Earnings Call Transcript - DGX Q2 2022

Operator, Operator

Good morning. Welcome to the Quest Diagnostics Second Quarter 2022 Conference Call. At the request of the company, this call is being recorded. The entire contents of the call, including the presentation and question-and-answer session that will follow, are the copyrighted property of Quest Diagnostics with all rights reserved. Any redistribution, retransmission or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited. Now I'd like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Go ahead, please.

Shawn Bevec, Vice President of Investor Relations

Thank you and good morning. I'm joined by Steve Rusckowski, our Chairman, Chief Executive Officer and President; Jim Davis, CEO elect; Mark Guinan, Chief Financial Officer; and Sam Samad, our incoming Chief Financial Officer. During this call, we may make forward-looking statements and will provide non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release. Actual results may differ materially from those projected. Risks and uncertainties, including the impact of the COVID-19 pandemic that may affect Quest Diagnostics' future results include but are not limited to, those described in our most recent annual report on Form 10-K and subsequently filed quarterly reports on Form 10-Q and current reports on Form 8-K. The company continues to believe that the impact of the COVID-19 pandemic on future operating results, cash flows and/or its financial condition will be primarily driven by the pandemic severity and duration, healthcare insurer, government, client payer reimbursement for COVID-19 molecular tests, the pandemic impact on the U.S. health care system and the U.S. economy; and the timing, scope and effectiveness of federal, state and local governmental responses to the pandemic, including the impact of vaccination efforts which are drivers beyond the company's knowledge and control. For this call, references to reported EPS refer to reported diluted EPS and references to adjusted EPS refer to adjusted diluted EPS. Any references to base business, testing revenues or volumes refer to the performance of our business excluding COVID-19 testing. Growth rates associated with our long-term outlook projections, including total revenue growth, revenue growth from acquisitions, organic revenue growth and adjusted earnings growth are compound annual growth rates. Finally, revenue growth rates from acquisitions will be measured against our base business. Now, here is Steve Rusckowski.

Steve Rusckowski, CEO

Thanks, Shawn and thanks, everyone, for joining us today. We performed well in the quarter, growing our base business year-over-year while increasing our share of COVID-19 molecular testing since March. As we have said before, we believe demand for COVID-19 molecular testing is not going away anytime soon. It will continue into 2023. Based on our overall performance in the quarter and our expectations for the remainder of 2022, we have raised our full-year guidance. We also made very good progress on our leadership transition. Jim will give you an update and take you through our second quarter highlights and then Mark will take you through our financial performance in more detail before we get into your questions. But before I turn it over to Jim, I'd like to say a few words about the saving access to Laboratory Services Act, now called Salsa, the important new federal laboratory legislation recently introduced in Congress as well as the U.S. Court of Appeals for the D.C. Circuit's recent ruling on our trade association's PAMA lawsuit. We're grateful for the efforts of Senate and House members who introduced this legislation on both sides of the aisle. In our view, Salsa could fix PAMA permanently, setting the Medicare clinical lab fee schedule back on a sustainable path. In 2014, the intent of Congress when passing PAMA was to reform the Medicare clinical lab fee schedule to a single national fee schedule based on private payer rates for the clinical laboratory services. Unfortunately, the first round of data collection failed to collect the data from large significant segments of the marketplace. The result was billions of Medicare cuts over 3 years, with more on their way if Salsa is not passed. Our trade association has coordinated Congressional Meetings along with public advocacy efforts that involve collaboration with the provider and patient communities. Last week, the D.C. Circuit Court issued a decision in the PAMA lawsuit filed in 2017 by our trade association, ACLA. In short, the court sided with ACLA and called the CMS's exclusion of hospital price data 'arbitrary and capricious.' Importantly, this case has been rejected for procedural reasons and this is the first opinion based on its merits. Unfortunately, the court is not requiring CMS to recalculate the flawed payment amounts. While disappointing, we believe this favorable ruling will give Congress additional strong grounds to finally fix PAMA's many flaws by passing Salsa. Now, I'd like to turn it over to Jim Davis.

Jim Davis, CEO Elect

Thanks, Steve. Our base business performed well despite softer utilization trends which we believe impacted us and the rest of the health care industry. I'm proud of the efforts our team has made to grow our share of COVID-19 molecular testing since the end of the first quarter. We also ramped our investments to further accelerate growth in the areas of advanced diagnostics and direct-to-consumer testing. In the quarter, we announced the selection of our next CFO, Sam Samad. Sam joins us from Illumina, where he served as Chief Financial Officer for over 5 years. As many of you know, he brings a depth of healthcare experience that will help us in many ways. Prior to Illumina, Sam held several financial and operational leadership roles at Cardinal Health and Eli Lilly and Company. Sam, welcome to Quest Diagnostics.

