Pediatrix Medical Group has released its first-quarter earnings for 2024, meeting market expectations. The company saw a modest increase in service volumes, specifically a 2.5% rise in NICU days, but experienced downturns in its primary and urgent care clinics. Pediatrix is currently executing a portfolio restructuring strategy, aiming to exit underperforming practices and reduce costs to stabilize margins.
The company maintains its adjusted EBITDA forecast for the full year and anticipates the restructuring impact to become more apparent in the latter half of the year. Accounts receivable and RCM transition challenges have influenced cash flow, but the company predicts a significant contribution to its full-year adjusted EBITDA in the next quarter.
Key Takeaways
- Pediatrix Medical Group's Q1 earnings met expectations.
- NICU days grew by 2.5%, indicating positive volume growth in hospital-based services.
- Declines observed in primary and urgent care clinics.
- Full-year 2024 outlook for adjusted EBITDA remains unchanged at $200 million to $220 million.
- Portfolio restructuring includes exiting underperforming practices, particularly in office-based and primary and urgent care sectors.
- Transition to a hybrid RCM model and focus on efficiency are underway.
- Impact of restructuring expected in the second half of the year.
- Cash flow affected by accounts receivable DSOs and RCM transition.
- Q2 is expected to contribute 24-25% of the full-year adjusted EBITDA.
Company Outlook
- Pediatrix reaffirms its full-year 2024 adjusted EBITDA outlook.
- Portfolio restructuring plan is set to stabilize margins and improve efficiency.
- The impact of restructuring efforts to be felt more significantly in the second half of the year.
Bearish Highlights
- Declines in primary and urgent care clinics are a concern.
- Cash flow challenges due to accounts receivable DSOs and RCM transition.
Bullish Highlights
- Positive volume growth in NICU days.
- Stable volumes in maternal-fetal medicine services expected to continue.
- Focus on core services for growth, including the recent acquisition of an MFM practice in California.
Misses
- No target for the run rate number was provided.
- Total revenue impact from the disposal of assets is still being determined.
Q&A Highlights
- Financial impacts from restructuring to affect results in the second half of the year.
- Discussions with health system partners regarding stipend support for ambulatory practices are ongoing.
- The company is unwinding certain practices, which is expected to result in non-same unit revenue in the coming quarters.
In summary, Pediatrix Medical Group (MD) is navigating through a period of restructuring with a focus on efficiency and core services. Despite some challenges, the company's leadership is confident in their strategy and the anticipated positive outcomes, particularly in the second half of the year. The next quarterly earnings call will provide further insights into the company's progress and financial health.
Full transcript - Mednax Inc (NYSE:MD) Q1 2024:
Operator: Ladies and gentlemen, thank you for standing by. Welcome to the Pediatrix Medical Group 2024 First Quarter Earnings Conference Call. At this time, all participant lines are in a listen-only mode, later there will be an opportunity for your questions. Instructions will be given at that time. As a reminder, this conference is being recorded for digitized replay. I would now like to turn the conference over to Charles Lynch. Please go ahead.
Charles Lynch: Thank you, operator, and good morning, everyone. Welcome to our call. I'll quickly read through our forward-looking statements and then we'll get into our content. Certain statements and information during this conference call may be deemed to be forward-looking statements within the meaning of the Federal Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on assumptions and assessments made by pediatrics' management in light of their experience and assessment of historical trends, current conditions, expected future developments and other factors they believe to be appropriate. Any forward-looking statements made during this call are made as of today, and Pediatrix undertakes no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the company's filings with the SEC, including the sections entitled Risk Factors. In today's remarks by management, we will be discussing non-GAAP financial metrics. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures can be found in this morning's earnings press release, our quarterly reports on Form 10-Q and our annual report on Form 10-K and on our website at www.pediatrix.com. With that, I'll turn the call over to our CEO, Dr. Jim Swift.
