All right. Good, good morning, everyone. My pleasure to have the team from Encompass Health today. I've got Doug Coltharp, the CFO, Mark Tarr, the President and CEO. Guys, appreciate you joining us today. Happy to be here. Yeah. I thought maybe, to sort of start the conversation, it might be helpful just to, Doug, if you want to maybe start with a quick recap of the quarter, some of the highlights, strong outperformance, modest raise in the guidance, so just maybe give us a recap. Yeah, the first quarter was a great start to the year. It really continued the momentum that we had throughout 2023. It always starts with what our volumes look like, and we've been fortunate that really for about the last six or so quarters we've had very strong volume. We had 10% total discharge growth was the primary metric that we used to measure our volume, and it was nicely balanced between same-store growth and new-store growth. 6.7% of that growth was in same-store, the balance coming from new stores, predominantly the De Novos that we've opened up within the last 12 years. We saw good strength across our geographies, and that remains a trait that, again, we have seen for the last several quarters. It was really balanced across our regions, and it was also balanced, well-balanced across payers and across disease categories as well. We continue to see strong growth in our primary categories of stroke and neuro. We did see faster growth in some of the orthopedic categories, but those are much smaller as an overall percentage of revenue. We managed our labor and expenses very well. It's certainly been the case that we've seen a stabilization in the utilization of premium clinical labor, and so that contributed to an expansion in our margin and allowed us to deliver an outsized growth in our adjusted EBITDA, even compared to the revenue growth. It is early in the year, so we took the opportunity to raise our guidance, as you suggested, and just feel good about the way the business is running right now. Yeah. If we look back over maybe the last 1-2 years, and if you look through all of the different disease categories, is there anything? I mean, you mentioned MSK was maybe growing a little bit faster. There was a little bit more strength, but maybe ranking some of them, like where you're seeing maybe more strength versus others over the last year or two. Well, if you think about our core categories, we include stroke, neurological, brain injuries, debility. Those are four key categories for us. Each one of those categories had double-digit growth in the first quarter. Collectively, they make about 63% of our discharges. So continuing to position our programs towards a higher acuity patient has certainly provided some benefits for us in terms of growth. Yeah. Always said it's like the most nondiscretionary and elastic element of healthcare services. Absolutely. Well, it's tied specifically to the demographics. You know, the average age of the patient that we treat in our facilities is 77, and the age cohort between 75 and 85, because of the aging of the baby boomers, remains the fastest-growing segment of the U.S. population. And really, the over-65 population has been the fastest growing for more than a decade now. The incidence of the maladies that are appropriate for treatment in an IRF setting haven't changed at all within that population. So as the population grows, so too the eligible patients. And with the capacity additions and the clinical capabilities that we've been expanding across our franchise, we've got the ability to treat more and more of those patients. Right. Well, and really right there in that growth corridor right now. I wanted to spend just a second, I mean, I've known you guys for a long time, and when I, anytime I've been in the headquarters and been able to see sort of the backbone of the operational system and the technology that you've developed to be able to drive accountability all the way to the field level. I don't know if you might just spend a little bit of time talking about some of those infrastructure investments you've made over, I mean, really, like 20 years as I sort of think about it. And maybe there's not a full appreciation for, I think, how you guys are able to operate the business as effectively as you do on a day-to-day basis. So with you, you've been there. You, you saw we, we are a very data-driven organization, both on the operations side and on our clinical side. We are. In 2010, we rolled out our first clinical information system, working hand in hand with Cerner to develop it from ground up, tested it, piloted it starting in that 2010 timeframe, and then rolled it out to our entire organization. So since then, that has reaped significant benefits in terms of just our ability to collect the data on our own discharges, continue to route best practices. Our clinicians and physicians have worked to create predictive analytics using that data, which helps us eliminate unnecessary acute care transfers. It helps us identify patients that may be at a fall risk. We've seen our falls go down significantly, and it has continued to allow us to build clinical best practices. On the management side, we have a system that we call our Beacon system, which our IT group consistently looks at itself, and we look at them as a strategic partner, not just a support group for our computer systems. But they have worked with us to create management reports on everything from labor. It really started out helping us to keep track of our labor and allow our managers to respond quicker because they were getting real-time data. They could respond quicker to fluctuations in volume. We look at everything from our clinical outcomes. We look at our other expense categories. And so it allows our managers to have full access into, in terms of their own organization as well as other hospitals in their region, and our