Viemed Healthcare Inc (VMD) 2024 Q3 法說會逐字稿

Greetings and welcome to Viemed's third quarter 2024 earnings conference call. (Operator Instructions) As a reminder, this conference is being recorded.

歡迎參加 Viemed 2024 年第三季財報電話會議。（操作員指示）謹此提醒，本次會議正在錄製中。

I would now like to turn the conference over to your host, Todd Zehnder COO. Thank you. You may begin.

現在我想將會議交給主持人 Todd Zehnder 營運長。謝謝。你可以開始了。

All right. Thank you, Rob. Good morning, everyone. We appreciate you joining us today. Please note that our remarks in this conference call may include forward-looking statements under the US federal securities laws or forward-looking information under applicable Canadian securities legislation, which we collectively refer to as forward-looking statements.

好的。謝謝你，羅布。大家早安。我們感謝您今天加入我們。請注意，我們在本次電話會議中的言論可能包括美國聯邦證券法規定的前瞻性陳述或適用的加拿大證券立法規定的前瞻性信息，我們將其統稱為前瞻性陳述。

Such statements reflect the Company's current views and intentions with respect to future results or events and are subject to certain risks and uncertainties, which could cause the actual results or events to vary from those indicated in forward-looking statements. Examples of such risks and uncertainties are discussed in our disclosure documents filed with the SEC or the security regulatory authorities in certain provinces of Canada.

此類陳述反映了公司目前對未來結果或事件的看法和意圖，並受到某些風險和不確定性的影響，這可能導致實際結果或事件與前瞻性陳述中所示的結果或事件不同。我們向美國證券交易委員會或加拿大某些省份的安全監管機構提交的披露文件中討論了此類風險和不確定性的例子。

Because of these risks and uncertainties, investors should not place undue reliance on forward-looking statements. The forward-looking statements made in this conference call are made as of today, and the Company undertakes no obligations to update or revise any forward-looking statements, except as required by law. The third quarter financial news release, including the related financial statements, are available on the SEC's website.

由於這些風險和不確定性，投資者不應過度依賴前瞻性陳述。本次電話會議中所作的前瞻性陳述截至今天，除法律要求外，本公司不承擔更新或修改任何前瞻性陳述的義務。第三季財務新聞稿，包括相關財務報表，可在 SEC 網站上取得。

I'll now turn it over to Viemed's CEO, Casey Hoyt to get things started.

現在我將把它交給 Viemed 的執行長 Casey Hoyt 以開始工作。

Okay. Thank you, Todd, and good morning, everyone. We appreciate you joining us today. The third quarter results exceeded both our projections and expectations, driven by continued organic growth in our core businesses as well as continued growth from recent M&A activity, leading to strong year-over-year and sequential growth in net revenue.

好的。謝謝托德，大家早安。我們感謝您今天加入我們。在核心業務持續有機成長以及近期併購活動持續成長的推動下，第三季業績超出了我們的預測和預期，導致淨收入同比和環比強勁增長。

Our third quarter net revenue established yet another company record of $58 million, exceeding the top end of our guidance and establishing a pathway to a strong finish in 2024.

我們第三季的淨收入再創公司紀錄，達到 5,800 萬美元，超出了我們指導的上限，並為 2024 年實現強勁目標奠定了基礎。

I want to acknowledge and thank our incredible Viemed family, which now numbers more than 1,150 employees. Their dedication to our Live Your Life mission and their relentless focus on patient satisfaction and operational performance will enable a strong finish to 2024.

我要感謝我們令人難以置信的 Viemed 家族，目前擁有超過 1,150 名員工。他們對「Live Your Life」使命的奉獻精神以及對病患​​滿意度和營運績效的不懈關注將為 2024 年取得圓滿成功。

You've heard us talk about earning the trusted place in the home for some time. I want to drill down on that a bit more this morning and why it matters. Viemed is substantially differentiated from HME providers to the point that we believe that even the description home medical equipment doesn't fully capture exactly what we're doing in the home and the value we're proving out every day to patients, providers and payers.

一段時間以來，您已經聽到我們談論如何贏得家庭中值得信賴的地位。今天早上我想更深入地探討這一點以及為什麼它很重要。Viemed 與 HME 提供者有很大區別，以至於我們相信，即使是家庭醫療設備的描述也不能完全準確地反映我們在家中所做的事情以及我們每天向患者、提供者和付款人證明的價值。

It's clear that there is a trend of providing clinical care in the home. Patients want to be treated in the comfort and safety of their home, hospitals and health systems want to avoid readmissions and payers know that the costs are lower in the home versus an institutional setting.

很明顯，在家中提供臨床護理已成為一種趨勢。患者希望在家中舒適和安全地接受治療，醫院和衛生系統希望避免再次入院，付款人知道在家中的費用比機構環境中的費用低。

Improving outcomes, patient satisfaction and operational efficiency are the pillars for delivering care in the home. Viemed has been a leader since day one with our high-touch, high-technology care model. What's become clear to us is that in today's environment, patient satisfaction is more critical than ever.

