Ladies and gentlemen, the program is about to begin. Reminder that you can submit questions at any time via the Ask Questions tab on the webcast page. At this time, it is my pleasure to turn the program over to your host, Joanna Gajuk. Please go ahead.
Thank you, and good afternoon, everyone. Thanks so much for joining our third annual Home Care Conference. My name is Joanna Gajuk. I'm the equity research analyst at Bank of America Equity Research, and I cover some of the home care providers. Now it's my pleasure to host this session with Chemed, one of the largest hospice providers. And with us on the phone are four members of the team, Kevin McNamara, President and CEO, Dave Williams, CFO, Nick Westfall, who's the CEO of VITAS, and also Mike Witzeman, who is the Chief Accounting Officer. The gentlemen agreed to go right into Q&A, but a note to the audience is that if you want to ask a question, there is a way for you to do that.
You can use the little window with Ask Question, and I'll be happy to pose the question on your behalf to our speakers. So first, thank you so much for joining. I want to start with the most recent news. Dave will be retiring from his CFO post right at the end of the year. So Dave, you know, we'll miss you really, and we wish you all the best in your retirement. And just, I guess, walk us through your thinking about the timing of things, and also, sounds like you still will be involved in some capaciy as you transition to your successor. So can you flesh out for us the plan for that?
Yeah, I will step down at December 31st, and Kevin and the board will determine what role they want me to play on a go-forward basis.
Yeah, and then-
Next-
With regard to... We anticipate, you know, at the, you know, sometime before the end of the year, it's my information that the board will appoint Mike Witzeman as CFO. Mike has-- It'll be a fairly seamless transition, my guess is, because Mike, Mike's been with the company since 2005. He's the Chief Accounting Officer, worked very closely with Dave with regard to the financial apparatus of the company and its underpinnings. And, you know, we look forward... Mike, Mike has, you know, has attended investor conferences in the past. He's, you know, obviously been closely associated with Dave and the rest of us for some time. So we, we expect a seamless transition.
But Dave is, as he suggested, he's not has no plans to go work for a, you know, a another healthcare company or anything like that. But we, you know, we certainly wish him the best as he moves from one role to the next in the circle of life. But you know, it's it's been a long time of a lot of good results, and everyone here is best of friends, and always good to work with your friends.
But other than that, I think, I guess, the bottom line, Joanna, as I say, it's kind of, you know, what we've seen at Chemed over the years, we have a number of people who've, and myself included, who've been here a long time, had a lot of success, and, you know, at various points, people say, "I'm ready to try something else." And that's. I think that's the... We're just seeing a continuation of that theme. But in any event, with that, we'll turn it over back to any questions you might have on that or any other subject.
Sure. Thank you for that, and good to hear, you know, the succession plan is in motion. I guess we're just waiting for the official announcement, so Mike, looking forward, I guess, to that and working with you. And I guess somewhat related topic, you know, I guess question to Kevin and maybe more to the board, but I guess, you know, obviously, you mentioned the team has been around for some time. So obviously, Dave transitioning to something else and Mike taking over, it begs the question, you know, what if, you know, there is a requirement, I guess, for a CEO change?
I mean, I'm not looking forward for Kevin to leave, by no means, but I'm just trying to think, should we expect a similar kind of process where there are internal candidates being kind of growing, there's a succession plan for that role as well?
Well, most probably, you know, that, you know, the board sees part of its duty is on a regular basis to examine the succession issues at the key officer positions of each of our operating units and then the headquarters. So they've gone into, you know, they go into this subject regularly. I think that with regard to what they hear from me is that, you know, I'm healthy, you know, still very actively interested in continuing, at least in the short to midterm. And that's, you know, that's what they're hearing from me. What I'm hearing from them is that, yeah, you know, that sounds good.
I think they feel comfortable that, you know, when you, when you look at the, you know, the bench strength for the CEO position at Chemed, there is a, you know, Dave and Nick, and, most of the two are, you know, when you look at the people over the years who've been long associated with the company, I mean, I, I wouldn't anticipate that the board would feel that they, had any need to make some dramatic, you know, move outside the company, just 'cause I think they think based on some of their comments, and it's up to the board, obviously. But at each of our in each of our operating units and at the headquarters, they think that any necessary transition to succession would be handled with, a minimum of, disorder.
Yeah, to answer your question, it's regularly reviewed as part of their duty.