James Swift: Thank you, Charlie. Good morning, everyone. Also with me today is Marc Richards, our Chief Financial Officer. Our first quarter results were in line with our expectations. Our same unit revenue growth reflected positive volumes in our hospital based services, with NICU days increasing 2.5%. On the office based side, we saw ongoing volume strength in maternal fetal medicine offset by declines in our primary and urgent care clinics, which I will touch on in my remarks this morning. Our practice level operating expenses continue to reflect modestly elevated salary and group health insurance trends, partially offset by lower benefit and incentive compensation. Finally, G&A expense was largely unchanged year-over-year despite the additional staffing we have added related to our internal front end revenue cycle management team. We are reaffirming our full year 2024 outlook of adjusted EBITDA between $200 million and $220 million, and I will focus on this since we believe we are well on our way to enacting changes that will stabilize our margins as compared to 2023 and enable a lower cost structure going forward. First and foremost, while we have historically undertaken regular portfolio management decisions leading to certain practice exits, we have now pivoted and are in the process of an accelerated portfolio restructuring plan under which we are exiting a meaningful number of underperforming office based practices now and before the end of 2024. This is in addition to steps we are taking toward performance improvement across our portfolio of practices, including restructuring and stipend renegotiations, which we believe will result in increased profitability for the organization. We've also made the strategic decision to exit our primary and urgent care clinic platform, which represents roughly two dozen clinics in Florida, Texas and Colorado. This decision was based on our review of the cost and time required to build this platform to scale, an undertaking that no longer fits at a time when we are focused on stabilization of our margin profile. We intend to complete this exit during the second quarter of this year. All of this portfolio restructuring activity is targeted to address the components of our practice portfolio that have diluted our consolidated operating margins, with the goal of either removing or remediating that dilution over the coming quarters. Importantly, we have created significant oversight of this restructuring through a strong internal project management team and with designated responsibilities, and our leadership is in a cadence of regular, frequent updates, all focused on execution. Second, the transition of our RCM function to a hybrid model is going well. As you may have seen in our recent filing, we finalized a contract with Guidehouse under which that organization will be our third party RCM provider. We have been working with Guidehouse since late 2023 and have been very pleased with the resources dedicated to pediatrics, the quality of work, and the collaboration with our internal team, which we expect will be fully staffed over the coming several months. As Marc will detail, our RCM performance has not been negatively impacted by this transition, and we believe our hybrid structure is the most cost effective way to fully support our practices. Finally, we remain intensely focused on efficiency. We believe that our portfolio restructuring activity will enable more effective nonclinical support in the future by emphasizing markets where we have significant infrastructure and system relationships. During the quarter, we also affected a number of physician eliminations across operations and G&A, such that we are confident that we can maintain a G&A expense level in 2024 that is comparable to or lower than 2023 as a percent of revenue, despite the internal additions we have made to our RCM team. From a timing perspective, much of the impact of our portfolio restructuring will be felt as we move through the second half of the year, and Marc will give some comments about our expected cadence of quarterly adjusted EBITDA. We do believe that taken as a whole, these operating plans will put Pediatrix in a position of far greater margin, stability and operational efficiency in addition to enhanced support of our practices and affiliated clinicians. I want to thank all of the Pediatrix associates, both clinical and nonclinical, for their hard work and dedication to this organization. We are confident that the operating plans we have in motion will benefit all stakeholders and will enable Pediatrix to effectively continue its mission to take great care of the patients. With that, I'll turn the call over to Marc Richards.
Marc Richards: Thank you, Jim. Good morning, everyone. I'll provide some additional details in a few areas. I'll start with cash flow. As a reminder, we are a user of cash in the first quarter of each year as we pay out incentive compensation and other benefits. During Q1, we used $123 million in operating cash flow compared to $101 million in Q1 of 2023. This differential largely relates to accounts receivable, where our DSOs declined in the first quarter of 2023. For Q1 of 2024, our accounts receivable DSO rose roughly a day and a half from 1231, reflecting a slight impact from the change healthcare incident and to a lesser degree, our RCM transition process. Related to change, we expect this impact to be just a cash deferral. We utilize change primarily for insurance verification and we were able to quickly pivot to two other vendors with minimal disruption. While this did have a slight timing effect for us during the first quarter, thus far in Q2, we believe that disruption is behind us based on cash receipts. Secondly, Jim noted that we have now finalized our contract with Guidehouse as our RCM provider and we have been fully engaged in transitioning from our former vendor. We are undertaking this transition in stages, which will continue in a deliberate fashion over the coming months. As of today, we have transitioned roughly one third of our affiliated practices to Guidehouse with the expectation of completion by the end of the third quarter. Finally, I'll touch on our 2024 outlook and our view of the quarterly progression of our adjusted EBITDA. As Jim noted, while our portfolio restructuring activity is already well underway, we anticipate that its financial impact will be largely weighted towards the second half of this year. As a result, we expect that adjusted EBITDA for the second quarter will contribute 24% to 25% of our full year outlook of $200 million to 220 million. With that, I'll turn the call back over to Jim.
