ATI Physical Therapy - Q2 2023

Transcript

Operator (participant)

Good afternoon, and welcome to ATI Physical Therapy's second quarter 2023 earnings conference call and webcast. All participants will be in a listen-only mode. After today's presentation, there will be an opportunity to ask questions. If you would like to ask a question during this time, please press Star, followed by 1 on your telephone keypad. If you would like to withdraw your question, again, press Star one. Please note, this event is being recorded. On the call today is Sharon Vitti, Chief Executive Officer, Chris Cox, Chief Operating Officer, Joseph Jordan, Chief Financial Officer, and Joanne Fong, Senior Vice President, Treasurer, and Head of Investor Relations. I will now turn the call over to Ms. Fong.

Joanne Fong (SVP, Treasurer, and Head of Investor Relations)

Thank you, Josh. Good afternoon, everyone, and thank you for joining us today. To quickly cover, we'd like to remind you of certain statements that made during this call forward-looking statements that are subject to various risks and uncertainties and reflect our current expectations based on our beliefs, assumptions, and information currently available to us. Although we believe these expectations are reasonable, we undertake no obligations to revise any statements to reflect changes that occur after this call. Descriptions of some of the factors that could cause actual results to differ materially from these forward-looking statements can be found in the Risk Factors section in the company's filings with the Securities and Exchange Commission. In addition, please note that the company will be discussing certain non-GAAP financial measures that we believe are important in evaluating performance.

Details on the relationships between these non-GAAP measures to the most comparable GAAP measures and reconciliation of historical non-GAAP financial measures can be found in the earnings press release as posted on ATI's website and files with the SEC. With that, I'd like to turn the call over to Sharon.

Sharon Vitti (CEO)

Thank you, Joanne, and welcome everyone. Earlier today, we reported our second quarter 2023 earnings results and previewed the growing momentum in our performance. During this call today, we'll share the details behind our strong operating achievements and our 2023 earnings guidance. As I sit here today, I am a year plus into my tenure here at ATI. I'm privileged to lead this fantastic national care delivery organization that is paving the way in the musculoskeletal ecosystem. Myself and the entire team are really proud of the progress to date to recover our business. This doesn't come with luck. This comes with very deliberate planning around our key enablers to our success.

The first being our leadership team, and that's at multiple levels in the organization, but putting together a leadership team that has the skills and talents to bring the business where it needs to go. Also very focused on refreshing our culture, focusing in on people, and aligning on goals to deliver on our purpose. Lastly, empowering our teams and supporting their success, giving them the tools, the right tools, people, process, technology, and data, that allow them to practice at the top of their license and excel in their roles and execute with excellence. We've come a long way in recovering our business, and we're picking our heads up and looking at what next, and the next chapter is transformation and growth.

While hiring clinical FTEs will unlock our growth for sure, we're utilizing transformation and operational excellence to advance our top and bottom line growth. Turning to the specifics for the second quarter, there are many successes. Frontline team members continue to advance towards operational excellence. Nearly all of our key performance metrics are improving sequentially and year-over-year. The team has momentum and continues to reach new targets. Our first half track record gives me confidence that we'll continue to deliver on our financial goals in 2023 and beyond. You've heard me talk about the three Ps of our practice: our pipeline, our provider base, and our provider productivity. We continue to focus on disciplined execution of these fundamental building blocks, driving growth and profitability in our business. Let's start with pipeline.

Demand for PT, for therapy, sports medicine, worksite injury and prevention programs remained strong in 2023. Our therapy referral volumes have exceeded pre-COVID levels. On the people front, clinical FTEs are growing quarter-over-quarter as our new talent acquisition team and recruiting tactics hit their stride. Combination of hiring and retention has been very powerful for us, allowing us to retain and grow our provider base. Lastly, we have productivity. Our productivity levels also steadily grew, have grown quarter-over-quarter. Second quarter marks the highest visits per day since pre-COVID levels, allowing us to provide outstanding care to more patients every day with fewer clinical FTEs. Chris will provide more details on our operational metrics, our valuable transformation activities, and the other operational improvements we're making. It's really rewarding to see the team's purposeful actions delivering meaningful improvements for our colleagues, patients, and our business.

