Earnings Call: Q1 2021

May 13, 2021

Earnings release

Good morning, everyone. Welcome to the Medical Facilities Corporation twenty twenty one First Quarter Results Conference Call. After management's remarks, this call will include a question and answer session whereby qualified equity analysts will be permitted to ask questions. Before turning the call over to management, listeners are reminded that certain statements made in today's call, including responses to questions, may contain forward looking statements within the meaning of the Safe Harbor provisions of Canadian Provincial Security Laws. Forward looking statements involve risks and uncertainties and undue reliance should not be placed on such statements. Certain material factors or assumptions are applied in making forward looking statements and actual results may differ materially from those expressed or implied in such statements. For additional information about the factors that may cause actual results to differ materially from expectations and about material factors or assumptions applied in making forward looking statements, please consult the MD and A for this quarter, the Risk Factors section of the annual information form and Medical Facilities' other filings with Canadian Securities regulated medical facilities does not undertake to update any forward looking statements. Such statements speak only as of the date made. Please note that today's call is being broadcast live over the Internet, and the webcast will be available for replay beginning approximately one hour following the completion of the call. Details of how to access the webcast replay are available in this morning's news release announcing the company's financial results. I would now like to turn the meeting over to Mr. Rob Horror, President and CEO of Medical Facilities. Please go ahead, Mr. Horror. Thank you, Pasha. Good morning, and welcome to our first quarter earnings call. Joining me today is David Watson, our Chief Financial Officer. Earlier this morning, we released our first quarter results. Our news release, financial statements and MD and A may be accessed through our website at www.medicalfacilitiescorp.ca and have also been filed with SEDAR today. Overall, we were pleased with our results for the first quarter. Our total revenue and other income was up 5.8, largely the result of an additional $4,100,000 in government release funds received by our facilities. We also benefited from favorable changes in payer and case mix. Perhaps the biggest takeaway for the quarter is that our volumes continue to normalize to pre COVID levels. If we look at the first quarter of last year, our numbers in both January and February compared favorably to the same months in 2019. However, in the March, our business was impacted by the cessation of elective cases as the pandemic began to spread across the country. Fast forward to the first quarter of this year and COVID-nineteen continued to impact our volumes, particularly in January and February. However, by March, we saw a strong rebound with volumes up more than 20% over January or February. Importantly, none of our facilities are experiencing restrictions with regards to types of cases. With vaccines continuing to roll out across the country, we are optimistic that our recovery will continue. We're also focused on growth including organic and inorganic opportunities. Near the end of the first quarter, we announced a 4,600 square foot expansion project underway at Arkansas Surgical Hospital. This follows the hiring of five new surgeons last year. The expansion will add two new operating rooms, bringing the total to 13 when completed, as well as three new recovery beds. Project is expected to be completed by the end of the year. We remain focused on executing on our ambulatory surgery platform strategy, growing through mix of de novo and acquisition opportunities. An increasing and aging population among the key drivers of growth in The U. S. Healthcare market and a disproportionate share of this growth has been in and is expected to continue to be in ambulatory settings. They say market is already a very attractive growth market prior to the pandemic. The pandemic seems to have accelerated the interest in ambulatory care. The space remains fragmented with many small operators. Therefore, we anticipate more consolidation in de novo growth opportunities. We have a strong balance sheet and are in a good position to evaluate the right growth opportunities as the pandemic subsides, hopefully in the back half of the year. With that, I will now turn the call over to David to discuss our first quarter financial results. David? Thanks, Rob, good morning, everyone. I will discuss our first quarter financial performance, then provide an update on our balance sheet and liquidity. But first, I would like to remind everyone that all dollar amounts expressed in today's call are in U. S. Dollars unless stated otherwise. Our facility service revenue for the first quarter was $94,000,000 which was up 1.3% from the $92,800,000 in the first quarter of twenty twenty. The increase was due mainly to favorable changes in case and payer mix. Overall same store surgical case volumes were on par with first quarter of last year. While outpatient cases increased by 2.6% and observation cases by 