Sam Samad, Incoming CFO

Thanks, Jim. It's an honor to join the Quest Diagnostics team. In previous roles, I had the opportunity to observe the many contributions Quest is making to healthcare. Just arriving less than 2 weeks ago, I've been impressed by the passion and dedication of everyone that I've met so far. I'd like to thank Mark Guinan for his partnership during this transition. I'm excited to be here. Jim, I'll turn it back to you.

Jim Davis, CEO Elect

Thanks, Sam and I look forward to working very closely with you. Now, turning to our performance in the second quarter. Total revenues were $2.5 billion. Earnings per share were $1.96 on a reported basis and $2.36 on an adjusted basis. Cash provided by operations was $402 million. COVID-19 testing revenues were approximately $355 million in the second quarter, down approximately 31% from 2021 and 41% from the previous quarter. In July, with the spread of the BA4 and BA5 variants, we continue to see the demand for COVID-19 molecular testing, consistent with the volumes we reported in June. Our positivity rate has increased since March and approximately 25% of the tests we performed in the first 2 weeks of July were positive. We believe that the COVID-19 trends since March contributed to the softness we observed in the broader healthcare utilization. As you've seen, we're successfully executing a strategy to increase our share of COVID-19 molecular testing. A key element of our strategy is to increase the number of testing access points through retail relationships. In addition to our CVS and Walmart relationships, we are now also collecting specimens at Rite Aid locations and the number of access points will continue to grow. Approximately half of our COVID-19 volume in the quarter came from retail channels. Quest is proud to have been selected by the CDC to participate in its increasing community access to testing, or ICATT program for COVID-19 testing. Through this program, qualified uninsured individuals can access COVID-19 molecular diagnostic testing for zero out-of-pocket costs. In addition, we're pleased to be the provider of COVID-19 PCR testing for qualified insured and uninsured customers of Rite Aid nationwide for zero out-of-pocket expense. We now have approximately 6,000 COVID-19 patient access testing sites through retail relationships as well as our own patient service centers. Through these efforts, we estimate that we are performing approximately 8% of COVID-19 molecular testing in the U.S., up from approximately 4% in March. Finally, the public health emergency was extended into October which will help us maintain our current level of reimbursement. Based on these factors, we raised our COVID-19 revenue guidance for full year 2022 to between $1.15 billion and $1.30 billion. Now, turning to our base business. In the second quarter, we continued to make progress executing our two-point strategy to accelerate growth and drive operational excellence. Here are some highlights from the quarter. Our M&A funnel remains strong. We are in late-stage discussions with several hospital health systems on the purchase of their laboratory outreach business. This is in addition to our normal conversations we have with C-suite leaders on performing reference testing and providing professional lab services. While this pandemic paused some of these discussions, it has also created opportunities because of the financial and labor pressures that many hospital health systems are facing. We continue to accelerate growth through health plan access. Excluding COVID-19, health plan volumes and revenues grew faster than our overall base business in the quarter. Health plans continue to see the value of working with us. Over the last 2 years, we have renewed 12 national and large regional health plan contracts with price increases. We expect more renewals with price increases this year. And we're proud to be selected as one of the UnitedHealthcare's preferred lab network providers for the fourth consecutive year, providing physicians and patients with improved access, quality and value. Finally, we're pleased to share today that we have renewed our strategic relationship with Florida Blue. Florida continues to be an important large and growing state for us.

