All right. Afternoon, everybody. Sticking around this afternoon. My pleasure to have Todd Young, CFO from Acadia. I thought it'd be maybe helpful to start, since Todd's relatively new to the organization, joining in a time of change, and you've been at other places in your career. I wanted to hear kind of observations around, you know, some of the strengths and weaknesses that you've identified within either the company operations, the finance functions. Maybe we'll just start there.
Sure. Yeah. I joined Acadia four months ago, right at the end of October, so still new. Getting used to being on the services side of healthcare. Grew up on the product side, including at Acadia Pharma, which has created a little confusion as I joined Acadia Healthcare. Overall, the company's in a really good spot from a market positioning standpoint. The demand for our services continue to grow, and we've got a nice diversified business across both the acute inpatient, specialty inpatient, residential, as well as the outpatient business with our opioid replacement therapy, what we call CTC. I think all of those give us a really good spot to drive growth from. Overall, I mean, the organization is very pleased that Debbie Osteen is back as CEO.
Debbie joined us back in January, and so her history in the industry and her proven track record of operating facilities is really something that's breathed fresh life into the employee base and a lot of excitement there. From the standpoint of, you know, our relative strength, certainly this opportunity to grow from a, you know, a base of new facilities, we've brought a lot of beds online over the last few years, and I think that puts us in a really good spot to be able to drive growth without needing as much incremental capital. From the standpoint of opportunities, you know, we do have to improve execution.
I think, you've heard, Debbie talk a lot here in her first month on the job about getting the right people in the right place in order to drive that growth. It is about people. It's about, you know, everything from hospital CEOs to the divisional leadership and making sure that, you know, we're set up to have the right people understanding the way to fill these hospitals, because the opportunity really is there. Overall, certainly, you know, the people, and their passion for taking care, of our patients is a real strength and, you know, I think we do have this opportunity to drive growth, with, you know, a lot of facilities we've brought online over the last three years that are, they just haven't built up at the pace that was originally expected.
We feel good about the markets they're in and that, you know, the opportunity is there with the right execution and the right leadership to do that. Overall, I think, you know, the strength is really this opportunity in front of us and the demand for the services. Certainly, you know, it's a different, you know, player base. We've seen, you know, some of the challenges of the litigation side and medical malpractice. That's a place that I'm getting my arms wrapped around on and something I just hadn't had exposure to previously, but now have been getting up to speed on. Overall excited for what we can do to serve more patients across the U.S.
Maybe as it relates to just, like, the organizational review.
Sure.
I know it's incredibly early, and Debbie's just getting her arms, listening probably more than taking action at this point, but how... You know, where are we in terms of, like, looking at the layers of the organization, identifying the right people, and what would be a reasonable timetable to think about for making some of the changes?
Yeah. I think, you know, obviously the benefit Debbie has is she's been around the organization, previously the CEO. She doesn't start from ground zero. It is something we're actively doing at the moment. I do think we'll have some movement on that in, you know, reasonably short order as we, you know, focus on, all right, how do we make sure that, you know, the right people are, you know, driving it and that we're taking advantage of, you know, basically better data streams, as you've heard her talk about on quality and dashboards that maybe we don't need as many people as we thought we did to do those same levels of effort. I do think we'll have something, you know, in reasonably short order that's faster than you'd normally see just because of her understanding of the company and, you know, the people that are here.
Okay. She said something on the call about, you know, removing barriers to problem-solving, and I think that's probably part of it. Maybe just elaborate a little bit more on, what you guys are doing.
I think a part of it is, again, it gets back to people, making sure, they feel supported. We also know who's accountable for decision-making, especially with new facilities and new JV facilities. That it isn't just a committee approach where you look, you know, left, you look right, and you're trying to find out, you know, who can you go to. Really making that a very clear, accountable structure as we move forward.
I think, you know, overall, as we evaluate, you know, any of the different groups, be it my world in finance, be it quality, be it compliance, legal, HR, IT, you know, all of those things, we're just trying to make sure we understand what, you know, the team is doing and how they're driving value to the facility level, or making sure that we've got the right, you know, compliance and other things in place for the enterprise.
Okay. Fewer meetings, less talk, more action.
Certainly that's a part of the goal.
