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spk19: Good morning. Our conference call this morning will review the financial results for the fourth quarter of 2022, ended December 31, 2022. Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this conference call. During the course of this call, the company will make various remarks concerning management's expectations, predictions, plans, and prospects that constitute forward-looking statements. Actual results may differ materially from these projected by these forward-looking statements as a result of a variety of factors, including those identified in the company's news release of February 23rd and in various other filings with the SEC. Your caution that any forward-looking statements reflect management's current view only and that the company undertakes no obligation to revise or update such statements in the future. In addition, management may also discuss non-GAAP operating performance results during today's call. including earnings before interest, taxes, depreciation, and amortization, or EBITDA, and adjusted EBITDA. A reconciliation of these non-GAAP results is provided in the company's press release dated February 23rd, which is available on the company's website at ChemEd.com. I would now like to introduce our speakers for today, Kevin McNamara, President and Chief Executive Officer of ChemEd Corporation, Dave Williams, Executive Vice President and Chief Financial Officer of ChemEd, and Nick Westfall, President and Chief Executive Officer of ChemEd's VITAS Healthcare Corporation subsidiary. I will now turn the call over to Kevin McNamara.
spk11: Thank you, Holly. Good morning. Welcome to ChemEd Corporation's fourth quarter 2022 conference call. I will begin with highlights for the quarter, and Dave and Nick will follow with additional operating detail. I will then open the call up for questions. Our fourth quarter 2022 operating results released last night exceeded key internal operating metric targets for both VITAS and Rotary. This resulted in ChemEd reporting fourth quarter and full year 2022 adjusted diluted earnings per share of $5.39 and $19.75, respectively. This compares to our initial adjusted earnings per share guidance issued in February of 2022 of $19.10 to $19.50. Our 2022 results were excellent given operating headwinds that developed and became more difficult as the year progressed. These headwinds consisted of greater disruption in hiring and retaining licensed healthcare workers, higher inflation for a longer period of time than anticipated, and the impact that inflation has had on some consumer spending decisions. For VITAS, these 2022 headwinds included Medicare re-implementing sequestration, resulting in a raw revenue reduction of approximately $15 million, and an industry-wide disruption related to staffing licensed healthcare professionals. Since we implemented our hiring and retention program in July 2022, VITAS staffing has improved significantly. Nick will provide more detailed information on this issue later in the call. We continue to see disruption in our referral patterns when compared to pre-pandemic admissions. Fortunately, these patterns continue to show improvement in key pre-admit patient locations. Pre-pandemic, nursing home patients represented 18% of our total average daily census, or ADC. The nursing home ADC ratio hit a low of 14.3% during the pandemic. Full-year 2021 nursing home-based census increased to 15.1% of the total ADC. This nursing home census expanded an additional 128 basis points to 16.4% in 2022. Our 2023 guidance anticipates continued improvement in senior housing-based census. For Ritter-Ritter, higher inflation throughout 2022 did marginally impact our revenue growth on the small portion of services that could be considered discretionary. We consider the vast majority of demand for road and river services as non-discretionary or emergency-based. Water restoration is an example of 100% non-discretionary service. Water from broken or backed up pipes must be removed immediately to avoid significant mold and water-related damage to the structure. Some road and river services could be considered discretionary or potentially deferred by the customer until the problem becomes more severe. As an example, a customer's collapsed main line is a non-discretionary excavation service. The failed sewage line must be replaced for the homeowner to remain in the residence at a replacement cost of approximately $3,000 to $6,000. A sewage main line with significant tree root penetration should be replaced as well. However, a temporary fix is possible by using a rotary steel cable machine to chop clear the tree roots from the main line for approximately $400 to $700. This lower cost fix is temporary as roots grow back into the perforated main line in about 9 to 15 months. The customer will then have to pay for the solution line to either be cleaned again or permanently replaced. Roto-Rooter is well-positioned post-pandemic, and we anticipate continued expansion of market share by pressing our core competitive advantages in terms of brand awareness, customer response time, 24-7 call centers, and Internet presence. Roto-Rooter services are primarily emergency-based and non-discretionary. Our ability to respond faster than the competition is a significant competitive advantage and will continue to provide Roto-Rooter with the ability to increase market share. With that, I would like to turn this teleconference over to David Williams.
spk07: Thanks, Kevin. VITAS's net revenue was $308 million in the fourth quarter of 2022, which is a decline of 2.5% when compared to the prior year period. This revenue decline is comprised primarily of a 2.8% reduction in our days of care and a geographically weighted average Medicare reimbursement rate increase of approximately 3.2%. partially offset by 200 basis points as a result of CMS re-implementing the 2% sequestration cut that was suspended at the start of the pandemic in 2020. Our acuity mix shift had a net impact of reducing revenue approximately $1.8 million or six-tenths of 1% in the quarter when compared to the prior year revenue and level of care mix. The combination of Medicare cap and other contra-revenue changes negatively impacted revenue growth by 30 basis points. In the fourth quarter of 2022, VITAS accrued $2.7 million in Medicare cap billing limitations. This compares to $3 million of Medicare cap billing limitations in the fourth quarter of 2021. Of VITAS's 30 Medicare provider numbers, 25 of these provider numbers have a Medicare cap cushion of 10% or greater. One provider number does have a cap cushion between 5 and 10 percent, and four provider numbers have a trailing 12-month billing limitation liability. The fourth quarter 2022 gross margin, excluding Medicare cap, in our hiring and retention bonus program was 26.9 percent. This is 135 basis point margin decline when we compare it to the fourth quarter of 2021. VITAS has reversed the severe attrition of our licensed healthcare professionals that began during the pandemic. This is evidenced by VITAS expanding our licensed healthcare staff by 275, coinciding with the launch of our hiring and retention program beginning on July 1st of 2022. This higher staffing increased the aggregate cost of sales in the quarter by an estimated $4.4 million. Excluding this capacity expansion, fourth quarter 2022 gross margins would have reflected a modest margin improvement when compared to the prior year quarter. Adjusted EBITDA margin in the quarter, excluding Medicare cap and other discrete items, was 19.8%, which is 189 basis points below the prior year period. Again, the adjusted EBITDA margin was negatively impacted by 200 basis points for the reimplementation of sequestration and an additional approximately 141 basis points due to the increased staffing and patient capacity from VITAS's hiring and retention program. Roto-Rooter generated revenue of $239 million in the fourth quarter of 2022, an increase of 6.1% when compared to the prior year. Roto-Rooter branch commercial revenue in the quarter totaled $58.6 million which is an increase of 8.7% over the prior year. Aggregate commercial revenue growth consisted of drain cleaning increasing 5.5%, plumbing increasing 13.8%, excavation expanding 5.1%, and water restoration increasing 27.3%. Commercial revenue is showing excellent growth in the fourth quarter. Road-roader branch residential revenue in the quarter totaled $159 million, an increase of 5% over the prior year. And the revenue growth consisted of drain cleaning decreasing 2.1%, plumbing expanding 7%, excavation expanding 4.9%, water restoration increased 13.2%. As Kevin previously noted, we have observed a slight pullback for some residential services, although expanding overall. This behavior does appear to have modestly impacted the revenue growth of some of our excavation work over the past several quarters. To illustrate this, let's take a look at growth in excavation for the past five quarters compared to the equivalent prior year period. In the fourth quarter of 2021, residential excavation revenue increased 12% over the prior year. In 2022, quarterly excavation growth was 5.9% in the first quarter, a slight decline of one-tenth of 1% in the second, an increase of 9 tenths of 1% in the third quarter, and growth of 4.9% in the fourth quarter of the year. This excavation growth rate is lighter than growth generated over the last several years. We believe most delayed excavation work will materialize over the next one to two years, as Kevin referred, that the delayed excavations become bigger problems for our residential customers. Roto-Rooter's gross margin in the quarter was 53.0%, a 68 basis point increase compared to the fourth quarter of 2021. Adjusted EBITDA margin in the fourth quarter of 2022 totaled $69.3 million, which is an increase of 11.4%. The adjusted EBITDA margin in the quarter was 29.0%, which is 138 basis point improvement when compared to the prior year. Can that on a consolidated basis? During the quarter, we repurchased 25,000 shares of Kemet stock for $13 million, which equates to a cost per share of $519. As of December 31, 2022, there was approximately $88 million of remaining share repurchase authorization under our plan. 2023 earnings guidance is as follows. VITAS's 2023 revenue prior to Medicare CAF is estimated to increase 6% to 7% when compared to the prior year. Forecasted revenue growth is negatively impacted by 75 basis points as a result of the sequestration relief in the first half of 2022 compared to full sequestration in 23. Average daily census, or ADC, is estimated to increase 3.5% to 4%, with the majority of our census growth coming in the second half of 2023 as increased staffing and operational capacity generates increased census. Full-year adjusted EBITDA margin prior to Medicare cap and accrued one-time bonuses for hiring and retention initiatives announced last year is estimated to be 16.3% to 16.6%. And we're currently estimating $11 million for Medicare cap billing limitations in calendar year 2023. The guidance includes increased wages related to expanding our staff of licensed healthcare professionals at a rate of about 25 licensed healthcare workers per month. The estimated increase in staffing should be viewed as VITAS expanding internal capacity to care for more patients. ADC growth from this capacity expansion is estimated to lag growth overall by 30 to 60 days, with margins improving on this ADC as the census growth patients remain on service. Roto-Rooter is forecasted to achieve full-year 2023 revenue growth of 5% to 5.5%. The adjusted EBIT margin for Roto-Rooter is estimated at 29.3% to 29.5%. Based upon the discussion, our full year 2023 earnings per diluted share, excluding non-cash expense for stock options, tax benefits from stock option exercises, and costs related to litigation and the retention program, and other discrete items, is estimated to be the range of $20.75 to $21.10. Adjusted earnings per diluted share should approximate our free cash flow per diluted share. Current 2023 guidance also assumes an effective tax rate and adjusted earnings of 25.1% in a diluted share count of 15.0 million shares. I will now turn this call over to Nick Westphal, President and Chief Executive Officer for VITAS Healthcare Business segment.
