.

2025 年第一季度，我們的行為健康醫院的同設施淨收入增加了 5.5%，這得益於調整後日收入成長 5.8%。調整後的病人就診天數與去年同期相比相對持平。

The year-over-year patient day growth comparison was negatively impacted by the extra leap day in 2024 and challenging winter weather conditions experienced this year, early in the first quarter in certain markets. We did experience a reacceleration of patient day growth in March.

2024 年額外的閏日以及今年第一季初某些市場遭遇的嚴酷冬季天氣條件對同比患者日數增長產生了負面影響。我們確實在三月經歷了患者日數增長的再次加速。

Our cash generated from operating activities decreased from $396 million during the first quarter of 2024 to $360 million this year due in part to delays in receipt of funds in connection with certain Medicaid supplemental payments in various states. We did receive $82 million of payments related to the Nevada supplemental program in April that were related to revenues recorded in the first quarter.

我們的經營活動產生的現金從 2024 年第一季的 3.96 億美元減少到今年的 3.6 億美元，部分原因是各州某些醫療補助補充付款相關的資金收到延遲。我們確實在 4 月收到了與內華達州補充計劃相關的 8,200 萬美元付款，這些款項與第一季記錄的收入有關。

In the first quarter of 2025, we spent $239 million on capital expenditures and acquired 1 million of our own shares at a cost of approximately $181 million. Since January 2019, we have repurchased approximately 30.3 million shares, representing 33% of our shares outstanding as of that date. As of March 31, 2025, we had $1.02 billion of aggregate available borrowing capacity pursuant to our $1.3 billion revolving credit facility.

2025 年第一季度，我們花了 2.39 億美元的資本支出，並以約 1.81 億美元的成本收購了 100 萬股自己的股票。自 2019 年 1 月以來，我們已回購約 3,030 萬股，佔截至該日已發行股票的 33%。截至 2025 年 3 月 31 日，根據我們的 13 億美元循環信貸額度，我們擁有 10.2 億美元的可用借款能力。

I will now turn the call over to Marc Miller, President and CEO, for closing comments.

現在，我將把電話轉給總裁兼執行長馬克米勒 (Marc Miller)，請他發表最後評論。

Thank you, Steve. We are pleased with our first-quarter operating results, which on a consolidated basis exceeded our internal expectations. We were particularly encouraged by the control of our operating expenses in both business segments. Our first-quarter operating results exclude any supplemental Medicaid revenues in Tennessee and the district of Colombia.

謝謝你，史蒂夫。我們對第一季的經營業績感到滿意，綜合來看，其業績超出了我們的內部預期。我們對兩個業務部門的營運費用的控制尤其感到鼓舞。我們第一季的營運表現不包括田納西州和哥倫比亞特區的任何補充醫療補助收入。

Pending CMS approval of these new programs. For programs that were originally approved in previous years, we have continued to record those revenues under the assumption that programs will be reapproved. As these programs have been a recent focal point, I believe it is worth reminding people that these are federally authorized and state-approved programs in place for many years, and they are designed to allow providers who have been historically underpaid by Medicaid to provide quality care to over 70 million Medicaid recipients nationally.

等待 CMS 批准這些新計劃。對於前幾年最初批准的項目，我們繼續記錄這些收入，假設這些項目將重新獲得批准。由於這些項目最近成為焦點，我認為值得提醒人們，這些是聯邦政府授權和州政府批准的、實施多年的項目，旨在讓那些歷史上一直被醫療補助計劃低估的醫療服務提供者為全國超過 7000 萬醫療補助計劃接受者提供優質醫療服務。

Even where these programs exist, our net Medicaid reimbursement generally remains below both average commercial and Medicare reimbursement. West Henderson Hospital in Las Vegas opened in late 2024 and posted a modestly positive EBITDA in the first quarter. Cedar Hill Regional Medical Center in Washington, DC, opened recently and has experienced strong demand for its emergency services from the outset.

即使有這些計劃，我們的醫療補助淨報銷額通常仍低於平均商業和醫療保險報銷額。拉斯維加斯西亨德森醫院於 2024 年底開業，第一季的 EBITDA 表現溫和。華盛頓特區雪松山地區醫療中心最近開業，其急救服務從一開始就受到強烈需求。

While we acknowledge a great deal of uncertainty in our external operating environment, we feel confident in our underlying businesses and based on current reimbursement and operating cost levels reiterate our full-year earnings guidance.

雖然我們承認外部經營環境存在很大的不確定性，但我們對我們的基礎業務充滿信心，並根據當前的報銷和營運成本水準重申我們的全年獲利預期。

We're pleased to answer questions at this time.

我們很高興回答這個問題。

(Operator Instructions) Justin Lake, Wolfe Research.

（操作員指示）賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

Appreciate all the detail. I wanted to focus on the behavioral side, Steve. I know you talked about leap year, you talked about weather, especially earlier in the year. Maybe you could give us an idea of what you saw in March, given weather would have been passed due the leap year impact would have been past (inaudible).

感謝所有細節。我想集中討論行為方面，史蒂夫。我知道你談到了閏年，談到了天氣，尤其是年初的天氣。也許您可以告訴我們您在三月看到了什麼，因為閏年的影響已經過去了，天氣已經過去了（聽不清楚）。

So how did March volume maybe even early April volume look? And any update on the full-year guidance in terms of your thoughts around behavioral volume we should be assuming for the year?

那麼 3 月甚至 4 月初的交易量如何？就您對我們全年應該假設的行為量的看法而言，您對全年指導有什麼更新嗎？

Yes. So our full-year guidance that we presented in late February presumed behavioral patient day revenue growth of 2.5% to 3%. And we believe that is still a reasonable target, and that remains our embedded target for our guidance. We accelerated from our sort of more muted flattish level, maybe even negative levels in January, February.

是的。因此，我們在 2 月底提出的全年指導預計行為患者日收入將增加 2.5% 至 3%。我們相信這仍然是一個合理的目標，而這仍然是我們指導的嵌入式目標。我們從 1 月和 2 月較為平緩的水平開始加速，甚至可能處於負水平。

It didn't quite get to the 2.5% to 3% target in March. But feel like it was indicative of the fact that weather had kind of muted our volumes in -- for five or six weeks in January and February. April is a little bit hard to say because obviously, we had Easter and Spring break in April, but it feels like recent volumes, again, give us confidence that, that 2.5% to 3% should be achievable for the full year.

3月份並未完全達到2.5%至3%的目標。但感覺這表明，在一月和二月的五到六週裡，天氣在某種程度上抑制了我們的銷售。四月的情況有點難說，因為顯然四月份有復活節和春假，但感覺最近的交易量再次讓我們有信心，全年應該可以實現 2.5% 到 3% 的增長。

Got it. And then maybe, Marc, you could just -- on the DPP side, it was good to hear that the things kind of started up again in Nevada. Any other states that you're kind of focused on in terms of where you're expecting to hear soon and any kind of updates beyond Nevada?

知道了。然後也許，馬克，你可以——從 DPP 方面來說，很高興聽到內華達州的事情再次開始。除了內華達州以外，您還關注其他州的情況嗎？您預計很快就會聽到哪些州的消息？還有什麼更新嗎？

Yes, I just think it's Washington, DC, and Tennessee.

是的，我認為是華盛頓特區和田納西州。

And Tennessee. In both cases, the state of Tennessee and the addition of Columbia advise, not just us, but their hospital community that they continue to expect approval, that's the message they get from the folks they deal with at CMS. Obviously, timing is still somewhat up in the air.

