US Physical Therapy Inc (USPH) 2022 Q4 法說會逐字稿

(Operator Instructions). I'd now like to turn the call over to Chris Reading, President and CEO. Please go ahead, sir.

（操作員說明）。我現在想把電話轉給總裁兼首席執行官 Chris Reading。請繼續，先生。

Thank you, Gretchen. Good morning, and welcome, everyone, to U.S. Physical Therapy's Fourth Quarter and Full Year Earnings Call. With me on the call this morning include Carey Henrikson, our Chief Financial Officer; Eric Williams and Graham Reeve, our co-COOs; Jake Martinez, our Senior Vice President and Controller; and Rick Binstein, our Executive Vice President and General Counsel.

謝謝你，格雷琴。早上好，歡迎大家參加 U.S. Physical Therapy 的第四季度和全年收益電話會議。今天早上與我通話的還有我們的首席財務官 Carey Henrikson；我們的聯合首席運營官 Eric Williams 和 Graham Reeve；我們的高級副總裁兼財務總監 Jake Martinez；和我們的執行副總裁兼總法律顧問 Rick Binstein。

Before we begin to discuss our results here this morning, we need to cover a brief disclosure statement. Jake, if you would, please.

在我們今天早上開始討論我們的結果之前，我們需要先做一個簡短的披露聲明。傑克，如果你願意，請。

Thank you, Chris. This presentation contains forward-looking statements, which involve certain risks and uncertainties. These forward-looking statements are based on the company's current views and assumptions. The company's actual results may vary materially from those anticipated. Please see the company's filings with the Securities and Exchange Commission for more information. Thanks.

謝謝你，克里斯。本演示文稿包含前瞻性陳述，涉及某些風險和不確定性。這些前瞻性陳述基於公司當前的觀點和假設。公司的實際結果可能與預期存在重大差異。有關更多信息，請參閱公司向美國證券交易委員會提交的文件。謝謝。

Thanks, Jake. So we have a lot to cover this morning. I'll start by discussing demand. As we look at volumes, which finished the year in really in a nice fashion. We’re steady in the quarter with October and November, coming in at 29.4 visits per clinic per day for both of those months. Then we started December really while averaging just above 30 visits per clinic per day for the first two and a half weeks.

謝謝，傑克。所以今天早上我們有很多內容要講。我將從討論需求開始。當我們看數量時，它確實以一種很好的方式結束了這一年。我們在 10 月和 11 月的季度保持穩定，這兩個月每個診所每天的訪問量為 29.4 次。然後我們真的從 12 月開始，在頭兩周半的時間裡，平均每個診所每天的訪問量略高於 30 次。

As you might recall, the country got hit with an extreme polar temperature and weather event just before Christmas and threw a little damper on volume going into the holidays. But otherwise we look very good throughout the quarter. Finish December with 20.6 visits per day, which by the quarter and a 29.1. And then overall for the year at 28.7. These were the second best volume per clinic per day numbers in our company's history, both the fourth quarter as well as the year.

您可能還記得，就在聖誕節前夕，該國遭受了極端極地溫度和天氣事件的襲擊，並在進入假期時對交易量造成了一些影響。但除此之外，我們在整個季度看起來都非常好。以每天 20.6 次訪問結束 12 月，按季度計算為 29.1 次。然後全年總體為 28.7。這是我們公司歷史上每個診所每天的第二好的數量，無論是第四季度還是今年。

Considering staffing challenges this year along with everything else, very proud of our partners, clinical teams, and all the many people who work to make sure our patients get taken care of and have a tremendous experience. They've worked extraordinarily hard these past few years under difficult conditions and continue to produce incredible results over nearly four and a half million visits this year.

考慮到今年的人員配備挑戰以及其他一切，我們為我們的合作夥伴、臨床團隊以及所有致力於確保我們的患者得到照顧並擁有豐富經驗的所有人感到非常自豪。在過去的幾年裡，他們在困難的條件下異常努力地工作，並在今年的近 450 萬次訪問中繼續取得令人難以置信的成果。

And I'll just mention that volume out of the gate starting this year has been ahead of expectations, it's been nice. Shifting gears on the injury prevention side of the business, with another strong growth year, with revenue up more than 75% on the year and 37.6% for the fourth quarter. Despite the strong results we were impacted throughout the year with open positions that were difficult to fill in some markets due to rather across the board employee scarcity this past year. That has seemingly begun to improve with more recent months seeing open positions filled at a greater rate allowing us to get to revenue and profit generation and a better overall timeframe.

我只想提一下，從今年開始的銷量超出了預期，這很好。在業務的傷害預防方面換擋，又是強勁增長的一年，收入同比增長超過 75%，第四季度增長 37.6%。儘管我們全年取得了強勁的業績，但由於過去一年的整體員工短缺，一些市場的空缺職位難以填補，因此我們受到了影響。這似乎已經開始改善，最近幾個月看到未平倉頭寸以更高的速度填補，使我們能夠獲得收入和利潤以及更好的整體時間框架。

And for some positions and this, this is a comment that's meant to be across the board for all parts of our company. For some positions, we are finally seeing a greater number of qualified applicants across our portfolio partnerships, which also feels like a good trend.

對於某些職位和這個，這是一條對我們公司所有部門都適用的評論。對於某些職位，我們終於在我們的投資組合合作夥伴關係中看到更多的合格申請人，這也是一個好的趨勢。

While this has improved in recent months, we're not yet close to being in what I would call a normal balance hiring environment. Although again, we've made progress as years unfolded and we will continue to work diligently on that as we start this new year.

雖然這在最近幾個月有所改善，但我們還沒有接近我所說的正常平衡招聘環境。儘管如此，隨著歲月的流逝，我們已經取得了進步，我們將在新的一年開始時繼續努力。

Another bright spot that we expect to continue to help us as we go forward has been our net rate and our related contract renegotiations which will continue through the entirety of our 2023 year. And that rate improved to 104.28 in the 2022, 4th quarter, up sequentially from 103.53 in the final quarter of 2021, in spite of the Medicare rate change, PTA reimbursement change and the sequester relief phase out in 2022 per contracting and OPS teams have worked hard to overcome some of these headwinds and that hard work is definitely paying off.

我們希望在前進過程中繼續幫助我們的另一個亮點是我們的淨利率和我們相關的合同重新談判，這將持續到我們整個 2023 年。該比率在 2022 年第四季度從 2021 年最後一個季度的 103.53 連續上升至 104.28，儘管 Medicare 費率發生變化，PTA 報銷發生變化，並且每個承包和 OPS 團隊在 2022 年逐步取消隔離減免很難克服其中的一些不利因素，而努力工作肯定會得到回報。

A rate progression quarterly this year went as follows. 103 even in Q1 of slightly to 103.18 in Q2, more traction in Q3 up to 104.01. And finally, to finish the year at 104.28 in the fourth quarter. Well, we are pleased to make some progress through the year. We have much more work to do before we are done.

今年每季度的利率進展如下。第一季度的 103 甚至略微上升到第二季度的 103.18，第三季度的牽引力上升到 104.01。最後，在第四季度以 104.28 結束了這一年。好吧，我們很高興在這一年中取得了一些進展。在我們完成之前，我們還有很多工作要做。

One of the things we've decided as part of our overall strategy is begin to drop payers. We will not acknowledge the value that our care. We (inaudible) buy off physical therapy provides the membership, the way of adequate and fair payment for the life improving care that we provide. Offering substandard contracts, it's not fair and it's not in keeping with a low cost, high value, return to function equation physical therapy offers its patients today.