Mark Guinan, CFO

Thanks, Jim. In the second quarter, consolidated revenues were $2.45 billion, down 3.8% versus the prior year. Base business revenues grew 2.9% to $2.1 billion, while COVID-19 testing revenues declined approximately 31% to $355 million. Revenues for Diagnostic Information Services declined 3.6% compared to the prior year. The decline reflected lower revenue from COVID-19 testing services versus the second quarter of 2021, partially offset by growth in our base testing revenue. Total volume measured by the number of requisitions declined 1.4% versus the prior year. Acquisitions contributed approximately 100 basis points to total volume. Total base testing volumes increased approximately 2% versus the prior year. Excluding acquisitions, total base testing volumes grew less than 1%. As we have seen in prior COVID surges, we experienced some softening of base testing volumes beginning in April as COVID-19 cases began to rise again throughout the spring. COVID-19 testing volumes were stronger than expected during the second quarter. Together with our JV partnership, Sonora Quest, we resulted approximately 3.7 million molecular tests. Quest alone resulted roughly 3.5 million molecular tests, down approximately 1.3 million tests and 2.8 million tests versus the prior year and first quarter, respectively. Our July COVID-19 molecular volumes have been consistent with the volumes we reported in June, averaging roughly 40,000 tests per day, excluding Sonora Quest. Revenue per requisition declined 2.6% versus the prior year, driven primarily by lower COVID-19 molecular volume. Base business revenue per requisition was up modestly. As we have highlighted in recent quarters, the pricing environment has improved, with unit price reimbursement pressure of less than 50 basis points in the quarter. Reported operating income in the second quarter was $388 million, or 15.8% of revenues compared to $533 million or 20.9% of revenues last year. On an adjusted basis, operating income was $435 million or 17.7% of revenues compared to $584 million or 22.9% of revenues last year. The year-over-year decline in adjusted operating income is primarily related to lower COVID-19 testing volume, a higher portion of COVID-19 molecular testing volume from nontraditional retail channels which carry additional expenses and logistics costs, investments to accelerate growth in our base business and slightly lower average reimbursement for COVID-19 molecular tests. In the quarter, approximately half of our COVID-19 molecular volume came through our retail partners versus roughly 1/3 last year. We expect the mix of COVID-19 molecular volumes through this channel to continue to grow in the third quarter. Reported EPS was $1.96 in the quarter compared to $4.96 a year ago. Adjusted EPS was $2.36 compared to $3.18 last year. Year-to-date cash provided by operations was $882 million in 2022 versus $1.2 billion in the prior year period. Given the limited M&A activity, we repurchased $200 million in stock during the second quarter. Now, turning to our updated guidance. Revenues are now expected to be between $9.5 billion and $9.75 billion. Base business revenues are expected to be between $8.35 billion and $8.45 billion. COVID-19 testing revenues are expected to be between $1.15 billion and $1.3 billion. Reported EPS expected to be in a range of $8.24 to $8.64 and adjusted EPS to be in the range of $9.55 to $9.95. Cash provided by operations is expected to be at least $1.7 billion and capital expenditures are expected to be approximately $400 million. Before concluding, I'll touch on some assumptions embedded in our updated 2022 guidance as well as some additional considerations. Our guidance assumes COVID-19 molecular volumes to average approximately 15,000 to 25,000 tests per day for the rest of the year. As we look toward 2023, we continue to assume our COVID-19 molecular testing run rate in the second half of 2022 continues into next year. Last week, the public health emergency was again extended another 90 days through mid-October. We assume average reimbursement for COVID-19 molecular testing to hold relatively steady through this period. While the public health emergency could be renewed beyond October, additional extensions are not captured in our guidance. As Jim noted earlier, we have successfully grown our share of COVID-19 molecular testing through our retail partners which accounted for approximately 50% of our COVID-19 molecular volume in the second quarter. As these retail partnerships continue to expand, we expect the mix through this channel to continue to grow throughout the remainder of the year. We continue to incur incremental costs to serve this channel. As COVID-19 positivity rates remain in the double digits, our ability to pull specimens for COVID-19 molecular testing continues to be limited. As a reminder, we are ramping investments to accelerate growth this year. We spent approximately $70 million in the first half of the year and we expect these investments to continue to ramp in Q3 to support the launch of our new consumer site later this year. A portion of these stand-up IT costs are temporary but variable marketing costs will increase following the launch of the new site. We'll also be adding additional headcount this year to support our consumer offering as well as bioinformatics capabilities within advanced diagnostics. I will now turn it back to Steve.

Steve Rusckowski, CEO

Thanks, Mark. As many of you know, this will be Mark's last earnings call as he is retiring next week. Mark, you've been a key member of our leadership team as we have transformed Quest and accelerated its growth. I'm grateful for everything you've done for the company, especially for the last 2.5 years of the pandemic. I will miss your partnership and counsel as we navigated many challenges over nearly a decade. I wish you and your family health and happiness as you approach the next chapter in your life. Thanks.

Mark Guinan, CFO

Thanks, Steve. Quest is a special place and it has been an honor to serve as CFO for the last 9 years. Thanks to the analysts and investors on this call. I have enjoyed working with all of you. My family and I are excited for what lies ahead.

Steve Rusckowski, CEO

Thanks, Mark. To summarize, as Jim shared, we had another good quarter driven by our efforts through share of COVID-19 testing while we believe our base business performed in line with the software utilization trends we're seeing in healthcare. We have raised our full-year guidance based on our performance in the quarter and our expectations for the remainder of 2022. Finally, we're grateful for the efforts of Senate and House members who introduced the saving access to Laboratory Services Act and fully support the passage of this important legislation. Now, we'd be happy to take any of your questions. Operator?

Operator, Operator

Our first question comes from Brian Tanquilut with Jefferies.

Brian Tanquilut, Analyst

Mark, congrats on the upcoming retirement and thanks for all the help over the years. So I guess, just my question on the base business, you called out some of the softness, right? I mean do you guys think that it's more COVID driven with the current mini surge that we're seeing? Or just any color you can share with us on that? And maybe I guess, Steve, taking it a little bit further, how are you thinking about the business today as we face a recession down the road in terms of the defensiveness of the volumes and the business overall as we get past COVID?

