Sentiment Analysis of the earnings transcript to help figure out if there are any bullish or bearish sentiments that could be gathered from it. We're doing ML and AI based analysis on the earnings call to get some more insights.
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| So again, that captures that volume back, which we're very pleased with |
| And our win rate has improved for the course of the last several months |
| So we feel that there's going to be a benefit as we get more of our marketing and execution around patient volumes from an elective ambulatory standpoint |
| We did highlight that the fourth quarter had some pretty strong comps that we went against |
| This outlook reflects clear progress in 3 priorities: effectively transitioning to a strong, sustainable revenue cycle management program; generating continued efficiencies across our support structure; and maintaining strong payer relationships and a high in-network status |
| And certainly, that becomes an element in terms of rightsizing the support for those practices and making sure that we really are executing with our hospital partners in that regard, and we've had some favorable results thus far |
| It is a testament to our mission that we have hosted these important events for so long with strong attendance that goes well beyond pediatrics affiliated clinicians |
| And then which – I think for ‘25 and beyond, what – I understand your G&A levers and you guys have done a good job with that and excellent jobs for dealing with the RCM issues that have occurred |
| As we've discussed in the past, we believe that these renegotiations were made possible by our ability to effectively navigate the arbitration process for out-of-network claims under the No Surprises Act, through which we've been able to demonstrate the value of the critical services our affiliated clinicians provide to their patients |
| We are very pleased that patients and our families now have in-network access to these services, and we are gratified to have a broad recognition by payers of our essential role in the market |
| Overall, I'm confident that our focus on the operating priorities that are critical to our success will benefit all stakeholders |
| These items clouded what we view as a stable and positive pricing comparison, which included favorable payer mix and a growth in contract and administrative fees |
| So I think that really breeds confidence within the clinician pool to remain a part of the organization |
| -- our overall same-unit volumes reflected strength within our office-based maternal field medicine services, partially offset by lower volumes in our hospital-based services |
| As Jim noted, we're pleased that our RCM transition did not cause any material disruptions in billing and collections in the fourth quarter |
| Third, although our in-network status has typically been above 95%, we entered this year with an even higher in-network position, following successful negotiations with 2 payers in 3 states where we previously had been out of network |
| Notably, these comparisons are against very strong volumes in the prior year quarter |
| I would say also, as we indicated, we expect through our RCM transition or rate to remain somewhat stable through '24, certainly, as we complete the various stages of the transition, and we move over to our complete hybrid solution, there's opportunity for rate improvement as we approach the end of the year |
| It assumes also stabilizing our practice level margin profile against the headwinds we face |
| When you said that the going in-network is usually a positive for the company, were you talking about positive on the rate perspective? Are we talking about this dynamic with the outpatient volumes usually getting a boost once you go in network? Charles Lynch I was referencing the rate our experience over the last several years is that when we are in an out-of-network position |
| So basically stable volumes and stable rates |
| So that's kind of a good baseline for you to think about |
| Before turning the call over to Marc, I want to emphasize that above all else, we are a clinically focused organization, and we take very seriously the critical role we play in the improvement and quality of patient care for the most fragile patients |
| Notably, these comparisons were against strong volumes in the prior year fourth quarter |
| As a result, we believe that the financial impact of these improvements will build cumulatively through 2024 |
| We're expecting stable volume throughout '24 in our guidance |
| Our underlying same-unit pricing was also stable, absent certain distortions from last year's fourth quarter that Marc will detail |
| And I think you have within the range we provided on revenue and adjusted EBITDA at a high level, our view on our goal is that the '24 represents safe stabilization of our margin profile as compared to 2023 following some of the headwinds we faced over the last year or 2 |
| I would say, as we progress through this transition, which is staged in various components throughout '24, we expect to maintain stable pricing through this transition, i.e., a continuance of what we saw in the fourth quarter of '23 |
| But also, again, I think what we’ve referenced is that we’re looking at all the practice in terms of the efficiencies in those practices that will be benefit to the organization |
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| This reduced our same-unit pricing growth by roughly 2% in Q4 of '23 |
| And I think as well as the issue that we've seen about being back in network in the case of our ambulatory practices that have been adversely affected because as opposed to the inpatient services where the patients do make it to the service largely in those other areas, we are really -- those patients are directed elsewhere |
| So if you walk through the pieces, same unit revenue quarter-over-quarter is down about 1.5%, at about 1% of that is attributed to volume, which brings same unit rate down to about a 50 basis point decline |
| Additionally, we recorded a modest amount of cares dollars in Q4 of '22, which also did not recur, reducing our same-unit pricing growth in Q4 of '23 by an additional 40 basis points |
| Additionally, I think what we've seen along the way and starting up new practices is that the -- in some of the specialties, the harder challenge to recruit in and pay those physicians |
| But where we stand right now, we're -- our historical experiences are less than 5% out of network position and we're lower than that as we enter this year, thanks to some of the recontracting we've done |
| And then maybe since you talked about inpatient, is there anything you're seeing in the hospital other than a tough comp from last year that kind of like hinders the ability to drive growth? Is it your hospital losing market share? Or is it just the birth rate altogether? Just curious how you're thinking about volumes |
| Within our expectations for the full year EBITDA is similarly an expectation of some moderation in underlying practice level of expense growth |
| Last quarter, too, I know you mentioned that you're planning to capable labor cost challenges and growth in clinician comp |
| But we don't see any indication of volumes decelerating going forward |
| First, the adjusted EBITDA guide was admittedly wider for the first quarter was admittedly wider than what you've guided to in the past |
| As Jim noted, underlying pricing level salary growth remained elevated in the mid-single digits |
| But I think in some of the specialties where we've largely had to use locums, we think that there's an expanding pool of clinicians where we are not going to have the -- really the contract labor as a headwind |
| And within that, and obviously, within our guidance for this year is some moderation in overall practice level expense growth versus what we experienced over the past this year |
| The reimbursement we're receiving from payers tends to be quite low, hence, the arbitration processes that we enter |
| Jim Swift I think that part of the volume issue is take the NICU out for a moment, we did not see the large amount of volume this year, this last year that we saw in '22 related to the other inpatient services such as Pedia Hospitalist, Pedia PDR and Pedia ICU |
| I think from the standpoint of our inpatient NICU services people talk a little bit about a higher degree of severe prematurity and increasing length of stays, and we've certainly seen that |
| Of course, despite the fact that we're anticipating a stable rate through '24 and a flat volume, there is a little bit of growth in the top line |
| The company previously sized around a $50 million RCM headwind in the first half of '23 |
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