LHC GROUP, INC.
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-Q
|
|
|
þ |
|
Quarterly report pursuant to Section 13 or 15 (d) of the Securities Exchange Act of 1934 |
For the quarterly period ended September 30, 2007
or
|
|
|
o |
|
Transition Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 |
For the transition period from to
Commission file number: 0-8082
LHC GROUP, INC.
(Exact Name of Registrant as Specified in Charter)
|
|
|
Delaware
(State or Other Jurisdiction of
Incorporation or Organization)
|
|
71-0918189
(I.R.S. Employer Identification No.) |
420 West Pinhook Rd, Suite A
Lafayette, LA 70503
(Address of principal executive offices including zip code)
(337) 233-1307
(Registrants telephone number, including area code)
Indicate by check mark whether the issuer (1) has filed all reports required to be filed by Section
13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such
shorter period that the registrant was required to file such reports), and (2) has been subject to
such filing requirements for the past 90 days. Yes þ No o
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated
filer, or a non-accelerated filer. See definition of accelerated filer and large accelerated
filer in Rule 12b-2 of the Exchange Act.
(Check one):
Large accelerated filer o Accelerated Filer þ Non-accelerated filer o
Indicate by check mark whether the registrant is a shell company (as defined in rule 12b-2 of
the Exchange Act). Yes o No þ
Number of shares of common stock, par value $0.01, outstanding as of November 2, 2007: 18,009,671
shares
PART I FINANCIAL INFORMATION
ITEM 1. FINANCIAL STATEMENTS.
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
|
|
|
|
|
|
|
|
|
|
|
September 30, |
|
|
December 31, |
|
|
|
2007 |
|
|
2006 |
|
|
|
(unaudited) |
|
|
|
|
|
|
|
(in thousands, except share data) |
|
ASSETS |
|
|
|
|
|
|
|
|
Current assets: |
|
|
|
|
|
|
|
|
Cash |
|
$ |
12,859 |
|
|
$ |
26,877 |
|
Receivables: |
|
|
|
|
|
|
|
|
Patient accounts receivable, less allowance for uncollectible accounts of
$8,955, and $5,769 at September 30, 2007 and December 31, 2006, respectively |
|
|
61,009 |
|
|
|
50,029 |
|
Other receivables |
|
|
2,633 |
|
|
|
3,367 |
|
Employee receivables |
|
|
33 |
|
|
|
34 |
|
Amounts due from governmental entities |
|
|
2,372 |
|
|
|
2,518 |
|
|
|
|
|
|
|
|
|
|
|
66,047 |
|
|
|
55,948 |
|
Deferred income taxes |
|
|
3,107 |
|
|
|
1,935 |
|
Prepaid income taxes |
|
|
519 |
|
|
|
|
|
Prepaid expenses and other current assets |
|
|
4,299 |
|
|
|
4,120 |
|
Assets held for sale |
|
|
678 |
|
|
|
1,171 |
|
|
|
|
|
|
|
|
Total current assets |
|
|
87,509 |
|
|
|
90,051 |
|
Property, building, and equipment, net |
|
|
12,609 |
|
|
|
11,705 |
|
Goodwill |
|
|
64,875 |
|
|
|
39,681 |
|
Intangible assets, net |
|
|
9,497 |
|
|
|
8,262 |
|
Other assets |
|
|
3,190 |
|
|
|
2,995 |
|
|
|
|
|
|
|
|
Total assets |
|
$ |
177,680 |
|
|
$ |
152,694 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LIABILITIES AND STOCKHOLDERS EQUITY |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Current liabilities: |
|
|
|
|
|
|
|
|
Accounts payable and other accrued liabilities |
|
$ |
5,666 |
|
|
$ |
5,903 |
|
Salaries, wages, and benefits payable |
|
|
14,897 |
|
|
|
10,572 |
|
Amounts due to governmental entities |
|
|
3,162 |
|
|
|
3,223 |
|
Amounts payable under cooperative endeavor agreements |
|
|
72 |
|
|
|
51 |
|
Income taxes payable |
|
|
|
|
|
|
1,219 |
|
Current portion of capital lease obligations |
|
|
96 |
|
|
|
211 |
|
Current portion of long-term debt |
|
|
433 |
|
|
|
428 |
|
|
|
|
|
|
|
|
Total current liabilities |
|
|
24,326 |
|
|
|
21,607 |
|
Deferred income taxes, less current portion |
|
|
2,598 |
|
|
|
2,104 |
|
Capital lease obligations, less current portion |
|
|
87 |
|
|
|
147 |
|
Long-term debt, less current portion |
|
|
2,887 |
|
|
|
3,051 |
|
Minority interests subject to exchange contracts and/or put options |
|
|
102 |
|
|
|
317 |
|
Other minority interests |
|
|
7,579 |
|
|
|
3,579 |
|
Stockholders equity: |
|
|
|
|
|
|
|
|
Common stock $0.01 par value: 40,000,000 shares authorized;
20,717,689 and 20,682,317 shares issued and 17,767,631 and 17,732,258
shares outstanding
at September 30, 2007 and December 31, 2006, respectively |
|
|
177 |
|
|
|
177 |
|
Treasury stock 2,950,059 shares at cost |
|
|
(2,856 |
) |
|
|
(2,856 |
) |
Additional paid-in capital |
|
|
81,423 |
|
|
|
80,273 |
|
Retained earnings |
|
|
61,357 |
|
|
|
44,295 |
|
|
|
|
|
|
|
|
Total stockholders equity |
|
|
140,101 |
|
|
|
121,889 |
|
|
|
|
|
|
|
|
Total liabilities and stockholders equity |
|
$ |
177,680 |
|
|
$ |
152,694 |
|
|
|
|
|
|
|
|
See accompanying notes.
- 1 -
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF INCOME
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Nine months Ended |
|
|
|
September 30, |
|
|
September 30, |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
|
|
(unaudited) |
|
|
|
(in thousands, except share and per share data) |
|
Net service revenue |
|
$ |
77,495 |
|
|
$ |
58,626 |
|
|
$ |
216,786 |
|
|
$ |
155,462 |
|
Cost of service revenue |
|
|
39,979 |
|
|
|
30,168 |
|
|
|
110,676 |
|
|
|
80,870 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross margin |
|
|
37,516 |
|
|
|
28,458 |
|
|
|
106,110 |
|
|
|
74,592 |
|
General and administrative expenses |
|
|
26,748 |
|
|
|
18,885 |
|
|
|
74,558 |
|
|
|
50,427 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Operating income |
|
|
10,768 |
|
|
|
9,573 |
|
|
|
31,552 |
|
|
|
24,165 |
|
Interest expense |
|
|
96 |
|
|
|
83 |
|
|
|
273 |
|
|
|
229 |
|
Non-operating income, including (gain) on
sales of assets |
|
|
(358 |
) |
|
|
(363 |
) |
|
|
(955 |
) |
|
|
(644 |
) |
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations |
|
|
11,030 |
|
|
|
9,853 |
|
|
|
32,234 |
|
|
|
24,580 |
|
Income tax expense |
|
|
3,377 |
|
|
|
3,094 |
|
|
|
10,246 |
|
|
|
7,409 |
|
Minority interest and cooperative endeavor
allocations |
|
|
1,413 |
|
|
|
1,325 |
|
|
|
4,327 |
|
|
|
3,448 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
|
6,240 |
|
|
|
5,434 |
|
|
|
17,661 |
|
|
|
13,723 |
|
Loss from discontinued operations (net of income tax
benefit of $157 and $93 in the three months ended
September 30, 2007 and 2006, respectively, and $539
and $393 in the nine months ended September 30,
2007 and 2006, respectively) |
|
|
246 |
|
|
|
163 |
|
|
|
843 |
|
|
|
728 |
|
Gain on sale of discontinued operations (net of
income taxes of $20 in the three months ended
September 30, 2007, and $20 and $336 in the nine
months ended September 30, 2007 and 2006,
respectively) |
|
|
31 |
|
|
|
|
|
|
|
31 |
|
|
|
667 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
6,025 |
|
|
|
5,271 |
|
|
|
16,849 |
|
|
|
13,662 |
|
Redeemable minority interests |
|
|
57 |
|
|
|
(72 |
) |
|
|
213 |
|
|
|
942 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income available to common stockholders |
|
$ |
6,082 |
|
|
$ |
5,199 |
|
|
$ |
17,062 |
|
|
$ |
14,604 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share basic: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
$ |
0.35 |
|
|
$ |
0.31 |
|
|
$ |
0.99 |
|
|
$ |
0.81 |
|
Loss from discontinued operations, net |
|
|
0.01 |
|
|
|
0.01 |
|
|
|
0.05 |
|
|
|
0.04 |
|
Gain on sale of discontinued operations, net |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.04 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
0.34 |
|
|
|
0.30 |
|
|
|
0.94 |
|
|
|
0.81 |
|
Redeemable minority interests |
|
|
|
|
|
|
|
|
|
|
0.01 |
|
|
|
0.05 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income available to common shareholders |
|
$ |
0.34 |
|
|
$ |
0.30 |
|
|
$ |
0.95 |
|
|
$ |
0.86 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Earnings per share diluted: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Income from continuing operations |
|
$ |
0.35 |
|
|
$ |
0.31 |
|
|
$ |
0.99 |
|
|
$ |
0.81 |
|
Loss from discontinued operations, net |
|
|
0.01 |
|
|
|
0.01 |
|
|
|
0.05 |
|
|
|
0.04 |
|
Gain on sale of discontinued operations, net |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.04 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income |
|
|
0.34 |
|
|
|
0.30 |
|
|
|
0.94 |
|
|
|
0.81 |
|
Redeemable minority interests |
|
|
|
|
|
|
|
|
|
|
0.01 |
|
|
|
0.05 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Net income available to common shareholders |
|
$ |
0.34 |
|
|
$ |
0.30 |
|
|
$ |
0.95 |
|
|
$ |
0.86 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted average shares outstanding: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Basic |
|
|
17,766,612 |
|
|
|
17,557,576 |
|
|
|
17,756,537 |
|
|
|
16,895,929 |
|
Diluted |
|
|
17,794,072 |
|
|
|
17,574,541 |
|
|
|
17,823,237 |
|
|
|
16,907,787 |
|
See accompanying notes.
- 2 -
LHC GROUP, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
|
|
|
|
|
|
|
|
|
|
|
Nine months Ended |
|
|
|
September 30, |
|
|
|
2007 |
|
|
2006 |
|
|
|
(unaudited) |
|
|
|
(in thousands) |
|
Operating activities |
|
|
|
|
|
|
|
|
Net income |
|
$ |
16,849 |
|
|
$ |
13,662 |
|
Adjustments to reconcile net income to net cash provided by operating activities: |
|
|
|
|
|
|
|
|
Depreciation expense |
|
|
2,201 |
|
|
|
1,742 |
|
Provision for bad debts |
|
|
7,291 |
|
|
|
2,836 |
|
Stock-based compensation expense |
|
|
758 |
|
|
|
536 |
|
Minority interest in earnings of subsidiaries |
|
|
3,932 |
|
|
|
3,460 |
|
Deferred income taxes |
|
|
(678 |
) |
|
|
(427 |
) |
Gain on divestitures and sale of assets |
|
|
|
|
|
|
(667 |
) |
Changes in operating assets and liabilities, net of acquisitions: |
|
|
|
|
|
|
|
|
Receivables |
|
|
(17,390 |
) |
|
|
(10,323 |
) |
Prepaid income taxes |
|
|
(519 |
) |
|
|
|
|
Prepaid expenses, other assets |
|
|
(318 |
) |
|
|
(3,652 |
) |
Accounts payable and accrued expenses |
|
|
2,958 |
|
|
|
10,498 |
|
Net amounts due under cooperative endeavor agreements |
|
|
21 |
|
|
|
16 |
|
Net amounts due governmental entities |
|
|
(61 |
) |
|
|
1,711 |
|
|
|
|
|
|
|
|
Net cash provided by operating activities |
|
|
15,044 |
|
|
|
19,392 |
|
|
|
|
|
|
|
|
Investing activities |
|
|
|
|
|
|
|
|
Purchases of property, building, and equipment |
|
|
(2,634 |
) |
|
|
(2,702 |
) |
Proceeds from sale of entities |
|
|
|
|
|
|
1,440 |
|
Cash paid for acquisitions, primarily goodwill and intangible assets |
|
|
(22,376 |
) |
|
|
(21,060 |
) |
|
|
|
|
|
|
|
Net cash used in investing activities |
|
|
(25,010 |
) |
|
|
(22,322 |
) |
|
|
|
|
|
|
|
Financing activities |
|
|
|
|
|
|
|
|
Issuance of common stock, net of underwriting discounts of $1,104 for the nine
months ended September 30, 2006 |
|
|
|
|
|
|
21,033 |
|
Principal payments on debt |
|
|
(159 |
) |
|
|
(1,163 |
) |
Payments on capital leases |
|
|
(175 |
) |
|
|
(327 |
) |
Proceeds from employee stock purchase plan |
|
|
303 |
|
|
|
85 |
|
Proceeds from exercise of options |
|
|
|
|
|
|
135 |
|
Offering costs incurred |
|
|
|
|
|
|
(250 |
) |
Minority interest distributions, net |
|
|
(4,021 |
) |
|
|
(3,392 |
) |
|
|
|
|
|
|
|
Net cash provided by (used in) financing activities |
|
|
(4,052 |
) |
|
|
16,121 |
|
|
|
|
|
|
|
|
Change in cash |
|
|
(14,018 |
) |
|
|
13,191 |
|
Cash at beginning of period |
|
|
26,877 |
|
|
|
17,398 |
|
|
|
|
|
|
|
|
Cash at end of period |
|
$ |
12,859 |
|
|
$ |
30,589 |
|
|
|
|
|
|
|
|
Supplemental disclosures of cash flow information |
|
|
|
|
|
|
|
|
Interest paid |
|
$ |
272 |
|
|
$ |
230 |
|
|
|
|
|
|
|
|
Income taxes paid |
|
$ |
12,052 |
|
|
$ |
120 |
|
|
|
|
|
|
|
|
See accompanying notes.
