Concentra Group Holdings Parent - Earnings Call - Q2 2025

Executive Summary

• Strong Q2 performance driven by volume and pricing: revenue $550.8M (+15.2% YoY), Adjusted EBITDA $115.0M (+13.2% YoY), Adjusted EPS $0.37; GAAP EPS $0.35, with margin compression tied to one-time integration and public company costs.
• Beat vs S&P Global consensus: revenue beat by ~$13.4M; EBITDA modest beat; EPS essentially in line-to-slight beat on “Primary EPS” (adjusted) basis; GAAP EPS was below adjusted consensus framing.
• Guidance raised: FY25 revenue to $2.13–$2.16B (from $2.10–$2.15B) and Adjusted EBITDA to $420–$430M (from $415–$430M); capex $80–$90M and ~3.5x year-end net leverage unchanged.
• Strategic catalysts: (1) Nova integration complete (67 centers) and Pivot Onsite closing (240+ clinics) pushing footprint to >1,000 total locations; (2) strong rate environment (RPV +4.4% YoY); (3) deleveraging path reaffirmed; and (4) quarterly dividend maintained at $0.0625.

What Went Well and What Went Wrong

What Went Well

• Broad-based growth: Visits per day +9.5% YoY to 55,005; Workers’ Comp VPD +9.3%, Employer Services VPD +10.3%; Revenue per visit +4.4% YoY (W/C +5.4%, Employer +3.1%).
• Executed M&A and integration: Closed Pivot Onsite (240+ clinics) on June 1 and completed Nova integration across systems/branding, expanding to >1,000 total locations serving ~215,000 employers.
• Management confidence on macro and reimbursement: “We are not seeing any slowdown... based on the data we look at every day” and expect a favorable 2026 rate year (doc fix conversion factor uplift in CA, OH, NC, TN).

What Went Wrong

• Margin pressure: Adjusted EBITDA margin declined 38 bps YoY (20.9% vs. 21.3%) driven by prior-year favorable items and one-time Nova/Pivot transition costs not adjusted out, plus incremental public company/separation G&A.
• Higher interest expense post-IPO recap reduced GAAP net income (down 12.9% YoY) and GAAP EPS ($0.35 vs. $0.50) despite strong operations; management attributed decline to recapitalization burden.
• G&A up as % of revenue (9.6% vs. 7.7% prior year) reflecting public company/separation and acquired G&A not fully synergized through quarter, with remaining synergies to be executed over 2025–Q1’26.

Transcript

Speaker 3

Morning and thank you for joining us today for Concentra Group Holdings Parent Incorporated's earnings conference call to discuss the second quarter 2025 results. Speaking today are the company's Chief Executive Officer, Keith Newton, and the company's President and Chief Financial Officer, Matt DiCanio. Management will give you an overview and then open the call for questions. Before we get started, we would like to remind you that this conference call may contain forward-looking statements regarding future events or the future financial performance of the company, including, without limitation, statements regarding operating results, growth opportunities, and other statements that refer to Concentra's plans, expectations, strategies, intentions, and beliefs. These forward-looking statements are based on the information available to management of Concentra today, and the company assumes no obligation to update these statements as circumstances change. At this time, I will turn the conference call over to Mr. Keith Newton.

Sir, you may begin.

Speaker 2

Thanks, Operator. Good morning, everyone. Welcome to Concentra Group Holdings Parent Incorporated's second quarter 2025 earnings call. We are pleased to report on a strong second quarter, sustaining the momentum we had in the first quarter of 2025. In Q2, we saw accelerated growth in visits across both workers' comp and employer services, even after excluding the impact of the visits in the centers acquired in the Nova Medical Centers transaction. We had another quarter of mid-single-digit year-over-year rate increases. With this strong growth on both volume and rate, we had a high single-digit revenue growth, excluding Nova. In addition, we successfully completed the integration and rebranding of our acquired Nova occupational health centers. We opened an additional occupational health center De Novo site in Chattanooga, Tennessee, bringing us to four De Novos open so far this year, with two to three additional anticipated by the end of the year.

We closed on the Pivot OnSite health clinic acquisition on June 1, which doubles the size of our on-site health clinic segment and brings Concentra Group Holdings Parent Incorporated to over 1,000 combined occupational health center and on-site health clinic locations across the country. The integration of Pivot OnSite is well underway and on track. Additionally, we expanded our board of directors and added two new directors, Bridget Bonner and Vipin Gopal, effective July 1. Bridget and Vipin bring a wealth of experience across the customer experience, digital transformation, data analytics, and AI spectrums, and we're thrilled to gain access to their unique skill sets and knowledge base. With their decades of experience at companies like Eli Lilly, Walgreens, UnitedHealth, and IBM, we expect them to contribute meaningfully to our future success.

