Steve G. Filton - Universal Health Services, Inc.
Management
Yeah, so I think – and we talked about this certainly last quarter and I think for several quarters really, again, beginning in the second half of last year. Look, I think that as a result of the improving U.S. economy and the improving economy in our local markets, we have seen a tightening of the available labor force in all or most of our markets. That tightening, I think, is manifested somewhat differently in the two divisions that we have. We just talked about on the behavioral side, quite frankly, we're just not able in some markets to find sufficient nurses and physicians. And as a consequence, we're forced to turn patients away. On the acute side, I think, it's manifested more prevalently in higher use of what we describe as premium pay, which would be overtime or shift differential payments that we make to our current employees or the use of temporary or agency nurses, where current employees are not available. And certainly that use of premium pay on the acute side has contributed to the margin pressure in Q2, as it did back in Q3 of last year. But I think we continue to sort of focus on that, and it got better in Q4 and Q1 of this year, and I think our sense is that we'll continue to focus on it and it is a solvable problem on the acute side. The one other comment I'll make on the acute side vis-à-vis margins is, while I think the volumes on the acute side were well within our expectations, the revenue per admission growth of 1.3% is probably 50, 75 basis points short of where we thought we'd be. I think that's a bit of a weaker patient mix, and that's mostly maybe a growth in uncompensated patients in the quarter, not by a material amount. But I think mostly the big change from Q1 is, in Q1, our other non-uncompensated volumes were just so strong, particularly our Medicare volumes were so strong, that they offset a bit of the uncompensated tick up in volumes. In Q2, as Medicare and other commercial volumes moderated some, the uncompensated rise had a bit more of an effect. So I think the staffing pressure or the premium pay pressure, along with the slight payer mix deterioration, probably explain the bulk of the pressure on acute care margins.