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spk05: Good day and thank you for standing by. Welcome to the Enzyme Group, Inc. first quarter fiscal year 2022 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker presentation, there will be a question and answer session. To ask a question during a session, you will need to press star 1 on your telephone. If you require any further assistance, please press star 0. I would now like to hand the conference over to your speaker today. Chad Keech, Chief Investment Officer, please go ahead.
spk00: Thank you, Operator.
spk02: Welcome, everyone, and thank you for joining us today. We filed our earnings pressure lease yesterday, and it is available on the investor relations section of our website at enzymegroup.net. A replay of this call will also be available on our website until 5 p.m. on Friday, May 27, 2022. We want to remind any listeners that may be listening to a replay of this call that all statements made are as of today, April 29, 2022, and these statements have not been nor will be updated subsequent to today's call. Also, any forward-looking statements made today are based on management's current expectations, assumptions, and beliefs about our business and the environment in which we operate. These statements are subject to risks and uncertainties that could cause our actual results to materially differ from those expressed or implied on today's call. Listeners should not place undue reliance on forward-looking statements and are encouraged to review our SEC filings for a more complete discussion of factors that could impact our results. Except as required by federal security laws, Enzyme and its affiliates do not undertake to publicly update or revise any forward-looking statements where changes arise as a result of new information, future events, changing circumstances, or for any other reason. In addition, the Enzyme Group, Inc. is a holding company with no direct operating assets, employees, or revenues. Certain of our wholly owned independent subsidiaries, collectively referred to as the service center, provide accounting, payroll, human resources, information technology, legal, risk management, and other services to the other operating subsidiaries through contractual relationships with such subsidiaries, including our captive real estate investment trust, Standard Bearer. which owns and manages our real estate business. In addition, our wholly owned captive insurance subsidiary, which provides certain claims-made coverage to our operating subsidiaries for general and professional liability, as well as workers' compensation insurance liabilities. The words Ensign, Company, We, Our, and Us refer to the Ensign Group, Inc. and its consolidated subsidiaries. All of our operating subsidiaries, the Service Center, Standard Bearer, and our captive insurance subsidiary, are operated by separate, wholly owned, independent companies that have their own management employees and assets. References herein to the consolidated company and its assets and activities, as well as the use of terms we, us, our, and similar terms used today, are not meant to imply, nor should it be construed as meaning, that the Enzyme Group Inc. has direct operating assets, employees, or revenue, or that any of the subsidiaries are operated by the Enzyme Group. Also, we supplement our gap reporting with non-gap metrics. When viewed together with our gap results, we believe that these measures can provide a more complete understanding of our business, but they should not be relied upon to the exclusion of gap reports. A gap to non-gap reconciliation is available in yesterday's press release and in our Form 10-Q. And with that, I'll turn the call back over to Barry, our CEO. Barry?
spk03: Thanks, Chad, and thank you all for joining us today. Our local leaders and their teams continue to be the examples of excellence in healthcare services as they navigate through the constant changes in each of their markets. The record results they achieved this quarter are particularly impressive given the continued disruption in the labor markets and the impact of Omicron early in the quarter. Despite all of that, our locally driven strategy led to continued improvement in occupancies, skilled revenue, and managed care revenue. We were particularly pleased that our operational leaders achieved sequential growth in overall occupancy for the fifth consecutive quarter, and managed care census has now grown sequentially seven quarters in a row. We are inspired by the commitment of our caregivers and their continued endurance and strength. During the quarter, our operators drove impressive growth in skilled mix. with same-store and transitioning operations combining for a skilled mix of 34.3% and same-store reaching a