Ardent Health Partners Q2 2024 Earnings Call Transcript

Quartr
Provided by Quartr
August 15, 2024

There are 11 speakers on the call.

Operator

Thank you for standing by. My name is JL, and I will be your conference operator today. At this time, I would like to welcome everyone to the Ardent Health Partners Second Quarter 2024 Earnings Conference Call. I would now like to turn the conference over to Stefan Neely, Valem Advisors.

Operator

You may begin.

Speaker 1

Thank you, operator, and welcome to Arden Health's Q2 2024 results conference call. Leading the call with me today is Arden's President and CEO, Marty Bonnick and Alfred Lumsdang, Chief Financial Officer. Today's discussion contains forward looking statements about future business and financial expectations. Actual results may differ significantly from those projected in today's forward looking statements due to various risks and uncertainties, including the risks described in our periodic reports filed with the SEC. Except as required by law, we undertake no obligation to update our forward looking statements.

Speaker 1

Further, this call will include the discussion of certain non GAAP financial measures, including adjusted EBITDA and adjusted EBITDAR. Reconciliation of these measures to the closest GAAP financial measure is included in our quarterly earnings press release, which was issued yesterday evening after the market closed and is available at ardenthealth.com. At the conclusion of our prepared remarks, we will open the line for questions. With that, I would like to turn the call over to Marty.

Speaker 2

Thank you, Stefan, and good morning, everyone. We appreciate you all joining us today for our first earnings call as a public company and for your support as we begin this exciting new chapter. I want to particularly acknowledge our team, including the more than 24,000 team members, each of whom work hard every day to deliver on our purpose of caring for our patients, our communities and one another. Today, I'll provide a brief summary of our Q2 financial results, share some key strategic updates and discuss our outlook for the rest of 2024. But first, I would like to take a moment to give a brief overview of Ardent and our compelling growth story.

Speaker 2

Ardent is a leading hospital operator and healthcare provider in 8 growing midsized urban markets across 6 states, including Texas, Oklahoma, New Mexico, New Jersey, Idaho and Kansas. We deliver care through a system of 30 hospitals and more than 200 sites of care. At our core, Arden is committed to making healthcare better. We strive to achieve this goal through an operating philosophy that puts the patient, our consumer, at the center of everything that we do. By creating this consumer focus, we cultivate deep and long lasting relationships with our patients that span their entire healthcare journey.

Speaker 2

To aid in this, we leverage technology within our facilities and beyond to expand our relationships with patients, making care easier to access, easier to deliver and easier to experience. We believe our differentiated care delivery model creates a unique and scalable growth platform. Our strategic framework is centered around market share growth, operational excellence and disciplined capital deployment. Through this strategic framework, we believe that we are well positioned to create sustainable long term growth and value for our shareholders and for the markets that we serve. Key to our growth strategy is a differentiated joint venture model, which enables us to build local market density in new markets, while also being capital efficient.

Speaker 2

Now looking at the Q2, our results were supported by broad based demand growth for our services, improved payer mix and reimbursement dynamics, along with continued strategic execution. The strong demand we experienced for our services during the Q2 resulted in a 3.4% increase in adjusted admissions relative to last year. Demand trends remain favorable across both inpatient and outpatient settings as total admissions grew 5.1% year over year. Inpatient volume growth was supported by an increase in admissions through the emergency department, partially due to strong growth in our EMS ED volumes. Another important dynamic impacting our inpatient volumes during the Q2 was the 2 midnight rule, which we estimated drove more than a 2% increase in admissions compared to the Q2 of last year.

Speaker 2

Surgery volumes decreased 2.2% compared to the prior year period. The decrease in surgeries was due to a 0.9% decrease in our inpatient surgeries and a 2.8% decrease in outpatient surgeries. Outpatient surgeries were particularly impacted by our service line optimization efforts, which reduced volumes and select lower margin services such as dental, otolaryngology and ophthalmology. Our inpatient surgical volume trends for the quarter reflect a decrease in bariatric and gynecological cases, partially offset by growth in higher acuity spine neurology and urology cases. Turning now to an update on our growth strategy.

Speaker 2

Our team is focused on advancing our key initiatives of targeted market share growth, operational excellence and disciplined capital allocation. When combined, we believe our strategy can allow us to achieve sustainable long term organic revenue growth in the mid to high single digits, adjusted EBITDA growth in the low to mid double digits and mid teens adjusted EBITDAR margins. Our plan to grow our market share is centered around improving access to healthcare within our markets. To achieve this, we are focused on investing in additional ambulatory sites of care such as urgent care centers, freestanding emergency rooms, outpatient surgery centers and physician clinics. We are also deepening our network of employed providers to widen the top of the funnel in terms of patient access.