I'll touch on some of the key financial highlights from the quarter, and then we will get into more details. As with the last quarter, we will continue to report certain metrics, both including and excluding the impact of our larger M&A, so that people have a good sense on how the core business is trending. I would note here at the outset that we had the same number of revenue days in Q2 2025 as Q2 2024, so there is no need to adjust the prior year comparisons for days. Total company revenue was $550.8 million compared to $477.9 million in the prior year, representing a 15.2% growth year over year. Excluding contributions from Nova, revenue was $519.4 million, resulting in an 8.7% increase over the prior year. Total patient visits increased 9.5% in the quarter to approximately 55,000 patient visits per day.

Our workers' compensation visits per day increased 9.3%, and employer services visit volume increased 10.3% relative to the prior year. Excluding the impact from the acquisition of Nova Medical Centers, total visits per day increased 2.4%. Workers' compensation visits increased 3.2%, a notable acceleration over Q1 growth, and employer services visits increased 2%, also better than Q1 results. A solid quarter across the board from a volume standpoint as work comp volumes rebounded from a softer Q1 and employer service visits continued the reversal into positive growth territory we have seen since the beginning of the year as we move to more normalized levels. We had another strong rate quarter with an approximately 4.4% increase in revenue per visit this quarter versus the same quarter prior year. This growth was driven by a 5.4% increase in workers' compensation and a 3.1% increase in employer services revenue per visit.

Adjusted EBITDA was $115 million in the quarter versus $101.6 million in the same quarter prior year, or a 13.2% increase. Adjusted EBITDA margin decreased from 21.3% in Q2 2024 to 20.9% in Q2 2025, primarily due to some favorable items impacting cost of services in the prior year, also some one-time Nova Medical Centers transition costs this quarter, along with incremental Nova Medical Centers G&A expense that wasn't synergized through the full quarter and other G&A cost increases in the current year that Matt DiCanio will touch on shortly. Overall, we are pleased with the company performance and our continued growth. Adjusted net income attributable to the company was $47.7 million, and adjusted earnings per share was $0.37 for the second quarter 2025.

As with the last few quarters, net income was lower than the same quarter prior year, primarily due to an increase in interest expense resulting from the IPO recapitalization. Adjusted EBITDA and adjusted net income reflect the add-back of transaction expenses related to our acquisition activity, as well as one-time costs related to our separation from Select Medical. Now, before I turn it over to Matt for additional information, I'd like to briefly comment on the significant progress we've made during the second quarter as it relates to our Q1 Nova Medical Centers acquisition and the related integration efforts, the June 1 Pivot OnSite health clinics acquisition, and our continued Select Medical separation efforts. We are incredibly proud of our team's efforts to manage these major initiatives and continue to achieve our goals on the timelines we established.

Matt will share more details, but everything is on track, and we are pleased about where we will be when all three are completed. Now, I'll hand it over to Matt to provide additional details on our financial results, capital allocation strategies, and growth efforts.

Speaker 1

Thanks, Keith, and good morning, everyone. I'll start by going through some more details on our results in our three operating segments. In our occupational health center operating segment, total revenue of $516.1 million in Q2 2025 was 14.4% higher than the same quarter prior year. Workers' compensation revenue of $332.2 million in Q2 2025 was 15.2% higher than prior year. As Keith mentioned, work comp visits per day increased 9.3% from prior year, and work comp revenue per visit increased 5.4% versus prior year. Work comp revenue per visit was $209, similar to our work comp rate last quarter. Within employer services, revenue of $174.3 million increased 13.7% from prior year. Employer services visits per day increased 10.3% from prior year, and employer services revenue per visit increased 3.1% versus prior year.

To help isolate from our Q1 acquisition of Nova Medical Centers, here are the same stats excluding the impact of Nova. Total revenue within the occupational health center operating segment was $484.8 million, a 7.4% increase over the prior year. Total visits per day increased 2.4% over the same quarter prior year. Revenue per visit increased 4.9% from $140 in Q2 2024 to $147 in Q2 2025. Workers' compensation revenue of $314 million in Q2 2025 was 8.9% higher than prior year. Workers' compensation visits per day were 3.2% higher than prior year, and work comp revenue per visit was 5.5% higher than prior year. Within employer services, revenue of $161.8 million increased 5.5% from prior year. Employer services visits per day were 2% higher than prior year, and employer services revenue per visit was 3.4% higher than prior year.

The most notable takeaway from the quarter was our solid volume growth, both compared to Q1 and also compared to Q2 of last year. Excluding Nova, year-over-year visit growth for work comp accelerated from 0.2% in Q1 to 3.2% in Q2, and employer services went from 0.9% in Q1 to 2% in Q2. We had spoken before about the softer work comp volume number in Q1, and we did, in fact, see a much stronger number in Q2. We are also pleased to see the continued positive growth trend and slight acceleration for employer services. Work comp and employer services visits can bounce around a little bit, but growth tends to be in the low single digits over time. We'll add more commentary later in our remarks, but we think our Q2 visit trends are a pretty good indicator of the broader economy.

