US Physical Therapy - Q1 2024
May 8, 2024
Transcript
Operator (participant)
Good day, and thank you for standing by. Welcome to the U.S. Physical Therapy first quarter 2024 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. In order to ask a question during that session, please press the star key followed by the number one key on your telephone. Please be advised that today's conference is being recorded. If you require any further assistance, please press star, then zero. I'd now like to turn the call over to Chris Reading, President and Chief Executive Officer. Please go ahead, sir.
Chris Reading (President and CEO)
Okay. Thanks, David. Good morning and welcome, everyone, to our U.S. Physical Therapy first quarter 2024 earnings call. With me on the line this morning include Carey Hendrickson, our Chief Financial Officer. Eric Williams, who is our Chief Operating Officer East. And Eric will be assuming a larger role in our company as he takes over as President just a few weeks after our annual meeting later this month, so we congratulate him on that. Graham Reeve, our Chief Operating Officer West. And Jake Martinez, our Senior Vice President, Finance and Accounting. Before we begin our prepared remarks, I'll ask Jake to cover a brief disclosure statement.
Jake Martinez (SVP of Finance and Accounting)
Thank you, Chris. This presentation contains forward-looking statements, which involve certain risks and uncertainties. These forward-looking statements are based on the company's current views and assumptions. The company's actual results may vary materially from those anticipated. Please see the company's filings with the Securities and Exchange Commission for more information.
Chris Reading (President and CEO)
Thanks, Jake. Okay, I'm going to keep my remarks reasonably brief, but I do want to give you kind of an overview of what I think are some important takeaways for the start of the year. So let me begin by saying that while these past few years have not been easy for anybody in our industry, I think our team has done some remarkable things in that period. We feel like we're off to a good start for this year as well. For some of you, I know that it may feel like this first quarter is a little bit of a disappointment. Having enjoyed an all-time record Q1 in 2023, this quarter was actually ahead of where we expected to be, and that expectation was baked into our original guidance, which you will see we are updating today.
While we experienced a tough start to the year, not based upon demand, which has been very strong, but a rough weather start for sure compared to last year. However, we bounced back very quickly, and visits have again been at or above previous record levels for visits per clinic per day. Visits per clinic were all-time highs for both February and March of this year, and I'm happy to report that April is another all-time high for that month, as we have built slowly but steadily in our volume progression so far this year. So what does that mean? Well, for one, it means that our facilities are being recognized and sought out for the great care we are providing the patients and their families and by the physicians who refer to us. And so demand has been very high.
I will also tell you that staffing, while improved, is really still the gating factor to be being able to capture even more volume. We're working hard on that. We have a new leader over that recruiting department, and I expect we will continue to make adjustments that will further assist us in meeting the demand that we're seeing for our services. Our partners are working with our ops team to network differently than maybe we have done in the past to increase the number and the quality of seeds planted, so to speak, with respect to talented clinicians in their markets. It's an all-hands-on-deck exercise, but I'm buoyed by the fact that demand is really strong, and that underpins all of this. Coupled with strong demand and record monthly volumes once we got outside of January, is the progress the team has made with respect to net rate.
In spite of the impact of a rather large, approximately 3.5% Medicare reduction to start the year, we were able to produce some uplift in our rate and some improvement in our work comp mix. It created some overall incremental improvement that we hope to build upon as the year progresses. For this first quarter, we saw a non-Medicare rate improved another 2.8% overall from Q1 2023 and up 5% since the same quarter in 2022. We're not done yet. We continue to work to lift reimbursement for the life-improving work that we are delivering across the more than 5 million patients. While demand is also improving, where demand is also improving is in our injury prevention business. First, you saw a recent acquisition announcement with respect to a really terrific company led by a fine team who recently joined our Briotix partnership.
