HCA Healthcare (HCA) 21 Apr 232023 Q1 Earnings call transcript

Company Profile

Participants

Frank Morgan	Vice President of Investor Relations
Sam Hazen	Chief Executive Officer
Bill Rutherford	Chief Financial Officer
A.J. Rice	Credit Suisse
Whit Mayo	SVB Securities
Justin Lake	Wolfe Research
Ben Hendrix	RBC Capital Markets
Gary Taylor	Cowen
Pito Chickering	Deutsche Bank
Joshua Raskin	Nephron Research
Brian Tanquilut	Jefferies
Andrew Mok	UBS
Scott Fidel	Stephens
Lance Wilkes	Bernstein
Calvin Sternick	JPMorgan
Steven Valiquette	Barclays
Jason Cassorla	Citigroup
Sarah James	Cantor Fitzgerald
Stephen Baxter	Wells Fargo
Jamie Perse	Goldman Sachs

Call transcript

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Operator

Welcome to the HCA Healthcare First Quarter 2023 Earnings Conference Call. Today’s call is being recorded.

At this time, for opening remarks and introductions, I would like to turn the call over to Vice President of Investor Relations, Mr. Frank Morgan. Please go ahead, sir.

Frank Morgan

to today’s welcome and morning everyone call. on Good our Hazen; and me this Bill Sam is morning With CFO, CEO, Rutherford. few Sam prepared and a remarks some questions. and then Bill we will will provide take

these might today’s to turn factors actual I me that forward-looking management’s to listed based the that various over current forward-looking risks call Before differ be and that expressed Sam, results expectations. other any contain those factors Numerous call on remind let our everyone are today. on cause statements press may statements should today’s from and and are in in release information More materially and filings. SEC uncertainties

On net included in EBITDA, information call HCA providing is this will be such is supplemental measures a income Healthcare, later and we adjusted Inc. This release. the A as being reference replay EBITDA and table recorded attributable which a on today. morning’s to reconciling adjusted non-GAAP call morning’s call, may today’s is financial available measure. of

that, call will to Sam. With turn over now the I

Sam Hazen

Thank quarter produced reflected expenses. morning. demand year for in into The for first services labor our call. in the The XXXX. had Thank momentum that end continued Frank, good we Alright. joining operational last at contract improvements and our the you solid the and earnings company particular of you, of costs our strong operating

grew by X.X% the were the Same to in quarter, per X%. Non-COVID company admissions on XX% earnings of share almost XX%. diluted quarter, grew strong the facilities Adjusted losses first were For across up close admissions EBITDA excluding $X.XX. volumes facility to year-over-year. grew sales

strong Inpatient This increased grew XX% continued facility admissions X.X%. surgeries payer a grew X.X%. and emergency business favorable X%. and to which acuity Our increased which visits, surgeries, outpatient be by Same equivalent supported driven room was by inpatient mix.

year. lines cardiology of including contributing X%. company's footprint procedures, categories which across service most The and as outpatient facility of compared revenue the was growth increase outpatient the broad-based also X%, increased to prior grew same Other demand to

also agenda, virtually accelerated With continued the we The the our levels. compared previous Hiring across average. saw turnover reduce the quarter. contract pre-pandemic rates hiring to positive nurse and cost fourth improvement to ended quarter improved to the results respect people XX%, These four last quarter improvements almost from to close metrics. increased we all Registered labor in quarter XX%, compared year. in helped

continue patients. quality to a our these increased We We stakeholder deliver Once in innovative across our to all believe training advanced invest care adapt groups. care our programs, programs to again, colleagues compensation value high and provide to people models. our ability demonstrated through and capabilities remarkable

to I their hard them thank want their effectiveness. and their dedication, work, for overall

we our quarter, us the continued capacity that to capacity. fully constraints prevented experience During operating from periodic

patients the where quarter. total fourth the to of compared was accept As fourth not we the quarter, other quarter, admissions in hospitals could and from down declined XX% X% instances in X.X% from which represented

above While improved still we are pre-pandemic remains levels. it with pleased trend this

We patients. demand our and the high believe our our investments intend encouraged improve making our quality disciplined people with we And plans our Close we rest with executing our necessary network, backdrop as provide the to through in we year. this services push maintain this, markets. are our our care resources and of strategic us provide to to remain saw of strong lastly, allocation by we to in will the technology approach and the we that capital

quarter factors our and the the with for you see the favorable results we strong will expect guidance demand, increased that year. we in Given have the

details. Bill to call the turn I'll that, more With for

Bill Rutherford

in billion, additional I the as Adjusted prior will quarter performance EBITDA $X.XX for good the for Sam, comments you, and the $X.XX morning, billion quarter. on Thank everyone. year. provide was Great. some compared our to

claims noted our related to in commercial that revenues in certain quarter year, recorded of disputed increase of this a in resolving period. $XXX a an million six-year the As with release, first we payer covered