Steve Rusckowski, CEO

Yes, sure. So thanks, Brian, for the question. So as we indicated, we were a little softer in the second quarter with the base business than what we expected. And we do believe there's a relationship, as we have said before, between the pickup in COVID infections and the amount of people that are going into their physicians and to some extent, what's happening with hospitals, even though that's a secondary slowdown, if at all. The second part of your question is longer term with worries about a potential slowdown in our economy and approaching recession. We're taking a hard look at what happened over the last 10 to 15 years of our business. Things did change quite a bit over the last decade. The last recession, the Great Recession in 2008, we had in parallel with that, the Affordable Care Act. We also had changes with healthcare policy and we had PAMA, so there's a lot of other effects. We do believe there may be some impact in our business related to a slowdown in the economy and the recession. We believe that we're essential through the delivery of healthcare and the need for healthcare going forward that we believe utilization will continue to be reasonable throughout any up and down in an economic cycle. We're taking a look at it and we're seeing if there are any differences this time around. Maybe people are saying this is an unusual set of circumstances given what's happened with healthcare and what's happened in the economy over the last 2 to 3 years. So Jim, anything you'd like to add to what we see with our base business?

Jim Davis, CEO Elect

Yes, Steve. What I would add is, look, we're in close touch with the payers. The payers have indicated to us, you saw UnitedHealthcare's announcement earlier this week, that they saw softer utilization of healthcare services as well. In addition to that, we track a group of Quest accounts that we know are 100% loyal to us. We call it our same-store sales analysis. We noticed in the quarter that it was basically flat, those accounts that are 100% loyal. The other thing we look at is just the mix business. We noticed our general health and wellness panels grew at a lower rate than some of our infectious disease, non-COVID infectious disease and chronic care types of testing that we do. Based on all that information, we come to the conclusion that the base was certainly softer this quarter.

A.J. Rice, Analyst

I want to offer my congratulations to Mark and best wishes and welcome aboard, Sam. I want to pivot to talk about margins. Within the base business, you've called out some inflationary pressures. They seem like they've been manageable. But you also talked about the Invigorate savings and they're largely offsetting it. I wonder if you could just sort of comment on how you're viewing base business margins? And then I'm assuming also on the COVID-related testing. As long as the PHE is in place, that margin is stable but has there been any reason to think that that has changed? We get the aggregate margin but I'm wondering about the underlying trends there. If you could just comment on it and how much that factored into your back half guidance outlook as well? Any changes?

Mark Guinan, CFO

Thanks, A.J., for the questions. Let me start with COVID. So as I mentioned in my prepared remarks, when you look at our COVID business, the good news was a lot more volume, a lot more revenue, a lot more dollars of operating margin. However, with that also goes less pooling, a larger mix shift towards the retail outlets which have higher expenses. We have had some slight erosion versus last year on average reimbursement a couple of dollars, not anything super significant. So the margin percentage was less but still, its contribution to the bottom line from COVID was much higher. As we look into the back half, at this point, we don't know where the positivity rates are going to go but we've not assumed a material change in the amount of pooling. We would expect to continue with the current mix or potentially grow that as a proportion of our total COVID volumes. So within the ranges, that's kind of how we're seeing the balance of the year play out on COVID. The positivity rate has been as high as we've seen through the pandemic, and a lot more people are doing rapid antigen testing and so on, we believe that the cases are underreported. But we believe that the prevalence of COVID right now is extremely high. In the earlier answer that we provided to Brian regarding the base business, there has been a historical negative correlation between those. We do believe that the base business has been impacted by the surge in COVID. We just aren't sure how long it will last. On the base business, we've shared that as we built our plan and the ranges for 2022, we built in a higher SWB, salary work benefits assumption that was in our guidance. Certainly, that's something we control and that's really within expectations. We have a couple of billion dollars that we have long-term contracts. We don't really expect inflation in a short window for that. But then we have some other costs where we don't have long-term contracts and there are things that everybody is familiar with. You've heard from other companies as well, things like fuel, housekeeping, security, and temporary labor. Those areas have been a little more inflationary than we would have anticipated going into the year. The good news is those are in our results year-to-date during our guidance. We're not expecting that to go away immediately. We certainly hope it's not long-term inflation. If you have wage inflation, you generally expect it to continue. If you add contractual inflation with your key suppliers around reagents and other things that may be longer-term as well or certainly a couple of years, we don't know how long this spike is going to last. But the incremental inflation we expect is probably around $0.05 to $0.08 a quarter in the first half and we're not expecting that to change. We hope it might but that's built into our guidance. Hopefully, that's helpful, A.J.

