Earnings Labs

InfuSystem Holdings, Inc. (INFU)

Q4 2012 Earnings Call· Thu, Mar 28, 2013

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Transcript

Operator

Operator

Good morning, and welcome to the Q4 Earnings Conference Call. My name is John, and I'll be your operator for today's call. At this time [Operator Instructions] Please note that this conference is being recorded. I will now turn the call over to CFO, Jonathan Foster. Jonathan, you may begin.

Jonathan P. Foster

Analyst

Good morning, everyone, and welcome to InfuSystem Holdings Fourth Quarter and Full Year 2012 Conference Call. This is Jonathan Foster, Chief Financial Officer. With me on the call today is Mr. Dilip Singh, our Interim Chief Executive Officer and Jan Skonieczny, our Chief Operating Officer. First of all, let me get some administrative matters out of the way. The company issued a press release earlier this morning. The release is available on most financial websites. Additionally, a web replay will be available on the company's website for 30 days. Except for the historical information contained herein, the matters discussed in this conference call are forward-looking statements that involve risks and uncertainties that could cause actual results to differ materially from those predicted by such forward-looking statements. These risks and uncertainties include general economic conditions, as well as other risks detailed from time to time in InfuSystem's publicly filed documents. The company has no obligation to update the forward-looking information contained in this conference call. While discussing our performance, we refer to certain non-GAAP measures such as EBITDA or adjusted EBITDA, which is not considered a measure of financial performance under Generally Accepted Accounting Principles. Now with that, I'd like to turn the call over to Mr. Dilip Singh.

Dilip Singh

Analyst

Thank you, Jon. Good morning, everyone. It's been an honor and a privilege to serve as Interim Chief Executive Officer for the past year. As I deliver what is essentially my valedictory address prior to handing the CEO responsibilities to a very capable annex [ph] team from whom you'll be hearing much in the weeks and months ahead. I'm pleased to report that 2012 represents what will certainly be viewed as a watershed period in the company's history. I arrived on the job on April 24, 2012. I had no previous business relationships with anyone on the management team and there had been a change in control of the company at the level of the Board of Directors. I inherited a business plan and operation in place for 2012. As in the past, with other turnaround situations that I have led, I immediately assessed the quality of the senior team and the business as a whole, including our critical customer relationships. The management team has run a sprint for the entire year, and I'm so grateful to them. I thank every employee for their hard work and dedication. It is reflected in the results that Jon will describe in greater detail. The Board of Directors and I made a series of strategic decisions during 2012 and everyone can see the results. One of the key accomplishments was putting a new Credit Agreement in place with bankers who are interested in helping InfuSystem grow. My Chief Financial Officer in his direct report, deserve thanks from all the shareholders for their intense efforts and documented results. The strength of our core business and quality of management team gave us the ability to put a flexible and strong financial package in place, all of which disclosed to you last December. It is with…

Jonathan P. Foster

Analyst

Thank you, Dilip. Now I'll discuss the financial results for the year. Total revenues for the year ended December 31, 2012 was $58.8 million. This was an 8% increase compared to $54.6 million for the year ended December 31, 2011. Primarily, in rental revenues. The increase in revenues is primarily related to the addition of larger customers, increased penetration into our existing customer accounts, and the resolution of the oncology drug shortage affecting certain products which was having a negative effect on our new patient startups on our pumps, as well as a major third-party payer group revising their claim processing guidelines in the fourth quarter. Gross profit for the year ended December 31, 2012 was $42.9 million, an increase of 21% compared to $35.4 million in the prior year. It represented 73% of revenues in the current year compared to 65% in the prior year. This increase in the gross margin as a percentage of revenue in 2012 was primarily related to the increase in rental revenue, specifically third-party billings, which generate a higher gross margin than sales revenue. For the year ended December 31, 2012, our selling and marketing expenses were $9.9 million compared to $9.4 million for the year ended December 31, 2011. As compared to the prior year, these expenses remained consistent at 17% of revenues. Getting our selling cost back in line as a percentage of revenues was a goal for the entire 2012, one that was accomplished in the fourth quarter. During the year ended December 31, 2012, our general and administrative expenses were $23.1 million compared to $18 million for the year ended December 31, 2011. General and administrative expenses have increased from 33% to 39% of revenues for the year ended December 31, 2012, compared to the same period in the prior…

Operator

Operator

[Operator Instructions] We do have a question from Joe Munda from Sidoti & Company. Joseph P. Munda - Sidoti & Company, LLC: Real quick, you guys talked in the press release about new customers added in the quarter. I was wondering if you could give us a little bit more color there, as well as the number of pumps and the current utilization rate that you guys have right now with the pumps?

