Earnings Labs

Pediatrix Medical Group, Inc. (MD)

Q3 2015 Earnings Call· Thu, Oct 29, 2015

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by and welcome to the MEDNAX 2015 Third Quarter Earnings Conference Call. Now, at this time, all participants are in a listen-only mode. As a reminder, today's call is being recorded. Your hosting speaker, Charles Lynch. Please go ahead, sir. Charles W. Lynch - Vice President-Strategy & Investor Relations: Thank you. Good morning, everyone. I'm going to read our forward-looking statements and then I'll turn the call over to Roger and Vivian. Certain statements and information during this conference call may be deemed to be forward-looking statements within the meaning of the Federal Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on assumptions and assessments made by MEDNAX's management in light of their experience and assessment of historical trends, current conditions, expected future developments, and other factors they believe to be appropriate. Any forward-looking statements made during this call are made as of today, and MEDNAX undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the company's most recent annual report on Form 10-K and its quarterly reports on Form 10-Q, including the sections entitled Risk Factors. In today's remarks by management, we will be discussing non-GAAP financial metrics. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures can be found in this morning's earnings press release, our quarterly report on Form 10-Q, or in the Investors section of our website located at mednax.com. With that, I'd like to turn the call over to our CEO, Roger Medel. Roger J. Medel - Chief Executive Officer & Director: Thank you, Charlie. Good morning and…

Operator

Operator

Thank you. First question is from the line of Ryan Daniels, William Blair. Please go ahead. Ryan S. Daniels - William Blair & Co. LLC: Yeah. Good morning, everyone. Thanks for taking... Roger J. Medel - Chief Executive Officer & Director: Good morning. Ryan S. Daniels - William Blair & Co. LLC: ... the questions. Let me start with one just on pediatric cardiology. I know it's not a huge piece of your sales, but it's a segment that apparently continued to see negative volume where the others are up. So I'm curious if there's anything that you would point to there that's pushing sustained volume declines even as the U.S. birth rate has stabilized over the last year or so. Roger J. Medel - Chief Executive Officer & Director: There's nothing specific that I would point to. I would tell you that a couple of years ago, there was a decrease in reimbursement for cardiac ultrasounds. And that had a significant impact back then. Other than that, there's nothing in specific that I could point to. And that was for both, adult and pediatric... Ryan S. Daniels - William Blair & Co. LLC: Right. Okay. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: And it's not significant dollars, Ryan. It's concentrated in a couple of areas, but it's just not big dollars. Ryan S. Daniels - William Blair & Co. LLC: Okay. So it's not impacting the overall growth? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: No. Ryan S. Daniels - William Blair & Co. LLC: Got it. Okay. And then, I guess as a follow-up just on mix. I know you had a 100 basis point decline year-over-year, and clearly that's something that's completely under your control. So, it's based on who's coming in and what insurance they have. But have you looked into anymore insights on what's going on there, just in regards to certain geographies. Are you surprised, maybe mix hasn't improved with the employment picture and exchanges putting a little bit more people on the commercial front. Any thoughts you might have there as we think about going forward? Thanks. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. So we've spent a lot of time looking at it in the individual regions where we're at. And we do have some specific examples of we know what's happening with some of the payors related to, for example, in one state where we had to hold some applications because we were waiting to get all the credentialing in. And so, we've seen pockets of that. So that's really the bigger driver of that. And there's nothing macro about it. We have seen, in some states where there has been some increases in enrollment on Medicaid, but that's really not a big factor. And we do have some specific payor situations in some of our states. Ryan S. Daniels - William Blair & Co. LLC: Okay. That's helpful. Thank you. I'll hop back in the queue.

Operator

Operator

And the next question is from the line of Kevin Ellich, Piper Jaffray. Please go ahead. Kevin K. Ellich - Piper Jaffray & Co (Broker): Thanks, and good morning. Thanks for taking the questions. I guess just following-up on the mix shift, Vivian, if we think – what's really pushing that? Is it Medicaid expansion? And even excluding the impact of parity, I think pricing was up about 30 basis points. And just wondering is that kind of the rate of pricing growth we should assume in 2016 once you guys lap parity? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: So as I just mentioned to Ryan, we do have some – when we looked at p mix there, there are some specific drivers in certain states with some of our applications. And other than that, we did see that there's some slight increase in enrollment, not really significant, as well as then on the pricing side, as I've mentioned to you guys before, that is somewhat seasonal because it just depends on execution of the work plan. And so, in any given quarter, you'll see some, really, fluctuations based on the number of contracts that we've gotten renegotiated when they pop up. Kevin K. Ellich - Piper Jaffray & Co (Broker): When you say applications, are you talking about applications for the exchanges, Vivian, or I guess I'm just trying to... Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: I'm saying applications for us to turn in our billing for government programs. Kevin K. Ellich - Piper Jaffray & Co (Broker): Okay. Okay. And then I guess, Roger, just big picture. As you expand further into anesthesia and other specialties, radiology, do you expect the mix to continue to shift more to government pay just naturally? Is that…