作為我們整體戰略的一部分，我們決定的其中一件事是開始放棄付款人。我們不會承認我們關心的價值。我們（聽不清）購買物理療法提供會員資格，這是為我們提供的改善生活的護理提供充分和公平支付的方式。提供不合標準的合同，這是不公平的，也不符合當今物理療法為患者提供的低成本、高價值、回歸功能等式。

A completed course of physical therapy results in a statistically healthier patient over the course of the next 12 to 24 months with lower overall healthcare spend for all things. And it's time that this is recognized. It's also time that we as providers refuse to accept lowball no margin contracts from payers. We're in the process of some very frank discussions with some of these payers. We've given notice to some of those same payers. If we cannot get a reasonable fair rate, we will opt out of those contracts. To date that has begun to bear some fruit. We will continue. We plan on continuing those negotiations and discussions as we work our way through an extremely large portfolio of contracts.

在接下來的 12 到 24 個月內，完成物理治療後，患者的整體醫療保健支出會降低，從統計學角度來看，患者會更加健康。是時候承認這一點了。這也是我們作為供應商拒絕接受來自付款人的低價無保證金合同的時候了。我們正在與其中一些付款人進行一些非常坦率的討論。我們已經通知了其中一些相同的付款人。如果我們無法獲得合理的公平費率，我們將選擇退出這些合同。迄今為止，這已開始取得一些成果。我們將繼續。我們計劃在完成大量合同組合的過程中繼續進行這些談判和討論。

Our other challenge particularly in the second half of 2022 surrounded the rapidly escalating inflationary environment, which impacted our cost of just about everything. For the final quarter of 2022, physical therapy total operating costs decreased slightly from our cost per visit in third quarter. PT salaries and related costs also decreased slightly about 1.6% from the prior quarter.

我們的另一個挑戰，尤其是在 2022 年下半年，圍繞著迅速升級的通脹環境，這影響了我們幾乎所有事情的成本。 2022 年最後一個季度，物理治療總運營成本比我們第三季度的每次就診成本略有下降。 PT 工資和相關成本也比上一季度小幅下降約 1.6%。

However, an increase of 1.4% from the prior year's fourth quarter. All things considered, I think that's a pretty good job. Considering that our turnover for clinicians on a percentage basis has remained relatively steady throughout this whole time when the profession in general has seen a considerable outflow. Very proud of our clinicians or partners in our recruiting teams work together, fill open positions so that we can drive the second highest visit volume on a per clinic basis in the history of the company during a supremely challenging period.

但是，比去年第四季度增長了 1.4%。考慮到所有因素，我認為這是一份相當不錯的工作。考慮到我們的臨床醫生流失率在整個這段時間裡一直保持相對穩定，而這個行業總體上已經出現了相當大的外流。非常自豪我們的臨床醫生或我們招聘團隊的合作夥伴一起工作，填補空缺職位，以便我們能夠在極具挑戰性的時期內推動公司歷史上每個診所的第二高訪問量。

The bright spot for us in ‘22 is in the area of development. Five acquisitions and a nice stable of De Novo and Tuck-In facilities added throughout the year, bringing our total facilities owned at year end to 640. Development discussions and opportunities continue to be strong. We expected another good development year as things unfold.

我們在 22 年的亮點在於發展領域。全年增加了五次收購和穩定的 De Novo 和 Tuck-In 設施，使我們在年底擁有的設施總數達到 640 個。發展討論和機會繼續強勁。隨著事情的發展，我們期待又一個良好的發展年。

Further, we expect pricing to come down with the current interest rate environment impacting buyers across the board. We expect to see other deals not always get over the finish line because of the leverage situation of some of those buyers as rates continue to rise.

此外，我們預計定價會隨著當前的利率環境全面影響買家而下降。我們預計其他交易並不總是能完成，因為隨著利率繼續上升，其中一些買家的槓桿情況。

Fortunately, we have completed all of the deals we have set out to complete. We expect that to continue as we begin a new year, further setting us apart from many others in our industry, much higher leverage and much less balance sheet flexibility.

幸運的是，我們已經完成了我們計劃完成的所有交易。我們預計在新的一年開始時這種情況會繼續下去，進一步使我們在業內脫穎而出，槓桿率更高，資產負債表靈活性更低。

One final note before I turn this over to Carey. The past couple of years we have bought in minority interest with mostly discretionary, mostly partial buyouts of a portion of our partners interest, and key strong partnerships across the country. These amounts toll rolled over $20 million in 2020, $31 million in 2021, over $13 million in 2022.

在我把它交給 Carey 之前的最後一點。在過去的幾年裡，我們購買了少數股權，主要是全權委託，大部分是部分收購我們合作夥伴的部分股權，並在全國范圍內建立了重要的強大合作夥伴關係。這些數額在 2020 年超過 2000 萬美元，在 2021 年超過 3100 萬美元，在 2022 年超過 1300 萬美元。

Additionally, we continue to bring in new younger partners into these top partnerships to continuously ensure we have a stable and ongoing leadership into the future. We're able to do those purchases in aggregate and an extremely efficient multiple overall throughout those three years that we just discussed.

此外，我們繼續將新的年輕合作夥伴引入這些頂級合作夥伴關係，以不斷確保我們在未來擁有穩定和持續的領導地位。在我們剛剛討論的那三年中，我們能夠匯總進行這些購買，並且整體上非常有效。

We are encouraged by our progress in some of these key areas as I mentioned, as we work hard to deliver for our patients, staffs, and our shareholders in this coming year. That concludes my prepared comments. And up, Carey has a lot of detail that he wants to cover, so I'm going to turn it over to you, Carey.

正如我所提到的，我們在其中一些關鍵領域取得的進展令我們感到鼓舞，因為我們將努力在來年為我們的患者、員工和股東提供服務。我準備好的評論到此結束。再往上，Carey 有很多他想介紹的細節，所以我將把它交給你，Carey。

Great. Thank you, Chris. Appreciate it. And good morning, everyone. We noted in our earnings release that we're still evaluating our income tax expense, just wanted to address that here.

偉大的。謝謝你，克里斯。欣賞它。大家早上好。我們在收益發布中指出，我們仍在評估所得稅費用，只是想在這裡解決這個問題。

Our financial statements as presented represent where we currently believe they will land. There was a matter that came to our attention late in our valuation of tax that we had to consider and we simply need a little more time to fully evaluate it. We expect to have that vetting process completed in short order and certainly by the time we file our 10-K next week.

我們所提供的財務報表代表了我們目前認為它們將落戶的地方。在我們必須考慮的稅收估值中，有一個問題引起了我們的注意，我們只需要多一點時間來全面評估它。我們希望在短期內完成審查過程，當然在我們下週提交 10-K 時完成。

Now turning to our results we reported just EBITDA to the fourth quarter of $17.9 million, which was an increase of 2.8% over the $17.4 million that we reported on a comparable basis in 2021. And our full year adjusted EBITDA was basically flat with the prior year.

現在轉向我們的結果，我們僅報告了第四季度的 EBITDA 為 1790 萬美元，比我們在 2021 年可比基礎上報告的 1740 萬美元增長了 2.8%。我們全年調整後的 EBITDA 與之前基本持平年。

Our operating results which include the impact of higher interest expense was $0.58 cents per share in the fourth quarter, and it was $2.70 for the full year of 2022. Our total company revenue increased 11.7% this year growing from $495 million in 2021 to $553.1 million in 2022.

第四季度，我們的經營業績（包括較高利息支出的影響）為每股 0.58 美分，2022 年全年為 2.70 美元。我們公司今年的總收入增長了 11.7%，從 2021 年的 4.95 億美元增至 5.531 億美元2022年。

Like all companies we're continuing to deal with some inflationary cost pressures, but our volumes remain strong. And our team is focused as always on finding ways to become even more efficient, so we can produce the best possible results for all of our stakeholders.

與所有公司一樣，我們繼續應對一些通脹成本壓力，但我們的銷量依然強勁。我們的團隊一如既往地專注於尋找提高效率的方法，以便我們能夠為所有利益相關者帶來最好的結果。

Our physical therapy patient volumes per clinic predate finished at 29.1 as Chris noted for the quarter, which was the second highest per day volumes in fourth quarter in our company's history, bested only by the fourth quarter of 2021. By month our average visits per clinic per day were 29.4 in both October and November, and then 28.6 in December, which is typically the lowest month in the fourth quarter due to the holidays, and then there was a little there was a weather issue that Chris also noted.