skilled mix of 35.2%. We also saw continued momentum in occupancy during the quarter, with same-store and transitioning occupancy increasing by 2.9% and 6.2%, respectively, over the prior year quarter. This growth in occupancy is particularly impressive given it occurred in the face of a surge of the Omicron variant, which typically results in lower patient volumes. This simultaneous progress in skilled medicine occupancy gives us tremendous confidence that we're in excellent position to continue to return to pre-pandemic levels over time. As we get closer to what we hope will soon be the end of the pandemic, our leaders' focus has shifted to sound operating fundamentals. Each operation is looking ahead and developing comprehensive strategies to thrive in spite of an evolving reimbursement environment, staffing challenges, and inflationary pressures. As general economic conditions have continued to put pressure on labor markets, our operators have discovered new methods for attracting healthcare professionals into our workforce while also strengthening their ability to retain and develop existing staff as we have focused on being the employer of choice in each of our communities. This gives us assurance that we are in very good position to continue on this path of strong clinical and financial performance. We continue to benefit from improved Medicaid funding in several states. We are grateful that the federal government has extended the state of emergency to July 2022 which keeps in place many of the regulatory and other forms of assistance helpful to patient care. While we certainly don't know for sure what the COVID future looks like, it's very possible that this additional funding will not be extended past July. But regardless of COVID trends, government waivers, or political climates, We are confident in our ability to make operational adjustments, take advantage of an attractive acquisition environment, and lean on our overall health to continue our long-term path of performance. As those that have been following us for a long time know, Ensign was born at a time when the post-acute care industry was undergoing a complete transformation, moving from a cost-plus reimbursement system to a fee-for-service model. We went public in 2007 at a time when the U.S. economy was entering a recession. In 2011, RUGS 4 was introduced, and a major correction was made the following year. Even now, we emerge from perhaps the most challenging time in our industry's history with the COVID-19 pandemic. Yet, in spite of these industry-altering events, since our IPO in 2007, we have achieved an adjusted EBITDA or CAGR of 21%, and a revenue CAGR of 14% for that same period. We've also formed multiple new businesses, spun off two public companies, and most recently established a $1 billion real estate company. All the while, we've been acquiring both struggling and performing skilled nursing assets and have grown from 58 buildings when we went public in 2007 to 251 operations today. Once again, we are reaffirming our annual 2022 earnings guidance to $4.01 to $4.13 per diluted share and annual revenue guidance of $2.93 billion to $2.98 billion. As a reminder, the new bid point of this 2022 earnings guidance represents an increase of 12% over our 2021 results and is 30% higher than our 2020 results. Our organization is extremely healthy, and our local operational and clinical leadership has never been stronger. Our culture and our local approach gives us confidence that we can and will continue to innovate and grow this year. While change could lead to some near-term quarterly fluctuations, we remind you that our model is built for times like these. We have seen and fully expect to see that continue throughout 2022 and beyond. I just want to take a minute to thank our incredible team members, facility leaders, field resources, clinical partners, and service center support staff. I can't emphasize enough how incredibly honored and grateful we are to work alongside them and witness their amazing sacrifice, effort, and outcomes. Many of them have picked up extra workloads in the face of staffing challenges and have made other sacrifices for the benefit of their coworkers. patients, and their operations. Their commitment in serving their communities has blessed the lives of so many. It's absolutely astounding to witness and an honor to be a part of that effort. Just as we've seen in the past, we most certainly expect some challenges ahead, and we'll lean on the lessons that we have learned and will continue to build on our foundational strength. We are excited about our future and look forward to continuing to show our dedication to all those that have entrusted us with the care of their loved ones. Next, I'll ask Chad to discuss our recent growth. Chad?