Steve Rusckowski, CEO

And A.J., just so it's clear. You all know that the Emergency Act has been extended and so we're assuming in our guidance that will be extended through October but we're not assuming that it extends past October until we have certainty around that, okay? So that is the assumption and what we've just provided for guidance for the remainder of the year. And I think since you asked, A.J., Jim, why don't you comment a little bit about the opportunities we still see around the bigger rate and you mentioned in our opening remarks about the things we have changed. But why don't you chat a little bit about why we're still bullish on the prospects of improving productivity.

Jim Davis, CEO Elect

Yes. So A.J., as we've talked in the past, there's still certainly a lot of opportunity around automation of manual processes in the laboratory. I touched on in my comments around some of the automated check-in procedures. So we've long had appointment scheduling. What we've added recently is when a patient walks into the PSC without an appointment, you actually go to the check-in and you schedule an appointment at that point. What we've seen is it really helps productivity in the PSC, as well as if the patient leaves, they may not come back to Quest. If they make an appointment to come back in 2 hours or the next day, we feel like the patient retention is better. Automation, the use of artificial intelligence in terms of readouts of manual curves in laboratories, all of that work continues. And then I'd tell you, the other thing that will help continue to drive productivity is our work around retention of our employees. Our productivity, like all companies, we're seeing a much higher increase in turnover. We feel like it has stabilized, albeit at a higher point. So as we drive retention higher and turnover lower, that will certainly help our productivity efforts in the back half of the year.

Mark Guinan, CFO

And I just want to add one thing about peace in the back half. Steve talked about the potential for the PHE to not be extended which at this point, we're not assuming it does extend. But I want to remind people that the price drop is not a full margin drop because when we get to beyond the PHE, there's not absolute certainty, but most people would expect the positivity rate will be significantly lower. We can pool a lot more. So we can get some margin offset there dollar-wise. The second one is that the retail relationships we have will change in the structure. We know how that's going to work. And basically, the significant costs we're incurring right now to get that volume for the retail outlets will go away because it's only permitted under the PHE. It's complicated but it will go away. So while the value per requisition will drop to whatever price we end up with and people have talked about the CMS rate that was originally published and certainly, that's potential, over time, that's not all a margin hit because there are some other costs that go away. We still will make a decent percentage margin, certainly fewer dollars per patient encounter. But I just want to ensure people are clear that COVID profitability doesn't fall completely off the cliff when the PHE goes away.

Jack Meehan, Analyst

First, Sam, congrats. I think you're going to be great for Quest. And Mark, of course, really enjoyed working together. Before you go, I do have more margin questions for you here. Specifically, can you just talk about what was the COVID testing margin in the quarter? Or how did it compare to the overall margin? And I guess what I'm trying to get into is just like how much of the sequential step down in earnings might have been related to the margin impacts you've talked about?

Mark Guinan, CFO

Yes. So Jack, as you know, we don't provide specific margins on subsegments of our business. But what I can give you directionally is I referred to half of our volume coming from retail channels or nontraditional channels and we talked about dollar-wise, what the incremental cost per counter is there. A year ago, in the second quarter, it was about 1/3 of our volume. In the second quarter last year, we did quite a bit of pooling. I think many of us by June of last year were thinking this might have been behind us before Delta hit us. This quarter, we expected in our plans to do quite a bit of pooling, but in reality, it was not a large amount. The other thing I did mention was a couple of dollars erosion on average reimbursement. I think you got all the pieces, I'm not going to provide a specific number but that should help you understand. The key thing is that the dollars we earned off COVID was much better than our plans. That's why we're rising guidance. So while the percentage was worse, the dollar bottom line was better.

Steve Rusckowski, CEO

Yes, Jack. In Q1, we did about $600 million worth of COVID. In the second quarter we're discussing right now, it was roughly $350 million. That was a material change in COVID. As Mark has gone through, there are a lot more dynamics in what the margin is in COVID. Essentially, that sequential comparison and our margin drop is primarily related to the drop in COVID testing.

Jack Meehan, Analyst

If I can squeeze in one more on the core business. What are your expectations for merit increases and SW&B this year? Have that changed at all?

Steve Rusckowski, CEO

Jim, do you want to take that?

Jim Davis, CEO Elect

No, it hasn't changed at all, Jack. We said 3% to 4% for the year. We're still within that guidance. We've already provided the merit increase for the year. We do that annually in the April time frame. So it's already in the Q2 numbers for sure.

Mark Guinan, CFO

Yes. As Jim referenced, the vast majority of our increase has already taken place. Certainly, like all other companies, we have some off-cycle adjustments based on promotions and other things. But most of the 'inflationary headwinds' in SWB were incurred in the second quarter. So if you look sequentially, that's one of the drivers of margin reduction first quarter to second quarter. That's been a historical event as well.

