Tenet Healthcare Corporation (THC) Earnings Call Transcript & Summary

Okay. Let's -- we're going to go ahead and get started here. Good morning, everyone. This is Whit Mayo. I'm UBS' Healthcare Facilities and Managed Care analyst. It's my pleasure to have members of Tenet's management team joining us this morning. Representing the company, we have Ron Rittenmeyer, the company's CEO; Dan Cancelmi, the Chief Financial Officer; and Saum Sutaria, the President of Tenet. So thanks, guys, for -- and of course, we have Regina. She's here as well. Ron, why don't I just hand it to you? I think you've got some prepared remarks you wanted to cover here at the beginning. So I'll just hand the virtual mic to you and Dan. Thanks.

All right. Thank you, Whit. I appreciate it. And we appreciate everyone joining us for this virtual conference. This is becoming quite an experience. I'm sure many of you attended the Q1 earnings as well as prior conferences where we spoke. So again, I'm just going to touch on some points to make sure we're all on the same sheet of music as well as some updates. We posted some slides. So I'll sort of follow the slide deck, if you have that. It's on our website, and I think it's on UBS as well. As we said -- so starting with Slide 3. Our trajectory -- I think we've said this many times at the end of February, was following the same performance trends that we had in 2019. The changes that we made in people, analytics, capital and focus. We're beginning to really show the results that we had expected. As you know, in 2019, we finished strong across all 3 businesses. And while we knew there was more to do in tightening performance and continuing to adjust to refine the portfolio, we really do feel confident based on what we saw that we're heading in that direction. When I used February -- the end of February, sort of a stake in the ground, we were already ahead of guidance by $40 million. Admissions were up 1.1%; outpatients were up 5.5%; emergency business were up 6%; and surgeries were really on a solid trend, all of which had continued into those early weeks of March. The USPI segment, again, ahead of budget due to similar service line expansions and higher acuity, and Conifer was continuing strong. Slide 4. I refer to mid-February. The pandemic was clearly beginning to take shape. And it was a -- clearly it was potentially a very serious situation at that time. So we began to take some early actions just in anticipation. But most of that was of unknown changes in terms of what would be expected, but we started to move in that direction. We started to acquire and forward buy PPE as much as we could in anticipation of an unknown need. We test our operations teams with developing a ventilator management system. We revisited and strengthened the clear supply distribution plan from our warehouse locations for rapid resupply to all our acute care locations. And we worked on a staff redeployment plan out of our internal Tenet resource staffing group so we could add critical staff if needed. We have protocols for infectious disease management, clearly. But we immediately designed and deployed additional protocols and contingency PPE utilization plans just to ensure we were -- we had tightened how we were going to engage dealing with this highly infectious situation. And really, based on that time on available CDC information, which kept it across the wire, we built an analytical tracking system and deployed it fairly quickly to monitor nationwide PPE usage and inventory, ventilator capacity and testing capacity. And then we used and stood up our command center, which became our COVID-19 command center. That command center is typically used for national disasters. But it's well situated to deal with any kind of emergency. We began a daily nationwide COVID-19 call with all hospitals, USPI and Conifer, led by our incident command center and our Chief Medical Officer, who brought in our nursing, pharmacy and supply chain leadership. So we had integrated all the key functional areas as a quick response team. And within a few work days, we had tracking and monitoring of all the key issues by hospital of positive and negative cases, persons under investigation, COVID discharges and deaths, coupled with a very tight communication process so that every hospital and every group, we're getting the exact same source of information and receiving the exact same precise recommended actions. It also allowed a pretty open and immediate sharing of learnings, best practices and peer support, which proved to be invaluable. The shelter-in-place suspension of all elective surgeries, as you know, began to quickly roll out between March 15 and 22. We saw the number of PUI cases in that period of time jump from less than 400 to well over 1,000, and a strong increase in confirmed cases. While the number of PUIs continued to increase daily, we did have significant increases in Detroit, Massachusetts, Florida and Southern California. But I would say, each system responded very aggressively, and while very stressed, did a very good job. Our other markets also felt the initial strains in these early weeks. And again, I think they dealt with it very effectively. The biggest issue is the unknown prep or the unknown surges that everybody anticipated, which forced us to stay open in many areas with a 24/7 coverage of staff, just in case we would see the surge. We did maintain the coverage. But fortunately, we never saw many of these spikes. On Slide 5, I'd point out that we quickly realized that we were going to see a significant drop in volume, and that would have a very big impact on our business. So we determined we needed a new staffing strategy for all of our headquarters in nonclinical operations. And within a few short weeks, we furloughed over 10% of the workforce, which included about 3% of field operations. We maintain a staff to cover and handle the actual and potential unknown demand for COVID-19 patients as well as the staffing needed to respond to emergencies that could present in the hospitals. We took action to furlough and flex down the teams at USPI. We closed over 100 facilities, and we reduced the hours and days in the balance of those facilities. We