$XXX admissions an Texas year we directed relates million X% as admissions also revenues of related it XXXX. the X.X% experiencing to to about quarter prior we year, that to additional for will still COVID the prior first year of of this earlier high comparisons, and level of the last expenses of In were volumes million compared note, payment in $XX an I quarter, for recorded COVID year. accounted program period.

care this quarter, in with In versus the year. quarter. about was volume Sam prior year and mix payments managed and approximately the admissions trends. quarter highlighted the year's the prior when support other year case COVID-related non-COVID good admissions of our versus and managed in this compared during X.X% payer addition, grew recognized care prior to facility grew and the coupled first XX.X% in $XX Same quarter, positive we million million mix $XXX metrics

both improved remain to as year and quarter of management operating team's higher fourth of to inpatient our with quarter. our pleased Non-COVID first contributed increasing admission with the year. X%, backdrop the as of prior under X.X%, from case last compared just compared per inflation. This cost non-COVID mix to even the sequentially revenue We

a our XX.X% year favorably improved as trend costs was to compared and quarter. Our revenue sequentially the supply in adjusted when of to continue Labor both as consolidated percentage EBITDA and well. prior the margin cost

have compared have percentage approximately pressures previously points increased subject a basis some We as cost the and prior when discussed been revenue, XX expenses year. other of to operating inflationary to

me key our let allocation and strategies. some growth they to So creation value cash a of flow capital and long-term speak metrics as part remain

billion operations the from $X.X $XXX this in the year increased to billion $X.XX million year. in from quarter prior flow cash Our

paid just $XXX million $XXX stock billion. under in Capital We of spending quarter. under and just the was during dividends repurchased $X.X our million

range EBITDA debt-to-adjusted times X ratio to leverage leverage near times. stated of end low our remains Our X the of

guidance follows. our As noted as updating morning, full-year are this our release in we XXXX

$XX.X and billion. billion $XX.X between range to revenues expect We

between HCA income billion. net attributable $X.XX range expect and We Healthcare to $X.XX to billion

expect billion $X.X adjusted EBITDA $XX.X year. range to to lastly, capital and spending And during between full-year and the earnings billion expect share We we $XX.X $XX.XX. billion. range approximate we to diluted $XX.XX full-year per And between expect

will that capital continue on we considers updated is invest agenda, planning acquisitions to future to it development. we based some I growth land for guidance mention also are spending exist believe and our opportunities

In addition, we are construction factored in costs some seeing well. our have inflationary as we that guidance increases into

ownership Finally, I Valesco will with our mention, in a on the venture transaction increase in Envision. early we closed April, to joint interest

this and consolidate EBITDA. adjusted the will second no material the venture, approximately annual with will revenues to generate in expect We of venture $X impact billion beginning quarter

we'll Q&A. We your look up over for to forward and questions. open it So with to that, I'll turn the call Frank,

Frank Morgan

Thank Bill. you,

the As to so yourself possible ask may give question. that reminder, as a to limit a please as opportunity one in many an question queue we

you those to may give like now who to would Rob, question. ask instructions a

Operator

Credit of [Operator the Rice Instructions] And from comes Suisse. your line A.J. from first question

open. Your line is

A.J. Rice

variables further? volume Are I'm maybe negative? there's the Or respect further a know of expenses a some Hi, quarter. that putting sit year? the this quarter, that obviously, as at different both side, at range, Maybe questions updated and here beat you're volume more in see could flash trends how your you out When rest a or metric the that little that everybody. and trends not the just of seeing the lot with you Or What little points positive trends the see look you labor particularly on Can than the you updated the well labor. with within offering the variability? are you positive I year, guidance the rest of other what as to open there either how highlighting of swing as the maybe year? or rest

Bill Rutherford

A.J., I'll Yes. this and Sam start Bill. add in. is can

that seeing that said there late are in the is I into we the but fortunate momentum first in that think ‘XX, we're saw market. comments, as we quarter. continued we believe our We

in see the We market. continue to expectations good volume

saw our same-store You admissions.

