Categories Earnings Call Transcripts, Health Care

Quest Diagnostics Inc. (DGX) Q2 2022 Earnings Call Transcript

DGX Earnings Call - Final Transcript

Quest Diagnostics Inc.  (NYSE: DGX) Q2 2022 earnings call dated Jul. 21, 2022

Corporate Participants:

Shawn Bevec — Vice President of Investor Relations

Stephen H. Rusckowski — Chairman, CEO, President

James E. Davis — CEO-elect

Sam Samad — Executive Vice President, Incoming Chief Financial Officer

Mark Guinan — Executive Vice President, Chief Financial Officer

Analysts:

Brian Tanquilut — Jefferies & Co. — Analyst

A.J. Rice — Credit Suisse — Analyst

Jack Meehan — Nephron Research LLC. — Analyst

Patrick Donnelly — Citigroup Inc. — Analyst

Pito Chickering — Deutsche Bank Magnus — Analyst

Ricky Goldwasser — Morgan Stanley — Analyst

Jon Conner — BofA Securities, Inc. — Analyst

Madeline Mollman — William Blair & Company, LLC. — Analyst

Rachel Vatnsdal — J.P. Morgan — Analyst

Presentation:

Operator

Good morning. Welcome to the Quest Diagnostics Second Quarter 2022 Conference Call. As a request to 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 we’ll provide non-GAAP measures. We provided 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 financial condition will be primarily driven by the pandemic severity and duration, healthcare insurer government and client payer reimbursement for COVID-19 molecular tests.

The pandemics impact on the U.S. healthcare 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. Before 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.

Stephen H. Rusckowski — Chairman, CEO, President

Good evening, 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 and 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 DC Circuit’s recent ruling on our trade associations 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 built into Medicare cuts over 3 years with more on the way if SALSA is not passed. Our trade association is coordinating could rational meetings all with public advocacy efforts that involves collaboration with the provider and patient communities. Last week, the DC 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 is exclusion of hospital price data quote arbitrary and capricious. Importantly, this case has been rejected for procedural reasons, and this is the first opinion based on its merits. Unfortunately, the quarter 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.

James E. 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 five plus 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. So, Sam. Welcome to Quest Diagnostics.

Sam Samad — Executive Vice President, Incoming Chief Financial Officer

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. Since arriving less than two 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 the his partnership during this transition. I’m excited to be here. Jim, I’ll turn it back to you.

James E. 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, 41% from the previous quarter. In July with the spread of the BA.4 and BA.5 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 two weeks of July were positive. We believe that the COVID-19 trends since March contributed to the softness we observed in the broader health care 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 CDS 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 it’s increasing community access to testing or iCAD 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 $1.5 billion and $1.30 billion.

Now turning to our base business, in the second quarter, we continue to make progress executing our two 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 are 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. Our health clients continue to see the value of working with us over the last two 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 United Healthcare’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. Earlier this month, the CMS transparency and coverage final rules became effective to help consumers know the cost of a covered item or service before receiving care. Beginning July 1st, 2022 group health plans and issuers of group or individual health insurance are required to post pricing information for covered items and services, we are leveraging that data to ensure patients and employers are aware of the value we offer.

This trend will continue to gather momentum as more pricing transparency requirements will go into effect in the next two years, we believe that pricing transparency favors Quest Diagnostics which powers Affordable Care. We do this by offering clinical innovation enabling better clinical outcomes through our quality speed and accuracy of test results, improving the patient experience with accessible and easy-to-use patient resources, and finally, reducing the cost of care. We continue to ramp our investments in advanced diagnostics capabilities.

In the quarter, we saw growth from hematology, prenatal genetics, and pharma services. We also introduced Quest AD-Detect, a blood test to aid in the early assessment of Alzheimer’s disease. We are seeing good early adoption from both primary care physicians and neurologists. Finally last week, we launched a lab developed molecular tests to aid in the detection of monkeypox. The test can differentiate monkeypox from other orthopoxviruses and we will be able to perform nearly 30,000 tests a week by the end of July.

In addition, we can expand testing to other laboratories in our network to further increase capacity, if needed. We continue to see growth in direct-to-consumer testing, thanks to our COVID-19 offerings and more importantly, our base business testing. Within the base business testing category, we saw strong growth from testosterone, comprehensive metabolic panels, and Lyme disease. We’re excited about the upcoming improved digital experience, which we expect to debut later this year.

We believe this improved experience will help us acquire, convert, and retain more customers who visited QuestDirect digital platform. We expect to have much more to say about our improved digital experience before the end of this year. The second part of our two-point strategy is to drive operational excellence. We remain focused on improving our operational quality, service, and cost, thereby driving productivity gains. We have several initiatives underway to make this happen. Focused on attracting and retaining our people, optimizing our network, automating and digitizing our processes, and getting paid for the work we do.

