Select Medical Holdings Corporation

Good morning, and thank you for joining us today for Select Medical Holdings Corporation's earnings conference call to discuss the second quarter 2021 results and the company's business outlook. Speaking today are the company's executive chairman and co-founder, Robert Ortenzio, and the company's executive vice president and chief financial officer, Martin Jackson. Management will give you an overview of the quarter and then open the call for questions. Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or the future financial performance of the company, including, without limitation, statements regarding operating results, growth opportunities, and other statements that refer to select medical plans, expectations, strategies, intentions, and beliefs. These forward-looking statements are based on the information available to management of Select Medical today, and the company assumes no obligation to update these statements as circumstances change. At this time, I will turn the conference over to Mr. Robert Ortenzio.

Thank you, operator. Good morning, everyone. Thanks for joining us for Select Medical's second quarter earnings conference call for 2021. We are very pleased with the financial results of the quarter, as well as a number of other business goals that we accomplished during the quarter. We experienced top-line growth in all four of our business segments compared to both the same quarter last year and pre-pandemic same quarter in 2019. The volumes in our inpatient and outpatient business segments are trending very nicely and are well above pre-pandemic volume numbers. In addition to the volume growth, the inpatient and outpatient rehabilitation hospitals and clinics posted their highest quarters for adjusted EBITDA in the history of the company. Concentra has made nice strides with volume improvement as more industries such as airlines, hospitality, municipalities, and schools reopen. On the development front, on May 1st, Scripps Healthcare entered into our existing joint venture partnership with UC San Diego Health on our 110-bed critical illness recovery hospital in San Diego, California. In June, we closed on a new outpatient joint venture with MonHealth in West Virginia, which marked our entry into the state for outpatient rehab. On July 1st, we entered into a new long-term acute care hospital joint venture with Ascension St. Thomas in Nashville, contributing our 70-bed Nashville hospital to the joint venture and moving forward with plans to add a 30-bed satellite hospital within a hospital at their St. Thomas West Campus later this year. Also on July 1st, we entered into a new joint venture with CHS Northwest Healthcare in Tucson, Arizona, and acquired a 47-bed long-term acute care hospital, Cura Tucson, which we plan to relocate to Northwest Medical Center later this year. And earlier this week, we entered into a new outpatient rehab joint venture with Cedars-Sinai in Los Angeles, California, contributing our 26 outpatient clinics in that market to the joint venture. We continue to work on finalizing the acquisition of Acuity Healthcare, which operates five long-term acute care hospitals through joint venture partnerships in New Jersey and West Virginia. We expect the deal to close sometime late Q3 or early Q4. Our development pipeline remains strong as we continue to look for opportunities to expand our footprint and partner with leading healthcare institutions throughout the country. In addition, Last week, US News and World Report released their annual rankings of top rehabilitation hospitals in the country. Our Kessler Institute of Rehabilitation in New Jersey was ranked number four in the country, its 29th consecutive year of being named among the nation's best. In addition, this year for the first time, we have three of our joint venture partner hospitals making the list. They are Baylor Scott & White Institute for Rehabilitation in Dallas at number 13, Emory Rehabilitation Hospital in Atlanta at number 26, and Ohio Health Rehabilitation Hospital in Columbus, Ohio at number 34. I couldn't be more proud of our clinical and operational teams at these hospitals and throughout the rest of our portfolio of hospitals for their hard work, expertise, and dedication to the care and treatment of our patients. Two other items I wanted to note are the Centers for Disease and Control, the CDC, and Select Medical collaborated on a clinical study regarding a long-term impact of COVID-19, which was recently published in the Morbidity and Mortality Weekly Report. Finally, as noted in our earnings press release yesterday, our board has declared a 12.5 cent per share dividend that will be payable August 30th to shareholders of record on August 18th. As we've done over the past year, we have outlined our business segment monthly revenue, volume, and occupancy statistics in our earnings press release and public filings. This quarter, we also included monthly results from 2019 to provide a data point of where each of our business segments were prior to the pandemic compared to where they are currently. We will continue to include this information as long as it provides meaningful insight to the impact of COVID-19 on the company's financial performance. Overall, revenue for the second quarter increased 26.9% to $1.56 billion and for year to date has increased 17.5% to $3.11 billion. Revenue in our critical illness recovery hospital segment in the second quarter increased 4.7% to $544 million compared to $520 million in the same quarter last year. Patient days were down 1.4% compared to the same quarter last year with 273,000 patient days in the quarter. Occupancy in our critical illness recovery hospital segment was 69% in the second quarter compared to 72% in the same quarter last year and 69% in the second quarter of 2019. Revenue per patient day increased 6.4% to $1,986 per patient day in the second quarter. Case mix index in our critical illness recovery hospitals was 1.33 in the second quarter