Welcome to the Quest Diagnostics third quarter 2020 conference call. At the request of the company, this call is being recorded. The entire contents of the call, including the presentation and question answer session that will follow, are 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 at Quest Diagnostics. Go ahead, please.
Thank you, and good morning. I'm here with Steve Rusckowski, our Chairman, Chief Executive Officer, and President, and Mark Guinan, our Chief Financial Officer. During this call, we may make forward-looking statements, and we'll discuss non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables through 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's severity and duration, the pandemic's 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, which are drivers beyond the company's knowledge and control. For this call, references to reported EPS refer to reported diluted EPS from continuing operations, and references to adjusted EPS refer to adjusted diluted EPS from continuing operations. References to base testing volumes or base business refer to testing volumes excluding COVID-19 molecular and serology testing volumes. Finally, 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. Now, here's Steve Rusckowski.
Well, thanks, Shawn, and thanks, everyone, for joining us today. Quest had a very strong third quarter benefiting from continued demand from COVID-19 testing, as well as the rapid recovery from healthcare utilization. We have performed over 22 million COVID-19 molecular and serology tests to date, more than any other provider. We've also developed and introduced several new innovations that are contributing to enabling the country's ability to return to work, the classroom, and the athletic field. I'm extremely proud of all that Quest Diagnostics has accomplished through the COVID-19 pandemic. I want to thank our 47,000 employees for their hard work and dedication. This morning, I'll discuss our performance for the quarter, our role in the COVID-19 pandemic, and update you on our non-COVID base business.
Then Mark will provide more detail on the third quarter results and our updated financial outlook for the remainder of the year. Our financial performance in the third quarter was very strong. For the quarter, total revenue grew by more than 42% to $2.79 billion. Earnings per share increased by more than 164% on a reported basis to $4.14, and nearly 145% on an adjusted basis to $4.31. These results reflect continued demand for COVID-19 testing and continued recovery in our base testing volumes as healthcare systems resume non-urgent care and elective surgeries. Organic base testing volumes orders declined high single digits in July and improved through the quarter to mid to high single digits decline in September versus the prior year. Demand for COVID-19 testing came from several areas.
Clinical testing ordered by healthcare providers as the virus spreads throughout much of the country, especially for non-COVID-19 pre-surgical patients and people in high-risk populations like nursing homes and prisons. In retail testing in our extended network access points, such as our drive-thru sites offered across the country by CVS and Walmart. Workplace testing as employers sought to return employees to the job in their offices. University testing to facilitate the return of students to campus life, including sports. Our consumer testing, direct testing offered by QuestDirect. We've also demonstrated innovation and agility in bringing COVID-19 testing to our nation. In the quarter, we were granted an Emergency Use Authorization, or EUA, to offer unobserved sample collection. We were the first provider to receive the EUA during the pandemic for specimen pooling.
Finally, we teamed up with Walmart and DroneUp to pilot a program for contactless delivery of specimen kits using drones. Also in the quarter, we announced an initiative along with our Quest Diagnostics Foundation to address and reduce healthcare disparities in underserved communities, including those impacted by COVID-19. This value-based commitment builds on our existing work with federally qualified health centers and will focus on serving people of color, elderly, and underserved populations in locations throughout the U.S. Quest plans to donate testing services and fund a range of initiatives estimated to total more than $100 million. Our goal is to improve access to testing, to drive awareness of value of diagnostic innovations in managing health.
Before updating you on our base business, what I'd like to do is comment on our recent CMS change to Medicare payment for COVID-19 testing and our decision to return the CARES Act funding to the government. In conjunction with our trade association, we've been currently reviewing how the new reimbursement policy for high-throughput COVID-19 molecular testing from CMS will impact laboratory and patients we serve. Last week's announcement removes some certainty that was an overhang on COVID-19 testing reimbursement. Finally, we're grateful for the CARES Act funding from last spring, which provided us with an important time of great uncertainty for our country. Several months into the pandemic, we no longer require this funding, and as a result, we believe returning these funds to the government now is the right thing to do. We're making progress on our strategy to accelerate growth in the base business.
