Financial Data and Key Metrics Changes - Net revenue for Q3 2025 was $821.5 million, reflecting a 6.6% year-over-year increase [4][17] - Adjusted EBITDA was $136.4 million, up 6.1% year-over-year, with an adjusted EBITDA margin of 16.6% [4][17] - Same facility revenue grew by 6.3%, with same facility case growth of 3.4% and rate growth of 2.8% [17][22] Business Line Data and Key Metrics Changes - Over 166,000 surgical cases were performed in Q3, representing a 2.1% growth, with significant increases in GI and MSK procedures [5][17] - Total joint surgeries in ASC facilities grew by 16% in Q3 and 23% year-to-date compared to the same period last year [5][17] - The payer mix showed commercial payers at 50.6% of revenues, down 160 basis points year-over-year, while governmental sources increased by 120 basis points [7][17] Market Data and Key Metrics Changes - The company observed softer-than-expected same facility volume growth in recent months, prompting adjustments to the fourth quarter outlook [7][15] - The revised guidance for full-year revenue is now expected to be in the range of $3.275 billion to $3.3 billion [12][21] Company Strategy and Development Direction - The company is focused on three growth pillars: organic growth, margin improvement, and capital deployment for M&A [4] - A strategic portfolio optimization process is underway to enhance flexibility and streamline operations, with a focus on divesting larger surgical hospitals [11][12] - The company plans to open two new DeNovo facilities in Q3, with nine under construction and more than a dozen in the development pipeline, primarily targeting higher acuity specialties [9][10] Management's Comments on Operating Environment and Future Outlook - Management acknowledged recent trends in surgical demand and payer mix, particularly among commercial patients, which have led to a more cautious outlook for Q4 [15][22] - The company remains confident in its long-term growth algorithm and the resilience of its business model despite near-term challenges [15][22] Other Important Information - The company has deployed approximately $71 million in capital for acquisitions in 2025 and anticipates a return to normal levels of annual capital investment moving into 2026 [8][9] - The cash balance at the end of the quarter was $203.4 million, with total available liquidity exceeding $600 million [18] Q&A Session Summary Question: What is causing the weakness in demand or procedure volumes as you think through Q4? - Management noted broad-based weakness in volumes and payer mix, with higher government payer mix than expected entering Q4, but still anticipates growth in cases and rates [24][25] Question: Is the low level of spend on acquisitions due to deal timing or evaluation? - Management confirmed strong deal flow but emphasized a disciplined approach to acquisitions, indicating that timing is a factor [26] Question: Can you elaborate on the payer mix commentary? - Management indicated that while there is always pressure from payers, the current issue is more about a weaker growth trend rather than systematic problems [30][31] Question: How do you expect free cash flow to land in Q4 and the year ahead? - Management refrained from providing specific guidance on free cash flow but noted strong operating cash flow and improvements in working capital [76][80] Question: What are the implications of the portfolio review process? - Management is focused on optimizing the portfolio to enhance cash flow and reduce leverage, with potential partnerships or divestitures being considered [55][60]

Financial Data and Key Metrics Changes - Net revenue for Q3 2025 was $821.5 million, reflecting a year-over-year increase of 6.6% [4][17] - Adjusted EBITDA for the quarter was $136.4 million, up 6.1% year-over-year, with an adjusted EBITDA margin of 16.6% [4][17] - Same facility revenue grew by 6.3%, with same facility case growth of 3.4% and rate growth of 2.8% [17][22] Business Line Data and Key Metrics Changes - Over 166,000 surgical cases were performed in Q3, representing a 2.1% growth, with significant increases in GI and MSK procedures [5][17] - Total joint surgeries in ASC facilities grew by 16% in Q3 and 23% year-to-date compared to the same period last year [5][17] - The payer mix showed commercial payers at 50.6% of revenues, down 160 basis points year-over-year, while governmental sources increased by 120 basis points [7] Market Data and Key Metrics Changes - The company observed softer-than-expected same facility volume growth in recent months, prompting adjustments to the fourth quarter outlook [7][15] - The revised guidance for full-year revenue is now expected to be in the range of $3.275 billion to $3.3 billion, with adjusted EBITDA between $535 million and $540 million [12][21] Company Strategy and Development Direction - The company is focused on three growth pillars: organic growth, margin improvement, and capital deployment for M&A [4] - A strategic portfolio optimization review is underway to enhance flexibility and streamline operations, with a focus on divesting larger surgical hospitals that do not align with the core ASC service lines [10][11] - The company plans to open two new de novo facilities in Q3, with nine under construction and more than a dozen in the development pipeline, primarily targeting higher acuity specialties [9][21] Management's Comments on Operating Environment and Future Outlook - Management acknowledged recent trends in surgical demand and payer mix, particularly among commercial patients, and is taking a cautious approach heading into Q4 [15][22] - The company remains confident in its long-term growth algorithm and the resilience of its business model despite near-term challenges [15][22] - Management emphasized the importance of disciplined capital employment and operational excellence for sustainable growth beyond 2025 [15] Other Important Information - The company has deployed approximately $71 million in capital for acquisitions in 2025 and anticipates a robust M&A pipeline with over $300 million in opportunities under evaluation [8][9] - The cash balance at the end of Q3 was $203.4 million, with total available liquidity exceeding $600 million [18] Q&A Session Summary Question: What is causing the weakness in demand or procedure volumes as you think through Q4? - Management noted broad-based weakness in volumes and payer mix, with higher government payer mix than expected entering Q4, but still anticipates growth in cases and rates [24][25] Question: Is the low level of spend on acquisitions due to deal timing or evaluation? - Management confirmed strong deal flow and a disciplined approach to acquisitions, indicating that timing is a factor but they expect to return to normal M&A flow [26] Question: Can you clarify the payer mix commentary regarding commercial volumes? - Management indicated that while there is always pressure from payers, the current issue is not due to systematic changes but rather a weaker growth trend than expected [30][31] Question: How do you expect free cash flow to land in Q4 and the year ahead? - Management refrained from providing specific guidance on free cash flow but indicated strong operating cash flow and improvements in working capital [76][80] Question: What are the expectations for de novo facilities going into next year? - Management expressed excitement about de novo opportunities, emphasizing that they are primarily focused on higher acuity facilities and have a strong pipeline [46][48]