Earnings Labs

Option Care Health, Inc. (OPCH)

Q1 2018 Earnings Call· Thu, May 10, 2018

$27.80

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Transcript

Operator

Operator

Greetings and welcome to the BioScrip First Quarter Fiscal 2018 Financial Results Conference Call. At this time, all participants are in a listen-only mode. A question-and-answer session will follow the formal presentation. As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Ms. Kathryn Stalmack. Please go ahead.

Kathryn M. Stalmack - BioScrip, Inc.

Management

Thank you. Good morning and thank you for joining us today. BioScrip's first quarter 2018 financial results were released earlier this morning. A copy of the release can be found in the Investor Relations section of our website at www.BioScrip.com. Within two hours of the call's completion, an audio replay will also be available in the Investor Relations section of BioScrip's website. Dan Greenleaf, President and Chief Executive Officer; and Steve Deitsch, Senior Vice President and Chief Financial Officer and Treasurer will host this morning's call. Before we get started, I would like to remind everyone that our comments may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act. Such forward-looking statements are based upon current expectations and there can be no assurance that results contemplated these statements will be realized. Please refer to our press release and our reports filed with the SEC, where you will find factors that could cause actual results to differ materially from these forward-looking statements. These forward-looking statements are based on information available to BioScrip today, and the company assumes no obligation to update statements as circumstances change. During the presentation, we will refer to adjusted EBITDA, a non-GAAP financial measure. A reconciliation of the most comparable GAAP financial measure is contained in our press release issued this morning. And now, I'd like to turn the call over to Dan Greenleaf. Dan?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Thanks, Kathryn. Good morning, everyone, and thank you for joining us. This morning, I'll discuss our first quarter 2018 performance and review some of the actions we're taking to drive continued improvement of BioScrip through remainder of this year and into 2019. I'll then hand it over to Steve Deitsch, our Chief Financial Officer for a more detailed discussion of our financial results and an update on our guidance for 2018. In the first quarter, we continued to execute successfully on our turnaround strategy, delivering 16% year-over-year growth in adjusted EBITDA. Higher core revenue mix increased gross profit margins and lower operating expenses drove our year-over-year improvement in adjusted EBITDA. Core revenue mix expanded 350 basis points to 75.4% for this quarter, up from 71.9% in the first quarter of 2017. In turn, our gross profit margin increased 32.7%, a 530 basis point improvement over the prior year on an apples-to-apples basis adjusting for ASC 606, a new accounting standard that Steve will address a bit later in the call. Similarly, operating expenses declined by $3.6 million compared to the prior year quarter. We achieved this performance despite facing higher than normal inclement weather in the Northeast that caused a significant number of temporary branch closures. 26 occasions where a branch was closed for a whole day and 49 occasions where a branch was closed for a partial day, which negatively impacted our first quarter 2018 adjusted EBITDA by an estimated $1.3 million due to lost sales of approximately $2.5 million, primarily for higher margin antibiotics therapies. In effect, we lost one billing day during the quarter due to inclement weather. Additionally, we incurred higher-than-average product acquisition and delivery expenses to serve our patients in the face of temporary industry-wide product shortages including immunoglobulins, antibiotics, IV solutions and supplies, which…

Stephen M. Deitsch - BioScrip, Inc.

Management

Thank you, Dan and good morning, everyone. My prepared remarks will include additional information on the company's first quarter performance and 2018 guidance. Net revenue for the first quarter of 2018 was $168.6 million compared to $217.8 million in the first quarter of 2017, a decrease of $49.2 million or 22.6%. This revenue decrease resulted primarily from our shift in strategy to focus on growing BioScrip's core revenue mix including contract changes with UnitedHealthcare effective September 30, 2017. The impact of the implementation of ASC 606 which during the first quarter of 2018 resulted in the recognition of amounts previously reported in bad debt expense, being reported as a reduction of revenue and lower patient volumes in certain product lines, including the impact of inclement winter weather. Our revenue mix in the first quarter was 75.4% core and 24.6% non-core with core mix increasing 350 basis points above our 71.9% core revenue mix in the prior year quarter. Gross profit for the first quarter of 2018 decreased $9.8 million or 15.1% compared to the prior year period, due to a lower first quarter 2018 revenue base including lower sales of antibiotic therapies that carry higher than average gross profit margins, the implementation of ASC 606 in the first quarter of 2018 and higher product acquisition and delivery costs related to temporary product shortages, offset partially by the impact of higher core product mix due to our core strategy, including the UnitedHealthcare contract transitions and supply chain improvements. Gross profit margin for the first quarter of 2018 was 32.7%, a 530 basis point improvement compared to the prior year quarter, stated on an apples-to-apples basis adjusted for the impact of ASC 606 adoption. Operating expenses were $49.4 million for the first quarter of 2018, a $10.6 million or 17.6% reduction compared…