spk02: Thank you, Barry. To start, I wanted to provide a brief update on Standard Bearer, our captive REIT. As we've discussed before, this new real estate company will enable us to build upon our established real estate investment platform of high-quality assets. We couldn't be more excited about this new organizational structure, which allows us to take the next step with our already thriving real estate business. which generated $11.9 million in FFO during the quarter and sits in an EBITDA to rent coverage ratio of 2.31 times as of the end of the quarter. We were also pleased to add two assets to the portfolio during the quarter, both of which are operated by Enzyme affiliates, bringing the asset value of our portfolio of 95 assets to approximately $1.02 billion. We have already begun evaluating several transactions, which include healthcare properties that will be operated by enzyme affiliates and other third-party operators. We have also had very productive strategy sessions with several like-minded operators and look forward to establishing new partnerships with them. As we've always said, we will remain disciplined and will not compromise the health of an operation in order to win a deal. We have already passed on several opportunities where the pricing became unrealistic. However, we are finding plenty of deals to execute on and are excited about the additions to our real estate portfolio during the quarter and the many more additions that we expect to add this spring and summer. As we said last quarter, Standard Bear adds an additional pathway to growth and does not alter our proven method of acquiring both struggling and strong-performing skilled nursing assets, which will often be the subject of long-term leases with other real estate partners. During the quarter and since, we've added nine new operations in some of our most mature markets, including one skilled nursing operation in Arizona, two skilled nursing operations in California, one skilled nursing operation in Texas, one senior living operation in Washington, two senior living operations in California, and two senior living operations in Arizona. Several of these acquisitions involve senior living operations that were once part of the spin-out of certain assets to the Pennant Group. After several years of operating independent of Enzyme, we, together with the Pennant team, determined that due to the nature of these buildings, most of which are part of a healthcare campus that already includes an Enzyme-affiliated skilled nursing operation, the operational efficiencies and other strategic advantages justified returning these operations to Enzyme. In total, these additions include two new real estate operations acquired by Standard Bearer, which will be leased to an Enzyme-affiliated tenant, and six long-term leases with third-party landlords. As this recent activity illustrates, the ratio between leased and owned will vary depending on the circumstances. We are first and foremost focused on the operational health of acquisitions, so when it makes sense and the pricing is right, we will opportunistically purchase the real estate. At the same time, when attractive leases come our way, we'll sign those too. As we've shown over our 22-year history, there will be many, many opportunities to do both. We are very excited about the nine new operations we added during the quarter and since and look forward to seeing them contribute to the success of their clusters and their markets as they implement proven enzyme operational clinical principles. This growth should illustrate our confidence and our ability to continue to perform in the short run and, most importantly, over the long run. We've been extra diligent to ensure that each new addition had the full support of a healthy market, a proven leadership plan, and a clear pathway to strong clinical and financial performance. Looking forward, we have another busy spring and summer ahead of us. The pipeline for our typical turnaround opportunities, including real estate acquisitions and leases, continues to be strong. We have a dozen or more new additions that we are working towards closing in the coming months, and are working through the transaction documents and related due diligence on several more. Lastly, during the quarter, we paid a quarterly cash dividend of 5.5 cents per share. Given our strength, we plan to continue our 20-year history of paying dividends into the future. We also continue to delever our portfolio, achieving a lease-adjusted net debt to EBITDA ratio of 2.1 times, a decrease of 0.21 times from the prior year quarter. Currently, we have $593.3 million of available capacity under our line of credit, which was recently increased by $250 million to $600 million in April, which, when combined with the cash in our balance sheet, gives us nearly $800 million in dry powder for future investments. We also own 102 assets, of which 95 are held by standard bearer, and 78 of which are owned completely debt-free and are gaining significant value over time, adding even more liquidity to help us with our future growth. And with that, I'll turn the call back over to Barry. Barry?
spk03: Thanks, Chad. Over the past two years, our nation and industry have grappled with the COVID pandemic and associated staffing shortages, and our affiliated facilities have not been immune to these challenges. But it has been inspiring to see how our high-caliber local leaders have repeatedly used these challenges as opportunities to refine their systems, refocus their efforts, and improve their clinical outcomes and financial performance. Today, I'd like to share two examples, one from a large suburban operation and another from a small rural facility, that highlight how our model continues to thrive regardless of circumstances. The first highlight comes from Willow Bend Nursing and Rehabilitation, located in the Dallas metro area. This 162-bed facility, led by CEO Kevin Reese and COO Valerie Kasanovich, has achieved five-star ratings in quality measures, health inspections, and overall excellence, and earned a reputation for being the provider of choice that can meet the changing needs of health plans and hospital systems. For years, Willow Bend has been one of our strongest performing affiliates in Texas. But in the first quarter, they managed to grow overall occupancy by more than 8% and managed care occupancy by more than 17% compared to the prior year quarter. And as a result, their pre-tax earnings increased by 28%. These incredible results were made possible because of the team at Willow Bend's relentless focus on hiring and retaining high-caliber staff. In fact, during the first quarter, the team's recruiting efforts resulted in a growth of their care staff by more than 