maintained a minimal staff, as recommended by CMS, in many USPI locations prepared to handle any overflow from hospitals. However, fortunately, that never occurred. Given the reductions in the hospital units not directly addressing COVID-19 patients, we were able to redeploy personnel, if possible, internally, to support COVID-19. And we shut down various service lines just to ensure we had adequate PPE as well as space availability for any surge. By the end of March, ER traffic and emissions have decreased by 35%, hospital surgeries by over 50% and USPI volume by over 75%. That obviously created a lot of issues. And we had a lot of people pulling back because of the shelter-in-place orders and the fear of going to a hospital. The increase in COVID cases in areas like Detroit, Florida and Mass, we use premium time and coverage. We also had USPI hospital nurse volunteers who were not needed at their locations due to the shutdown, travel to our Detroit and Arizona hospitals, and some of them volunteered to go to New York City to support that area, which was in dire need. We added temporary staffing, where possible and available, to ensure we had the needed coverage in all hotspot areas. We took these actions immediately, proved effective in supporting every location, and we continued to acquire as much PPE as we could, regardless of pricing, which, in many cases, rose to 7x or greater times what our normal contracted price was. Our GBC center in Manila, 900 associates. The lockdown hit on March 15 and within a short period of time, they were fully functional at home and performed at about 98% of their pre-lockdown levels. So they did a great job. So let's talk about today. We're carefully coordinating a comprehensive recovery effort across every location as we continue to treat COVID patients. Past few weeks, we've engaged in the planning, detailed steps to reopen elective surgeries and to reopen our hospitals to our patients in our communities. The plans focus on every physician and how they'll engage in their respective practice, very important, including how they plan to prioritize cases and then how that fits into a methodical ramp of OR schedules, procedures and diagnostic screening. All of that has to balance staffing and support units to effectively have a labor plan that mirrors the demand curve. A labor plan that allows our physicians to fully engage and ensure their needs are met and balanced with the needs of the patient and the facility we're using. As we show on Slide 6, we've begun to resume elective surgeries, and our early read is promising. We're open in about 10 of the 12 markets now. And in these 10 markets, admissions are at 80% of pre-COVID levels. Hospital surgeries are also at about the 80% pre-COVID level, and USPI is now pushing past the 70% mark. Very promising results, and we're building on these in every market. In hospitals, it's going to be a balance of how quickly COVID cases fall and how effectively we can balance the surgical volume and mostly how well we can reach out into the communities and reassure the patients and overall community the hospital is open and safe. Opening physicians' offices and clinics and ensuring patients believe they are safe from COVID is truly critical. Additionally, ER volumes will be more focused. And we've initiated a marketing plan detailed to reinforce our ER safety from COVID and highlighting the trauma levels and the skills and the fact that we are fully open for business. Campaigns will be tailored to reengage our community, and we've been successful with that in the past using the Community Built on Care. We'll follow that same pattern. It's early, obviously, to make predictions. I know you'll ask that. But I'm not quite sure how we can make these predictions yet. It really depends on how we engage in every level and how successful we are to determine the speed and curve of the restart. But we're comfortable and we're feeling good about what we see, at least, at this point in the process. We've also taken steps to ensure that we have adequate bed capacity and ICU capacity in case we have a resurgence, which you know is required in all of these areas. There is a lingering question, and I know it's going to be asked about, what we believe will happen if the surge comes back in the fall or winter. On Slide 7, I comment about this. As with everyone else, obviously, we have no idea if that's going to happen. But importantly, we have a plan. And we believe it will really assist us in responding more succinctly and effectively in every market. Our view is the plan has to be tailored by market, demographics and the learnings from that market from our current situation on deployment of people, supplies and support. But as a general framework, we're going to isolate COVID patients in markets where we have multiple facilities designating a specific facility to receive COVID patients. Testing, treatment, admissions, whether we send them home to get self-isolated, all will be ordinate from a primary location. Where we have fewer locations, we'll designate a specific winger floor that can quickly adapt to the COVID patient load and provide this care isolated from the balance of the facility. Our belief is we can maintain a safe, clean facility that either does not treat COVID patients or allows us to show that they are totally isolated and the rest of the facility can continue to operate effectively in our communities. So this type of plan is going to be discussed in every community. We're going to market the plan so people understand what we're doing. And it will also ensure the USPI surgical centers can remain open and functioning, allowing a normal flow of patients to continue to receive the needed medical care and life-saving actions that we do provide. From a financial perspective, I detailed some things on Slide 8 that you can easily see. We've addressed actions to improve our liquidity, and we focused on operating to the demand level to ensure we wind up, start up, gear up based on volumes we are receiving and manage the demand supply curve and the demand supply match in a very conscious level. So I'm going to hold beyond that and let Dan talk about the financials. So Dan?

