Earnings Labs

Pediatrix Medical Group, Inc. (MD)

Q3 2018 Earnings Call· Thu, Nov 1, 2018

$22.26

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Transcript

Operator

Operator

Ladies and gentlemen, thank you for standing by, and welcome to the MEDNAX 2018 Third Quarter Earnings Conference Call. At this time, all participants are in a listen-only mode. Later, we'll conduct a question-and-answer session. Instructions will be given at that time. As a reminder, today's call is being recorded. I'd now like turn the conference over to your host, Charles Lynch. Please go ahead.

Charles W. Lynch - MEDNAX, Inc.

Management

Thanks, operator. Good morning, everyone. Welcome to our third quarter earnings conference call. I'm going to read our forward-looking statements, and then I'll turn the call over to Roger. 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 or 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 - MEDNAX, Inc.

Management

Thank you, Charlie. Good morning, and thanks for joining our call to discuss our results for the third quarter of 2018. Our EBITDA and EPS results were within the guidance ranges that we provided in August, despite the challenges related to soft patient volumes. The continued impact of our corporate and operating initiatives helped meaningfully to offset those volume trends during the quarter. And we remain on track to meet the targets that we established for these initiatives in 2018. Before I dive into the results, I wanted to take a moment to discuss an announcement that we made this morning about MedData, our unique management services organization focused on some of the most challenging areas within revenue cycle management, including eligibility services, patient engagement, and patient pay collections. We announced that we are initiating a sale process for this business. This is an important and impressive business, led by a highly capable team, with over 2,000 people working every day to drive results for clients. And based on the dynamic environment and revenue cycle management, the organization has a tremendous opportunity to continue to grow. That said, from a strategic perspective, we have concluded MedData's current opportunities are more parallel to, rather than central to our current plans to grow and develop at MEDNAX. We believe MedData need to start to focus to reach its future potential that will be best achieved under separate ownership, so that is what we plan to do. We would expect to continue to engage MedData services, which have been extremely valuable to us, following a potential sale. And we also believe that the right partner would enable MedData to continue to accelerate and enhance its service offerings. For MEDNAX, this potential transaction would allow us to focus our organization on physician services, which…

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Thanks, Roger. Good morning, and thanks for joining our call. I'll provide a brief overview of our third quarter and some additional details in a couple of areas. Our consolidated revenue growth of 3.2% reflected same-unit growth of 1.2% and acquisition-related growth of 2%. Same-unit growth was evenly divided between volumes and pricing. On the volume side, we saw growth across all of our service lines except neonatology, where NICU days decreased by 1.9%. Radiology was the greatest contributor to volume growth, along with our other pediatric services, primarily newborn nursery care, as well as pediatric cardiology. Pricing growth was driven primarily by modest improvements in managed care contracting. Payer mix trends reduced pricing by only a slight amount, with unfavorable mix in anesthesiology, partially offset by favorable mix in neonatology and other pediatric services. On the cost side, practice salary and benefits expense was $626 million or 69.8% of revenue, as compared to $586 million or 67.5% of revenue last year, reflecting growth in clinical compensation, premium pay, and agency labor, as well as acquisition-related growth, and staffing additions related to our organic growth initiatives. As we indicated, when providing guidance for the third quarter, we are providing continued employment through the end of 2018 to certain physicians affiliated with Southeast Anesthesiology Consultants, who were affected by the contract non-renewal. And the expense related to this employment was accounted for as normal practice salary and benefits expense in our income statement for the quarter. The amount of this expense was roughly $10 million, which is in line with our expectations. Turning to our corporate and operational initiatives. The financial improvements we generated during the third quarter were in line with our expectations. These included operational improvements of $10 million and $6 million in improvements in G&A expense. In the…

Stephen D. Farber - MEDNAX, Inc.

