RadNet - Earnings Call - Q1 2020

Transcript

Speaker 0

Good day, everyone. Welcome to today's RadNet Incorporated First Quarter twenty twenty Financial Results Conference. Today's conference is being recorded. At this time, I'd like to turn things over to Mr. Mark Stolper, Executive Vice President and Chief Financial Officer of RadNet.

Please go ahead.

Speaker 1

Thank you. Good morning, ladies and gentlemen, and thank you for joining Doctor. Howard Berger and me today to discuss RadNet's first quarter twenty twenty financial results. Before we begin today, we'd like to remind everyone of the Safe Harbor statement under the Private Securities Litigation Reform Act of 1995. This presentation contains forward looking statements within the meaning of The U.

S. Private Securities Litigation Reform Act of 1995. Specifically, statements concerning anticipated future financial and operating performance and liquidity, our response to and the effect of the expected future impact of COVID nineteen, our ability to stabilize and continue to grow the business by generating patient referrals and contracts with radiology practices, recruiting and retaining radiologists and technologists, consummating acquisitions and joint ventures, receiving third party reimbursement for diagnostic imaging services, successfully integrating acquired operations, generating revenue and adjusted EBITDA for the acquired operation as estimated among others are forward looking statements within the meaning of the safe harbor. Forward looking statements are based on management's current preliminary expectations and are subject to risks and uncertainties, which may cause RadNet's actual results to differ materially from the statements contained herein. These risks and uncertainties include those risks set forth in RadNet's reports filed with the SEC from time to time, including RadNet's annual report on Form 10 ks for the year ended December 3139 and our quarterly report on Form 10 Q for the quarter ended 03/31/2020.

Undue reliance should not be placed on forward looking statements, especially guidance on future financial performance, which speaks only as of the date it

Speaker 2

is made.

Speaker 1

RadNet undertakes no obligation to update publicly any forward looking statements to reflect new information, events, or circumstances after the date they were made or to reflect the occurrence of unanticipated events. And with that, I'd like to turn the call over to doctor Berger.

Speaker 3

Thank you, Mark. Good morning, everyone, and thank you for joining us today. On today's call, Mark and I plan to provide you with highlights from our first quarter twenty twenty results, give you more insight into factors which affected this performance, and discuss our future strategy. After our prepared remarks, we will open the call to your questions. I'd like to thank all of you for your interest in our company and for dedicating a portion of your day to participate in our conference call this morning.

Before we start, I just wanted to say on behalf of myself and the entire RadNet team. We hope that all of you are safe and your families are healthy and doing well. We know this has been a difficult and challenging time for everyone around the world, and we are extremely grateful for all of our stakeholders, including our employees, business partners, lenders, and shareholders. We are wishing you all of the best. Today's prepared remarks will be a bit of a departure from what we usually highlight during our financial results call.

This morning, Mark and I will focus on giving you an understanding of what we have been facing under COVID nineteen, the actions that we have taken to reduce costs and conserve cash, our current and projected liquidity position, our thoughts on our anticipated recovery, and some discussion around the post COVID operating opportunity. I'd like to start off by giving you a status update on where our business stands and how it has been impacted by COVID nineteen. After having strong operating results in January and February, months that performed ahead of our original internal operating plan, we began to see our volumes drop dramatically beginning the March. This is when we began to take swift and decisive decisive actions to sustain our business through a potentially prolonged period of time during which we could face a material drop in procedural volume. We analyzed all aspects of our business and focused on ways to most effectively reduce our cash spend.

We created a multipronged plan to impact major and cash flow categories. Specifically, we created a plan to reduce salaries and professional fees by 50% and lower our facilities rental payments by close to 70%. We investigated every local market in which we operate to identify centers we could temporarily close and where we felt with a high degree of confidence, we could direct patient volume to facilities that would remain open. We also evaluated our large categories of cash cash spend and identified vendors that would work with us to lower our costs or defer payments. Our goal was that by early April, we will have most of our cost savings and cash conservation measures instituted.

I am pleased to report that we have been successful in achieving this goal. First, we analyzed all of our 335 locations and identified sites in our clustered approach that could be temporarily closed and whose business could be consolidated into nearby facilities. By temporarily closing facilities and redirecting the patient flow to other RadNet sites who were able to save on employee costs, utilities, repairs and maintenance, and other center level operating costs, all while preserving the revenue we were going to recognize at the closed sites. Our clustering and geographically concentrated approach to market penetration has greatly helped us during this period. We have been able to close 97 of our locations, representing almost 30% of our facilities.

