環球健康 (UHS) 2025 Q2 法說會逐字稿

Good day, and thank you for standing by. Welcome to the Q2 2025 Universal Health Services earnings conference call. (Operator Instructions) Please be advised that today's conference is being recorded.

您好，感謝您的支持。歡迎參加 2025 年第二季全民健康服務收益電話會議。（操作員指示）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 begin.

現在，我想將會議交給今天的發言人、執行副總裁兼財務長 Steve Filton。請開始。

Thank you, and good morning. Marc Miller is also joining us this morning. We both welcome you to this review of Universal Health Services results for the second quarter ended June 30, 2025.

謝謝，早安。馬克米勒 (Marc Miller) 今天早上也將加入我們。我們歡迎您閱讀截至 2025 年 6 月 30 日的第二季全民健康服務業績報告。

During the conference call, we'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 a 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, and our Form 10-Q for the quarter ended March 31, 2025.

在電話會議期間，我們將使用相信、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 日的年度 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 2025 年 3 月 31 日的季度 10-Q 表中的“風險因素”和“前瞻性陳述和風險因素”和“前瞻性陳述和風險因素”。

We'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 reported net income attributable to UHS per diluted share of $5.43 for the second quarter of 2025. After adjusting for the impact of the items reflected on the supplemental schedule included with the press release, our adjusted net income attributable to UHS per diluted share was $5.35 for the quarter ended June 30, 2025.

在開始提問之前，我們想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，該公司報告 2025 年第二季歸屬於 UHS 的每股攤薄淨收入為 5.43 美元。在根據新聞稿中補充時間表所反映的項目的影響進行調整後，截至 2025 年 6 月 30 日的季度，我們歸屬於 UHS 的每股攤薄淨收入為 5.35 美元。

During the second quarter of 2025, on a same-facility basis, adjusted admissions to our acute care hospitals increased 2.0% over the second quarter of the prior year, and surgical volumes were down slightly. Still, same-facility net revenues in our Acute Care Hospital segment increased by 5.7% during the second quarter of 2025 as compared to last year's second quarter after excluding the impact of our insurance subsidiary.

2025 年第二季度，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二季度增加了 2.0%，手術量略有下降。儘管如此，在排除保險子公司的影響後，我們急診醫院部門的同設施淨收入在 2025 年第二季與去年第二季相比成長了 5.7%。

We note that West Henderson Hospital, which opened in late 2024, has had a certain cannibalization impact on the division's same-facility volumes and revenues. Meanwhile, operating expenses continue to be well managed. Other operating expenses on the same-facility basis increased 3.1% over last year's second quarter, again, after excluding the impact of our insurance subsidiary.

我們注意到，2024 年底開業的西亨德森醫院對該部門的同類設施數量和收入產生了一定的蠶食影響。同時，營運費用持續得到良好的管理。在排除我們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二季增加了 3.1%。

For the second quarter of 2025, our solid Acute Care revenues, combined with effective expense controls, resulted in a 10% increase in same-facility EBITDA. During the second quarter of 2025, excluding the impact of the Tennessee Medicaid directed payment program, same-facility net revenues of our behavioral health hospitals increased by 5.4%, driven by a 4.2% increase in revenue per adjusted day. Adjusted patient days were up 1.2% compared to the prior year's second quarter.

2025 年第二季度，我們穩健的急性照護收入加上有效的費用控制，使同設施 EBITDA 成長了 10%。2025 年第二季度，不計入田納西州醫療補助定向支付計劃的影響，我們的行為健康醫院的同設施淨收入增長了 5.4%，這得益於調整後日收入增長 4.2%。調整後的患者就診天數與去年同期第二季相比增加了 1.2%。

Our cash generated from operating activities decreased by $167 million to $909 million during the first six months of 2025 as compared to $1.076 billion during the same period in 2024. We expect to collect the $58 million of Tennessee directed payment program receivables in the third quarter. The new hospitals in Las Vegas and the District of Columbia contributed $35 million to the receivable increase.

2025 年上半年，我們的經營活動產生的現金減少了 1.67 億美元，至 9.09 億美元，而 2024 年同期為 10.76 億美元。我們預計在第三季收回田納西州定向支付計畫應收款 5,800 萬美元。拉斯維加斯和哥倫比亞特區的新醫院為應收帳款增加貢獻了 3500 萬美元。

In the first half of 2025, we spent $505 million on capital expenditures, 25% of which related to the two new (technical difficulty) replacement facilities in California and Florida, both set to open in the spring of 2026. During the first half of 2025, we also acquired 1.9 million of our own shares at a total cost of approximately $332 million. Since 2019, we have repurchased approximately 34% of the company's outstanding shares.

2025 年上半年，我們的資本支出為 5.05 億美元，其中 25% 與加州和佛羅裡達州的兩個新的（技術難度）替代設施有關，這兩個設施都計劃於 2026 年春季開放。2025 年上半年，我們也收購了 190 萬股自己的股票，總成本約 3.32 億美元。自2019年以來，我們已回購了該公司約34%的流通股。

As of June 30, 2025, we had approximately $1 billion of aggregate available borrowing capacity pursuant to our $1.3 billion revolving credit facility. The recently enacted One Big Beautiful Bill Act includes several significant changes in the Medicaid program, including changes to state-directed payment programs and provider taxes.

截至 2025 年 6 月 30 日，根據我們的 13 億美元循環信貸額度，我們擁有約 10 億美元的可用借貸能力。最近頒布的《一項偉大的美麗法案》對醫療補助計劃做出了幾項重大改變，包括對國家指導支付計劃和提供者稅收的改變。

Beginning with the 2028 state fiscal years and primarily phased in over a five-year period through 2032, these program changes will limit both the level of payment and the amount of provider tax assessment that states are permitted to utilize to finance the nonfederal share of their respective Medicaid supplemental payments.

從 2028 年州財政年度開始，主要在五年內分階段實施至 2032 年，這些計劃變化將限制各州可用於資助其各自醫療補助補充支付的非聯邦份額的支付水平和提供者稅收評估金額。

The legislation provides for different limits depending on whether states have previously expanded their Medicaid eligible population as permitted under the Affordable Care Act. We cannot predict, among other things, that this legislation will ultimately be implemented as enacted or if certain states may attempt to implement countermeasures to mitigate its impact.

該法案規定了不同的限制，取決於各州是否已經根據《平價醫療法案》擴大了醫療補助合格人口。除其他事項外，我們無法預測這項立法最終是否會以頒布的方式實施，或者某些州是否會嘗試實施對策來減輕其影響。

Our current projected 2025 full-year net benefit from previously approved state Medicaid supplemental programs is approximately $1.2 billion. At this time, assuming no changes to our Medicaid revenues or other changes to related state or federal programs, we estimate that commencing with the 2028 state fiscal years, our aggregate net benefit will be reduced on an annually increasing and relatively pro rata basis by approximately $360 million to $400 million in 2032.

我們目前預計，2025 年全年從先前批准的州醫療補助補充計劃中獲得的淨收益約為 12 億美元。目前，假設我們的醫療補助收入沒有變化，或相關州或聯邦計劃沒有其他變化，我們估計從 2028 年州財政年度開始，我們的總淨收益將按每年增加和相對比例減少，到 2032 年將減少約 3.6 億美元至 4 億美元。

Given the various uncertainties, including the evolving state-by-state interpretations and computations related to the legislation, our forecasted estimates are subject to change potentially by material amounts. Our future operating results potentially starting in 2026 may also be impacted by other factors which are more difficult to predict, such as the impact of Medicaid work requirements, which may decrease Medicaid enrollment, and factors that could unfavorably impact insurance exchange enrollment such as the scheduled expiration of insurance exchange subsidies.

鑑於各種不確定因素，包括各州對立法不斷變化的解釋和計算，我們的預測估計可能會發生重大變化。我們未來的經營業績可能從 2026 年開始，也可能受到其他更難預測的因素的影響，例如醫療補助工作要求的影響，這可能會減少醫療補助的登記人數，以及可能對保險交易所登記產生不利影響的因素，例如保險交易所補貼的預定到期。

I'll 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。

Thanks, Steve. So based primarily on the increased DPP reimbursement, we are increasing our midpoint of our 2025 EPS guidance by 7% to $20.50 per diluted share, up from $19.20 per diluted share previously. Medicaid supplemental programs in Washington, DC; and other potential programs that are not yet fully approved are not included in our revised guidance.

謝謝，史蒂夫。因此，主要基於 DPP 報銷額的增加，我們將 2025 年每股收益預期中點上調 7% 至每股攤薄收益 20.50 美元，高於之前的每股攤薄收益 19.20 美元。華盛頓特區的醫療補助補充計劃；以及其他尚未完全批准的潛在計劃未包含在我們的修訂指南中。

We remain pleased with the performance of West Henderson Hospital, which produced a positive EBITDA in the second quarter. At the same time, we acknowledge the significant drag created by the recently opened Cedar Hill Regional Medical Center in Washington, DC. Timing of hospital certification and other start-up issues proved a bit more challenging than we anticipated. But demand, especially for emergency services, has been very encouraging.

我們對西亨德森醫院的表現仍然感到滿意，該醫院在第二季度實現了正的 EBITDA。同時，我們承認，近期在華盛頓特區開幕的雪松山地區醫療中心（Cedar Hill Regional Medical Center）造成了重大拖累。醫院認證的時機和其他啟動問題比我們預期的要困難一些。但需求，特別是緊急服務的需求，一直非常令人鼓舞。

Although recovery to expected results will continue into the back half of this year, we remain confident in the positive long-term prospects for the facility that prompted our development partnership with the District of Columbia.

儘管恢復到預期結果將持續到今年下半年，但我們仍然對該設施的長期積極前景充滿信心，這促使我們與哥倫比亞特區建立了發展夥伴關係。

De novo growth continues in our Behavioral segment. We recently opened a 96-bed behavioral hospital in Grand Rapids, Michigan, which is a joint venture with Trinity Health Michigan; and a 41-bed substance use disorder and dual diagnosis treatment center in Mount Pleasant, South Carolina.

