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CEO Keith Newton expressed bullishness on the On-site segment, stating that the introduction of an advanced primary care product is enabling them to win new business and should drive a core growth rate faster than historical levels. For the core business, President & CFO Matthew DiCanio reiterated the long-term algorithm of low-single-digit volume growth, while Newton added that an uptick in hiring rates would specifically benefit employer services growth.

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Executive Matthew DiCanio confirmed the revised guidance includes both the Physicians Health Center (PHC) and the pending Pivot acquisition. He stated that while the long-term average for workers' comp rate increases is 3%, it could remain higher in the near term if inflation persists. DiCanio clarified that the company was not signaling a concern with the 0.2% organic workers' comp visit growth but was providing transparency to separate core performance from the one-month impact of the Nova acquisition, noting the real highlight was the positive turn in employer services visits.

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Executive Matthew DiCanio stated that while the Florida rate increase is included in the 2025 guidance, the company does not quantify impacts on a state-by-state basis. Executive William Newton added that Florida was the most significant overdue state, as most others have regular fee schedule reviews. He confirmed 'absolutely' that the rate update makes Florida a 'much more attractive state' for capital deployment, evidenced by recent de novo projects and active M&A evaluation.

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Executive Matthew DiCanio affirmed the long-term workers' comp rate expectation of +/- 3% annually, likely higher next year due to the Florida increase. He noted the industry mix is highly diversified and similar for both workers' comp and employer services. Regarding the new service, DiCanio said the advanced primary care offering is in its early stages but is expected to be a significant growth contributor. Executive William Newton added that M&A is also an opportunity in this area.

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President & COO Eric Williams attributed the cost control success to 2024 investments in recruiting systems, increased student rotations, a new applicant tracking system, and a strong focus on mentorship, which has led to the lowest turnover rates in seven years. CEO Christopher Reading and CFO Carey Hendrickson addressed the Medicare proposal, estimating a positive rate increase between 1% and 1.75% for 2026, which would be a welcome tailwind after years of cuts.

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CFO Carey Hendrickson stated she expects the overall net rate to increase in 2025 versus 2024, projecting an underlying non-Medicare rate increase of around 2% or better. She also anticipates cash flow growth in 2025. CEO Christopher Reading added that for home care expansion, the company is evaluating both organic growth with existing partners and potential acquisitions to build out capabilities.

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CFO Carey Hendrickson confirmed the 2024 EBITDA guidance of $80 million to $85 million is unchanged and already included the Metro deal. She noted Metro's clinics are larger with higher visit volumes but a similar net rate and adjusted EBITDA margin profile to USPH's existing PT business. Executive Christopher Reading identified the pending Medicare rate cut as a key headwind for next year, offset by tailwinds from a full-year contribution from Metro and continued success in commercial rate negotiations and growing the workers' comp business, which saw revenue increase nearly 19% YoY.

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Interim CEO & Chairman Denise Warren explained that free cash flow guidance was held steady due to working capital variability, including accruals for severance and activist-related costs. Regarding costs, she clarified it was less about incremental spending and more about the timing of incentives; the expense was recognized in Q2, but the full economic benefit from the resulting late-quarter move-ins will be realized in Q3.

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EVP & CFO Dawn Kussow confirmed the guidance raise was driven by Q1's outperformance but is balanced by caution around macroeconomic uncertainty, not current operational weakness, citing strong April occupancy. She explained the 'SWAT teams' succeed by removing barriers—such as accelerating CapEx or hiring—to get quicker results. Both she and EVP & General Counsel Chad White affirmed these actions are sustainable and learnings are being scaled across the portfolio.

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EVP & CFO Dawn Kussow highlighted strong January occupancy performance, noting a smaller sequential decline than in recent years. She explained the 2025 EBITDA growth is driven by favorable flow-through from RevPAR growth and solid expense management, with the NOI and rent impacts from the Ventas transition expected to be largely offsetting. President & CEO Lucinda Baier added that the company is always proactive in matching its G&A infrastructure to the size of the business.

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Dawn Kussow, EVP & CFO, attributed the sequential pressure to normal expense variability, noting a 1% variance is about $5 million. She specifically highlighted higher-than-expected employee health and insurance costs. While not providing a specific figure, she stated Q4 occupancy is expected to increase sequentially and guided analysts to use the year-to-date RevPOR growth of 4.3% to model RevPAR. For 2025, she reiterated the goal of steady occupancy growth and improved adjusted EBITDA and free cash flow, deferring specific guidance.

