The Pennant Group, Inc.

Good day and thank you for standing by. Welcome to the Pennant Group conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1-1 on your telephone. You will then hear an automated message advising your hand is raised. Please be advised today's conference is being recorded. I would now like to hand the conference over to your speaker today, Derek Bunker. Please go ahead.

Thank you, Corey, and welcome, everyone. Thank you for joining us today. Here with me today are Brent Garasoli, our CEO, John Dockner, our president, and Jen Freeman, our CFO. Before we begin, I have a few housekeeping matters. We called the earnings press release and 10Q yesterday. This announcement is available on the investor relations section of our website at www.penninggroup.com. The replay of this call will also be available on our website until 5 p.m. Mountain Time on Friday, December 9, 2022. We want to remind anyone that may be listening to a replay of this call that all statements made are as of today, November 8, 2022, and these statements have not been nor will they 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 securities laws, the tenant 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 tenant group is the holding company with no direct operating assets, employees, or revenues. Certain of our independent subsidiaries, collectively referred to as a service center, provide accounting, payroll, HR, IT, legal, risk management, and other services to the other operating subsidiaries through contractual relationships with such subsidiaries. The words tenant, company, we, our, and us refer to the tenant group, Inc., and its consolidated subsidiaries. All of our operating subsidiaries in the service center are operated by separate 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 the terms we, us, and our, and similar terms used today are not meant to imply, nor should it be construed as meaning, that the tenant group has direct operating assets, employees, or revenue, or that any of the subsidiaries are operated by the tenant group. Also, we supplement our gap reporting with non-gap metrics. When viewed together with our GAAP 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 GAAP reports. A GAAP to non-GAAP reconciliation is available in yesterday's press release and in our 10-Q. With that, I'll turn the call over to Brent Carasoli, our CEO.

Thanks, Derek, and welcome, everyone, to our third quarter 2022 earnings call. Thank you for joining us today to discuss our quarterly results. Again, I'd like to recognize our frontline workers, staff, and leaders in Pennant who sacrifice every day and provide life-changing service across the communities we serve. As we've detailed over the last several quarters, we continue to build long-term foundational strength through several key efforts. First, we are focused on recruiting and developing CEO-level healthcare leaders equipped with Pennant best practices to accelerate our next phase of growth Second, we are investing in people, systems, and data tools designed to improve the ability of our local teams to respond to the unique needs of our healthcare communities. These are ongoing processes designed to build the engine that will drive outsized performance for many years to come. While this quarter's earnings didn't fully reflect the progress we expected as we navigated continued wage pressures, full sequestration, and a softer hospice ADC, We're seeing notable progress as measured by revenue, admissions, occupancy, and cash flow. We're seeing strength build in many of our markets and clusters. We are on track to make significant improvement in the second half of 2022 and are positioned to produce strong results going into 2023. We have substantial latent potential in our existing operations. We've been improving our cash flow and balance sheets. and we are beginning to return to the brisk pace of strategic acquisitions that we've executed on for much of our history. We know where we are going, how to get there, and we are excited about the progress we're making toward operational excellence and our ability to generate and deploy cash toward a creative growth in an active M&A landscape. As we mentioned in our press release yesterday, we are revising our guidance for full year 2022 in light of the pressures mentioned earlier. However, our updated guidance demonstrates confidence in our momentum through the end of the year and into 2023. We are encouraged by improvements in our recently acquired operations and believe there remains significant opportunity to drive better earnings as we continue to acquire high-quality assets and execute with discipline around our core opportunities. We look forward to tackling the many strategic and organic growth opportunities before us. At this point, I've asked John Gochner to provide an update on operational and investment results.