15.4%, inpatient cases were down 15.1%. Total revenue and other income, which includes an additional $4,100,000 in government stimulus, was $98,100,000 for the quarter. We did not receive any government stimulus funding in first quarter of last year. Operating expenses for the quarter decreased 2.4% to $79,800,000 As a percentage of total revenue and other income, operating expenses decreased to 81.3% from 88.1% in the first quarter of last year. Adjusted EBITDA for the quarter was $25,100,000 or 25.6% of revenue compared to $18,600,000 or 20% in the first quarter of last year. In first quarter this year, we generated cash available for distribution totaling CAD7.9 million resulting in a payout ratio of 27.6%. Our balance sheet remains strong. At quarter end, we had cash and cash equivalents of $58,000,000 and consolidated net working capital of $42,700,000 compared to $45,000,000 at year end. The outstanding balance on our corporate credit line was $31,000,000 Inclusive of lease liabilities as per IFRS 16, our net debt to equity stands at 0.51 times. We are well resourced to capitalize on potential growth opportunities and our leverage remains significantly lower than our U. S. Trading peers. This concludes my financial review for the quarter. For additional detail on our financial results, including specific results for each facility, please refer to our MD and A. With that, we'd now like to open the line for questions. Tasha? First question comes from the line of Endri Leno with National Bank. Hi, good morning. Thanks for taking my question. First one for me, case volume for the quarter, how does it compare to your more normalized level, let's say, in 2019? And as a second part to this question, the 26% recovery you saw in March versus January and February, how is that trending into April? Yes. So hi, Andrew. Good morning. The case line is still running below normalized. We're about 8.7% below first quarter twenty nineteen. And then the second part of that, Endri, is that the March volume strength we see some strength continuing into April. So Okay. Great. And on that 8% that is below twenty nineteen, that I would assume also includes the weather event in Arkansas. Is there any way to normalize for those or is that tough to do? It's tough to know, part of this we say, January was really again impacted by COVID. February was also COVID and weather, but in the middle part of the country there and of course Arkansas as well. So, yeah, it's hard to really normalize for all of that activity. Okay. Thank you for that. My second question is more on, we've talked about this postponed cases and potentially a backlog building there. Do you think there is still any sort of a backlog left? Or how do you see it recovering if it's still there or do you think these cases are sort of permanently postponed, let's say? Well, it's very difficult to say. As we said last quarter and continue to say, we're among all of our peers as well, difficult to predict what that is. We did see some return of cases. Some of that was just earlier in the year. We believe that there will be some additional cases in demand that hard to tell what that will be, but the back half of the year, we're expecting to have some the scope of which is hard to determine or predict, but we do expect some strengthening from that demand in deferred care. Okay. Great. One more for me and I'll jump in the queue in case there's any other questions. But perhaps more for David, but the NCI cash flows of the facilities were a little bit high in the quarter at 9.5. Does it contain any government support there as well? Or would the government support go solely to the corporation? No. The government support is coming into the individual facilities. Okay. So if we're to look at it, mean about fiftyfifty more or less would be kind of a good guideline of how much that goes to the corporation, how much of the facilities? Well, know, stimulus funds come into the facilities to support the operations. To the extent the facilities, you know, are then making distributions, at some point, you know, those distributions are made based on ownership percentages. So, yeah, I mean, roughly fifty-fifty. Okay. Thank you. That's it for me for now. I'll jump in the queue. Thanks. Thank you. Your next question is from the line of Paul Steuarton with IA Capital Markets. Hi guys, congrats on the quarter. Just calling in for Chelsea. Just a couple of quick ones here. So in terms of the Black Hills and, Sioux Falls, there's some really nice revenue growth there with with case mix and and so forth. How much of that is is sort of the the government stimulus side of it and how much of it is the is the case case mix? Yeah. So of the 4,100,000.0 government stimulus, went primarily to those two facilities with, you know, a little more than half of that going to to Black Hills. Okay. Perfect. That that's helpful. And, just in terms of the the case mix there that you've been seeing, is is this something that we can look at as as sort of continuing to trend in the same direction, direction? Or does this tend to be more of a, you know, this quarter is maybe taken, you know, on its own? How you see the trends there? Yes, that's really hard to say. I don't think that's a trend per se. I mean the impact of course, early part of the quarter