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Select Medical Holdings Corporation (SEM)

Q1 2018 Earnings Call· Fri, May 4, 2018

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Transcript

Operator

Operator

Good morning, and thank you for joining us today for Select Medical Holdings Corporation’s earnings conference call to discuss the first quarter 2018 results and the company’s business outlook. Speaking today are the company’s Executive Chairman and Co-founder, Robert Ortenzio; and the company’s Executive Vice President and Chief Financial Officer, Martin Jackson. Management will give you an overview of the quarter and then open the call for questions. Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or the future financial performance of the company, including, without limitation, statements regarding operating results, growth opportunities and other statements that refer to Select Medical plans, expectations, strategies, intentions and beliefs. These forward-looking statements are based on the information available to management of Select Medical today, and the company assumes no obligation to update these statements as circumstances change. At this time, I will turn the conference call over to Mr. Robert Ortenzio.

Robert Ortenzio

Management

Good morning, everyone. Thank you for joining us for Select Medical’s First Quarter Earnings Conference Call for 2018. Before I outline our operational metrics, I want to provide you with some summary comments and updates since we presented to you last quarter. Our Inpatient Rehab and Concentra business segments both had a great quarter with strong double-digit revenue and adjusted EBITDA growth on a same-quarter year-over-year basis. Our Inpatient Rehab segment experienced significant growth in terms of both revenue and adjusted EBITDA as our joint venture development projects opened in late 2016 and throughout 2017 continued to mature. On a same-quarter year-over-year basis, revenue grew 20.7% and adjusted EBITDA increased 64%, which was driven by growth in both volume and rate in this segment. We continue to build our JV pipeline with expected two to three new projects per year. We opened our new Ochsner rehabilitation joint venture early this week, and believe our Dignity, Las Vegas joint venture will open in the fourth quarter of this year. We expect double-digit growth in both revenue and EBITDA for the foreseeable future in this business segment. Our Concentra segment had same-quarter year-over-year revenue growth of 42.1% and adjusted EBITDA growth of 35.7%, driven primarily by the acquisition of U.S. HealthWorks on February 1, which added 219 centers and 21 on-site clinics. Beginning February 1, U.S. HealthWorks’ results are included in our Concentra segment and consolidated in Select’s financials. U.S. HealthWorks added $90 million of net revenue, [approximating] $9 million of EBITDA. Concentra on a standalone basis without U.S. HealthWorks realized a 6% growth in revenue, 14% growth in adjusted EBITDA and adjusted EBITDA margin of 18.3%. Our LTAC segment also had a good quarter on a year-over-year same quarter basis with revenue growth of 4.4%, occupancy rate growing from 68% to…

Martin Jackson

Management

Thank you, Bob. Good morning everyone. For the first quarter, our operating expenses, which include our cost of services, general and administrative expenses were $1.1 billion. This compares to $957 million in the same quarter last year. Beginning in 2018, the majority of the expense we historically characterize as bad debt is now included as a component of net revenue and reflected as a reduction of revenue on the income statement. As a percentage of our net revenue, operating expenses for the first quarter were 87.6% compared to 87.8% in the same quarter last year. Cost of services, which were $1.07 billion for the first quarter compared to $929 million in the same quarter last year. As a percent of net revenue, cost of services were 85.1% for the first quarter. This compares to 85.2% in the same quarter last year. G&A expense was $31.8 million in the first quarter compared to $28.1 million in the same quarter last year. G&A as a percent of net revenue was 2.5% in the first quarter compared to 2.6% of net revenue for the same quarter last year. During the first quarter of this year, we incurred $2.9 million of U.S. HealthWorks acquisition costs that have are included in the G&A expense. Excluding these costs, G&A as percent of revenue was 2.3% in the first quarter of this year. As Bob mentioned, total adjusted EBITDA was $163.2 million and the adjusted EBITDA margin was 13% for the first quarter. This compares to adjusted EBITDA of $138.9 million and an adjusted EBITDA margin of 12.7% in the same quarter last year. Depreciation and amortization was $46.8 million in the first quarter as compared to $42.5 million in the same quarter last year. We generated $4.7 million in equity and earnings of unconsolidated subsidiaries during…

Operator

Operator

Thank you. [Operator Instructions] And our first question comes from Frank Morgan from RBC Capital Markets. Your line is now open.

