Chemed - Q4 2025

Transcript

Operator (participant)

Good day, and thank you for standing by. Welcome to the Chemed Corporation fourth quarter 2025 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star 1 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 1 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Holley Schmidt, Assistant Controller. Please go ahead.

Holley Schmidt (VP and Assistant Controller)

Good morning. Our conference call this morning will review the financial results for the fourth quarter of 2025, ended December 31, 2025. Before we begin, let me remind you of 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 those 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 25 and in various other filings with the SEC. You are cautioned 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 25th, 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, Michael Witzeman, Chief Financial Officer of Chemed, and Joel Wherley, President and Chief Executive Officer of Chemed's VITAS Healthcare Corporation subsidiary. I will now turn the call over to Kevin McNamara.

Kevin McNamara (President and CEO)

Thank you, Holley. Good morning. Welcome to Chemed Corporation's fourth quarter 2025 conference call. I will begin with highlights for the quarter, then Mike and Joel will follow up with additional details. I will then open the call for questions. The fourth quarter of 2025 fell short of our expectations for both subsidiaries. We will touch on the circumstances that led to these results, but more importantly, we will discuss what's being done to improve these results for 2026 and beyond. VITAS continues to execute the strategies required to fully mitigate potential Florida Medicare cap billing limitations for the government's fiscal 2026. Admissions at VITAS during the quarter totaled 17,419, which equates to a 6% improvement from the same period of 2024.

An important metric that we have been tracking related to Florida admissions is the percentage of total admissions that come from hospitals. Our analysis indicates that an appropriate balance for sustained long-term stability in the Florida patient base, given the current mix of referral sources, is that between 42% and 45% of total admissions come from hospitals. During our community access program, this ratio dipped below the preferred range for a sustained period. In the fourth quarter of 2025, this ratio was 44.8%, which represents a high watermark during the post-pandemic period. The continued emphasis on short-term hospital-based admissions had two main impacts on the results for the fourth quarter of 2025. The first impact is that the Florida Medicare cap position in the fourth quarter improved by almost $25 million in 2025 compared to 2025.

It is important to remember that our fourth quarter is the first quarter of the government fiscal year. The year-over-year improvement gives management even more confident that the Florida Medicare cap problem of 2025 is behind us. The second impact is that due to the overwhelming success of garnering elevated short-stay patient admissions, our revenue growth and EBITDA margin were lower than anticipated. Ultimately, the percentage of total admissions that come from hospitals was higher than we originally budgeted in both the third and fourth quarters of 2025, resulting in this muted revenue growth and EBITDA margin. In mid-January 2026, VITAS management responded to the improved Florida Medicare cap position by instructing operating personnel to begin the process of refocusing admissions to a more balanced approach between hospital admissions and pre-admission, other pre-admission locations. That process is underway.

In the guidance that Mike will discuss further, we have anticipated that the more balanced approach will start being reflected in financial results, mainly in the second half of the year. All patients are short-term patients for the first 30 days after admission, regardless of their pre-admission location. As a result, refocusing the admission patterns will result in revenue growth and EBITDA margins building over the course of 2026. In December, we were granted a certificate of need to begin operating in Manatee County, Florida. Manatee County is in western Florida, between Hillsborough and Sarasota. Approximately 3,000 Medicare patients received hospice care in Manatee County during the government's fiscal 2024, which is the most recently published government information. Manatee represents another significant opportunity for VITAS in 2026 and beyond. Let's turn to Roto-Rooter.

Roto-Rooter revenue declined 3.7% in the fourth quarter of 2025 compared to the same period of 2024. Branch commercial revenue increased 1.6% compared to the fourth quarter of 2024. We continued to add commercial business managers to select branches during the quarter. Branches with commercial business managers had percentage revenue increases, 10% more than those without them. Roto-Rooter Management intends to continue and expand this program in 2026. Branch residential revenue declined 3.1%. Total leads were flat in the fourth quarter of 2025 compared to the same period of 2024. As discussed in the past few quarters, the trend of increasing paid leads, offset by declining natural leads, continues. During the fourth quarter, paid leads increased 9.4% compared to the same quarter of 2024.

The decline in natural leads essentially offset the increase in paid leads. Roto-Rooter Management has contracted with a new third-party search engine optimization provider in late December. The new provider does not provide services to any of our private equity competitors. Additionally, they focus on understanding and responding to the underlying code used by internet search engines to develop their search algorithms. We believe that these two factors will give us the ability to more positively impact our natural search results in 2026. Write-offs related mainly to our water restoration business, increasingly became an issue over the course of 2025. In the fourth quarter of 2025, implicit price concessions and credit memos increased at Roto-Rooter by $4 million, or 57%, compared to the fourth quarter of 2024. A similar increase in write-offs was seen in the third quarter of 2025.

