TruBridge - Q4 2023
February 29, 2024
Transcript
Operator (participant)
Ladies and gentlemen, please stand by. The conference will resume momentarily. We thank you for your patience. Ladies and gentlemen, we thank you for your patience. Our event will now resume.
Chris Fowler (President and CEO)
Yeah, this is Chris. We're going to go back to Vinay starting at the beginning of guidance. So we just wanted to make sure that we went ahead and put him straight into the fire. So here we go.
Vinay Bassi (CFO)
Thank you. Moving to our guidance, first, in an effort to improve our transparency, we will begin providing guidance for the upcoming quarter starting today. For the first quarter, we expect revenue to be in the range of $82 million-$84 million, Adjusted EBITDA to be between $8.5 million and $9.5 million. For the full year 2024, we expect revenue of $340 million-$350 million, Adjusted EBITDA to be $45 million-$50 million. I want to give you a little insight into our thought process and assumptions that went into this year's guidance. Firstly, we have assumed impact of AHT in the guidance. In other words, the guidance assumes only 15 days of AHT in Q1. As a point of reference, AHT accounted for approximately $16 million in revenue in 2023, with approximately $2 million a contribution to Adjusted EBITDA.
Secondly, a full year of Viewgol is included in these numbers. For 2024, we expect revenue of less than $20 million, with an approximately $4.5 million contribution to Adjusted EBITDA. Starting with bookings, we took a conservative approach for the full year and assumed 2024 will be relatively flat compared to last year, excluding AHT and Viewgol. In terms of quarterly cadence, we expect the first quarter to be the lowest of the year and then build as the year progresses. That said, please keep in mind that bookings are lumpy. The midpoint of our annual revenue ranges implies 6.5% growth, excluding AHT from 2023, and that will be primarily driven by organic growth in our RCM business and the full year contribution from Viewgol.
Last year, RCM including Viewgol in Q4 accounted for 57% of our total revenue, and this year we think could be about two-thirds of total revenue. We are forecasting our EHR business to be relatively flat, excluding the impact from sunsetting of our Centriq platform. I also want to provide further detail on how we anticipate EBITDA margins to progress over the year. The first quarter will be our lowest EBITDA margin in 2024 at approximately 11% based on the midpoint of our quarterly guidance range. This is because we have just begun ramping our global workforce and therefore have some duplicated costs during the initial transition to ensure continuity for our existing customers. We expect the second half to have higher EBITDA margins to reflect the benefits from already negotiated vendor savings, savings from ramping the offshore workforce, and expected first half bookings converting to revenue.
I have been conservative to not include any other future cost savings initiatives in our guidance that we have initiated as part of cost rationalization and capital allocation strategy. These initiatives are in the preliminary stages but include a review of overall cost structure relating to vendor spend, G&A including real estate, and CapEx spend. We could see benefits in the second half, but there are too many moving parts as it relates to the contribution from the offshore transition, along with other factors, to count them in the financials for now. I'd like to close out my first call by thanking Chris and the rest of the CPSI team for a warm welcome to the company and a great first couple of months.
I'm excited to help CPSI successfully capitalize on the many opportunities that lie ahead of us, and I look forward to getting to know many of you in the coming weeks and months and keeping you updated on our progress as the year unfolds. With that, I will open the call up to questions.
Operator (participant)
Thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate that your line is in the queue. You may press star two 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 star keys. One moment, please, while we pull for questions. Our first question comes from Jeff Garro with Stephens Inc. Please proceed with your question.
Jeff Garro (Managing Director, Healthcare IT Equity Research)
Yeah, good afternoon. Thanks for taking the questions and welcome to the call, Vinay. Want to ask about margins in 2024. Would expect Viewgol and further offshore leverage, as well as potentially some reduced R&D following the post-acute divestiture, to be accretive to margins. So could you discuss those in some more detail and also any potential offsets that have you landing at those roughly flat EBITDA margins at the midpoint of the guidance year over year? Thanks.
Vinay Bassi (CFO)
Thank you, Jeff. First of all, I'm excited and looking forward to building this relationship with all of you. You're absolutely right. It looks like a flat margin, and all the reasons you outlined are also factored in. But there are a big couple of big offsets that I would highlight. One is our budget for 2024 will be based at full bonus. So compensation-related expense adds a significant portion, and this compensation is bonus accrual as well as merit increase. That offsets most of these gains right now. And barring that, then obviously we had smaller increases from the full-time impact of the hirings that we had done in the second half of 2023. Full year impact is felt in 2024. So these are investments in support technology and sales and marketing.