Steve Rusckowski, CEO

Jim and I actually in a couple of financial conferences try to dimensionalize what's going on with our wage bill. We talked about 50,000 people and the most pressure we see is on the real frontline people. They're primarily what we call specimen processors. When the specimens come into our laboratories, they do the sorting, it's a tough job. It's at night and we're paying them fairly, and we've increased that for their hourly wages. The second is couriers. And that pressure is about 10% to 11% of our workforce salary. So, and at the same time, it represents a larger percentage of our workforce count of the 50,000 people. So that's where we see the most pressure.

Patrick Donnelly, Analyst

Sam, looking forward to continue to work with you and not to put you on the spot on your first call here. But I'm sure on the way in, as you know, there are a lot of questions in this call already regarding margins. How did you get comfortable with that? It would just be helpful maybe to hear your perspective on that as I'm sure it was a key consideration, something you dug into on your way in and I know investors are hyper-focused on that piece as well.

Sam Samad, Incoming CFO

Yes. Patrick, thanks for the welcome and I look forward to working with you and the rest of the folks on the call as well. Listen, it's really early days. I've been here in, I'm in my second week here. So all I can tell you is coming in, obviously, we're in a challenging environment right now. But Quest has an incredible reputation with incredible people that really provide a significant value to healthcare. So I've been impressed with the passion that I've seen, the knowledge and the contributions that I think we can make in healthcare. So I'm going to defer on your question because it's really early days. But Mark can comment on it more.

Mark Guinan, CFO

Yes. So Patrick, appreciate the question. We know where people's heads are at right now around the business and that's where ours are as well. There's a number of things that we generally control. Then there are some things that are a little bit less in our control. We do our best to forecast those things. We put together ranges. I believe we're very transparent about how those things play out. So you get a sense of, okay, well, what really is going on in the business? And because of that, I believe that, generally, we've not surprised people. We've given you delivered on your expectations. We've given you timely updates. We've given you interim information. And based on my time with Sam and I think the team here, I would expect that to continue. So you would expect that with my departure that we're not going to change the way we talk to, the way we share. I think everybody appreciates what a great job Shawn does and know they can call him any time and he'll be as transparent as possible.

Patrick Donnelly, Analyst

Yes, that's helpful. I appreciate it guys. And then Steve, maybe a quick one. You've continued to talk about more constructive conversations with some of the covering lives and payers. Can you just talk about, I guess, the kind of outlook on pricing? It seems as confident as you guys have sounded on that front in years. Maybe just talk about how you're feeling on the pricing side given some of those payer conversations?

Steve Rusckowski, CEO

Yes. So thanks for the question. And we are very pleased with the progress we have made with all payers and where we are today versus when I started which was over 10 years ago. We've got a network now that is the strongest network that we've ever had. Our relationships with all the significant payers, national and regional, are very strong. They are increasingly realizing that it's good for their membership and good for their competitiveness in the market to have us in the network. We bring a lot of value. We're entirely focused on what we call powering affordable care which is consistent with what Jim has driven around making sure we have great quality, great service and a great experience. You heard earlier from Jim. We continue to push on working smarter, getting more productivity but also a better product. Payers understand that. We have gotten increases from the payers over the last negotiation rounds. We believe that is something we're going to continue to push for.

Mark Guinan, CFO

So what I will add is that we really moved the needle on commercial. Over the last couple of years, we've talked about more pricing pressure in the client bill, which is our hospital and some cases, where we contract directly with physicians. Instead of being a headwind on price, I would expect to be at least neutral, if not a tailwind. We've moved it from being a major headwind to at least neutral and it more likely positive. It's in recognition of our strategic value to them. We're not a commoditized provider of laboratory results. There's so much more to how we're helping them and these value-based contracts we referenced, we can earn a better payment for ourselves. A much better place is where we were and we feel we're in a good position.

Pito Chickering, Analyst

Mark, it's a pleasure working with you over these years. And Sam, I look forward to working with you in the future. Quick two part on the inflation side. So the first one is a follow-up on the pricing question that you just gave. Can you quantify what the better commercial rates are for 2023 because you priority locked it in at this point versus 2022? And then a follow-up on A.J.'s question just to make sure I understand, you were seeing an additional $0.05 to $0.08 of inflationary pressures. Was that more or less than you expected when you guys gave guidance on the fourth quarter call? And then on previous calls, you talked about sort of the 2023 EPS of $8.50. Should we add those inflationary pressures against that $8.50? Or can you offset those with increased efficiency as well as the new recent COVID retail agreements you've done?