Yeah, thank you for that. I guess talking about operations, so VITAS's results have been coming at better than expected this year. The guidance for VITAS has been raised again, and so now when I look at this, the revenue guidance is about 3% above the initial guidance they gave earlier in the year. And also the segment EBITDA guidance is about 10% above this initial view, adjusting for the costs associated with the retention bonus program. So is that how we should think about it, that this VITAS's outperformance is really driven by the benefit of the retention program, resulting essentially in better volumes? That's how we should think about that?
Well, I'll turn it over to Nick. But I mean, yes, I think that you should—Well, you should assume that the fact that we've been able to replace many of the key clinical personnel that we lost during the pandemic, you know, it's kind of build them, and they will build it, and they will come. Having a lot of things breaking in the right direction has meant that, you know, we're basically back to where we were before the pandemic and with some very good internal metrics in some ways to suggest not only we're back as far as census, but in a little better position with regard to some of our metrics. But Nick, why don't you-
Yeah.
Why don't you weigh in on this side?
Yeah, just to add a little bit more commentary to it. I would think about the retention program as much as a catalyst that help us get us to where we are today. I know we spoke about it a little bit on the third quarter earnings call, and all commentary as we sit here today is consistent with that, which is, you know, obviously, our ability to build clinical capacity with the catalyst of the retention program, combined with the compounding effect of all the cultural benefits that come, have allowed us, with the expiration of the retention program, to really continue to see ongoing and improved levels of our ability to attract and retain talent. And the compounding effect of that has been our ability then to go out and continue to sequentially improve referrals, increase admissions across all segments.
When you combine that with our community access focus, that's gonna continue, it puts us in a really good position, as you pointed out, to outperform our volume expectations at the beginning part of the year, all driven due to our ability to outperform from a human capital and team standpoint. And with the expiration of the program, that continued performance gives us, you know, strength and confidence in where we finish the year and where we're gonna jump off on as we move into 2024 and get into a very predictable realm of growing earnings, you know, inside of a predictable range on a go-forward basis. So it feel very good overall. And, you know, that story has not changed since any of the narrative, I think, over the last few quarters, just further strengthened around the confidence in our stability.
Right. And I guess the retention bonus program, to your point, ended in June, and on the third quarter earnings call, you said that actually the turnover did not increase right after the program ended. So why do you think is that? Why this turnover is, you know, continued to be stable even after the program ended? And also, you know, if you can share any trends since then, what have you seen, you know, in November?
Yeah, let me start, Nick, and just say, and put very generally speaking, not surprisingly, you know, with this program, we got a lot of goodwill with the employees for, you know, maybe to start with. Yeah, they got, they got, you know, they got money. You know, that's always a good reason for why employees come to work. But also, it, it showed that we were responding to their needs. They were concerned, they were overworked, they, they were underappreciated, you know, to the extent that, you know, the program responded to those issues, that's very good. To the extent that, to the extent that they, they saw that the, you know, the burnout factor was, was largely mitigated. I mean, all those things combined to a, a good situation. Now, we, we can't kid ourselves.
What I just don't remember really from speaking for Nick is to say, you know, we did see that that goodwill was the type that would be dissipated from the day that they cashed the check. The answer is no. In fact, to the extent that it hasn't and to the extent that it's been maintained, it's a little surprising to us. It's heartwarming, it's good, it's, you know, it's financially rewarding. We don't kid ourselves that over time, that goodwill, you know, it gets dissipated just by the next, you know, time the employee has a bad interaction with his or her boss. I mean, as to the extent that any number of things that cause dislocation among employees. But for the present time, it's much better than we expected.
But regarding trends and rates, Nick, what could you add?
Yeah, I mean, really the underpinning is ever since the enactment of the program all the way through today, there's been a singular universal reinforcement of a whole bunch of the other things, whether it's recognition programs, whether it's just simple prioritization. We also have an annual recognition program that's underway right now. And all those, you know, I hate to use the word cultural, but it's really the cultural wraparound with it, really has continued to dissipate any burnout, create a communal, you know, a real collaborative environment that our existing team members want to continue to be part of, and it begins to self-recruit, you know, for itself inside of the marketplace.
So anybody that wants to join the hospice industry, by definition, has, you know, has some higher priority for mission focus, the ability to provide care at the bedside and do the right thing for patients and families. And we believe we've really accelerated a competitive advantage we have in each of our local markets for anybody that wants to get into the hospice industry, that we're the best option, for them inside of that space, and they're joining a team that's happy and will continue to be happy. And it'll be a number one priority. It is right now for all of our leaders. It'll continue to be in 2024, and we're not gonna put our foot off the gas in terms of reinforcing that.