正如 Chris 在本季度指出的那樣，我們每個診所的物理治療患者數量早於 29.1，這是我們公司歷史上第四季度的第二高每日數量，僅次於 2021 年第四季度。按月計算，我們每個診所的平均訪問量10 月和 11 月每天為 29.4，然後 12 月為 28.6，這通常是第四季度由於假期而最低的月份，然後克里斯也注意到了一點天氣問題。

Our net rate for our physical therapy operations was $104.28 in the fourth quarter of 2022. That was a $0.75 cent per visit increase over the fourth quarter of 2021. That's particularly notable when you consider that the fourth quarter of 2021 had the 2% sequestration relief which was no longer there in the fourth quarter of 2022. And that the fourth quarter of 2022 included the 0.75% Medicare rate reduction that was in effect beginning of 2022 as well as the PTA reimbursement change.

2022 年第四季度，我們物理治療業務的淨費率為 104.28 美元。與 2021 年第四季度相比，每次就診增加了 0.75 美分。考慮到 2021 年第四季度有 2% 的扣減減免，這一點尤其值得注意2022 年第四季度不再存在。2022 年第四季度包括 2022 年初生效的 0.75% 醫療保險費率降低以及 PTA 報銷變更。

A rate increase in each quarter in 2022, moving from $103 in the first quarter $203.18 in the second quarter to $104.01 the third and then to $104.28 in the fourth quarter. Again, this is despite the pressures on Medicare rates from the reductions put in place the beginning of the year and the phase out sequestration relief.

2022 年每個季度的費率都會增加，從第一季度的 103 美元到第二季度的 203.18 美元到第三季度的 104.01 美元，然後到第四季度的 104.28 美元。同樣，儘管年初實施的削減和逐步取消固存救濟措施對醫療保險費率造成了壓力，但情況仍然如此。

We've seen some nice commercial rate increases this year, due to the hard work of our contracting team, which results in our average commercial rates also increasing each quarter in 2022. Our average commercial rate in the fourth quarter of 2022 was 3.4% higher than it was in the fourth quarter of 2021.

由於我們的承包團隊的辛勤工作，我們今年看到了一些不錯的商業費率增長，這導致我們的平均商業費率在 2022 年每個季度都在增長。我們在 2022 年第四季度的平均商業費率高出 3.4%比 2021 年第四季度要好。

We still have a lot of work to do on this front. But we're making progress and we expect that progress to continue. And as Chris noted, we're going to renegotiate or terminate contracts that reimburse us at a rate that is less than what it costs us to serve our patients, which is primarily related to a subset of our Medicare Advantage Contracts.

我們在這方面還有很多工作要做。但我們正在取得進展，我們希望這種進展能夠繼續下去。正如克里斯指出的那樣，我們將重新談判或終止以低於我們為患者提供服務的成本向我們報銷的合同，這主要與我們的 Medicare Advantage 合同的子集有關。

Physical therapy revenues were $121 million in the fourth quarter of 2022, an increase of $6.8 million or 6% from the fourth quarter of 2021. Our physical therapy operating costs were $96.8 million, compared to $90.2 million in the prior year. And on a per visit basis, our physical therapy operating costs were (inaudible) per visit the fourth quarter, which was a decrease of $1.09 cent per visit from the third quarter of 2020. We're pleased to see that cost per visit amount come down some of the fourth quarter from where it was in the third quarter.

2022 年第四季度物理治療收入為 1.21 億美元，比 2021 年第四季度增加 680 萬美元或 6%。我們的物理治療運營成本為 9680 萬美元，而去年同期為 9020 萬美元。在每次訪問的基礎上，我們的物理治療運營成本是第四季度每次訪問（聽不清），比 2020 年第三季度每次訪問減少了 1.09 美分。我們很高興看到每次訪問的成本金額第四季度比第三季度有所下降。

Our physical therapy margin also improves in the fourth quarter. It was 20.0%, that's less than it was in the fourth quarter of 2021 when it was 21%, but it is up from 18.7% in the third quarter of 2022.

我們的物理治療利潤率在第四季度也有所提高。為 20.0%，低於 2021 年第四季度的 21%，但高於 2022 年第三季度的 18.7%。

The revenue from our industrial injury prevention business were $18.9 million in the fourth quarter which was a $5 million or 37.6% increase over the previous year. Expenses on the industrial injury prevention business increased $4.5 million and so we ended up with operating income of $3.3 million in the fourth quarter of ‘22. That was 19.4% greater than the prior year.

我們工傷預防業務的收入在第四季度為 1890 萬美元，比上年增長 500 萬美元或 37.6%。工傷預防業務的支出增加了 450 萬美元，因此我們在 2022 年第四季度的營業收入最終達到 330 萬美元。這比上一年增加了 19.4%。

For the full year of 2022, our IIP revenue increased 75.5% with our operating income up 49.3%. On a same store basis, our industrial injury prevention revenue was at 9.1% in the fourth quarter versus the previous year. And for the full year it was up 20.7%. And that same store operating income was at 12.9%.

2022 年全年，我們的 IIP 收入增長 75.5%，營業收入增長 49.3%。在同店基礎上，我們第四季度的工傷預防收入與去年同期相比為 9.1%。全年增長了 20.7%。同店營業收入為 12.9%。

Our corporate office costs were $11.9 million in the fourth quarter of ‘22. As a percent of revenue, those corporate costs were 8.4% of revenues in the fourth quarter of 2022 which is virtually the same as it was in the fourth quarter of 2021 when they were 8.3% of revenue. And then for the full year our corporate costs were 8.3% of revenue, that's down from 9.4% of revenue in 2021.

22 年第四季度，我們公司的辦公成本為 1190 萬美元。作為收入的百分比，這些企業成本在 2022 年第四季度佔收入的 8.4%，與 2021 年第四季度幾乎相同，當時佔收入的 8.3%。然後全年我們的企業成本佔收入的 8.3%，低於 2021 年收入的 9.4%。

You'll note the release we did record a $9.1 million impairment related to our November 2021 industrial injury prevention acquisition that we made in the fourth quarter of ‘21. We recorded that in the fourth quarter of this year. The impairment analysis was initially triggered by the sellers not achieving their earn-out, our assessment of the expected future performance of the acquisition hasn't changed, and its projected cash flows over time are similar to those at the time of the acquisition.

你會注意到我們確實記錄了與我們在 21 年第四季度進行的 2021 年 11 月工傷預防收購相關的 910 萬美元減值。我們在今年第四季度記錄了這一點。減值分析最初是由於賣方未實現盈利而觸發的，我們對收購的預期未來業績的評估沒有改變，其預計的現金流量與收購時的現金流量相似。

However, we have used the higher discount rate and discounting those cash flows to pressed value now that we did when we when determining the value with the (inaudible) to that higher discount rate was really the source of the majority of that impairment amount.

但是，我們使用了更高的貼現率並將這些現金流貼現為壓力值，就像我們在用（聽不清）確定更高貼現率的價值時所做的那樣，這實際上是大部分減值金額的來源。

Our interest expense increased from $191,000 in the fourth quarter of 2021 to $2.2 million in the fourth quarter of 2022, which was due to an increase in our debt primarily related to acquisitions that we've closed during and since the fourth quarter of last year. And then also, of course significantly higher interest rates in the fourth quarter of this year than last year.

我們的利息支出從 2021 年第四季度的 191,000 美元增加到 2022 年第四季度的 220 萬美元，這是由於我們的債務增加主要與我們在去年第四季度期間和自去年第四季度以來完成的收購有關。當然，今年第四季度的利率也明顯高於去年。

Our balance sheet overall remains in an excellent position. We have a $150 million term loan with a five year swap agreement in place that fixes the one month term SOFR rate on that $150 million at 2.815%. Including a clickable margin based on our leverage ratio, the all in rate on that $150 million of debt was 4.665% in the fourth quarter.