Operator

Operator

At this time, we will be conducting a question-and-answer session. Our first question come comes from David MacDonald of SunTrust Robinson Humphrey. Please proceed with your question.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Good morning, guys. A couple of questions.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Hey, good morning, Dave.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Dan, can you just talk a little bit about the product shortages, did you see that linger – are we back at normalized levels or is there still a little bit of a drag. And if – and just give us some sense of the timing of that. I would assume that there's a little bit of leakage in terms of impact into the second quarter. But just wanted to get some clarity on that so we have a better sense of the pacing of the quarters?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah. So just – so just for everybody's for the purposes of the broader group here. This was initiated or began with the hurricanes that went through Puerto Rico predominantly. And most of our manufacturers have facilities in Puerto Rico. And if the Puerto Rico facilities come back online and begin to produce product again, as we see they have, we expect this to go down. We also had kind of an anomaly today with one of our immunoglobulin products that, by way of a – by way of – it really was a paperwork mistake by the company that resulted in that product being unavailable to us for about three months or four months. And so you've seen this movie. I mean we switch all the patients over to one product and then we have to switch them back and we had already switched the patients over to another product. And on the Puerto Rico's, if you will, supply issues, I mean what it caused us to do was, we spent a lot of money in delivery this quarter because we were moving stuff around branches. We also did, as you could imagine today, we did some buyouts just to make sure that we had enough inventory. But I see it largely behind us in terms of order of magnitude, Dave. I still think there'll be some one-offs going forward but I think by and large I think it's mostly behind us.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Okay. And so just on the idea – on the immunoglobulin patients, those are kind of settled in, you've got them back on whatever therapy is most appropriate and then in terms of the forward buys you kind of have all the product you need and you're back to kind of normalized levels there?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah. I would say yes the both of those, Dave.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Okay. Okay. Secondly, Dan, can you talk a little bit about, look everyone on earth is talking about value-based care and you guys mentioned it a little bit in your prepared comments. But...

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yes.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

...are you actually seeing contracts or talking about contracts where there's an opportunity to participate depending on a set of outcomes and value-based metrics where if you guys perform there's a potential opportunity care in (21:33) some of the savings?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yes, we are.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Okay.

Daniel E. Greenleaf - BioScrip, Inc.

Management

And we're doing that at the payor level, we're doing it at the integrated delivery network level. We also see significant opportunities potentially do it with physician groups. So, yeah, and again I think by virtue of what we do, Dave, and I know you can appreciate this [Technical Difficulty] (22:00) value-based care.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Sure.

Daniel E. Greenleaf - BioScrip, Inc.

Management

And our business it by – in its essence is value-based care because it's more – it's as effective, it's safer, it costs a hell of a lot less for the patients and the healthcare system and the patients provide. There's not a metric that I can think of that we don't win on. And again if you look at any of the metrics that that we measure, we think we are value-based care already. We also believe we're already the transformative company in this industry, Dave. I think there's a whole bunch more that's going to come out of this, out of this company and this team here in the mid-term. And I prefer to talk to some of this stuff not in a broader group because it has strategic implications.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Yeah. Okay. Steve, just a couple of questions, I assume just given that the EBITDA guidance hasn't changed, the expectations around cash flow and free cash flow are unchanged, is that accurate?

Stephen M. Deitsch - BioScrip, Inc.

