Good day, and thank you for standing by. Welcome to the Chemed Corporation First Quarter 2022 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker presentation, there will be a question-and-answer session. Please be advised that today's conference is being recorded. To ask a question during the session, you will need to press star one on your telephone. If you require any further assistance, please press star and zero. I would now like to hand the conference over to your speaker today, Holley Schmidt. Please go ahead.
Good morning. Our conference call this morning will review the financial results for the first quarter of 2022, ending March 31, 2022. Before we begin, let me remind you that the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 apply to this conference call. During the course of this call, the company will make various remarks concerning management's expectations, predictions, plans, and prospects that constitute forward-looking statements. Actual results may differ materially from those projected by these forward-looking statements as a result of a variety of factors, including those identified in the company's news release of April 26 and in various other filings with the SEC. You are cautioned that any forward-looking statements reflect management's current view only and that the company undertakes no obligation to revise or update such statements in the future.
In addition, management may also discuss non-GAAP operating performance results during today's call, including earnings before interest, taxes, depreciation, and amortization, or EBITDA, and adjusted EBITDA. A reconciliation of these non-GAAP results is provided in the company's press release dated April 26th, which is available on the company's website at chemed.com. I would like now to introduce our speakers for today, Kevin McNamara, President and Chief Executive Officer of Chemed Corporation, Dave Williams, Executive Vice President and Chief Financial Officer of Chemed, and Nick Westfall, President and Chief Executive Officer of Chemed's VITAS Healthcare Corporation subsidiary. I will now turn the call over to Kevin McNamara.
Thank you, Holley. Good morning. Welcome to Chemed Corporation's first quarter 2022 conference call. I will begin with highlights for the quarter, and Dave and Nick will follow up with additional operating detail. I will then open up the call for questions. Our first quarter 2022 operating results released last night reflect very solid performance for both VITAS and Roto-Rooter. Both operating segments' financial results exceeded our internal estimates despite the continued disruption triggered by the pandemic. For VITAS, this disruption remains elevated with regard to the hiring and retention of licensed healthcare professionals. U.S. News & World Report has estimated as many as 20% of licensed healthcare workers exited the labor market during the pandemic. This has impacted turnover within VITAS' licensed staff, and our turnover rate continues to be above our pre-pandemic rate in several of our professional classifications.
Fortunately, we are beginning to see indications of normalization as we continue to expand resources focused on hiring and retention initiatives in our markets. Beyond managing staffing levels, we are observing increased pressure on salaries and wages. To date, we have managed these pressures with increased paid time off, or PTO. We view it as inevitable that healthcare wages will permanently increase if we continue to have a nationwide systemic imbalance in supply and demand for licensed healthcare professionals. The guidance we issued earlier this year anticipates significant increases in overall compensation for licensed healthcare professionals when compared to pre-pandemic annual compensation rates. Fortunately for VITAS and the hospice industry, there is a natural hedge against inflationary pressures on costs, specifically labor.
The annual increase in Medicare and Medicaid hospice reimbursement rates is based primarily on inflation in the hospital wage index basket, as measured by the federal government's Bureau of Labor Statistics. Typically, the annual inflation measured as of March 31 is used to determine the following October 1 reimbursement increase. This should give the hospice industry reasonable long-term stability in operating margins in an inflationary environment, albeit with a 6- to 18-month lag from inflation measurement to the actual reimbursement increase. The second pandemic triggered challenge for VITAS is the continued disruption to senior housing occupancy and related hospice referrals. Our recent admission data suggests senior housing is in the process of recovery. Pre-pandemic, nursing home-based patients represented 18% of our total average daily census, or ADC. The nursing home ADC ratio hit a low of 14.3% during the pandemic.
In the fourth quarter of 2021, our nursing home-based patients represented 15.6% of our total ADC. This increased an additional 30 basis points to 15.9% in the first quarter of 2022. Our 2022 guidance anticipated sequential improvement in senior housing-based patients in the first quarter of 2022, with an acceleration in senior housing admissions anticipated throughout 2022. For Roto-Rooter, our most significant challenge has been to increase manpower. We increased technician headcount by 8% in 2021, and our technician manpower in April 2022 has expanded 6.8% when compared to the average quarter one, 2021 headcount. The April 2022 headcount has expanded 3.3% when compared to our average manpower in the fourth quarter of 2021.
Based on current service demand levels, Roto-Rooter continues to remain understaffed in many of our markets. Technician compensation plays a crucial role in recruiting new employees as well as retention of our existing base. Our average 2021 technician and field sales force compensation is over $81,000 per year. Most of our technicians are paid on a commission basis manner on revenue generated. As a result, pricing for our services is a critical component in increasing technician wages. We successfully implemented an inflation-based price increase at the beginning of 2022, and we'll carefully monitor key inflation metrics for consideration of additional price increases in the second half of 2022. Roto-Rooter is well positioned post-pandemic, and we anticipate continued expansion of market share by pressing our core competitive advantages in terms of brand awareness, customer response time, 24/7 call centers, and internet presence.