We get all the other complements of serving more patients every day, more than we did the day before it, as a result.
Thank you for that. I guess with this census growth that you've experienced this year, I was thinking also to check with you when it comes to the market share, right? In your markets, you know, kind of where do you stand currently in some of your key markets? And also, where can the share grow? I mean, do you expect the kind of impact of this success, I guess, with hiring and retention to kind of, you know, continue to allow you grow faster maybe than the market and, you know, where could it go when it comes to market share?
Yeah. I mean, by definition, whenever you talk about market share, it's unique in every market. We have a complement of information, some of which is more real-time than others, that makes us feel comfortable. More often than not, we are, we have gained share and anticipate continuing to gain share. The question becomes, you know, if that share is built in two fashions. One is more people becoming aware and accessing the benefit as a percentage of the total than before. And what we're also trying to do is make sure that the identification and awareness are happening earlier in their disease trajectory than typically happened.
The combination of both of those things will allow more patients to come to us, and just as importantly, or maybe more importantly, come to us earlier in their disease trajectory, which is, as we all know, more beneficial for them, the patients and family, as well as the Medicare Trust Fund. So it's really the complement of all those things that, you know, we evaluate when we look at gaining share, but also not just gaining share for share's sake, gaining share with earlier access and identification of patients across the country. So it's, you know, it's not absolute in every market in which we operate, but overall, we feel good about our ability to continue to gain market share, in, you know, in those markets so we compete on a day in and day out basis.
Let me put it this way, Joanne. There are a couple counties in Florida where we have such a dominant position. You might say, "Well, there's limits to how far can you go in those counties?" But I've been surprised over the last 10 years, even after having established a dominating position, that those counties have continued to grow, almost beyond comprehension. So even those counties, even the counties in Florida, where we have a very dominant position, there's still been nice growth with regard to almost any other operation, VITAS. There's again no limitation in that regard on the other markets. It's a function of VITAS that's having enough people.
We saw a very unusual time when we clearly didn't have enough people to then establishing the, you know, make sure our reputation. Keep in mind, we don't own any of the referral sources. We have, compared to almost any other hospice in the country, we have no, no connection to referral sources other than they've decided that the patients that they're referring will get better service with VITAS. So to the extent that we maintain that advantage, and have the people to provide it, those are the only limitations we face.
Yeah. I think the last piece, which I assume is understood by most of the audience listening, but is important to reaffirm, is, I mean, there's very real reality around the ever-increasing aging demographics of the entire country. And, you know, we're seeing some really positive things in terms of overall awareness and acceptance of hospice and palliative care. When you take the very public experience that, you know, President Carter had.
Is having
... is having, coming out and talking about, you know, electing the hospice benefit that was, by definition, enacted when he was president, and the real positive experience he has had throughout that entire journey, and continues to have, really helps, you know, derail misperceptions around hospice benefit, and it being brink of death or giving up, and really talks about the experience, not only the patient, but their overall family can have by seeking and electing the benefit early enough in their disease trajectory.
Right, and talking about the-
Those types of things play a really, really big role for the future upside of the entire industry, and appreciate everything he's done to lead that.
No, I agree, definitely. More of these, you know, figures, I guess that are out there in the media, you know, talking about openly, you know, choosing hospice definitely helps the entire industry. So I appreciate that comment. And just talking about the industry, right, we've seen a consolidation over the years in hospice, and, you know, just thinking about how has that changed dynamics in your market? Are you seeing kind of the market changing because of this consolidation? And also with that, do you expect more consolidation to happen going forward?
Would anticipate more consolidation to continue to happen going forward. I don't think there's gonna be any change in direction regarding that. In terms of what the level of impact on a market-by-market basis, it's obviously unique. Most of the consolidation or a lot of the consolidation inside of the industry was, is due to people becoming part of larger integrated systems, insurance plans, that the investment thesis there seems to be more focused on home health in the curative setting, less about the hospice subsector of that. And so that's had minimal dislocation, where we would be competing in those markets. The rest that we're very much paying attention to is the consolidation of, and particularly the nonprofit segment, as people are in different innings, either exiting the pandemic or still in, you know, difficulties related to it.