還有田納西州。在這兩種情況下，田納西州和哥倫比亞大學不僅向我們建議，而且也向他們的醫院社區建議，他們繼續期待獲得批准，這是他們從 CMS 的工作人員那裡得到的資訊。顯然，時機仍有些懸而未決。

But again, kind of as your question alludes to, Justin, we're encouraged that after a -- would seem like a full pause in any new approvals or reapprovals by the Trump administration after they took off as a number of programs have been reapproved and there even have been a couple of new programs, none that affect us. but the new programs have been approved.

但是，正如你的問題所暗示的那樣，賈斯汀，我們很高興看到，在川普政府開始實施一些新項目並重新批准這些項目之後，似乎完全暫停了所有新項目的批准或重新批准，因為一些項目已經重新獲得批准，甚至還有幾個新項目，但這些項目都沒有對我們產生影響。但新計劃已獲批准。

So it feels to us like that process has sort of been resurrected or restarted, and we view that as a hopeful sign. And again, most importantly, for us, the Nevada program was reapproved. And as I noted in my remarks, we were actually paid for the first quarter revenues in April.

因此，我們感覺這個過程好像已經復活或重新啟動，我們認為這是一個充滿希望的跡象。對我們來說，最重要的是，內華達州的計畫再次獲得批准。正如我在演講中提到的那樣，我們實際上是在四月收到了第一季的收入。

Appreciate it. Thanks.

非常感謝。謝謝。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

I just wanted to follow up on Justin's question a little bit. So if you're still at 2.5% to 3% on behavioral volumes for the year, I think that implies a step up for the rest of the year that is above the guide range or above the high end of the guide range? Is it the right way to [set it]?

我只是想稍微跟進一下賈斯汀的問題。因此，如果今年的行為量仍保持在 2.5% 到 3% 之間，我認為這是否意味著今年剩餘時間的行為量將有所提升，超出指導範圍或指導範圍的高端？這是正確的方法嗎[設定]?

Yeah. Mathematically, I think that's correct, Sarah.

是的。從數學上來說，我認為這是正確的，莎拉。

Okay. Got it. And then the Nevada DPP that came in from the quarter, how many months was that related to? Because I think it was approved in April. So should we think about that as four months? And if so, are you running a little bit ahead on your DPP guide for the year?

好的。知道了。那麼本季內華達州 DPP 的情況與幾個月有關？因為我認為它在四月就獲得批准了。那麼我們應該將其視為四個月嗎？如果是這樣，那麼您今年的 DPP 指南是否比現在提前了一點？

Yeah. So no, that was just the first quarter payment. That $82 million, I will remind people is the gross payment that we get from the state. It's not net of our provider taxes. We've continued to pay the taxes on a regular basis. So we paid our taxes in Nevada in the first quarter.

是的。所以不，那隻是第一季的付款。我要提醒大家，這 8,200 萬美元是我們從州政府獲得的總付款。這不是我們供應商稅後的淨額。我們一直按時繳稅。所以我們在第一季就向內華達州繳了稅。

That growth amount that we received, the $82 million is in April related to the first quarter. But I think to your confusion, as you're thinking, if you annualize that $82 million, it's a lot more than the net benefit that we drive, and it's because it doesn't include the provider tax element.

我們收到的成長金額 8,200 萬美元是 4 月收到的，與第一季相關。但我認為，正如您所想的，讓您感到困惑的是，如果將這 8200 萬美元按年化，它將遠遠超過我們獲得的淨收益，這是因為它不包括提供者稅部分。

Got it. That's helpful. Thank you.

知道了。這很有幫助。謝謝。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Question on tariff. Can you help us understand what actions you're taking now to prepare for potential tariffs and what your GPO has communicated to you thus far?

關於關稅的問題。您能否幫助我們了解您目前正在採取哪些行動來應對潛在的關稅，以及您的 GPO 迄今為止向您傳達了什麼訊息？

Yeah. So first of all, I'll reiterate, I think at least one of our peer companies talked about from a tariff perspective, just sort of framing the issue. I think they said that they estimate about 60% of their supply chain purchases are sourced in the US and Canada and Mexico. So at the moment are not subject to tariffs, another 15% are pharmaceuticals, which are also at the moment, not subject to tariffs.

是的。首先，我要重申，我認為至少有一家同業公司從關稅的角度討論了這個問題。我認為他們說過，他們估計約 60% 的供應鏈採購來自美國、加拿大和墨西哥。因此，目前不受關稅影響，另外 15％ 是藥品，目前也不受關稅影響。

So at the moment, and I would say our numbers, we guesstimate are roughly the same. About three-quarters of our supply chain purchases are insulated from tariffs. The way we're, I think, protecting ourselves or actively sort of dealing with the issue is we do find some vendors who have fixed contractual prices with us have started to include things like fees or (inaudible) or -- I'm not even sure how to describe them, on their invoices, we've been sort of ignoring those factor because I think we believe they're not part of the contract.

因此目前，我想說我們的數字和估計的數字大致相同。我們的供應鏈採購中約有四分之三不受關稅影響。我認為，我們保護自己或積極處理這個問題的方式是，我們確實發現一些與我們簽訂了固定合約價格的供應商開始在他們的發票上包含費用或（聽不清楚）之類的內容——我什至不確定如何描述它們，我們一直忽略這些因素，因為我認為我們相信它們不是合約的一部分。

We continue to monitor any vendors who would tell us that they're considering cancellation of contracts or they're finding availability of products problematic. We're not really getting any of that feedback yet but certainly preparing if we do for alternatives -- other sourcing alternatives, other pricing alternatives, et cetera. But at the moment, it feels like there's not a great deal of pressure, again, in large part because I think a good chunk of our supplies are insulated from tariff impact at the moment.

我們會持續監控那些告訴我們他們正在考慮取消合約或發現產品供應有問題的供應商。我們實際上還沒有收到任何回饋，但如果我們確實收到了回饋，我們肯定會為替代方案做準備——其他採購替代方案、其他定價替代方案等等。但目前，感覺壓力並不大，很大程度上是因為我認為我們很大一部分的供應目前不受關稅的影響。

Got it. And maybe just a follow up on the behavioral side. Maybe weather aside, are you seeing any changes in your behavioral referral patterns or willingness of JV partners to work with UHS?

知道了。或許只是行為方面的後續跟進。除了天氣因素之外，您是否看到您的行為推薦模式或合資夥伴與 UHS 合作的意願發生了任何變化？

No, I don't think so. I know you said weather aside, but I would just make the comment about weather. And we talked about this, I think, on the year-end earnings call, the weather that we're talking about winter weather was in places that I think doesn't -- don't normally experience winter weather and more in the central part of the country, Virginia, Kentucky, Tennessee, Arkansas. And the challenge, I think, is twofold for us from a winter weather perspective in those places.

不，我不這麼認為。我知道您說除了天氣之外，但我只想評論一下天氣。我們在年終收益電話會議上討論過這個問題，我們談論的冬季天氣發生在一些我認為通常不會出現冬季天氣的地方，主要集中在美國中部地區，如弗吉尼亞州、肯塔基州、田納西州和阿肯色州。我認為，從這些地方的冬季天氣角度來看，我們面臨的挑戰是雙重的。

Number one, schools are closed. And I think -- I remember that, I believe in February in a number of our Virginia facilities, schools are supposed to be open, I think, for 19 days that month, and we're only open for 11. And so that has a big impact on our child and adolescent population and admissions in our child adolescent population.