我們的行為部門持續實現新的成長。我們最近在密西根州大急流城開設了一家擁有 96 張床位的行為醫院，這是與 Trinity Health Michigan 合資成立的；此外，我們還在南卡羅來納州芒特普萊森特開設了一家擁有 41 張床位的物質使用障礙和雙重診斷治療中心。

In addition, we are developing a 144-bed behavioral health hospital in Bethlehem, Pennsylvania, which is a joint venture with the Lehigh Valley Health Network and is expected to open later this year, as well as a 120-bed behavioral health hospital in Independence, Missouri, which is expected to open in late 2026. In addition, we are also continuing to grow our Cygnet behavioral health network in the UK, which has added 6 new facilities and 137 beds so far this year.

此外，我們正在賓州伯利恆開發一家擁有 144 張床位的行為健康醫院，該醫院是與利哈伊谷健康網路合資成立的，預計將於今年稍後開業，同時我們還在密蘇裡州獨立市開發一家擁有 120 張床位的行為健康醫院，預計將於 2026 年底開業。此外，我們還在繼續擴大我們在英國的 Cygnet 行為健康網絡，今年迄今已增加了 6 個新設施和 137 張床位。

At this time, we're pleased to answer your questions.

現在，我們很高興回答您的問題。

(Operator Instructions) Pito Chickering, Deutsche Bank.

（操作員指示）德意志銀行的 Pito Chickering。

Hey, good morning, guys, and thanks for taking my questions. I just want to circle back on -- I think you said $360 million to $400 million of net impact in 2032 with the current law in place.

嘿，大家早安，感謝你們回答我的問題。我只是想回到剛才的話題——我想您說過，根據現行法律，到 2032 年，淨影響將達到 3.6 億至 4 億美元。

I just want to make sure that those numbers make sense and if you're sort of talking about sort of losing of $380 million of sort of EBITDA over that time period. Just curious what your views are to offset that with core ops, and how you view that impacting your sort of core growth rate with those headwinds?

我只是想確保這些數字有意義，如果你談論的是那段時間內 3.8 億美元的 EBITDA 損失。我只是好奇，您如何看待透過核心營運來抵消這一影響，以及您如何看待這些不利因素對您的核心成長率產生影響？

Yeah. So, Pito, obviously, those reductions don't begin, as we know, materially until 2028. So we certainly have time to think about strategically how we might alter our business approach, particularly in the Behavioral business, where we can alter the structure of our programs, not necessarily cater to as many Medicaid-centric programs, et cetera.

是的。因此，皮托，顯然，正如我們所知，這些削減要到 2028 年才會開始實質實施。因此，我們當然有時間從策略上思考如何改變我們的業務方法，特別是在行為業務方面，我們可以改變我們的專案結構，而不一定迎合那麼多以醫療補助為中心的專案等等。

Additionally, obviously, there could be, as we noted in the remarks, new DPP programs approved during that time. And finally -- well, maybe not finally, but I think it's also possible, as we noted in our remarks, that some of the changes are not ultimately implemented.

此外，顯然，正如我們在評論中指出的那樣，在此期間可能會有新的 DPP 計劃獲得批准。最後——好吧，也許不是最終，但我認為，正如我們在評論中指出的那樣，有些變化也有可能最終不會實施。

We believe or some have speculated that Congress particularly extended these cuts for a period of time to give it some room to come back and tweak if they had to. But if the cuts remain in place and are enacted as the bill lays out, we certainly feel like there are things that we can do both from, again, shifting revenue sort of -- sources of revenues, particularly in the Behavioral division, cost-cutting initiatives, et cetera.

我們相信，或者有人猜測，國會特別將這些削減措施延長一段時間，以便在必要時給予其一些回頭進行調整的空間。但如果削減措施繼續實施並按照法案規定實施，我們當然覺得我們可以做一些事情，再次，從轉移收入來源，特別是在行為部門，削減成本的舉措等等。

And I'll remind you -- I know some of our peers have made the same point. Five years ago when the pandemic hit and did so with very little notice, we specifically and we as an industry pivoted fairly quickly and fairly dramatically in terms of headcount reductions, capital spending reductions, et cetera, a whole host of initiatives to react to what at the time was an extremely dramatic and largely unexpected reduction in revenues.

我要提醒你們──我知道我們的一些同行也表達了同樣的觀點。五年前，當疫情來襲且幾乎沒有人注意到的時候，我們整個行業在裁員、削減資本支出等方面做出了相當迅速和劇烈的調整，採取了一系列舉措來應對當時極其劇烈且很大程度上出乎意料的收入減少。

So again, I think we have great confidence in our ability to shift and be flexible, especially with several years of notice and preparation that we'll have this time around.

因此，我再次強調，我們對我們的轉變和靈活性能力非常有信心，特別是考慮到這次我們將有幾年的通知和準備時間。

Let me just add on -- Pito, let me add on to this as well. So Steve laid out in his prepared remarks, the worst-case and which we obviously want to be transparent. And that's what the numbers are today. I don't expect that that's what will happen in a number of ways. So Steve mentioned a couple of things that we'll pivot, and we'll make moves that are necessary.

讓我補充一下——Pito，讓我也補充一下這一點。因此，史蒂夫在他準備好的發言中闡述了最壞的情況，我們顯然希望保持透明。這就是今天的數字。從很多方面來說，我並不認為這樣的事情會發生。史蒂夫提到了我們將要調整的幾件事，我們將採取必要的行動。

In talking with all of the folks down in DC, representatives from many of the states that we cover, they are starting to recognize even right now, what they passed simply can't be left as is because the effect on some of the healthcare programs in their states, and not just at a place like UHS, but these not-for-profit hospitals in their states, could be detrimental.

在與華盛頓特區所有民眾、我們所報道的許多州的代表交談時，他們開始意識到，即使是現在，他們所通過的法案也不能保持原樣，因為這將對他們所在州的一些醫療保健項目造成影響，而且不僅僅是在像 UHS 這樣的地方，而且對他們所在州的這些非營利性醫院，都可能造成不利影響。

So they're already talking about what needs to be done to make sure that programs aren't closing, shifts aren't taken, things like that. So I fully expect that this is a floor that is a -- well, it is what it is today. But I expect this will get better. We anticipate that. There will be changes made because we think they have to be.

所以他們已經在討論需要做什麼來確保專案不會關閉、輪班不會被佔用等等。所以我完全相信這是一個底線——嗯，它就是今天的樣子。但我預計情況會好轉。我們預計這一點。我們認為必須做出改變，所以才會做出改變。

So while I think this is a worst-case scenario, again, I'll point out, he mentioned 2028, Steve did, and 2032. We're going to do a lot to make sure that we don't hit these numbers that we just talked about. So I just wanted to give a little context and perspective to that.

因此，雖然我認為這是最糟糕的情況，但我再次指出，他提到了 2028 年，史蒂夫也提到了 2032 年。我們將採取許多措施來確保不會達到我們剛才談到的這些數字。所以我只是想提供一點背景和觀點。

Great. Thanks so much. And then sort of a follow-up here, looking at the Behavioral. Can you sort of talk about the split between the hospital patient days in behavioral versus outpatient, sort of what you saw this quarter, what you assume for the back half of the year, and kind of how you're going to be improving the outpatient side of Behavioral? Thanks so much.

偉大的。非常感謝。然後在這裡進行跟進，觀察行為。您能否談談行為治療和門診住院患者天數的劃分，您在本季度看到了什麼，您對今年下半年的預測是什麼，以及您將如何改善行為治療的門診方面？非常感謝。

Yeah. So in the table towards the back of the press release, we disclosed year-over-year growth in ADC. And then, of course, in the body of the press release, we disclosed adjusted patient days. Adjusted patient days have grown faster in the second quarter than unadjusted patient days, indicating that outpatient is growing faster than inpatient, which was not the case in Q1.

是的。因此，在新聞稿後面的表格中，我們揭露了 ADC 的年增長。然後，當然，在新聞稿正文中，我們揭露了調整後的病人天數。第二季調整後病人天數的成長速度快於未調整後病人天數，顯示門診病人的成長速度快於住院病人，而第一季的情況並非如此。

We talked about that at some length in the first quarter and talked about our focus on outpatient growth. And I think as we think about getting closer to the 2.5% to 3% adjusted patient day target that we've been talking about for some time, I think we believe that that growth in outpatient is a significant opportunity for us.

我們在第一季詳細討論了這個問題，並討論了我們對門診成長的關注。我認為，當我們考慮更接近我們已經談論了一段時間的 2.5% 到 3% 的調整後患者日數目標時，我認為我們相信門診量的增長對我們來說是一個重要的機會。

A number of the insurance companies, as they've been talking about their increase in medical loss ratios, have pointed to the increase in spending on behavioral care. And while they don't provide this level of detail, we believe that a significant chunk of that increase is in outpatient. And we are determined to get a larger share of that, I'll call it, outpatient pie as we go forward.

許多保險公司在談到醫療損失率上升時，都指出行為照護支出增加是造成此現象的原因。雖然他們沒有提供這種程度的細節，但我們相信，這一增長的很大一部分來自門診病人。我們決心在未來的發展中獲得更大份額，我稱之為門診份額。

So focus on outpatient -- we've talked about this, I think, in our last couple of conference calls -- is a significant focus of ours, made some progress in Q2, and anticipate making further progress in the back half of the year and quite frankly, years to come after that.

因此，專注於門診——我想，我們在最近的幾次電話會議中已經討論過這個問題——是我們關注的一個重點，我們在第二季度取得了一些進展，並預計在今年下半年以及坦率地說，在未來幾年內會取得進一步的進展。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

Hi, good morning. Question on Cedar Hill. You called out $25 million of start-up losses in the quarter. Can you update us on the latest accreditation status of that hospital? What's baked into guidance for the back half of the year? And how are you thinking about the ramp to mature profitability now? Thanks.