spk26: Thanks, Dave. As Kevin referenced earlier, we implemented a targeted hiring and retention bonus program at VITAS effective July 1st, 2022. This program focused on licensed nurses, nurse managers, home health aides, and social workers. These one-time retention bonuses range from $2,000 to $15,000 per licensed healthcare professional. The total estimated 12-month forward-looking cost of this program, including payroll taxes and government-mandated overtime calculations, will be approximately $40 million. All retention bonus payments are individually clip-fested and then paid out after the employee has successfully completed 12 additional months of continuous employment. During the fourth quarter, we expanded this licensed healthcare professional staff by 103 employees, bringing total licensed healthcare staffing expansion attributed to this program to 275 employees in the second half of 2022. It's important to note the majority of this increase is attributed to registered nurses, which includes admission nurses. In the fourth quarter, our average daily census was 17,434 patients, a decline of 2.8% over the prior year, and an increase of 192, or 1.1%, sequentially. The monthly ADC growth we experienced within the fourth quarter is very encouraging given the timing lag of adding patient care capacity and then the subsequent census expansion. In the fourth quarter of 22, total VTOS admissions were 14,829. This is an 8.7 percent decline when compared to the fourth quarter of 2021. I am very encouraged by our sequential increase in admissions, expanding 149 patients, or 1.1% over the third quarter. This is attributed primarily to the capacity expansion from our hiring and retention program. In the fourth quarter, our nursing home admissions increased 9.4%, and assisted facility admissions expanded 2.7%. Hospital-directed admissions declined 11.3%, and home-based patient admissions declined 7.5% in the quarter. Comparing the fourth quarter of 22 to our second quarter is also encouraging. In the fourth quarter, our admissions were slightly above our admissions in the second quarter. This multi-quarter sequential performance illustrates the consistency with which our community-based access initiative is performing as we continue to be focused on incrementally admitting more appropriate patients each and every day. Our average length of stay in the quarter was 103.9 days. This compares to 97.9 days in the fourth quarter of 21 and 106.2 days in the third quarter of 22. Our median length of stay was 16 days in the quarter and compares to 15 days in the fourth quarter of 21 and 17 days in the third quarter of 22. This growth in our median length of stay is attributed to the successful execution of our community access initiative I referenced earlier, as well as the indications of patients accessing the hospice benefit in timeframes closer to pre-pandemic levels. Overall, I'm very pleased with the execution of the entire VITAS team regarding how we continue to serve our communities, as well as our renewed focus on recruiting and retention of our workforce. To recap, We have now generated two quarters of sequential growth in licensed healthcare workers, sequential growth in admissions, as well as ADC. We've developed what I believe is a very sustainable path to building back our clinical capacity and patient base to pre-pandemic levels. Before I turn this call back over to Kevin, I'd like to thank every one of my fellow VITAS team members and our leadership team. Their sheer will and daily perseverance to deliver on our mission got us through the pandemic. And now the execution of our strategies through the end of 22 has prepared us to have an exciting 2023 where we will continue to make a difference in every community we serve. With that, I'll turn the call back over to Kevin. Thank you, Nick.
spk11: I will now open this teleconference to questions.
spk14: Thank you, sir. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To adjourn your question, please press star 1-1 again. Please stand by while we compile the Q&A roster. And I show our first question comes from the line of Jonah Gajuk from Bank of America. Please go ahead.
spk18: Good morning. Thanks for taking the questions here. So I guess just following up to Nick's comments, the latest comments on the trends. So I guess you said a monthly ADC growth trends been encouraging during the fourth quarter. So can you give us some flavor of how things are tracking so far this year? Has this persisted, the improvement that you've seen in Q4, and I guess also Q3? kind of, you know, any any color can give us on some of these metrics, as you've seen them live, you know, this quarter so far.
spk11: Well, before Nikki, I'll just say we're loathe to talk about intro, you know, quarter unreleased quarter activity, other than to say, I'll just say, Yeah, it's good. It's, you know, it's, it's what we expect to see.
spk26: I'd use the word very encouraging. Very encouraging, like you referred to in the fourth quarter, and we're still very encouraged sitting here today.
spk11: And I'd say the same thing with Roto-Rooter. Roto-Rooter has one other good thing going for it, which is weather. We've had great Roto-Rooter-type weather. So, yeah, we don't like to talk about it other than to say it's good.
spk18: Okay, that's good. Encouraging. I like that. And I guess, so when it comes to your guidance for the year for VDAS, just coming back before we talk about order, so VDAS margins, right, the guidance calls for these margins to be down, you know, because 70 to 100 basis points year for year. So obviously sequester coming back, obviously high more people. And I guess also census, right, still going to be maybe 4% or so below 2019 levels. So is that a way to think about it that before you, you know,
spk07: uh reach or you know get closer to the pre uh pre-pandemic margins you need to um uh you know get the census back to to that level yeah join us uh this is day so i'll comment on a macro basis and and nick can give a lot more color on a more detailed but on a macro basis if you think about what we're doing beyond the fact that we have a headwind on sequestration um so obviously that impacts us by what nick 75 bits in $9 million. Then we also have an issue, of course, of the fact that the reimbursement increase was inadequate relative to some of the wages. So that creates a bit of a headwind, period. But absent that, you have to expect the margin to be down as we build capacity. That's a drag on profitability. You add licensed healthcare workers, they can't be immediately productive. in terms of then the next day we expanded census. So there's a lag. We have a lag at about 30 to 60 days right now of adding capacity, and then we see an impact on census. And frankly, six months ago, I would have said that lag is easily 60 to 90 days. So the cause and effect is tighter than we want, but the bottom line is you add capacity, that's a strain on margin. Then you bring on new patients more than you would have otherwise, That's also a strain on margins in terms of the admissions process. And most patients, all patients, are negative margin for the first solid 15 as much as 30 days in program. And then as the patients in program age out, then they become positive margin. So that's a long-winded way of saying you have to expect margins to lag to increase capacity to grow the business. And the other thing I'd add is this is a mirror image of what happened in 2020. when census held in but we did have weakness and we lost our capacity to a certain degree with healthcare workers resigning. So margins were much higher than you would have anticipated because census was there but you didn't have the FTEs. So bottom line is grow our capacity by adding healthcare workers, licensed healthcare workers, and then that will lag 30 to 60 days for census. And then census will lag, that marginal increase in census, by about 30 days until those patients are profitable.
spk26: And just to recap a few pieces in Dave's depiction, the $9 million or 75 basis points year-over-year comparison, obviously that has a marginal implication related to it. And as we sit and grow all the pieces they've talked about in terms of clinical capacity and the timing flags with it. It all translates into that 16.3 to 16.6 adjusted EBITDA X cap margin we released as part of the guidance. But, you know, the bottom line on a day in and day out basis is we're continuing to be laser focused on driving growth inside of the organization. And that's the combination of clinical capacity as well as servicing more patients And from a bottom line, total contribution from a dollar standpoint and then the ultimate marginal contribution, that will come through. And 2024 probably looks more like, you know, an estimated ongoing margin now that the pandemic is fully behind us. And we'll see what census level we're at at that point in 2024.