Jeff Garro (Managing Director, Healthcare IT Equity Research)
Got it. That helps. And you stepped back a bit and throw one out there for Chris. You've done the Viewgol acquisition. You've divested the post-acute business. Curious if we should think about potential for additional strategic moves to come, or do you now have the platform that you want to grow and drive leverage across?
Chris Fowler (President and CEO)
You know, I think it's a super fair question. And I would say right now for 2024, we've got a full plate and we're looking to execute. And so we were excited about obviously getting the Viewgol deal done at the end of last year. Excited about the AHT divestiture, creating the additional focus there. And right now, top of mind for us is continuing to drive sales and revenue growth and really capturing the value of the Viewgol workforce transformation over the course of this year. And going back to that margin question, you can look at. I'm excited about the fact that we're providing the quarterly look-ahead guidance, which allows a bit more visibility for you guys as we're continuing to march through this transformation.
You can also tell just from TruBridge looking at Q1 over the course of the year, there's a pretty steady ramp as that margin grows as we continue to execute on the offshore workforce.
Jeff Garro (Managing Director, Healthcare IT Equity Research)
Excellent. I appreciate that. One last one from me before I jump back in the queue, but want to make sure we hit bookings and saw the nice finish to the year. Could you help us think about the pipeline from here and where our expectations should be for bookings in 2024?
Chris Fowler (President and CEO)
Yeah. We were definitely thrilled to see the rebound that we had in Q4 over Q3. We continue to remain cautiously optimistic. I think the trap we fell into last year, Jeff, was getting a little over our skis with and I know we've talked about this throughout the year of how quickly this market was going to unlock. So if you look at our guidance, I think that we've taken a very measured approach at how the bookings contribution has impact over the course of the year. With that said, the pipeline continues to be strong. We're continuing to have the same great conversations with customers and seeing those pick up both in our existing customer base and with our outside of the EHR.
Jeff Garro (Managing Director, Healthcare IT Equity Research)
Great. Thanks again for taking the questions. I'll hop back in the queue.
Operator (participant)
Our next question comes from Sarah James with Cantor Fitzgerald. Please proceed with your question.
Sarah James (Managing Director, Equity Analyst, Healthcare Services and HCIT)
Thank you. I was hoping you could unpack the seasonality a little bit more. So the year looks like, especially on the EBITDA side, a little bit more back-end loaded. Are there any one-timers in there we should think about? Is the cost of rebranding in 1Q 2024 and how sizable is that?
Vinay Bassi (CFO)
Yeah. So that's a great question. Sarah, nice to meet you again. Sarah, the margins I give is Adjusted EBITDA margins and rebranding and all our one-time items that are taken out. We have a rebranding cost for this year, but it's not included in the Adjusted EBITDA margin. You're right. The margin is back-end loaded for two reasons. The ramping that Viewgol has is on a month-to-month basis. So if I have something in the first month, I get in the last quarter all the benefits. So it's a ramping up of month by month so that my fourth quarter will be the maximum benefit. That's one. Secondly, my vendor savings that we have negotiated, it kicks in from Q2 onwards. So that's the second aspect of it. And obviously, the bookings and the revenue that you expect is the benefits that we will see is also back-end loaded.
It's a mix of all three. The good advantage part of it is vendor savings has already been negotiated, and the bookings first half will give us a great color for the second half of revenues.
Sarah James (Managing Director, Equity Analyst, Healthcare Services and HCIT)
Great. Thank you, Vinay. Maybe you could give us a little bit of insight into your process there, how you've been going through the review of the business units and how you think about guidance philosophy, whether it's conservative or optimistic?
Vinay Bassi (CFO)
That's a great question that you say. I've always been told future will tell me whether I was optimistic or conservative, but I'll tell you how I have thought through these. As you know, Sarah, there are a lot of moving pieces, a lot of pieces that could change. But how I have thought through is looking at the past to be my looking at history and then looking at future and breaking it to two parts, like what Chris said. One, being a little conservative on making sure what we learned of optimism of 2023 is not baked into 2024. So a flat bookings number excluding Viewgol and AHT was a good, especially despite coming high, a good on the Q4. That was one.
