Community Health Systems (CYH) 26 Oct 232023 Q3 Earnings call transcript

Good morning, and welcome to the Community Health Systems Third Quarter 2023 Earnings Conference Call. [Operator Instructions] Please note, this event is being recorded. I would now like to turn the conference over to Anton Hie, Vice President, Investor Relations. Please go ahead.

Thank you, Gary. to Systems' welcome Conference Quarter and Call. morning, Community Third Health XXXX Good

today's Hingtgen, are and me call Joining on Tim President Chief Kevin and Chief Financial Officer. Hammons, Officer; Executive

that our report and I'd results are in to expressed a to on statements. headings in significantly and certain begin, Factors intend reports described subject filed statements, statements furnished forward-looking XX-K today's to those to Risk rely or all other do unknown number are forward-looking do including call not the to in facts. These as historical such we Before statements or forward-looking annual remind We in everyone current risks, any from may update may Form discussion. these this with which like contain any Actual SEC. not solely known that differ of conference forward-looking of statements

and of call We've of afternoon, I Officer. as issued Chief and turn expenses All financial or -- a Hingtgen, press of impairment release our today's on the will a losses or expense from adjusted calculations from will early the EPS. losses our benefits gains debt, and with and website. we calculations related discuss Tim definitions businesses, statements termination employee call also to Executive slide With presentation EBITDA on government Yesterday well exclude and supplemental posted on said, related charges. as extinguishment other we expense that adjusted and gains matters termination over legal sale costs, to restructuring other

quarter thank our and morning, joining and call. third Thanks, Anton, conference for good you

give strong same-store and gains development were quarter the up and record since practice included including and which performance far strategic that the continue this competitive we point physicians the towards is strengthen priorities for investments. We of more reinforcing and demand Surgeries a at of near-term industry of the of we by or and X.X% record XXXX, markets the Our typically these you in as visits, overall, XXXX. ER third our plans for our to indicator the initiatives, for an increased admissions for quarter, level volumes. physician strongest the and the we activities move been to a map on for quarter, quarter navigating vacations we confidence have had discussing targeted outpatient more macroeconomic position. Year-over-year grew the reflected but solid for overall highest our levels, X.X% the middle same-store admissions care pandemic. our our road update I favorable year-over-year quarter so third prepare seasonality, normal leading year volume market pre growth XXXX investments want in access reached had fourth year and and [indiscernible] demonstrating in patients. Since the future our or volume impact end sequentially Same-store environment. the adjusted X.X% our

safety and categories. They the accelerate advanced control As focus quality. supplemental in debt, X organization-wide outlined are: expenses this growth, covers strengthen workforce, main and our

as remain create to growth operational in capacity we accelerate to our core patient First, more our and about for and of initiatives a growth we optimistic care. ability number the implement prospects markets invest

and XXXX, market opportunities. Upon growth our in the integral advance are to Tennessee all our the growth markets. completion, prospects both open the to open Nashville Our campus of schedule XXX to next than will at to beds track expansion share expected expansion have with early their on the to we occupancy across more projects rates conditions Alabama full the opportunity project XXXX. since in end Due markets, and Knoxville and added Foley, on achieving high are incremental Tucson high initiated portfolio year

stay of capacity length intensely and work. are focused optimization on We

improved Our strong patients reduction safely resulted with setting and stay to into discharge in home in the workforce priority. a post-acute efforts an return hospital admission total care of growth X.X% favorable or quarter Strengthening key resulted a sequentially. This move year net in patient to to in remains and the leave days. another length ready and promptly compared last our

quarter. and nursing the in continue Our labor and enabling recruitment contract clinical to retention perform in well, strategies further improvements third

providers In now programs medicine and hospitals, more terms have of than emergency hospitalist our this work XXX we and model. select to medicine CHS insource working in under ED hospitalists

We the strategic with effort quarter. financial and from the pleased in benefits this are third

to needed, We well. are services underway in is confident and select in our currently scale markets this as anesthesia planning solution as in-source ability to