Our central scheduling departments have been effective in directing all patient flow to facilities that remain open. Temporarily closing these facilities has enabled us to furlough about 3,600 employees of our roughly 8,600 in our total workforce force. The furloughed staff remains employed by RadNet, and we continue to fund their benefit plans and health care expense. However, we have ceased paying their salaries and corresponding employee taxes, and these employees are eligible to collect unemployment benefits from federal and state funded programs. We are in frequent communication with these furloughed employees, and we are committed to bringing them back to the work in a methodical way as soon as our volume allows us to gradually reopen our facilities.

In addition to the furloughs, we cut the salaries of the vast majority of non center level employees who remain working. These cuts were led by our executive management team and salaried physicians who are taking 50% reductions in their salaries. Below the executive management level, salary reductions range from five to 25%. As a result of these actions, we have met our goal of a 50% decrease of our salaries and professional fee expenses and associated cash burn. Our landlords have also greatly contributed to our cash conservation measures.

Most of our landlords have agreed to three to six month full or partial deferrals of rent payments, and most are providing a six to twelve months to repay these deferrals. As a result, our cash expenditures for rent payments in the second quarter has been reduced by almost 70%. Additionally, all of our lessors lessors with whom we have operating leases on equipment, including OEMs and third party finance companies, have agreed to restructure rental payments to let us to allow us, starting with the payment we would have made in April, to defer six payments and add these amounts to the back end buyout of the leased equipment. Additionally, we have suspended all new capital projects. The vast majority of capital expenditures we will make during the remainder of the year are either for capital equipment already delivered to the company or construction that was substantially completed prior to April for which we currently owe money.

In addition to the traditional fixed cost and cash outflows, which I have discussed, rental, rent, employees, etcetera, our variable expenses have also decreased with the lower procedural volumes. The most significant of these variable outflows are payments we make to our third party contracted radiology groups, which generally are a function of revenue and procedural volumes. We typically pay our third party rally groups in the neighborhood of 15 to 20% of our cash collections to interpret our exams. As a result of lower payments from RadNet, our contracted groups have taken actions to manage their staffing levels and control their own costs. We have remained in close dialogue with all our contracted radiology groups and are confident that they, like RadNet, are all taking the appropriate measures to ensure their health and survival through the COVID nineteen environment.

Each contracted group has a plan to restack our facilities as appropriate when revenues and volumes begin to return to normal levels. Other variable expenses that have adjusted the revenues and procedural volumes include medical and pharmacy supplies, utilities, equipment repair, and maintenance, and certain employee related expenses such as travel, meals, and other employee expense reimbursement items. All these expenses and cash outflows have now adjusted more than proportionate to our lower procedural volume levels. Contributing to our strong liquidity position, the payments we received subsequent to the end of the first quarter under the CARES Act and from Medicare. Specifically, we received almost $15,000,000 under the first 30,000,000,000 appropriation of the Corona's Aid, Relief, and Economic Security Act or CARES Act.

This allocation to RadNet was calculated based upon our share of overall Medicare billings relative to all Medicare providers during 2019. Subject to our compliance with future reporting requirements, we do not anticipate being required to repay this money. A second 20,000,000,000 appropriate appropriated under the CARES Act was announced two weeks ago. We we were asked by CMS to submit tax returns evidencing our overall collections during 2018, and we believe there may be additional allocation to us from this $2,020,000,000,000 dollar appropriation that could be based on our proportion of the overall annual US health care spend currently estimated at about $2,600,000,000,000. At this time, it is too early and speculative to estimate the amounts we may receive.

We should have more information about this appropriation in the coming weeks. In addition to the grant, already received under CARES Act. We received almost $40,000,000 in accelerated Medicare advanced payments. This money is to be repaid to CMS in getting a hundred and twenty days at from its receipt and shall be repaid through the adjudication of future Medicare services we provide over a three month period. We anticipate this money to be substantially repaid during the fur third and fourth quarters of this year.

So how bad did our volumes get? And where are our procedural volumes today? As I mentioned earlier, volumes began to dramatically decline by the March. They continued to decline as more states and local municipalities adopted stay at home orders and related policies. Our volumes hit a trough during mid April, whereby we were down almost 85% on the East Coast and 65% on the West Coast relative to our original operating budget.

The New York Tri State area was impacted the hardest, while California's impact was and has been less. I'm very happy to say that our volumes have materially improved over the past several weeks whereby our procedural volumes are down on a blended East and West Coast basis about 40% as of today. We expect this to improve as stay at home orders are lifted. Already, governors in several stages in which we operate are allowing for non emergent medical procedures to be performed. One thing I should mention in regards to the impact on procedural volumes and revenue from COVID nineteen is that our capitation business has really been a bright spot.