- 3 -
LHC GROUP, INC. AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
(Unaudited)
1. Organization
LHC Group, Inc. (the Company) is a healthcare provider specializing in the post-acute
continuum of care primarily for Medicare beneficiaries in non-urban markets in the United States.
The Company provides home-based services, primarily through home nursing agencies and hospices, and
facility-based services, primarily through long-term acute care hospitals and outpatient
rehabilitation clinics. As of the date of this report, the Company, through its wholly and
majority-owned subsidiaries, equity joint ventures, and controlled affiliates, operated in
Louisiana, Alabama, Arkansas, Mississippi, Texas, West Virginia,
Kentucky, Florida, Georgia,
Tennessee, and Ohio.
Unaudited Interim Financial Information
The consolidated balance sheet as of September 30, 2007 and the related consolidated
statements of income for the three months and nine months ended September 30, 2007 and 2006, and
cash flows for the nine months ended September 30, 2007 and 2006 and related notes (interim
financial information) have been prepared by LHC Group, Inc. and are unaudited. In the opinion of
management, all adjustments (consisting of normal recurring accruals) considered necessary for a
fair presentation in accordance with accounting principles generally accepted in the United States
have been included. Operating results for the three months and nine months ended September 30, 2007
are not necessarily indicative of the results that may be expected for the year ending December 31,
2007.
Certain information and footnote disclosures normally included in financial statements
prepared in accordance with accounting principles generally accepted in the United States have been
condensed or omitted from the interim financial information presented. These consolidated financial
statements should be read in conjunction with the notes to the consolidated financial statements
included in the Companys Consolidated Financial Statements in the Companys Annual Report as filed
with the Securities and Exchange Commission on Form 10-K for the year ended December 31, 2006,
which includes information and disclosures not included herein.
2. Significant Accounting Policies
Use of Estimates
The preparation of financial statements in conformity with accounting principles generally
accepted in the United States requires management to make estimates and assumptions that affect the
reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at
the date of the financial statements and the reported revenue and expenses during the reporting
period. Actual results could differ from those estimates.
Critical Accounting Policies
The most critical accounting policies relate to the principles of consolidation, revenue
recognition, accounts receivable and allowances for uncollectible accounts, and accounting for
goodwill and intangible assets.
Principles of Consolidation
The consolidated financial statements include all subsidiaries and entities controlled by the
Company. Control is generally defined by the Company as ownership of a majority of the voting
interest of an entity. The consolidated financial statements include entities in which the Company
absorbs a majority of any losses, receives a majority of any residual returns, or both, as a result
of ownership, contractual or other financial interests in the entity.
All significant inter-company accounts and transactions have been eliminated in consolidation.
Business combinations, which are accounted for as purchases, have been included in the consolidated
financial statements from the respective dates of acquisition.
- 4 -
The following describes the Companys consolidation policy with respect to its various
ventures excluding wholly-owned subsidiaries:
Equity Joint Ventures
The Companys joint ventures are structured as limited liability companies in which the
Company typically owns a majority equity interest ranging from 51% to 99%. Each member of all but
one of the Companys equity joint ventures participates in profits and losses in proportion to
their equity interests. The Company has one joint venture partner whose participation in losses is
limited. The Company consolidates these entities as the Company absorbs a majority of any losses,
receives a majority of any residual returns and generally has voting control over the entity.
Cooperative Endeavors
The Company has arrangements with certain partners that involve the sharing of profits and
losses. Unlike the equity joint ventures, the Company owns 100% of the equity in these cooperative
endeavors. In these cooperative endeavors, the Company possesses interests in the net profits and
losses ranging from 67% to 70%. The Company has one cooperative endeavor partner whose
participation in losses is limited. The Company consolidates these entities as the Company owns
100% of the outstanding equity and the Company absorbs a majority of any losses and receives a
majority of any residual returns.
License Leasing Arrangements
The Company, through wholly-owned subsidiaries, leases home health licenses necessary to
operate certain of its home nursing agencies. As with wholly-owned subsidiaries, the Company owns
100% of the equity of these entities and consolidates them based on such ownership as well as the
Companys right to receive a majority of any residual returns and the Companys obligation to
absorb a majority of any losses.
Management Services
The Company has various management services agreements under which the Company manages certain
operations of agencies and facilities. The Company does not consolidate these agencies or
facilities, as the Company does not have an ownership interest and does not have a right to receive
a majority of any residual returns or an obligation to absorb a majority of any losses.
The following table summarizes the percentage of net service revenue earned by type of
ownership or relationship the Company had with the operating entity:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Nine Months Ended |
|
|
September 30, |
|
September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Wholly-owned subsidiaries |
|
|
44.6 |
% |
|
|
43.8 |
% |
|
|
45.2 |
% |
|
|
40.7 |
% |
Equity joint ventures |
|
|
41.7 |
|
|
|
43.4 |
|
|
|
41.2 |
|
|
|
46.4 |
|
Cooperative endeavors |
|
|
1.4 |
|
|
|
1.3 |
|
|
|
1.4 |
|
|
|
1.5 |
|
License leasing arrangements |
|
|
10.4 |
|
|
|
8.9 |
|
|
|
10.0 |
|
|
|
9.3 |
|
Management services |
|
|
1.9 |
|
|
|
2.6 |
|
|
|
2.2 |
|
|
|
2.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Revenue Recognition
The Company reports net service revenue at the estimated net realizable amount due from
Medicare, Medicaid, commercial insurance, managed care payors, patients, and others for services
rendered. Under Medicare, the Companys home nursing patients are classified into a group referred
to as a home health resource group prior to the receipt of services. Based on this home health
resource group, the Company is entitled to receive a prospective Medicare payment for delivering
care over a 60-day period referred to as an episode. Medicare adjusts these
prospective payments based on a variety of factors, such as low utilization, patient
transfers, changes in condition and the level of services provided. In calculating the Companys
reported net service revenue from home nursing
- 5 -
services, the Company adjusts the prospective Medicare payments by an estimate of the
adjustments. The Company calculates the adjustments based on a historical average of these types of
adjustments. For home nursing services, the Company recognizes revenue based on the number of days
elapsed during the episode of care.
For the Companys long-term acute care hospitals, revenue is recognized as services are
provided. Under Medicare, patients in the Companys long-term acute care facilities are classified
into long-term diagnosis-related groups. Based on this classification, the Company is then entitled
to receive a fixed payment from Medicare. This fixed payment is also subject to adjustment by
Medicare due to factors such as short stays. In calculating reported net service revenue for
services provided in the Companys long-term acute care hospitals, the Company reduces the
prospective payment amounts by an estimate of the adjustments. The Company calculates the
adjustment based on a historical average of these types of adjustments for claims paid.
For hospice services, the Company is paid by Medicare under a per diem payment system. The
Company receives one of four predetermined daily or hourly rates based upon the level of care the
Company furnished. The Company records net service revenue from hospice services based on the daily
or hourly rate. The Company recognizes revenue for hospice as services are provided.
Under Medicare, the Company is reimbursed for rehabilitation services based on a fee schedule
for services provided adjusted by the geographical area in which the facility is located. The
Company recognizes revenue as these services are provided.
The Companys Medicaid reimbursement is based on a predetermined fee schedule applied to each
service provided. Therefore, revenue is recognized for Medicaid services as services are provided
based on this fee schedule.
The Companys managed care payors reimburse the Company under the terms of the related
contracts. Accordingly, the Company recognizes revenue from managed care payors consistent with
those terms.
The Company records management services revenue as services are provided in accordance with
the various management services agreements to which the Company is a party. The agreements
generally call for the Company to provide billing, management, and other consulting services suited
to and designed for the efficient operation of the applicable home nursing agency, hospice, or
inpatient rehabilitation facility. The Company is responsible for the costs associated with the
locations and personnel required for the provision of the services. The Company is generally
compensated based on a percentage of net billings or an established base fee. In addition, for
certain of the management agreements, the Company may earn incentive compensation.
Net service revenue was comprised of the following:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Nine Months Ended |
|
|
September 30, |
|
September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Home-based services |
|
|
81.6 |
% |
|
|
76.0 |
% |
|
|
81.3 |
% |
|
|
72.8 |
% |
Facility-based services |
|
|
18.4 |
|
|
|
24.0 |
|
|
|
18.7 |
|
|
|
27.2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The following table sets forth the percentage of net service revenue earned by category of
payor:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Nine Months Ended |
|
|
September 30, |
|
September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Payor: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Medicare |
|
|
82.0 |
% |
|
|
81.3 |
% |
|
|
82.0 |
% |
|
|
83.7 |
% |
Medicaid |
|
|
5.0 |
|
|
|
4.1 |
|
|
|
5.6 |
|
|
|
4.3 |
|
Other |
|
|
13.0 |
|
|
|
14.6 |
|
|
|
12.4 |
|
|
|
12.0 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
100.0 |
% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
- 6 -
Home-Based Services
Home Nursing Services. The Company receives a standard prospective Medicare payment for
delivering care. The base payment, established through federal legislation, is a flat rate that is
adjusted upward or downward based upon differences in the expected resource needs of individual
patients as indicated by clinical severity, functional severity, and service utilization. The
magnitude of the adjustment is determined by each patients categorization into one of 80 payment
groups, known as home health resource groups, and the costliness of care for patients in each group
relative to the average patient. The Companys payment is also adjusted for differences in local
prices using the hospital wage index. The Company performs payment variance analyses to verify the
models utilized in projecting total net service revenue are accurately reflecting the payments to
be received.
Medicare rates are subject to change. Due to the length of the Companys episodes of care, a
situation may arise where Medicare rate changes affect a prior periods net service revenue. In the
event that Medicare rates experience change, the net effect of that change will be reflected in the
current reporting period.
Final payments from Medicare may reflect one of five retroactive adjustments to ensure the
adequacy and effectiveness of the total reimbursement: (a) an outlier payment if the patients care
was unusually costly; (b) a low utilization adjustment if the number of visits was fewer than five;
(c) a partial payment if the patient transferred to another provider before completing the episode;
(d) a change-in-condition adjustment if the patients medical status changes significantly,
resulting in the need for more or less care; or (e) a payment adjustment based upon the level of
therapy services required in the population base. Management estimates the impact of these payment
adjustments based on historical experience and records this estimate during the period the services
are rendered.
Hospice Services. The Companys Medicare hospice reimbursement is based on an
annually-updated prospective payment system. Hospice payments are also subject to two caps. One
cap relates to individual programs receiving more than 20% of their total Medicare reimbursement
from inpatient care services. The second cap relates to individual programs receiving
reimbursements in excess of a cap amount, calculated by multiplying the number of beneficiaries
during the period by a statutory amount that is indexed for inflation. The determination for each
cap is made annually based on the 12-month period ending on October 31 of each year. This limit is
computed on a program-by-program basis. None of the Companys hospices exceeded either cap during
the nine months ended September 30, 2007 or 2006.
Facility-Based Services
Long-Term Acute Care Services. The Company is reimbursed by Medicare for services provided
under the long-term acute care hospital prospective payment system, which was implemented on
October 1, 2002. Each patient is assigned a long-term care diagnosis-related group. The Company is
paid a predetermined fixed amount applicable to that particular group. This payment is intended to
reflect the average cost of treating a Medicare patient classified in that particular long-term
care diagnosis-related group. For selected patients, the amount may be further adjusted based on
length of stay and facility-specific costs, as well as in instances where a patient is discharged
and subsequently readmitted, among other factors. Similar to other Medicare prospective payment
systems, the rate is also adjusted for geographic wage differences. Revenue from patients covered
by private insurance is recognized in accordance with the terms of the individual contracts.
Outpatient Rehabilitation Services. Outpatient therapy services are reimbursed on a fee
schedule, subject to annual limitations. Outpatient therapy providers receive a fixed fee for each
procedure performed, adjusted by the geographical area in which the facility is located. The
Company recognizes revenue as the services are provided. There are also annual per Medicare
beneficiary caps that limit Medicare coverage for outpatient rehabilitation services.
Accounts Receivable and Allowances for Uncollectible Accounts
The Company reports accounts receivable net of estimated allowances for uncollectible accounts
and adjustments. Accounts receivable are uncollateralized and primarily consist of amounts due from
third-party payors and patients. To provide for accounts receivable that could become uncollectible
in the future, the Company establishes an allowance for uncollectible accounts to reduce the
carrying amount of such receivables to their
- 7 -
estimated net realizable value. The credit risk for other concentrations of receivables is
limited due to the significance of Medicare as the primary payor. The Company does not believe that
there are any other significant concentrations of receivables from any particular payor that would
subject it to any significant credit risk in the collection of accounts receivable.
The amount of the provision for bad debts is based upon the Companys assessment of historical
and expected net collections, business and economic conditions, and trends in government
reimbursement. Uncollectible accounts are written off when the Company has determined the account
will not be collected based on its collection efforts.