第一，學校關閉。我認為——我記得，我相信在二月份，我們維吉尼亞州的許多學校應該開放 19 天，而我們只開放了 11 天。這對我們的兒童和青少年人口以及兒童青少年人口的入學率產生了很大的影響。

And the other thing that the weather impacts is our outpatient programs. Obviously, from an inpatient perspective, we may lose admissions over a two- or three- or four-day period if the weather is bad, but we obviously continue to treat the patients that we have.

天氣影響的另一個面向是我們的門診計畫。顯然，從住院病人的角度來看，如果天氣惡劣，我們可能會在兩天、三天或四天內失去入院病人，但我們顯然會繼續治療現有的病人。

But our outpatient program is pretty much closed down during those days where it's difficult for people to travel and they can't clear the roads, et cetera. So we really see an outsized impact on our outpatient and our child and adolescent business when we experience those winter conditions.

但在人們出行困難、道路無法暢通等情況下，我們的門診計畫基本上都關閉了。因此，當我們經歷冬季天氣時，我們的門診、兒童和青少年業務確實受到了巨大影響。

Other than that, no, on your question about are we seeing really any sort of structural changes in our referral patterns or willingness of referral sources to send those patients leased to that is no, which is really why, I think ultimately, we remain confident that we should be able to reach that 2.5%, 3% target that we set originally.

除此之外，關於您的問題，我們是否真的看到我們的轉診模式或轉診來源願意將這些患者轉診到那裡，發生了任何結構性變化，答案是沒有，這就是為什麼我認為最終我們仍然有信心能夠達到我們最初設定的 2.5%、3% 的目標。

Great. Thanks for the color.

偉大的。謝謝你的顏色。

Ben Hendrix, RBC Capital Markets.

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

Just following up on that last question, moving to the rate side, the strong 7.2% rate growth there. Just wanted to -- I imagine there's some payer mix dynamics there with redetermination? And then I just wanted to also get any other observations you have on payer mix changes, or any case mix developments in the behavioral side there driving that rate growth? And also when do you expect that to, I guess, normalize out to a more long-term steady-state growth rate?

接下來是最後一個問題，轉到利率方面，利率成長強勁，達到 7.2%。只是想——我想像重新確定後會存在一些付款人組合動態？然後，我還想了解您對付款人組合變化的其他觀察，或者行為方面推動費率增長的任何病例組合發展？另外，您預計什麼時候才能恢復到更長期的穩定成長率？

Yeah. So our revenue per adjusted day on a same-store basis, I think as we disclosed on that -- in our opening comments, was 5.8%. I think, again, our guidance for the year was in the 4% to 5% range. So we continue to -- and that 4% to 5% certainly would be a moderation of the rates that we've been getting over the last several years. And I think most of that is not necessarily kind of payer mix or redetermination impact, et cetera, the things that you mentioned.

是的。因此，我認為，正如我們在開場白中所披露的那樣，我們按同店計算的每日調整收入為 5.8%。我認為，我們對今年的預期是在 4% 到 5% 的範圍內。因此，我們會繼續下去——4% 到 5% 的利率肯定會比過去幾年的利率有所緩和。我認為其中大部分不一定是您提到的付款人組合或重新確定的影響等等。

But just generally better contractual pricing that we've been getting, particularly from our managed Medicaid payers. That number has been moderating some over the last several years. I think partly because as we get those prices, and we start to anniversary the impact, it's not as significant. I also think that as capacity increases in the behavioral industry in general. It diminishes a little bit of our leverage over the payers who, I think, right now have to deal with a scarcity of capacity, particularly innovation capacity where they can send their patients.

但總體而言，我們獲得的合約定價更好，特別是來自我們管理的醫療補助支付者。過去幾年來，這一數字一直在下降。我認為部分原因是，當我們獲得這些價格並開始回顧其影響時，它就不那麼重要了。我也認為，隨著行為產業整體能力的提升。我認為，這削弱了我們對付款人的影響力，付款人現在必須應對能力短缺的問題，特別是他們可以將患者送往的創新能力。

So again, I think the pattern that we're seeing in terms of strong behavioral pricing is one that we've been seeing for some time. It has moderated a little bit. It is moderating more slowly than maybe we originally anticipated, and that our guidance presumes. And I think we would presume that, that would continue to be the case. So as volumes recover as the year goes on, hopefully, we can -- if we're short of the 2.5% to 3% target for any period of time, hopefully, our pricing will offset that.

因此，我認為，就強勁的行為定價而言，我們所看到的模式是我們已經看到一段時間了。已經稍微緩和了。它的減緩速度可能比我們最初預期的要慢，而且我們的指導也假設如此。我認為我們會假設這種情況會持續下去。因此，隨著年內銷售的回升，希望我們能夠——如果我們在任何時期內未能達到 2.5% 至 3% 的目標，希望我們的定價能彌補這一差距。

Great. Thank you.

偉大的。謝謝。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Just wanted to ask more of a philosophical question on the Medicaid supplemental payment programs. Obviously, we don't know what the ultimate outcome is going to be from a legislative regulatory point of view here, but it does seem like we could be living in a world where there's like a significant restriction at a minimum in your ability to grow this economic earnings stream going forward.

只是想問一些有關醫療補助補充支付計劃的哲學問題。顯然，從立法監管的角度來看，我們不知道最終結果會是什麼，但看起來我們可能生活在一個至少在未來增加經濟收入流的能力方面受到重大限制的世界。

I know that this has only served to kind of improve your Medicaid reimbursement to maybe more sustainable levels versus actually make money. But as we think about your P&L leverage to supplemental programs, I mean, how should we think about a world where maybe that is a more fixed stream going forward, your ability as a company to still kind of deliver the type of same-store revenue and adjusted EBITDA growth rates that you've targeted historically?

我知道這只能在某種程度上提高你的醫療補助報銷額度，使其達到更可持續的水平，而不是真正賺錢。但是，當我們考慮您的損益表對補充計劃的槓桿作用時，我的意思是，我們應該如何看待一個可能未來會更加固定的流量的世界，您作為一家公司是否有能力仍然提供您歷史上所瞄準的同店收入和調整後 EBITDA 增長率？

Yeah. I mean, look, I think honestly, we're already in that world. I mean, I think, as you know, in our 10-K, we present a very detailed disclosure on Medicaid supplemental payments. And our projected Medicaid supplemental payments for 2025 were already generally flattish with what they were in 2024. So we certainly are not counting on growth in those programs. And it's certainly possible that we will see some deceleration in those supplemental payments or in other Medicaid reimbursement.

是的。我的意思是，說實話，我們已經身處那個世界了。我的意思是，我認為，正如你所知，在我們的 10-K 中，我們對醫療補助補充支付進行了非常詳細的披露。我們預計 2025 年的醫療補助補充支付金額將與 2024 年的額度基本持平。所以我們當然不指望這些項目能夠成長。當然，我們很可能會看到這些補充支付或其他醫療補助報銷有所減少。

And I think what that really means ultimately is the way we're going to grow the behavioral business in the intermediate and long term is with more volume growth. And that's why it is -- we acknowledge it's important that we get to that 2.5% to 3% target -- patient day target because ultimately, we think going forward, our Medicaid rates in particular are likely to be impacted by legislative action.

我認為這最終意味著我們在中長期內發展行為業務的方式是透過更大的數量來成長。這就是為什麼——我們承認達到 2.5% 到 3% 的目標——病人日數目標——非常重要，因為最終，我們認為，展望未來，我們的醫療補助費率可能會受到立法行動的影響。

[Travis], I think we can go to the next question.

[崔維斯]，我想我們可以進入下一個問題了。

Benjamin Rossi, JPMorgan.

