Encompass Health Corporation

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EHC

US29261A1007

Healthcare Facilities & Services

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Encompass Health : Q1 2024 Earnings Conference Call transcript

April 29, 2024 at 12:10 pm EDT

Corrected Transcript

25-Apr-2024

Encompass Health Corp. (EHC)

Q1 2024 Earnings Call

	Total Pages: 19
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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

CORPORATE PARTICIPANTS

Mark Miller	Douglas E. Coltharp
Chief Investor Relations Officer & Senior Vice President-Investor	Chief Financial Officer & Executive Vice President, Encompass Health
Relations and Strategic Planning, Encompass Health Corp.	Corp.
Mark J. Tarr
President, Chief Executive Officer & Director, Encompass Health Corp.

.....................................................................................................................................................................................................................................................................

OTHER PARTICIPANTS

Kevin Fischbeck	John W. Ransom
Analyst, BofA Securities	Analyst, Raymond James & Associates, Inc.
A.J. Rice	Pito Chickering
Analyst, UBS Securities LLC	Analyst, Deutsche Bank Securities, Inc.
Andrew Mok	Ben Hendrix
Analyst, Barclays Capital, Inc.	Analyst, RBC Capital Markets LLC
Ann Hynes	Brian Tanquilut
Analyst, Mizuho Securities USA LLC	Analyst, Jefferies LLC
Scott J. Fidel	Jared Haase
Analyst, Stephens, Inc.	Analyst, William Blair & Co. LLC

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

MANAGEMENT DISCUSSION SECTION

Operator: Good morning, everyone, and welcome to Encompass Health's First Quarter 2024 Earnings Conference Call. At this time, I'd like to inform all participants that their lines will be in a listen-only mode. After the speakers' remarks, there'll be a question-and-answer period. [Operator Instructions] You'll be limited to one question and one follow-up question. Today's conference call is being recorded. If you have any objections, you may disconnect at this time.

I will now turn the call over to Mark Miller, Encompass Health's Chief Investor Relations Officer.

Mark Miller

Chief Investor Relations Officer & Senior Vice President-Investor Relations and Strategic Planning, Encompass Health Corp.

Thank you, operator, and good morning, everyone. Thank you for joining Encompass Health's first quarter 2024 earnings call. Before we begin, if you do not already have a copy, the first quarter earnings release, supplemental information and related Form 8-K filed with the SEC are available on our website at encompasshealth.com.

On page 2 of the supplemental information, you will find the safe harbor statements, which are also set forth in greater detail on the last page of the earnings release. During the call, we will make forward-looking statements which are subject to risks and uncertainties, many of which are beyond our control. Certain risks and uncertainties, like those relating to regulatory developments as well as volume, bad debt and labor cost trends, that could cause actual results to differ materially from our projections, estimates, and expectations are discussed in the company's SEC filings, including the earnings release and related Form 8-K, the Form 10-K for the year ended December 31, 2023 and the Form 10-Q for the quarter ended March 31, 2024 when filed. We encourage you to read them.

You are cautioned not to place undue reliance on the estimates, projections, guidance and other forward-looking information presented, which are based on current estimates of future events and speak only as of today. We do not undertake a duty to update these forward-looking statements.

Our supplemental information and discussion on this call will include certain non-GAAP financial measures. For such measures, reconciliation to the most directly comparable GAAP measure is available at the end of the supplemental information, at the end of the earnings release and as part of the Form 8-K filed yesterday with the SEC, all of which are available on our website.

I would like to remind everyone that we will adhere to the one question and one follow-up question rule to allow everyone to submit a question. If you have additional questions, please feel free to put yourself back in the queue.

With that, I'll turn the call over to Mark Tarr, Encompass Health's President and Chief Executive Officer.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Thank you, Mark, and good morning, everyone. The broad-based momentum of our business continued in the first quarter, evidenced by 13.4% revenue growth and adjusted EBITDA increase of 19.2%. Owing largely to our Q1 results, we are increasing our 2024 guidance. Doug will cover the details of the quarter and increased

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

guidance in his comments. Demand for IRF services remains strong and we are continuing to invest in capacity additions to meet the needs of patients requiring inpatient rehabilitation services.