A portion of the estimated Medicare prospective payment system reimbursement from each
submitted home nursing episode is received in the form of a request for accelerated payment (RAP).
The Company submits a RAP for 60% of the estimated reimbursement for the initial episode at the
start of care. The full amount of the episode is billed after the episode has been completed. The
RAP received for that particular episode is deducted from the final payment. If a final bill is
not submitted within the greater of 120 days from the start of the episode, or 60 days from the
date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any
other claims in process for that particular provider. The RAP and final claim must then be
re-submitted. For any subsequent episodes of care contiguous with the first episode for a
particular patient, the Company submits a RAP for 50% instead of 60% of the estimated
reimbursement. The Company has earned net service revenue in excess of billings rendered to
Medicare. Only a nominal portion of the amounts due to the Medicare program represent cash
collected in advance of providing services.
Our Medicare population is paid at a prospectively set amount that can be determined at the
time services are rendered. Our Medicaid reimbursement is based on a predetermined fee schedule
applied to each individual service we provide. Our managed care contracts are structured similar to
either the Medicare or Medicaid payment methodologies. Because of our payor mix, we are able to
calculate our actual amount due at the patient level and adjust the gross charges to the actual
amount expected to be received for services at the time of billing. This negates the need for an
estimated contractual allowance to be booked at the time we report net service revenue for each
reporting period.
At September 30, 2007, our allowance for uncollectible accounts, as a percentage of patient
accounts receivable, was approximately 12.8%, or $9.0 million. For the nine months ended September
30, 2007, the provision for bad debts increased to 3.4% of net service revenue compared to 1.8% of
net service revenue for the same period in 2006. Adverse changes in general economic conditions,
billing operations, payor mix, or trends in federal or state governmental coverage could affect our
collection of accounts receivable, cash flows and results of operations.
The following table sets forth our aging of accounts receivable (based on the billing date) as
of September 30, 2007:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Payor |
|
0-30 |
|
|
31-60 |
|
|
61-90 |
|
|
91-120 |
|
|
121-150 |
|
|
151+ |
|
|
Total |
|
|
|
(in thousands) |
|
Medicare |
|
$ |
19,098 |
|
|
$ |
1.291 |
|
|
$ |
2,304 |
|
|
$ |
1,299 |
|
|
$ |
2,315 |
|
|
$ |
12,515 |
|
|
$ |
38,822 |
|
Medicaid |
|
|
3,328 |
|
|
|
639 |
|
|
|
806 |
|
|
|
609 |
|
|
|
433 |
|
|
|
4,367 |
|
|
|
10,182 |
|
Other |
|
|
4,063 |
|
|
|
1,619 |
|
|
|
1,608 |
|
|
|
1,251 |
|
|
|
1,442 |
|
|
|
10,977 |
|
|
|
20,960 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total |
|
$ |
26,489 |
|
|
$ |
3,549 |
|
|
$ |
4,718 |
|
|
$ |
3,159 |
|
|
$ |
4,190 |
|
|
$ |
27,859 |
|
|
$ |
69,964 |
|
Goodwill and Intangible Assets
Goodwill and other intangible assets with indefinite lives are reviewed annually for
impairment or more frequently if circumstances indicate impairment may have occurred.
The Company estimates the fair value of its identified reporting units and compares those
estimates against the related carrying value. For each of the reporting units, the estimated fair
value is determined based on a multiple of earnings before interest, taxes, depreciation, and
amortization or on the estimated fair value of assets in situations when it is readily
determinable.
- 8 -
Included in intangible assets, net are other intangible assets such as licenses to operate
home-based and/or facility-based services and trade names. The Company has valued these intangible
assets separately from goodwill for each acquisition completed after January 1, 2006. The Company
has concluded that these licenses and trade names have indefinite lives, as management has
determined that there are no legal, regulatory, contractual, economic or other factors that would
limit the useful life of these intangible assets and the Company intends to renew and operate the
licenses and use these trade names indefinitely. Prior to January 1, 2006, the Company recognized
the fair value of indefinite-lived licenses and trade names together with goodwill as a single
asset for financial reporting purposes.
Components of the Companys home nursing operating segment are generally represented by
individual subsidiaries or joint ventures with individual licenses to conduct specific operations
within geographic markets as limited by the terms of each license. Components of the Companys
facility-based services are represented by individual operating entities. Effective January 1,
2004, management aggregates the components of these two segments into two reporting units for
purposes of evaluating impairment.
Other Significant Accounting Policies
Due to/from Governmental Entities
The Companys critical access hospital and long-term acute care hospitals are reimbursed for
certain activities based on tentative rates. Final reimbursement is determined based on submission
of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an
estimated basis in the period the related services are rendered and further adjusted as final
settlements are determined. These adjustments are accounted for as changes in estimates. There have
been no significant changes in estimates during the three months ended September 30, 2007 and 2006.
Property, Building, and Equipment
Property, building, and equipment are stated at cost. Depreciation is computed using the
straight-line method over the estimated useful lives of the individual assets, generally ranging
from three to ten years and up to thirty-nine years on buildings. Depreciation expense for the
three months ended September 30, 2007 and 2006 was $747,000 and $614,000 respectively. Depreciation
expense for the nine months ended September 30, 2007 and 2006 was $2.2 million and $1.7 million,
respectively.
Capital leases are included in equipment. Capital leases are recorded at the present value of
the future rentals at lease inception and are amortized over the shorter of the applicable lease
term or the useful life of the equipment. Amortization of assets under the capital lease
obligations is included in depreciation and amortization expense.
Long-Lived Assets
The Company reviews the recoverability of long-lived assets whenever events or circumstances
occur which indicate recorded costs may not be recoverable. If the expected future cash flows
(undiscounted) are less than the carrying amount of such assets, the Company recognizes an
impairment loss for the difference between the carrying amount of the assets and their estimated
fair value.
Income Taxes
The Company accounts for income taxes using the liability method. Under the liability method,
deferred taxes are determined based on differences between the financial reporting and tax bases of
assets and liabilities, and are measured using the enacted tax laws that will be in effect when the
differences are expected to reverse. Management provides a valuation allowance for any net deferred
tax assets when it is more likely than not that a portion of such net deferred tax assets will not
be recovered.
Minority Interest and Cooperative Endeavor Agreements
- 9 -
The interest held by third parties in subsidiaries owned or controlled by the Company is
reported on the consolidated balance sheets as minority interest. Minority interest reported in the
consolidated statements of income reflects the respective interests in the income or loss of the
subsidiaries attributable to the other parties, the effect of which is removed from the Companys
consolidated results of operations.
Several of the Companys home health agencies have cooperative endeavor agreements with third
parties that allow the third parties to be paid or recover a fee based on the profits or losses of
the respective agencies. The Company accrues for the settlement of the third partys profits or
losses during the period the amounts are earned. Under the agreements, the Company has incurred net
amounts due to the third parties of $84,000 and $64,000 for the three months ended September 30,
2007 and 2006, respectively, and $205,000 and $184,000 for the nine months ended September 30, 2007
and 2006, respectively. The cooperative endeavor agreements have terms expiring at the end of June
2008.
For agreements where the third party is a healthcare institution, the agreements typically
require the Company to lease building and equipment and receive housekeeping and maintenance from
the healthcare institutions. Ancillary services related to these arrangements are also typically
provided by the healthcare institution. The Company expenses these amounts as incurred.
Minority Interest Subject to Exchange Contracts and/or Put Options
The Company has a put option agreement with the minority interest holders of a majority-owned
subsidiary, St. Landry Extended Care Hospital, LLC (St. Landry), which allows the minority
interest holders to redeem their minority interests for cash. As of September 30, 2007,
approximately 76.5% of the doctors have converted their minority interests to cash.
There were no redemptions in the nine months ended September 30, 2007. In the nine months
ended September 30, 2007, the Company recorded a mark-to-market charge of $213,000 for these
redeemable minority interests. Included in minority interests subject to exchange contracts and/or
put options liability at September 30, 2007 and December 31, 2006 is $104,000 and $317,000,
respectively, related to these redeemable minority interests.
Stock-based Compensation
The Company has two stock option plans that are administered by the compensation committee of
the board of directors, which selects persons eligible to receive awards and determines the number
of shares and/or options subject to each award, the terms, conditions, performance measures and
other provisions of the award. Readers should refer to Note 6 of the Companys consolidated
financial statements in its Annual Report on Form 10-K for the year ended December 31, 2006 for
additional information related to these stock-based compensation plans.
The Company accounts for its stock-based compensation plans using the fair value recognition
provisions of Statement of Financial Accounting Standards (SFAS) No. 123(R) (revised 2004),
Share-Based Payment, a revision of SFAS No. 123, Accounting for Stock-Based Compensation .
Earnings Per Share
Basic per share information is computed by dividing the relevant amounts from the Consolidated
Statements of Income by the weighted-average number of shares outstanding during the period.
Diluted per share information is computed by dividing the relevant amounts from the Consolidated
Statements of Income by the weighted-average number of shares outstanding plus dilutive potential
shares.
- 10 -
The following table sets forth shares used in the computation of basic and diluted per share
information:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
Nine Months Ended |
|
|
September 30, |
|
September 30, |
|
|
2007 |
|
2006 |
|
2007 |
|
2006 |
Weighted average number of shares
outstanding for basic per share
calculation
|
|
|
17,766,612 |
|
|
|
17,557,576 |
|
|
|
17,756,537 |
|
|
|
16,895,929 |
|
Effect of dilutive potential shares: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Options
|
|
|
4,799 |
|
|
|
2,828 |
|
|
|
6,895 |
|
|
|
1,741 |
|
Restricted stock
|
|
|
22,661 |
|
|
|
14,137 |
|
|
|
59,805 |
|
|
|
10,117 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Adjusted weighted average shares
for diluted per share calculation
|
|
|
17,794,072 |
|
|
|
17,574,541 |
|
|
|
17,823,237 |
|
|
|
16,907,787 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Recently Issued Accounting Pronouncements
In September 2006, the Financial Accounting Standards Board (FASB) issued SFAS No. 157,
Fair Value Measurements (SFAS No. 157), which defines fair value, establishes a framework for
measuring fair value in accounting principles generally accepted in the United States (GAAP) and
expands disclosures about fair value measurements. SFAS No. 157 will be effective for financial
statements issued for fiscal years beginning after November 15, 2007, and interim periods within
those fiscal years. The adoption of SFAS No. 157 is not expected to have a material effect on the
Companys consolidated financial position or results of operations.
In February 2007, the FASB issued SFAS No. 159, The Fair Value Option for Financial Assets and
Financial Liabilities Including an Amendment to FASB Statement No. 115 (SFAS No. 159), which
permits entities to choose to measure many financial instruments and certain other items at fair
value. SFAS No. 159 is effective as of the beginning of an entitys first fiscal year that begins
after November 15, 2007. The adoption of SFAS No. 159 is not expected to have a material effect on
the Companys consolidated financial position or results of operations.
3. Acquisitions and Divestitures
The following acquisitions were completed pursuant to the Companys strategy of becoming the
leading provider of post-acute healthcare services to Medicare patients in non-urban markets in the
United States. The purchase price of each acquisition was determined based on the Companys
analysis of comparable acquisitions and target markets potential cash flows. Goodwill generated
from the acquisitions was recognized based on the expected contributions of each acquisition to the
overall corporate strategy. The Company expects the goodwill recognized in connection with the
acquisition of existing operations to be fully tax deductible.
2007 Acquisitions
During the nine month period ended September 30, 2007, the Company acquired the existing
operations of 11 entities and a majority ownership interest in the existing operations of 8
entities for $19.9 million in cash, $4.1 million in equity of Company subsidiaries, and $2.5
million in acquisition costs. Goodwill of $25.2 million and other intangibles of $1.3 million were
assigned to the home-based services segment. The allocation of the purchase price to certain
acquisitions during the nine months ended September 30, 2007 has not been finalized and subject to
change upon completion of final valuation.
2007 Divestitures
In the first quarter of 2007, the Company reclassified the operations of one long-term acute
care hospital out of discontinued operations as the Company no longer holds the assets for sale.
The facility had previously been identified as held for sale and accounted for in discontinued
operations throughout the year ended December 31, 2006. Goodwill of $401,000 and other assets
related to this hospital were classified as assets held for sale at December 31, 2006. The
operating results for the three months and nine months ended September 30, 2006,
previously disclosed in discontinued operations, have been reclassified to continuing
operations in the statement of income.
On July 1, 2007, the Company sold the assets of a critical access hospital to a third party.
On September 28, 2007, the Company closed one pharmacy operation. The operating results of these
two entities are included in discontinued operations for the three months and nine months ended
September 30, 2007.
