EX-99.2 3 amed1q23ecsupplementalsl.htm EX-99.2 amed1q23ecsupplementalsl
1 Amedisys First Quarter 2023 Earnings Release Supplemental Slides May 3rd, 2023 Exhibit 99.2


 
2 This presentation may include forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward-looking statements are based upon current expectations and assumptions about our business that are subject to a variety of risks and uncertainties that could cause actual results to differ materially from those described in this presentation. You should not rely on forward-looking statements as a prediction of future events. Additional information regarding factors that could cause actual results to differ materially from those discussed in any forward-looking statements are described in reports and registration statements we file with the SEC, including our Annual Report on Form 10-K and subsequent Quarterly Reports on Form 10-Q and Current Reports on Form 8-K, copies of which are available on the Amedisys internet website http://www.amedisys.com or by contacting the Amedisys Investor Relations department at (225) 292-2031. We disclaim any obligation to update any forward-looking statements or any changes in events, conditions or circumstances upon which any forward-looking statement may be based except as required by law. www.amedisys.com NASDAQ: AMED We encourage everyone to visit the Investors Section of our website at www.amedisys.com, where we have posted additional important information such as press releases, profiles concerning our business, clinical operations and control processes and SEC filings. FORWARD-LOOKING STATEMENTS Exhibit 99.2


 
3 OUR KEY AREAS OF FOCUS Strategic areas of focus and progress made during Q1’23 • Home Health*: Total same store admissions +8% • Hospice: Total same store admissions -5%, ADC -1% • Personal Care: PC Network drove ~$262K in revenue to Home Health and Hospice via care coordination • High Acuity Care: Admissions +85% over prior year 1 Organic Growth • Quality: Amedisys Jul’23 preview STARS score of 4.47 • 99% of care centers at 4+ Stars based on Jul’23 preview • 42 Amedisys care centers rated at 5 Stars in the Jul’23 preview • Hospice quality – outperforming industry average in all hospice item set (HIS) categories 3 Clinical Initiatives • Focusing on optimizing RN / LPN & PT / PTA staffing ratios. • Current LPN Ratio: 48.2% (vs. 47.8% in 1Q’22) • Current PTA Ratio: 54.4% (vs. 53.4% in 1Q’22) 4 Capacity and Productivity • Completed divestiture of Personal Care business effective 3/31/2023 5 M&A 2 Recruiting / Retention • Targeting industry leading employee retention amongst all employee categories • Q1’23 Voluntary Turnover 18.7% *Note: Home Health same store volume is defined as admissions plus recertifications 2023 Reimbursement • Final Hospice industry rule – Amedisys impact +3.8% increase (effective 10/1/22) • Final Home Health industry rule – Amedisys impact flat (effective 1/1/23) 2024 Reimbursement • Proposed Hospice industry rule – Amedisys estimated impact +2.8% increase (effective 10/1/23) 6 Regulatory Exhibit 99.2