Finally, quality a and couple of safety notes initiatives. about our

clinical launched quality, just leverage excel was where into and provided This market ago. designed level can better great data to clinical over further and leading a insights company-wide areas and has scorecard safety improvement. Our in year we areas very resource of advance patient targeted X at to

care hurdles certain behaviors to of are all of which prevention infections and headwinds, a in in quartile initiative evolving top resulted hospitals reduction inflationary including are sustainable areas stop now has For and mortality nationally team. Health face for challenges, the in to management of company-wide example, dedicated the consumer due our hospital-acquired sepsis to a and majority providers sepsis. our of for reimbursement continue pressures, focus regulatory

where over strengthen need these dynamics, we the through when call to exercise to we With order me and turn in results. continue let our Kevin, control to can that, adaptability to As we you. we industry will navigate further

everyone. Tim, and morning, good Thanks,

as evidence and Power return encouraged further contract are for from success core the of our & progress care the labor investments We in early and by in in services, ongoing as the initiative. physician in-sourcing Project demand continued well health reductions our

was net was XX.X% sequentially as billion, mix quarter. Commercial down volume consolidated basis total and second company increased the in adjusted admission. same-store third per expected. grew faster XX a from a to results. quarter adjusted operating average were of the X.X% year-over-year on Commercial points at representing from Advantage revenue increase Net the in a by quarterly flat financial of XXXX, X.X% on revenues than $X.X second the a and over Medicare Moving On while a net revenue X.X% basis, net quarter driven X% growth admissions revenue, basis. growth

down medical admits surgical from growth When an XX.X% Adjusted and the which declined cost sequentially million improving was our to on points retention quarter and the our outpaced XXXX typical as was and representing million as margin year. CHS third -- provider prior $XX XX admits sequentially up million, margin. points nurse million the strong $XX noted. of labor Tim third excluding However, only over pressures funds basis profitability. We quarter $XXX basis EBITDA and stepped management million $XX $XXX were helped was pleased contract from seasonal expense, expectation XXX as for million, $XX to in outperform recruitment expectations from labor exiting driving relief deliver year-over-year strong very results, previous versus more than us benefit

average for improved Our XX% also rate contract hourly labor sequentially.

Additionally, factoring those $X compared APP. in-sourced which gross to up overall subsidy increased in for approximately up previously expected, physicians in year. quarter, with the versus payments by sequentially wage we physicians, for from the Medical estimate of in-sourcing net former the associated second contract. When million APP the X% slightly from paid inflation OpEx a revenue other X% benefited expenses we specialist forecasted than approximately full line in better the our included fees slightly came year-over-year as reported to

has this in-sourcing progress And in encouraging. As quarters improvement scale as with Tim expect our the noted, very further the initiative been coming we we effort.

quarter million Moving Cash third than reverse $XXX affected as items XXXX. of $XXX get in billing the flows $XX our performance providers of million we with cash should various in work million in physician to delays the the on certain cash that compared was credentialed system our temporarily more flow to statement. clinical under initiative fourth X and agreements. were to from operations markets The quarter. Most insourcing our in network notably, related upgrades by

related these being submitted. been are Importantly, successfully and completed have claims

So we to seeing expect quarter. fourth these payments in the begin

for expenditures $XXX months for and to $XXX were million, track quarter with million, were on Capital guidance the million. our first the $XXX of million $XXX X

as in free typical. the to fourth flow quarter expect We in significant continue improvement performance is cash

for However, at debt was positioned from well to cash quarter in the $XXX performance EBITDA to and $XXX environment, and million the approximately updating of of of $XXX and are light current cash on we our million to our date to liquidity adjusted trailing million. Net ABL, $XX operating million the and legislative end guidance hand, standpoint remain to equivalents we our a meet with borrowing forward. Xx capacity going under flows needs

proceeds the pay warehouse expect the in divestiture Western from planned debt. Additionally, primarily continue to be to of used to Florida Health down we assets

returns markets. with strategic October We X, we acquisitions reduction, achieving it key will risk, continue expansions our we interest off we debt & Projects makes and results. Power, including recycle and and higher capacity towards of modernization certain our inbound receive in the potentially and when transaction consider enterprise-wide capital and in line kicked with sense as to service optimization financial pleased select lower initiatives certain the very early are and assets,

shared wave our up Oracle no functionality in Chain implemented of workflows have care. with we and XX deployments, our patient first Supply and part new stood of facilities services of disruption have the at As our finance and our

look upon which We can Empower lines Project providing to forward and believe further as CHS' opportunities within you to updates Empower insight the the are quarters. shareholder and increasingly we'll Project and improved significantly for from in months reveal forward visibility case we value. We business coming confident markets drive with operators in the and that capitalize further business press our

guidance night's As range last release, we the are noted in we updating XXXX. for press

