Ardent Health, Inc.

Thank you for standing by. My name is Ian and I will be your conference operator today. At this time, I would like to welcome everyone to the Ardent Health Partners third quarter 2024 earnings conference call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question and answer session. If you would like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, again, press star 1. Thank you. I will now hand the call over to Dave Stiblo, Senior Vice President of Investor Relations. You may begin your conference.

Thank you, Operator, and welcome to Ardent Health's third quarter 2024 results conference. Thank you.

Thank you, Operator, and welcome to Ardent Health's third quarter 2024 results conference call. Joining me today is Ardent's President and Chief Executive Officer, Marty Bonick, and Chief Financial Officer, Alfred Lumsdain. Marty and Alfred will provide prepared remarks, and then we will open the line to questions. Before I turn the call over to Marty, I want to remind everyone that 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. 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 gap financial measure is included in our quarterly earnings press release, which was issued yesterday evening after the market closed and is available at ardenhealth.com. With that, I'll turn the call over to Marty.

Thank you, Dave, and good morning, everyone. We appreciate everyone joining on the call and webcast this morning. Today, I'll provide a summary of our third quarter financial results, share some key strategic updates, and discuss our outlook for the rest of 2024. Before we dive into our business update, I want to acknowledge this week's election results and express our gratitude for a very timely and orderly election process. As a company, we appreciate the significant role that government has in our industry. That being said, we remain confident in our strategies and the strength of our business. Our company successfully navigated and demonstrated a strong track record of growth during the prior Trump administration, and we have confidence that we are even better prepared and will continue to grow through his next administration. Demographically, we know that we have an aging and sicker population, coupled with the fact that our markets are growing three times faster than the US average. Collectively, we believe that demand for healthcare services will remain strong and Arden is well positioned to continue to drive value to our patients and our shareholders. While it is premature to predict any specific changes that may occur, we are prepared to navigate any shifts in healthcare policy that may arise from a new administration. As an example, health exchange subsidies are set to expire at the end of 2025, and we know this will be a key focus area for the industry. For Ardent, our exposure to the exchanges is relatively small, largely due to the markets that we operate in, with year-to-date revenue contribution from exchanges at 3.6%. Should there be any potential changes to the health insurance exchanges, we anticipate them being incremental, aimed at preserving access to coverage and affordability to citizens nationwide. Given the highly regulated nature of our industry, we will continue to be actively involved and engaged in federal policy discussions and any potential impact on our business. Moving into our business results, this is our second quarter to provide an update as a public company following our IPO in July. As CEO, my focus is on ensuring we are providing exceptional quality and service to our patients while delivering sustainable long-term shareholder value. In pursuit of that, you can expect us to adhere to our strategic framework of market share growth, of both the inpatient and outpatient businesses, margin expansion, and disciplined capital deployment. As a new public company, we understand the importance of executing and delivering against our financial goals to establish credibility with our investors and build a track record of performance. To that end, we are pleased with our strong third quarter operating and financial results. Growth across our key volume metrics of admissions, inpatient surgeries, and outpatient surgeries modestly accelerated compared to the first half of 2024. Admissions increased 6.4% in the third quarter compared to the prior year, outpacing the 5.3% growth in the first half of 2024. Similarly, adjusted admissions grew 3.8% during the third quarter compared to the same prior year period, up from 3.3% in the first half of 2024. Total surgeries for the quarter returned a nominal growth of 0.3% compared to the prior year, an increase from the 1.9% decline in the first half of 2024 and overstepping our continued intentional service line optimization efforts. These are all encouraging signs of the underlying strength of our business and help drive total revenue growth of 5% year over year. Excluding the impact of two discrete non-recurring revenue items that Alfred will describe later in more detail, our year over year growth would have been approximately 8%. Our disciplined operating performance and continued focus on expense management contributed to strong adjustments at EBITDA growth of 15% year over year to 98 million, and 50 basis points of margin expansion to 6.7%. Meanwhile, adjusted EBITDA margin before non-controlling interest expanded 60 basis points to 10.9% in the third quarter, and year-to-date is 11.4%. We talk about this measure because it helps the investment community better compare Arden to our peers given our differentiated joint venture model and asset ownership structure. As a reminder, our goal over the next several years is for adjusted EBITDA margins to reach the mid-teens which we expect to be driven by both the adoption of state-directed payment programs in several of our key states, as well as other internal margin improvement and efficiency initiatives. As a reminder, the New Mexico supplemental program has been approved by the state and signed into law by New Mexico's governor. As of August 5th of this year, the program has been submitted to CMS for its approval, which historically takes an average of 120 to 140 days, a process which we are closely monitoring. And despite the upcoming change in administration, we believe in the nonpartisan durability of state DPP programs as these programs began under the former Trump administration and now span 44 states across the country. As we step back and evaluate the business at this point of the year, we are encouraged by what we believe to be durable volume and demand gains. We are making progress towards our margin expansion goals through our service line optimization and supply chain initiatives. And we have a strong balance sheet as we look grow inorganically in a disciplined manner. Like our peers, we are seeing elevated levels of payer denials compared to last year and generally view them as aggressive