我們的資產負債表總體上保持良好狀態。我們有一筆 1.5 億美元的定期貸款，其中包含一份五年期掉期協議，該協議將這 1.5 億美元的一個月期限 SOFR 利率固定為 2.815%。包括基於我們槓桿率的可點擊保證金，第四季度 1.5 億美元債務的總利率為 4.665%。

In our statement of comprehensive income you'll note that our swap agreement currently has a mark to market value of $5.4 million, which means the current expectation is that we will pay $5.4 million less in interest expense of the remaining term of our five year swap agreement than we would have paid without the swap at a variable interest rate.

在我們的綜合收益表中，您會注意到我們的掉期協議目前按市值計價為 540 萬美元，這意味著目前的預期是我們將支付 540 萬美元的利息費用，減去我們五年期掉期的剩餘期限協議比我們在沒有以可變利率掉期的情況下支付的費用要多。

In addition we estimate that the swap agreement saved us approximately $700,000 in interest expense in the second half of 2022. We also have a $175 million revolving credit facility that had $31 million drawn on December the 31st, and we had a cash balance on our balance sheet of $31.6 million at December 31.

此外，我們估計掉期協議在 2022 年下半年為我們節省了大約 700,000 美元的利息支出。我們還有 1.75 億美元的循環信貸額度，在 12 月 31 日提取了 3,100 萬美元，我們的餘額中有現金餘額截至 12 月 31 日為 3160 萬美元。

The borrowings on our revolver are at a variable rate. And the weighted average variable interest rate on the debt on our facility in the fourth quarter was approximately 5.75%. We also noted in the release that we increased our quarterly dividend rate from $0.41 cents per share to $0.43 cents per share effective at the first quarter of 2022. We're pleased to increase that again as we have each year since the inception of the dividend in 2011.

我們循環貸款的借款利率是可變的。第四季度我們貸款的加權平均浮動利率約為 5.75%。我們還在新聞稿中指出，自 2022 年第一季度起，我們將季度股息率從每股 0.41 美分提高到每股 0.43 美分。我們很高興再次提高股息率，因為自派息開始以來我們每年都會這樣做在2011年。

Our volumes in January and the first couple of weeks of February have been very strong at a comparative basis the same month in the past years. And while inflation pressures remain our cost on a per visit basis stabilized in the fourth quarter of 2022 as compared to the third quarter of 2022. We believe the progress we've made with commercial and other rate wins in 2022 and that we expect to continue to have in 2023, will enable us to offset the headwinds in 2023 related to the 2% Medicare rate reduction that became effective on January the 1st, as well as the full year impact of the phase out of sequestration relief which occurred during 2022, which together represent an impact on our revenue in 2023 of approximately $4.3 million.

與過去幾年同月相比，我們 1 月份和 2 月份前幾週的銷量非常強勁。儘管通脹壓力仍然存在，但與 2022 年第三季度相比，我們在 2022 年第四季度的每次就診成本保持穩定。我們相信，我們在 2022 年取得的商業和其他利率勝利方面取得了進展，並且我們希望繼續取得進展到 2023 年，將使我們能夠抵消 2023 年與 1 月 1 日生效的 2% Medicare 費率降低相關的不利因素，以及 2022 年逐步取消固存救濟的全年影響，這合計對我們 2023 年的收入產生約 430 萬美元的影響。

With expected continued strong volume, a minimal in our rate negotiations and the continued excellent focus of our operating team on making our operations as efficient as possible. We estimate that our adjusted EBITDA will be in the range of $75 million to $80 million in 2023, which excludes the potential impact of acquisitions in 2023. Contributions from our acquisitions will be additive to our adjusted EBITDA.

預計交易量將持續強勁，我們的費率談判微乎其微，並且我們的運營團隊將繼續專注於使我們的運營盡可能高效。我們估計 2023 年我們調整後的 EBITDA 將在 7500 萬美元至 8000 萬美元之間，這不包括 2023 年收購的潛在影響。我們收購的貢獻將增加我們調整後的 EBITDA。

Our guidance in 2023 and’24 will be on adjusted EBITDA, will continue to provide operating results and operating results per share in our earnings reports that our guidance will be related to adjusted EBITDA. We'll also provide information related to our debt interest rate, so that you can project our interest expense accurately.

我們在 2023 年和 24 年的指導將針對調整後的 EBITDA，將繼續在我們的收益報告中提供經營業績和每股經營業績，我們的指導將與調整後的 EBITDA 相關。我們還將提供與我們的債務利率相關的信息，以便您可以準確地預測我們的利息支出。

For 2023, we expect the rate on our $150 million term loan to be 4.915%, based on our leverage pricing grid. The debt on our line of credit which was $31 million at the end of 2022 will be at a variable rate of one month term SOFR plus a spread based on our leverage grid currently are all in variable rate. Its approximately 6.65% which includes the January increase and the Fed funds Rate. That rate is expected to move in tandem with any changes in the Fed Funds Rate going forward.

根據我們的槓桿定價網格，我們預計 2023 年 1.5 億美元定期貸款的利率為 4.915%。到 2022 年底，我們信貸額度上的債務為 3100 萬美元，將採用一個月期限 SOFR 的可變利率加上基於我們槓桿網格的利差，目前均為可變利率。其約為 6.65%，其中包括 1 月份的增長和聯邦基金利率。預計該利率將隨著未來聯邦基金利率的任何變化而變化。

In closing, we're in a good position as we start 2023. And we look forward to producing strong results for all of our stakeholders in 2023. And with that, Chris, I'll turn the call back to you

最後，我們在 2023 年開始時處於有利位置。我們期待在 2023 年為我們所有的利益相關者取得豐碩的成果。克里斯，我會把電話轉回給你

Yeah, thank you Carey, great job. Operator, we're going to go ahead and open it up for questions now.

是的，謝謝凱里，幹得好。接線員，我們現在將繼續進行提問。

(Operator Instructions). We'll take our first question from Brian Tanquilut from Jefferies.

（操作員說明）。我們將從 Jefferies 的 Brian Tanquilut 那裡回答我們的第一個問題。

Morning, Brian. Morning, go ahead.

早上好，布賴恩。早上好，繼續

Chris, maybe the first question for you. You know as we think about the environment, in the physical therapy space, some of your bigger competitors are clearly struggling with, over levered balance sheets and tough operations, high turnover rates of clinician. So as I think about market share opportunities from some of those disruptions or distractions, and then M&A opportunities, I mean, how are you thinking about, you know what was in front of you and when, what you guys can do to make potentially gain market share as a result of all this?

克里斯，也許是你的第一個問題。你知道，當我們考慮環境時，在物理治療領域，你的一些更大的競爭對手顯然正在努力應對過度槓桿化的資產負債表和艱難的運營，以及臨床醫生的高流動率。因此，當我考慮一些中斷或乾擾帶來的市場份額機會，然後是併購機會時，我的意思是，你是怎麼想的，你知道擺在你面前的是什麼，什麼時候，你們可以做些什麼來獲得潛在收益這一切導致的市場份額？

Yeah, I appreciate the question, Brian. So, you know, anytime, you know, I'm going to speak broadly. Anytime there's, you know, a tough operating environment, let's call it that, you know, it affects certain providers more than it affects other providers. And because we do have, you know, a really nice balance sheet overall, our interest rates are up as well. But, you know, we started with a great balance sheet and so we have more flexibility.