Operator

Operator

Our next question is from the line of Brooks O'Neil, Dougherty & Co. Please go ahead. Brooks G. O'Neil - Dougherty & Co. LLC: Roger and Vivian. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Hi, Brooks. Roger J. Medel - Chief Executive Officer & Director: Hey, Brooks. Brooks G. O'Neil - Dougherty & Co. LLC: So, I was hoping you mentioned that vRad was off to a great start, maybe you could just give us a few more details there and kind of what your outlook for that business is and how it fits with the rest of the mix? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. So, vRad is performing as we told you guys when we acquired that it was. So they're really doing on the volume side high-single-digits. And so we're happy with the results. As I said also in my commentary, Brooks, on the gross profit side, on the EBITDA side, they are also helping with that given their margin profile as we also said when we acquired them. So really, right now, we're happy with the performance. Brooks G. O'Neil - Dougherty & Co. LLC: That's great. And then I guess I just wanted to ask you. I know I asked you about the ER business at the Investor Day, but subsequent to that, we've seen these announcements of AmSurg trying to buy TeamHealth and the issues – I guess some issues in the hospital business, some issues with Envision. Can you just comment, obviously, with your realigned structure, you're focusing more on trying to serve your hospital patients. How do you view the environment out there today? And any comments would be just much appreciated. Roger J. Medel - Chief Executive Officer & Director: Well, I'm not sure what you just…

Operator

Operator

And next question is from the line of Brian Tanquilut, Jefferies. Please go ahead.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Hey good morning, guys. Vivian, just to follow-up on your comments on the payor mix and pricing. So outside of parity and outside of the payor mix shift, as you renew your contracts, are we still getting sort of the typical between, put it 3%, 5% rate increases on a same contract basis? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. I mean, it fluctuates but yeah, it's still in that range.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Okay. Got it. And then G&A ramp for the quarter was pretty, I don't want to say steep, but it was a good chunk and then Alegis obviously kicks in, in Q4. So what were the drivers for the G&A uptick in Q3, and then how should we think about all that with Alegis in Q4? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. And so, again, it's the first full quarter for vRad. And so, as I mentioned to you guys before, Brian, on the portfolio companies, they do have a higher G&A percentage than overall MEDNAX. So that's really the effect you're seeing in there. I don't think really think that Alegis per se is going to move that more because they're smaller. So, I think in this range is where you're going to see it, give or take a few basis points here and there, but I don't think Alegis itself will be able to move the needle. But the other portfolio companies, and again, vRad being in the full quarter, that's it. That's why I wanted to specifically address that if we take those out, MEDNAX per se really – our G&A grew at the same rate, slightly below revenue.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Got it. All right. And then was there any uptick from ICD-10 or any issues related to ICD-10 in the quarter? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: So we are happy to report that we had a very successful rollout of that. And right now, as you would expect, we keep very close tabs on that. And we have a committee here, as I've mentioned before, that is responsible for it and is really meeting daily to look at the progress of that. And right now, I'm happy to say that we have not reported any issues with that. And so we'll see as the cash comes in, right? Roger J. Medel - Chief Executive Officer & Director: We're more worried about how prepared the payors are. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. Yeah, exactly. Roger J. Medel - Chief Executive Officer & Director: (26:48).

Brian Gil Tanquilut - Jefferies LLC

Analyst

Got it. And last question for me. Everyone is talking about cost inflation or wage inflation. And I know you don't employ that many nurses relative to doctors, but what do you see in terms of just wage growth going forward, and then I'll hop out the call? Thank you. Roger J. Medel - Chief Executive Officer & Director: Yeah. We're not seeing anything significant... Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: No. Roger J. Medel - Chief Executive Officer & Director: ... down that road. Our doctors have a bonus plan in place, and we utilize that plan to address the issue of pay raises and those kinds of things. So we're not expecting anything on that front.