Speaker 2

Through the first half of this year, we have acquired or opened 8 urgent care clinics and are actively evaluating numerous ambulatory investment opportunities within our existing markets. Urgent care facilities are currently our most immediate focus as they broaden our geographic footprint and access to new patients in our communities. As it relates to our provider network, we employed 1780 5 providers at the end of the Q2, an increase of 6.5% compared to the same time last year. We are currently focused on recruiting both primary care and specialty care providers to expand access in our markets to support our targeted service line growth strategies. In terms of operational excellence, as I've already mentioned, we've been very focused on service line optimization, which was an initiative we began in the second half of last year.

Speaker 2

Year to date, our service line optimization efforts have focused on curtailing low margin and low acuity cases, causing a nearly 2% decrease in our total surgery volumes and resulting in improved margins overall. We are also making strong progress improving our supply utilization through a variety of sourcing and procurement initiatives along with other enterprise standardization initiatives. These efforts combined with our service line optimization initiatives contributed to the 70 basis point improvement in our adjusted EBITDAR margins relative to the Q2 of 2023. In addition, fundamental to our growth strategy is a focus on disciplined capital allocation, which includes maintaining a lean balance sheet to support opportunistic growth through investment in M and A. With the completion of our initial public offering last month, we have substantial available liquidity to pursue expansion into new and adjacent high growth midsize urban markets.

Speaker 2

Our current pipeline of potential opportunities is robust and we are actively evaluating potential targets that represent attractive return opportunities for growth. As we look forward to the second half of the year, we continue to expect strong demand for growth across our markets along with continued margin expansion and strategic execution. To that end, yesterday, we initiated guidance for the full year of 2024. Alfred will provide more on our guidance in a moment, but I do want to highlight a few key elements of our guidance, which includes total revenue growth of between 6% 9% and adjusted EBITDA growth of between 32% 38%. In closing, I'm very proud of the hard work and commitment of our entire team, which has allowed us to reach this important milestone for Ardent.

Speaker 2

As we enter into this new chapter in growth, in partnership with all of our shareholders, we are excited about the growth opportunities ahead and believe we have an exciting roadmap to create value for shareholders, while continuing to improve access to healthcare in the markets we serve. With that, I'll now hand the call over to Alfred.

Speaker 3

Thank you, Marty, and good morning to everyone joining us on the call today. As Marty indicated, we're pleased with our Q2 results, which reflected both improved revenue realization and margin expansion. Our total revenue for the quarter was $1,500,000 an increase of 7.5% compared to the Q2 of 2023. As Marty noted, the growth in our total revenue was the result of increased volumes and better rates, partially due to improved payer and service mix. Our net patient service revenue mix for the Q2 reflects a 70 basis point reduction in Medicaid revenue mix, offset by a 55 basis point increase in managed care and a 55 basis increase in Medicare, which includes managed Medicare.

Speaker 3

Our net patient service revenue mix for the 2nd quarter reflects a 70 basis point reduction in Medicaid revenue mix, offset by a 55 basis point increase in Managed Care and a 55 basis point increase in Medicare, which includes managed Medicare. Of note, these changes in payer mix reflect the ongoing Medicaid redeterminations. So far, we've seen approximately 2 thirds of our redetermined patients stay within government coverage and approximately 20% convert to commercial plans. In addition, our total revenue for the 2nd quarter reflects a $13,000,000 increase in our supplemental revenues due to the implementation of the Oklahoma DPP program, which became effective on April 1 this year. Adjusted EBITDA for the quarter was $122,000,000 compared to $102,000,000 in the Q2 of 2023.

Speaker 3

Adjusted EBITDAR margin before non controlling interest as a percentage of net revenue was 12.7% during Q2 of 2024 compared to 12.0% in Q2 of 2023. As Marty discussed, our adjusted EBITDAR margins benefited by improved surgical mix, the impact of our cost reduction efforts, as well as the overall improvement in our payer mix. The comparison of adjusted EBITDA to the prior year is also impacted by approximately $8,000,000 in benefit from government stimulus funds recognized in the Q2 of last year. Specifically relating to our expenses for the Q2 of 2024, I'd highlight that our contract labor expense declined by approximately $7,000,000 year over year or 22%, as we continue to see a normalization of contract labor utilization and rates across each of our markets and continued improvements in our nursing retention. As a percentage of total salaries and benefits, our contract labor expense for Q2 of 2024 was 4.3% compared to 5.7% for Q2 of last year.