Here are three examples, one, we’re partnering with universities to help build our pipeline of expertise in medical technology, cytology, and histology, we’re also teaming up with the learning and development recruiting company to provide phlebotomy certifications to pre-screen the candidates in exchange for a two-year commitment to work at Quest. Two, our scheduled check-in initiative, which encourages patients to make appointments has now expanded to a 1,000 of our patient service sites, in one area which is implemented the program, we are seeing a 20% decrease in average wait times as well as an improvement in patient satisfaction.

We’re also building the payment process into the digital customer experience, which frees up our phlebotomists to focus on specimen collection, thereby increasing their capacity and improving the patient-employee experience. Three, we continue to implement digital technology to provide end-to-end specimen tracking including the arrival patterns that enabled load leveling across the network, which improves our productivity and provides greater transparency for our clients. We’re not immune to the current inflationary environment and are managing through rise in fuel and labor costs. Like many companies, higher than normal.

Employee turnover in some job categories is impacting our ability to drive further productivity gains. However, these increased costs are in line with our expectations and are built into our guidance. We are expecting another year of solid Invigorate savings and productivity improvements to help offset these pressures. Finally, I’m very proud of our recently released 2021 Corporate Responsibility Report and invite you all to download it. You can find it on our website. Among the highlights, in 2021, we launched our first formal materiality assessment to help identify the most significant ESG topics to the company and our stakeholders.

Also, to enhance the level of our ESG disclosures we began reporting in accordance with the SASB guidelines. But we’re very proud of the contributions Quest is making to empower better health and grateful to our 50,000 colleagues who are making that vision a reality every day. Now Mark will provide more details on our performance and share more insights on our updated guidance for the remainder of 2022.

Mark Guinan — Executive Vice President, Chief Financial Officer

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 value. 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 experience some softening in 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 test 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 rep 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, higher portion of COVID-19 molecular testing volume from non-traditional 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 a third 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 a 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 reach 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 cost 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 this 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 the state of IT costs are temporary, but variable marketing costs will increase following the launch of the new site. We’re 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.

Stephen H. Rusckowski — Chairman, CEO, President

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 two and a half years of the pandemic. I would miss your partnership in console as we navigated many challenges over nearly a decade and wish you and your family, health and happiness as you approach to the next chapter in your life. Thanks.

Mark Guinan — Executive Vice President, Chief Financial Officer

Thanks, Steve, Quest is a special place, and it has been an honor to serve as CFO for the last nine 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.

Stephen H. Rusckowski — Chairman, CEO, President

Thanks, Mark. And to summarize, as Jim shared, we had another good quarter driven by our efforts to increase 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, hence, fully support the passage of this important legislation. Now, we’d be happy to take any of your questions, operator.

Questions and Answers:

Operator

Thank you. We will now open it up to questions. As the request of the company.

[Operator Instructions]

Our first question comes from Brian Tanquilut with Jefferies. Your line is open.

Brian Tanquilut — Jefferies & Co. — Analyst

Hey, good morning guys.

Stephen H. Rusckowski — Chairman, CEO, President

Hey there.

Brian Tanquilut — Jefferies & Co. — 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, we called out some of the softness, right. I mean, do you guys think that it’s more COVID driven with the current many 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? Thanks.

Stephen H. Rusckowski — Chairman, CEO, President

Yeah, sure. So. Thanks, Brian, for the question. So, as we indicated, we were a little softer in the second quarter where the base business than what we expected in the second quarter and we do believe there is a relationship as we have said before between pick up 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 slow down, if at all. And the second part of your question is longer term with worries about a potential slowdown in our economy and are approaching recession, what’s our view on that and we’re taking a hard look at what happened over the last 10 to 15 years of our business and things did change quite a bit over the last decade. As you know, the first or the last recession, the big Great Recession in 2008, we have in parallel with that the Affordable Care Act.

We also had changes with health care policy and we had PAMA, so there’s a lot of other effects and so, yes, we do believe there may be some impact in our business related to a slowdown in the economy in the recession, we do believe that we’re so essential to the delivery of healthcare and the need for health care going forward that we believe that’s the thing utilization will continue to be reasonable throughout any up and down in the economic cycle. So, but we’re taking a look at it and we’re seeing if there is any differences this time around. As you know, maybe but we’re saying this is of the 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 like to add to what we see with our base business?