Thanks, Brent. Our third quarter operational results reflect positive momentum in each of our operating segments. In our home health and hospice segment, strong top and bottom line results were led by a 10.2% increase in total home health admissions, a 10.1% increase in total Medicare home health admissions, and a 7.8% increase in hospice admissions each over the prior year quarter. Our home health revenue grew a strong 16.5% over the prior year quarter as we continued to lean into our relationships with partners across the communities we serve, and our acquisitions from 2021 continued to mature. Though there is still some temporary drag in the growth of our hospice average daily census due primarily to a shorter average length of stay were improving sequentially as we saw ADC grow 0.4% over the second quarter of 2022, which itself was an increase of 2.4% over the first quarter. As our average length of stay normalizes and our local teams continue strong admissions, we expect our ADC growth to return to traditional levels Our leaders exercise rigorous cost discipline in the face of significant increases in the cost of labor, fuel, and other inflation-sensitive areas, leading to adjusted EBITDA of 14.2 million, 1 million, or 7.7% above the third quarter 2021. Our clinical metrics continue to be the foundation of our success. highlighted by the majority of our home health agencies operating at a CMS star rating of 4.5 or above and a real-time acute care hospitalization rate of 12%, which is measurably below the reported national average of 14.2% and shows our value proposition to our health system and payer partners. During the quarter, We acquired the operations of Ardent Hospice and Palliative Care with locations in the Central Valley and Palm Springs, California, to our hospice portfolio. This is a highly strategic acquisition for us as we build on strong, proven leaders in our California market with deep partnerships throughout the state to help drive these locations forward. We also recently announced the acquisition of Kenosha Visiting Nurse Association, a home health and personal care agency that has served Kenosha, Wisconsin, and its surrounding communities for more than 95 years. We are grateful the organization's board has entrusted us with such a significant legacy and excited to write a new chapter for another operation in the Milwaukee area, where we also have strong leadership producing exceptional financial and clinical results. The staff and patients of KVNA are in good hands with our local leadership team. We're excited for the budding opportunity inherent in each of these acquisitions. On the regulatory front, CMS recently released the 2023 Home Health Final Rule, which included CMS's decision to reduce the behavioral adjustment cuts calculated by half for calendar year 2023. These cuts were also offset by a stronger than originally proposed 4% market basket update. Based on our claims data and run rates, on 2022 Medicare home health revenue, we expect a net negative impact of approximately 1% in our Medicare home health revenue for 2023. While the final rule's negative behavioral adjustments represent a headwind for providers in our industry, Pennant's home health and hospice segment began in and has thrived through periods of uncertainty and reimbursement cuts, much like today, thanks to the scalability of our operating model built on local leadership, our commitment to maintaining a strong and flexible balance sheet, and our opportunistic approach to acquisitive growth. The final rule, together with the growth of Medicare Advantage and home health value-based purchasing reimbursement programs, show how home health providers that can effectively manage costs and improve quality will be increasingly recognized and rewarded. We have been preparing for the implementation of the final rule, And much like the change to reimbursement affected through PDGM several years ago, we are confident we can pull the right levers to continue our growth, even in a challenging reimbursement environment. In our senior living segment, we continued our recovery by taking a step forward in many key metrics. Same store senior living segment revenue of $32.2 million was an increase of $3.4 million, or 11.8%, over the prior year quarter. while adjusted EBITDA of $1.5 million represents growth of $1.4 million over the prior year quarter. Year to date, segment adjusted EBITDA of $4 million represents growth of $3.2 million over the prior year period. Excluding the communities we exited year to date, average occupancy improved 140 basis points over the prior year quarter and revenue per occupied room increased 12.2% over the prior year quarter, in part due to rate increases that went into effect over the summer and better processes for tracking and billing more accurately for the level of care provided. The momentum our senior living leaders are generating is demonstrated by occupancy improving 0.4% and rev pour increasing $87 or 2.5% each over the second quarter 2022 on a same store basis. Labor challenges linger with average wages up in the third quarter by 2.7% over the second quarter. We continue to attract and develop senior living leaders who are contributing to and will be instrumental in our turnaround in the segment. We have more to accomplish. With higher cost of services and occupancy several points below pre-pandemic levels, however, we know that achieving exceptional operational results starts with talented local leaders and resource support. And as we've been building our leadership strength in this segment, we're beginning to see the fruits of that key effort. Overall, we are pleased with the progress made in the third quarter in a challenging operating environment. Our operators, clinicians, resources, and service center partners all share a single focus on operational excellence. At the same time, our pipeline of potential investments continues to expand. We remain focused on evaluating operations that fit our strategic criteria of small to medium-sized operations with strong reputations in their communities, but with significant organic growth potential where our operational expertise can capture that upside for our stakeholders. While we continue to be very disciplined as we look to deploy capital Our cash flow is improving. We are pleased to have a strong balance sheet, and we see several dynamics that favor strategic buyers like ourselves that are focused on maintaining the legacy of sellers, providing an exceptional employee experience, and delivering quality clinical care. Finally, I'm grateful for the persistent dedication and hard work of our 5,400 tenant family members, and I'm confident as we continue to perform, we will achieve exceptional clinical and financial results. With that, I'll hand it over to Jen for a review of the financials. Jen?