pretty non-COVID activity remains busy. room robust, volume was Our emergency

So positive that on volume outlook we given. feel we've reasonably our

a on trends side, mix. and acuity Our the and cost in revenue the managed unit, are have believe per anticipated. We with ‘XX. for then quarter is watermark contract year it And with continued We We're so that They the very labor. with. pleased mix that to of in be levels pleased we're there's well. Obviously, the labor where high was today. -- payer we mark hope case the labor, cost improved throughout stable in improvement knew we first maintained utilization we're made, around high us teams last pleased of especially

about we're so And the feeling cost generally, pretty metrics. good

for view tends I speaking, in balance those revised mentioned trends are that professional operating show our the we that our inflationary other reflects as outlook some But guidance of much our some fees input seeing, and itself have of and don't over. we fixed-cost around to year. There our items we're generally think as cost the

A.J. Rice

Okay.

Bill Rutherford

A.J. Thanks,

Operator

Mayo the from line And Securities. SVB comes question your Whit next from of

Your line open. is

Whit Mayo

of strength cost with or this question even supply it's growth. look just corollary thanks. of some I outpatient surgeries and the surgical kind particular growth just maybe Hey, lines? and between good of comment a weakness wondering service HOPD, ASCs was you're of unpack you is And some any could the on if that to across pockets seeing the two those guys very surgical the in

be So if dynamic, you on could helpful. elaborate Thanks. that would maybe that

Sam Hazen

your Whit, for is had settings. question. strong you both this in Sam, We activity Thank

within ambulatory more than Across we settings, both surgery units actually saw of solid volumes growth. hospital categories slightly surgical our inside in volume outpatient Our were service up our was centers. really all what

So in it I comments. was broad-based, mentioned my as

to invest in both. We continue

as our to more across number complementary significant as well of ambulatory that surgery company. with some new networks that have pipeline development in possible acquisitions we developments, a have a are investment the the We center

our really we're activity. with So surgical pleased

of activity, as activity, growth with surgeries our room also are as emergency our pleased a result seen elective very well across surgical in different we've both disciplines. our as emergency as inpatient surgeries, We

obstetric down only much category our as as of was our business. didn't we where in The parts that volume other have actually we C-sections did

that the you up if service were actually lines. for And in more dynamic, significantly we categories so acute our of more normalize

volume from So for standpoint. very surgical us solid result a

incredibly Our continued well. to supply have costs perform

capability cost. our practices, contracting, And utilize increased our increased so logistics, leverage great acuity, and forth. activity, have supply good inventory chain a We to even supply continue and with we in to we company, best management metrics maintain it around surgical

Operator

your Lake from Justin Wolfe line of next question the comes from And Research.

is Your open. line

Justin Lake

the Thanks. Good morning. labor on wanted I side. follow-up to

Thanks. year-over-year. labor hours XX% And labor me? came said know, that Can temp down -- just percentage of, in year Where guidance? or a little color as do labor in were you dollars. metrics? think SWB terms SWB the anything percentage through I out-of-the temp nursing from come in as labor trends for a that's expect temp expecting terms a of you then that of And percentage implied some of temp temp you you that you're give in else, year of kind -- of the confirm us on hours costs those to of labor

Bill Rutherford

Thanks, This Bill. is Yes. Justin.

continue year-over-year. lot I'll of our So our down is the we'll with about a in labor down, yes, trends and contract in front. And XX% to that there. It's the up pleased so really be rooted confirm, that fact is was effort turnover recruitment in again,

quarter, the so last half about our year, That our to of last the X.X% running and was we of X.X% ‘XX, SWB. trends. contract through For about good were labor compares mid-Xs

know, You this XX.X%. was we labor almost where year, of time about as a contract a hours were as XX.X%, XX.X%, percent last

So again, a retention. area, efforts in rooted we that of really have and the by recruitment just continued in improvement lot

we in finish year, that hope to go to trends this get favorable we in year. the can we that time by through As and we we'll the I X.X% hope continue X% see

of lot to teams the focus that. effort by a So continues the on

Operator

comes next Ben the from Markets. line RBC Capital from Your of Hendrix question

is Your line open.

Ben Hendrix

and in on admission out you. the out dynamics admission quarter there growth. Perhaps the same-facility further looks for first revenue you. for you of maybe the Thank could per outpatient offset Could the comps? inpatient flush the that year-over-year Thank you a rates like balance and how volume It comment the play lower little could rate the equivalent year.