James E. Davis — CEO-elect

Yeah and Steve, what I would add is, look, we’re in close touch with the payers and the payers have indicated to us and 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 called our same-store sales analysis and we noticed in the quarter that it was basically flat. Those accounts that are 100% loyal. So, the other thing we look at is just the mix of our business and we know, just 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. So, we — based on all that information, we come to the conclusion that the base was certainly softer this quarter.

Brian Tanquilut — Jefferies & Co. — Analyst

Thank you.

Operator

Thank you for your question. Our next question is from A.J. Rice with Credit Suisse. Your line is open.

Stephen H. Rusckowski — Chairman, CEO, President

Hey A.J.

A.J. Rice — Credit Suisse — Analyst

Good morning. Also, my congratulations to Mark and best wishes and welcome aboard Sam, looking forward to working with you. Maybe I’ll just pivot over — talk about margins. Obviously, within the base business, you’ve called out some inflationary pressures, it 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 that as long as the PHE is in place that margin is stable, but is there been any reason to think that, that is changed, or give the aggregate margin, but I wonder about the underlying trends there if you could just comment on it. How much that factored into your back-half guidance outlook as well, any changes?

Mark Guinan — Executive Vice President, Chief Financial Officer

Thanks. Thank you 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 as larger mix shift towards the retail outlets, which have higher expanses and then we have had some slight erosion versus last year on an 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 pulling. We would expect to continue with the current mix or potentially grow that as a proportion of our total COVID volumes. So within the range, is that kind of how we’re seeing the balance of the year play out on COVID. So, with the positivity rate drops down and the positive I’m looking at Jim here has been as high as we’ve seen through the pandemic. Now, a lot more people are doing rapid antigen testing.

So, and we believe that the cases are under-reported. But we believe that the prevalence of COVID right now is extremely high and so in the earlier answer that we provided to Brian around the base business, there has been a historical negative correlation between those and we do believe that the base business has absolutely 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 with benefits assumption that was in our guidance and 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.

And so we’re really not exposed to 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 in everybody’s familiar with and you’ve heard from other companies as well, things like fuel, things like housekeeping, security, a temporary labor, and so 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 unlike where if you have wage inflation you generally expect that will continue. If you contractual inflation with your key suppliers around reagents and other things that might be a longer-term as well or is certainly a couple of years. We don’t know how long this spike is going to last. But I can tell you it’s probably like $0.05 to $0.08 a quarter in the first half and we’re not expecting that to change. We’d hope it might, but in the guidance that we provided. So hopefully that’s helpful for you A.J. And A.J, so it’s clear, you all know that the Emergency Act has been extended. And so we’re assuming in our guidance. So it will be extended through October, but we’re not assuming in our guidance that extends past October until we have certainty around that. Okay, so, so that is the assumption and what we’ve just provided for guidance for the remainder of — the remainder of the year. But I think since you asked A.J., Jim won’t you comment a little bit about the opportunities we still see around the big array and you mentioned in our opening remarks about the things we have changed but won’t you chat a little bit about why we’re still bullish on the prospects for improving productivity.

James E. Davis — CEO-elect

Yeah, 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 procedure. 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 — and if the wait room is full you schedule an appointment at that point.

And what we’ve seen is it really does help 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 two hours or the next day, we feel like the patient retention is better. But automation, the use of artificial intelligence in terms of readouts of manual curves and laboratories, all of that work continues and then I’d say the other thing that will help continue to drive productivity is our work around retention of our employees. So our productivity like all companies, we are seeing a much higher increase into turnover. We feel like it is stabilized, albeit at a higher point. So as we now drive retention higher and turnover lower that will certainly help our productivity efforts in the back half of the year.

Mark Guinan — Executive Vice President, Chief Financial Officer

And I just want to add one thing about PCR in the back half. Steve talked about the potential for PHE will 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. First off, there’s not absolute certainty. But most people would expect the positivity rate will be significantly lower.

We can pull a lot more, so we can get some margin offset there dollar-wise, and then the second one is that the retail relationships that we have will change in the structure. We know how that’s going to work. And basically, the significant cost we’re incurring right now to get that volume for the retail outlets will go away because it’s only permitted under the PHE if 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 the margin hit because there’s some other costs that go away.

So we still make a decent percentage margin certainly fewer dollars per patient encounter. But I just want to make sure people are clear that COVID profitability doesn’t fall completely off a cliff when the PHE goes away.

A.J. Rice — Credit Suisse — Analyst

Okay, great.

Operator

Thank you for your question. Our next question is from Jack Meehan with Nephron Research. Your line is open sir.

Stephen H. Rusckowski — Chairman, CEO, President

Hey, Jack. Good morning.

Mark Guinan — Executive Vice President, Chief Financial Officer

Hey, Jack.