The following table summarizes the operating results of divestitures which have been presented
as loss from discontinued operations in the accompanying consolidated statements of income:
- 11 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
|
Nine Months Ended |
|
|
|
September 30, |
|
|
September 30, |
|
|
|
(in thousands) |
|
|
|
2007 |
|
|
2006 |
|
|
2007 |
|
|
2006 |
|
Net service revenue |
|
$ |
1,084 |
|
|
$ |
1,187 |
|
|
$ |
3,150 |
|
|
$ |
4,729 |
|
Costs, expenses and minority interest and
cooperative endeavor allocations |
|
|
1,487 |
|
|
|
1,443 |
|
|
|
4,532 |
|
|
|
5,850 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations before
income
tax benefit |
|
|
403 |
|
|
|
256 |
|
|
|
1,382 |
|
|
|
1,121 |
|
Income tax benefit |
|
|
157 |
|
|
|
93 |
|
|
|
539 |
|
|
|
393 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loss from discontinued operations |
|
$ |
246 |
|
|
$ |
163 |
|
|
$ |
843 |
|
|
$ |
728 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
The changes in recorded goodwill by segment for the nine month period ended September 30, 2007
were as follows:
|
|
|
|
|
|
|
Nine months |
|
|
|
Ended |
|
|
|
September 30, |
|
|
|
2007 |
|
|
|
(in thousands) |
|
Home-based services segment: |
|
|
|
|
Balance at December 31, 2006 |
|
$ |
35,740 |
|
Goodwill acquired during the period from acquisitions |
|
|
24,793 |
|
|
|
|
|
Balance at September 30, 2007 |
|
$ |
60,533 |
|
|
|
|
|
Facility-based services segment: |
|
|
|
|
Balance at December 31, 2006 |
|
$ |
3,941 |
|
Goodwill reclassified from held for sale during the period |
|
|
401 |
|
|
|
|
|
Balance at September 30, 2007 |
|
$ |
4,342 |
|
|
|
|
|
The above transactions were considered to be immaterial individually and in the aggregate.
Accordingly, no supplemental pro forma information is required.
4. Credit Arrangements
Long-Term Debt
Long-term debt consisted of the following:
|
|
|
|
|
|
|
|
|
|
|
September 30, |
|
|
December 31, |
|
|
|
2007 |
|
|
2006 |
|
|
|
(in thousands) |
|
Notes payable: |
|
|
|
|
|
|
|
|
Due in yearly installments of $50,000 through August 2010 at 6.25% |
|
$ |
150 |
|
|
$ |
190 |
|
Due in monthly installments of $20,565 through October 2015 at LIBOR
plus 225 basis points (7.60% at September 30, 2007) |
|
|
2,876 |
|
|
|
2,898 |
|
Due in monthly installments of $12,500 through November 2009 at 3.08% |
|
|
294 |
|
|
|
391 |
|
|
|
|
|
|
|
|
|
|
|
3,320 |
|
|
|
3,479 |
|
Less current portion of long-term debt |
|
|
433 |
|
|
|
428 |
|
|
|
|
|
|
|
|
|
|
$ |
2,887 |
|
|
$ |
3,051 |
|
|
|
|
|
|
|
|
In August 2005, the Company entered into a promissory note with the seller of A-1 Nursing
Registry, Inc. (A-1) in conjunction with the purchase of the assets of A-1. The principal amount
of the note is $250,000 and it bears interest at 6.25%.
In August 2005, the Company entered into a promissory note with Bancorp Equipment Finance,
Inc. to purchase an airplane, for a principal amount of $2,975,000 with interest on any outstanding
principal balance at the one month LIBOR rate plus 225 basis points (7.60% at September 30, 2007).
The note is collateralized by the Companys
- 12 -
airplane and is payable in 119 monthly installments of
$20,565 followed by one balloon installment in the amount of $1,920,565.
Certain of the Companys loan agreements contain restrictive covenants, including limitations
on indebtedness and the maintenance of certain financial ratios. At September 30, 2007 and December
31, 2006, the Company was in compliance with all covenants.
Other Credit Arrangements
The Company maintains a revolving-debt arrangement. Under the terms of this arrangement, the
Company may be advanced funds up to a defined limit of eligible accounts receivable not to exceed
the borrowing limit. At September 30, 2007 and December 31, 2006, the borrowing limit was
$22,500,000, and no amounts were outstanding. Interest accrues on any outstanding amounts at a
varying rate and is based on the Wells Fargo Bank, N.A. prime rate plus 1.5% (9.25% at September
30, 2007). The annual facility fee is 0.5% of the total availability. The agreement expires on
April 15, 2010.
5. Income Taxes
The Company adopted the provisions of FASB Interpretation No. 48 Accounting for Uncertainty
in Income Taxes (FIN 48) effective January 1, 2007. The adoption did not have a material effect
on the consolidated financial position or results of operations of the Company. At the date of
adoption, the Company had no unrecognized tax benefits. The Company recognizes interest and
penalties related to uncertain tax positions in interest expense and general and administrative
expenses, respectively. As of September 30, 2007, there was no accrued interest or penalties
relating to unrecognized income tax benefits recorded in the statement of operations. There was no
accrued liability for interest or penalties related to unrecognized income tax benefits recorded in
the statement of financial position at September 30, 2007.
The Company is subject to both federal and state income tax for jurisdictions within which it
operates. Within these jurisdictions, the Company is open to examination for tax years ended after
December 31, 2002.
6. Stockholders Equity
The following table summarizes the activity in stockholders equity for the nine month period
ended September 30, 2007 (amounts in thousands, except share data):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Common Stock |
|
|
|
|
|
|
|
|
|
|
|
|
Issued |
|
|
Treasury |
|
|
Additional |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Paid-In |
|
|
Retained |
|
|
|
|
|
|
Amount |
|
|
Shares |
|
|
Amount |
|
|
Shares |
|
|
Capital |
|
|
Earnings |
|
|
Total |
|
Balances at December 31, 2006 |
|
$ |
177 |
|
|
|
20,682,317 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
80,273 |
|
|
$ |
44,295 |
|
|
$ |
121,889 |
|
Net income |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
16,849 |
|
|
|
16,849 |
|
Options exercised |
|
|
|
|
|
|
527 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Issuance of 1,167 shares of
vested restricted stock |
|
|
|
|
|
|
1,167 |
|
|
|
|
|
|
|
|
|
|
|
33 |
|
|
|
|
|
|
|
33 |
|
Nonvested stock compensation |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
725 |
|
|
|
|
|
|
|
725 |
|
Issuance of vested
restricted stock |
|
|
|
|
|
|
22,476 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Excess tax benefits from
issuance of nonvested stock |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
89 |
|
|
|
|
|
|
|
89 |
|
Issuance of common stock
under Employee Stock
Purchase Plan |
|
|
|
|
|
|
11,202 |
|
|
|
|
|
|
|
|
|
|
|
303 |
|
|
|
|
|
|
|
303 |
|
Recording minority interest
in joint venture at
redemption
value |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
213 |
|
|
|
213 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Balances at September 30, 2007 |
|
$ |
177 |
|
|
|
20,717,689 |
|
|
$ |
(2,856 |
) |
|
|
2,950,059 |
|
|
$ |
81,423 |
|
|
$ |
61,357 |
|
|
$ |
140,101 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
- 13 -
Share Based Compensation
On January 20, 2005, the board of directors and stockholders of the Company approved the 2005
Long Term Incentive Plan (the Incentive Plan). The Incentive Plan provides for 1,000,000 shares
of common stock that may be issued or transferred pursuant to awards made under the plan. A
variety of discretionary awards for employees, officers, directors and consultants are authorized
under the Incentive Plan, including incentive or non-qualified statutory stock options and
restricted stock. All awards must be evidenced by a written award certificate which will include
the provisions specified by the compensation committee of the board of directors. The compensation
committee will determine the exercise price for non-statutory stock options. The exercise price
for any option cannot be less than the fair market value of our common stock as of the date of
grant.
Also on January 20, 2005, the 2005 Director Compensation Plan was adopted. The shares issued
under our 2005 Director Compensation Plan are issued from the 1,000,000 shares reserved for
issuance under our Incentive Plan.
Stock Options
At September 30, 2007, 19,000 options were issued and exercisable. During the nine months
ended September 30, 2007, 2,000 options were exercised and no options were forfeited. These options
were exercised through a net exercise transaction, in which 1,473 shares were returned to the
Company and 527 shares were issued to the participant. There were no options granted during the
nine months ended September 30, 2007. There were 15,500 options granted and 8,000 options exercised
in the nine months ended September 30, 2006. No options were forfeited during the nine month period
ended September 30, 2006.
Nonvested Stock
During the nine months ended September 30, 2007, 12,600 nonvested shares of stock were granted
to our independent directors under the 2005 Director Compensation Plan. Of these 12,600 shares,
9,100 shares vest in one year, while the remaining 3,500 shares vest one third immediately, and the
remaining two-thirds vest over the two year period following the grant date. During the nine months
ended September 30, 2007, 114,571 nonvested shares were granted to employees pursuant to the 2005
Long-Term Incentive Plan. Of these 114,571 shares, 2,000 shares vest over a three year period while
the remaining 112,571 shares vest over a five year period. The fair value of nonvested shares is
determined based on the closing trading price of the Companys shares on the grant date. The
weighted average grant date fair values of nonvested shares granted during the nine month period
ended September 30, 2007 were $30.41.
The following table represents the nonvested stock activity for the nine months ended
September 30, 2007:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Weighted |
|
|
|
|
|
|
average |
|
|
Number of |
|
grant date |
|
|
Shares |
|
fair value |
Nonvested shares outstanding at December 31, 2006
|
|
|
86,716 |
|
|
$ |
18.29 |
|
Granted
|
|
|
127,171 |
|
|
|
30.41 |
|
Vested
|
|
|
(23,643 |
) |
|
|
17.72 |
|
Forfeited
|
|
|
(36,217 |
) |
|
|
27.42 |
|
|
|
|
|
|
|
|
|
|
Nonvested shares outstanding at September 30, 2007
|
|
|
154,027 |
|
|
$ |
24.28 |
|
As
of September 30, 2007, there was $4.2 million of total unrecognized compensation costs
related to nonvested shares granted. That cost is expected to be recognized over the weighted
average period of 4.0 years. The total fair value of shares vested in the nine month period ended
September 30, 2007 was $657,000. During the nine months ended September 30, 2006, 8,167 shares
vested. The Company records compensation expense related to nonvested
share awards at the grant date for shares that are awarded fully vested, and over the vesting
term on a straight line basis for shares that vest over time. The Company has recorded $758,000 and
$336,000 in compensation expense related to nonvested stock grants in the nine months ended
September 30, 2007 and 2006 respectively.
- 14 -
Employee Stock Purchase Plan
The Company has a plan whereby eligible employees may purchase the Companys common stock at
95% of the market price on the last day of the calendar quarter. There are 250,000 shares reserved
for the plan. The Company issued 3,240 shares of common stock under the plan at a per share price
of $27.08 during the three months ended March 31, 2007, 2,755 shares of common stock under the plan
at a per share price of $30.81 during the three months ended June 30, 2007, and 5,207 shares of
common stock under the plan at a per share price of $24.89 during the three months ended September
30, 2007. At September 30, 2007 there were 231,702 shares available for future issuance.
7. Commitments and Contingencies
Contingencies
The terms of several joint venture operating agreements grant a buy/sell option that would
require the Company to either purchase or sell the existing membership interest in the joint
venture within 30 days of the receipt of the notice to exercise the provision. Either the Company
or its joint venture partner has the right to exercise the buy/sell option. The party receiving the
exercise notice has the right to either purchase the interests held by the other party or sell its
interests to the other party. The purchase price formula for the interests is set forth in the
joint venture agreement and is typically based on a multiple of the earnings before income taxes,
depreciation and amortization of the joint venture. Total revenue earned by the Company from joint
ventures subject to these arrangements was $3.5 million and $3.4 million for the three months ended
September 30, 2007 and 2006, respectively and $10.4 million and $10.6 million for the nine months
ended September 30, 2007 and 2006, respectively. The Company has not received notice from any joint
venture partners of their intent to exercise the buy/sell option nor has the Company notified any
joint venture partners of any intent to exercise the buy/sell option.
The Company is involved in various legal proceedings arising in the ordinary course of
business. Although the results of litigation cannot be predicted with certainty, management
believes the outcome of pending litigation will not have a material adverse effect, after
considering the effect of the Companys insurance coverage, on the Companys consolidated financial
statements.
Compliance
The laws and regulations governing the Companys operations, along with the terms of
participation in various government programs, regulate how the Company does business, the services
offered, and interactions with patients and the public. These laws and regulations, and their
interpretations, are subject to frequent change. Changes in existing laws or regulations, or their
interpretations, or the enactment of new laws or regulations could materially and adversely affect
the Companys operations and financial condition.
The Company is subject to various routine and non-routine governmental reviews, audits, and
investigations. In recent years, federal and state civil and criminal enforcement agencies have
heightened and coordinated their oversight efforts related to the healthcare industry, including
with respect to referral practices, cost reporting, billing practices, joint ventures, and other
financial relationships among healthcare providers. Violation of the laws governing the Companys
operations, or changes in the interpretation of those laws, could result in the imposition of
fines, civil or criminal penalties, termination of the Companys rights to participate in federal
and state-sponsored programs, and suspension or revocation of the Companys licenses.
If the Companys long-term acute care hospitals fail to meet or maintain the standards for
Medicare certification as long-term acute care hospitals, such as average minimum length of patient
stay, they will receive payments under the prospective payment system applicable to general acute
care hospitals rather than payment under the system applicable to long-term acute care hospitals.
Payments at rates applicable to general acute care hospitals would likely result in the Company
receiving less Medicare reimbursement than currently received for patient services.
Moreover, all of the Companys long-term acute care hospitals are subject to additional
Medicare criteria because they operate as separate hospitals located in space leased from, and
located in, a general acute care hospital, known as a host hospital. This is known as a hospital
within a hospital model. These additional criteria include requirements concerning financial and
operational separateness from the host hospital.