Management

Yeah, that's correct, Dave. We – as Dan mentioned, we did do some inventory buy-ups and you can see that on our balance sheet. So we are carrying a higher level of inventory today than we typically would. And so we will likely have some additional inventory payments in the second quarter higher than maybe a typical quarter but that will even out as we go through the balance of the year.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

And is it fair to say, Steve, some of the progress you've made on revenue cycle management should wash some of that out as we think about it on an annual basis?

Stephen M. Deitsch - BioScrip, Inc.

Management

That's correct, we're making a lot of progress there as Dan outlined, our new team and our existing team mates that have been working hard for several quarters are making a lot of progress. I mean the denied claims reduction...

Daniel E. Greenleaf - BioScrip, Inc.

Management

It's – I mean...

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Yeah.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Dave, it's just remarkable because we've been – I mean this company been pounding on that for six years, seven years. We pounded on it here the day we got here and it's – when you've got – you end up with the right people in the right seats like Danny and his team and Harriet and her team, things happen quickly. And I even look at like what's happened on the held revenue, I mean, we – the held revenue at our simple verification location has gone from – this is, these aren't big numbers but they've gone from somewhere in the $3 million range to $300,000. But all these things just add up in terms of, as you can imagine in terms of cash flow, in terms of working capital. We've also done some things, Dave, in terms of just orientation and we had a – we were unbalanced related to our collectors versus our billers. We had more, we were over-weighted in collectors. And so one of the things we've done is we've shifted the orientation of the organization more to billers. And that – I mean it makes obvious sense, why you do that because you bill to get paid. But again in some instances, it just wasn't intuitive here. And – so I really – I got to tell you and as we – as this – as our revenue cycle management team continues to make this progress, I – where I've shared three or four things, we've got 10 other things that again for somewhat for strategic purposes, I don't want to share but suffice to say this is gone, what I see is this is gone from a very much a weakness prior to kind of this team coming onboard to what I would describe as really one of the strengths of the organization and it's only going to get stronger going forward.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Okay. Guys last question, just with regards to the patients that were impacted by the Cures Act, I know various different competitors did different things in terms of potentially moving away from those patients or not. I know you guys stuck by them. Is there a chance that you're seeing disproportionate growth amongst some of those folks and that that $9 million potentially has an upward bias by the time some of the payment rules change?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah. Dave, what I would share with you is that our census hasn't dropped.

David S. MacDonald - SunTrust Robinson Humphrey, Inc.

Analyst

Okay. Okay. Thanks very much, guys.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thanks, Dave.

Daniel E. Greenleaf - BioScrip, Inc.

Management

All right. Thanks, Dave.

Operator

Operator

Our next question comes from Brooks O'Neil of Lake Street Capital Markets. Please proceed with your question.

Brooks O'Neil - Lake Street Capital Partners

Analyst

Good morning. So, I was just hoping to follow-up a little bit on some of the things David was asking about specifically. I know you're not providing quarterly guidance but can you give us sort of an impression of what you expect to sort of quarterly progression to be. Are we looking at a hockey stick type earnings here, where the bulk of the $54 million to $58 million is in Q4, or are we looking at more of a steady sort of linear progression from here to whatever number makes sense for Q4?

Daniel E. Greenleaf - BioScrip, Inc.

Management

So, Brooks, the only thing I can share with you, look at last year. Look, last year is an excellent analog for how this business ebbs and flows.

Brooks O'Neil - Lake Street Capital Partners

Analyst

Perfect. Secondly, obviously there's a lot of pending consolidations in the industry, do you see or have you seen anything that's likely to impact BioScrip and BioScrip's opportunities in the marketplace?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Not at this time, Brooks. I mean, I – what I – what – so those consolidations are occurring, but frankly what I'm more excited about, Brooks is, I'm excited about where the trends are going in healthcare. I'm excited about the conversations that we're having with payors about redirection programs and the materialness of those – of those conversations, which are so far advanced from at any point in time that I've been part of this industry. I'm excited about the trends that are undeniable about patients moving to the home and that care is being redirected to the home. And that outside of the operating room, outside of the ER room and outside of the ICU, the home will be the general ward. And so as much as there are – there are external factors that are occurring, Brooks, in the marketplace, I think, I fundamentally – I don't think, I fundamentally believe that we have a much more ability to impact the outcome of this company much more than any external factors that are occurring. And we've got – we just have a ton of wind at our back and it's – my mind is – are we prepared to take our future. And I feel like I talked about Vision 2020, I feel like we're better prepared than ever. And then I look at the broader organization and I look at every – if we look at last quarter, first quarter of 2017, you compare it to first quarter of 2018, I don't care what you look at, we're better off. We're better off margins. We're better off core. We're better off liquidity wise. We're better off in terms of operational cash flow. We're way, way, way better off in terms of a management team. And moreover, I'm not facing Cures, I'm not facing a refinancing, I'm not incurring the challenges of exiting a UnitedHealthcare contract. I'm not undergoing significant management changes and I'm not integrating a company. So, when I look out, Brooks, and I look out to the future, and I – this is really a future-looking question you're asking me. I don't think we've ever been in a better position as a company in the 10 years or 12 years or whatever period of time this thing's been public.