是的，我很欣賞這個問題，布賴恩。所以，你知道，任何時候，你知道的，我都會廣泛發言。任何時候，你知道，一個艱難的運營環境，我們稱之為，你知道，它對某些供應商的影響比對其他供應商的影響更大。你知道，因為我們確實有一個非常好的整體資產負債表，我們的利率也在上升。但是，你知道，我們從一個很好的資產負債表開始，所以我們有更大的靈活性。

We've already seen and I don't want to be too specific, but we've already moved some key people, you know from will call assets that are more distressed. We've seen opportunities to pick up some clinic, and we've done that. And we have a really good development plan for around our top 30 to 35 partnerships which make up basically about 80% of our overall earnings, and those include De Novo and Tuck-in acquisitions of smaller practices in existing strong markets.

我們已經看到了，我不想說得太具體，但我們已經轉移了一些關鍵人物，你知道這些人將被稱為更痛苦的資產。我們看到了開設一些診所的機會，我們已經做到了。我們為前 30 到 35 個合作夥伴制定了一個非常好的發展計劃，這些合作夥伴基本上占我們總收入的 80% 左右，其中包括 De Novo 和 Tuck-in 對現有強大市場中較小實踐的收購。

And so I expect as we've seen in the past that although I would love for the market to have a great tailwind for all of us, it's not that way right now. But for us, there'll be some opportunity in here for us on the development front, for sure.

因此，我希望正如我們過去所看到的那樣，儘管我希望市場能為我們所有人帶來巨大的順風，但現在並非如此。但對我們來說，肯定會有一些發展方面的機會。

That makes a lot sense. Carey, you called out how your cost per visit is down slightly, but as I think about the labor market, I know in your case, the challenges last year were more in the lower end of the labor or the skilled spectrum. Maybe just any color you can share with us on what that looks like right now?

這很有意義。凱里，你提到了你的每次訪問成本是如何略微下降的，但當我想到勞動力市場時，我知道在你的情況下，去年的挑戰更多是在勞動力或技術領域的低端。也許您可以與我們分享任何顏色，了解它現在的樣子？

Yes. I mean just as our total operating cost did, our salaries and related costs also came down in the fourth quarter versus the third quarter. And Chris talked about how we're seeing more success in finding and hiring qualified candidates. I'd say there's going to continue to be some labor pressure for sure, but we feel much -- we're in a best better position as we begin 2023 than we were in the middle of 2022, particularly. And Chris, I don't know where Eric or Graham, if you have any comments on that.

是的。我的意思是，就像我們的總運營成本一樣，我們的工資和相關成本在第四季度也比第三季度有所下降。克里斯談到了我們如何在尋找和僱用合格候選人方面取得更大的成功。我想說的是，肯定會繼續存在一些勞動力壓力，但我們感覺很多——我們在 2023 年開始時處於比 2022 年年中更好的位置，尤其是。克里斯，我不知道埃里克或格雷厄姆在哪裡，如果你對此有任何意見。

Just Brian, we're not seeing rates come down yet. We don't think, we're going to continue to test that. And I'll let either Graham or Eric discuss the rollout of some automation at the front desk and speak on that just for a minute

只是布賴恩，我們還沒有看到利率下降。我們不認為，我們將繼續測試它。我將讓 Graham 或 Eric 討論在前台推出一些自動化並就此發表一分鐘的講話

Yeah. Chris, this is Eric. I'll tie in a couple of comments here. So no question, rates have not come down yet for clinical staff or front office staff as it relates to replacing positions, but it was a little bit easier there in Q4 in terms of hiring people. So the time to fail open positions got shorter.

是的。克里斯，這是埃里克。我將在這裡發表一些評論。因此，毫無疑問，與更換職位相關的臨床人員或前台人員的費率尚未下降，但在招聘人員方面，第四季度要容易一些。因此，開倉失敗的時間變短了。

And without a doubt, the biggest challenge we saw last year from a rate side was on the non-clinical side, very competitive environment. Those folks have the opportunity to work anywhere besides health care. So that was top. And so we realized that we needed to bring automation into our environment that help and so last year, we upgraded our EMR system of our databases in order to take advantage of automated functionality which is available on the platform. And this is really going to help us on the front office side.

毫無疑問，我們去年從費率方面看到的最大挑戰是在非臨床方面，競爭非常激烈的環境。這些人有機會在醫療保健以外的任何地方工作。所以那是最重要的。因此，我們意識到我們需要將自動化帶入我們的環境，因此去年我們升級了數據庫的 EMR 系統，以利用平台上可用的自動化功能。這真的會在前台幫助我們。

So examples of that automated functionality would be appointed reminders going out to appointment on-demand messaging, things that we weren't doing everywhere before. And the ones that we're the most excited about that we think is really going to give us some leverage here, our check-in kiosks for patients, allowing them to check themselves in for the appointments, complete forms, questionnaires, medical history, where we don't need front office people doing that anymore.

因此，該自動化功能的示例將是指定提醒，以指定按需消息傳遞，這是我們以前沒有在任何地方做的事情。我們最興奮的是，我們認為這真的會給我們帶來一些影響力，我們的患者登記亭，允許他們檢查自己的約會、完整的表格、問卷、病史，我們不再需要前台人員這樣做了。

And then there's a patient port that offers patients the ability to request appointments, message the clinic, and provide access to the medical record, things before that our front office would have to do. So we're in the process of rolling that out right now with our largest partnerships. We're going to gain significant traction over the year across the portfolio, and we think that's going to allow us to leverage our front office costs as a whole.

然後是一個患者端口，讓患者能夠請求預約、向診所發送消息並提供對醫療記錄的訪問權限，而在這之前我們的前台必須做這些事情。所以我們現在正在與我們最大的合作夥伴一起推出它。我們將在今年的整個投資組合中獲得巨大的吸引力，我們認為這將使我們能夠整體上利用我們的前台成本。

Awesome. Thank you guys.

驚人的。感謝你們。

Thanks Eric.

謝謝埃里克。

Our next question comes from Lawrence Solow from CJS Securities.

我們的下一個問題來自 CJS 證券的 Lawrence Solow。

Morning, Larry.

早上好，拉里。

I guess just on looking on a sort of high level same-store sales volumes, we’re very good and some at the end of the year well and strong, excluding the holiday season and started this year strong. Full year last year, obviously, it feels like you hit kind of a wall, I mean, you had really good 2021, of course. And I think last year, some, just staffing issues and maybe a little step back from COVID or whatever you kind of let down a little for the year. What do you look at over the back half of the year at least, how should we look at '23? Do you feel like volumes should growth and volume should return? Or are there some things that will still hold you back, before we even get into the pricing discussion, but just in terms of volumes on a same store sort of level?

我想只要看看某種高水平的同店銷售量，我們就非常好，有些在年底表現強勁，不包括假期，今年年初表現強勁。去年一整年，很明顯，感覺就像碰壁了，我的意思是，當然，你在 2021 年過得非常好。而且我認為去年，一些，只是人員配備問題，也許從 COVID 或任何你今年有點失望的事情中退一步。至少在下半年你怎麼看，我們應該如何看待 23 年？你覺得銷量應該增長還是銷量應該恢復？或者在我們進入定價討論之前，是否有一些事情仍然會讓您退縮，但只是在同一商店級別的數量方面？

I can tell you, we're out of the gate pretty well, really well. That month, 1.5 months, 2 months doesn't make for a year yet. But our plan for the year is certainly up volumes this year. As you mentioned, last year, we were impacted on a couple of different fronts, while COVID is kind of for everybody in the rear view mirror. What happened last year was people had not taken vacations in really long time. And so that, in combination with just a really tight labor market, increased our time to fill positions.

我可以告訴你，我們已經走出了大門，非常好。那個月，1.5 個月，2 個月還不到一年。但我們今年的計劃肯定是今年的銷量。正如你提到的，去年，我們在幾個不同的方面受到了影響，而 COVID 對後視鏡中的每個人都是一種影響。去年發生的事情是人們真的很長時間沒有休假了。因此，再加上非常緊張的勞動力市場，增加了我們填補職位空缺的時間。

And the pullback from a record year, which was ‘21 which was really strong was a fraction of a visit. And so we're working hard to deliver a good year. We're out of the gate. We're out the gate in good fashion, and we hope we can certainly do that through the year.