Bill Rutherford

first step, Ben. Yes. I'll make a

our year-over-year and revenue you COVID COVID reported. emissions X%, non-COVID, really runs per influence the COVID first, X.X% comparisons, much went activity year-over-year has from comparisons. on a to our as year the have When is last to admission on higher think, than I recognize influencing the significant the

remarks, mix. prepared in talked sequential our We've growth. revenue per admission my was non-COVID in improvement why seen So about case I X.X%

sequentially say I'd where with payer acuity have the revenue that. the is we our we especially in our we're think when and I yield at mix look on and performance overall, pleased

talked during the reported, about, as the with volume. with that the Outpatient So the COVID COVID, was revenue driven, we quarter, we're we was per room. was heavy main When thing as growth really exclude the unit affecting ramps. the pleased emergency

per we admission that influencing well. down as admission per while the So equivalent is the statistics broke

the with as pleased the well again, seeing inpatient. that demand we're But as growth outpatient very

with So seeing. top we're we're that the line pleased metrics

Ben Hendrix

quick a your of kind to that the network -- is degree normalization of of some which seeing Can you patterns your versus as the Just to capabilities? just parse in Thanks. investments acuity expand out admission follow-up. kind made you've of terms the you're

Bill Rutherford

I mean, invest with had volume fuel acuity in do hard to our we obviously, out. and but we a it's the It's We demand that offerings parse all-inclusive. it our service that recovery of a growing in to continue good services. see surgical that. to continue I mean helped marketplace, higher

both and think attribute to we're are parse hard I from it's out other. So and the the trends that But seeing. factors or one

Sam Hazen

case-mix the understand important it's and consider up actually we've view think that high over composite Yes. case XXXX strong our index, lost really holding component joint is And acuity mix in or when surgery. total our I a you Bill, that of to

So speaks the our underlying I acuity mix think to within remaining portfolio. that inpatient

We surgery also had total in when inpatient growth and again outpatient look the at quarter. you joint

the and advance clinical of Bill specific And and setting but out again, program mix But outpatient a really cases strong to able And yet, to efforts their now sustain as acuity what in it's development mix, been are inpatient total. markets we to to we've capabilities. certain nonetheless, yielding those in hoped. due certain facilities that's alluded in our

Next question?

Operator

Gary the Cowen. Taylor from comes question next of Your line from

open. line Your is

Gary Taylor

Hi. Good morning.

about is Sam expressions EBITDA starts favorite rates. clearance talking when my of One

So was to but hear solid not that this catchphrase quarter. otherwise, morning, disappointed I really

about is cycle. commercial question rate My

tease I think be there. moving even what's to COVID, we with out when with all the it's of happening the to Q, parts going see sort hard

any just if settlement about your one-off? So you're completely renewals? million on you commercial Or how there update on off-cycle see positioned Does material the in with $XXX renewals. to could say Is a just rate is it activity you're us just of how the doing environment of this wanted payers? terms anything sort Thanks. on

Sam Hazen

EBITDA the disappoint, not our quarter Gary, clearance to XX%. So, in was

So metric us in that's really inflation. of recognizing the good operating a really face for leverage

the where we're productive into to when we management our turn speaks So their cost, facilities team's drive we embedded sort it proves earnings to of a to can way. very our have ability operations that manage activity able it in model into fixed Again, effectively.

on cycles. what's with We're going contracting pleased in our payer

As we in increases, of, targeting sort again most allowing, we mid-single-digit providers that and circumstances. for and said, are marketplace the I achieving think responsible the And we're recognize payers pressures in increases. are the

are appropriate that for So through quarter maintain two-thirds the trend point is XXXX XXXX. this through we're about of way We're XX% of time, We're particular about we contracted to way today's the of at circumstances. necessary the a there. roughly XXXX. the we able and feel and in way And for

best-in-class through business, that underpaid I circumstance. in were able recognized resolve were efforts revenue their efforts of talked we in a is the other other through which payer don't support anything particular we organization, reflective some believe the about, our capability. of of settlement we that cycle we and particular our around previous components it's claims that in and one processes those our years, Parallon The payments to in place know we in have felt And marketplace quarter. than specifics that were

sure controls that And are that relationships that ensuring in the have or in the we that we we answer company. making is the those but we think underpayments say disputes the sure for work not to continues and around that will an way wouldn't will place, I right appropriate that new get to we we place our if be are we we are And opportunity. anything to right then get reimbursement procedures that's on denials through there think say I the make have appropriate, it necessarily, ongoing focused earned. that right the

Operator

from Deutsche line the Pito of question comes from next Chickering Your Bank.