With that, I would like to turn this teleconference over to Dave.
Thanks, Kevin. VITAS's net revenue was $299 million in our first quarter of 2022, which is a decline of 5.3% when compared to the prior year period. The revenue decline is comprised primarily of a 4.1% decrease in our days of care, partially offset by a geographically weighted average Medicare reimbursement rate increase of approximately 1.3%. Acuity mix shift had a net impact of reducing our revenue approximately $7.1 million or 2.2% in the quarter when compared to the prior year revenue and level of care mix. The combination of Medicare cap and other contra revenue changes offset a portion of this revenue decline by approximately 30 basis points. In the first quarter of 2022, VITAS accrued $2.5 million in Medicare cap billing limitations.
This compares to $1.5 million of Medicare cap billing limitations in the first quarter of 2021. Of VITAS's 30 Medicare provider numbers, 28 of these provider numbers have a Medicare cap cushion of 10% or greater, and only 2 provider numbers have an estimated fiscal 2022 Medicare cap billing limitation liability. Roto-Rooter generated revenue of $231 million in the first quarter of 2022, which is an increase of $19.8 million or 9.4% when compared to the prior year quarter. Roto-Rooter branch commercial revenue in the quarter totaled $54.4 million, which is an increase of $6.9 million or 14.4% over the prior year quarter.
This aggregate commercial revenue growth consisted of drain cleaning revenue increasing 17%, plumbing increasing 17.1%, water restoration expanding 8.6%, and excavation increasing 7.1%. Roto-Rooter branch revenue in the quarter totaled $157 million, which is an increase of $10.5 million or 7.2% over the prior year period. This aggregate residential revenue growth consisted of drain cleaning increasing 3.1%, plumbing expanding 14.6%, and excavation increasing 5.9%, with water restoration increasing 7.7%. Now let's look at Chemed on a consolidated basis. During the quarter, Chemed repurchased 57,500 shares of stock for $27.4 million, which equates to a cost per share of $475.71.
As of March 31st, 2022, there was approximately $175 million of remaining share repurchase authorization under this plan. Chemed restarted its share repurchase program in 2007. Since that time, Chemed has repurchased approximately 15.8 million shares, aggregating approximately $2 billion at an average share cost of $126.42. Including dividends over this period, Chemed has returned approximately $2.2 billion to our shareholders. We anticipate providing 2022 updated guidance as part of our June 30th, 2022 earnings press release. I'll now turn this call over to Nick Westfall, President and Chief Executive Officer of our VITAS subsidiary.
Thanks, Dave. In the first quarter, our average daily census was 17,313 patients, a decline of 4.1% over the prior year. This year-over-year decline in average daily census is a direct result of the pandemic-related disruptions across the entire healthcare system since March of 2020. In the first quarter of 2022, VITAS admissions in total were 16,530. This is an 8.9% decline when compared to the first quarter of 2021 admissions and a 1.7% sequential increase when compared to the fourth quarter of 2021. In the first quarter, on a year-over-year basis, our hospital-directed admissions declined 15.7%. Total home-based pre-admit admissions expanded 2.8%.
Nursing home admissions increased 7.8%, and assisted living facility admissions declined 7.4%. Our average length of stay in the quarter was 104.8 days. This compares to 94.4 days in the first quarter of 2021 and 97.9 days in the fourth quarter of 2021. Our median length of stay was 14 days in the quarter and compares to 12 days in the first quarter of 2021 and 15 days in the fourth quarter of 2021. With that, I'd like to turn this call back over to Kevin.
Thank you, Nick. Now it's appropriate to consider any questions that come before the group.
As a reminder, to ask a question, you will need to press star one on your telephone. To withdraw your question, press the pound key. Please stand by while we compile the Q&A roster. Our first question comes from Joanna Gajuk of Bank of America. Please proceed.
Yes, good morning. Thank you so much for taking the question. I guess a couple of follow-ups first. You said that the quarter was better than internal expectations. Can you quantify the magnitude of, you know, how much better was it versus internal? I guess what drove that, I mean, versus our model and the Street estimate seems like margins were better. Can you kinda talk to us, you know, any major drivers for that? Are those sustainable?
I made that comment, and I just meant that, you know, we gave guidance in February, and obviously, we're a little ahead of that guidance and, you know, but we're gratified by that overall performance. Dave, point out obviously our margins were a little bit higher than we anticipated.