Management

Thanks, Vivian; thank you, Roger; and good morning, everyone. I've worked in prior roles with many of you on this call, and I'm glad to be working with you again. I've been with MEDNAX now for about two months, and I've had the pleasure over this time to get a better sense of the people, the business, and the mission that drives everything that we do here. It's the time of significant change for MEDNAX, and I'm honored to have the opportunity to be part of it. There are two areas where I'd like to focus my comments this morning: First, a few comments on our cost and margin opportunities with the sense of our intermediate and longer-term perspective; and second, some perspective on capital deployment and capital structure. I'll start with cost of margin opportunities. As Roger and Vivian have discussed, there are significant cost initiatives underway with meaningful results already delivered and high expectations for 2019. Roger also commented earlier that there are areas where, we may make additional investments in tools and resources to supplement these initiatives. I've been spending a good portion of my time working to understand opportunities of cost, and while these are preliminary, I believe, there are significant additional opportunities to reduce costs and improve operating efficiency that are incremental to what has already been discussed. To be clear, these opportunities are perhaps a bit less tactical and a bit more strategic. It will require meaningful technology and operational investments and will have longer lead times than many of the change efforts already discussed. These include areas like, technology-enabled process change, shared service expansion and improvements, and also meaningful deployment of administrative tools and technology directly into our practices. In short, we believe there are significant opportunities to harness data and analytics and…

Roger J. Medel - MEDNAX, Inc.

Operator

Thank you, Stephen. And with that operator, let's open up the call for questions.

Operator

Operator

Thank you. Our first question is going to come from the line of Kevin Fischbeck from Bank of America. Please go ahead.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

All right. Great. Thank you. Best wishes, Vivian; and welcome, Stephen. I guess, a question on MedData. How has that business been performing over the past few years? And obviously, the overall business has been under some pressure. Has that business been growing nicely, or has that also been relatively flat earnings trajectory?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

So, good morning, Kevin. Thank you for your comments. And, yeah, so MedData has performed. It had some growth, but honestly, not met our expectations from when we had originally acquired it. I do think that that industry that they're in is changing. And as Roger mentioned in his comments, I think, they need focus to have someone that is going to be able to enable the technology and things that are happening in that industry. And so, we feel that they are going to be better served by having someone that can focus on that, because obviously, given the initiatives that we have here with our physician services arm, that's really what the company needs to focus on at the moment. And so, as we said, they have a great management team. They have a great product. They will continue to be used by MEDNAX, because they've done really well by us in the service line that they have on the patient pay side. But we feel that they need some dedicated focus. I don't know if Roger, you, or Stephen have anything else to add to that?

Roger J. Medel - MEDNAX, Inc.

Operator

No, I think that's it. It's a great company. And we believe they need some investments. And we, at this point in time, just are prepared to make investments in our sector, as opposed to...

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

Okay. So, divesting it won't really change your growth profile at all, as far as how we think about that. And then, I don't know, I guess it's kind of early, but is the thought process that that business, given the opportunity that you see would probably be at a higher valuation than the company overall, where it's trading at right now?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Well, we just started this process, but we have heard from bankers et cetera that that market right now is really looking to expand. And so we think that there are good opportunities. And I'm hesitant to talk about valuation at this point, because it's just too preliminary to tell. But we know that there's a lot of interest in that sector.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

Okay. And then, I guess, trying to dig into the anesthesia payer mix. Is that just purely kind of the demographic story, if you will, of just the senior population growing faster than the commercial population and high deductibles pushing down commercial volumes, or is there something else going on kind of underneath that? I guess, there seems to be a lot of focus on out of network and things like that? Is there an issue contractually on the commercial side that's causing that shift?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yes. So, no, not for us. We're consistent with what we've said in the past related to what you just said on demographics changing and the out of pocket. But we don't see, as we've said before, this issue without a network. And again, the anesthesia mix, yes, it's negative, but it's been consistent in that range. It's not like what we saw at the beginning of 2017. But, nonetheless, nothing else to say there, Kevin; it's the usual, we've said in the past.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

Okay. And then, I guess, just last question then. Nothing else changing as far as kind of your view about what kind of organic revenue growth you need to show margin expansion. It sounds like the company kind of has a renewed emphasis on cost control. I wasn't sure if you guys were thinking that if you're able to execute in some of those efficiencies that you're looking at, you might be able to maintain margins at a lower organic revenue growth rate?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Well, yeah. I mean, that's the goal right? And as Stephen said in his commentary, I think we're looking to continue to evolve that and expand it. And so, I think we're going to have more than what we had announced in the last quarter. And we're actually pretty satisfied with where we're at with it as it relates to the progress, because we have continued to deliver on the metrics that we set internally. But nonetheless, we're not satisfied that, that's where we should end. And so, we're going to continue to look at this. And as Stephen said, make investments where we need to on automation, because we still want to make sure that we can impact some of these premium pay and agency labor and all that. And that'll come with some of the automation there. And so, we think there is a lot more opportunity. But some of these things are more strategic in nature and are going to take a bit longer.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