Brian Gil Tanquilut - Jefferies LLC

Analyst

All right. Thanks, guys.

Operator

Operator

And next question is from the line of Ralph Giacobbe, Citi. Please go ahead.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst

Thanks. Good morning. So, in the recent past there was sort of a thought and hope of economic improvement, and sort of higher birth rates maybe turning the corner and driving better volume. Volumes obviously softened a little bit in total and then we've got sort of the mix shift to Medicaid. So I guess the question is – I mean, do you still sort of have a comfort or a conviction that the other better volume sort of will show through? And then specific for this quarter, can you give us a sense at all of commercial volume if that was sort of up, down, or flat? Roger J. Medel - Chief Executive Officer & Director: Well, when we look at the statistics, we still see that there was an increased number of births going back from 1975 to 1990. And that number has stayed at the 4 million babies per year in a row since 1990 for the past 25 years. And so because half their babies born are boys and half are girls, we expect that. There're an additional half a million women of child-bearing age that are coming into our service area. And so we continue to believe that because of that, because of that statistic, we continue to believe that we will see birth rates growing up. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: But also, honestly, the volumes were good considering last year, if you guys remember, we basically had very high volumes as well. And so we're happy with it.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst

Okay. And then the commercial volumes in the quarter? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. I mean, again, overall, we saw a mix shift towards government, but again in some places the commercial was actually offsetting that. And so, yes, we're still seeing commercial growth.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst

Okay. And then ex-parity the guide for 4Q, same-store revenue zero to 2%, can you sort of give us a breakdown on how you see that between price and volume? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Well again, we had some pretty good volumes last year in the fourth quarter. Third and fourth quarter were very good last year. So we do have something baked in there for payor mix, again just because I don't know where that's going to end up, so some in for payor mix and then the rest volume.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst

Okay. All right. Thank you very much.

Operator

Operator

And next question is from the line of Kevin Fischbeck, Bank of America Merrill Lynch. Please go ahead.

Joanna S. Gajuk - Bank of America Merrill Lynch

Analyst

Yes. Hi. This is actually Joanna Gajuk filling in for Kevin. So I just wanted to go back briefly to the comments around G&A. So when you said the increase is reflective of the business mix, that you now have more non – I guess, practice businesses there. So the idea there is that the labor cost actually is reported in that line rather than SWB because in fact the SWB line was down year-over-year. So that's the way to think about that, kind of the cost structure is changing because of the way of the reporting of labor costs between the two different types of businesses you're in? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. I mean, again it is labor cost, but of course vRad does have some labor cost in their gross profit. The point is that, yeah these companies are smaller and they have a higher percentage of G&A.

Joanna S. Gajuk - Bank of America Merrill Lynch

Analyst

Okay. So it's not just labor. You're just talking about the G&A, right? That makes sense, too. All right. And then so second of all, going back to the commentary around acquisitions, so can you give us a flavor for, I guess, the multiples? I know that, Roger, you mentioned that – you told us in the past when you saw the anesthesia multiples growing up or starting to creep up. So has it accelerated. Are you seeing any change or would you expect, I guess, things have changed there if in fact there is a large merger that was also discussed during this call? Would you view it as a sort of benefit to you in a sense that it would remove competitors for anesthesia deals? Any color on that or any view you might have? Thank you. Roger J. Medel - Chief Executive Officer & Director: Well, as I said before multiples have gone up way beyond where we would have liked to have seen them and there are number of practices that are in the market. And as I've said before, if it's just about how much money can I get for my practice and the practice will go to highest bidder will likely not to be the winner of those deals. Now, we continue to do deals as you have seen throughout this year, because there are others who are not just interested in how much they're going to make, but also what's also important is who is going to be my partner. Am I going to get flipped to somebody else three or four years from now. I don't know who I'm going to be working for. Is my hospital happy with who my new partner is going to be. So the number of other considerations that sometimes, and I'll say often, influence where the practice is going. It's not just about the money. But multiples have gone up, there's no doubt about it.

Joanna S. Gajuk - Bank of America Merrill Lynch

Analyst

So any color on – of the two competitors with deals merging whether that kind of remove them from the market? Roger J. Medel - Chief Executive Officer & Director: Well, I don't know. I guess if a couple of those came together, that would remove one competitor, but I don't have any insight or any comment on any of that. We're not involved in any of that stuff.