Thank you, John, and good morning, everyone. Detailed financial results for the three and nine months ended September 30th, 2022 are contained in our 10Q and press release filed yesterday. Our third quarter results were strong, though a bit shy of our expectations due to slower than anticipated ramps in our hospice volumes and a cost of services impacted by elevated labor in the quarter. For the three months ended September 30th, 2022, we reported total GAAP revenue of 118.4 million, an increase of 6.4 million or 5.7% over the prior year quarter. GAAP diluted earnings per share of 16 cents and non-GAAP adjusted earnings per diluted share of 14 cents, an increase of 3 cents or 27.3% over the prior year quarter. We are pleased to report ongoing strength in our GAAP cash flow from operations for Q3 2022 of 8.1 million, bringing our year-to-date cash flow from operations to 13 million. Excluding the repayment of 6.2 million in Medicare advance payments, which were completed in the second quarter, our year-to-date cash flow from operations is 19.2 million. Also, excluding the two announced acquisitions in the third quarter and since, Free cash flow would have been $5.5 million in Q3, including $2.6 million of CapEx for improvements in our communities. This strong cash flow is important as we take a strong balance sheet into a recessionary environment with a reimbursement headwind that should present greater acquisition opportunities. We're excited to grow and continue to generate solid cash flow for our stakeholders. Other key highlights for the three months ended September 30th, 2022 include 57.5 million drawn on our revolving line of credit and $3 million cash on hand at quarter end and 1.98 times net debt to adjusted EBITDA leverage ratio. As mentioned in our press release yesterday, we are revising our fiscal year 2022 annual guidance to revenue between 458 million and 462 million. Consistent with our prior guidance and how we have measured ourselves all year, this excludes revenue from transferred and newly acquired communities and startups. With those items added back in the full year, revenue would be between $467 million and $473 million. Additionally, we revised adjusted earnings per diluted share to between $0.55 and $0.60 on 30.3 million of diluted shares. Adjusted EBITDA was revised to between $31 million and $33.5 million. Our revised earnings guidance reflects ongoing growth in our home health and hospice admissions and senior living metrics, offset by a slightly slower than anticipated ramp in our hospice ADC, elevated G&A spend related to investments in creating increased efficiencies in systems and processes, including increased focus on cash collections. and investments in training an increased number of leaders that will be poised for new opportunities, with ongoing wage pressure in both operating segments and the service center. While staffing inflation and other operating challenges will likely persist for the foreseeable future and continue to create hurdles we have to overcome, we know our leaders across the company are capable of confronting these headwinds and continuing the ramp in performance that we've experienced year to date. We are confident in our future and expect further organic top and bottom line growth in 2023, in addition to opportunities to acquire high-quality assets that we expect to execute on over the next year and beyond. And with that, I'll hand it to Brent to highlight a couple of our local leaders.