Brooks O'Neil - Lake Street Capital Partners

Analyst

Great. Thank you very much. That's all I had.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thanks, Brooks.

Operator

Operator

Our next question comes from Kevin Ellich with Craig-Hallum. Please proceed with your question.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Good morning, guys. Thanks for taking this question.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Hi, Kevin.

Stephen M. Deitsch - BioScrip, Inc.

Management

Hi, Kevin.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

I think (30:31) so we saw some nice improvement on the quarter revenue mix, Dan. Just wondering your thoughts in terms of still on track to get to that 85% mix. Have you guys – can you remind us, how long do you think that'll take? Are we going to see it in the next four to six quarters?

Daniel E. Greenleaf - BioScrip, Inc.

Management

I think, how I look at it is, if we're really humming along here, I think you could look at 1%, somewhere 1% every couple of months I think would be – I think would be accurate. I think that – and in some instances, for example, at other places I've worked, we've seen 1% every month. But just for the purposes of gauging the speed at which this happens, I would say probably 1% every couple of months in terms of... (31:23)

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Okay. That's helpful. And then clearly you've made some nice investments in the management team and the sales force, et cetera. You know, could you provide some color in terms of I guess, key takeaways and how are you measuring. I mean, you've clearly shown up in the results, but just a little bit more color on other investments that you might need to make or we kind of at that point where you've done enough?

Daniel E. Greenleaf - BioScrip, Inc.

Management

No, I think, again, if I look at my Vision 2020 or our Vision 2020, and I think about the four pillars, one is field force effectiveness. Another one is revenue cycle in bad debt. Another one is procurement and another one is strengthening the relationship with the payors. You know, we're going to continue to make investments in those areas that we believe will get us to that above $75 million in 2019, Kevin. So and that includes things like IT, technology is very important. I think, part of it also is – as we reframe this business as what types of people do we invest in, that's really important. And again, as we look to continue to transform this industry and transform this company, we're going to continue to make strategic investments in certain people. And again, I hope you understand I've got competitors sitting on the phone, and I don't really want to tip my hand to them. But suffice to say that we'll continue to make those. I don't think, if you're looking at it from a CapEx standpoint or an OpEx standpoint, I don't think it's anything extraordinary, Kevin. So I don't – I don't think there's anything that really is going to be a got you or jump out at you. You know we've made a lot of investments since we've been here and disciplined investments, I would say, and strategic investments and I think you'll continue to see that practice.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Understood, that's helpful. And then, Steve, you talked a little bit about pacing for the year and whatnot but are there any other costs that we should be thinking about as we update our models over the next few quarters? And then on top of that could you get – could you tell us what the adjusted DSO was and maybe I missed that in your prepared remarks for the impact from the weather and whatnot?

Stephen M. Deitsch - BioScrip, Inc.

Management

Yes. So, hi, Kevin, thanks for your question. And I would tell you that there's really nothing incremental or out of the ordinary coming with respect to our operating expenses as we move into the second half of the year. I think Dan did a nice job of re-articulating what we've – we said on last quarter's call that we expect our EBITDA to progress this year in the same manner that it did in 2017. And if you look at the way last year progressed, we're sort of right on track with where we expected to be and with getting to the $54 million to $58 million.

Daniel E. Greenleaf - BioScrip, Inc.