We are not seeing any slowdown based on the data we look at every day that covers employers of all sizes, industries, and geographies. Moving on from our occupational health centers, our on-site health clinic segment reported revenue of $22.6 million in Q2 2025, a 45.2% increase from the same quarter prior year. Excluding the one-month impact from the Pivot OnSite acquisition that closed on June 1, on-site segment revenue grew 9.9% year over year. Overall, a nice quarter as it relates to our core on-site performance and obviously a major milestone adding the Pivot OnSite locations to our portfolio. A quick reminder for everyone, we do not report visit metrics for our on-site business given the nature of the revenue model. Finally, other businesses generated revenue of $12.1 million, an 8.5% increase against the same quarter prior year.

Now switching to expenses, cost of services was $389.3 million, or 70.7% of revenue in Q2 2025, down from 71% of revenue for the same quarter prior year. We realized a nice decrease here primarily driven by better staffing efficiencies in conjunction with the strong revenue growth. This improvement would have been even better if not for approximately $750,000 of one-time costs related to the Nova and Pivot transitions that are not adjusted out of adjusted EBITDA, as well as several favorable adjustments in the prior year. Overall, our labor costs continue to be stable, trending approximately 3% higher than prior year, which is a consistent theme for us over the years. Our teams are doing a great job managing staffing to the visit volumes, and we have made good progress filling open positions.

We want to emphasize this point as labor dynamics have not historically been an issue for this business model. Our total general and administrative expenses were $52.9 million, or 9.6% of revenue in Q2 2025, compared to 7.7% of revenue in the same quarter prior year. This comparison is not apples to apples, though, as we have expenses in Q2 of this year that we did not have in the prior year before we were a public company and separated from Select Medical. We also have some acquisition-related expenses here related to Nova and Pivot. Excluding items that are added back for the purposes of calculating adjusted EBITDA, including equity compensation expense, one-time Select separation costs, and M&A transaction costs, G&A expense was $46.6 million for the quarter, or 8.5% of revenue compared to 7.8% of revenue in the same quarter prior year.

The increase was largely driven by incremental Nova G&A expense that wasn't synergized through the full quarter and planned increases in personnel costs related to becoming a public company and our ongoing separation from Select Medical. The overall adjusted EBITDA margin in Q2 2025 was 20.9% compared to 21.3% during the same quarter prior year. To reiterate, the primary drivers of this slightly lower margin are some favorable one-time cost of services items from the prior year, certain one-time Nova and Pivot integration expenses totaling approximately $750,000 that are not adjusted out of adjusted EBITDA, incremental G&A expense from Nova that was not fully synergized through the entirety of the quarter, and the planned increase in personnel related public company and Select separation costs. In Q2 2025, we generated $88.4 million operating cash flow.

It was a nice cash flow quarter for us, driven primarily by our financial performance, but also due to the timing of payroll and other payables at quarter end. Investing activities used $79.5 million of cash in the second quarter, predominantly driven by the Pivot acquisition closing on June 1st. Also included in this number is $25.2 million of CapEx, with approximately $18 million of that from our normal course capital program for upgrading and maintaining existing facilities, De Novo expansion, and technology investments, and approximately $7 million of one-time CapEx associated with our Nova center integration and rebranding efforts. Financing activities resulted in net cash inflows of $12.9 million for the second quarter, primarily due to our revolver draw of $35 million as part of the Pivot acquisition, partially offset by two quarterly dividend payments that both fell into Q2.

We ended the quarter with a total debt balance of $1.67 billion and a cash balance of $74 million. Our net leverage ratio per our credit agreement at the end of June was 3.8 times. We found that some investors are not including the annualized impacts from our recent acquisitions in their leverage calculations, especially if doing a quick screen on Bloomberg or other sources, so we felt it was important to call this out. For the remainder of this year, we will be focused on continuing our delevering path while we look to fully integrate Nova Medical Centers and Pivot OnSite and continue to make progress with our separation from Select Medical. The second half of the year is our strongest cash flow period, especially Q4, with collections coming in from the highest volume months. Now switching to our growth efforts.

With respect to the integration of Nova Medical Centers, we are progressing well and now have all centers converted to Concentra systems, processes, and signage as of the end of July. We expect this to drive both increased top-line growth and operational efficiencies going forward. As we've mentioned, we incurred material conversion costs, which occurred in May, June, and into July that impacted our cost of services and were not added back to adjusted EBITDA. We expect to see these costs decline significantly going forward. Our teams are now focused on growing visits and adding additional services. We expect this will take some time like other acquisitions in the past, but we are confident in the team's ability to do so.