During Q1, we added 51 beds to existing hospitals. Over the balance of the year, we plan to open six de novo hospitals with a total of 280 beds, as well as a 40-bed freestanding hospital to be licensed as a satellite location of an existing hospital. Consistent with our historical practice, the satellite will be accounted for as a bed addition. We anticipate adding another 93 beds to existing hospitals in 2024, inclusive of the aforementioned satellite.

We continue to build and maintain an active pipeline of de novo projects, both wholly-owned and joint ventures with acute care hospitals. Since the beginning of this year, we've announced three additional de novo projects, bringing our pipeline to 14 hospitals under development with opening dates beyond 2024.

We remain keenly focused on further enhancing the quality of our patient care and resulting outcomes through the deployment of clinical technologies and protocols. We have previously highlighted the installation of in-house dialysis capabilities at many of our hospitals. We now offer this service in 88 of our hospitals and we'll continue the rollout to additional locations in 2024.

As another example of an ongoing clinical project, our quality of life improvement project incorporates an individualized approach to inpatient care in which our therapists focus on a specific patient's interest, lifestyle, home improvement and community mobility needs. The goal of this program is to improve the patient's inpatient experience and readiness for discharge to their community.

On March 27 of this year, CMS released the 2025 IRF proposed rule. This included a proposed net market basket update of 2.8%, which we estimate would result in an approximately 3% increase for our IRFs beginning October 1 of 2024 based on our current patient mix. The IRF final rule is expected to be released in late July or early August.

Review Choice Demonstration, or RCD, began in August 2023 in Alabama. Recall that under RCD Cycle 1, which lasted six months, every Medicare claim was reviewed for documentation and medical necessity. The affirmation rate target set by CMS under Cycle 1 was 80%. All seven of our Alabama hospitals ended Cycle 1 above the target affirmation rate.

For Cycle 2 in Alabama, which runs from May 1 through October 31, we had the choice of continuing with 100% pre-claim review or a random spot check pre-claim review of 5% of claims. Based on our Cycle 1 claim experience, we elected to continue with 100% pre-claim review for Cycle 2. The target affirmation rate for Cycle 2 is 85%.

On March 1, CMS announced it is expanding IRF RCD to Pennsylvania for hospitals billing to the Medicare administrative contractor Novitas. Our nine hospitals in Pennsylvania will not be subject to RCD at this time, as they bill to a different Medicare administrative contractor.

During Q1, many providers across the US healthcare spectrum experienced significant disruptions due to the cyberattack on Change Healthcare. We have historically used Change for the vast majority of our claims processing across our payer base. Our teams in our centralized business office and information technology quickly rallied to successfully implement workarounds using alternative third-party vendors and enhancing our own claims processing capabilities. As a result of these efforts, we experienced minimal impact to our Q1 cash flow from the Change outage. We resumed claims processing with Change in early April and continue to maintain the alternative channels we recently developed.

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

Across our 160 inpatient rehabilitation hospitals, we are daily providing high-quality,cost-effective care to medically complex patients. Our dedicated clinical teams work collaboratively with physicians to administer this care, producing leading scores in patient satisfaction and quality outcomes. This value proposition increasingly resonates with patients, caregivers, referral sources and payers. The demand for inpatient rehabilitation services remains considerably underserved and continues to grow as the US population ages. We intend to continue to expand our capacity and capabilities to meet this need.

Now, I'll turn it over to Doug.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Thank you, Mark, and good morning, everyone. As Mark stated, we are very pleased with our Q1 results. Revenue growth for the quarter of 13.4% was primarily driven by volume, as total discharges grew 10%, inclusive of 6.7% same-store growth. Q1 revenue growth did benefit from both leap year and the timing of the Easter holiday. Our Q1 revenue also included a $6.9 million increase in provider tax receipts, primarily attributable to prior periods.