嗨，早安。關於雪松山的問題。您指出本季新創企業虧損 2,500 萬美元。能向我們介紹一下該醫院的最新認證情況嗎？下半年的業績預期有哪些？現在您如何考慮提高成熟的獲利能力？謝謝。

Yeah. So again, I think our mistake when it comes to Cedar Hill was we were too optimistic about how quickly we'd obtain Medicare certification. And just as a little bit of background for people who may not fully understand, until a hospital gets what's called deemed status for Medicare certification, they're not able to bill for or collect from Medicare.

是的。所以，我認為我們在 Cedar Hill 問題上犯的錯誤是，我們對獲得醫療保險認證的速度過於樂觀。對於那些可能不完全了解的人來說，我需要稍微介紹一下背景信息，在醫院獲得所謂的醫療保險認證的認定狀態之前，他們不能向醫療保險收取費用。

And a number of commercial payers generally follow that. And honestly -- and usually, Medicaid follows that. In the case of Cedar Hill, specifically, we've already gotten the District of Columbia to agree to pay us back to when they deemed us to be ready for the Joint Commission survey, which results in Medicare certification.

許多商業付款人通常都遵循這種做法。說實話 — — 通常情況下，醫療補助計劃都會遵循這項原則。具體來說，就 Cedar Hill 而言，我們已經獲得哥倫比亞特區的同意，當他們認為我們已準備好接受聯合委員會的調查時，我們會向我們付款，這將使我們獲得醫療保險認證。

So we have been getting paid for Medicare -- for Medicaid, rather. But we're awaiting the Joint Commission survey. We believe it is imminent, could occur this week, and we hopefully occur next week. Once we get that certification, then that becomes the effective date that we're able to bill. It will take us obviously some time to get the bills out and collect, but that becomes the effective date.

因此，我們一直在獲得醫療保險（或更確切地說是醫療補助）的報酬。但我們正在等待聯合委員會的調查。我們相信它即將發生，可能會在本週發生，我們希望在下週發生。一旦我們獲得該認證，該日期就成為我們可以開立帳單的生效日期。顯然，我們需要一些時間來取出並收取賬單，但這將成為生效日期。

The delicate balance that a facility goes through sort of in these early times is -- we're not necessarily trying to promote all the surgical, elective, procedural business that we might otherwise because we're not necessarily getting paid for it. So most of the activity at the facility right now is emergency room activity, which, as I think Marc noted in his comments, has been quite busy and encouraging that there is great demand for the hospital in this location.

在早期階段，醫療機構要經歷一種微妙的平衡——我們不一定試圖推廣所有的外科手術、選擇性手術和程序性業務，因為我們不一定會因此而獲得報酬。因此，目前該設施的大部分活動都是急診室活動，正如馬克在評論中指出的那樣，急診室活動非常繁忙，而且令人鼓舞的是，這個地方對醫院的需求很大。

But once we get our certification, we'll begin to build up more surgical and procedural volume, and round out the services that are being offered by the hospital. So we have a $25 million loss or EBITDA drag in Q2. Embedded in our guidance in the back half of the year is another $25 million drag for the back half of the year.

但一旦我們獲得認證，我們將開始增加更多的手術和程序量，並改善醫院提供的服務。因此，我們第二季的虧損或 EBITDA 拖累為 2,500 萬美元。我們對下半年的預期中還包含下半年另外 2,500 萬美元的拖累。

So some improvement, but recognizing that there will be a ramp-up once we get our certification. And then I think the general sense is that by the time we get to 2026, the facility will be back on a course of ramping up to kind of divisional-wide profitability after 12 or 18 months of additional operations.

因此有一些改進，但我們認識到，一旦我們獲得認證，就會有一個提升。然後我認為一般的感覺是，到 2026 年，經過 12 或 18 個月的額外運營，該工廠將重新回到全部門盈利的軌道上。

Great. And maybe just a quick follow-up on that. Like outside of the discrete items related to state-directed payments in Cedar Hill, the EBITDA guidance looks largely unchanged. One, do I have that right? And two, what are the offsetting positives, allowing you to keep the underlying EBITDA intact despite the soft Behavioral quarter? Thanks.

偉大的。也許只是對此進行快速跟進。與 Cedar Hill 中與國家指示支付相關的獨立項目一樣，EBITDA 指引看起來基本上沒有變化。一、我有這個權利嗎？第二，有哪些抵銷性正面因素，使得您在行為季度表現疲軟的情況下仍能保持基礎 EBITDA 不變？謝謝。

Yeah. So I think if you go through the math, there's roughly $185 million of new DPP revenues in that $1.2 billion that I alluded to earlier from our last disclosure last quarter. Offsetting that is roughly $50 million in the Cedar Hill drag, the $25 million in the second quarter and the $25 million in the back half of the year.

是的。因此，我認為，如果你計算一下，你會發現在我們上個季度披露的 12 億美元中，大約有 1.85 億美元的新 DPP 收入。抵銷這一損失的是雪松山拖累的約 5,000 萬美元、第二季的 2,500 萬美元和下半年的 2,500 萬美元。

And then a bit more of a drag in terms of scaling back our Behavioral projections for the back half of the year, largely because we are falling short of that volume target that was originally embedded in our guidance. I mean, that's -- those are basically the significant pieces of the guidance revision.

然後在縮減下半年的行為預測方面，我們會面臨更大的阻力，主要是因為我們沒有達到最初在指導中設定的交易量目標。我的意思是，這些基本上是指導修訂的重要部分。

Great, thank you.

太好了，謝謝。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great. Thanks. Good morning. Maybe just a piggyback on the outpatient Behavioral commentary. I mean, you were talking about getting a bigger share of the outpatient pie. I guess, how would you see that unfolding? Is this more de novo build-out?

偉大的。謝謝。早安.也許只是對門診行為評論的附帶評價。我的意思是，您談論的是獲得更大的門診份額。我想，您會如何看待這件事的發生？這是更多的全新建設嗎？

You've got less than 2 times leverage ratio currently. You've talked about a number of de novo bells and JVs in your prepared remarks. I guess, I'm just hoping you can give us any color on a pathway to grabbing more outpatient share. Thanks.

您目前的槓桿率低於2倍。您在準備好的演講中談到了許多新的企業和合資企業。我想，我只是希望您能為我們提供一些獲取更多門診份額的途徑。謝謝。

Yeah. We've talked about this, I think, in some detail on the last couple of calls, but happy to revisit the issue. Generally, we generate outpatient revenues in Behavioral in two very broad ways. One is step-down business. We refer to it as step-down business.

是的。我認為，我們在最近的幾次通話中已經詳細討論過這個問題，但很高興再次討論這個問題。一般來說，我們透過兩種非常廣泛的方式來產生行為門診收入。一是降級業務。我們稱之為降級業務。

These are patients who are inpatients in our facilities. But when they are discharged, they require further less intense care and will go into programs that we either described as intensive outpatient or partial hospitalization. And often, those programs are offered by us on our campus, et cetera.

這些是我們醫院的住院病人。但當他們出院時，他們就不需要那麼密集的護理，而是會進入我們所謂的強化門診或部分住院治療計畫。通常，這些課程都是我們在校園裡提供的，等等。

And as you might expect, we control or are able to refer many of those patients to our own program, although many of them also leave and go elsewhere. And we're focused on keeping as many of those patients in our programs, both because we think, clinically, that's most effective for them. There's a lot of continuity with our medical professionals, et cetera. So that's something that we can do immediately and just do a better job of controlling that patient flow.

正如您所料，我們能夠控製或將許多患者轉介到我們自己的專案中，儘管其中許多患者也離開並去了其他地方。我們致力於讓盡可能多的患者留在我們的計畫中，因為我們認為從臨床角度來看這對他們來說是最有效的。我們的醫療專業人員等等都保持著很大的連續性。所以這是我們可以立即做的事情，並且更好地控制病人流量。

But the other aspect of outpatient revenue in Behavior is what we described as step-in business. These are patients who enter the Behavioral system in an outpatient program. Very often, it's a freestanding outpatient program, not located on the campus, other than an acute behavioral hospital. We have found that there is a large number of patients who are often not comfortable with their first sort of experience in Behavioral Care being on the campus of an acute behavioral hospital.

但行為中的門診收入的另一個面向是我們所謂的步入式業務。這些是進入門診行為系統的患者。通常，它是一個獨立的門診項目，不在校園內，而是急性行為醫院。我們發現，許多患者對於在急性行為醫院接受首次行為護理感到不自在。

And so we are establishing a larger footprint in freestanding behavioral hospitals that are located generally not on the campuses of our existing hospitals. Those hospitals -- the capital investment in those outpatient facilities is not great. They're generally leased facilities in a storefront or that sort of setting.

因此，我們正在獨立的行為醫院中建立更大的足跡，這些醫院通常不在我們現有醫院的園區內。那些醫院──那些門診設施的資本投資並不大。它們通常是在店面或類似場所租賃的設施。

Maybe there's $1 million of capital on average in each of those. The bigger issue is just really staffing them with the therapist and creating a flow of patients. So we intend to open 10 to 15 of those new outpatient facilities a year over the next several years and increase our presence both in the step-in business and do a better job in the step-down business.

也許每家公司平均有 100 萬美元的資本。更大的問題實際上是為診所配備治療師並創造患者流量。因此，我們計劃在未來幾年內每年開設 10 到 15 個新的門診設施，並增加我們在入院式醫療業務中的份額，同時在出院式醫療業務中做得更好。

Okay. Got it. Thanks. Helpful. And maybe just as a follow-up, for the Acute Care business, can you talk about volume growth trends across payer cohorts in the quarter? What type of volume growth you saw against -- for commercial, Medicare, Medicaid, exchange?