8% in spite of one of the most competitive hiring environments we've seen in decades in the Dallas-Fort Worth area. The second example we'd like to highlight is Oahe Health and Rehab, an award-winning 58-bed facility in Holmdale, Idaho, a town with a population of 2,600 in western Idaho. While hiring is difficult everywhere, it has become nearly impossible in small rural communities. Nonetheless, CEO Melissa Truesdale and COO Georgia Nelson have found a way to thrive by creating a family environment where staff feel valued and where resulted turnover rates are less than a fourth of the industry average. Retaining quality staff has allowed Oahe to meet their community's growing demand and increase occupancy to 92% in the first quarter. which represents a 9% improvement from the prior year quarter. As you would expect, Medicare skilled census also skyrocketed and EBIT improved by 47%. In the same way that COVID required our facilities to improve their infection control and clinical systems early in the pandemic, the staffing shortage has pushed our facilities to innovate and improve their systems around recruiting and retaining staff. The progress demonstrated by Willow Bend and Owyhee is reflective of progress that we are seeing globally across our organization. In the first quarter alone, while the industry was experiencing unprecedented staffing challenges, we grew our frontline workforce by 3%. This incredible progress is the culmination of hundreds of local leaders relentlessly focused on recruiting and retention. We are confident that our model of peer-to-peer best practice sharing will only accelerate this improvement in coming months. We hope that these examples are helpful in illustrating some of the many different levers our local operators are pulling in order to meet the needs of their healthcare continuum partners. With that, I'll turn the time over to Suzanne to provide some more detail on the company's financial performance and our guidance, and then we'll open it up for questions. Suzanne?
spk01: Thank you, Barry, and good morning, everyone. Detailed financials for the quarter are contained in our 10Q and press release filed yesterday. Some additional highlights for the quarter include GAAP diluted earnings per share was $0.89. Adjusted diluted earnings per share was $0.99, an increase of 13.8%. Consolidated GAAP revenue and adjusted revenues were both $713.4 million, an increase of over 13%. Total skilled service segment income increased 10.5% to $98.3 million. GAAP net income was $50.3 million, an increase of 2.3%. And adjusted net income was $56.4 million, an increase of 13.7%. Other key metrics as of March 31st include cash and cash equivalents of $248.5 million and cash flow from operations of $45.9 million. As of March 31, 2022, we repurchased 133,000 shares of our common stock for approximately $10 million, completing the October 2021 stock repurchase program. Given the stock's recent performance, our liquidity, and our confidence in near and long-term results, we have established an additional share buyback program of $20 million, and we believe this to be a very wise use of our capital. As we said before, share buybacks are one of the many levers we have to deploy capital to benefit our shareholders. We also wanted to address the current status of the state of emergency in reimbursement matters. Recently, HHS extended the public health emergency for another 90 days. With this extension, the federal government will continue to provide various waivers and enhance FMAP funding to July 14, 2022. Additionally, as a reminder, the suspension of the 2% sequestration continued through April 1st, 2022, at which time the suspension amount was adjusted to 1% through June 30th. Starting July 1st, the full 2% sequestration will be back in place. The suspension had and will continue to have a positive impact on our revenue, depending upon how the pandemic affects our Medicare census. As you all know, a new billing system was implemented in October 2019 called PDPM. When finalizing PDPM, CMS stated that the new case mix model would be implemented in a budget-neutral manner, meaning that the transition from RUGS to PDPM should not result in a payment reduction or increase. Subsequently, COVID hit the industry, resulting in higher acuity patients and had a direct impact on the PDPM rates. When evaluating PDPM last year, CMS acknowledged that COVID affected their PDPM analysis and decided to take a step back to further study the impact. CMS recently issued a proposed rule regarding Medicare rates and PDPM. Under the proposed rule, which asked for commentary from providers, CMS would make a parity adjustment that would reduce Medicare rates downward by 4.6%, with the goal of making PDPM budget neutral. The ultimate timing and the amount of the proposed adjustment will be subject of much discussion during the next several months before the rule is finalized. Additionally, CMS announced a larger-than-normal payment rate increase of 3.9%, which includes adjustments for the annual market basket, the positive forecast error, and productivity. Depending upon CMS' parity adjustment for PDPM, the net rate increase And the final rule could either be a negative 0.7% or it could be less or even could be a net positive change depending upon the timing and the amount of the final adjustment. Despite these announcements by CMS, we are reaffirming our 2022 annual earnings guidance of $4.01 to $4.13 per diluted share and annual revenue guidance of $2.93 billion to $2.98 billion. We have evaluated multiple scenarios, and based upon our solid performance and positive momentum, we've seen an occupancy and skilled mix, as well as some additional strength from Medicaid programs. We remain confident that we can achieve our earnings and revenue projections within these ranges. Our 2022 guidance is based on diluted weighted average common shares outstanding of approximately $57.3 million, a tax rate of 25%, the inclusion of acquisitions closed in the first half of 2022, the exclusion of losses associated with startup operations which are not yet stabilized, the inclusion of management's expectations of Medicare and Medicaid and reimbursement rates net of provider tax, and with the primary exclusions coming from a one-time legal fee and stock-based compensation. Additionally, other factors that could impact the quarterly performance include variation in reimbursement systems, delays and changes in state budgets, the seasonality and occupancy and skilled mix, the influence of the general economy and census and staffing, the short-term impact of our acquisition activities, variations in insurance accruals, surges in COVID-19, and other factors. And with that, I'll turn the call back over to Barry. Barry?