改善治療效果、病患滿意度和營運效率是提供居家照護的支柱。Viemed 從第一天起就憑藉我們的高接觸、高科技護理模式一直處於領先地位。我們清楚的是，在當今的環境下，患者滿意度比以往任何時候都更重要。

A focus on patient outcomes and personalized care, not to mention offering support to address patient concerns becomes increasingly important, particularly when it comes to patient compliance. Utilizing advanced tools such as our proprietary Engage platform can boost provider communication and care coordination.

關注患者的治療結果和個人化護理，更不用說提供支持來解決患者的擔憂變得越來越重要，特別是在患者依從性方面。利用我們專有的 Engage 平台等先進工具可以促進提供者的溝通和護理協調。

These solutions need to be scalable to streamline operations and provide the accurate data ultimately needed for value-based care. This isn't a future state we're talking about at Viemed. This is the model that we have been deploying with our RTEs at the center of everything we do in the home.

這些解決方案需要具有可擴展性，以簡化營運並提供基於價值的護理最終所需的準確數據。這不是我們在 Viemed 談論的未來狀態。這是我們一直在部署的模型，我們的 RTE 是我們在家中所做的一切的中心。

It's the reason why we've allocated capital investments in technology, recruiting, training and the provision of social services we offer to our patients. We're ready for where the industry should be going, and we expect to continue to lead it.

這就是我們在技術、招聘、培訓和為患者提供社會服務方面進行資本投資的原因。我們已準備好迎接產業的發展方向，並期望繼續引領產業發展。

On the regulatory front, we're seeing some positive signs of support for the industry. Viemed has been a leading advocate for the reconsideration of NCD 280.1, emphasizing objective and comprehensive coverage policies for NIV therapy.

在監管方面，我們看到了一些對該行業支持的積極跡象。Viemed 一直是重新考慮 NCD 280.1 的主要倡導者，強調 NIV 治療的客觀和全面的覆蓋政策。

We believe that the request for the NCD is another signal we've seen from CMS that they are serious about holding MA plans accountable for appropriate guidelines to deliver clinical care.

我們認為，對 NCD 的請求是我們從 CMS 看到的另一個訊號，表明他們認真地要求 MA 計劃對提供臨床護理的適當指南負責。

The majority of comments submitted on the NCD have been positive, and we think this is a real opportunity for the industry to serve those in need and facilitate continued expansion. The reason we've been proactive on the NCD is that establishing clear and consistent guidelines will create a stable business environment for providers and reduce uncertainty for patients.

大多數關於非傳染性疾病的評論都是正面的，我們認為這是該行業為有需要的人提供服務並促進持續擴張的真正機會。我們在非傳染性疾病方面積極主動的原因是，建立清晰一致的指導方針將為醫療服務提供者創造穩定的商業環境，並減少患者的不確定性。

The research supports the efficacy of the NIV, resulting in significant reductions in costs, hospitalizations and improved patient outcomes. And the data exhibits there is medical necessity for putting patients on the device immediately and improving their quality of life.

研究支持 NIV 的功效，可顯著降低費用、住院率並改善患者預後。數據表明，立即讓患者使用該設備並改善他們的生活品質具有醫療必要性。

We've submitted our comments on the NCD and have sponsored or supported much of the research cited in other comments. We'll continue to provide a leadership role through Viemed and through the industry trade associations.

我們已經提交了關於非傳染性疾病的評論，並贊助或支持了其他評論中引用的大部分研究。我們將繼續透過 Viemed 和行業貿易協會發揮領導作用。

I'd also like to highlight that there has been some recent movement on the [75-25] reimbursement relief. Recall that this rate adjustment for certain products in certain areas would increase Medicare reimbursements for providers serving those areas.

我還想強調，最近在 [75-25] 報銷減免方面出現了一些進展。回想一下，某些地區某些產品的費率調整將增加為這些地區提供服務的提供者的醫療保險報銷。

This isn't dead by any means. It adds positive momentum with some recent legislative support, and it should be backed up for consideration at the end of the year. As we've noted before, restoration of this relief would be positive for the financial performance in 2025.

這無論如何都沒有死。它通過最近的一些立法支持增加了積極的勢頭，並且應該在年底得到支持以供考慮。正如我們先前指出的，恢復這項減免措施將對 2025 年的財務表現產生正面影響。

Let me now turn to some brief updates on the business. The continued strength of our vent business was on display again this quarter with a 4.3% sequential increase in active vent patients. That sequential growth is usually a leading indicator for future quarters and reinforces the positive outlook we have on the business. The 400-plus increase in vent patients we've experienced in both Q2 and Q3 is as good as we produced in a number of years.

現在讓我談談有關該業務的一些簡短更新。本季度，我們的呼吸機業務再次展現出持續的強勁勢頭，活躍的呼吸機患者數量環比增加了 4.3%。這種連續成長通常是未來幾季的領先指標，並強化了我們對業務的積極前景。我們在第二季和第三季經歷的通氣患者增加了 400 多名，這與我們多年來的表現一樣好。

One of the reasons our vent growth has been so strong is the operational overhaul we completed earlier in the year. Those efforts resulted in internal processes, driving higher vent utilization and vent patient billings.