Frank Morgan

Analyst

Good morning. I was very interested in that occupancy progression across the first quarter in the LTAC business and the margin improvement, so I'm just curious what caused – was it a change in the switching staff over from the contract or temporary staffing to get less costly permanent labor in there to help those margins improve so much, or was it just purely volume overcame the cost of the contract labor. And just curious, is that a good sustainable number if you could hold that level of occupancy, is the 19% margin is the number we should be looking for?

Robert Ortenzio

Management

Yes, Frank. There really was quite a jump-up, I mean in our average daily census, from December to January, and then it continued in February and March. And I guess the point is that we are trying to make is that, we went from about – a little bit north of 2700 [ADC] to a little bit north of 2700, all the way up to about 3,000. So, we needed to add additional clinicians at that point in time. And in order to do that rapidly, as we said, we had to include a bunch of agency nurses, as well as overtime for our people, and then also some traveling nurses. The premium associated with hiring those people is pretty significant. And as we went through February and March, we were able to make some adjustments for that. And as we made those adjustments, we saw the margins improve.

Frank Morgan

Analyst

Got you, and…

Robert Ortenzio

Management

To the extent that we are able to maintain a 71% occupancy rate over a longer period of time, we think that the higher margins are achievable.

Frank Morgan

Analyst

Got you. And, the adjustments you made, were those just either being more optimizing the use of contract or was it - did you hire people in place of the temps?

Martin Jackson

Management

We did hire some additional people. The other thing is you had a number of signing bonuses that took place early on in the quarter and then those nurses were with you, so that’s one of the other additional expenses, it’s really front-end loaded.

Frank Morgan

Analyst

Okay. That makes sense. Now I guess the other big question is, why did the occupancy, I mean, we are certainly glad to see that. But can you point to any one thing? Was it, is there any change you’ve seen in the competitive landscape? Are you seeing competitors drop out of the market? Or is it just kind of the - you’re just gaining traction with this education of on-patient criteria and getting appropriate patients? And, then, with flu any way, I mean, what’s the correlation between complaint basis cases and effective flu?

Robert Ortenzio

Management

Well Frank, this is Bob. And, there is no question in the quarter in those couple of months where we really saw that spike in our occupancy that I think - we think that there is a pretty strong correlation with the flu. With a lot of older people, it’s a big pulmonary event. So, you’re going to see more event patients, and I think we can point directly to that. So, that is without question part of that surge on occupancy that we saw, and I think we saw it across the whole healthcare spectrum.

Frank Morgan

Analyst

And, I guess, maybe that 71% occupancy doesn’t hold in the near-term, maybe it does, maybe it doesn’t. But is it fair to say that 19% margin that’s like whenever you - if you stay at this occupancy at 71% or if you get back to this occupancy, is it fair to say that 19% is a good representation of what you should be able to do financially at that margin level or at that occupancy level.

Martin Jackson

Management

Frank, I think 17% to 18% is probably a good number for us, and at 71% occupancy rate without fluctuation. I think we’ve also talked in the past about the fact that our expectation is we will be able to get back on an annual basis to historical levels, which is that 71%. And it really is just an educational process that we are going through as we continue to explain to our referral sources about the new criteria reimbursement.

Robert Ortenzio

Management

Yes, I think Mark is right. We certainly think that there is some upside and we want to continue to drive to that, but we really don’t want to go ahead of ourselves on that. So, we do think that there is good opportunity for us in the future to get our occupancies back on an annual basis on those low 70s. And, with that and depending on the labor market, we expect to have - see the rewards of that.

