Good afternoon, everyone. Welcome to the Cross Country Healthcare's earnings conference call for the third quarter 2022. Please be advised that this call is being recorded, and a replay of this webcast will be available on the company's website. Details for accessing the audio replay can be found on the company's earnings release issued this afternoon. At the conclusion of the prepared remarks, I will open the lines for questions. I will now turn the call over to Josh Vogel, Cross Country Healthcare's Vice President of Investor Relations. Thank you, and please go ahead, sir.
Thank you, and good afternoon, everyone. I'm joined today by our President and Chief Executive Officer, John Martins, as well as Bill Burns, our Chief Financial Officer, Dan White, Chief Commercial Officer, and Marc Krug, Group President of Delivery. Today's call will include a discussion of our financial results for the third quarter of 2022, as well as our outlook for the fourth quarter. A copy of our earnings press release is available on our website at crosscountryhealthcare.com. Please note that certain statements made on this call may constitute forward-looking statements. These statements reflect the company's beliefs based upon information currently available to it.
As noted in our press release, forward-looking statements can vary materially from actual results and are subject to known and unknown risks, uncertainties and other factors, including those contained in the company's 2021 annual report on Form 10-K and quarterly reports on Form 10-Q, as well as in other filings with the SEC. The company does not intend to update guidance or any of its forward-looking statements prior to the next earnings release. Additionally, we reference non-GAAP financial measures such as adjusted EBITDA or adjusted earnings per share. Such non-GAAP financial measures are provided as additional information and should not be considered substitutes for or superior to those calculated in accordance with U.S. GAAP. More information related to these non-GAAP financial measures is contained in our press release.
Also, during this call, we may refer to pro forma when normalized numbers pertain to our most recent acquisitions as though the results were included or excluded from the periods presented. With that, I will now turn the call over to our Chief Executive Officer, John Martins.
Thanks, Josh, and thank you to everyone for joining us this afternoon. Before I get started, I'd just like to take a moment to welcome the newest members of the Cross Country family that joined us this past month through our recent acquisitions of Mint and Lotus, two physician staffing companies that we believe not only expands our market presence, but brings us a talented team of professionals to join the ranks of Cross Country locums and sets the stage for accelerated organic growth. Welcome, Mint and Lotus. The third quarter marks six months for me as CEO of Cross Country, and I am amazed and excited by what we have achieved during this time, as well as what lies ahead. As an organization, we continue to execute well across so many fronts, from sales to delivery and across our technology initiatives.
Our unwavering commitment to always act ethically and to deliver best-in-class service has positioned us as an integral partner to the thousands of clients and tens of thousands of clinicians and professionals we serve. Our success is rooted in the dedication of our employees and their commitment to maintaining a vibrant workplace culture that stresses the importance of diversity, equity, and inclusion. The culture at Cross Country has never been stronger, as evidenced by our recent recognition with the Best Companies for Happiness award from Comparably. We take great pride in becoming the employer of choice for so many, and we will continue to elevate and evolve our organization by investing in our people and culture.
As noted in our press release today, we posted another strong quarter for both revenue and adjusted EBITDA, exceeding the upper end of the guidance ranges we shared at our Investor Day event in mid-September. In addition to highlighting our outstanding leadership team, we announced full- year 2023 minimum guidance and had the opportunity to share more insight into Cross Country's innovative technology and impact it is having on our business. The shift from being almost exclusively internally focused to heavier investments in externally facing technology was evidenced in the launch of Intellify, our proprietary cloud-based vendor management system, and this represents a significant milestone for the company in our evolution as a tech-enabled workforce solutions company. I'll go more into details on Intellify later in the call, but first let me provide some comments on our third quarter results.
With consolidated revenue of $636 million, we grew by nearly 70% year-over-year, with all lines of business reporting growth. The strong revenue performance, coupled with stable gross margins and cost management, drove adjusted EBITDA of $64 million, representing a 10% adjusted EBITDA margin. Increasingly, our revenue growth is coming from volume as bill rates have trended down throughout the year. In fact, travel bill rates for the third quarter were down 12% sequentially and down nearly 20% since the first quarter, though still 10% higher than a year ago. With a backdrop of continued strong demand amidst the tight labor market, travel rates have stabilized over the last several months, and we believe they are settling into a new normal for the market, as anticipated.
Bill will step through the guidance a little bit later. It's important to note that the sequential decline in travel bill rates expected for the fourth quarter is primarily attributable to the wind down of higher rate assignments and not necessarily due to the continued decline in the billings. As a partner to dozens of healthcare systems, we are sensitive to their need to reduce costs for contingent labor and will continue to do all that we can to help them achieve their goals, leveraging our full complement of services, including helping them build up their core staff and offering them technology solutions such as Intellify that will help them better manage their spend. Today, our largest source of revenue comes from our managed service programs, or MSPs, representing 55% of our consolidated revenue for the third quarter.