我們的通風口成長如此強勁的原因之一是我們在今年稍早完成的營運檢修。這些努力催生了內部流程，推動了更高的排氣利用率和排氣患者費用。

The new sales structure we put in place and discussed last quarter is having an impact as well. With an 18% increase in average monthly setups per sales rep compared with what they were producing prior to the implementation, we've been accelerating the recruitment of sales reps to maintain our industry-leading organic growth. We expect to have more to report on this effort in Q4.

我們在上季實施並討論的新銷售結構也產生了影響。與實施前相比，每位銷售代表的平均每月設定增加了 18%，我們一直在加快銷售代表的招聘，以保持行業領先的有機成長。我們預計在第四季度將有更多關於這項工作的報告。

In our sleep business, all I can say is what a difference a quarter makes in terms of the overall narrative around GLP-1 drugs. Based on what we've seen from ResMed and others so far, we believe it's pretty conclusive that GLP-1s are not impeding the growth of the sleep business.

在我們的睡眠業務中，我只能說一個季度對 GLP-1 藥物的整體敘述產生了多大的影響。根據我們迄今為止從 ResMed 和其他公司看到的情況，我們相信 GLP-1 不會阻礙睡眠業務的成長是相當確定的。

As we noted before, in fact, it appears to be bringing more patients into treatment for sleep apnea and other disorders as they lose weight. Despite the increasing use of GLP-1 therapies for weight loss, both obesity and sleep apnea rates continue to climb.

正如我們之前指出的，事實上，隨著體重減輕，它似乎讓更多的患者接受睡眠呼吸中止症和其他疾病的治療。儘管越來越多地使用 GLP-1 療法來減肥，但肥胖和睡眠呼吸中止症的發生率仍在繼續攀升。

For patients with moderate to severe obesity-related sleep apnea, research consistently shows that combining PAP therapy with weight loss provides greater benefits than either treatment alone.

對於患有中度至重度肥胖相關睡眠呼吸中止症的患者，研究一致表明，將 PAP 治療與減肥相結合比單獨使用任何一種治療都有更大的益處。

Real-world data reveals that OSA patients prescribed GLP-1 medications are 10.8% more likely to start PAP therapy with significantly higher adherence rates, evidenced by increased PAP resupply orders at one- and two-years post setup.

真實世界數據顯示，服用 GLP-1 藥物的 OSA 患者開始 PAP 治療的可能性高出 10.8%，且依從率顯著提高，這一點可以從設定後一年和兩年的 PAP 補給訂單增加證明。

The improvement in sentiment and the increasing amount of published research lines up with what we're seeing in our business. We're seeing sequential growth in CPAP units, patients, resupply orders and home sleep tests. Even though sleep is currently contributing 17% of our total revenue as of Q3, we believe we've only scratched the surface of what this business can contribute to our overall growth.

情緒的改善和發表的研究數量的增加與我們在業務中看到的情況相符。我們看到 CPAP 設備、患者、補給訂單和家庭睡眠測試的連續成長。儘管截至第三季度，睡眠業務目前占我們總收入的 17%，但我們相信，我們只觸及了這項業務對我們整體成長的貢獻的表面。

We're still on track with our East Alabama joint venture integration plans. We've made incremental progress each of the last two quarters. And as this is our test case for future JVs like this, we are easing our way into our growth plans. We outlined a plan for annualized revenue of approximately $4 million when we made this acquisition, and that's the path we're on. We expect to have more to report out on the JV at the year end.

我們仍在按計劃實施東阿拉巴馬合資企業整合計劃。過去兩個季度我們每季都取得了漸進的進展。由於這是我們對未來此類合資企業的測試案例，因此我們正在逐步實施我們的成長計劃。當我們進行這次收購時，我們制定了年化收入約為 400 萬美元的計劃，這就是我們正在走的道路。我們預計年底會有更多關於合資企業的報告。

Our M&A pipeline remains robust with a focus on adding complementary services that could expand our core businesses. These new opportunities could also build on the strong relationships we've already earned with patients and could enhance our value to providers and payers through greater scale and efficiencies.

我們的併購管道仍然強勁，重點是增加可擴展我們核心業務的補充服務。這些新機會還可以建立在我們與患者已經建立的牢固關係的基礎上，並可以透過​​更大的規模和效率來提高我們對提供者和付款人的價值。

Overall, I'm pleased with how we've executed throughout this quarter. We've regularly challenged our team to hit our strategic goals, and they've delivered. With record-breaking quarters in 2024 on top of our highest EBITDA quarter ever in Q3, we have built up a lot of positive momentum for the fourth quarter that will feed into 2025.

總的來說，我對我們整個季度的執行感到滿意。我們定期向我們的團隊提出挑戰，要求他們實現我們的策略目標，他們已經實現了。繼第三季 EBITDA 有史以來最高季度之後，我們在 2024 年實現了創紀錄的季度業績，我們已經為第四季度積累了許多積極的勢頭，並將持續到 2025 年。

The increasing vent patient and sleep patient growth, together with our sleep resupply business provide a strong base of organic growth. We have no intention of letting up. We are laser-focused internally on finishing on a strong note, which will provide the exit velocity for a stronger year in 2025.

不斷增加的通氣患者和睡眠患者的成長，加上我們的睡眠補給業務，為有機成長奠定了堅實的基礎。我們無意放鬆。我們內部集中精力以強勁的業績收尾，這將為 2025 年實現更強勁的一年提供退出速度。

For more on our operational and financial results for the quarter, I'll turn the call back over to Todd.