Joanna S. Gajuk - Bank of America Merrill Lynch

Analyst

Right. And just lastly though quickly, just coming back to the discussion around payor mix. So is that a way to think about it? You don't see any sort of change, major change in the underlying trend? You're just saying that there's fluctuation because you didn't make it sound like the business mix is changing and that's impacting payor mix. So, is that the way to think about it if there's no really major change in underlying trends, if there's kind of normal fluctuation or was there something that happened this quarter? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Well, like I said Joanna, I mean, there's several factors of it. Some are ours related to payors and application for government and all that. Some of it, we have seen a slight increase in the enrollees in Medicaid programs but again I wouldn't call any of this a trend at this point because the numbers are not significant enough to say that. Again, there's been accumulation of them for what made up the quarter, but yeah, nothing that I would say this is going to be a continuous trend going forward. But we're always very cautious on p mix because we don't really have the underlying factors of it, other than what we can glean out from our own information.

Joanna S. Gajuk - Bank of America Merrill Lynch

Analyst

Great. Thank you so much.

Operator

Operator

Our next question is from the line of Chris Rigg, Susquehanna. Please go ahead.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Good morning. Just wanted to follow-up on an earlier question with regard to labor, what percentage of your direct costs are related to nurses? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: I don't look at that like that, honestly because we look at the clinician line in total. So there's physician cost and there's CRNAs and NMPs and it totally, so I don't really have that.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Okay. And then just on the NICU volumes and Roger's big picture comments on population growth. I mean, when you think about the changes in demographics, should that be in impacting births now, or are we still a year or two away or several years away from when you think this extra half a million or so people really begin to impact the volume side? Roger J. Medel - Chief Executive Officer & Director: Well, we would expect that it's been 25 years. So we would expect that that should happen probably at any point, I suppose. I can't predict as to when that's going to happen, but it's been 25 years so we expect that that would start at some point.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Okay. And then just lastly, obviously, you've done several deals recently and you had the decent size buyback earlier in the year. Just capital priorities at this point. Are you in a deleveraging mode or just you feel comfortable with the leverages and use capital as priorities present themselves, or just any color there would be helpful. Thanks a lot. Roger J. Medel - Chief Executive Officer & Director: Yeah. We're comfortable with where we are. We believe that there will be more opportunities. And, of course, we would rather put our money to work by acquiring practices and generating not only income, but the significant amount of cash flow that comes with these practices. So we'll evaluate where we are at the end of the year and make whatever decisions, if we're going to make any, after the end of the year.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Great. Thank you. Roger J. Medel - Chief Executive Officer & Director: Yeah.

Operator

Operator

Your next question is from the line of Chad Vanacore, Stifel. Please go ahead. Mr. Vanacore, your line is open. Chad C. Vanacore - Stifel, Nicolaus & Co., Inc.: Okay. Hey, I just wanted to follow-up on Joanna's questions because I'm not sure I got that all. So expense controls in the quarter were good, in particular SWB was better than expected. Have you been doing something that helped you avoid some of the same pitfalls that other staffing companies can have during the quarter? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: I don't know what those pitfalls are, but as we said, our physicians typically have contracts. And so we're not renewing their contracts all the time. And so we haven't really seen. When I look at same unit numbers, honestly, it's not unusual increase there at all. And so we're not seeing those increased costs, I guess, like some other companies are reporting. Chad C. Vanacore - Stifel, Nicolaus & Co., Inc.: Okay. And then just on the acquisition front, would you expect the acquisition pricing to moderate next year, seeing as the other staffing companies seem to be pressured? Roger J. Medel - Chief Executive Officer & Director: Well, we would hope so. Obviously hard to predict, but we do think there is a possibility that prices or multiples will moderate given the recent activity in the sector. Chad C. Vanacore - Stifel, Nicolaus & Co., Inc.: All right. And then have you seen any enhanced cross-selling opportunities since you've had vRad under your belt? Roger J. Medel - Chief Executive Officer & Director: Yeah. I mean, I don't have any specific wins to point to, but we are having significant conversations with some of our hospital partners about helping them, particularly on the Pediatrix side…