Third quarter spend under management from our MSPs was nearly $2 billion in annualized contingent labor spend, which is 4 x the size of the programs we managed at the end of 2019. Generally, we fill all of our clients' needs through a combination of direct fill and through a partner network of subcontractors. For the third quarter, Cross Country's capture rate on the $2 billion spend was 71%, which was up 200 basis points over Q2. Increasingly, our MSP clients will be able to benefit from the adoption of our proprietary vendor management system, Intellify, which enhances their visibility into their program spend. As of September, we had 10 programs live on the platform, with five more scheduled for deployment in the fourth quarter.
As we called out on Investor Day, Intellify also lowers our cost of fulfillment and will save millions of dollars annually once it is fully deployed. We currently anticipate the majority of our clients will be converted in the next 12-18 months, depending on our success in winning new accounts, as they would naturally be launched on Intellify as programs go live. The anticipated benefits of Intellify go well beyond cost savings, as the technology also allows us to be more competitive in the market, giving us access to capture significant incremental client spend through vendor neutral offerings, as well as technology extensions for direct licensing by the clients for their internal use. Our tech roadmap is far from complete, but we are making terrific progress.
Year to date, we have spent more than $12 million on technology-related investments, more than half, which is focused on externally facing technologies such as Intellify and our candidate portal known as Gateway. Gateway provides candidates a superior experience with real-time matching to open positions and the ability to self-select interests and schedules. Through this self-service model, we believe Gateway will also significantly improve operational productivity once fully deployed. As I like to say, you are never really done creating technology, but our tech transformation over the last few years is impressive. We have completely redesigned our entire ecosystem from the ground up using a data-centric model that interconnects all components within the ecosystem. Having a single tech stack enables us to provide the highest level of analytics while ensuring speed to market, as well as best-in-class experience for candidates, clients, and our teams.
It also provides us the foundation to build additional capabilities. On the strength of our performance, we continue to not only invest in growth through capacity and technology as well as acquisitions such as Mint and Lotus, but we are also able to deploy capital in a more meaningful way through paying down expensive debt and repurchasing our shares of common stock. As we announced in August, our board authorized an additional $100 million repurchase program, and we quickly put that to work. Through a combination of exhausting our prior authorized plan and leveraging the new plan, we repurchased more than 1 million shares of stock before our mandatory blackout in mid-September. The average cost of shares repurchased was $24 and we have $87 million remaining under the new program.
We will continue to be opportunistic with share repurchases, balancing investments in our technology initiatives, strategic personnel, and tuck-in acquisitions that further bolster and diversify our portfolio. Looking to the fourth quarter, overall demand remains robust and well above pre-pandemic levels. It is interesting to note that despite the relatively high demand and the recent surge of pediatric respiratory cases, we are not yet seeing significant spikes in demand for seasonal needs, which could be a further tailwind as we head into the end of the year. Specific to our travel business, orders remain steady across most specialties, with growing demand for emergency room, ICU, labor and delivery, and pediatrics. Supply constraint continues to be the biggest challenge faced by our clients, with clinicians looking to retire early or leave the bedside due to fatigue and burnout.
In fact, a recent survey by Bain showed that 25% of U.S. clinicians are considering switching careers outright, mostly due to burnout. Additionally, data from the Bureau of Labor Statistics continues to indicate a wide spread between healthcare job openings and hires. For the fourth quarter, we expect revenue to be between $590 million and $600 million, well above the $550 million exit runway we shared at our Investor Day. While Mint and Lotus will contribute to our performance, the majority of the increase comes from higher volumes as well as a slightly higher projected bill rates. Our adjusted EBITDA guidance implies a margin of 9%, in line with our goal to maintain adjusted EBITDA margins in the high single to low double digits. I've called this out before, but it's worth repeating.
Though we strive for continued margin expansion every quarter, we will continue to make investments that may interrupt the trend, but we believe will ultimately drive greater shareholder value. Though we are encouraged that bill rates have stabilized, we recognize the potential for future volatility. That said, we are well-positioned to continue driving organic growth thanks to the investments we have made in revenue producers, the development of market-leading technologies, and by counting and continuing to win new clients. We therefore reiterate our targets for 2023, announced in mid-September to deliver full- year 2023 revenue of at least $2.2 billion and adjusted EBITDA in excess of $200 million. In closing, I am very encouraged by our clients, our business, and our prospects as we approach 2023.
As bill rates continue to normalize and demand remains strong, it sets up an exciting runway for long-term, sustained, profitable growth across all lines of business. I want to thank all of our dedicated professionals who made Cross Country Healthcare their employer of choice. I'd also like to thank our shareholders for believing in the company and of course, our talented team who have supported our transformation into a high-performance, tech-enabled total workforce management solutions firm. With that, let me turn the call over to Bill.