好的。知道了。謝謝。很有幫助。也許只是作為後續問題，對於急性照護業務，您能否談談本季各個付款人群體的交易量成長趨勢？您認為商業、醫療保險、醫療補助、交易所的交易量成長如何？

And if payer mix was a benefit in the quarter, would you expect that -- where your payer mix kind of came in this quarter, would you expect it to persist at least through the remainder of this year? Or are there puts and takes there? Just any color would be helpful. Thanks.

如果付款人組合在本季度帶來好處，您是否預期 - 本季的付款人組合情況如何，您是否預期它會持續至少到今年剩餘時間？或是那裡有投入和產出？任何顏色都有幫助。謝謝。

Yeah. What I would first say is that we said in our -- or I said in our prepared remarks that Acute Care revenue exclusive of our insurance subsidiary grew by 5.7% year over year in the second quarter. That's pretty much spot on with what our guidance presumed.

是的。我首先要說的是，我們在我們的準備好的發言中說過，不包括保險子公司的急性護理收入在第二季度同比增長了 5.7%。這與我們的指導假設基本一致。

We talked about 6%, 7% Acute Care revenue growth, so 6% at the midpoint. We're kind of running right there. I think without the cannibalization of our same-facility revenues that we're getting from West Henderson, we'd be right there, maybe in the low 6s.

我們談到了急性護理收入成長 6%、7%，所以中間值為 6%。我們好像就在那裡奔跑。我認為，如果沒有西亨德森對我們同類設施收入的蠶食，我們的收入就會達到這個水平，也許在 6% 出頭。

So we're, I think, kind of right where we thought. In the second quarter, I think we were skewed a little bit more to pricing than to volume, but generally spot on. To your point, I think the pricing benefit in Q2 was a bit payer mix-driven.

所以我認為，我們的想法基本上已經正確。在第二季度，我認為我們更傾向於定價而不是數量，但總體來說是正確的。對於你的觀點，我認為第二季的定價優勢有點受付款人組合驅動。

As I think a number of our peers have commented as well, we saw a little bit less Medicaid volume and a little bit more commercial exchange volume in particular. And I think that drove somewhat more favorable pricing.

我認為我們的許多同行也都評論過，我們發現醫療補助量略有減少，而商業交易量則略有增加。我認為這會帶來更有利的定價。

But again, I'll make the point that we, probably, were a little less bullish about how some of the -- we considered sort of extraordinary Acute Care revenue growth numbers that we and others have been putting up over the last several years would start to moderate. I think that's been true in the first half of this year. And so in our minds, the Acute business is sort of growing very much in line with our expectations.

但我再次指出，我們可能對我們和其他人過去幾年提出的一些非凡的急性護理收入成長數字將如何開始放緩不那麼樂觀。我認為今年上半年的情況確實如此。因此，在我們看來，Acute 業務的成長非常符合我們的預期。

Okay. Great. Thank you.

好的。偉大的。謝謝。

Benjamin Rossi, JPMorgan.

摩根大通的班傑明‧羅西。

Hey. Good morning. Thanks for taking the question here. So Behavioral pricing continued to outperform during the quarter and growing just under 7% for the first half of the year versus your original growth range that you previously outlined in the 4% to 5% range.

嘿。早安.感謝您在這裡提出這個問題。因此，行為定價在本季繼續表現出色，上半年的成長率略低於 7%，而您先前概述的原始成長範圍為 4% 至 5%。

Is there any way to frame the breakdown here between rates, acuity, and contribution from incremental supplemental payments? And then what does your back-half guidance contemplate regarding growth as you progress towards your now-revised goals on the volume side?

有什麼方法可以劃分費率、敏銳度和增量補充支付貢獻之間的差異嗎？那麼，當您朝著現在修改的數量目標前進時，您對下半年的成長有何指引？

So in our prepared remarks, I said that excluding the Tennessee impact -- and we exclude Tennessee because I think that's an incremental benefit in the quarter. We don't exclude the other $43 million of DPP in the quarter. Because if you go back to the second quarter of last year, there was a $35 million unexpected benefit in the states of Washington and Idaho. And so those two, in our minds, offset.

因此，在我們準備好的發言中，我說過，排除田納西州的影響力——我們排除田納西州是因為我認為這是本季度的增量收益。我們不排除本季另外 4,300 萬美元的 DPP。因為如果回顧去年第二季度，華盛頓州和愛達荷州有 3,500 萬美元的意外收益。因此，在我們看來，這兩者是相互抵消的。

But excluding the Tennessee directed payment, we said that revenues increased by 5.4%. And that's basically broken down between a 4.2% increase in pricing and a 1.2% increase in adjusted patient days. As you know, I mean, we said in our guidance that pricing, we assumed, would be in that 4% to 5% range.

但我們表示，如果不包括田納西州的直接付款，收入將增加 5.4%。這基本上分解為價格上漲 4.2% 和調整後患者天數上漲 1.2%。如您所知，我的意思是，我們在指導中說過，我們假設定價將在 4% 到 5% 的範圍內。

We've generally been outpacing that. The second quarter moderated a little bit. But I would say that 4% to 5% is what we believe the sustainable pricing growth in Behavioral is at least for the intermediate term. And the 1.2% volume growth is what we think or where we think is the opportunity to improve, particularly again on the outpatient side of things.

我們總體上已經超越了這一水準。第二季略有緩和。但我想說，我們認為行為科學的可持續定價成長率至少在中期內是 4% 到 5%。我們認為 1.2% 的銷售成長或代表改進的機會，尤其是在門診方面。

Great. Appreciate the color. And just as a follow-up, taking a look at your average length of stay in Acute, seeing that down both annually and on a sequential basis, could you just walk us through some of the drivers of that deceleration and maybe where you see room to bring that down further?

偉大的。欣賞色彩。作為後續問題，看看您在 Acute 的平均住院時間，發現每年和連續的時間都在下降，您能否向我們介紹一下導致這種減速的一些因素，以及您認為還有什麼空間可以進一步縮短住院時間？

And then have you seen any variation in length-of-stay trends across your payer classes between Medicaid, Medicare, and commercial, particularly among your exchange populations?

那麼，您是否看到醫療補助、醫療保險和商業之間的付款人類別的住院時間趨勢有任何變化，特別是在您的交換人群中？

Yeah. I mean, obviously, length of stay peaked during the pandemic when it was driven much higher by the high acuity of COVID patients in particular. And it's been coming down steadily since then. I think we believe that there still is some room for length of stay to be further reduced.

是的。我的意思是，顯然，住院時間在疫情期間達到頂峰，尤其是由於新冠患者的高風險因素，住院時間大幅延長。自那時起，這一數字一直在穩步下降。我認為我們認為停留時間還有進一步縮短的空間。

I think probably the biggest challenge we have in reducing length of stay further is placement of patients into sub-acute facilities. That could be skilled nursing facilities, nursing homes, home health programs. Often, there is a sort of a scarcity or a lack of availability in those programs.

我認為，進一步縮短住院時間所面臨的最大挑戰可能是將患者安置在亞急性治療設施中。這可能是專業護理機構、療養院、家庭保健計劃。通常，這些程式存在某種稀缺性或可用性不足的情況。

I don't know that it really varies by payer. I think, sometimes, it's an obstacle for us because the payers don't have all of the sub-acute providers in a geography in their networks, and that can be challenging. But yeah, I mean, I think we continue to believe that length of stay has some room -- I'm not going to say a material amount -- but some incremental room to improve from where it currently is.

我不知道這是否真的因付款人而異。我認為，有時這對我們來說是一個障礙，因為付款人的網路中並沒有涵蓋某個地區的所有亞急性醫療服務提供者，這可能很有挑戰性。但是的，我的意思是，我認為我們仍然相信住院時間有一定的空間——我不會說一個實質性的數額——但是從目前的情況來看，還是有一些漸進的改善空間。

Great. Appreciate the color.

偉大的。欣賞色彩。

Craig Hettenbach, Morgan Stanley.

摩根士丹利的克雷格·赫滕巴赫。

Yes, thank you. Just following up on Behavioral. And I know there's been kind of back and forth with the payers on kind of price and access. I'm just curious, on just a longer-term basis, do you think some of that normalizes in terms of the contribution between volume and price? Or how are you thinking about that?

是的，謝謝。只是跟進行為。我知道付款人之間在價格和訪問權限方面存在一些爭論。我只是好奇，從長期來看，您是否認為其中一些在交易量和價格之間的貢獻方面會正常化？或者您對此有何看法？

Yeah. So I think what we've consistently said is that the way we think about the long-term model of the Behavioral business is that 7%, 8%, I'll call it 7% at the midpoint is the reasonably expected revenue growth rate.

是的。所以我認為，我們一直在說的是，我們對行為業務的長期模型的看法是，7%、8%，我稱之為中間值的 7% 是合理預期的收入成長率。

And that would be made up of 4% to 5% price and 2.5%, 3% volume. And we've generally been hitting those price targets and frankly, in most periods, exceeding the price targets. It's the volume that has been the bugaboo for us.

其中價格佔 4% 至 5%，交易量佔 2.5% 至 3%。我們通常都能達到這些價格目標，坦白說，大多數時期都超過了價格目標。對我們來說，音量一直是個困擾我們的問題。

We've improved, as I said, from the first quarter and expect improvement in the back half of the year. But again, I'll call it that 6.5%, 7% revenue growth skewed a little bit more to pricing than to volume as sort of being the model that we're expecting in the Behavioral business for, I'll call it, the intermediate future.

正如我所說，我們從第一季開始就有所改善，預計下半年也會有所改善。但是，我再次強調，6.5%、7% 的收入成長更取決於定價而不是數量，這是我們在行為業務中預期的模型，我稱之為中期未來。

Got it. And I appreciate all the color and detail on the One Big Beautiful Bill in terms of impact. When I think about potential offsets, how are you thinking about just kind of leveraging technology and AI? Kind of where are things today, and how could that kind of ramp as a potential offset in the coming years?