- 15 -
The Company anticipates there may be changes to the standard episode-of-care payment from
Medicare in the future. Due to the uncertainty of the revised payment amount, the Company cannot
estimate the impact that changes in the payment rate, if any, will have on its future financial
statements.
In August 2004, the Centers for Medicare and Medicaid Services, or CMS, adopted new
regulations that implement significant changes affecting long-term acute care hospitals. Among
other things, these new regulations, which became effective in October 2004, implemented new rules
that provide long-term acute care hospitals operating in the hospital within a hospital model with
lower rates of reimbursement for Medicare admissions from their host hospitals that are in excess
of specified percentages.
These new rules also reclassified certain long-term acute care hospital diagnosis related
groups (DRGs), which could result in a decrease in reimbursement rates. Further, the new rules kept
in place the financial penalties associated with the failure to limit to 5% the total number of
Medicare patients discharged to the host hospital and subsequently readmitted to a long-term acute
care hospital located within the host hospital.
The Company believes that it is in material compliance with all applicable laws and
regulations and is not aware of any pending or threatened investigations involving allegations of
potential wrongdoing. While no such regulatory inquiries have been made, compliance with such laws
and regulations can be subject to future government review and interpretation as well as
significant regulatory action, including fines, penalties, and exclusion from the Medicare program.
8. Segment Information
The Companys segments consist of (a) home-based services and (b) facility-based services.
Home-based services include home nursing services and hospice services. Facility-based services
include long-term acute care services and outpatient rehabilitation services. The accounting
policies of the segments are the same as those described in the summary of significant accounting
policies.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, 2007 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
|
|
|
|
(in thousands) |
|
|
|
|
Net service revenue
|
|
$ |
63,217 |
|
|
$ |
14,278 |
|
|
$ |
77,495 |
|
Cost of service revenue
|
|
|
31,135 |
|
|
|
8,844 |
|
|
|
39,979 |
|
General and administrative expenses
|
|
|
22,107 |
|
|
|
4,641 |
|
|
|
26,748 |
|
Operating income
|
|
|
9,975 |
|
|
|
793 |
|
|
|
10,768 |
|
Interest expense
|
|
|
64 |
|
|
|
32 |
|
|
|
96 |
|
Non-operating income, including gain on sale of assets
|
|
|
246 |
|
|
|
112 |
|
|
|
358 |
|
Income from continuing operations before income
taxes and minority interest and cooperative endeavor allocations
|
|
|
10,157 |
|
|
|
873 |
|
|
|
11,030 |
|
Minority interest and cooperative endeavor allocations
|
|
|
1,264 |
|
|
|
149 |
|
|
|
1,413 |
|
Income from continuing operations before income taxes
|
|
|
8,893 |
|
|
|
724 |
|
|
|
9,617 |
|
Total assets
|
|
$ |
148,909 |
|
|
$ |
28,771 |
|
|
$ |
177,680 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended September 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue
|
|
$ |
44,536 |
|
|
$ |
14,090 |
|
|
$ |
58,626 |
|
Cost of service revenue
|
|
|
21,292 |
|
|
|
8,876 |
|
|
|
30,168 |
|
General and administrative expenses
|
|
|
14,966 |
|
|
|
3,919 |
|
|
|
18,885 |
|
Operating income
|
|
|
8,278 |
|
|
|
1,295 |
|
|
|
9,573 |
|
Interest expense
|
|
|
53 |
|
|
|
30 |
|
|
|
83 |
|
Non-operating income, including gain on sale of assets
|
|
|
251 |
|
|
|
112 |
|
|
|
363 |
|
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations
|
|
|
8,477 |
|
|
|
1,376 |
|
|
|
9,853 |
|
Minority interest and cooperative endeavor allocations
|
|
|
879 |
|
|
|
446 |
|
|
|
1,325 |
|
Income from continuing operations before income taxes
|
|
|
7,598 |
|
|
|
930 |
|
|
|
8,528 |
|
Total assets
|
|
$ |
113,529 |
|
|
$ |
37,220 |
|
|
$ |
150,749 |
|
- 16 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended September 30, 2007 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue
|
|
$ |
176,275 |
|
|
$ |
40,511 |
|
|
$ |
216,786 |
|
Cost of service revenue
|
|
|
84,874 |
|
|
|
25,802 |
|
|
|
110,676 |
|
General and administrative expenses
|
|
|
60,739 |
|
|
|
13,819 |
|
|
|
74,558 |
|
Operating income
|
|
|
30,662 |
|
|
|
890 |
|
|
|
31,552 |
|
Interest expense
|
|
|
180 |
|
|
|
93 |
|
|
|
273 |
|
Non-operating income, including gain on sale of assets
|
|
|
661 |
|
|
|
294 |
|
|
|
955 |
|
Income from continuing operations before income taxes and
minority
interest and cooperative endeavor allocations
|
|
|
31,143 |
|
|
|
1,091 |
|
|
|
32,234 |
|
Minority interest and cooperative endeavor allocations
|
|
|
3,673 |
|
|
|
654 |
|
|
|
4,327 |
|
Income (loss) from continuing operations before income taxes
|
|
|
27,470 |
|
|
|
437 |
|
|
|
27,907 |
|
Total assets
|
|
$ |
148,909 |
|
|
$ |
28,771 |
|
|
$ |
177,680 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Nine Months Ended September 30, 2006 |
|
|
Home-Based |
|
Facility-Based |
|
|
|
|
Services |
|
Services |
|
Total |
|
|
(in thousands) |
Net service revenue
|
|
$ |
113,105 |
|
|
$ |
42,357 |
|
|
$ |
155,462 |
|
Cost of service revenue
|
|
|
54,389 |
|
|
|
26,481 |
|
|
|
80,870 |
|
General and administrative expenses
|
|
|
38,954 |
|
|
|
11,473 |
|
|
|
50,427 |
|
Operating income
|
|
|
19,762 |
|
|
|
4,403 |
|
|
|
24,165 |
|
Interest expense
|
|
|
148 |
|
|
|
81 |
|
|
|
229 |
|
Non-operating income, including gain on sale of assets
|
|
|
439 |
|
|
|
205 |
|
|
|
644 |
|
Income from continuing operations before income taxes
and minority interest and cooperative endeavor
allocations
|
|
|
20,053 |
|
|
|
4,527 |
|
|
|
24,580 |
|
Minority interest and cooperative endeavor allocations
|
|
|
2,141 |
|
|
|
1,307 |
|
|
|
3,448 |
|
Income from continuing operations before income taxes
|
|
|
17,912 |
|
|
|
3,220 |
|
|
|
21,132 |
|
Total assets
|
|
$ |
113,529 |
|
|
$ |
37,220 |
|
|
$ |
150,749 |
|
ITEM 2. MANAGEMENTS DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND
RESULTS OF OPERATIONS
CAUTIONARY NOTICE REGARDING FORWARD-LOOKING STATEMENTS
This Managements Discussion and Analysis of Financial Condition and Results of
Operations contains forward-looking statements. Forward-looking statements relate to
expectations, beliefs, future plans and strategies, anticipated events or trends and similar
expressions concerning matters that are not historical facts or that necessarily depend upon future
events. In some cases, you can identify forward-looking statements by terms such as may, will,
should, could, would, expect, plan, intend, anticipate, believe, estimate,
project, predict, potential, and similar expressions. Specifically, this report contains,
among others, forward-looking statements about:
|
|
|
our expectations regarding financial condition or results of operations for periods after September 30, 2007; |
|
|
|
|
our future sources of and needs for liquidity and capital resources; |
|
|
|
|
our expectations regarding any future indebtedness under our credit facility;
|
- 17 -
|
|
|
our expectations regarding the size and growth of the market for our services; |
|
|
|
|
our business strategies and our ability to grow our business; |
|
|
|
|
the implementation or interpretation of current or future regulations and legislation; |
|
|
|
|
the reimbursement levels of third-party payors; |
|
|
|
|
the effect of adjustments and corrections to prior reimbursement levels by third-party payors on our
financial condition or results of operations; |
|
|
|
|
the effect of and applicability of annual caps established by third-party payors on our financial condition
or results of operations; |
|
|
|
|
possible changes in legislation and/or government regulations that would affect our business; |
|
|
|
|
possible effects of legal proceedings on our financial condition and results of operations; |
|
|
|
|
the sufficiency of our self-funded medical insurance plan; |
|
|
|
|
the impact that the cost of medical supplies may have on our financial condition or results of operations; |
|
|
|
|
the impact of interest rates on our business; |
|
|
|
|
our discussion of our disclosure controls and procedures; and |
|
|
|
|
our discussion of our critical accounting policies. |
The forward-looking statements contained in this report reflect our current views about
future events and are based on assumptions and are subject to known and unknown risks and
uncertainties. Many important factors could cause actual results or achievements to differ
materially from any future results or achievements expressed in or implied by our forward-looking
statements. Many of the factors that will determine future events or achievements are beyond our
ability to control or predict. Important factors that could cause actual results or achievements to
differ materially from the results or achievements reflected in our forward-looking statements
include, among other things, the factors discussed in the Part II, Item 1A Risk Factors, included
in this report and in other of our filings with the SEC, including our annual report on Form 10-K
for the year ended December 31, 2006. This report should be read in conjunction with that annual
report on Form 10-K, and all our other filings, including quarterly reports on Form 10-Q and
current reports on Form 8-K, made with the SEC through the date of this report.
You should read this report, the information incorporated by reference into this report
and the documents filed as exhibits to this report completely and with the understanding that our
actual future results or achievements may be materially different from what we expect or
anticipate.
The forward-looking statements contained in this report reflect our views and
assumptions only as of the date this report is signed. Except as required by law, we assume no
responsibility for updating any forward-looking statements.
- 18 -
We qualify all of our forward-looking statements by these cautionary statements. In addition,
with respect to all of our forward-looking statements, we claim the protection of the safe harbor
for forward-looking statements contained in the Private Securities Litigation Reform Act of 1995.
Unless the context otherwise requires, we, us, our, and the Company refer to LHC Group,
Inc. and its consolidated subsidiaries.
Overview
We provide post-acute healthcare services primarily to Medicare beneficiaries in non-urban
markets in the United States. We provide these post-acute healthcare services through our home
nursing agencies, hospices, long-term acute care hospitals and an outpatient rehabilitation clinic.
Since our founders began operations in 1994 with one home nursing agency in Palmetto, Louisiana, we
have grown to 167 service providers in Louisiana, Mississippi, Alabama, Texas, Arkansas, West
Virginia, Kentucky, Florida, Tennessee, Georgia, and Ohio as of September 30, 2007. Approximately
58% and 55%, respectively, of our net service revenue for the three months ended September 30, 2007
and 2006 was derived from patients who do not reside in Metropolitan Statistical Areas (MSAs).
Segments
We operate in two segments for financial reporting purposes: home-based services and
facility-based services. We derived 81.6% and 76.0% of our net service revenue during the three
months ended September 30, 2007 and 2006, respectively, and 81.3% and 72.8% of our net service
revenue during the nine months ended September 30, 2007 and 2006, respectively, from our home-based
services segment and derived the balance of our net service revenue from our facility-based
services segment.
Through our home-based services segment we offer a wide range of services, including skilled
nursing, private duty nursing, physical, occupational, and speech therapy, medically-oriented
social services, and hospice care. As of September 30, 2007, we owned and operated 139 home nursing
locations, 9 hospices, a diabetes self management company and a private duty agency. Of our 150
home-based services locations, 91 are wholly-owned by us and 52 are majority-owned or controlled by
us through joint ventures, two are cooperative endeavors, and five are license lease arrangements.
We also manage the operations of four home nursing agencies in which we have no ownership interest.
We intend to increase the number of home nursing agencies that we operate through continued
acquisition and development, primarily in underserved non-urban markets, as we implement our growth
strategy. As we acquire and develop home nursing agencies, we anticipate the percentage of our net
service revenue and operating income derived from our home-based services segment will increase.
We provide facility-based services principally through our long-term acute care hospitals and
an outpatient rehabilitation clinic. As of September 30, 2007, we owned and operated four long-term
acute care hospitals with seven locations, of which all but one are located within host hospitals.
We also owned and operated an outpatient rehabilitation clinic, two medical equipment locations, a
health club, and a pharmacy. Of these 12 facility-based services locations, six are wholly-owned
by us and six are majority-owned or controlled by us through joint ventures. We also manage the
operations of one inpatient rehabilitation facility in which we have
no ownership interest. Due
to our emphasis on expansion through the acquisition and development of home nursing agencies, we
anticipate that the percentage of our net service revenue and operating income derived from our
facility-based segment will continue to decline.
Recent Developments
Medicare
Home-Based Services. The base payment rate for Medicare home nursing in 2007 is $2,339 per
60-day episode. Since the inception of the prospective payment system in October 2000, the base
episode rate payment has
varied due to both the impact of annual market basket based increases and Medicare-related
legislation. Home health payment rates are updated annually by either the full home health market
basket percentage, or by the home health
- 19 -
market basket percentage as adjusted by Congress. The
Centers for Medicare & Medicaid Services (CMS) establishes the home health market basket index,
which measures inflation in the prices of an appropriate mix of goods and services included in home
health services.
On August 29, 2007, CMS published a final rule, updating and making major refinements to the
Medicare home health prospective payment system (HH-PPS) for 2008 (the Final Rule). The Final
Rule, including any amendments thereto, will be effective on January 1, 2008. In the Final Rule,
CMS made a number of refinements to the HH-PPS methodology, including the following:
|
|
|
Under the Social Security Act, CMS may adjust the standard payment amount to eliminate
the effect of coding and classification changes that do not reflect changes in case-mix. In
the proposed rule, CMS identified a change in case-mix of 8.7 percent (i.e., change that is
not due to changes in the underlying health of patients). Therefore, CMS proposed a 2.75
percent reduction in the national 60-day episode rate for 3 years starting in 2008.