That opportunity will help us to further broaden our exposure to several additional industry, we call them verticals, essentially industry types, where over time we expect to gain additional sales traction as well as cross-selling opportunities given that we have a much broader subset of services available now to sell. For the quarter, revenue grew 9.8%, which in turn produced a gross profit increase of over 15%. I'm very proud of our teams and our partnerships in this area. They continue to attract opportunities for further expansion while they make a large difference for these companies in terms of the injuries they prevent and the cost that they save as a result of the fine work of our embedded clinical and technical resources.
We have other highlights to cover, so let me turn the call over to Carey to discuss our results in more detail before we open things up for questions.
Carey Hendrickson (CFO)
Thank you, Chris, and good morning, everyone. Our first quarter results is, as Chris noted, we're better than we anticipated coming into the quarter, driven by strong volumes in February and March and a growing net rate. As we noted in our release and also in our year-end earnings release, we had the significant adverse weather events in January 2024 that Chris noted, that we knew were going to make comparisons to the first quarter of 2023 challenging since there weren't any significant weather events in the first quarter of last year. Volumes in January of 2024 were light as expected, but volumes quickly picked up back up in February and March, and we experienced record volumes in each of those two months.
Our hard work on rate negotiations and our focus on increasing workers' comp as a percentage of overall business continued to take root in the first quarter of 2024 and resulted in a net rate increasing year-over-year despite that Medicare rate reduction that was in effect for most of the first quarter that Chris noted. From an EBITDA standpoint, we reported adjusted EBITDA for the first quarter of 2024 of $16.7 million compared to $18.5 million in the prior year. We noted in our earnings release that the Medicare rate reduction brought our Q1 2024 EBITDA down by about $1.7 million, and then the adverse weather in January was a negative impact of about $1.3 million. Our operating results were $7.7 million in both the first quarter of 2024 and the first quarter of 2023.
On a share basis, on a per-share basis, operating results were $0.51 in the first quarter of this year versus $0.59 in the first quarter of last year, and that's because of the decrease related to the increase in shares that we had associated with the secondary offering that we completed in May of 2023. Our average visits per clinic per day in the first quarter was 29.5, which is the second highest volume in the company's history for a first quarter, second only to the 29.8 that we had in the first quarter of 2023. January was at 27.4, and that compares to 28.9 in the previous year, so we're down from 28.9 to 27.4, but then February was at 30.4 and March was at 30.8. Both of those months, as Chris noted, were higher than the same months in the previous year.
Volumes continued strong in April with our average visits per day just north of 31, and that's a record high average visits per day number for the company ever and the first time we've ever had average visits per day at or above 31 for a month. Our net rate was $103.37 in the first quarter of 2024, which was an increase of $0.25, again, despite that Medicare rate reduction that was in effect for most of the first quarter of 3.5%. The increase was largely related to our strategic priority of increasing reimbursement rates through contract negotiations with commercial and other payers and then our focus on growing our workers' comp business. Excluding Medicare, our net rate was up 2.8% versus the first quarter of last year with increases in each of the major categories other than Medicare.
Workers' Comp, which is one of our highest rate categories, increased from 9.3% of our revenue mix in the first quarter of 2023 to 10% in the first quarter of 2024. And both of those initiatives, increasing net rate, the rate negotiations, and the Workers' Comp business, will remain high priorities throughout the year. Our physical therapy revenues were $134.4 million in the first quarter of 2024, which was an increase of $5.3 million or 4.1% from last year despite the setbacks that we had from weather and the Medicare rate reduction. The increase was driven by having 28 more clinics on average in the first quarter of this year than we had in the first quarter of last year, coupled with the increase in our net rate.
Our physical therapy operating costs were $110.4 million, which was an increase of 8.1% over the first quarter of the prior year, due in part to having 28 more clinics on average in the first quarter than in the first quarter of last year. On a per-visit basis, our total operating costs were $85.50 in the first quarter, which was up from just under $82 in the first quarter of 2023. Our average cost per visit was high in January because we had less operating leverage due to the lower number of visits, and then it returned to more normal levels in February and March, which averaged $82.90 per visit. Our salaries and related cost was really the same story. They were $61.42 in the first quarter of 2024. That was up from $59.14 in the first quarter of 2023.