Q1 adjusted EBITDA increased 19.2% to $273 million, driven by revenue growth, stable premium labor trends and prudent expense management. Other operating expenses as a percent of revenue decreased 80 basis points, benefiting from the favorable impact of on-site dialysis implementation and efficiencies in our recruiting efforts. Q1 adjusted EBITDA included approximately $5 million related to the aforementioned provider tax receipts.

Q1 net preopening and ramp-up costs were $1.8 million, as compared to $4.2 million in Q1 last year. Given the timing of our new hospital openings and the balance between joint venture and wholly-owned de novos, our net preopening and ramp-up costs will be concentrated in the final three quarters of the year. We anticipate $15 million to $18 million of de novo net preopening and ramp-up costs for 2024, as compared to $6.6 million in 2023.

We continue to generate significant levels of free cash flow. Adjusted free cash flow for the quarter increased 5.6% to $167.6 million due to higher adjusted EBITDA, partially offset by an increase in working capital, which was unrelated to the Change Healthcare outage and higher cash tax payments.

Primarily based on the strength of our adjusted EBITDA growth, our net leverage again declined, falling to 2.5 times from 2.7 times at year-end 2023. We ended the first quarter with no amounts drawn on our $1 billion revolving credit facility and more than $130 million of cash on hand.

As Mark alluded to, based primarily on our Q1 results, we are raising our 2024 guidance as follows: net operating revenue of $5.25 billion to $5.325 billion, adjusted EBITDA of $1.03 billion to $1.065 billion, and adjusted earnings per share of $3.86 to $4.11. The key considerations underlying our guidance can be found on page 12 of the supplemental slides.

And with that, operator, we'll now open the lines for questions.

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

QUESTION AND ANSWER SECTION

Operator: Thank you. [Operator Instructions] And we'll take our first question today from Kevin Fischbeck with Bank of America.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Good morning.

Kevin Fischbeck

Analyst, BofA Securities

Good morning. Thanks. I guess, I would love a little bit more color on the volume in the quarter. Do you have any details about the strength you mentioned, the leap year help. There's been a lot of kind of focus on how maybe March slowed down. Any comments about volume intra the quarter and how things are maybe trending so far in April? Thanks.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

The volume remained pretty constant throughout the quarter. And so, in the month of February, you had the extra day because of leap year, which certainly helped volume in that month. And then March, discharge volumes certainly benefited from the fact that the Easter holiday fell on the last day of the quarter, which also happened to be a Sunday. But really, we saw good momentum on volume through the entire quarter.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Kevin, not only was it consistent throughout the quarter, but if you look at it geographically across our eight regions, it was very consistent across all of our regions and we're very pleased with the progress that we've continued to made on just overall volume growth.

Kevin Fischbeck

Analyst, BofA Securities

Great. And then I guess maybe...

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

And it's across payers as well. When we look at the total discharge volume growth, we had a 12% increase in Medicare fee for service and north of an 11% increase in Medicare Advantage.

Kevin Fischbeck

Analyst, BofA Securities

Okay. Great. And then I guess maybe just to talk about that then for a second. A lot of focus on Medicare Advantage rates and can you talk a little bit about how the contracting there for you is going? And then are you expecting any pressure or flow through from the negative rate adjustments they're getting for next year? Is there any concern about how that might flow down through to your contracting or their utilization management? Thanks.

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

Douglas E. Coltharp	A
Chief Financial Officer & Executive Vice President, Encompass Health Corp.

So we're right at about 90% of our Medicare contracted revenues being on an episodic basis versus on a per diem basis. And the payment differential for the quarter was just over 3%, so good progress there. Most of those contracts that are on an episodic basis, the annual increases are tied directly to the Medicare fee-for-service rule. So at this point in time, we're really not expecting any adverse consequences from what's going on with regard to the Medicare Advantage rule.

Kevin Fischbeck

Analyst, BofA Securities

All right. Great. Thanks.

Operator: Our next question will come from A.J. Rice with UBS.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Good morning.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Good morning, A.J.