有關本季度營運和財務業績的更多信息，我會將電話轉回給托德。

All right. Thanks, Casey. In reviewing the financial results, all figures are in US dollars and the full results have been made available on the SEC website. I'll focus my prepared comments on providing some additional color behind our strong performance. You'll notice we added some new disclosures this quarter around our sleep therapy patient count and sleep resupply orders.

好的。謝謝，凱西。在審查財務結果時，所有數據均以美元為單位，完整結果已在 SEC 網站上發布。我將把準備好的評論重點放在為我們的強勁表現背後提供一些額外的色彩。您會注意到，我們本季添加了一些有關睡眠治療患者數量和睡眠補給訂單的新揭露資訊。

Based on feedback we've received from the investment community, we've been exploring some incremental disclosures that can assist in measuring our performance. Our goal is to build on these disclosures over the next couple of quarters.

根據我們從投資界收到的回饋，我們一直在探索一些可以幫助衡量我們績效的增量揭露。我們的目標是在接下來的幾季以這些披露為基礎。

The new company record for revenue this quarter and the 17% increase was driven almost entirely by organic growth with organic or acquired revenue accounting for $1.1 million of that year-over-year increase. Our revenue increased 6% on a sequential basis with inorganic or acquired revenue accounting for only $327,000.

本季度公司營收新紀錄以及 17% 的成長幾乎完全是由有機成長推動的，其中有機或收購收入佔同比增長的 110 萬美元。我們的營收季增 6%，無機收入或收購收入僅為 327,000 美元。

The organic growth story at Viemed is alive and well and in our mind, provides a high level of predictability of growth in a very capital-efficient manner. Our core business in vents accounted for 55% of the revenue this quarter with sleep increasing to 17%.

Viemed 的有機成長故事充滿活力，在我們看來，它以非常資本高效的方式提供了高水準的成長可預測性。我們的核心業務通風口佔本季營收的 55%，其中睡眠業務增加至 17%。

Our oxygen and staffing businesses continue to grow as well with those each contributing roughly 10% of this quarter's revenue. We're also making incremental improvements with the East Alabama Medical Center JV.

我們的氧氣和人員配備業務也在持續成長，這兩項業務分別貢獻了本季營收的約 10%。我們也與東阿拉巴馬醫療中心合資企業進行漸進式改善。

Gross margin was fairly consistent with the last two quarters at 59.3%. Recall, that's down year-over-year due to a change in product and service mix as sleep, oxygen and staffing continue to grow at a faster rate. Slightly above and below the 60% mark is where this current business mix should be.

毛利率與前兩季相當一致，為 59.3%。回想一下，由於產品和服務組合的變化，睡眠、氧氣和人員配備繼續以更快的速度增長，這一數字比去年同期下降。目前的業務組合應該處於略高於或低於 60% 的水平。

The EBITDA margin for the quarter was 24.1%, which is up from 23.3% in the second quarter and compares favorably with 24.5% a year ago. We've made substantial improvement each quarter, and we're aiming for another strong performance in the fourth quarter.

本季 EBITDA 利潤率為 24.1%，高於第二季的 23.3%，與去年同期的 24.5% 相比也表現良好。我們每季都取得了實質的進步，我們的目標是在第四季再創強勁表現。

We've done a really good job of managing SG&A with these expenses down to 46% of revenue this quarter compared with 48% in the second quarter and 48% a year ago. We are investing in new sales talent and improving our patient experience in the home.

我們在管理 SG&A 方面做得非常好，本季這些費用佔收入的比例降至 46%，而第二季為 48%，一年前為 48%。我們正在投資新的銷售人才並改善我們的患者在家中的體驗。

The continued reduction in SG&A as a percentage of revenue is a reflection of good cost controls, but also the leverage we're getting from better productivity and efficiencies from operational and process improvements that have been put in place. As expected, our gross CapEx this quarter was higher than normal, driven by our strategic acceleration of the vent exchange initiative.

SG&A 佔收入百分比的持續下降反映了良好的成本控制，同時也反映了我們從已實施的營運和流程改善中提高生產力和效率中獲得的槓桿作用。正如預期的那樣，在我們策略性加速通風交換計畫的推動下，我們本季的總資本支出高於正常水準。

For the quarter, we invested approximately $11 million on CapEx, primarily on various respiratory equipment for our patients. Offsetting these purchases was approximately $6 million of related sales and exchange proceeds, putting our net cash CapEx for the quarter at approximately $5 million.

本季度，我們在資本支出上投資了約 1,100 萬美元，主要用於為患者提供各種呼吸設備。大約 600 萬美元的相關銷售和交換收益抵消了這些購買，使我們本季的淨現金資本支出約為 500 萬美元。

We expect to sell more vents over the next several quarters, but the pace and amount will be determined by the remediation process established by Philips and the related governmental agencies.

我們預計在未來幾季銷售更多的通風口，但速度和數量將取決於飛利浦和相關政府機構制定的補救流程。

We have once again funded our CapEx out of discretionary cash flow and continue to manage the business in order to drop free cash flow onto the balance sheet. Our percentage of net CapEx to EBITDA was at 36% this quarter compared with 64% in the second quarter and 58% a year ago. We will continue to update our free cash flow disclosure on an annual basis.