As a reminder, the five elements of our strategy to accelerate are: to grow more than 2% per year through strategically aligned accretive acquisitions, expand relationships with health plans and hospital health systems, offer the broadest access to diagnostic innovation, be recognized as the consumer-friendly provider of diagnostic information services, and finally, support population health with data analytics and extended care services. I'll share a few highlights from our strategy to accelerate growth. Our M&A pipeline remains strong. Since the second quarter, we closed our acquisition of Mid-America Clinical Laboratories, or referred to as MACL, which is in Indiana, we did a couple teeny small target acquisitions. Our recent acquisitions have been performing well during the pandemic. For example, our Memorial Hermann Outreach acquisition announced earlier this year, as well as this recent MACL acquisition, have driven growth in both COVID-19 testing and our base business.
We've also seen growth in advanced diagnostics from our acquisition of Blueprint Genetics. The second growth driver, expanding relationships with health plans and hospital health systems, is also delivering. Our hospital reference testing volumes, excluding COVID-19, have returned to growth year-over-year. Given the challenges that hospitals are facing, we expect many more to be open to discussions about how Quest can help them achieve their lab strategy. In Professional Laboratory Services this year, we have logged a record amount of bookings, requisite larger and longer-term agreements than in the past. We also continue to make progress on our health plan strategy. Within the UnitedHealthcare Preferred Lab Network, we're helping United reduce out-of-PLN lab spending through the previously announced zero out-of-pocket benefit. In addition, United has added enhancements that reduce the administrative burden for ordering physicians and patients related to those tests requiring pre-authorization.
In August, we entered into a new strategic relationship with Anthem in 12 states. We're working with Anthem to improve quality and efficiency in delivery of laboratory services. Finally, additionally, we're working with major national payers to enable their members to access COVID-19 testing through Quest's relationships with major retailers. We made progress on our third element of our strategy to accelerate growth by offering the broadest access to innovation. In the quarter, we launched three new combined COVID-19 and respiratory virus tests, reducing time for physicians to diagnose and treat patients by identifying nearly 20 viral and bacterial infections from a single swab. We also launched our automated next-generation sequencing solution that enables individuals to access useful genetic testing insights about hereditary diseases at consumer price points through AncestryHealth. Finally, we grew our direct-to-consumer services in the quarter.
Quest's direct test offerings continue to resonate with consumers. In the quarter, we launched our COVID-19 active infection test, offering consumers a choice of using an at-home kit or a [de novo specimen collection done at a drive-thru location. We made remarkable progress in the surge of sign-ups to our MyQuest patient portal. Today, roughly 13 million patients have a MyQuest account to make appointments or receive their results through their smartphone or their computer. In the third quarter, on average, more than 100,000 patients per week signed up for this service. This is more than double the rate we've experienced before the pandemic. Now the second part of our two-point strategy is to drive operational excellence. We continue to pursue our goal to reduce our costs base by 3% per year.
We also see more opportunities ahead to drive further productivity gains, while at the same time enhancing our customer experience and overall service levels. Here's a couple examples. We have standardized on the Siemens immunoassay platform in 14 of our 18 regional laboratories. This solution drives workflow efficiencies and has enabled more than a 50% reduction in our equipment footprint. We are still in the early stages of this realized savings, but so far, we're pleased with its progress. Also, our new flagship laboratory in Clifton, New Jersey, is being prepared to go live in early 2021. When complete, the state-of-the-art facility will be the most highly automated in our laboratory network and will represent the final regional lab to be converted to our standard operational IT system, which we call Q Suite.
This will mark the culmination of a multi-year initiative to simplify, streamline, and standardize our regional laboratory operations. Now I'd like to turn it over to Mark to take you through results and update you on our outlook. Mark?
Thanks, Steve. In the third quarter, consolidated revenues were $2.79 billion, up roughly 43% versus the prior year. Revenues for diagnostic information services grew approximately 44% compared to the prior year, which reflected significant demand for COVID-19 testing services, offset by a modest decline in base testing volumes. Volumes measured by the number of requisitions increased 19.7% versus the prior year, with acquisitions contributing approximately 3%. We continued to experience improving performance in our base business in the third quarter. Orders for organic base testing compared to our pre-pandemic business declined high single digits in July and improved to a mid to high single-digit decline in September versus the prior year. For the entire third quarter, base testing volumes declined roughly 5% versus the prior year and benefited from recent M&A and the new PLS wins that Steve highlighted earlier.