entire company. It really allows the ability to create and roll out best practices across all aspects of our business, both clinical and operationally. And I think that last point is worth underscoring. It's really a hallmark of our strategy and it's embedded into our culture that, we utilize standardization and best practices and roll those out across our platform. And that really creates, a lot of flexibility and strength in our organization. When you consider the fact that we are a very big fish in a relatively small pond in the IRF space, IRF services are all that we provide, and we've got roughly a 35% market share when you think just about the Medicare population. What we have done with regard to the continued refinement of best practices and the standardization of those best practices, as well as things like hardware across our platform, is create a system where across our 160+ hospitals, you could take an employee at any level and pick them up and move them from one of our physical facilities and drop them into another, and they would know how everything works. All of the systems that they're accessing are the same. The hardware, the equipment is all the same. The way they go about their business, with the exception of some modest adjustments that would have to be made for changes in physical plant, would be very much the same. That also gives us great flexibility when we think about moving around hospital leadership or developing hospital leadership. That has paid great dividends with regard to our program. Many of the CEOs in our De Novo hospitals are either moving from another hospital within our system, or they're coming up through the training program that we have, the apprentice program that we have, which we call Developing Future CEOs. When you look at the investments you made into the electronic medical record, how would you grade, like, the return you've been able to see in terms of the connectivity with hospitals and being able to grab greater mind share? Has that been helpful as you sort of develop your relationships with the referral sources? Absolutely. And about a 1/3 of our portfolio are joint venture partnerships. So having this clinical information system, having the interfaces with whether it's our partners or having the ability to collect the data that we can go out and then show our referral sources, the outcomes that we get on our patients and that connectivity that you have, it absolutely helps to develop the relationships with the referral sources, helps give them confidence in terms of their ability to refer to a quality provider. And then, you know, physicians and discharge planners, they too are data-driven. So if you can show them data, it goes a long way in their continued confidence in you as a provider. You know, with more than 90% of the patients coming into our facilities, coming directly from an acute care hospital, one of the most important elements of our value proposition that we can provide to those acute care hospitals is the ability to take patients out of their facilities on a timely basis and allow them to reduce the length of stay and open up those beds for another patient. And the clinical information system is instrumental to that process. The interoperability that exists between that system and the acute care hospitals allows us to identify very early in the stay of a patient in the acute care hospital whether or not that patient is likely to require IRF services upon discharge. And so we can begin the dialogue early in the process with the discharge planners and the case managers in the acute care hospitals. That, combined with our ability to treat a higher acuity patient, means that many times we're able to take that patient after a shorter stay in the acute care hospital versus our peers who need for them to get more of that acute treatment before they're ready to start their rehab regime. Yeah. It was, I don't know how many years ago, it could have been 10 years ago that American Stroke Association, American Heart Association, came out and endorsed inpatient rehab as the preferred setting of care for stroke patients. I was trying to find, like, additional studies or data, like, that's been conducted since that was published. Have you seen any, have you guys done any peer review studies with them, or has there been any subsequent, you know, I don't know, anything we've learned out of that, that partnership? Well, we continue our relationship with the American Heart Association and have co-branded now with them for the past five or six years, working on all of our marketplaces. And with, as you noted, American Heart, American Stroke Association came out a number of years ago with independent research that showed that if you have a stroke and you need inpatient rehabilitation, the best setting to get that is in a rehab hospital. And so we have worked hand in glove with them and having that co-branding where we help with education on, for stroke patients, clearly they are on the prevention side, and so it's been just a real beneficial relationship moving forward. We haven't seen that they have updated any of those studies. We do track the results for our own stroke patients. First of all, in every year since we started, and I think this is our sixth year as Mark suggests, since we started that partnership, we've seen our stroke market share go up. And so that's been a, a nice trend line there. And the, as we continue to roll out and refine our clinical protocols for addressing stroke patients across our franchise, we're seeing that the results that were already very positive for the patients who come to us are only getting better. Where are we on the Review Choice demo? You guys periodically also have other audits that you've had to deal with, whether it's in Palmetto, Cahaba, or maybe Doug, you just want to broadly take that question. Yes. Remember, Review