Because under our capitated arrangements, we get paid a fixed amount for enrolling managed by the medical groups with whom we capitate, our capitation revenue and the associated cash flow has remained constant during the COVID nineteen period, despite being required to perform fewer services for these patient populations during this period. Enrollment for these HMO patients with our contracted medical groups has remained intact, as patients and their employees, even for those who have been furloughed, have continued to pay health care premiums. The predictability of this capitated revenue and cash flow has benefited us more than ever before during this period. Before I turn the call over to Mike to discuss the financials, I just like to take this moment to recognize our workforce. The real heroes from RadNet have been our several center level employees and their managers who continue to come to work each day to service our medical communities and patients in need.

To keep our patients and employees safe, we instituted new operating protocols. These include added viral waiting room capabilities excuse me. Virtual waiting room capabilities, which allow patients to be called or texted for their exam when they while they sit safely in their cars. We have also provided personal protective equipment for all employees and patients and have created a sterile environment as possible. I am certainly grateful that these employees and RadNet as a company can play an important role in an unprecedented time.

I look forward to bringing back our furloughed workforce and reopening our closed facilities as increasing patient volume dictates. At this time, I'd like to turn the call back over to Mark to discuss some of the highlights of our first quarter twenty twenty performance. Performance. When he is finished, I will make some closing remarks.

Speaker 1

Thank you, Howard. I'm now going to briefly review our first quarter twenty twenty performance and attempt to highlight what I believe to be some material items. I will also give some further explanation of certain items in our financial statements as well as provide some insights into some of the metrics that drove our first quarter twenty twenty performance. In my discussion, I will use the term adjusted EBITDA, which is a non GAAP financial measure. The company defines adjusted EBITDA as earnings before interest, taxes, depreciation and amortization and excludes losses or gains on the disposal of equipment, other income or loss, loss on debt extinguishments and non cash equity compensation.

Adjusted EBITDA includes equity earnings in unconsolidated operations and subtracts allocations of earnings to non controlling interest in subsidiaries and is adjusted for non cash or extraordinary and one time events taking place during the period. A full quantitative reconciliation of adjusted EBITDA to net income or loss attributable to RadNet, Inc. Common shareholders is included in our earnings release and our current report on Form eight ks filed with the SEC. With that said, I'd now like to review our first quarter results. For the first quarter of twenty twenty, RadNet reported revenue of $281,600,000 and adjusted EBITDA of $20,400,000 Revenue increased $10,000,000 or 3.7% as a result of the contributions from Kern Radiology and Zylka Radiology, a slight business shift in favor of advanced modalities and increases in reimbursement from capitated and fee for service payors.

The increase in aggregate revenue was net of a 3.3% decline in same center volumes and a 0.6% decrease in aggregate volumes. Adjusted EBITDA decreased 12,700,000 or 38.5%. This was primarily due to the impact of COVID-nineteen particularly on our same center performance. We estimated that our revenue was reduced by COVID-nineteen by estimated $25,000,000

Speaker 0

during the quarter

Speaker 1

and revenue EBITDA was reduced by approximately $14,000,000 For the first quarter of twenty twenty, as compared to the prior year's first quarter, MRI volume increased 1.2%, CT volume increased 3.4%, and PETCT volume increased 4%. Overall volume, taking into account routine imaging exams, inclusive of X-ray, ultrasound, mammography and all other exams, decreased 0.6% from the prior year's first quarter. In the first quarter of twenty twenty, we performed 1,862,498 total imaging procedures. The procedures were consistent with our multimodality approach, whereby 76.5% of all the work we did by volume was from routine imaging. Our procedures in the 2020 were as follows.

Note that the CT volumes for last year have been restated to account for a change we made as of January 1 in how we account for one of our CT CPT codes. The comparative numbers that follow are on an apples to apples basis. 02/3055 MRIs as compared with 259,912 MRIs in the first quarter of twenty nineteen. 163,082 CTs as compared with 157,679 CTs in the first quarter of twenty nineteen. 10,683 PETCTs as compared with 10,273 PETCTs in the first quarter of twenty nineteen.

And 1,425,678 routine imaging exams, inclusive of x-ray, ultrasound, and mammography, and all other exams, as compared with 1,444,425 of all these exams in the first quarter of twenty nineteen. Net loss for the 2020 was $16,400,000 or negative 33¢ per share compared to a net loss of $3,700,000 or negative $08 per share reported for the three month period ended March 3139. This is based upon a weighted average number of shares outstanding in the first quarters of 50,300,000.0 shares in 2020 and forty nine point six million shares in 2019. Affecting net loss in the 2020 were certain noncash expenses and nonrecurring items, including the following: $6,600,000 of noncash employee stock compensation expense resulting from the vesting of certain options and restricted stock 218,000 of severance paid in connection with headcount reductions related to cost savings initiatives, and $1,100,000 of non cash amortization of deferred financing costs and loan discounts related to financing fees paid as part of our existing credit facilities. Overall GAAP interest expense for the 2020 was $11,600,000 This compares with GAAP interest expense in the 2019 of $12,300,000 The lower interest expense results mostly from a lower LIBOR rate relative to last year's first quarter.