Let's take a look at unit economics. Our key metrics are also improving here. Our rate per visit not only stabilized, but is trending favorably. Payers are increasingly recognizing the value of high quality physical therapy and positive patient outcomes, resulting in higher reimbursements. Even with modest rate increases, physical therapy still remains a lower cost treatment pathway for musculoskeletal issues beyond the alternative, alternatives available. Equally exciting, we're starting to see some payers move to more flexible structures for reimbursement terms. For an example on this front, we're proud to be partnering with the payer to expand access to a traditionally underserved population while ensuring the rates make sense for our practice. This is beneficial to our communities, our clinics, and to the payer members.

We've had solid operational achievements, combined with strong market demand for therapy and sports medicine services, and that's all translating into improved financial performance. We've seen higher sequential and year-over-year revenue, adjusted EBITDA, and profit margins. Second quarter marked ATI's highest revenue since the start of the pandemic in early 2020. Joe will walk through the financials in more detail and our 2023 guidance. Let me be clear, we are being deliberate in our plans to deliver long-term sustainable growth and generate value for our patients, employees, community, and our shareholders. I've mentioned on previous calls that we will be looking to form strategic partnerships that position ATI as a leader through leveraging our national single-branded, standardized care model. Many, many of you may have read, most recently, we announced a partnership to elevate our digital telehealth capabilities.

Now, what this does, this allows us to create options for patients and meet our patients where they are through a hybrid care model. Our providers work with patients to develop a personalized treatment plan that integrates virtual physical therapy with hands-on care. I sit here very grateful for our incredible ATI teams. They are laser-focused on the best way to bring the ATI purpose to life: to exceed patient expectations by providing the highest quality of care in a friendly, encouraging environment, with impactful outcomes to improve each patient's health. Every day, our teams are making a difference in our local communities and continue to challenge themselves to realize our full potential. Now, I will turn the call over to Chris to talk about clinic operations.

Chris Cox (COO)

Thank you, Sharon. I'm thrilled about the strong operational progress in the first half of this year and simultaneously energized by the remaining opportunities ahead. As our field teams continue to execute and our central operations team continues to optimize workflows and processes, all with the goal of enhancing our capacity for care and elevating the patient experience. I want to thank our clinicians, field leaders, health services teams, and central teams for their continued focus and passion on improving the health and outcomes of our patients. Today, I want to touch on three themes. First, four-wall performance and execution. Second, our progress in removing administrative burdens from our clinics. Finally, improvements in our revenue cycle. As it relates to four-wall performance, labor productivity during the quarter was at 9.5 visits per day per clinical FTE.

This exceeds our high of 9.4 that was set last quarter. Also, in the second quarter, ATI clinician turnover declined to an annualized rate of 19%, which is on par with pre-COVID levels. In this tight labor environment, this level of retention speaks to ATI's unique culture and is the direct result of our efforts to improve clinic operations and tailor our employee value proposition to each person. Ultimately, provider growth is essential to the continued success of our business. While there continues to be an imbalance in the PT labor market, we increased clinical FTE compared to last quarter and will continue prioritizing efforts that advance retention and recruitment. One meaningful example of our strong employee engagement and community impact is the ATI Foundation, which recently relaunched.

The foundation was started in 2003 as a way for ATI employees and patients to give back to the communities in which they live, work, and serve. There was a temporary pause in activities with the pandemic, we have once again opened community grant applications to provide funding to children and adults with physical impairments so they can lead their most fulfilling lives. You can follow the foundation on social media for exciting updates and developments on this front. Our second theme, reducing administrative burdens in clinics, has helped to support the four-wall performance around productivity and retention that I mentioned. In our last call, I talked about some of the activities we have underway with leveraging technology and tools.

On the front end, we are achieving greater efficiencies and higher customer satisfaction with our call center initiatives, referral management, centralized patient intake, scheduling, and focus on access. We are about 60% of the way through rolling out our modernized and centralized intake support platform across all 900+ clinics. We are seeing providers in those markets that are already supported by this model able to spend more time operating at the top of their license, focusing on patients and delivering high-quality, evidence-based care. This has always been the goal, and we are getting closer to realizing it through our transformation work. We expect the centralized intake rollout to be completed by the end of the year. What's more, this effort is only phase one.