However, after publishing the proposed rule, CMS updated its analysis and found a change in
case-mix of 11.75 percent. Therefore, in the Final Rule, CMS adopted a 2.75 percent
reduction in the national 60-day episode rate for 3 years starting in 2008, and extended
the adjustment period to a 4th year via a 2.71 percent reduction for 2011. In the Final
Rule, CMS requested public comment on the 2.71 percent reduction for 2011 and set an
October 29, 2007 deadline for public comment. |
|
|
|
|
To adjust for case-mix, HH-PPS currently uses 80 category case-mix classifications to
assign patients to a home health resource group (HHRG). In the Final Rule, CMS increased
the HHRG case-mix classifications from 80 to 153. |
|
|
|
|
CMS decreased the home health market basket increase from 3.3 percent in 2007 to 3.0
percent for 2008. |
|
|
|
|
The Deficit Reduction Act of 2005 provides for a 2 percent reduction in a home health
agencys market basket increase if certain quality measure data are not submitted to CMS.
For 2007, CMS identified 10 required quality measures. CMS added the following two
additional quality measures for 2008: (1) emergent care for wound infections, deteriorating
wound status; and (2) improvement in status of surgical wound. Now, a total of 12 quality
measures must be reported for a full home health market basket increase in 2008. If a home
health agency does not submit quality data, the home health market basket percentage
increase will be reduced by 2.0 percentage points and the agency will receive only a 1.0
percent update for 2008. |
|
|
|
|
For episodes beginning and ending in 2008, the Final Rule sets the national 60-day
episode rate at $2,270.32, a decrease from $2,339.00 in 2007. This new amount reflects the
3.0 percent home health market basket increase and the 2.75 percent reduction for the
change in case-mix. |
|
|
|
|
Previously, there was a single therapy threshold set at 10 visits. The Final Rule
implements multiple therapy thresholds set at 6, 14 and 20 visits, with graduated payment
levels between the thresholds, to reduce the impact of financial incentives on the delivery
of therapy visits. Further, CMS included scores for infected surgical wounds, abscesses,
chronic ulcers, gangrene, dysphagia, tracheostomy and cystostomy. CMS also added
gastrointestinal, pulmonary, cardiac, hypertension, cancer, blood disorders and affective
and other psychoses diagnosis groups, and assigned points for some secondary diagnosis and
some combinations of conditions in the same episode. |
|
|
|
|
The low utilization payment adjustment (LUPA) reduces the national standard rate when
minimal services are provided during a 60-day episode. LUPAs are episodes with 4 or fewer
days. In the proposed rule, CMS recognized that initial and only episode LUPAs may not
offset the full cost of initial visits. Therefore, in the Final Rule, CMS adopted an
increase of $87.93 for LUPA episodes that occur as the only episode or the initial episode
during a sequence of adjacent episodes, which will be adjusted annually by the home health
market basket. |
|
|
|
|
CMS continued using the pre-floor and pre-classification hospital wage index data to
adjust the labor portion of the HH-PPS rates.
|
- 20 -
|
|
|
CMS eliminated the significant change in condition (SCIC) payment adjustment. |
|
|
|
|
Payment for non-routine medical supplies (NRS), which was $49.62 at the onset of the
HH-PPS, has been updated yearly as part of the national standardized 60-day episode payment
rate. In the proposed rule, CMS proposed revising the NRS methodology, and accounting for
NRS costs based on 5 severity groups and a national conversion factor. In the Final Rule,
CMS adopted a 6 severity group methodology and a national conversion factor of $52.35 for
2008. |
|
|
|
|
The outlier threshold is defined as the 60-day episode payment plus a fixed dollar loss
(FDL) amount. The proportion of additional costs paid as outlier payments is referred to as
the loss sharing ratio. The FDL ratio and loss sharing ratio are selected so that estimated
total outlier adjustments do not exceed 5 percent of total HH-PPS payments. In 2007, the
FDL ratio is 0.67. In the proposed rule, CMS proposed maintaining the FDL ratio at 0.67.
However, after further analysis, CMS adopted a FDL ratio of 0.89 in the Final Rule. |
In terms of legislative activity affecting home health, the U.S. House of Representatives
passed legislation addressing the reauthorization of the Childrens Health Insurance Program
(CHIP), physician payment reform, and a broad array of Medicare and Medicaid issues. The House
package, called the Childrens Health and Medicare Protection Act (H.R. 3162) passed narrowly by a
vote of 225-204 on August 1, 2007. The $90 billion bill expanded the CHIP program, eliminated the
scheduled 10 percent Medicare physician payment reduction, and addressed a number of provider
specific Medicare issues. The bill, however, also significantly cut payments to several provider
groups, including home health. Under the bill, Medicare home health service rates would receive a
reduction of $2.6 billion over five years through a one-year freeze in the market basket update for
2008. The bill also provided for a two-year renewal of the 5 percent additional payments for home
health services furnished in a rural area, beginning January 1, 2008. This provision would add $0.3
billion over five years to rural home health agencies.
For its part, the U.S. Senate passed a $35 billion CHIP reauthorization bill on August 2, 2007
but did not include payment reductions for home health or other providers. In negotiations this
fall, House and Senate leaders decided to strip out the childrens health portions of the CHAMP
bill and broker a deal to pass CHIP legislation separate from Medicare and Medicaid policy. While
this childrens health-only legislation has passed the House and Senate twice, the President
continues to veto each version.
Currently, the Senate Finance Committee is holding member-level meetings to determine how to
move a Medicare package through the Senate in order to conference legislation with the House. The
Committee is contemplating a cut in the market basket update, despite a recent letter to the
Committee signed by 61 Senators requesting the Committee to not include any payment reductions to
home health services. It is expected that the base text of the House Medicare bill (H.R. 3162),
with its provisions on home health, will be the negotiating position for the House when leaders
determine a process to legislate on Medicare before adjourning in December..
On June 29, 2007, CMS announced a 3.3% rate increase for hospice care and hospice services
provided during the twelve-month period beginning on October 1, 2007 through September 30, 2008. In
addition, CMS also announced that the hospice cap amount for the cap year ending October 31, 2007
was $21,410.
In August 2006, CMS announced the payment rates for hospice care furnished from October 1,
2006 through September 30, 2007. These rates are 3.4% higher than the rates for the previous year.
In addition, CMS announced that the hospice cap amount for the year ended October 31, 2006 is
$20,585.
Facility-Based Services Under the long-term acute care hospital prospective payment system
implemented on October 1, 2002, each patient discharged from our long-term acute care hospitals is
assigned a long-term care diagnosis-related group (LTACH-DRG). CMS establishes these long-term care
diagnosis-related groups by categorizing diseases by diagnosis, reflecting the amount of resources
needed to treat a given disease. For each patient, the Companys long-term acute care hospitals are
paid a pre-determined fixed amount applicable to the
particular LTACH-DRG to which that patient is assigned. The payment is further increased for
severity based on co-morbidities, complications, and procedures. The payment is decreased for
short-stay outlier patients whose stay
- 21 -
does not reach a predetermined minimum assigned for the
LTACH-DRG. In addition, extremely high cost patients, after crossing a fixed loss threshold,
receive an additional high-cost outlier payment intended to account for resource utilization
requirements above the LTACH-DRG payment.
On May 2, 2007 CMS published its annual long-term acute care hospital update (LTACH Final
Rule) for the LTACH Rate Year which began July 1, 2007. There are five major portions of the LTACH
Final Rule that are noteworthy for the operations of our long-term acute care hospitals. The LTACH
Final Rule projects an overall decrease in payments to all Medicare certified long-term acute care
hospitals of 3.8% compared to an impact estimated at 2.9% under the proposed rule. Included in the
LTACH Final Rule are the following: (1) an increase to the standard federal payment rate of 0.71%
which is a base rate of $38,356.45; (2) revisions to payment methodologies impacting short stay
outliers, which reduce payments by 0.9%; (3) adjustments to the wage index component of the federal
payment resulting in projected reductions in payments of 1.0%; (4) an increase in the high cost
outlier threshold from $18,477 per discharge in the proposed rule to $22,954 in the LTACH Final
Rule resulting in projected reductions of 2.5%; and (5) an extension of the policy known as the 25
Percent Rule to all LTAC hospitals, with a three-year phase-in, which CMS projects will not result
in payment reductions for the first year of implementation but estimates reductions of 2.4% in the
second year of implementation. The LTACH Final Rule also states that the annual update to the
LTACH-DRG classifications and relative weights will be made in a budget neutral manner, effective
October 1, 2007, which means that even after annual re-weighting of LTACH-DRGs, total payments to
LTACHs will not be reduced in 2008.
The LTACH Final Rule regarding extension of the 25 Percent Rule to freestanding facilities
should not have an effect on our one existing freestanding location based on our analysis that no
single referral source is currently greater than 25% of Medicare discharges.
Under Medicare, we are reimbursed for rehabilitation services based on a fee schedule for
services provided adjusted by the geographical area in which the facility is located. Outpatient
therapy services are subject to an annual cap of $1,780 per beneficiary effective January 1, 2007.
The Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006 provided for an
exceptions process that effectively prevents application of the caps. The exceptions process
ends January 1, 2008. We are unable to predict whether Congress will extend the exceptions process
for 2008. We cannot assure you that one or more of our outpatient rehabilitation clinics will not
exceed the caps in the future.
Office of Inspector General
The Office of Inspector General (OIG) has a responsibility to report both to the Secretary of
the Department of Health and Human Services and to Congress any program and management problems
related to programs such as Medicare. The OIGs duties are carried out through a nationwide
network of audits, investigations and inspections. Each year, the OIG outlines areas it intends to
study relating to a wide range of providers. In fiscal year 2007, the OIG indicated its intent to
study topics relating to, among others, home health, hospice, long-term care hospitals, and certain
outpatient rehabilitation services. No estimate can be made at this time regarding the impact, if
any, of the OIGs findings.
Components of Expenses
Cost of Service Revenue
Our cost of service revenue consists primarily of the following expenses incurred by our
clinical and clerical personnel in our agencies and facilities:
|
|
|
salaries and related benefits;
|
- 22 -
|
|
|
transportation, primarily mileage reimbursement; and |
|
|
|
|
supplies and services, including payments to contract therapists. |
General and Administrative Expenses
Our general and administrative expenses consist primarily of the following expenses incurred
by our home office and administrative field personnel:
|
|
|
salaries and related benefits; |
|
|
|
|
insurance; |
|
|
|
|
costs associated with advertising and other marketing activities; and |
|
|
|
|
rent and utilities; |
|
|
|
accounting, legal and other professional services; and |
|
|
|
|
office supplies; |
|
|
|
Depreciation; and |
|
|
|
|
Provision for bad debts. |
Results of Operations
Three Months Ended September 30, 2007 Compared to Three Months Ended September 30, 2006
Net service revenue for the third quarter ended September 30, 2007, increased 32.2% to $77.5
million compared with $58.6 million in 2006. For the three months ended September 30, 2007 and
2006, 82.0% and 81.3%, respectively, of net service revenue was derived from Medicare. For the
third quarter, home-based services accounted for 81.6% of revenue and facility-based services
accounted for 18.4% of revenue compared with 76.0% and 24.0%, respectively, for the comparable
prior year quarter.
Income from continuing operations for the third quarter of 2007 totaled $6.2 million, or $0.35
per diluted share, compared with income from continuing operations of $5.4 million, or $0.31 per
diluted share, for the third quarter of 2006. Income from continuing operations for the third
quarter of 2007 includes a charge of $560,000 net of tax, or $0.03 per diluted share, related to
the severance and consulting agreement entered into with our former Chief Financial Officer.
Net income for the third quarter of 2007 totaled $6.0 million, or $0.34 per diluted share,
compared with net income of $5.3 million, or $0.30 per diluted share, for the third quarter of
2006.
Net Service Revenue
Home-Based Services.
Net service revenue for home-based services for the three months ended September 30, 2007,
increased 41.9% to $63.2 million compared with $44.5 million for the three months ended September
30, 2006. Total admissions increased 52.0% to 11,216 during the period, versus 7,377 for the same
period in 2006. Average home-based patient census for the three months ended September 30, 2007,
increased 29.4% to 16,862 patients as compared with 13,029 patients for the three months ended
September 30, 2006.
- 23 -
Facility-Based Services.
Net service revenue for facility-based services for the three months ended September 30, 2007,
increased 1.3% to $14.3 million compared with $14.1 million for the three months ended September
30, 2006. The increase in facility-based net service revenue is due primarily to the change in the
acuity of the patients. Patient days decreased 4.0% to 11,202 in the three months ended September
30, 2007, from 11,674 in the three months ended September 30, 2006.
Organic Growth
Organic growth includes growth on same store locations (owned for greater than 12 months),
and growth from de novo locations. Growth from acquired locations owned less than 13 months is
not included. In the third quarter of 2007, we changed the way we calculate organic growth to a
more common method. This method takes the organic number from the current period and compares it to
the total number from the same period in the prior year as opposed to the old method which took the
organic number from the current period and compared it to the organic number from the same period
in the prior year.