Choice Demonstration started in the state of Alabama, which is where we have seven hospitals. And it began in August of last year with a 6-month initial Cycle 1, it was labeled, all of our hospitals, because they were, under the MAC Palmetto, were subject to, to RCD. It was 100% pre-claim review. The hurdle rate that was required, in terms of, actually, it's called an affirmation rate for the 1st 6-month period, was to be north of 80%. And we moved through that with all seven of our hospitals north of 80%. There was kind of a period of settling down and getting everything ready for Cycle 2, which began on May 1st. In Cycle 2, which is another 6-month period, the affirmation rate increases from 80% to 85%. Because we had cleared the initial affirmation rate, we were given a choice to either stay in a mode of having 100% pre-claims review for those seven hospitals or move to a spot, a random spot audit of about 5%. We felt that we had already made the investments in the infrastructure and the people and had established a good working relationship with Palmetto on the pre-claims basis. And that allows for a more iterative dialogue before a claim is either affirmed or denied while the patient is still within our care and we can provide incremental documentation. So we have stayed with that. So we're just a month into Cycle 2. RCD is now expanding to the state of Pennsylvania. We do have a significant presence in terms of the number of hospitals in Pennsylvania. Having said that, for various reasons, mostly related to the capacity of the various MACs that are out there, it is specifically focusing on those hospitals that roll up through Novitas. Our hospitals in the state of Pennsylvania, as they do in Alabama, all roll through Palmetto. For the time being, we will not be participating in RCD in the state of Pennsylvania. But generally speaking, the program has gone about as well as we could have anticipated. What I will say is that RCD is another example of how our clinical information system and having that electronic documentation and our ability to, you know, to monitor that and submit information to the MACs. So that's just has been very helpful. That's a good example of what those previous investments have helped us achieve. Yeah. And what you've seen it time and time again, because you've known our company for a long time, we get enough lead time when the regulatory change is coming that we make the investments in people and processes, and we put a lot of time in, and we get ready well ahead of it coming through. And this is another case where, frankly, we were educating Palmetto and CMS on what this was going to look like when it got implemented. And it'll be interesting to see how it goes with Novitas because there isn't anybody like us to educate them. Right. Can we spend just a minute on Medicare Advantage? I mean, you guys worked many, many years ago to kind of close the, the rate gap, which is, is good. But I'm, one of the things that I've sort of detected talking to a lot of the acute care hospitals is, like, there is certainly, like, growing friction that has been there for, a few years and maybe increased post-discharge denials and just behavioral changes that have become on the margin a little bit more challenging, maybe either on their, their yield, their collection, or just back-office stuff. Is there any behavior that you would call out in terms of changes within MA plans today, or do you feel like the relationship you have is, is pretty good? I think overall the relationship is positive. We continue to see very good growth in the Medicare Advantage book of business that we have. It's been outpacing fee-for-service for the last several years, although we continue to see good growth in fee-for-service as well. We've had a more than 10-year initiative of really trying to underscore our value proposition to the MA plans. By doing that, moving them away from per diem pricing for the services we provide to being on an episodic basis with that episode tied specifically for the fee-for-service reimbursement. Today, as we sit here, more than 90% of our Medicare Advantage contracts are on an episodic basis. The payment differential that exists between our fee-for-service and our Medicare Advantage book of business was 3% in the first quarter. We've done a good job there. And we've done it by underscoring the value proposition that we have, particularly for the higher acuity patients. More recently here, we've seen that acuity spectrum broaden some, which I think is a positive thing. We don't have issues with Medicare Advantage with regard to things like collection or post-claims denials for the most part. Those really are not at a level of incidence that causes us any concern. The biggest issue we have is being able to get the patients out of the acute care hospitals, IRF-eligible patients out of the acute care hospitals, and being able to do that in a timely manner. The Medicare Advantage plans are kind of notorious for trying to hold patients who are eligible for discharge to a post-acute setting in the acute care setting longer to the point where they may no longer meet medical necessity by the time they're ready to be discharged. That's an expensive proposition for the acute care hospital. You know, where it translates is we continue to see referral conversion to referral rates in the MA book of business that are substantially lower than they are for fee-for-service. That to us is an opportunity, not a threat. We are making progress on it. If you look at some of the language that's been included in the last rule from CMS for Medicare Advantage, there's a specific focus on improving the access to IRF services for Medicare Advantage beneficiaries. I think we've gotten better just in the prior authorization process itself in terms of providing the clinical information that the MA plans need to determine