We now have a roadmap going into 2024 that will provide us enhanced digital capabilities, patient self-service tools, and reduce additional administrative efforts in our clinics that will continue to unlock value. With fewer distractions from administrative duties and a predictable operating rhythm in the clinic, employee satisfaction and ability to focus on our patients continues to rise. Finally, we made strides in revenue cycle management during the quarter. On our last call, I talked about a larger transformation to move our RCM function to best-in-class performance. We've since made the decision to consolidate our relationships and work more closely with a single leading vendor partner to drive collection rates. This effort will both reduce costs and allow us to employ more automation in our collection efforts.

In the second quarter, days sales outstanding improved yet again to another record low of 42 days, down from 45 days last quarter. We have also seen a reduction in bad debt expense, driven by technology and process enhancements that we have made internally. As I've discussed, my priority is to drive the innovation of our processes and systems to better support our field and clinic teams. While we still have work to do, I'm encouraged by the progress we've made thus far, and I look forward to providing updates as we continue building on our momentum. Now, I'd like to turn the call over to Joe to discuss financials.

Joseph Jordan (CFO)

Thank you, Chris, and thanks to everyone for joining the call today. As Chris said, I'll cover our second quarter 2023 financial results, and I'll also review our 2023 guidance. Let's start with the financial results. Our net revenue was $172 million in the second quarter, which is a 5.5% increase over the prior year second quarter of $163 million. That breaks down as net patient revenue of $157 million, which increased 5.7% year-over-year, with other revenue of $15 million, increasing 4.1% year-over-year, which is primarily due to higher management service agreement revenue.

Visits per day per clinic during the quarter was 25.7, which is a 0.7 visit per day increase quarter-over-quarter from 25 in the first quarter of 2023. Year-over-year, it's a 1.5 visit per day increase from 24.2 in the second quarter of the prior year. This increase in clinic capacity utilization and the associated leverage of fixed costs was the largest contributor to the company's improved gross margin. Rate per visit during the quarter was $104.74. That's a sequential increase of 0.9% from $103.76 in the first quarter of 2023, and a 1.1% increase year-over-year from $103.57.

As Chris discussed, the sequential increase is primarily the result of favorable contract negotiations, and the year-over-year increase was due to the same favorable contract negotiations as well as service mix. Salaries and related costs in the second quarter of 2023 was $95 million, which is a 6.4% increase year-over-year from $90 million in Q2 of the prior year. That's primarily due to three things: increased support staff, which enabled our clinicians to spend more time on patient care, increases in incentives for our frontline members, and wage inflation. Now, PT salaries and related costs per visit during the quarter was $54.81, which sequentially increased 3.5% from $52.98 in the first quarter, and 2.2% year-over-year from $53.64.

The increases in cost per visit were primarily due to the increased support staff and wage inflation that I previously mentioned, and they were partially offset by higher, higher labor productivity, as visits per day per clinical FT improved 0.1 quarter-over-quarter and 0.4 year-over-year. Rent, clinic supplies, contract labor, and other was $50 million in the second quarter, which was consistent with the prior year. Those same costs on a per clinic basis were approximately $54,000, which decreased 4.4% quarter-over-quarter from $56,000 in the first quarter, and increased 1.6% year-over-year from $53,000 in the second quarter of the prior year.

The sequential decrease from Q1 was primarily driven by spending on the annual National Leadership Event, held in the first quarter that we previously disclosed, and that was partially offset by higher contractor spend. When looking at the year-over-year increase, it was mostly due to higher contractor spend. Our provision for doubtful accounts during the quarter was $2 million or 1.5% of PT revenue, which is an improvement over the prior year, which was $4 million and 2.4% of PT revenue. The improvement in performance in the second quarter of 2023 was the result of the company's continued focus on driving improvements within revenue cycle management, which Chris mentioned, and the resulting improvements in AR collections.