 
4 HIGHLIGHTS AND SUMMARY FINANCIAL RESULTS (ADJUSTED): 1Q 2023(1) Home Health total same store admissions +8%; Hospice same store admissions -5%; EBITDA margin decline driven by the return of sequestration ($9M), planned wage increases and the shift in Home Health volumes from episodic to per visit payors 1. The financial results for the three-month periods ended March 31, 2022 and March 31, 2023 are adjusted for certain items and should be considered a non-GAAP financial measure. A reconciliation of these non- GAAP financial measures is included in the corresponding 8-K detailing quarterly results for each respective reporting period. 2. Same Store volume – Includes admissions and recertifications. 3. Same Store is defined as care centers that we have operated for at least the last 12 months and startups that are an expansion of a same store care center. 4. Free cash flow is defined as cash flow from operations less routine capital expenditures and required debt repayments. 5. Reflects the suspension of sequestration for the three-month period ended March 31, 2022 and the reinstatement of sequestration at 2% for the three-month period ended March 31, 2023. Growth Metrics: • Total Admissions: 617 • Number of admitting JV markets: 10 Other Statistics: • Patient Satisfaction: 85% High Acuity Care Adjusted Financial Results Growth Metrics: • Billable hours/quarter: -2% • Clients served: +6% Other Statistics: • Revenue per hour: +10% • Cost per hour: +6% Personal Care Same Store Volume (3): • Admissions: -5% • ADC: -1% Other Statistics: • Revenue per Day(5): $168.83 (+1.7%) • Cost per day: $88.14 (-2.5%) HospiceHome Health Same Store (2)(3) : • Total Admissions: +8% • Total Volume: +5% Other Statistics: • Revenue per Episode(5): $2,974 (-1.3%) • Visiting Clinician Cost per Visit: $99.47 (+4.0%) • Medicare VPE decreased 0.6 (-4.6%) Amedisys Consolidated • Revenue Growth:+2.0% • EBITDA: $58M • EBITDA Margin: 10.4% (ex. Contessa: 11.4%) • EPS: $1.00 Amedisys Consolidated Amedisys Consolidated Balance Sheet & Cash Flow • Net debt: $334.5M • Net Leverage ratio: 1.3x • Revolver availability: $519.2M • CFFO: $26.0M • Free cash flow (4): $19.7M • DSO: 46.3 (vs. Q1’22 of 46.3 and up 0.2 days since Q4) $ in Millions, except EPS 1Q22 1Q23 Home Health 335.7$ 343.3$ Hospice 193.1 193.4 Personal Care 14.0 15.0 High Acuity Care 2.5 4.7 Total Revenue 545.3$ 556.4$ Gross Margin % 44.8% 43.6% Adjusted EBITDA 66.3$ 57.8$ 12.2% 10.4% Adjusted EPS 1.23$ 1.00$ Free cash flow (4) 43.9$ 19.7$ Exhibit 99.2


 
5 62.7% 12.0% 25.3% Home Health Revenue Medicare FFS Private Episodic Per Visit 61.7% 34.8% 2.7% 0.8% Amedisys Consolidated Revenue Home Health Hospice Personal Care High Acuity Care • Medicare FFS: Reimbursed for a 30-day period of care • Private Episodic: MA and Commercial plans who reimburse us for a 30-day period of care, majority of which range from 95% - 100% of Medicare rates • Per Visit: Managed care, Medicaid and private payors who reimburse us per visit performed 94.5% 5.5% Hospice Revenue Medicare FFS Private Hospice Per Day Reimbursement: • Routine Care: Patient at home with symptoms controlled ~97% of the Hospice care AMED provides, in line with overall hospice industry provision of care • Continuous Care: Patient at home with uncontrolled symptoms • Inpatient Care: Patient in facility with uncontrolled symptoms • Respite Care: Patient at facility with symptoms controlled • Home Health: 348 care centers; 34 states & D.C. • Hospice: 165 care centers; 31 states • Personal Care: We divested our personal care business during the three-month period ended March 31, 2023. • High Acuity Care: 10 admitting joint venture markets; 8 states; 34 referring hospitals • Total AMED: 522 care centers; 37 states and D.C. OUR REVENUE SOURCES: 1Q’23 Exhibit 99.2