and higher than they should be. Payers have also been slower to pay claims. However, we have managed these challenges with key assistance from our revenue cycle management partner, Ensembl. Importantly, the year-over-year impact to revenue and earnings from denials activity did not accelerate during the third quarter. Our strong third quarter results, coupled with increased visibility and momentum from our strategic execution, give us confidence to raise our full year 2024 adjusted EBITDA guidance to $425 to $440 million, compared to $415 to $435 million previously, which represents a 2% increase to the midpoint. We are also modestly raising the midpoint of our revenue outlook. During last quarter's earnings call, I shared that a key component of our market share growth strategy is to invest in ambulatory sites of care, such as urgent care centers, freestanding emergency rooms, outpatient surgery centers, and physician clinics. This provides additional access points for patients and is consistent with our focus on creating a consumer-centric ecosystem of care capable of meeting patient needs across the care continuum. As an example, when we drill down in urgent care, patients are using that access point when there is a backlog at their local primary care office, or when they do not have a primary care provider. These urgent care centers are becoming our first interaction with many patients, thereby bringing new patients into our system. As mentioned during our second quarter call, we acquired eight urgent care centers earlier in the year. We are already seeing an increase in new patients, with 30% of the patients treated at these urgent care centers representing new patients to Arden Health, providing us with the opportunity to further bring these patients into our ecosystem of care. While this is a relatively small data point in isolation, it illustrates the rationale for our outpatient growth strategy. Ultimately, we expect the scaling of our urgent care footprint to produce incremental downstream hospital and outpatient volumes over time. As we evaluate additional M&A opportunities in existing and new growing midsize urban markets, we operate from a position of balance sheet strength. At the end of the third quarter, we had over $560 million of cash available and available liquidity of approximately $850 million. We expect our least-adjusted net leverage ratio to move closer towards our three-times target by year-end once the effect of last year's cybersecurity events have rolled off, putting us in a comfortable leverage position to execute on our strategy. The M&A pipeline is active, and we will continue to evaluate outpatient as well as new market opportunities. We will remain fiscally disciplined both in terms of what we are willing to pay and our overall leverage. And we will seek assets where we can deliver synergies and demonstrate accretion over a two to three year horizon. We will continue to explore joint venture opportunities as part of our inpatient M&A growth strategy as the model has provided differentiated value to Arden. I want to spend a moment discussing the benefits of that joint venture model, why it has served us well, and provide a little context as to why it makes sense for all constituents. At a high level, Arden is a leading joint venture partner of choice for premier academic medical centers, large nonprofit health systems, and community physicians and foundations. We operate 18 hospitals through joint ventures and have at least one joint venture in each of the eight markets we serve. When we form a joint venture with another health partner, it allows Arden to have access to the health partner's strong brand, reputation, regional presence, and provides us the ability to recruit new physicians to our markets that further advance our service line and growth strategies. Meanwhile, our joint venture partner receives a minority share of the bottom line economics and benefits from Arden Health's acumen in operating community hospitals, financial strength, and access to investment capital it might not otherwise have. And Arden Health has the ability to scale using a successful model that allows us to maintain majority ownership and full operational control as the daily operator. Shifting gears, I want to take a moment to provide an update on how we are leveraging the strength of our technology platform and enhancing it through a number of artificial intelligence initiatives. While still in the early innings, we see the promise of AI to drive performance improvement across multiple avenues from transforming care delivery models and improving quality outcomes to consumer outreach and engagement to process efficiencies at the bedside as well as behind the scenes across our business processes. Today, I will highlight just two of these use cases. The first uses AI to optimize our operating room schedules and drive strategic surgical growth. Collaboration between providers and operating room schedulers to manage and release blocks of surgical time based on surgeon patterns has resulted in over 500 additional cases being booked into these release blocks, resulting in $2.3 million of year-to-date incremental revenue and helping to backfill openings created by ongoing service line optimization efforts. This reduces the amount of time patients often wait for surgery and ensures our valuable OR resources are maximized. We are now working to scale the solution across the enterprise where appropriate. Another use case I will highlight is the implementation of new call center technology to better interact with patients in our markets. Through the use of natural language processing, our patients can talk with virtual agents to quickly find a physician, access our clinics, schedule or change appointments, or obtain prescription refills without talking to a live representative. In our pilot location, this technology has resulted in a 75% reduction in abandoned calls, and a 25% increase in service levels, collectively making healthcare easier for our patients to access and reducing the staffing burden to deliver care effectively. Before turning the call over to Alfred, I want to make a couple of high-level comments regarding the recent hurricane activity. First, it has not lost on us the devastation to human life, infrastructure, and property these catastrophic events have caused. Our thoughts and prayers go out to the affected communities, first responders, and volunteers. As it relates more specifically to Ardent, we were fortunate to not have direct facility exposure to the hurricanes. That has allowed us to operate as usual. Like our peers, we are monitoring the IV fluid shortage and have implemented conservation plans to avoid overstocking and waste. Ardent has not experienced any significant service disruption, and we continue to work with our vendors to receive our full allotment. With that, I will now hand the call over to Alfred.