The company has put into place modifications to the billing and collection support functions. Collection experience began to improve in early 2026. We anticipate improvement to accelerate through the course of the year. Our guidance reflects management's belief that 2026 is expected to be a transition year for both VITAS and Roto-Rooter. VITAS financial results are expected to build over the course of the year as we rebalance our patient mix. We are very confident the Florida Medicare capital limitation in 2025 is fully behind us. The demographic makeup of the U.S. population, along with the addition of new territories in Florida, provides VITAS with significant growth opportunities over the next several years. Roto-Rooter continues to deal with a difficult operating environment. We have initiatives in place that I believe can lead to modest growth, mainly coming in the back half of 2026.

We anticipate continued improvement in overall leads based on the past few quarters of paid lead generation improvement, plus the impact of the new search engine optimization company. Improved overall leads should lead to modest organic growth in 2026. The addition of more commercial sales resources is anticipated to further improve organic growth. As Mike will discuss further, improvements we are working on with respect to water restoration, billing, and collections, should provide a $4 million-$6 million tailwind in 2026. We believe these improvements, along with an aggressive program to find and reacquire franchises in desirable territories, gives us confidence that we can meet or exceed our 2026 guidance. We believe that the difficult operating environment is temporary, there has not been any impairment in the underlying long-term growth outlook for Roto-Rooter. With that, I would like to turn this teleconference over to Mike.

Michael Witzeman (CFO)

Thanks, Kevin. VITAS' net revenue was $418.8 million in the fourth quarter of 2025, which is an increase of 1.9% when compared to the prior year period. This revenue increase is comprised primarily of a 1.3% increase in days of care and a geographically weighted average Medicare reimbursement rate increase of approximately 2.2%. The acuity mix shift negatively impacted revenue growth 143 basis points 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 approximately 20 basis points. A $2.4 million Medicare cap billing limitation was accrued in the fourth quarter of 2025.

There was no Medicare cap billing limitation accrued for a Florida program in the fourth quarter of 2025. Average revenue per patient day in the fourth quarter of 2025 was $288.01, which is 86 basis points above the prior year period. During the quarter, high acuity days of care were 2.2% of total days of care, a decline of 32 basis points when compared to the prior year quarter. Adjusted EBITDA, excluding Medicare cap, totaled $91.6 million in the quarter, which is a decline of 1.7% when compared to the prior year period. Adjusted EBITDA margin in the quarter, excluding Medicare cap, was 21.7%, which is 79 basis points below the prior year period.

The lower EBITDA margin in the quarter reflects the impact of admitting more hospital-based, short-stay patients. Now, let's turn to Roto-Rooter. Roto-Rooter branch residential revenue in the quarter totaled $155.6 million, a decrease of 3.1% from the prior year period. This aggregate residential revenue change consisted of plumbing increasing 6.3% Excavation essentially flat, offset by water restoration declining 10.3% and drain cleaning declining 3.2%. As Kevin mentioned, water restoration write-offs, also referred to as implicit price concessions and credit memos, have been increasing over the course of 2025. Historically, total write-offs have been slightly below 3% of gross revenue. There was an uptick to the mid 3% range in the first half of 25.

We then experienced a significant jump in the second half of 2025 to over 4.5%. As a result of those increases, total write-offs increased $11 million in fiscal 2025 compared to 2024. Primarily through the use of artificial intelligence, many insurance companies have increased their scrutiny of every line item on every job we bill. This has led to the higher write-off percentage. Roto-Rooter management also believes that it has led to a reluctance to bill for certain water restoration services at the branch level. As the scrutiny on collections has increased over the year, billing employees in some branches have reduced their billings per job to help ensure a higher collection rate. This was the biggest factor that led to the 10.3% decline in residential water restoration revenue in the fourth quarter of 2025.

In response to this issue, Roto-Rooter is taking steps to improve its documentation through better use of technology. They have also undertaken a project to centralize water restoration, billing, and collections. Billing and collections were historically performed at each branch. This led to some inconsistent practices across the company. Centralizing these processes is expected to create more concentrated expertise and result in better billing and collection results. The financial impact is expected to be seen mostly in the second half of the year as these improvements take hold. Additionally, during the transition period, we expect some duplication of costs and investment in technology, which will cause some marginal headwinds in the first half of the year. Roto-Rooter branch commercial revenue in the quarter totaled $55.2 million, an increase of 1.6% from the prior year period.