Jack Meehan — Nephron Research LLC. — Analyst

Good morning. First, Sam. Congrats. I think you’re going to be great for the Quest and Mark, of course, really enjoyed working together. But before you go. I do have more margin questions for you here.

Mark Guinan — Executive Vice President, Chief Financial Officer

Let me go now.

Sam Samad — Executive Vice President, Incoming Chief Financial Officer

Expect the Otherwise, Jack. Thanks.

Jack Meehan — Nephron Research LLC. — Analyst

Of course. So 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 just talked about.

Mark Guinan — Executive Vice President, Chief Financial Officer

Yeah. So Jack as you know we don’t provide specific margins on sub-segments of our business. So what I can give you directionally is I referred to half of our volume coming from retail channels or non-traditional channels and we’ve talked about one dollar-wise what the incremental cost per account is there. A year ago. In the second quarter, it was about a third of our volume.

So you can see that’s pretty significant. A year — in the second quarter last year we did quite a bit of pooling and that’s buried in the interim quarters between that and now, but there was quite a bit of pulling last year because the positivity rate had fallen to I think many of us by June of last year we’re thinking this might have been behind us before Delta had us and this quarter we expected in our plans to do quite a bit of pulling but in reality, it was not, it was not a large amount. So that to give you a little bit of idea.

The other thing I did mention a couple of dollars erosion on the average reimbursement. So I think you got all the pieces, you know, I can provide a specific number, but that should help you understand, but I think the key thing is that the dollars we earned off COVID was much better than our plans, and that’s, and we expect it to continue and that’s why we’re raising guidance. So while the percentage was worst $1 bottom line was better.

Stephen H. Rusckowski — Chairman, CEO, President

Yeah, Jack and as you know in Q1 we did about $600 million worth of COVID and in the second quarter that we’re talking about right now. It was roughly $350 million. So there was a material change in COVID and as Mark has gone through, there’s a lot more dynamics and what the margin is in COVID but essentially that sequential compare in our margin drop is primarily related to the drop in COVID testing.

Jack Meehan — Nephron Research LLC. — Analyst

Got it. If I can squeeze in one more on the core business, what are your expectations for merit increases and SWNB this year, if that changed at all?

Stephen H. Rusckowski — Chairman, CEO, President

Jim, you want to take that?

James E. Davis — CEO-elect

No, it hasn’t changed at all, Jack. We said 3.4% 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 timeframe. So it’s already in the Q2 numbers for sure.

Mark Guinan — Executive Vice President, Chief Financial Officer

So, yeah, as Jim referenced the vast majority of our increase has already taken place. Sort of like all other companies. We have some off-cycle adjustments based on promotions and other things, but you know most of the quote inflationary headwinds and SWB were caught in the second quarter. So if you look sequentially, that’s one of the drivers of margin reduction. First quarter, second quarter that’s been a historical event as well. That’s not new but we don’t anticipate going forward to see significant inflation beyond, kind of the run rate, we were on in Q2.

Stephen H. Rusckowski — Chairman, CEO, President

Jim and I actually — in couple of financial conferences tried to dimensionalize what’s going on with our wage bill and we talked about of the 50,000 people that the most pressure we see is what are really our real front-line people and they’re primarily what we call specimen processors when the specimen has come into our laboratories, they do the sorting. It’s a tough job, but it’s at night and we’re then we think fairly and we’ve increased that for those — their hourly wages. And the second is careers and to give you an idea, because it is the area that we have the most pressure. Roughly, it’s about 10% to 11% of our workforce salary, okay. 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 have the most pressure so even at that number went up considerably you give an idea of the impact that would have on our margins. So that’s where we see the most pressure.

Jack Meehan — Nephron Research LLC. — Analyst

Okay, thank you.

Operator

Thank you for your question. Our next question is from Patrick Donnelly with Citi. Your line is open.

Patrick Donnelly — Citigroup Inc. — Analyst

Great, thanks for taking the questions guys.

Stephen H. Rusckowski — Chairman, CEO, President

Good morning, Patrick.

Patrick Donnelly — Citigroup Inc. — Analyst

Sam, I’m 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’s a lot of question. As you’ve seen this call already in terms of the margin and the margin profile going into kind of next year as we work our way through kind of the hike, high margin COVID coming out in some of the expenses around DTC and retail, the wage inflation. I guess when you came in and Mark, feel free to chime in obviously.

But, Sam, Just how did you get comfortable with that. It would just be helpful maybe to hear your perspective on that is I’m sure it was a key consideration of then you dug into on your way in and I know investors are hyper-focused on that piece as well. So if you’re willing would love to hear your general thoughts on kind of how we work our way through the margin side as we kind of work our way into next year.