Thanks, Jen. It's my pleasure to spotlight a few leaders and markets in our organization that have achieved remarkable results through operational excellence. Under the leadership of CEOs and market leaders Tiffany Morse and Jeanne Brogny, our senior living market covering the state of Wisconsin has experienced an inspiring turnaround over the past 18 months. Because of their establishment of and commitment to rigorous adherence to our unique operating model, Tiffany and Jeanne have led a charge to turn our 19 Wisconsin communities they focused on finding and developing key leaders in Wisconsin that elevated our operations. Leaders like CEO Tammy Wagner, new Chief Marketing Officer Christine Gomez, clinical market leaders Michelle Dove and Jamie Campbell, and strong future CEO-level leaders. In the third quarter of 2022, compared to the prior year quarter, this budding group of talented Wisconsin-based leaders and many others have increased revenue by 22.7%, and took EBITDA from a negative $350,000 to a positive $534,000, growing occupancy by 6.9% to 88.5% and revenue per occupied room by 11.2%, despite one of the most difficult operating environments we've experienced. These results are emblematic of what our model is designed to foster. Talented local leaders supported by expert resources meeting the needs of their local communities, and in turn achieving incredible operating results. In our home health and hospice segment, our California market is rapidly turning a flywheel of success due to the leadership of CEOs Andrea Docter, Jordan Baker, and Adam Bone, CCOs Jesse Allande and Tina McMahon, and clinical market leader Bill Bradley, cluster leaders Nels Lund, Charlie Marinko, and Tim Johnson, and many others we could name. This group of healthcare leaders have collectively improved the California market's financial and clinical results, building a deep bench of leaders committed to our model and supporting each other in achieving these results. Over the last few years, this foundational strength enabled them to successfully transition our home health and hospice joint venture with Scripps Health, First Call Hospice in Sacramento, a successful de novo home health startup in Riverside County, and recently Ardent Hospice and Palliative Care in the Central Valley in Palm Springs. In the third quarter of 2022, compared to the prior year quarter, this market increased revenue by 31.7% and EBITDA by 148% on the back of hospice ADC that grew by 35% and home health admissions that increased by 11.2%. At the same time, their rigorous focus on quality clinical processes is leading to better outcomes and strong star ratings than other clinical measures. This group of leaders is showcasing what can be achieved in each of their local operations and together as clusters and markets through the application of our unique operating model. Before we move to Q&A, I want to once again make sure to recognize and thank all of our incredible clinical partners frontline workers who provide life-changing service to our patients and residents every day and make us who we are. With that, we'll open it up for questions.

Thank you. At this time, we will conduct the question and answer session. As a reminder, to ask questions, you will need to press star 11 on your telephone and wait for your name to be announced. Please stand by while we compile the Q&A roster. Our first question comes from the line of Tao Kui from Stifle. You're up.

Hi. Good morning, everyone. My first question is on the guidance. Could you help us kind of bridge between the third quarter and the fourth quarter? I noticed that the guidance suggests kind of a flat top line performance, but a little bit improvement on the EBITDA number. I know that the hospice rate is going up. is getting raised in the fourth quarter. Could you help us explain some of the moving pieces between the third quarter and to the fourth quarter?

Sure. There's a couple of different things that are going on. And actually, we're going to experience an increase in revenue. So it may look flat because of the way that we're reporting our revenue guidance, but actually we're reporting an increase in revenue. We should see an increase from our hospice increased rates of about 1.5 million. And then with increase with census and admissions in home health, as well as our hospice census growth, we're actually factoring an additional increase in that as well, along with our senior living occupancy improving at a similar pace to what it's done. And we do expect for a GNA to remain at a at the same percentage, a little bit less for the fourth quarter than it occurred in Q3.

What about on the expense side? Do you see any cost moderation in the fourth quarter versus 3Q?

We're assuming a similar cost in the fourth quarter versus Q3. A little bit of cost moderation in the increase quarter over quarter. And then the incremental margin on the senior living occupancy growth will be where we can pick up some extra margin growth because of already covering our indirect costs and having the staff that we need for increased occupancy.