Second aspect on margins, some of it is my history and my background, laser-focused on the controllable and making sure the rigor that we need. We have started putting on these expenses and everyone to fight to stay on that on the P&L has, I would say, some of it which are fully baked is already captured, like the vendor saving. But the other that I mentioned in my prepared remarks are work that I'm trying to do and have an ROI-focused and more near-term focused. So CapEx, product development expenses that we are spending, looking at it from a project by project and the ROI of not having too long-term and near-term is the cadence that I have just started. It's still early, but I would say that's the mindset I have. So answer your question.
I feel at least 60 days in, it looks like a balanced budget to the best of my ability of understanding. But I feel more like what Chris said, cautiously optimistic, and there's a lot more work to be done in the coming months. Chris, what would you?
Chris Fowler (President and CEO)
No, I think you nailed it. And again, Sarah, I would say definitely between the optimistic and conservative, I would say realistic is over the first 60 days is the way that I would categorize, Vinay, and appreciate that approach. Also, again, I'm going to say this for the second time. I love the fact that we're giving the quarterly guidance, which I think helps everybody kind of keep track of our progress as we go, as we do know that it's not quite a straight line on this transformation.
Operator (participant)
Our next question comes from Stephanie Davis with Barclays. Please proceed with your question.
Stephanie Davis (Managing Director, Senior Research Analyst, Healthcare Technology and Distribution)
Hey, guys. It's Stephanie Davis from Barclays. But it's okay because I can have a new name as you guys have a new name too.
Congrats on the rebranding. Now, I was hoping to hear, Chris, you just came from a customer conference week on the heels of that rebrand. So tell me, what's the feedback? What are folks looking for? And what was the big area of demand that everyone talked about?
Sarah James (Managing Director, Equity Analyst, Healthcare Services and HCIT)
Hello, Chris. Are you there? Okay. Please stand by while I.
Chris Fowler (President and CEO)
Aria?
Operator (participant)
We're welcoming back our speaker now to answer Stephanie Davis from Barclays.
Chris Fowler (President and CEO)
Correct. Well, we'll call her Stephanie. So Stephanie, thanks for the question. Like I was saying, we have been thrilled with the response to the rebrand on all fronts. Granted, it is early days. But obviously, you shared your email and obviously, you've been bugging us about this for quite a while. I think the sentiment from the street has been finally make it easier to tell the story. Our customers and our employees all seem to get it as well and appreciate the consolidation and the ease of how we talk about who we are.
Going to the conference to ViVE, what I would say that we saw kind of more than anything is that people are looking for insights, insights on where there are opportunities for them to improve efficiencies, which lined up really nicely with we had a little soft launch for an analytics platform that we're driving out. And so our thought is that step one is the technology that's available to find the areas for improvement on the RCM side. And then obviously, with the opportunity for us to back that up with some services that come in, which I think is as much top of mind to the customers as identifying what those problems are. Once you've identified them, then it's about how do you solve them.
Stephanie Davis (Managing Director, Senior Research Analyst, Healthcare Technology and Distribution)
When I think about a legacy industry that does a lot of insights work, I think in Nielsen and we've got Vinay coming from there. Vinay, is there anything you're seeing in that opportunity where you can kind of get some learnings from your past?
Vinay Bassi (CFO)
I would say Stephanie Davis, not just Nielsen, but Avaya, my banking, everything has. I'm learning from those experiences and utilizing it here. The key one, I would say, is focus a lot on my controllable, which is cost structure and CapEx because that's an influence I can make. Having lived through two private equity learnings, and they have been amazing teachers to me. So bringing that cadence of an ROI mindset has helped me a lot, one. Secondly, in my Nielsen on having focused on revenue and all, it's building that partnership with the business where accountability is and ownership are shared. And that translation of bookings into revenue in the right, from a forecasting, is the second one. And the third, which is not Nielsen, not Avaya, it's just who I am. Cash is the only truth I'm going after.
Improving my free cash flow has been the mantra that I'm committed to. It's a journey that I know might be longer, but every day, every month is where I'm looking to make a difference.
Stephanie Davis (Managing Director, Senior Research Analyst, Healthcare Technology and Distribution)
Love hearing that. On the revenue cycle side, I want to dig in a little bit. It looks like your cross-sales motion has been a little bit softer for the past two quarters. Is there any color on this? And then last one's a quick housekeeping one. I didn't see an NPR metric. Is that going to be disclosed or is there anything you can share on that?