Yeah. I don't like meetings. When you look at the new de novos that you've opened up in the last few years and the underperformance, any common themes as to why they've underperformed some of the targets?
I mean, I think we probably had outsized expectations from the start that, you know, obviously proven, that's an easy one when you know what the actuals look like after the fact. I think the timing element certainly is one where assumptions that things would move faster meant staffing occurred earlier, which meant you had ran losses with, you know, a fixed cost base being, you know, de-levered even sooner. I think that's part of it. I think some of it just gets to understanding, you know, the timeline and the urgency of getting through licensure requirements. Obviously, most of the new beds we've brought on have been in the acute facility space. In order to get to involuntary patients with Medicaid, we've got to go through all the licensure process-
Right.
I ncluding getting Medicare tie-in numbers and the like. Some of those just went much slower than what had been historically the norm. That's a part of it, and I think just, you know, a lot of kind of overarching volume of change over the last couple of years that, somewhat like in the case of, you know, you do a big M&A deal, you assure everyone that, it won't cause any disruption internally, and yet you're doing lots of change all at the same time, and that does create it. I think there's been some of that over the last couple of years that, you know, we're really focused on the facilities, focused on, you know, driving admissions and taking care of our patients safely, versus a lot of other distractions.
With that, I think we're gonna get, you know, a bump in quality of delivery, as we just focus on that key deliverable, which is running the facility well.
Okay. There's been a handful of underperforming facilities that have emerged in the last year or two, many of which have been shut down, most of which I think were probably specialty even due to environmental factors and industry factors and GLP-1s impacting the demand for eating disorder. Are we through the bulk of closure activity at this point? It doesn't sound like Debbie believes that closing facilities is probably the right action to take.
We think so. Our focus really is on, you know, taking advantage of the beds we have and, you know, driving occupancy with them. We don't, you know, expect to be closing any facilities other than the ones, you know, we called out on our earnings call, a few weeks back. We did consolidate two facilities in Pennsylvania as part of the New York Medicaid decision that were leased facilities that, you know, were leases were coming up, so it made more sense to consolidate into some bigger facilities for efficiency reasons and then one facility that we had previously announced in Q3 or Q4 of last year that officially closed in January. Fundamentally, our focus is on making facilities work.
As we've seen from the cost of adding new beds has become much more expensive with the construction costs. you know, we think there's an opportunity to serve more patients in the, in the beds we have and are really looking to do that. That being said, if there's something that happens to a facility and we do not think it is financially viable, then we'll make the decision to close it. right now, our focus in 2026 is operating all of our facilities as well as we can run them.
You mentioned New York, Pennsylvania, headwind at $25 million-$30 million. What's the math behind that? Is it just saying, "Here's all of the out-of-state patients, and if we get none of them, like, that revenue's gone?" Is that-
Yes. Like, fundamentally, it's a conservative assumption based off losing all of those patients that we historically had from New York. We're gonna actively backfill, and I'd like to think that gives us some, you know, additional opportunity relative to the guidance we've given.
Yeah.
You know, fundamentally, yes, we took out, you know, that patient population revenue. We also took out the associated expenses of the, you know, care you need as occupancy grows. You know, we'd argue it's probably a conservative view. We're actively looking to backfill, those beds. You know, we did get approval from New Jersey Medicaid to be inside their system, which means we can take, Medicaid patients from New Jersey. We're obviously looking in, you know, greater Pennsylvania as well, just given the location of the facilities.
Okay. You've got a number of de novos you're opening up this year as well, and, I would have thought that the startup losses would have been less than what you're guiding to kind of, like, flat to slightly down, something in that range. How would you characterize that assumption that you've embedded in the plan this year?
Yeah, we've got, you know, a number of large facilities coming online. We brought on, you know, ECU Health, which I believe is 166 beds in December 10th.
Yeah.
It's certainly embedded there. Tufts opened, I guess two weeks ago in the big snowstorm in Boston, pleased to get that one, ongoing. Orlando Health's the next one on the docket. We've generally tried to use, you know, good reflective assumptions based off recent history, when building out our guidance because that is the most, you know, relevant timeframe we have. Now, do we wanna do it faster? Are we moving with a sense of urgency? Are we trying to make sure we get all of our documentation done to get The Joint Commission in to do the surveys as promptly as possible?