A.J. Rice

Analyst, UBS Securities LLC

Hi. How are you, guys? I know SWB per FTE was about 4% to 5% in the quarter, and I think that's your target for this year. I wonder when you look at it, underlying permanent wage trends, premium labor sign-on bonuses, ship bonuses, is there any place where you're running higher than the pre-pandemic, where there's still opportunities in your mind potentially to improve on that year-to-year rate?

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Yeah. So total SWB for the quarter was actually up 3.8%, so slightly below the low end of the range that we have out there for the year. And the biggest reason for that is that we would expect a higher growth rate on benefits for the last three quarters of the year, just based on the positive accrual adjustments we had in the last three quarters of 2023.

Both categories of premium labor continue to be elevated above where they were pre-pandemic, although they settled down quite a bit. If we look at what transpired in the quarter in terms of sign-on and shift bonuses, the total there was $14.3 million. That's about a $2 million improvement over where we were in Q1 of last year and it's up just modestly about $1.2 million from the run rate we experienced in Q4. That's not unanticipated, just given our normal seasonal trends and also the volume increase that we had in the quarter.

Looking at kind of the same pattern for contract labor dollars, we were at $19.3 million in Q1. Again, that compares favorably to $20.7 million in Q1 of last year, up sequentially from Q4 which was $17.7 million. We again would attribute that predominantly to seasonal patterns and to the volume trend. The contract labor FTEs as a

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

percentage of total FTEs for the quarter was at 1.6%. That's in the range that we've been - we were running at in the second half of last year, right around 1.5%. Again, pre-pandemic, we would have been just below 1%.

So, we do think that there's some continued opportunity, but it really does feel like at least for the foreseeable future, A.J., we've kind of settled into this rate - this range. I will note, we continue to make good progress through our recruiting efforts on the quarter. Net new RN hires for the quarter were 148, and that's a pretty significant increase over the less than 50 that we had in Q1 of last year.

A.J. Rice

Analyst, UBS Securities LLC

Okay.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

And final comment on labor, A.J., is not only on the recruitment side, but retention continues to be a big focus. And our turnover, particularly around the nursing, continues to trend downward, as well as therapy. So, we're seeing a lot of positive aspects within the broader umbrella of labor itself.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Yeah. And just to put a finer point on Mark's comments there, annualized Q1 nursing turnover was at 20.2% and therapist turnover 6.6%. So those are very positive numbers.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

And both of those would be lower than pre-pandemic.

A.J. Rice

Analyst, UBS Securities LLC

Yeah. It's a very low number on the therapists. Interesting. Thanks a lot.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Thank you.

Operator: Our next question comes from Andrew Mok with Barclays.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Hello, Andrew.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Good morning.

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

Andrew Mok	Q
Analyst, Barclays Capital, Inc.

Hi. Good morning. I was hoping you could give us a little bit more detail on de novo openings this year, just overall cadence and timing. There were no openings in Q1. So, how should we think about the six de novos for the balance of the year? Thanks.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Yeah. Certainly, as we alluded to at the beginning of the year, you're going to have a different pattern this year than you did last year. Last year, we benefited in terms of the annual net preopening and ramp-up costs by the fact that we had earlier openings. We had those that were predominantly JVs. Five of the ones that we opened last year were JVs, and you had a couple of hospital and hospitals which tend to ramp up faster. We're skewed now with our openings into the final three quarters of this year, which is leading to kind of the year-over-year change and particularly over the balance of the three quarters.

If you look over the final three quarters of last year, net preopening and ramp-up costs were negative $2.4 million. If you subtract out from the $15 million to $18 million range we have for 2024, the $1.8 million we experienced in Q1, you're left with an anticipated $13.2 million to $16.2 million impact in Q2 through Q4. The midpoint of that range is $14.7 million, so that would represent a little over a $12 million delta on a year-over-year basis.

Andrew Mok

Analyst, Barclays Capital, Inc.

Got it. That's helpful. But if we just take a step back and think about the six de novos, should we think two per quarter for the remaining three quarters or is there even more of a back-end skew to that?

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

I think we've got two opening in Q2 and then the balance are in Q3.