Sam Samad — Executive Vice President, Incoming Chief Financial Officer

Yeah, Patrick. Thanks for the warm 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 and 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 so far really impressed with the passion that I’ve seen people here the knowledge and the contributions that I think we can make in healthcare. So I’m going to punt a little bit on your question because it’s really early days and really ask Mark to more comment on it, but I’m very excited about how we can work through these challenges. But it’s, it’s really early days. Patrick, I’m in my second week here, so I’ll let maybe Mark talk about it more.

Mark Guinan — Executive Vice President, Chief Financial Officer

Yeah. So, Patrick, good, I appreciate the question. We know where people’s heads are at right now around the business and that’s what drives our as well. So I can assure you, we’re spending a lot of time on that. We’ve spent a lot of time on that. There is a number of things that we generally control and then there are some things that are a little bit less in our control. So we do our best to forecast those things we put together ranges, and then we are, I think we believe we’re very transparent with you about how those things play out.

So you get a sense of, okay, well, what really is going on the business? And because of that I believe that generally, we’ve not surprised people when we’ve given you, 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, and that with my departure that we’re not going to change the way we talk to you, the way we share with you, give all those updates. I think everybody appreciates what a great job Shawn does and now they can call him any time, any place, and get them and he’ll be as transparent as possible.

So really I think what it comes down to is we — I believe we’re focused on the right things. And also I believe we do our best job of being as transparent as possible around all those key drivers.

Patrick Donnelly — Citigroup Inc. — Analyst

Yeah. That’s helpful. I appreciate it guys. And Steve, maybe a quick one, you’ve continue to talk about more constructive conversations with some of the cover — covering lives and payers, can you just talk about, I guess the, the kind of outlook on pricing, I mean, it seems as confident as you guys have sounded on that front since in years. So maybe just talk about how you’re feeling on the pricing side, given some of those payer conversations.

Stephen H. Rusckowski — Chairman, CEO, President

Yeah. So thanks for the question. And we are, we are very pleased with the progress we’ve made with all payers and where we are today versus when I started, which is over 10 years ago. We’ve got a network now, that is the strongest network that we’ve ever had.

And I would say our relationship with all the significant payers national and regional is very strong and they are increasingly realizing that it’s good for their membership and good for their competitiveness in the market to have us in network and we bring a lot of value, and so we’re entirely focused on what we call powered Affordable Care, which is consistent with what Jim has driven in the company around making sure that we have great quality great service and a great experience And we heard earlier from Jim as we continue to push on just working smarter and by working smarter, we’re getting more productivity, but we’re also going up a better product and payers understand that.

And so, as Jim mentioned, we have gotten some increases from the payers over the last several negotiation rounds. We continue to believe that is something we’re continuing to push forward because we do bring a lot of value in the marketplace and we’re very competitive in the marketplace. And so if you look at the price effect that we saw in the quarter and what we have typically said in the past, historically. Remember, historically we said you should plan about 100 basis points was the price effect. Well, in this quarter and the last quarter, we’ve actually saw less than that, and that’s the best position we bet in and I will share within that envelope.

The commercial payer portion of it is significantly less than where we’ve been historically, but we still see pressure with price with our hospital business with our client billed business and that’s in that I’ve brought as well. But on the commercial payer side, we’re in a very different place than we were before and I’ll share with you the part of Jim and I is — my transition is Jim and I are going into the nationals on the regional payers and we’re talking about what we’ve done in the past and more importantly, what we’re doing in the future. We just had a meeting last week with one of the national payers and they see us as a much more significant player in the marketplace than what people think about it as far as, which is a laboratory.

We’re much more of the lab. We actually help them improve the value of health care going forward. So much better place than where we were in a good place right now.

James E. Davis — CEO-elect

And so what I will add is that we’ve 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 as Steve referenced the hospital and then some cases where we contract directly with physicians but instead of being a headwind on price. I will tell you that, starting next year and going forward, I would expect commercial to be at least neutral, not a tailwind. So we moved it from a major headwind to be a net these at least neutral and more likely positive.

So I wanted to dimensionalize a little more why you’re hearing the positive common sourse and it’s in really recognition of what Steve said, which is our strategic value to them. Not a commoditized provider of a laboratory result there is so much more to how we’re helping them and then these value-based contracts that we referenced were based on performance. We can earn a better payment for ourselves and so because of that we’ve really, really move the environment and the relationships with the commercial payers.

Patrick Donnelly — Citigroup Inc. — Analyst

Great, thank you guys.

Operator

Thank you so much for your question. Our next question is from Pito Chickering with Deutsche Bank. Your line is open.