spk03: Thanks, Suzanne. We again want to thank you for joining us today and express our appreciation to our shareholders for their confidence and support. We know that this year will continue to be challenging You know, present with us several unique challenges, but we're encouraged by our operational strength and our core business. We're also thrilled to have an additional growth lever and standard bearer, which will help us accelerate our mission to change post-acute care. With Ensign Affiliated Operations as its primary tenant, it's a perfect launching pad to create significant real estate value as we follow our proven model while we align with others in our industry. As Chad pointed out earlier, we believe little to no value is being assigned to our real estate by investors when, in fact, the value is more than a billion dollars. We're eager to grow that value and take advantage of opportunities we previously would have passed on and leverage our best-in-class field leadership team to help attract and partner with other great providers in our space. And speaking of talented field leaders, we want to recognize them for their heroic efforts along with those of our nurses, therapists, and other frontline care providers who continue to provide industry-leading example of life-enriching service to our residents, coworkers, and their communities. We're also appreciative of our colleagues here at the service center who are working tirelessly to support our operations, enabling us to succeed in spite of the challenges we faced. Thank you for making us better every single day. We'll now turn the Q&A portion over to our call. Victor, can you please instruct the audience on the Q&A procedure?
spk05: As a reminder, to ask a question, you need to press star 1 on your telephone. And to withdraw your question, just press the pound key. Please stand by while we compile the Q&A roster. Our first question will come from the line of Teo Q from Stifel. You may begin.
spk07: Thank you. Good morning, everyone. Barry, I really appreciate the details you provided on labor management initiatives to improve recruiting and reduce turnover. And certainly your performance has surpassed many of your peers. I wanted to ask about another staffing matter that could have long-term implications on industry. I think the federal government is trying to implement a minimum staffing requirement that could be implemented by next spring. We know that CMS is engaging the industry to formulate the guideline. Obviously, some of the states already pushed out their own rules. Could you maybe talk about the staffing level today in your facilities and the mix of RNs, CNs, et cetera, and where do you think the federal rule may shake out to be to give us an idea on the potential impact? Thank you.
spk03: Yeah, it's a good question, Tal. And, you know, the answer could be a lengthy one, but I'll try to summarize it in a pretty straightforward way. I mean, first and foremost, we know very little, right? There's been just an overall kind of impetus to look at this. It'll begin with a long-term study. That will take a full year to do. as they've outlined it. They're certainly asking for a lot of feedback from the operator community, which is positive, and we are involved with that at our federal association level and will continue to be. But one important distinction, you know, in the face of a potential federal staffing mandate, you know, As you pointed out, we see ourselves a bit differently, and frankly, we are different than, I would say, most of the post-acute world in the skilled nursing space in that we already take a higher acuity-type patient that necessitates a higher than what I would call average staffing level. So when you think about just kind of the overall... drive for a federal staffing mandate has to contemplate all types of providers and the vast majority have a lower acuity level than what we typically see. That being the case, a federal staffing minimum that takes into account kind of what the average operator does would mean that we're probably much higher than the average threshold, just given our acuity level that we already see. We don't worry too much about it. We try not to focus too much on the what-ifs, especially when there's very little detail given around it. But we feel okay. It's certainly not a model we necessarily agree with. That's not the way to drive quality, in our opinion. But regardless of what the federal government does with a regulatory mandate around staffing, we're not too worried about it, just given our model and the types of patients that we see.
