US Physical Therapy Inc (USPH) 2023 Q2 法說會逐字稿

Good day, and thank you for standing by. Welcome to the U.S. Physical Therapy Second Quarter 2023 Earnings Conference Call.

美好的一天，感謝您的支持。歡迎參加美國物理療法 2023 年第二季度收益電話會議。

(Operator Instructions)

（操作員說明）

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

請注意，今天的會議正在錄製中。

(Operator Instructions)

（操作員說明）

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

我想將電話轉給總裁兼首席執行官克里斯·雷丁 (Chris Reading)。請繼續，先生。

Thank you, sir. Good morning, and welcome, everyone, to U.S. Physical Therapy's Second Quarter 2023 Earnings Call. With me on the line include Carey Hendrickson, our Chief Financial Officer; Eric Williams and Graham Reeve, our Co-COO; Rick Binstein, our Executive Vice President and General Counsel; Jake Martinez, our Senior Vice President of Finance and Accounting.

謝謝你，先生。早上好，歡迎大家參加 U.S. Physical Therapy 2023 年第二季度收益電話會議。與我通話的包括我們的首席財務官凱里·亨德里克森 (Carey Hendrickson)；我們的聯席首席運營官埃里克·威廉姆斯 (Eric Williams) 和格雷厄姆·里夫 (Graham Reeve)； Rick Binstein，我們的執行副總裁兼總法律顧問；傑克·馬丁內斯 (Jake Martinez)，我們的財務和會計高級副總裁。

Before I provide a little color on the quarter, we need to cover a brief disclosure statement. So Jake, if you could take that, please.

在對本季度進行一些介紹之前，我們需要先介紹一份簡短的披露聲明。傑克，如果你能接受的話，請接受。

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.

克里斯，本演示文稿包含涉及某些風險和不確定性的前瞻性陳述。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。請參閱該公司向美國證券交易委員會提交的文件以了解更多信息。

Thanks, Jake. So this morning, I'm going to keep my commentary kind of at a high level, and then we'll turn it over to Carey to go through the financials in more detail. I want to start by thanking our partners, our operations leadership team, sales and marketing directors and our digital marketing support and development teams, all of whom are working hard every day to drive patients to our door, we can effect life-changing care, allowing them to quickly return to work sports into all those activities that support families uplift parts as well as communities.

謝謝，傑克。因此，今天早上，我將保持我的評論處於較高水平，然後我們將其交給凱里，以更詳細地了解財務狀況。首先，我要感謝我們的合作夥伴、我們的運營領導團隊、銷售和營銷總監以及我們的數字營銷支持和開發團隊，他們所有人每天都在努力工作，將患者送到我們家門口，我們可以實現改變生活的護理，讓他們能夠迅速重返工作崗位，將體育運動融入到所有支持家庭和社區的活動中。

This would not be possible if not for the care, connection and dedication of our front line caregivers. Many therapists across our more than 150 individual partnerships. In these first 6 months, first 2 quarters of 2023 as a result of the excellent care and outcomes, you continue to provide our patient -- you continue to provide our patient demand has been greater than ever before in the history of our company. Quarter 1 delivered record visits per point for that, the highest ever for is normally a seasonally slowest quarter at 29.8. March gave us the best single month at that point at 30.7 visits per point per day. I'm pleased and proud to say that despite challenges in the labor market this past year, we were able to continue that quarter 1 momentum.

如果沒有我們一線護理人員的關懷、聯繫和奉獻，這是不可能的。我們在 150 多個個人合作夥伴中擁有許多治療師。在2023 年的前6 個月，即前2 個季度，由於出色的護理和成果，你們繼續為我們的患者提供服務——你們繼續為我們的患者提供服務，我們的患者需求比我們公司歷史上以往任何時候都大。第一季度的每點訪問量創歷史新高，通常是季節性最慢的季度，為 29.8。 3 月份是我們當時最好的單月訪問量，每天每個點的訪問量為 30.7 次。我很高興也很自豪地說，儘管去年勞動力市場面臨挑戰，我們仍能夠繼續第一季度的勢頭。

In fact, we've turned it up even more in the second quarter new record volume in April and May at 30.9% for both months and overall Q2 volume at 30.4% visits per clinic per day on average. We produced some very good additions, both acquired and de novo since quarter 2 a year ago. We've added 48 clinics in total this year 22 de novo clinics through the end of July which, as you know, earlier, mostly during our overall average until we get fully speed with staff and overall community involvement and for penetration.

事實上，我們在第二季度的 4 月和 5 月創下了新紀錄，兩個月的就診量達到了 30.9%，第二季度的整體就診量達到了平均每家診所每天 30.4% 的就診量。我們生產了一些非常好的產品，包括收購的和從一年前第二季度開始的新產品。截至7 月底，我們今年總共增加了48 家診所，其中22 家是從頭開始的診所，正如您所知，早些時候，大部分是在我們的總體平均水平期間，直到我們與工作人員和整個社區的參與和滲透完全同步。

These new facilities, of course, become much more highly productive in the years to come, and they will continue to grow for many years serving patients and families. This quarter, our mature facility same-store volume grew 2.6% and against the strong comparative quarter in 2022. Our same-store for the year is up 4.2% overall. [NAND] is not an issue for us. Also on the very positive side of the equation, general cost improvement, especially in light of the very significant labor scarcity and general inflation has played every corner of our country these past 4-plus months.

當然，這些新設施在未來幾年將變得更加高效，並且它們將繼續發展多年，為患者和家庭提供服務。本季度，我們成熟設施的同店銷量增長了 2.6%，與 2022 年同期的強勁對比相比。我們今年的同店銷量總體增長了 4.2%。 [NAND] 對我們來說不是問題。同樣從積極的一面來看，過去四個多月以來，總體成本改善，特別是考慮到勞動力嚴重短缺和總體通脹，已經影響到我國的各個角落。

In spite of that, we've seen salary and related costs per visit as well as total cost per visit declined now 3 quarter in a row at the peaking in the third quarter of 2022 as inflation began to quickly accelerate last year. Our team is making real progress to very focused multifaceted efforts to address costs, streamline operations where possible and innovate with new solutions some of which are so long out across our main partnerships, which is to say that we're not done yet, and we have more progress to make.

儘管如此，隨著去年通脹開始迅速加速，我們發現每次訪問的工資和相關成本以及每次訪問的總成本已連續三個季度下降，並在 2022 年第三季度達到峰值。我們的團隊正在通過非常集中的多方面努力取得真正的進展，以解決成本問題，盡可能簡化運營，並通過新的解決方案進行創新，其中一些解決方案在我們的主要合作夥伴關係中已經存在很長時間了，也就是說我們還沒有完成，我們有更多進步要做。

In the area of commercial payer contracts, we continue to make progress with rate increases and at the same time, absorbing the 2% Medicare rate reduction this year and the 1% sequester relief phase out, which impacted us in this quarter. This rig area is where we continue to work on multifaceted approach and where we have more opportunity to further improve. What we have seen over this past year was tighter than normal labor dynamics and extremely high volume demand is that on a small percentage basis, the number of licensed PT assistance that we have hired to fill a very strong demand has increased over where we've historically been.