Got you. That's helpful. So my second question is on the senior living business. Obviously, that business has a lot of operating leverage to the upside. And looking at this year, you were able to grow your rate pretty aggressively at 12%. But if we look at the outcomes, it grows at 140 bps on the same story. It's relatively small. How should we think about the two components going to 2023 as you think about additional recovery and the pricing power you have today?

Yeah, Sal, I mean, I think What we would expect to see is continued growth on the rate increases, right? I mean, we're trying to catch up with some of the inflationary pressures, and we've made consistent changes in that regard. In addition to that, we're also doing a much better job of managing each of the residents that are coming in, understanding the opportunities from a care standpoint, and really getting a full picture of managing both the costs and the revenue opportunities. And so as you look into 2023, some of those same levers that we've been pulling this year, we would anticipate rolling into 2023. And we've consistently seen occupancy growth, which is encouraging in spite of these rate increases. So I would expect to see occupancy growth, rate increase, revenue pour, or rev pouring increase as well. So that's what we're anticipating rolling into 2023.

Great. And one final question for me. You mentioned that you're looking at the small and big size acquisitions in the home health area. I'm just curious, after the final rule came out, any changes in the pipeline or in your conversation with the potential targets and whether that has changed at all? And what do you think the market model is today?

I appreciate the question and I think our strategy remains the same. We've always been focused on some of these small to mid-sized providers and then taking advantage of larger opportunities when they've presented themselves. As far as the pipeline, We're excited about what we have. It's pretty robust. I would say the change to the final rule is in the process of spurring some additional folks to make a decision. The fact that there's a little more certainty, at least for the 2023 operating environment, and then some positive moderation in the rules impact. I think will lead to some of those home health agencies that have been sitting on the sidelines waiting to see what was going to happen to engage. And so we're pleased with what's in our pipeline, and we're also excited to see that kind of uptick that we think will come in the wake of the final rule.

Great. Thank you.

Thank you, Tal. Thank you. And as a reminder, you can hit star 1-1 if you would like to Get in the queue to ask a question. Stand by as our next question queues up. Our next question comes from Scott Fiddle at Stevens.

Hi. Thanks. Hi, everyone. First question, just on maybe just unpack some of the dynamics in the hospice, ADC and length of stay, pressure in the third quarter, maybe talk about, you know, sort of, how much COVID may have impacted that versus other COVID factors, and maybe how those stats were exiting the quarter as compared to how they averaged throughout the quarter.

Yeah, great questioning. Good morning, Scott. Thanks for being on. Our hospice length of stay was softer than what we had originally projected. It's one of the drivers behind where we ended the quarter, but we're really pleased with the momentum going into October. It feels like we're picking up steam. I think what is driving that ADC remaining flat is a couple of things. One, as you mentioned, our length of stay is declined by about nine days, which is pretty significant for us. The second is we continue to receive an elevated number of referrals from our hospital partners. And we're grateful for that. But we're also seeing the census at our skilled nursing and assisted living partners continue to increase. And so we're optimistic that those settings that often identify the need for hospice a little bit sooner, that as their census rebounds, we're going to see an increased number of referrals from those trusted partners. And so we see sort of that starting to happen, those census starting to increase in some of our key partnerships. And we look forward to that bringing us back to a more traditional level of growth. You see on the home health side kind of how we've been able to lean into those partnerships, produce great quality outcomes, and the impact that has had on our admissions and on our our ADC, we expect the same from our hospice. And so it's been a little bit of a, we've had some ups and downs with length of stay and where our referrals are coming from. But the good news is admits have remained strong. The community continues to trust our local leaders and the excellent care that we provide. And that will eventually turn into an increased ADC.

Okay, got it. That next question, just interested if you can, just go into a little more detail on how the acquisitions, you know, trying to improve the performance and margins in let's call it the class of 2021 and 2022. Maybe give us an update on sort of what progress you've seen there and then, you know, how much embedded opportunity you have still remaining in getting those, you know, acquisitions up to where you would like to see the margins, you know, more traditionally.