我們再次從可自由支配的現金流中為我們的資本支出提供資金，並繼續管理業務，以便將自由現金流納入資產負債表。本季我們的淨資本支出佔 EBITDA 的比例為 36%，而第二季為 64%，一年前為 58%。我們將繼續每年更新我們的自由現金流揭露。

Similar to last quarter, we recorded a small gain of $0.5 million that was primarily driven by the Trilogy return program. We would expect to continue reporting these gains until the project is completed, likely next year.

與上季類似，我們錄得 50 萬美元的小額收益，這主要是由 Trilogy 退貨計劃推動的。我們預計將繼續報告這些成果，直到專案完成（可能在明年）。

The balance sheet remains in great shape as we paid down our line of credit by $2 million during the quarter, giving us $55 million available on our credit facilities, along with a $30 million accordion if needed for an attractive use of proceeds. We built up cash by $2.5 million to $11.3 million as of quarter end and improved working capital to $11.3 million.

資產負債表仍然保持良好狀態，因為我們在本季度支付了200 萬美元的信貸額度，為我們的信貸安排提供了5500 萬美元的可用資金，如果需要的話，還可以提供3000 萬美元的手風琴，以有吸引力地使用收益。截至季末，我們的現金增加了 250 萬美元，達到 1,130 萬美元，營運資金增加到 1,130 萬美元。

The tremendous opportunity we have to upgrade our vent fleet through the Philips buyback is enabling us to prioritize investing in our organic growth. The increased liquidity also gives us the flexibility to consider additional M&A in the future that can be complementary to our growth.

透過飛利浦回購，我們擁有升級通風口系列的巨大機會，這使我們能夠優先投資於我們的有機成長。流動性的增加也使我們能夠靈活地考慮未來進行更多併購，以補充我們的成長。

The momentum in the business is demonstrated in our outlook for the fourth quarter. We are anticipating net revenue in the range of $59.7 million to $60.9 million. The midpoint of that range implies sequential growth of 4.0% and a year-over-year increase of 18.9%. This outlook is based on sequential growth in vent patients, continued contribution from our sleep business, along with anticipated growth in our other products.

我們對第四季度的展望證明了該業務的勢頭。我們預計淨收入在 5,970 萬美元至 6,090 萬美元之間。該範圍的中點意味著環比增長 4.0%，同比增長 18.9%。這一前景是基於通氣患者的持續成長、我們睡眠業務的持續貢獻以及我們其他產品的預期成長。

There aren't too many moving parts for us coming into the fourth quarter. Without assuming any material diversion from the margin profile we've experienced most of this year and the typical liquidity ramp we see during the fourth quarter, we believe it's realistic to expect a solid adjusted EBITDA finish to the year as well.

進入第四季度，我們沒有太多變化。在不假設我們今年大部分時間經歷的利潤率狀況發生任何重大轉移以及第四季度我們看到的典型流動性增長的情況下，我們相信預計今年調整後的EBITDA 也將實現穩健的預期是現實的。

With the improvement we've made every quarter this year from operational and sales efficiencies, driving organic growth, self-funding CapEx through cash flow and improving the balance sheet, it's critical to maintain that momentum and operational excellence during the fourth quarter. We're confident that we will, which should position us very well for a good year in 2025.

隨著今年每季我們在營運和銷售效率、推動有機成長、透過現金流自籌資本支出以及改善資產負債表方面取得的進步，在第四季度保持這一勢頭和卓越營運至關重要。我們有信心做到這一點，這將為我們在 2025 年的美好一年做好準備。

Thank you for joining us today. This concludes our prepared remarks. We will now open the floor up for questions.

感謝您今天加入我們。我們準備好的演講到此結束。我們現在開始提問。

(Operator Instructions) Brooks O'Neil, Lake Street Capital Markets.

（操作員說明）Brooks O'Neil，湖街資本市場。

Thank you, very much and good morning, guys. Congratulations on the terrific progress you're making. To be honest, you guys provided such a great overview. I only have one significant question, and I probably should know the answer to this before I even ask it.

非常感謝你們，大家早安。祝賀您的巨大進步。老實說，你們提供了非常好的概述。我只有一個重要的問題，在我提出這個問題之前我可能應該知道答案。

But Casey provided a nice overview of the positive shift in the regulatory environment. I'm curious if what they're talking about involves any increased reimbursement or maybe I should say, any change in reimbursement? Or is it just clarifying some of the usage guidelines and whatnot?

但凱西很好地概述了監管環境的積極轉變。我很好奇他們所說的話是否涉及增加報銷，或者也許我應該說，報銷方面有任何變化嗎？或只是澄清一些使用指南之類的？

No problem. There's two regulatory -- not issues, but things that I commented on, 75-25 is a rate relief reimbursement fluctuation. Brooks, I'm not sure if you recall, but back during COVID, we've got rate relief and what they did at the beginning of last year is they recalled that relief.