what's the best setting for these patients. It's particularly evident in stroke patients, where they have seen that, you know, to get the outcomes, not to have the readmissions back to the acute care hospitals, if you send it to an Encompass Health Hospital, you're going to get the best outcomes that you can for these stroke patients. You know, it's, I think it's interesting to reflect back on the second and third quarter of 2020 when we were in those initial and the most heightened states of the pandemic and the Medicare Advantage plans waived pre-authorization. So we stated at that time that the SNFs were in no position to take those patients out of acute care hospitals. And the acute care hospitals were being overwhelmed with COVID patients. SNFs would not touch a COVID patient. We could not only take COVID patients, but we could also provide the required rehab regimen. Mark and I made the statement a couple of times during that timeframe that we believed that if we could take those patients and provide that service to the Medicare Advantage plans under that period of no pre-authorization, that they would really get to see for the first time how strong our value proposition was and the market share that we gained during that temporary period would prove to be sustainable over the long term. That's exactly what's transpired since that period. I can't remember if you've shared, like, some statistics, some data around, like, that conversion rate or the utilization, fee-for-service versus MA. Like, what's the difference today? It's substantial. Okay. Yeah. Okay. I can do the math in my head, I'm sure. Let's talk about some of the development activity. Before getting into, like, the forward forecast, let's work backwards a little bit. As you guys look at capital returns on a lot of the projects, and you said, like, five years ago, four, three, two, one, how was the variation of IRRs, ROIC? I know some of the construction costs have gone up. That might influence that. But, you know, maybe normalize for some of those factors. How would you sort of, I don't know, rank sort of the cohorts of, the classes of De Novos? Yeah. You know, it's a little tricky to get into that because you've got a different number opening every year, and they're in a different geography. And the economic environment, although it doesn't impact us a great deal from a cyclicality perspective, varies from year to year. But a couple of things that we have put out there, we really restarted the De Novo program in 2010. And my recollection is that between 2010 and 2019, we opened up roughly 31 De Novos. That was before the period where we really kind of hit the accelerator on the De Novo activity. And if we go back and we just look at the returns on capital that we've gotten from that group of more than 30 hospitals, it's north of 19%. So well in excess of our cost of capital. It's really, without exception, all of the hospitals within that aggregate cohort have performed well. We started accelerating the number that we were opening on a per annum basis beginning in 2020. When we look at the 2021 through 2022 class, those are performing very, very well. 2023, the early reads, and you saw this in the numbers that we reported last year, those came out of the gate very well. What we're seeing for the most part is that the fact that we've had an increase in construction cost, which we have and everybody has had over the last several years, an increased labor cost, which can be put pressures on the returns, we've been able to offset through a number of initiatives. First is we've increased the utilization of prefabricated construction. Ultimately, we think that provides us, when we're doing a fully prefabricated hospital, it's about a 15% savings versus traditional construction cost. But more importantly, it's a 25% improvement in speed to market. So it's the same, even if it's the same capital spend, you're getting the door open and starting to accrue cash flow earlier. We've moved to a larger footprint to try to get more scale out of the ground. Our typical prototype up until about 2020 was a 40-bed hospital. Now we're at a 50-bed hospital, and sometimes they're larger than that. And then just the learning curve that we've been able to ascend by opening more of these hospitals, we've gotten better on the front end of doing all the things from staffing to establishing payer contracts to establishing referral contracts before the hospitals open on day one, such that our ramp-up of the hospitals has accelerated significantly, with the more recent classes. It's getting tougher out there, but we're still finding very high-quality projects that are delivering good returns for us. You mentioned you, when you hit the accelerator, let's talk about some of the factors that drove the decision to hit the accelerator. I think one, I mean, there was some lifting of COVID, CON provisions in the state of Florida that gave you an opportunity. Maybe there's some more states coming. But what are some of the other environmental external factors that sort of shaped the decision to accelerate it? Partnerships on JVs could have been one, just inbound interest. But it's been notable the velocity of press releases that have come out of the organization the last few years. You know, I think it was really, the primary thing was the increasing supply-demand imbalance that had been growing for more than a decade. And again, we go back to the demographics, and the age cohort of over 65 from 2010 through 2020, grew somewhere between 4%-5%, while the rest of the U.S. population was increasing at less than 1%. Over that same decade-plus, the supply of licensed IRF beds in the U.S. was essentially flat. It was up less than 1%. And so, as a result of that, when you looked upstream as a proxy of how many IRF-eligible patients coming out of acute care hospitals were actually finding