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CEO Christopher Hunter confirmed that the risk applies to states where supplemental payment program rates are above Medicare. CFO Heather Dixon affirmed that the higher-than-expected Tennessee benefit is due to rates moving closer to commercial levels. Dixon also confirmed that a mid-single-digit volume growth expectation for Q4 is still reasonable due to easier comps.

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Executive Heather Dixon clarified that a specific dollar amount for the Tennessee program has not been disclosed, only that total net supplemental payments are guided to be flat to up $15 million for the year. She confirmed there was a $10 million out-of-period payment in 2024. Executive Christopher Hunter detailed the multi-faceted approach to improve facilities, including direct outreach to referral sources, talent reviews, and enhanced quality control.

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EVP & CFO Doug Coltharp stated there are no plans for acquisitions in adjacent service lines, as the focus remains on de novo projects which offer superior returns. He attributed the strong same-store volume growth to success in treating medically complex patients, with significant increases in neurological, stroke, and brain injury cases.

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CEO Mark Tarr attributed the broad-based demand to aging demographics. CFO Douglas Coltharp highlighted the long-term supply-demand imbalance in the IRF market and noted high barriers to entry, including significant capital outlay, clinical expertise, and compliance needs, which favor scaled operators. He confirmed that bed expansions offer the highest return on capital by leveraging existing infrastructure and established market demand.

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CFO Douglas Coltharp explained that maintenance CapEx includes programmatic asset replacements like patient beds, wheelchairs, and drug dispensing systems to ensure quality. He attributed the strong 2024 free cash flow to better-than-expected EBITDA and favorable working capital, noting that some of the working capital benefit was a pull-forward from 2025 related to group medical claim liabilities.

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EVP & CFO Brian Poff estimated the acquisition's EBITDA margin profile would be around 13-14%. President & COO Bradley Bickham added that they like the Western Pennsylvania market and see future rate increase potential. Regarding budget pressures, Bickham noted the cuts are not effective until 2028 and expressed confidence that states would be reluctant to cut essential services for the elderly and disabled, which could ultimately increase their costs.

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W. Bickham, President and COO, confirmed that weather events in January were offset by a rebound in February and March, and he expects Personal Care hours to grow in the 2% to 2.5% range going forward. For hospice, he attributed the success to strong ADC growth and leadership changes, projecting revenue growth at the higher end of the 5% to 7% range for the year.

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CFO Brian Poff confirmed that Gentiva's lower-rate Texas operations would reduce the average hourly rate, partially offset by an Illinois rate increase. President and COO W. Bickham attributed recent volume softness to Medicaid redeterminations, which are now subsiding. He outlined a path to 2%+ hours growth through normalizing admission trends and deploying a new caregiver application. Bickham also stated that potential Medicaid work requirements pose no direct negative impact and could even increase caregiver supply.

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President and COO Brad Bickham clarified that the New York operations were already excluded from same-store figures and that the primary headwind was the Medicaid redetermination process slowing new client intake, which he expects to normalize by Q1 2025. Regarding hospice, Bickham noted recent leadership changes in sales and expressed optimism that new sales training will help the segment return to a mid-to-high single-digit admission growth rate.

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CEO Eric Evans confirmed that they are open to various partnership structures, including selling stakes to health systems, if such actions accelerate deleveraging and free cash flow growth. He also stated that the entire portfolio, including surgical hospitals, is under review. Evans reiterated confidence in achieving same-store revenue growth at the high end of the 4% to 6% range for the full year.

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CEO J. Evans confirmed there has been no adverse payer mix shift and that commercial payer negotiations remain constructive, with good rate visibility for the year. CFO David Doherty added that revenue cycle improvements have successfully mitigated denial pressures seen in prior quarters, leading to a two-day improvement in Days Sales Outstanding (DSO).

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CEO J. Evans explained that divestitures are part of ongoing portfolio optimization to exit markets where they are not the best owner and reinvest in higher-growth areas. CFO David Doherty clarified the revenue impact is included in guidance and represents less than a 2% headwind. Regarding site neutrality, Doherty reiterated the 1% revenue impact is not material and the bottom-line effect would be even more negligible after factoring in non-controlling interests and potential cost actions.

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CEO Jon Rousseau stated that the strong, broad-based growth in specialty pharmacy is the result of a long-term strategy and investments, and he sees no change to the growth trajectory given the large market and innovation pipeline. Regarding the Medicare proposal, Rousseau commented that it was uncertain if it would present an opportunity, as BrightSpring primarily operates outside the hospital setting.