Absolutely, all of that, and I think that's our goal is obviously to do, and run everything better than what we've assumed, based on the ability to do so, understanding that, you know, we also don't wanna just assume initiatives have already worked before, you know, we've seen traction of them working. That's the balance within that.
Right.
W e do have a lot of new, big facilities coming online here that are driving that, you know, number with the 26 facilities being about $30 million of it, and the rest of that, delta of about $20 million coming from the 25 facilities that haven't moved to same-s tore yet.
Remind me, are there any de novo slated to be opened in 2027?
Not right now. There'll be more beds inside facilities that we would expect to continue to grow as licensure goes on a especially at Tufts, where they get it on a unit-by-unit basis. We only opened 24 beds when we opened Tufts.
Yeah.
I think it's a 144 bed facility. There's a number of units that would come on, including some in 2027.
Acadia has always added beds to existing facilities that hit, you know, peak occupancy, whatever. You know, you take a wing down, you build some more beds. Would you expect the target around those number of bed additions to existing facilities to change going forward? What are you baking in this year for new beds to existing facilities?
You know, we've given the 400-600 in total beds. That includes some expansion beds that'll come online. We haven't broken it out specifically yet, but we'll do it on an actual basis. We do expect to continue that efficient expansion sort of mindset, often, you know, adding, you know, 40 beds to a facility where you're already at sort of 80%, which given you have adolescents, adults, often that means you're kind of fully occupied. You can leverage the fixed infrastructure, leverage the referral sources, and continue to do that efficiently. You know, I think that'll be more the focus in the 2027, 2028 timeframe than new facilities, as we, you know, have brought on a number of new facilities, as we've talked about, that we need to fill.
Okay. Of all the things you've built, I think what resonated with investors is at the midpoint, you guided a $600 million of EBITDA, let's say, and there's another $200 million of embedded earnings.
Yep.
A $150 million, like, to get to the EBITDA margins you think, plus the add back of $50 million or so of startup losses. Like, how have you as a company deployed resources around those facilities to really try to focus on getting them back on plane to, you know, get to where they need to be?
As you can imagine, those facilities get a lot of attention. I mean, that's where, you know, we're sitting and we're reviewing those, on a very regular basis to understand, all right, how are they tracking, how are they tracking relative to expectations? How are they tracking relative to what we believe they can do in the marketplace? You know, that, you know, fundamentally, you know, obviously a facility that's 85% occupied and going great, we pay attention to because we don't want that to change. Those that are, you know, running at, you know, 20% capacity, they were opened in 2025, and we've got to get it to 80% capacity, that's where the focus, you know, is making sure we're thinking about that on the right track, have the right leaders in place, really driving that.
A lot of focus with our JV partners. I think that's a place where Debbie believes there is opportunities. You know, we will look and have looked at all of our referrals from, you know, JV partner hospitals and seeing, okay, what number do we get from our best JV partners versus our worst JV partners? The question is, all right, why can't we make them all look like our best partners? A lot of time being thought about that JV partner strategy and how do we use them both after they're opened as well as on the front end. As we talk about how do we ramp things quicker, they often have relationships with payers or, you know, governmental approval bodies where we're trying to take advantage of their market position to help us.
I would ask how long is it gonna take to realize that $200 million, but you're not gonna tell me. Just maybe remind us and refresh what is a typical timetable that you can generally get facilities from open to target?
We've said, you know, kind of inside 5 years. It's not as illuminating as you'd like, understand that, but it's, you know, it's 3,000 beds. That math makes it $50,000 of EBITDA per bed. You know, we have facilities obviously that make more than that on a per bed basis. We have some that make less, but we feel like that's, you know, a reasonable assumption as we, you know, drive these. Obviously ones that we opened in 2023 are much farther along that curve. We also have, you know, some that, you know, had really great starts. Henry Ford, for example, was one with a really great health system in Greater Detroit. They had beds that they were closing down that we're moving over to our facility.
That's an example where the JV partner is usually beneficial and helpful in driving greater occupancy sooner. That one will get to a higher level of profitability earlier as a result, so. Yeah, that's the big opportunity in front of us is, you know, these 3,000 beds brought on between 2023 and 2026, primarily acute beds there. That doesn't include expansion beds. As we talked about, we do add, you know, 10 to 40 beds to facilities. Those are already in our same-store base, we also view that as, you know, opportunity to continue to drive profitability in the base business as well.