Mark Guinan, CFO

Well, thanks for all the questions, Pito. I'll start with 2023. We've not locked down our plan. And if we did, we generally don't give specific guidance until our fourth quarter earnings call. So we will not make any comments. In terms of the amount of the increases, I'm not going to dimensionalize that. We don't have a planned lockdown but we have enough contracts that are already set for next year and enough progress on some that are either, like Florida Blue or some others, that are getting close to being locked down for renewal that I have confidence to say what I said which is that this is not going to be a next year for us on a price perspective...

Steve Rusckowski, CEO

So just to add to that, so what you're hearing from us is, yes, we hear your comments about inflation. Yes, we have inflationary pressure. Yes, we're managing that. But what you're also hearing from us is we're in a better price position than we've been in. You need to think about that too in your prospect for what we're going to do in '23. We're not going to provide guidance but we still feel confident with what we shared at Investor Day in 2021 around the prospects of what we're going to do going forward.

Mark Guinan, CFO

Yes. So I was going to continue that you're hearing from us is what's happening now, Pito. The $0.05 to $0.08 is more inflation than we would have anticipated. Nonetheless, other things have changed as well. Most notably, we did a lot more COVID, so we delivered a lot more earnings. So just like we don't expect the high level of COVID and we could be wrong to expect and continue into 2023, we'd be really disappointed if the inflation we're seeing in noncontracted areas were to carry to 2023. But even if it does, we've got multiple pieces that are moving, including a better pricing environment in the commercial book. So in no way are we saying that when you put all these together, that, that $8.50 is not something we're still confident in.

Ricky Goldwasser, Analyst

Mark, wishing you the best of luck in the future and really enjoyed working with you. So thank you for all the color and your patience. In terms of the question, I just want to go back to the utilization environment. You gave some color there but what we're hearing from the managed care companies is the softness that they're seeing is ER visits and inpatient admissions which shouldn't really have an impact on lab testing, right, if it's more outside the four walls of the hospitals. Can you give us color on where you're seeing softness in utilization by geography and maybe by end market, i.e., what type of test? And how do you think about it, right, sort of 2.5 years into the pandemic? What's structural in the software utilization versus transition in your view?

Mark Guinan, CFO

If I can just start quickly and then I'll pass it on to Jim. Our source is not just seeing their medical loss ratios. But I'd point to two things in addition to what Jim talked about earlier, our same-store sales. One is we actually get data from the payers, okay, in total. We know how many patient encounters they had for laboratory work. We know what our volume was and we can see that. The good news is we continue to gain share in those commercial books. However, we continue to see their total volume has been down, certainly in the second quarter. This payer data is provided by them to us that gives us the confidence to say utilization has dipped in our space. The other one is I'd point to billing data of other independent labs. If you look at that, it suggests that utilization is down. While you may be hearing it's emergency room and inpatient, the data we have suggests that the market in which we operate is also depressed in the second quarter.

Steve Rusckowski, CEO

And the second part is, remember COVID and we're 2 years into it. Every time COVID infections go up, our base business comes down some. If you think about a physician and what they need to do to run their offices, large portions of our business are through physicians in their offices. If there's call outs of their staff or if their patients miss their appointments because they are now infected, it affects volume. So there's no question there's a correlation. And the good news for us is when that happens, our COVID business goes up.

Jim Davis, CEO Elect

Ricky, I want to emphasize that we are affected by hospitals. We receive $1 billion a year from reference work and an additional $0.5 billion from PLS. A decline in inpatient and outpatient procedures impacts our operations on the health system and hospital side. On the physician office side, we track accounts nationwide that are completely loyal to Quest, which we measure as same-store sales. Our general health and wellness panels expanded at a slower rate compared to some of our non-COVID infectious disease and chronic care testing. If there has been a shift in population from New York City to the southeast, we are definitely experiencing the effects in our business.

Derik De Bruin, Analyst

This is John on for Derik. Thanks for all the colors and for being out the initiatives for renewal you were going to ask. In addition to that and in addition to the price increases you're expecting and the plan to clamp down the employee turnover, how should we think about the incremental spend in 2023? Are you thinking about ramping these down to offset the inflationary pressure? And on PAMA, could you just remind us what your expectations are in '23, especially if nothing else happens on the legislative front?

Jim Davis, CEO Elect

Yes. In terms of 2023, as Mark said, there are a lot of moving parts at this point. We're committed to investments in advanced diagnostics. We're committed to investments in our consumer-initiated testing business. Obviously, we can modulate those things if we see inflation getting worse. But at this point, we can't give you any further guidance than what we've given you around those. We're committed to advanced diagnostics, we're committed to our clinical consumer-initiated testing business.