spk07: Got you. My second question is for Chad. I'm standing there. In the prepared remarks, I think you mentioned you are in active discussion with like-minded operators. Could you talk about any quality of trades that you're looking for in your operator partner? Are these going to be smaller regional operators, or would you consider partnering with larger and multi-state operators as well? And in terms of the opportunities you're looking at, what is the current breakdown of mature versus turnaround opportunities? Are there any new markets you're contemplating getting into? Thank you.
spk02: Yeah, thanks. Great question. So, yeah, I mean, I wouldn't say that size of the operator is necessarily a factor. I mean, for us, it's going to be, you know, kind of as Barry was saying, I mean, I think it's operators that see the post-acute space much like we do. And, you know, I think cultural alignment will be important as well. Just in terms of, again, generally how we see efforts towards quality and making sure that we're a solution to whatever the hospital needs. and, you know, managed care partners, you know, need us to be and those kinds of things. So, you know, all that said, you know, there's lots of ways to be a really good operator. And, you know, we don't presume to have all the answers. And, you know, we have our model, but there's other ways of doing things. And so we're very cognizant of that as well, and we'll look to learn from others as well. And so in terms of the criteria, I think obviously our first priority or our first desire would be if there's an opportunity to operate it ourselves. But there are many opportunities that come our way that for various reasons they're not a fit for us. One of the things that we look to first is who the leadership is going to be in any particular market. Oftentimes, we're approached with a set of facilities that present new markets or new areas where we don't currently have a presence. In many cases, we've kind of lost out on opportunities because we were saying we would only do the deals that are in our markets already. And oftentimes sellers like to work with a single buyer. And that's not even necessarily always a new state. Sometimes there can be markets within a state that we're not in. So there are things like that that I think will certainly open up the opportunities. And to your second question, our first priority will be operating ourselves in markets we're in, and then the second one would be operating ourselves in maybe a new market, but then the third would be to look to these other partnerships where it's not a fit for us operationally. And that could include new states. We've been very... deliberate in our effort to enter into new states. It's a lot of work to get to know an entire new regulatory environment, new managed care partners, new hospital systems. It just takes a long time and many years to really develop your reputation in a new state. Aligning with like-minded operators in new states, I think, is certainly some of these initial discussions I referenced earlier. or in states where Enzyme currently isn't operating. So that's going to provide a lot of options for us as well. But, yeah, really excited about it. The feedback we've gotten from many folks has been really positive, and I think there's a lot of excitement in working together, you know, not just as, you know, sort of a source of financing or, you know, someone that owns a real estate, but other sort of partnerships that we can offer as well as fellow operators that get pretty exciting.
spk01: I think the other thing we're looking for is people who want to be in it for the long haul, who want to have very successful operations and aren't trying to offload every dollar into the real estate and look at it as a one-time transaction for them, but someone who really is excited about being the best-in-class operator themselves and so that we can have that great partnership that Chad just talked about.
spk07: Great. Thanks for speaking, Carla. That's it for me.
spk05: Thanks, Tal. Our next question will come from the line of Scott Fidel from Stevens. You may begin.
spk06: Hi, thanks. Hi, everybody. I wanted to maybe just start the first question just going back to the proposed CMS Medicare rule for FY23, and just interested in how you're handicapping what you think ultimately probably ends up to be the likely outcome. I mean, I would assume maybe we end up with like a two-year phase of the PDPM recalibration, you know, could be one scenario, and how you balance, you know, the opportunities and the risks from that with, opportunities, you know, clearly being potentially more opportunity on the M&A front and the risks being just needing to manage margin against maybe, you know, a bit tighter pricing. So, interested in all your thoughts around that topic.