知道了。就影響力而言，我很欣賞《美麗的一張大鈔》的所有色彩和細節。當我考慮潛在的抵消時，您是如何考慮利用技術和人工智慧的？目前的情況如何？未來幾年這種成長將如何作為潛在的抵銷因素？

Sure. I mean, obviously, it is always our goal to be as efficient and productive as possible. And to the degree the technology, whether that's AI or other kinds of technology, can help us do that, we're certainly open to that.

當然。我的意思是，顯然，我們的目標始終是盡可能地有效率和有成效。只要科技（無論是人工智慧還是其他技術）能夠幫助我們做到這一點，我們當然願意接受。

We can -- the AI discussion, I think, could be a whole separate discussion in a separate call. But I'll just briefly say that we're experimenting with uses of AI in things like revenue cycle, where certain tasks like denial management and denial appeals, et cetera.

我認為，我們可以在單獨的電話會議中就人工智慧進行單獨討論。但我只想簡單地說，我們正在嘗試將人工智慧應用於收入週期等領域，其中包括拒絕管理和拒絕上訴等某些任務。

We know that the payers for some time have been using AI to generate things like denials and patient status changes, et cetera. And I think we're developing sort of countermeasures to that using AI more productively, et cetera, than I think humans can actually do that.

我們知道，付款人一段時間以來一直在使用人工智慧來產生諸如拒絕和患者狀態變化等資訊。我認為我們正在開發某種應對措施，以比人類更有效地利用人工智慧等等。

From a clinical perspective, one of the early experiments we've done is using AI to follow up with patients on their post-discharge instructions. So an AI-generated entity will call a patient and make sure that they've followed up with the appropriate doctor appointments, and they fill their prescriptions and they're following their diet, whatever the post-discharge instructions are.

從臨床角度來看，我們早期進行的實驗之一是使用人工智慧追蹤患者的出院後指示。因此，人工智慧生成的實體將呼叫患者並確保他們已跟進適當的醫生預約、開出處方並遵循飲食，無論出院後指示是什麼。

And we have found in the early stages that that's very -- been very well received and efficient. And again, it frees up a clinical person, generally a nurse who would otherwise be making that call. So yeah, I mean, I think that AI and technology tools in general are certainly one way that we envision becoming more productive over the next several years.

我們在早期階段就發現這種方法非常受歡迎且非常有效。再次，它釋放了原本需要撥打電話的臨床人員（通常是護士）。是的，我認為人工智慧和整體技術工具肯定是我們設想在未來幾年內提高生產力的一種方式。

Helpful. Thank you.

很有幫助。謝謝。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Thanks. Hi, everybody. Maybe a couple of questions. First on -- obviously, the managed care space has been quite disrupted the last few years and culminating this year. Just wondering if you see that impacting discussions with the MCOs at all on either Medicare Advantage, commercial, whatever.

謝謝。大家好。也許有幾個問題。首先——顯然，管理式醫療領域在過去幾年中受到了相當大的干擾，並在今年達到了頂峰。只是想知道您是否認為這會影響與 MCO 就醫療保險優勢計劃、商業計劃或其他任何方面進行的討論。

And I'd ask that both from the Behavioral perspective and the commercial perspective, where are you at? And is rate updates consistent terms that you're seeing being asked for, the percent of business getting done for this year, next year, and the following year?

我想問的是，從行為角度和商業角度來看，您處於什麼位置？並且，費率更新是否與您所看到的要求一致，即今年、明年和後年完成的業務百分比？

AJ, I mean, I think our experience has been -- and I think it's been alluded to in some previous questions. On the Behavioral side, we've gotten pretty strong managed care increases over the last several years, largely, I think, because the payers are struggling with access to behavioral facilities.

AJ，我的意思是，我認為我們的經驗是——而且我認為在之前的一些問題中已經提到過。在行為方面，在過去幾年中，我們的管理式醫療費用大幅增加，我認為這主要是因為付款人很難獲得行為治療設施。

I think there's a scarcity, particularly of inpatient behavioral beds, that payers are challenged by. Where I think we probably feel the impact of the managed care industry's challenges the most is in sort of the day-to-day revenue cycle interactions we have with payers. We -- I don't know that we've seen an enormous increase in the level of denials or patient status changes.

我認為存在短缺問題，特別是住院行為床位短缺，這對付款人構成了挑戰。我認為，我們可能最能感受到管理式醫療產業挑戰的影響，就是我們與付款人的日常收入週期互動。我們——我不知道我們是否已經看到拒絕的程度或患者狀態變化的大幅增加。

But if you talk to anybody who works in our revenue cycle in either Behavioral or Acute, they'll just describe to you what is sort of a daily slog of having to counter aggressive behavior on the part of payers all the time and denials and denial appeals and appeals of patient status changes, that sort of thing.

但是如果你和任何在我們行為或急性收入周期中工作的人交談，他們就會向你描述每天必須應對付款人的攻擊性行為以及拒絕、拒絕上訴和患者狀態變化的上訴等事情。

We've invested, I think, a lot. We've had some pretty significant third-party consulting reviews of our revenue cycle practices to allow us to improve people, process technology, so that we're trying -- to be able to counter the payers in sort of the aggressive behavior we have found in those areas. I don't know that it's incrementally more materially different than it has been, but it's certainly been this way for some time now.

我認為我們已經投入了很多。我們對我們的收入周期實踐進行了一些相當重要的第三方諮詢評估，以便我們改進人員和流程技術，從而能夠對抗我們在這些領域發現的付款人的激進行為。我不知道它是否在實質上與以前有所不同，但這種情況確實已經持續了一段時間了。

Okay. Maybe just also ask you about labor. Any updated thoughts on both lines of business with respect to things like wage rates, use of contract labor, turnover, et cetera? And I know, particularly with Behavioral, your biggest challenge you talk about in trying to get back to your -- or get to your growth targets there has seemed to be getting the staffing. Any update or thought on that?

好的。也許還會問你關於分娩的問題。對於工資率、合約工使用、營業額等方面，您對這兩條業務線有什麼最新的看法嗎？我知道，特別是對於行為醫學而言，您談到的試圖恢復或實現成長目標的最大挑戰似乎就是人員配備。對此有什麼更新或想法嗎？

Yeah. So I mean, I think from a labor or wage inflation perspective, obviously, wage inflation has decelerated significantly from its peaks during the pandemic. Maybe decelerated is not the right choice of words, but it is accelerating at a much lower rate than it had been during the height of the pandemic. I think we find that in both of our segments. I think we find the use of temporary traveling nurses to be lower again in both segments.

是的。所以我的意思是，我認為從勞動力或工資通膨的角度來看，工資通膨顯然已從疫情期間的高峰大幅放緩。也許「減速」並不是一個正確的措辭，但它正在以比疫情高峰期低得多的速度加速。我認為我們在兩個領域都發現了這一點。我認為我們發現這兩個領域臨時巡迴護理師的使用率都較低。

But you are correct that we continue in the Behavioral business in certain geographies and certain markets to be hampered or for at least our volumes to be hampered by our inability to hire all the staff that we need. And it's not -- it's often nurses, but, sometimes, that could be therapists.

但您說得對，由於我們無法僱用所需的所有員工，我們在某些地區和某些市場繼續開展行為業務會受到阻礙，或者至少我們的業務量會受到阻礙。事實並非如此——通常是護士，但有時也可能是治療師。

Therapists, I mentioned earlier, could be -- or hiring a therapist could be an obstacle to building out outpatient. But it also can even be the nonprofessional people, the people we call mental health technicians. So we've done a great deal in the last several years to improve our recruiting.

我之前提到過，治療師可能會——或者聘請治療師可能會成為開展門診服務的障礙。但也可以是非專業人士，我們稱之為心理健康技術人員。因此，過去幾年我們做了很多工作來改善我們的招募工作。

But also, and I think almost probably more importantly, to recruit our retention to make sure that when we hire people, they feel properly trained. We feel that they're properly trained to maximize the safety and quality of care to our patients but also to -- for them to feel comfortable in delivering that care and so that they're wanting to stay at the facility for longer periods of time, et cetera, and longer tenured -- result in longer-tenured employees.

但同時，我認為更重要的是，招募我們的留任人員，確保當我們僱用員工時，他們感覺自己受到了適當的培訓。我們認為，他們接受了適當的培訓，不僅能最大限度地保證患者的安全和護理質量，還能讓他們感到舒適地提供護理，從而願意在該機構工作更長時間，等等，從而成為任期更長的員工。

So we continue to invest in that. So it remains a challenge. It's still a tight labor market. And again, I do think while it is not the pervasive issue that it was at the height of the pandemic, staffing scarcity, it continues to be an issue in some markets and some geographies.

因此我們將繼續對此進行投資。所以這仍然是一個挑戰。勞動市場依然緊張。再次強調，我確實認為，雖然人員短缺問題不像疫情高峰那麼普遍存在，但在某些市場和地區仍然是一個問題。

Okay. Maybe just if I can squeeze one more in there. On your DPP comments, you had -- I know a lot of states or there are some states scrambling to still get credit under the Beautiful Bill before the window shuts. And Washington, DC, was a big one for you that was still pending.

好的。也許只要我能再擠進一個就好了。關於您對 DPP 的評論，我知道很多州或有些州正在努力在《美麗法案》關閉之前獲得信貸。而華盛頓特區對你來說是一個尚未解決的大問題。

Any update there? And then with respect to your long-term impact of the Big Beautiful Bill, you said $380 million exposure. Any way to break that down between Acute and Behavioral exposure?

有任何更新嗎？然後關於《大美麗法案》的長期影響，您說曝光金額為 3.8 億美元。有什麼方法可以區分急性暴露和行為暴露嗎？

Yeah. So the $380 million is about -- or at the midpoint of the range that we gave, which is $380 million -- is about 60% Behavioral and 40% Acute. As far as your other question about other programs, the DC program has been pending approval for a number of months now. We don't necessarily have any inside information.