As it relates to our cost synergies, through the end of Q2, we estimate that we have captured just over 70% of our planned operational and back-office synergies, which is right on track with our original underwriting. The remaining 30% will be systematically executed through the remainder of 2025 and into Q1 2026. Overall, this acquisition is tracking well, but more work to do before we are fully integrated and closer to run rate performance. On the De Novo front, we opened one location in Chattanooga, Tennessee, in Q2 2025 and have two or three more locations planned for the second half of this year, depending on some construction variables. With respect to 2026 activity, to date we have executed or are close to executing five new leases and have a number of other active targets that are candidates for opening in 2026.

In general, we continue to identify a lot of white space across the country with high workplace injury density and little to no existing Concentra footprint, so we have a good opportunity to continue to accelerate our De Novo activity. We also have a pipeline of small bolt-on M&A deals that we intend to pursue in parallel with our De Novo strategy. I'd like to reiterate that both De Novos and bolt-on M&A are down the fairway for us given our average run rate build and acquisition multiples of less than 3 times EBITDA over the past decade. We will continue to execute on this corporate development strategy in concert with reaching our leverage targets on our projected timeline. We do not expect any larger acquisitions for the remainder of this year.

Lastly, on the growth front, we are excited about the closing of the Pivot OnSite acquisition on June 1. Integration efforts are underway, but mostly focused on combining the two G&A teams. No changes at the on-site location level like we had with the Nova integration efforts. As previously stated, this is a deal that enhances our ability to compete in the broader on-site space, where we now view ourselves as a top five player in terms of scale. We've onboarded a number of new leaders that are going to be integral towards growing the business going forward, and we have a robust sales pipeline of both occupational health and advanced primary care opportunities that should set us up nicely for continued organic growth into next year.

Longer term, we expect additional on-site acquisition opportunities to continue to arise, including advanced primary care focused platforms, as we look to meaningfully grow our on-site segment. Finally, last note on capital allocation, we are pleased to announce a continuation of our dividend this quarter, with Concentra's board of directors declaring a cash dividend of $0.0625 per share on August 6, 2025. The dividend will be payable on or about August 28, 2025, to stockholders of record as of the close of business on August 21, 2025. Now back to Keith to comment on a few important topics, most of which are popular topics we are asked by investors and research analysts.

Speaker 2

Thanks, Matt. Overall, many positives to the quarter and a solid first half for 2025. We're pleased about the opportunities ahead in the second half of the year and 2026. As Matt mentioned, I want to take a few minutes and cover a couple of topics and questions that come up periodically. I'll start first on our visit trends, their correlation to economic indicators, and what we're seeing as it relates to the job market. As we discussed before, we track total employment and hiring and quit rates, but many variables are included in driving our visit volumes. Our work comp visit growth rates quarter by quarter will move around a bit for a variety of reasons, but over time we expect to see low single-digit growth rates. It was good to see a stronger quarter in Q2.

Our employer services visit growth rates have now been positive for two quarters in a row. We believe this is a solid indicator of the health of the labor market and broader economy. We are not seeing any indication of slowdown for what we have been recently experiencing as we monitor our visit trends on a daily basis. There are some shifts in industry mix, but no extended trend, either positive or negative in any industry we serve. If anything, we're seeing more stability now than we have in more recent quarters. We've shown in the past that we can navigate well through any ups and downs in the broader economy. A recent example is how we grew EBITDA through many quarters of negative employer service visit declines.

We want to emphasize this point as employment and hiring trends are important to us, but we have many other variables such as reimbursement increases and staffing controls that limit our exposure to economic swings. Secondly, we're getting some questions about how the recent legislation or the Big Beautiful Bill impacts us as a company. As we've mentioned in the past, our industry is very unique in that workers' compensation fee schedules are governed by each individual state, and employer service pricing is set by us with market pricing adjustments each year. For workers' comp, each state has its own fee schedule, and the calculation of that fee schedule varies from one state to the next. Each state sets the fee schedule for their particular state, but are not the entities making the payments to providers, so it does not impact or relate to their specific state budgets.

Because of this, most of the time we are not impacted by federal legislation. With the recent legislation, there is one item of note that will impact us in a favorable way in 2026. It's primarily tied to the 2.5% DOC fix provision. There are four states: California, Ohio, North Carolina, and Tennessee that utilize the conversion factor component of the Medicare physician fee schedule as one component of their calculation each year in adjusting their workers' comp fee schedules. These four states will see that 2.5% conversion factor increase as part of their fee schedule updates. We will benefit most from California, as it is one of our largest states, and also because California has an MEI inflationary adjustment as another component of its fee schedule calculation that will be incremental to the DOC fix increase. It's still early, but we're expecting another strong rate year in 2026.

We'll continue to track other state changes, and we'll likely have more information later this year on how 2026 is shaping up. Overall, we want to emphasize how unique our reimbursement environment is and how federal changes are unlikely to impact us, unlike other healthcare service companies. Lastly, this legislation has some tax and depreciation regulation changes that, while not impacting our overall effective tax rate, will help us in a material way from a cash flow standpoint by over $15 million in 2025 and about a third of that in 2026. Last topic I wanted to comment on is our separation from Select Medical and how that is progressing. We're about eight months into the two-year project, and all teams are doing a great job to set us up for complete separation by November 2026. I credit both Concentra and Select colleagues in their collaborative approach.