This aggregate commercial revenue change consisted of excavation increasing 10.9%, drain cleaning increasing 2%, plumbing essentially flat between years, offset by a 20% decline in water restoration. The water restoration decline is a symptom mainly of the increased insurance scrutiny previously discussed. Roto-Rooter management believes that our commercial business continues to represent a significant opportunity for growth in 2026 and beyond. Commercial customers generally use our services more often than residential customers. They also have direct access to our local managers and thus generally do not search for us over the internet. In response to the commercial business opportunity, Roto-Rooter management hired commercial business managers at select branches during 2025. The preliminary results in the branches with commercial business managers are encouraging. As a result, Roto-Rooter continues to add commercial business managers in early 2026.

It is a roughly 45-day process to get these positions trained and productive, which also may cause some marginal drag in the first half of 2026. Adjusted EBITDA at Roto-Rooter in the fourth quarter of 2025 totaled $47.5 million, a decrease of 21.1% compared to the prior year quarter. The adjusted EBITDA margin in the quarter was 21.5%. The fourth quarter adjusted EBITDA margin represents a 477 basis point decline from the fourth quarter of 2024. The decline in EBITDA margin was caused by higher marketing costs and higher water restoration write-offs. During the quarter, we repurchased 400,000 shares of Chemed stock at an average price of $436.39. These purchases were funded by the free cash flow generated by both VITAS and Roto-Rooter.

Since the beginning of the program, we've returned over $2.9 billion to shareholders through repurchases at an average cost of approximately $167 per share. Let's turn to the 2026 guidance. VITAS revenue, prior to Medicare cap, is estimated to increase 5.5%-6.5% when compared to 2025. Average daily census is estimated to increase 3.5%-4%. Full year EBITDA margin, prior to Medicare cap, is estimated to be 17.5%-18%. Medicare cap billing limitations are estimated to be $9.5 million in calendar 2026, compared to $27.2 million in calendar 2025.

The estimate for 2026 is in line with our historical run rate prior to 2025 and includes no limitations related to our Florida combined program. Roto-Rooter is forecasted to achieve full year 2026 revenue growth of 3%-3.5%. Roto-Rooter's adjusted EBITDA margin for 2026 is expected to be 22.5%-23%. We believe this forecast is achievable based on anticipated improved lead volume in 2026, improved billing and collections in our water restoration service line, and a lift in our commercial business through a commercial-focused sales force.

Based on the above, full year 2026 earnings per diluted share, excluding non-cash expense for stock options, tax benefit from stock option exercises, costs related to litigation and other discrete items, is estimated to be in the range of $23.25-$24.25. This compares to full year 2025 adjusted earnings per diluted share of $21.55. The 2026 guidance assumes an effective corporate tax rate on adjusted earnings of 24.5% and a diluted share count of 13.9 million shares. It's important to note that the 2026 earnings trajectory is weighted towards the second half of the year. We estimate 55% of the consolidated adjusted net income and consolidated adjusted EBITDA prior to Medicare CAP is projected to be generated in the second half of the year.

I will now turn the call over to Joel.

Joel Wherley (COO)

Thanks, Mike. In the fourth quarter of 2025, our average daily census was 22,462 patients, an increase of 1.3%. In the quarter, hospital-directed admissions increased 9.9%. Home-based patient admissions increased 4.1%. Assisted living facility admissions increased 5.6%, and nursing home admissions declined 8.7% when compared to the prior year period. Our average length of stay in the quarter was 115.1 days. This compares to 105.5 days in the fourth quarter of 2024. Our median length of stay was 17 days in the fourth quarter of 2025, one day less than the median in the fourth quarter of 2024.

As Kevin discussed above, we have very successfully transitioned our admission pattern towards more hospital-directed admissions in our Florida combined program. To add some context to that success, at the end of the fourth quarter of 2025, that Medicare cap billing limitation was less than $2 million. As of the end of January 2026, we have no billing limitation in our Florida combined program. This success has allowed us to begin the process of balancing the admission patterns to a better mix of hospital-based admissions and other pre-admission locations. It's important to remember that hospital-based admissions generally provide for shorter stay patients than other pre-admission locations. Admitting more short-stay patients results in ADC pressure and lower margins, as previously mentioned. However, in the first roughly 30 days of any patient's stay with us, the economics are the same for us, regardless of their pre-admission location.

Only when a patient exceeds that 30 days do we see the more positive financial impacts. Balancing the mix of admissions will lead to accelerated revenue growth and improved EBITDA margins as the year progresses. In December 2025, we were notified that we received a new CON to operate in Manatee County, Florida. As Kevin mentioned, this represents another opportunity for significant growth over the next 2 years. This is the 4th CON awarded to VITAS over the past 2 years. The previous awards in Pinellas, Marion, and Pasco Counties have met or exceeded our expectations. Currently, Marion and Pasco are admitting between 40 and 50 first-time Medicare patients per month. In just its second full month of operation, Pinellas admitted 28 first-time Medicare patients. We will continue to aggressively pursue CON opportunities in Florida in the territories in which we do not currently operate.