Thank you, Marty. Good morning to everyone joining on the call today. As Marty indicated, we're pleased with our third quarter results, which reflect improving volume growth, solid revenue progression, and material margin expansion compared to the prior year. Our total revenue for the quarter was $1.4 billion, an increase of 5.2% compared to the third quarter of 2023, driven by higher volumes and rates. I'd note that total revenue growth was affected by two items. The third quarter of 2023 benefited by approximately $25 million of discrete non-recurring revenue associated with Medicaid supplemental programs, the majority of which related to a one-time allocation to Oklahoma hospitals participating in the SHOP program in consideration for a delay in implementing the Oklahoma DBP program. Second, our total revenue for the third quarter of 24 reflects a reduction of over $10 million relative to the third quarter of last year due to Ardent making a strategic decision to transfer an ecology and infusion center to an academic health system partner earlier this year. The profitability of this business was breakeven to us, and the transfer allowed us to better optimize our portfolio and resources, all while improving margins. Excluding these two items, total revenue growth for the third quarter of 2024 would have been approximately 8%. Similarly, we reported net patient service revenue per adjusted admission growth of 0.9% for the third quarter of 2024 compared to the prior year. Excluding the two 2023 revenue items, growth in net patient service revenue per adjusted admission would have been over 3%. Adjusted EBITDA for the quarter grew 15% compared to the prior year to $98 million, and the associated margin expanded 50 basis points year over year to 6.7%. Adjusted EBITDA margin before non-controlling interest expanded 60 basis points compared to the prior year to 10.9%. Higher patient volumes, increased reimbursement rates, strategic service line optimization, and cost reduction initiatives all contributed to strong financial performance. In terms of revenue mix, Medicaid volumes declined 80 basis points year over year to 10.2%, similar to the decline over the first half of 2024. This decline largely reflects the impact of Medicaid redeterminations. On the flip side, our commercial mix increased 60 basis points year over year to 43.3%. driven primarily by growth in exchange volumes. Overall, our exchange revenue contribution is still a modest 3.6% of total revenue on a year-to-date basis. One other callout to note is the contribution of other revenue, which increased 50 basis points year-over-year in the third quarter of 24 to 2.3%, driven primarily by an increase in ACO revenue recognized compared to the prior year. As Marty mentioned, third quarter volumes showed accelerating year-over-year growth compared to the first half of 24. Third quarter admissions of approximately 40,000 represented an increase of 6.4% over the prior year, which represents a step up from the 5.3% growth during the first half of 2024. The increase reflects strong growth in general medicine, including particular strength in our pulmonology and gastroenterology service lines, as well as the impact of the two midnight rule, which we estimate contributed approximately one quarter of the 6.4% increase in admissions. Adjusted admissions grew 3.8% year over year during the third quarter, up from 3.3% in the first half of 2024. Total surgeries returned to nominal growth of 0.3%, which is an improvement from the 1.9% decline during the first half of 2024. Our strategic service line optimization efforts discussed during our second quarter call continued to be a volume headwind for certain lower margin service lines, such as ENT. At the same time, growth in higher acuity service lines, such as orthopedics, produced a more favorable overall case mix. During the third quarter, we continue to execute on our cost savings initiatives. Our supply expense as a percent of total revenue improved 70 basis points year over year to 17.4%. This reduction reflects improvements in our supply chain performance