而從創紀錄的一年中回落，那是真正強勁的“21”，只是一次訪問的一小部分。因此，我們正在努力工作以度過一個美好的一年。我們出了門。我們以良好的方式走出了大門，我們希望我們一定能在這一年中做到這一點。

As we mentioned, we made some improvements in staffing. It's beginning to feel better. And I hope that continues. We'll see, but so far so good.

正如我們提到的，我們在人員配置方面做了一些改進。開始感覺好多了。我希望這種情況繼續下去。我們拭目以待，但到目前為止還不錯。

Got it. And Chris, you sound very encouraged just about pricing. I know even over the last few quarterly calls, it sounds like at least in the near term, hopefully, the increase in commercial rates will even maybe more than offset the government comp. But it does sound like, at least qualitatively that I know you can't get into too many specifics, but it sounds like you're starting to get better things, things are coming our way and hopefully over -- you can't move a needle too fast, but hopefully, over the next several quarters, the needle will keep moving in your direction, it sounds like.

知道了。克里斯，關於定價，你聽起來很受鼓舞。我知道，即使在過去的幾個季度電話會議上，聽起來至少在短期內，商業利率的上漲甚至可能超過政府補償。但這聽起來確實像，至少在定性上，我知道你不能談太多細節，但聽起來你開始得到更好的東西，事情正在朝著我們的方向發展，希望結束——你不能移動針太快了，但希望在接下來的幾個季度裡，針會繼續朝你的方向移動，聽起來像是。

Yes. That's the goal. Frankly, Larry, this is overdue. We've taken contracts probably in the past and accepted them that we should have pushed back on par. Frankly, we're just not going to continue to do that. And we're getting some good results from the efforts. It does take time, as you mentioned. And in our structure, we don't just have one big contract for everybody because we have lots of regions and lots of partnerships. But working our way through, the team has done a really good job. It's going to take some time. But I do think we can offset some of the Medicare pricing things for this year and continue to move the ball forward.

是的。這就是目標。坦率地說，拉里，這已經過期了。我們可能在過去接受過合同，並接受了我們本應推遲的合同。坦率地說，我們只是不會繼續這樣做。我們正在從這些努力中獲得一些好的結果。正如你所說，這確實需要時間。在我們的結構中，我們不只是為每個人簽訂一份大合同，因為我們有很多地區和很多合作夥伴。但是通過我們的努力，團隊做得非常好。這需要一些時間。但我確實認為我們可以抵消今年的一些醫療保險定價，並繼續向前推進。

Great. If I could just squeeze one more in. Just in terms of just acquisitions and it sounds like you probably have maybe an upper hand or certainly a better position than a lot of your competitors on that front. What about just leverage? You're not super levered, but you're more levered than you guys have been historical so about a little less than about 2x. So would you consider taking that up higher? I mean, is there and still not be all that high, especially for a business that generates pretty good cash flow. Any thoughts on that?

偉大的。如果我能再擠進一個。就收購而言，聽起來你可能在這方面比你的許多競爭對手有優勢或肯定處於更好的位置。單純的槓桿呢？你不是超級槓桿，但你比你們歷史上的槓桿率更高，所以大約不到 2 倍。那麼你會考慮提高它嗎？我的意思是，是否存在並且仍然沒有那麼高，特別是對於產生相當好的現金流的企業而言。對此有什麼想法嗎？

Yes. Carey, you want to start with that, and then I can jump in if needrd.

是的。凱里，你想從那個開始，然後如果需要我可以加入。

Sure. Yes. Larry, as you noted, our leverage ratio at the end of the year was 2.0x. I mean I think we would be comfortable moving that up from there certainly. We just -- it just has to be the right deal and at the right price. I mean I think that's what we're really focused on right now. We do have the available capacity. We have $31 million drawn at the end of the year on our $175 million facility. So we obviously have plenty of capacity there.

當然。是的。拉里，正如你所說，我們年底的槓桿率為 2.0 倍。我的意思是我認為我們肯定會很樂意將其從那裡提升。我們只是 - 它必須是正確的交易和正確的價格。我的意思是我認為這就是我們現在真正關注的。我們確實有可用的容量。到年底，我們從 1.75 億美元的貸款中提取了 3100 萬美元。所以我們顯然在那裡有足夠的能力。

And it's really about just -- and we have a lot of good deals in the pipeline. And Chris, you may want to talk about that. So they are deals in the pipeline. And we're just going to evaluate them each one individually and make sure we do smart deals.

這真的只是 - 我們有很多好的交易正在進行中。克里斯，你可能想談談這個。所以他們正在籌備中。我們只是要單獨評估它們，並確保我們進行明智的交易。

Yes. I don't really have anything to add. I don't want to talk too much about what's prospective because it's not done until it's done. But we're trying to be smart about how we deploy capital. Part of that is in our dividend increase this year, and we expect to continue to do deals, and we're hoping we can get those done at pricing that makes sense for everybody.

是的。我真的沒有什麼要補充的。我不想談論太多關於預期的事情，因為它在完成之前就沒有完成。但我們正試圖在如何部署資本方面變得聰明。其中一部分是我們今年的股息增加，我們希望繼續進行交易，我們希望我們能夠以對每個人都有意義的價格完成這些交易。

[Opeartor Instructions). We'll take our next question from Matt Larew from William Blair.

[操作員說明]。我們將從威廉·布萊爾的馬特·拉魯那裡接受我們的下一個問題。

I wanted to go back on the payer issue on more time in reference of the some contracts paying below your cost of care. Directionally, could you maybe just size up what that passive contracts look like as a percentage of your revenue? And have you given part deadlines for when you expect people to compensate you appropriately. And then the third piece is, do you have a sense of other operators in the markets are starting to take a similar tax in their approach or sort of the distressed nature of some of those assets by make them more willing to string along?

我想參考一些支付低於您的護理費用的合同，花更多時間回到付款人問題上。從方向上講，您能否估計一下被動合同佔您收入的百分比？並且您是否給出了您期望人們適當補償您的部分截止日期。然後第三點是，你是否感覺到市場上的其他運營商開始在他們的方法中徵收類似的稅，或者通過讓他們更願意堅持下去來解決其中一些資產的不良性質？

Let me start with that, Carey. I don't want to get into too deep detail into some of these discussions that are sensitive. The percentage of our reimbursement on some of these lower contracts isn't particularly great. Its low single digits. We have a lot of contracts that we are renegotiating across the commercial spectrum and contracts that are much higher paying contracts where we have gotten increases as well.

讓我從這個開始，凱里。我不想對其中一些敏感的討論進行太深入的討論。我們對其中一些較低合同的報銷百分比並不是特別高。它的低個位數。我們有很多合同正在商業範圍內重新談判，而這些合同的薪水要高得多，我們也得到了增加。

Some cases, we have given notice and that is according to the terms in individual contracts, and so those do vary. And with respect to other providers, other competitors in the market, frankly, I hope everybody is going to do what we've started to do, and I would encourage them to look hard. Volume that cost you money to see isn't volume that any of us should be seeing.

在某些情況下，我們已經發出通知，並且是根據個別合同中的條款進行的，因此這些情況確實有所不同。至於其他供應商，市場上的其他競爭對手，坦率地說，我希望每個人都去做我們已經開始做的事情，我鼓勵他們努力尋找。花錢看的數量不是我們任何人應該看到的數量。

And the world changed last year in terms of inflation in a lot of different areas. And certainly, employee inflation was one of those. We do a tremendous -- we provide a tremendous service to our patients. It bends the downstream cost curve for the entire health care system when a patient comes through a completed course of physical therapy that's well documented now in some independent studies.