We also experienced a significant contribution from COVID-19 testing during the third quarter, performing approximately 9.9 million molecular tests and 1.5 million serology tests. We exited the third quarter averaging approximately 93,000 COVID-19 molecular and 11,000 serology tests per day. Revenue per requisition increased 20.9% versus the prior year, driven largely by COVID-19 testing. This was partially offset by unit price headwinds of approximately 1.7% in the third quarter, in line with our prior expectations. This included the ongoing impact of PAMA. Reported operating income was $718 million, or 25.8% of revenues, compared to $313 million, or 16% of revenues last year. On an adjusted basis, operating income was $831 million, or 29.8% of revenues, compared to $349 million, or 17.9% of revenues last year.
The year-over-year increase in operating margin was driven by the strong revenue growth in the third quarter, reflecting the relatively high drop-through on incremental volume in our business. Reported EPS was $4.14 in the quarter, compared to $1.56 a year ago. Adjusted EPS was $4.31 compared to $1.76 last year. Cash provided by operations was approximately $1.46 billion year to date through September 30th, versus $895 million in the same period last year. Cash from operations through the third quarter includes approximately $138 million of provider relief funds under the CARES Act. As a result of our strong financial position, we are planning to return the entire CARES Act funding we received, which Steve noted earlier. Additionally, we are accelerating the redemption of our senior notes maturing in April of 2021. We will use the proceeds of the bond offering that we completed in May 2020 to repay these notes.
We expect to complete the early debt redemption in November. Turning to guidance, we raised our full year 2020 outlook as follows. Revenue is now expected to be between $8.8 billion and $9.1 billion, an increase of approximately 13.9%- 17.8% versus the prior year. Reported EPS expected to be in a range of $8.22- $9.22, and adjusted EPS to be in a range of $9- $10. Cash provided by operations is expected to be at least $1.75 billion, and capital expenditures are expected to be approximately $400 million. We continue to operate under the uncertainty caused by the COVID-19 pandemic. Continued recovery in the base business, as well as demand for and duration of COVID-19 molecular testing, are significant swing factors that remain challenging to forecast. With that high degree of uncertainty in mind, please consider the following.
The midpoint of our full-year outlook generally assumes base testing volumes to remain modestly below last prior year levels as we exit 2020. COVID-19 testing volumes averaging nearly 90,000 tests per day for the molecular test and 10,000 tests per day for the serology test in Q4. COVID-19 molecular reimbursement, generally stable with recent trends. Our performance through mid-October is slightly above these assumptions, but again, our guidance reflects the uncertainty of the current environment. Finally, as Steve mentioned, we are currently in the early stages of launching our recently announced initiative with the Quest Foundation to reduce health disparities in underserved communities. As we move forward, we expect to exclude the costs associated with this multi-year initiative in determining our adjusted results. While we aren't prepared to share a detailed outlook for 2021 today, I'd like to offer some considerations for next year.
We are likely to have an easy compare in our base business for much of the year, especially in Q2. Demand for COVID-19 testing is likely to persist well into 2021. We believe that molecular PCR testing will continue to play a very important role in diagnosing, tracking, and tracing active COVID-19 infections, and that there will eventually be a growing need for serology testing as vaccines and additional therapies come to the market. We are working to understand the details of the recent CMS announcement regarding COVID-19 molecular reimbursement for 2021. Finally, as a reminder, there will be no Medicare reimbursement cut under PAMA in 2021, given the one-year delay included in the CARES Act. I will now turn it back to Steve.
Well, thanks, Mark. To summarize, we had a very strong third quarter and have performed over 22 million COVID-19 molecular and serology tests to date. We've also developed and introduced a number of new innovations, allowing the country to get back to work, into the classroom, and onto the athletic fields. We've seen further signs of recovery in healthcare utilization as our base testing volume continued to recover rapidly throughout the third quarter. Finally, again, I'm extremely proud of all that Quest Diagnostics has accomplished throughout this very difficult time, and I thank all the 42,000 people at Quest Diagnostics for all their hard work and dedication. Now we'd be happy to take any of your questions. Operator?
Thank you. We will now open the floor to questions. At the request of the company, we ask that you please limit yourself to one question. If you have additional questions, we ask that you please fall back in the queue. First question is from Ann Hynes with Mizuho Securities. Your line is now open.