line Your open. is

Pito Chickering

any guys. Or Thanks And for so on their this full-time increase wages color wage nurse competitors XXXX? how inflation year good tracking you questions. expectations? my versus seeing again Hey, Any morning, are you is us your pretty wage taking in far on on this non-nursing And where can inflation at is that staff, in what for guidance? your assume nursing for XXXX is it point? reflect And non-nursing and the tracking? stable you

Sam Hazen

Sam. is this Peto,

increases overall significant And to per face around the that's I our over from think other. making we the in or the one some circumstances with market all our compensation hour progress. aspects us understandings data to what's across new of increases latter of And expected in and we trend workforce fairly make of where the them pleased trending to new market are year. in we're certain part responding ‘XX, ‘XX, modest happening to continue this

our I on As our turnover was down. mentioned call,

pre-pandemic was approaching running levels. XX% six you about We -- turnover annualized. at to XXXX about XX.X% nursing were last and Our running We're look in XX% months the XX%, when XXXX.

the So we good again, and nurses for and a it's, think resourcing our of increase factor around macro really of some actions happening, to efforts very program specific capabilities other our and compensation trends, trend caregivers. a

we're where in we're the efforts So our are encouraged recruitment by that really the teams, market. seeing of competitively and we the metrics

Will the our as to We have we to through there there adjust progresses. manage market into through year? year or those able appropriately, the to move believe a we guidance here we and as Yes. that's should changes be factored be

Operator

of Nephron Joshua Raskin Your next Research. from question line comes from the

Your line open. is

Joshua Raskin

that were we increase I'm lastly, XQ months And contemplated I and assuming new the above for are curious getting came purchases. the accelerated in estate you types in that you inpatient And interested been taking to have I'm bit I'm a for the over specifically Could speak maybe of heard are question. anything thinking? little if ago? that where that especially thanks. time. facilities then funded real as weren't specifically ones in projects hospital Hi, the year? Appreciate the in those CapEx guidance three

Sam Hazen

for Yes. This Thank question. Sam. the you is

We our outpatient time, hospital network, need we have over of a to we're adding where we're number going significantly serve communities to we believe, network. to add our obviously that to

we approximately communities grow, believe We over that and communities. that markets of as going markets, our those so have differentiating to facilities hospitals new have facilities. across we're support in XXX require that that that's one of But get our and the HCA, out we time, our share continue outpatient X,XXX or attributes that to us some in we is hospital possibilities are great great themselves, in to gain believe prospects growth before -- to of build

a have do San in new hospital in construction in Antonio under opening two Antonio. -- actually San -- or We

we adding keep is up in hospitals XX% run particular high for markets and market, we hospitals, opposed As we new to we for That hospitals. we Texas we new for occupancy, Antonio on example, it's land those own in where land circumstance to own Dallas do us in every that of as one community. speak, Austin, occupancy. but open in new But approximately for San have uniquely think better

purchased recently first the City. in in just Lake and We new Las quarter Salt land Vegas for hospitals

hospitals Florida land have markets. new of in for We number a

for in acquiring that what spending, that's So we capital development. of you're land part is our seeing future network are

we there in of the advanced are on but our that, that spending, increased have our too to capital it significantly some pressure development. elements outpatient guidance. facility That doesn't are addition put much In

need are to occupancy. the everybody And facilities build And lot we approximately for ran still need to have care. quarter, be that in to where situation In the high a company to its over believe facilities. staffing accommodate have demand have health I sufficient inpatient we important We XX% first we a up it's in of what physical our understand, the capacity as we occupancy think we levels then XX% capacity time. to finally, of for

capacity the on acquisitions network are and things: of development; platform constraints have really So projects outpatient facilities existing land then those hospital the mixed among today. development; future we that relieving three for

Bill Rutherford

overall we add, really Bill. capital. is and also generating we increasing can philosophies I'll the strong invested we're And returns obviously that within within see on that Josh, we continue capital our And resources allocation to have. capital accommodate this

confidence continue the to So we investments future. have will growth that these us generate into for

Operator

the from Tanquilut of Your next Brian Jefferies. question from comes line

open. is line Your

Brian Tanquilut

sequentially called the Hey, second thinking just how pieces contribution know moving out Hospital. to maybe Thank good question we in morning. envisioned thinking on anything Bill, you. and the the the or should be New about But should we be revenue quarter? maybe for considerations then year-over-year? just a Orleans I you that about

Bill Rutherford

mean, year, high is material. we nothing balance We last quarter off Brian, the began of quarter, in second coming which we we're quarter saw first normalization. the costs the of I first we of the to Obviously, start labor principally went see anniversary improvement COVID obviously year. kind Yes. volume, once in the improvement some second quarter. through some high of continued and as the

out, year, quarter can't COVID the the to should the say terms the wouldn't high comparisons, the one I I most the of things got especially for for material, there's do So balance call normalize to in of the of part. behind anything can We But now that. begin that majority us typically year-over-year we've next.