Operator

Operator

Okay. Next question is from the line of Gary Taylor, JPMorgan. Please go ahead.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Hi. Good morning. Roger J. Medel - Chief Executive Officer & Director: Hey, Gary. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Good morning, Gary.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Hi. Couple of questions. One, I just wanted to make sure I'm very precise about the change in government payor mix. I had a note in my model. One time – when you guys talk about 100 basis point change year-over-year, is that on net or gross same-store Medicaid billing? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: That's on gross.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Okay. And that percentage change in mix that you've called out over the last couple of years, that has always excluded parity impact, so it... Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. Well, I guess not really because it would be all in there, yeah.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Okay. So it has been included. Okay. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yes.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

And I know I asked the same question last quarter, but just on payor mix, so that tick-up in Medicaid versus commercial, is that – are you generally seeing that across all service lines and geographies, there's nothing really to call out there? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah, not really.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Okay. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Some states have a lot more improvement in commercial. So, yeah, not really.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Okay. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Not all across the board.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

And when I kind of do my back-of-the-envelope on what I think may be a 100 basis point shift in mix year-over-year, I kind of come up with – that's maybe a 5%, 6% earnings headwind year-over-year. Would you be willing to endorse that being in the ballpark or not? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: No. I'll tell you why not, because it just depends on where you're getting that hit, it depends on where – in that state, what the difference is between government and commercial. So that could have a significant impact. And so, for example, this quarter, that 100 basis points really is slightly less than what we would do if we did it all across the board, because some states that are pretty favorable had a more commercial mix, and so it's not a straightforward calculation.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Right, on the payment differential. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yes. Exactly, Gary.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Last question. Roger, maybe this one is for you. I know you don't give forward year guidance or even long-term guidance, but I have had a lot of questions from investors just about, really what does kind of organic growth look like at MEDNAX over the next few years? You've had, obviously, the benefit of parity and now really difficult comps going up against that. So I think almost everyone would argue the reported numbers are probably understated versus what the real go-forward looks like. But if you look kind of the last five years or so before parity, volumes kind of ran 1% to 2% same-store, price kind of ran 2%, it was kind of a 3% to 4% same-store revenue growth story. Is that still a number that makes sense and then the new specialties, cross-selling, contract adds potentially adds to that on a non-same-store but organic basis. Is that a reasonable way to think about this? Roger J. Medel - Chief Executive Officer & Director: Yeah. I mean, I think 3% to 4% makes sense. I think that's an appropriate number to be thinking about. Obviously, we're putting in a lot of initiatives to improve that, to increase it. We think that with the addition of vRad and their focus on organic growth and some other things that we are putting in place, we'd like to see that increase. So, I think that going forward, that same 3% to 4% is a reasonable assumption and our expectation is to try and improve that.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Last question, if I could. So when vRad or even the Anesthesiology segment with some of your sales restructuring, presumably there's some cross-selling there and you'll be able to add some specialties in hospitals where you have existing contracts already. Will you report that out as same-store, or will that be kind of a same-store plus organic and kind of carved out separately, or will you just imagine rolling it all into that same-store revenue that you report? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: So it depends on how it falls out, Gary. I mean, if it's significant enough, we could consider doing non-purchase versus purchase growth, but quite candidly, it hasn't made an impact. But typically, if it's in the same unit you'll see it in there.

Gary P. Taylor - JPMorgan Securities LLC

Analyst

Okay. Well, thank you.

Operator

Operator

Our next question is from the line of Whit Mayo, Robert Baird. Please go ahead. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Hey, thanks. Just a few questions. Roger, a few quarters ago you offered up what I guess I'd call maybe a commitment or belief that you felt like you could grow your earnings double-digit. And just curious, do you still share that view, and Charlie might throw a pencil at you, but just curious what you think about your growth rate. Roger J. Medel - Chief Executive Officer & Director: No. We did it this quarter and we believe we're going to continue to go down that path. We've said it during our conversation in New York last month and we're saying it again. We expect continued double-digit growth. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: And by the way, the fourth quarter forecast also contemplates that. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Right. And so back to just the question on parity, what did you say the headwind in the fourth quarter will be or what you expect to record for parity? Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: It'll be slightly or roughly around $0.01. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Okay. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Basically similar to what we did in the third quarter. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Okay. And just remind me the margin on – I'm just trying to make sure I size up sort of what the EBITDA headwind is for the full year. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Well, yeah. So on the top-line basis, roughly you're talking about $52 million difference, right? Because…

Operator

Operator

And next question is from the line of Dana Hambly, Stephens. Please go ahead.