Okay. Thanks, Ron, and good morning, everyone. Let me start off on Slide 9. As Ron mentioned, up and through the middle of March, we were on track for a very, very strong quarter. Through February, our adjusted EBITDA was $40 million, ahead of our budget, with all 3 of our business units ahead of plan. The performance improvement that we've produced over the past several years was continuing with solid volume growth and pricing growth, higher acuity growth as well as pretty tight cost management. However, due to the effects of the COVID situation, we estimate our adjusted EBITDA in the quarter was negatively impacted by about $125 million. Due to the strong performance through mid-March and the quick actions we took to reduce our costs in the back half of the month, our adjusted EBITDA was only down 6% compared to last year. On Slide 10, I'll just point out that from an EPS perspective, our EPS was strong at $0.89 per share compared to a loss of $0.19 in last year's first quarter. A large portion of this EPS growth related to an income tax benefit we recognized in March of this year associated with the easing of the interest expense deduction limits by the CARES Act. Now let's turn to Slide 11, which outlines the significant volume declines in the back half of March due to COVID-19. Not surprisingly, these volume trends worsened in April, as governmental shelter-in-place orders and guidance to restrict elective procedures to further hold as well as a growing reluctance of patients to seek care. However, as Ron mentioned, volumes have started to improve in May, which is encouraging. From a cash flow perspective in the quarter, cash flows improved, despite the COVID-19 headwinds, due in part to us deferring about $75 million of 401(k) matching contributions at the end of March as we wanted to preserve liquidity at that point. We do intend to fund the 401(k) match to our employees in the second quarter. On Slide 12, you can see the first quarter results for each of our business segments broken down between the first 2 months of the quarter and the month of March. When you add up the numbers from February, you see we have generated $451 million of EBITDA at that point, and we're well on our way to a strong quarter. Although our businesses were materially impacted by the pandemic in the back half of March, our strong performance by all 3 of our businesses, up until that point, enabled us to confront the challenges from a much stronger position. As we mentioned, in early April, due to the pandemic, we withdrew our 2020 guidance as the projection of volumes and earnings for the remainder of the year create difficulty in predicting with any precision. Some analysts are still updating their models for our 2020 numbers and should consider the impact we disclosed for the back half of March as you model your numbers for the rest of the year. Let's now turn to Slide 13 to discuss our liquidity. As of yesterday, we had approximately $2,440,000,000 of excess cash, which is slightly higher than last week. Also, we continue to have no borrowings outstanding under our $1.9 billion line of credit facility. We did executed on two important actions in April to enhance our liquidity. First, we issued $700 million of secured notes and used a portion of the proceeds to repay all outstanding borrowings on our line of credit. And we amended our revolver in April to increase our borrowing capacity from $1.5 billion to $1.9 billion. Also on this slide, we point out certain of our larger receipts and disbursements during the month of April. As we've talked, we have received about $1.5 billion of Medicare advances in April. And after a 4-month grace period, as we've mentioned, we will start repaying these advances in August. Our hospitals have up to 1 year, in other words, through next March, to repay the advances on an interest-free basis. And our surgery centers and physician practices have through this November to repay the advances. One thing, we are hopeful that the repayment terms for the Medicare advances are extended beyond 1 year and a more reasonable interest rate is charged if the repayment period is extended. The Democrat stimulus proposal announced last week did contain these type of concepts. We have also received up until now about $517 million of grant aid so far from the recent stimulus legislation. These grant funds are to reimburse providers for incremental costs incurred and lost revenues due to the COVID-19 situation. The $517 million of grant funds we've received so far include $345 million related to the initial $50 billion distribution of grant aid earmarked for providers. We've also received $150 million of additional grant funds for our hospitals that treated a large number of COVID-19 in-patients, and we also received $22 million of grant funds for our rural and critical access facility. So when you add up all those amounts, we've received about $517 million of grant funds so far. Maybe one thing, just to remind everyone, these grant funds will not have to be repaid as long as we satisfy the terms and conditions of the grants. Next, let's turn to Slide 14, where we've summarized significant opportunities for additional liquidity in the near future. I'm not going to go through each of these since we've discussed most of these previously. But I do want to point out that we continue to expect that we'll be able to complete the sale of our Memphis hospitals this year for about $350 million of proceeds as that process is still on track. And there's still about $100 billion of grant aid under the recent stimulus legislation that has not been fully distributed to providers. We do anticipate we'll be eligible for a portion of those funds. However, that's ultimately contingent on how they determine those money should be allocated. We have taken other actions to enhance and preserve liquidity. As we've been managing through this time period, including dialing back our anticipated capital expenditures this year by about $300 million, reducing and significantly scaling back discretionary spend. We've been discussing and negotiating with vendors to extend payment terms and reducing contractual obligations. We have had, due to the significant volume declines in our facilities, we have had to furlough certain corporate and administrative overhead personnel across the company as well as furlough and flex down staff in our facilities only if they were not needed for patient care needs in other areas of our facilities. So due to the actions that we have taken in response to the pandemic to reduce our spend and the fact that we have been and we'll continue to collect on cash on accounts receivable generated from periods before COVID-19 took hold, we do not anticipate a material cash burn in the second quarter, even if you back out the Medicare advances and the stimulus grant so far. Ultimately, it will depend how the environment and situation unfolds over the rest of the quarter. I'll now turn it back over to Ron.