Concentra has hired almost 50% of the staff we project we will need, and we've started reducing the amount we pay Select for the services they have historically provided. Much more work to do, but our teams estimate that we're at approximately the midpoint in this separation process from a people, contract, and project standpoint. With that, I will hand it back to Matt to wrap up the call with our financial outlook update.

Speaker 1

Thanks, Keith. Okay, to round out the call today with the previous comments as a general backdrop, we are raising our 2025 revenue guidance to $2.13 to $2.16 billion, from $2.1 to $2.15 billion, and the lower end of our adjusted EBITDA range to $420 million from $415 million. The result is a new 2025 adjusted EBITDA range of $420 to $430 million. We remain on target for $80 to $90 million of CapEx, which includes significant one-time Nova spend and a 3.5 times leverage ratio by year end. Furthermore, we are on track for our leverage ratio to be below 3 times by the end of 2026.

To wrap it up, I'd like to reiterate the takeaways we'd like investors to leave with: solid organic visit growth this quarter, another strong rate quarter with a good early outlook on rate for next year, raised guidance, no major reimbursement risk, stable labor trends, positive momentum with strategic M&A integration efforts, tremendous white space available to us across all our service lines, a clear path to continued delevering with very strong cash flow, and continued solid EBITDA margins. With our unique reimbursement model and direct-to-employer relationships, we view ourselves as a B2B business services provider and a differentiated investment opportunity versus other healthcare services companies today. That concludes our prepared remarks. We thank everyone for the time today. We'd like to turn it back to the operator to open the call for questions.

Speaker 3

Thank you. At this time, we'll be conducting our question and answer session. If you would like to ask a question, please press *1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue, and you may press *2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the * keys. One moment, please, while we pull for questions. Thank you. Our first question is coming from Benjamin Rossi with JPMorgan. Your line is live.

Speaker 0

Good morning. Thanks for taking my question here. For the 2025 guidance update, could you just walk me through what's being contemplated in your changes to revenue and adjusted EBITDA from M&A contribution or aggregate improvements to either your core volumes and pricing across segments? Just on cadence, I know last year you had some weather-related drag in 3Q. Are there any other year-over-year dynamics to consider or incremental M&A spend within this guide for the back half of the year?

Speaker 1

Sure. Good morning, Ben. Thanks for the question. I'll take the first part, and then we can get to the second part after that. As far as the guidance, we thought it was appropriate to raise guidance. We obviously had a strong quarter on both revenue and EBITDA. We had previously given guidance a few months back that included the M&A. All of that's factored in. Really, the way we're thinking about guidance is pretty similar performance to what we've seen year to date. Obviously, we'll have the incremental Nova Medical Centers and Pivot OnSite performance that we didn't have before those deals closed earlier this year. Pretty much run rate consistent performance through the remainder of this year. The second part of your question was around some weather. There was some weather last year, and it was primarily July that we had called out previously.

That will be a factor in Q3, but there's no other material events that we want to point out for the remainder of the year.

Speaker 0

Got it. Okay. Just as a follow-up, on the on-site total clinic count regarding your on-site health clinics, could you help me bridge to that 406 reported centers following the Pivot OnSite acquisition? I just recall when you gave us the initial overview of the acquisition back in April, you described the combined entity being around 360 centers all in with about $120 million in combined revenue. Is that revenue figure still applicable for 2025 under the combined setup?

Speaker 1

Yes. Yeah, no change to the revenue. A slight update to the count of on-sites. There are 240 total on-sites, and the update there, I think we had previously said 200 plus, but there's a slight difference in how we count for them versus how Pivot OnSite had counted for them. Post-acquisition, we updated that to about 240 on-sites that were acquired.

Speaker 0

Great. Thanks for the clarification.

Speaker 3

Thank you. Our next question is coming from Justin Bowers with Deutsche Bank. Your line is live.

Hi, good morning, everyone. One question for each of the main segments. Nice to see the workers' comp accelerate into 2Q. Now that you've had a chance to sort of do the look back, anything to explain the softer trend in 1Q? With respect to the guide, does the guide accommodate flattish to 3% same store workers' comp visits, or just help us think about the guide on workers' comp, and then I'll follow up with employer services.

Speaker 2

Yeah, Justin, this is Keith. I think, and we've mentioned it, that the quarters can vary a little bit for a lot of reasons. I don't really think there's a whole lot to the first quarter as far as the softness. There's a lot of dynamics going on in the world today that can, I think, impact us here and there. Employers seem to have been in a somewhat stable wait-and-see at times. I think it's the comps compared to last year, what was happening then versus this year. We've just continued to put our heads down, continued to do the things we're doing, and I think the fruits of our labor are starting to bear as a result of that. I don't know if you have any comments.

