Earnings Call: Q4 2020

Mar 11, 2021

Earnings release

Good morning, everyone. Welcome to the Medical Facilities Corporation twenty twenty Fourth 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 securities 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 factors that may cause the 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 regulators. 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 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 Horar, President and CEO of Medical Facilities. Please go ahead, Mr. Horar. Thank you, Chris. Good morning, and welcome to our fourth quarter twenty twenty earnings call. Joining me today is David Watson, our Chief Financial Officer. Earlier this morning, we released our fourth quarter and year end results. Our news release, financial statements and MD and A are available on our website and have been filed with SEDAR. I would like to start by expressing my gratitude to our physician partners and all of our healthcare associates who continue to deliver outstanding care to patients each and every day. We are incredibly proud of how well they managed challenges of this past year. There are a few key takeaways that I will cover in my remarks today. First, our case volumes continue to recover and are closer to pre COVID levels. Second, we continue to benefit from decisions we made both prior to and during the pandemic. And third, we are well positioned to capitalize on market opportunities as the recovery continues. 2020 got off to a strong start. However, by the March, COVID-nineteen had begun to surge. As a result, stay at home orders and temporary succession of elective cases were implemented, which had a material impact on our business, most significantly in April and May. The third quarter saw a dramatic rebound in case volumes and volumes continue to normalize throughout the fourth quarter despite the higher prevalence of COVID-nineteen across The United States. Notably, hospital surgical case volume dropped to thirty six percent of the prior year in April, but rebounded to ninety four percent in the fourth quarter. Despite the improvement, however, COVID continued to impact our volumes during the fourth quarter as some patients deferred care. The second quarter drop in cases and the following recovery was even more dramatic in ambulatory surgery centers. Last April, our ASC case volumes were only eight percent of prior year, but in the fourth quarter they improved to ninety percent of fourth quarter twenty nineteen levels. Our ability to recover quickly was due to the hard work and commitment of our partners and associates to ensure that our facilities continue to provide a safe environment for patients and staff. Of critical importance was the government relief funding that our hospitals and ASCs received at various times throughout the year. These funds in addition to the changes we made to our dividend, retirement of our debentures at the 2019 and selling down our position in Unity Medical allowed us to weather this unprecedented storm as well as we did. Despite the challenges of the pandemic, our balance sheet remains strong as David will speak to you in a moment. And as a result, we are better positioned to capitalize on growth opportunities as the recovery continues to unfold throughout 2021. I'll discuss this further as well as our outlook for the year later in the call. Now, I would like to turn the call over to David to discuss our financial results for the quarter and the year. Thanks, Rob, and good morning, everyone. As usual, a reminder that all dollar amounts expressed in today's call are in U. S. Dollars unless otherwise stated. I'll discuss our fourth quarter and year end financial performance, then provide an update on our balance sheet and liquidity. For the year, total revenue and other income from continuing operations was $389,900,000 down 2.1% from fiscal twenty nineteen. The 2020 figure included $26,000,000 in government stimulus income received by our surgical hospitals and ASCs. The year over year decrease was primarily due to the decline in case volume, especially earlier in the year when the pandemic forced facilities to reduce elective surgeries or temporarily cease operations. In addition to the pandemic affecting elective procedure volumes, the 2019 included cases from Two Rivers and Central Arkansas Surgical Center, whereas the 2020 did not. As Rob mentioned, we saw a dramatic rebound in case volumes in the back half of the year. However, they did not reach prior year levels. On a same store basis, total surgical cases were down seven point one percent, outpatient cases were down eight point eight percent, and inpatient cases declined nine point two percent from the fourth quarter of twenty nineteen. Observation cases on the other hand increased by twenty six point eight percent. In the fourth quarter, we had total revenue and other income of $109,500,000 which included $2,400,000 of government stimulus income. This is 3.9% lower than the same period last year. Excluding transaction costs and the sale of the controlling interest in UMASH, adjusted EBITDA for 2020 was $96,100,000 This is a decrease of 0.2% from prior year adjusted EBITDA, excluding the $22,000,000 non cash goodwill impairment charge. As a percentage of revenue, adjusted EBITDA in 2020 improved to 24.7% compared to 24.2% in 2019. In the fourth quarter, we had EBITDA of $28,400,000 down 13.1 from the fourth quarter of last year. Our EBITDA margin for the quarter decreased to 6% of revenue from 28.7% in 2019. The decline was mainly due to lower case volumes, which translated to lower income from operations at most of the facilities. For the year, cash available for distribution totaled CAD40 million resulting in a payout ratio of 21.8%. And for the quarter, we had cash available for distribution of CAD10.1 million, resulting in a payout ratio of 21.5%. Importantly, despite the challenges of the pandemic and largely the result of decisions we made in the months leading up to the pandemic, we have a very strong balance sheet as of year end. At year end, our corporate debt outstanding stood at $38,000,000 down from $84,800,000 at the end of twenty nineteen. On a consolidated basis, total long term debt excluding lease liabilities decreased by $53,700,000 to $97,700,000 and cash and cash equivalents totaled $66,200,000 $23,200,000 of the cash balance represents advances from Medicare that will be offset against future billings. Our net debt to EBITDA as of year end