在商業付款人合同領域，我們繼續在加息方面取得進展，同時吸收今年 2% 的醫療保險費率降低和逐步取消 1% 的自動減支減免，這對本季度的我們產生了影響。這個鑽機領域是我們繼續致力於多方面方法的地方，也是我們有更多機會進一步改進的地方。在過去的一年裡，我們看到比正常的勞動力動態更加緊張，而且需求量極高，我們為滿足非常強勁的需求而僱用的有執照的PT 援助數量在很小的百分比基礎上有所增加，而我們已經增加了數量。歷史上曾經是。

That in combination with the high demand has resulted in a greater percentage of Medicare visits being touched by a PT assistant with a further 15% PTA reduction reimbursement reduction creates a negative impact on our net rate. So we're in the middle of a large-scale push to elevate this issue across our platform to retrain any and all of our front desk staff to better optimize scheduling to make sure that our clinical leadership is doing everything possible to ensure that we have optimal scheduling and clinically directed resources to not only provide exceptional patient care, but to be sure that we get fully paid for providing that care.

再加上高需求，導致 PT 助理接觸的 Medicare 就診比例更高，PTA 報銷進一步減少 15%，這對我們的淨費率產生了負面影響。因此，我們正在大規模地推動在我們的平台上提升這個問題，以重新培訓我們所有的前台工作人員，以更好地優化日程安排，以確保我們的臨床領導層正在盡一切可能確保我們最佳的調度和臨床指導的資源不僅可以提供卓越的患者護理，而且可以確保我們因提供這種護理而獲得全額報酬。

We believe this heightened awareness, which may have been diluted a bit dealing with front office turnover a late 2022 and early 2023 coupled with the high demand for our services has resulted in some addressable inefficiencies which flow through to a net rate. Given the already very low cost nature of the incredible care that we provide, this becomes an all-hands-on-deck effort to ensure that we have paid at a level that aligns with the results we are achieving. We're not there yet, but we are very focused on working hard to make the necessary adjustments. Other positives for the quarter. Drew where our company completed a secondary offering at the end of May, which has proven to be very successful allowing us to pay off our highest interest rate debt further invest the remaining significant proceeds directly to further grow our partner-centric company.

我們認為，這種意識的提高可能會在2022 年底和2023 年初處理前台人員流動問題時有所淡化，再加上對我們服務的高需求，導致了一些可解決的低效率問題，並最終導致了淨費率。鑑於我們提供的令人難以置信的護理成本已經非常低，這需要全力以赴，以確保我們支付的費用與我們所取得的成果相一致。我們還沒有做到這一點，但我們非常專注於努力做出必要的調整。本季度的其他積極因素。德魯，我們公司於五月底完成了二次發行，事實證明，這非常成功，使我們能夠償還最高利率的債務，進一步將剩餘的大量收益直接投資，以進一步發展我們以合作夥伴為中心的公司。

We are currently busy doing just that, and you will continue to see us add new partners and experience in new states, while we also explore offerings and other adjacent service areas we believe we can further strengthen our business in physical therapy as well as our injury prevention business services. On the IP front, this year seems to be unfolding much the way we expected. We have seen major increases in spend across some of our longest tenured relationships and as we discussed last quarter, we've seen some companies fearful of a pending recession pull back from prior levels of spend and engagement in a defensive move for them.

我們目前正忙於這樣做，您將繼續看到我們在新的州增加新的合作夥伴和經驗，同時我們還探索產品和其他鄰近的服務領域，我們相信我們可以進一步加強我們在物理治療和傷害方面的業務預防商業服務。在知識產權方面，今年的發展似乎與我們預期的非常相似。我們看到一些長期存在的關係的支出大幅增加，正如我們上季度討論的那樣，我們看到一些公司擔心即將到來的經濟衰退，從之前的支出水平回落，並採取了防禦性舉措。

Counteracting that, our teams have done a great job replacing the vast majority of that pull back with exciting new business that I'm happy to say we're able to staff now with greater efficiency much less time than where we were 9 months ago. Both of our IP partnerships are working hard together to cross-sell and expand programs we're looking for new opportunities. We continue to explore acquisition-based opportunities as well as expect that our reinvigorated balance sheet will provide us with dry powder and runway to do that over the coming quarters and years.

為了解決這個問題，我們的團隊做得很好，用令人興奮的新業務取代了絕大多數的倒退，我很高興地說，我們現在能夠以比9 個月前更高的效率和更少的時間來配備員工。我們的兩個知識產權合作夥伴正在共同努力交叉銷售和擴展我們正在尋找新機會的項目。我們將繼續探索基於收購的機會，並預計重振的資產負債表將為我們在未來幾個季度和幾年內實現這一目標提供乾粉和跑道。

Finally, I want to end my comments much the way I started by thanking those colleagues and many dear friends who've been with me now as I close in on my 20th anniversary here with the company. It's been an amazing fun and exhilarating ride with more good things to come. I feel extremely glad to be working alongside so many talented and committed team members across our home office support group as well as our many partnerships around the country. We've made a huge difference in the lives of millions of patients, and I'm proud to say that my life and I think the lives of many of our partners and staff has been made better as a result of the work that we do as well.

最後，我想以一開始的方式結束我的評論，感謝那些在我加入公司 20 週年之際一直陪伴在我身邊的同事和親愛的朋友。這是一次令人驚奇的有趣和令人興奮的旅程，還會有更多美好的事情發生。我非常高興能夠與我們的家庭辦公室支持團隊以及我們在全國各地的眾多合作夥伴中這麼多才華橫溢且忠誠的團隊成員一起工作。我們為數百萬患者的生活帶來了巨大的改變，我很自豪地說，我的生活以及我認為我們許多合作夥伴和員工的生活由於我們所做的工作而變得更好以及。

And we're not done. As you've heard, we always have challenges to tackle on things to address. That has been the way -- has been the way it's been for the entirety of my 38 career, including the early chapters of treating therapists and clinician. And we continue to have the energy and the drive to fight for better reimbursement for the life improving work that we deliver so consistently every day for rules and regulations that make sense and increase access to the very (inaudible) treatment that we provide versus the much more costly and often riskier inventions, it should not be positioned as first choice options.

我們還沒有完成。正如您所聽說的，我們始終面臨著需要解決的挑戰。這就是我 38 整個職業生涯的方式，包括治療治療師和臨床醫生的早期章節。我們繼續有精力和動力去爭取更好的報銷，以改善生活，我們每天都堅持不懈地提供有意義的規則和法規，並增加獲得我們提供的（聽不清）治療的機會，而不是更多的治療。由於發明成本更高且往往風險更大，因此不應將其定位為首選。

I believe physical therapy should be first option primary care equivalent for prevention and treatment of musculoskeletal enduring disease, we will continue to fight for that rightful place in the health care continuum. And for those of you who are listening from other companies please get dialed into the constant work we are doing within APTQI. We need you to fight alongside us with us as we work towards these important goals. That concludes my prepared comments. So Carey, if you would cover the financials in more detail. Carey?

我相信物理治療應該是預防和治療肌肉骨骼持久性疾病的首選初級保健，我們將繼續為在醫療保健連續體中爭取這一應有地位而奮鬥。對於那些正在傾聽其他公司意見的人，請了解我們在 APTQI 中不斷開展的工作。當我們努力實現這些重要目標時，我們需要您與我們並肩作戰。我準備好的評論到此結束。凱里，請您更詳細地介紹一下財務狀況。凱里？

Great. Thank you, Chris, and good morning, everyone. We had an excellent second quarter in many respects. We had all-time high patient volumes. We had strong growth in revenue, continuing downward trend in our salaries and total operating cost on a per visit basis. We had growth in our physical therapy operating income and our physical therapy operating margin percentage and year-over-year growth in our total company's adjusted EBITDA.