$XX.X our of our our in into billion opportunities recovery of us Specifically, longer-term $XX.X reason gives to billion. We revenues the for volume billion heading targets X-year to optimism anticipate $X.X billion the quarter. operating EBITDA in confident to remain we and fourth now markets continued and net in adjusted and X- growth $X.XX

for prudent with remaining this quarter I'll one is operator the the questions. back to just However, call over we that, poll turn believe With update to the year. in

[Operator Instructions]

The first is Hendricks with RBC. question from Ben

the bridge you versus I guide cash the flow us and flagged the Can I was new was current for just there. to cash a items down number of from prior us the the hoping quantify you help of I EBITDA revision. color to you those more flow get range. on could think guidance some magnitude hoping help

Ben. the Thanks, Yes. question. Sure. appreciate I

we're EBITDA guide at So of lower refund the of -- related the are expect really about tax we if reduction. until XXXX. did really actually couple that years. timing This represents goes that the XX% anything. That come And end starts now a tax of it the cash more items the cash But range. not refund then in that about know we of will a a a federal year. new couple we than back there are think flows, for current

of half year result of going second We of also this effect into That as code IRS the this a taxpayer that's became deduction cash the limitation a predominantly in year, on the is interest a is we coming year. into XXXJ X/X that. be And that to we And the to interest would in that refund that approximately deduction the do expect limitation if also down. get expect turn rolled so, would guide back. another

that on the us require our inflow overall make on is then because some This outflows and is compensation payments. sold investments made corresponding we year. section flows. in item there's in we operating net actually the include to And guidance has hand we cash, this but to retirement rules included that a impact Another payouts accounting these a had cash investing in deferred X

to a really cash about was included But the accounting that reduction. was reflect that, So net XX% from X we flow guide the cash impact. operations, of that in

of million. EBITDA during litigation this to reserves the quarter of some an couple is in as fourth the adjustment of $XX in quarter expected The year. there, increase out called other items payment that of The governmental about we an in

physicians and X% to expect that. in included early are of some that's quarter, the flow around probably 'XX a as but mentioned, get either down. the part going delayed ramp we guide cash in-sourced maybe related up, we've and billing then to those And mentioned, out, flowing physicians partially fourth little those I the So bit about drag, that we been the that turn There's as we credentialed. has into would as the bills of

adjustments and those So I think are the of that just timing all covers of majority issues. substantially

much with have APP you're give you for? regard? that. for an Appreciate us last top billing on, regard how line related revenue guys you of bringing one Great. how much that that very of subsidies to to with idea the And for And positions providers from can your accounts And other you are the billing. in asking the exposure

Sure.

are physicians our the of practicing all hospitals. So in

in or with completed -- of under either are payers. we So agreements credentialed process our getting have those physicians the

are providers there in that. So from involved other subsidies no

this the the magnitude million. only of approximately X expenses, kind for million for approximately and this of quarter, $XX represented terms months $XX cost of this revenue of In quarter

of in a that source. EBITDA to So physicians we net $X million related kind impact those

not that is we that a subsidies So the million paying overly but approximately APP. to compared material, were $X benefit previously

I'm pleased and quarter, think going to that. looking our with taken of how has these on lot our we forward. ability rapidly opportunities in-source said transaction we're really to, comments, Ben, Kevin, of last in the Yes, shape as to a months I And add in providers the X we see this

of is internal that job experience have just different I the team key are hospital-based think standing running regard that the who of traditional and outstanding enterprise, practices. And our of finish which now from of we an component wins just past our of medical some that operating are an has more done in up. uniquely group leaders practice

We some those those competencies to are medical us and Again, those for out won't think, fee our approach we that to that to be across-the-board help specialist medical resources, capabilities, tackle now initiative spend. managing resources adding balance the company. also fee we're helps really it having functionality, But anesthesia, specialist the an clients us experiencing.

The Brian is next with from Jefferies. question Tanquilut

up follow you last that made. I'll maybe with Tim, point that

point this physician then about, outsourcing because physician are number positive. of are your in in sounds are out and some like And as to in-house subsidy this you a a a we parts would expectations in-source bring of second, what in outsourcers? if outsource difficult what to processes modest about think see whole, forward to versus at to these possible decide of those what turning the thinking to terms terms we decision third-party going we of how it that's as staffing all one, be So payments seeing as or subsidies? And be if And are some pressures, how bring to some it is option? like those moving you