是的。因此，3.8 億美元大約是 - 或者說是我們給出的範圍的中點，即 3.8 億美元 - 其中約 60％ 是行為方面的，40％ 是急性方面的。至於您關於其他項目的另一個問題，DC 項目已經等待批准好幾個月了。我們不一定掌握任何內線消息。

We do get sort of periodic updates from the district itself, where the district provides it to the hospital association and we get through them. And they say they continue to have ongoing conversations with CMS, which I think is fairly typical; meaning, CMS ask them questions, ask for data. They provide it. They sometimes reach out to us, the hospitals, for help in providing that data. We provided data.

我們確實會從學區本身獲得定期更新的信息，學區會將信息提供給醫院協會，然後我們再通過他們獲取。他們說他們會繼續與 CMS 進行對話，我認為這是相當典型的；意思是，CMS 會向他們提問，要求提供資料。他們提供它。他們有時會向我們（醫院）尋求幫助來提供這些數據。我們提供了數據。

The district continues to believe that the program that they've submitted meets the criteria of CMS in other programs that have been previously approved. And they continue to expect the program to be approved, although they don't really estimate a timeframe.

該學區仍然認為，他們提交的計劃符合 CMS 之前批准的其他計劃的標準。他們繼續期待該計劃獲得批准，儘管他們並沒有真正估計時間表。

There are other states that we understand have either submitted preprints or intend to. I think it's worth noting that the bill doesn't preclude new programs. It just suggests that any new programs after the passage of the bill are subject to the caps in the bill, whether they're the provider tax caps or the reimbursement caps. But it's entirely possible that there are states who can still submit new programs even now that the bill has been passed.

據我們了解，其他州也已經提交了預印本或打算提交。我認為值得注意的是，該法案並不排除新的計劃。這只是表明，法案通過後的任何新計劃都受法案中規定的上限約束，無論是提供者稅上限還是報銷上限。但即使該法案已經通過，一些州仍然有可能提交新的計劃。

Okay. All right. Thanks so much.

好的。好的。非常感謝。

Matthew Gillmor, KeyBanc.

馬修·吉爾摩（Matthew Gillmor），KeyBanc。

Hey, thanks. Steve, you made a comment about West Henderson cannibalizing some of the same-store growth on the Acute side. Are you able to quantify what that impact would be? Or just give us some sense for the drag on the same-store.

嘿，謝謝。史蒂夫，你評論說西亨德森蠶食了 Acute 部分同店增長。您能量化這種影響嗎？或者只是讓我們來了解一下同店銷售的拖累。

Yeah. Hard to do in an absolute precise way, Matthew. But I think the way we look at it is we look at the ZIP codes that West Henderson is getting patients from and sort of try and triangulate and say, these are the likely ZIP codes that prior to West Henderson opening would have gone to either Henderson Hospital or one of our other hospitals.

是的。馬修，很難以絕對精確的方式做到這一點。但我認為我們看待這個問題的方式是，我們查看西亨德森接收患者的郵政編碼，然後嘗試進行三角測量，然後說，這些郵政編碼可能是西亨德森開業之前亨德森醫院或我們的其他醫院的郵政編碼。

We think that that impact is maybe 50, 60 basis points from an adjusted admission perspective and kind of a similar impact on revenues. So again, best guess, that's not a perfect or completely precise estimate, but that's our best guess.

我們認為，從調整後的入場費角度來看，這種影響可能達到 50 到 60 個基點，對收入的影響也類似。所以再說一次，最好的猜測，這不是一個完美或完全精確的估計，但這是我們最好的猜測。

And then following up on some of the expense management discussion, I wanted to see if there was anything to report with respect to professional fees and physician expenses. I think you had most recently said that you were expecting that to be up 5%, and it was stable. But just curious, are there any progress there or sort of incremental pressures with certain specialties?

然後，在跟進一些費用管理討論之後，我想看看是否有關於專業費用和醫生費用需要報告的內容。我想您最近說過，您預計這一數字將上漲 5%，而且是穩定的。但只是好奇，那裡有什麼進展嗎？或是某些專業領域是否有增加的壓力？

Yeah. I mean, I think that as you described it, in our guidance, we assume that after fairly dramatic increases in those physician expenses in the last couple of years, that our assumption in 2025 was that they would increase by roughly the overall inflation rate, 5% or 6%, something like that. And I think that's been the case.

是的。我的意思是，我認為正如您所描述的，在我們的指導中，我們假設在過去幾年中這些醫療費用大幅增加之後，我們對 2025 年的假設是，這些費用將大約增加整體通貨膨脹率，即 5% 或 6% 左右。我認為事實確實如此。

We continue to feel pressure from different physician groups around the country. I think a number of our peers have suggested that after the initial pressures over the last several years have come from ER doctors and anesthesiologists.

我們繼續感受到來自全國各地不同醫生團體的壓力。我認為我們的許多同行都表示，過去幾年最初的壓力來自急診室醫生和麻醉師。

More recently, we're seeing more radiologists asking for increased subsidies, something that, quite frankly, we hadn't seen in years. We've seen that same dynamic, although we've been able to continue to operate within that sort of 5% growth dynamic. That has not really changed.

最近，我們看到越來越多的放射科醫生要求增加補貼，坦白說，這是我們多年來從未見過的情況。我們也看到了同樣的動態，儘管我們能夠繼續在 5% 的成長動態內運作。這一點其實並沒有改變。

Got it. Thank you.

知道了。謝謝。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，費茲傑拉領唱者。

Thank you. You've talked a lot about the opportunity for growth in outpatient Behavioral. Given what that implies for mix, is 2.5% to 3% adjusted admissions for Behavioral volume still the right long-term target or the right target for '25 given year-to-date performance? And can you speak to how inpatient Behavioral, specifically, has been doing year-to-date versus your expectations?

謝謝。您已經談了很多關於門診行為治療的成長機會。考慮到這對組合意味著什麼，2.5% 至 3% 的行為量調整入院率是否仍然是正確的長期目標，或者根據年初至今的表現，是否是 25 年的正確目標？您能否具體談談住院行為治療今年迄今的表現與您的預期相比如何？

Yeah. I mean, so I think, obviously, what we're seeing, I think, in Behavioral is payers trying to shift more patients from the inpatient setting to the outpatient setting. Obviously, that's a dynamic that we -- certainly not new. We've seen it in the Acute space for a decade or two already. It's not new to the Behavioral space either, but I think there's more of an emphasis on it.

是的。我的意思是，所以我認為，顯然，我們在行為醫學中看到的是付款人試圖將更多的患者從住院環境轉移到門診環境。顯然，這是我們所知道的一種動態——當然並不新鮮。我們已經在 Acute 領域看到它一二十年了。這對於行為領域來說也不是什麼新鮮事，但我認為人們更重視它。

And to be fair, I think our business has been an inpatient-centric business for most of its history. We have always had an outpatient presence. But I don't know that our focus has been as intense as it is currently in part to take advantage of that shift.

公平地說，我認為我們的業務在大部分歷史中都是以住院病人為中心的業務。我們一直都有門診病人。但我不知道我們的焦點是否像現在這樣強烈，部分原因是為了利用這種轉變。

So I think that one of the reasons why it has been difficult for us to reach that 2.5% to 3% target that has been elusive -- and we certainly acknowledge it's been elusive -- is that there's been a shift to outpatient. And we've been not necessarily capturing what I would describe as our fair share of that outpatient business.

因此，我認為我們難以達到 2.5% 至 3% 這一難以實現的目標的原因之一（我們當然承認這一目標難以實現）是轉向門診治療。而且我們並沒有獲得我所描述的門診業務的公平份額。

Our focus has clearly changed. Like I said, we've seen sequential improvement from Q1 to Q2, both in overall adjusted patient days, but specifically in outpatient. I think we believe we'll continue to see improvement over the balance of the year and do believe that over the long term, that 2.5% to 3% adjusted patient day growth target, is a reasonable target for this business, that the demand is there. We just have to be able to service it in the right setting with the right staff, et cetera.

我們的重點顯然已經改變。正如我所說的，我們看到從第一季到第二季都有連續的改善，不僅在整體調整後的患者天數方面，而且特別是在門診方面。我認為，我們相信我們將在今年餘下的時間裡繼續看到改善，並且相信從長遠來看，2.5％至3％的調整後患者日增長目標是該業務的合理目標，需求是存在的。我們只需要能夠在正確的環境中由正確的人員提供服務等等。

Thank you.

謝謝。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

Great. Thanks. I appreciate your commentary on the West Henderson Hospital. But maybe can you just more broadly give us an update how Nevada and the Las Vegas markets are doing in terms of volume trends, payer mix, any other data you're able to share?

偉大的。謝謝。我很欣賞您對西亨德森醫院的評論。但是，您能否更廣泛地向我們介紹內華達州和拉斯維加斯市場在交易量趨勢、付款人結構等方面的最新情況，以及您能分享的其他數據？

Yeah. I mean, I think we've seen a little bit of slowdown in our Nevada volumes. There's been, I think, a great deal written in recent months about the overall Nevada economy and the Las Vegas economy slowing down a bit. We're seeing some impact from that.

是的。我的意思是，我認為我們已經看到內華達州的銷量有所放緩。我認為，最近幾個月已經有很多關於內華達州整體經濟和拉斯維加斯經濟放緩的報導。我們正在看到它帶來的一些影響。

But as I said, even if you exclude the cannibalization from West Henderson or just exclude West Henderson's ER volumes, like our overall ER volumes are up slightly, not by a great deal. But yeah, I mean, Vegas' performance while still very solid and while West Henderson's performance is extremely positive, we are seeing a little bit of pressure from some of the economic softness in the market.