偉大的。謝謝你，克里斯，大家早上好。我們的第二季度在很多方面都表現出色。我們的患者數量創歷史新高。我們的收入強勁增長，但每次訪問的工資和總運營成本持續下降。我們的物理治療營業收入和物理治療營業利潤率以及公司調整後 EBITDA 總額均實現同比增長。

And in addition, as Chris noted, we completed a successful equity offering that further strengthened our capital structure, providing significant capital for future growth initiatives. The equity offering provided us with approximately $164 million in net proceeds for the issuance of 1.9 million shares. We used $35 million of those proceeds to pay down the debt on our revolving credit facility which at the time was at a variable rate of about 7.2%, leaving approximately $129 million. They also lowered our leverage ratio, resulting in a 25 basis point decrease in the rate on our outstanding $150 million term loan based on our leverage grid. We've invested that cash at this point at a high-yield savings account prior to deployment into acquisitions. The savings and interest expense and the interest income on the net proceeds makes the offering immediately accretive even with the issuance of the 1.9 million shares.

此外，正如克里斯指出的，我們成功完成了股權發行，進一步加強了我們的資本結構，為未來的增長計劃提供了大量資本。此次股權發行為我們發行 190 萬股股票提供了約 1.64 億美元的淨收益。我們用其中 3500 萬美元的收益來償還循環信貸額度的債務，當時的可變利率約為 7.2%，剩下大約 1.29 億美元。他們還降低了我們的槓桿率，導致我們未償還的 1.5 億美元定期貸款（基於槓桿網格）的利率降低了 25 個基點。在部署到收購之前，我們目前已將這些現金投資於高收益儲蓄賬戶。即使發行了 190 萬股，儲蓄和利息支出以及淨收益的利息收入也使本次發行立即增值。

And of course, the return on those net proceeds will increase substantially when we deploy them into acquisitions. We reported adjusted EBITDA for the second quarter of $21.7 million which was the second highest quarterly EBITDA amount in our history and an increase of $0.4 million over the $21.3 million we reported in the second quarter of 2022. Our operating results, which includes the impact of higher interest expense, was $0.76 per share in the second quarter of 2023. Our total company revenues increased 7.7% in the second quarter growing from $140.7 million in the second quarter of last year to $151.5 million in the second quarter of '23 and our total company gross profit increased $1.4 million from $30.8 million in the second quarter of last year to $32.2 million in the second quarter of '23.

當然，當我們將這些淨收益用於收購時，其回報率將會大幅增加。我們報告的第二季度調整後EBITDA 為2170 萬美元，這是我們歷史上第二高的季度EBITDA 金額，比我們在2022 年第二季度報告的2130 萬美元增加了40 萬美元。我們的經營業績，其中包括利息支出增加，2023 年第二季度每股0.76 美元。第二季度我們公司總收入增長了7.7%，從去年第二季度的1.407 億美元增長到2023 年第二季度的1.515 億美元，我們的總收入增長了7.7%。公司毛利潤從去年第二季度的 3080 萬美元增加到 23 年第二季度的 3220 萬美元，增加了 140 萬美元。

As Chris noted in his remarks, our average visits per clinic per day in the second quarter was 30.4%, which is the highest volume for any quarter in the company's history. April and May were both at 30.9%, highest volumes for any month in our history, and our average visits per clinic per day in June was 29.6%, which is a normal seasonal decline related to vacations taken in the summer months and higher than the 28.9% that we had in June of last year. Our net rate was $102.03 in the second quarter of '23, which was a decrease of 1.1% compared to our net rate of $103.18 in the second quarter of last year. The net rate for our commercial and workers' compensation visits both increased approximately 1%, while the net rate associated with Medicare visits was down 3.5%.

正如 Chris 在講話中指出的那樣，第二季度我們每個診所每天的平均就診率為 30.4%，這是公司歷史上任何季度的最高訪問量。 4 月和5 月的訪問量均為30.9%，是我們歷史上任何月份的最高訪問量，6 月份每個診所每天的平均就診量為29.6%，這是與夏季休假相關的正常季節性下降，並且高於去年 6 月的增長率為 28.9%。 2023 年第二季度我們的淨利率為 102.03 美元，與去年第二季度的淨利率 103.18 美元相比下降了 1.1%。我們的商業和工人賠償就診的淨費率均增加了約 1%，而與醫療保險就診相關的淨費率下降了 3.5%。

As we noted in the release and as Chris mentioned, the Medicare rate decrease was primarily due to the 2% rate reduction from CMS that was effective at the beginning of this year. Coupled with the effect of the second quarter of last year included a 1% sequestration relief on Medicare rates. As we've talked about on our last couple of earnings calls, we've either renegotiated or terminated the subset of our Medicare Advantage contracts that reimburses at a rate that's less than what it costs us to serve our patients.

正如我們在新聞稿中指出的以及克里斯提到的，醫療保險費率下降主要是由於今年年初生效的 CMS 費率下降了 2%。再加上去年第二季度的影響，包括醫療保險費率 1% 的自動減支減免。正如我們在過去幾次財報電話會議上談到的那樣，我們要么重新談判，要么終止了醫療保險優惠合同的子集，該合同的報銷費率低於我們為患者提供服務的成本。

The terminations were effective in June in July and most of the associated renegotiated rates are also now in effect, so we expect the impact of this work to begin showing up in the second half of 2023. We also continue to focus on renegotiations of commercial contracts and as Chris noted, we're making other necessary adjustments to adjust our net rates. Physical Therapy revenues were $130.1 million in the second quarter of 2023 and which was an increase of $11 million or 9.2% for the second quarter of 2022. The revenue increase at our same-store clinics was 1.3% and the patient visits up 2.6% versus the prior year.

終止於 6 月和 7 月生效，大多數相關的重新談判費率現已生效，因此我們預計這項工作的影響將在 2023 年下半年開始顯現。我們還繼續關注商業合同的重新談判正如克里斯指出的，我們正在做出其他必要的調整來調整我們的淨利率。 2023 年第二季度的物理治療收入為 1.301 億美元，比 2022 年第二季度增加了 1100 萬美元，增幅為 9.2%。我們同店診所的收入增長了 1.3%，患者就診量增長了 2.6%。前一年。

Our physical therapy operating costs were $102.1 million, an increase of 10% over the second quarter of the prior year. On a per visit basis, our total operating costs were $80.61 in the second quarter, which was a decrease of 0.6% compared to $81.09 per visit in the second quarter of the prior year. And we were pleased to see our physical therapy operating cost per visit decreased for the third consecutive quarter after peaking in the third quarter of last year. Our total operating costs were $85.14 per visit in the third quarter of 2022 and decreased to $84.5 in the fourth quarter. They declined further to $81.97 in the first quarter of '23 and then declined again to $80.61 in the second quarter of 2023.

我們的物理治療運營成本為 1.021 億美元，比去年第二季度增長 10%。按每次訪問計算，第二季度我們的總運營成本為 80.61 美元，與去年第二季度每次訪問 81.09 美元相比下降了 0.6%。我們很高興看到每次就診的物理治療運營成本在去年第三季度達到峰值後連續第三個季度下降。 2022 年第三季度，我們的每次訪問總運營成本為 85.14 美元，第四季度降至 84.5 美元。它們在 23 年第一季度進一步下降至 81.97 美元，然後在 2023 年第二季度再次下降至 80.61 美元。

Our salaries and related cost per visit decreased 1.2% in the second quarter of this year versus the prior year, and they've also declined for 3 consecutive quarters. From $60.99 in the third quarter of '22, down to $60.04 in the fourth quarter, down to $59.14 per visit in the first quarter and then down to $57.59 per visit in the second quarter of 2023. Our Physical Therapy margin also improved for the third consecutive quarter increasing from 18.7% in the third quarter of '22 to 20% in the fourth quarter, 21% in the first quarter of this year and ended 21.5% in the second quarter of 2023.

