Financial Data and Key Metrics Changes - Revenue for the first quarter was $68.4 million, a decrease of 6% year-over-year and down 2% sequentially from the fourth quarter [11] - Gross profit dollars were $10.9 million, a 22% decrease from last year but a 2% increase sequentially from the fourth quarter [13] - SG&A expenses were $11.4 million, an increase of $1.6 million year-over-year and $1.3 million sequentially [16] Business Line Data and Key Metrics Changes - The decrease in revenue was attributed to lower volumes due to client attrition and lower volumes at select larger clients, with client attrition contributing approximately $7 million to the decline [12] - New clients secured during 2024 finished the first quarter at approximately 80% of their anticipated run rate, expected to provide incremental growth in revenue and gross profit [13] Market Data and Key Metrics Changes - The industrial sector showed some weakness, impacting volumes, but other end markets did not exhibit significant changes [53] - The company is seeing increased demand for its services, particularly from prospects that have never used its model before, indicating a robust pipeline [44] Company Strategy and Development Direction - The company is focused on generating cash, improving profitability, lowering debt, and increasing operating efficiency [9] - A cultural shift towards operational excellence is being implemented, emphasizing performance and accountability across the organization [20] - The company aims to improve EBITDA, cash generation, and pay down debt through various initiatives [20] Management's Comments on Operating Environment and Future Outlook - Management remains optimistic about the company's ability to execute operational improvements and expects steady improvement throughout the year [26] - The company anticipates both top and bottom line growth for 2025, with more meaningful growth expected as the year progresses [27] Other Important Information - The company completed the sale of a non-core part of the RWS business, generating $5 million in cash used to reduce debt [8] - Cash at the end of the first quarter was $1.4 million, with approximately $21 million of available borrowing capacity [17] Q&A Session Summary Question: Any notable KPIs to highlight as you focus on execution moving forward? - Management has started to baseline all processes and identified weaknesses, implementing changes to address these gaps [31] Question: Are you seeing any increase in weakness in your market? - No significant change in market weakness has been observed, but there is hope for strength returning [38] Question: How do you plan to bring down DSO? - Strategies include improving billing efficiency and having ongoing conversations with larger clients to accelerate collections [46][48] Question: What is the timetable to evaluate the initiatives being put in place? - A year from now, the company expects to look very different, with results beginning in Q2 and largely in Q3 and Q4 [70] Question: What caused customer attrition? - Attrition has been mostly related to customers being acquired with different programs in place, with some isolated attrition noted [56] Question: How do bonuses work for employees? - Bonuses are built over an annualized forecast and will be adjusted based on the company's performance throughout the year [60]

Financial Data and Key Metrics Changes - First quarter revenue increased by 4% to $1.5 billion compared to the prior year, driven by adjusted admissions growth of 2.7% and net patient service revenue per adjusted admission growth of 1.2% [12][14] - Adjusted EBITDA grew by 2.5% to $98 million, with growth impacted by an increase in payer claim denials compared to the first quarter of the previous year [15][18] - Total cash at the end of the first quarter was $495 million, with total debt outstanding at $1.1 billion, resulting in total available liquidity of $790 million [17] Business Line Data and Key Metrics Changes - Admissions grew by 7.6%, with inpatient surgery growth at 3.4%, while outpatient surgeries declined by 2.3% [14] - Supply costs as a percentage of revenue declined by 60 basis points year over year, indicating improved supply chain efficiencies [8] - The growth rate of physician professional fees was 6%, down from 13% during the same period last year, showing signs of moderation [8][16] Market Data and Key Metrics Changes - The company reported strong exchange volume growth, with admissions in the quarter growing by 40%, reflecting improved enrollment in exchanges and new plans [61] - The overall market growth is estimated at about 3% per year, indicating durable demand in the company's operating regions [39] Company Strategy and Development Direction - The company is focused on expanding its outpatient and acute care hospital footprint, supported by approximately $500 million in cash and a favorable lease-adjusted net leverage ratio of three times [5][10] - A new Chief Operating Officer has been appointed to enhance strategic growth and operational excellence initiatives [5][41] - The company is actively pursuing M&A opportunities, with increased interest in its joint venture model from potential academic and non-profit partners [9][10] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving full-year 2025 financial guidance, reaffirming strong demand trends and operational improvements [10][19] - The company is optimistic about the approval of the 2025 New Mexico DPP program, which is currently awaiting final CMS approval [12][57] - Management noted that while there are pressures from professional fees and payer behaviors, they expect underlying EBITDA growth to accelerate in the latter half of the year [15][72] Other Important Information - The company has seen a notable increase in payer claim denials, which has impacted cash flow, but this is not expected to be a long-term trend [15][29] - The company’s credit rating was upgraded to B+ from B, reflecting improved net leverage and cash flow profile [18] Q&A Session Summary Question: Inquiry about seasonality and sequential EBITDA decline - Management indicated that the sequential decline in EBITDA is not abnormal and attributed it to various seasonal factors, including the impact of the flu season [25][26] Question: Follow-up on elevated denials and payer behavior - Management confirmed that the elevated denials are consistent with previous trends and noted a slowdown in payments even on clean claims [28][29] Question: Supply chain initiatives and margin expansion opportunities - Management highlighted participation in a GPO and ongoing efforts to improve utilization within service lines as key opportunities for margin expansion [32][33] Question: Update on expansion initiatives and market opportunities - Management reported a growing pipeline of potential acquisitions and partnerships, particularly with academic institutions, and emphasized the importance of being disciplined in evaluating these opportunities [46][54] Question: Status of the New Mexico DPP program approval - Management expressed optimism about the approval process for the New Mexico DPP program, expecting it to be finalized soon [57][59] Question: Exchange volumes and payer mix - Management noted significant growth in exchange volumes, with admissions growing by 40% in the quarter, and indicated that exchange revenue is now in the mid-single digits as a percentage of total revenue [61][62]