Kevin the and start type for to some financial that I'll Brian, then plan. up of that it had implementations of of

be opportunity, we have we starting when end to As quarter, by really said our the don't pursue of all all. mean not single our every hospital-based to I it's were last We an contracts in-sourcing serviced one model. expect in-source

type sights on not XXX% a to of work. have we our transition that So set

happens. it if However, again, time, building over what that's

keeping inability we really to we're clinical align still how our a providers. and to of patient those more early be that. We closely of a model from slight it's think for from we're inclined it's glean we I in-source providers in-sourced -- EBITDA improvement benefit initiatives, eye in-source it much something purposes safety that but able hospital-based financial first like the do think Kevin to result on. a the say with out, like would the to X our months can we throughput initiatives that called also we under see our a affiliation type there But as model. close was to

I traditional characterize they're relationships don't not the partnering spend Hence, with point don't we for on reason and I types out to those or us providers, I approach really that of contracting the we physician of our XXX% have process. our hospital-based initiatives. have want should contracted is don't think to same hospital-based our make to that believe this we tremendous if good road. down upside that there

few that. Yes. And kind maybe on around of to add a just financial metrics

the point net this represent they basis medical That's increase current a quarter. year. fees XXX did Our points basis specialist approximately about of prior over XXX revenue

work quarter expected fees. down of for been in They've forward. our indicated, renegotiate we the mentioned, would anticipated. They pretty high small watermark quarter as on than further and where further be continue harder get ran reduce sequentially. to flat expect we in not the first relatively with in previously first expecting to just as the thought we had contracts reduction specialist in-source previously in near going things, year fourth quarter, to to I in we sequentially, look had third we number these material medical Tim to of try we term line Although was the either quarter, kind we as the increase a much the a to are the

sense. guidance like QX Kevin, then about XX.X% I a makes margin at target. your the kind is That And mid-teens maybe, a know margin deck, guidance, think implied kind as point showing midpoint. I slide of for your the like you still in of to

and that margin So that mid-teens incremental how driving are lift margin going about opportunities sequential target. you forward thinking get to then to

Sure.

number a there's things. think I of

grow a capacity, line, number we growth to mentioned we've our growth that which to the and portion will expanding to initiatives, as investments add costs, of bigger as through margin. leverage a So will continue of fixed flow much in bottom

next lift little higher We expect our to a be rate year.

about now. base significant A rate, big take The take with this fairly Medicare if majority the Our completed are backs. year, portion you by backs was government the although of those think rate was of in offset that XXXX.

we into Medicare of XXXX, rate X% had XXXX. should better kind in X% seeing and that lift have in lift to commercial XXXX in So that a rate going similar we're we

work well. really there commercial well. manage more think then there's doing continue we're some the I the expenses, So on side expenses runway as we to on And

XXXX, the runway continues out in in additional to of capture be able to being expense power into XXXX. then there's to us going project as we kind -- that reduction. on improvement that's into Our rolled margin think And lengthen

Rice UBS. A.J. is The next with question from

then a very things. of generally you're side flat commercial call about a dynamic? think, know I of related I deck, really percentage on your seen self-pay low going on uptick it, that slide on also off bit base. little from and in payer Is else there, there year-to-year mix ask trends. wanted you -- the an Or something your other. sort care is in comment commercial Just to your on managed to I you've just there? And reverifications or X in you

out you public of well and others little managed it? that bit Some -- are that are enrollment. they've as other behind the that that in companies that off if from got say pointing care and of your And somehow anything exchange have the Is a the that rest the you seeing does then lift markets? a

Sure.

it this amount couple a a jump point quarter but I'll to We're to significant some self-pay, decline a Tim, that collectibility really out a material increase we either. collectibility self-pay, is there. in base, small was redetermination, we're to nothing it small in. as seeing There had a on very So on decline a in things feel small Medicaid adjustment again, seeing there. just not not very Relative and nothing in of and and there's good relates really self-pay any volume. And volumes free

did we in see that's us. commercial, to So of having both of don't believe negative kind on we and commercial a Medicare business in year-over-year impact business that Relative terms increase volume.

commercial volumes Some outpatient a seeing seeing less so the inpatient to are more always year more well. Medicare pressure we are rate side, a offset out on to fee-for-service compared shift business MA we of on this between and because have business, mix in an collect MA Medicare fee-for-service. revenue and into of that traditional lift commercial as because continued continues did that effect of that was but we had outpatient of we the net -- it's revenues, the