Management

And with the exception obviously of the shortages.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Right, sure.

Daniel E. Greenleaf - BioScrip, Inc.

Management

In the northeasters.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Yep.

Stephen M. Deitsch - BioScrip, Inc.

Management

Yeah. So we're comfortable and we've got, Dan articulated again a number of drivers that will continue to enhance our profitability revenue cycle being a significant component of that from a cost perspective as well as a DSO perspective, and then also supply chain. Supply chain is going to continue to drive our gross profit margin. And so will our core product mix, so those – those are going to be big drivers as we move into the second part of the year.

Daniel E. Greenleaf - BioScrip, Inc.

Management

I think the other thing, Kevin, I'd say about this is that, one of the reasons why I like how well-positioned we are, is because we get the advantages of scale. So in other words, we get the advantages that UnitedHealthcare or Walgreens or CVS has in terms of purchasing power. And as well as, I think strength of our ability to hire the absolute best talent which we've done as a company. And we also are not disadvantaged by being too small. And then where you just – you're not going to have sophistication on the payor side. You're not going to have the sophistication on the revenue cycle management side. You're not going to have the sophistication at different levels within our organization and which really puts us in a really unique position where it doesn't take 17 signatures to get a roll of toilet paper. And on the other hand, it doesn't – we don't have all of the – and I've worked at Schering-Plough for a decade, so I know what that was like. And then on the other hand, we're not so fragile that we can't make – or less attractive that we can't make the right investments that we know that are needed to scale this industry and to scale this company.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Sure. Well,

Stephen M. Deitsch - BioScrip, Inc.

Management

And Kevin just to...

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Yep, go ahead.

Stephen M. Deitsch - BioScrip, Inc.

Management

Kevin, just to answer your second question on DSO. We're at 45.8 days at the end of the first quarter compared to 44.2 days last year. And that's really at an intentional. We're really focused on collecting old receivables instead of writing them off. I think previous, some previous practices were to focus more on a DSO level and we're – and our teams are more focused on not necessarily writing off old receivables, we're really focused on collecting them. And one of the things that we didn't mention earlier is, we've seen – we expect that we've got (37:43) $5 million of targeted DSOs that are over 360 days old that we're still, we expect to collect and the team, they're making a lot of progress on it. And so, I think, that's...

Daniel E. Greenleaf - BioScrip, Inc.

Management

That's another really amazing thing, Kevin, because in the past, this company would have written all that off and we were just looking most recently at like $5 million that historically would have been written off. And we've already collected $2 million of it.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Wow, (38:11)

Daniel E. Greenleaf - BioScrip, Inc.

Management

And this is just one example of where things are just way better here in terms of – and again, as we talk about the strength of our business is our revenue cycle management team.

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

That is the impressive. I think most companies would write-off receivables when they're turning 360 (38:25) days old, so that's really impressive. And Dan again, it's great that you guys don't have to worry about getting 16 (38:32) signatures to get the toilet papers, so. Anyways, thanks guys... (38:38)

Daniel E. Greenleaf - BioScrip, Inc.

Management

I couldn't resist. I couldn't resist, Kevin. Do you have to do that?

Kevin Ellich - Craig-Hallum Capital Group LLC

Analyst · Craig-Hallum. Please proceed with your question.

Hopefully not.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Okay, good.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thanks, Kevin.

Operator

Operator

Our next question comes from Brian Tanquilut of Jefferies. Please proceed with your question.

Jason Plagman - Jefferies LLC

Analyst · your question.

Hey, guys. It's Jason Plagman on for Brian. So just wanted to dive a little deeper on a couple topics that you mentioned as part of Vision 2020. So your first one on the supply chain savings, what level of savings do you think that initiative could drive over the next couple of years separate from the improvement in the core mix, but just pure, better purchasing savings?

Daniel E. Greenleaf - BioScrip, Inc.

Management

I think eight figures would be a reasonable target.

Jason Plagman - Jefferies LLC

Analyst · your question.

And as far as – is that spread over a few years or how quickly can you achieve that number?

Daniel E. Greenleaf - BioScrip, Inc.

Management

I think we're well on our way.

Jason Plagman - Jefferies LLC

Analyst · your question.