Now that we believe the Florida Medicare cap issue is behind us, we are focused on returning VITAS to a more normal, sustainable, organic growth pattern. We will look to achieve higher overall growth through the pursuit of new starts, not only in Florida, but other CON states as well. We also continue to evaluate strategic acquisitions to add to VITAS's overall growth. With that, I'll turn it back to Kevin.

Kevin McNamara (President and CEO)

Thank you, Joel. I will now open this teleconference to questions.

Operator (participant)

Thank you. At this time, we will conduct the question and answer session. As a reminder, to ask a question, you will need to press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile the Q&A roster. Our first question comes from the line of Joanna Gajuk of Bank of America. Your line is now open.

Joanna Gajuk (Director of US Equity Research)

Oh, hi, good morning. thanks for taking the question. I guess first couple of questions on the Roto-Rooter business. thanks for the details around the I guess, different issues, I guess, happening at the Roto-Rooter. I guess just to summarize, because I think you tried to address a couple of these things, you know, what gives you confidence you can actually grow revenues in, you know, 3% or so, in 2026 after, you know, revenues were pretty much flat in 2025?

Kevin McNamara (President and CEO)

Well, let me start, Joanna, I'll start with, you know, from 20,000 feet. You know, the, we, you know, we revised guidance in, at the end of the second quarter, of last year. You know, we talked at that time, the, you know, there were struggles at Roto-Rooter. The problem at VITAS was we were on our way to running a, you know, a Medicare cap liability in Florida. We announced that, you know, we were going to have to make changes to push our mix of, hospital-based admissions and community access to a, of, you know, a different level, okay. We made those adjustments to that point.

Actually, from our perspective, from our calculations, at the end of the third quarter, we were basically right at our guidance. I mean, it might have been a little below what analysts, you know, were predicting, but that just the difference was only seasonality. We were at our level. The fourth quarter was a $0.70 per share miss, okay? Massive, big problem. Raises questions like, "Okay, you've given guidance, how are you gonna, you know, how are you gonna reach those numbers?" Okay, now, to answer your question, let's start with Roto-Rooter, okay? Roto-Rooter, as we've said, has been going through a transition, okay?

The transition, the most significant transition is going from a majority of free leads, that is, from natural search, to paid leads, okay? You know, Google's a smart company. They say, "Why should we give paying customers free leads?" You know, they've been very successful in engineering their algorithms to yield that. That has a negative effect on us as far as number one, for to answer your question on sales, has an effect of reducing our natural search leads, okay? We mentioned at the end of the third, you know, at the end of the fourth quarter, we looked back at the quarter and we said, "Okay, we have an improvement there.

Our paid leads have increased almost 10%. Unfortunately, natural leads are down almost the, you know, equivalent number. Our total leads were flat. You look at our sales, you know, we would expect, you know, sales to be relatively flat in that case, and then, you know, making improvements, growing to the following year. Well, we had a problem, as we said, with water restoration, and it was an overhang from the first half of the year. Again, we were, you know, we had various decentralized billing practices, insurance companies kind of sharpened their pencil, and basically, during the course of the year, increasingly, we weren't collecting at the same rate we were expecting. That dramatically, you know, goes right to profitability and sales, okay?

We believe that has normalized, as Mike said, not to the 2024 level or 2023 level, but certainly better than the 2025 level. When we talk about growth, to the extent that we the way I look at the Roto-Rooter numbers, I look at, okay, what's going on with paid search and natural? The paid search is growing nicely. Last three quarters, almost 10% per quarter, okay? Comes at a cost. We're paying, you know, $94, you know, a lead, compared to, you know, previously zero on a lot of those leads. That's still a good business, you know, as long as it's stable and growing, that's fine. We look at our natural leads, okay?

Why were they so negatively affected last year? As we've said in the past, you know, the place that most people get their natural leads from is what's known as the map section of Google. Okay, in October of 2024, Roto-Rooter was showing up on the maps nationwide 72% of the time, okay? Within a few months, that fell to a low of 24% of the time, okay? Massive change in visibility, as it's known in the industry. Accordingly, you know, leads were falling, you know, leads were falling, sales were falling. Tough time for Roto-Rooter. Looking ahead to 2026, what do we see? Well, we see a business that, you know, on the paid lead side, is, you know, continues to improve.