Thanks, John, and good afternoon, everyone. Once again, we have delivered results that have exceeded our expectations with both revenue and adjusted EBITDA above the high end of the revised guidance issued during our Investor Day in mid-September. The overachievement relative to the updated guidance was driven by better than expected performance across several lines of business, including education, physician staffing, and search, as well as the impact from a small labor disruption we supported in the final weeks of the quarter. We continue to execute well across multiple fronts and experienced robust year-over-year growth across all of our lines of business. As a result, consolidated revenue for the quarter was $636 million, up 70% over the prior year and down 16% sequentially.
The primary driver of our growth continues to be the number of professionals on assignment, and to a much lesser extent, the impact from rates. Gross profit was $144 million, which was up 71% over the prior year and down 16% sequentially. Gross margin of 22.6% was flat sequentially, but up 20 basis points over the prior year as we continue to see a decline in COVID-related crisis orders and a normalization in bill pay spreads across our travel base business. Our solid top-line performance, combined with improved productivity and operational efficiencies, fueled another quarter of strong earnings with adjusted EBITDA of nearly $64 million, representing a margin of 10%, making it the fourth quarter in a row of delivering double-digit adjusted EBITDA margins.
Turning to the segments, Nurse and Allied reported revenue of $612 million, representing an increase of 72% over the prior year and a 16% decline sequentially. Our largest business, Travel Nurse and Allied, was up nearly 90% over the prior year, fueled by an increase in the number of billable hours of more than 73%. The sequential decline in travel was predominantly driven by the expected decline in bill rates, which were down 12%. Looking to the fourth quarter, we anticipate average bill rates will decline once again, though at a more modest pace, likely in the high single digits. Travel demand has remained very strong, with orders continuing to be more than 10% above the start of the third quarter and well ahead of pre-pandemic levels.
From a trend perspective, bill rates have leveled off and remained stable for the last 4+ months after having declined throughout most of the first half of the year. Looking into 2023, we will likely see that rates a little bit higher than we anticipated last quarter. That said, rates could step down in the future if clients see lower needs for contingent labor, though at the moment, it's hard to predict when that might happen or how it might affect our bill rates considering the incredibly tight labor market. Our local business was up 9% from the prior year, though down 14% sequentially, with the sequential drivers fairly evenly split between rates and volume.
The majority of the volume decline has come from a drop in local contract or block book assignments, returning to more normal levels for our local business following the pandemic. Also, with the Nurse and Allied, our home care business rose 23% over the prior year as we continue to ramp our managed service outsourcing arrangements with several large PACE providers. Lastly, our education business reported a 38% increase over the prior year and was down 11% sequentially, due entirely to the impact from summer vacation. We remain excited at the prospects for this business to continue growing organically in the high double digits into the future. In fact, we expect the fourth quarter to be the single highest revenue quarter for this business in its history.
Finally, the physician staffing segment delivered nearly $24 million in revenue, which was up 27% over the prior year and 8% over the prior quarter. Billable days were up 8% over the prior year and 6% sequentially, with growth across a wide range of specialties. On a year-over-year basis, excuse me, average revenue per day filled increased across virtually all specialties as needs continue to rise. Moving down the income statement, total selling, general and administrative expense was $80 million, up 52% over the prior year and down 7% sequentially. As a percent of revenue, our SG&A was 12.6%, down nearly 150 basis points over the prior year.
On the improved operating leverage stemming from the growth in our business as well as greater productivity from our revenue producers. The majority of the increase in SG&A over the prior year was driven by continued investments in people and higher compensation on the continued strong performance of the company, as well as investments in our technology initiatives that are not capitalizable. On a sequential basis, the decline was primarily driven by lower incentive compensation associated with the sequential trend in the business, which was partly offset by continued investments in our workforce, which grew by 4% over the prior quarter. We continue to believe the market supports further investments in resources, and we will leverage our capacity planning models to ensure that they are targeted to the areas with the greatest opportunities.
In addition to the investments in people, we're also investing heavily in our technology with additional resources and developers to facilitate the rapid deployment of candidate and client-facing technology like our new VMS and Intellify. Year to date, we've spent more than $12 million on technology, and given the nature of some of the projects, roughly 60%-70% of it qualifies for capitalization or deferral. During the quarter, we recognized $2.5 million in restructuring charges and $3.8 million in asset impairments, primarily related to the closure of additional office space during the quarter. Interest expense of $3.5 million represented a decline of 9% over the second quarter on lower average borrowings across the quarter. With the majority of the remaining debt outstanding related to our subordinated term loan, our effective interest rate was 9%.