I guess, just to clarify, I think, it was Roger who said something along the lines that the pressures you're seeing right now are expected to persist. The cost cuttings should hopefully allow you to kind of keep things more stable. But then if things improve off the growth rates that you're seeing now, then you can grow EBITDA. When you say that, are you talking about the 0% to 2% that you expect in Q4, are you talking about kind of year-to-date number, which is even more like 2% or 3%?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yeah. No, it would be more – I mean, if it bounces us back, right, because right now, we saw this quarter, obviously, same unit. And specifically, first, we're not where we wanted them to be. And so, our fourth quarter guidance reflects that because we've seen this volatility in the past, but, yes, we don't expect that to persist. If it doesn't persist, obviously, we'll have a lot more opportunity for margin expansion as well as positive EBITDA.

Roger J. Medel - MEDNAX, Inc.

Operator

Yeah. And one thing I want to add here is that if we go back to 2010, over that 8, 8 1/2 year time period, there's only been two quarters in that time period when we have seen birth decline to this kind of level, the 2% level. So, just to put it into perspective, this was a pretty significant drop in births that we saw during the quarter. And when we see this in the past, births have come back. So, that's what we were talking about.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America. Please go ahead

Okay. Thank you.

Operator

Operator

Thank you. Our next question then will come from the line of Brian Tanquilut from Jefferies. Please go ahead.

Brian Gil Tanquilut - Jefferies LLC

Analyst · Jefferies. Please go ahead

Hey. Good morning, guys. Roger, or Vivian, as I think about margins, just to follow-up on Kevin's question, do you think you can – with the cost cuts, is there an ability to at least hold margins or drive margin expansion if same store remains in the flat to 2% range, you think?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Well, obviously, Kevin, more on the 2% range. So, again, as we look at these cost initiatives, we continue to drive that. And so, not so much on the flat side, that would be a bigger hurdle, obviously, but certainly, on the 2%. Remember, if I can refresh all of your memories, we used to say here that you needed kind of 3% to kind of have margin stability here. And then we kind of started to raise that because of some of the premium pay and some of the salary pressures we were seeing. Now, given some of our initiatives, that's coming back down. And so, yes, there is opportunity there Brian.

Brian Gil Tanquilut - Jefferies LLC

Analyst · Jefferies. Please go ahead

Okay. And then, Viv, just to follow up – or one more question just on the rate side. Are you seeing any more increasing stipend payments? Is that a factor in the deceleration in the same-store kind of rate growth?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

So, yes, thank you for that. So, we do see, as I said to you guys before, some variability in the timing of not only for what you're suggesting on the contract revenue, Brian, which is also true, but also on the managed care piece. Because, again, that just has to do with the timing of when you negotiate the commercial contract. So, that was lighter this quarter than what we had seen for the first half of the year. But again, we're not expecting that to slow down permanently. It's just the timing of the managed care contracting, et cetera.

Brian Gil Tanquilut - Jefferies LLC

Analyst · Jefferies. Please go ahead

So, Viv, just to follow-up on that, like quick question. So, do you still think that you can get managed care rate growth, at least in the NICU side, in sort of the historical 3% to 5%, 4% to 5% range?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yeah. We're still sticking to that. Yes, absolutely. And again, timing related.

Brian Gil Tanquilut - Jefferies LLC

Analyst · Jefferies. Please go ahead

Got it. Thank you.

Operator

Operator

Thank you. Our next question then will come from the line of Ana Gupte from Leerink Partners. Please go ahead.

Ana Gupte - Leerink Partners LLC

Analyst · Leerink Partners. Please go ahead

Yeah. Hey. Thanks. Good morning. So, on the pediatric and child services, beyond the birth rates, are you pursuing share gains with the RFPs that are in the pipeline, cross-selling, well-baby care or any other specialty services? And is that likely to help offset some of the volatility we're seeing just on the secular trends?