Andrew Mok

Analyst, Barclays Capital, Inc.

Got it.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

One will likely extend into Q4.

Andrew Mok

Analyst, Barclays Capital, Inc.

Okay. That's helpful. And then occupancy in the quarter ticked up to about 76.7%, which I think was a notable sequential and year-over-year increase. I know you have elevated bed additions coming online this year, but can you give us a sense for what full capacity looks like or maybe where your top decile hospitals sit on an occupancy basis? Thanks.

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Encompass Health Corp. (EHC)	Corrected Transcript
Q1 2024 Earnings Call	25-Apr-2024

Douglas E. Coltharp	A
Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Yeah. So occupancy during the quarter was definitely favorably impacted by normal seasonality, as well as the volume increase we saw and the fact that there were no counterweights in terms of de novos opening in the quarter. Again, as we move forward, we would hope to see the overall occupancy rate continue to move up modestly over time. And really the primary reason there, in addition to the fact the demand environment remains very positive, is that we are increasingly seeing a higher percentage of our overall beds in private rooms, which eliminates the capacity constraints that can be caused by gender compatibility and other issues requiring patient isolation.

And again, the increase in private beds is coming from really two initiatives, the first being that virtually all of our capacity additions, be they bed additions to existing hospitals or de novos, are comprised of all private rooms. And then the second is when we are doing major remodels and renovations, where we are able, we are taking the opportunity to convert semi-private rooms to private rooms.

In terms of targeting a specific theoretical occupancy peak, it's hard to do that because we still have such a mixed bag within our overall physical plan. But generally speaking, in a facility that is all semi-private, you start to hit capacity constraints north of 80%. When you're in a facility that is all private room, you can run into the mid- to high-90s.

Operator: Our next question will come from Ann Hynes with Mizuho Securities.

Mark J. Tarr

President, Chief Executive Officer & Director, Encompass Health Corp.

Good morning.

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Good morning.

Ann Hynes

Analyst, Mizuho Securities USA LLC

Good morning. So I just want to talk about guidance. You beat consensus estimates on the adjusted EBITDA side by close to 10%. So even by Encompass's conservative history, just the 1% guidance rate seems conservative to me. So maybe can you tell us what the quarter actually was versus your internal expectations? And is there anything we should consider as we go out throughout the rest of 2024, why you wouldn't be able to see this type of strong growth going forward?

Douglas E. Coltharp

Chief Financial Officer & Executive Vice President, Encompass Health Corp.

Yeah. Ann, I think you really hit on the key point, which is, as a reminder, we issue annual guidance. We don't provide quarterly guidance. And I know that creates a challenge for you and your peers because you need to provide quarterly estimates that are out there.

When we were thinking about our own expectations for Q1 performance, we were specifically looking at the momentum that we had coming in from Q4, the normal seasonality. But then we acknowledged the fact that you

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Company Profile

Encompass Health Corporation is an owner and operator of inpatient rehabilitation hospitals in the United States. The Company provides specialized rehabilitative treatment on an inpatient basis. It operates hospitals in 37 states and Puerto Rico, with concentrations in Florida and Texas. It operates 161 inpatient rehabilitation hospitals. Its inpatient rehabilitation hospitals offer specialized rehabilitative care across an array of diagnoses and deliver comprehensive patient care services. The Company provides care to patients who suffer from cognitive disabilities or injuries due to medical conditions, such as strokes, hip fractures and a variety of debilitating neurological conditions. Its hospitals also treat patients with or recovering from the COVID-19 virus. Its hospitals have settings for treating the debilitating effects of the COVID-19 virus, such as significant muscle weakness, cognitive impairments, shortness of breath with activity and malnutrition.

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Healthcare Facilities & Services

Calendar

2024-06-30 - Ex-dividend day

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Ratings for Encompass Health Corporation

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ESG Refinitiv

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Sell

Buy

Mean consensus

BUY

Number of Analysts

Last Close Price

87.09 USD

Average target price

95.3 USD

Spread / Average Target

+9.43%

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Sector Hospitals, Clinics & Primary Care Services

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