Thanks, Dan. So I just want to summarize a couple of takeaways. Pre-COVID-19 performance, strong momentum continuing from 2019 very positive. Two, we've experienced, obviously, the same kind of volume drop others have. I believe we responded very, very quickly. Three, we have acted swiftly to protect our facilities, our employees and our patients. We realized early on that taking steps to protect our facilities and patients and our staff was obviously critical, and I think we did a pretty good job with that. The amount of infection that our employees received in the field from COVID was below what we believe we heard about from many other places, very small. Fourthly, we bolstered our balance sheet and liquidity, had a lot of support from the CARES Act, which is helpful. But we believe that more is needed from the government. We believe there is more to support hospitals specifically, because we believe that hospitals were forced to stay open with no revenue. And that should be somewhat a driving factor in the government making decisions of where to allocate funds. We reduced cash. We reduced Capex, vendor spend. We've gone after contracts aggressively, and fundamentally, we have absolutely reduced all discretionary spending, travel, et cetera. And we have furloughed and flexed schedules accordingly, and we do it actively every day and no returns without volume. So we're being very tight on bringing people back until we see the volume actually start to occur. Next, we plan, I think, a very effective and safe restart and very detailed planning and very tight coordination across our system. And then finally, I guess, I would say the operational turnaround and discipline over the last 2 years has really paid off because without it, I don't believe we would have been geared up as quick as we were. The team responded effectively, quickly and absolutely without any hesitation. And I believe some of that, I would attribute to the fact that we've rebuilt the team. We focused on a lot of change in the last 2 years. And by doing so, I believe that forced us to be much more effective and much more of decision-to-action speed than we've ever had in the past. So I'm very proud of my team and the people in the field who did such an incredible job maintaining our hospitals and running them with -- in a way that allowed them not to be overrun and dealt with some unbelievable experiences. So with that, I guess, Whit, I turn it back to you for any questions you want to start with what time remaining.