Frank Morgan

Analyst

Got you. And, then just hopping over to the IRF side of the business clearly that part of your business seems to be really picking up speed as these projects mature, but how far away do you think we are on some of your earlier projects? Like how close are we to optimal margin on those particular projects? And, what would that number be? Would that also be a sort of high-teens kind of a number?

Martin Jackson

Management

Yes, it would be a high-teens number. And, you don’t remember Frank, as we continue to grow, as we bring on incremental joint venture deals, it becomes a smaller component of our overall base. So, you will see the margins continue to grow on the rehab side. And, again as development becomes smaller and smaller component overtime that has less of an impact of the overall margin.

Robert Ortenzio

Management

Yes, even as you’ve seen big gains with these numbers that is not to suggest that the hospitals that are driving those gains are fully mature. They are just hospitals that have come out of the startup period and are now contributing pretty dramatically, but they’re still not fully mature operation, so we think…

Frank Morgan

Analyst

Got you. One more, but maybe a Bob question and I’ll hop back in the queue. But I’m just curious you’ve been very successful with your JV development strategy continue to add new wins, right. I’m just curious if you could give us kind of why you think - what’s the biggest driver for Select in terms of being able to distinguish itself to really going out winning that business and being as successful as you’ve been? Thanks.

Robert Ortenzio

Management

It’s really been the history of doing that going all the way back to 2011 and before, we plotted a strategy where we wanted to partner with the very large systems, the multi-billion dollar systems, Banner which is one of our older ones and then on to Cleveland Clinic. As we’ve gotten marquee system partners and we’ve been very successful with them and gained their trust. I think that perpetuates the ability to do that with more systems. And, we see that in our pipeline and I think that often times everybody, when there is a thought that we kind of capture that business with great systems along comes another one, whether our recently announced Banner Health System which is just fabulous system or deal with UCLA and Cedars or with Ochsner, these are all in the healthcare world, these are undisputed leaders in what they do. And, we feel the partnering with them, positions us very nicely. So, I think it’s difficult than for others to follow on exactly. So, we are really excited about that, we are excited about our pipeline and some of the things that we are doing. And, our ability with some of these big systems to then spread to research and training, we think it’s really exciting for our company. So, we are really pleased with where we are.

Frank Morgan

Analyst

Thank you.

Operator

Operator

Thank you. Our next question comes from Peter Costa from Wells Fargo Securities. Your line is now open.

Peter Costa

Analyst

Thanks. I think Frank covered the LTAC business pretty well. But I would like to talk about the Concentra business for a moment. If U.S HealthWorks came on, it looks like about 14% adjusted EBITDA margin. How long do you think it will take you to get that up towards the sort of the 17% that you were at last year for the rest of Concentra, and can they go higher overall or is it the same type of business and stated - does it stay lower? Where do they end up?

Martin Jackson

Management

It’s a great question Peter. Let me point out those, the margin for U.S. HealthWorks, the approximate margin for U.S. HealthWorks is about - in the first quarter, it’s about 10%.

Peter Costa

Analyst

Okay.

Martin Jackson

Management

Okay. And, so that margin and that has some severance costs, I think it’s about $2.3 million for the severance expense in that, so you add that back you’re in that 11% plus range. The ability to get that up to 16-17%, we think over the next year or so is very achievable.

Peter Costa

Analyst

And, do you think it takes a year or do you think - how long do you think that takes?

Robert Ortenzio

Management

Yes, we do. We do think it will probably take a year to 18 months because a lot of that has to do with some of the synergies that we are attempting to get. So, again we are going to do that over, we are going to use our very systematic approach that we go through and do it on a timely basis, but we think it’ll take probably 18 months to fully achieve those margins.

Peter Costa

Analyst

And, then did you pickup any receivables with U.S. HealthWorks or how did that come on board in terms of the receivable fund?

Robert Ortenzio

Management

Sure. It was a stock deal. So, yes, we certainly picked up the receivables.

Peter Costa

Analyst

How much?

Robert Ortenzio

Management

Probably somewhere - I don’t have the specifics right in front of me. But I believe it’s right around $80 million.