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CEO Jon Rousseau explained that gross profit per script is a function of product mix, payer mix, and procurement, with favorable trends in product mix and internal sourcing. He noted the generic pipeline remains robust. CFO Jennifer Phipps added that significant growth in the specialty business also contributed to the mix. Regarding the Amedisys assets, Jon Rousseau stated he was bound by confidentiality but noted the situation was unique, fit their platform's strength, had no geographical overlap, and would not impact their transaction until the primary deal closes.

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Executive Jon Rousseau explained the dual nature of the IRA's impact. While lower patient out-of-pocket costs are a positive for utilization, the risk lies in the price negotiations for eight specific drugs in the Home and Community pharmacy business. He stated that while CMS guidance has been favorable toward a margin true-up, the final mechanism is still pending. Rousseau quantified the potential downside as a 'couple percent of EBITDA,' which he is confident the company's diversified model could absorb and grow through, but noted the industry is actively seeking a permanent fix.

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CEO Jon Rousseau confirmed that lower Part D costs are a positive tailwind for volume and expects another increase in January. He characterized the STELARA situation as "idiosyncratic," likely influenced by its inclusion on the IRA list, and not a precedent for future biosimilars. He emphasized the overall attractiveness of the infusion market due to its deep pipeline and high barriers to entry.

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Chairman, President & CEO Thomas Ryan clarified the growth guidance was for the second half of 2025 and revealed that Q2 large cemetery sales were a strong $52 million. Executive VP & CFO Eric Tanzberger stated the capital deployment strategy remains consistent, focusing on M&A, greenfield investments, and share repurchases. He also expressed confidence in meeting the full-year M&A investment target of $75-$125 million, citing a strong pipeline.

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CEO Thomas Ryan explained that the decline in cemetery sales was primarily due to timing issues with large sales, which are historically volatile, and expressed confidence in the pipeline, citing a strong April. He noted that sales at Rose Hills remain strong. CFO Eric Tanzberger addressed tariffs, stating that about two-thirds of merchandise is sourced domestically and long-term contracts should mitigate near-term impacts, making any effect immaterial to current guidance.

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Chairman and CEO Tom Ryan stated that January funeral volumes were down about 3%, in line with expectations against a tough comparison. He noted the California wildfires caused a temporary disruption at Rose Hills but expects sales to be deferred, not lost. Executive Eric Tanzberger explained the $11 million restructuring charge was primarily related to enhancing efficiency in corporate and back-office functions through technology, with expected cash savings in 2025.

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Chairman and CEO Thomas Ryan confirmed the funeral volume forecast is for same-store organic volumes. He stated that large sales production is now running around $160M-$170M annually, a 60-70% increase from pre-COVID levels of about $100M. Regarding margins, he attributed recent improvements to the core business and SCI Direct, and anticipates the new insurance contract will be a much bigger positive factor in 2025, potentially lifting margins by 100-150 basis points. On the cremation rate, Ryan noted that while it ebbs and flows, he believes an annual shift of around 100 basis points is still possible.

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EVP & CFO Michael Witzeman noted that while the cause for the April-May dip was unclear, June-July trends have returned to expectations. CEO Kevin McNamara added that new CONs, like Pinellas County, represent significant future opportunity but are not included in the current models for resolving the cap issue. Regarding Roto-Rooter, Witzeman clarified that the second-half guidance includes a conservative $4 million accrual for higher insurance costs. He also confirmed no change in capital deployment strategy, with both acquisitions and share buybacks remaining priorities.

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CFO Michael Witzeman and CEO Kevin McNamara addressed the marketing change, noting the new agency brings more resources and fresh ideas to navigate the complex, bidding-based online search environment. For Q4, Witzeman guided to a similar year-over-year revenue trend as Q3 for Roto-Rooter, but with margin improvement as one-time marketing transition costs will not repeat. For 2025, management is cautious on Roto-Rooter, expecting flattish revenue, while for VITAS, they anticipate high-single to low-double-digit census growth. VITAS CEO Nicholas Westfall added that the finalized Medicare rate update provides a ~3.9% tailwind for VITAS heading into 2025.

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CEO John Rademacher noted the advanced practitioner model is expanding to serve oncology and neurology patients, though it's not yet a material part of the portfolio. CFO Mike Shapiro explained that mature infusion suites see over 20% nurse productivity uplift, creating capacity and value. He also stated that the company has proactive procurement strategies to manage potential tariff impacts, which are not expected to be material in 2025.

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CFO Michael Shapiro confirmed the muted Q1 Stelara impact was anticipated due to inventory timing. CEO John Rademacher sized the annual medical supply spend at roughly $100 million, with less than 10% sourced from China, viewing the risk as manageable. Shapiro affirmed they will continue to deploy capital via both M&A and buybacks, focusing on smaller, complementary acquisitions like Intramed while remaining judicious.