Cash paid for interest during the period, which excludes non cash deferred financing expense and accrued interest, was $9,900,000 as compared with $10,300,000 in the first quarter of last year. With regards to our balance sheet, as of 03/31/2020, unadjusted for bond and term loan discounts, we had $686,600,000 of net debt, which is our total debt at par value less our cash balance. This compares with $679,200,000 of net debt as of March 3139. Note that this debt balance includes New Jersey Imaging Network's debt of approximately $57,600,000 for which RadNet is neither a borrower nor a guarantor. As of 03/31/2020, we were, drawn $80,000,000 on our $137,500,000 revolving line of credit and had a cash balance of $94,300,000.

Since quarter end, we have repaid our revolver in full and as of April 30 had a cash balance of approximately $50,000,000 As Doctor. Berger mentioned in his prepared remarks, we believe we have little to no cash burn through the end of the second quarter and we believe that the cost savings and cash conservation measures we have put in place may result in our being undrawn on a revolver at year end and with a meaningful positive cash balance. Although we do not believe we need to raise any additional capital at this time, we will continue to evaluate government funding options such as the Main Street expanded loan facility should we determine it would be in the best interest of our stakeholders to substantially increase Although our cash reserves. At 03/31/2020, our accounts receivable balance was $144,200,000 a decrease of $10,500,000 from year end 2019. The decrease in accounts receivable is mainly the result of the dramatic decline in our procedural volumes and revenues in the March, partially mitigated by the longer collection cycle we experienced in the first quarter from the resetting of patient deductibles as of January 1.

Our days sales outstanding or DSO was 43.9 at 03/31/2020, lower by approximately zero point eight days as of year end 2019. Through 03/31/2020, we had total capital expenditures net of asset dispositions and sales imaging center assets and joint venture interests of 50,800,000 Note that each year, we front load the majority of our capital decisions into the first quarter. So CapEx is disproportionately higher in the first half of the year. Most of what we paid for during the first quarter was for equipment delivered to the company or construction projects that were substantially completed before April 1. As doctor Berger mentioned in his remarks, we have suspended all new capital projects the remainder of the year.

With respect to Medicare reimbursement for 02/2020, there is nothing to report at this time. As is typical each year, we are expecting CMS to release a preliminary rate schedule sometime in June or July, at which time we will analyze CMS's proposal, our industry's lobbying group, the Association for Quality Imaging, will provide CMS our industry's feedback. At the time of our second quarter financial results call, we will be in a position to comment on CMS' proposal and its impact, if any, upon RadNet's future results. I'd now like to turn the call back to doctor Berger, will make some closing remarks.

Speaker 3

Thank you, Mark. From adversity often comes opportunity. While COVID nineteen has impacted us and everybody else in a very different way, it can also be the catalyst for opportunity. I strongly feel this has been and will continue to be the case for RadNet. First, COVID nineteen has caused us to analyze everything we do as a company and evaluate how we deliver our services on what we spend money, how we spend our money, and how we could improve what we do.

Through this process of identifying ways to lower expenses and conserve cash, I believe I believe we have learned things that will change the way we deliver our services and how we manage our business in the future. Without getting too specific, I believe that in a post COVID environment, we can reduce what we have historically been spending on employee travel and other employee reimbursed expenses. I believe that we will be able to staff our centers in supporting general and administrative functions I believe that we will be able to procure medical supplies, equipment service, and perform general and administrative functions at a lower cost. I also believe that our entire executive management team will benefit from the experience of managing through this very trying period.

In addition to improvements in the way we can manage RadNet in the future, I also believe that the post COVID environment will provide us opportunities to accelerate our growth. As difficult as this period has been for the RadNet, small operators have had an even more challenging time. Most of our competitors are small radiologist owned operators who lack the scale, capital, and human resources to emerge from the COVID nineteen period with the same financial and operating strength than that we will. As a result, we think that there will be more m and a opportunity for us in the post COVID period at multiples that will more align with the prices we have paid in the past. Furthermore, for the couple of months, hospitals have focused on COVID nineteen and other very acute patients.

This will continue for some will continue for some time. The vast majority of outpatient business that historically has been performed within the hospitals prior to COVID nineteen has shifted to the ambulatory providers such as RadNet. This means that patients and the referring physicians will become accustomed to using outpatient providers, and we don't believe this business will be recaptured by a hospital for some period of time. Ambulatory patients will likely feel more comfortable and safer being directed into freestanding alternatives to hospitals. This could have a material impact on our volumes in the future and could accelerate the existing trend, mostly because of the differential in cost of hospitals losing outpatient business to ambulatory freestanding providers.