摩根大通的班傑明‧羅西。

Thanks for taking my question. So how would you describe, I guess, patient utilization activity during 1Q across acute. And then when parsing those volumes up by payer, how do you frame growth between maybe your traditional managed care book versus your ACA exchange-related volumes.

感謝您回答我的問題。那麼我想您如何描述第一季急性期的患者利用活動？然後，當按付款人分析這些交易量時，您如何建立傳統管理式醫療帳簿與 ACA 交易所相關交易量之間的成長。

Just curious if you've seen any variation at the regional level for states where enrollments in a better like Texas or Florida versus the state like Nevada where it might be less pronounced?

我只是好奇，您是否看到在德克薩斯州或佛羅裡達州等入學率較高的州與內華達州等入學率可能不那麼明顯的州在地區層面上存在任何差異？

Yeah. I don't -- so I think specifically your question about exchange utilization, again, I think one of our peers talked about the fact that their exchange volumes were up 20% or so in the first quarter over last year's first quarter. I think we saw a similar increase. Again, these are relatively small numbers on an absolute basis.

是的。我不知道——所以我認為你關於交易所利用率的問題，我認為我們的一位同行談到了這樣一個事實，即他們的交易所交易量在第一季度比去年第一季度增長了 20% 左右。我認為我們也看到了類似的成長。再次，從絕對值來看，這些數字相對較小。

I think about -- for us, at least, exchange or patients with exchange coverage represent about 6% of our adjusted admissions in our acute care space. That's a little bit of an increase over what we were running. And if that utilization is coming from anywhere, I think it's probably our Medicaid utilization is probably not growing as fast, and that's probably what's generating most of that exchange increase.

我認為——至少對我們來說，交換或具有交換覆蓋的患者約占我們急性護理領域調整入院人數的 6%。這比我們之前運行的數量略有增加。如果這種利用率來自哪裡，我認為可能是我們的醫療補助利用率可能成長得不那麼快，這可能是產生大部分交換成長的原因。

But overall, I don't think that that patient mix is affecting our pricing or our profitability in any significant way.

但總的來說，我認為患者組合不會對我們的定價或獲利能力產生任何重大影響。

Got it. Thanks. And then just as a clarification. On the Medicaid taxes, so you received the payments in April. Did your 1Q other operating expenses contain those related Nevada Medicaid taxes? Or is that a 2Q item?

知道了。謝謝。然後只是為了澄清一下。關於醫療補助稅，您在四月收到了付款。您第一季的其他營運費用是否包含相關的內華達州醫療補助稅？還是這是第二季的商品？

No. The point that I was trying to make to Sarah before was we continue to pay the provider taxes on a regular basis. So our first-quarter provider taxes were in our numbers even though -- again, the revenue was in there as well. It's just that the cash was not.

不。我之前試著向莎拉說明的一點是，我們會繼續定期繳納提供者稅。因此，我們的第一季供應商稅包含在我們的數字中，儘管收入也包含在內。只是沒有現金。

Got it. Thanks for the clarification.

知道了。感謝您的澄清。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究。

Just back on behavior. I'm curious on demand trends outside of weather and some of these other temporal effects. Are you seeing any differences in demand by acuity sort of demand for specific services. And then just a quick follow up on West Henderson. I know it's very early there, but I'm just curious how you're seeing competitive dynamics impacted in the market and maybe just a comment on your other facilities there as well.

回到行為上。我對天氣和其他一些時間影響之外的需求趨勢很好奇。您是否發現對特定服務的敏銳度需求有任何差異？然後我們來快速跟進一下西亨德森的情況。我知道現在還為時過早，但我只是好奇您如何看待競爭動態對市場的影響，或許也對您在那裡的其他設施發表評論。

Yeah. So I'll answer the Henderson question first and come back to behavioral. Yeah, I mean we're very encouraged by our West Henderson results for a hospital basically in its first full quarter being open to have a positive EBITDA really is extraordinary.

是的。因此，我將首先回答亨德森的問題，然後再回到行為問題。是的，我的意思是，我們對西亨德森醫院的業績感到非常鼓舞，因為這家醫院在開業的第一個完整季度就實現了正的 EBITDA，這確實很了不起。

There's a little bit of cannibalization from our existing hospitals, and we thought about this in our year-end call. So I would suggest that a little bit of our same-store adjusted admission metrics a little bit our same-store profitability is sort of muted by the fact that there's been a bit of cannibalization, although I don't think it's terribly significant. But just generally pleased.

我們現有的醫院存在一些蠶食現象，我們在年終電話會議上考慮到了這一點。因此，我認為我們的同店調整入場指標和同店獲利能力在一定程度上受到一定程度的蠶食影響，儘管我認為這並不十分重要。但整體來說還是很高興。

And that's -- honestly, while I think this is better than we even expected, the whole reason we built West Henderson and invested in this project is we think that it's a growing part of the Las Vegas market. It would -- the demand would be there. It has been. And I think we think West Henderson will continue to grow at a brisk pace. We're very encouraged by the early results.

而且那是——老實說，雖然我認為這比我們預期的要好，但我們建造西亨德森並投資這個項目的全部原因是我們認為它是拉斯維加斯市場中不斷增長的部分。它會——會有需求。它一直。我認為西亨德森將繼續快速成長。早期結果令我們非常鼓舞。

As far as your behavioral questions and really sort of if demand has changed, no. And again, I think we've said the same thing really for the last several years, which is measured both by sort of macro kind of data that industry-wide data that tracks behavioral demand across a variety of diagnoses and services.

就您的行為問題以及需求是否真的改變了而言，答案是否定的。而且，我認為我們在過去幾年裡確實說過同樣的話，這是透過某種宏觀數據和追蹤各種診斷和服務的行為需求的行業範圍的數據來衡量的。

I think generally, that has been strong in our own sort of micro data, which is our inbound activity of calls and internet inquiries, et cetera, continues to be quite strong. And so the challenge is, do we have the physical capacity to meet those demands, do we have the labor for us to meet those demands. I think those situations have improved in the last several years, but can still be challenging in some markets.

我認為整體而言，我們自己的微觀資料一直表現強勁，也就是我們的來電和網路查詢等活動持續保持強勁。因此，挑戰在於，我們是否有物質能力來滿足這些需求，我們是否有勞動力來滿足這些需求。我認為這些情況在過去幾年中有所改善，但在某些市場仍然充滿挑戰。

We also acknowledge there is more competition in some markets. But again, I'll sort of go back to what I said before. I think because the demand remains strong, because the labor market has stabilized, et cetera. I do think we have the view that that 2.5% to 3% patient day growth target is still a very achievable target.

我們也承認某些市場競爭更加激烈。但再一次，我還是要回到我之前說過的話。我認為這是因為需求依然強勁，勞動市場已經穩定，等等。我確實認為，2.5% 至 3% 的患者日增長目標仍然是一個非常容易實現的目標。

Perfect. Thank you.

完美的。謝謝。

Craig Hettenbach, Morgan Stanley.

摩根士丹利的克雷格·赫滕巴赫。

On the acute business, can you talk about any trends that set out just from an acuity perspective? And then outside of volume growth, any levers there that you're looking to potentially pull to continue to improve margins in that segment?

關於急性業務，您能否談談僅從敏銳度角度出發的任何趨勢？那麼，除了銷售成長之外，您希望採取什麼措施來繼續提高該領域的利潤率？

Yeah. So from an acuity perspective, I would say acuity was muted a little bit in Q1 by the busier flu season. So we had on a sort of a relative percentage basis, more medical patients than surgical or procedural patients in Q1 because of the busy flu season. I think that will normalize as the year goes on.