But again, those salaries-related costs were high in January, but then they returned to more normal levels in February and March, which averaged $59.42 per visit, which is comparable to that $59.14 that we saw in the first quarter of 2023. Our physical therapy margin was 17.9% in the first quarter of 2024. That margin was also impacted by January due to having less operating leverage, but then it increased to 20.6% in February and March on a combined basis, which is, back to very close to the first quarter of 2022 and 2023 margin, which was 21%. Chris talked about IIP and what a great job they did. In the first quarter, revenues were up almost 10%. IIP income was up 15.1%, and then our margin increased from 19.5% in the first quarter of 2023 to 20.4% in the first quarter of 2024.
Our balance sheet continues to be in an excellent position. We have $143 million of debt on our term loan with a swap agreement in place that places the rate on that debt at 4.7%, which, as you know, is a very favorable rate in today's market, and it's well below the current Fed funds rate. In the first quarter of 2024 alone, this swap agreement saved us $900,000 in interest expense with cumulative savings of $4.2 million since we put that in place in the third quarter of 2022. In addition to the term loan, we also have a $175 million revolving credit facility that had nothing drawn on it during the first quarter, and we have approximately $105 million of excess cash over and above what we need for working capital, ready for deployment into growth initiatives.
Including the April 30 acquisitions that we announced last week, we've deployed just over $40 million of cash into acquisitions so far this year. As we noted in our release, we're raising our EBITDA guidance range for the full year of 2024 to $82.5 million-$87.5 million. That's an increase of $2.5 million on both ends of the range. Our guidance previously considered that a 3.5% Medicare rate reduction versus last year's rates would be in place for all of 2024. However, as we noted in an 8-K that we put out in March, Congress addressed the Medicare reduction in the Consolidated Appropriations Act of 2024 and adjusted that reduction from 3.5% to 1.8%. That's effective March 9 through the end of 2024.
It was not retro to the beginning of the year, but it will be from that March 9 forward at 1.8% reduction rather than 3.5%. The outperformance of our internal expectations in the first quarter of 2024 due to our strong volumes in February and March and our continued progress in that rate gives us confidence to raise the range by more than just the $2 million affected over that's related to the Medicare rate change, even though it's early in the year. As a reminder, the expected EBITDA contribution from acquisitions we've closed so far this year and another one that we expect to close by the end of July are included in our guidance just as they were in our previous guidance. In closing, our first quarter was ahead of our internal expectations. February and March were strong months from a volume, revenue, EBITDA, and margin perspective.
Our net rate grew in the first quarter over the prior year, even with a 3.5% Medicare reduction in place for most of that first quarter, and we had very good momentum as we started the second quarter, as evidenced by our average visits per day in April. We increased our full-year guidance by $2.5 million to reflect all of those things. With that, Chris, I'll turn the call back to you.
Chris Reading (President and CEO)
Yeah, really appreciate it, Carey. Great job. Thank you. So, Operator, let's go ahead and open up for questions and comments.
Operator (participant)
At this time, if you'd like to ask a question or leave a comment, please press the star and one keys on your telephone keypad. Keep in mind you may remove yourself from the question queue at any time by pressing star and two. Again, it is star and one to ask a question today. And we'll take our first question from Brian Tanquilut from Jefferies. Please go ahead. Your line is open.
Carey Hendrickson (CFO)
Morning, Brian.
Brian Tanquilut (Senior Equity Research Analyst)
Hey, morning, guys. Good morning, and Eric, congrats. Chris, or maybe my first question, as we think about your commentary that, you know, Q2 or Q1 was essentially in line with internal expectations, you know, the salaries cost stands out to us, you know, up 3.5% sequentially. So just curious, you know, what are you seeing there, and what needs to happen for that to maybe normalize, or are these the normalized levels that we should be thinking about from a, you know, salaries and related costs as a percentage of revenue perspective going forward?