As a result of the significant cash generated during the quarter and the level of availability on our asset borrowing line, we chose to make an optional prepayment of $50 million just after the end of the third quarter to reduce our interest costs further. I'll go into more detail on the capital allocation in just a moment. Finally, on the income statement, income tax expense was $14 million, representing an effective tax rate of 28.5%. Based on our latest projections, we now believe our full- year effective tax rate will be between approximately 28.5%-29%, excluding discrete items. Our profitability for the quarter resulted in adjusted earnings per share of $1.07, which was 75% higher than the prior year.
Turning to the balance sheet, we ended the quarter with $30 million in cash and $133 million in outstanding debt, including $124 million under our subordinated term loan and $9 million in borrowings under our ABL facility. Cash on hand was intentionally high as we were preparing to fund the closing of our two locum tenens companies, Mint and Lotus. From a cash flow perspective, we generated more than $140 million in cash from operations during the quarter, representing the single highest quarter in the company's history. Our days sales outstanding was 67 days, representing a one-day increase over the second quarter, primarily due to the sequential decline in revenue relative to the timing for collections. We expect DSO will start to normalize as we progress through the fourth quarter and into the start of 2023.
With the significant cash flows we generated, we not only reduced the overall indebtedness for the company by $76 million, but we funded the acquisitions I mentioned a moment ago, repurchased more than 1 million shares of our stock at an average price of $24, as well as paid the first earn out payment on our acquisition of WSG for having achieved the targeted results. Looking ahead, we expect to continue to generate a significant amount of cash in the fourth quarter, and as I mentioned a moment ago, have already repaid an additional $50 million of the subordinated term loan in the fourth quarter, bringing the year-to-date prepayments to $100 million. With regards to future share repurchases, we will continue to be opportunistic.
Though as we shared at our recent Investor Day, we believe the best use for cash continues to be to fund future growth. This brings me to our outlook for the fourth quarter. We're guiding to fourth quarter revenue of between $590 million and $600 million, representing a sequential decline of 6%-7%, driven predominantly by the anticipated decline in travel bill rates, partly offset by growth in our education and the impact of our recent acquisitions from Mint and Lotus. Gross margins are expected to be between 22.3% and 22.8%, largely consistent with the current quarter. Based on our estimated revenue and gross profit, we're expecting adjusted EBITDA to be between $52 million and $57 million, representing an adjusted EBITDA margin of approximately 9%.
The sequential decline in adjusted EBITDA margin is primarily due to the impact of lower average bill rates in travel, as well as continued investments in our technology initiatives and in our workforce. Adjusted earnings per share is expected to be between $0.85 and $0.95 based on an average share count of 37.1 million shares. Also assumed in this guidance is an interest expense of $3.2 million, depreciation and amortization of $3.4 million, stock-based compensation of $2.1 million, and an effective tax rate of 29%. This concludes our prepared remarks, and we would now like to open the line for questions. Operator?
Thank you. We will now begin our question and answer session. If you would like to ask a question over the phone lines, please press star one from your phone, unmute your line, and speak your name clearly when prompted. Your name and affiliation are required. If you would like to withdraw your question, press star two. Again, to ask a question over the phone lines, please press star then one. Our first question comes from Kevin Fischbeck with Bank of America. Your line is open.
Great, thanks. I guess maybe the first question, the quarter came in better. The guidance for Q4 is coming in better, but you haven't really changed the outlook for next year. I mean, are you still thinking then that ultimately the bill rates stabilize at the same rate you thought before? Or are you now starting to think that the starting point for next year is probably gonna be higher and that there could be some upside to the next year outlook?
Sure. Hi, Kevin. Thank you for the first question. Good evening, this is John. I'll start and have Bill add some more color. But yeah, when we're looking at in terms of our guidance, or what our targets were for 2023, that was really the minimum target we were looking at that $2.2 billion and that $200 million of EBITDA. And at this point again, you know, not having that perfect crystal ball in front of us, we're looking at where rates have leveled off. If we look at what happened with the rates, we saw the rates going on a decline as we went through the year.
Right now what's happening is some of the higher rates that were in the beginning of the year and through second quarter, those people are coming off assignments now, and now we've leveled off those bill rates. As we see in the future, we're thinking the bill rates will remain stable at the current rate they're at. But what I would say is there's a lot of different trends from the macroeconomic trends that could have impact on those rates. Of course, when we talk about rates, I'd be remiss not to talk about supply and demand that really causes the rates to fluctuate. Because there's such a wide spread between the demand and supply and balance, there's a lot of volatility that could happen in next year.
As of now, this $2.2 billion of revenue is the floor we see, and we do think that there is potential upside to this. We're also cautious to say that there could be some headwinds of macroeconomic trends that could impact that. When you look at this $2.2 billion minimum floor we have, you know, you can think of that, of us hitting that ball right down the center of the fairway. Bill, would you like to add to that?