Yes. No. Quite the response effort. You should be proud of how the organization has responded. Maybe just to start maybe to hear from Saum a little bit back on the -- your marketing campaign, focusing on the ER, I think it goes beyond the ER. Maybe just to elaborate a little bit more on where you are in that campaign process? What we should expect to see? What you're doing? Anything would be helpful.

Sure, Whit. Happy to do that. Our marketing campaign, in particular, is a portion of our start-up campaign. And as Ron described it, we're focused on 3 or 4 different areas. The first is the emergency department. We remain very concerned that patients are not coming to the emergency department despite the safety of that environment and also the obvious medical necessity of emergency care. Minor things become major things very quickly in some cases. And so our pathway in the emergency department is really grounded in 2 things. One is infection control processes and the division of patients with potentially having respiratory symptoms that could be at risk of having COVID, and separating those patients effectively from patients that don't. Obviously, visitation policies and other things underlie that in the emergency department. But we've basically created a safe 2-track system in our ERs in order to provide effective access for all people needing emergency care. We've engaged with the EMS providers to make sure that they understand that operational flow, and obviously, have supported triage outside of the hospital setting in order to understand what's coming in the door from an ambulance perspective before it gets there. Now coupled with that, to your point, is the marketing program that has started primarily with a focus on describing these processes to patients, giving them a sense of comfort, outlining the safety of the hospitals. But at the same time, messaging, especially for people with heart disease, abdominal disease, neurological disease, that small things can indeed become big things very quickly, and helping people, enlisting our physicians, for example, in some of these campaigns to really describe some of the symptomatology that people ought to be considering in getting necessary care. So that's one component of it. I think part of the start-up process also involves demonstrating that we've created a safe environment. So in many of our markets, we've been the first to open up the hospital selectively and thoughtfully to visitors, especially for same-day elective surgery, for example, or short-stay surgery. And that's made a big difference. And it's got a lot of attention and the processes we put in place just for those areas sends a broader message to the community about the commitment to safety in our hospitals. I've mentioned it in the past also that our staff rate of infections has been very low, sub 1% across the network. That's very different than what we're seeing in other areas. And again, I think that's a testament to the safety processes that are in place that protect our staff in the community. And then finally, as Ron mentioned, we've had a very disciplined approach to identifying and working with the physicians and the patients to not only service the backlog, but those that have developed symptoms during the course of this 8-week pandemic, so far, that needed to be scheduled for procedures. That's true in our USPI platform and in the hospital platform. It's the same process used in both places in order to help get the scheduling done very effectively. So that's a flavor of how it's been.