沒問題。有兩個監管——不是問題，而是我評論過的事情，75-25 是利率減免報銷波動。布魯克斯，我不確定你是否還記得，但在新冠疫情期間，我們進行了利率減免，他們在去年年初所做的就是回顧了這種減免。

And so, the 75-25 movement was a rural demographic mix split that they were going back and looking at the areas that we received relief and seeing if we could get that recalled basically. That's not dead. There's a lot of movement behind it. It's about $140 million lift for CMS to recall that, which is not that big. We represent less than 2% of the CMS Medicare spend as an industry.

因此，75-25 運動是農村人口結構的分裂，他們要回過頭來看看我們接受救濟的地區，看看我們是否可以基本上召回這些地區。那還沒死。背後有很多動靜。CMS 召回產品大約需要 1.4 億美元，但金額並不算大。作為一個行業，我們僅佔 CMS Medicare 支出的不到 2%。

So we got some legislative support behind us, and we'll be hopeful at the end of the year to maybe recover that. But that would just be a net win for us. The other is the NCD comment, that's no relation to any kind of reimbursement shift, but it's just good policy to develop clear clinical guidelines.

因此，我們得到了一些立法支持，我們希望在今年年底能夠恢復這項支持。但這對我們來說只是一個淨勝利。另一個是非傳染性疾病評論，這與任何形式的報銷轉變無關，但這只是製定明確的臨床指南的好政策。

CMS is acknowledging that they're a little too vague right now, and it's allowing MA to make up their own rules for lack of a better description. And so, they're honing in on that to where MA follows their clinical guidelines.

CMS 承認它們現在有點太模糊，並且允許 MA 制定自己的規則，因為缺乏更好的描述。因此，他們正在研究 MA 遵循其臨床指南的方向。

And in order to do that, they got to go into a comment period and ask for all comments, which there was no better time to have all of the research buttoned up that we've invested into over the last five to seven years to be able to kind of comment through the lens of data and publish research and rather than our opinion as a vent provider, it was extremely powerful. And we saw a lot of our peers and industry associations follow suit to our comments and latch on to them as well.

為了做到這一點，他們必須進入評論期並徵求所有評論，現在是把我們在過去五到七年裡投入的所有研究都搞定的最佳時機。而不是我們作為發洩者的觀點，它非常強大。我們看到許多同行和行業協會紛紛效仿並關注我們的評論。

So the industry was reasonably aligned with all of their commentary as it related to this. So CMS should have some powerful data to write some clear guidelines here in the future, which would be a major win for our entire industry.

因此，該行業與他們所有與此相關的評論是合理一致的。因此，CMS 應該擁有一些強大的數據，以便將來在這裡編寫一些明確的指導方針，這將是我們整個行業的重大勝利。

(Operator Instructions) Doug Cooper, Beacon Securities.

（操作員指示）Doug Cooper，Beacon 證券公司。

Hey, good afternoon, guys. Nice quarter. Todd, I just wanted to focus in on the -- I guess, the increased disclosure around the sleep business. I just want to make sure I understand the disclosure here. So I guess it's the fourth bullet point in your press release.

嘿，下午好，夥計們。不錯的季度。托德，我只是想關注——我想，更多關於睡眠業務的披露。我只是想確保我理解這裡的披露。所以我想這是你們新聞稿中的第四個要點。

The Company increased its sleep therapy patient count by 11% sequentially to 19,478. And then the Company also increased its resupply orders by 9.7% sequentially to 22,143. So there's, let's call it, just round figures, 20,000 patients in your sleep program today. And then -- but there's 22,000. It looks almost like there's more people in the resupply program than you have actual patients. How should I read that?

公司睡眠治療患者數量較上月增加 11%，達到 19,478 名。隨後公司補貨訂單也較上季增加 9.7% 至 22,143 份。因此，我們今天的睡眠計劃中有 20,000 名患者，我們稱之為整數。然後——但有 22,000 個。看起來參與補給計畫的人數幾乎比實際的病人還要多。我該怎麼讀呢？

Those are mutually exclusive, Doug. So the sleep therapy patients are the ones that are on PAP therapy, like we're actually renting them the machine right now. The resupply process developed over the last, call it, 5 to 10 years.

這些是互相排斥的，道格。因此，睡眠治療患者就是接受 PAP 治療的患者，就像我們現在實際上正在向他們租用機器一樣。再補給過程是在過去 5 到 10 年發展起來的。

And so, they're no longer in their generally, what, 13 month cap period. And so, they're just on resupply. So you should add those together effectively to get to what the patients that we serve during the quarter, which was roughly 42,000.

因此，他們不再處於通常的 13 個月上限期限內。所以，他們只是在補給。因此，您應該將這些有效地加在一起，以獲得我們在本季度服務的患者數量，約為 42,000 名。

42,000. Okay. And then so the resupply order, that's 22,000, is that 3 times a year?

42,000。好的。那麼補給訂單是 22,000 份，是一年 3 次嗎？

I think on average, we're a little -- we're probably closer to 2, 2.5 times per year. It depends on insurance companies, and it just depends on patient preference on how often they reorder. But ours is between 2 and 2.5 as a total company.