from a number of supply expense initiatives that our team has been implementing throughout the year. Contract labor expense declined by approximately $3 million year over year and represented 3.9% of total salaries and benefits for the third quarter of 24 compared to 4.6 during the third quarter of 2023. We continue to see a normalization of contract labor utilization and rates across each of our markets, as well as improvements in our nursing retention. Salaries and benefits as a percentage of total revenue increased 60 basis points year over year to 43.8%. This increase is attributable to an additional $8 million of equity-based compensation recorded in the third quarter of 2024 following our IPO in July. During the third quarter of 2024, professional fees as a percentage of total revenue increased 100 basis points year over year to 18.9%. consistent with the increase during the first half of 2024. The increase in professional fees continues to be driven by a combination of higher hospital-based physician subsidies, as well as higher fees paid to our outsourced revenue cycle partner from increased cash collections year over year. Other operating expenses for the third quarter were 8.2% of total revenue, a year over year decrease of 90 basis points, This decrease was primarily driven by lower provider assessments associated with Medicaid supplemental program revenues during the third quarter of 2024 compared to the third quarter of 2023. Moving on to cash flow and liquidity, we ended the third quarter with total cash of $563 million and total debt outstanding of $1.1 billion. Our total cash and available liquidity at the end of the third quarter was $851 million. Cash provided by operating activities during the third quarter was $90 million, compared to $89 million during the third quarter of 2023. Capital expenditures during the third quarter were $43 million, up from the quarterly average of $31 million during the first half of 2024. Just as a reminder, we previously guided to a sizable increase in capital spending over the back half of the year. As of September 30th, 2024, our total net leverage as calculated under our credit agreement was 1.6 times, and our lease adjusted net leverage was 3.5 times. We expect our lease adjusted net leverage ratio will move closer to our three times target by year end. as the impacts of the cybersecurity incident that materially impacted fourth quarter 2023 financial results roll off. In September, we announced a repricing amendment to our term loan credit agreement. The amendment reduced our interest rate by 50 basis points and eliminated the credit spread adjustment. We expect the repricing will create approximately $5 million in annual interest cost savings for us going forward. Now turning to our outlook, our solid third quarter results coupled with momentum from our strategic execution give us confidence to increase our 2024 adjusted EBITDA guidance midpoint by approximately 2%, as well as a modest increase to our revenue guidance midpoint. A complete list of our guidance metrics is listed in our earnings release, but key highlights include Total revenue of between $5.8 and $5.875 billion versus $5.75 to $5.9 billion previously. Net income attributable to Arden Health of $156 to $176 million, implying full-year EPS of between $1.18 and $1.32. Net income guidance has been reduced to reflect an expected delay in receiving business insurance proceeds related to the 2023 cybersecurity event. We still expect to recoup the entirety of our claim, but the expected final settlement has pushed into 2025. Adjusted EBITDA of $425 million to $440 million. versus previous guidance of $415 to $435 million. Total adjusted admissions growth of between 4.5 to 5% up from 4 to 4.5% previously. Net patient service revenue per adjusted admission growth of 2.6 to 3.3% compared to 2.3 to 4.4% previously. Finally, we continue to expect capital expenditures of between $170 to $185 million. Now, with that, I'd like to turn the call back over to Marty for a few final comments on the quarter before we open the call up to questions.