James Swift: Thank you, Marc. Operator, let's now open up the call for questions.
Operator: Certainly. [Operator Instructions] We have a question from the line of Pito Chickering with Deutsche Bank. Please go ahead.
Pito Chickering: Hey, good morning. So I'm trying to do the math there, and so apologies, but I guess looking at all the practice disposition, so what percent of the annual EBITDA should we be modeling on the fourth quarter? I'm just trying to figure out what the exit rate we should be modeling on core growth for 2025.
Charles Lynch: Hey Pito, it's Charlie. We wanted to be clear on our expectations through the first half of this year. And if you think about the math we've provided, given the first quarter adjusted EBITDA of 37% against, that $200 million to $220 million I think is in the range of 18% or so of the full year. And with the second quarter, as Marc laid out, between 24% and 25%, that can give you a sense of the contribution from the first half of this year as we expected for the second half. Keep in mind that our normal seasonal pattern of adjusted EBITDA, all else being equal, would yield our third quarter being the strongest contributor of the year, followed by the fourth quarter. Based on the timing of our activity, some of that might be affected by that activity as it continues to contribute. But that's the baseline you should be thinking about the normal seasonal pattern is such that the third quarter tends to be the strongest.
Pito Chickering: Okay. And on these practice disposition, I guess looking at both the office and urgent primary care, are these practices that are coming up for renewal or are you sort of exiting these contracts sort of mid, I guess, contracting cycle just because of all the margins? And then do you have the same success rate on renewing practices today, that you historically have? Just want to understand more about why now is the time to deliver those assets.
James Swift: This is Jim. Yes, I don't think that there's anything related to contractual requirements. We do have some of these practices, may have some call contracts with some of our affiliated health systems, so some work around that. But we didn't envision the restructuring to coincide with any contracts, either employment agreements or service coverage obligations. We did this because these were practices that we felt were really negative in terms of their EBITDA contribution and have in the past. We've had some remediation we've done with them, but it was time to look at these effectively and dispose of them.
Pito Chickering: Okay and then just last question. I'm going to get a couple inbounds in this one. With the dispositions this year and the full year guidance you're reiterating, do you think you guys can grow in 2025 with sort of the revised asset base?
James Swift: I think it's a little bit premature to think into 2025. The only thing I would comment, Pito, is that the financial impacts that we anticipate from this activity, while it will affect our results, it should affect our results in the second half this year. That would not reflect the full year impact of this restructuring activity. I think that's about as far as we're going to go related to 2025.
Pito Chickering: All right, great. Thanks so much.
Operator: Next, we have a question from Brian Tanquilut with Jefferies. Please go ahead.
Unidentified Analyst: Hi, this is [indiscernible] in for Brian. I appreciate you taking my question. Just curious to know your outlook on the volume and rate side of the business, just curious if there's anything we should know in terms of the cadence for those two KPIs for this year?
Charles Lynch: It's Charlie. I'll give a quick comment and I'll turn it over to Jim. Just related to the first quarter, and this might provide you a little bit of detail on our office based patient volumes, we saw real strength in our maternal-fetal medicine volumes. They were up about 3% for the first quarter, keeping in mind that there was no leap year impact on our office based services, effectively the same number of office days, so that's a solid number. The real offset on the office based side in volumes was primary and urgent care. So for the rest of our business, things looked fairly stable. On the hospital based side, our NICU days were up about 2.5%. The leap day effect is about a percentage point on that. So still, growth in our NICU days, underlying bursts were relatively stable, I would say roughly flat with rate of admission and length of stay up slightly, which is a phenomenon we have seen relatively consistently the last couple of years. So to put that together, I would say that our outlook for 2024, as we developed our budget and our forecast, was for a stable volume profile across our business line and stable demand and I would say that, Jim, that's effectively what we experienced in the first quarter.