今年第二季度，我們的工資和每次訪問的相關成本比去年同期下降了 1.2%，並且已經連續 3 個季度下降。從22 年第三季度的60.99 美元下降到第四季度的60.04 美元，第一季度下降到每次就診59.14 美元，然後下降到2023 年第二季度每次就診57.59 美元。第三季度我們的物理治療利潤率也有所提高連續季度從22年第三季度的18.7%增長到第四季度的20%，今年第一季度的21%，到2023年第二季度的21.5%。

Really pleased with the progression that we've seen in all of those metrics. Our IIP revenues were $19.2 million in the second quarter, which is down slightly from the second quarter of '22. And our IIP expenses were even with the prior year at $15.3 million with IIP operating income of $4 million, and our margin and IIT business was 20.7% in the second quarter of '23. Our interest expense was $2.6 million in the second quarter of this year, which was an increase of $1.6 million over the second quarter of the prior year. Of course, that higher interest expense is due to the increase in our debt-related acquisitions we closed during or since the second quarter of last year and also a higher interest rate in the second quarter of this year versus last year.

我們對所有這些指標的進展感到非常滿意。第二季度我們的國際投資頭寸收入為 1,920 萬美元，比 2020 年第二季度略有下降。我們的 IIP 支出與上年持平，為 1530 萬美元，IIP 營業收入為 400 萬美元，23 年第二季度我們的利潤率和 IIT 業務為 20.7%。今年第二季度我們的利息支出為260萬美元，比去年第二季度增加了160萬美元。當然，較高的利息支出是由於我們在去年第二季度或自去年第二季度以來完成的債務相關收購的增加，以及今年第二季度比去年更高的利率。

Our balance sheet remains in an excellent position. We have a $150 million term loan with a 5-year swap agreement in place that fixes that 1-month term SOFR rate on that $150 million at 2.8%. And including the applicable margin based on our leverage ratio, all-in rate of our $150 million of debt was 4.9% in the second quarter, a very favorable rate in today's market, and it's below the current Fed funds rate. And as I noted earlier, the net rate on that term loan moved down 25 basis points to 4.65% after the secondary offering.

我們的資產負債表仍然處於良好狀態。我們有一筆 1.5 億美元的定期貸款，並簽訂了一份為期 5 年的掉期協議，該協議將這 1.5 億美元的 1 個月期 SOFR 利率固定為 2.8%。包括基於槓桿率的適用保證金，第二季度我們 1.5 億美元債務的總利率為 4.9%，在當今市場上是一個非常有利的利率，並且低於當前的聯邦基金利率。正如我之前指出的，二次發行後該定期貸款的淨利率下降了 25 個基點至 4.65%。

In the second quarter of 2023 alone, the swap agreement saved us $800,000 in interest expense with cumulative savings to date related to the swap of $1.5 million over the first 12 months. In addition to the term loan, we also have $175 million revolving credit facility that had approximately $35 million drawn on that prior to the completion of the equity offering of course, we paid that down with some of the net proceeds. And so there's no -- there's nothing drawn on the revolver.

僅在 2023 年第二季度，互換協議就節省了 80 萬美元的利息費用，迄今為止，前 12 個月與互換相關的累計節省額為 150 萬美元。除了定期貸款外，我們還有 1.75 億美元的循環信貸額度，在股權發行完成之前，我們已提取了約 3500 萬美元，當然，我們用部分淨收益支付了這筆貸款。所以左輪手槍上沒有畫任何東西。

Borrowings on the April 1 through May 30, we're at a variable rate just north of 7%. In closing, we've had a very solid first half of the year, and we'll continue to work hard to produce the best results possible for all of our stakeholders this year. The strength of our results in the second quarter give us continued confidence in the adjusted EBITDA guidance range we provided at the beginning of the year of $75 million to $80 million. And with that, I'll turn the call back to Chris.

4 月 1 日至 5 月 30 日的借款，我們的浮動利率略高於 7%。最後，我們的上半年表現非常出色，今年我們將繼續努力，為所有利益相關者創造最好的結果。第二季度的強勁業績使我們對年初提供的 7500 萬美元至 8000 萬美元的調整後 EBITDA 指導範圍充滿信心。然後，我會將電話轉回給克里斯。

Thanks, Carey. I appreciate that. Operator, let's go ahead and line up for questions.

謝謝，凱里。我很感激。接線員，我們去排隊提問吧。

(Operator Instructions)

（操作員說明）

And we'll go first to Brian Tanquilut with Jefferies.

我們首先請見 Jefferies 的 Brian Tanquilut。

I guess, I'll ask the question. It sounds like based on the metrics that Carey shared with us this morning, whether it's productivity of the clinic, cost per visit and all these KPIs, it looks like you're executing very well. But as I think about some of those key points, right? I mean the productivity of the clinic and the cost to do deliver care how much runway do you think there is left to drive some of those metrics?

我想，我會問這個問題。聽起來，根據凱里今天早上與我們分享的指標，無論是診所的生產力、每次就診的成本以及所有這些 KPI，看起來你們的執行情況都非常好。但當我思考其中一些關鍵點時，對吧？我的意思是診所的生產力和提供護理的成本，您認為還有多少跑道可以推動其中一些指標？

Yes, it's a good question. So I mean individual clinician productivity, there's not a lot of elasticity there. Individual clinic throughput, I wouldn't call it out productivity, but just being the number of patients that we can get through an individual clinic. We've got as much room as we had probably 4, 5, 6 years ago.

是的，這是一個好問題。所以我的意思是個體臨床醫生的生產力，那裡沒有太多的彈性。個體診所的吞吐量，我不會稱之為生產力，而只是我們可以通過個體診所接待的患者數量。我們現在的空間和四、五、六年前一樣多。

I mean we constantly adjust our hours. We can expand our hours most of our clinics are not open on Saturdays. A lot of our clinics, I think to say this, that a lot of our clinics in certain markets closed early on Fridays. We've got capacity on a per clinic basis, to continue to have that number increase. So that's not going to be a limiting factor. And we certainly have room to move this in that rate this quarter, a little bit of a disappointment as we've really got extremely granular with where that issue is, I think the fact that we had the turnover that we had and the scarcity we had in '22, particularly at the front desk. This caused us not to be as valid in as we need to be from a scheduling perspective.

我的意思是我們不斷調整我們的工作時間。我們可以延長營業時間，大多數診所周六不營業。我想說的是，我們在某些市場的很多診所在周五很早就關門了。我們每個診所都有能力繼續增加這個數字。所以這不會成為限制因素。我們當然有空間在本季度以這個速度移動這個問題，有點令人失望，因為我們確實非常了解這個問題的具體位置，我認為我們擁有我們的營業額和我們的稀缺性這一事實22 年的時候，特別是在前台。從調度的角度來看，這導致我們沒有達到我們需要的有效程度。

I'm actually encouraged by the fact that it's, I think, addressable the team, the clinical services team in conjunction with our operations group is on top of that, and they were holding out some very, very detailed training, not just on that and a couple of other areas that I think will help us as we going forward. So on one hand, for the quarter, a little better -- but we have made progress, as you pointed out, in all of the areas that we've been focused on. I think we'll make progress there. We know what to do.

事實上，我認為這是一個可以解決的團隊，臨床服務團隊與我們的運營團隊是最重要的，他們正在進行一些非常非常詳細的培訓，而不僅僅是在這方面，這讓我感到鼓舞。我認為還有其他一些領域會對我們的前進有所幫助。因此，一方面，本季度情況有所好轉，但正如您所指出的，我們在我們關注的所有領域都取得了進展。我想我們會在那裡取得進展。我們知道該怎麼做。

Got it. And then maybe since you mentioned rate, obviously, 1% net rate growth on the commercial side being offset by some of the Medicare stuff. But as we think about maybe the number of contracts that you have, without going to percentages, right? I mean how much opportunity is left to, number one, drive positive rate trend within the portfolio of contracts? And maybe the second would be to push our rate increase above, say, a 1% number.