SG&A during the quarter was $37 million, which is a 15% increase year-over-year from $32 million in Q2 of the prior year. It's primarily driven by higher transaction costs associated with the TSA closing earlier this quarter or second quarter. It's partially offset by lower legal settlement fees. Operating loss, excluding impairment charges, was $12 million, which is consistent with the prior year, as higher revenue and higher associated earnings in 2023 were offset by higher G&A due to the previously mentioned transaction costs. Interest expense during the quarter was $17 million, compared to $11 million in the second quarter of 2022. The increase is primarily driven by higher interest rates, as well as interest from the use of the revolving credit facility.

Income tax expense during the quarter was $100,000, compared to income tax benefit of $13 million in the second quarter of the prior year. Net loss was $22 million, compared to a $136 million net loss in Q2 of the prior year, with the prior year including $128 million in impairment charges. adjusted EBITDA during the quarter was $9 million, or a 5.4% margin, and that increased over the prior year from $5 million, which was a 3.3% margin. The year-over-year increase in adjusted EBITDA was primarily due to higher revenue and the associated earnings that come along with that, as well as the impact from improved collections that I talked about earlier.

Cash use year to date, 2023, was $45 million, and it breaks down as $5 million used to fund operations, $10 million used in financing activities, and $30 million used in sorry, $10 million used in investing activities and $30 million used in financing activities. It's important to note that within financing activities, it includes $25 million repayment on the revolving line of credit. Our liquidity as of June 30, 2023, was approximately $58 million, and that consists of cash and cash equivalents of $38 million, and available revolver capacity of $20 million. In addition, the company may access $25 million of additional funds through the delayed draw term loan, which is outlined in the Second Lien Note Purchase Agreement, subject to certain limitations.

Looking ahead to the full year, 2023, we currently expect revenue to be in the range of $680 million-$695 million, which equates to a 7%-9% growth over 2022. We've had a strong first half of the year, Sharon talked about, in terms of pipeline and productivity, and we have sustained focus on growing our clinical headcount, which will also grow visit volumes, which underpin our outlook for the remainder of the year. We're balancing our optimism with the recognition that reaching full clinic capacity utilization across our fleet will be a multi-year effort. For revenue rates, we're modeling an increase of approximately 1% for the full year, 2023, compared to 2022.

As a reminder, that contemplates the Medicare Physician Fee Schedule change, which included a rate reduction of approximately 2% in 2023. Although for ATI, this reduction is partially offset by Medicare bonus payments, resulting from our excellent rating under the MIPS program, and that offsets approximately half of the rate reduction, so that would take it down to 1%. The rest of the rate increase is a result of some of the payer negotiations that Sharon and Chris talked about earlier, as well as general mix. For adjusted EBITDA, we expect 2023 to be in the range of $30 million-$36 million, which represents approximately 4%-5% profit margin and really reflects the solid progress that we're making.

Now, we're, while we're pleased with the operational improvements that we've made, 2023 adjusted EBITDA remains muted due to the multi-year timeframe to execute against our clinical FTE growth plans and optimize our clinic operations, as I mentioned. As the business continues to ramp up, we expect to better leverage our fixed costs and to further enhance profitability, with 2023 being a solid step in the right direction. Turning to our clinic footprint optimization initiatives, we closed four clinics, underperforming clinics, during the quarter, and we opened six new clinics in higher growth markets during the quarter. Overall, we anticipate a limited number of new clinics in 2023, and those will be in select locations with attractive opportunities. We're focused on maximizing our fleet by expanding where there is demand and pursuing lease savings where possible and where it makes sense.

We're continuously monitoring local markets and clinic performance potential for further expansion opportunities, but on balance, we'd anticipate a net reduction of approximately 20 clinics for the full year, 2023. I'd now like to turn the call back over to Sharon.

Sharon Vitti (CEO)

Thank you, Joe. Solid Second quarter 2023 results demonstrate our strategy is working, we're aligned on our goals, and we have the right teams in place to execute with excellence. We've now delivered multiple quarters of sequential improvement in various key performance indicators and are continuing those trends in Q3. With each quarter, we're helping more patients successfully reach their health goals while positioning our business for sustainable long-term growth. This whole team is excited for the second half of the year and beyond. I look forward to keeping you updated on our progress. Thank you for joining us today. We will now open the line for Q&A.

Operator (participant)

At this time, if you would like to ask a question, please press star followed by 1 on your telephone keypad. Your first question comes from the line of Brian Tanquilut with Jefferies. Your line is open.