Yes. That's really helpful. I've got a question around the geographic difference in some of the volume. I mean, not every one of your markets is open. I think maybe 10 of your markets, you said, is open today. But maybe any color around how the hospitals are performing? How USPI is performing? Where the markets are open? I know you said you're 80% of pre-COVID level -- 70% of pre-COVID levels on USPI. But how that might look in some of the markets that have been open for longer than others?

Yes. Well, first of all, I would say all of the markets are ramping up regardless of whether they're "open" or not because the medically necessary work in the urgent work in the markets that are still closed or at least not fully open for elective surgery. Those cases are piling up as well, right? So not surprisingly, they're ramping up a bit also. But you're absolutely right. I mean, there are markets that are running much hotter in COVID, in particular, Massachusetts and Detroit. And certainly, in the Miami-Dade market, where there have been really large nursing home outbreaks. We've managed that in a couple of different ways. In our Detroit and Massachusetts markets, obviously, we have been focused on cohorting within the hospitals in order to create capacity and COVID safe zones in the hospitals to do that. In Miami-Dade, where we have multiple facilities with capacity, we're able to cohort even in individual hospitals. And actually that's allowed us to -- in Florida, which has opened up a bit more, that's allowed us to begin to take care of the patients that we see in the community that need care, elective care even, in that environment. And so that -- and those markets are lagging a little bit behind the markets that accelerated their openings much earlier. I think they'll catch up. Look, one of the things that's important here is testing capacity. And as the testing capacity and turnaround times continue to improve, we're able to clear the PUIs into either COVID or non-COVID status much faster, which helps with capacity, obviously.

I think I just want to transition to Conifer for a second to make sure I covered this. I mean, your message is we're moving forward with the spin. Obviously, this adds an element of complexity. Just how some of the questions you're asking internally or changing around Conifer? How you're thinking about leverage, the timing of the spin? Just any additional comments would be helpful.

Yes, sure. We are -- in fact, we have a large meeting this afternoon with bankers, lawyers, myself and people from Conifer that -- Joe Eazor and his team, a couple of his team members saw myself, Dan are -- Mike Maloney, our M&A guys. We -- I think what I've said is it's kind of a couple of key things we got to work through. Obviously, in the past X number of weeks, seems like a lifetime. But in the last 2-plus months, we didn't spend a lot of time on this. We were obviously buried in everything else. The reality is, I think where we are is we need to determine, again, revisit lockdown on the long poles in the tent. Obviously, given the IRS ruling is one of those. There was never a concern with that in normal business. I don't think there's still a concern at all. But I just think we need to reidentify those, make sure that we're on schedule. I don't believe we have any scheduling issues in front of us. But we want to ensure that we are and that we've got people deployed clearly up against that and refocus their energies where they need to be refocused. So it's really taking an assessment of what I call -- what are the various long poles that we need to make sure we've defined, locked down, and we're moving with a way to measure that. At the same time, a subset of that is to get us back into a cadence of reviews. So that those reviews can be continued. And when you get off track, it's easy to let things slip. We haven't -- I don't believe we've done any of that. But having said that, we need to get back to our review schedule, which was very frequent and we had measurable milestones. So we'll go back to that. As of today, we start that again. The second thing is the commercial side of the business. I mean, clearly, sort of hard to be doing sales calls right now. But there is an opportunity potentially out there for us to go visit and look at what is our offerings and how might they change relative to the market? And so Joe and his team are going to get focused on that. We're going to talk about that today. So back to the commercial side, we really need to drive that harder and see whether this pandemic has created some opportunity in that area for us. So those are the first -- the big two. I think the third thing, you asked about the markets and debt and whatever. Look, nothing's changed in terms of our thinking in that point, nor am I going to give out a number. But clearly, we're going to have to see where the market is. I suspect that we'll be fine. But I don't know that. I mean, the same question gets asked about where are you going to be next week? Where are you going to be next month? What is your targets? I mean, I look at guidance the same way. We get these quarterly guidance consensus numbers that I'm not quite sure that they make sense right now that we see because, obviously, April was a pretty big negative hit. And we're coming back in May and June, and I think we'll come back very well. But I've got to -- we need to see where the debt markets go with the -- and the equity markets. So I think that's a live-action kind of thing that will change monthly as we know more about the pandemic, as is there going to be a vaccine or not. I mean, these are real-world things that we're going to have to just monitor. But I don't see anything today, when I look ahead 13 months, 14 months, that I'm going to say would change that schedule. My assumption is that these things are going to happen and that we're going to continue to move forward. But I mean, these are real things that we've got to watch and be very aware of. If we see anything that we think is a glitch -- I mean, do I expect bumps in the road? Yes, I think we will always have. As we recover from this thing, everybody is going to have bumps in the road. There's nothing that's going to be perfect here. But having said that, we're going to approach this same as we approached it before, with the same energy, same focus, same stake in the ground in terms of date. And if something changes, we'll be transparent about it. But as of now, no changes, no messages. Let's not all read into this some kind of message. There is no message. I'm just being transparent about what are the things I think about and what are the things we have to do as a team. And I think we're geared up and ready to do them. So that's -- bankers are lined up. Earnings are still on the game. We're still moving forward with a full court press. So it's the best I can give you today.