The acceleration of this trend could also drive more hospitals towards joint ventures and partnerships, which now represents over 25% of all RadNet facilities. Additionally, during this COVID nineteen period, telehealth and telemedicine has flourished. I believe this will continue in the post COVID era. More patients will be availing themselves of telemedical services in the future, and I believe this will be beneficial for RadNet. Because telemedicine does not allow for the traditional physical exam, I believe physicians will order more diagnostic tests and rely on their results for diagnostics and treating their patients at a distance.

In particular, I believe this will drive increased utilization of routine imaging, specifically ultrasound and x-ray, as tools that will be utilized earlier in the patient diagnostic staging. Furthermore, I believe in the post COVID environment, artificial intelligence will have an even more important role in health care and population health. Artificial intelligence will be used for identifying high risk patients for certain chronic diseases, including cancer, diabetes, or ailments that could make them more susceptible to or at risk from future viruses like COVID nineteen. In the post COVID nineteen era, there will likely be more of an emphasis on screening tools and wellness. Diagnostic imaging will play a critical role in these initiatives.

So even in this challenging time, we have caused to be very optimistic about the future of RadNet. RadNet will weather the storm similar to our experience with the credit crisis and recession beginning in 02/2008, and we expect to emerge as a stronger and better positioned company in our industry and health care in general. Operator, we are now ready for the question and answer portion of the call.

Speaker 0

We'll hear first today from Brian Kinquillet with Jefferies.

Speaker 4

Hey. Good morning, guys. Hope everyone's doing well. Howard, I guess my first question for you, and you kinda alluded to it. But as as we think about 2021, you know, once we get past COVID, it seems like, you know, we're starting to see a a restart or re reignition of, you know, hospital volumes and and making business.

So as I think about, you know, getting past this and assuming that we don't see a second wave, how are you thinking about 2021 in terms of, let's say, earnings power or, you volume trends versus where you were, let's just say, you know, early March?

Speaker 3

Good morning, Brian. Hope you're well and safe. Sounds like you are. Thank you for the question. As I mentioned in my closing remarks, I think we'll all be facing a new definition of normal.

And because of the in the post COVID period, which could easily, in some respects, last into 2021, particularly with the concern about the development of a vaccine. I believe a lot of the measures and safety procedures will have

Speaker 1

to be

Speaker 3

continued. In that regard, I think more and more patients will look to ambulatory outpatient providers as opposed to going to hospitals for those services. So in that respect, the initiatives often spoken about by the health care insurers trying to direct patients away from hospitals primarily because of differential in reimbursement. They now be heightened because of perceived and probably realistic additional safety measures. I think that the other thing that that this crisis has really indicated is the need for better population health and management.

The the crisis has certainly focused on areas of the health care delivery system, were inadequately prepared for the patients that got very sick and needed to be hospitalized and had shortages of PPE and clean ventilators and other measures along with sufficient ICU beds and isolation capabilities. But going forward, I think the ability to assess the population health and manage wellness will help reduce the burden on hospitals and make the ability to respond to crisis even easier. Where I think, interestingly enough, the outpatient imaging industry fits into this is in the recovery process and reopening towards looking at 2021. As patients begin to get their toes back into the water reopening the economy, we're better for our patients and the population to feel comfortable than going to outpatient health care providers. Both know how to manage the safety and mitigation risk that they will see in their office in their offices, as well as the need to take advantage of what was delayed health care that can only lead to more cost and more morbidity and mortality in the future.

It's interesting that just today, an article in the prestigious journal Cancer identified in particular that the risks of mortality for breast cancer in a study that was overseen by Rosal Tavar in Sweden, one of the most respected mammographers in the world, that they saw a forty one percent decrease in mortality from breast cancer as a result of screening mammography. The fact that we have had a lot of delayed elective mammograms being put off will only mean that the longer that goes, the more likely that there will be increased after cost and morbidity from this. And that's not just in breast cancer, but all forms of other diseases and cancer. So I believe this heightened awareness will help us and will, I think, cause a refocus by everybody, whether it's health health care insurers, physicians, and public health officials to look at outpatient ambulatory services and particularly imaging as a critical role in managing managing the health care of our population.

Speaker 1

Now that that makes a lot of sense. Howard, one one of the things

Speaker 4

that you mentioned in your prepared remarks that kinda piggybacking off of your promises made with a few seconds ago. I wanna do accelerate geology. You know, clearly, there is a shift or that's happening, and that we're probably sick, you know, from physician's offices to sell it telemedicine in in some cases. Right? So whether that's a teledoc or just a doc practice using either their own platform or or just using Zoom and and FaceTime, How are you or how do you have to change your marketing strategy?