Chris Fowler (President and CEO)
Yeah, I'll take the first and then let Vinay talk a little bit about the NPR and kind of the approach there. As it relates to the bookings and just kind of from a macro view, I would say we're still very confident as it relates to the cross-sell opportunity. We continue to see that end of the market continue to have some momentum. I think we still have the same challenges to an extent while we're seeing them turn down a little bit. It's the economic impact of the jobs in the community, and it is the concept of outsourcing in general. Remember, we're still talking about a market that 70%-80% of it's still being done in-house, and there's not a regulatory push to drive to this model. And so we're still selling the idea of outsourcing before we're selling TruBridge as the provider for that service.
We're making great strides. That sales force has now been intact for a full year. They definitely have their feet under them, one, on the value proposition of what it is that we're selling, and two, building that relationship with their customers. We're expecting to see that as the year unfolds, continue to make progress there. I'll let Vinay talk a little bit about the NPR.
Vinay Bassi (CFO)
Yeah. So, Stephanie, I feel bookings is a great metric because it is effort and reward of our own that we are reflecting. NPR, I just wanted to take a little more time to do the homework of understanding the ins and outs because, like everyone else, a portion of our NPR data is relied on third-party inputs. And when it's not in our control, knowing how the out inputs come in, what's the cadence, I just want to do that homework a little bit longer to just make sure I understand what are the ins and outs and how is that a leading indicator for me. So that's the reason why you didn't see it in this. But bookings, which is obviously deals closed, is a great indicator for us for the time being.
Stephanie Davis (Managing Director, Senior Research Analyst, Healthcare Technology and Distribution)
Super helpful. Looking forward to seeing the metrics. Thank you, guys.
Chris Fowler (President and CEO)
Thanks, Stephanie or Jesse, whichever it is.
Operator (participant)
Our next question comes from George Hill with Deutsche Bank. Please proceed with your question.
Maxima (Analyst)
Yeah. Hi. It's Maxima for George. Thanks for taking the question. Can you talk a little bit about what has changed in outsourcing conversations lately with prospective clients, just given the recent macro environment? Thanks.
Chris Fowler (President and CEO)
Yeah. And I'm sorry I didn't catch your name, but I'll answer the question. I did hear most of that. What I would say is definitely we're seeing the increased interest, and that is based on, as I said in the prepared remarks, the pressure on the labor market specific to the communities that we're serving. And secondly, as the reimbursements continue to get more complex, the need for the specialized skills and continuing to stay on top of that continues to ratchet up.
To give an example of that, if you go back five years ago, the vast majority of these hospitals, their payments were on the backs of traditional Medicare, Medicaid, and probably a Blue Cross was going to make up the vast majority of their payments and a pretty straightforward payment model that they were getting reimbursed on and also getting paid within 14-17 days. While it may not be the dollars that they want to get, they knew the money that they were going to get. They knew in the time that they would get it, and they could budget for that. What's happened, as you've seen this kind of proliferation of the move to the Medicare Advantage or the Value-Based Care model, it's created more complexity and making a little not quite so straightforward in getting that money in.
So it's about, again, having the resources, one, that are available, just the bodies and the chairs, and then secondly, making sure that they're able bodies and that they're on top of the changing landscape of how that reimbursement is. So that's really where the vast majority of the conversation has shifted to. And again, as we have this is what we do. We live and breathe by this specifically with more than half of our business. And so we're able to sell the success that we've had with our 20+ years of experience to be able to bring that consistency and success into the delivery for those opportunities.
Operator (participant)
It appears that there are no further questions at this time. I would now like to turn the floor back over to Chris Fowler for closing comments.
Chris Fowler (President and CEO)
Well, thanks, everybody, for joining us. Also, thank you for the patience with our technical difficulties. Hopefully, that'll be a one-time and only. And obviously, thank you to the new co-pilot that we've got sitting with us, Vinay Bassi. I'm looking forward to going and finishing this transformation and continuing the progress that we've started here at CPSI, soon to be TruBridge on Monday. But hope everybody has a wonderful rest of your day and good weekend. And thank you again for your support in our company. Bye-bye.
Vinay Bassi (CFO)
Thank you.
Operator (participant)
This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.