spk11: I would just add with one separate move, there's nothing that has changed in the hospice market. The pandemic was a big rock thrown into a pond, which caused all sorts of ripples and effects and splashes, but it's going to return to, you know, based on what's going on there today, we expect it to return to the same general dynamics from before the pandemic, and VITAS has not lost market share. I think that the number of percentage of deaths that have a brush with hospice is going to return to its previous level, and VITAS will be there and by that point have the staff to deal with them. So, yeah, to us it's a, you know, we're just getting back to something. We already have the institutional, you know, people involved for a 19,000, 20,000 census hospice. Now we're just waiting for the operating conditions to return to normal.
spk07: And, Joanne, if you think about it, so we're guiding adjusted EBITDA margin, X cap in the retention program for VTAS of about 16.3% to 16.6%. But let's just go back to the last full year we had before the pandemic. So that would have been the 2019 full-year adjusted EBITDA margin was 17.8%. So, frankly, just taking into consideration the The headwind on sequestration, but the fact that we're still down from our census of 19,000 plus at the end of 19. Frankly, we're coming back on the adjusted EBITDA margin faster than I would have thought. And frankly, with some of the changes that have been forced on us through bobbing and weaving during the pandemic, I suspect Nick is a lot more efficient now than we were a few years ago. So I think there is actually, it's more likely than not, once we return to normal size census, get back to pre-pandemic levels, I think our margin is going to end up a little higher because these efficiencies have now been incorporated into our normal operating approach.
spk26: And we'll see what the pricing implication is on October 1 of 2023.
spk18: Right, it was actually on my list, too, since you mentioned that. So what do you assume for your Medicare rating in the fourth quarter of 23? Five percent. Did you say five, plus a five? Okay, so nicely accelerating from, like, I guess call it four percent.
spk13: It's nice to get a guess right now.
spk26: As you know, they released a preliminary report related to it in the late, you know, In the next 30 to 45 days, that will help to inform the ballpark range we would anticipate October 1.
spk07: Frankly, we don't consider the model they use to develop our increase in rate is less than transparent.
spk18: Great. That's another topic. But just coming back to the hiring and increasing the capacity, so just to clarify, the $275 these are new hires or these are net hires and also what percent of the base is it? And also, so you mentioned before that you expect to add roughly 25 per month still of staff. So I assume that's gross or is it net? And, you know, so is that enough? Like really what I'm getting at, like how much more do you really need to increase your net staff to be back to, you know, the, the, capacity that you had before COVID?
spk26: So let me, the baseline answer, which is the most important one here, is those are net numbers. And it's enough.
spk11: I mean, I guess the other answer is to answer your second question. Methodically absorb them in. That's right. It's not like we're looking to greatly exceed that number.
spk26: And so, you know, it's the methodical approach Kevin alluded to that is always focused back to where things maybe call it were in an environment, I'm talking about this philosophically, where we want to add clinical capacity to be able to absorb the demand we see in the marketplace, and we're still ramping up to that, and that demand is not only to help fulfill referral and admission activity, but also, of course, to care for patients who are joining the benefit more traditional you know at the time window more traditional than they were pre-pandemic which is encouraging and um you know will be on service with us hopefully you know for a longer period of time than they were uh during the disruption time period of the pandemic where you know the health care system referred them later to all hospice providers inside of the benefit so it's a long-winded way to say we will methodically continue to grow clinical capacity, and we wanted to guide towards that, which helps with, as Dave was alluding to, a little bit of the short-term marginal compression. But the bottom line is, as long as we can continue to improve our retention, improve our hiring, resulting in net growth of clinical capacity, feel really good about the other operating metrics from a top-line perspective, from our ability to absorb what continues to be elevating demand in every market in which we serve, and deliver predictable and sustainable operating results.
spk11: And, Joanna, one thing that we follow is to say, you know, what we're trying to achieve is we have the two grow in tandem. We know there's a lot, as Dave said, a lag factor. The current quarter is is probably affected by 141 basis points based on our rough calculations to give you an idea that that's... So we're running a little ahead. The way that we do this is if you want to grow, and we think at the optimum rate, you're out ahead with the hiring. So you can put a cost on that is 141 basis points. We're not looking... to be further ahead and have that grow to 200 basis points or 250 basis points.
spk07: No, but I'd be comfortable methodically keeping that as we expand capacity.
spk11: We have headlights. That clears the area ahead of you.
spk07: But let's have just a clear understanding, and Nick can provide probably a lot of anecdotal color on this, but if you think about it, adding capacity has put us in a virtuous cycle. And what I mean by that is our tenured people were getting strained. Their schedules were a havoc. They were scrambling to take care of patients. We're hiring these people. They trained them, and they were resigning. So it was burning out our tenured staff. So we've now entered the point where we're adding capacity. It's giving relief to the tenured staff. It's not being on this horrible treadmill of you hire people, they resign. You hire other people. So from that standpoint, the life of our long-tenured people have gotten massively better now from where it was the fourth quarter of last year. That's reaffirming our ability to retain existing personnel as well as adding. So we're actually what we think is we're in a horrible spiral, you know, at the end of 2020 in the pandemic. And Nick and his team have completely reversed that.
spk26: Just to add on that, Joanna, because I'm sure it will be embedded inside of either a subsequent question or other folks' questions. If you think about it, very generally at a high level, it has a compounding effect to it, which is fantastic, meaning the baseline Dave alluded to, existing staff, real burnout and shortages, and that also is elevated by people accessing the benefit later in their disease trajectory. You couple that with a frustration because everyone joins hospice usually from a calling standpoint of not being able to meet patient demand. And so our teams have done a fantastic job at three very high-level behavioral pieces. Focusing daily on the existing employee experience. That's our tenured staff Dave was alluding to. There's a lot of detailed, tactful things inside of it. But also part of that is helping them understand the light that's at the end of the tunnel related to that burnout and frustration. The second is focusing on hiring and really improving the new hire experience. We measure that through 90-day and first-year turnover. Both of those are... performing substantially better than they were in the pandemic. The third is taking that new team and really elevating the integrated culture. And I know those three things sound simplistic. They're difficult to execute upon. The team's done a wonderful job. And the result is the compounding effect of all three of those things lead to less burnout, a camaraderie of a mission-focused organization, and then the ability to meet more and more demand and respond to demand And everyone personally begins to elevate their fulfillment of being able to impact the communities in ways they signed up originally to be part of the hospice benefit and be part of VITAS. So that calling combined with the compounding effect is really taking hold and it's something I'm very encouraged by as we have launched into 2023.
spk18: No, it's definitely good to see the trends improving there and the staffing, and thanks for all this call. Just one last on that topic, because you're talking about, you know, adding, continue to add on more staff, but I guess this retention program is going to end, so I guess the question there obviously is, you know, do you foresee a risk of higher turnover, you know, starting second half of 23 when people, you know, get their bonuses and maybe leave, so can you talk about expectations for that and kind of what you assume in your guidance on that front. Thank you.
spk26: Yeah, so obviously aware of the risk. Based upon what I just talked about from the compounding effect that has nothing to do with the Difference Maker Program, but the Difference Maker Program helps provide the catalyst for the existing staff as well as the staff that join us to be incentivized inside of it. That's what we deem our recruiting and retention programs, the Difference Maker Program. So a little less concerned than you may think because of those pieces and the compounding effect, because once we have the existing staff and the new staff that are with us for a year and that experience is elevated, our retention metrics just continue to improve in a substantial way. But we're aware of the risk and not discounting it either.
spk11: We expect to see something, but we believe that the the healthcare professionals that go to work for hospice in general are not dollar-driven as a priority. I mean, they could go to other jobs and get a higher rate of pay. It's the nature of the business. And what Nick is suggesting is there are really two things. Number one, there's a view within the workforce that VITAS is stepping up the plate to do what's necessary. What's necessary is not necessarily to give people more money, but it's to increase staff to have the right amount of staff for the services we're offering. And so the net effect is, at the end, if these are not hired guns, they'll get right out of town at the 12-month date.
spk12: Some will.
spk11: In other words, I think that some people would normally move jobs or have a change with a month or two short of the period in which they're going to get their payment, I could see them postponing it and happening. But we think that will just be within normal ranges.