Marty? Thank you, Alfred. In summary, we continue to make substantial progress as we execute on our key strategic initiatives and leverage the consumer-focused platform we have built to create long-term shareholder value. We are encouraged by underlying volume growth trends that showed improvement in the third quarter compared to trends in the first half of 2024. Our focus on operational excellence continues to result in improved margin realization, as evidenced by our strong adjusted EBITDA growth and guidance raise. And we continue to advance our focus on market share growth, taking a disciplined approach to evaluating opportunities in both the ambulatory space as well as the new markets. With our strong balance sheet and recent IPO, we are well positioned to execute on growth opportunities and continue improving the quality of care in the communities we serve. I want to close by thanking our 24,000 team members and more than 1,800 employed and affiliated providers who continue to deliver exceptional care to patients across the communities we serve. Together, we are focused on making healthcare better and fulfilling our purpose of caring for our patients, our communities, and one another. With that, operator, please open the line for questions.

At this time, I would like to remind you that in order to ask a question, please press star followed by the number one on your telephone keypad. Once again, that is star followed by the number one. I will pause for just a moment to compile the Q&A roster. Our first question comes from the line of Matthew Gilmore with KeyBank. Your line is open. Hey, thanks.

I have a question. I wanted to ask about the sequential acceleration in volumes you mentioned. I was curious what you'd attribute that to. I think you did maybe mention midnight as a factor, but just curious if there was sort of more operational drivers maybe comping out of some of the service line exits or more just environmental things that are going on.

Thanks, Matthew. Yes, there's a number of factors that are, in fact, impacting that growth that we're seeing. Two midnights is certainly a piece of that, but we're also very focused on the optimization of our facilities from a length of stay and efficiency perspective, as well as backfilling the capacity that we create through those length of stay efficiencies through our transfer center. Consistently, we're seeing, you know, improved benefit and reduced denials of transfers and improved acceptances of those transfers coming in. So it is multifactorial.

I would just add, I don't think 2 midnight accelerated at all in Q3. It's, you know, continued, you know, as we said, you could think about it as about, you know, 20 to 25% of the admins growth.

Great. Thanks. And then the follow-up on exchanges, appreciate the disclosure there. I was curious if there was anything sort of about your markets in particular that resulted in lower exchange volumes overall versus some of the peers. Is that just perhaps broader Medicaid coverage? But just kind of any color there would be great.

Yeah, we really think that it's a factor of the size markets we're in. We operate in these midsize urban markets. Still a lot of health, you know, traditional employer-sponsored insurance available to people. And so we think that it's largely just a factor of that size.

Got it. Thank you.

Our next question comes from the line of Ben Hendrix with RBC Capital Markets. Your line is opened.

Great. Thank you very much. You noted that your surgery growth reflected the impact of your service line optimization efforts. I was wondering if you could comment on where we are in that optimization process versus kind of where you want to be. and how you see the case mix involving in terms of various categories, joint, cardio, urology, et cetera, and then just by extension, how that's shaping the scope of your ambulatory M&A efforts. Thanks.

Yeah, several questions there, Ben. Thank you. Yes, we do see the impact of our rationalization of surgeries starting to curtail, but, you know, that's something that will continue likely through the end of the year as we move into the next year. The second part of your question was focused on how that focuses on ASCs, I believe. You know, we see the continued shift from inpatient to outpatient like the industry is seeing, you know, and so that is a portion of our planning in terms of growing our ASCs in our existing markets in partnership with physicians, and so that will be a continued focus for us to grow.

Thank you.

Our next question comes from the line of Scott Fidel with Stevens. Your line is opened.

Hi, this is Rajon for Scott. I had a quick question around the contracting environment with Medicare Advantage plans. You noted you didn't see an acceleration in denial claims year over year, but seeing how MA plans are seeing pressures on rates and margin, just wondering if you could provide some color on how contracting is kind of going out for the 2025 book.

Yeah, we're about, great question, we're about 85% contracted into the new year and still seeing good performance around that. Slightly moderated from what we were seeing 18 to 24 months ago, but still tracking at that mid single digit range for 2025.

There's no question the environment has gotten more, you know, I'd say contentious. It's not a surprise. You see the same commentary from the payers that we do. And while, you know, to Marty's earlier comments, while there hasn't been an acceleration in denial activity, it continues to be very high, certainly higher than, you know, we believe it should be.

Great. Thank you.

Our next question comes from the line of Benjamin Rossi with JPMorgan Chase. Your line is open.

Good morning. Thanks for taking my question. So on the decision to transfer oncology and infusion services to your health system partner, could you just walk us through your broader autonomy in decisions like this with respect to your ownership stake in any given market? And then are there any, like, certain specialties or clinics that typically fall under management by your partners instead of Ardent? or any lines of demarcation kind of worth noting across your ownership areas?