Speaker 7

Good afternoon. Thank you. You've got Taji on for Brian. My first question would have to be around your guidance. Expecting $680 million-$695 million in revenues, and then $30 million-$36 million in EBITDA, suggesting a ramp in the back half of the year. I know that you touched upon, you know, expecting improvement in terms of visits and then also, that 1% rate bump. Maybe if you can also talk through any other elements or assumptions embedded in the guidance, and what gives you confidence in that ramp, just so we have all the moving pieces that are included in those numbers.

Joseph Jordan (CFO)

Hey, hey, Taji, it's Joe. Happy to do that. Thanks for the question. Some of the other key KPIs to think about there, as I think about the business, the two most important are productivity of our clinicians and the number of clinicians we have. Both of those, as well as referrals, end up driving our visits. We've seen a steady ramp Sharon talked about in referrals. We've seen productivity hitting near all-time highs or at all-time highs in the first half of 2023. As we built the forecast for the full year 2023, we're assuming generally a continuation of the productivity we've seen all year. Based on what we've seen in the first half, plus July, there's no reason to think that that would slow down.

We've, we've been thoughtful on how we've, provided support to the clinicians to enable them to hit those types of productivity levels. We assume a steady growth in clinical FTE, consistent with what we've seen in the first half of the year. Beyond that, I did touch upon, during the script, the revenue rate, so you have that. Within SG&A, maybe the only other thing to think about is, we did mention we had the transaction happen in the first half of the year. I think SG&A is assumed to be relatively steady state if you adjusted pro forma without the transaction.

Sharon Vitti (CEO)

Yeah. Joseph, I think the other would be, incremental improvement in our bad debt expense.

Joseph Jordan (CFO)

Yep

Speaker 7

Which is a little kind of a secondary factor, but we've seen good performance there.

Joseph Jordan (CFO)

Yeah. Then as, as far as confidence goes, Taji, I mean, we, we've built momentum throughout the first half of the year. You can see the Q2 results relative to Q1, there was a, a performance improvement that was pretty significant. Some of that has a seasonality component to it. There is obviously a seasonality component of the business, but we've continued to see momentum and, you know, feel good about, about where the business is heading as a result of some of the referral stuff Sharon talked about. You can see in the back part of our earnings release, the attrition is really low in the second quarter, combination of where those trends are going makes us feel good about the guidance that we put out.

Sharon Vitti (CEO)

Yeah, and when we look at, as we created our six plus six for the rest of the year, we looked at the R&O, the risks and opportunities are very balanced. I think we're pushing, but we also are, are continuing to make sure we don't get ahead of ourselves.

Speaker 7

That's really helpful, Joe and Sharon. Then just one follow-up, looking at rates. I know that you had talked about how some of the stronger rate growth is due to more favorable contracting. Just curious, how much more of your contracting do you have to do for the year? I'm just trying to gauge how much more runway there is in terms of securing bumps from payers. Then a smaller point as well, on the value-based arrangements, can you maybe talk through the structure of those agreements and your penetration across, I guess all of your payer agreements? Like, I guess, what % include, like, a value-based incentive?

Sharon Vitti (CEO)

You know, the payer stuff is hard, Taji, 'cause because it, it's, it's so variable. It depends on when we sign the contract, what the anniversary is, so it's an ongoing throughout the year. I would say we've probably touched half of our payers, and it just, it kind of is how the year rolls out and how we put the campaign out. I, you know, I can't give you anything concrete around the percentage of payers that, you know, we'll possibly give. You know, we'll, we'll be speaking to around a, an up, an up, an anniversary, increase in rate. On the VBC or the value-based care or the, you know, the creative arrangements, that is a very small percentage of our current business.

We certainly are venturing into that space to get more experience and to also capitalize on the benefits of our really, our quality care and our great outcomes. I think our MIPS is only upside, but it's probably one of the best examples of the, you know, our performance in that kind of an arrangement. I, I don't think there's anything to share at this point around VBC, other than pilots that we're engaged in and using those as learning situations to be able to look at, is there a, a broader offering for the, the payer market?

Speaker 7

Great. Thank you.