spk07: And, Joanna, we have some pretty strong statistics to support our expectation, and that is we know if we can keep an employee for 12 months, the probability they're a long-tenured employee, three or more years, is significantly higher than people are with us less than 12 months. And it actually goes. Employees are with us 90, 180, 270, or 360. That attrition rate drops, but we get them for a year. Behavior, they know what they know, and we hang on to them. And as Nick said, plus we've reinforced our tenured folks. So we have strong statistics. If you get into a year, the probability you hang on to these people for definitely more for an additional year, but really three or more years, is probably pushing around 75%.
spk26: It all comes back to you join the hospice industry clinically because it's a calling and something you want to do. If you are looking to maximize personal earnings, the reality is you go become a travel nurse, like many had done, until that carousel stops. But those aren't typically what we see embedded inside the industry.
spk18: Thank you. I want to dominate with just the last question on the Rotterdam side. So the guidance calls for revenues, right, to be up 5% COVID. So that's a still solid number. So are you assuming, you know, some slowdown? Because you mentioned, you know, you're seeing potentially, you know, some of these excavation jobs being postponed. So are you assuming this continues into next year? And also, can you break down the 5% of how much is price versus volume? And is this, you know, kind of assuming that you'll go faster than the market or in line with the market? Thank you.
spk07: Yeah, that's a great question, Joanna. And, yeah, of course, we pass through price increase on a bespoke basis. What we look to for Baltimore is going to be different than what we do in Cincinnati. But the range of our price increase is going to be around 5.5% to 6%. So, frankly, if you look at that, we can talk about large jobs, small jobs, geographic. But we're essentially, in terms of raw procedures, estimating we're going to be flat, which is actually, we think, fairly reasonable. conservative. As Kevin mentioned, it's angels on the head of a pin on what is truly considered emergency. But no one gets a warm fuzzy by calling Roto-Rooter and paying us $600 to get their house back to where it was the day before. So what I'm saying is the majority of our jobs are non-discretionary. Maybe they can delay it. And we've taken guidance assuming an increase in consumer headwinds on spending. But the ability of the people to avoid these kind of emergency plumbing and drain cleaning services is limited. But it's not recession-proof, as Kevin always says. It's very recession-resistant. But we think we developed, in our guidance, some headwinds on demand that will be much higher than it is today. So, frankly, I think it's more likely than not we are at the higher end of the Roto-Rooter guidance. But we are guessing a little bit. But I go back to the Great Recession and the little impact that that had on our demand, and that was before we implemented water restoration, which is now going to be pushing hopefully $200 million or slightly below that. That is 100% non-avoidable. You've got standing water, in some cases gray or black water in your house, you're paying us to get rid of it.
spk09: And it's insurance coverage.
spk07: It's insurance-paid. Just to give a little bit more color, both water restoration and excavation are derived from additional procedures from basic small jobs. As you can see, water restoration continued to grow, but excavation, they're less than that water restoration. The growth was there, but not as much, which just tells you They didn't delay the water restoration, but they deferred a small portion of the excavation work. Otherwise, excavation and water restoration probably would have been closer to the same rate.
spk11: And I'll just... I don't want to, you know, beat a dead horse, but let me put it from my perspective. I know, in theory, you know, consumer demand and, you know, inflationary pressures and recessionary pressures, you know, have an effect on any business. But, you know, Roto-Rooter is... It's such a basic business. If you ask me what has affected numbers more than the financial environment, it's the fact that in the last 18 months, private equity companies have been investing in service companies. First thing the service companies need is local management. Red River is one of the go-to places to hire service companies. qualified service managers. And, you know, if you ask me how we're going to make sure we hit our numbers, it's going to be doing a better job holding on to our branch managers and excavation managers. The work is available, but it's a bit of an art rather than a science. And, again, we have some programs now to improve our retention of those key people. But if you look over the 18 months, It's been an onslaught. I mean, we have a couple litigation matters going on that subject of poaching of kind of several people all from one branch. We have some compensation plans in place. But I'll tell you right now that if we do a better job of that, that will greatly outweigh any overall financial metric.
spk17: Thanks for all the answers. Appreciate it.
spk14: Thank you. And I assure our next question comes from the line of Ben Hendricks from RBC Capital Markets. Please go ahead.
spk23: Hey, thanks, guys. Quick question on capital allocation. Is there any change or anything we should consider this year regarding your capital allocation priorities or balance sheet management strategy for...
spk07: Hi, Ben. This is Dave Williams. Just slightly in that what I would say is if you look at our balance sheet, and, you know, we redid our credit facility last year, and we upped it $100 million from $450 to $550 million. And we actually put a piece of term loan on there of $100 million. It had, I think it's running $1.25 million quarterly amortization on it. But given the spike in interest rates, Frankly, before, when it was a 30 basis point penalty, we didn't have to keep a super tight lock on the balance sheet. Interest rates were low. How much we can invest our cash was low. But now it matters. So your point's a good one. We're actually going to accelerate the payment of that term debt. As a matter of fact, we've given notice that we're going to tranche down $50 million by the end of this month, and we'll probably eliminate all of the term debt early into Q2, and then we're going to triage that free cash flow probably to share repurchasing after we have now zero debt. Just because, I mean, the swing line we would do would be at 7.75%, and I think SOFR plus 100 basis points spread, which is still a great rate, but that takes us to, what, 6.5% right now. So screw that. We're getting rid of all interest expense regarding the term debt cash outflow. And then capital goes to shares. Mortals sit on our balance sheet for opportunistic investments.
spk00: Great. Thanks for that, guys.
spk14: Thank you. And I show our next question comes from the line of Mike Wiedehorn from Oppenheimer. Please go ahead.
spk15: Good morning, thanks for taking my call. Majority of my questions have been answered, so I have one or two here. You discussed earlier about the referral trends and how they continue to evolve. Can you discuss how that strategy has impacted your length of stay and acuity and where the patients are coming in in this process?
spk26: Yeah, so without getting specific in the granular delineation of all of it, one of the things that we needed to respond to, particularly during the pandemic, was the referral demand, in many instances, coming to us shorter in their disease trajectory than typically. We had to be very mindful around where we were sending out scarce resources to not only respond and also bring on service. So the demand was has always been there and continues to be there. We reference it from a community access standpoint that we flow through our educational efforts, our emphasis efforts, but to clarify, we're still, of course, and you can see it in the metrics, serving all of the segments of the market that we reference and refer to externally from a pre-admit standpoint. That has continued. That strategy continues and carries over. And so on the margin, what ends up happening not only is people access the benefit earlier in their disease trajectory, but we also focus in on the community who typically refers patients and the types of patients earlier than the average to the hospice benefit. That compounding effect along with the compounding effect of staffing and clinical staff availability, really yields an acceleration of ADC growth for the same number of admissions coming into the organization. I don't know if that answers your question or not, Mike, but sort of directionally, it has made a difference, it'll continue to make a difference, and that's part of what's inferred inside of our 23 guidance of an ADC going up 3.5% to 4%, and not referencing admission guidance specifically, because it causes a little confusion.
spk15: That's good color. And one other question. I know you guys are obviously always very quiet on the M&A front. Can you kind of discuss what the market looks like and where valuations are, and are you seeing any changes in the competitive landscape?
spk07: I don't think I've seen enough to actually be able to give a thought on what multiples are going for.
spk26: Yeah, the multiples have a wide range, and it's really probably driven by who the owner is, right? Because you have private equity that may expect larger multiples, and it's really just, you know, there's one aspect on price. I think the underlying piece for a lot of the providers in the space, and you hear it from other public commentary, is If you don't have the culture and strategic approach for retaining and growing your clinical capacity, by definition, all operating metrics related to the business are going to decline. And that's going to influence pricing as well as availability of each and every one of those providers. So that's really not significantly different than anything pre-pandemic except for the If you weren't proactively taking those steps in the middle of the pandemic to improve it, you have seen an acceleration of decline in your operating metrics, which is going to impact overall valuation as well as the multiple someone's willing to pay. There aren't too many platform assets out there, so now it is people plucking off individual single and regional providers that really don't have the balance sheet or scale to continue to operate. That's what we see in the space.
spk16: Thanks very much. Appreciate it.
spk14: Thanks, Mike. Thank you. I'm sure no further questions in the queue. At this time, I'd like to turn the call back over to Kevin McNamara, President and CEO, for closing remarks.
spk11: Thank you. Yes, we'll finish the call. Thank you for your attention. It was a nice, solid quarter for us, and we look forward to talking to you all at the into the next quarter. Thank you.
