Barry Port
Analyst · Stifel. Your line is open
Good morning, everyone. As we celebrate the completion of the spin-off of the Pennant Group, we are very pleased to announce one of our largest third quarter improvements in our history with GAAP earnings per share for the quarter of $0.48, an increase of 26.3% over the prior year quarter and adjusted earnings per share of $0.55, up 19.6% over the prior year quarter. These extraordinary results are a testament to the quality outcomes that are being achieved by our local leaders and caregivers as they continue to drive impressive increases in occupancy and are even more noteworthy given that in the third quarter of 2018 we had the largest quarter-over-quarter improvements in our history. These results also demonstrate the enormous potential inherent within our growing portfolio. Much of the improvement has come from strong increases in occupancy and skilled mix across all operations, including same-store, transitioning and newly acquired operations. Our same-store skilled services occupancy was 80%, an increase of 210 basis points over the prior year quarter and our transitioning skilled services occupancy was 77.9%, an increase of 240 basis points over the prior year quarter. We are excited about the momentum we continue to see an occupancy as this is the second quarter in a row where we have experienced an increase of over 200 basis points in both same-store and transitioning operations. We believe that these results also demonstrate that even in a period where occupancies across the industry may be down and what is historically one of our slowest quarters, we are able to consistently drive results across all payor types, including Medicaid, Medicare managed care and private pay. We are especially grateful to our service center partners who worked tirelessly to prepare for and complete our recent spin-off, while simultaneously providing support to our local leaders. While it would have been easy to allow the spin-off to become a distraction, our unique operating model of local leadership, combined with the support of a world-class service center has been proven once more. The results also show yet again that our local approach to healthcare scalable, even in the midst of a transformational spin and continued acquisitions. Throughout our history, we have primarily focused our acquisitions on distressed healthcare operations that require significant clinical financial and cultural turnaround so because most of these operations are losing money at the time we acquired them, the value and growth we experienced is all organic. When we talk about organic growth, we're speaking about the turnaround that has to occur in nearly all of our acquisitions before they contribute to the bottom line. Remember, it often takes several years to truly transition a healthcare operation as the clinical reputational and cultural transformations take time to have a meaningful impact. Of course some transitions are quicker than others but over the period of 20 years and 260 acquisitions, we've established a track record of both top and bottom line organic growth. So we often experience significant improvements in performance in the first quarter after we take ownership. It's difficult to make a true pre and post-acquisition comparison due to the varying standards and bookkeeping maintained by sellers. However, we can highlight our operational improvements that occur after we take over our operations, more specifically across all our skilled nursing acquisitions, our improvement between our first quarter of ownership and our fifth quarter in occupancy, skilled mixed revenue and EBITDA margin is approximately 390, 440 and 80 basis points respectively. Over a broader timeframe, our improvement in the same measures between the first quarter and the 45th quarter is approximately 1,300, 1,400 and 470 basis points respectively, which demonstrates the dramatic organic improvement continues for many years following the initial transition period. Let me provide some examples of this ongoing improvement. We continue to see success in secondary markets as our local leaders innovate to meet the needs of their communities. In 2011, we acquired Wayne Continuing Care and Rehabilitation in Wayne, Nebraska. Our Executive Director, Cheri Wingert, and Director of Nursing, Jordan Gilfrey, have led their exceptional team to outstanding clinical, cultural and financial performance in 2019. Both Cheri and Jordan are homegrown leaders in our organization, with Cheri completing an administrator and training program and Jordan having worked as a Charge Nurse and Assistant Director of Nursing prior to becoming leaders at Wayne. The facility grew occupancy by 14.5% and revenues by 41% over third quarter of 2018. At the same time, the facility has also continued to strengthen its clinical reputation as evidenced by their continued Five Star CMS rating and successful survey results, all while working hard to serve an increasingly acute resident population and meet the needs of their unique community. We've also seen continued improvement in some of our strategic urban markets. Mission Hills Post Acute Care acquired in 2014 is a 75-bed facility just north of downtown San Diego. Once an obscure third or fourth choice in their market, Executive Director Matthew Scott and Director of Nursing Enrique Gonzalez have transformed Mission Health into a post-acute powerhouse. With a culture promoting from within, several of their key leaders have come from other internal positions. Matthew, a former Chief Therapy Officer from another Ensign-affiliated operation himself, has leveraged his expertise and helped Mission become known for their amazing patient outcomes and successful transitions back to home. Matt and Enrique are always looking for new opportunities to expand their service operations up the acuity chain to better serve their local healthcare markets' needs. In spite of continuous improvement since acquisition, over this last year, they have managed to grow occupancy by 4.3%, revenues by 21.6% and earnings by over 3.6 times. They have an impressive four-star CMS rating and are truly a facility-of-choice in San Diego with much more runway to improve as they continue to innovate. All of these examples demonstrate that even in an ever-changing environment, through the right partnerships and superior outcomes, we're able to drive significant organic improvements in all of our operations. We are excited about the progress some of our underperforming operations continue to make, but we want to emphasize the tremendous potential there remains within our existing portfolio, not to mention the enormous opportunities for future disciplined acquisitions. For the second time this year, we increased our 2019 annual earnings guidance to between $2.24 and $2.31 per diluted share and annual revenue of between $2.35 billion and $2.4 billion. Overall, the midpoint of this guidance represents an increase of 21.2% over Ensign's 2018 annual earnings. When adjusting for only the fourth quarter impact of the Pennant spin-off, this newly increased 2019 guidance translates to between $2.15 and $2.21 per diluted share, an annual revenue of between $2.27 billion and $2.3 billion. We are very pleased with our performance so far this year and are confident that our local leaders will continue to adjust to local market conditions that we will continue to carry this momentum into the fourth quarter and beyond. We are also very excited to give you our 2020 annual earnings guidance of between $2.22 and $2.30 per diluted share and annual revenue guidance of between $2.3 billion and $2.35 billion, which does not include any of the results from the spun out Pennant businesses. We are very optimistic that with the continued upside that is inherent in our portfolio and attractive acquisitions on the horizon that we will be able to continue to meet or exceed our pre-spin growth rates. To underline this confidence, the midpoint of our 2020 guidance represents an increase of 18.3% over the midpoint of our 2019 full year spin-adjusted earnings guidance, which is between $1.88 and $1.94 per diluted share. As we said in the recent past, the primary drivers of our strong results are exceptional local leadership, high quality healthcare outcomes, strong regulatory results, healthy occupancy and consistent collection efforts. As we have focused in these areas, our local leaders are more and more successful in driving strong relationships with the acute and managed care partners, which continues to be an ongoing advantage. Our focus isn't just on skilled occupancy. It's developing an appropriate mix across all payer types that fit the unique needs of the markets we serve. Thanks to our distinctive local leadership model and our disciplined real estate investments and acquisitions, we are confident that this performance is sustainable over the long-term. We believe we are on a path to make up for all of Pennant's 2019 earnings by the end of 2020 and that we haven't even come close to reaching our full potential. To do so, it will take the relentless commitment to our culture and the repetitious adherence to sound fundamentals. And with that, I'll ask Chad to give us an update on our recent investment activity. Chad?