Operator

UBS. the next from comes question Mok Andrew Your line of from

Your line open. is

Andrew Mok

Hi, good morning.

on the could results? expect of that could months? updated have provided operating on out over you you and how Thanks. what on intermediate-term past. play redeterminations that the breakeven And You view next provide to some near in impact to XX an metrics Medicaid Hoping sort XX

Bill Rutherford

got mean, formalized Thanks. We've company. inside to a Yes. continue the attention area obviously, fairly I pay this of to. is an approach we

the We've We redeterminations just haven't keeping plans. they are alternative made close but themselves patients state to event are them Medicaid our we outreach displaced to Medicaid. to very coverage as yet occur, also help look in find seen any impact to those at to beginning

subsidies encouraged potentially that a or percentage to relatively of qualify enhanced that individuals some studies employer-sponsored those high of insurance for We the marketplace. continue health with third-party through read be we within coverage coverage the

to close that. very staying are we So

people with to available where coverage. our community people agencies to coverage work and We help identify are trying land states are help increasing necessary that them, efforts other to to

impact We too benefit able quantify believe the their the of coverage in be. be hopefully, long wouldn't to to find that some run. downside, material can to early So anticipate when over what But and employer. there really through or could that people ultimately, be the I upside any may exchanges

Operator

Your from Stephens. next question Fidel from comes the of Scott line

is open. line Your

Scott Fidel

if you how if both you're the talk Interested about diminished are the could surgical about the quarter? sustainability of -- thanks. thinking was the any catch-up year? COVID interested over balance there those in you inpatient growth And in over the the Hi, see as do first Or and just of year, really trends types trends of of the sustainable outpatient. growth course

Bill Rutherford

We're looking exactly contribution -- we're that. the to the of pleased one, with It's hard trends. parse

and I we demand think the pleased the we're in the market. overall, activity see with

continue see volume return does believe in -- that both that itself, to if inpatient we patterns. should normal We see And going we're outpatient continued historical growth surgical to show to volume. and

growth. continue help outpatient reasonable surgical in invest should our outpatient We drive That footprint. to

continue development program inpatient good well. growth help side to in inpatient show the should Our as surgical

that. to have just we'll So see

think, continue I X% growth. that. see the as goes hopefully, we'll would And we typically, surgical type of to see year on, to X%

Sam Hazen

to add Yes. And just that, to Bill.

continue we would as capacity, increase also because open to instances our capacity, able as we surgical operating do also. not have prefer our we're it we sufficiently our as of rooms all think I to affects staffing

the believe labor our we continues more demand is allow there. in to as so And think to the market us surgical that and still get we will open better, situation capacity, up

think have where we're if our our some things move we and that it and year strategies. we up, our agenda So should we will, surgical resource with volumes, you staffing human are with by as we the prop through encouraged

Operator

the Your Lance from line Bernstein. Wilkes from comes of next question

open. is Your line

Lance Wilkes

your of the grown how continued you impediments permanent to you're registered forward, like perfect bit particular And had about from over talk you something question. obviously, maybe year? are been that's Can staff in any the your Actually, as levels outlook then nurse little for growth? or staff temporary lead a Could you last which looking into has staff my great. particular, a about And talk has shift there growth? that or to

Sam Hazen

was it's you first look first up factor actually, two X% more Well, me like lane out last let quarter you -- sure this make our total when headcount X% And divestiture. around quarter, against that the at when

market. So obviously in X% which solid up is the we're improvement quarter-over-quarter,

momentum As we've the quarter some of And programs third we with our year, forth. the that's mentioned momentum in see and our last first and were some into with well. so really carried quarter to quarter fourth retention through the starting hiring,

I think know our overall something don't the rest the the in run move will we will the in XX% to as that that's I nursing. it hiring hot that. it was compared But to we that and quarter average, or XX% running like up the was mostly hot as through that rest year. of move the run need year it nor we through of up

to them to support care. high-quality deliver continue. best We're other succeed programs and have efforts put and in our position that our So with people encouraged will with our recruitment, we retention by our efforts the

a have in We education. significant making clinical we're investment

for those by our of School Galen people really what we're and and Nursing our over time. Our programs to do continues encouraged grow, will facilities

effort parcel all are they to resources very of company. our can amount have a we supplied things technology to they're in comprehensive right staff, make the to high-quality with and those be right sure deliver So and care part successful and the growing