我認為平均而言，我們每年可能會接近 2、2.5 次。這取決於保險公司，也取決於病人對重新訂購頻率的偏好。但我們公司的整體規模在 2 到 2.5 之間。

Okay. And just on when I relate back to your financials, I see the line item, other durable medical equipment rentals of $12.5 million, that's directly related to the 42,000 patients.

好的。就在我回顧你們的財務狀況時，我看到了 1250 萬美元的其他耐用醫療設備租金這一行項目，這與 42,000 名患者直接相關。

That would have the 22,000 patients -- or excuse me, the 20,000 patients that are renting the machine. The resupply would be service revenue. But additionally, on that -- the other rentals, you would have your oxygen patients, everything else vest, nebulizers just the whole continuum of products.

那將有 22,000 名患者——或者對不起，是 20,000 名租用機器的患者。再供應將是服務收入。但除此之外，在其他租賃方面，您將擁有氧氣患者、其他一切背心、霧化器等整個產品系列。

Okay. And then finally, just the other equipment sales, that would be the resupply program, the $8.4 million?

好的。最後，其他設備銷售，即補給計劃，840 萬美元？

Yes.

是的。

Is there anything else in that number other than the resupply program or is that predominant?

除了補給計畫之外，這個數字還有其他什麼嗎？

It's primarily resupply, but there is other things in there.

主要是補給，但裡面還有其他東西。

Okay. And then to your point, Casey, the 469 patients you added on the vent program, I think I went back and looked -- this might be -- in fact, it might be the biggest lift I've seen on an absolute basis. Maybe well, I went back five years.

好的。然後說到你的觀點，凱西，你在通氣計劃中添加的469 名患者，我想我回去看了——這可能是——事實上，這可能是我所見過的絕對基礎上最大的提升。也許好吧，我回到了五年前。

There might have been one quarter where you added more than that, and there was 455 in the prior in quarter two. What do you attribute to -- is it just increased sales? Or are the referring docs are they becoming more comfortable with the program?

可能有一個季度您添加的數量超過了這個數量，而之前第二季度的數量為 455。您認為這歸因於什麼——僅僅是銷量增加嗎？或者參考文件是否對這個程序變得更加滿意？

I mean, I really attribute it to our training program, our restructure of the sales force. We're doing more with less. And these guys are extremely productive. They're polished. They're more educated. We have the right people in the right spots throughout the country. It wasn't an easy movement. We moved 12 folks into middle management and just restructured the entire sales force.

我的意思是，我確實將其歸因於我們的培訓計劃和銷售隊伍的重組。我們用更少的資源做更多的事情。這些人的工作效率極高。它們很光滑。他們受過更多教育。我們在全國各地的正確地點擁有正確的人員。這不是一個容易的動作。我們將 12 名員工調任為中階管理人員，並重組了整個銷售團隊。

I would say that we still -- and we started talking about this at the beginning of the year, but we've yet to really benefit from the recruiting, the localized recruiting benefits that are on the ground just because we've been so laser-focused on training our folks up.

我想說的是，我們仍然——而且我們在今年年初就開始討論這個問題，但我們還沒有真正從招聘中受益，因為我們一直如此激光，所以我們還沒有真正受益於本地化的招聘福利。 -專注於訓練我們的員工。

But that's the next phase of the sales restructure is really recruiting people localized in their backyards. And we have the recipe now for training. We have the recipe right now for finding the right people. Now it's 2024 and -- I mean Q4 and 2025 is going to be about recruiting and finding these guys and incrementally growing. So we're super excited about where we sit right now.

但這是銷售重組的下一階段，實際上是在他們的後院招募當地人員。我們現在有了訓練的秘訣。我們現在有找到合適人才的秘訣。現在是 2024 年，我的意思是第四季和 2025 年將是招募和尋找這些人並逐步成長的時期。所以我們對我們現在所處的位置感到非常興奮。

Okay. And just finally, on the M&A side, you said the pipeline is looking pretty robust. Any color on what -- is it in the sleep? I'm assuming it wouldn't be vents, but would it be sleep? Would it be outside of the respiratory space? Maybe just more color on size of the companies you might be looking at?

好的。最後，在併購方面，您說管道看起來相當強勁。有什麼顏色嗎──是在睡覺嗎？我猜這不是通風口，但它會是睡眠嗎？它會在呼吸空間之外嗎？也許只是對您可能正在尋找的公司的規模進行更多的描述？

We're not always going to be leaning towards respiratory, Doug. We're not exclusive to that. I mean we will look at other businesses. We've looked at other businesses. We generally have said that the size of the HMP acquisition was just a really good size, which was that $25 million to $30 million range.

道格，我們並不總是傾向於呼吸系統。我們並不是唯一這樣做的。我的意思是我們會關注其他業務。我們也研究過其他企業。我們通常認為 HMP 收購的規模非常不錯，介於 2,500 萬美元到 3,000 萬美元之間。

But we'll do smaller deals as necessary, or we'll look at larger deals. So we've got a little bit of everything in there right now, but it just feels like we're getting more inbound calls over the last, call it, three months than we had the prior couple of years.

