Tao Qiu

Tao Qiu asked for a bridge from the first-half RevPAR growth to the higher full-year guidance, considering divestments, and requested more detail on the strategy for the assets collateralizing the 2027 debt refinancing.

Answer

Interim CEO & Chairman Denise Warren explained that the transition of 55 underperforming Ventas communities in the second half will be a primary driver of the improved consolidated RevPAR metric. Regarding the 2027 debt, she clarified the goal is to boost the collateral pool's performance to a level where they can satisfy the loan while removing some properties from the pool, thereby creating a portfolio of unencumbered assets for future flexibility. The SWAT team's approach for these assets is the same as for others: improving operational performance.

Tao Qiu of Macquarie asked for details on the communities in the sub-70% occupancy bucket, questioning why the company isn't more aggressive with dispositions, and also inquired about the CEO search criteria and potential strategy shifts.

Answer

EVP & CFO Dawn Kussow detailed that many sub-70% occupancy communities are already slated for disposition or are part of 'high opportunity' turnaround groups. EVP & General Counsel Chad White added that an initial group of 14 non-core assets is already in the disposition process, with more being evaluated. Interim CEO Denise Warren stated the CEO search prioritizes a candidate with both proven operational expertise and a long-term strategic vision to unlock the company's intrinsic value.

Tao Qiu asked for a breakdown of the 2025 RevPAR guidance, specifically the impact from the Ventas lease amendment, and the underlying assumptions for rate and occupancy. He also inquired about Brookdale's strategy to accelerate growth and create shareholder value beyond 2026.

Answer

EVP & CFO Dawn Kussow explained that the 2025 RevPAR guidance of 4.75% to 5.75% already incorporates the expected impact of the Ventas transaction, along with assumptions for move-ins, move-outs, and the flu season. President & CEO Lucinda Baier added that future growth will be driven by expanding proprietary programs like Brookdale HealthPlus and EngagementPlus, enhancing the dining experience, and capitalizing on favorable demographic trends for their needs-based portfolio.

Tao Qiu from Macquarie requested details on the drivers of the expected 2025 adjusted free cash flow improvement. He also asked if the clinical outcomes from Brookdale HealthPlus are being leveraged for sales or premium pricing, and questioned the performance consistency across the 41 newly acquired communities.

Answer

Lucinda "Cindy" Baier, President & CEO, and Dawn Kussow, EVP & CFO, identified the key drivers for 2025 free cash flow as acquisition benefits and the annual rate increase, while noting variable interest rates as a potential risk. Regarding HealthPlus, Cindy Baier stated its primary goal is driving higher occupancy through a superior product, with Medicare Advantage payments currently covering incremental costs. She also confirmed the 41 acquired properties have varied performance, providing future flexibility for capital recycling, but emphasized the transaction is financially solid on its own terms.

Tao Qiu asked how the proposed MSSP rule change, which accelerates the transition to higher-risk arrangements, affects Privia's strategy and the competitive landscape.

Answer

CEO Parth Mehrotra stated the change does not alter Privia's strategy, as their objective has always been to move to the MSSP enhanced track as quickly as possible to maximize economic benefits. He believes the rule may force non-performing ACOs to make difficult decisions, potentially creating tailwinds for high-performing, scaled groups like Privia to attract those physicians and lives.

Tao Qiu from Macquarie asked if any further changes to MA risk contracts are contemplated for 2025 and whether the mix of collections would continue to shift away from value-based care, given the challenging environment.

Answer

CEO Parth Mehrotra stated that no further changes are anticipated, as the necessary renegotiations were completed at the start of 2024. He clarified that the previous decline in value-based collections as a percentage of total was a function of revenue recognition changes from moving off full-risk contracts, not a change in the underlying business of managing lives. The focus remains on generating positive margin, regardless of the contract structure.

Tao Qiu questioned the conservatism of the full-year guidance given strong first-half results. He also asked about potential future headwinds, the margin outlook, and the nature of contracting discussions with hospitals amid reimbursement pressures.

Answer

EVP & CFO Kasandra Rossi noted that guidance reflects tougher year-over-year comparisons in the second half of 2025, though margins are expected to remain stable. CEO Mark Ordan added that hospitals are not retreating from their essential services; instead, Pediatrix is actively partnering with growing hospital systems on strategic initiatives like hub-and-spoke models.

Tao Qiu from Macquarie Group noted the company's strong same-store case volume compared to hospital peers and asked for contributing factors. He also inquired about the company's exposure to health exchange volume and the potential impact of declining exchange membership.

Answer

CEO Eric Evans attributed the consistent volume growth to the company's multi-faceted strategy, including a robust physician recruitment engine and service line expansion, with particular strength in GI and MSK. He clarified that the company's exposure to health exchange volume is 'immaterial,' as its elective surgical business is not typically sourced from channels like the ER, making potential declines in exchange membership a non-significant risk.

Tao Qiu sought to reconcile the components of the 2025 revenue growth guidance, noting a potential gap after accounting for acquisitions and divestitures. He also asked about physician recruiting trends and the labor environment.