Dilip Singh

Analyst

Joe, thanks for the question. We have gained quite a lot of providers in our rental business. Jon can tell you exactly the total number of pumps we have. Utilization as you know, previously discussed, we don't disclose because of competitive reasons. So we can definitely tell you how many pumps we have. Jon?

Jonathan P. Foster

Analyst

We have 24,000 pumps in one of our rental fleets, and then we have roughly 26,000 pumps in another. We are buying more pumps. It is seasonal. Typically, most of our customer adds are in the first quarter, and it does take a while for those to ramp up.

Operator

Operator

Our next question is from Boris Peaker from Oppenheimer. Boris Peaker - Oppenheimer & Co. Inc., Research Division: I guess my first question is for Jon. You mentioned on the call that in terms of selling cost, your goal was accomplished. And my understanding, that was selling cost as a fraction of revenue. Do you anticipate kind of a similar fraction of revenue going forward, and I guess the same kind of a cost in terms of G&A. I'm not asking for a specific guidance, but just kind of want to get a sense, the current fraction of revenue, is that a reasonable long-term trend line? Is there more opportunity for cost savings? Or do you think it's going to go up?

Jonathan P. Foster

Analyst

Well, I think a sales force has just done a tremendous job this year, and what they were able to produce and also at the same time keeping their expenses in line. With increased sales, I think you will see increased dollars, but as all businesses, we tend to hope that we'll be able to increase sales at a higher rate than we increase our selling expenses. With G&A, 2012, to be quite honest, was a mess, with everything, with the concerned shareholder cost, the strategic alternatives, I think you'll see G&A costs settling down, and you will see some improvements as we move forward in the year. Boris Peaker - Oppenheimer & Co. Inc., Research Division: Got it. That's helpful. Now my follow-up question is, you mentioned there was a change in reimbursement for some patients, including requiring some out-of-pocket expenses. And I see that there was a slightly greater allocation for doubtful accounts. Could you just comment on that. Exactly, what was the change? How does that affect some patients and how did the doubtful accounts calculations change?

Jonathan P. Foster

Analyst

I'll let Jan Skonieczny take the first part of that, and I'll follow-up on the other aside.

Janet Skonieczny

Analyst

Thank you Jon, good morning. I'll comment on this. The one thing is -- that's constant is that payment terms with third-party payers change always. I've been here for a very long time, and that's one thing that I've always been a part of and one of the -- actually one of the company's strengths. We always have ups and downs in revenue and in bad debt expense due to the changing term, and the important takeaway from this is that, now that we have a national pricing contract with these major group of payers, it enables us to establish direct payor relationships with members of the group.

Jonathan P. Foster

Analyst

Yes. And so to kind of follow-up on that, and thank you Jan. The -- we have some pretty strict accounting revenue recognition policies within this company, and we adhere to them. So there's very little room in there for -- to nudge any estimates, it's fairly strict. But as Jan mentioned, the contracts change, add a network, in network. Sometimes you'll see revenue go up and bad debt go up if there's a higher payment from a patient. And if eventually we're able to negotiate that contract, where more of the reimbursement is coming from the third party payer, you'll see bad debt go down and potentially you might see conversely revenue go down as well. But all in all, net-net, it ends up being the same.

Operator

Operator

And we have Joe Munda from Sidoti & Company. Joseph P. Munda - Sidoti & Company, LLC: I had another follow-up. It's similar to the question that was just asked. In the case of Medicare with 31% of gross billings, and I mean, with what's going on with the Affordable Care Act, can you give us some indication of what the potential impact could be going forward in your best guess?

Janet Skonieczny

Analyst

Okay. I'll take a stab at your question, but could you restate it for me please, just so I'm clear on what the ask is?

Jonathan P. Foster

Analyst

Joe? I guess operator. I think the operator took them off the queue. Why don't you just talk in general about the Affordable Care Act, Jan?