We see, let's focus on the visibility, okay? Our visibility, both through some of the internal changes we made and the use of our basically, AI-centric natural search, our visibility up to about 35%, you know, up from 24%. You know, so that, you know, to answer your question, that gives me some confidence in saying, yes, you know, as long as those. We don't have to just have to continue those improved rates for growth in Roto-Rooter on the revenue side. I mean, there's nothing. You know, there's nothing that has changed in the nature of, and quality of the service market of Roto-Rooter. Then you add one thing Mike mentioned, you know, again, it's not that surprising given the difficulty of the home services.

It seems like, you know, the availability of repurchases of other franchises is speeding up, which has given Mike enough confidence to include that in his remarks. Again, those issues give me a lot of confidence that Roto-Rooter sales are going to be higher this year than the previous year. I'm just gonna say, the other point is, you gotta remember that I think it's an important one. When you talk about overall strength of the business, as we've talked, you know, about the at VITAS with the, call it, preloading of Medicare cap cushion in Florida, that's so significant. Just order of magnitude, we're at about a $28 million better position in cap cushion sitting, you know, right now. Right now, I'd say it's probably higher than that. It's probably more like $35 million.

Okay, the only question is, will VITAS be able to grow census to take advantage of that cushion? As we said during our remarks, they're doing that, probably beyond our expectations. You know, that, in a, in sort of a sense, that lower margin and lower sales we saw in the fourth quarter was basically just lending... We were borrowing from last quarter, that to see profits and revenue that we're gonna see in this year. All of those are some of the basic points of what I see happening to what looks like on paper, a very bad miss in the fourth quarter.

Just let me go, just in terms of dollars and cents, so that $0.70 miss, probably about 30%-33% was associated with VITAS's getting more of a higher percentage of their admits being short stay rather than long stay. That's something I see as a good thing. That was something ultimately they were trying to do and just we're a little more successful at it than initially anticipated. With regard to, on the Roto-Rooter side, the lion's share of the miss was associated with the water restoration situation, which we've talked about, and there's every indication that's being ameliorated somewhat. The rest, you know, the rest of Roto-Rooter, it's largely, you know, the marketing costs.

The increased marketing costs that comes from, you know, getting that 10% increase in in paid leave. It's not a good situation. Again, it's one where, you know, we went a long period of time with always exceeding analyst estimates, and we can't kid ourselves. A $0.70 per share miss is, you know, not to be trifled with. It's big, and it's causing, you know, a lot of change and a lot of renewed emphasis on important matters here at the company and both subsidiaries. Mike, anything to add?

Michael Witzeman (CFO)

Just to summarize, particularly for Roto-Rooter, Joanna, I would characterize our confidence in the 3%-3.5% revenue growth in 2026, based on three specific things. As Kevin mentioned, you know, some things we've done to change the lead trajectory, hopefully to provide some organic growth, but modest organic growth is built in. The increase in commercial sales force will also lead to some more modest organic growth. Then, as we've talked about, the water restoration write-offs. You know, we've estimated that of the $11 million, that, you know, the increase of write-offs of $11 million, we're gonna recover maybe half of that this year. So that's a five and a half million dollar tailwind.

I would say those are the three very key components of how we get to the 3% to 3.5%.

Joanna Gajuk (Director of US Equity Research)

Great, thank you. If I may, on the margins, right, for the segment, obviously, things impact the margins, and you gave us the guidance for 26. On the last call, where you kind of were talking about targeting a longer term, I guess you were talking about 26, maybe the margin should be closer to 24%, but clearly, they will not be there. You also said, like, you know, longer term, this business should get, you know, 25%-26% margin. Are those still, you know, those targets, are those targets still on the table or sort of like, we have to think about the business differently? Thank you.

Michael Witzeman (CFO)

I think the answer to that question depends on how quickly Roto-Rooter gets back to a more normalized top-line growth path. If they get to, you know, somewhere 5% or north revenue growth, I think the 24%-25% is still achievable. I don't anticipate the marketing costs to improve dramatically, we need to really to drive top line, and get some leverage based on that revenue growth to offset the marketing costs. Yes, I believe it's achievable, but the path isn't as clear maybe as it had been in the past because of the marketing, the additional marketing spend. The other thing I would just mention, and it's, you know, I think it's obvious, Joanna, to you, but you followed us long enough.

We are not too far away from where our margins were pre-pandemic. The 24%-25% that we've talked about is higher than in the historical Roto-Rooter margins. We are, you know, we're right now pretty close to what the pre-pandemic margin is. It's just we need to drive some top line and get some leverage from that.

Operator (participant)

Thank you. Our next question comes from the line of Brian Tanquilut of Jefferies. Your line is now open.

Brian Tanquilut (Senior Equity Analyst and Healthcare Services Equity Research)

Hey, good morning, guys. Mike, maybe.