spk14: Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect.
spk20: The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. you Thank you. Thank you. music music
spk19: Good morning. Our conference call this morning will review the financial results for the fourth quarter of 2022, ended December 31, 2022. Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this conference call. During the course of this call, the company will make various remarks concerning management's expectations, predictions, plans, and prospects that constitute forward-looking statements. Actual results may differ materially from these projected by these forward-looking statements as a result of a variety of factors including those identified in the company's news release of February 23rd and in various other filings with the SEC. Your caution that any forward-looking statements reflect management's current view only and that the company undertakes no obligation to revise or update such statements in the future. In addition, management may also discuss non-GAAP operating performance results during today's call, including earnings before interest, taxes, depreciation, and amortization, or EBITDA, and adjusted EBITDA. A reconciliation of these non-GAAP results is provided in the company's press release dated February 23rd, which is available on the company's website at ChemEd.com. I would now like to introduce our speakers for today, Kevin McNamara, President and Chief Executive Officer of ChemEd Corporation, Dave Williams, Executive Vice President and Chief Financial Officer of ChemEd, and Nick Westfall, President and Chief Executive Officer of ChemEd's VITAS Healthcare Corporation subsidiary. I will now turn the call over to Kevin McNamara.
spk11: Thank you, Holly. Good morning. Welcome to ChemEd Corporation's fourth quarter 2022 conference call. I will begin with highlights for the quarter and Dave and Nick will follow with additional operating detail. I will then open the call up for questions. Our fourth quarter 2022 operating results released last night exceeded key internal operating metric targets for both VITAS and Rotary. This resulted in ChemEd reporting fourth quarter and full year 2022 adjusted diluted earnings per share of $5.39 and $19.75, respectively. This compares to our initial adjusted earnings per share guidance issued in February of 2022 of $19.10 to $19.50. Our 2022 results were excellent given operating headwinds that developed and became more difficult as the year progressed. These headwinds consisted of greater disruption in hiring and retaining licensed health care workers, higher inflation for a longer period of time than anticipated, and the impact that inflation has had on some consumer spending decisions. For VITAS, these 2022 headwinds included Medicare re-implementing sequestration, resulting in a raw revenue reduction of approximately $15 million and industry-wide disruption, related to staffing licensed healthcare professionals. Since we implemented our hiring and retention program in July 2022, VTAS staffing has improved significantly. Nick will provide more detailed information on this issue later in the call. We continue to see disruption in our referral patterns when compared to pre-pandemic admissions. Fortunately, these patterns continue to show improvement in key pre-admit patient locations. Nursing home patients represented 18% of our total average daily census, or ADC. The nursing home ADC ratio hit a low of 14.3% during the pandemic. Full-year 2021 nursing home-based census increased to 15.1% of the total ADC. This nursing home census expanded additional 128 basis points to 16.4% in 2022. Our 2023 guidance anticipates continued improvement in senior housing-based census. For Rotorua, higher inflation throughout 2022 did marginally impact our revenue growth on the small portion of services that could be considered discretionary. We consider the vast majority of demand for Rotorua services as non-discretionary or emergency-based. Water restoration is an example of a 100% non-discretionary service. Water from broken or backed-up pipes must be removed immediately to avoid significant mold and water-related damage to the structure. Some reservoir services could be considered discretionary or potentially deferred by the customer until the problem becomes more severe. As an example, a customer's collapsed main line is a non-discretionary excavation service. The failed sewage line must be replaced for the homeowner to remain in the residence. at a replacement cost of approximately $3,000 to $6,000. A sewage mainline with significant tree root penetration should be replaced as well. However, a temporary fix is possible by using a rotary steel cable machine to chop clear the tree roots from the mainline for approximately $400 to $700. This lower cost fix is temporary as roots grow back into the perforated mainline in about 9 to 15 months. The customer will then have to pay for the solution line to either be cleaned again or permanently replaced. Roto-Rooter is well positioned post-pandemic, and we anticipate continued expansion of market share by pressing our core competitive advantages in terms of brand awareness, customer response time, 24-7 call centers, and Internet presence. Roto-Rooter services are primarily emergency-based and non-discretionary. Our ability to respond faster than the competition is a significant competitive advantage and will continue to provide Rotary with the ability to increase market share. With that, I would like to turn this teleconference over to David Williams.
spk07: Thanks, Kevin. VTAS's net revenue was $308 million in the fourth quarter of 2022, which is a decline of 2.5% when compared to the prior year period. This revenue decline is comprised primarily of a 2.8% reduction in our days of care and a geographically weighted average Medicare reimbursement rate increase of approximately 3.2%, partially offset by 200 basis points as a result of CMS re-implementing the 2% sequestration cut that was suspended at the start of the pandemic in 2020. Our acuity mix shift had a net impact of reducing revenue approximately $1.8 million or six-tenths of 1% in the quarter when compared to the prior year revenue and level of care mix. The combination of Medicare cap and other contra revenue changes negatively impacted revenue growth by 30 basis points. In the fourth quarter of 2022, VTAS accrued $2.7 million in Medicare cap billing limitations. This compares to $3 million of Medicare cap billing limitations in the fourth quarter of 2021. Of VITAS's 30 Medicare provider numbers, 25 of these provider numbers have a Medicare cap cushion of 10% or greater. One provider number does have a cap cushion between 5% and 10%, and four provider numbers have a trailing 12-month billing limitation liability. The fourth quarter 2022 gross margin, excluding Medicare cap in our hiring and retention bonus program, was 26.9%. This is 135 basis point margin decline when we compare it to the fourth quarter of 2021. VITAS has reversed the severe attrition of our licensed healthcare professionals that began during the pandemic. This is evidenced by VITAS expanding our licensed healthcare staff by 275, coinciding with the launch of our hiring and retention program beginning on July 1st of 2022. This higher staffing increased the aggregate cost of sales in the quarter by an estimated $4.4 million. Excluding this capacity expansion, fourth quarter 2022 gross margins would have reflected a modest margin improvement when compared to the prior year quarter. Adjusted EBITDA margin in the quarter, excluding Medicare cap and other discrete items, was 19.8%, which is 189 basis points below the prior year period. Again, the adjusted EBITDA margin was negatively impacted by 200 basis points for the reimplementation of sequestration and an additional approximately 141 basis points due to the increased staffing and patient capacity from VITAS's hiring and retention program. Roto-Rooter generated revenue of $239 million in the fourth quarter of 2022, an increase of 6.1%, when compared to the prior year. Ritter-Ritter branch commercial revenue in the quarter totaled $58.6 million, which is an increase of 8.7% over the prior year. Aggregate commercial revenue growth consisted of drain cleaning increasing 5.5%, plumbing increasing 13.8%, excavation expanding 5.1%, and water restoration increasing 27.3%. Commercial revenue is showing excellent growth in the fourth quarter. Woodwarder branch residential revenue in the quarter totaled $159 million, an increase of 5% over the prior year. And the revenue growth consisted of drain cleaning decreasing 2.1%, plumbing expanding 7%, excavation expanding 4.9%, water restoration increased 13.2%. As Kevin previously noted, we have observed a slight pullback for some residential services, although expanding overall. This behavior does appear to have modestly impacted the revenue growth of some of our excavation work over the past several quarters. To illustrate this, let's take a look at growth in excavation for the past five quarters compared to the equivalent prior year period. In the fourth quarter of 2021, residential excavation revenue increased 12% over the prior year. In 2022, quarterly excavation growth was 5.9% in the first quarter, a slight decline of one-tenth of 1% in the second, an increase of nine-tenths of 1% in the third quarter, and growth of 4.9% in the fourth quarter of the year. This excavation growth rate is lighter than growth generated over the last several years. We believe most delayed excavation work will materialize over the next one to two years, as Kevin referred that the delayed excavations become bigger problems for our residential customers. Roto-Rooter's gross margin in the quarter was 53.0%, a 68 basis point increase compared to the fourth quarter of 2021. Adjusted EBITDA margin in the fourth quarter of 2022 totaled $69.3 million, which is an increase of 11.4%. The adjusted EBITDA margin in the quarter was 29.0%, which is 138 basis point improvement when compared to the prior year. KEMET on a consolidated basis. During the quarter, we repurchased 25,000 shares of KEMET stock for $13 million, which equates to a cost per share of $519. As of December 31st, 2022, There was approximately $88 million of remaining share repurchase authorization under our plan. 2023 earnings guidance is as follows. VITAS's 2023 revenue prior to Medicare cap is estimated to increase 6% to 7% when compared to the prior year. Forecasted revenue growth is negatively impacted by 75 basis points as a result of the sequestration relief in the first half of 2022 compared to full sequestration in 23. Average daily census, or ADC, is estimated to increase 3.5% to 4%, with the majority of our census growth coming in the second half of 2023 as increased staffing and operational capacity generates increased census. Full-year adjusted EBITDA margin prior to Medicare cap and accrued one-time bonuses for hiring and retention initiatives announced last year is estimated to be 16.3% to 16.6%. And we're currently estimating $11 million for Medicare cap billing limitations in calendar year 2023. The guidance includes increased wages related to expanding our staff of licensed healthcare professionals at a rate of about 25 licensed healthcare workers per month. The estimated increase in staffing should be viewed as VDAS expanding internal capacity to care for more patients. ADC growth from this capacity expansion is estimated to lag growth overall by 30 to 60 days, with margins improving on this ADC as the census growth patients remain on service. Roto-Rooter is forecasted to achieve full-year 2023 revenue growth of 5% to 5.5%. The adjusted EBIT margin for Roto-Rooter is estimated at 29.3% to 29.5%. Based upon the discussion, our full-year 2023 earnings per diluted share, excluding non-cash expense for stock options, tax benefits from stock option exercises, and costs related to litigation and the retention program and other discrete items is estimated to be the range of $20.75 to $21.10. Adjusted earnings per diluted share should approximate our free cash flow per diluted share. Current 2023 guidance also assumes an effective tax rate and adjusted earnings of 25.1% in a diluted share count of 15.0 million shares. I will now turn this call over to Nick Westphal, President and Chief Executive Officer for VITAS Healthcare Business segment.