Speaker 3

In total, for the Q2 of 2024, salaries and benefits were $624,000,000 or 42.4 percent of total revenue, compared to $598,000,000 or 43.7 percent of total revenue in the Q2 of last year. Our supplies expense for the quarter was approximately $259,000,000 or 17.6 percent of total revenue compared to $253,000,000 or 18.5 percent of total revenue in the Q2 of last year. This 90 basis point decrease in supplies expense as a percentage of revenue reflects improvements in our supply chain performance from a number of supply expense initiatives that our team has been implementing this year. Professional fees for the Q2 of 2020 4 were $272,000,000 or 18.5 percent of total revenue compared to $235,000,000 or 17.1 percent of total revenue in the prior year period. A majority of the increase in professional fees relates to higher hospital based physician subsidies compared to 2023.

Speaker 3

So far in 2024, we continue to see some pressure in certain specialties such as anesthesia and radiology, but overall, we believe that the subsidy dynamic has largely normalized relative to the significant increases we saw throughout 2023. Other operating expenses for Q2 were $115,000,000 or 7.9 percent of total revenue compared to $109,000,000 or 7.8 percent of total revenue in Q2 of last year. The decrease in other operating expenses primarily reflects an approximately $7,000,000 benefit from a sale of aged patient accounts receivable in Q2 of this year. Moving now to cash flow and liquidity. We ended the 2nd quarter with total cash of $335,000,000 Cash provided by operating activities during the 2nd quarter was $120,000,000 compared to $43,000,000 during the Q2 of 2023.

Speaker 3

The increase in cash from operating activities compared to the prior year reflects our improved profitability and higher cash flow resulting from changes in net working capital. Capital expenditures during the Q2 were $39,000,000 compared to $34,000,000 in the Q2 of last year. The increase in CapEx was primarily driven by an $8,000,000 increase in growth CapEx relating to medical imaging equipment and surgical robots. At the end of the second quarter, our total net debt outstanding was $758,000,000 During the quarter, we repaid $100,000,000 of outstanding borrowings under our term loan B using cash on hand, while simultaneously increasing capacity under our undrawn revolving credit facility by $100,000,000 At the end of the Q2, our total available liquidity was $624,000,000 When factoring in the $209,000,000 of net proceeds from the initial public offering in July, our net debt would have been $549,000,000 and total available liquidity would have been $832,000,000 at the end of the second quarter on a pro form a basis. As of June 30, 2024, our total net leverage as calculated under our credit agreements was 2.3 times and our lease adjusted net leverage was 4.0 times.

Speaker 3

Pro form a for the net proceeds of the IPO, our lease adjusted net leverage was 3.6 times. I'd like to turn now to recap our full year 2024 financial guidance, which we announced in our press release yesterday afternoon. Total revenue of between $5,750,000,000 $5,900,000,000 adjusted EBITDA of between $415,000,000 $435,000,000 net income attributable to Arden Health Partners of between $163,000,000 $182,000,000 implying full year EPS of between $1.23 1 $0.37 Finally, capital expenditures of between $170,000,000 $185,000,000 Our guidance for the year reflects total adjusted admissions growth of between 4.0% 4.5% compared to 2023 and net patient revenue per adjusted admission growth of between 3.0% and 4.0%. Our guidance also reflects an adjusted EBITDA impact of approximately $27,000,000 from the Oklahoma DPP program. As it relates specifically to our expectations for the second half of the year compared to 2023, we expect to see continued volume and rate growth across our markets supported by our focus on sustainable operational excellence and margin improvement.

Speaker 3

Before opening the call up for questions, I also want to provide a quick update on the New Mexico Directed Payment Program. This supplemental program has been approved by the state and signed into law by the Governor of New Mexico. As of August 5 this year, the program has been submitted to CMS for its approval, which historically takes on average 120 to 140 days. We'll continue to keep you posted on any material updates to the status of this program going forward. Now with that, operator, I'd like to open up the line for questions.

Operator

Thank you. The floor is now open for questions. Your first question comes from the line of Jason Kaczorla of Citi. Your line is open.