Michael Witzeman (CFO)

Good morning, Brian.

Brian Tanquilut (Senior Equity Analyst and Healthcare Services Equity Research)

Good morning. Yeah. As I think about VITAS first, right? I know on the in previous calls, you've given some insight into what you thought growth would be in the top line, and obviously, the in the guidance that you formally gave last night, it's below that range that you previously provided. Just curious, what is the delta there? How do we think about the progression of VITAS revenues and EBITDA over the course of the year?

Michael Witzeman (CFO)

Yeah, sure. From a top line perspective, and then this also will, I guess, dovetail into your second question about the timeline. You know, we're sitting right now with a patient mix that for the second half of the year, of 2025, we really emphasized the short stay pre-admission locations, mainly hospitals. As you well know, long-stay patients are the ones that generally provide for more revenue growth and EBITDA margin growth. We're sitting today with a patient mix that has let us eliminate the Florida Medicare cap issue. Now we need to refocus the admission pattern. By doing that, we will get back to the normalized growth rate that we think is somewhere in the 7%-9% top line area.

We'll get there. It's just gonna take, you know, it's gonna build during the year because every patient, essentially, when you first admit them in the first 30 to 45 days, are short-stay patients. They are negative margin for us for a period of time. They'll become long-stay patients over time, but in the first quarter, we're gonna continue to have a very elevated number of short-stay patients, regardless of the pre-admission location. It builds over the course of the year. That's why, in 2026, the revenue is a little bit below our targeted range, and the cadence of how it goes quarter to quarter, the first quarter is gonna be muted from a revenue and a EBITDA perspective, and then start to grow and normalize in the second through fourth quarter.

Kevin McNamara (President and CEO)

Let me just add one thing. That, you know, when you're talking about revenue at VITAS, you're talking about ADC. If VITAS is able to grow ADC, they will grow their revenue. To the extent that they have a much larger ability in Florida to go out and seek longer-stay patients, that's longer-stay patients is how you grow ADC, essentially. It takes, you know, 10 short-stay patients to have the same contribution as 1, you know, medium-stay patient as far as, you know, going to your ADC number. I think what you'll find is that VITAS is already well on its way. This isn't speculation, you know, with VITAS. They're well on their way to growing, you know, that average daily census in Florida and beyond.

Brian Tanquilut (Senior Equity Analyst and Healthcare Services Equity Research)

That makes sense. Then maybe, Kevin, since I have you, shifting gears to Roto-Rooter. You know, this is a business that used to be very stable and predictable. One question we're getting asked a lot by investors is, you know, is there a structural change or structural impairment that has happened, whether it's VITAS or Roto as an asset or the plumbing industry as a whole? I'm just curious how you're thinking about, you know, the cleanliness or the smoothness of the trajectory for Roto going forward, because it feels like every quarter we're bumping up against some speed bumps that are of different natures.

Kevin McNamara (President and CEO)

Certainly, the last 7 quarters, that's the case. What you're describing, we can't get away from it. Yes, that certainly that's the case. What has been going on during this period? I mean, I would say that the 2 major issues, let's start with private equity, introduction of private equity, money and practices into the, you know, into our sector, okay? Had an immediate effect on us. We hired our branch managers with a promise of, you know, great riches, that has stopped. You know, several of them have seen trees don't grow to heaven, and they've come back, you know, to our employ. The biggest impact, aside from just existing and offering services at below cost on the plumbing side, they have disrupted the paid search model.

We are paying more per lead than we did, you know, two years ago, but it is keep in mind, we paid the same amount the last three quarters, so it is not it hasn't continued to go up. We're winning that battle. Last three quarters, we've gotten a 10% increase in each of the last three quarters. You know, so I consider the threat of private equity largely diminished at this point, okay. I'm speaking to the overall, you know, saying, has there been something changed in the plumbing industry? I think private equity. Private equity came in, and they said, "Look, we have a different investment horizon." You know, we're in a marathon, they're in a sprint.

They wanna build the top line and flip it, you know, that's a tough competitor, okay? They also, as I said, I'm going back, I'm repeating myself, but they're basically HVAC companies that said, "You know, we're very happy with paying $124 per lead," okay? A lead on a job that they'll say they'll clean any drain for $90, okay? The reason they're happy doing that is they view as that becomes a long-term customer for their HVAC services. You know what I mean? That's a tough competitor if you're in the plumbing side. Roto-Rooter has dealt with that.