compared to 1.32 in the same quarter last year. As we had mentioned in our most recent earnings call, staffing remains an issue in the critical illness recovery hospitals and it did have an impact on the number of patients we were able to admit for the quarter. We had a number of our hospitals that were unable to accept patients due to lack of clinician availability. This cap in census represents a reduction of occupancy of approximately 1.5%. I would like to point out that these staffing challenges have been isolated to our critical illness recovery hospitals, and we have not experienced this issue in any of our other business segments. Revenue in our rehabilitation hospital segment in the second quarter increased 26.1% to $213 million compared to $169 million in the same quarter last year. Patient days increased 24.8% compared to the same quarter last year with almost 105,000 patient days. Occupancy in our rehab hospitals was 85% in the second quarter compared to 71% in the same quarter last year and 75% in the second quarter of 2019. Revenue per patient day increased 1% to $1,849 per day in the second quarter. Revenue in our outpatient rehab segment in the second quarter increased 67.8% to $280 million compared to $167 million in the same quarter last year. Patient visits were up 79.2% with 2.4 million visits in the quarter compared to 1.3 million visits in the same quarter last year and 2.2 million visits in the second quarter of 2019. Our revenue per visit was $102 in the second quarter compared to $106 per visit in the same quarter last year. This reduction in rate is due to a change in our payer mix caused by the pandemic and related lockdowns. Revenue in our concentra segment in the second quarter increased 46.1% to $456 million compared to $312 million in the same quarter last year. visits compared to 2.15 million visits in the same quarter last year and 3.1 million visits in the second quarter of 2019. Revenue per visit in the centers increased to $125 in the second quarter compared to $124 in the same quarter last year. I also want to highlight that we recognize $98 million in other operating income in the second quarter related to funds that we received under the CARES Act provider relief. for incremental costs and lost revenues incurred as a result of the COVID pandemic. Last year, we recognized $55 million in other operating income related to these funds. The adjusted EBITDA results for our critical illness recovery hospital, rehabilitation hospital, and outpatient rehab segments do not include any recognition of this income. We record other operating income related to those segments under our other activities. Adjusted EBITDA results for our Concentra segment included recognition of this income, including $32.3 million in the second quarter of this year and $800,000 in the same quarter last year. Total company adjusted EBITDA for the second quarter increased 91.3% to $342 million compared to $178.8 million in the same quarter last year. Our consolidated adjusted EBITDA margin was 21.9 for the second quarter compared to 14.5 for the same quarter last year. Our critical illness recovery hospital segment adjusted EBITDA was $72.9 million in the second quarter compared to 89.7 in the same quarter last year. Adjusted EBITDA margin for the segment was 13.4% in the second quarter compared to 17.3 in the same quarter last year. We experienced a deterioration of EBITDA margin in the quarter due to significantly higher nursing costs, which was driven by both an increase of both hours and rates of agency staffing. Our rehabilitation hospital segment adjusted EBITDA increased 83.9% to $50.8 million in the second quarter, compared to $27.6 million in the same quarter last year. Adjusted EBITDA margin for the rehab hospital segment was 23.9% in the second quarter compared to 16.4% in the same quarter last year. Our outpatient rehab adjusted EBITDA was $45.6 million in the second quarter compared to adjusted EBITDA loss of $6.3 million in the same quarter last year. Adjusted EBITDA margin for the outpatient segment was 16.3% in the second quarter. Our Concentra adjusted EBITDA increased 230.3% to $137.1 million in the second quarter, including the $32 million in CARES Act payments recognized in the quarter. This compares to $41 million in the same quarter last year, which included $800,000 in CARES payment recognition. Adjusted EBITDA margin was 30% in the second quarter compared to $13.3 in the same quarter last year. Excluding the $32.3 million of CARES Act payments, the adjusted EBITDA margin would have been 23% for the quarter. Earnings per common share increased 213% to $1.22 for the second quarter compared to $0.39 for the same quarter last year. In both periods, our earnings per common share was positively affected. by the CARES Act provider relief funds recognized in the respective quarters. Excluding the CARES Act income, earnings per share would have been 72 cents in the second quarter this year and 9 cents per share in the same quarter last year. On the regulatory front, last week CMS issued the final inpatient rehab rules for fiscal 2022, effective October 1st of this year. The final rule includes a 2.3% increase in the standard payment amount which is slightly less than the 2.5 included in the proposed rule. In addition, the high-cost outlier threshold increased by 20%, which was slightly worse than what was in the proposed rule. The CMG relative weight and average length of stay values were also updated in the final rule. Finally, this week, CMS also issued the final LTAC rules for fiscal 22. The final rule included a 2.2% increase in the federal base rate Again, slightly less than the 2.5% increase outlined in the proposed rule. The high-cost outlier threshold was increased 21%, and the MSL, LTC, DRG relative weights and expected length of stays were also updated in the final rule. That concludes my remarks, and I'll turn it over to Marty Jackson for some additional financial details before we open the call for questions.