Peter Costa

Analyst

Okay. Thank you.

Robert Ortenzio

Management

Sure. Thanks.

Operator

Operator

Thank you. Our next question comes from Bill Sutherland from Benchmark. Your line is now open.

Bill Sutherland

Analyst

Thank you. Bob, I wonder if you could go through the pipeline of a development schedule here for your future IRF JVs? Thanks

Robert Ortenzio

Management

We only disclose any of our partnership after they’re signed. So, we don’t give any information. I think the most that we give is some kind of guidance on how many new deals we expect to do per year. I think we’ve said two to three. We’ve had good success in achieving that over a multi-year basis. So, we don’t give any more detail other than that.

Bill Sutherland

Analyst

I’m sort of thinking about the ones that you have signed and you’ve broken, in some cases broken ground?

Robert Ortenzio

Management

Yes, we do. Any of those that are announced or the recently announced ones were the Banner deal, well Ochsner was just opened, Dignity in Las Vega, which is under construction, and Banner Health System in Arizona where we expect to do 2 rehab hospitals pretty much simultaneously with them and some other post-acute care services. And, then also in - the narrative today there was the announcement of the expansion of the Baylor joint venture with the signed acquisition of a rehab hospital in the Austin area specifically in Lake Travis.

Bill Sutherland

Analyst

So, you’ve got this time next quarter you’ll have the Ochsner added to the total, plus the Baylor, and then Vegas comes on Q4 and then Banner is next year?

Robert Ortenzio

Management

Yes, I think that’s right.

Bill Sutherland

Analyst

Okay. I noticed you have one last LTAC quarter-over-quarter, is there much more portfolio optimization there to go?

Robert Ortenzio

Management

Well, I think that any of that optimization, as you put, is will be ordinary course, we may see an opening here or there, we may see a consolidation here or there. So, I don’t think that you would - we’ve had a lot of questions about whether there were closures as a result of the implementation of the new criteria, I think that has passed. So, you won’t see any closures as a result of that. But sometimes there’s other reasons why we may either open it an LTAC, relocate it or close consolidate one to only ordinary course at this time.

Bill Sutherland

Analyst

Yes, I recalled some mention of plans to open an LTAC, was it in Virginia?

Robert Ortenzio

Management

Yes, we did, Bill. We did Riverside was the LTAC we have opened up on in the eastern part of Virginia.

Bill Sutherland

Analyst

Okay. So, that was the one that was added to the portfolio last year, okay.

Robert Ortenzio

Management

Yes, we also I think have announced that we’ll open a new LTAC in ‘19 with one of our joint ventures in Florida.

Bill Sutherland

Analyst

Okay. And, Marty on integration cost for U.S. HealthWorks, should there be any additional ones this quarter?

Martin Jackson

Management

We think there will be additional integration cost over the next three quarters, Bill. I mean, our expectation as those integration cost shouldn’t exceed probably $5 million to $6 million, including the $2.3 million that I mentioned before that was already spent in the first quarter.

Bill Sutherland

Analyst

Okay. And, then last for me. I wonder if you could go back to the commentary in the IRF, I’m sorry, in the adjusted EBITDA margin for LTAC for ‘17 without gains on closed hospitals, I’m not sure I understand the commentary means there?

Martin Jackson

Management

Yes, if you take a look at the amount of - the difference in the hospital number between Q1 of ‘17 versus Q1 of ’18, we have closed 6 hospitals. And, those hospitals actually contributed positive EBITDA in the first quarter of ‘17. So, when you remove that - you actually had significant - you actually had some very nice growth on the same store basis.

Bill Sutherland

Analyst

That makes sense, okay. Thanks guys.

Martin Jackson

Management

Thanks, Bill.

Operator

Operator

Thank you. And, our next question comes from Kevin Fishbeck from Bank of America. Your line is now open.