Hi, good morning.
Morning, Ann.
How's everything? I just wanted to touch back on your comments, Mark, about the reimbursement for next year. I know that a lot still is unknown. Just for modeling purposes, maybe can you talk about your current turnaround time, what you expect your molecular capacity to be by that time in January, and should we assume, would you need to make any more further investments to be able to get that $100 reimbursement per molecular test? My second question is just about cash flow. Obviously, it's very elevated because of all the testing. What do you expect? How do you expect to deploy that once you're able to, and maybe about timing of the cash deployment since it's very elevated. Thanks.
Yeah. Let me start with the operational piece of that, Ann. First of all, we're running about a capacity of 200,000 tests per day, even though what you heard from our guidance is we're running less than that in terms of actual results. We've done that for two reasons. One is to be prepared for the fall, where we're anticipating further demand for COVID-19 testing. Secondly is when we have more capacity and we result less, it helps us with turnaround time. I'm happy to share that right now we're averaging less than two days for testing for COVID-19. What I'll also say, as I said in my early introductory remarks, we're trying to understand the exact guidelines, and I'm sure there'll be more detail from CMS in terms of recovery. Excuse me, reimbursement changes.
When we're looking at turnaround times, we're looking at it today from specimen collection to results, and that's also by calendar day. There'll be more specificity based on this from CMS. There'll be more clarity around that. We're performing well. We've got big capacity versus our demand. We're not stopping there. We're actually increasing our capacity as we speak. We're working out some of the last capacity we can get out of some of the new systems we put in place. Secondly, is we're looking at applying pooling to some of our IVD platforms. That should get us to eventually coming out of this year at 250,000 per day versus the 200 today. We should be able to meet the demand and keep our turnaround times at the level I've already indicated. Mark?
Yeah. Just to add to that, Ann, the devil's in the details. We need to understand exactly when the clock starts on turnaround time. Based on where we think it should end up. We expect to be in very good shape around meeting the criteria. At this point, assume we have to get more than half of those tests turned around in two days or less, but obviously, we need clarification and certainty around that. That's for obviously Medicare, and we still have to work through some of the issues with the commercial payers as well to understand how it's going to work with them.
That's why we're cautious in terms of committing too much. We're optimistic. We're repaying the debt early from April that we issued as a pre-issuance in May, shows our confidence, returning $138 million, which of course is deducted from our projection when I said at least $1.75 billion. We're expecting a very strong cash year. Steve mentioned we have a very strong M&A pipeline. As I have said many times to investors, I would prefer to do M&A because when we do it, we're highly confident that that's a better return for our shareholders. We do have very strict criteria. We have to find deals that meet those criteria. I'm optimistic that we will deploy a chunk of that from M&A.
At some point, you can expect us to return to our normal capital strategy as we move forward throughout the calendar year or early next year.
Great. Thanks.
Next question is from Stephen Baxter with Wolfe Research.
Hi. Thanks for the question. I wanted to ask you about the progression of core volumes through the quarter. I believe you said August core volumes were down mid to high single digits, in today's release, I think it also has the September exit rate at about the same level down mid singles to high singles. This really seems to suggest that the baseline volume return to normal has slowed a little bit. Is that consistent with what you guys have actually experienced, and if so, what do you think needs to happen to see it improve further? If it's not, what's the nuance that I'm missing? Just to put a finer point on it, does guidance assume that you see a continued improvement from the September exit rate or basically a continuation at that level? Thank you.
Sure. Thanks for the question, Stephen. As we mentioned, volume improved from July, but really September versus August, it was fairly flat. Yes, there was a little stagnation in improvement of the base volumes, not completely surprising given the recent uptick in COVID again. It hasn't gotten worse for us, but it did not continue its improvement. That's why when I talked about what we expect in Q4, we don't expect a full recovery anytime this calendar year. Obviously we have a very broad range, $300 million. Within that range, there's multiple variables, but in terms of the base business, we're not counting on, in the middle of that, a complete recovery. We're not expecting it to move materially away from where it's been the last couple of months.
That would get you to the lower end and upper end of the range, depending on that, along, of course, with COVID testing as well, where they go from that midpoint. Not counting on anything, but certainly improvement could lead us toward that upper end, and if it eroded a little bit, it could lead us toward the lower end of our guidance.