Speaker 4

Great. Thanks guys and congrats on the quarter. I just wanted to ask about 24 EBITDA guidance and what it implies for the back half of the year. If we add back that $63,000,000 of cybersecurity headwind in the Q4 of 2023, it seems like 20 24 guidance implies that second half EBITDA would basically be flat at the midpoint year over year. That comes after meaningful growth year to date in the Oklahoma DPP benefit.

Speaker 4

I guess you have the range out there, but just any color in terms of how you're approaching EBITDA guidance and maybe what the puts and takes are and that we should be thinking about for the second half?

Speaker 5

Sure. I appreciate the question. Yes, you're correct. If you look at just the midpoint of guidance, it would apply pretty modest year over year growth relatively flat if you adjust out for cyber. Obviously, we're just out of the gate in terms of guidance.

Speaker 5

We clearly had some benefit in Q2 from a couple of things from a timing perspective. We had a sale of HDAR that was a relatively small amount, but usually we have we expect those types of events to happen in the back half of the year. So there's just a little bit of timing going on as well as some supplemental activity. We're early in our obviously in our public co history and our expectations are to have guidance that we fully meet. So we haven't done anything in terms of modifying guidance at this point.

Speaker 5

And again, I would point to real timing activity as well as if you look at last year, the Oklahoma DPP program was scheduled to go live originally in October of 2023. They postponed the go live until April of this year, but as a consequence, they provided Oklahoma provided a refund of the SHOP tax that and that hit in Q4 of last year. So that was kind of a one timer in the back half of the year.

Speaker 4

Okay, great. Thank you. And then maybe just as a follow-up, I was just hoping to give a little bit more color around your ambulatory expansion. I know I think you guys have previously suggested a $20,000,000 $25,000,000 kind of annualized spend there. I guess, can you just give us a sense on the pipeline, timing around that ambulatory expansion, what that looks like?

Speaker 4

And then maybe just how you're perhaps how you're balancing any opportunity to kind of pull that forward or accelerate that spend would be great. Thanks.

Speaker 2

Yes. As we said, we implemented or grew our urgent care platform by 8 facilities in the first half of this year. We expect to see meaningful growth in the second half on urgent care as well. We've got the number of de novos and acquisition targeted acquisitions in the pipeline, but nothing definitive to say. But I would expect to see growth in the second half of this year based upon what's in our pipeline.

Operator

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

Speaker 6

Hi, thanks. Good morning. First question, just appreciate the update on the redeterminations and the comment around 20% shifting over to commercial. Just interested if you could share with us what your exchange admissions contributions were in the Q2 to admissions growth and what you're budgeting for the full year for that as well?

Speaker 5

Yes. Exchange volumes overall were up fairly significantly basically from an admin's perspective about a third year over year. However, for us, it's still a relatively small contribution from a revenue perspective, just over 3% of our revenues. So, the volumes are still relatively modest overall, even though on a year over year basis, it is growing and clearly a big part of that growth has been the redeterminations.

Speaker 6

Okay, got it. And then as a follow-up question, I thought it might just be helpful if you could walk us through in a little more detail. I've actually got a couple of questions on this already. Just around sort of the sequencing of the Oklahoma DPP and sort of how that builds into the full year expectations. As you highlighted in the release, you had around $13,000,000 in the second quarter.

Speaker 6

You're assuming $27,000,000 for the full year. So that would sort of imply one more sort of similar payment. But maybe if you could walk us through, is this something that you would expect quarterly or biannually or is there some conservatism just around that sort of processing of Oklahoma DDP revenues over the course of the year would be helpful?

Operator

Yes.

Speaker 5

Good question, Scott. And I think that's partially was a component of the answer to Jason's question as well. And I know it is a little bit, I'll say, confusing. We're expecting the program is live, went live on April 1 and relative we'll expect relatively consistent revenue impact from that. We said $13,000,000 in Q2.

Speaker 5

We would expect relatively consistent revenues in the coming quarters. There is, of course, a tax component to that. So the net is smaller than that, call that $10,000,000 $11,000,000 From a year over year perspective, we did have this SHOP tax refund in Q4 of last year. And that's why the full year impact, it's not as simple as taking 3 times the $13,000,000 for the rest of the year. However, going into next year, we'll also from a Q1 perspective, we'll get a full quarter impact of the program in Q1 of next year on a year over year basis.

Speaker 5

So again, that's why it's not as simple just that shop tax, I'll call it refund last year makes it not as simple as taking 3 times the Q2 impact. Hope that makes sense.