Dana R. Hambly - Stephens, Inc.

Analyst

Hey, thanks for the question. And Roger, appreciate the comments at beginning with the long-term big picture outlook. And with that I'm going to ask a question, that's a very short-term focused. Just on the acquisition front with the change in the trading multiples of the public equity guys, I assume at some point that it trickles over into the private equity market, I'm sorry into the private deals. Does this create a period of inertia in the deal activity? And if so, is that a couple of weeks, a couple of months, a couple of quarters, just any idea there? Roger J. Medel - Chief Executive Officer & Director: Well obviously, my crystal ball, it doesn't work that well. But I have to agree that I think along the same lines as you're thinking along. If multiples have gone down, and the private equity deals of course are based on paying a multiple now that will be increased down the path. So I think that it's reasonable to think that there will be some of these that will be sitting on the sideline in a way to see what happens to multiples between now and the end of the year.

Dana R. Hambly - Stephens, Inc.

Analyst

Yeah. Is that true of the larger deals, is it maybe not so much true with the smaller deals? Roger J. Medel - Chief Executive Officer & Director: Well, I could see that really across all deal sizes.

Dana R. Hambly - Stephens, Inc.

Analyst

Okay. Thanks. Roger J. Medel - Chief Executive Officer & Director: Yeah.

Operator

Operator

Okay. Our next question is from the line of Nicholas Jansen, Raymond James. Please go ahead. Nicholas M. Jansen - Raymond James & Associates, Inc.: Hey, guys. I just wanted to focus maybe a little bit on utilization management by payors. If I go back to look at the birth data from 2003 to 2007 when you guys were growing NICU volume growth at like 3% to 5% when the birth rate was or the number of births was kind of growing 1% to 2%, now the birth rate is kind of growing 1% to 2%, and your NICU volume growth is kind of growing the same as the birth rate. So, I was just wondering if there's anything different today that payers are doing maybe in managed Medicaid that's resulting in that recovery and NICU volume growth never going to potentially happen. Thanks. Roger J. Medel - Chief Executive Officer & Director: Well, that's not how we think about it. I don't think there's anything special going on today. I think that NICU volumes tend to fluctuate admissions based on the patient population that the hospital is serving, et cetera, et cetera. But no, I don't think there's anything different in NICU admissions today than there was seven or eight years ago. Nicholas M. Jansen - Raymond James & Associates, Inc.: I'll keep it at one. Thanks, guys. Roger J. Medel - Chief Executive Officer & Director: Yeah.

Operator

Operator

Okay. Next question is from the line of Brian Tanquilut, Jefferies. Please go ahead.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Hey, Vivian just one quick follow-up. We've been getting a lot of e-mails as the call progressed. People are trying to figure out the comment about the application delays on Medicaid. So how exactly does that impact the payor mix if you're submitting the billings to Medicaid? So if you don't mind just giving us more color to clarify that comment. Thank you. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: It's really based on one state, but how that impacts that is because the payor mix is based on billed. And so I had those unbilled, right? And so now I'm billing them and they were government bills. And so that's why it impacts the numbers of that. But it was specifically in one state. It was an isolated situation.

Brian Gil Tanquilut - Jefferies LLC

Analyst

So to follow-up, just so when you file the bills – let's just say State of Tennessee, it's still Medicaid though, right, in your accounting. So maybe I'm not getting it, but I don't get how it changes the payor mix because in your book it should be Medicaid from the get-go. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: It was unbilled. And so it wasn't...

Brian Gil Tanquilut - Jefferies LLC

Analyst

Unbilled. Got it. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: ...included in the payer mix. Yes, right. So then when I bill it, it gets included as bills. Yes.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Okay. Got it. That makes sense. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Thank you so much. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Yeah. You're welcome.

Operator

Operator

Okay. Now, at this time we have no questions in queue. Roger J. Medel - Chief Executive Officer & Director: Okay. Well, thank you. If there are no more questions, let me thank you for your attendance this morning. I look forward to speaking with you again next quarter. Thanks. Vivian Lopez-Blanco - Chief Financial Officer & Treasurer: Thank you.

Operator

Operator

Thank you. Ladies and gentlemen, that does conclude your conference. We do thank you for joining while using AT&T Executive Teleconference. You may now disconnect. Have a good day.