Janet Skonieczny

Analyst

Sure. So one question that seems to be on everybody's mind is how will this new sequester cut, affect the company. And the company will be experiencing beginning April 1, a 2% decrease in Medicare payments. That is not anything different than any other medical provider out there, but it's important to understand that, that's a 2% decrease in payments from Medicare, not a 2% decrease in the fee schedule. With respect to competitive bidding, we did submit our bids by the end of 2012, and we submitted our bids to request contract in each of the 9 MSAs that will be affected by the round 1 recompete. The important takeaway here is that we have a task force that is extremely focused and keeping on top of updates as information is released to us by CMS. And another thing to remember is, although Medicare is 30% of our revenue, the other 70% of our third-party payer revenue is derived from other payers and which we're continuing to add to our list of contracted payers. So that's the offset. We keep our focus in all areas.

Jonathan P. Foster

Analyst

And with regard to numbers, if you go to the 2% and the CMS and the percentage that's in our K, you're talking roughly $200,000 potentially from April to December, that the 2% cut would have an impact on. From a standpoint, the CMS, that is an unknown. It's one of the risks that we've stated in our 10-K. I think we have some good action plans internally within the company that we would be able to respond somewhat against those cuts. And I think Jan and her operations team has a very good handle on the situation. They've encountered a lot of change throughout the decades that they've been here.

Operator

Operator

Our next question is from Dan Baldini from Oberon Asset Management.

Dan Baldini

Analyst

I have sort of an accounting question. When I look at your profit and loss, in cost of revenue, you have pump depreciation and loss on disposal. And for example, for the full year 2012, it's $6.752 million. But then if I look in the cash flow statement, you have depreciation of $5.668 million, and then you have a gain on sale of medical equipment. So I'm just curious, what are the -- under this pump depreciation and loss of disposal, what are the elements there, obviously there's the depreciation, but is there a loss or a gain on the sale of the medical equipment?

Jonathan P. Foster

Analyst

You have a gain, I guess that's just some semantics there on the P&L side. With regard -- that's a great question because with the recent kind of guidance from the SEC and also the way that we work with pumps, our predominant source of revenue is from our rental income. When we buy a pump, it may go into our rental pool, then go back and be sold or vice versa. It may be where we potentially originally bought it for sale and now it's going into the rental pool. So from that matter, that's why the changes were made on the balance sheet and while we just group medical equipment in 2 groups, one that's not in service and one that's in service. From a standpoint of the cash flow statement, we did have a gain on that in 2012.

Dan Baldini

Analyst

And is it sort of a -- is it -- do you expect that you'll have gains on the disposal of this equipment on a regular basis?

Jonathan P. Foster

Analyst

I'm sorry, could you repeat that?

Dan Baldini

Analyst

Do you expect you'll have gains on the disposal of equipment on a regular basis?

Jonathan P. Foster

Analyst

I guess 2 things there. I mean, again, let me clarify that. We had gains on pumps that we sell. Because our pumps are depreciated with our service capabilities in Kansas, we keep our pumps in top-notch condition. You can't tell the difference between a 15-year old pump and a 5-year old pump. I mean literally, if you put them in front of you, you can't really tell the difference. We do have though in our rental fleet, just like in any rental fleet, you do have sometimes pumps that are lost. So that's where the loss on disposal comes from. That's where that language comes from. So of course those are not going to have a gain. But on ones that we sell, we definitely have a gain.

Dan Baldini

Analyst

Okay. So but my question was, you regularly sort of update your equipment fleet, and in the course of doing this, you dispose of pumps and you record gains. It would have...

Jonathan P. Foster

Analyst

That's correct.

Dan Baldini

Analyst

Yes, okay. And so the reason you have gains is that your depreciation schedule sort of depreciates them faster than the economic depreciation?

Jonathan P. Foster

Analyst

By all means, yes.

Dan Baldini

Analyst

Yes. So if you're making some sort of a calculation where you, like EBITDA, where you add back depreciation, shouldn't you then also add back or subtract the gain on the sale of the pumps because really, if I think about the sort of economic or the true economic aspect of these pumps, the depreciation charge in a way is overstated, but it's corrected by the gains that you have on the sale of the pumps?

Jonathan P. Foster

Analyst

Correct. When we sell a pump, we actually reverse the prior depreciation and work that out. So it does come out of EBITDA. But again, just because our predominant source is rentals, a major source of our income is sales. I mean, we do sell pumps. So again, adjusted EBITDA is a non-GAAP measure, so I guess there can be 2 sets of judgments on that. But from our standpoint, selling pumps that have been in our rental fleet is part of our business. Very similar if you look at other rental companies. Apria is one. The ones that are also in rentals and sales, you can look at Rent-A-Center, Aaron's, actually Men's Warehouse, they have tuxedos that have similar type of accounting issues there. And so, from our standpoint of our accounting, we feel that we're in line with the industry.