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CFO Michael Shapiro confirmed the guidance revision was 'for the most part' due to the Intramed deal. CEO John Rademacher elaborated on the advanced practitioner model, explaining that their 15 current sites allow for more complex clinical services, broader market access (especially for Medicare FFS), and deeper pharma partnerships. Regarding Medicare Advantage, he described relationships as constructive, positioning Option Care Health as a key partner in helping plans manage their medical loss ratios by providing high-quality, lower-cost care.

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CFO Michael Shapiro stated that 2025 guidance would be provided in February but affirmed the situation does not change their conviction in their medium-term growth targets of high single-digit revenue and low double-digit enterprise growth. CEO John Rademacher reported adding three infusion suites in the quarter and noted they continue to drive efficiency and are being used to experiment with new service models, such as for Alzheimer's therapies.

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CFO and COO Brian Scott declined to provide specific segment metrics but indicated that the Q2 forecast assumes 'normal seasonality' for nursing, implying a low single-digit sequential volume decline, and stable bill rates. He attributed the Q1 gross margin beat to a combination of small items, including a favorable $1.5 million workers' compensation adjustment and better-than-expected VMS revenue. The Q2 guidance reflects the absence of this one-time item, with underlying margins remaining stable.

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CEO Caroline Grace noted that while some systems adjust rates for critical needs, a significant uptick has not yet been observed. CFO and COO Brian Scott confirmed the Q1 guidance of ~8% adjusted EBITDA margin is a good starting point for the first half, with improvements expected later in the year. Regarding international business, they explained the outlook assumes modest visa date improvements, and any delay would primarily push the recovery into 2026 rather than significantly impact 2025.

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President and CEO Cary Grace noted that while Travel Nurse demand has increased, it remains about 35% below pre-COVID levels, whereas Allied and Locums demand are above 2019 levels. She expects Nurse gross margins to eventually improve as market overcapacity rationalizes and the international nurse business recovers in 2025. She also agreed that industry fragmentation and tech demands will likely drive consolidation, an area of interest for AMN.

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CEO Martin Bonick stated there is a mix of near-term and exploratory M&A conversations and reiterated his hope for a transaction within the calendar year. Regarding the New Mexico DPP, he expressed confidence in its approval, noting other states are seeing renewals, and is hopeful for a Q2 decision. CFO Alfred Lumsdaine added that state-level feedback indicates a normal approval process.

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Executives confirmed the easy Q4 volume comparison. CEO Marty Bonick and CFO Alfred Lumsdaine acknowledged a strong respiratory season is boosting Q1 2025 volumes but noted these are lower-acuity cases. On site-neutral reform, Marty Bonick estimated a potential impact of less than $10 million for Ardent, given its current smaller outpatient footprint.

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CEO Steven Sell described the final rate notice as a clear tailwind but cautioned that its full benefit depends on other factors. He cited disciplined growth and quality incentives as additional tailwinds, but noted the full implementation of V28 would be a headwind, along with uncertainty in macro utilization trends. He concluded that assuming all else is constant, the benefit would flow through, but that is a significant assumption.

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CEO John Kao emphasized that Alignment's business model was specifically built to thrive in any rate environment, whether increasing or decreasing. He explained that when rates are compressed, their focus on being a low-cost producer of high-quality products provides a competitive advantage. When rates rise, as expected in 2026, their relative advantages remain intact, creating opportunities for margin expansion.

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CFO Celeste Mellet attributed about one-third of the company's quarterly earnings beat to CenterWell, primarily from its PCO and pharmacy businesses. She explained that while some of the outperformance was due to the timing of admin expenses, a portion could be durable, driven by a favorable drug mix in specialty pharmacy and higher-than-expected patient growth.

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CEO James Rechtin stated that Humana is forecasting a 'normalized' trend for 2025 following an elevated trend in 2024, with early data supporting this view. Regarding the MA rate notice, he commented that the retrospective component reflects recent industry trends, but the forward-looking component likely underestimates future trend. He noted they would not comment further ahead of the final notice.

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CFO Susan Diamond responded that utilization has been tracking in line with the updated estimates from Q2. For 2025, she said the company has assumed a normal utilization trend on top of the higher 2024 baseline. She expressed confidence in these assumptions, noting the absence of major regulatory changes that created uncertainty for 2024.

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Saumya Sutaria, Chairman and CEO, attributed the performance to a combination of factors, including successful expense management initiatives, a strong growth environment, and improved staff recruiting and retention, which allowed for volume growth without adding significant contract labor. Sun Park, EVP and CFO, added that strong acuity, favorable payer mix, and broad operating discipline across labor, supplies, and other operating expenses were key contributors.