是的。因此，從敏銳度的角度來看，我認為第一季的敏銳度因流感季節較為繁忙而降低。因此，從相對百分比來看，由於流感季節繁忙，第一季的內科患者數量多於外科或程序患者。我認為隨著時間的推移這種情況將會正常化。

But our acuity as measured by our CMI, actually was still relatively strong in Q1, which I think suggests that the procedural business that we did have was still pretty solid and relatively high acuity business. And obviously, I think after the first quarter, even in March, we saw flu volumes declined dramatically as you would expect. And so I think as the year goes on, I think it's fair to expect acuity will grow a little bit.

但以我們的 CMI 衡量的敏銳度實際上在第一季仍然相對強勁，我認為這表明我們的程式業務仍然相當穩固，並且是敏銳度相對較高的業務。顯然，我認為在第一季之後，甚至在三月份，我們看到流感數量正如你所預期的那樣急劇下降。因此我認為隨著時間的推移，可以合理地預期敏銳度會有所增長。

Got it. And then just as a follow up on just capital deployment, updated thoughts on just kind of CapEx plans for this year versus buybacks and how you're approaching that?

知道了。然後，作為對資本部署的後續跟進，您對今年的資本支出計劃與回購有何看法，以及您如何處理這些問題？

Yeah. I mean, our original guidance was for, I think, $800 million to $1 billion of CapEx. We had $240 million, a little bit high in Q1 because we still had some costs flowing over from West Henderson. We still have some other whole hospital projects ongoing.

是的。我的意思是，我們最初的指導是，我認為，資本支出為 8 億至 10 億美元。我們的資金為 2.4 億美元，第一季略高，因為我們仍有一些成本從西亨德森流過來。我們還有一些其他的整座醫院項目正在進行中。

So yeah, I mean, I think we're on track to be in that range as we suggested. I think our share repurchase guidance for the year was in the $600 million range. We had $180 million in the first quarter. So we're tracking a little bit above that. We'll see, but I think as long as there continues to be some level of uncertainty and softness in the market and our share price, I suspect will continue to be an active acquirer of our shares.

是的，我的意思是，我認為我們正朝著我們所建議的方向發展。我認為我們今年的股票回購預期在 6 億美元左右。我們第一季的營收為 1.8 億美元。因此，我們的追蹤範圍略高於此。我們會看到，但我認為，只要市場和我們的股價繼續存在一定程度的不確定性和疲軟，我​​懷疑我們會繼續積極收購我們的股票。

Thank you.

謝謝。

Matthew Gillmor, KeyBanc Capital Markets.

馬修·吉爾摩（Matthew Gillmor），KeyBanc 資本市場。

I wanted to ask about the expense management topic. Any areas of particular outperformance to call out and sort of how you're feeling about the sustainability of that. I was particularly interested in the premium labor costs. I think they've been running $60 million per quarter. Just kind of curious whether that's running through the early part of '25?

我想問一下費用管理的話題。有哪些領域表現特別出色，您對此有何看法？我對高昂的勞動成本特別感興趣。我認為他們每季的支出是 6000 萬美元。我只是有點好奇這是否會持續到 25 年初？

Yeah. So as to premium pay, premium pay in the quarter was, I think, $63 million, which I think you would suggest Matthew, is we've been running in the low 60s. So pretty consistent. Yeah, I think the operating expense controls, we certainly have been present now for several quarters are really a reflection of a few different things. I think as the labor markets have settled out, obviously, premium pay, use of temporary labor has declined and reached kind of a steadier level.

是的。至於加班費，我認為本季的加班費為 6,300 萬美元，我想你會建議馬修，我們的加班費一直在 60 出頭。非常一致。是的，我認為我們已經存在了幾個季度的營運費用控制實際上反映了一些不同的事情。我認為，隨著勞動市場的穩定，顯然，額外工資、臨時工的使用已經下降，並達到了更穩定的水平。

I think wage inflation has certainly decelerated from the heights that it had reached during the pandemic, that's certainly helpful. It limits the amount of sign-on bonuses and recruitment bonuses and things that we have to pay in order to attract talent.

我認為薪資通膨肯定已經從疫情期間達到的最高水準放緩，這肯定是有幫助的。它限制了簽約獎金、招募獎金和我們為了吸引人才而必須支付的費用。

I also think and we've talked about this on previous calls, we've been more actively managing productivity and appropriate staffing levels, et cetera, post pandemic because there isn't nearly as much competition for labor. It's still a pretty tight labor market but not nearly as tight as it was at the height of the pandemics. So it's allowed us to go back to some of the blocking and tackling mechanisms that I think we paused during the pandemic because there was such a lack of staff.

我還認為，我們在之前的電話會議上也討論過這個問題，疫情過後，我們一直在更加積極地管理生產力和適當的人員配備水平等等，因為勞動力競爭並沒有那麼激烈。勞動市場仍然相當緊張，但遠不及疫情高峰時期那麼緊張。因此，這使我們能夠恢復一些阻止和解決機制，我認為這些機制在疫情期間我們暫停了，因為當時人手嚴重短缺。

So I think, again, our operating expenses in both business segments really look positive. And I think they should remain so. Obviously, we've talked about some of these (inaudible) pressures mainly tariffs, and obviously, that's difficult for us to predict. But I think in terms of the things we can control, we think that these expense levels and expense controls are certainly sustainable.

因此，我認為，我們兩個業務部門的營運費用確實看起來是正面的。我認為他們應該保持這種狀態。顯然，我們已經討論了一些（聽不清楚）壓力，主要是關稅，顯然，這對我們來說很難預測。但我認為就我們能夠控制的事情而言，我們認為這些費用水平和費用控制肯定是可持續的。

And then, Steve, a quick follow up on the Medicaid supplementals. We all appreciate the level of disclosure you provide. In terms of the expectation for 2025, are you still expecting $997 million from the last disclosure? Or has that number changed at all?

然後，史蒂夫，快速跟進醫療補助補充計劃。我們非常感謝您所提供的揭露程度。對於 2025 年的預期，您是否仍預期上次披露的 9.97 億美元？或者這個數字已經改變了？

Yeah. So we're still compiling that for our first-quarter 10-Q, but I would suggest that, that number has not changed in any material way.

是的。因此，我們仍在為第一季的 10-Q 編制這些數據，但我認為，這個數字並沒有任何實質的變化。

Got it. Thank you.

知道了。謝謝。

Michael Ha, Baird.

麥可·哈，貝爾德。

I just want to follow up on Sarah's question on behavioral health volume cadence for the rest of the year. It is a pretty big, implied step up. So I was wondering if you could elaborate more on cadence -- quarterly cadence. Are we talking an immediate large step-up in 2Q or is something more modest and then larger step-ups in 3Q, 4Q?

我只是想跟進莎拉關於今年剩餘時間行為健康音量節奏的問題。這是一個相當大的、隱含的進步。所以我想知道您是否可以更詳細地闡述節奏——季度節奏。我們談論的是第二季的立即大幅成長，還是先小幅成長，然後在第三季、第四季出現更大幅度的成長？

And maybe specifically as it relates to the three big headwinds that impacted volumes last year, how much of that is still redeterminations, labor constraints, those handful of sites? What's the latest update on those? I presume maybe labor is still ongoing, but have we now fully stepped over the other two headwinds. Trying to get a better sense on just falling recovery over the balance of the year.