Operator

Operator

Our next question is from Shaun Noll from Stirling Capital.

Shaun Noll

Analyst

What was the -- just to clarify, what was the debt level, what was the debt levels when you guys came in on the company?

Jonathan P. Foster

Analyst

Oh, I'd have to go back and add that up. I mean, during the year, let me just talk in general, if you look at the third quarter press release we had, we have reduced debt by $6 million from the first part of the year to the end of the year. Part -- when we did the debt transaction, this was from Q1 to the end of Q3, when we did the debt transaction, there were 2 things that happened. The debt was an expensive process, bringing that on, we had some capitalized costs that also were refinanced. I think it was just shy of $2 million. We had fees to Houlihan Lokey. We had attorney's fees. We had bank placement fees. It was expensive money. Still cheaper than what we had saddled with the Fifth Amendment in BofA. We also had some settlement costs that were very buried in accounts payable during Q1, Q2, Q3 of roughly $2 million. And in that, we had to pay -- we paid that off with the debt financing. So that added to the debt as well. So during the year, we reduced our debt. But from a standpoint -- if you look at it year-over-year, we're at $31 million, less $9 million, and if you look at the additional debt cost, the issuance cost and also what we covered with the concerned shareholder group, we reduced the overall debt burden of the company.

Shaun Noll

Analyst

Okay. Thank you. Then I guess the only follow-up question I have would be, it's more of a statement, I'm surprised there was no disclosure from you guys when the Medicare cuts were announced, any thoughts on how you're going to keep shareholders updated on that key topic in the future?

Jonathan P. Foster

Analyst

Well, it is. It is one of our -- it's our first risk in our risk section in our 10-K. Second of all, our product codes have not been involved in any of the announced bids from a standpoint of their initial round 1 and round 2. The price cuts vary depending on the codes, so we don't want to set any false expectations because we don't know. The price cuts range from scary to not that bad. We have, as Jan just mentioned, we have submitted our bid. Our codes came up in round 1 recompete. That's disclosed in the 10-K, and that will be announced when, Jan, sometime this summer?

Janet Skonieczny

Analyst

Yes. Late -- probably mid-to-late summer. There'll be an announcement as to what the cuts are, and it's also important to note that any cuts that are released won't take place until January 2014. So -- but again, as Jon mentioned, we don't really know what those cuts are going to be with respect to competitive bidding. Things are unfolding daily. We get additional information, but nothing up to this point has been definite with respect to the round 1 recompete.

Jonathan P. Foster

Analyst

Information is very limited coming from the government. So from that standpoint, believe me, soon as we hear anything in our contracts, we will definitely file an 8-K.

Operator

Operator

Our next question is from Kevin [indiscernible], a retail investor.

Unknown Analyst

Analyst

So from the perspective of your sales force, can you just give us a little color on what the typical sales process looks like from, I guess, initial contact with a prospect until you sign them. And in addition to that, about how sticky is the business you guys bring in?

Dilip Singh

Analyst

Yes, this Dilip. So we have rentals and we have sales. On the rental side, the process starts with approaching the providers. This could be community oncology clinics. This could be large clinics treating multidisciplinary cancers. And once we go to the providers, we show them that we can -- the pump as a service means, we tell them we have been in this business, we know how to source the technology of these pumps, and we are totally aware of the changing trends in the technology and how it can impact the providers because they're the ones who are providing these services to the patients. Then pump as a service is -- because we have a very good service engineering group which can service large pumps, ambulatory pumps, and so we take the responsibility of servicing these pumps when they -- especially when they come out of warranty from the manufacturers. We have built a large amount of -- which is a tremendous amount of high-quality intellectual property of the company, third-party payer relationships. And Jan talked a little bit about it, the 70% of our revenue coming from commercial third-party payers and 30% coming from CMS. So we then take the billing aspect off the hands of our providers. We do all the billing for the patients. And last not but the least, where we excel the most is, we have the customer care and a nursing support line once the patient start utilizing our pumps, infusion pumps to ensure that we can serve our patients in a very effective manner, 7 by 24 and this is supported by the nurses. So just talking about rental would not be fair to the company because we provide pump as a service. Once we go to these providers, and the…

Operator

Operator

The next question is from Michael Potter from Monarch Capital Group.