Yeah, so a couple of questions nestled in there. So on the oncology piece, you know, that is part of our continued strategic service line rationalization process. You know, oncology rates vary significantly across, you know, multiple geographies. And so where we can get rates that make sense, you know, we're continuing to provide those services. You know, as a taxpaying organization, we don't qualify for 340B, and so infusion services is one of those things that there's a high drug cost that goes with that and, you know, varying reimbursement rates. And so where we have academic partners that we can join forces with in Oklahoma, we've got a, you know, national cancer designation sponsor that we're able to expand essentially the services we're providing and still service our customers throughout our health system. That was an opportunity that we look forward to. Alfred, do you want to talk about just the general ownership structure?

Sure. I think the important thing to remember in this is that we retain full operational control in these JVs so that there are no um i'll say bright lines in terms of what we do versus what our partner does the advantage you know that marty uh articulated in our uh previous comments in terms you know it's the strategic advantages of having uh academic partners where we can make decisions like this that make uh create a win-win uh for both parties uh based on the you know the local environment but very important to understand that we retain full operational control

Great. Thanks for clarifying.

Our next question comes from the line of Tim Greaves with Loop. Your line is open.

Hi. Thank you for taking the question. I want to talk about more so the margins and that mid-teens growth that you guys spoke about. I wanted to know about the timeline. Do you guys have a timeline and maybe how

that has uh changed or maybe been reaffirmed due to the performance so far yeah i would say we're very much on track with our expectations to achieve uh mid-teams margins over the next several years you can think about that you know uh you know it's again it's it will be a multi-year journey the implementation of the DPP program in Oklahoma this year and the expectation for New Mexico next year are certainly a big component of that journey, as well as the continued margin enhancement initiatives, as well as the ambulatory growth initiatives in our market. So you're you're looking at, you know, from, you know, I'd say a two to three year type journey. And, you know, but our timeline for that has not been changed. You know, I would say 24, you know, to the raising of our guidance is very much on track.

Okay, thank you.

Once again, if you would like to ask a question, please press star, follow the number one. Once again, that is star, follow the number one. Our next question comes from the line of Craig Hettenbach with Morgan Stanley. Your line is open.

Yes, thanks. Marty, just following up on the comments around encouraging volume trends. I think previously you talked about things settling, you know, kind of back to pre-COVID levels. So just how are you seeing things in Q4 and then any kind of headwinds or tailwinds to consider looking into 2025 from a volume perspective?

Yeah, thanks, Craig. Yeah, we've seen strong demand in our markets. And we think largely, you know, several factors, as I mentioned before, you know, they're just the aging growing population coupled with the fact that our markets are growing, you know, three times faster than the US average. And so when I mentioned before that we were sort of getting back to pre COVID, we were seeing strong growth pre COVID. And, you know, we don't see, you know, any hangover from that at this point, the service demand has been good coupled by the fact again, that we've been able to improve efficiencies and just maximize the vet occupancy that we have through our incoming transfer centers. We know that there's continued demand across our regions, again, as they're growing for that higher acuity level service. And we're making sure that we have the ability to absorb that capacity into our system. So our outlook for next year, we've not officially said anything, but we expect based upon the favorable demographics are positioned and the operational enhancements we're making to, you know, yield continued strong demand going into next year.

Got it. Thanks for that. And Alfred, just following up on the commentary, kind of the multiyear journey of margin expansion and the progress you've seen this year. Do you see kind of more of the same into next year in terms of some of the operating leverage or anything else you would call out there of things to watch into 2025?

Sure. Good question. Of course, again, the big step up for next year would largely come through the addition of the DPP program in New Mexico, but from an operational perspective, which is where your question know over time that will continue to you all say decrease but you know i'd say we're still in the middle innings of of that journey so there's still a fair bit of operational improvement for us to continue to harvest over the next couple years got it thank you there are no further questions at this time i would like to hand things back over to marty mike

Thanks, everybody, for your time and attention. We appreciate your focus on Ardent, and we're looking forward to continuing the strong trajectory as we enter this next chapter of growth for the company. If you have any questions, as always, please reach out to Dave Stiblo and Investor Relations. Thank you all.

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