Sharon Vitti (CEO)

Thank you.

Operator (participant)

As a reminder, if you would like to ask a question at this time, please press star followed by the number one on your telephone keypad. We'll pause for just a moment to compile any remaining questions. Our next question comes from the line of Mike Petusky with Barrington. Your line is open.

Mike Petusky (Managing Director and Senior Research Analyst)

Hey, guys. Thanks for the questions. Joe, is there any sort of guide or, or anything additional to talk about in terms of expectations for cash flow from ops and CapEx for the rest of the year?

Joseph Jordan (CFO)

We, we didn't guide the cash flow from ops or CapEx, but I think you could, you could expect second half CapEx to be pretty similar to the first half. I would say overall cash flow, probably somewhere in the mid-single-digit cash usage, which would include the, the investing activities I just talked about.

Mike Petusky (Managing Director and Senior Research Analyst)

What about the expectation for sort of cash interest in the second half?

Joseph Jordan (CFO)

Cash in-- It's obviously dependent on the interest rate environment, Mike, but I would suspect it would be similar to Q2, all things being equal on, on interest rate. The transaction took effect in Q2, and the interest piece of it really took effect back to, I believe, April, even though it was signed in, in June. Most of Q2 reflects the new debt agreement.

Mike Petusky (Managing Director and Senior Research Analyst)

Okay.

Joseph Jordan (CFO)

Use that as a proxy for the second half of the year.

Mike Petusky (Managing Director and Senior Research Analyst)

Okay. All right. Then, Sharon, as, as far as, and I, I suspect this is ongoing, but as, you know, I, I, you guys have talked about assessing facilities and, and sort of, you know, you know, kind of ranking them in buckets and trying to figure out, you know, what, what's gonna, what's gonna make sense. Did you guys sell any, facilities in the quarter, or did I miss that? Can you just sort of update, you know, where you are in that assessment?

Sharon Vitti (CEO)

Mike, you are 100% right. This is ongoing, interestingly, when we came out with the information last year, as we look at it on a quarterly basis, our watch list and our close list does move a little bit. We did not sell any clinics in Q2. I think the work that we've done really is to take a look at a few things. One, we, as Joe mentioned, have closed some clinics, and we have a few more that we'll be closing over the course of the year. Number two, we're really looking at how do we maximize our footprint. There are some opportunities where we have more demand than the capacity of the clinic, so it's not held up by the, you know, the workforce.

There's opportunities to look at expansion, to look at re- renovations, reload. That's kind of the work we're doing right now: How do we maximize our current footprint? Then I'd say the third is, we're looking at where those strategic pockets are for growth. It's just a little bit of a different look than before. We're really looking at where we, where we absolutely have the demand, and we have the resources to be able to grow in a market. That'll be something that we will be really working on in 2024.

Mike Petusky (Managing Director and Senior Research Analyst)

Okay. I, I, I've had a sense, maybe, maybe three, six months ago, that there was a little bit more likelihood or urgency around the idea of potentially divesting clinics. It, it almost sounds like maybe with the, the refinancing that you guys have, have backed off that, or, or am I reading too much into this? Are you still, you know, actively, potentially looking at divesting meaningful numbers of clinics, or can you just speak to that? Thanks.

Sharon Vitti (CEO)

Say it again?

Mike Petusky (Managing Director and Senior Research Analyst)

Sorry, did I break, did I break up?

Sharon Vitti (CEO)

No, no, no. No, I was trying to get the numbers quickly for you.

Mike Petusky (Managing Director and Senior Research Analyst)

Okay.

Sharon Vitti (CEO)

You know, you're, I, I don't think... I, I can't say we haven't slowed down. The discipline is still there. Things have changed a little bit, and yes, there's, I, I would say as our, as our key operating metrics move up, that has also allowed some of our underperforming watch list clinics to start come, breaking even and getting to profitability. I would say we have, we have, we closed 22 in the first half of the year, and those were definitely on the closed list. We divested 4 clinics. There was another group of clinics that we were looking at divesting and ended up not doing that because of some changes in that marketplace.