也許具體來說，就影響去年產量的三大不利因素而言，其中有多少仍然是重新確定、勞動力限制和少數幾個站點造成的？這些的最新更新是什麼？我猜也許分娩仍在繼續，但我們現在已經完全克服了另外兩個逆風嗎？試圖更了解今年餘下時間的復甦情況。

Yeah. So Michael, honestly, I think you asked and answered your own question. I mean, I think of the three that we have talked about historically, the only one that is persistent I think is labor. Labor scarcity has certainly improved from, again, when it was really, really extreme during the height of the pandemic, but it's still a tight labor market, and we still compete in various markets or find the competition for a variety of kind of staff levels, whether that's nurses or therapists or mental health technicians to be problematic in certain markets.

是的。所以邁克爾，說實話，我認為你已經問了並回答了你自己的問題。我的意思是，我認為我們在歷史上討論過的三個因素中，唯一持久的因素就是勞動力。勞動力短缺的情況肯定已經比疫情高峰期更加嚴重，但勞動力市場仍然緊張，我們仍然在各個市場競爭，或者發現各種級別的員工競爭，無論是護士、治療師還是心理健康技術人員，在某些市場都是成問題的。

And in certain markets, I do think it creates kind of a cap on our volumes. But I don't think that's getting worse. And I think we continue to make progress there. I'll make the point that I think a big muting factor in Q1 is simply the leap day comparison that probably has about 100 -- a little over 100 basis point impact. Obviously, that's something that we know over the year will -- the impact will diminish. And I think we always assume that the 2.5% to 3% for the year took into account the one weekday for the year.

在某些市場，我確實認為這會對我們的銷售造成一定限制。但我不認為情況會變得更糟。我認為我們將繼續在這方面取得進展。我要指出的是，我認為第一季的一個很大的影響因素是閏日比較，其影響可能約為 100 — — 略高於 100 個基點。顯然，我們知道，隨著時間的推移，其影響將會逐漸減弱。我認為我們總是假設一年的 2.5% 到 3% 是考慮到一年中的一個工作天。

So that will get -- that comparison will not be as difficult as the year goes on. Yes, I'm not going to make a comment about exactly where we're likely to wind up in Q2. Again, just to repeat what I said now a number of times, which is the original guidance of 2.5% to 3% for the year is something we think we can achieve. We acknowledge that it requires a step-up from where we were in Q1.

因此，隨著時間的推移，這種比較將不再那麼困難。是的，我不會對我們在第二季可能出現的情況做出具體評論。我再重複一次我多次說過的話，即我們認為我們能夠實現今年 2.5% 至 3% 的最初預期。我們承認，這需要比第一季有所提升。

And just one more question about California and Florida proposal. I think they already submitted filed the CMS to raise the DPP payments to average commercial rates. Just any update there? I know historically, I think about six months for approval, but there might have been a bit of a moratorium just given the new administration. But also, Steve, you mentioned a lot of GPC programs that were paused are now being resurrected.

還有一個關於加州和佛羅裡達州提案的問題。我認為他們已經向 CMS 提交了文件，要求將 DPP 付款提高到平均商業費率。那裡有任何更新嗎？我知道從歷史上看，批准大約需要六個月的時間，但考慮到新政府的上台，可能會有一點暫停的時間。但是，史蒂夫，你也提到很多暫停的 GPC 專案現在正在恢復。

So curious on those two. And also maybe more broadly, given this administration's focus on budget, Medicaid, provider taxes, whether you think future proposals to raise EPP to average commercial rates might have maybe less likelihood of being passed over the next few years.

對這兩個人很好奇。而且也許更廣泛地說，考慮到本屆政府對預算、醫療補助、供應商稅收的關注，您是否認為未來幾年將 EPP 提高到平均商業費率的提案可能不太可能獲得通過。

Yeah. So it feels, Michael, like this is really kind of a two-track process at the moment in that there are new programs being submitted. There are new programs that have been submitted in our case, Tennessee, (inaudible), Tennessee and DC that are being considered by CMS. And the impression that we have, again, as your question alluded to, is that there was sort of a pause as the administration changed and the policymakers and CMS change, but it feels like the administrative process of reviewing and approving these programs has sort of been restarted.

是的。因此，邁克爾，感覺這實際上是一種雙軌進程，因為有新的程式正在提交。在我們的案例中，田納西州（聽不清楚）、田納西州和華盛頓特區已經提交了一些新計劃，CMS 正在考慮這些計劃。正如您的問題所提到的，我們的印像是，隨著政府、政策制定者和 CMS 的變化，出現了某種停頓，但感覺審查和批准這些計劃的行政程序已經重新啟動。

And again, forget about what we're saying, I think what the states who have submitted these programs are saying is that they expect that they're going to go through the normal process, be approved in the normal course, et cetera.

再說一遍，別管我們說什麼了，我認為提交這些計劃的州所說的是，他們希望這些計劃能夠經過正常程序，在正常過程中獲得批准，等等。

That's separate and apart from any legislative action that the House and Senate may take to limit these programs in the future, et cetera. So again, I think we're viewing this separately. We think the Tennessee and DC programs based on the feedback we get from those respective governments are likely to be approved at some point. I think it's difficult to predict.

這與眾議院和參議院將來可能採取的限制這些計劃等的任何立法行動都是獨立的。所以，我認為我們應該分別看待這個問題。根據我們從各自政府獲得的回饋，我們認為田納西州和華盛頓特區的計劃很可能會在某個時候獲得批准。我認為這很難預測。

California and Florida have just been submitted. I think it's even more difficult to predict what the timing of that would be. But that, I think, is separate in the part then from whatever legislative action may impact those supplemental programs going forward.

加州和佛羅裡達州剛剛提交了申請。我認為預測這一時間會更加困難。但我認為這與未來可能影響這些補充計劃的任何立法行動是分開的。

Pito Chickering, Deutsche Bank.

皮托·奇克林，德意志銀行。

Thanks for taking my question. I guess the first one here is can you guys sort of talk about the settlement of the Pavilion case and remind us how much commercial insurance you have for the lawsuits and what is the timing of the Cumberland case?

感謝您回答我的問題。我想第一個問題是，你們能否談談 Pavilion 案的和解情況，並提醒我們你們為這些訴訟投了多少商業保險，以及 Cumberland 案發生的時間是什麼時候？

Yeah. So as we disclosed in the press release, we have a tentative settlement in the pavilion case. It is limited by -- disclosure is limited by confidentiality. It also requires approval of the court, which we think probably is not coming until next month. And when we get that approval in our next filing, we'll disclose how much insurance is still remaining.

是的。正如我們在新聞稿中所披露的那樣，我們在展館案上已經達成了初步和解。它受到——披露受到保密的限制。它還需要法院的批准，我們認為可能要到下個月才能批准。當我們在下次申請中獲得批准時，我們將揭露剩餘的保險金額。

But I will say at this point, there is still substantial if this settlement is approved, there will still be substantial commercial insurance for the 2020 year remaining. And that's important because the Cumberland cases that you also referenced or 2020 cases. But we'll give those details once the settlement is approved by the court.

但我現在要說的是，如果這項和解獲得批准，那麼在 2020 年剩餘的時間裡，仍然會有大量的商業保險。這很重要，因為您提到的坎伯蘭案件或 2020 年案件。但一旦法院批准和解，我們就會提供這些細節。

As far as the timing of the Cumberland cases, they've moved -- the three cases have been adjudicated are moving slowly. We have not gotten ruling them even on the post-trial motions, let alone any appeals, et cetera. None of the other cases have been tried. So it's moving quite slowly from the perspective of those cases.