Chris Reading (President and CEO)
Yeah, well, I think in, I may pull Carey back in for part of this. Certainly, I think the impact in January, you know, on light revenue, light volume, you know, impacted us there on a percent of revenue basis. When we look at the rest of the quarter, the February and March numbers, which I'll get Carey to revisit here momentarily, you know, those returned to a more normal level, and I think that's a better indication of where we think this will be going forward. So, Carey, you want to hit those again quickly?
Carey Hendrickson (CFO)
Yeah, you bet. So, so far salaries and related costs in February and March, they were $59.42 per visit, and that is up only slightly from $59.14 in the first quarter of 2023, which is a good comparison because January's, the Januarys were so different. And each year, January of last year didn't have any weather, and of course, we know we had the weather event and weather events in January of this year. So, I think that's a better comparison and something you should look at for going forward is something around that $59.42, kind of per visit from a salary standpoint. And that will actually probably go down a little, you know, it varies because there's a certain amount of your salaries-related costs that are relatively fixed.
So, a lot of it varies with the cost per visit, but you do have just some base level of employees that are on a that make that fixed. So it will vary and probably come down a little bit in the second quarter from the first is what I would anticipate, given that we'll have. That's one of our. It's actually usually our highest volume quarter, so that may be a little less in the second quarter, but then, you know, vary a little bit from that as we go into the third and the fourth. So, I feel like we're in a decent place from salaries and related costs. It's just that January impacted that number quite a bit, because we didn't have the operating leverage that we did in the February and March months.
Brian Tanquilut (Senior Equity Research Analyst)
Okay.
Chris Reading (President and CEO)
Brian, does that.
Brian Tanquilut (Senior Equity Research Analyst)
Yeah, that makes a lot of sense.
Chris Reading (President and CEO)
Yeah, okay.
Brian Tanquilut (Senior Equity Research Analyst)
And then maybe my follow-up question, Carey, as I think about, you know, I appreciate your comment that Q1 was within your internal range, and you're obviously raising guidance for the year. Any color you can share with us to help us think about how or what your internal expectations are for Q2, understanding that, you know, you're off to a really strong start in April?
Carey Hendrickson (CFO)
Yeah, I mean, gosh, we, you know, we don't usually give guidance by quarter, but I would just say, you know, we expect it to be at a level that is up from last year's first quarter second quarter, excuse me, and certainly up from where we were in the first quarter of this year. You know, it's a lot of it honestly, a lot of it's going to depend on what net rate, obviously, and then just how strong those volumes are in April, May, and June, but that's certainly an expectation. I mean, we've added acquisitions since the second quarter of last year. We've and we've improved our net rate since the second quarter of last year. It certainly should be up.
Chris Reading (President and CEO)
Yeah, Brian, I mean, we're not going to get to the point and I know you're not asking us to do this where we're going to guide by quarter. I know ATI just did that. I don't think that's the right move for us. But we're comfortable in the guidance that we updated for the year, and you guys have the hard job of trying to, you know, parse that out between quarters.
Brian Tanquilut (Senior Equity Research Analyst)
No, totally understand, Chris, and thank you for the comments.
Chris Reading (President and CEO)
Thank you.
Operator (participant)
We'll take our next question from Joanna Gajuk with Bank of America. Please go ahead. Your line is open.
Joanna Gajuk (Equity Research Analyst)
Good morning. Thank you. Thanks for taking questions here. I guess coming back to volumes and the comments around, you know, February, March, were pretty good months, and then, I guess, April in particular, looks like it's pretty good. You know, the question is, what is driving this better volume here? And also, what do you assume, I guess, for the rest of the year?