Yeah, sure. Thanks, Kevin. John made the point I was gonna make, which is it was minimum guidance as we called out. Look, there's a lot of unknowns as we look at 2023, you know, the potential for further economic disruption, the potential pullback in some demand for contingent labor, although again, not seeing that today. Is it possible rates could go down a little bit further? Of course. I mean, if you recall earlier this year, we had thought it would be a sequential double-digit decline. We're now calling for a high single. So there's a little bit more room we would anticipate that is there potentially on the rate side. But after four months of kind of seeing the stability in the rates, it's hard to see when that might play out that way.
To John's point, there is some potential upside there. I remind you know, the other lines of business are growing well. We're seeing phenomenal growth in our home care, out of our education, our search businesses. That's why we've not changed the $2.2 billion, but I think as we get through the fourth quarter, we'll obviously look to give you a little bit better lens on 2023.
Okay. That's helpful. I guess you mentioned that some of the variability in bill rates is due to the changes in the crisis orders as a percentage of total. Is there a way to kinda give us that number? Where was that as a percentage of total orders in Q3, and what was that normally like in 2019 and pre-pandemic?
You know, Kevin, we've stopped actually tracking things as crisis orders. I'd say that in the third quarter, even if I look at the labor disruption rates that we saw, they were not, like, remarkably different than what we're seeing in the broader marketplace. The market is settling into a more of a premium rate relative to pre-pandemic. I wouldn't call them necessarily premium rates today. It's really just what the market is demanding. You know, as far as splitting it down, it'd be an arbitrary split to tell you how the percentages are shaking out relative to pre-pandemic, because we simply are not flagging orders as premium rate orders or crisis orders.
Maybe just last question. You mentioned that the pediatric respiratory cases aren't coming in the seasonally the way that you I mean, we hear a lot about it, I guess, in the news about the triple whatever they're calling it now. Is that because? Are the hospitals just waiting to actually kinda see it fully come through before they ask for that staff? Is there a reason why they wouldn't be staffing up in front of that? Any color there?
Sure. I'll start, and then maybe Marc, you wanna add or Dan. As we said, we're seeing cases come up, and obviously you watch the news in the media, right? What you're seeing is tons of patients being diverted and going 70 mi to get to a hospital. We are seeing an uptick in pediatric specialties, but not at the surge that we would have expected with the triple threat of RSV, of the flu and a little bit of COVID in there. What we're anticipating that could happen to be a scenario as these children are getting this through this triple threat, and now as we're heading towards the holidays, you have Thanksgiving and the December holidays coming up.
In most of the country, it's going to become a little colder and more people will be inside. We think that triple threat has the potential to really cause an increase in demand towards the end of the year. Now, when we look at our numbers of the $2.2 billion for next year, these potential tailwinds are not baked into those numbers at all.
Of course, we're hoping that this doesn't come to fruition, but we are very well prepared with the capacity of our recruitment team, with our sales folks going out to potential new clients to make sure that we can help serve the communities and the hospitals and the patients at the bedside if it comes to fruition that we have this triple threat surge move into the adult population as well. Marc or Dan, do you wanna add anything to that?
Sure, John. I mean, we have seen most recently a sharp increase in the pediatric respiratory orders. Probably not as strong or as high as we would have expected at this point, but overall pediatric order volume has increased almost 20% since the start of Q4. That's more in line with what we expect.
This is Dan. What I will add is that we have a decent number of children's facilities that are in our pipeline for sales. One of the things that we like to do is to have capacity to help those customers that are in our pipeline. We're getting reached out to kind of in a real-time basis right now for assistance on some of those specialties specifically.
All right. Great. Thank you.
You bet.
Our next question comes from A.J. Rice with Credit Suisse. Your line is open.
Thanks. Hi, everybody. Maybe just trying to get my arms around the market dynamics again. You know, I think you guys may have been the ones that had said earlier in the year that, maybe in the early part of the summer, the rates had gotten to a level where some travel nurses were saying, "Hey, at that level, I'm just gonna go back into my permanent job." Or is that how much of a constraint is that on seeing declining rates, the fact that it hasn't declined? Are we at a point now where if it were to continue to decline, it would start to drive some nurses back?
Another dynamic we sometimes see, or we saw many years ago at this point, is nurses get nervous about whether their permanent job is still available to them and begin to think that maybe they should go back. I wondered if the economic backdrop is unsettled enough or not really that may be part of the equation in what you're seeing on nurses that are out on travel but wondering whether they should go back. Is that entered into the equation at all?
Sure. Hey, A.J., it's John. So I would say that when we look at where we are with the core nurses that moved out of their core positions to move in travel, sure, some of them definitely went back, you know, after Q2 into Q3, went back to their core jobs. But we don't believe that these nurses are thinking, it's like musical chairs, that if they don't go back into their job, into a core job, there won't be any chairs left. When we look at the macroeconomic trends, you know, unemployment is still at a historic low. When we look at the JOLTS BLS data, if we look at from the Affordable Care Act in 2014 to today, open positions have increased by 233%.