Kevin Fishbeck

Analyst

Great, thanks. I wanted to ask question on the physiotherapy turnaround, it wasn’t quite clear, I think when you guys first talked about turning that business around. You gave that 6 to 9 months turnaround at towards the end of last year. When you say 6 to 9 months, you’re talking about from the original 6 to 9 months; you’re saying that it’s still 6 to 9 months from today?

Martin Jackson

Management

Yes, Kevin, we think it’s probably 6 to 9 months from today. I think we modified that the last earning’s call where we say - we thought it’s going to take 9 to 12 months. So, we’ve seen that come down from the last quarter when we’re saying, we think it’s 6 to 9 months. But we are seeing some nice improvements in many of the areas that we are focused on physio, and again we think that 6 to 9 months from now we will back on track.

Kevin Fishbeck

Analyst

Okay. So, if you could just remind us what the remaining issues are right now to reaching the target margins?

Martin Jackson

Management

It has to do with what we had talked about before which was, we lost a number of physiotherapist in certain markets. And, it’s really just replenishing those PTs that have good relationships with their referral sources. And, we continue to, as I said we continue to make progress there and see some nice traction.

Kevin Fishbeck

Analyst

Okay. And, then I guess a little bit about the labor backdrop right now, I wasn’t sure if, it sounds like the LTAC cost were not really labor, broader labor issue is more kind of volume driven, I’m not sure physiotherapy labor on is a shortage issue or whether it’s just going to be one time specific to that business issue, but if you talk a little bit about your ability to hire or retain staff across your different business lines?

Martin Jackson

Management

Yes, I think as it relates to the first quarter when we talk about the increase in the labor cost and really has to do with the substantial acceleration of our average daily census. And, having to immediately bring on nurses, so we could - basically take care of those patients. And, we’ve got an ongoing HR Program to recruit and bring on an onboard clinicians, but when you see that substantial jump as I mentioned a couple of hundred ADC, you really just can’t go through your standard HR Recruiting Program, you’ve got to make adjustments and that’s what we did.

Kevin Fishbeck

Analyst

And, I guess, what’s the kind of the overall wage expectation for 2018?

Martin Jackson

Management

I mean, expectation is, I think we build into our budget somewhere in that 3% to 3.5% increase on clinicians.

Kevin Fishbeck

Analyst

Okay. And, then Concentra, the core growth there kind of X U.S. HealthWorks is pretty strong. Does that – business get helped by flu at all or is that kind of a good number to be thinking about the next few quarters?

Martin Jackson

Management

For the most Concentra is really focused on worker entries, on the worker comp side.

Kevin Fishbeck

Analyst

Okay. So, is there anything about the comp or I guess you talked about kind of 14% kind of core Concentra growth. Is that something that’s the way to think about the next few quarters?

Martin Jackson

Management

We think that they did very, very well this quarter. I would not, I certainly don’t and I know Bob doesn’t assume that we are going to see 14% same quarter year-over-year growth on EBITDA line. I think what you’ve got to do is you’ve got to take a look at the second and third quarter were pretty strong last year so. A – Robert Ortenzio: They have done a great job and they have exceeded our expectations and they’re performing very well. And, so the great momentum, but we don’t want to get ahead of ourselves in terms of where you can normalize all that.

Kevin Fishbeck

Analyst

Okay. And, then just last question. Equity earnings, I think, was down year-over-year what was that related to?

Martin Jackson

Management

This is really the unconsolidated entities that we have including our Baylor and Emory they were down a little bit on a year-over-year same quarter basis and that’s really reflected in that number.

Kevin Fishbeck

Analyst

Is that because like kind of staff losses or anything that you would point to or just a little bit weaker?

Martin Jackson

Management

Just a little bit weaker, just a little bit weaker.

Kevin Fishbeck

Analyst

Okay. Thank you.

Martin Jackson

Management

Thanks, Kevin.

Operator

Operator

Thank you. And, that concludes today’s Q&A session. I would now like to turn the call back over to Mr. Ortenzio for any closing remarks.

Robert Ortenzio

Management

No closing remarks. Thanks everybody for joining us.