Chris Reading (President and CEO)
So, you know, I, I got to tip my hat to our clinicians and our partners, 95% of whom are clinicians. You know, they're doing a great job with patients. We're, we're doing, I think, a better than ever job in outreach, not just to physician referral sources, but to communities, social media, other things, driving patients. Frankly, our demand is high enough that if, if we could just magically import staffing on an incremental basis where and when, you know, we need it, we could drive volumes, you know, even higher. And so the gating factor for us right now, staffing, teams worked very hard. Turnover for this quarter is at the lowest level that I can remember since I've looked at turnover, you know, going back many, many years. So our partners who largely influence that are doing a very good job.
We're continuing to work to try to get it down even further, but staffing is really the gating factor. Demand is high.
Joanna Gajuk (Equity Research Analyst)
Oh, that's great to hear. So essentially, I'm in demand there. So for the turnover, are you willing to share the actual percent of turnover you're seeing among your clinicians?
Chris Reading (President and CEO)
It's nicely below 20. I don't want to get into a pattern where we've got to put it out every single quarter because it's going to move around a little bit, but it's lower than it was last year, and it's well below 20 at this point.
Joanna Gajuk (Equity Research Analyst)
Oh, that's great. Thanks. That's helpful. Just to have a magnitude of things, always good. And I guess your other segment, the industrial injury prevention, revenue's up nicely, and profit's up 15%. So, I just want to clarify, like, this is all organic. There's not really the deal that you announced that didn't even close that in the quarter. And the second quarter.
Chris Reading (President and CEO)
That's right.
Joanna Gajuk (Equity Research Analyst)
Yeah, like, thank you. And then what is really driving that? I mean, are you, like, growing with your existing partners? You're adding new clients. Like, I guess what's driving that 10% revenue growth and nicely you know, obviously nicely translated into profit, but I guess starts with top line.
Chris Reading (President and CEO)
Yeah, thank you. So, Eric, if you can, you guys are both, Eric and Graham, doing a great job at, you know, working with these two partnerships. Our partnerships, in fact, are doing a very good job, and Briotix has come out, you know, really strong. So, Eric, you want to speak to that?
Eric Williams (COO East)
Yeah, it actually is, it's both of those. I mean, we are adding new clients. We're adding new verticals. You know, we're heavy in distribution retail, heavy in automotive, adding additional manufacturing and distribution clients as well. And then we're expanding product lines within existing clients. So it's a combination of both. The business development pipeline for both of our injury prevention businesses, Progressive and Briotix, is very, very deep right now. So terrific same-store growth, terrific new client growth. We're really bullish in terms of the direction we're headed and really excited about the acquisition that we just announced here on April 1st. It continues to go really, really well, and we expect good things out of our injury prevention business as we move forward through the year.
Joanna Gajuk (Equity Research Analyst)
So it sounds like in that business, staffing maybe is not a gaining factor, or would you say, you know, is it that much better?
Carey Hendrickson (CFO)
It's not.
Joanna Gajuk (Equity Research Analyst)
Staffing is maybe not that much better, but it sounds like maybe better.
Carey Hendrickson (CFO)
It's different, you know, so when you take a look at the big pain factor that we deal with in the physical therapy side here, we are predominantly hiring PTs. And it's a big chore to do those, and you really got to be good at recruiting and retention in order to make an impact on your business. And as Chris mentioned, we're doing well on both fronts there with the best, you know, retention rates we've had in a long, long time. When you look at the injury prevention side, we have the luxury and flexibility of going in a different direction from a staffing perspective. So you're looking at athletic trainers in those businesses, so it's a slightly different hiring requirement. The challenge on the injury prevention side really, and we have them.
It's not. They're not all full-time positions. So a lot of the various accounts and clients that we staff for aren't looking for 40 hours a week. They could be looking for six hours a week, eight hours a week. So it's a challenge for those injury prevention businesses to be able to bundle those positions to have an easier time finding someone because it's always easier to find somebody full-time than part-time. So slightly different type of clinical need, which makes it a tad bit easier on the injury prevention businesses as opposed to PT.