Okay. Fair enough. And then on the – expanding your relationships with the payors, any additional color you can provide on progress on that front and when we – should we expect to see any benefit from that in the second half this year, is that more of a 2019 lift?

Daniel E. Greenleaf - BioScrip, Inc.

Management

No, I think that we have one instance where we have one payor that a third of our revenue now comes from redirection. So we're seeing it already.

Stephen M. Deitsch - BioScrip, Inc.

Management

Yeah.

Daniel E. Greenleaf - BioScrip, Inc.

Management

And I just think there is, and I – as we've staffed up our managed care team, there isn't – I don't think there's a payor we're talking to, Jason, that isn't saying what we're doing is not a really, really good idea. And so I don't think these things are – obviously most of these are big companies that don't move really fast but there is – I think there's clear energy behind this. And we've already demonstrated pretty substantial (40:55) results that that are really helping us in these discussions.

Stephen M. Deitsch - BioScrip, Inc.

Management

And, Jason, this is Steve. I would just add to that that Dan outlined that as one of our investment areas and we've really built out a, what we think is an industry leading payor relations team and that team is in the field every day meeting with payors during the first quarter they had 47 visits with payors that we have not met with in the past. And so these people are getting out and building these relationships and talking about the benefits of BioScrip and redirection and it's making a difference.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah. And just you know, Jason, when I joined there was not a payor team here. I mean there was a couple people that did this, but there was not what I would describe as a payor team that's really ready to help with the transformation and I think we're extremely well-positioned to do that now.

Jason Plagman - Jefferies LLC

Analyst · your question.

Great, that's helpful. And then last one from me, any concern about or impact that you're seeing from the tight clinician labor market in – and nurse wage inflation or wage inflation in general?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Well, it's so interesting. That's a great question, Jason, and I fully understand it because we're seeing the tight labor market across the board. I mean we're here in Denver and unemployment is I think below 2% now. So it's real and I don't know if you've seen any of the Wall Street Journal articles talking about companies going into the teenager ranks now, I mean GE's even doing this. So we understand that's a macro issue. The interesting thing is about our nursing population is that 70%, 80% of them have what's called a certificate that it gives them a special qualification to serve patients. I guess the best way to describe the kind of serve patients at home. Now they don't have to have this but 70% to 80% elect to have this. So this is a really kind of unique subset of nurses that love to deliver care in the home, they love kind of the autonomy that comes with that, they love the flexibility that comes with that. And we're starting to do some really cool stuff with them too that I think they really feel like they can be an active participant in this transformation. So it's, yeah, we'll have – there'll be some markets that we're challenged in. But again I think we've got my view of it is, first of all, we have an amazing nursing team. And again you look at this top box score of over 85%, which is just unbelievable. And secondly, we've got a nursing team that really loves this industry, loves what they get to do and this is a very unique, a very unique role in the overall nursing community. And when you – and when you find the right person here and again if you just look at, they elected to get this certificate, there's a tremendous loyalty to the patients and there's tremendous loyalty to this industry.

Jason Plagman - Jefferies LLC

Analyst · your question.

That's helpful. And so it sounds like it's not of concern that your operating expense could be pushed up by inflation in the near-term?

Daniel E. Greenleaf - BioScrip, Inc.

Management

I don't really see it. One of the neat things we've been able to do this year, Jason, is for the first time since 2009 we paid bonuses to the organization and we also were able to distribute equity amongst a number of our team members that historically had not gotten that before. So there's other things we're doing that I would share with you that BioScrip historically hasn't done that had been very, very meaningful also to team members here and I think we got – as a result of what we went through last year in terms of turning this company around, I think we've got a level of engagement amongst our team that's, I think just continues to grow and improve.

Jason Plagman - Jefferies LLC

Analyst · your question.

Great. Thanks, guys.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thank you.

Operator

Operator

Our next question comes from Mike Petusky of Barrington Research. Please proceed with your question.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Hey, good morning guys. Thanks.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Hi, Mike.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Thanks for taking the questions. Steve, I may have missed this earlier. I had been under the impression that some level of bad debt expense would stay post ASC 606. Is that not right or can you help a little bit as far as how to model that going forward?