就坎伯蘭案件的時間而言，它們已經進展——三起案件的裁決進展緩慢。我們甚至還沒有對審判後的動議做出裁決，更不用說上訴等等了。其餘案件均未審理。因此，從這些案例的角度來看，進展相當緩慢。

Great. And then a follow up here. The acute hospital segment saw 110 basis point improvement in supply costs. How does that leverage due to just the flu and lower surgical volumes? How much do you actually do to better supply management? And how should we be thinking about supply leverage in 2025 as surgical volumes come back?

偉大的。然後在這裡進行跟進。急性醫院部門的供應成本改善了 110 個基點。僅由於流感和手術量減少，這會產生什麼影響？您實際上做了多少工作來改善供應管理？隨著手術量的回升，我們該如何看待 2025 年的供應槓桿？

Yeah, I think our original guidance for the year presumes relatively modest inflation rates for supply expense increases in the sort of 2.5% and 3.5% range. We did [opposite] of that or is that in Q1? I think some of that, as your questions suggests, is that (inaudible) of patients more medical, more respiratory, less procedural so that by its nature, medical cases tend to have less of a supply component than procedural cases.

是的，我認為我們最初對今年的預測是供應費用成長的通膨率相對溫和，在 2.5% 到 3.5% 的範圍內。我們做了與此相反的事情，還是在 Q1 中？我認為，正如您的問題所暗示的，部分原因是（聽不清楚）患者更多的是醫療、呼吸系統疾病，而不是程序性疾病，因此從本質上講，醫療病例往往比程序性病例的供應成分要少。

I would think for the year, again, something in that sort of modest inflationary expense is the way that I would think about supply expense growth, it also to be fair to both our operators and our supply chain professionals. I think we're doing a good job from a contractual pricing standpoint and product replacements to cheaper products, et cetera. So some of that positive supply results are from active management on our part.

我認為，對於今年而言，這種適度的通膨費用是我對供應費用成長的看法，這對我們的營運商和供應鏈專業人員來說也是公平的。我認為從合約定價的角度以及產品替換為更便宜的產品等方面來看，我們做得很好。因此，部分正面的供應結果來自於我們的積極管理。

Great. Thanks so much.

偉大的。非常感謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Can you tell us how physician fee expense growth ended up in the first quarter, both from a year-over-year perspective and versus your internal expectations?

您能否告訴我們第一季醫師費用成長情況如何，與去年同期相比以及與您的內部預期相比如何？

So we said in our original guidance that professional fees broadly and then the physician expenses that you're talking about will simply increase by, again, an expected inflation rate, 5%, something like that. And that is certainly the way that we're tracking. We see some amount of pressure, meaning requests from physicians for either accelerated or increased or new fees.

因此，我們在最初的指導意見中表示，專業費用總體上以及您談論的醫生費用將再次增加，預期通膨率將增加 5% 左右。這當然是我們正在追蹤的方式。我們看到了一定程度的壓力，這意味著醫生要求加速或增加或增加新的費用。

But I think we're dealing with that and our general expectation is that we should be able to control those professional fees and physician expense to or limit it to just some overall inflationary increase.

但我認為我們正在處理這個問題，我們的總體期望是，我們應該能夠控制這些專業費用和醫生費用，或將其限制在整體通膨增長範圍內。

Got it. And then just lastly, I'm sorry if I missed it, but can you parse out the impact from the higher flu and respiratory season we saw in the first quarter?

知道了。最後，如果我錯過了，我很抱歉，但您能否分析一下我們在第一季看到的流感和呼吸道感染高發季節的影響？

Yeah. I mean -- so the easy part is, I think we would suggest that there was probably something less than $10 million, maybe $7 million or $8 million of incremental profits from the -- what we would describe as sort of excess flu cases for the number of flu cases this year in excess of last year.

是的。我的意思是——簡單的部分是，我認為我們可能會認為，今年流感病例數超過去年，由此產生的增量利潤可能少於 1000 萬美元，也許是 700 萬美元或 800 萬美元——我們稱之為超額流感病例。

What's harder to do is kind of calculating sort of kind of crowd out of that procedural cases, I think, were somewhat softer, as I think a number of our peers have suggested as well, whether that was due directly to the flu season, not hard to say. But I think we have always had a position that the flu tends to have a relatively immaterial impact on results, both positive and negative, meaning during a busy flu season, which this was or not busy flu season and I think this quarter was any different.

更難做的是計算出程序性案件的某種擠出效應，我認為，程序性案件有些溫和，正如我們的許多同行也建議的那樣，這是否直接歸因於流感季節，並不難說。但我認為，我們始終認為，流感對業績的影響相對不大，無論是正面影響還是負面影響，這意味著在流感高峰期，無論現在是還是不是流感高峰期，我認為本季都會有所不同。

The one other item I'd add just to clarify is while the flu was, I think if you -- there are these maps that show flu activity around the country. And while generally, flu activity was much higher just about everywhere. Nevada is one of the few states that had a very light flu season. So in our biggest acute care market, I don't think we had much of an impact from the flu season.

我要補充說明的另一點是，當流感流行時，我想如果你——這些地圖顯示了全國各地的流感活動情況。整體而言，幾乎所有地方的流感活動都比較活躍。內華達州是少數幾個流感季節病情較輕的州之一。因此，在我們最大的急性護理市場中，我認為我們不會受到流感季節的太大影響。

Okay. Thank you.

好的。謝謝。

Joanna Gajuk, Bank of America Securities.

美國銀行證券的喬安娜‧加朱克 (Joanna Gajuk)。

So maybe just switching gears a little bit to pricing. So first, can you talk about commercial rate updates you've seen, I guess, this year for future, have you noticed any change in managed care contracting terms? And maybe any change from plants in terms of just how aggressive they are or how willing they are to respond to your request given they see high cost.

因此，也許只是稍微改變一下定價的想法。那麼首先，您能談談您所看到的商業費率更新嗎？我想，今年對於未來，您是否注意到管理式醫療合約條款有任何變化？也許工廠在攻擊性方面會發生一些變化，或者在它們看到高昂的成本後，它們是否願意回應你的請求。

Yeah. So first of all, again, I'll just remind everybody that our overall guidance for our Acute Care segment this year was 5% to 6% same-store revenue growth split pretty evenly between price and volume, so 2.5% to 3% price, 2.5% to 3% volume, that 2.5% to 3% price assumption includes a commercial price assumption, probably the 4% to 5% range. Again, I think we're tracking those numbers.

是的。首先，我再次提醒大家，我們今年對急性護理部門的總體指導是同店收入增長 5% 至 6%，價格和銷量之間分配相當均勻，因此價格為 2.5% 至 3%，銷量為 2.5% 至 3%，2.5% 至 3% 的價格假設包括商業價格假設，可能是 4% 至 5% 的範圍。再次，我認為我們正在追蹤這些數字。

I would describe the relationship with the managed care companies is always difficult and [log], whether that's contractual pricing negotiations or the day-to-day processing of claims and then denials and denials, appeals, et cetera. We're very focused on that. I think we've improved the number of our own internal revenue cycle functions to deal with some of the more aggressive behavior on the part of payers.

我認為與管理式醫療公司的關係總是很困難，無論是合約定價談判還是日常索賠處理，然後是拒絕和上訴等等。我們非常關注這一點。我認為我們已經改進了我們自己的內部收入周期功能的數量，以應對付款人的一些更激進的行為。

But again, I think our first-quarter results would suggest that we're not seeing any meaningful impact from any more aggressive behavior on the part of the payers.