spk01: Yes, Scott, and, you know, just a reminder, I think it's sometimes confusing when you talk about the year that it starts. This is the rate starting October 1st of 2022. Obviously, it's the two components that we're really looking at, that positive that I talked about in the prepared remarks, the 3.9% increase, and then the proposed parity adjustment of the 4.6% cut for the overall negative 0.7. You know, I think we see that the positive is really good, you know, having all those components in it. Obviously, there's still a component that's always missing because of the inflation that occurs in the current year really isn't reflected for, you know, it has about a year lag period. And so we believe, you know, if this is what we'll get this year, that there's another opportunity for that to have another forecasting error adjustment next year where we might have another big positive come in. So that's on the kind of net market basket rate that we would normally see. And then with regards to the parity adjustment, kind of looking at that, you know, as we've been talking about, and again, in the prepared remarks I said, We've included the whole thing going into our overall guidance, but we're really hopeful and we see a lot of pathway forward to having that cut maybe over a two, potentially even a three-year period, but more likely over a two-year period and really cut in half. And so that really then, if that gets cut in half, that really puts us kind of exactly where we initially had our guidance and the assumptions that we had in our initial guidance that we've released in Q4 um, or it was around a, you know, one and a half, 1.6% increase overall, but I'll let Barry give some additional color on that.
spk03: Yeah. I mean, we look at the, the, the reality is, is, you know, whether, whether it happens this year in full or not, it's, it's, uh, I, I think on the one hand, if it does happen, we see, you know, it happens all in one year. We see an opportunity for growth, which is, which is, uh, which is exciting for us. On the other hand, if it happens over a two-year span, we certainly see a pathway and no need to adjust any guidance and have any concern for us being on the path that we predicted that we would be on for the year.
spk01: So long story short, either way we feel like it's going to be within the range of guidance that we put out. I think the other thing that we've been talking about is that there's an opportunity for us to continue to see acquisitions out there, and maybe Chad can give some color on that.
spk02: Yeah. It's been kind of an interesting period here because we see a lot of deals, and obviously we did nine this last quarter, so finding deals in there that are priced appropriately, but But we've also been sort of outbid, I would say, by others that we think are paying prices that just don't make sense. And we continue to see some sellers coming to market with really high expectations. And with all of this on the horizon, we're going to stay disciplined and think that at some point that's going to have to correct and And so, yeah, I mean, again, the pipeline is still strong, and we still, like I said in our prepared remarks, we've got, you know, a dozen or so deals we're working on now. But, you know, if this all happened in one fell swoop in the fall, you know, it just might accelerate, you know, some of that adjustment in pricing expectations. And that's why we've... updated our revolver and have all that dry powder.
spk06: Understood. And then maybe just as my follow-up question, could be helpful if just on the staffing dynamics, if you're able to give us any insight on how the sequencing of hires and turnover sort of played out over the course of the quarter and any early observations you can give us on the staffing dynamics that you're seeing so far in the second quarter through April.
spk03: Yeah, great question. So, you know, we obviously, we track it very closely, and we're looking at it from a number of different angles, both in terms of agency usage and, you know, we call it kind of net hires. And so, you know, we certainly, the winter has kind of been the toughest. It peaked for us, you know, in kind of January, And since then, we have seen really, really positive momentum in terms of our net hires. And when you look at it in terms of full-time equivalents, we've grown our workforce by 3%. We've seen our agency usage finally start to come down. And we expect that trend to continue as we track things through where we are currently. And so, All very encouraging trends as we kind of break that down and see all those indicators pointing towards, you know, a real positive direction for us, Scott.
spk06: Great. And if I could just sneak one more in. Just interested on your current thinking around occupancy and maybe how you're modeling it, you know, internally in your outlook in terms of, you know, would you – Should we expect that, you know, absent another new severe variant, you know, coming, you know, into the picture that generally we'll just see sort of progressive improvement and occupancy sort of play out throughout the course of the year? Or do you think that we'll have some of the traditional seasonality play out, you know, when thinking about the various quarters? And that's my next question.
spk03: Yeah, great. Thanks, Scott. Great questions. And it's a good question. Seasonality, we expected last year to see some of that happen. It didn't necessarily. We saw steady improvement even through the summer, which was very unusual for us. You know, we're on our fifth quarter in a row of consecutive improvement in occupancy. You know, more than that when you look at managed care. Look, we're pretty positive about the direction we're going, and I wouldn't be surprised. I mean, normally at this point in time we see some slowdown as we head into the summer months. We haven't seen that yet, knock on wood. So, you know, overall we feel pretty positive that we'll continue to improve. I mean, it makes sense for us because we're still in a recovery mode from where we used to be from an occupancy standpoint. We know that the We know that the demand is there. We see volume, and we've only been limited by some kind of artificial things that have happened or one-time things that have happened, both in terms of surges and variants and some staffing challenges. But even in spite of those, we've seen improvement in occupancy, which gives us some confidence that that trend will keep continuing at the pace that we've seen it. Okay, thank you.