 
6 HOME HEALTH AND HOSPICE SEGMENT (ADJUSTED) – Q1 2023(1) • Revenue per Episode down 1.3% due to the reinstatement of sequestration at 2.0%. Reimbursement is flat year over year. • Y/Y Total CPV up $4.16 (+3.9%) primarily due to raises, an increase in salaried employees, higher contractor costs (COVID-related rate increases are no longer classified as an adjusting item) and visit mix. • Cost per episode down 1.1% (Medicare) Home Health Highlights • Net revenue per day +1.7%; +3.8% Hospice rate update effective 10/1/2022 was offset by the reinstatement of sequestration at 2%. • Cost per day down $2.29 (-2.5%) primarily due to clinical optimization and reorganization initiatives, lower staffing levels and lower contractor utilization partially offset by planned wage increases. Hospice Highlights 1. The financial results for the three-month periods ended March 31, 2022 and March 31, 2023 are adjusted for certain items and should be considered a non-GAAP financial measure. A reconciliation of these non-GAAP financial measures is included in the corresponding 8-K detailing quarterly results for each respective reporting period. 2. Pre-Corporate EBITDA does not include any corporate G&A expenses. 3. Same Store information represents the percent change in volume, admissions or ADC for the period as a percent of the volume, admissions or ADC of the prior period. 4. Same Store is defined as care centers that we have operated for at least the last 12 months and startups that are an expansion of a same store care center. 5. Reflects the suspension of sequestration for the three-month period ended March 31, 2022 and the reinstatement of sequestration at 2% for the three-month period ended March 31, 2023. 6. Prior year amounts have been recast to conform to the current year presentation. $ in Millions 1Q22(6) 1Q23 Medicare 224.1$ 215.4$ Non-Medicare 111.6 127.9 Home Health Revenue $335.7 $343.3 Gross Margin % 45.6% 42.9% Pre-Corporate EBITDA (2) $70.3 $58.8 20.9% 17.1% Operating Statistics Same Store Growth (3 )(4 ) Total admissions 2% 8% Total volume 0% 5% Medicare revenue per episode (5 ) $3,013 $2,974 Medicare recert rate 34.2% 32.3% Total cost per visit $106.29 $110.45 HOME HEALTH $ in Millions 1Q22 1Q23 Medicare 182.5$ 182.7$ Non-Medicare 10.6 10.7 Hospice Revenue $193.1 $193.4 Gross Margin % 45.5% 47.8% Pre-Corporate EBITDA (2) $36.9 $45.2 19.1% 23.4% Operating Statistics Admit growth - same store (3 )(4 ) 2% -5% ADC growth - same store (3 )(4 ) -3% -1% ADC 12,920 12,730 Avg. discharge length of stay 89 90 Revenue per day (net)(5) $166.04 $168.83 Cost per day $90.43 $88.14 HOSPICE Exhibit 99.2


 
7 $ in Millions 1Q22 2Q22 3Q22 4Q22 1Q23 Home Health Segment - Total 83.2 88.7 87.7 89.9 89.0 % of HH Revenue 24.8% 25.5% 25.9% 26.2% 25.9% Hospice Segment - Total 51.3 50.8 48.6 50.8 47.9 % of HSP Revenue 26.6% 25.6% 24.4% 25.7% 24.8% Personal Care Segment - Total 2.2 2.3 2.3 2.4 2.2 % of PC Revenue 15.8% 15.2% 14.0% 14.9% 14.9% High Acuity Care Segment - Total 4.3 5.1 5.2 5.1 4.4 % of HAC Revenue 155.0% 116.2% 95.0% 87.8% 94.6% Total Corporate Expenses 38.4 35.5 38.3 40.4 44.2 % of Total Revenue 7.0% 6.3% 6.9% 7.2% 7.9% Total 179.4 182.4 182.1 188.6 187.7 % of Total Revenue 32.9% 32.2% 32.6% 33.6% 33.7% GENERAL & ADMINISTRATIVE EXPENSES – ADJUSTED (1,2,3) Notes: • Year over year total G&A as a percentage of revenue increased 80 basis points ($8 million) • Excluding our home health acquisitions ($3 million), total G&A is up $5 million due to planned wage increases, IT fees, recruiting fees and insurance-related costs • Total G&A decreased $1 million sequentially • Lower spend across our segments primarily due to the seasonality of health insurance costs which was partially offset by higher incentive compensation costs, recruiting fees and IT fees in corporate 1. The financial results for the three-month periods ended March 31, 2022, June 30, 2022, September 30, 2022, December 31, 2022 and March 31, 2023 are adjusted for certain items and should be considered a non-GAAP financial measure. A reconciliation of these non-GAAP financial measures is included in the corresponding 8-K detailing quarterly results for each respective reporting period. 2. Adjusted G&A expenses do not include depreciation and amortization. 3. Prior periods have been recast to conform to the current year presentation. Impacted by acquisitions and raises 32.9% 32.2% 32.6% 33.6% 33.7% 31.0% 33.0% 35.0% 1Q22 2Q22 3Q22 4Q22 1Q23 Total G&A as a Percent of Revenue G&A as a Percent of Revenue 1Q22 2Q22 3Q22 4Q22 1Q23 Salary and Benefits 25.6 25.3 23.8 25.5 26.3 Other 11.1 7.7 13.2 12.5 15.5 Corp. G&A Subtotal 36.7 33.0 37.0 38.0 41.8 Non-cash comp 1.7 2.5 1.3 2.4 2.4 Adjusted Corporate G&A 38.4 35.5 38.3 40.4 44.2 Exhibit 99.2