知道了。然後，也許既然你提到了利率，很明顯，商業方面 1% 的淨利率增長被一些醫療保險的內容所抵消。但當我們考慮一下你擁有的合同數量，而不是百分比，對嗎？我的意思是，第一，在合約組合中推動正利率趨勢的機會還有多少？也許第二個就是將我們的加息幅度推高至 1% 以上。

We have so many contracts to happen any as we do just because of our companies configured across more than 150 partnerships. But we've got a lot of contract negotiation left in us to do Carey, I don't know if you want to comment further.

我們有如此多的合同要簽訂，只是因為我們的公司擁有 150 多個合作夥伴。但我們還有很多合同談判要做，我不知道你是否想進一步發表評論。

No, I agree. We have lots of contracts. It's a constant focus for us, Brian. We're up -- and we're having good success. I mean we're having success in these rate negotiations I'd say the big payers are the ones that just takes longer to get -- make progress with them. And so we're continuing to work at it every day.

不，我同意。我們有很多合同。布萊恩，這是我們持續關注的焦點。我們已經崛起——並且取得了巨大的成功。我的意思是，我們在這些利率談判中取得了成功，我想說的是，大支付者只是需要更長的時間才能與他們取得進展。因此，我們每天都在繼續努力。

Brian, some of these contracts we're getting increases now, but we have been sequential annual increases that are yet to come even on the one you've completed already.

布萊恩，其中一些合同我們現在正在增加，但我們已經連續逐年增加，即使您已經完成的合同也還沒有增加。

Yes. We're working to build in 3-year step increases for the most part. So we'll have less to touch each year. We know we're going to be getting those contractual rate increases as the year goes along. So that's the move to...

是的。我們正在努力實現大部分的 3 年逐步增長。所以我們每年接觸的東西都會減少。我們知道，隨著時間的推移，我們的合同利率將會上漲。這就是我們要採取的行動...

Last question for me, Chris. I mean, obviously, you guys did the raise, you're sitting on a bunch of capital right now, a lot of balance sheet flexibility. I mean what does the market look like? I know your space is obviously dominated by a bunch of PE-backed players. And I know your appetite has been more on the smaller side rather than the big platforms. But what does the market today look like in terms of either competition for deals or opportunities popping up that probably are more scaled given your capital availability?

我的最後一個問題，克里斯。我的意思是，顯然，你們進行了加薪，你們現在坐擁大量資本，資產負債表具有很大的靈活性。我的意思是市場是什麼樣的？我知道你的空間顯然是由一群 PE 支持的玩家主導的。我知道您的興趣更多地集中在較小的平台而不是大平台上。但是，從交易競爭或機會的出現（考慮到您的可用資金規模可能更大）的角度來看，今天的市場是什麼樣子的？

Yes. I think the opportunity is still strong. I think what we're seeing right now is a lot of the PE-backed companies have been decidedly more flat this year, particularly because a number have either done significant deals themselves or gotten to the point where I think interest rate increases were leverage is high and I think, to a certain extent, the reality that many of these individual operators have kind of missed the peak as said in this year.

是的。我認為機會仍然很大。我認為我們現在看到的是，許多私募股權支持的公司今年的業績明顯更加平穩，特別是因為一些公司要么自己完成了重大交易，要么達到了我認為槓桿率提高的程度。我認為，在某種程度上，現實是許多個體經營者已經錯過了今年所說的高峰。

I mean we're not in 2019 anymore at the height of this or even early '21 when things were still really, really hot and I think there's a little timing remarks in the market. Having said that, we're busy. Now for us, sometimes, we're ready to go and then the partner has something and things push a little bit. And that's happened on a couple of occasions this year. We'll still get those things done. It's just taking a little bit longer. But we're looking at bigger deals too and opportunities not just in PT, but in injury prevention. So it's going to be lumpy. It's always been lumpy, but we're going to get good things done.

我的意思是，我們已經不再是 2019 年的高峰期，甚至不再是 21 年初，當時事情仍然非常非常熱門，我認為市場上有一些時機評論。話雖如此，我們很忙。現在對我們來說，有時，我們已經準備好出發，然後合作夥伴有一些東西，事情會有點推動。今年已經發生過幾次這種情況。我們仍然會完成這些事情。只是需要的時間稍微長一點而已。但我們也在尋找更大的交易和機會，不僅在物理治療方面，而且在傷害預防方面。所以它會變得凹凸不平。事情總是崎嶇不平，但我們會做好事。

We'll take our next question from Joanna Gajuk with Bank of America.

我們將回答美國銀行喬安娜·加尤克 (Joanna Gajuk) 提出的下一個問題。

So in terms of this commercial rate increases, if I can just follow up there. So the 1% I guess experiencing right now. Are you kind of suggesting that as you negotiate incremental the additional contracts that rate increase could actually accelerate into next year?

因此，就商業利率的上漲而言，如果我能跟進的話。我猜這 1% 的人現在正在經歷。您是否建議，在談判增量合同時，費率上漲實際上可能會加速到明年？

Joanna, it's just going to depend on the timing of it kind of like M&A, it's lumpy, it's which ones you get and the timing of those. I certainly expect those commercial rates to continue to increase over time. We're working hard at that as far as the rate of increase, it's hard to say.

喬安娜，這只是取決於它的時機，就像併購一樣，它是不穩定的，這取決於你得到哪些以及這些的時機。我當然預計這些商業利率將隨著時間的推移繼續增加。我們正在為此努力，至於增長率，很難說。

These contracts last and they go on for years and every additional one builds on what we've done previous.

這些合同持續多年，每一份額外的合同都建立在我們之前所做的基礎上。

Yes. As we just mentioned, too, we also have step increases built in for -- on the ones that we renegotiated. So those should continue to help us as we go forward. So I think -- I mean, I feel there's always a lot of work to be done at commercial rates because there are so many contracts. So we've got -- we've still got a bit of work to do, but we've made good progress, and I think we're going to continue to make good progress. I know we are, and we should see those rates continue to grow as we go forward.

是的。正如我們剛才提到的，我們還針對我們重新談判的內容增加了步驟。因此，當我們前進時，這些應該繼續幫助我們。所以我認為——我的意思是，我覺得總是有很多工作需要以商業價格完成，因為合同太多了。所以我們還有一些工作要做，但我們已經取得了良好的進展，而且我認為我們將繼續取得良好的進展。我知道我們是這樣，而且隨著我們的前進，我們應該看到這些比率繼續增長。

And Carey, when you say the increases that we're seeing, the not 1% increase there, in some cases, double-digit price increases. Or 3% to 5% or 6% increase. We're just not touching the whole portfolio, yes.

Carey，當你說我們看到的增長時，不是 1% 的增長，在某些情況下，是兩位數的價格增長。或者增加3%到5%或者6%。是的，我們只是沒有觸及整個投資組合。

That's right. We're getting 3% to 5%, 6% increases in year one. And over a 3-year period, a lot of times, it's like 10% to 12% increase over that 3-year period that we've got built in. And I also say we're also making progress on some of the other Medicare Advantage contracts because those are a focus for us as well. And those we can impact and we've terminated a number of those contracts I mentioned in my remarks, but there are other ones that we can still renegotiate, and we're working on those as well.