Because of economics and other pieces, people are looking to consolidate or affiliate in one way, shape, or form, and we'll see how that plays out. But right now, I think we're able to continue to differentiate with the level of service in which we're providing and offering a really attractive place for people to come work and fulfill the mission and that we set out as an organization.
And I guess when it comes to the consolidation question that I received here from the audience is, obviously, we know there's a pending acquisition by Pennant Group, right, of the Amedisys assets. And I guess the question was whether you would be looking or would you be interested, if there was to be a divestiture, say, of the hospice assets, would it be something that you would consider looking at? And I guess even outside of that particular transaction of question from me, in terms of just your interest, right, to also acquire some existing operations.
So the short answer, and the one we've been consistent with, is we're always open, and we do look at a large number of those opportunities. The question becomes, you know, we have our own strategic priorities and theses around what makes sense, what we're interested in, particularly what markets we may want to expand into, that we're not in today, and what's the best entry point. So, you know, nothing's ever off the table totally, but, you know, we look at it very specific and have a pretty good understanding, we believe, of what value there is and what value there could potentially be inside of the hospice segment specifically. But we wouldn't just be buying something for the sake of buying something, and hoping it works out.
Yeah, and-
There's a strategic thesis for it.
And when you look at it, Joanna, over time, the hospice assets that have become available, I mean, the Amedisys hospice assets, when you look at their census size, they're under 100, with, they're in markets that, you know, getting to 100 would be, you know, a big job. Our break- even, maybe because of our full-service hospice offering all levels of service in each one of our programs, is higher than that. So in other words, and I say this, I don't mean to demean their efforts, it's maybe what's necessary in their markets, but the, it's hospice-like in a sense. And unless we made a, unless we made a, company-wide decision, it hasn't... Put it this way, it's not in the area of our expertise to operate on those lower-numbered census programs.
Unless we made that decision, it's almost like two different businesses. You know, as Nick started, he referred to two different segments of the hospice industry. It's a different segment. It's a different business. Could we be successful at it? Maybe. Would it inject an element of risk into our business that is not currently there? Yes. Would we wave away as out of hand? No. Would we pay a premium price for it? No. So all those factors really have, you know, if you look at the past as prologue to the future, it suggests that it would have to be a special situation for anything of that size for us to want to change the risk profile of the Chemed investment.
Yep.... It's always looking at best alternative use of capital compared to everything else. I think the other aspect you referenced, not only consolidation inside of home care and hospice, but there continues to be ongoing consolidation in every healthcare vertical. And so, you know, as we look at opportunities where we would be the preferred provider to an ever-growing, larger entity that, you know, a referring healthcare provider across the space, are there opportunities then, or are there desires for us to expand into markets to service that entity, you know, along with the rest of the community? Potentially, but, you know, we got to let the pandemic get rather far in the rearview mirror, I think, before some of that stuff starts to creep up.
And I guess when it comes to VITAS, though, and the outlook, I guess, for this year, right? The guidance calls for a 9% revenue growth this year. I know you don't have a specific guidance for next year, but I guess, you know, how should we think about the outlook into next year when it comes to VITAS' top line growth? And also, you know, essentially, can you grow another, you know, another year of high single digits? And I guess, what would be the long-term kind of growth algorithm for that business?
So yeah, as you point out, we'll come up with guidance here in the next few months regarding 2024. We typically only give guidance on one year at a time. But when we start thinking about, you know, the impressive, you know, mid- to high-single-digit volume growth combined with, you know, the rate increase and then, you know, potentially some stabilization regarding high acuity, which has tended to eat into that top line growth over time, we feel, we feel good about the predictability of the business and the predictability of operating profit generation inside of a predictable range. So, you know, we feel good about it, but we'll hesitate to provide any specific numbers.
What is unusual about this year?
Right.
I mean, we're retreating to normalcy.
Mm-hmm.
Yep. So when we think about, you know, the confidence we have in building sequential census sequentially, it's very much there. And right now, we're lapping some low points from the, you know, the fall to latter half of 2022, which helps on the year-over-year comps, but we feel real good about sequential growth.
But when it comes to, say, you know, five years out, you know, is this business kind of a mid-single- digit top line growth, or how should we think about it?
Probably so. I think the one thing when you look at the macro trends inside of the industry, in the space, you know, hospice as a sector is the second highest growth, forecasted second highest growth rate of everything that Medicare evaluates, right? So it's talking mid to high- single- digits across the country. The real question there is less about the number of lives and the demographics coming in. That's an important component of it. But also, will the country and the industry continue to move in the direction of feeling more comfortable of accessing the benefit earlier in their disease trajectory? And the combination of both of those things very much impacts, you know, five-year forecasts out, but it's not just about lives, it's as much about lives accessing the benefit earlier.