Can we spend just a minute on malpractice? I mean, recognizing of course the frequency of activity on the legal side has been quite high, and we've seen industry challenges as well. Cost per claim has gone up. Just it'd be helpful to hear just the process that you guys undertake to establish reserves and any way to maybe characterize your level of comfort around the malpractice reserve today.
Yes. Very fair question given the impact on our 2025 results from our PLGL expense. Embedded in PLGL expense is both the premiums we pay for insurance, and so we do have insurance for these claims. The insurance market has changed a lot. It used to be in 2022, I believe, you know, $3 million of self-insurance and then the insurance would kick in. That's now moved to $15 million, and for certain sexual assault claims, there's cost sharing even up above $25 million. That insurance has changed dramatically with respect to its relative protection for most claims.
As we got our actuarial report, which we have to do, every year, the big change that had the big impact in 2025, where PLGL expense went up $61 million, was both historic claims not being reserved at a high enough amount. We had to increase the amount on those historic claims that were already in our embedded base. That was about $18 million, which is what we don't expect to repeat in 2026 because we feel like we've adequately reserved for those historic claims based off the settlements we see across our entire base. The number of claims jumped up dramatically. After being reasonably stable for, you know, three to four years, they were up 186% last year. That dramatic jump is a big driver of the cost.
As we look forward, for this year, we assume claim volume would stay at that elevated ladle. Level, excuse me. We didn't assume it would get better, and revert to the mean of the previous years. One other difference we've made from just a monitoring standpoint is I meet with our legal team every month, and I look at what claims came in the door, what settlements did we have, how was that tracking versus what the actuarial estimate that we used to establish the PLGL reserve is tracking. So, you know, we just gave guidance. I've looked at it. We're in line right now with those assumptions, which is what, you know, gives me, I guess, the most confidence at the moment that, you know, what we've assumed is running at the right level for 2026. That is a continued process.
You know, if you look at our balance sheet reserve for this, it's now up to $155 million after being, you know, $78 million last year. We do have a lot bigger reserve on the balance sheet, as a lot of these adjustments we've had have really been non-cash costs. As this new claim volume, this 186% growth, most of that won't play out from either a settlement or a litigation standpoint in the courts for, you know, two to seven years just because of the nature of how long it takes to work through the settlement. A lot of this was a negative on EBITDA, but less of a flow-through to cash flow.
Some of your peers will perform a malpractice test twice a year. Does it make sense to you to maybe have a more formal review more often?
Yes. We'll be doing that at least twice a year.
Okay.
A s part of the actuarial assumption.
Yeah. Managed Medicaid, that's been described as, you know, a pressure point for you guys' plans shifting their behavior. Debbie seems to think that the activity with the plans is probably, in her mind, no different than what she's seen in the past. How would you characterize the your experience with some of those payers today?
I think it obviously varies by payer. You know, I take comfort as well in Debbie's long experience in the industry and her view of this, as she feels like this is very much sort of the cycles that you go through over longer stretches. You know, we have seen our bad debt, you know, increase last year, as we called out, and a lot of that's, you know, embedded in the base, and we've assumed that stability into 2026 versus a significant improvement. You know, the team's very, you know, focused on doing the right advocacy for patients, having the right documentation in place so that we can, you know, defend, you know, our assumptions and our documentation in a review we get.
Understanding that, you know, obviously some of those players are having greater financial challenges and, you know, that's always something we have to be cognizant of as they look to improve their bottom line. The team is very focused on that and very focused as we have the negotiations with the payers of getting some better data. We've been able to, you know, obtain some better information on, you know, how others in the industry and rates they're getting from payers that we think will help our team as we focus both at a corporate-wide on lots of big contracts as well as at the facility level with smaller ones is, you know, that's a key element every year is those rate negotiations we go through.
Yeah. It was a few years ago that Medicare started to cover partial hospitalization and intensive outpatient programs. The industry has sort of coalesced around a strategy to try to advance that. Just maybe update us on where Acadia is in terms of, you know, allocating capital and focusing on an outpatient access point strategy.