X% forward you on you're underlying in that I zone in we mind? levels that to increases. Okay. sort And wage of that next labor then that increases, at expectation mentioned X% pre-pandemic that in sounds year-to-year carry the cost, wage it's year sort running something your in an back this can et for Is of you're quarter, cetera. trend follow-up, mean like my least

X Yes. managed think past We've fortunate, quarters. been I and wages we've very this

QX recall, about closer was X%. X.X%. was you X.X%, QX If QX, to

employees markets or a of inflation. in look we out, a So the so care Still and keep make that below in about market we really into wage in trends we currently probably, more historical to over point, but and year. thinking some market. I had something in reasonable pressure hard X% still to also being obviously the seeing into around this as wanting work is elevated that kind check for sure would of to matter, X% probably our We're XXXX, X% staff averaging bit anticipate at little our of expectation all guided we're as terms all little taking appropriately. that differs will wages. towards guide a of nurse XXXX for bit It to range running approximately continue our

is next Jason question Citi. with from The Cassorla

ask in reimbursement payment in can that Mississippi. to just reimbursement. number are Medicaid those the out wanted guess And fluctuate aggregate. states one how potential about programs. in context, backdrop seems you see of including Medicaid building do I I a Great. that? dollars about supplemental But generally year-to-year It I know thinking the Or program you are improving? Medicaid greater that

think like number great those that helpful think for payment who a the to Medicaid I or But state services a submitted not been positive programs are we what helpful And years That's and question. are reports have go has probably the adjustment approval right, their generally, states at a as adopted supplemental Texas But coming make out by reimbursement increase CMS. who an of CMS providers you for for by it patients. point, the all that approved generally, us. programs people Mississippi. And generally Medicaid other covered others have I have do to would are you're through this over have does has very to for be by past Florida as providing some obviously few have seen and of the Mississippi well the there

point we on approved the positive. too to tell what program that will and So this see exactly of quantification be. this what a would be But will it's early as at

seasonality that I volume up to guess up you And a as wanted talking your I to X% guess trends so in far is the know year ask overall you volumes. Fair surgeries Okay. I this in quarter, overall against enough. about just comp. And follow-up, a noted seems that over It surgery other like remarks, are about of in the are to surgery on outpacing I follow difficult X%. to that time. normalized X% there you this outlook drove on then have that, growth volume prepared just to over given that X% and factors making the curious the you're setting, growth you're paradigm surgery the I'm fits about acuity your that in how in investments investments how into higher too. quarter? And outpatient lines thinking book, service just

I'll being our increased the on our anything really was impacts quarter. the for provider good other quarter We high It that year, key the a start a as last with it view think driver in for quarter. was seasonality patient third the third comp us. vacations see and than opening I in don't performance comp remarks inched a good we called us. out in It surgery

leads our opportunities fourth of volumes vacations. our of for ASC surgery. with So surgical we in mix procedural earnings the and specialties what had expect to good better which be we strategies, in a the And like growth We really it's I cases, quarter. strong timing growth just colorectal always sequential ambulatory for the spine. fourth is cardiac commercial our people's in that, think confidence really quarter, pleased, our really We're quarter frankly, to kind general than hopefully, select as anticipate, for surgery a in strategies

overall we numbers. facing we in year. pleased really a were comp challenging just saw our with what more just It's from that So prior

Yes.

although maybe year. reiterate, over to prior decline positive saw I it that just in that's want think sequentially, surgery was we Tim. I right,

we with improvement surgical quarter us. the back and up surgeries also expect in in And normal for strong but pick a quarter being and the growth we we adjusted very in of just to attributing was quarter continued that both kind the admissions, to we third the saw kind that continued Second only of still saw quarter. are admissions softness that with in fourth sequential seasonality,

growth make the guess, confidence the surgery in I across to portfolio. I'll just kind last think opportunities I our comment support the of,

inpatient surgical are is I pre-covid the growing of us think capacity, I'll We we transfer then Certainly, the recruitment opportunities, invest new, I in acuity business, record well provider more I'll and business our that with our the drive seeing specialist that. And as exceeding that center in the thing as the last baseline. to for the volumes input is say, guess, search are growth add well. we bodes

prior We year, believe, and are up X%. over sequentially I X% by and

up great So lines there again, as and demand for providers. in service open right out and invest capacity us still we the

with The question Wells [Technical Difficulty] is Stephen from next Fargo. Baxter

Yes.