I would say it's, I, I would say the attention hasn't changed, but where, you know, the, the conclusions to, from the data have caused us to either continue to close some clinics or move forward and keep some clinics. I mean, that's our whole goal, is not to be closing clinics, but to be getting them to the performance level that allows us to have profitability per clinic. I think there's a combination of a little dynamicism in the, in the marketplace, and then also, as we improve our performance overall, it is helping some of these clinics get to where they need to be.

We've also changed some of our strategies around referrals and around our talent, and so many times when there are clinics that haven't performed, it some of it relates to not having, right, the right attention around either our referrals or having enough talent, if you will, to be staffing the clinics. I would say with some of the changes in our strategy over the last six months, instead of peanut butter, we've really focused in on very specific marketplace strategies, which in turn have paid off.

Mike Petusky (Managing Director and Senior Research Analyst)

Okay. All right. One, one more question. It sounds like there's not a ton of people in the queue, so I'll ask one more, if that's okay.

Sharon Vitti (CEO)

Go for it.

Mike Petusky (Managing Director and Senior Research Analyst)

The... Thanks. So last quarter, you guys said, "Hey, look, we- we're seeing a lot of demand. We don't necessarily have the, the clinical staff in place to, to, to sort of, take care of all the demand we have." I, I, I think I asked the question, "Well, what, what type of clinical workforce would you need?" I think you guys guessed somewhere around 2,900, something like that, relative to the sub 2,700 you all have at the end of June. You know, I understand a number of these things are sort of multiyear, but how long, you know, given, you know, the low unemployment rate, I mean, it, it, it feels like it may take a while for you guys to get sort of fully, what you would consider fully staffed up.

I mean, have you, have you guys thought about that in terms of, is that a three-year goal, or, or, you know, how, how do you all think about that, particular item? Thanks.

Sharon Vitti (CEO)

That's a great question, Mike. you know, I, I think there's 2 ways to think about it. One is, what does ATI need? I think you, you know, you're right. Those are the numbers we said, and we might even push them up a little bit given the, you know, the continued demand.

Mike Petusky (Managing Director and Senior Research Analyst)

Sure.

Sharon Vitti (CEO)

I have great confidence in our team. You know, our TA, our talent acquisition team really was recreated and fully, up to, up to speed or in, you know, in action, at the end of Q1. We're starting to see that traction. I think the bigger issue. I think we're gonna be able to keep moving in regards to both retaining our staff and creating a great value proposition for new recruits. I mean, I got to tell you, I do, I do not see, and yes, there may be high unemployment, or sorry, low unemployment, on the PT front, this is a macro-level issue.

I, you know, I think until we start, we, the big we, start looking at, you know, opening up the top of the funnel, getting more PT students into the, into the programs and kind of breaking that cycle like other sectors have done, I think it's gonna, it's gonna take a little bit. So I, I think, I think ATI is gonna do the job they need to do, but I also think the macro level trends are, are gonna continue to be headwinds.

Mike Petusky (Managing Director and Senior Research Analyst)

Yeah. I mean, do you-- I mean, I, I'd assume it's at least a 3-year sort of.

Sharon Vitti (CEO)

Yeah, I, it's, it's not gonna be... You know, in my, in my, when I first started, I was like, "Oh, give it a year, and it'll, you know, it'll loosen up," like many other-

Mike Petusky (Managing Director and Senior Research Analyst)

Right

Sharon Vitti (CEO)

... you know, situations. I'd be confident to say this isn't gonna break open before the end of the year, and I think 2024 is gonna be another hard year.

Mike Petusky (Managing Director and Senior Research Analyst)

Yeah. All right. Fair enough. Thank, thank you so much, guys. Appreciate it.

Sharon Vitti (CEO)

Thanks, Mike.

Operator (participant)

Your next question comes from the line of Bill Sutherland with The Benchmark Company. Your line is open.

Bill Sutherland (Senior Equity Analyst)

Hello. Thanks. Hello, everybody. Yeah, I, I was gonna talk about the labor issue, too. The one remaining part of that set of questions that I was thinking about is the contractors. I think they were. Can you just talk about the level that you are at, as % of your workforce, and where you wanna get that to?