Ours is very focused on the continuum of care, making sure that our patients in the acute setting are stepping down into places that allow them to continue to get better over time, and that's really where our outpatient focus is as a step down from the acute versus it being on a pure outpatient model for patients. Now, obviously, our opioid replacement therapy CTC business is entirely outpatient, but when we get to the straight behavioral, it's really more focused on having that right continuum of care, having outpatient be part of the therapy. We do have, you know, straight outpatient as well in a lot of our specialty businesses.
That was part of the hit we took in Pennsylvania, was a lot of our outpatient, population were New York residents, that, you know, we now can't treat because of New York's decision.
On the CTC business, there was some hysteria among the investment community when there was, you know, legislation out, I'm forgetting even the name of the...
AHA or something like that.
Well, I think that's a different one.
No. Is that a different one?
That's a different one. It'll come to me in a minute, the punchline is that you could access methadone from non-CTC locations. It could be dispensed at a Walgreens or CVS. Is there any update around that idea, that concept, that legislation? Is it dead? Is it, you know?
I know I don't think it's dead, but it doesn't seem to be overly active at the moment either.
Yeah.
Our perspective is that, you know, we're treating some pretty acute patients that have, you know, a real need and part of what our value proposition is patients come in and get their therapy and move on in less than five minutes. Now, if they have a therapy session, it's obviously longer, but if they're coming in just to get the methadone and move on, less than five minutes.
Right.
W ell-run process. We're seeing, you know, you know, tens of thousands of patients a day. Oh, I mean, most of us have probably been to a Walgreens recently. It usually isn't less than five minutes. I do think that that's a real competitive advantage we have versus an alternative, option for people to get, a daily therapy, especially before work, you know, 6:00 A.M., 7:00 A.M. type time frames.
We spent some time a few years ago really examining the, you know, the National Opioids Settlement. Are you guys seeing any of those dollars directly or indirectly flow into the organization?
Very little. Yeah. I think it's something we're always working on and on the lookout for. We have seen a few things on some, you know, capital grants where we'll get, you know, some mobile units that we put into place that came from grants that came from the settlement dollars. Given the amount of money that's been allocated to that, we've seen very little flow in from a business demand perspective.
Okay. Thinking about all the organizational review things you guys are going through right now, If you're me and you're looking at my little Excel model and playing with the corporate overhead number?
Sure.
W ould I expect that it would be, you know, flat on a dollar basis this year, growing at a smaller percentage of revenue? What's the right way to think about the corporate costs function this year?
Yeah. It's very much in the flat to down. There's a little build back of incentive comp.
That's what I was gonna ask. How much is that?
We haven't given specifics. That's the only thing growing I'd say is that add back of assuming that we're back at 100% funding. Overall, you know, that's been a focus where, you know, as I said, we've got an ongoing review right now of those costs. As a general matter, as we built the budget, you know, back in November, December, you know, it was very much focused on no growth in corporate, where is there opportunities to reduce heads, reduce, you know, spend in that area.
The board last year authorized a share buyback authorization. I don't remember, maybe $200, something in that.
I think $300.
$300.
Yep.
Getting old. I can't remember. I can't imagine that that's a priority at this point right now to think about that.
I think our leverage now is, you know, 4x. We've guided to being in that general range for 2026, which is a little higher than we would like it to be. I think most of the feedback we get from investors, it's a little higher than they would like to see it. I think from a capital, free capital perspective, we'd be looking more to pay back debt than to buy back shares. As you've seen in the guidance, you know, we're bringing CapEx down dramatically here in 2026. That's allowing us to, you know, expect to be free cash flow positive for the year, that should help us, you know, start down this path of reducing leverage. That's certainly more the focus than stock buyback.
Okay. I know we're just in the beginning of 2026, but going into 2027...
Yep.
What does the slope of the CapEx spend look like?
It'll drop off more. I mean, as I said, we don't have a big de novo build plan right now. With those being the main drivers of getting these finished this year, you know, I would expect the growth CapEx to take another step down. It won't be $300 million because there's not $300 million to take out of it this year. I do think it'll make another drop and something that, you know, we'll obviously provide greater guidance on when we get closer to 2027.
Okay. All right. We've got about 10 seconds here. If there's a question in the audience, I could keep going, but... Todd, I appreciate it. Thanks for the time today.
Thank you. Thank you. Thanks for the conference.
Thanks for coming.
Appreciate it.