Answer

CFO David Doherty explained the wide 6-11% revenue growth range reflects early-year conservatism and variability in the timing and nature of the remaining $150 million in planned M&A. CEO J. Evans highlighted the record physician recruiting in 2024, which is heavily orthopedic-focused and expected to double its impact in 2025. Doherty added that inflationary impacts on salaries (SWB) have been fully moderated, with the SWB-to-revenue ratio now in line with historical levels.

Tao Qiu from Stifel asked for comments on the final Medicare ASC payment rule, the potential for regulatory changes under a new administration, and the reason for the sequential step-up in D&A expense.

Answer

CEO J. Evans expressed satisfaction with the overall Medicare update, noting that key growth drivers are already on the approved list. He stated that the ASC model is favored by both political administrations due to the value it creates. CFO David Doherty attributed the increase in depreciation and amortization (D&A) expense directly to the new assets acquired and added to their portfolio over the past two years.

Tao Qiu of Macquarie Group inquired about a potential strategy shift towards larger portfolio deals, the lessons learned that provide confidence in execution, and the current M&A pipeline. He also asked about the strategy for leasing assets to third-party operators and the rent coverage Ensign underwrites for these deals.

Answer

Chad Keetch, CIO, EVP & Secretary, clarified that it's not a strategy shift but an application of their local-first model, which breaks large portfolios into smaller deals for existing clusters. He noted that for third-party leases, Ensign ensures disciplined pricing to achieve healthy rent coverage, targeting around 1.5x, and is seeing growing interest from potential partners.

Tao Qiu asked about the record $200 million investment spend in the quarter, questioning the sustainability of this investment pace and the expected mix between real estate and lease deals in the pipeline. He also inquired about staffing constraints given record-high occupancy and whether there is a specific occupancy level that triggers accelerated operating leverage.

Answer

Chad Keetch, Chief Investment Officer, stated that the strong deal flow is a continuation of recent trends and that the company remains disciplined, with talent being a greater constraint on growth than capital. He noted the quarter's high real estate mix was opportunistic and expects future deals to be more lease-focused. CEO Barry Port addressed staffing, explaining that Ensign is an 'anomaly' with improving turnover and moderating wage inflation, allowing occupancy to rise without compromising care. He asserted there is no 'magic number' for occupancy, seeing continuous organic upside. CFO Suzanne Snapper added that the company is now in a 'stability phase' with wages, which creates the potential for future leverage.

Tao Qiu inquired about the distribution of same-store occupancy, which has surpassed pre-pandemic levels, and asked to quantify the potential upside from occupancy and skilled mix. He also requested an update on the timing of state supplemental payments and any early discussions on 2026 Medicaid rates.

Answer

CEO Barry Port explained that while the current 81.7% same-store occupancy is a new high, significant upside remains as many mature operations are in the 90% range. He noted that driving acuity is fundamental to their model. CFO Suzanne Snapper added that supplemental payments are recognized quarterly within the Medicaid rate and that most state programs are now operating in a normal cycle post-FMAP.

Tao Qiu questioned the decision to reiterate mid-single-digit growth guidance for 2025, given that current performance trends higher. He also asked about the collection strategy related to Genesis, potential recovery expectations, and any long-term macro concerns from state healthcare budget changes.

Answer

President & CEO Ted Wahl explained that the guidance aims for accuracy, accounting for the variable timing of new business starts, but acknowledged the trend is toward high-single digits. Regarding collections, he stated the strategy continues to focus on promissory notes and disciplined decision-making, but it's too early to comment on specific Genesis recoveries. He expressed a constructive view on the macro environment, citing strong industry fundamentals and positive occupancy trends as key drivers.

Tao Qiu of Macquarie Group questioned the decision to reiterate mid-single-digit revenue growth guidance for 2025 despite strong H1 results trending higher. He also asked about recovery expectations from the Genesis bankruptcy and how this event will shape future collection strategies, and inquired about any concerns over moderating state healthcare budgets.

Answer

President & CEO Ted Wahl explained that the guidance reflects the variable timing of new business starts, though he acknowledged the trend is toward the high single digits. Regarding collections, he emphasized the continued use of promissory notes and disciplined decision-making, stating it's too early to predict Genesis recoveries. He also expressed a constructive view on the macro environment, noting that strong industry fundamentals and positive occupancy trends are expected to offset any moderate state-level budget pressures.

Tao Qiu asked for clarification on the Q2 revenue guidance, noting that it implied flat sequential organic growth after accounting for a recent acquisition, and questioned the drivers behind the $15 million increase in the full-year operating cash flow guidance.

Answer

Theodore Wahl (executive) explained that the Q2 revenue guidance of $445 million to $455 million accounts for the variable timing of new business starts, and reiterated that the mid-single-digit annual growth target is a better indicator of cadence. Vikas Singh (Chief Financial Officer) stated that the increased cash flow guidance was driven by a combination of receiving $12.2 million in ERC funds and the continuation of strong underlying collection momentum seen in recent quarters.

Tao Qiu from Macquarie Group inquired about the expected cadence of EBITDA margin expansion throughout 2025, considering Gentiva-related expenses. He also asked for commentary on the potential impact of an ACA expansion rollback on Addus's business.