Chris Reading (President and CEO)
I would say this, and Eric, I think Eric did a great job outlining that. Our turnover rate in injury prevention is really low. It's lower even than at our facilities. And they've been very creative, and so I think that combination, you know, again, we have more demand at any given point in time, and this will always be the case, than we can staff to. There's always a bit of a lag, but they're doing a really good job right now, and I'm proud of that group.
Joanna Gajuk (Equity Research Analyst)
Oh, great. And talking about deals, I just also, clarification, confirmation, when it comes to what's included in your guidance. So there was no change in there, right? You're the kind of the $2 million is the Medicare rate, and $0.5 million, I guess, is Q1. I just want to make sure there's nothing around moving around the deals. Like, I guess the deals are tracking as in line with your initial expectations in terms of the contribution in the in the guidance.
Chris Reading (President and CEO)
Yeah, I would say this. One of the deals that we had factored into our original guidance, it didn't happen and isn't going to happen. But we've got other activity, and all of that has been included in our guidance for the remaining part of the year. And so we had a little in, and net, you know, we're comfortable where we are for the year at this point.
Joanna Gajuk (Equity Research Analyst)
Great. Thank you so much.
Chris Reading (President and CEO)
Thanks, Sharon.
Eric Williams (COO East)
Thank you, Joanna.
Operator (participant)
We'll take our next question from Larry Solow with CJS Securities. Please go ahead. Your line is open.
Carey Hendrickson (CFO)
Great.
Hey, Larry.
Larry Solow (Managing Director)
Good morning, guys. Thanks.[crosstalk] Hey, good morning. Question, I guess, on just the good price momentum. It sounds like, outside of Medicare. I know, you know, the core contract negotiations sound like they're going even a little better than expected. And also, yeah, good to see workers' comp, I know, picking up a little bit. That's kind of lagged, I guess, even since COVID. So maybe a little more color on the workers' comp side and then just overall, you know, the progression on your contract negotiations.
Chris Reading (President and CEO)
Eric, why don't you go ahead? And then, Carey, if you have anything to add, you can jump in at the end.
Eric Williams (COO East)
Sure. You bet. Yeah, sure on the work comp side. So, look, we've talked about this on a number of quarterly calls here over the course of the past, you know, year and a half. There's been a tremendous amount of effort to really drive both volume and rate. And it's not an overnight turn, unfortunately. And we're really starting to see the fruits of the efforts that we put in here over the course of that timeframe. You know, one of the really, you know, key drivers for us here is the fact that since second quarter of last year, we've signed 10 new work comp payer contracts, four of which came online mid-Q1. So and we have a number of additional contracts in process, just as Carey has a number of different contracts that he's looking to renegotiate rates on.
A lot of effort to beef up in this area, and we expect this trend to continue as we move forward through the year.
Carey Hendrickson (CFO)
Yeah, and Larry, I'd say, you know, this mix of, of growing from 9.3%-10%, it's, it's both. It's both volume and rate. So volume picked up. It's so it's the volume outpaced the growth of the other categories so that it increases a percent of the mix, and then also net rate increased as well. So, good on both fronts, and that resulted in that, overall mix of revenue increasing.
Larry Solow (Managing Director)
Great. What, what about just, you know, I know no one knows for certain, but just Medicare outlook. Obviously, they, you know, they reduced their rate, the, cut a little bit, gave you a little bit of relief on the original cut from this year. I, I think Physician Fee Schedule and, and all that balancing should be done by next year. Is that kind of the, the what industry pundits kind of believe or, you know, again, not holding you to this, but what is sort of the, the, the current, you know, belief going forward on that side of it?
Chris Reading (President and CEO)
Yeah. If I was to predict what Medicare CMS is going to do business, I'd probably need a couple more jobs. So I'm not sure exactly. I think we get out of this system that we're in completely in 2026. We were actually just a big group of us in D.C. Now, it's been three weeks ago. We had a meeting at the White House, meeting at HHS. We met with the head of AARP, you know, their regulatory head. We met with a couple consumer-facing groups. We have a bill right now on fall prevention, that could be some additional directed volume for us. And we met with MedPAC. And I would say the MedPAC meeting was the meeting where we've got more opportunity to help educate them.