themselves in an IRF bed for their post-discharge care, and we used CMS-13 eligible discharges as a proxy for that, the conversion rate was only about 13%. We knew the population was out there, and we knew that we were getting good returns on investment from our De Novo activity. We found ourselves in a position with not only the operational and the clinical capabilities, but also with the balance sheet strength and with excess free cash flow generation to be able to make those investments. It's proven to be a very good strategy for us. You know, we're definitely pleased with the progress that we've seen and the performance of our De Novos. But there is a ton of work that goes behind the scenes to get all these up and out of the ground and have the ramp-up that we have. And we're just very proud of the way that our operators and our support staff in Birmingham help us to not only get the hospitals up, but help us to identify the marketplaces that have the greatest need. It's so easy in my Excel model, though. Yeah. No, we have to remind people there's work that goes into that. Yeah. With no disrespect for those brands that we all know and love, but it's not like opening up a Starbucks or a McDonald's. Yeah. There's a lot more to it. Can we spend just a minute on the renal, our dialysis programs that you've introduced in the last few years? Just the size of that, the number of patients, the census, any, anything to share? Yeah. So, dialysis patients make up about between 3%-5% of our total discharges. And it was really come out of out of necessity back in 2020, 2021, where we had dialysis providers were kind of cutting us off. They didn't have the staff to care for our patients. So we were. We had a continuing need because our patients, many of them had were on dialysis. So we started using the Tablo device, started rolling that out, in our facilities and having separate dialysis suites where we would have either two or four of these devices in there and be able to bring our patients in there to be to have their dialysis treatment, dialysis care, that help the patients to be able to not only have the dialysis care but also to continue with their rehabilitation and not have to send the patients out or be dependent upon a third party to come in to provide that care. So we've seen quality and clinical advances that benefit the patients from it. We've seen economic benefit from it. It's about half the cost per treatment than what we had to pay to have a third-party provider come in and provide that. So we think that we can have these rolled out to up to 75%-80% of our hospitals before it's all said and done. Not every hospital needs a dialysis program like this. Other hospitals have third-party providers that seems to be going well. But we do think there's been a nice roll for the Tablo devices in our hospitals. Yeah. I think, I mean, wasn't it like a pre-COVID rule that, and it didn't, like, relax this, but CMS, I think, identified, like, it makes a lot of sense for skilled nursing and patient rehab. We don't need to take the patients out. It costs more money to transport them over to DaVita, bring them back. There's risk of hospitalizations during all of that. I mean, wasn't that, like, the catalyst for this, where there was a regulatory change? Or am I totally missing? Well, that was a part of it. That was a part of it. But it's very difficult to send a patient out, bring a patient back after dialysis, and still have three hours a day of therapy. And even when that third party was coming to our facility to provide the dialysis, it was a little bit like the antiquated notion of the cable guy, right? We'll be there sometime between 12:00 P.M. and 5:00 P.M. Well, it's hard to plan a therapy schedule for a patient when they may be called into dialysis sometime during that period of time. And even the difference in the technology, the technology that historically was deployed by those third-party providers, you know, that would, it was very taxing on our patients. And to think that they would then be able to go participate in aggressive therapy following their dialysis treatment, that was not going to be the case. The impact on the patients from the Tablo device, just because of the new technology, is substantial less, and the recovery period is much faster. Their ability to participate in that therapy is enhanced. I think it's just another example of how we, you know, evaluate the various technologies that are out there that would benefit our patients or provide continued efficiencies in our hospitals. And that's something we look at every year. Okay. Maybe just one last one that, since we have a minute, and I've talked to you guys periodically over the years about value-based care and the, you know, the inertia towards innovation and payment models and, and, and whatnot. The IRF business is a little bit more unique. But where do you sort of stand evaluating where you stand in alternative payments and how you make sure that you're leaning forward and not behind? So I, I don't know, just, like, kind of an open-ended question. First of all, I think just being the most efficient provider. I agree. We have the highest quality outcome, puts you in a really good position regardless of what's coming down from a regulatory standpoint. Yeah, we continue to work closely with our trade associations, dialogue with CMS. We keep an eye on, in terms of any developments that are out there. But we think we're well positioned. And if you look at our history with regulatory changes, we've done a really good job of evaluating them, implementing them, and then rolling them out. We've had discussions at a high level with some of the payers, the major payers out there, about our willingness and our readiness to participate in some of those models. They've said, "That sounds great. We'll get back to you." And in all instances, they ultimately.