去年世界在許多不同領域的通貨膨脹方面發生了變化。當然，員工通貨膨脹就是其中之一。我們做得非常好——我們為我們的病人提供了非常好的服務。當患者完成完整的物理治療過程時，它會彎曲整個醫療保健系統的下游成本曲線，這在一些獨立研究中已有詳細記錄。

And some use that information to get ourselves not an extraordinary rate. We don't need to be greedy, but we shouldn't be paid certainly not below our cost, and we should be paid to have an adequate margin because these payers have adequate margins more than adequate in some cases, in my view. And so my encouragement is for everybody to do this, and we'll see what happens. All I can control is what happens to you, but we're focused on it here right now.

有些人利用這些信息來讓自己不走尋常路。我們不需要貪心，但我們的報酬肯定不應該低於我們的成本，我們應該得到足夠的保證金，因為在我看來，這些付款人在某些情況下有足夠的保證金。所以我鼓勵每個人都這樣做，我們會看看會發生什麼。我所能控制的就是發生在你身上的事情，但我們現在專注於此。

Okay. That make sense. If I can switch to IIP of the number of acquisitions in the last couple of years, would you think about sort of the same-store outlook for that business? How are you viewing it for '23 versus in years past? And is there a similar environment with some of the other operators in this space potentially been over lever under stress where opportunities might come up or given the deals you've done, are you sort of ready to digest those and move forward organically (inaudible).

好的。有道理。如果我可以切換到過去幾年收購數量的 IIP，您會考慮該業務的同店前景嗎？與過去幾年相比，您如何看待 23 年的情況？並且是否存在與該領域的其他一些運營商類似的環境，可能會在機會可能出現的壓力下過度槓桿化，或者考慮到您已經完成的交易，您是否準備好消化這些並有機地向前發展（聽不清） .

Yes. Well, I mean we have a very good organic opportunity in injury prevention. That business, in general, just by the nature of it, where companies have many, many plants and maybe we start with one, but we expand services to others. And so it's kind of an embedded natural organic opportunity there. We continue to look for deals there aren't as many or as many providers in this space. We actually have a call I think it's early next week, Carey, with some bankers who are helping us look and think about and consider similar and potentially adjacent opportunities, in some cases, slight expansions to the portfolio, similar acquisitions. We don't have anything ready to go yet for sure.

是的。好吧，我的意思是我們在傷害預防方面有很好的有機機會。總的來說，這項業務就其性質而言，公司有很多很多工廠，也許我們從一個開始，但我們將服務擴展到其他人。因此，這是一種嵌入式的天然有機機會。我們繼續尋找交易，在這個領域沒有那麼多或那麼多的供應商。我們實際上有一個電話，我認為是下周初，Carey，一些銀行家正在幫助我們尋找和思考並考慮類似和潛在相鄰的機會，在某些情況下，投資組合的輕微擴張，類似的收購。我們還沒有任何東西可以確定。

This year, I'm going to say that this year, I expect that just by virtue of the size of that business that organically, we had just an incredible year this last year. I hope we can produce another good year. But we haven't necessarily budgeted that way. We've been a little bit more conservative. I think it will depend a lot on whether the economy gets into a recession, we're seeing some cautions begin to creep in, in some sectors. We know the auto sector has been beat up for a while, just between chip shortage and the pivot to electric cars, and that's kind of frozen people, in a lot of cases in terms of their purchases.

今年，我要說的是，今年，我希望憑藉有機的業務規模，去年我們度過了令人難以置信的一年。我希望我們能再創造一個美好的一年。但我們不一定以這種方式進行預算。我們已經有點保守了。我認為這將在很大程度上取決於經濟是否陷入衰退，我們看到某些行業開始出現一些謹慎情緒。我們知道汽車行業已經遭受了一段時間的打擊，只是在芯片短缺和轉向電動汽車之間，在很多情況下，就他們的購買而言，這是一種凍結的人。

And so there are certain industries, I think we'll continue to do well. There are other industries where I think things will slow down a little bit. We'll slow with them likely. And then as things pick back up, we'll pick back up accordingly. So this year, I think we'll be a little bit more muted than years past, but we're working hard to -- as we have to overcome any headwinds into at the end of it to lay down a good year when it's all said and done.

所以有些行業，我認為我們會繼續做得很好。我認為還有其他行業會放緩一些。我們可能會放慢他們的速度。然後隨著事情的好轉，我們會相應地恢復。所以今年，我認為我們會比過去幾年更加沉默，但我們正在努力工作——因為我們必須在年底克服任何不利因素，以便在一切都結束的時候度過一個美好的一年說和做。

Okay, thanks Chris. And maybe for Eric or Graham, a follow-up to your comments around automation and other tools you can need on the patient in their action side of the front end. Where do you -- are you piloting those tools? You mentioned rolling out, maybe just curious, what kind of time frame on the flexible, lot the tools that you've evaluated, do you feel like they're adequate relative to what you want or the things that you need to tweak, maybe to the sense for (inaudible), that strategy of the automation strategy is? An then for (inaudible).

好的，謝謝克里斯。也許對於埃里克或格雷厄姆，你對自動化和其他你可能需要的工具在前端的行動方面對病人的評論進行跟進。你在哪裡——你在試用這些工具嗎？你提到推出，也許只是好奇，靈活的時間框架是什麼樣的，很多你評估過的工具，你覺得它們相對於你想要的或你需要調整的東西是否足夠，也許從某種意義上說（聽不清），自動化戰略的戰略是什麼？然後（聽不清）。

Yes, we're rolling it out. So we rolled it out and on the process of rolling it out at our first partnership right now is our largest partnership in the portfolio. Learning from that, it's always partially implemented in that portfolio right now, really, really well received, by the way, by the front desk as well as the patients who are utilizing those.

是的，我們正在推出它。所以我們推出了它，並且在我們的第一個合作夥伴關係中推出它的過程是我們投資組合中最大的合作夥伴關係。從中吸取教訓，它現在總是在該產品組合中部分實施，順便說一句，前台和使用這些產品的患者真的非常受歡迎。

And our learnings from this first partnership that we're rolling out will allow us to roll it out concurrently at other partnerships. So we should get, have a fairly fast implementation as we -- a faster implementation as we move through the year. But we'll have a better idea in terms of the timing for our top 40 partnerships, which is where we're focused to start within the next -- by the end of April, April 30th.

我們從我們正在推出的第一個合作夥伴關係中學到的知識將使我們能夠在其他合作夥伴關係中同時推出它。所以我們應該得到，有一個相當快的實施，因為我們 - 一個更快的實施，因為我們在這一年中移動。但就我們的前 40 家合作夥伴關係的時間安排而言，我們會有更好的想法，這是我們關注的重點，即在 4 月底，即 4 月 30 日之前開始。

Okay. Thank you for the questions.

好的。謝謝你的問題。

Thank you.

謝謝。

The next question comes from Mike Petusky from Barrington Research.

下一個問題來自 Barrington Research 的 Mike Petusky。

So slightly described here, 5 earnings reports. So if you covered this for gift, but I'll ask it anyway. Have you guys given any update on progress with the GPO and how partners are either starting to be attraction with that or not so much?

所以在這裡稍微描述一下，5 份收益報告。所以，如果你把這個作為禮物，但我還是會問的。你們有沒有提供任何關於 GPO 進展的最新信息，以及合作夥伴如何開始對它產生吸引力或沒有那麼大的吸引力？

Graham, do you want to take that?

格雷厄姆，你想接受嗎？

Chris, I didn't hear the question.

克里斯，我沒聽到這個問題。

GPO progress. GPO progress and how it's being received and...

GPO 進展。 GPO 進展及其接收方式和...

Yes. It's been well received, and we're actually going live on the 27th. We're rolling out 180 locations starting on the 27th, of February. It's been worth getting all of the items that we need in different partnerships located in the warehouse as they been a bit adjacent to their practices. But we are going live on that next week.

是的。它受到了好評，我們實際上將於 27 日上線。我們將從 2 月 27 日開始推出 180 個地點。值得在倉庫中獲得我們在不同合作夥伴關係中需要的所有物品，因為它們與他們的實踐有點接近。但我們將在下週進行現場直播。

Great. How many partnerships does that represent the 180?