Yeah. We're watching that carefully. If you go back and hear what I said, we started off July in high single digits, and then also as I indicated in September, it was mid to high, so slight improvement there, but we're watching it as we enter the fourth quarter and as we sit here in the fourth quarter in October.
Next question is from Ricky Goldwasser from Morgan Stanley.
Hey, Ricky.
Morning, Ricky.
Hi. Good morning. I had a question on the gross margins. You came in meaningfully higher than us. Clearly, we're seeing the benefit of the return of core volumes. Can you maybe help us quantify, of the gross margin that we saw in the quarter, what is coming from the return of core versus realized price for COVID-19 testing? We understand the reimbursement, we're hearing you talk a lot more about direct-to-consumer test.
To consumer does come with a higher price point. Certainly, there are other expenses that go with direct to consumer. We've actually invested incrementally in some marketing to drive awareness and so on. From a gross margin perspective, the consumer testing is higher than our core business. Recall, even though we feel good about that business, it's still a very small part of our overall enterprise. Between COVID and base, obviously we don't get into gross margins on specific test offerings. The one benefit I will point out on COVID is that there's no patient responsibility. When you think about it, and I don't have the precise numbers, but just let's say because of our overall enterprise, about 20% of our revenues come from patients.
If we collect, as we've shared, $0.70 on the dollar, you can imagine that there's about a 6% higher margin on that particular business because it's 100% reimbursed by payers instead of having any patient responsibility. There is some benefits in the gross margins on COVID that really is unrelated to price and really has everything to do with the coverage policies and not having that inability to collect all the money that we're due.
Great. Just one follow-up, if I may. You've given us some early puts and takes for 2021. We're starting to hear some companies that are accelerating hiring in preparation for next year. When you think about the increased need for serology associated with COVID vaccine, et cetera, should we assume a step up in costs related to increased hiring in preparation for that?
Ricky, we have managed our workforce carefully over the last six to nine months. As you recall, in the second quarter, we had to bring down our workforce. We furloughed over 6,000 people. We reduced work schedules. We cut salaries, including myself and Mark and our board. We saw the steady recovery in our H business, coupled with the COVID testing that we've done. We've restated salaries. We've brought back full work weeks, and we brought back the vast majority of the furloughed employees. Actually, we've hired people. We've hired people where we need to hire people, particularly in areas like specimen processing. You can see with the volumes we're seeing, you have to have a lot of people to receive all these specimens to sort it out before they go in the lab.
I'll tell you, we're still being very careful before we add another person. We're being very careful in overhead, and Mark can go through exactly what's in our expenses, but we've been very limited in hiring in our expense categories. We'll continue to be very critical with our hiring for our overhead within our laboratory operations and our operations in general. The reason for that is we want to make sure we don't get ahead of ourselves. We feel we got good leverage in the third quarter, as you see, and we believe we have the workforce in place to manage the demand we're getting right now. With the exception of some of the volume-based jobs, as I mentioned. As we get into deeper into the fourth quarter. Modest hiring. We're back to full workforce, and we're watching.
Don't have any proactive plans to add resources, Ricky. We're going to continue to monitor demand short window as next year at this point.
Next question.
Interesting enough, as the last point is, we still have attrition in some of our jobs. We are in some places still trying to keep up. Operator, next question.
Next question is from Ralph Giacobbe from Citi. Your line is now open.
Great, thanks. Good morning.
Good morning, Ralph.
I want to go back to the sort of reimbursement comments, and then specifically in your prepared remarks on the CMS reimbursement tweak and it removing an.
First of all, for this year, we had some uncertainty, as you know, in the third quarter about the emergency order that's in place extended to October. We were hopeful that the rate would continue at $100. It's our expectation, given that the new rate changes with the incentive that we've outlined, it goes on January. We're assuming $100 for reimbursement for the remainder of this year. Up until we heard this, there was some uncertainty about 2020. Secondly, in 2021, remember the original rate was at $51. It went up to $100. The new reimbursement that's being spoken of, again, is if you get the turnaround time for two days, you're at $100. If you don't, it's $75. That would remove some of that uncertainty of it going.
We're reverting back to where it was before we got the bump from $51- $100. Mark, you want to take it on the commercial side?