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Dr. Saum Sutaria, Chairman and CEO, explained that the 4-6% range is their long-term target, and recent years have been exceptionally strong. The 2025 guidance represents a return to this historical average. He noted that the mix of volume and acuity can be lumpy year-to-year, and the plan is to continue shifting towards higher-acuity procedures.

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Chairman and CEO Dr. Saum Sutaria responded that Tenet focuses on post-synergy multiples and has not seen any notable changes in ASC purchasing multiples. EVP and CFO Sun Park confirmed that the Q4 hospital revenue guidance reduction was "primarily driven by the divested hospitals" and does not include any material impact from hurricanes.

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CFO Mike Marks explained the Q1 increase was driven by a reconciliation payment and a new program accrual in a specific state. He updated the full-year 2025 guidance for these payments to a range of a $50 million year-over-year improvement to a $200 million decline. He clarified that this wide range is largely dependent on whether the Tennessee program, for which no benefit was recorded in Q1, receives CMS approval.

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CFO Mike Marks stated that professional fees are about 24% of other operating expenses. He expects cost pressures to moderate further in 2025 but remain above normal inflation. While radiology saw pressure in 2024 and will continue to in 2025, it is a smaller portion of hospital-based physician subsidies and is not expected to be a material impact.

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CFO Mike Marks provided a detailed breakdown of Q3 same-facility equivalent admission growth: Medicare was up 5%, Medicaid was down 8.5%, managed care (excluding exchanges) grew just under 4%, exchange volumes surged 43%, and uninsured volumes increased 7.2%, for a total growth of 4.5%.

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CFO Mark Keim responded that the Medicare business is performing as anticipated and the company remains confident in its full-year 89% MCR guidance. He confirmed that key factors like utilization and Part D costs are tracking in line with the original 2.7% trend assumption.

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Executive Steve Filton outlined an expected 5-6% revenue growth for the acute division, split evenly between 2.5-3% volume growth and 2.5-3% pricing growth. Regarding wages, Filton and Marc Miller stated they have seen moderation and a stable environment, not the incremental pressure suggested by some national surveys, partly due to a reduced dependence on higher-cost temporary labor.

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Executive Steve Filton projected mid-single-digit acute revenue growth for 2025, split between volume and pricing. He and Marc Miller noted that UHS is not seeing significant wage pressure and that the labor environment has stabilized. Filton clarified the 2025 DPP decline is mainly due to roughly $60-$80 million in non-recurring prior-period payments recognized in 2024.

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Steve Filton indicated that while not formal guidance, the behavioral business is expected to see mid-to-upper single-digit revenue growth, skewed towards 4-5% pricing and 3-3.5% volume. He believes strengthened mental health parity rules are helpful for appeals but unlikely to create a landscape change in volumes. He also confirmed there is no change to the revised 2024 guidance.

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Executive Martin Jackson confirmed that IRF start-up losses are the primary driver for the 2025 consolidated margin outlook. He expects LTAC margins to be 'relatively stable' as the company effectively manages through the high-cost outlier threshold changes. For the outpatient division, Jackson attributed the positive outlook to improved commercial contract rates, which have increased net revenue per visit, and enhanced clinical productivity from new technology rollouts.

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CFO Joel Ackerman explained that DaVita is not providing a range for 2025 volume growth, instead focusing on the flat midpoint. He clarified that 2024 growth was 0.47%, and the 2025 forecast is lower due to headwinds from fewer treatment days and lost peritoneal dialysis admissions. CEO Javier Rodriguez attributed the wide oral drug OI range to uncertainties in drug mix, patient volume, and adherence, noting the midpoint is most likely.

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CFO Joel Ackerman outlined a 2025 volume model starting with a 50 basis point base, which would then be subject to mortality trends. CEO Javier Rodriguez clarified the home mix is 15.5% total (13% PD, 2% HHD) and expressed confidence in retaining patients despite the temporary PD supply issue. Ackerman confirmed that while 2025 RPT growth will be elevated relative to historical norms, it is expected to be lower than the 3.5% to 4% range guided for 2024.

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Executive Timothy Noel stated that the company remains consistent in its long-term view of targeted margins for Medicare Advantage. He explained that their pricing approach for 2025 was consistent with prior years, which allows them to focus on providing benefit stability for members rather than needing to engage in significant pricing 'catch-up' to restore margins.

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John Rex, President & CFO, confirmed that the sequential revenue decline in Optum Health was the primary result of portfolio and contract refinements. He stated this was part of a deliberate strategy to refine legacy contracts and focus the portfolio on core, high-performing businesses.

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