但我再次認為，我們的第一季業績表明，我們並沒有看到付款人採取任何更激進的行為所帶來的任何有意義的影響。

And if I may, in your [psych] segment, can we talk about pricing there, too? So you alluded to the idea that you do think there could be some changes to Medicaid stock funding coming from Congress. So with that uncertainty, are states behave differently when it comes to their budgeting process when it comes to rates for [psych].

如果可以的話，在您的[心理學]部分，我們可以也討論一下定價嗎？所以您暗示您確實認為國會可能會對醫療補助股票資金做出一些改變。因此，在這種不確定性下，各州在預算過程中的行為會有所不同，尤其是在[心理學]。

Yes. I don't think so. I think the reality is providers, payers, government entities, are all in this sort of uncertain environment. And I think the way most of us are having is as we -- whether it's negotiating contracts or the states the dictating rates, et cetera, are doing so based on the best information they have available. If that changes, their behavior may change.

是的。我不這麼認為。我認為現實情況是，供應商、付款人、政府實體都處於這種不確定的環境中。我認為我們大多數人的做法是——無論是談判合約還是規定費率等等，都是基於他們所掌握的最佳資訊。如果這種情況發生變化，他們的行為可能會改變。

But I think it's very difficult for any player in the space to anticipate exactly what the changes are going to be and to react to them currently. So I think we all, for the most part, are dealing with the information at hand and when and if it changes, we'll adopt or adapt our behavior to that.

但我認為，對於該領域的任何參與者來說，要準確預測即將發生的變化並對其做出反應都是非常困難的。所以我認為，我們所有人，在大多數情況下，都在處理手頭上的信息，當信息發生變化時，我們就會採取或調整我們的行為。

If I may squeeze a very last one, sorry if I missed. So just to confirm, in your guidance, you do not assume Tennessee and DC DPP approvals, correct?

如果我可以擠出最後一個，我很抱歉錯過了。因此，只是為了確認，在您的指導中，您不假設田納西州和華盛頓特區 DPP 的批准，對嗎？

So our guidance did not assume anything for Tennessee or DC and our results do not include anything for DC and Tennessee.

因此，我們的指導沒有對田納西州或華盛頓特區做出任何假設，我們的結果也不包括華盛頓特區和田納西州的任何內容。

Great. Thanks.

偉大的。謝謝。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Maybe just to go back to -- I know you've gotten asked a lot about supplemental payments. But one thing that one of your peers raised the other day that was sort of interesting is they were saying that they saw some states maybe tweaking down payment rates under the traditional Medicaid formula because they had supplemental payment programs that were offsetting it in aggregate the industry was doing okay, they felt.

也許只是回到——我知道你經常被問到有關補充付款的問題。但是前幾天您的一位同事提出的一個有趣的問題是，他們說他們看到一些州可能在傳統醫療補助方案下調整了首付率，因為他們有補充支付計劃可以抵消它，從總體上看，他們認為這個行業做得還不錯。

Are you seeing any of the states that you're in tweak the base payment rate, which probably would lend some support to the discussion the industry is making about. You got to look at the total picture. But I was wondering if you're seeing any of that.

您是否看到您所在的任何一個州調整了基本支付率，這可能會為該行業正在進行的討論提供一些支持。你必須看一看整體情況。但我想知道您是否看到了這些。

Yeah, AJ, I don't know that we've seen that in any sort of material way. It certainly could be on the horizon, but we have not seen that in any really impactful way.

是的，AJ，我不知道我們是否以任何實質的方式看到過這種情況。它當然有可能出現，但我們尚未看到它產生任何真正影響。

Okay. I know you were -- guys helped out a lot by making some comments about what it might look like if you lost the enhanced subsidies on the exchange, I think your number was $40 million to $50 million for that. I don't know -- I assume there's no update on that because there's really not any new information, I don't think.

好的。我知道你們——你們對如果你們失去交易所的增強補貼會怎麼樣發表了一些評論，提供了很大的幫助，我認為你們的數字是 4000 萬到 5000 萬美元。我不知道——我認為沒有更新，因為我認為確實沒有任何新資訊。

But I wonder because there's a lot of discussion, obviously, around the supplemental payments about the possibility of moving the provider tax limit from 6% to 5%. Have you guys looked at that? Do you have a sense of what that might mean or how to think about that?

但我感到疑惑，因為顯然圍繞補充付款有很多討論，關於將提供者稅限從 6% 提高到 5% 的可能性。你們看過這個嗎？您是否知道這可能意味著什麼或如何看待它？

Yeah, we certainly have looked at it, AJ. I don't know that any of the companies as far as I know have really estimated that impact because, in part, it's a very detailed calculation. The states are not always forthcoming in terms of all the data that we would need to make the calculation. So again, I think everybody is kind of reserving estimates until we see what the actual move might be. But yeah, I mean we're certainly going through those calculations and doing a lot best to try and understand what the impacts could be.

是的，我們確實看過了，AJ。據我所知，我不知道有任何一家公司真正估計過這種影響，因為在某種程度上，這是一個非常詳細的計算。各州並不總是能提供我們進行計算所需的所有數據。所以，我認為每個人都在保留估計，直到我們看到實際的舉動。但是的，我的意思是我們肯定會進行這些計算，並盡最大努力去了解可能產生的影響。

Do you think most of the states once you get meaningful supplemental payments, where are they at relative to what percent of provider tax they're getting relative to revenues of hospitals?

您是否認為，大多數州一旦獲得有意義的補充付款，相對於醫院收入而言，他們獲得的提供者稅佔比是多少？

Yeah. So several of the largest states or states that are sort of most impactful to us are certainly under 6%. That would include Texas and Florida. So the impact if legislation would go from a 6% cap to a 5% cap, the impact would be limited in those states. But again, those calculations can be pretty complicated.

是的。因此，幾個最大的州或對我們影響最大的州的比例肯定低於 6%。其中包括德克薩斯州和佛羅裡達州。因此，如果立法將上限從 6% 降至 5%，則對這些州的影響將是有限的。但同樣，這些計算可能相當複雜。

Okay. All right. I'll leave it at that. Thanks a lot.

好的。好的。我就不多說了。多謝。

So I'm showing no further questions at this time. I would like to now turn it back to Steve Filton for closing remarks.

所以我現在沒有其他問題。現在我想請史蒂夫·菲爾頓作最後發言。

So I have just one quick housekeeping item. We omitted our gross revenue disclosure in the press release last night, I think we were under the impression that nobody was really using that metric. I have been [disabused] to that notion over the last 12 hours, a number of people have asked for it.

所以我只有一個快速的整理事項。我們在昨晚的新聞稿中省略了總收入揭露，我想我們的印像是沒有人真正使用這個指標。在過去的 12 小時裡，我已經不再抱持這種想法，因為很多人都這樣要求過。

So we filed an 8-K this morning as we normally do, normally, we just see a duplicate of the press release, but we've included in that the gross revenue information. So people who are seeking that growth (inaudible) data can find it in the 8-K that we filed today. Other than that, we'd just like to thank everybody for their time and look forward to speaking to everybody next quarter.

因此，我們今天早上像往常一樣提交了 8-K 表格，通常我們只會看到新聞稿的副本，但我們在其中包含了總收入資訊。因此，尋求成長（聽不清楚）數據的人可以在我們今天提交的 8-K 表中找到它。除此之外，我們只想感謝大家抽出時間，並期待下個季度與大家交談。

Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.

感謝大家參加今天的會議。該計劃確實就此結束。您現在可以斷開連線。