I mean, I'm kind of spinning off here into a different discussion, but I think that of the two major things that Roto-Rooter has been dealing with the last seven quarters, private equity, definitely one of them. I don't see that as a long-term problem for Roto-Rooter at this point, okay? One that is a problem, we're still going on, you know, in the transition. We are going through a transition where Google, we used to get in excess of 55% of our leads on the natural search. You know, somebody just finds Roto-Rooter in the Google, ignoring the sponsored ads. That has totally flipped. We're on our way to you know, just over 40% of our leads come on the natural side.

I think there's a firming up in that market, on, in that percentage, just again, by some of the things that Roto-Rooter is doing, having to do with fighting back on visibility. To answer your question, is Google going away? No, no. That is a change in the business. As Mike says, it's a change that kind of leads us more back to pre-pandemic numbers, as far as, you know, sales growth and margin, which wasn't the worst of all worlds, okay?

you know, what I would say to your clients that say, "What has happened to the plumbing industry?" I would say, private equity has come in, disrupted everything, but they're seeing that it's tough to give away the service, you know, to provide the service at a loss. They're not growing. Companies have stopped buying our competitors. you know, it's just, the problem is diminishing rather than increasing. Google, we can't kid ourselves. Google is, we're dependent on Google. We deal with them. We hope, you know, we hope we can keep just having slight improvements in it, but the thing that has changed is we've gone from a business where the leads were predominantly free, and now they're predominantly, we're paying them out.

Let me go back and say, there's nothing wrong with the leads. They're very profitable. The business is a good business, you know, paying, you know, getting leads from, for, through paid ads. It just has a negative comparison to getting them for free. No, I would say that with regard to Roto-Rooter, good cash flow, strong growth on the, you know, excavation, water restoration side. The water restoration has been a real black eye for us for the last three quarters, but it's something we've looked to, you know, put behind us. Not by wishful thinking, by the way, by centralizing billing and using our technology to make sure that the support for every bill is almost redundant.

I mean, just that's how you, that's how you get past the AI sensors, as it were, and ultimately get paid. No, I don't have any long-term concerns on Roto-Rooter at this point, to be honest with you.

Michael Witzeman (CFO)

Brian, the only thing I would add is from an industry perspective, there's been a lot of talk and a lot of, you know, things published that the trades, including the plumbing industry, are, you know, pretty resistant to the changes that are coming from artificial intelligence and those sorts of things. We definitely believe that plumbing, the industry itself, has not, it has not and is not going to have major changes in the viability of the industry as a whole. I think, I mean, honestly, just to the point of your question, 2026 is the year that Chemed management and Roto-Rooter management show or don't show, but we believe will show, the ability to manage that and get back to a more profitable, more sustainable level of growth for Roto-Rooter itself.

Kevin McNamara (President and CEO)

Well, let's put it this way: It comes down to leads. This past quarter, as bad as this past quarter was, our total leads were flat, okay? Total leads were flat. Unfortunately, I say, just a, you know, there was a shift between some, you know, between paid and unpaid, but leads were flat, okay? From those leads, we're increasingly improving our ancillary services, that is excavation and water restoration. If you say: How does Roto-Rooter continue to grow? It's by having the leads, you know, be a little better than flat, continue to grow the ancillary services. You know, our goal for Roto-Rooter historically has not been double-digit growth, okay? It's not been 30% margins.

It's been growth on the top line of 7%-8%, with 24%-25% margins, depending on the seasonality in the quarter. From that, with that cash flow, that has achieved over Let's say, prior to this year, you know, over the previous 21 years, that is, with the years in which we owned both VITAS and Roto-Rooter, they grew the net income at 11% per annum compounded. I mean, they did that with just, you know, the basic blocking and tackling and benefit of good cash flow. We get a lot of questions. I mean, I could talk about this all day because we're gonna talk about it all day. People are gonna say, "Is there something significantly wrong with Roto-Rooter?" No, they're going through a difficult period.

They're paying for leads that they used to get for free. If you want, you know, like, a one-sentence capsule commentary.

Brian Tanquilut (Senior Equity Analyst and Healthcare Services Equity Research)

Awesome. Thank you, guys.

Operator (participant)

Thank you. Our next question comes from the line of Ben Hendrix of RBC Capital Markets. Your line is now open.

Ben Hendrix (Analyst)

Great. Thanks a lot, guys. Just starting with VITAS. Appreciate all the commentary about Florida cap and the dynamics in the fourth quarter. Appreciate that, you know, you have a little bit more visibility on the, you know, not having a cap liability in that state. We're getting a lot of questions on how we square that with some of the with the broader higher level cap stats that we're seeing, specifically the greater than 10% cushion coming down over the last couple of years, and also an increase in the 0%-10% cushion buckets and the liability buckets. Can you kind of help us think about, you know, the cap more broadly, how we think those stats might evolve, kind of given the dynamics that we're seeing in Florida?