Yeah, as you know, Scott, our traditional strategy has been to buy sometime somewhat underperforming assets, whether that's clinically or operationally, and to leverage our operating model, our approach to local leadership and our operational expertise to improve those. What that means is it ends up that some of our quarters are lumpy from a margin standpoint as we acquire and integrate those operations. I think what we've seen in Q3 and what we're continuing to see is a number of those acquisitions really pick up steam. An example I'd use is our hospice in Sacramento, which has continued to grow month over month from an ADC perspective, from a clinical outcome perspective and a trust in the community perspective, and has positioned itself to now do additional acquisitions in that market. But that's true pretty much across the board. We're seeing significant improvement. The upside is still huge. We've talked a little bit about how those 20 and 21 acquisitions that occurred during COVID, it was harder and it took longer to implement the changes that we so often implement in order to improve clinical and operational performance. And that delay sort of backed that up a little bit, but it didn't change our long-term opportunity. The long-term opportunity of those operations mirrors those that we have across our platform that have consistently contributed year-over-year double-digit growth. And so we're really excited to see those continue to add value and for us to realize what Brent described as the latent potential in our platform.

Yeah, Scott, the other thing that I would add, and this is why we've been focusing so much on developing our leaders, there's a direct correlation between having a strong leadership team in place at these new acquisitions and, frankly, any of our operations and the success, the financial and clinical success that we can realize. One of the challenges that we faced during the pandemic is that pipeline was sort of disrupted for a number of different reasons. Our ability to connect and come together and develop and train and all of that was just it wasn't as robust and strong as we've had it historically. And so that's why we're really revamping our efforts to build that leadership pipeline. We talked about the investments that we're making. And, you know, we're confident that as we do this in the right way, because this is what we've seen over our history, as we have strong, talented local leaders that step into these opportunities, we very quickly see significant growth. And so that's what we're building towards. That's what we're planning on. And that's what we'll continue to focus on so that we can, you know, have better, more quick turnarounds with our new acquisitions and in areas that we're struggling, continue to drive performance there as well.

understood and uh and then just one final question for me um you know i think it would be helpful just just how how you know framing or how you're thinking about the trajectory on home health margins um for 2023 obviously there's going to be a you know a headwind here around the one percent rate cut that you're gonna have to manage through and um so you know maybe talk about you know how you think about wage inflation trending against that and then some of the other levers that you may be able to still pull to try to match up expenses, you know, to that rate cut to the best extent possible. And that's it for me. Thanks.

Yes, Scott, the reality is that while the final rule was a net improvement over the proposed rule, it still wasn't close to what we hoped it would be, which is a true recognition of the value of home health in the continuum. And the result of that is we've still got operational work to do in order to offset it. And the good news is we've been working on that, projecting a much larger cut, and in the face of this new information, we're able to continue to dial in our operations. We continued to experience relatively high wage pressure in Q3. Sequentially, we were up about 2 plus percent in Q3. And so that's ameliorating, but not as quickly as we'd like it to, which means that we have to focus on other levers as we continue to be competitive and seek to establish ourselves as the employer of choice in each community that we serve. A few of those opportunities still remain in the way we're managing episodes. We still think that we have, you know, a significant opportunity to manage those episodes more tightly, to continue to improve the utilization of mid-level staff, and to hire more LPNs, LVNs, PTAs, CODAs, who can provide those routine visits in an appropriate way. And we'll continue to monitor and seek to improve Those levers, we also have an opportunity when you look at the type of patient that we're serving, about 40% of our episodes are early episodes. And so we see that there's some opportunity to continue to improve our relationships with hospital partners and be the provider of choice for those institutional early referrals as well as for all community referrals. And so we see a number of levers to offset that. Our margin will continue to be lumpy as we go through the acquisition and transition process with new operations. But we do see a continued opportunity for improvement in the fourth quarter and into 2023. Okay.

Thank you.

Thank you, Scott.

Thank you. At this time, there is no further questions. Thank you for your participation in today's conference and this does conclude the program you may now disconnect