James Swift: Yes, that's exactly what we saw. And I think we remain encouraged by the volumes that we've seen in maternal-fetal medicine, which really carries over from the end of last year. So, not that that's necessarily a leading indicator in terms of neonatal volume, but it is encouraging to us that that is a platform that's very important to the organization.
Unidentified Analyst: Got it. Thank you very much for that clarity. And then I guess just pivoting to the SWV line. Curious to know how you all think that's going to progress throughout the year. I know Q1 is usually high from a seasonal perspective, but curious if you could provide any color on that front?
James Swift:
SWB:
SWB:
Unidentified Analyst: Got it. Thank you.
Operator: And next, we have a question from Kevin Fischbeck with Bank of America. Please go ahead.
Kevin Fischbeck: Great, thanks. Can you help size from a revenue perspective, what the assets that you're looking to exit would represent? And just to be 100% clear, it sounds like you're saying that they have an absolute negative EBITDA margin, so confirm that as well?
Marc Richards: Yes. Kevin, in terms of the total asset count, I would point you to a couple other pieces here with respect to call it some of the disposition activity that we're going through. If you look at kind of non-same unit revenue for the quarter, it's down about $6.8 million. The bulk of our disposition functions right now are reflected in that non-same unit line item. So some of the components related to kind of the wind down of the losses you'll see coming through non-same unit in the coming quarters. In terms of all the pieces there, this effort remains fluid. So nailing down the various components right now, it's a little premature, but we'll be able to provide additional details in the coming quarters as these practices are unwound.
Kevin Fischbeck: I guess maybe just to make sure I understand that comment, so you're saying that in Q1 it's 7 million, so that would run rate to $28 million. But it sounds like this is going to build as the year goes on. So it's going to be more than $28 million annualized, and we can track that pace as that number through the year, that's the way to think about it?
Marc Richards: That's right. That's correct, Kevin. That number right now reflects in process dispositions, and will continue to grow as we continue to execute on our plan.
Kevin Fischbeck: Okay. But there's no target for run rate number at this point?
Marc Richards: Still to be determined at this point, I'd say.
Kevin Fischbeck: Okay, and then there was a second part of this, and I missed it. It sounded like you said you were doing something about redoing stipends or something. What was the other area about the margin improvement?
Marc Richards: No, I think in that setting, Kevin, obviously we're always in discussions with our health system partners to the extent that there are services, whether those be ambulatory services or inpatient services, if there's a requirement for us to provide coverage, we want to make sure that our services are adequately reflected in terms of the stipend support. So it's part of the discussion we have year-over-year with our health system partners, and that's just with regard to the coverage requirements of those ambulatory practices.
Kevin Fischbeck: Okay, then maybe just my last one. I think that you guys had gotten into this kind of urgent care business with the view that it was going, going to add a leg of growth to the company. How do you guys think about when you're done with this portfolio restructuring? What is the right growth algorithm for pediatrics from a top line perspective? Thanks.
Marc Richards: Yes, I think for primary and urgent care it's probably twofold. One, we acquired a couple of assets in primary and urgent care and they're very good practices. The problem is that there were not a larger number of attractive acquisitions to do in primary and urgent care. And obviously then it becomes a heavy lift in terms of rolling out these independent practices in that portfolio across the country. So we just thought that the time to do that was distracting from what we need to do. Our focus, though, on growth would be in the core services that we continue to perform. If you look at it from the standpoint, we didn't announce it specifically on a press release, we did acquire an MFM practice in California that has been a great addition to our portfolio of MFM. So you'll see more of that activity both on our core and longstanding ambulatory services that fit with our inpatient services and our ability to execute on both organic and inorganic growth on the inpatient side.
Kevin Fischbeck: All right, thanks.
Operator: [Operator Instructions] And we have no other questions. You may continue.
Charles Lynch: Thank you all for joining the call today. We'll talk to you next quarter.
Operator: Ladies and gentlemen, that does conclude your conference for today. Thank you for your participation. You may now disconnect.
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