Or, you know, do you have to partner with someone like a CellDoc or an Amwell to make sure you capture the volumes there and also not to lose the share that you have with your existing doctors who are leaving their offices to, go virtual?

Speaker 3

I I think that, the role of imaging will be heightened, in this period because as doctors do more telehealth, the need to perhaps get some of these diagnostic exams sooner since they will be unable to do typical physical examination, use their stethoscopes and other tools, may be best to go ahead and send these patients to the outpatient, imaging providers, rather than have the patient make, another visit into their offices only then to require, the diagnostic imaging test. That along with the fact that, radiology has been a very early adopter of telehealth by using its PACS systems to be able to use the imaging in remote way will be enhanced by things like artificial intelligence and other technologies that are evolving inside of imaging to provide more targeted and specific diagnostic capability. That along with, I think, the emergence of some of the pharmacies that will be looking to do some of their early patient management and visits in their pharmacies, we believe will also align us with some of these groups to help provide that kind of screening capability on a mass level that has not necessarily been part of the pattern in the past.

So I I think all of these changes, some of which will occur as a result of technology and some of them which will occur simply because of changing patterns of delivery will be of enormous benefits to RadNet in the future. Brian, to to

Speaker 1

to to expand a little bit more on what doctor Berger was saying, a lot of the telehealth that we're seeing today is from local physicians who, you know, have physical, practices who are trying to service their patient base by doing appointments, you know, via technology. And so those are physicians that we already have a relationship with in our local markets who are familiar with our centers, are referrers, you know, have been referrers of ours in the past and will continue to be in the future. Those are, from a marketing perspective, those are targets of our, marketing representatives. But to your point, you know, to the extent that medicine is going be delivered by, you know, more centralized, teledocs that may not be actually physically located in our markets, then we're going to need to establish some of those relationships with those larger companies like two that you mentioned, so that they're aware of the services that we provide, and, you know, our quality and our access in the markets where their patients, you know, may reside, which are, you know, which could be very different from where the doctor is located. So it will ultimately require us to have relationships with some of these larger centralized physician practices.

Speaker 4

That makes sense. And then last question for me, Mark. You know, you paid down your revolver after the quarter. You know, obviously, I I know you were you did a good job preparing the company for the worst case scenario thinking that, you know, you you had enough cash even if all you put down the April levels for for a year. Right?

So what was the mindset behind paying it down as soon as you did given, you know, what could be viewed as ongoing uncertainty related to COVID?

Speaker 1

Sure. Sure. Well, some of the benefit of of living through the credit crisis, you know, back in 02/2010 time frame was that, you know, there there there was a liquidity crunch at the time and companies were extremely concerned with their banks' abilities to fund committed revolvers. And and if you remember at that time, there were a number of banks that, were unable to fund or unwilling to fund, revolvers that were committed at the time, and that created serious liquidity problems, for companies during that period of time. When this, when the COVID, period started, we were concerned with, you know, the stability of the banking system.

We were, unaware at that time of of how, effective the federal government was going to be, with, providing liquidity in the banking institutions and and and and backing up the banks that they needed, further liquidity. And so we pulled down, and you can see at at quarter end, we were $80,000,000 drawn on a revolver, not because we needed the money, but because we were concerned with our ability to access that capital if something were to happen in the banking system. As the federal government has provided, you know, tremendous liquidity into the marketplace, our concerns about our ability to access our revolver, went away. And so we decided to pay back, you know, the remaining balance on our, on our revolving line of credit, partially because we didn't wanna pay the negative carry on the interest expense, and we had confidence that we we would be able to tap that liquidity should we need it in the future, which, by the way, I don't think we will.

Speaker 4

Got it. Alright. Thanks, guys.

Speaker 3

Thanks, Brian.

Speaker 0

Brian. We'll hear next from Mitra Rambopal with Sidoti.

Speaker 2

Yes. Hi. Good morning. Thanks for taking the questions. Just wanted to follow-up on liquidity.

Clearly, the cash conservation was a primary focus as a result of COVID nineteen and given that things have stabilized. I know, Howard, you've said indicated you're seeing some m and a opportunities that might not have existed before. I'm just trying to get a sense in terms of the thinking behind the cash conservation versus maybe pursuing some m and a opportunities?

Speaker 3

Well, I think cash conservation and keeping our liquidity is of the foremost concern. And based on our projections through the end of the year, we're quite comfortable that that liquidity will be quite substantial and perhaps the best in the company's history. Part of that will be watching the return of our volumes and making certain that we balance our costs, such as salaries and other spending to measure it with the increase in volume and not get, to use an expression, too far over the tips of our schemes where we get concerned again about liquidity. So over the next the balance of this quarter and going into the third quarter, to the extent that our liquidity maintains the levels that we projected through the end of the year, we will then be judicious in looking at acquisitions that may, in fact, help us further enhance our strategy in the markets that we're in. Perhaps expand joint ventures with our hospital partners.