The following table sets forth the percentages for organic growth under the new calculation:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months ended |
|
Three months ended |
|
Three months ended |
|
|
March 31, 2007 |
|
June 30, 2007 |
|
September 30, 2007 |
Net Revenue |
|
|
36.0 |
% |
|
|
29.3 |
% |
|
|
26.0 |
% |
Average Census |
|
|
35.2 |
% |
|
|
30.3 |
% |
|
|
15.2 |
% |
Average Medicare Census |
|
|
32.6 |
% |
|
|
28.0 |
% |
|
|
17.7 |
% |
Admissions |
|
|
45.6 |
% |
|
|
35.2 |
% |
|
|
24.4 |
% |
Medicare Admissions |
|
|
32.5 |
% |
|
|
34.7 |
% |
|
|
19.8 |
% |
Episodes |
|
|
33.5 |
% |
|
|
35.7 |
% |
|
|
43.0 |
% |
Cost of Service Revenue
Cost of service revenue for the three months ended September 30, 2007 was $40.0 million, an
increase of $9.8 million, or 32.5%, from $30.2 million for the three months ended September 30,
2006. Cost of service revenue represented approximately 51.6% and 51.5% of our net service revenue
for the three months ended September 30, 2007 and 2006, respectively.
Home-Based Services. Cost of home-based services revenue for the three months ended September
30, 2007 was $31.1 million, an increase of $9.8 million, or 46.2%, from $21.3 million for the three
months ended September 30, 2006. Approximately $8.6 million of this increase resulted from an
increase in salaries and benefits. Approximately $7.7 million of the increase in salaries and
benefits expense was due to acquisitions and developments that occurred in 2006 and approximately
$3.1 million of the increase in salaries and benefits expense was due to acquisitions and
developments that occurred in 2007. The growth in salaries and benefits expense due to
acquisitions and developments is offset by a decrease in the salaries and benefits expense in the
same store locations by approximately $2.2 million. The remaining increase in cost of service
revenue was attributable to increases in supplies and services expense and transportation expense.
Supplies and service expense increased approximately $357,000. Supplies and services expense
increased $669,000 related to acquisitions and developments that occurred in 2006, and $204,000
related to acquisitions and developments that occurred in 2007. The growth in supplies and services
expense due to acquisitions and developments is offset by a decrease in the supplies and services
expense in the same store locations by approximately $516,000. Transportation expense increased
approximately $735,000. Transportation expense increased $676,000 related to acquisitions and
developments that occurred in 2006 and $200,000 related to acquisitions and developments that
occurred in 2007. The growth in transportation expense due to acquisitions and developments is
offset by a decrease in the transportation expense in the same store locations by approximately
$140,000. Cost of home-based services
revenue represented approximately 49.3% and 47.8% of our net home-based services revenue for
the three months ended September 30, 2007 and 2006, respectively.
- 24 -
Facility-Based Services. Cost of facility-based services revenue for the three months ended
September 30, 2007 was $8.8 million, a decrease of $32,000, from $8.9 million for the three months
ended September 30, 2006. The entire increase resulted from an increase in supplies and services
expense of $266,000 offset by a decrease in salaries and benefits expense of $298,000. The increase
in supplies and services expense is due primarily to the change in the acuity of the patients. Cost
of facility-based service revenue represented approximately 61.9% and 63.0% of our net
facility-based services revenue for the three months ended September 30, 2007 and 2006,
respectively.
General and Administrative Expenses
General and administrative expenses for the three months ended September 30, 2007 were $26.7
million, an increase of $7.9 million, or 41.6%, from $18.9 million for the three months ended
September 30, 2006. General and administrative expenses represented approximately 34.5% and 32.2%
of our net service revenue for the three months ended September 30, 2007 and 2006, respectively.
General and administrative expenses for the third quarter of 2007 includes a charge of $904,000
related to the severance and consulting agreement entered into with our former Chief Financial
Officer.
Home-Based Services. General and administrative expenses in the home-based services segment
for the three months ended September 30, 2007 were $22.1 million, an increase of $7.1 million, or
47.7%, from $15.0 million for the three months ended September 30, 2006. Approximately $6.1 million
of the increase in general and administrative expenses was due to acquisitions that occurred in
2006 and approximately $2.0 million of the increase in general and administrative expenses was due
to acquisitions that occurred in 2007. The growth in general and administrative expense due to
acquisitions and developments is offset by a decrease in the general and administrative expense in
the same store locations by approximately $1.0 million. General and administrative expenses in
the home-based services segment represented approximately 35.0% and 33.6% of our net service
revenue for the three months ended September 30, 2007 and 2006, respectively.
Facility-Based Services. General and administrative expenses for the three months ended
September 30, 2007 were $4.6 million, an increase of $722,000, or 18.4%, from $3.9 million for the
same period in 2006. The entire growth was attributable to internal growth and is due to an
increase in bad debt expense. General and administrative expenses in the facility-based services
segment represented approximately 32.5% and 27.8% of our net service revenue for the three months
ended September 30, 2007 and 2006, respectively.
Income Tax Expense
The effective tax rates for the three months ended September 30, 2007 and 2006 were 35.1% and
36.3% respectively.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense remained consistent for the
three months ended September 30, 2007 at $1.4 million, compared to $1.3 million for the same period
in 2006.
Discontinued Operations
Revenue from discontinued operations for the three months ended September 30, 2007 and 2006
was $1.1 million and $1.2 million, respectively. Costs, expenses, and minority interest and
cooperative endeavor allocations were $1.5 million and $1.4 million, respectively, for the three
months ended September 30, 2007 and 2006. For the three months ended September 30, 2007, the loss
from discontinued operations was $246,000 as compared to a loss
from discontinued operations of $163,000 for the same period in 2006. In the second quarter of
2007, the Company placed its critical access hospital into discontinued operations. Sale of the
hospital was completed on July 1, 2007.
- 25 -
Nine Months Ended September 30, 2007 Compared to Nine Months Ended September 30, 2006
Net service revenue for the nine months ended September 30, 2007, increased 39.4% to $216.8
million compared with $155.5 million in 2006. For the nine months ended September 30, 2007 and
2006, 82.0% and 83.7%, respectively, of net service revenue was derived from Medicare. For the
nine months ended September 30, 2007, home-based services accounted for 81.3% of revenue and
facility-based services was 18.7% of revenue compared with 72.8% and 27.2%, respectively, for the
comparable prior year period.
Income from continuing operations for the nine months ended September 30, 2007 totaled $17.7
million, or $0.99 per diluted share, compared with income from continuing operations of $13.7
million, or $0.81 per diluted share, for the nine months ended September 30, 2006. Income from
continuing operations for the nine months ended September 30, 2007 includes a charge of $560,000
net of tax, or $0.03 per diluted share, related to the severance and consulting agreement entered
into with our former Chief Financial Officer.
Net income for the nine months ended September 30, 2007 totaled $16.8 million, or $0.94 per
diluted share, compared with net income of $13.7 million, or $0.81 per diluted share, for the nine
months ended September 30, 2006.
Net Service Revenue
Home-Based Services.
Net service revenue for home-based services for the nine months ended September 30, 2007,
increased 55.9% to $176.3 million compared with $113.1 million for the nine months ended September
30, 2006. Total admissions increased 73.7% to 32,656 during the period, versus 18,799 for the same
period in 2006. Average home-based patient census for the nine months ended September 30, 2007,
increased 28.9% to 16,208 patients as compared with 12,573 patients for the nine months ended
September 30, 2006.
Facility-Based Services.
Net service revenue for facility-based services for the nine months ended September 30, 2007,
decreased 4.4% to $40.5 million compared with $42.4 million for the nine months ended September 30,
2006. The decrease in net service revenue is due to the adjustment in the first half of 2007
relating to revenue with respect to commercial patients in the LTACH setting. Patient days
increased 1.5% to 34,329 in the nine months ended September 30, 2007, from 33,814 in the nine
months ended September 30, 2006.
Organic Growth
Organic growth includes growth on same store locations (owned for greater than 12 months),
and growth from de novo locations. Growth from acquired locations owned less than 13 months is
not included. In the third quarter of 2007, we changed the way we calculate organic growth to a
more common method. This method takes the organic number from the current period and compares it to
the total number from the same period in the prior year as opposed to the old method which took the
organic number from the current period and compared it to the organic number from the same period
in the prior year.
The following table sets forth the percentages for organic growth under the new calculation:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months ended |
|
Six months ended |
|
Nine months ended |
|
|
March 31, 2007 |
|
June 30, 2007 |
|
September 30, 2007 |
Net Revenue |
|
|
36.0 |
% |
|
|
34.8 |
% |
|
|
43.3 |
% |
Average Census |
|
|
35.2 |
% |
|
|
32.2 |
% |
|
|
14.5 |
% |
Average Medicare Census |
|
|
32.6 |
% |
|
|
29.8 |
% |
|
|
15.8 |
% |
- 26 -
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three months ended |
|
Six months ended |
|
Nine months ended |
|
|
March 31, 2007 |
|
June 30, 2007 |
|
September 30, 2007 |
Admissions |
|
|
45.6 |
% |
|
|
39.8 |
% |
|
|
47.6 |
% |
Medicare Admissions |
|
|
32.5 |
% |
|
|
38.5 |
% |
|
|
41.4 |
% |
Episodes |
|
|
33.5 |
% |
|
|
37.1 |
% |
|
|
47.9 |
% |
Cost of Service Revenue
Cost of service revenue for the nine months ended September 30, 2007 was $110.7 million, an
increase of $29.8 million, or 36.9%, from $80.9 million for the nine months ended September 30,
2006. Cost of service revenue represented approximately 51.1% and 52.0% of our net service revenue
for the nine months ended September 30, 2007 and 2006, respectively.
Home-Based Services. Cost of home-based services revenue for the nine months ended September
30, 2007 was $84.9 million, an increase of $30.5 million, or 56.0%, from $54.4 million for the nine
months ended September 30, 2006. Approximately $26.5 million of this increase resulted from an
increase in salaries and benefits. Approximately $23.4 million of the increase in salaries and
benefits expense was due to acquisitions and developments that occurred in 2006 and approximately
$4.1 million of the increase in salaries and benefits expense was due to acquisitions and
developments that occurred in 2007. The growth in salaries and benefits expense due to
acquisitions and developments is offset by a decrease in the salaries and benefits expense in the
same store locations by approximately $1.0 million. The remaining increase in cost of service
revenue was attributable to increases in supplies and services expense and transportation expense.
Supplies and service expense increased approximately $1.5 million. Supplies and services expense
increased approximately $1.9 million related to acquisitions and developments in 2006, and
approximately $348,000 related to acquisitions and developments in 2007. The growth in supplies and
services expense due to acquisitions and developments is offset by a decrease in the supplies and
services expense in the same store locations by approximately $735,000. Transportation expense
increased approximately $2.5 million. Of this $2.5 million, approximately $2.1 million of the
increase in transportation expense was due to acquisitions and developments that occurred in 2006,
$278,000 was due to acquisitions and developments that occurred in 2007, and $98,000 was due to
internal growth. Cost of home-based services revenue represented approximately 48.1% and 48.1% of
our net home-based services revenue for the nine months ended September 30, 2007 and 2006,
respectively.
Facility-Based Services. Cost of facility-based services revenue for the nine months ended
September 30, 2007 was $25.8 million, a decrease of $679,000 or 2.6%, from $26.5 million for the
nine months ended September 30, 2006. The entire decrease resulted from an increase in supplies and
services expense of $780,000 offset by a decrease in salaries and benefits expense of $1.5 million.
The increase in supplies and services expense is due primarily to the change in the acuity of the
patients. Cost of facility-based service revenue represented approximately 63.7% and 62.5% of our
net facility-based services revenue for the nine months ended September 30, 2007 and 2006,
respectively.
General and Administrative Expenses
General and administrative expenses for the nine months ended September 30, 2007 were $74.6
million, an increase of $24.1 million, or 47.9%, from $50.4 million for the nine months ended
September 30, 2006. General and administrative expenses represented approximately 34.4% and 32.4%
of our net service revenue for the nine months ended September 30, 2007 and 2006, respectively.
General and administrative expenses for the nine months ended September 30, 2007 includes a charge
of $904,000 related to the severance and consulting agreement entered into with our former Chief
Financial Officer.
Home-Based Services. General and administrative expenses in the home-based services segment
for the nine months ended September 30, 2007 were $60.7 million, an increase of $21.8 million, or
55.9%, from $39.0 million
for the nine months ended September 30, 2006. Approximately $15.8 million of the increase in
general and administrative expenses was due to acquisitions and developments that occurred in 2006
and approximately $2.9
- 27 -
million of the increase in general and administrative expenses were due to
acquisitions and developments that occurred in 2007. The remaining increase in general and
administrative expenses of approximately $3.1 million was primarily attributable to internal
growth. Of the $3.1 million attributable to internal growth, $1.7 million is related to an increase
in bad debt expense. General and administrative expenses in the home-based services segment
represented approximately 34.5% and 34.4% of our net service revenue for the nine months ended
September 30, 2007 and 2006, respectively.
Facility-Based Services. General and administrative expenses for the nine months ended
September 30, 2007 were $13.8 million, an increase of $2.3 million, or 20.4%, from $11.5 million
for the same period in 2006. The entire growth was attributable to internal growth and is due to an
increase in bad debt expense. General and administrative expenses in the facility-based services
segment represented approximately 34.1% and 27.1% of our net service revenue for the nine months
ended September 30, 2007 and 2006, respectively.