這是正確的。第一年我們的增長率為 3% 到 5%，甚至 6%。在 3 年期間，很多時候，我們已經內置的 3 年期間增長了 10% 到 12%。我還說，我們在其他一些方面也取得了進展Medicare Advantage 合同是因為這些也是我們關注的重點。那些我們可以影響的合同，我們已經終止了我在講話中提到的一些合同，但我們仍然可以重新談判其他合同，我們也在努力處理這些合同。

Because Medicare Advantage is becoming a bigger portion of our Medicare visits overall. And so we've got -- and that we can address somewhat. We can't address what CMS hands down, but we can address at least to a certain extent, those Medicare Advantage contracts and how they relate to those CMS rates.

因為 Medicare Advantage 在我們整體 Medicare 就診中所佔的比例越來越大。我們可以解決這個問題。我們無法解決 CMS 規定的內容，但我們至少可以在一定程度上解決那些 Medicare Advantage 合同以及它們與 CMS 費率的關係。

Okay. So you say on the commercial, it's just kind of accumulate over time because you obviously have a 3-year contract, so you renegotiated like 1/3 of your book and then you're negotiating another 1/3, so kind of like over a 3-year period, are you going to have a the slowing through the book. So eventually, it's going to be more effective on what's going on in all of the contracts versus now only 1/3 of this contract. So that makes sense and on this last comment on the MA part of the business. So is there a way to think -- I know it's a small portion, but to your point, is because the Medicare [population]. So how -- I guess, how to think about the portion of that business that already kind of was reset and a portion that -- how big is the portion that kind of you're still trying to either renegotiate or drop these contracts?

好的。所以你在廣告中說，這只是隨著時間的推移而積累的，因為你顯然有一份為期3 年的合同，所以你重新談判了書的1/3，然後你又談判了另外1/3，所以有點像結束三年的時間裡，你會放慢閱讀這本書的速度嗎？因此，最終，它會對所有合同中發生的事情更加有效，而不是現在只有該合同的 1/3。所以這是有道理的，最後對業務的 MA 部分的評論也是有道理的。有沒有辦法思考——我知道這只是一小部分，但就你的觀點而言，是因為醫療保險[人口]。那麼，我想，如何考慮該業務中已經被重置的部分以及您仍在嘗試重新談判或放棄這些合同的部分有多大？

So within Medicare, the commercial advantage Medical Advantage. So right now, I'd say the Medicare advantage -- I mean it's grown as a percentage. It's around 40% to 45% of our total Medicare bucket. So if you look at all the Medicare visits, it's about 40% to 45% of it and that's up from where it was in the upper 30s last year at this time. So that piece, there's been a push to get people to Medicare Advantage. I'd say we're still early innings on that, too.

因此，在 Medicare 中，商業優勢是 Medical Advantage。所以現在，我想說的是醫療保險優勢——我的意思是它以百分比的形式增長。這大約占我們醫療保險總額的 40% 到 45%。因此，如果你看一下所有醫療保險就診，就會發現大約佔 40% 到 45%，比去年同期的 30% 以上有所上升。因此，一直在推動人們享受醫療保險優惠。我想說我們還處於早期階段。

We've done some really good work as it relates to identifying some of these contracts that we just know are not -- they're not they're not suitable. And so we've terminated those. So we've identified the primary ones that are in that situation. We've got still others that address. Again, we've made progress on those as well, and those are the same kinds of increases we're seeing. A lot of times, those are double-digit right off the bat because we're going from -- it could be where they paid 80% to 85% of Medicare and bumping them up to 100% or it may be from 80% to 90%, but those are really nice sizable increases on some of those contracts we're making.

我們做了一些非常好的工作，因為它涉及到識別一些我們只知道不合適的合同——它們不是不合適的。所以我們已經終止了這些。因此，我們已經確定了處於這種情況的主要因素。我們還有其他人的地址。同樣，我們在這些方面也取得了進展，這些增長與我們所看到的相同。很多時候，這些都是兩位數，因為我們從——這可能是他們支付 80% 到 85% 的醫療保險，然後將他們提高到 100%，或者可能是從 80% 到 100%。 90%，但對於我們正在簽訂的一些合同來說，這確實是相當大的增長。

That's good to hear. And the last piece, I guess, on the pricing workers' comp. So what do you spend now in terms of your mix? And I guess because that's the highest rates of all the different payers, right? So what's the mix there? And kind of -- I know you kind of -- the bucket, so to speak, the client are in the pandemic, and I guess was there was some work being done to kind of bringing back maybe to the 14% pre-COVID of any update on that front?

聽起來還不錯。我想最後一篇是關於定價工人的補償。那麼您現在在組合方面的支出是多少？我想是因為這是所有不同付款人中最高的費率，對嗎？那麼那裡的混合是什麼？我知道你是這樣的，可以這麼說，客戶正處於大流行之中，我想是否正在做一些工作來恢復到新冠疫情前的 14%這方面有什麼更新嗎？

Yes. So for our mix -- go ahead. I'm sorry, Eric, are you going to say something?

是的。所以對於我們的混合——繼續吧。對不起，埃里克，你有什麼話要說嗎？

Yes. I was going to weigh in. This is Eric Williams in terms of where we're headed on the work comp side. So yes, we started putting in a lot of efforts second quarter of last year to rebuild some of the relationships with the networks we brought back in the individual who actually built the work comp program for us years ago.

是的。我本來打算參與其中。這是埃里克·威廉姆斯（Eric Williams），他介紹了我們在工作補償方面的發展方向。所以，是的，我們從去年第二季度開始投入大量努力，重建與幾年前為我們實際建立工作補償計劃的個人所帶回的網絡的一些關係。

And in second quarter of this year, this is the third straight quarter where we saw an uptick in volume, still a lot of opportunity. The volume we actually saw in Q2 was the highest volume we've seen over the course of the last 6 quarters. So we signed some new network agreements here beginning of the year. We've got a number of additional contracts in play right now, and we feel optimistic in terms of our ability to continue to drive this as a higher percentage of our mix it was just under 10% here in Q2 of this year.

今年第二季度，這是我們連續第三個季度看到銷量上升，仍然有很多機會。我們在第二季度實際看到的交易量是過去 6 個季度中我們看到的最高交易量。因此，我們今年年初在這裡簽署了一些新的網絡協議。我們現在已經簽訂了許多額外的合同，我們對繼續推動這一業務的能力感到樂觀，因為今年第二季度我們的比例略低於 10%。

And I would just say for workers' comp increase as a percent of the mix, is really notable because, as you know, our volume has been increasing pretty significantly. So they're increasing at a pace that is greater than our overall increase. So that's -- that's good. And they were closer to 9% in the first quarter as part of the mix and workers' comp is about 10% in the second quarter. To address just kind of the mix overall. Joanna, commercial is about 47% in the second quarter. Medicare is 34%, workers' comp is 10%, Medicaid was about 3.5% and then there's just everything else, which is maybe 6% or so.

我只想說，對於工人的薪酬增長所佔的比例來說，確實值得注意，因為如您所知，我們的數量一直在顯著增加。因此，它們的增長速度大於我們的總體增長速度。所以那是——那很好。作為組合的一部分，第一季度的工資接近 9%，第二季度的工人工資約為 10%。只是為了解決整體的混合問題。喬安娜，第二季度的商業化程度約為47%。醫療保險佔 34%，工人補償佔 10%，醫療補助約為 3.5%，然後就是其他一切，可能是 6% 左右。

Great. And so helpful, if I may, just squeeze last 1 on pricing and I guess the outlook into next year. So the America proposal calls for, call it, all in, 3.25% which that was finalized, would be worse than 2023 rate cut. So what's your take on that proposal? And how much work, I guess, is being there? And what's your visibility to Congress, stepping in again and trying to lessen that cut here.