spk05: Once again, that's star one for questions. Our next question will come from Ben Hendricks from RBC Capital Markets. Your line is open.
spk04: Hey, thanks, guys. On your managed care revenue growing and that becoming a larger piece of the skilled mix, can you talk a little bit about your managed care contracting and you know, how that's progressing and the willingness of, you know, your managed care payers to acknowledge the higher staffing costs you're seeing?
spk01: Yeah, maybe I'll start and then Barry can add some color. I mean, I think this is something that we, as you could recall, we've been working on a really long time. Those relationships are both, you know, some of them are at a national level, but the strong, strong part of the relationship is that local level, that local operator relationship that local clinician, that local managed care resource really working with the managed care team at their local level and really creating an atmosphere where they can make solutions and solve problems there. And so that's really what we've seen really take off. I think what we saw was during the pandemic, a lot of discussion about the acuity of the patient and how the acuity of the patient played into getting care at a skilled nursing facility versus potentially getting care in other locations during that period of time. And I think it created some additional trust with us and our managed care partners that we've seen continue to happen after the pandemic. And I think early on we were hopeful for this, but it feels like it's really in full motion. I would say on the increases, I think Managed Care is always looking to make sure they capture as much dollars as they can, and we are as well. And so it's, as you can imagine, a healthy discussion and debate about what rates people should get and how much people should get in. So we're always in discussion with them at various levels, again, locally as well as nationally, to try to make sure that people recognize the additional cost associated with that direct labor component. that we are obviously occurring right now and showing them that information and those numbers and trying to give them some additional insight and tell that labor market that is a challenge right now. And so it's a discussion. I wouldn't say it's a one and done. It's an ongoing discussion that's going to take, you know, because we don't have three or four contracts in the organization. We have hundreds of contracts that happen daily with our team as well as the managed care providers.
spk04: Thank you for that. And then separately, just with expectations for rising interest rates, is this any changes at all or any impact on the way you're thinking about your growth strategy, whether it be changes in your triple net lease term rates or your capacity to, even though you have very strong liquidity, any capacity to potentially lever your unencumbered real estate assets?
spk02: Yeah, it's a great question, Ben. I mean, you know, we certainly keep a close eye on it. And, you know, I would just say, you know, we're going to just make sure that we're in line with where the market is, you know, especially from kind of the real estate side of things. But, you know, really happy with the terms of our new credit agreement. You know, there is a kind of a – I guess, a floating kind of SOFR-based element to that. But we're so healthy, and our debt levels are so attractive, our banking partners gave us a really good term. So we're really excited about that. We obviously have a bunch of unlevered real estate assets that we could get some fixed financing if we want to do that, too. All of it, though, at the end of the day, it comes down to the prices that you're paying. And so long as, you know, you're doing that and, you know, everything we do, we make sure there's a forward-looking element to, you know, how we think we can perform. And, you know, obviously, you know, real estate expenses are a big part of that. But, you know, as long as you can, you know, make sure you're paying a proper price and that there's enough cushion there to give the operators room, you know, it doesn't, you it just kind of affects the terms of the deal, so to speak.
spk03: I'll just add one thing, too, Ben, that as you're talking about the triple net leases, I mean, Chad and his team have been very diligent over the years to ensure that all of our leases have kind of a cap on inflation as far as the rate increases go, the escalators. So we really, you know, Our average escalator increase cap is right at around 2.5% for all of our triple net leases, which has been a really good hedge against what we're seeing ahead. So we've got a good safety net there that will keep our leases in line. Great. Thank you, guys.
spk01: Thanks, Ben.
spk02: Appreciate it.
spk05: Thank you. And I'm not showing any further questions in the queue. I'd like to turn the call back over to Barry for any closing remarks.
spk03: Thank you, Victor, and thank you, everyone, for joining us today.
spk05: And this concludes today's conference call. Thank you for participating. You may all disconnect. Everyone, have a great weekend. Thank you.
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