Roger J. Medel - MEDNAX, Inc.

Operator

Yeah, for sure. We're pursuing those, and we have special emphasis right now on well-baby care. We only do well-newborn care, probably less than half the hospitals where we provide NICU services. And we think that's a big opportunity for us, and we've got a special program which is focused exactly on that. Also, OB hospitals is another area that is growing very fast for us. So, yes, we're specifically targeting those two areas for growth.

Ana Gupte - Leerink Partners LLC

Analyst · Leerink Partners. Please go ahead

And like when will that materialize do you think in a way that can you know drive more predictable volumes on that service line in that business segment?

Roger J. Medel - MEDNAX, Inc.

Operator

Well, it's materializing every day. I mean, it's contributed to our growth in other services, as we said at the beginning of the call this quarter. And we believe that it will accelerate over the next whatever – this quarter and beyond. And our hope is that we can have a significant opportunity for growth there. But that growth is already happening and has contributed in this third quarter.

Ana Gupte - Leerink Partners LLC

Analyst · Leerink Partners. Please go ahead

Okay. And on the anesthesia side, on the contracting with the anesthesiologists, are you seeing any push from your workforce, from your anesthesia staff, to change the incentive structure more to pay-for-performance or introducing equity or anything? And can you talk about what that looks like for you in the next year or two?

Roger J. Medel - MEDNAX, Inc.

Operator

Yeah, we're renegotiating those contracts as they come due. And we talk about having a different kind of structure where we're sharing revenue with them. And we've already been successful a couple of times in making those changes. And we're hopeful that as we will – and continue to negotiate these contracts, again, when they come due, that we will be able to move more of our existing groups into that revenue-sharing model.

Ana Gupte - Leerink Partners LLC

Analyst · Leerink Partners. Please go ahead

And will that drive volumes that offset any other kind of wage pressure from changes in contracting?

Roger J. Medel - MEDNAX, Inc.

Operator

I mean, I don't know whether it will drive volume or not. I wouldn't say that. What it will do is it will sort of share the responsibility rather than having guaranteed salaries for them to having a percentage of the revenue, which will – and we have seen it already drive them to be just more efficient in how they staff their services, et cetera. So, that's the force behind that.

Ana Gupte - Leerink Partners LLC

Analyst · Leerink Partners. Please go ahead

Got it. Thanks, Roger.

Roger J. Medel - MEDNAX, Inc.

Operator

Yes.

Operator

Operator

Thank you. Our next question then will come from the line of Gary Taylor from JPMorgan. Please go ahead.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Hi. Good morning. Just a few questions. The first one, Vivian, I was wondering if you're going to move up north and retire somewhere cold.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

No, Gary. I'm planning to spend time in Spain.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Okay. All right.

Roger J. Medel - MEDNAX, Inc.

Operator

It's not as cold in Spain.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

But not as cold as the Northeast. Thank you, Gary.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Okay. Best wishes.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Thank you.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

A couple of questions. On the 4Q, when you mentioned the 6 million on the G&A, was that a sequential G&A improvement you were talking about?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

That's year-over-year.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Okay, year-to-year.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yes.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