但我們會根據需要進行較小的交易，或者我們會考慮較大的交易。所以我們現在已經有了一些東西，但感覺我們在過去三個月裡收到的入站電話比前幾年要多。

Ilya Zubkov, Freedom Broker

伊利亞·祖布科夫，自由掮客

Yeah. Good afternoon and thank you for taking my question. So my first question is on the EBITDA margin expansion. I see that adjusted EBITDA margin is expanding from quarter-to-quarter this year. And I was wondering if the primary driver for that is permanent like economy of scale? And if yes, could it be in effect next year as well?

是的。下午好，感謝您提出我的問題。我的第一個問題是關於 EBITDA 利潤率的擴張。我發現今年調整後的 EBITDA 利潤率逐季擴大。我想知道其主要驅動力是否像規模經濟一樣是永久性的？如果是的話，明年也可以生效嗎？

Yeah. I mean, generally, our EBITDA margins do get stronger as the year goes on. If you look at it just quarter-over-quarter, we generally see higher margins. But the answer is yes, we do see some efficiencies that have come with scale. The reduction year-over-year is just due to the revenue composition as vents become a slightly smaller percentage of our revenue.

是的。我的意思是，總的來說，隨著時間的推移，我們的 EBITDA 利潤率確實會變得更強。如果你只看季度環比，我們通常會看到更高的利潤率。但答案是肯定的，我們確實看到了規模帶來的一些效率。年比減少只是由於收入組成所致，因為通風口在我們收入中所佔的比例略小。

It's a challenge to keep our margins flat, but we were pretty close with that, and that just shows that everything across the board is getting a little bit more efficient with scale and we get the leverage of becoming a bigger company.

保持利潤率持平是一個挑戰，但我們已經非常接近了，這表明，隨著規模的擴大，所有事情都變得更加高效，我們獲得了成為更大公司的槓桿作用。

So a lot of moving parts and pieces, but we're extremely excited about the overall metric. That's why in my prepared remarks, I talked about revenue as a percentage -- or excuse me, SG&A as a percentage of revenue because the gross margin is very product driven. The G&A is something that we have more control over and the scalability that you're referring to.

雖然有很多變化，但我們對整體指標感到非常興奮。這就是為什麼在我準備好的發言中，我談到了收入的百分比——或者對不起，SG&A 是收入的百分比，因為毛利率是由產品驅動的。G＆A 是我們擁有更多控制權的東西以及您所指的可擴展性。

Great. And another one on the current progress in replacement of recalled ventilators. So I see that CapEx is growing, and I wanted to ask if you expect further increase in CapEx in nearest quarters? And what is the expected timing for full replacement of recalled ventilators?

偉大的。另一篇是關於目前更換召回呼吸器的進展。所以我看到資本支出正在成長，我想問您是否預計最近幾季的資本支出會進一步增加？預計何時全面更換召回的呼吸器？

Yeah. I mean, like I said in the earlier part, we definitely saw an increase this quarter, but we're starting to measure it on a net CapEx because the third quarter was where we really got into a groove of selling or distributing our vents back to Philips.

是的。我的意思是，就像我在前面部分中所說的那樣，本季度我們確實看到了增長，但我們開始用淨資本支出來衡量它，因為第三季度是我們真正陷入銷售或分銷通風口的最佳狀態。

And obviously, our vent patient count is growing, so we have to replace those vents with CapEx. It's why you saw us very deliberately disclose net CapEx and we're very proud that I think the net CapEx as a percentage of EBITDA is probably the lowest it's ever been in our corporate history.

顯然，我們的通風口患者數量正在增加，因此我們必須用資本支出替換這些通風口。這就是為什麼你看到我們非常刻意地揭露淨資本支出，我們非常自豪，我認為淨資本支出佔 EBITDA 的百分比可能是我們公司歷史上最低的。

I would expect that number to continue to be very large this quarter. And very likely, it will stay like that through at least the middle of next year. We're waiting on Philips and the FDA and anybody else that is going to be needed to make a decision of when they can actually remediate some of their vents versus us just selling them back to them.

我預計這個數字在本季將繼續非常大。而且很可能，這種情況至少會持續到明年年中。我們正在等待飛利浦、FDA 和其他任何需要的人做出決定，他們何時可以真正修復他們的一些通風口，而不是我們直接將它們賣回給他們。

But we'll be working in conjunction with them to see how that all shakes out to determine whether we keep selling at the rate that we are right now or maybe we send some back to be able to stay on patients and so forth. So it's a little early for us to say how long it will take us to finish, but it will definitely go into next year because we still have a pretty significant fleet out there.

但我們將與他們合作，看看這一切會如何發展，以確定我們是否繼續以現在的速度銷售，或者我們可能會寄回一些以便能夠留在患者身上等等。因此，現在說我們需要多長時間才能完成還為時過早，但肯定會在明年進行，因為我們仍然擁有相當重要的機隊。

We have reached the end of the question-and-answer session. I'd now like to turn the call back over to management for closing comments.

我們的問答環節已經結束。我現在想將電話轉回給管理層以徵求結束意見。

I want to thank everybody for listening in. And if you have follow-up questions, please reach out to us, and we look forward to talking to everyone. Have a great day.

我要感謝大家的收聽。如果您有後續問題，請聯絡我們，我們期待與大家交談。祝你有美好的一天。

This includes, this concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

這包括今天的會議到此結束。此時您可以斷開線路，我們感謝您的參與。