spk26: Thanks, Dave. As Kevin referenced earlier, we implemented a targeted hiring and retention bonus program at VITAS, effective July 1st, 2022. This program focused on licensed nurses, nurse managers, home health aides, and social workers. These one-time retention bonuses range from $2,000 to $15,000 per licensed healthcare professional. The total estimated 12-month forward-looking cost of this program, including payroll taxes and government-mandated overtime calculations, will be approximately $40 million. All retention bonus payments are individually clip-vested and then paid out after the employee has successfully completed 12 additional months of continuous employment. During the fourth quarter, we expanded this licensed healthcare professional staff by 103 employees, bringing total licensed healthcare staffing expansion attributed to this program to 275 employees in the second half of 2022. It's important to note the majority of this increase is attributed to registered nurses, which includes admission nurses. In the fourth quarter, our average daily census was 17,434 patients. a decline of 2.8% over the prior year, and an increase of 192 or 1.1% sequentially. The monthly ADC growth we experienced within the fourth quarter is very encouraging given the timing lag of adding patient care capacity and then the subsequent census expansion. In the fourth quarter of 22, total VTOS admissions were 14,829. This is an 8.7% decline when compared to the fourth quarter of 2021. I am very encouraged by our sequential increase in admissions, expanding 149 patients, or 1.1% over the third quarter. This is attributed primarily to the capacity expansion from our hiring and retention program. In the fourth quarter, our nursing home admissions increased 9.4%, and assisted facility admissions expanded 2.7%. Hospital-directed admissions declined 11.3%, and home-based patient admissions declined 7.5% in the quarter. Comparing the fourth quarter of 22 to our second quarter is also encouraging. In the fourth quarter, our admissions were slightly above our admissions in the second quarter. This multi-quarter sequential performance illustrates the consistency with which our community-based access initiative is performing as we continue to be focused on incrementally admitting more appropriate patients each and every day. Our average length of stay in the quarter was 103.9 days. This compares to 97.9 days in the fourth quarter of 21 and 106.2 days in the third quarter of 22. Our median length of stay was 16 days in the quarter and compares to 15 days in the fourth quarter of 21 and 17 days in the third quarter of 22. This growth in our median length of stay is attributed to the successful execution of our community access initiative I referenced earlier, as well as the indications of patients accessing the hospice benefit in timeframes closer to pre-pandemic levels. Overall, I'm very pleased with the execution of the entire BTOS team regarding how we continue to serve our communities, as well as our renewed focus on recruiting and retention of our workforce. To recap, We have now generated two quarters of sequential growth in licensed healthcare workers, sequential growth in admissions, as well as ADC. We've developed what I believe is a very sustainable path to building back our clinical capacity and patient base to pre-pandemic levels. Before I turn this call back over to Kevin, I'd like to thank every one of my fellow VITAS team members and our leadership team. Their sure will and daily perseverance to deliver on our mission got us through the pandemic. And now the execution of our strategies through the end of 22 has prepared us to have an exciting 2023 where we will continue to make a difference in every community we serve. With that, I'll turn the call back over to Kevin. Thank you, Nick.
spk11: I will now open this teleconference to questions.
spk14: Thank you, sir. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To adjourn your question, please press star 1-1 again. Please stand by while we compile the Q&A roster. And I show our first question comes from the line of Jonah Gajuk from Bank of America. Please go ahead.
spk18: Good morning. Thanks for taking the questions here. So I guess just following up to Nick's comments, the latest comments on the trends. So I guess you said a monthly ADC growth trends been encouraging during the fourth quarter. So can you give us some flavor of how things are tracking so far this year? Has this persisted, the improvement that you've seen in Q4, and I guess also Q3? kind of, you know, any color can give us on some of these metrics as you've seen them live, you know, this quarter so far.
spk11: Well, before, Nick, I'd say we're loathe to talk about, you know, quarter, unreleased quarter activity other than to say, I'll just say, yeah, it's good. It's, you know, it's what we expect to see.
spk26: I'd use the word very encouraging. Very encouraging, like you referred to in the fourth quarter, and we're still very encouraged sitting here today.
spk11: And I'd say the same thing with Roto-Rooter. Roto-Rooter has one other good thing going for it, which is weather. We've had great Roto-Rooter-type weather. So, yeah, we don't like to talk about it other than to say it's good.
spk18: Okay, that's good. Encouraging. I like that. And I guess, so when it comes to your guidance for the year for VDAS, just coming back before we talk about, so the VDAS margins, right, the guidance calls for these margins to be down, you know, because 70 to 100 basis points year for year. So obviously sequester coming back, obviously high more people. And I guess also census, right, still going to be maybe 4% or so below 2019 levels. So is that a way to think about it that before you, you know, reach or get closer to the pre-pandemic margins you need to get the census back to that level?
spk07: Yeah, join us. This is Dave. So I'll comment on a macro basis, and Nick can give a lot more color and more detail. But on a macro basis, if you think about what we're doing, beyond the fact that we have a headwind on sequestration, so obviously that impacts us by what, Nick? 75 bits. in $9 million. Then we also have an issue, of course, of the fact that the reimbursement increase was inadequate relative to some of the wages. So that creates a bit of a headwind, period. But absent that, you have to expect the margin to be down as we build capacity. That's a drag on profitability. You add licensed healthcare workers, they can't be immediately productive. in terms of then the next day we expanded census. So there's a lag. We have a lag at about 30 to 60 days right now of adding capacity and then we see an impact on census. And frankly, six months ago I would have said that lag is easily 60 to 90 days. So the cause and effect is tighter than we want, but the bottom line is you add capacity, that's a strain on margin. Then you bring on new patients more than you would have otherwise That's also a strain on margins in terms of the admissions process. And most patients, all patients, are negative margin for the first solid 15 as much as 30 days in program. And then as the patients in program age out, then they become positive margin. So that's a long-winded way of saying you have to expect margins to lag to increase capacity to grow the business. And the other thing I'd add is this is a mirror image of what happened in 2020. when census held in but we did have weakness and we lost our capacity to a certain degree with healthcare workers resigning. So margins were much higher than you would have anticipated because census was there but you didn't have the FTEs. So bottom line is grow our capacity by adding healthcare workers, licensed healthcare workers, and then that will lag 30 to 60 days for census. And then census will lag, that marginal increase in census, by about 30 days until those patients are profitable.
spk26: And just to recap a few pieces in Dave's depiction, the $9 million or 75 basis points year-over-year comparison, obviously that has a marginal implication related to it. And as we sit and grow all the pieces they've talked about in terms of clinical capacity and the timing flags with it, it all translates into that 16.3 to 16.6 adjusted EBITDA X cap margin we released as part of the guidance. But, you know, the bottom line on a day-in and day-out basis is we're continuing to be laser focused on driving growth inside of the organization, and that's the combination of clinical capacity as well as servicing more patients And from a bottom line total contribution from a dollar standpoint and then the ultimate marginal contribution, that will come through in 2024 probably looks more like, you know, an estimated ongoing margin now that the pandemic is fully behind us and we'll see what census level we're at at that point in 2024.