When we look at the ratio of open jobs to hires from the BLS, JOLTS data, historically, that number has been a ratio of less than 2x, and probably somewhere between 1.5x to 1.7x. It hit a high in March of about 2.94x, and currently in September, it stands at about 2.8x. The clinicians that we're speaking to, they realize there's a lot of jobs out there. Hospitals, of course, understand that they need to hire for the core staff. At Cross Country, what we're really doing is we're looking at how we can help hospitals really solve the challenges of the core staff.
Because if you look at the studies that have been out there, I think it was McKinsey, I believe, who had a study a couple of months ago that said there's a 400,000 nurse shortage today in the United States. If we look at, you know, every study, we talk about this all the time, right? If we look at all the different studies out there over the last you know, year or two, in the next 10 years, there's gonna be a 1 million nurse shortage. The demand is there, the demand will continue to be there. For us, it's working with hospitals to say how can we upskill clinicians to get to acute care? How can we create more preceptors and educators to create more supply into the hospitals?
What we're looking at is, for the foreseeable future, there is going to be this incredible chasm of supply, demand, and balance, that's just not going to go away. Even if we were to have a macroeconomic downturn, it would take a lot for it to turn from this historic high demand, where unemployment rates would have to be pretty significantly high, for clinicians to say, "Hey, I'm gonna return to a permanent job." Dan?
Yeah. A.J., this is Dan. I would like to sort of add to what John said. I think everybody realizes that we have an RPO and search division, which does, in fact, help people, our customers, with filling their permanent positions. You know, that business itself is, you know, somewhere between $25 million-$30 million now, up over 60% year-over-year. We have a huge opportunity to help our customers with these problems. It's beneficial to us to do that. I would say about 80% of that is our RPO business, which is more consistent in a recurring revenue. For us, it's kinda a little bit of both sides of the equation.
A.J., this is Bill. If I could just put a point on that, we're seeing it in relation to our numbers and that we don't guide at the business level. For us, sequentially in the fourth quarter, we're expecting volumes to essentially be flat. We're not seeing a falloff in ACPs or healthcare professionals, you know, willing to take assignments and so that's how we see the fourth quarter shaping out.
A.J., just to add to all of that, we did see renewal rates drop in Q2, which means a portion were going back to their core jobs. At this point, we are seeing them back up, which, you know, for me, means it's probably leveled off at this point as rates have stabilized.
Okay. Maybe just looking at the other side of the coin, we're reading so much about hospitals facing downgrades, swinging to operating losses. You said that, you know, hospitals are hurting out there, but they obviously need nurses to service the patients, or it's just a vicious spiral. What? Any interesting aspects to that discussion, ways they're leaning on you that may be different than history to try to figure out ways to address the current environment in which they find themselves?
Yeah. A.J., this is Dan. I'll maybe start that and see if anyone else wants to add in some color. Just this past quarter, we started a team that does workforce optimization for our clients. We'll go in, do an assessment of kinda how their utilization is working on a unit-by-unit basis across the system, and then give them advice for how exactly, you know, to fill those gaps, if you will. We're building technology that helps us take that currently very manual process and make it a deeper part of our Intellify platform. You know, ultimately, what we wanna have for our customers is, you know, manage your core staff better, supplement that with regional or local flow pool resources, and then bring on your travelers to augment that.
And so far, the reception on that process, if you will, is really high, both from existing customers and prospective customers.
Okay, great. Thank you so much.
You bet.
Our next question comes from Brian Tanquilut with Jefferies. Your line is open.
Hey, good morning, guys. Oh, good afternoon, guys, and congrats on the quarter. I guess just a question again on the bill rates. Is there a seasonality factor that we should be thinking about? I mean, I appreciate that it's been flattish for the past few weeks, but any thoughts on seasonality and pricing that we should consider?
Hey, Brian, it's Bill. Thanks. No, I don't think there's a real seasonality to our bill rates, certainly not across the travel business. We don't typically see that at any point in our history, and I know that in the last couple of years, it's hard to point to history and say that that's a good predictor. We do not normally see a seasonal fluctuation in bill rates. There may be in specialty needs, and there may be geographic needs that vary throughout the year, but not on the bill rates.
Yeah. I would just add to that, Brian. This is John. I think what Bill said is, you know, the geographical and the regional rates have changed. I think when we looked at COVID during most of that two-year period with a national rate because everyone had the same surge in demand. Now, even with pediatrics, we're seeing pockets of areas that get hit with the triple threat. Now it's spreading more and more, so it may become a national price, but I think regionalization pricing is really what we're seeing more of.
Got it. Okay. The last thing about the locums business. I mean, any feedback so far that you've heard from your clients in terms of cross-sell opportunities as you try to get bigger and deeper in that locum space?