And maybe even if they're properly acquired, be further deleveraging for that for us. I also wanna add one other comment to Mark's discussion about liquidity. We are also gonna be benefiting and and have started immediately from lower cost of borrowing. Our our big debt for our credit facility is a LIBOR based borrowing with a 1% floor prior to the or subsequent to the first quarter, that borrowing was well above the 1% floor, which caused us which caused us a much higher interest payment that we made in early April. Since then, we have elected LIBOR borrowing, which we believe through the balance of this year will be well below the 1% and probably will be a cash flow savings to the company of perhaps $5,000,000 for the balance of this year.

So all of those will get factored into our overall cash management as it always does, but with more of a, an eye on making certain that the volumes which we expect and are already seeing, beginning to return, are are used to measure our liquidity and cost conservation. So that being said, we're always looking and are always approached about acquisitions and new joint ventures. And we will use basically our cash liquidity as the benchmark as as to the wisdom of doing some of these new acquisitions and joint ventures.

Speaker 2

Okay. That's great. Thanks for the color. Also, just on the I think you'd mentioned there are about 70 locations that were temporarily closed. Just wanna get a sense as to when you think you might be able to reopen all of those facilities or locations, or do you anticipate maybe some may not

Speaker 1

be reopened?

Speaker 3

Actually, the number of facilities, Mitra, is closer to a 100. It's 97 that are closed as we speak right here. We will continue we we don't anticipate at this time closing permanently any of those facilities. All those facilities were necessary before COVID nineteen based on access, and, based on the volumes that, we produced. Since we expect those volumes will eventually return and access in our markets are extremely important for the payers and our physician referrers, we expect to keep virtually all of those centers open and bring back all of our full employees in a very measured way over the next ninety to a hundred

Speaker 1

and eighty days. We're monitoring volume by center and to the extent that any center or any market starts having backlogs because the demand starts coming back for, you know, for these types of diagnostic services, we'll start opening, methodically, centers one by one to try to fill that demand, you know, up up to the point where there's a full recovery. So we're going to do it on a center by center basis, but it's based upon the volumes that we're seeing in our imaging centers.

Speaker 2

Okay. That's great. And I believe you you mentioned you'd on the capitation and future service, you did see some price increasing in the first quarter. Just wondering if you can give us a sense of how meaningful that was for you.

Speaker 3

Well, some most of these increases were already contractually provided for. We had a series of renegotiations of our capitation arrangements in 2019. And throughout this year, we will be seeing increases as the anniversary dates of those contracts occur. And going into this year, the overall increases that we've experienced so far are probably in the five to 6% range. And through the remainder of this year, we expect another perhaps two to 3% increase in our capitation rates spread out through the remainder of this year.

Speaker 2

Okay. Thanks. And then finally, just back on the expansion plans, if you can give us an update on the where we are on the DeepHealth acquisition and also on the Pulsar Pro installations. I assume those are probably going at least on the Pulsar Pro that might be delayed given the environment.

Speaker 3

Yes. I think the Pulsar projects are delayed not so much because we want to delay them, but simply because until the more nonemergent work increases, particularly as a result to prostate cancer and the urologist and other specialists that that see these patients begin to ramp up. Clearly, will have a delay in that. But we're very enthusiastic about the TULSA project and prostate cancer in general, which we believe in the upcoming perhaps twelve to eighteen months, may evolve into similar to mammography, more of a screening procedure that we believe can be performed on a mass population basis rather than just waiting for individuals to have signs indicative that they might have prostate cancer. So a lot of our focus both in terms of artificial intelligence as well as conversations with the payers to revisit prostate as, and perhaps transition it into a screening tool along with other areas like colon cancer and lung cancer, will be a major focus for us going into the latter part of this year.

Speaker 2

Okay. Thanks for taking the questions.

Speaker 3

Thank you, Mitra. Stay safe.

Speaker 0

And from Raymond James, we'll hear next from John Ransom.

Speaker 1

Hey. Good morning. What are you doing, if anything, on your your intake? It seems like people probably don't wanna be hanging around and and, you know, waiting to get scanned. Can you do anything to, do more real time patient sequencing so that we're not, having people sit in waiting rooms, or is that something, down your list of things to do?

Sure. One of the things that we've instituted, which is, something that we are contemplating continuing into, you know, into the future, potentially permanently are virtual waiting rooms so that patients are able to check-in, fill out, the intake forms digitally, either on their phone or if or we can give them an iPad and then go back to their cars and sit in their cars, you know, in isolation. And then we're able to text them or call them at the time of at the time of their appointment so that they're not waiting in a crowded waiting room with other patients, you know, and and and, you know, are not associated with any risk because of that. So that's been the biggest operational change that we had, you know, in our in our waiting rooms, and it's been met with with high success and and has been applauded by our patients.