And then just when we think about looking at the EBITDA this quarter, adding back $16 million on Atrium, EBITDA's up $5 million year-over-year. If we look at the 4Q guidance, we add back $15 million, $16 million. It's flat to down. Is that just purely a function of the fact you had really strong same-unit revenue growth? In the fourth quarter last year, you're guiding only 0% to 2% this time around. So, just the negative operating leverage, or anything more explicit than that?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yeah. So, it's a little bit of all of that, but also given that obviously we kind of lowered the revenue, given what we saw in the third quarter, right. So that's a piece of it, right, the flat to 2%. And then, there's things that usually happen in the fourth quarter that are a little different from the third quarter, namely, as you would expect, there's some higher expenses. So, typically, we do see about a 50 bp to 60 bp decline in margins there because of seasonality. So, a few of those things are, as you would expect, some of the year-end true-ups like, typically, you have a little bit higher healthcare costs. You do have true-ups on bonuses, as we're going through and looking at what the practice results are. And then, just supplies and practice expenses are typically a little big higher. So, all of that does contribute to Q4 being slightly on the margin side, being slightly less than Q3, everything else being the same.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Okay. And then last question. Correct me, if I'm mistaken, but I believe last quarter, Roger, you had said 2019 would be a year of modest EBITDA growth. Wondering if you're still seeing that, and if that includes/excludes the EBITDA headwind you still have from the Atrium contract exit in the first half of the year?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yeah. So, we are still – I mean, obviously we have a different baseline right, but yes, we are expecting to continue with some growth there. And remember, that we do have the lap of the year-over-year with the Charlotte matter, because even Q3 – I think one of guys put that in one of the notes. I can't remember who it was, but barring Charlotte, we did have some positive growth in Q3. Again, Q4 being slightly less given some of these things that I mentioned on the margin. But yes, we're expecting 2019 to have growth.

Gary P. Taylor - JPMorgan Securities LLC

Analyst · JPMorgan. Please go ahead

Great. Thank you very much.

Operator

Operator

Thank you. Our next question now is going to come from the line of Chad Vanacore from Stifel. Please go ahead. Chad Christopher Vanacore - Stifel, Nicolaus & Co., Inc.: Thanks. So, on the anesthesia physician contracts that you're carrying to the end of the year, should we expect that full cost to evaporate after year-end; or alternatively, what percent of those contracts do you expect to retain into 2019? So, have you moved a portion of these clinicians to other practices, and are they servicing other contracts?

Roger J. Medel - MEDNAX, Inc.

Operator

Yeah, we have moved some physicians, but it evaporates at the end of 2018. Chad Christopher Vanacore - Stifel, Nicolaus & Co., Inc.: All right, Roger. That, basically $9 million EBITDA lift that you get in first quarter?

Roger J. Medel - MEDNAX, Inc.

Operator

Right. Chad Christopher Vanacore - Stifel, Nicolaus & Co., Inc.: Okay. And then just on MedData, what percentage of that $46 million EBITDA generation is internal to MEDNAX? So, presumably, a large portion of this is intercompany income?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

So, it's probably roughly in the 10% to 12% range. Chad Christopher Vanacore - Stifel, Nicolaus & Co., Inc.: All right. That's it for me. Thanks.

Roger J. Medel - MEDNAX, Inc.

Operator

Thanks, Chad.

Operator

Operator

Thank you. Our next question then will come from the line of Matt Borsch from BMO Capital markets. Please go ahead.

Matthew Borsch - BMO Capital Markets

Analyst · BMO Capital markets. Please go ahead

Hi. Yes. Thank you. Could you just talk about your acquisition strategy going into 2019? How is the trends – if at all, the trends in the back half of this year affecting your view of what you want to do next year?

Roger J. Medel - MEDNAX, Inc.

Operator

Well, at the end of the day we're going to have to grow our way. And there's only so much you can cut. And although we have a lot of room, I think, to still gain some efficiencies, we have to think about our growth as well. I'm very excited about this large neonatal practice that we acquired right after the third quarter. It's a practice that we have been looking at and friends with for many, many years. And it demonstrates that we are able to – if you remember, historically, we bought neonatology practices in the four to five multiple ranges, and that's exactly where we were able to accomplish this very large acquisition. So, we have a renewed effort to re-contact the existing neonatology practices that are still out in the market. And we believe that we may be able to get maybe one or more of those deals done in 2019, so we're excited about that. We're excited about radiology. We do have some growth in radiology. I think, this fourth quarter, we will have two of the four radiology practices that we acquired last year, will fall into the same-unit calculation. And I think that will be helpful to us both our large practice in South Florida, as well as the one up in Connecticut. And so, we believe that will contribute to our same-unit growth calculations as well. So, all of that is looking good for us, starting in the first quarter of next year. And we will continue to focus on women and children's services acquisitions particularly in the neonatal field and some radiology, as I stated on the call, some smaller tuck-in kind of acquisitions. And hopefully, we'll see opportunities to enter other markets that makes sense for us from a geographic and a payer mix standpoint. And I think we'll see even before the end of this year a small radiology acquisition to follow as well. So, that's, as we said, a combination of share repurchases and strategic acquisitions is where we see 2019.