Stephen M. Deitsch - BioScrip, Inc.

Management

Sure. So we completed our analysis in the first quarter and based upon the ASC 606 standard, effectively all of our bad debt expense with the exception of where you have payors that default from a credit perspective, which is de minimis and frankly, totally immaterial, all of it is reflected as a – what's called an implicit price concession per the accounting standard, and all of that gets reflected as a reduction to revenue. If we were to have a significant payor that would default and do financial purposes that would be a bad debt expense, but most of our bad debt expense originates because of considered implicit price concessions due to authorizations or verification issues that we're working to lower, as Dan has talked about. And also, on the patient side, since we do – and maybe this is getting a little too technical, Mike, but since we don't do credit checks on patients, the accounting standard requires that that is also considered an implicit price concession despite the fact that most patients when they don't pay, they don't pay because they don't have the financial wherewithal. So that results in all of the – effectively, all of the amounts that were previously reported as bad expense getting reflected as a contra revenue amount.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Okay, so it sounds – it sounds like if you're modeling this, you're modeling that as a zero going forward, right, generally?

Stephen M. Deitsch - BioScrip, Inc.

Management

That's correct.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Okay. All right. And then you compared kind of the cadence of how this year is likely to unfold to last year? And I guess I want to slightly press you guys on that. You know last year's second quarter you virtually doubled EBITDA from the first quarter of last year. And obviously you guys called out that some of this product shortage issue is still kind of hanging over a bit at least. I guess, my question is, would you expect this year's second quarter to be north of the $10 million you guys reported a year-ago second quarter. Thanks.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Mike, you're a sneaky guy, right there.

Michael Petusky - Barrington Research Associates

Analyst · your question.

I'm not trying to be sneaky.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Go ahead, Steve.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Go ahead.

Stephen M. Deitsch - BioScrip, Inc.

Management

Here's what I would tell you. We're not going to give specific quarter-to-quarter guidance. But what I would tell you is, if you think about our first quarter and some of the things that we outlined, several of those things we don't expect to repeat as we go into the second quarter. We're not having another national meeting, although as impressive and as exciting as that was for everybody, we're not going to do that every quarter. So that's going to drive OpEx savings compared to the first quarter. We're not going to – knock on wood, we're not going to continue to see any of these products shortages that drive higher acquisition costs and higher delivery costs. So that's going to be a catalyst for us. And we expect revenue to be higher, as we move forward, because our seasonally weak first quarter. You know, weather was worse than expected as we talked about, far worse and with our concentration in the Northeast, we're – percentage-wise...

Daniel E. Greenleaf - BioScrip, Inc.

Management

Disproportionately.

Stephen M. Deitsch - BioScrip, Inc.

Management

...disproportionately. Thank you, Dan, disproportionately affected probably the – many other companies. So we believe that while we won't say the second quarter is going to be x, we believe the second quarter will continue to go upward as will the third quarter, as will the fourth quarter. Okay.

Michael Petusky - Barrington Research Associates

Analyst · your question.

So what. Hey, thank you. So last, I guess last, question.

Daniel E. Greenleaf - BioScrip, Inc.

Management

You want to try that one again, Mike.

Michael Petusky - Barrington Research Associates

Analyst · your question.

So, yes, so thank you. So last question...

Daniel E. Greenleaf - BioScrip, Inc.

Management

Let me ask it other another way.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Last question, different subject. Dan, you've called out a bunch of different things that you guys are excited about, investing in the...

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah.

Michael Petusky - Barrington Research Associates

Analyst · your question.

...sales team, revenue cycle management, provider relationship, strengthening the relationship with payors, et cetera, I guess, what are the two or three things that you feel like as you look out over the next couple two, three years, hey, if we really execute on – in this area, in this area, in this area, this thing can really go, I mean, what are the two or three areas... (50:18)

Daniel E. Greenleaf - BioScrip, Inc.

Management

No, it is four. And they're almost all equivalent in terms of their value creation.

Michael Petusky - Barrington Research Associates

Analyst · your question.

Okay. (50:24)

Daniel E. Greenleaf - BioScrip, Inc.

Management

Its sales force – its sales force effectiveness...

Michael Petusky - Barrington Research Associates

Analyst · your question.