Speaker 3

In addition to that, John, other measures that we're taking, once patients are in our facilities, of course, all of our employees will be masked and gowned, have gloves. We're putting in shields that are from vast plastic shields, to further separate, the the patients from our employees. In addition to the virtual waiting rooms, we're, very much person on remote scheduling and registration so that patients have to spend less time in our offices. And I I I wanna applaud our IT division, ERAD. This is another one of those cases where owning our own IT infrastructure allows us to make these kind of adaptations to the way we wanna run our business on a real time basis rather than having to wait for some vendor to come up with it.

In addition to that, we're also gonna be scheduling our patients differently so that there is more time in between patients for us to, you know, clean the rooms and make certain that there's less and less interaction between other patients. So I think all of the measures that that we uniquely can do and that health care providers in particular should be doing may allow outpatient imaging to be a very good barometer of the comfort level of reopening some of our communities for patients coming out and feel comfortable that it's time to get back to more normal functioning.

Speaker 1

Great. My other question, kind of shifting gears a little bit, is, at what point I know you're not gonna run out and go do a big deal tomorrow, but at what point do you think you'll be able to model 2021? If if you're looking let's say somebody comes to you and wants to tell you a bunch of centers, when do you think you'd be comfortable saying, yeah. We think we have a handle on 21 numbers, and and we know what would pay for this asset.

Speaker 3

I think we're gonna be able to look at 2021 when we get deeper into the third quarter. Our projections for the balance of this quarter and the third quarter shows some relatively conservative ramping up of patient volumes and revenue. Mhmm. And that by the fourth quarter, we hope to not be all the way back, but certainly well on the way to approaching our more expected the volumes. So I would think that if we either meet or exceed the projections that we have for the balance of the second quarter and then getting deeper into the third quarter, I realized it will help us in early preparation for our 2021 budget.

So I think from the standpoint of monitoring the the company, looking at our second quarter results would be extremely important as well as obviously when we can issue our third quarter results.

Speaker 1

And and then thinking about capital, you are, you know, you're heavily concentrated in a couple of states, you know, California, New York that are probably gonna be on the conservative end of opening up. Is is that a is a political risk something if you think about it? Is that is that a consideration when you're looking at maybe we look at a couple states that that don't have don't have, you know, that type of governance or or not really?

Speaker 3

Well, actually, California is leading the way, I think, both on a national scale and certainly by our own numbers in not having seen the same level of decrease in volumes and proceeding more rapidly in the recovery than the East Coast. So I think the California experience is one that has been particularly gratifying and is also the one where we have the most majority, 90 plus percent of our capitation revenues. All of the medical groups that we capitate with are starting to reopen their offices actually this month. So we expect those volumes to go up. And when we talk about capitation, I wanna remind everybody that all of our medical groups see fee for service patients in addition to the HMO capitated lives and are very much a harbinger of where our overall volumes will be.

So at least in California time, we expect to have a much more rapid recovery. And I I think the effectiveness of both the governor of California and the mayor have been successful in reducing the spread of the virus and certainly the numb the number of fatalities. New York is a little bit more New York and Northern New Jersey are a little bit more of a wildcard simply because of the density of the population, the requirement for public transportation. But governor Cuomo and governor Murphy, I think it is, in New Jersey, if I'm quick Right. Have done an excellent job of bringing that down.

And I'm very happy to see that our volumes, which had dipped down to almost 90% reduction in in New York, have begun a nice steady recovery over the last ten to twelve days. And I suspect that as the shelter at home and we in phase one get introduced here probably the end of this week, we will expect those businesses, that business in those regions to increase. As far as our two other major markets, Delaware and Maryland, I'm happy to report that last week the governor of, Maryland, opened up, the non emergent procedures, particularly, mammography to be reinstituted. So we expect to see a fairly aggressive increase in screening mammography, which only got further emphasized in terms of its importance with the article that came out in the journal Cancer Today, was very you know, for RadNet that has over 20% of its volume in mammography, particularly gratifying.

Speaker 1

Great. That's it for me. Thank you.

Speaker 3

Alright, John. Take care. Stay well.

Speaker 0

And gentlemen, with no other questions, I'd like to turn things back to you all for any closing remarks.

Speaker 3

Again, I would like to take this opportunity to thank all of our shareholders and stakeholders for their continued support and the employees of RadNet for their dedication and hard work. Management will continue its endeavor to be a market leader that provides great services with an appropriate return on investment for all of our stakeholders. Thank you for your time today. I look forward to our next call. Stay well and be safe.

Speaker 0

And again, that will conclude today's conference. Thank you all for joining us.