但正如我所說，即使排除西亨德森的蠶食或僅排除西亨德森的急診量，我們的整體急診量也會略有增加，但不會大幅增加。但是的，我的意思是，儘管拉斯維加斯的表現仍然非常穩健，而西亨德森的表現也非常積極，但我們看到市場經濟疲軟帶來了一些壓力。

Okay. Great. Just one follow-up. Net leverage continues to come down even with the increases, at least, year over year in share repos and capital spending. I guess, can you remind us how we should think about capital deployment strategy and if we should maybe just expect this to continue to come down through the back half of the year? Thanks.

好的。偉大的。僅一個後續行動。儘管股票回購和資本支出至少年增，但淨槓桿率仍在持續下降。我想，您能否提醒我們，我們應該如何考慮資本配置策略，以及我們是否應該預期這一數字將在下半年繼續下降？謝謝。

Yeah. So in our initial 2025 guidance, we guided to a share repurchase number in the $600 million to $700 million range. And that was really the free cash flow that we were anticipating in that original guidance. Obviously, the revised guidance presumes a higher level of free cash flow.

是的。因此，在我們最初的 2025 年指引中，我們預期股票回購金額將介於 6 億至 7 億美元之間。這確實是我們在最初的指導下預期的自由現金流。顯然，修訂後的指南假定自由現金流水準較高。

And I think it's reasonable to assume that that incremental free cash flow will likely be dedicated to an elevated level of share repurchase. It's possible that as we evaluate what we think to be a pretty compelling share price at the moment, that we'll decide to be even more aggressive from a share repurchase perspective.

我認為，可以合理地假設，增量自由現金流可能會用於更高水準的股票回購。當我們評估目前我們認為相當有吸引力的股價時，我們可能會決定從股票回購的角度採取更積極的行動。

But again, at a minimum, I think it's at least safe to assume that as our free cash flow increases, that incremental amount will be dedicated to additional share repurchase.

但至少，我認為至少可以安全地假設，隨著我們的自由現金流的增加，增量金額將用於額外的股票回購。

Michael Ha, Baird.

麥可·哈，貝爾德。

Thank you. Just sort of a follow-up to Pete's question. So it sounds like you're very confident in finding the offsets the DPP headwinds after 2032. I just wanted to fully clearly confirm that we should be thinking about Behavioral Health long-term margin targets as unchanged. All that recent strength in Behavioral margins pricing should remain resilient and durable even in the face of this gradual headwind.

謝謝。這只是對 Pete 問題的後續回答。所以聽起來你對找到 2032 年後抵銷民進黨逆風的方法非常有信心。我只是想完全清楚地確認，我們應該將行為健康的長期利潤目標視為不變。即使面臨這種逐漸出現的逆風，行為利潤定價近期的強勢仍應保持彈性和持久性。

And basically, do you still believe, over time, you can get back to those sort of high 20s margin from a decade ago? And I know there's no immediate rush, but curious if you have any early sense on online when you look to have the mitigation plan with all of the offset leverage fully fleshed out.

基本上，您是否仍然相信，隨著時間的推移，您可以回到十年前的 20 多歲的高利潤率？我知道現在不著急，但我很好奇，當您希望制定出包含所有抵消槓桿的緩解計劃時，您是否在網上有任何早期的感覺。

Yeah. I mean, obviously, Michael, I think people are asking very specific questions about a period that doesn't begin for three years and doesn't end until eight years from now. Difficult to project.

是的。我的意思是，邁克爾，顯然，我認為人們問的是一個非常具體的問題，關於一個三年後才開始、八年後才結束的時期。難以投射。

I think what we've tried to express in our commentary is that particularly on the Behavioral side, which is really, I think, the rest of your question, we do have the ability to shift programming and to shift sort of targeted patient programs in certain places, in certain geographies, where maybe we're seeing the DPP impacts the greatest.

我認為我們在評論中試圖表達的是，特別是在行為方面，也就是您問題的其餘部分，我們確實有能力改變編程，並改變某些地方、某些地區的有針對性的患者計劃，在這些地方，我們可能看到 DPP 的影響最大。

And -- but we have plenty of time to do that. And frankly, one of the challenges we have is to do the timing right. So in other words, we're not seeing those reductions for several years. It doesn't make sense for us to all of a sudden exit Medicaid-centric programs when Medicaid reimbursement over the next several years will remain at current levels. So we're going to have to time that out right, et cetera.

而且——但我們有足夠的時間來做這件事。坦白說，我們面臨的挑戰之一就是把握正確的時機。換句話說，我們幾年內都不會看到這種減少。當未來幾年的醫療補助報銷額仍將保持在當前水準時，我們突然退出以醫療補助為中心的計劃是沒有意義的。因此我們必須正確安排時間等等。

But yeah, I mean, I think what we tried to express, and I think what our peers have tried to express, is that I think as for-profit providers, especially, we have proven in a number of instances, I think, most recently with the challenges of the pandemic, to be quite nimble and flexible and willing and able to adjust our business for some pretty significant challenges and that we're confident with the time period that we have to prepare that we'll be able to do that in this case as well.

但是的，我的意思是，我認為我們試圖表達的，以及我們的同行試圖表達的，我認為作為營利性提供商，尤其是在最近應對疫情挑戰的情況下，我們已經在很多情況下證明了我們非常靈活，願意並且能夠調整我們的業務以應對一些相當重大的挑戰，並且我們對我們必須準備的時間段有信心，在這種情況下我們也能夠做到這一點。

Got it. Thank you. And just a follow-up question, sorry, another policy one. But as it relates to work requirements in '27, just given the outsized procedural disenrollment that we've seen from redeterminations, but with work requirements, I know MCOs are very focused on it.

知道了。謝謝。這只是後續問題，抱歉，另一個政策問題。但由於它與 27 年的工作要求有關，鑑於我們從重新確定中看到的過多的程序取消註冊，但有工作要求，我知道 MCO 非常關注它。

But from a provider perspective, if lives were to drop off and they're ineligible for subsidized marketplace coverage that prevents an [offset in cash admit] to the extent that actually end up driving up the uninsured and provider of bad debt over the coming years, I'm just curious, high level, how you're thinking about the potential ripple effect of Medicaid work requirements onto UHS.

但是從提供者的角度來看，如果生命力下降，他們就沒有資格獲得補貼市場覆蓋，從而阻止 [現金抵消]，最終導致未來幾年無保險和壞賬提供者的數量增加，我只是好奇，高層，您如何看待醫療補助工作要求對 UHS 的潛在連鎖反應。

And are there any things that you guys can do as a provider to maybe even help sort of bridge that gap or practically engage your own Medicaid patients to sort of improve member retention? Thank you.

作為服務提供者，你們可以做些什麼來幫助彌合這一差距，或者實際上讓你們自己的醫療補助患者參與進來，以提高會員保留率？謝謝。

Yeah. So again, I don't know that -- there's lots of different estimates about how many patients might be removed from the Medicaid rolls as a result of work requirements and quite frankly, who those patients are.

是的。所以，我再說一遍，我不知道——關於有多少病人可能因為工作要求而被從醫療補助名單中除名，以及坦率地說，這些病人是誰，有很多不同的估計。

Obviously, the bill and the narrative around the bill was that they were largely eliminating young, healthy, particularly male patients. If that's really the group that -- and I'm not enough of a Medicaid expert to speak to this fluently. But if that's really the group being eliminated, I don't know that that's a group that has utilized our services in great numbers.

顯然，該法案及其周圍的敘述表明，他們在很大程度上消滅了年輕、健康的患者，尤其是男性患者。如果那真的是那個群體——而且我不是醫療補助專家，無法流利地談論這個問題。但如果這真的是被消滅的群體，我不知道這個群體是否大量利用了我們的服務。

To be fair, on the Acute side, most of our Medicaid business comes through the emergency rooms as most of our uninsured business does. And there's not a great deal we can do. I mean, there are ways that we can effectively manage that business or manage that business more effectively. And we'll certainly focus on that.

公平地說，在急性方面，我們的大部分醫療補助業務都透過急診室進行，就像我們大部分的無保險業務一樣。我們能做的並不多。我的意思是，我們可以透過一些方法來有效地管理該業務，或更有效地管理該業務。我們一定會關注這一點。

But for the most part, we have to take the patients that come to us. Again, I'll make the point that on the Behavioral side, we have more optionality in the patients that we're able to take. And if patients generally don't have insurance, they usually find their way to other settings rather than our hospitals.

但大多數情況下，我們必須接收來找我們的病人。再次強調，在行為治療方面，我們在接收患者方面擁有更多的選擇權。如果病人沒有保險，他們通常會去其他地方而不是我們的醫院。

You can just tell that from our uncompensated care load in the Behavioral segment, which is dramatically less than it is in the Acute segment. So in terms of referral sources, in terms of the programs that we stress, et cetera, we have the ability to be flexible in terms of targeting patient groups, et cetera, that are more preferable from our perspective. And certainly, we'll do that as this plays out.

您可以從行為領域的無償照護負擔中看出這一點，該負擔明顯低於急性領域的無償照護負擔。因此，就轉診來源、我們所強調的項目等方面而言，我們有能力靈活地針對目標患者群體等，從我們的角度來看，這是更可取的。當然，隨著事情的進展，我們會這麼做。

But as we look at it, on a forward-looking basis, it's difficult to predict with precision, how many of these patients they're going to be and what the characteristics of that patient population is going to look like.

但從長遠來看，我們很難準確預測這些患者的數量以及這些患者群體的特徵。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great. Thanks. I just want to try to get a little more color on the weakness in the Behavioral business because it sounds like you're saying you're not getting your fair share.

偉大的。謝謝。我只是想嘗試更多地了解行為業務中的弱點，因為這聽起來像是你說你沒有得到公平的份額。

So is there competition out there? Is that what's driving the weakness in volumes? Or is it still more of the staffing and other issues that have historically kind of been the issue there?