Yeah.

Daniel E. Greenleaf - BioScrip, Inc.

Management

...its revenue cycle and bad debt, because we see opportunities to, as we move stuff to the front, we're going to drive efficiencies there. We see opportunities to certainly drop our bad debt, payor relationships is a big one and it's a very important one as you – and as we've talked about, we've made a very concerted, disciplined and strategic effort to make sure we're well-positioned on that front. And then the fourth is procurement. And we're – I just can't – at some point, Mike, I can probably share with you some shape or form around our Vision 2020, I think it'll be important for investors to really understand just how granular this is, how specific this is, how much time we spent with the help of Ares working on this that we feel like we know what the hell we're doing and then moreover there's another 12 or so initiatives that are not priority initiatives but we think could be incrementally valuable as well. And, but those are the big four and those are the four we're going to be talking about internally or externally and at some point, Mike, we can probably roll out like just how specific this really is.

Michael Petusky - Barrington Research Associates

Analyst · your question.

All right. Very good, guys. Thank you very much.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thanks a lot, Mike.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Thanks.

Operator

Operator

Our next question comes from Dana Hambly of Stephens. Please proceed with your question.

Jacob K. Johnson - Stephens, Inc.

Analyst · your question.

Hey, thanks. This is Jacob Johnson on for Dana. Dan, just one big picture question. You've had some surprises since you joined BioScrip. Are you still today encountering things that need to be fixed or do you think you're just now at the point of enhancing the platform that you have built?

Daniel E. Greenleaf - BioScrip, Inc.

Management

Yeah. I think we're, what I see is we're really at a point where we're enhancing the platform. One of the terms I think I took it out or I may have – but I think we're kind of at a, I don't like using blocking and tackling stage, because I think that seems really rudimentary. But I think there's a real component of that that we just need to go out now and execute, like we talked about. I'm not dealing with the Cures legislation this year. I'm not dealing with the refinancing this year. I'm not dealing with the exit of – partial exit of UnitedHealthcare contract. I'm not dealing with significant management changes and I'm not dealing with an integration. So, Jacob, when I look out, I mean I really feel like at this stage it's about execution around the things that are going to drive the greatest value for our stakeholders. And I don't see anything getting in the way. I mean admittedly there's things that occur in the marketplace like product shortages but those are temporal in nature and I don't think they're going to last. But, Jacob, I think we're at a point and again I look around the table here in this room and I just – l look around our top 50 people, we had a leadership team meeting in here with General Sattler about leadership development and leadership. And we've really got this just rock solid, air tight leadership team now. That is everybody's oars in the water, they've been equitized, they've been bonus, and again if I look at Harriet and Danny, who are our two most recent upgrades, I mean they're absolutely best-in-class. And they're the kind of people like you're already seeing with Danny in some of the revenue cycle management that are going to accelerate things. And the question is, for me, is like how do we continue to accelerate things across the board here and move things forward. And that's my – because I feel like we talked about a period of unequal time because of the changes that are occurring and we think we have such an amazing and unique opportunity here and how do we grasp that and drive that. And so I think even I would share with you that some of our thinking has changed. We're like – we were in a place where we had to survive. I consider last year was kind of – as again as I lay out all the things we had to do, I think any one of those could have been a death sentence for the previous management team. I'll just be very candid with you. And now we've kind of moved through those things and we're really forward looking right now and we've got – with the talent that's on this leadership team now, we have a lot of firepower to throw down on what we're trying to do.

Jacob K. Johnson - Stephens, Inc.

Analyst · your question.

Great. Thanks for all the color. Appreciate it.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Thank you, Jacob.

Stephen M. Deitsch - BioScrip, Inc.

Management

Thanks, Jacob.

Operator

Operator

Ladies and gentlemen, we've reached the end of our question-and-answer session. I would like to turn the call back over to Mr. Dan Greenleaf for closing remarks.

Daniel E. Greenleaf - BioScrip, Inc.

Management

Okay. Well, thank you all for joining the call today. We are pleased with the solid momentum and the execution of our plans. We look forward to updating you again on our continued progress in August when we announce our second quarter 2018 financial results.

Operator

Operator

This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.