Joseph Jordan (CFO)

Yeah. Yeah, Bill, it's Joe. The, they're roughly 6% of our workforce right now, 185 contractors at the end of Q2. I think the contractors will be with us for, for a little while, just given the overall labor dyn-dynamics. At, you know, at some point, they are more expensive than ATI full-time PTs or PTAs. We'd, we'd obviously like to bring the contractors down. It won't-- It'll never get to 0, but if it gets, gets down to 1%-2% of our workforce in the long run, I think that's where we'd like to be. In the short term, because we have so much demand for therapy at ATI, I think we'll, we'll be living with the contractors for a bit.

Sharon Vitti (CEO)

Yeah, Bill, we're, we're using them selectively. I know we're using more than we would normally, but using them selectively in markets that are just, you know, deserts for recruits. Again, that is also playing into the fact that, to Joe's comment, that we're, we're gonna probably need them for the foreseeable future.

Bill Sutherland (Senior Equity Analyst)

I'm remembering, a couple of years ago, maybe during the roadshow, the, the affiliation you had with a couple of programs. I think one was Duke. Is that something that you can, or do you still have it, or can you tool it up?

Sharon Vitti (CEO)

Yeah, great question, Bill. You know, our university relations, if you will, you know, as with any organization, kind of fell by the wayside during COVID. We have a multi-channel approach, and I think I'm really excited about what we're doing. On the other side of it, it takes a little bit for it to, you know, bear fruit. I would say everything from the usual, right? Bringing in students, precepting, having, you know, alumni relationships. I would say the other thing that we're focusing on is a little bit of where you're going.

How do we start working differently with the universities, especially as it relates to both the top of the funnel, the number of folks coming in, the diversity of candidates, and then the ability to prepare them to be, to be successful, both in the exam and, when they graduate? So that is a more comprehensive approach than just bringing in folks from a, you know, for their, for their clinicals.

Bill Sutherland (Senior Equity Analyst)

Mm-hmm.

Sharon Vitti (CEO)

I think that's the way we have to go, and I think it's a partnership. I, you know, I think, I, I don't think ATI is the only one doing this. I think it's a partnership with the universities to, to really, I would say, modernize, the way, the, the whole PT university piece starts, and then how we transition those folks into being, successful therapists in the, in the marketplace.

Bill Sutherland (Senior Equity Analyst)

Got it. Last one I wanted to ask was on the reduction of the administrative burden, particularly the centralized intake. Will we see this mostly in PT productivity, or is there a clinic overhead factor that will show up as well?

Joseph Jordan (CFO)

You'll see it mostly in the productivity. If, if you think about the model that we're transitioning from, it was. Some model, some markets were already centralized, but others were running a hub-and-spoke type of model, where they might have one front desk individual supporting five or six clinics. Largely, those folks are moving into the centralized model, and it gives us the capacity to be able to support the clinics. For example, when there's a call-out, when there's a resignation, we have the redundancy and the capabilities to be able to cover for that. The other thing it does, that we're seeing, you know, some leading indicators of is, it just helps us to capture, you know, 100% of the referrals that are coming in.

If you have, you know, for example, a clinic where, you know, the administrative person has been out, and the clinicians are all seeing patients, and the phone rings and, and no one answers, you know, that's, that's no longer gonna happen. Then finally, you know, we do expect that it will also aid in our retention, because it, it takes things like answering phone calls out of the clinics and really, you know, makes that a better environment for our clinicians.

Sharon Vitti (CEO)

Yeah. Our patient experience is more. It's kind of their first, in many cases, their first time interacting with ATI, and it's, you know, they can expect a standardized experience. We have all data on call handling times and, you know, service levels as it relates to that initial call. I, I think that's a qualitative piece, but certainly an important piece.

Bill Sutherland (Senior Equity Analyst)

Mm-hmm. Great. That's good color. Appreciate it. Thanks, everybody.

Sharon Vitti (CEO)

Thanks, Bill.

Operator (participant)

There are no further questions at this time. I'll turn the call back to CEO, Sharon Vitti, for closing remarks.

Sharon Vitti (CEO)

I wanna thank everyone for joining us today, and we look forward to coming back together in Q3 and sharing our results on Q3. Thank you. That is the end of the call.

Operator (participant)

This concludes today's conference call. Thank you for joining. You may now disconnect.