 
8 OPERATIONAL EXCELLENCE: HOME HEALTH COST PER VISIT (CPV)-ADJUSTED YOY Total CPV impacted by labor cost pressures and prior year benefit related to COVID contractor add-back. *Note: Direct comparison with industry competitors CPV calculation ** Note: In 1Q’22, the addback of COVID costs reduced Visiting Clinician CPV by $1.50. Accordingly, our YOY increase is $2.29 or 2.4% $25.00 $50.00 $75.00 $100.00 1Q22 4Q22 1Q23 Cost Per Visit (CPV) Salaries Contractors Benefits Transportation $95.68 $103.38 $99.47 Components 1Q’22(1) 4Q’22(1) 1Q’23 YoY Variance Detail Initiatives Salaries $70.34 $74.25 $72.79 $2.45 YoY increase due to planned wage increases, an increase in salaried employees and visit mix Sequential decrease due to one less holiday and lower new hire pay Staffing mix optimization, productivity and scheduling improvement initiatives in place to help overcome salary increases Contractors $5.60 $5.60 $6.50 $0.90 Prior year benefited from COVID add- backs (1Q’22: $1.17, 4Q’22: $0.75) Focused efforts on filling positions with full-time clinicians Benefits $12.43 $15.81 $12.95 $0.52 YoY increase due to higher payroll taxes on salary increases described above Sequential decrease due to the seasonality of health insurance claims Focus on cost containment and spend optimization with specific focus on high-cost claims Transportation & Supplies $7.31 $7.72 $7.23 ($0.08) YoY and sequential variances due to the capitalization of fleet vehicle leases in 1Q’23; YoY decline was partially offset by increases in clinician mileage reimbursement *Visiting Clinician CPV $95.68 $103.38 $99.47 $3.79** Clinical Managers $10.61 $11.60 $10.98 $0.37 Fixed cost associated with non-visiting clinicians Sequential variance due to impact of fixed costs on higher visit volumes Unit cost reduced as volume increases Total CPV $106.29 $114.98 $110.45 $4.16 1. Prior year periods have been recast to conform to the current year presentation. Exhibit 99.2


 
9 DRIVING TOP LINE GROWTH Home Health admissions growth remains strong; volume impacted by mix shift. Sequential Hospice average daily census decline due to softer admission volumes and seasonality. 0% -2% 1% 1% 5% 2% 0% 5% 5% 8% -4.0% -2.0% 0.0% 2.0% 4.0% 6.0% 8.0% 50,000 100,000 150,000 1Q22 2Q22 3Q22 4Q22 1Q23 Volume SS Volume Growth SS Admit Growth Home Health Growth Hospice Growth -3% 0% 1% -2% -1% 2% 6% -3% -8% -5% -9.0% -6.0% -3.0% 0.0% 3.0% 6.0% 12,000 12,500 13,000 13,500 14,000 1Q22 2Q22 3Q22 4Q22 1Q23 ADC Admits SS ADC Growth SS Admit Growth *2022 Hospice care center closures impacted 2023 ADC by ~ 129 and Admits by 176 Exhibit 99.2


 
10 3.00 3.50 4.00 4.50 PS Industry Performance Amedisys PS Score PS Industry Avg PS Top Competitor 3.00 3.50 4.00 4.50 QPC Industry Performance Amedisys QPC Industry Avg QPC Top Competitor INDUSTRY LEADING QUALITY SCORES Metric Oct 22 Release Jan 23 Release Apr 23 Preview Jul 23 Preview Quality of Patient Care 4.49 4.49 4.49 4.47 Entities at 4+ Stars 100% 99% 99% 99% Metric Jul 22 Release Oct 22 Release Jan 23 Release Apr 23 Preview Patient Satisfaction Star 3.92 3.60 3.57 3.65 Performance Over Industry +5% +3% +1% NA Quality of Patient Care (QPC) Patient Satisfaction (PS) • Amedisys maintains a 4-Star average in the Jul 2023 HHC Preview with 99% of our providers (representing 99% of care centers) at 4+ Stars and 79% of our providers (representing 80% of care centers) at 4.5+ Stars. •30 Amedisys providers (representing 42 care centers) rated at 5 Stars. Notes: (1) CMS did not provide QPC Star and HH-CAHPS performance releases in 2021 due to COVID-19 PHE. (2) Jul 2023 QPC Star Preview performance period = Oct 2021 – Sep 2022 (Jul 2020 - Jun 2021 for ACH). (3) Apr 2023 HH-CAHPS Preview performance period = Oct 2021 – Sep 2022 (4) QPC Star and HH-CAHPS Results for Amedisys Legacy providers only. CMS Blind Period CMS Blind Period Exhibit 99.2