偉大的。如果可以的話，非常有幫助，只需擠壓最後 1 個定價即可，我猜明年的前景。因此，美國的提案要求最終確定的 3.25% 的降息幅度將比 2023 年的降息還要糟糕。那麼您對該提議有何看法？我想，那裡有多少工作要做？你對國會的能見度如何，再次介入並試圖減少這裡的削減。

Obviously, does that proposed rule came out middle to the end of July as it does every year. So we're early in that process. Again, I mentioned APTQI in my prepared comments, our delivery partner, lobby group leadership in APTQI, all of our individual member companies who are very active in Washington are all putting a full court press. We just unfortunately, it's difficult in when we get finalized in December on a short runway changes necessary to immediately come out of the gate and over companies, and this is now a few years overall.

顯然，這項提議的規則是否會像每年那樣在七月中旬到月底出台？所以我們處於這個過程的早期。我在準備好的評論中再次提到了 APTQI，我們的交付合作夥伴、APTQI 的遊說團體領導層、我們所有在華盛頓非常活躍的個人會員公司都在全力施壓。我們只是不幸的是，當我們在 12 月最終確定需要立即走出大門並超越公司的短跑道變更時，這是很困難的，而現在已經過去了幾年。

We think it's very misplaced these reductions they're picking on probably the greatest value in health care for returning people to function from significant injuries and surgeries, which sell work without physical therapy, but it's early. And in summer, and so we've got not as we have in the past, a lot more work to do. I'm hopeful we'll make progress. I'm not going to give you much more than that on a crystal ball because I don't know yet. But we're going to -- the effort is massive directionally in that regard.

我們認為，他們選擇的這些削減可能是醫療保健領域最大的價值，可以幫助人們從嚴重受傷和手術中恢復功能，這些削減是非常錯誤的，這些手術在沒有物理治療的情況下出售工作，但現在還為時過早。在夏天，我們不像過去那樣有更多的工作要做。我希望我們能取得進展。我不會給你比水晶球更多的信息，因為我還不知道。但我們將在這方面做出巨大的定向努力。

We'll take the next question from Larry Solow with CJS Securities.

我們將回答 CJS 證券的拉里·索洛 (Larry Solow) 提出的下一個問題。

My question was answered already, but go to see, I guess, the topic to that on the pricing. But it does feel like, I guess, just in terms of your guidance just on the shorter term, you didn't -- it feels like you have a little bit of a tailwind, at least going to the back half just from fixing up some of the scheduling misalignments and walking away from some of these Medicare agreement that you just spoke to, right?

我的問題已經得到解答，但我想，請看看有關定價的主題。但我想，就你的短期指導而言，你確實感覺沒有——感覺你有一點順風，至少從修復中進入後半部分一些日程安排不一致以及放棄您剛才談到的一些醫療保險協議，對吧？

So again, not asking you to do it as guide on the back half of pricing, but perhaps this is at least a low watermark for the year, it could slowly work our way up in the back half. Is that fair to say?

再說一遍，並不是要求您將其作為後半段定價的指南，但也許這至少是今年的低水位線，它可能會在後半段慢慢上升。這麼說公平嗎？

We do believe there's potential to move that rate out, yes, based on the things that we've talked about today, the things we think it's addressable and related to the work we've already done. Yes.

我們確實相信有可能取消該利率，是的，基於我們今天討論的事情，我們認為這是可以解決的並且與我們已經完成的工作相關的事情。是的。

And obviously, the negotiation is much more of a multi-yield thing, and you touched on sort of gas just like not getting 1% price increase you're getting probably more than that or a lot more than that mid-single digits or whatever, but you have so many contracts, right? So I (inaudible), that you're only moving 5% of the time or whatever, right? So it gets divided by 20% or maybe not that much, but a multiplier effect. But so fair to say that you still probably haven't worked through a lot or majority of your contracts haven't changed.

顯然，談判更多的是一種多收益的事情，你談到了某種天然氣，就像沒有獲得1% 的價格上漲一樣，你得到的可能比這個多，或者比中間個位數多得多，或者其他什麼。但你有這麼多合同，對吧？所以我（聽不清），你只有 5% 的時間在移動或者其他什麼，對吧？所以它會被除以 20%，或者可能不是那麼多，但會產生乘數效應。但公平地說，您可能仍然沒有完成很多工作，或者大部分合同都沒有改變。

Yes, that's right. That's not even close. We've got a lot more to do.

恩，那就對了。那還差得遠。我們還有很多事情要做。

Okay. Okay. Great. And just in terms of volume. Obviously, a really good, strong first half, really back half of the year. Is there anything sort of incorporated you kind of -- I think the average volume in the first half was like [4.5%] up we look at both quarters. Do you expect those trends to continue in the back half or more historical rate on or 2% to 3%, which is what we actually saw this quarter, but any thoughts on that?

好的。好的。偉大的。僅就數量而言。顯然，上半年非常好，很強勁，下半年也非常好。有沒有什麼東西可以把你納入進來——我認為上半年的平均交易量大約上升了[4.5%]，我們看看兩個季度。您是否預計這些趨勢會在後半段或更高的歷史水平上繼續下去，即 2% 至 3%，這是我們本季度實際看到的，但對此有什麼想法嗎？

I mean if you look back to last year, to the front part of the last year, we didn't have the scarcity that we really became acute in, I would say, probably in June of last year and forward, we didn't have the question of all the other things. And so -- the first half of this year, actually, the part that we're in are just completed had tougher comps, the second half of a year ago in '22 we actually. We couldn't address all the volume that we might have just because staffing was so tight.

我的意思是，如果你回顧去年，去年的前半段，我們並沒有真正變得嚴重的稀缺性，我想說，可能是在去年六月及以後，我們沒有有所有其他事情的問題。所以 - 今年上半年，實際上，我們剛剛完成的部分有更艱難的比較，實際上是一年前的 22 年下半年。我們無法僅僅因為人員配備太緊張而解決我們可能擁有的所有數量。

And so I can tell you, staffing's not easy right now, but it feels a lot better than included a year ago, we made adjustments. Our team has done a really good job and so I'm hoping we can expand some of those same-store numbers just because in part, volume has continued to be strong, but our comp is a little bit weaker in the second half of the year.

所以我可以告訴你，現在人員配置並不容易，但是感覺比一年前好多了，我們做了調整。我們的團隊做得非常好，所以我希望我們能夠擴大其中一些同店數量，部分原因是銷量持續強勁，但我們的競爭在下半年有點弱年。

Yes. The weakness comment I would say that the first quarter was such a big jump because it was -- we just -- we've never experienced volumes like that in January and February, particularly. And so that was a really nice jump in the first quarter. I wouldn't expect it to get back like the 6% mature clinic growth in the second half of the year. But as Chris mentioned, the comps are a little bit -- are not quite as strong as we go into the back half of the year.

是的。疲軟評論 我想說，第一季度的增幅如此之大，因為我們從未經歷過像一月和二月那樣的交易量，特別是在一月和二月。所以第一季度的跳躍非常好。我預計它不會像下半年成熟診所 6% 的增長那樣恢復。但正如克里斯所提到的，競爭有點——不像我們進入今年下半年那樣強勁。

Got you. And you probably -- obviously, like you said, what better position at the beginning of this back half anywhere last year to in terms of your staffing. Okay. Just last question, Carey, while you're here. Just you mentioned you've done a really good job and costs on a per visit basis or down overall cost really hung in that overall margin in the last few years has actually been pretty steady despite rapid inflation and price pressure, which we really commendable to you guys.