Speaker 1

Yeah, and I'll just add to that. I think the second part of your question was the remainder of the year. Just to add on to what Keith said, Q1 of 2024 was the toughest comp for this year. Q2 of 2024, as a comparison, was kind of middle of the road, so versus this quarter. What we're projecting in our guidance is really, you know, closer to an average of our Q1 and Q2 numbers for the remainder of the year.

Thank you, Matt. That's helpful. Just on employer services, right? Keith, you talked about this in the prepared remarks. There was some noise around the economy, but you're seeing it sounds like trends are pretty stable. Do you think the performance there for you guys is more reflective of market, or individual initiatives, or sort of a mix of both there?

Speaker 2

I would put it as a mix of both. I mean, there's a lot of things that we're doing as far as trying from different levers, from account management, sales activities, and those type things as far as penetrating further, reevaluating some of the organizational structure of the sales and how we're approaching things both from the account management side and penetrating the employers and also incremental, new business. It seems that employers are still somewhat in a wait-and-see, you know, when all the numbers, the indicators that come out, that seems to tell us that.

We're hopeful that as we progress further through the year, as there's better clarity relative to what's going to happen in the future, whether it's tariffs, whether it's all the other things happening right now, that maybe employers start to become a little more activity-wise from a hiring standpoint, and then we start to pick up the benefit of that. I don't think we're really picking up the benefit of anything there other than just a stable workforce right now and just the activities that we're deploying.

Appreciate it. I'll jump back in queue.

Speaker 3

Thank you. Our next question is coming from Jamie Pearce with Goldman Sachs. Your line is live.

Speaker 0

Thank you. Good morning. You've spoken a lot about the volume acceleration that you saw in the second quarter. As we think about the back half of the year, is the right way to think about volume growth for both of the businesses more like what you saw in the second quarter or more like what you saw on a year-to-date basis? I'm just trying to put a finer point on volume expectations as we move through the back half of the year. To push on this macro topic for a second, it is pretty clear you are not seeing anything yet. You've said that several times. Are you factoring anything into the guidance or any cushion broadly into the guidance if there were more of a slowdown in hiring trends?

Speaker 1

Yeah. Good morning, Jamie. It's Matt. Just to reiterate on the back half of the year, the way we're thinking about it is closer to the year-to-date performance. We had a little bit soft Q1, obviously a stronger Q2. I think it's better to look at more of the average or the year-to-date numbers as we move through the rest of this year. We are not factoring in significant changes to our visit volumes on the upside or downside through the remainder of this year. You know, we're coming off a strong Q2. Based on my comments on how we're thinking about the back half of the year closer to the year-to-date averages, I think there's, you know, hopefully that gives you some thoughts for the rest of the year.

Speaker 0

Yeah, that's helpful. Can you spend a minute talking through some of the one-time items that were still included in the adjusted EBITDA? You mentioned some in cost of service. Just trying to better understand the margin progression for gross and operating margin in the second quarter, excluding some of these one-time items, and if that margin progression should continue for the balance of the year.

Speaker 1

Yeah, sure. I could hit that. There's a few things going on. I'll walk through one at a time. Cost of services, we were better versus prior year from a percentage of revenue, and it was primarily staffing efficiencies. We would have been even better if it wasn't for some prior year favorable reversals that happened in 2024, and then also the Nova startup transition costs. There were some costs related to our system integration efforts that were over a two to three-month period. Some of those were adjusted out, but some of them were more normal, kind of front-loaded startup costs for the business that were not adjusted out. Those burdened cost of services. We expect those will go away now that we've completed the transition efforts at the end of July. August moving forward, those expenses should go away.

That would have made cost of services even better than it was versus prior year. From a G&A standpoint, it was really two things. It was the Nova and Pivot synergies that had not been fully realized, the full impact of those synergies. We closed the Nova transaction on March 1, and we closed the Pivot transaction on June 1. There was a period of time before synergies and actions were taken, and there's still more synergies to be had. We basically acquired that G&A and were not able to fully synergize out in the first quarter post-transaction, but we expect that to flow through in the coming months and coming quarters. We also had some planned and expected public company and separation costs that are included in G&A that were not there in the prior year, when we were not a public company.

When you factor in both of those and look at our EBITDA margin, which was 40 basis points lower than last year, our view is factoring those in that we would have been flat or potentially even higher than prior year. That's including the fact that we're now a public company and separating from Select Medical. Hopefully, that helps.

Speaker 0

Yeah, it does. Thank you.

Speaker 3

Thank you. Our next question is coming from Ben Hendricks with RBC Capital Markets. Your line is live.