Their original calculations with respect to the Physician Fee Schedule as it impacted us was based on a misunderstanding of the code set under which we bill. In short, they were trying to cut the reimbursement to what they thought were the highest income level physicians, you know, across their fee schedule Physician Fee Schedule, so included physiatrists, pain management doctors, and in some cases, orthopedic surgeons, portions of our code set. But we make up physical therapy makes up 85% of that code set. And again, physical therapists making somewhere in the, you know, $70,000-$90,000 a year range, and they had no idea of that. And yet, you know, their recommendation to CMS was to cut because they thought they were knocking these highly compensated physicians back, and we ended up being what they called collateral damage.
Frustrating that mistakes don't get fixed quickly in Washington, but we've got good line of communication. We've got better data over a period of years with studies and other things that we've done on how much physical therapy saves the system when entered and accessed on a primary care basis, really physical therapy first for musculoskeletal problems. And so, while this isn't an easy fight, I think it's a fight where facts matter, and facts and reasonableness are on our side. We've just got to continue to drive home the message and be more effective and more diligent with our dealing in Washington. It's a little frustrating, but we're committed to the whole industry with APTQI kind of in a leadership role now alongside the APTA. We're very focused on making progress.
Larry Solow (Managing Director)
Got it. No, I appreciate that call, Chris. I guess just last question or at this point, I just noticed that you had a net six closures, six closed facilities. Is that just, is that, you know, did you happen to accelerate on some underperforming facility closures, or, you know, what's sort of the outlook for net openings in 2024?
Chris Reading (President and CEO)
Yeah, I think you'll see us with strong openings, you know, similar to what we've done the last couple of years. We're having a good organic de novo opening schedule for the remaining part of the year. You know, we're in good shape through the end of April, and then we're finding tuck-ins at very, very reasonable prices where we can fold those into strong existing partnerships. So we expect that to go well. The closures really are a result of just what we believe is a healthy pairing of facilities that have been around—some of those for multiple decades. And at the end, it's they're at the end of their useful life, and the leases just happen to be up. And so they don't carry with them a lot of closure costs.
It allows us to focus efforts on where we can get the greatest return. It's kind of like trimming a fruit tree. You got to prune some branches to have more fruit at the end of the day. So that's what we do. Timing is kind of no message there.
Larry Solow (Managing Director)
Gotcha. No, I appreciate that analogy for the time. Thanks a lot, Chris.
Chris Reading (President and CEO)
Thanks, Larry.
Operator (participant)
As a reminder, if you'd like to ask a question, please press the star and one keys on your telephone keypad. We'll take our next question from Mike Petusky with Barrington Research. Please go ahead. Your line is open.
Chris Reading (President and CEO)
Hey, Mike.
Michael Petusky (Managing Director and Senior Investment Analyst)
Hey.
Chris Reading (President and CEO)
Good morning, Mike.
Michael Petusky (Managing Director and Senior Investment Analyst)
Hey, good morning. So, on injury prevention, you know, Chris, I think maybe 1.5 years, two years ago or so, you know, you sort of expressed some caution, "Hey, some companies are pulling back on these types of services, concern about recession, all the rest." I mean, do you feel like, you know, in light of the comment you made about demand improving, I mean, do you feel like most of these executives have sort of somehow made peace with the economic backdrop, or can you just speak to, you know, your sense of that? Thanks.
Chris Reading (President and CEO)
Sure, sure. Thanks, Mike. Mike, you know us. You've known us for 20, the entirety of the time I've been here, 21 years now, and we tell everybody what we think and what we're seeing and feeling and hearing. And, you know, going into last year, we felt like we were seeing from the CEOs and CFOs who make these decisions in some sectors that they were, you know, anxious, and they were pulling back, not just with us, but with a lot of vendors and in a lot of areas. We're not feeling that right now. And while there may be individual sectors or companies that are still a little tepid relative to the interest rate environment, look, I think consumer demand continues to, you know, be high.