Answer

CFO Brian Poff outlined a historical margin cadence, with Q1 as the low point, followed by a 40-50 basis point expansion in Q2 from payroll tax caps, and another step-up in Q4 from the annual hospice rate increase. Executive R. Allison clarified that an ACA rollback would have no direct effect on Addus, as their elderly and disabled patient base qualified for Medicaid long before the expansion.

Tao Qiu from Macquarie asked about the timing of potential impacts from federal Medicaid cuts, the components of the expected Q1 margin decline, and the reason for strong growth in hospice revenue per patient day.

Answer

CEO R. Allison and President and COO W. Bickham projected that any impact from federal budget changes would likely be a 2026 event, not 2025. CFO Brian Poff detailed the expected 200 basis point sequential gross margin decline, attributing over 100 bps to normal payroll tax resets and merit increases, with the remainder due to the mix shift from the lower-margin Gentiva business. Poff also explained that strong hospice revenue per day was driven by the Medicare rate increase, a favorable service mix, and a positive implicit price concession.

Tao Qiu of Macquarie Group inquired about the reimbursement environment in Missouri and North Carolina, two new states Addus will enter via the Gentiva acquisition, and asked for insight into the deal's potential EPS accretion for 2025. He also asked about the potential impacts of a federal minimum wage increase and a Medicare expansion for personal care services.

Answer

President and COO Brad Bickham described Missouri's reimbursement as solid and noted North Carolina's business is a small, high-margin case management operation. CFO Brian Poff stated the deal will be accretive, with more significant synergies expected in 12-18 months post-systems conversion. Regarding policy, management believes a federal minimum wage hike would not be material as they already pay above it, and they view potential Medicare expansion for personal care as a significant positive for the industry.

Tao Qiu asked about the adequacy of the Administrator in Training (AIT) program pipeline for the current acquisition pace, the expected run-rate for stock-based compensation, and the financial impact from Medicaid supplemental programs in the quarter.

Answer

An executive, likely Derick Apt, affirmed the AIT program provides a significant advantage and a deep bench of talent, though many leaders from the recent large acquisition are expected to be a good fit. Apt clarified that the forward run-rate for stock-based compensation is just over $4 million per month, as the large Q2 charge was mostly a one-time IPO-related vesting. He stated the Q2 impact from Medicaid supplemental programs was negligible and that potential revenue from California's program is not in guidance until payment is received from the state.

Inquired about the adequacy of the leadership pipeline for the current acquisition pace, the future run-rate of stock-based compensation, and the financial impact of Medicaid supplemental programs in the quarter.

Answer

Management expressed confidence in their leadership pipeline, which is supported by their AIT program and the retention of capable leaders from acquisitions. The go-forward run rate for stock-based compensation is projected at just over $4 million per month. The impact from Medicaid supplemental programs was negligible in Q2, and future payments are not included in guidance until cash is received.

Tao Qiu inquired about the adequacy of the leadership pipeline (AIT program) to support a faster acquisition pace, the expected run-rate for stock-based compensation, and the financial impact from Medicaid supplemental programs in the quarter and guidance.

Answer

PACS management explained that the leadership pipeline is strong, and the recent large acquisition included many capable local leaders, which supplements their AIT program. Executive Derick Apt clarified that the $90.9M stock compensation charge included a one-time $80M IPO-related vest, with the ongoing run-rate being just over $4M per month. He also noted that the impact from California's supplemental payment program was negligible in Q2 and is excluded from guidance until cash is received due to historical payment timing uncertainty.

Tao Qiu from Stifel, Nicolaus & Company asked about the decline in home health visits per episode to 12.5 in Q4 and inquired about the expected stabilized level for 2023.

Answer

EVP, CFO & Acting COO Scott Ginn attributed the Q4 dip to typical holiday seasonality and ongoing capacity issues. He stated that while VPE would likely remain lower in Q1, he expects it to hover around the 13.0 to 13.2 range for the full year, similar to the prior year's average, but it would not return to that level immediately.

Tao Qiu asked if labor issues at referral partners like hospitals were delaying patient demand, and whether staffing competition was primarily from within the home health industry or from other healthcare settings.

Answer

President and CEO Chris Gerard confirmed that slow recovery and capacity constraints at hospitals are creating a headwind for referral volumes, particularly in home health. He clarified that staffing competition is broad-based, with Amedisys losing clinicians not just to competitors but also to other care settings and burnout. He noted that 20% of new nurse hires are returning employees, which highlights a key retention opportunity.

Tao Qiu from Stifel asked if there was further room to optimize visits per episode given the strong quality scores, and how visit patterns under the new managed care payment model would compare to fee-for-service.

Answer

President and CEO Chris Gerard stated that under the new case rate models, visits per admission are expected to align closely with PDGM levels by using the Medalogix tool for optimization. Regarding current fee-for-service, he noted they are pleased with the 13.2 visits per episode and are not aggressively seeking further reductions, despite data suggesting it's possible, prioritizing the excellent quality outcomes being achieved.