So where we're by are. we pretty encouraged

Operator

Your line JPMorgan. the of Calvin Sternick next question from from comes

line is open. Your

Calvin Sternick

ask about and you to I Wanted quarter said questions. but levels pre-pandemic for still improving. the labor capacity. above the for know Thanks X.X%

other variables for year-end? the rate of levels? to think sense, some historical to do So what Thanks. back down declination to getting where the And are by get want a you just you key can get

Sam Hazen

our is capacity capacity of important have so of mentioned, benchmarked so levels. and forth. abilities staffing emergency bed and more just our pre-pandemic XXXX, a as and Even where very all sort of, to environment. be back and open in our room lot that leverage, we were our up because get in metrics such. we hopefully, obviously, surgical our capacity comparison We I of But levels to can a to Well, of, sometimes we normalized constrained, against can

we as better went get to March than first better January continue will was through an example. quarter, it think I as the

positive hopeful continued year. within So hiring move of sequentially balance of trend we will line we through hiring, sustain quarter. move that that itself the that timing of look should that's the with at improvement the as our and We're we And some year. as as up that, the a some through the

So things. those main the are

we our course staff beds capital certain come that That will year, is -- But the forth the to and our facilities, I we into and open most allowing up us the always will have over Some important getting circumstances. as think help variable appropriately. so do. online staff in sufficient of

Operator

Your line question Steven Valiquette from the Barclays. from comes of next

open. is line Your

Steven Valiquette

thanks. Good morning, everybody. Great,

So really over normalized of medical strongest suggested then the commentary likes some January monthly from from that main view questions And in I really question hospital one volume on in at the or one at week were them When volumes past their least hospital-related two, companies March. and no know one the the looking here. of performance. device February,

is your the was could So momentum not high-level really just overall throughout in on my comment generally the if quarter? pretty just you or whether operations more question consistent

from to continue year that Or all XQ? mainly is to would quarter helpful. all be meant outlook strong for expect then the just also, all momentum should overall operations of from Just the XQ? kind an And just prior first in around is increase Thanks. the rest unchanged witnessed your we thoughts of reflect into full-year view? is the the generally of And the ‘XX upside guidance

Bill Rutherford

think Well, there. again, seen on I momentum we've

through hard the guidance the think we're there. a referenced with exactly exactly yes, the principally I it But we But happen the pretty first I see at to by others, quarter seeing, and few it’s think, look is, is we saw. as they that we performance the was in quarter, volume trends what some demand call continue period markets. of to will. positive what may on consistent feeling the We're in good So

add continue to to able continue our capacity, to We that. be serve

incorporated right to where into goes stand going think we now reasonable and year assumptions the So on. guidance forward. we've we monitor as continue And that's we'll all the

Operator

Cassorla Citigroup. Your next the Jason from of line question comes from

is line Your open.

Jason Cassorla

Great, thanks.

-- XQ perhaps seeing commercial potential just you that a of and mix more volume out Or ahead helpful. be favorable noted pure And us core I then broad-based? Any quarter. volume in year? can commercial trend give growth on commercial you this You hoping split you if payer saw commercial. think volumes exchange-related that the coverage on between in is sense or later forward on color Thanks. changes do volume just pull very are commercial any would currently perhaps was

Bill Rutherford

mentioned as over I volume Yes. my commercial comments, was in up XX%. little our I a mean, non-COVID

pleased. with saw So enrollment obviously, pleased really a exchange We states. we're good We're stat that's very our across enrollment. the very

you've seen, that in up Some Difficulty] publicly the that would to exchange seen released exchange where And we've Texas up expect be. Florida, [Technical of well enrollment volume close to XX%, XX%. we data with pretty

up, just those volume some on pure of year-over-year impact was because to for such XX% comparisons so quarter. what, or the make non-exchange hard Our has exchange an the It's on COVID that.