Thanks, Bob. Good morning, everyone. For the second quarter, our operating expenses, which include our cost of services in general, administrative expense, were $1.33 billion, or 84.9% of revenue. For the same quarter last year, operating expenses were $1.12 billion, and 90.5% of revenues. Cost of services. were $1.29 billion for the second quarter. This compares to $1.08 billion in the same quarter last year. As a percent of revenue, cost of services were 82.6 percent for the second quarter. This compares to 87.8 percent in the same quarter last year. G&A expense was $35.7 million in the second quarter. This compares to $33.5 million in the same quarter last year. G&A as a percent of revenue was 2.3% in the second quarter, compared to 2.7% of revenue for the same quarter last year. As Bob mentioned, total adjusted EBITDA was $342 million, and adjusted EBITDA margin was $21.9 million for the second quarter. This compares to total adjusted EBITDA of $178.8 million, and an adjusted EBITDA margin of 14.5% in the same quarter last year. Excluding the CARES Act's income recognized in the quarter, adjusted EBITDA margins would have been 15.6% in the second quarter this year and 10% in the same quarter last year. Depreciation and amortization was $51 million in the second quarter. This compares to $52.3 million in the same quarter last year. We generated $11.8 million in equity and earnings of unconsolidated subsidiaries during the second quarter. This compares to $8.3 million in the same quarter last year. Interest expense was $33.9 million in the second quarter. This compares to $37.4 million in the same quarter last year. We recorded income tax expense of $65.7 million in the second quarter this year. which represents an effective tax rate of 25.1 percent. This compares to the tax expense of $23.3 million and an effective rate of 25.7 percent in the same quarter last year. Net income attributable to non-controlling interests were $31.3 million in the second quarter. This compares to $15.8 million in the same quarter last year. Net income attributable to select medical holdings was $164.9 million in the second quarter, and earnings per common share were $1.22. At the end of the second quarter, we had $3.4 billion of debt outstanding and over $800 million of cash on the balance sheet. Our debt balance at the end of the quarter included $2.1 billion in term loans, $1.2 billion in six and a quarter senior notes, and $70 million of other miscellaneous debt. Net leverage based on the credit agreement EBITDA dropped to 2.51 times at the end of the second quarter. This is down from 3.02 times at the end of the first quarter and 3.48 times at the end of the year. On June 2nd, we completed an amendment to select and concentra revolving loans We increased the availability on Select's revolving loan from $450 million to $650 million and simultaneously canceled the $100 million consensure revolving loan, which was set to mature in March of next year. Neither revolving loans had any borrowings outstanding. Operating activities provided $123.1 million of cash flow in the second quarter. Our day sales outstanding, or DSO, was 54 days at June 30th, 2021. This compared to 56 days at both March 31st, 2021 and December 31st, 2020. During the second quarter, we repaid $73 million of Medicare advances. And as of June 30th, 2021, we have $251 million remaining on the balance sheet. We expect similar quarterly recoupments until the advancements are fully repaid. Investment activities used $35.7 million of cash in the second quarter. The use of cash included $36.7 million in the purchase of property and equipment, and $8.4 million acquisition and investment activity in the quarter. We also generated $9.4 million in proceeds from the sale of assets in the quarter. Financing activities used $34.3 million of cash in the second quarter. This included $16.9 million in dividend payments, $9.8 million in net payments and distributions to non-controlling interests, and $6 million in repayments of other debt in the quarter. Our total available liquidity at the end of the second quarter was almost $1.4 billion, which includes the $800 million of cash and close to $595 million in revolver availability under the Select Credit Agreement. Additionally, in our earnings press release, we provided an updated business outlook for calendar year 2021. For the full year of 2021, we now expect revenue in the range of $5.85 to $6.05 billion. Expected adjusted EBITDA to be in the range of $970 million to $1 billion. And expected earnings per common share to be in the range of $2.91 to $3.08. This concludes our prepared remarks, and at this time, we'd like to turn it back over to the operator to open up the call for questions.