about think hopeful. Yes. Sorry end, I on my that, problem

So I with where just in a tracking line generally wanted just I'm We below, in right ask of, a model quarter couple to to bit make question, a little I the think, had sure related but correctly. was. our

pretty as EBITDA you're think I close consensus quarter. to well for in the

that thought normal tell, to case the So quarter? levels a And that seasonality as that. sounds bit about that best typical little love might third I little But excess the to clarify you reflects. you closer in and it understanding than a point you're quarter that's I see that I at of third to revision something just in bit that more just would this want can saw something suggesting make to seasonality then hear correctly, the not saw and tracking you less and just what guidance comments the sure I'm the like seasonality

I'll And comments with Sure. start our some on guidance.

quarter. guidance update year EBITDA with off So around just our first really we where reflect soft very We started to a kind year-to-date. are wanted of the

first the through outsized we're did back third with on back, not of the only quarter. I second quarter, have came have. We quarter, think, but much miss expectations in in quarter the some that that line the third kind we that of really and clawed performance miss Now in the the caught of

of is reflective update really results. So our just year-to-date the

our from -- million highest year. implied quarter would of EBITDA, now is our If revenue, it's net fourth be quarter you billion what of at of think $XXX $X.XX the the EBITDA about still the midpoint, that updated guidance,

which it's had implied the we quarter of expected, at year. is the the midpoint highest margin a As margin XX%

So in to growth with update of X quarter an I continued are and out we still think third reflects again the go the only and just quarter year. where reflects coming

I just, kind is, over patient of QX, and behavior think the I particularly had and and normal of maybe physician for outpatient that in would we some vacations In What cost so of kind forth. management. stepped it's terms then really think that experienced prepandemic seasonality some point terms in behavior side kind of I of we with seasonality again, out of the continued with just around growth,

normal business business more a we quarter of so the kind we did terms straight volume EBITDA line the we that much from from So and of experience the patient but more may of not growth Pandemic. than we in had year at more sequentially than the was be type little that throughout of the maybe it we seasonal historically on seasonality, beginning pressure behavior, -- recovered of when thought and a year anticipated and

[Operator question with The next Nephron Research. from Josh Raskin is Instructions]

would touch business. and same-store little a sort of bit Just same-store sort revenue overall on just of

some up mentioned -- weakness this you the the created guys year. down we of XXXX. of normal think then and of the to color number you do XQ, sort we're X% the a more first And And X% Is go kind quarter. some maybe in here. of kind a through that that was number volatility what's this then just think through at So path on back is about it X% as in of to

into of about fits would would our look X% So kind and mid-single-digit kind that's revenue and revenue of -- same-store of I thanks, longer-term net next that year, think to that, kind growth, growth expect of go into we of delivering we as medium-term what Josh. right we kind be that's goals, I think where as that do target. X%,

significant health We XXXX some you not were and And health about when were was XXXX due kind going some travel the saw exodus people move systems comp. back is softness are -- can they the into and since things the free system, to about from lifted. other coming to volatility, in quarter doing restrictions normal of in care more the real behaviors. of to terms the that's return on so care go on we of masking we the second to part as of of that and restrictions of kind lifted had In -- and April forth, respects

in So of we quarter terms had in a little that volume. the easier second comp

of a about, sequentially contributed continue So to to the as But grow. growth. bit we that think I I think kind little percentage again,

in on that not terms seasonality seeing and The normal admissions admissions, the of back to more unexpected were quarter, helpful. stepping the adjusted that kind now over into in. So normal getting of surgeries, very we're third is setting recovery behaviors

just Got a talk bit, bit. but on mentioned a of mix. I payer sort you down then it to you little Medicare little you. question, helpful. That's A.J.'s didn't was And know

anything self-pay moving So other stuff and that again, down? was Medicare there? sort Or some drove rate parts is impacted of in it that just kind on there of

The Medicare but -- the year-over-year. fee for service Advantage was up Medicare down, was

the fee-for-service that maybe out of of Medicaid year-over-year into flat. programs that's was MA and a self-pay population kind then and of up were So just traditional commercial Medicare shift programs. business relatively

This would concludes to session. over our Hinson back closing I Tim to any for conference question-and-answer like remarks. the turn

and we health across health to of workers daily you, And much care care themselves it careers. Thank and appreciate care across workforce. devoted have expressing say those just Gary. on want I appreciation I CHS very I'm close who remind to by the proud health nation. want my rely about how our for to I

us you great you (XXX) can Thank and have day. reach As additional have you, if XXX-XXXX. questions, always, a at

you The today's has now conference attending concluded. Thank presentation. for

You disconnect. now may