Also just a little detail on, are we at Cap risk in other markets? Thanks.

Kevin McNamara (President and CEO)

I'm gonna turn it over to Joel, Let me start by saying, keep in mind, in Florida, where we have a dominant position, I want to end the year with, you know, a small %. I want to monetize as much of that cap room that we created as possible. We don't want to cut it too close. I just feel in Florida, we have more control over our destiny than any other state. You know, whenever we talk about cap buckets and whatnot, I personally look at it, Florida and everywhere else. Joel, why don't you give.

Joel Wherley (COO)

Let me, let me start with just the sort of, the specific metrics you were talking about, Ben, and then we'll let Joel talk about the, you know, color commentary around it. In 2026, we see again, $9.5 million, which is pretty consistent with where we've been for the 5 or so years before 2025. That's comprised of California mainly. California is by far the largest. Because of some of the things we learned in Florida, the cap liability in California, actually, Joel and his team did some of the same things to help improve California. California has actually gotten, you know, a little bit better.

It's, I don't think we're in a position, or we don't think it's going to ever go to zero, but it's in a very manageable position right now. There's always, there always has been, and there probably always will be some of our smaller programs that bounce in and out of cap based on, you know, they're so small and the cap calculation is so sensitive, that if, you know, in a smaller program, if we lose a IPU relationship in one hospital, it can have a temporary impact that particular program jumps into cap for a short period of time.

That's what you're seeing is, the cap liability in total has not changed, but, you know, it's a couple of short program or small programs that we think are currently projected to be in cap, but, it's, you know, it's 50/50, and they're very small liabilities. That's why you see the number of programs look like it's going up, but the dollar amount isn't, because it's just small programs that from time to time do this, and they always have for the entire time that we've owned VITAS.

Kevin McNamara (President and CEO)

Joel, give me your opinion. I don't want to color it. Are you that concerned with non-California or Florida Cap?

Joel Wherley (COO)

I am not, and primarily for this reason, we are utilizing all of the very effective strategies that we have lifted up within the Florida CCN in every single potential cap market we have out there. If you look at fourth quarter specifically, that's the first quarter of the Medicare cap year. You have full revenue, but the slate is wiped clean on admissions, so you are starting over on a new year. We always see some of the small programs dip into cap in that first quarter of the Medicare cap year. We have no additional concerns about major programs out there that will, we expect a Medicare cap billing limitation for 26 that we have not seen previously.

To Mike's point, we've made very good progress in the state of California, with our historical programs that have been in Medicare cap. We've talked previously about why that happens in California. The short answer to that, Ben, is that no, we have no additional concerns specific to cap, and in fact, we're very happy with the progress we're making and our ability to minimize, that billing limitation in CCNs outside of Florida, and as we indicated, with no billing limitation within the Florida CCN.

Ben Hendrix (Analyst)

Thanks, guys. Appreciate the color. Just a quick one on Roto-Rooter. We also have a lot of questions on kind of how we model this, you know, the marginal, you know, the margin impact on the paid search mix versus the natural search mix, specifically that $90 some odd, you know, per lead number that you've thrown out there. Kind of, how does that look on, like, on a conversion-adjusted basis? You know, if assuming some of those leads quite convert or there's no follow-through. Is there a stat that we can think of in terms of the conversion-adjusted dollars per lead on a paid search?

Kevin McNamara (President and CEO)

Sure. As you mentioned, we pay, you know, roughly $90 per lead, and that hasn't changed over the last few quarters. Historically, until and then continuing today, it takes between one and a half to two leads to convert to a paying job. You're looking at a $150-$180 customer acquisition cost for a paying job on the jobs we do from a paid lead standpoint. That's, I think, roughly 60%-65% of our leads are paid at the moment.

Ben Hendrix (Analyst)

That's helpful. Thank you.

Operator (participant)

Thank you. This concludes the question and answer session. I would now like to turn it back to Kevin McNamara for closing remarks.

Kevin McNamara (President and CEO)

Well, my remarks are limited to the fact that, you know, we had a tough quarter, but there is, at least on this side of the line, abundant confidence that the guidance we make, is guidance we wanna hit. We know that it's bad enough to have bad results, but it's even worse to miss guidance. To the extent that the guidance is out there, we are very confident, but based on our results in the, you know, the most recent quarters, I can see why reasonable investors might say, "Okay, forget last year, but are they even gonna make this year?" I was gonna say that when you combine some of the trends we've talked about, and insider insight, you know. Again, we're more confident now than we are on the normal guidance, to be honest with you.

With that, I would just like to thank everyone, for their attention, and, we'll be back three months from today. Thank you.

Operator (participant)

Thank you for your participation in today's conference. This concludes the program. You may now disconnect.