Yeah, I'll take that one, Brian. This is Dan. We absolutely are getting tons of interest from customers for physicians. Obviously, that helps them on the revenue side of their equation and so on and so forth. The other thing that I would say is that from a cross-selling opportunity, we don't have locums in most of our MSPs. In fact, it's one of the best areas and one of the reasons why, you know, we wanted to add this capability. What I might add too is just from an integration perspective, we're already seeing those teams fill each other's orders, if you follow me. You know, the existing locums team here at Cross Country is filling orders that were with both Lotus and Mint and vice versa.
The kind of integration leverage we're getting out of this is incredibly high, which again gives us, you know, more confidence to go into our customer base.
Dan, this is John. I would just add that also with the acquisitions of Mint and Lotus, that's really helped us create more capacity than we've had before. That business, if we look at where that business is trending, Brian, it's gonna be, you know, roughly $150 million business, giving us more capacity to help us be able to bring that offering to our clients in a larger scale than we could have ever done before.
Awesome. Thanks, guys.
Yeah.
Our next question comes from Tobey Sommer with Truist Securities. Your line is open.
Thank you. Wanted to start on gross margins. When do you expect gross margin compression to end, and what kind of strategies do you have in mind to sort of claw some of that gross margin back?
Hey, Tobey. This is Bill. Well, look, I think, you know, part of it is it's always a competitive dynamic. You're in competition for the healthcare professionals, so we're always gonna have to make sure that we have a market pay rate that moves along with it. We can see that the pay rates have come down slightly faster than the bill rates. The stubborn piece has been the housing costs, and as you can imagine, with the inflation backdrop, you know, that's the piece that is gonna be a little bit harder to you know, claw back, as you call it. I think the opportunities really lie around other efficiencies within our gross profit. If you think about Intellify, for example, that's set to save us millions of dollars.
In the part of the third quarter and going into the fourth quarter, we've already begun the conversion of a number of accounts and have gotten north of $100 million in spend actually migrated onto the platform. That's gonna drive annual savings just from what we've already migrated of over $1 million annually. Obviously, we've got a roadmap to do that throughout the fourth quarter and into the first half of 2023. Of course, there's other efficiencies. You know, if we look at everything up and down the line across, whether it's our professional liability insurances, our workers' comp insurances, the credentialing costs that we have. A lot of it's gonna be looking across those opportunities.
Of course, you know, the broader consolidated impact will come from improving, continuing to improve the mix. Any other comments, John?
Yeah. Hey, Tobey, this is John. Yeah, I would just say, as was said, we're going to keep increasing our diversification. If we look at our WSG or Workforce Solutions Group that that works in the PACE centers and home health, that's a business that is also going to be north of $100 million, and that's a higher margin business. As we continue to invest in those other peripheral businesses of ours that grow, as we're getting them to grow at a faster rate, that'll help drive gross margins. I think really what's going to propel us to drive gross margins even faster is our movement and entry into the vendor neutral space with Intellify. Now, we announced at our Investor Day that we're moving into this vendor neutral space.
It's, you know, somewhere between a $10 billion-$20 billion market where we have zero penetration in. As we build and we're building a pretty long, big pipeline right now in MSPs and our vendor neutral business, Intellify, that's going to help us increase our gross margins and our EBITDA margins because those vendor neutral businesses are very highly profitable in the GM gross margin side as well as the EBITDA side.
That's helpful from a mix standpoint. If I think about the travel and allied business as it's currently formulated, how do the gross margins, you know, either in the quarter or implied in your guidance compare to what you think 2023 looks like in that business? Just trying to get a sense for whether there is a rebound in the offing or, you know, is there further compression that you expect?
I don't think there's further compression, Tobey. I think, you know, intentionally we've opted to give the majority of the compensation through to the nurse. Our margins have been depressed a little bit in that business. We've seen it in the low twenties kind of range for our gross margin across travel. I think that while we're still down a couple of hundred basis points, I don't anticipate getting all that back in 2023. I do think that there's room for let's call it somewhere in that, you know, 100 basis point improvement over the next, you know, 12 months. Marc, anything you want to add?
No, you know, I think we're gonna. It's gonna be slow and gradual. I don't expect it to be overnight. I think, you know, I don't expect any further compression. To John's point earlier, our other businesses, the education division is a high margin business, and it's actually a great story. It's up almost 70% Q3 2022 versus Q3 2019. Q4 shaping up to be our best quarter ever. We're seeing diversification there as well. Paraprofessionals are our fastest growing segment within the education business. Demand has shifted a little bit. Traditionally we saw strong demand for speech-language pathologists and special ed professionals, but we're also seeing today very strong demand in mainstream teachers and paraprofessionals where we enjoy great margins.
Thank you. How did the volume of travelers in 3Q, which looks like it's down about 7% quarter-over-quarter, compare to your expectations when you gave guidance for the third quarter?