X%. at we overall, pretty back non-COVID But managed XX, were is of look still up growth even if up strong. care And and I the at it

thinking good basically we're demand. will continue, markets. see We most again, our that So in still payer of employment full good there's mix

with health So we that plays the we're that pleased exchange activity we'll are seeing across insurance markets. out. where see the But

Operator

line question Cantor from next the Fitzgerald. Your from comes Sarah of James

open. line Your is

Sarah James

the a to that few made contract labor. of Thank trying you. on piece you together I'm comments

year. increasing with I of savings guys is margin down then going a you what the So exiting of bottom before? actually thought X.X% relief? it that of sort how little think to You been as thinking to how talked headcount? were line you about much versus you've any to to about reinvesting bit about And the a is in inflation that? getting Or wage X% falling the lower. do Is line

Bill Rutherford

our side. has a continue labor existing invest utilization wage to both reducing has the our the there's obviously, our been through labor, hiring to to us continue our as invest spoken well earlier in employed rates, that workforce. employees in was of lot And we about our that in parts call. on And focus moving mean, of I premium Well, allowed and as

And fortunate allowed roll to we've we of we kind into to it the workforce. that yes, our so investments when the up, at overall contract impact. are been reduce look labor, able all make us employed And as we that's

continue. I that think will

expectations consistent. reasonably around commentary think I our has been our

think we make We ran of to kind looked in we that can at If range. X% you pre-COVID, it was continue where that. on probably progress

much of But the back of benefit labor it's are employees. our again, investing we contract So into consistent. existing fairly

Operator

of Your line the Fargo. Stephen comes from Wells next from question Baxter

is line open. Your

Stephen Baxter

I follow-up Hi, just to wanted thanks. on another question.

mentioned a the alluded where You point. have you to be typical us might think you amount rate at been decent you to same general environment? compared visibility And a magnitude. of acknowledged I payers mean, two-thirds, I dynamics having pretty on also remind more the commercial contracting continuing in pre-COVID just XXXX by how this at that the can

Just want was Thanks. to by meant confirm you those if that what comments?

Sam Hazen

the part we're, understood of that renewed commercial our on contracts. We question, part I or with running were like our sure the not the prepandemic running question. I'm X.X mid-single-digits But I said, of contracting. first second so

we reflective is up environment of, and think, the inflationary the was themselves. question? that responsible bit. ask Again, find received by it's little it think So well reasonably most overall What second it's a payers But organizations the renewed. been that I it's we've a

Bill Rutherford

Well, I our consistent that around the it completed was historical. one other think where with contracts 'XX? of Is the are for its percentage

Sam Hazen

is. Oh, it yes,

Bill Rutherford

historically been. And consistent we if with would where it is have

Operator

of next from Your Goldman line comes question Jamie Perse the from Sachs.

open. line Your is

Jamie Perse

Good outpatient. about I question wanted a you. to thank Hey, ask shift procedure morning. the to

couple and years? from First, last has can you help the over been us the quantify of revenue that what shift EBITDA headwind to

shift knees is in how And shift the analogous that think in amenable then transition the categories little two, to the be that we thinking up that that hips, think the categories there cardiology X% impacting big that that in setting homogenous, in Are are a quarter. categories like bit total of was to like Thank do You a big the outpatient cardiology? patients we about about more out are category you should so mentioned you. and joints near-term?

Sam Hazen

facing any category see total same the of as particular did. don't joints pressure type We procedural

of pre-pandemic. around company reversed XX% are was total today done is somewhere our our XX% joints think an I done with inpatient. as That as outpatient an

of we've as already joints. of cardiac this in particularly, not rest was So of cardiac, total And the a setting. it categories respect that. period. our time headwind impact outpatient are And P&L a as discrete to the are The with large in volumes a absorbed piece today all over

like we anticipate don't particular so have shifting anything that joints total And in category shifted.

margin. holistic We've continue, robotics it sort seen joints. some total joints shift not over incremental our time cardiac the in seen with is spine, of, We've more and on like repositioning seen platform. like structurally in We've some Those some total years. over They're the did. than that's

facilities, the outpatient company -- And transition. about so a in multifaceted facilities, navigated every that's our And our and Again, for just offering those patients that has both is setting ambulatory so effectively one our for patient. surgery centers of forth. within settings we have right physicians,

to our advance surgeons And to year-over-year result seen as our I of I the line think up we programs, service year, multifaceted our continue offering. said and good like up with actually total to that grow are well. orthopedic our earlier, and were our they and organization year, previous a compared our as has And leaders work able capabilities in so growth been joints, we've last to

Operator

Morgan. no over call remarks. at I closing this are to the turn for Mr. Frank there time. further questions you back final some And

Frank Morgan

you a have questions you. answer joining any call. for you We the for for you around great your we have hope If today, can weekend. might help everyone thanks thank Rob, additional and I'm for Thank this. this afternoon.

Operator

for today's conference concludes participation. Thank call. you your This

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