sort of set up a stronger payer or case mix rather. So you saw more of an urgent higher case mix acuity in that mix for March. The second thing, we also get a little bit benefit of payer mix too, a little bit stronger on the commercial than on the Medicare. So both those sort of set up for a quarter even without the stimulus was on par to the prior a little bit exceeding the prior year. So I don't think that's necessarily a carry forward trend for the rest of the year on for the first quarter, but Okay, perfect. Yes, that's very helpful. Thank you. Sure. Thanks. Next question is from the line of Doug Meehan with RBC Capital Markets. Yes, good morning. First question has to do with the potential loan forgiveness. I noted that in the MD and A, you've taken out the wording of reasonable assurance that the stimulus loans will be forgiven. Was that by design or was it just a change? Like, what are the chances that you actually have to pay back those loans today versus, you know, last quarter? Yeah. Hey, Doug. It's David. You know, I don't think the likelihood has changed from prior quarter. We're, you know, the facilities submitted their applications and like most healthcare providers that have done that are just waiting. But we don't see if there's any change in likelihood. Okay. So there's no reason for taking that or changing that wording. Okay. That's good. No. Second thing just has to do with about the opportunities around acquisitions? Are they looking more like ASCs? Or is there still the potential for specialty surgical hospital? Maybe you can tell us what the landscape looks like with respect to the acquisition front today. I'll be happy to. I'll take that on. This is Rob. The most of the growth opportunity for us on the pipeline and coming especially coming out of COVID is in the ASC space. It is extremely dynamic as we called out in the script, fractured. The pandemic highlighted that need to have a safe separate place to do necessary cases outside the four walls of acute care setting. So a lot of opportunity, not only in the existing ASC space, but we've mentioned over the year that we expect over the next, say, five to ten years that this space for the ambulatory surgery centers is extremely dynamic, set up for growth and will likely double over the next ten years. Predominantly, Doug, it's going to be in the ASC space. And no change to multiples or anything that you're seeing right now as we come out of the COVID situation? Can Yes, comment on slight uptick in the existing multiple acquisition side, not appreciably. We like the de novo opportunities where you're getting in a higher return on investment. So we see a lot of that development will be in the de novo space where you've got a better return, but we do see some opportunities in both acquisitions and the de novo. Excellent. And then last question just has to do with the dividenddistribution. Given your low payout ratio right now, have you given any consideration to a moderate increase at some point? Doug, we don't have plans at this point to raise the dividend. But coming out of COVID, we're going to continue to evaluate the best method to optimize our shareholder return. Excellent. Okay. Thanks very much. Thank you. We do have a follow-up question from the line of Andrew Lena with National Bank. Hi, good morning. Thanks for the follow-up. I was wondering if you guys can talk a little bit about cost inflation, what you're seeing out there, be it in labor, it in supplies? And the second part to that, any labor shortages particularly on the medical staff side of things? Know, Andrea, saw some impact on pricing last year. It's a little early this year. We haven't really seen any significant change on that front. And on the labor side, no, we are not experiencing any labor shortages. Okay. Great. Thank you. And one more or two more actually for me. But on the divestment of that TRxC from MFC Nueterra, I was wondering is it possible to quantify what the contribution was in previous quarters so that we can have an apples to apples comparison with this year? Give me a second. No, I don't have that at the moment, but we can follow-up with you. Okay, great. Thank you. And then one last one, the St. Luke's ASC, how is it trending in the first year? Or is that on this quarter actually, if you compare it to the previous quarter, have you seen any uptick or any improvements there? Or any comment? Yes. Our comment is that we it opened late due to COVID. Certainly, we're pleased to see it to get open and fully functioning and operational. In the first quarter, we saw month over month sequential growth. So we're off to a good start there. It's fully invested and the partnership is heavily engaged and we're pleased with the trajectory right now. Okay, great. Thank you. That's it for me. Thanks very much. Thank you. I do apologize, that was our final question. I would like to hand the call back over for closing remarks. Thank you, Pasha, and thank you to everyone for spending time with us today. We thank our physician partners, nurses, and all staff who deliver outstanding care to patients each day. As always, we look forward to reporting on our progress again next quarter. Thank you. Thank you, ladies and gentlemen. This concludes today's conference call. We ask that you now disconnect your lines.