Matthew Borsch - BMO Capital Markets

Analyst · this year a small radiology acquisition to follow as well. So, that's, as we said, a combination of share repurchases and strategic acquisitions is where we see 2019

Just one quick follow-up, which is, are you seeing the neonatology volume trends impacting valuation in a way that might benefit you in the near term?

Roger J. Medel - MEDNAX, Inc.

Operator

Well, I think the valuation of our neonatal, like I said, – I'm sorry, I'm not sure I understand your question.

Matthew Borsch - BMO Capital Markets

Analyst · BMO Capital markets. Please go ahead

Well, I'm sorry, I mean, in terms of potential acquisitions that maybe this becomes a little bit better environment to do acquisitions, because the market's not as hot?

Roger J. Medel - MEDNAX, Inc.

Operator

For neonatology you mean?

Matthew Borsch - BMO Capital Markets

Analyst · BMO Capital markets. Please go ahead

Yeah.

Roger J. Medel - MEDNAX, Inc.

Operator

I don't think – no. I mean, I think that being able to acquire these practices at a 4 to 5-time multiple is pretty good. And it's not been a valuation issue that has kept these practices from joining us. It's always a fear of losing their independence. That is always the number one reason why, these larger practices that are still left elect not to come, be part of what we're doing.

Matthew Borsch - BMO Capital Markets

Analyst · losing their independence. That is always the number one reason why, these larger practices that are still left elect not to come, be part of what we're doing

Got it. Thank you.

Roger J. Medel - MEDNAX, Inc.

Operator

Yeah.

Operator

Operator

We have a question from the line of Ralph Giacobbe from Citi. Please go ahead.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst · Ralph Giacobbe from Citi. Please go ahead

Thanks. Good morning. I just want to go back to expectations for growth in 2019. And maybe more specifically try to get to the right baseline as you guys are thinking about the business, and where we're at this point. I mean do you think it's fair to use that fourth quarter EBITDA number as sort of a run rate maybe after making the SAC adjustment? Is that the sort of a reasonable way or jumping off point to think about 2019 at this point?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Well, we're hoping that it'll get better, because, again, fourth quarter, as I mentioned in the prior question, the margins do get impacted with some of the things that are usually year-end phenomenons, as you true-up the books for the year for healthcare and all that stuff. So, we would expect it to be slightly better.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst · Ralph Giacobbe from Citi. Please go ahead

And just if I could push on that a little bit, because I think, typically, your first and second quarter are your weakest EBITDA generating quarter. It's usually sort of third and fourth that are a little bit more than a quarter of the EBITDA contribution. So, I just want to make sure I understand sort of the seasonality of using that or not using that.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

So, thank you for that clarification. It's the first quarter that we do have significant seasonality. Because one of the things that happens in the first quarter is that these physicians are meeting their FICA expense and all this, so it is much lower. So, the first quarter is the one that has the big seasonality. I was referring to between third and fourth quarter.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst · Ralph Giacobbe from Citi. Please go ahead

Yes, okay. I guess, I'm just trying to get to the baseline of how to think about – when we think about growth in 2019, just what the right – there's been a lot of moving parts, a lot of pressure in the business. And so, it's just whether or not you see fourth quarter as kind of a good starting point or not. And it sounds like the answer's no, because of these incremental considerations.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Well, I mean, yes. You adjusted for some of the – like I said, it's roughly 50 basis points to 60 basis points in margin; and then, of course, what we said, the Southeast impact. So, if you do that adjustment then, you're in the ballpark. Again we're hoping that organic growth is not going to continue to be flat to 2%. We're hoping that we go back to more of the first half of the year trends. So, that, hopefully, will be impacted positively as well. But nonetheless, that would be in range barometer there.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst · Ralph Giacobbe from Citi. Please go ahead

Okay. All right. Thank you.