No. Always helpful, Ron. Maybe turning to USPI for a second. I think a lot of investors are really trying to figure out how the industry is going to respond to this in terms of the restart. And what's been the feedback with a lot of your physicians in terms of their desire to ramp up productivity levels? Do you think about running after hours? Running on Saturday? Is that an option for you? Something you think about? Any comments would be great.

Yes, Whit. It's Saum. A couple of thoughts for you there. I mean, first of all, the physicians are generally motivated to come back and get moving, especially those that have been more idle. And that's not to say that some of them don't have their own concerns about the infection control processes and other things. But generally speaking, they're all working very constructively with the hospitals and the ASCs to put in place those processes. We developed system-wide infection control processes for restart 4 or 6 weeks ago. And so the important part of that is that, frankly, it gave it a lot of time to socialize with these doctors, get their input, modify them where necessary in some of the markets and things of that nature. But by and large, I would say that they're definitely interested in getting back to work. Their primary problem is that physician offices can be pretty tight spaces. And how do you do social distancing and appropriate separation of patients in the back of the office in such a way that you can run at full throughput? And that's really going to be one of the important parameters that has to be monitored in terms of physicians' offices, not only being open, but up and running at full throughput, from the perspective of what impact that will have on things that they do downstream, that may require a facility. The other side of this, of course, is patients and patients and their fear and concerns. And we've gone out of our way to make sure that people understand we've performed tens of thousands of surgeries in our ASCs, for example, in the last 8 weeks that were urgent and medically necessary. We don't have a single recorded case of a COVID transmission occurring as a result of that. I mean, that tells you something about the environment that has been created. And so we're obviously pushing that safety message there. On the hospital side, I think we covered it earlier. This is a combination of messaging upon messaging, public health officials' messaging, community leaders' messaging. I mean, it's going to have to be a concerted effort from many stakeholders, including the physicians, which I think was the start of your question. But the medical community alone can't do this. And it's going to be a process of creating comfort among patients to get back into their normal healthcare routines.

Got it. Well with that, guys, we are just out of time. As always, really appreciate your time. Very comprehensive overview, very helpful and insightful. Regina, thanks for all the work. To Ron, Saum, Dan, thanks again for coming. If anyone has any questions, reach out to myself or my team and we'll get back to you as soon as we can. We will have Encompass up in, I think, 10 minutes. So hope to hear or see everyone soon. Bye.

Thanks, Whit.

Thanks, Whit.