Pito Chickering — Deutsche Bank Magnus — Analyst

Hey, good morning guys. Thanks for taking my questions. Mark it’s been a pleasure working with you over these years and Sam, I look forward to working with you in the future. A quick two part on the inflation side. So the first one is a follow-up on that pricing question that you just gave. Can you quantify what the better commercial rates are for 2023 because you probably already locked this at this point versus 2022?

And then a follow-up on A.J.’s questions to make sure I understand that you were seeing an additional $0.05, $0.08 of inflationary pressures, was that more or less than we expected because gave guidance in the fourth quarter call? And then on previous calls, you talked about sort of 2023 EPS of $0.50. So we add those inflationary pressures against that $0.08, $0.50 or can you offset those with increased efficiencies, as well as these new recent covered result or retail agreements, you’ve done. Thanks so much.

Mark Guinan — Executive Vice President, Chief Financial Officer

Well, thanks for all the questions, Pito. I’ll start with 2023. We’ve not locked down our plan, and even if we did, we generally don’t give specific guidance until our fourth quarter earnings call. And I’ll leave it to management team. I’ll be leaving exactly when they decide to do that, but you know that could accommodating specifics around 2023 in terms of the amount of the increase is, again, I’m not going dimensionalize that we don’t have a plan locked down, but we have enough contracts that are already set for next year and enough progress on some that are either, as we referenced 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, it’s not going to be a headwind next year for us on a price perspective to go.

Stephen H. Rusckowski — Chairman, CEO, President

So just to add to that. So what you’re hearing from us is yes, we hear — we hear your comments about inflation and yes, we have inflationary pressure. And 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. We need to think about that too. And thinking about the prospect of what we’re going to do in ’23. We’re not going to provide guidance, but we still feel confident what we shared at Investor Day in 2021 around the prospects of what we’re going to do going forward.

Mark Guinan — Executive Vice President, Chief Financial Officer

And yeah, so I was going to continue that what you’re hearing from us is what’s happening now Pito and the $0.05 is more in place than we would have anticipated. However, other things have changed as well. Most notably, we did a lot more COVID we delivered a lot of our earnings. So just like we don’t expect the high level of COVID and we could be wrong to expect and continue into 2023. Also, we’d be really disappointed if the inflation we’re seeing in the non-contracted areas were to carry into 2023, but even if it does, we’ve got multiple pieces that are moving, including a better pricing environment, the commercial book, so in no way, shape or form. Are we saying that when you put all these together at that $850 million or in that range is not something we’re still confident in.

Pito Chickering — Deutsche Bank Magnus — Analyst

Thanks so much.

Mark Guinan — Executive Vice President, Chief Financial Officer

Yeah.

Operator

Thank you for your question. Our next question is from Ricky Goldwasser with Morgan Stanley, your line is open.

Ricky Goldwasser — Morgan Stanley — Analyst

Yeah, hi, good morning. And Mark wishing you best of luck in the future and really enjoyed working with you. So thank you for all the, all the color as always, and your patience. In terms of the question, I just want to go back to the utilization environment. I mean you gave some color there. But what we’re hearing from the managed care companies is the softness that they’re seeing is in AR visits and in in-patient admissions, which didn’t really have an impact on lab testing right, it’s more outside the four walls of hospitals. So can you maybe give us some color on where are you seeing softness in utilization by geography enabled by end market in what type of test and how do you think about it led sort of 2.5 years into the pandemic, what’s structural in the soft — in the softer utilization versus transition in your view.

Mark Guinan — Executive Vice President, Chief Financial Officer

If I can just start quickly and then I’ll pass it on to Jim. So, Ricky, our source is not in their medical loss ratios, but I would point to two things. In addition to what Jim talked about earlier, which is our same-store sales as we call it. So, one is we actually get data from the payers. Okay. In total, so 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. So it’s payer data that’s being provided by them to us that is the basis for our confidence to say and utilization has dipped in our space. The other one is I’d point to the Zeiss’ data, which is based on billings of other independent labs and if you look at that, that certainly suggests that utilization is down. So while you may be hearing it’s emergency room and in-patient, the data that we have in the best data we have also suggests that the market in which we operate, is also depressed in the second quarter.