It's what's in part driving some of the inflation that we're seeing. Employment's still pretty good. And I think there's a sense that the Fed, you know, isn't going to run to the rescue anytime soon, and this is going to be the state of the state for a while. And we're just feeling really good about what we're onboarding. We're seeing good opportunities. We're winning some good fights. And, you know, I think you're, you're hearing what we think the year is going to look like, just like you heard last year that we thought things were going to be a little slower. So that's just kind of where we are.
Michael Petusky (Managing Director and Senior Investment Analyst)
And then, maybe this may be for Carey or anybody who should take this. In terms of the place you are and, you know, the multi-year effort to sort of get better, you know, more appropriate reimbursement from commercial payers, I mean, how much work there do you feel like is? I understand it'll be ongoing for, you know.
Carey Hendrickson (CFO)
Yeah.
Michael Petusky (Managing Director and Senior Investment Analyst)
For a while. But in terms of the heavy lift, what you really want to accomplish, how far into this do you feel like you are at this point?
Carey Hendrickson (CFO)
Yeah. I'd say we're through about two-thirds of the initial heavy lift, if you will. But it's as you noted, it's an ongoing effort. So when we get done with this, we're just start right back over again and go through it. There's always opportunities, and we're, so it's a never-ending process. But I'd say from the initial lift, we're probably two-thirds of the way through.
Michael Petusky (Managing Director and Senior Investment Analyst)
And then, I just guess, last question on just M&A. And Chris, I heard you say, "Hey, we're seeing some really reasonable prices for some tuck-ins." And I'm just curious, you know, in terms of the conversations you're having, are there bigger sort of needle-moving deals out there where you would say, "Hey, you know, there's active discussions." You know, the time note, it could, you know, could come in six months. It could come in two years. But, you know, are there larger deals out there or larger partnerships out there that are looking for, you know, exit strategies and, you know, where you guys could, you know, be a reasonable option?
Chris Reading (President and CEO)
Yeah. Yeah, for sure. And Mike, you know, it's an interesting time right now. I know that from time to time, over a period of many years, we've sometimes gotten criticized a little bit for having a conservative balance sheet. Interesting. You know, many, many of our competitors are really balance sheet constrained. And so we're able to continue to grow and have discussions and really to create meaningful points of differentiation, not just culturally and normal life after, but really, you know, predictable stability because we're so well capitalized. And so you're going to continue to see us grow. We're talking to some large and large companies. I'm not going to promise timing around that, which I know you're not asking for. But we're not afraid to grow. We want to do it the right way.
And at the same time, we need to meet people where they are, and that, you know, involves their own personal timing and circumstance. And so I think we're seeing in a really good light the deals that we've won recently. We haven't been the highest bidder on. And yet, not that we've gotten them cheaply, the larger ones that we've announced, but I think in part, it's because people see us being able to execute on our strategy over a long period of time where others are beginning to feel the effects of the capital market, which is not in their favor right now.
Michael Petusky (Managing Director and Senior Investment Analyst)
Hey, nice start to the year. Thank you.
Chris Reading (President and CEO)
Thanks, Mike.
Operator (participant)
Once again, to ask a question today, please press the star and one keys on your telephone keypad. We can pause for a moment to allow any further questions to queue. There are no further questions on the line at this time. I'll turn the program back to our speakers for any closing comments.
Chris Reading (President and CEO)
Sure. All right, David. Thank you. Thanks, everybody. We appreciate your time today. Carey and I are available later if, again, as always. You know, when you have questions or things you want to bounce around, we're happy to speak to those. Thank you for your time today, and have a great rest of your week. Bye now.
Operator (participant)
This does conclude today's program.