As things like the NORC research study and others have helped to illustrate, you know, not only is quality improved, but total cost of care reduction to the Medicare Trust Fund only accelerates rather dramatically as more people access the Hospice Benefit earlier in their disease trajectory.
Right. And when it comes to, you know, these projections and your primary payer is really the Medicare fee-for-service. But clearly, there's some growing penetration when it comes to Medicare Advantage and CMS, you know, is testing it, carving in hospice into Medicare Advantage in certain states, and we are in third year of this demonstration, right? CMS extended the demonstration until 2030. They included some modifications. So how do you think about this carving really being expanded nationwide and mandated, right? Is this extension really an indication of what eventually will happen? Because I guess there's also a follow-up question from the audience about, you know, really hospice getting paid by Medicare Advantage plans. Like, what would be the implications for this business from this happening?
Yeah, I think it's a great question. It's an interesting one, and one in which we continue to pay attention to, of course. The extension of the demonstration for the carve-in, right, came out of CMMI, and it was on the heels of a year's worth of publicly released results in that first-year period, which really concluded that there was no concrete benefit to any of the plans that participated or the providers that participated in the first year. And just to, you know, as a point of reference, the majority of all of the plans that participated owned their own hospice providers.
As we fast-forward in the year two experience, and then as we launch into, you know, the next year, it's important, you know, to take a look at those overall larger plans that are participating, and particularly those that are no longer participating. So United and Optum, I believe, are, you know, they don't have a participating plan in the upcoming year from a VBID standpoint. Humana still continues to operate. Obviously, they continue to have their minority ownership interest in Gentiva, and so it's one we're very much paying attention to. But in this exact same regard, the one unique thing on the hospice benefit with the carve-out is, I would argue, the first, even though it's fee-for-service or per diem, it is the first capitated reimbursement system or value-based piece that got enacted, right, in the early 1980s.
And so, you know, there is some real conflict when you start thinking about overall design if you're going to try to carve in the Hospice Benefit to the overall Medicare Advantage payment mechanism. And, and as an independent provider, there's some real considerations we would need to, we would need to think through, and we've been very open and transparent with CMS and CMMI, sharing some of those things as they start thinking about network adequacy and helping to ensure that many of those conflicts aren't taken off the backs of patients and families in those markets where, you know, the demonstration project is active.
Thank you for that. I guess another topic when it comes to the Medicare reimbursement. There's a couple of different things, couple of different questions that I got. One of them is around the Medicare cap and the potential reform for that. MedPAC clearly has been calling for changes for, I guess, four or five years, so maybe even more. Every single year, I know that the industry is opposing this particular proposal from MedPAC in terms of cutting 20% the cap and making some changes. How do you think... You know, what is the appetite really, right, from CMS to make changes to the cap, to the Medicare cap?
Also, if it was to happen, if it was lowered, what would be the impact to the company from that?
Got it. Sounds good. So let me take that in two parts with it. I think the first piece for the audience, if you look at MedPAC's even most recent presentation over the last few weeks regarding the outlook of the hospice industry, there's an important series of slides inside of that, that MedPAC, and there's some new leadership as well inside of MedPAC, has acknowledged the desire to go back and reevaluate some of the research that was done back in 2015 by them, that led to some of those recommendations over the past few years. One of the catalysts you could speculate was things like the NORC study and others that really illustrated the overall total cost of care reduction and quality improvement across every primary care disease when a patient's on the Hospice Benefit for six months or longer.
That starts to challenge these that there's an issue inside of the Hospice Benefit, and in some way, shape, or form, there is a limitation to how long a patient could remain eligible and receive the Hospice Benefit. So that's a really important item that will play out in 2024, and we'll see what path that goes down. But as an industry, we feel confident in the value proposition hospice provides. When you flip to the proposal that we agree with everyone else in the industry around a 20% reduction to the overall Medicare cap rate, there we have real concerns with it.
But without even getting into the VITAS specific component, the primary concern for the overall industry is that type of cut has a very large potential to create what we would refer to as hospice deserts, particularly in rural markets. And the last thing we want as a country, and I'm being philosophical with this, is to have a provider not have the ability to provide hospice care in any rural market because a hospital is not within a, you know, 60-90-mi radius associated with it. And so, you know, being draconian and just trying to slash the cap for maybe misguided other reasons, could have some real catastrophic impact around access to care across the country.