那麼，那裡有競爭嗎？這是造成交易量疲軟的原因嗎？或者這仍然是人員配備和其他歷史上一直存在的問題？

Yeah. So what I tried to say earlier, Kevin, is in terms of the step-down patients, the patients that we discharge, we do capture a good share of those. But there are still a good number of those patients who go elsewhere.

是的。凱文，我之前想說的是，就停藥的病人而言，也就是我們出院的病人，我們確實佔了其中很大一部分。但仍有相當多的病人選擇去其他地方就診。

And we probably can be more effective in the control of those patients in large part because I think we believe that the care they'll receive and the continuity of care that they'll receive in our facility is greater than they will elsewhere.

我們可能能夠更有效地控制這些患者，很大程度上是因為我認為我們相信他們在我們的機構中接受的護理和護理的連續性比在其他地方更好。

But yeah, I mean, on what we described as the step-in business, more of the freestanding business, yes, there are a lot of other entities out there of all sorts, large, small, et cetera, that offer those services. And we just have not historically really competed aggressively in that space. And we'll do some more in the future.

但是的，我的意思是，對於我們所描述的介入業務，更多的是獨立業務，是的，還有很多其他各種各樣的實體，大的、小的等等，都提供這些服務。而從歷史上看，我們在該領域並沒有真正積極競爭。我們將來還會做更多。

We do have advantages. We have relationships with payers. We have relationships with referral sources, long-standing relationships, that some of these newer and smaller providers just don't have. But staffing and therapists are an issue as well in these settings. A lot of therapists have been working more remotely in more recent years, et cetera. And so competition for therapists is also intense.

我們確實有優勢。我們與付款人有關係。我們與推薦來源建立了長期關係，而一些較新、較小的供應商則沒有這種關係。但在這些環境中，人員配置和治療師也是一個問題。近年來，許多治療師都開始進行更多遠距工作等等。因此治療師的競爭也很激烈。

So there's not a single reason that, I think, our outpatient has not grown as much as we think it should. But I think more important -- most importantly, our focus on this is going to enable us to grow at a faster pace in the coming periods than we have in the last few periods.

因此，我認為，沒有任何原因導致我們的門診量沒有達到我們預期的成長。但我認為更重要的是——最重要的是，我們對此的關注將使我們在未來時期比過去幾個時期以更快的速度成長。

Yeah. I guess, maybe if you could just expand on that. Because I guess, like staffing and things are things that you kind of should have had, I guess, had a view on as to where you would be at this point this year.

是的。我想，也許你可以進一步闡述這一點。因為我想，對於人員配備和其他事情，你應該有一個大致的了解，知道今年這個時候你會處於什麼位置。

So if we think about the guidance reduction itself and kind of what you thought coming into the year now, what you think volumes will look like, is it that it has incrementally been harder to staff or something going on there?

因此，如果我們考慮指導減少本身以及您對今年的情況的看法，您認為交易量會是什麼樣子，是否人員配備變得更加困難了，或者發生了什麼其他事情？

Or has it been the competition or maybe slower progress on some of the initiatives that you were thinking about doing? And then to that and whatever the answer is, what, if anything, are you doing differently for 2026 to try and get that back [to two to three]? Thanks.

或者是競爭的原因，或者是您正在考慮的一些計劃進展較慢？然後，無論答案是什麼，你會在 2026 年採取什麼不同的措施來試圖恢復這種狀態[到兩到三]？謝謝。

Sure. I feel like it's a little bit redundant. I think we've addressed this. Yeah, I think it's all those things. I think we're building and creating more capacity, which we didn't have. So that's new capacity.

當然。我覺得有點多餘。我想我們已經解決了這個問題。是的，我認為是所有這些。我認為我們正在建造和創造更多我們以前沒有的產能。這就是新的產能。

We're focused on our sort of discharge and referral processes for patients who are being discharged from our facilities. We're trying to focus more on recruitment and retention effectiveness, doing all those things. And that are challenging but did improve quarter over quarter and we expect will improve further in the back half of the year.

我們專注於為從我們的醫療機構出院的患者提供出院和轉診流程。我們正努力更加重視招募和留任的有效性，做所有這些事情。這很有挑戰性，但確實逐季有所改善，我們預計今年下半年將進一步改善。

All right. Thanks.

好的。謝謝。

Joshua Raskin, Nephron Research.

Joshua Raskin，腎元研究。

Hi, thanks. I know you talked about this a little bit, Steve. But I'm just curious on the sort of AI and the technology that you're using in the RCM side. Are those internal investments, or are you using external vendors more often now? And then is that impacting sort of the coding and patient acuity sort of like the -- is that why we're seeing on the pricing or the revenue per admit side?

你好，謝謝。我知道你談論過這個，史蒂夫。但我只是好奇您在 RCM 方面使用的 AI 類型和技術。這些是內部投資嗎，還是您現在更頻繁地使用外部供應商？那麼，這是否會對編碼和病患敏銳度產生影響——這就是我們在定價或每次入院收入方面看到的原因嗎？

Yeah. So I think it's a combination, Josh. I mean, we've publicly disclosed our investment in Hippocratic AI, which is a company dedicated to the development of AI applications in healthcare. We also have relied on some vendors.

是的。所以我認為這是一個組合，喬希。我的意思是，我們已經公開揭露了我們對 Hippocratic AI 的投資，這是一家致力於開發醫療保健領域人工智慧應用的公司。我們也依賴一些供應商。

You talked about coding. We've used AI -- an AI vendor or a vendor that uses AI technology for coding in our emergency rooms. And I don't know that that's resulted in necessarily increased or elevated coding. But I think it's resulted in increased efficiency, taking a relatively routine task and allowing it to be taken care of in a more efficient way.

您談到了編碼。我們已經使用了人工智慧——人工智慧供應商或使用人工智慧技術在我們的急診室進行編碼的供應商。我不知道這是否必然會導致編碼增加或升高。但我認為這會提高效率，讓相對常規的任務能夠以更有效的方式處理。

So it's a combination. I think we've used some outside vendors. We're also investing and working closely with a company that's developing new AI technology. We're doing some things on our own. So I think it's a combination of us trying to take advantage.

所以這是一個組合。我認為我們已經使用了一些外部供應商。我們也正在投資一家開發新人工智慧技術的公司並與其密切合作。我們正在自己做一些事情。所以我認為這是我們試圖利用的結合。

And quite frankly, some of the technology -- some of the new technologies -- and we've talked about this, I think, a little bit before, like patient rounding technology, which is not necessarily AI. But it's sort of like an Apple Watch kind of technology where patients wear that sort of device. And we're able to track them and their location more closely, and often they're checked on and those sort of things. All those things, I think, result in greater efficacy and also, honestly, greater patient safety and quality of care.

坦白說，一些技術——一些新技術——我想我們之前已經討論過這個問題，例如病人巡房技術，它不一定是人工智慧。但它有點像 Apple Watch 那樣的技術，患者可以戴這種裝置。我們能夠更密切地追蹤他們及其位置，並且經常對他們進行檢查之類的事情。我認為，所有這些都能提高療效，坦白說，還能提高病人的安全性和照護品質。

Yeah. Perfect. And then just last quick one. I know we talked about this last quarter as well. But tariffs, any updated thoughts on potential impact from tariffs?

是的。完美的。最後再簡單說一下。我知道我們上個季度也討論過這個問題。但是關稅，對於關稅的潛在影響有什麼最新的看法嗎？

Not really. We haven't seen any sort of material impact from tariffs and have not necessarily sort of been told by our GPO or even by any significant vendors, that significant increases in supply expense are on the horizon.

並不真地。我們尚未看到關稅的任何實質影響，我們的 GPO 甚至任何重要供應商也沒有告訴我們供應費用即將大幅增加。

So obviously, the tariff -- the negotiations at the highest levels continue, and we'll have to see how that all sorts out. And it has had little impact on our business to date.

因此，顯然，關稅——最高層的談判仍在繼續，我們將拭目以待一切結果如何。到目前為止，它對我們的業務影響不大。

Thank you.

謝謝。

And, operator, we're going to have to make this our last question. We have another commitment at the top of the hour.

接線員，這是我們的最後一個問題。我們此刻還有另一項約定。

Raj Kumar, Stephens.

拉吉·庫馬爾，史蒂芬斯。

Hey, thanks. Excuse me. Just one from the policy perspective. Just kind of thinking about the proposed elimination of the inpatient-only list.

嘿，謝謝。打擾一下。僅從政策角度而言。只是在考慮取消住院病人名單的提議。

Maybe kind of walk us through the puts and takes for UHS, and then kind of maybe what your view is on the potential impact from an inpatient admissions growth perspective and overall rate growth perspective over the next few years as that policy gets potentially phased in?

也許您可以向我們介紹 UHS 的利弊，然後，隨著該政策可能分階段實施，您對未來幾年住院人數增長和總體費率增長方面的潛在影響有何看法？

Yeah, difficult to say. I mean, I think what you're referring to is there's a number of the site neutrality proposals, and they differ. And the devil is always in the details. The industry broadly, writ large, is lobbying hard and making the point that it's been subject to some pretty significant cuts, many of which we've already discussed at some length.

是的，很難說。我的意思是，我認為您所指的是存在許多站點中立性提案，而且它們有所不同。魔鬼總是藏在細節裡。整個行業，從廣義上講，都在大力遊說，並強調其已經受到了一些相當重大的削減，其中許多我們已經進行了詳細討論。

So we'll see. I mean, I think it's difficult for us to sort of project what the impact is until we know what the details of a specific bill would be.

我們拭目以待。我的意思是，我認為在我們知道具體法案的細節之前，我們很難預測其影響是什麼。

Thank you.

謝謝。

So I'd like to thank everybody for their time. And I look forward to speaking with everybody again next quarter.

我要感謝大家抽空。我期待下個季度再次與大家交談。

Okay. This concludes today's conference call. Thank you for participating. You may now disconnect.

好的。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。