was 0.33. At year end consolidated net working capital declined to $45,000,000 compared to $71,500,000 the year before. The change resulted from the sale of the controlling interest in UMASH in February 2020 and its underlying real estate assets in June, as well as the payer advances and government stimulus funds repayable recognized in current liabilities. This was partly offset by the receipt of government stimulus funds by the facilities and cash proceeds from the UMASH sale transaction. As of year end, we had cash and cash equivalents of $66,200,000 and $112,000,000 available on our $150,000,000 credit facility. This concludes my financial review. For additional detail on our financial results, including specific results for each facility, please refer to our MD and A. I would now like to turn the call back to Rob to provide a few comments on our outlook before we open the call for questions. Thanks, David. Last September, we announced the opening of St. Luke's Surgery Center, Chesterfield in Missouri. This is a de novo ASC and offers six specialties including orthopedics, gynecology, GI, plastic surgery, and general surgery. We're happy with the early performance of the St. Luke's ASC and expect cases to continue to ramp up throughout 2021. Ambulatory Surgery Centers are an important part of our growth thesis, whether through acquisition or development of new centers. Ambulatory Care is one of the fastest growing and higher margin segments of The United States healthcare industry. Patients prefer the accessibility and lower costs afforded by ASCs. And on top of that, the pressure on acute care hospitals during the pandemic highlighted the important role that ASCs can play in the healthcare landscape by providing an alternative and safe site for a growing list of surgical procedures. MFC is well aligned with the expected growth in the ASC space. Our balance sheet remains strong and we are well positioned to capitalize on potential market opportunities. We believe that there is even more opportunity coming out of COVID and we have a robust pipeline of acquisition targets and potential de novo projects that we continue to review. With that, we would now like to open the line for questions. Operator? Thank you. Your first question comes from Endri Leno of National Bank. Your line is open. Hi. Good morning, and congrats on the recovery of volumes in Q4. I had a couple of questions. I mean, first, I'll start. Rob, you mentioned in your prepared remarks that there were some case surgeries postponed in Q4. I was wondering if you can talk a little bit more about them in the sense that if we were to normalize Q4 results from these, where would your overall case volume be in Q4? How quickly do you think these cases will be rescheduled or have any of them already? Yes, that's a good question, Andrey, and thank you and good morning. So we're really talking about patients who are reticent to come for either a clinic visit or even have surgery. We've seen, as we've talked about the ebb and flow and actually more the flow of COVID through the fourth quarter, we know those cases are there. Our facilities and we really can't measure that, but we know it's there just episodically. So coming out of COVID and as the vaccines roll out, we expect that to return. It's hard to calculate exactly what that is, but we do know there is some demand in some cases. I'll tell you, for the most part, those who truly needed urgent care and treatment got it. But there'll be some deferred care. We're not alone in that. I think every healthcare system is in the same boat with that. Okay. Great. Thank you. My second question is that, I mean, you also mentioned in the prepared remarks, it was also a bit touched upon in the Q3 call. Is that of the possibility of picking up cases from acute care hospitals? Was this the case in q four? I mean, did you think you saw any volumes because of that? And does this still hold true for 2021 since the pandemic sort of, you know, recedes and fades? Yeah. Actually, it was the case in Q4. Some hospitals were limiting elective cases and scheduled cases as COVID admissions increased in their facilities. We did have a number of our facilities that benefited from physicians, even those that were employed by other health systems that brought cases to our facilities. The experience was outstanding. The patient satisfaction was extremely high and comments that we received that they'd like to continue to do that. Don't really have any numbers to put to that rolling forward, but it was a positive experience. As we called out in our ASC space, the same thing applied to the ASCs where those cases couldn't get done in the hospital, we did get a benefit in the ASC space. Great. Thank you very much. And last one for me, I'll jump to the queue. But if you can talk a little bit about OSH, I mean, what was happening there? I mean, you had revenue down, but expenses were up, and then they had this default on their debt. Mean, first of all, what's happening there? Then what is the outlook for that hospital? In Q1 or for the rest of 2021? Yeah. Hey, Andrew. It's David. So in Q4, OSHA had weak volume. Were down about 9%. That corresponded to about a 10% drop in the revenue. And on the expense side, they've seen they've had fairly high health benefits expense, primarily COVID related and that had an impact on the quarter. Consequently, you know, you look at the results for the quarter, it had an impact on their ability to, you know, meet their covenants, they trip the covenant And as a result of that, they paid down the debt subsequent to year end. Okay. Great. Thank you. So how does the situation look then now in Oklahoma? Has it improved at all or does it continue to be similar to Q4? No, I think this is a single again, this is primarily predominantly a spine hospital with orthopedics. The outlook, I think we think we're very optimistic on that. It will return. COVID was a big issue here. So coming out of all of that, the outlook for OSH, we're very optimistic will return and be back to normal. Okay, great. Thank you very much. I'll jump in the queue. Thank you. There are no further questions. I will now return the call to Mr. Horar for closing comments. Thank you for joining us on today's call and for your continued interest in MFC. As always, we look forward to reporting on our progress again next quarter. Thank you. Ladies and gentlemen, this concludes today's conference call. Thank you for participating. You may now disconnect.