Steve Rusckowski, CEO

Just to add to that, because we've commented on this before, it's important to think about this as you think about '23. We started to make investments in 2020 to accelerate growth beyond what we had already invested in to accelerate growth. In terms of '20 and '21 and now we're at '22. We obviously would not make investments unless we thought there would be a return. Therefore, you have heard from us, you're seeing growth rates in advanced diagnostics that have come up. You've heard about us feeling good about our consumer-initiated testing, growing faster than we have seen growing in the past. You should think about the improvements you're going to see in those two businesses in relationship to that in what we invested.

Mark Guinan, CFO

The only thing I would add is that, to Steve's point, when you ask about our investments ramping down, I think there's two ways to think of investments. One is what's the P&L net impact and what is the level of spend. We're at Investor Day, talked about growing our direct consumer business to $0.5 billion by 2025. That is still our intention. We expect significant revenue growth. In order to drive that revenue growth, we believe we need to spend more. However, the good news is that a lot of 2020 and 2021 was pre-revenue, pre-contribution margin. As we go ahead, we would expect the net impact to actually be less and to be less of a headwind.

Madelin Malman, Analyst

This is actually Madelin Malman on for Matt Larew. Just going off of the previous question for your investments into the base business. I know previously, you've given a number around $160 million for this year. Do you anticipate it's still being about that? Has inflation driven that cost higher? Any color you have there? And then my other question, just speaking to your investments in advanced diagnostics. You mentioned that you are ahead of schedule for your anticipated 8% growth. Is that still the case?

Mark Guinan, CFO

Sure. So let me take part of it and I'm sure either Steve or Jim will jump in. First of all, inflation really hasn't impacted the level of investment in a material way. We're on track to spend about what we told you previously. I would expect we're going to spend more next year. We're going to spend more in marketing but we're going to spend a lot less and not much at all in the IT platform creation. It's really going to be tied to a very high variable cost and highly tied to revenue growth. We'll monitor, as Jim says and I'm sure Sam and Jim will as well, to make sure we're not getting ahead of ourselves. If we do what we expect to do and we need to do to get to $0.5 billion by 2025, the spending will continue to go up. The only other dimension I want to mention here is when we talk about investments in the base business, there's a nuance here. Advanced diagnostics absolutely is the base business. But this consumer business is new. A lot of our work may cannibalize what would have otherwise come through our traditional channels. We believe a lot of it is incremental to the overall amount of volume that we perform. Jim or Steve, you want to add anything?

Jim Davis, CEO Elect

Yes. As you know, we don't generally give you numbers every quarter about different segments of our business. In advanced diagnostics, we generally give you an annual update and we'll do that again. But we keep on indicating that we believe we're making progress towards getting to a higher level of growth, as we indicated in our Investor Day in '21. We feel good about the progress. You should see more returns in our '23 guidance or the expectations around that because we believe they still remain good opportunities.

Rachel Vatnsdal, Analyst

Can you spend a minute talking about the monkeypox market? You flagged in your prepared remarks that Quest was 1 of the 5 labs that was selected by the CDC to expand testing capacity and you guys are going to have roughly 30,000 testing capacity for a week. Can you walk us through the market opportunity there? And then is this contemplated in the guidance at all?

Jim Davis, CEO Elect

Yes. At this point, it's hard to anticipate what the market opportunity has been or will be. Our testing volumes at this point are modest. If we've done 500, 600 tests that would be on the high side. However, it is growing. We do see growth. We've only had the test up and running for 2 weeks. We're not approved for New York state yet. We expect that to happen within the next week or two. Most of our volume at this point is coming off of the West Coast. We'll keep you updated on what we're seeing.

Mark Guinan, CFO

Sure. We're going to continue with what we've done. That is, the dividend and we've already gotten there this year with the share repurchases to deliver a majority of our free cash flow to our shareholders. With the $1.7 billion guidance and $400 million of capital, at least $650 million between the dividend and share repurchases we already covered. We've also shared that we prefer to do M&A rather than share repurchases because we have very rigorous financial parameters for the deals we do. It’s really going to be situational quarter-by-quarter. It may be different. Jim referenced we have a deep pipeline, we have some negotiations well advanced. We'd all be very disappointed if we didn't execute some deals before the end of the year. Don't know the exact timing but I'd rather spend more on M&A.

Steve Rusckowski, CEO

Okay. So thank you, everyone. And again, thank you, Mark, for your time here at Quest. We're going to miss you and we wish you well. Thank you for joining the call. We appreciate all your questions and support. Have a good day.

Operator, Operator

Thank you for participating in the Quest Diagnostics second quarter 2022 conference call. A transcript of prepared remarks on this call will be posted later today on Quest Diagnostics' website at www.questdiagnostics.com. A replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at 888-5660439 for domestic callers or 203-3693045 for international callers. Telephone replays will be available from approximately 10:30 a.m. Eastern Time on July 21, 2022, until midnight Eastern Time, August 4, 2022. Have a great day. Goodbye.