Operator

Operator

We have a question from the line of Matthew Gillmor from Robert Baird. Please go ahead. Matthew D. Gillmor - Robert W. Baird & Co., Inc.: Hey. Thanks for the question. Picking up on the 2019 outlook. And you've talked about sort of low mid-single digit growth, so sort of an expectation. Can you give us some sense for what's assumed from a birth perspective? Does that sort of contemplate flat births or positive birth?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

I wish we could be so good, but we're not. So, I will admit to that. We don't have that crystal ball. So, usually, what we do is that we make an assumption on overall same-unit, because we can't be as precise as that. We just can't. Matthew D. Gillmor - Robert W. Baird & Co., Inc.: Got it. And one quick follow-up. So, the MedData EBITDA number you disclosed, is that the number we should think about coming out of MEDNAX's EBITDA, or are there any costs that won't go away, or maybe some overhead that you can remove, so you actually get a bigger benefit than the $46 million? Just wanted to sort of understand how that impacts MEDNAX when it's removed.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Yeah. So, roughly, that's the number, because they've been operating pretty independently, so there's not overhead here that is justifiable to go away for that reason. Matthew D. Gillmor - Robert W. Baird & Co., Inc.: Got it. Thank you.

Operator

Operator

Thank you. We have a question from the line of A.J. Rice from Credit Suisse. Please go ahead. A.J. Rice - Credit Suisse Securities (USA) LLC: Hi, everybody. Best wishes, Vivian; and congratulations to Stephen. Just a couple of very specific things around the third and fourth quarter. I think you mentioned a couple of times increased clinical compensation contract and premium labor. Is that sort of just the ongoing dynamic that you've been experiencing for a while, or was there a step up somehow in the current quarter? And do you think that's going to continue? I guess, I would also ask about 0% to 2% in the fourth quarter. I just want to make sure, I understand what's behind that. Is that simply assuming that what you saw in the NICU and births in the third quarter persist in the fourth quarter, or is there something else behind that, that's building up to that revenue growth expectation? And then my last piece on this is – thanks for the comments about the contribution from the two cost-reduction initiatives. But I think last quarter, the comment was that you expected about $35 million in operational improvements in 2018 and about $25 million on the G&A cost initiative. Is that still the goal for this year? Are you on track for that, or has there been a change?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

No, no. We're on track for that. So, if you add up what we said, we're pretty much in that ballpark. So, we think that like I said before, A.J., the experience we've had so far has been positive, and we've been delivering on both the G&A side, as well as the operational efficiency side. A.J. Rice - Credit Suisse Securities (USA) LLC: Okay.

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

Your other question, let me see if I remember all parts of it. So, I think the prior piece of it was related to what we have in the forecast for the fourth quarter as it relates to top line. So, yeah, that does continue the trend, because we don't know – as Roger said, we typically don't see it as so harshly, certainly on NICU births, but we think it's just conservative to continue with that at least for the next quarter. And so, that's what it does. There's nothing more to than that. And then, as it relates to the salary and benefit plan, I think it was the last piece of your question. Yeah, actually, it did get slightly better because we still saw some increases, as I said. But it really was slightly better than what we see in the first half of the year, and certainly, on the nurse anesthetist side for sure. A.J. Rice - Credit Suisse Securities (USA) LLC: If I can maybe just clarify one point on that fourth quarter, NICU assumption. I know it's probably not fair to ask this, but is that just your assumption, or do you have something in the October results that you're seeing already that suggest – it sounds like it's fairly unusual to have two quarters like this in a row. But I just wondered, do you see something and sort of the early read on the quarter so far that suggest it'll continue to be that soft?

Vivian Lopez-Blanco - MEDNAX, Inc.

Management

No, we haven't. But again, we want to deliver the forecast that we have set out there. So, we thought it'd be prudent, given that, that's something we can't control. A.J. Rice - Credit Suisse Securities (USA) LLC: Okay. All right. Thanks a lot.

Operator

Operator

Thank you. And at this time, I have no further questions in queue.

Roger J. Medel - MEDNAX, Inc.

Operator

Okay. If there are no further questions, I'll thank everyone for participating this morning. And I will look forward to speaking with you again at the end of the fourth quarter. Thank you, operator

Operator

Operator

Thank you. And ladies and gentlemen that does conclude our conference for today. Thank you for your participation and for using AT&T Executive TeleConference. You may now disconnect.