While we don't operate rural markets, we're adamantly opposed to it because, you know, any negative impact to the overall industry we see as bad for the collective good, let alone the country.
And let me, Nick, just say we're not whistling past the graveyard. You know, Medicare is a government program. I mean, anything, you know, the government could do anything. Okay, let's watch what they have done. A couple of years ago, with regard to high acuity, they increased reimbursement 35% and 40% with regard to the two parts. You know, and the reason they did that is they said, "That's a really good service. It will save us money. Why don't- You know, let's get- Let's provide that to the patients. Let's encourage hospices to provide that level of service they're not now. If that's what it takes, it'll, you know, we'll do well by increasing that." And, you know, that's what they did. What do they do every year since the hospice benefit? They've increased reimbursement.
It's always possible they come a year where they don't, but, I mean, that's... If you look at what they do, it's been a very stable, solid, predictable, reimbursement model. And, you know, when you... And, actually, I would say, given the per diem basis, that we don't charge per service, we can't do unnecessary services. When, it's one that's a very clean service, so hard to game, you know, from a provider standpoint, compared to almost any other, you know, service provided through Medicare, you know, and paid for by the federal government. So, you know, nothing's perfect, you know, but relatively speaking, it's, you know, you look at hospitals and say, "It's predictable. It's been...
The government has consistently reimbursed in a very cogent manner, and you know, it's not unreasonable to take some comfort there.
Yeah. And that's why I referenced things like the NORC study and others, Joanna, where you say in 2019, you know, the study found that out of, on $20 billion of reimbursement, $3.5 billion were saved in total cost of care by people electing the hospice benefit, as opposed to them not. And the real resonating finding was not, you know, you could go from $3.5 billion to $7 billion of savings on $20 million, you know, a little bit more than $20 million of spend, if you simply got, you know, 15%-20% of those patients accessing the benefit a few weeks earlier in the remaining disease trajectory.
That's what, you know, the realm of magnitude in terms of the benefit to the overall Medicare Trust Fund could mean, but it all needs to be balanced and, of course, always focused on the best outcomes for patients and families, and what's best for the country and the Medicare system.
No, I agree. There's clearly the data to support the argument that, you know, the hospice benefit saves money for, for the system. But at the same time, right, we also been, you know, reading in these proposals and final regulations really, both in hospice and home health, about these different provisions that imply more oversight for hospice, right? And it seems that the biggest one is really the Special Focus Program, but which CMS finalized really without any changes, and so not really giving in to the industry's pushback. So how do you expect this program to really impact your operations? 'Cause it sounds like this is happening, you know, taking effect, I guess, starting January.
Actually, there's been a modification on a public announcement by CMS since that point, Joanna, just for reference, and I think it's that modification's illustrative here. Which is, they came out on their public webinar a few weeks back, and made everybody aware that, while the program continues unmodified, which was not consistent with 18 months of recommendations by technical advisory panels, trade associations, providers, even the bipartisan congressional leadership that enacted the rule to begin with, we'll see that, you know, they're saying it's not even gonna be enacted until at least October of 2024.
And they've been very consistent in the stated narrative of being open to continue to listen to modifications to the proposed algorithm, which is what gave everybody the consternation to begin with, around some real flaws inside of it, and that it may not achieve the intent of the original Hospice Act. Which was, you know, no one that's a well-established, mission-focused provider is concerned about oversight, but we wanna make sure it gets targeted at those providers it's intended to, not do the exact opposite with it. So, so hopefully, we'll see some continued modifications and openness over the next 11 months before the SFP really begins to go into effect.
They quickly pivoted and pushed it back 10 months, but we're trying, the industry's trying as a collective group to continue to stay front and center to get the recommendations in place that they were beating the drum on for the last 10 months.
Is there still a chance that maybe Congress could step in and mandate CMS to adjust this methodology?
I think there's a whole lot of potentials inside of there. Our goal is just to try to get it accomplished in the least disruptive way.
No, I appreciate it. I think this is the end of the time we have allocated. There's a lot to talk about. So thank you so much, gentlemen, for spending this time with us. And thanks to the audience for your participation. I hope you still staying for a couple of more sessions today, and we have another day tomorrow. So thanks everyone for joining.