Income Tax Expense
The effective tax rates for the nine months ended September 30, 2007 and 2006 were 36.7% and
35.1% respectively.
Minority Interest and Cooperative Endeavor Allocations
The minority interest and cooperative endeavor allocations expense for the nine months ended
September 30, 2007 was $4.3 million, an increase of $879,000, or 25.5%, from $3.4 million for the
same period in 2006. The increase is due primarily to an increase in joint ventures.
Discontinued Operations
Revenue from discontinued operations for the nine months ended September 30, 2007 and 2006 was
$3.2 million and $4.7 million, respectively. Costs, expenses, and minority interest and cooperative
endeavor allocations were $4.5 million and $5.9 million, respectively, for the nine months ended
September 30, 2007 and 2006. For the nine months ended September 30, 2007, the loss from
discontinued operations was $843,000 as compared to a loss from discontinued operations of $728,000
for the same period in 2006. In the second quarter of 2007, the Company placed its critical access
hospital into discontinued operations. Sale of the hospital was completed on July 1, 2007.
Liquidity and Capital Resources
Our principal source of liquidity for our operating activities is the collection of our
accounts receivable, most of which are collected from governmental and third party commercial
payors. Our reported cash flows from operating activities are impacted by various external and
internal factors, including the following:
|
|
|
Operating Results Our net income has a significant impact on our operating cash
flows. Any significant increase or decrease in our net income could have a material impact
on our operating cash flows. |
|
|
|
|
Start-Up Costs Following the completion of an acquisition, we generally incur
substantial start-up costs in order to implement our business strategy. There is generally
a delay between our expenditure of these start-up costs and the increase in net service
revenue, and subsequent cash collections, which adversely affects our cash flows from
operating activities. |
|
|
|
|
Timing of Payroll Our employees are paid bi-weekly on Fridays; therefore, operating
cash flows decline in reporting periods that end on a Friday. Conversely, for those
reporting periods ending on a day other than Friday, our cash flows are higher because we
have not yet paid our payroll. |
|
|
|
|
Medical Insurance Plan Funding We are self funded for medical insurance purposes.
Any significant changes in the amount of insurance claims submitted could have a direct
impact on our operating cash flows. |
- 28 -
|
|
|
Medical Supplies A significant expense associated with our business is the cost of
medical supplies. Any increase in the cost of medical supplies, or in the use of medical
supplies by our patients, could have a material impact on our operating cash flows. |
Operating activities during the nine months ended September 30, 2007 provided $15.0 million in
cash compared to $19.4 million for the nine months ended September 30, 2006. Net income provided
cash of $16.8 million. Non-cash items such as depreciation and amortization, provision for bad
debts, equity-based compensation, minority interest in earnings of subsidiaries and deferred income
taxes totaled $13.5 million. These non-cash charges are offset primarily by an increase in accounts
receivable of $17.4 million due to increased revenue.
Days sales outstanding, or DSO, for the three months ended September 30, 2007, was 69 days.
DSO was also 69 days for the same three-month period in 2006. When adjusted for acquisitions and
unbilled accounts receivables, DSO at September 30, 2007 was 64 days. The adjustment takes into
account $4.1 million of unbilled receivables that the Company is delayed in billing due to the lag
time in receiving the change of ownership after acquiring companies. For the comparable period in
2006, adjusted DSO was 63 days, taking into account $4.4 million in unbilled accounts receivable.
Compared to DSO at June 30, 2007 of 75 days, the decrease in DSO equates to approximately $5.1
million. Cash collection in excess of claims billed contributed about $3.8 million to this decrease
and the increase in the bad debt reserve in the quarter contributed about $1.3 million.
Investing activities used $25.0 million and $22.3 million in cash for the nine months ended
September 30, 2007 and 2006, respectively. In the nine months ended September 30, 2007, cash used
by investing activities was $2.6 million for the purchases of property and equipment consisting
primarily of computer hardware, software, and licenses, and $22.4 million in the cost of
acquisitions.
Financing activities used $4.1 million and $16.1 million in the nine months ended September
30, 2007 and 2006, respectively. In the nine months ended September 30, 2007, cash used by
financing activities was $4.0 million for minority interest distributions.
At September 30, 2007, we had working capital of $63.2 million compared to $68.4 million at
December 31, 2006, a decrease of $5.2 million. This decrease in working capital was due primarily
to an increase of $4.3 million in salaries, wages and benefits payable.
Indebtedness
Our total long-term indebtedness was $3.5 million at September 30, 2007 and $3.8 million at
December 31, 2006, respectively, including the current portions of $529,000 and $639,000. In April
2005, we entered into an amended and restated senior secured credit facility with Residential
Funding Corporation due April 15, 2010. We, together with certain of our subsidiaries, may become
borrowers under the credit facility. Our obligations and the obligations of our subsidiary
borrowers under our credit facility agreement are secured by a lien on substantially all of our
assets (including the capital stock or other forms of ownership interests we hold in our
subsidiaries and affiliates) and the assets of those subsidiaries and affiliates.
Our credit facility makes available to us up to $22.5 million in revolving loans. The total
availability may be increased up to a maximum of $25.0 million, subject to certain terms and
conditions. Total availability under our credit facility may be limited from time to time based on
the value of our receivables. As of September 30, 2007, we had no outstanding balance under our
credit facility.
Interest on outstanding borrowings under our credit facility accrues at a variable base rate
(based on Wells Fargo Banks prime rate or the federal funds rate), plus a margin of 1.5%.
Our credit facility contains customary affirmative, negative and financial covenants. For
example, we are restricted in incurring additional debt, disposing of assets, making investments,
allowing fundamental changes to our business or organization, and making certain payments in
respect of stock or other ownership interests, such as dividends and stock repurchases. Financial
covenants include requirements that we maintain a debt to EBITDA ratio
- 29 -
of no greater than 1.5 to 1.0 and a fixed-charge coverage ratio of not less than 1.4 to 1.0.
As of September 30, 2007, we have met all of the covenants included in the credit agreement.
Our credit facility also contains customary events of default. These include bankruptcy and
other insolvency events, cross-defaults to other debt agreements, a change in control involving us
or any subsidiary guarantor, and the failure to comply with certain covenants.
Contingencies
For a discussion of contingencies, see Item 1, Notes to Consolidated Financial Statements
Note 7 Commitments and Contingencies of this Form 10-Q, which discussion is incorporated herein
by reference.
Off-Balance Sheet Arrangements
We do not currently have any off-balance sheet arrangements with unconsolidated entities or
financial partnerships, such as entities often referred to as structured finance or special purpose
entities, which would have been established for the purpose of facilitating off-balance sheet
arrangements or other contractually narrow or limited purposes. In addition, we do not engage in
trading activities involving non-exchange traded contracts. As such, we are not materially exposed
to any financing, liquidity, market or credit risk that could arise if we had engaged in these
relationships.
Critical Accounting Policies
For a discussion of critical accounting policies, see Item 1, Notes to Consolidated Financial
Statements Note 2 Significant Accounting Policies of this Form 10-Q, which discussion is
incorporated herein by reference.
ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK
As of September 30, 2007, we had cash of $12.9 million, which consisted of highly liquid money
market instruments with maturities less than 90 days. Because of the short maturities of these
instruments, a sudden change in market interest rates would not be expected to have a material
impact on the fair value of the portfolio. We would not expect our operating results or cash flows
to be materially affected by the effect of a sudden change in market interest rates on our
portfolio. At times, cash in banks is in excess of the FDIC insurance limit. The Company has not
experienced any loss as a result of those deposits and does not expect any in the future.
Our exposure to market risk relates to changes in interest rates for borrowings under the
senior secured credit facility we entered into in April 2005. A hypothetical 100 basis point
adverse move (increase) in interest rates would not have materially affected the interest expense
for the nine months ended September 30, 2007 since there were no amounts outstanding on the credit
agreement during this period.
ITEM 4. CONTROLS AND PROCEDURES
Evaluation of Disclosure Controls and Procedures
The Company maintains disclosure controls and procedures (as defined in Rule 13a-15(e) and
15d-15(e) promulgated under the Securities Exchange Act of 1934, as amended (the Exchange Act))
that are designed to provide reasonable assurance that information required to be disclosed in the
Companys reports filed under the Exchange Act, is recorded, processed, summarized and reported
within the time periods specified in the SECs rules and forms. Such information is also
accumulated and communicated to management, including the Companys Chief Executive Officer and
Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure.
Management of the Company, under the supervision and with the participation of the Chief Executive
Officer and Chief Financial Officer, evaluated the effectiveness of the design and operation of the
Companys disclosure controls and procedures as of the end of the period covered by this report.
As reported in the
- 30 -
Companys quarterly report on Form 10-Q for the quarter ended June 30, 2007, the Company had a
material weakness related to the controls over the recording of contractual adjustments on
commercial contract claims in its Long-Term Acute Care Hospital (LTACH) business. As a result of
this weakness, the Companys management, including the Companys principal executive and principal
financial officers, concluded that the Companys disclosure controls and procedures were not
effective as of June 30, 2007. To address the material weakness described above, the Company
implemented additional manual controls and procedures over the recording of contractual adjustments
related to commercial contracts in the LTACHs. The Company has also continued to work with outside
consultants to identify and implement appropriate methods of ensuring these controls and procedures
may not be circumvented in the future.
Although the Companys remediation efforts with respect to the above referenced material
weakness are substantially completed, management will not be able to affirmatively conclude that
the internal controls over financial reporting implemented to remediate the material weakness are
operating effectively until such controls are successfully tested in connection with the audit of
the Companys financial statements for the year ended December 31, 2007. Because additional
testing is required to determine if the material weakness described in the Companys quarterly
report on Form 10-Q for the quarter ended June 30, 2007 has been fully remedied, the Companys
chief executive officer and chief financial officer concluded that the Company did not maintain
effective disclosure controls and procedures as of the end of the period covered by this report.
Changes in Internal Controls
Except for the controls implemented to address the material weakness identified in the
Companys quarterly report on Form 10-Q for the quarter ended June 30, 2007, there have been no
changes in the Companys internal control over financial reporting (as defined in Exchange Act Rule
13a-15(f)) that occurred during the three months ended September 30, 2007, that have materially
affected, or are reasonably likely to materially affect, the Companys internal control over
financial reporting.
PART II OTHER INFORMATION
ITEM 1. LEGAL PROCEEDINGS.
We are involved in litigation and proceedings in the ordinary course of business. We do not
believe that the outcome of any of the matters in which we are currently involved, individually or
in the aggregate, will have a material adverse effect upon our business, financial condition, or
results of operations.
ITEM 1A. RISK FACTORS.
There have been no material changes from the Risk Factors we previously disclosed in our Form
10-K for the year ended December 31, 2006 filed with the Securities and Exchange Commission on
March 16, 2007.
ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS.
None
ITEM 3. DEFAULTS UPON SENIOR SECURITIES
None
ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS
None
- 31 -
ITEM 5. OTHER INFORMATION
None
ITEM 6. EXHIBITS.
|
|
|
|
|
|
3.1 |
|
|
Certificate of Incorporation of LHC Group, Inc. (previously filed as
an exhibit to the Form S-1/A (File No. 333-120792) on February 14,
2005). |
|
|
|
|
|
|
3.2 |
|
|
Bylaws of LHC Group, Inc. (previously filed as an exhibit to the Form
S-1/A (File No. 333-120792) on May 9, 2005). |
|
|
|
|
|
|
4.1 |
|
|
Specimen Stock Certificate of LHCs Common Stock, par value $0.01 per
share (previously filed as an
exhibit to the Form S-1/ A (File No. 333-120792) on February 14, 2005). |
|
|
|
|
|
|
4.2 |
|
|
Reference is made to Exhibits 3.1 and 3.2 (previously filed as an
exhibit to the Form S-1/A (File No. 333-120792) on February 14, 2005
and May 9, 2005, respectively). |
|
|
|
|
|
|
10.1 |
|
|
Consulting and Severance agreement, dated August 15, 2007, between LHC
Group, Inc. and Barry E. Stewart (previously filed as Exhibit 10.1 to
the Form 8-K (File No. 000-51343) on August 15, 2007). |
|
|
|
|
|
|
31.1 |
|
|
Certification of Keith G. Myers, Chief Executive Officer pursuant to
Rule 13a-14(a)/15d-14(a), as adopted pursuant to Section 302 of the
Sarbanes-Oxley Act of 2002. |
|
|
|
|
|
|
31.2 |
|
|
Certification of Peter J. Roman, Chief Financial Officer pursuant to
Rule 13a-14(a)/15d-14(a), as adopted pursuant to Section 302 of the
Sarbanes-Oxley Act of 2002. |
|
|
|
|
|
|
32* |
|
|
Certification of Chief Executive Officer and Chief Financial Officer
of LHC Group, Inc. pursuant to 18 U.S.C. Section 1350, as adopted
pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
|
|
|
* |
|
This exhibit is furnished to the SEC as an accompanying document and is not deemed to be filed
for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the
liabilities of that Section, and the document will not be deemed incorporated by reference into any
filing under the Securities Act of 1933. |
- 32 -
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused
this report to be signed on its behalf by the undersigned thereunto duly authorized.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
LHC GROUP, INC. |
|
|
|
|
|
|
|
|
|
|
|
Date
|
|
November 8, 2007
|
|
|
|
/s/ Peter J. Roman
|
|
|
|
|
|
|
|
|
Peter J. Roman
Senior Vice President and Chief Financial Officer |
|
|
- 33 -