Great. Thank you very much. I just wanted to follow up on a comment Keith made when discussing the employment and jobs macro data. I appreciate that your platform has been very stable amid some changing numbers that we've heard. You also, I think, mentioned that you saw some mixed dynamics in your underlying business, perhaps with industries or customers. I was wondering if you could expand on that and where you're kind of seeing a shift, and if that's in any way could, in the future, create headwinds or unanticipated dynamics. Thanks.

Speaker 2

Thanks, Ben. Actually, I think in our prepared remarks, we said we have not seen shifts within the diversification of the industries. There's no one industry that's more than 9% or 10% of our business, and there are several that fall kind of in that 8% range, whether it's manufacturing, healthcare, services, distribution, all of those. We really haven't seen much of a shift in any of that. It's been fairly stable. I think what we've seen really from an employment standpoint, as everybody knows, is a relatively slow, from a hiring perspective out there. It's still, I think, a wait-and-see. Let's get better clarity on what's going to happen, relative to how employers, but fortunately, what they've done is kept a stable workforce. We haven't seen the layoffs that historically would start to drive a recessionary type situation. That's why I believe our volumes have stayed relatively stable.

The diversification amongst the employers is relatively stable, so really not seeing much of any changes within the mix of what's walking into our centers.

Speaker 1

Yeah. Ben, I would just add to a lot of discussion around the short term, but we're also really excited about the long term. Every day you hear additional proposed investment back in the United States with all the reshoring efforts that are going across the country. Every time we see an update like that, it's exciting for our business, both our center business and our on-site and telemedicine segments.

Great. Thank you very much. Just to wrap up some of the cost discussion, I was just wondering if, when you take into account the full synergies of Nova Medical Centers, the G&A rationalization you mentioned at Pivot OnSite, and then the full transition from Select Medical, maybe it's an exit rate for 2026. How are you thinking about a run rate G&A and cost of service margin going forward?

Yeah, sure. Obviously, a lot of things going on as I've described before. What I think we would point to right now is, exiting 2025, if you just look at the midpoint of our EBITDA and revenue guidance, that implied margin is pretty similar to what we had last year. We're taking on two major acquisitions and separating from our parent company. I think that speaks for itself. We'll give more thoughts on 2026 in subsequent quarters.

Great, thank you.

Yep.

Speaker 3

Thank you. Our next question is coming from Joanna Gajuk with Bank of America. Your line is live.

All right. Good morning. Thanks for taking the question. The on-site segment is relatively small, but excluding Pivot OnSite, the revenue grew like 10%. Is that the organic growth we should be looking at for the segment, or are there some de novos in there that are driving that fast growth?

Speaker 2

On the on-site, if I understood what you were saying, excluding Pivot OnSite.

Yes.

Should you participate? Yeah. With the deployment of an advanced primary care product that we've talked about in the past as an additional service within our on-sites, we're hoping it's going to start to ramp our core growth rate on our on-sites at a faster pace than what we've historically seen when just focused on occupational health. In the early returns we are seeing, we are starting to win business that historically we really did not go out and bid on just because of the type of service it was. We're very bullish on what we think our on-site is going to be doing from a core standpoint outside the potential for M&A activity. There's a lot of activity in that sector right now.

As it relates to what we're doing just from a core deliverance of the services, with the addition of advanced primary care, we're starting to win some business that historically we did not win. I would anticipate a better growth rate than historically what we've seen over the last few years from a core.

Okay. Thanks for that. Following up, if I got it right, when you were talking about the second half, employer services volumes grew on average, I guess, 1.5% in the first half and workers' comp also. You're guiding us to assume similar growth in the second half. Is it a fair assumption, for, I guess, long-term organic growth for these businesses when it comes to volume?

Speaker 1

Yeah, I would reiterate what we said in the past about our growth algorithm and how we think about volumes in the low single-digit range, right, in the plus or minus 3% approximately over a long period of time. Then our smaller core M&A and de novo efforts of 1 to 2% per year. That's really how we're thinking about it. Q1, as just to mention again, a little soft. Q2, obviously better. We're looking at in between those two numbers.

Speaker 2

I think once we start seeing quit rates start to increase, job openings start to increase, hiring starting to increase, then certainly, we'll start to tweak up from an employment services growth rate.

Great. Thank you. Thanks for the answers. Thank you.

Speaker 3

Thank you. Our next question is coming from Stephen Baxter with Wells Fargo. Your line is live.

Speaker 0

Hi. Thanks for the question. I just wanted to ask about the guidance revision. It is kind of a small difference, but you're increasing the revenue by more than you're increasing the EBITDA on a percentage basis. I just wanted to know if there's any kind of note there. Obviously, you called out a lot of discrete cost items in the second quarter, but I wasn't sure if those cost items were just to aid us in the comparisons or whether they were actually coming in maybe a little bit above what you might have expected. I have a quick follow-up too. Thank you.