Stephen H. Rusckowski — Chairman, CEO, President

And the second part is, remember COVID and we’re two years into it. And every time COVID infections go up our base business comes down some. And if you think about the physician and what they need to do to run their offices and as you know, a large portion of our business is through physicians and their offices. If there is call-outs of their staff or if their patients are missing their appointments because they are now infected it affects volumes. So there is no question there is a correlation. And the good news for us is when that happens, our COVID business goes up, right. So, Jim you should…

James E. Davis — CEO-elect

Yeah, Ricky. And the last thing I’d say is, we’re not immune to a hospital the in-patient work. Remember, we get $1 billion a year and reference work. We have another $0.5 billion and PLS. So when in-patient and out-patient procedures are down. That certainly does affect our business on the health system hospital side. On the physician office side, again, we closely look at a set of accounts across — spread across the country that we know are 100% loyal to Quest and we measure that we call it same-store sales. Again, our general health and wellness panels from a mix standpoint, we’re certainly lower than some of our chronic disease panels in the quarter. And then the last thing in geographic mix, we’ve talked, and it hasn’t changed dramatically, that our book of business in New York City is down still low to mid-double digits. On the other hand, we see incredibly strong growth in the southern part of the country in the southeast portion as well as the Southwest and parts of the West. So if there’s been any population migration out of New York City into the Southeast, then we’re certainly seeing some of that in our business.

Shawn Bevec — Vice President of Investor Relations

Operator, next question.

Operator

Thank you. Our next question is from Derik de Bruin with Bank of America. Your line is open.

Stephen H. Rusckowski — Chairman, CEO, President

Hey, Derrick.

Mark Guinan — Executive Vice President, Chief Financial Officer

Hey, Derrick

Jon Conner — BofA Securities, Inc. — Analyst

Good morning, this is Jon on for Derrick. And thanks for all the colors and thanks for taking out the initiatives because we knew we were going to ask, but 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.

Mark Guinan — Executive Vice President, Chief Financial Officer

Yeah, so in terms of 2023, as Mark said, there is a lot of moving parts at this point, we’re committed to investments in advanced diagnostics. We’re committed to investments in our consumer-direct, 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 committed to our clinical and for our consumer-direct, consumer-initiated testing business.

Stephen H. Rusckowski — Chairman, CEO, President

Yeah. So in terms of, so, just to add to that because we’ve commented on this before and support and you think about this as you think about ’23. We started to make investments in 2020 to accelerate growth beyond what we read that are reinvested into accelerate growth. So I think about ’20 and ’21 and now we’re into ’22 and we obviously would not make investments unless we thought there would be a return and so 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 a growing in the past and as you think about ’23, you should think about the improvements you’re going to see in those two businesses in relationship with them in what we invested. And so therefore you should not think about this as headwinds as we really think about it as tailwinds because we will get a return on those investments we made over the last several years. Jim?

James E. Davis — CEO-elect

Yeah, you asked about PAMA and we’ve said that it’s in our 2023 guidance outlook that we provided. At this point and we’ve said, it’s about a $90 million headwind.

Mark Guinan — Executive Vice President, Chief Financial Officer

So only thing I would add is that to Steve’s point when you ask investments ramping down, I think it there’s two ways to think of investments. One is, what’s the P&L net impact and, one, is the level of spend. But, so we have Investor Day talked about growing our direct consumer business to $0.5 billion by 2025. That is still our intention. So as you can imagine over the next several years, including 2023 we’re expecting significant revenue growth and in order to drive that revenue growth, we need to spend more. However, the good news is that a lot of 2020 and 2021 was pre-revenue, pre-contribution margin. And as we go ahead, we would expect the net impact to actually be less and to be less of a headwind, so really we’re going to be investing less on the bottom line, but spending more money to drive that accelerated growth and then obviously when we get to the scale and size that we’re at this point of aspiring to. Then, we expect a healthy margin on that business.

Jon Conner — BofA Securities, Inc. — Analyst

Thanks that makes sense. Thank you.

Operator

Thank you for your question. Our next question is from Matt Larew with William Blair. Your line is open.

Stephen H. Rusckowski — Chairman, CEO, President

Hey, Matt.

Madeline Mollman — William Blair & Company, LLC. — Analyst

Hi, this is actually Madeline Mollman 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 were ahead of schedule for your anticipated 8% growth is that still the case?

Mark Guinan — Executive Vice President, Chief Financial Officer

Sure. So let me take part of it, and I’m sure either Steve or Jim will jump in. So first off inflation really hasn’t impacted the level of investment in any material way and we are on track to spend about what we told you previously as I referenced a minute ago, we haven’t put our final plans together but at this point, I would expect, we’re going to spend more next year and we’re going to spend more in marketing, but we’re going to spend a lot less. It’s not much at all in the IT platform creation. So it’s really going to be tied a very high variable cost and highly tied to revenue growth and we’ll monitor as Jim says and I’m sure, Sam, and Jim will be all over this to make sure we’re making the progress and to make sure we don’t get spending ahead of ourselves. But if we do what we expect to do and we need to do to get $0.5 billion by 2025 the spending will continue to go up.