spk11: I would just add with one separate move, there's nothing that has changed in the hospice market. The pandemic was a big rock thrown into a pond, which caused all sorts of ripples and effects and splashes, but it's going to return to, you know, based on what's going on there today, we expect it to return to the same general dynamics from before the pandemic, and VITAS has not lost market share. I think that the number of percentage of deaths that have a brush with hospice is going to return to its previous level, and VITAS will be there and by that point have the staff to deal with them. So, yeah, to us it's a, you know, we're just getting back to something. We already have the institutional, you know, people involved for a 19,000, 20,000 census hospice. Now we're just waiting for the operating conditions to return to normal.
spk07: And Joanna, if you think about it, so we're guiding adjusted EBITDA margin X cap in the retention program for VTAS of about 16.3% to 16.6%. But let's just go back to the last full year we had before the pandemic. So that would have been the 2019 full year adjusted EBITDA margin was 17.8%. So frankly, if you take it, just take into consideration The headwind on sequestration, but the fact that we're still down from our census of 19,000 plus at the end of 19, frankly, we're coming back on the adjusted EBITDA margin faster than I would have thought. And frankly, with some of the changes that have been forced on us through bobbing and weaving during the pandemic, I suspect NIC is a lot more efficient now than we were a few years ago. So I think there is actually, it's more likely than not, once we return to normal size census, get back to pre-pandemic levels, I think our margin is going to end up a little higher because these efficiencies have now been incorporated into our normal operating approach.
spk26: And we'll see what the pricing implication is on October 1 of 2023.
spk18: Right, it was actually on my list too, since you mentioned that. So what do you assume for your Medicare rating in the fourth quarter of 23? Five percent. Did you say five, plus the five? Okay, so nicely accelerating from like, I guess call it four percent. That's an educated guess right now.
spk26: As you know, they released a preliminary report related to it in the late, you know,
spk07: in the next 30 to 45 days that'll help to inform the ballpark range we would anticipate october 1. but frankly we don't consider the the the model they use you see emissions to develop our increase in rate is less than transparent right that's not a topic but i'm just coming back to the to the hiring and increasing the capacity so just to clarify the 275
spk18: these are new hires or these are net hires? And also, what percent of the base is it? And also, so you mentioned before that you expect to add roughly 25 per month still of staff. So I assume that's gross or is it net? And, you know, so is that enough? Like, really, what I'm getting at, how much more do you really need to increase your net staff to be back to, you know, the... capacity that you had before COVID.
spk26: So let me, the baseline answer, which is the most important one here is those are net numbers. And it's enough.
spk11: I mean, I guess the other answer is to answer your second question. To methodically absorb them in. That's right. It's not like we're looking to greatly exceed that number.
spk26: And so, you know, it's the methodical approach Kevin alluded to that is always focused back to where things maybe call it were in an environment, I'm talking about this philosophically, where we want to add clinical capacity to be able to absorb the demand we see in the marketplace, and we're still ramping up to that, and that demand is not only to help fulfill referral and admission activity, but also, of course, to care for patients who are joining the benefit more traditional you know at the time window more traditional than they were pre-pandemic which is encouraging and um you know will be on service with us hopefully you know for a longer period of time than they were uh during the disruption time period of the pandemic where you know the health care system referred them later to all hospice providers inside of the benefit so it's a long-winded way to say we will methodically continue to grow clinical capacity, and we wanted to guide towards that, which helps with, as Dave was alluding to, a little bit of the short-term marginal compression. But the bottom line is, as long as we can continue to improve our retention, improve our hiring, resulting in net growth of clinical capacity, feel really good about the other operating metrics from a top-line perspective, from our ability to absorb what continues to be elevating demand in every market in which we serve, and deliver predictable and sustainable operating results.
spk11: And, Joanna, one thing that we follow is to say what we're trying to achieve is we have the two grow in tandem. We know there's a lot, as Dave said, a lag factor. The current quarter margin is probably affected by 141 basis points based on our rough calculations to give you an idea that that's... So we're running a little ahead. The way that we do this is if you want to grow, and we think at the optimum rate, you're out ahead with the hiring. So you can put a cost on that is 141 basis points. We're not looking... to be further ahead and have that grow to 200 basis points or 250 basis points.
spk07: I'd be comfortable methodically keeping that as we expand capacity.
spk11: We have headlights. That clears the area ahead of you.
spk07: Let's have just a clear understanding, and Nick can provide probably a lot of anecdotal color on this, but if you think about it, adding capacity has put us in a virtuous cycle. What I mean by that is our tenured people were getting strained. Their schedules were a havoc. They were scrambling to take care of patients. We're hiring these people. They trained them, and they were resigning. So it was burning out our tenured staff. So we've now entered the point where we're adding capacity. It's giving relief to the tenured staff. It's not being on this horrible treadmill of you hire people, they resign. You hire other people. So from that standpoint, the life of our long-tenured people has gotten massively better now from where it was the fourth quarter of last year. That's reaffirming our ability to retain existing personnel as well as adding. So we're actually, what we think is we're in a horrible spiral, you know, at the end of 2020 in the pandemic and Nick and his team have completely reversed that.
spk26: Just to add on that, Joanna, because I'm sure it will be embedded inside of either a subsequent question or other folks' questions. If you think about it, very generally at a high level, it has a compounding effect to it, which is fantastic, meaning the baseline Dave alluded to, existing staff, real burnout and shortages, and that also is elevated by people accessing the benefit later in their disease trajectory. You couple that with a frustration because everyone joins hospice usually from a calling standpoint of not being able to meet patient demand. And so our teams have done a fantastic job at three very high-level behavioral pieces, focusing daily on the existing employee experience. That's our tenured staff Dave was alluding to. There's a lot of detailed, tactful things inside of it. But also part of that is helping them understand the light that's at the end of the tunnel related to that burnout and frustration. The second is focusing on hiring and really improving the new hire experience. We measure that through 90-day and first-year turnover. Both of those are... performing substantially better than they were in the pandemic. The third is taking that new team and really elevating the integrated culture. And I know those three things sound simplistic. They're difficult to execute upon. The team's done a wonderful job. And the result is the compounding effect of all three of those things lead to less burnout, a camaraderie of a mission-focused organization, and then the ability to meet more and more demand and respond to demand And everyone personally begins to elevate their fulfillment of being able to impact the communities in ways they signed up originally to be part of the hospice benefit and be part of VITAS. So that calling combined with the compounding effect is really taking hold and it's something I'm very encouraged by as we have launched into 2023.
spk18: No, it's definitely good to see the trends improving there and the staffing. And thanks for all this call. Just one last on that topic. Because you're talking about, you know, adding, continue to add on more staff. But I guess this retention program is going to end. So I guess the question there obviously is, you know, do you foresee a risk of higher turnover, you know, starting second half of 23 when people, you know, get their bonuses and maybe leave? So can you talk about you know, expectations for that and kind of what you assume in your guidance on that front. Thank you.
spk26: Yeah, so obviously aware of the risk. Based upon what I just talked about from the compounding effect that has nothing to do with the Difference Maker Program, but the Difference Maker Program helps provide the catalyst for the existing staff as well as the staff that join us to be incentivized inside of it. That's what we deem our recruiting and retention programs, the Difference Maker Program. So a little less concerned than you may think because of those pieces and the compounding effect, because once we have the existing staff and the new staff that are with us for a year and that experience is elevated, our retention metrics just continue to improve in a substantial way. But we're aware of the risk and not discounting it either.
spk11: We expect to see something, but we believe that the the healthcare professionals that go to work for hospice in general are not dollar-driven as a priority. I mean, they could go to other jobs and get a higher rate of pay. It's the nature of the business. And what Nick is suggesting is there are really two things. Number one, there's a view within the workforce that VITAS is stepping up the plate to do what's necessary. What's necessary is not necessarily to give people more money, but it's to increase staff to have the right amount of staff for the services we're offering. And so the net effect is, at the end, if these are not hired guns, they'll get right out of town at the 12-month date.
spk12: Some will.
spk11: In other words, I think that some people would normally move jobs or have a change with a month or two short of the period in which they're going to get their payment, I could see them postponing it and happening. But we think that will just be within normal ranges.