Generally, it's going to be negotiation, Ralph. We have provisions in our contracts for new tests, and certainly the high-throughput COVID-19 molecular test is one of those. There is no provision for it to fall automatically to any sort of relationship to CMS or what have you. They are. Even once they get rolled out, we see a roll. Whether it's the level of testing we're seeing today or something a little less, we expect there to be a meaningful amount of COVID testing, including the PCR testing, throughout a reasonable part of next year.
Yeah. Just to add to that, remember with the economy, we saw this back in the Great Recession, that whatever happens in the economy will affect access. Access is important to us in the insured lives. The second is consumer confidence. We know a large portion of the population is paying for upgrades out of their own pocket, and therefore, they're going to think twice of utilizing it. We are thinking about that as we think about modeling 2021. Now, with that said, if you look at it where we are with our base business versus where it was, when you think about the math in the full year, it should be an easy comparison, as Mark said in his comments about 2021.
Even if it's down versus 2019, just to look at the comparison of what the full year will be for 2020 versus 2021, given where we are right now, that makes for an easy comparison. As far as PCR, remember, we brought up our first PCR test on March 9th, and we've been ramping rapidly. We have not had a full year of PCR. We're hitting our stride. We're building capacity because we do anticipate more demand. Winter is coming, and we're all anticipating more demand as we enter the winter, clearly in the first quarter. We'll start to see, hopefully, some of the vaccines. As we all know, those won't be broadly deployed immediately, and the pandemic and the virus will be with us for a large portion of 2021.
If you think about the full year of 2021 for COVID-19 versus what we did in 2020, there's still going to be a lot of volume for testing. You have the full 12 months versus essentially a half year for PCR in 2020. Something to think about as you do your models.
Yeah. To Steve's point, for this year, based on our guidance expectations, we see our base volume down organically in the high teens. Even if it's down a couple 100 basis points in 2021, it'll still be an easy compare for the full year.
Last question is from Mike Newshel with Evercore ISI. Your line is now open.
Thank you.
Hey, Mike.
Going back to the geographic differences on the core volume rebound you mentioned, I'm just wondering if you're seeing fluctuations tied specifically to whether a new COVID outbreak, is there patient behavior changing and affecting the core business when cases spike and recede? Is that variation just more correlated to how far along local economies are in reopening? Is there volatility at the local level, or is it just some states are bouncing back faster than others?
Yeah. Well, it's by states. The big four states, California shut down first, and we saw a steady rebound. They're still not back to pre-pandemic levels, particularly in some of the large cities like L.A. If you go into Texas, we actually saw a good rebound in Texas. We have a great presence in Texas, both in Houston and Dallas. Despite some of the flare-ups we saw in the summer, they still continue to be in the range of where we were pre-pandemic. If you look at Florida, went down in the spring into the summer. There's still issues in Florida. We're still not where they were pre-pandemic.
If you go to the Northeast, New York, and if you go up to Boston and Connecticut, actually, we've seen some nice steady recovery with the exception of, as we've indicated earlier, New York City, but specific to the borough of Manhattan. We still have a ways to go to recover there. We're watching those, typically related to infection rates. Where we have had some of these flare-ups, interesting enough, like in the state of Texas and Florida in the summer months, it did not have as negative of a consequence to our base business as we saw back in the spring. We're watching it carefully. So far we're getting there. Again, it can't overlook that clinical franchise element of this, because some portion of the volume effects are related to these specific businesses like prescription drug monitoring.
There's other issues related to what it takes to get those back to pre-pandemic levels that are not related to the geography at all.
Yeah. I can't say they're precisely negatively correlated, but actually that would be my representation. The areas with the lowest positivity rates, like New York, actually are down the most. We haven't seen a huge parallel movement between spikes in COVID-19 over the last several months and a downturn in utilization. Actually, it's kind of gone the opposite direction.
Okay. Thank you all for your questions. We appreciate your support on this call today in general, and we wish you all a great day.
Thank you for participating in the Quest Diagnostics third quarter 2020 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 1-800-337-6568 for domestic callers or 402-220-9660 for international callers. Telephone replays will be available from approximately 10:30 A.M. Eastern Time on October 22, 2020 until midnight Eastern Time, November 5, 2020. Thank you. Goodbye.