Yeah. It's a good question, Tobey. I'd say it was probably a little bit deeper decline than we had anticipated. If I go back to when we first gave our guidance, it was down just a little bit more significantly. As we look across where that came from, it was the wind down of higher fill rate assignments. You know, and but we've seen good production in across the weeks, you know, throughout the tail end of the third quarter as we're going into the fourth quarter. I think it was really just a step down from the crisis needs from the COVID pandemic.
Yeah.
I don't think it was anything more significant than that.
Yeah. I'd add probably from towards the end of the second quarter to the middle of the third quarter is probably where we saw a little bit of a dip in our volume production, which we didn't anticipate as deep of a volume production. Then we had the steady increase in demand, and now our production is catching up to that.
Perfect. Last one from me. Could you comment, John, about what you're thinking about in terms of the timing of deploying some of this cash? You did buy some stock and then put it on halt. The stock kind of went on a tear right after you bought some. So that's understandable. Are multiples coming down from private companies sufficiently such that you could continue to do acquisitions that are accretive like the bolt-ons you did in Physician?
Without a doubt, yes. Also on a buyback program, yes, our stock did have a run, but we also were in a mandatory blackout period. That's one of the reasons why we halted buying. Yes, we did have a nice run on the stock. Look, when we look at where we're gonna be in 2023 and beyond, acquisitions are a large part of what we'll be doing with our capital deployment. You know, we're slowly seeing multiples coming down. I anticipate we'll see multiples continue to come down, especially, you know, if the broader economic conditions fall unfavorable. Yeah, we're still very active in the M&A market.
Thank you.
Our final question comes from Kevin Steinke with Barrington Research. Your line is open.
Good afternoon. I just wanted to ask about your plans for recruiter hiring over the next several quarters, the volume you think you have to add there and any challenges in finding staff, any upward pressure on compensation costs, et cetera?
Hey, Kevin, this is John. I will start and hand over to Marc Krug. To start, we're always looking at our capacity model that we have that kind of shows recruiter productivity or producer productivity with how much demand there is, kind of a formula that we have, an algorithm that shows what we need. Look, we're a growth company, and we'll continue to invest in people, and we're gonna continue to invest where demand is. As long as demand stays this strong and continues to increase, we're going to be hiring producers, not only in our nurse and allied business, but in education, in locums, in our WSG business, in our RPO and search business. You know, we will continue to invest in those. Marc, could you have any?
Sure. Hey, Kevin. You know, at this point, we really don't have challenges finding staff because we're virtual now, so it's a much bigger pool to select from. We're finding great talent. You know, our compensation costs are steady. They haven't changed a whole lot. Recruiter productivity is still very strong, almost double what it was pre-pandemic. As long as that's the case, you know, we're gonna continue to top grade higher and make sure we have enough capacity.
Kevin, this is Bill. Just two quick points. One, I did mention in the prepared remarks that we did grow our staff 4% in the third quarter, so that's just, you know, one quarter of sequential change. That was quite an investment we made. Of course, most of those were in revenue producers. Just to dovetail into Marc's comment, you know, when you look at our comp structure, I think we're among the most competitive in the marketplace. We give our folks the ability to earn more as they grow their books of business. I think it's part of what helps it be very attractive for folks to join Cross Country.
All right. Yeah, that's helpful. You mentioned recruiter productivity, and I believe you mentioned that as a contributing factor to the margin improvement in the quarter. Just wondering how much more room there is to run in terms of improving recruiter productivity. I know newer people can ramp up faster, but just as you look at the staff overall, is there more room to run there on productivity improvement?
This is John again. I'll start and hand off to Bill and Marc. I think, you know, with our continuing investments in technology, especially with our Gateway portal, which we had rolled out in April this year rather, and we talked a lot more about it on Investor Day, there's a lot of room and runway for us to have more productivity. As we start really becoming a more self-service model for clinicians, our producers will be able to have larger capacity gains, which will flow right through the bottom line to our EBITDA, lowering SG&A and increasing higher EBITDA. I don't know if Bill and Marc wanna comment.
I was just gonna say the same thing, John. I think when you look at the initial driver of the big gains we've had in productivity, you would tie it back to the applicant tracking system we put in for travel. That's just one piece of the puzzle, and there's obviously other levers that we're looking to pull.
Yeah, in addition to what they said, what John and Bill said, we're also doing enhancements to the applicant tracking system right now, and that's really helping drive productivity. We're tweaking the organization to fuel growth and making sure revenue producers focus on revenue producing activity.
All right. Thanks for taking the questions. Appreciate it.
Thank you.
Ladies and gentlemen, this does conclude the Q&A period. I'll now turn it back over to John Martins for closing remarks.
Thank you. In closing, I'd like to thank everyone for participating in today's call. We look forward to updating you on our progress on the next call in February. See you then.
Ladies and gentlemen, this does conclude today's conference. Thank you for your participation. You may now disconnect.