 
11 HOSPICE QUALITY: AMEDISYS HOSPICE CONTINUES TO MOVE TOWARDS BEST-IN-CLASS Hospice Quality Notes: Included in the above analysis are only active providers. Exhibit 99.2


 
12 DEBT AND LIQUIDITY METRICS Net leverage ~1.3x 1. Net debt defined as total debt outstanding ($403.4M) less cash ($69.1M). 2. Leverage ratio (net) is defined as net debt divided by last twelve months adjusted EBITDA ($253.6M). 3. Liquidity defined as the sum of cash balance and available revolving line of credit. Outstanding Revolver - Outstanding Term Loan 383.1 Promissory Notes 0.2 Finance Leases 20.1 Total Debt Outstanding 403.4 Less: Deferred Debt Issuance Costs (3.3) Total Debt - Balance Sheet 400.1 Total Debt Outstanding 403.4 Less Cash (69.1) Net Debt (1) 334.3 Leverage Ratio (net) (2) 1.3 Term Loan 450.0 Revolver Size 550.0 Borrowing Capacity 1,000.0 Revolver Size 550.0 Outstanding Revolver - Letters of Credit (30.8) Available Revolver 519.2 Plus Cash 69.1 Total Liquidity (3) 588.3 As of: 3/31/23 Credit Facility Outstanding Debt As of: 3/31/23 Exhibit 99.2


 
13 CASH FLOW STATEMENT HIGHLIGHTS (1) Total cash flow from operations for Q1-23 of $26M. 1. Free cash flow defined as cash flow from operations less routine capital expenditures and required debt repayments. $ in Millions 1Q22 2Q22 3Q22 4Q22 1Q23 GAAP Net Income 31 .7 29.0 25.4 31 .5 24.9 Changes in working capital (5.4) 1 3 .6 (67 .3) 6.9 (1 4.3) Depreciation and amortization 8.0 6.2 5.5 5.2 5.7 Non-cash compensation 7 .3 5.1 3 .5 0.6 3 .3 Deferred income taxes 3.2 2 .8 1 3 .0 4.3 2 .8 Other 3.8 0.7 6.3 (7 .6) 3 .6 Cash flow from operations 48.6 57.4 (13.6) 40.9 26.0 Capital expenditures - routine (0.9) (1 .5) (1 .5) (1 .5) (1 .0) Required debt repay ments (3.8) (3.2) (3 .2) (3 .2) (5.3) Free cash flow 43.9 52.7 (18.3) 36.2 19.7 Capital Deployment Acquisitions - (7 3.3) 1 .4 - - Share Repurchases - (1 7 .4) - - - Total - (90.7) 1.4 - - Exhibit 99.2


