Operator: Thank you. [Operator Instructions] Our next question comes from Sarah James of Cantor Fitzgerald. Please go ahead.
Sarah James: Thank you. I just wanted to follow up on the train of thought from that last question. So as you think about, where you’re investing to capitalize on the new regulatory environment, does that have a link to your case mix? I noticed the 40% of hiring that’s coming in, in the MSK space, is above your current case mix. So do you see evolving into that being a more dominant part of your business?
Eric Evans: Yeah, Sarah, great question. I mean, look, I think we have been talking for quite some time, that we are focused on growing in areas — first of all, higher acuity areas in our ASCs and surgical facilities. It is the highest contribution dollar per minute. And so it makes logical, since we’re focused there. We also know it’s what matters most to the health system, to payers, to CMS, the amount of savings we can drive is incredible for those procedures, often 10,000 plus a case. And that’s why, yes, absolutely, you should see that mix continue to change. Now that doesn’t take away the fact — we love our GI business. We love our Ophthalmology business. They’re great businesses. But when you think about our ASCs, think about de novos for example, almost all of them are ortho or cardio based.
So like we are very, very focused on moving where we can add the most value, and that certainly provides protection against lower acuity stuff that maybe does change spaces. And look, we don’t talk about that, but on the lower end of things, things leave our facilities, and that’s okay because it’s the right answer overall. I would like to point out, too, this is the recent CMS announcement, they added shoulders and ankles, in particular, total shoulders. We were really pleased during COVID, that we had some facilities that were accepted and able to do total shoulders. We had fantastic clinical results. We save patients a lot of money. Initially, they weren’t included coming off the inpatient-only list. We were certainly pleased to see that, and we see those kind of opportunities to continue to push higher acuity patients safely into our space with a better experience, better outcomes and really just ultimately the best answer for the healthcare system, as a tremendous opportunity.
One little set, I’d throw out to going back to the site transition, it’s still 3:1, the number of joint — total joints that are in the HOPD versus the ASC environment. So we’re in the early innings of a lot of this stuff. You will see us continue to change that mix to higher acuity over time just because that’s where [indiscernible].
Sarah James: Great. And then can you provide any color on your case mix volume by specialty this quarter?
Wayne DeVeydt: Yeah, Dave’s just looking into — yeah, Dave is looking at it now, just so we can give you the exact specifics.
Dave Doherty: And this information will be in our Q, a little bit later today, just so you have it. So the nearly 3% same-facility growth that we saw in cases this year in the quarter, is our top three are all north of — our top three kind of target areas, Ophthalmology, GI and MSK, particularly the ortho component of MSK are all north of 4% same facility growth. So those were all growing very nicely for us. It’s not going to change the overall mix of the business, but that’s where you can see that higher acuity come through in our same facility calculation. So I think it’s fair to say, much like we’ve seen all year, Sarah, that the — our growth engine is kind of running along all of our specialties. So we’re seeing kind of nice growth in every single one of those areas.
Sarah James: Thank you.
Dave Doherty: Yeah.
Operator: Our next question comes from Ann Hynes of Mizuho Securities. Please go ahead.
Ann Hynes: Hi, good morning. In the past, you have talked about your revenue algorithm as 2% to 3% case growth, 2% to 3% revenue per case growth. But I feel like that’s a little still given, especially this quarter with revenue per case of 11%. How should we think about that going forward just given the mix of higher acuities changing? That would be my first question. And my second question is just on Q4 seasonality. The EBITDA ramp going into Q4 seems like a little higher than normal. Is there anything that you would call out for Q4, that would be great. Thanks.
Wayne DeVeydt: Ann, good morning. I’ll take the first question, and then I’ll have Dave talk about seasonality. But — went blank.
Dave Doherty: The growth algorithm.
Wayne DeVeydt: Yeah. On the growth algorithm, let me remind everybody that the three components of the growth algorithm, and I’m just going to focus on the one that you’ve highlighted, which is the 2% to 3% volume then the 2% to 3% rate. And is that starting to become somewhat stale in light of what we continue to produce. I’ll start by answering this way, which is we fully expect going into next year to be north of the high end of that range, right, which is clearly 6%. We have no indication that, that should slow. So I think that’s a fair question you’re asking, and it appears that we ought to be able to outperform that on a same-store basis. We continue to target the 2% to 3% on volume because we want the team to be focused on the right procedures and the high acuity procedures.
And so if you were to look at it last year, we had a very strong year last year with 3.8% volume growth on a year-to-date basis. You look at it this year, we’re at 3.5% on top of that strong growth last year. So I still think the 2% to 3% is the right algorithm target, we would bias towards the high end of that range, if not slightly better. Clearly, where you’re going to see this differentiated approach is going to be on the 2% to 3% that we talk about revenue component. And I think a combination of the acuity mix we were going after, the combination of the new rev cycle initiatives that Dave has put forward, et cetera, yeah, we clearly will be north of that. And again, to give you an exact percentage, we don’t want to get ahead of our Board, as the team is coming forward with the final plan for next year.
But all in, we should easily exceed our 6% top line algorithm that we’ve laid out for you.
Dave Doherty: Yeah. And let me just address that seasonality question because — and maybe you can show me the numbers that you’re looking at. But if you take the midpoint of our guidance, what would imply is our fourth quarter results should come in somewhere around the low 30s, about 32% of our full year guidance at that midpoint. That’s consistent with what we have seen in the past, with the exception of the COVID year. If you go back to 2019, 2018, you go back to last year, we have a higher proportion of our business in the fourth quarter. It’s — as a CFO, that’s what makes it — I always sweat Christmas because I’m trying to see how those cases come in. But that’s all a result of our patients kind of chasing after the deductible, before it resets at the beginning of the year.
So you see a higher preponderance of commercial business and higher volume, both of those things, typically come through starting in late November and going all the way through the end of the year. And that’s just how the business kind of runs. It’s predictable enough for us to kind of put that in there. But nonetheless, it still does — it contributes to that higher average growth rate, that you see inside the fourth quarter.
Ann Hynes: All right. Great. Thank you.
Operator: [Operator Instructions] Our next question comes from Bill Sutherland of Benchmark Company. Please go ahead.
Bill Sutherland: Good morning guys. Most of mine have been asked. But hey, Eric, I’m kind of curious on the non-consolidated deals. Are you — I mean, directionally, is it moving in the same direction, as the consolidated deals in terms of the mix of specialty? And are you — and the second add-on is, are you all looking a little increasingly at multi-specialty centers, as you particularly do three-way deals?