偉大的。那代表 180 個合夥企業有多少？

30, probably. We try to do them in geographic diverse areas to test the program. And after the first good partnerships go live, we'll be rolling it out in further partnerships. I can get the exact number for you. I don't have it in front of me.

30，大概吧。我們嘗試在不同的地理區域進行測試以測試該程序。在第一個良好的合作夥伴關係上線後，我們將在進一步的合作夥伴關係中推廣它。我可以為你得到確切的數字。我面前沒有。

All right, well, great. That is meaningful progress, so that's great. I'm just curious because so much, I guess, your commentary started with the sort of contract negotiations and some commentary in Q&A. Is there a chance that ultimately some of these payers just sort of don't get it and you end up saying, well, I mean, obviously, there's a chance. But I guess realistically as you said, like the tone of these conversations, I mean, do you think revenues could actually shrink? Or do you think ultimately, everybody sort of going to get this, and it's just a matter of do you get this offer (inaudible).

好吧，很好，很好。這是有意義的進步，所以這很棒。我只是很好奇，因為我猜你的評論大多是從合同談判和問答中的一些評論開始的。是否有可能最終這些付款人中的一些人只是有點不明白，你最終會說，好吧，我的意思是，顯然，有機會。但我想像你所說的那樣現實，就像這些談話的語氣，我的意思是，你認為收入真的會縮水嗎？或者你認為最終每個人都會得到這個，這只是你是否得到這個提議的問題（聽不清）。

I don't think anything happens informally. But look, we're prepared. In fact, in some markets where we have given notice, and they've said, fine, we have other providers, will use other providers. We're able to fill those slots with better paying patients, frankly, better paying plans. And so we may lose some of these in the short run. Now interestingly, in one of our big partnerships where they said, fine, we don't care. We're not going to move. Within 2 months, they came back and offered a very meaningful increase to our rate, but we had to play chicken. And we're prepared to not take the business. And we think we can replace that business and let that go, frankly, to the market, to our competitors and if they want to take it, let them take it.

我不認為任何事情都是非正式的。但是，看，我們已經準備好了。事實上，在我們已經發出通知的一些市場，他們說，好的，我們有其他供應商，將使用其他供應商。我們能夠用支付更高的患者，坦率地說，更好的支付計劃來填補這些空缺。因此，我們可能會在短期內失去其中一些。現在有趣的是，在我們的一個大型合作夥伴關係中，他們說，好吧，我們不在乎。我們不會搬家。在 2 個月內，他們回來並提供了非常有意義的提高我們的費率，但我們不得不玩雞。我們準備不接受這項業務。我們認為我們可以取代該業務，坦率地說，將其交給市場，交給我們的競爭對手，如果他們想接受，就讓他們接受。

Yes. And sort of on a related note in terms of pricing. And I know its way, way early, but in ‘24 in terms of CMS, I mean, is the industry lobbyists and EBITDA and others that sort of get this. I mean, I guess what I'm trying to get to is, will there be any kind of referee from sort of what the industry has been sort of going through the last few years in terms of these headwinds, because it just seems between inflation and the pricing. It's just made it awfully difficult for smaller operators, particularly who are leveraged operators as to do business.

是的。以及在定價方面的相關說明。我很早就知道它的方式，但在 24 年的 CMS 方面，我的意思是，行業遊說者和 EBITDA 以及其他人都明白這一點。我的意思是，我想我想說的是，就這些逆風而言，過去幾年該行業經歷過的事情是否會有任何類型的裁判，因為它似乎介於通貨膨脹之間和定價。這讓小型運營商變得非常困難，尤其是那些利用槓桿運營商開展業務的運營商。

I'm trying to get out of the predicting what CMS is going to business because what they do doesn't make a lot of sense. And in fact, it doesn't make a lot of sense to our lawmakers and others or our efforts in APTQI and with APTA and other constituencies are focused really largely outside of CMS. So I won't predict what CMS does. But I will say that we've made headway, I think, in helping key constituents in Congress understand what it is a physical therapy does between balance and fall prevention.

我試圖擺脫對 CMS 將開展業務的預測，因為他們所做的事情沒有多大意義。事實上，這對我們的立法者和其他人來說沒有多大意義，或者我們在 APTQI 以及 APTA 和其他選區的努力實際上主要集中在 CMS 之外。所以我不會預測 CMS 會做什麼。但我要說的是，我認為我們在幫助國會的主要成員了解物理療法在平衡和預防跌倒之間的作用方面取得了進展。

Falls are a massive, massive cost to the health care system and to individuals and their ability to function. But we are, again, -- you don't hear about it as much, but it's still a massive problem. And there's some great studies out that just indicate a massive cost differential when people start with the primary care of musculoskeletal care, which is really physical therapy. And so we're trying to pound that message and drive it home.

跌倒對醫療保健系統和個人及其運作能力來說是一個巨大的代價。但是，我們再說一次——你聽得不多，但它仍然是一個大問題。並且有一些很棒的研究表明，當人們從肌肉骨骼護理的初級護理開始時，成本差異巨大，這實際上是物理治療。因此，我們正在努力傳達這一信息並將其帶回家。

Washington is a little dysfunctional for these days. And so again, my ability to predict what happens. But I think we have a great story. I think we have good data, and we're going to continue to bang on it. And at some point, it's got a turnaround in my view.

華盛頓近來有點不正常。再一次，我預測會發生什麼的能力。但我認為我們有一個很棒的故事。我認為我們有很好的數據，我們將繼續努力。在我看來，在某個時候，它出現了轉機。

One more quick one for Carey. In terms of the borrowing capacity, I mean, to me, it looks like it could go to 4x if you want it, but there's probably maybe a comfort level slightly lower than that, or for the right deal, would you go (inaudible) of deal, can you just (inaudible) speak to maybe where the top end realistically, in your view as far as you're comfortable? Thanks.

凱莉再快點。就借貸能力而言，我的意思是，對我來說，如果你願意的話，它看起來可以達到 4 倍，但可能會有比這略低的舒適水平，或者為了合適的交易，你會去嗎（聽不清）當然，在您認為舒適的情況下，您能否（聽不清）說說現實中的高端？謝謝。

Yes. Well, right now, our covenantant is at 3x. So -- but not to say that we couldn't go to our banks, which we have a great relationship with and get -- if it was the right deal and the right timing, we could go higher than that. I don't think that we would necessarily be comfortable much above 3, though for very long. If we went above 3, it would be something that we would bring down pretty quickly. That's my perspective. Yeah.

是的。那麼，現在，我們的契約是 3 倍。所以——但並不是說我們不能去我們的銀行，我們與銀行有很好的關係並獲得——如果這是正確的交易和正確的時機，我們可以做得更高。我不認為我們一定會在 3 以上感到舒服，儘管會持續很長時間。如果我們超過 3，我們會很快降低它。這是我的觀點。是的。

(Operator Instructions). It appears we have no further questions at this time. I will now turn the program back over to our speakers for any additional closing remarks.

（操作員說明）。看來我們現在沒有其他問題了。我現在將把程序轉回給我們的發言人，聽取任何額外的結束語。

Okay. Thanks, Gretchen. Listen, I just want to thank everybody for the questions for the time today for the ongoing support. We greatly appreciate it. I know we've got some follow-up calls scheduled with some of you. So for those who don't talk to , I hope you have a great day. And that concludes our conference call this morning. Thank you.

好的。謝謝，格雷琴。聽著，我只想感謝大家今天提出的問題，感謝大家一直以來的支持。我們非常感激。我知道我們已經與你們中的一些人安排了一些後續電話會議。所以對於那些不說話的人，我希望你們今天過得愉快。今天早上我們的電話會議到此結束。謝謝。

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

今天的節目到此結束。感謝您的參與。您現在可以斷開連接。