And what I mean by that, we have invested heavily in new graduate training programs. We’ve done that throughout the year. That actually created a little bit of a headwind in the quarter and throughout the year for us. We think that will help us as we push into the fourth quarter and on into ‘24, with making adjustments to our labor agenda. We’ve invested in our Galen College of Nursing facilities, as well as our other clinical education. So we’re investing in our agenda for the long-term prospects that all of these initiatives represent. Bill spoke to the revenue yield. I think the revenue yield from acuity, payer mix, and pricing is positive. So I mentioned that our same-stores results were in line with our expectation. I think the second thing that’s important here Gary, is that we pride ourselves on making adjustments if we have a variance and I am confident in our teams.
I’m confident in who we are as an organization. And we’ve proven it over time that we can make adjustments and find solutions to really complex problems. And so we’ve got one. It’s not what we anticipated. But again, we had the necessary requirements to consolidate a business that was struggling and somewhat distressed, but very important to our offerings in the community. So I think as we work through it, as we gain a better understanding of it, we will be able to make adjustments and get the proper reimbursement we need from the payers for the services that we’re now providing. And so, fortunately, our balance sheet remains strong as Bill alluded to, and our ability to invest in our agenda to maintain our positioning and execute on our agenda remains strong.
So when I pull up and provide some context here, I’m encouraged by what I see in the quarter and for the year and what that portends for the company as we push into the future.
Bill Rutherford: And, Gary, this is Bill. On your clarification, pro-fees as a percent of other operating, it was just under 24% in Q3, similar to what it was in Q2.
Gary Taylor: Thank you.
Operator: Our next question comes from Ann Hynes with Mizuho. Your line is open.
Ann Hynes : Hi, good morning. I know you don’t want to provide 2024 guidance now, but is there any major headwinds and tailwinds that you want to call out before heading into the event? And to that degree, I know Nevada is introducing a UPL program. Do you have any sense what that incremental benefit will be next year? Thanks.
Bill Rutherford: Ann, this is Bill. Yeah there is. Only one we’ll pull out, as I mentioned in my comments, is the payer settlement we recorded in the first quarter. Other than that, we’ll give you our full commentary later on 2024. And on Nevada, it’s still too early. We’re waiting for the approval level and when we discuss ‘24, we’ll update you on what our thinking is and the estimate of that is.
Ann Hynes : All right, thanks.
Operator: Our next question comes from Whit Mayo with Leerink Partners. Your line is open.
Whit Mayo: Hey, thanks. Good morning. Sam, can you maybe just go back and elaborate on the ER revitalization program. How Valesco plays into that and exactly where you are in the evolution of that program and any tangible progress that you expect to see in 2024? Thanks.
Sam Hazen: So our ER revitalization program was initiated maybe a year ago, nine months ago, without remembering the exact point. We determined that a couple of things. One, demand for emergency room services continues to be robust. It was actually more resilient coming out of the pandemic than we had anticipated. So we felt we needed to reenergize our operations, because we had had some turnover in our leadership and we had business opportunity associated with demand. So our teams came together and went about sort of revitalizing, for lack of a better term, our basic operations with respect to our emergency rooms. We have proven standards and processes over time that we think create a really good experience and a positive outcome for our patients.
And so we wanted to retrain a number of our new leaders, including some of our physician leaders through Valesco and others into these standards and these processes. And the early results of our program are really positive. Our patient satisfaction is up four or five points from when we began the program. Our throughput continues to improve. I think we’re seeing an ER patient within nine or 10 minutes with a clinician, as soon as they present to our door. Our throughput times with respect to discharging our patients has improved, as well as those who get admitted, we’re able to get them onto the floors more efficiently than we were before. We continue to believe we have opportunities to strengthen that program, and so we’re expanding the reach of our training.
Again, that will include our physician leaderships, both in Valesco, as well as other hospital provider contractors that we have. And we think this will play in well with into our investments that we’re making, into our emergency room platform, both hospital-based as well as our freestanding emergency rooms, which continue to perform at an even higher level. So all of that to say is its yielded volume growth, it’s yielded patient throughput improvement, and most importantly, it’s yielded patient satisfaction increases that we are encouraged by and we will continue to hopefully achieve.
Whit Mayo: Thanks.
Operator: Our next question comes from Brian Tanquilut with Jefferies. Your line is open.
Brian Tanquilut: Hey, good morning guys. Sam, it seems like you have an idea of what needs to be done at Valesco. But maybe going down to the nuts and bolts of it, as we think about the fact that you employ these docs now, it sounds like this is more of a revenue issue. So is that just a matter of tacking them onto the HCA contract or what needs to be done there? Maybe just for Bill, and kind of related to this, if you can give us the contribution of Valesco to revenue per same-store admin. Thanks.
Sam Hazen: Let me speak to how we’re approaching it. Again, we’re learning as we go. I forgot the – I think it was like 5,000 physicians across, how many programs?
Bill Rutherford: 200 programs.
Sam Hazen: 200 different programs. A really large-scale business that again, we felt we were at a point where we had to make a decision and I am comfortable that we made the right decision for the company long-term. So as we learn more and more about this business, we think there are going to be opportunities on how we allocate the staffing underneath this business. Obviously, our emergency rooms are 24/7/365. We won’t necessarily change the staffing per se, but there could be complimentary approaches to that. There are overhead opportunities we think over time we will be able to get to. But you’re right, ultimately we will need to get paid for these services appropriately. We do have some contracts today. We feel like those will have to be adjusted in the future.
And we are confident that we can achieve appropriate reimbursement underneath these programs and get us to where it’s an appropriate service that’s reimbursed reasonably as we get through it. But that’s just not happening immediately and that’s part of the challenge. And again, we need anesthesiologists, we need emergency room physicians, we need hospitals in order to deliver the volume and maintain provisioning. And so that rationale went into our decision-making, and so now we have to rationalize the operations, and I think those are the areas that we’re going to focus on. And we believe in a reasonable period of time we’ll make progress on that.
Bill Rutherford: Brian, to your revenue numbers, Valesco revenue is just under $400 million year-to-date, about $380 million on a year-to-date basis.
Operator: Our next question comes from Stephen Baxter with Wells Fargo. Your line is open.
Stephen Baxter : Yes, hi thanks. I appreciate all the commentary on the professional fees and the growth slowing in the third quarter. So it does still seem like a pretty challenging environment out there for those firms. And as we do some checks, hearing and anesthesia in particular remains a pressure point. Is this something that you think you can manage closer to flat going forward or is this just becoming part of the new norm around something that you’ll need to offset as you think about the puts and takes for 2024? Thank you.