Michael David Potter - Monarch Capital Group, LLC

Analyst

Just a couple of questions. You mentioned in the release, I guess we had an increase in our same customers, we added new customers, and we also had a bump in revenue from change in billing, or I guess from billing customers directly. Can you break that out? What was the same customer sales growth and the revenue from new customers for the quarter and for the year?

Jonathan P. Foster

Analyst

Michael, for competitive reasons, we don't break that out. I will tell you though, in general terms, the landing larger customers is definitely one of the ways that we do focus on is focusing on the larger pump facilities on the third-party payer side. On our pure rental business, B2B type sales, those can come in smaller, smaller gains. I will tell you that the organic growth of this company is what's driving sales growth.

Michael David Potter - Monarch Capital Group, LLC

Analyst

Okay. You also reported adjusted EBITDA. Does the adjusted EBITDA take into account the $600,000 retention payment that was paid during the year and also stock compensation because I don't see that as line items?

Jonathan P. Foster

Analyst

No. It does include the $600,000 retention related to the concerned stockholder issue. We...

Michael David Potter - Monarch Capital Group, LLC

Analyst

So the $600,000 is included in the $2.2 million?

Jonathan P. Foster

Analyst

Yes. And we did not add back stock compensation. We've internally kind of debated whether we add that back or not. But no we haven't. That is just always something that we are trying to make sure we get the correct amount to the -- present it to the investors. So no, we did not add back the stock compensation.

Michael David Potter - Monarch Capital Group, LLC

Analyst

Okay. And what do you anticipate, what's the CapEx budget for 2013?

Jonathan P. Foster

Analyst

Again, for -- since pumps equal revenue in our business, it is a direct correlation. We don't disclose that either.

Michael David Potter - Monarch Capital Group, LLC

Analyst

Pumps only equal revenue when you're giving the utilization rate, which you're not giving.

Jonathan P. Foster

Analyst

Well, no. We only buy pumps when we know that we need them. The timeline for us between order and delivery is, what Jan, 3 weeks, generally?

Janet Skonieczny

Analyst

3 to 4 weeks.

Jonathan P. Foster

Analyst

3 to 4 weeks. So we only order pumps on our third-party payer side, or our rental side when we know we have customers coming on because typically there is a delivery date, an exchange date. So from that standpoint, pumps equal revenue in this business.

Janet Skonieczny

Analyst

Right. And we're constantly working to manage our fleet and make sure that we're forecasting new accounts as they come on and have a good handle on what their pump needs are going to be.

Operator

Operator

Next question is from Boris Peaker from Oppenheimer. Boris Peaker - Oppenheimer & Co. Inc., Research Division: I just wanted a little more clarification, you mentioned clearly, you have 2 lines of business here, sales and rental of pumps. On the sales side, I'm just curious if you're seeing any kind of trend in the industry because it would seem to me people that are probably buying pumps are unlikely to be going into renting pumps in the future. So I just wanted to kind of get your thoughts on that.

Jonathan P. Foster

Analyst

Good question. From a standpoint of whether it's sales or rentals with our customer base, it really varies in the health care industry, whether a hospital or a facility is tied on their CapEx budget. If they are, then rental is the way for them that they prefer to go. From a standpoint if they have additional CapEx, and they're looking at rentals and they believe they have a good base business, then they will probably opt for sales because that would generally be a lower cost of ownership for them, if they have the capital and a good cost of capital. One of the reasons on the B2B side that our rental businesses provide such a service is that during, say for example a flu season, that they can rent from us and then when patients are gone and their billings are gone, they can get rid of the -- they change a fixed charge into a variable charge. That was our last question.

Operator

Operator

Sorry, yes, that was our last question. I'll turn it back over to you Jonathan, if you have any final remarks.

Jonathan P. Foster

Analyst

Great. I think I'll turn it over to Dilip. I think he has some closing items.

Dilip Singh

Analyst

Thank you all for participating in the call. In conclusion, we are encouraged by our continued progress and the opportunities available for us. I would like to thank my Board of Directors, executive management team, all employees, partners and General Counsel of InfuSystem for this past year and making this personally and professionally a very happy and productive year for all of us. Thank you, and goodbye.

Operator

Operator

Thank you, ladies and gentlemen. This concludes today's conference. Thank you for participating. You may now disconnect.