明白你了。顯然，就像你說的，去年下半年開始時的人員配置方面，有什麼比這更好的位置了。好的。最後一個問題，凱里，你在這兒的時候。剛才您提到，您做得非常好，每次訪問的成本或總體成本確實下降了，儘管通貨膨脹和價格壓力快速，但過去幾年的總體利潤率實際上相當穩定，我們真的值得稱讚你們。

Can you just explain to me how come on a -- if I just look on a year-over-year basis, your margins, salary as a percentage of revenue and it's still up. Is that just more of a function of the acquired clinics pricing? Or what's kind of driving that?

你能否向我解釋一下，如果我只看同比情況，你的利潤率、工資佔收入的百分比，而且它仍然在上升，這是怎麼回事？這是否更多地取決於所收購診所的定價？或者是什麼驅動了它？

Yes. It's a combo because when you're looking at those percentages, you're looking at -- there's a double impact, right? There's the impact of volume and there's impact of rate. And so I think that the rate and how that influences revenue when you're looking at those costs as a percent of revenue is really -- is what impacts that.

是的。這是一個組合，因為當你查看這些百分比時，你會看到——有雙重影響，對嗎？有數量的影響和速率的影響。因此，我認為，當你將這些成本佔收入的百分比視為真正影響收入的因素時，費率及其對收入的影響方式才是真正的影響因素。

Yeah, I still agree with you. It's driven off. It's a driver. It's reflective of the pressure that I think we've done it pretty well with the pressure on that rate.

是的，我仍然同意你的觀點。已經被趕走了這是一名司機。這反映了壓力，我認為我們在這個利率的壓力下做得很好。

Yeah, and that's why the best metric we believe to look at for those costs is looking at on a per visit basis.

是的，這就是為什麼我們認為衡量這些成本的最佳指標是基於每次訪問。

That's all. I totally understand why you do that, appreciate that color.

就這樣。我完全理解你為什麼這樣做，欣賞那種顏色。

We'll take our next question from Matt Larew with William Blair.

我們將回答馬特·拉魯和威廉·布萊爾提出的下一個問題。

It's Madeline Mollman for Matt. Just one on the segment. I know it was down slightly this quarter, and you mentioned that some contracts -- you talked to some customers about delaying contracts or pushing them back or putting pause on them. With the macro environment starting to improve -- have you seen these customers reengaging, wanting to restart contracts, beginning discussions for that at all?

我是馬特琳·莫爾曼。該段中只有一個。我知道本季度略有下降，您提到了一些合同 - 您與一些客戶討論了推遲合同或推遲合同或暫停合同的問題。隨著宏觀環境開始改善——您是否看到這些客戶重新參與，想要重新啟動合同，並開始對此進行討論？

No. I'm going to tell you, and I don't know that, that today, close to know if we have certain contracts where people were concerned and now that they're not. I honestly -- I think things are coming still with those few customers, not a lot, and it's heavily weighted on the tech side of the business. What their business is heavily tech influenced. I still think they're kind of same outlook as they were before. Having said that, we've added a lot of good customers this year and across both partnerships, we further diversified our client base.

不，我要告訴你，我不知道，今天，我們很接近知道我們是否有某些人們關心的合同，但現在卻不是了。老實說，我認為那些少數客戶的情況仍然存在，而不是很多，而且它在業務的技術方面佔據了很大的比重。他們的業務深受科技影響。我仍然認為他們的觀點與以前相同。話雖如此，我們今年已經增加了很多優質客戶，通過這兩種合作夥伴關係，我們進一步實現了客戶群的多元化。

But to my knowledge, and Eric, you might speak to it. I don't know if we've seen any big reversals that are meaningful yet.

但據我所知，埃里克，你可能會說出來。我不知道我們是否已經看到任何有意義的大逆轉。

No, I would agree with that. I think you summed that up perfect, Chris. I mean the IIP businesses have done a nice job of trying to diversify their portfolios. But the tech sector and the automotive sector got hurt really hard. And that was a business that we saw fall away tail end of last year. We've seen other customers on the retail side and distribution side actually increased.

不，我同意這一點。我認為你總結得很完美，克里斯。我的意思是，國際投資頭寸企業在嘗試實現投資組合多元化方面做得很好。但科技行業和汽車行業受到的打擊非常嚴重。我們在去年年底看到這項業務的下滑。我們看到零售方面和分銷方面的其他客戶實際上有所增加。

So on a macro basis, I think things have stabilized. And I think there's opportunity for growth here going forward, but not near as robust as it was in 2022.

因此，從宏觀角度來看，我認為情況已經穩定下來。我認為未來存在增長機會，但不會像 2022 年那樣強勁。

Great. And then again, on IIP, can you talk a little bit about what you expect past 2023? I know this is a more muted year, the long-term growth for that segment to be? I think last year, same-store growth was in the 20% range for the first 3 quarters of 2022. So just what can we expect that segment to grow over time.

偉大的。再說一次，關於國際投資頭寸，您能談談您對 2023 年之後的預期嗎？我知道今年是更加平靜的一年，該細分市場的長期增長是什麼？我認為去年 2022 年前 3 季度的同店增長在 20% 範圍內。那麼我們可以預期該細分市場隨著時間的推移會增長多少。

Look, we haven't had IIP all that long, and the growth has been extraordinary. So for me, right now, it has many moving parts as we're in between politics and the economy and interest rate environment and the fed all the many things that influence. CEOs and CFOs to make decisions they aren't uniform across the country because different sectors, as Eric mentioned, recover at different rates or get hot or cold at a different times.

看，我們的國際投資頭寸還沒有持續多久，但增長卻非常驚人。所以對我來說，現在它有很多變化的部分，因為我們處於政治、經濟、利率環境以及美聯儲所有影響因素之間。首席執行官和首席財務官在全國范圍內做出的決策並不統一，因為正如埃里克提到的那樣，不同的行業以不同的速度復甦，或者在不同的時間變熱或變冷。

So expect us to be ahead of our PT growth and to be very positive as we go forward. All other macro things being relatively stable and equal. We've demonstrated that we can grow this business through acquisition. Our clients, generally speaking, are very, very sticky. They stick with us, most clients expand, particularly those clients that have numerous operations positioned around the country. But I'm not going to be able to take a growth rate at this point because I just don't have topics that are clear enough to do that.

因此，期望我們能夠領先於 PT 的增長，並在前進過程中保持非常積極的態度。所有其他宏觀事物都相對穩定和平等。我們已經證明我們可以通過收購來發展這項業務。一般來說，我們的客戶非常非常粘。他們堅持與我們合作，大多數客戶都在擴張，特別是那些在全國各地擁有眾多業務的客戶。但目前我無法確定增長率，因為我沒有足夠清晰的主題來做到這一點。

At this time, we have no further questions in queue. I will turn the call back to Chris Reading for any additional or closing remarks.

目前，我們隊列中沒有其他問題。我會將電話轉回克里斯·雷丁（Chris Reading）以獲取任何補充或結束語。

Yes. Thanks, everyone. We know we covered a lot. We appreciate your time and attention this morning and Carey and I are available today and rest of the week and next week, we've got board meetings come for next week. But after that, we'll come back up for air. So if you have any questions or any follow-up necessary, please give us a call, and have a great day.

是的。感謝大家。我們知道我們涵蓋了很多。感謝您今天早上的時間和關注，凱里和我今天以及本週剩餘時間和下週都有空，我們下週將召開董事會會議。但在那之後，我們會回來呼吸空氣。因此，如果您有任何疑問或需要任何後續行動，請致電我們，祝您有美好的一天。

Thank you all. This concludes the U.S. Physical Therapy Second Quarter 2023 Earnings Conference Call. You may disconnect your line at this time, and have a wonderful day.

謝謝你們。美國物理療法 2023 年第二季度收益電話會議至此結束。此時您可以斷開線路，度過美好的一天。