Speaker 6

Yes, it does. Okay, that helps explain that. Okay, great. Thank you.

Operator

Your next question comes from the line of Whit Mayo of Leerink Partners. Your line is open.

Speaker 7

Hey, thanks. Good morning, guys. Can you maybe spend just a minute on the service line optimization? I think you've kind of framed some of the impacts that you saw on surgical trends, calling out dental, ENT, ophthalmology. Just how much did that contribute to the decline?

Speaker 7

How much do you think that weighs on the metrics for the year? Did you annualize this next year? Is this an ongoing initiative? Just maybe any color would be helpful.

Speaker 5

Yes. I think I'll start and then let Marty jump in. From our perspective, when we look at the surgical decline, it essentially and there's always puts and takes, right? But it essentially covers all of it. And we've also seen pressure, and I think that is a broad industry dynamic as well on our bariatric cases unrelated to our service line optimization.

Speaker 5

But I think if we look just at how much of the year over year decline did that service line optimization

Speaker 2

impact, it was effectively the entire amount of the decrease. Yes, actually slightly more than that. It was we saw surgical growth when you net in the addition. So we were focusing on taking out some lower level cases, dental, ophthalmology, ENT. If you look at just those three categories that'd be great to about 117% of the decline.

Speaker 2

So we backfilled that with higher acuity cases. We also have been focused on our oncology programs. We closed an OB program last year in one of our Texas markets. And so all those things are continuing to play out and we'll see the rest of that impact basically cycle out as we go through the balance of this year.

Speaker 7

Okay. And maybe just, Alfred, I think contract labor, you framed around a 4.3% as a percentage of total SW and B this quarter down from 5.7%, if I get the numbers right. Right. What are you budgeting for in terms of the rest of the year? Do you think you make additional improvement from current levels or is this a steady state that you would expect?

Speaker 5

I would say it's closer to steady state with than any I wouldn't expect the same kind of quarter over quarter decreases that we've seen as we go forward. We're still very focused. Average hourly rate has come down nicely and we are still very focused on utilization. And of course from a quarter over quarter we would expect seasonally Q4 to be our strongest from a volume perspective and so there will be more utilization potentially. So I think we're too we'll call it the new normal.

Speaker 5

We're still focused on getting back to pre pandemic levels, but we're getting much closer to that. So I don't think we'll see the kind of step functions down that we've seen in

Speaker 2

the last several quarters. Yes. That being said, we are seeing strong recruitment and retention for our team members. And as that trend continues, we do expect, as Alfred said, to get back towards pre pandemic levels around those rates, but again, not the significant step down that we saw.

Speaker 7

Okay. Maybe just to clarify that point, just the I mean if I take the Q2, the 4.3% of SWB, that's you're kind of run rating that in terms of like your guidance for the rest of the year, you're not assuming a material or modest level of improvement?

Speaker 5

Not assuming a modest I mean, not assuming a material level of improvement from

Speaker 3

where

Speaker 2

we are. Okay.

Speaker 8

Perfect. Thank you.

Operator

Your next question comes from the line of Craig Hettenbach of Morgan Stanley. Your line is open.

Speaker 9

Great. Thanks for the color and the timing of New Mexico. On supplemental payments more broadly, can you just talk about your confidence in expanding in that and really a contribution to margins as we go forward?

Speaker 3

Yes. I think at

Speaker 5

a macro level, we view these programs as pretty consistent and enduring. I think now with New Mexico and Tennessee, with their DPP programs, something like 44 states have a program in place. So we think relatively predictable. Now obviously, New Mexico has not been approved by CMS yet and we'll be back obviously once that approval has happened. But

Operator

yes,

Speaker 5

I think from we think it is the amounts historically have been largely quite predictable.

Speaker 9

Got it. And then just a follow-up question on the strong adjusted admissions growth. Can you share any insights or color by some of the markets like maybe some markets that are trending above?

Speaker 5

Yes, it's been pretty consistent throughout our markets. Obviously, the 2 midnight rule has been a tailwind in this and that's been consistent across all of our markets. So, I don't think there's anything at an individual market level that I would particularly point to.

Speaker 9

Okay. Thanks for that.

Operator

Your next question comes from the line of Kevin Fischbeck of Bank of America. Your line is open.

Speaker 10

Hi, good morning. This is Joanna Gajuk filling in for Kevin today. Thanks for taking the question. So if I may just first follow-up on the discussion around the supplemental payment programs. I understand we're waiting for the New Mexico and you're saying it's broadly, I guess, accepted program across 44 different states.