Speaker 1

No. We saw some of the costs from the transition efforts in maybe the tail end of May, but mostly in June. We expect those same, similar numbers in July because we were converting the same number of centers in July and then potentially into early August. We expect those costs to go away. Just being mindful of what we've seen over the last two, three months as we went through a pretty massive effort to put our systems and signage in, and change our workflows at all of those 67 centers. We're really proud of the work that teams have done and excited that that's behind us and looking forward to the remainder of the year.

Speaker 2

Yeah, I'll just add, there's a lot of dynamics in play from the cost perspective right now relative to the synergies being executed on from a Nova perspective, the synergies being executed on from a Pivot perspective, the timing of separation cost and adding people and TSAs going down. There are a lot of moving parts to that. We just wanted to be conservative with our approach to how we gave guidance from an EBITDA standpoint at this point in time. If we get better visibility and clarity as we go through Q3, we'll continue to sharpen the pencil on that.

Speaker 0

Got it. Okay. Thank you. I appreciate the caller. I guess I didn't realize that you have some linkages in some of your states to the DOC fix. If the DOC fix gets done as part of, you know, closer to year-end spending packages related to 2015, do you expect that you would see a true up in this year's results, or I guess how would you expect that to play out if something did ultimately get done for this year?

Speaker 2

I would not expect anything. Most of the states don't necessarily adopt it whenever these things happen. They're on their own timing. It's not like if something like this were to happen, we're going to immediately see it. I would anticipate 2026. As we get further into this year, we'll talk more about it and see it. Most of the time, states are going to implement their fee schedules. The majority of them, if there's any changes they're going to make for whatever reason, I'd say the majority of them are probably January of 2026 when they do it. Others later in the year also, but they're all on their own schedules relative to when they do it.

Speaker 0

Got it. Okay. One thing we've kind of observed, at least with regards to the on-site opportunity, is we've had a couple of years now of just really high-cost trends within the employer group business that all the managed care companies have discussed. How much do you feel like that's starting to influence the conversations that you have? Do you think that's really been a material driver of maybe increased interest in the model versus what you might have seen going back a couple of years when things were a little bit more stable? Thank you.

Speaker 2

I mean, we all are reading, it's anticipated that most companies are facing some pretty big employee benefits costs as we go into 2026. We're certainly having those conversations more and more with employers. I think more so because we now have a product that's competitive with those employers, with those on-site companies that kind of focused on the commercial side or the group health side with these employers. Historically, our focus from an on-site perspective had been occupational health. We weren't necessarily having these type of conversations with employers because we were dealing more with safety and risk, versus HR and benefits. Now we're at a, we have a seat at the table really with both sides of an employer's house relative to benefits and safety and risks.

Certainly, as I mentioned earlier, we're winning some deals now relative to this where we're basically providing advanced primary care services to that employer and their employee base at the work site where historically, we were not doing that.

Speaker 3

Thank you. Our next question is coming from Anne Heins with Mizuho. Your line is live.

Great. Thank you. In your prepared remarks, you made a comment that labor dynamics is not an issue for this business model. Can you remind us why that is? Secondly, I know you have a leverage target goal of 3x by the end of 2026. How do you balance that with the M&A potential and opportunity? Thanks.

Speaker 2

Yeah. Labor dynamics, when you look at our model, typically, we've got doctors, physical therapists, and the individuals that are supporting those clinicians are medical assistants. We don't have RNs, LBNs. A lot of the labor pressures that health systems faced were with that type of discipline. Historically, there's more of a base draw from a medical assistant standpoint, hourly individuals. Historically, we did not feel the same pressures that the health systems faced over the last few years from that perspective. That's really our model. Our model is based on visits per day, per FTE within a center, those type metrics. We're able to lever up, lever down, based on volumes for the most part, and adjust accordingly. That's pretty much kind of how we have managed this business over the years.

Speaker 1

I can take the second question. On the leverage question, you said, we've stated that we're targeting 3.5 times by year-end and sub 3 times by the end of next year. We feel good about where we are because we're still working through the Nova Medical Centers and Pivot OnSite integrations. We're still working through, call it, the second half of our Select Medical separation efforts. Our teams are very focused on executing on those successfully. We're going to naturally delever, especially in Q4 with the strongest cash flow quarter we have. Looking at 2026, we'll have a lot of those three main work streams behind us for the most part. We'll continue to look at M&A. Our leverage targets and strategy are not impacted by our core de novos and smaller M&A. We'll continue doing that as we delever.

I think at some point next year, we'll continue to look at more sizable M&A efforts. For right now, we're very focused on executing on what's in front of us.

Thanks.

Speaker 0

Yep.

Speaker 3

Thank you, ladies and gentlemen. We appear to have reached the end of our question and answer session. I would like to hand the call back over to Mr. Newton for any closing remarks.

Speaker 2

No, I just want to thank everybody for joining us today and appreciate it. Thank you very much.

Speaker 3

Thank you, ladies and gentlemen. This does conclude today's call, and you may disconnect your lines at this time. We hope you have a wonderful day, and we thank you for your participation.