spk07: And, Joanna, we have some pretty strong statistics to support our expectation, and that is we know if we can keep an employee for 12 months, the probability they're a long-tenured employee, three or more years, is significantly higher than people are with us less than 12 months. And it actually goes. Employees are with us 90, 180, 270, or 360. That attrition rate drops, but we get them for a year. Behavior, they know what they know, and we hang on to them. And as Nick said, plus we've reinforced our tenured folks. So we have strong statistics. If you get into a year, the probability you hang on to these people for definitely more for an additional year, but really three or more years, is probably pushing around 75%.
spk26: It all comes back to you join the hospice industry clinically because it's a calling and something you want to do. If you are looking to maximize personal learnings, the reality is you go become a travel nurse, like many had done, until that carousel stops. But those aren't typically what we see embedded inside the industry.
spk18: Thank you. I don't want to dominate, but just a last question on the Rotterdam side. So the guidance calls for revenues, right, to be up 5%, COVID. So that's a still solid number. So are you assuming, you know, some slowdown? Because you mentioned, you know, you're seeing potentially, you know, some of these excavation jobs being postponed. So are you assuming this continues into next year? And also, can you break down the 5%, like how much is price versus volume? And is this, you know, kind of assuming that you'll go faster than the market or in line with the market? Thank you.
spk07: Yeah, that's a great question, Joanna. And yeah, of course, we pass through price increase on a bespoke basis. What we look to for Baltimore is going to be different than what we do in Cincinnati. But the range of our price increase is going to be around 5.5% to 6%. So frankly, if you look at that, we can talk about large jobs, small jobs, geographic. But we're essentially, in terms of our raw procedures, estimating we're going to be flat, which is actually, we think, fairly conservative. As Kevin mentioned, it's angels on the head of a pin on what is truly considered emergency. But no one gets a warm fuzzy by calling Roto-Rooter and paying us $600 to get their house back to where it was the day before. So what I'm saying is the majority of our jobs are non-discretionary. Maybe they can delay it. And we've taken guidance assuming an increase in consumer headwinds on spending. But the ability of the people to avoid these kind of emergency plumbing and drain cleaning services is limited. But it's not recession-proof, as Kevin always says. It's very recession-resistant. But we think we developed, in our guidance, some headwinds on demand that will be much higher than it is today. So, frankly, I think it's more likely than not we are at the higher end of the Roto-Rooter guidance. But we are guessing a little bit. But I go back to the Great Recession and the little impact that that had on our demand, and that was before we implemented water restoration, which is now going to be pushing hopefully $200 million or slightly below that. That is 100% non-avoidable. You've got standing water, in some cases gray or black water in your house, you're paying us to get rid of it.
spk09: And it's insurance coverage.
spk07: It's insurance-paid. Just to give a little bit more color, both water restoration and excavation are derived from additional procedures from basic small jobs. As you can see, water restoration continued to grow, but excavation, they're less than that water restoration. The growth was there, but not as much, which just tells you They didn't delay the water restoration, but they deferred a small portion of the excavation work. Otherwise, excavation and water restoration probably would have been closer to the same rate.
spk11: And I'll just, I don't want to, you know, beat a dead horse, but from my perspective, I know in theory, you know, consumer demand and, you know, inflationary pressures and recessionary pressures, you know, have an effect on any business. But, you know, Roto-Rooter is, It's such a basic business. If you ask me what has affected numbers more than the financial environment, it's the fact that in the last 18 months, private equity companies have been investing in service companies. First thing the service companies need is local management. Red River is one of the go-to places to hire service companies. qualified service managers. And, you know, if you ask me how we're going to make sure we hit our numbers, it's going to be doing a better job holding on to our branch managers and excavation managers. The work is available, but it's a bit of an art rather than a science. And, again, we have some programs now to improve our retention of those key people. But if you look over the 18 months, It's been an onslaught. I mean, we have a couple litigation matters going on that subject of poaching of kind of several people all from one branch. We have some compensation plans in place. But I'll tell you right now that if we do a better job of that, that will greatly outweigh any overall financial metric.
spk17: Thanks for all the answers. Appreciate it.
spk14: Thank you. And I assure our next question comes from the line of Ben Hendricks from RBC Capital Markets. Please go ahead.
spk23: Hey, thanks, guys. Quick question on capital allocation. Is there any change or anything we should consider this year regarding your capital allocation priorities or balance sheet management strategy for...
spk07: Dave Williams Hi, Ben. This is Dave Williams. Just slightly in that what I would say is if you look at our balance sheet and, you know, we redid our credit facility last year and we upped it $100 million from $450 to $550 million. And we actually put a piece of term loan on there of $100 million. It has, I think it's running $1.25 million quarterly amortization on it. But given the spike in interest rates, Frankly, before when it was a 30 basis point penalty, we didn't have to keep a super tight lock on the balance sheet. Interest rates were low. How much we can invest our cash was low. But now it matters. So your point is a good one. We're actually going to accelerate the payment of that term debt. As a matter of fact, we've given notice that we're going to tranche down $50 million by the end of this month, and we'll probably eliminate all of the term debt costs early into Q2, and then we're going to triage that free cash flow probably to share repurchasing after we have now zero debt. Just because, I mean, the swing line we would do would be at 7.75%, and I think SOFR plus 100 basis points spread, which is still a great rate, but that takes us to, what, 6.5% right now. So, uh freak screw that we're getting rid of all interest expense regarding the term debt cash outflow and then capital goes to shares mortals sit on our balance sheet for opportunistic investments great thanks for that guys thank you and i show our next question comes from the line of mike wederhorn from oppenheimer please go ahead
spk15: Good morning, thanks for taking my call. Majority of my questions have been answered, so I have one or two here. You discussed earlier about the referral trends and how they continue to evolve. Can you discuss how that strategy has impacted your length of stay and acuity, and where the patients are coming in in this process?
spk26: Yeah, so without getting specific in the granular delineation of all of it, one of the things that was we needed to respond to, particularly during the pandemic, was, you know, the referral demand in many instances coming to us shorter in their disease trajectory than typically. We had to be very mindful around where we were sending out scarce resources to not only respond and also, you know, bring on service. So the demand was has always been there and continues to be there. We reference it from a community access standpoint that we flow through our educational efforts, our emphasis efforts. But to clarify, we're still, of course, and you can see it in the metrics, serving all of the segments of the market that we reference and refer to externally from a pre-admit standpoint. That has continued. That strategy continues and carries over. And so on the margin, what ends up happening not only is people access the benefit earlier in their disease trajectory, but we also focus in on the community who typically refers patients and the types of patients earlier than the average to the hospice benefit. That compounding effect along with the compounding effect of staffing and clinical staff availability, really yields an acceleration of ADC growth for the same number of admissions coming into the organization. I don't know if that answers your question or not, Mike, but sort of directionally, it has made a difference, it'll continue to make a difference, and that's part of what's inferred inside of our 23 guidance of an ADC going up 3.5% to 4% and not referencing admission guidance specifically because it causes a little confusion.
spk15: That's good color. And one other question. I know you guys are obviously always very quiet on the M&A front. Can you kind of discuss what the market looks like and where valuations are, and are you seeing any changes in the competitive landscape?
spk07: I don't think I've seen enough to actually be able to give a thought on what multiples are going for.
spk26: Yeah, the multiples have a wide range, and it's really probably driven by who the owner is, right, because you have private equity that may expect larger multiples, and it's really just, you know, there's one aspect on price. I think the underlying piece for a lot of the providers in the space, and you hear it from other public commentary, is If you don't have the culture and strategic approach for retaining and growing your clinical capacity, by definition, all operating metrics related to the business are going to decline. And that's going to influence pricing as well as availability of each and every one of those providers. So that's really not significantly different than anything pre-pandemic except for the If you weren't proactively taking those steps in the middle of the pandemic to improve it, you have seen an acceleration of decline in your operating metrics, which is going to impact overall valuation as well as the multiple someone's willing to pay. There aren't too many platform assets out there, so now it is people plucking off individual single and regional providers that really don't have the balance sheet or scale to continue to operate. That's what we see in the space.
spk16: Thanks very much. Appreciate it.
spk14: Thanks, Mike. Thank you. I'm sure no further questions in the queue. At this time, I'd like to turn the call back over to Kevin McNamara, President and CEO, for closing remarks.
spk11: Thank you. Yes, we'll finish the call. Thank you for your attention. It was a nice, solid quarter for us, and we look forward to talking to you you all at the end of the next quarter. Thank you.
spk14: Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect. Good day.
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