 
14 INCOME STATEMENT ADJUSTMENTS (1) 1. The financial results for the three-month periods ended March 31, 2022, June 30, 2022, September 30, 2022, December 31, 2022 and March 31, 2023 are adjusted for certain items and should be considered a non-GAAP financial measure. A reconciliation of these non-GAAP financial measures is included in the corresponding 8-K detailing quarterly results for each respective reporting period. 2. Other (income) expense, net includes a $2.2 million loss related to our Personal Care divestiture on March 31, 2023. Q1 adjustments primarily related to clinical optimization and reorganization initiatives, Personal Care divestiture and acquisition and integration costs. $000s Income Statement Line Item 1Q22 2Q22 3Q22 4Q22 1Q23 Revenue Contingency accrual Net Service Revenue -$ 8,374$ 931$ -$ -$ Cost of Service Clinical optimization and reorganization costs Cost of Service, Inclusive of Depreciation - 195 1,154 33 114 COVID-19 costs Cost of Service, Inclusive of Depreciation 3,733 1,803 1,701 1,510 - Integration costs Cost of Service, Inclusive of Depreciation - 1,401 311 - - Fuel supplement Cost of Service, Inclusive of Depreciation 337 1,016 1,962 261 - G&A Acquisition and integration costs G&A, Salaries and benefits 316 1,674 1,025 378 500 Clinical optimization and reorganization costs G&A, Salaries and benefits - 810 1,386 (152) 52 Personal Care divestiture G&A, Salaries and benefits - - - - 318 COVID-19 costs G&A, Salaries and benefits 24 12 - 3 - Executive Board of Directors/CEO transition awards G&A, Salaries and benefits 3,500 - - - 750 Severance G&A, Salaries and benefits - - - 993 - Fuel supplement G&A, Salaries and benefits - - 218 33 - Acquisition and integration costs G&A, Other 1,062 3,649 2,129 1,065 1,167 Legal fees - non-routine G&A, Other 51 190 - - - COVID-19 costs G&A, Other 129 72 159 104 - Clinical optimization and reorganization costs G&A, Other - 59 1,290 2,399 3,838 Personal Care divestiture G&A, Other - - - - 196 Legal settlement G&A, Other - (1,058) - - - Other Items Investment impairment Investment impairment - - 3,009 - - Interest component of certain items Interest Expense - 4,652 (207) - - Other (income) expense, net (2) Total Other (Expense) Income, Net 2,298 760 793 814 3,052 Total 11,450$ 23,609$ 15,861$ 7,441$ 9,987$ EPS Impact 0.26$ 0.56$ 0.36$ 0.19$ 0.22$ EBITDA Impact 11,450$ 18,957$ 16,068$ 7,441$ 9,987$ Exhibit 99.2


 
15 2023 Guidance Exhibit 99.2


 
16 AMEDISYS 2023 UPDATED GUIDANCE Updated Revenue, EBITDA and EPS guidance ranges for FY 2023 ($M except for EPS) Original Guidance Updated Guidance Adjusted Revenue $2,244 - $2,274 $2,254 - $2,274 Adjusted EBITDA $230 - $240 $235 - $245 Adjusted EPS $4.13 - $4.36 $4.14 - $4.36 Exhibit 99.2


 
17 Environmental, Social, Governance (E.S.G.) Considerations Exhibit 99.2


 
18 ENVIRONMENTAL, SOCIAL, GOVERNANCE (E.S.G.) CONSIDERATIONS Sustainable, high-quality, patient focused, home-based care model Environmental • Amedisys is dedicated to the sustainability of our business and the communities in which we serve • Environmental health has a strong correlation with physical health • A greener fleet – newer vehicles, in circulation for a shorter time, optimize fuel usage. Sophisticated scheduling practices reduce our clinicians’ driving time and fuel usage helping to minimize our carbon footprint • Virtual care centers, along with flexible working schedules and locations, have created fewer emissions Social • Amedisys strives to create an organizational culture and climate in which every individual is valued, all team members have a sense of belonging with one another and to the organization and feel empowered to do their best work • Provider of Home Health and Hospice services to frail, elderly patients in their most preferred care location – their homes • Highest quality Home Health company as measured by Quality of Patient Care Star scores (4.47 Stars) • The Amedisys Foundation was formed to provide support to our patients and employees. The Amedisys Foundation has two funds: the Patients’ Special Needs Fund and the Amedisys Employees 1st Fund. The Patients’ Special Needs Fund provides financial assistance to our home health, hospice and high acuity care patients during a difficult time Governance • Amedisys has a culture of compliance starting with oversight from the Board of Directors and cascading down to the care center level • Our Board of Directors operates several sub-committees including: • Quality of Care Committee • Compliance & Ethics Committee • Audit Committee • Compensation Committee • Nominating & Corporate Governance Committee • Nominating and Corporate Governance Committee oversees our strategy on corporate social responsibility, including evaluating the impact of Company practices on communities and individuals, and develops and recommends to our Board of Directors for approval matters relating to the Company’s corporate social responsibility and ESG considerations Exhibit 99.2