The only other dimension, I want to mention here is, because when we talk about investments in the base business, it’s a little nuance here advanced diagnostics absolutely is the base business, but really this consumer business is new. So while a lot of the work we do is similar to what we’ve done historically in our base business, it’s really a new business category or opportunity and some of it may cannibalize what would have otherwise come through our traditional channels, but we do believe that a lot of it is actually incremental to the overall amount of volume that we perform Jim or Steve, you want to?

Stephen H. Rusckowski — Chairman, CEO, President

Yeah so as you know, we don’t generally give you numbers every quarter about different segments of our business. In advanced diagnostics, we can kind of gave you an annual update and we’ll do that again. But we keep on indicated that we believe we are making progress of getting to a higher level of growth. As we indicated in our Investor Day in ’21. We feel good about the progress and we gave you a number in the beginning of the year. And the same is true about our consumer-initiated testing. We periodically, give you an update to show that we’re making progress. So we’re feeling good about the investments made the returns will get. And again, if you see more returns in our ’23 guidance or the expectations around that, because we believe they still remain to be good opportunities.

James E. Davis — CEO-elect

And just to clarify the target that we outlined at the Investor Day for the direct-to-consumer business was $250 million by 2025.

Stephen H. Rusckowski — Chairman, CEO, President

My apologies, Jim.

Madeline Mollman — William Blair & Company, LLC. — Analyst

Great, thank you so much.

Operator

Thank you for your question. Our last question will come from Rachel Vatnsdal with JP Morgan. Your line is open.

Rachel Vatnsdal — J.P. Morgan — Analyst

Thanks. Hi, thanks for taking the questions. So can you spend a minute talking about the monkeypox market you flagged in your prepared remarks the Quest was one of the five labs that was selected by the CDC to expand testing capacity and you guys are going to have roughly 30,000 I’m testing capacity for a week. So can you just walk us through the market opportunity there and then is this contemplated in the guidance at all?

Stephen H. Rusckowski — Chairman, CEO, President

Jim, Jim will handle that.

James E. Davis — CEO-elect

Yeah. So at this point it’s hard to anticipate what the market opportunity has been or will be. I can tell you 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 and we do see growth. We’ve only had the test up and running for two weeks and over that two-week period, it’s grown day by day. Right now, we’re not yet approved for New York State. We expect that to happen within the next week or two. I’m sure you’re reading that that is where the major outbreak is in New York City. So we would expect to participate in that market. But most of our volume at this point is coming actually off of the West Coast and so we’ll keep you updated on what we’re seeing.

Rachel Vatnsdal — J.P. Morgan — Analyst

Great. And then in light of the current environment. Can you just walk us through some additional color on how you’re conserving use of cash between share repurchases, dividends, and then M&A. Thanks.

Mark Guinan — Executive Vice President, Chief Financial Officer

Sure. So we’re going to continue with what we’ve done and what that is, is that between 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 and with $1.7 billion guidance and $400 million of capital. So at least $650 million between the dividend share repurchases, we really covered that. As we also shared, we rather do M&A than share repurchases.

Because we have some very rigorous financial parameters around the deals that we do. And so it’s really going to be situational quarter by quarter, it may be different. Jim referenced that we have a deep pipeline and actually also commented that we have some negotiations that are well advanced. So, I think 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 of those. But certainly, as I said I’d rather spend more on M&A, as will Steve would and you’ll hear from Sam and Jim as they take over the reins their view, but I wouldn’t expect it to materially change so really no change to what we’ve done in the past. And at this point, no specific plans for cash deployment, because we’re really, it’s really dependent on that progression of the M&A.

Stephen H. Rusckowski — Chairman, CEO, President

Okay, so thank you, everyone, and again thank you Mark for your time here at Quest, we’re going to miss you, and wish you well. So, thanks everyone for joining the call. We appreciate all your questions and support and we’ll see you in our travels. Have a good day.

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.questdxiagnostics.com, a replay of the call may be accessed online at www.questdiagnostics.com/investor or by phone at 888-566-0439, for domestic callers or 203-369-3045 for international callers. Telephone replays will be available from approximately 10:30 AM Eastern Time on July 21st, 2022 until midnight Eastern Time, August 4th, 2022. Have a great day. Goodbye.

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This transcript is produced by AlphaStreet, Inc. While we strive to produce the best transcripts, it may contain misspellings and other inaccuracies. This transcript is provided as is without express or implied warranties of any kind. As with all our articles, AlphaStreet, Inc. does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company’s SEC filings. Neither the information nor any opinion expressed in this transcript constitutes a solicitation of the purchase or sale of securities or commodities. Any opinion expressed in the transcript does not necessarily reflect the views of AlphaStreet, Inc.

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