Speaker 10

But I guess as we're thinking going into elections and what might happen like the different scenarios in terms of the outcome and how this could impact the Medicare supplemental payment program in particular, right, if Republicans were to take over and try to kind of go after Medicaid while we're speaking. And then, I guess, how much is at risk in your states when it comes to the supplemental payment programs? Thank you.

Speaker 2

Yes. I mean, it's a good question and everybody's got that same question on their minds. The way in which we've looked at it, as Alfred said, with the approval of New Mexico, it'll be 44 states that have these live. If you go back to the inception of these programs, they started back in 2016 under the Trump administration and then have continued to grow under the Biden administration. And so given that this is now widespread across the country, we feel that there's significant durability.

Speaker 2

CMS has also published guidance that has to be achieved by 2028 in terms of how these how they're going to try to standardize and normalize these programs across the country. So I think that also gives us some visibility in terms of how the government is thinking about these programs as a contributing funding source for these lower income patients. And so we have good reason to believe that regardless of the collection outcomes that these should have the durability.

Speaker 10

Right. And what do you think about the concept of some of these states when they expanded these supplemental payment programs they went with the rate increase all the way up to commercial rates and some states are like the rates but more kind of in line with Medicare. So would you say that those states that went with higher rates all the way to commercial would be more at risk when it comes to potential program changes?

Speaker 2

I think it's just too early to know what the platforms neither of the candidates have really established any firm guidance on this. And so I think anything that we would say is just complete speculation on that part.

Speaker 10

Thank you. If I may ask a question on a separate topic. So you talk about your I guess, managing your balance sheet, but also looking at potential acquisitions. You talk about you actively validating a pipeline. So can you talk about your plans?

Speaker 10

Should we expect a transaction within the next 12 months? And I guess how many different assets are you looking at? What types of assets you're looking at when it comes to targeting expansions? Thank you.

Speaker 2

Yes. I mean, we've got a robust pipeline of activity as everybody knows that there's a sort of tale of 2 cities going on in the healthcare world. There are systems like ours that are performing well and still a lot that are struggling. And so we're in conversations with a number of different opportunities that are attractive. We're going to be very picky in terms of where which markets we go into that fit our criteria of those midsize urban markets, good growth profile and someplace where we can get a significant foothold in those markets.

Speaker 2

At this point, we don't have anything definitive to discuss, but we're encouraged by the pipeline that we have and are hopeful to see an opportunity arise in the not too distant future. But that being said, it's too early to put anything definitive out there.

Operator

Your next question comes from the line of Timothy Greaves of Loop Capital Markets. Your line is open.

Speaker 8

Hi. If I could, I wanted to go back to total surgeries and then decline there. It seems like the service line optimization and the move away from lower acuity services to higher ones is the reason for it. I just wanted to kind of like go into more of what is the depth of services that you guys offer in the higher acuity versus lower acuity services? And maybe further in on that, how much of the split, what is the split between the lower versus higher surgeries that you guys give?

Speaker 2

We're full service providers absent high end transplants. We do a full complement of mix of surgeries, orthopedics, neurosurgery, general surgeries, etcetera. And so the surgeries that we've taken out, as you said, tend to be higher volumes, but not as a percent of the total, but they're just they're quicker turnaround cases. And so you see a bigger numeric impact than you would for some of the higher acuity cases that take more time. And so, as we said, the delta that we saw in terms of the surgery decline was fully captured in terms of taking some of those lower margin services out, not all, but making progress around those and then backfilling with some of those higher margins.

Speaker 2

So, Elphr anything you want to add?

Speaker 5

No, I think it's difficult to give a precise answer or a precise definition of lower acuity and higher acuity, right, because even within categories of something like orthopedics, there are, I'll say, lower acuity orthopedics and higher acuity orthopedics. To Marty's point, the lower acuity clearly are a higher volume and having the OR time freed up for higher acuity surgeries and really focusing on growing those types of surgeries, spine, orthopedics has been a significant focus.

Speaker 8

Okay. Thank you for taking the question.

Operator

This concludes our Q and A session. I will now turn the conference back over to Marty for closing remarks.

Speaker 2

Thank you everyone for your support of Artemix as we enter into this exciting new chapter for the company. We believe we've got a strong foundation for profitable growth and we look forward to keeping you apprised of our progress. And with that, that concludes our call today. Thank you.

Operator

This concludes today's conference call. You may now disconnect.

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