That's right. What it really comes down to is what I'd just call the sequential acceleration of inflation. On average, we certainly expect more inflation in, say, Q2, 3 and 4 than Q1, or say differently, more inflation cost escalations in Q2 over Q1, and we expect Q3 to be a little more difficult with inflation than Q2. Sequential pressure, all other things held constant, assuming we don't do anything to remediate some of the inflation pressures. With that said, Joanna, yeah, VITAS beat on margin. They were like, what, Nick, roughly a fraction of 1% below where we thought on revenue. Margins were a little stronger to the tune of, you know, call it, you know, $2 million.
We try to avoid, you know, parsing things in terms of internal guidance on quarters, but VITAS basically came in at revenue stronger by, you know, slightly by, you know, 100-ish basis points on margin that we're pleased with. Roto-Rooter beat a little bit on revenue and definitely beat on margin, not to the magnitude of VITAS, but pretty solid quarter as well. Relative to our internal estimates, Joanna, again, I'll use adjectives, not specific numbers, but underlying Roto-Rooter, we were exceptionally pleased for a couple of reasons, one of which was we kept talking about what we expected was the pivot from residential to commercial as kids go back to bricks and mortar schools, parents start returning to a place of work at least, you know, for a few days a week.
We fully expected commercial to increase, you know, restaurants, retail business, all of the above. That happened at 14% increase on revenue. On the commercial side, that was a little higher than our internal estimates. What we were super pleased at is we continued to have some really solid growth in Roto-Rooter residential, and that grew at a little over 7%. From our internal estimates, we're seeing a great pivot to commercial without really what I'd consider any weakness on the residential side. Margins are stronger because we were conservative on inflationary pressure starting right away in Q1. Clearly, it'll kind of boil throughout the year. VITAS side, obviously, we're taking more effort to just maintain what I'd call a strong labor presence to maintain quality of care and plans of care.
We're just, like I said, trying to manage the balance of licensed healthcare workers. On the Roto-Rooter side, more dynamic. If we see inflationary pressures, we'll continue to raise prices if that's appropriate. We have to look at pricing as a major tool because that maintains our plumbers and drain cleaners, and that's the enticement for people to come on board to the Roto-Rooter team. Yes, we outperformed internally. I'd still say, modestly better than I would've realistically thought at the high end. The reality is we are gonna have a little bit of pressure going forward, but I feel exceptionally comfortable in our macro guidance.
No, that's great, Carl. I appreciate the details. I guess to this last point, talking about the labor pressures. You said that, you know, your guidance already had accepted or assumed, you know, significant increases in overall compensation, I guess in federal market . Can you quantify for us what exactly you assume in terms of the growth in,
No, we don't give out that granular detail and certainly within a quarter.
Okay. No, not was talking about the quarter, but talking about the full year.
No, we won't go into that kind of detail either.
I guess on the flip side, right, the Medicare rate update, the proposal came out, calling for, you know, call it roughly 3% rate update. Was this kind of how you were expecting and modeling, you know, in terms of including in the guidance and I guess, anything else in that proposal that, you know, you're looking at that, you know, we should be also focused on?
I'll comment on the proposed rate increase, and I'll defer to Nick and Kevin on some of the other components in that proposed rule. No, actually, I was surprised at how low the number was, and I was also a little surprised that they actually didn't give the underlying metrics to do the calculation. Historically, CMS has utilized the hospital wage index basket from April 1 to March 31, and that's the solid data from the BLS they use for the following October 1 increase. With the slight rebasing that they did in October 1 of 2021, there was a little bit more shift to CPI, a little less emphasis on the hospital wage index basket.
The way the ratio roughly works is 65% of the increase is a hospital wage index basket, 35% is based upon CPI or inflation. I was surprised when they came out in about the second or third week of March before that data is finalized with their proposed rule. More importantly, the headline number on CPI at March 31, 2022 was 8.5%. If you just take 35% of 8.5%, assume the hospital wage index basket will be flat, no increases in that regard, you would come up with obviously a larger number than they're proposing, even after you take out the 40 basis points of productivity factor that they included in. Of course, most of that's supposed to relate to the hospital wage index basket.
I really wanna see the underlying data, and it does seem like CMS is building in more of a lag from the measurement of inflationary pressures in hospice and to the point where they pass it through to reimbursement on October one.
They obviously didn't use the March numbers at the very least.
Clearly. Even still, I think the CPI pressures then. What was the number through February? What, 7.9% or something like that? We're curious to see the underlying data. At the end of the day, they could create more of a lag, but at some point, the way the reimbursement factors work, reimbursement will catch up, in totality to the total inflation over whatever time period we wanna talk about.
Yeah. You know, as it relates to the other aspects of the rule in general, as well as guidance, you know, we put a realistic estimate in inside of that last quarter, so it won't materially impact our full year guidance. We'll be able to talk more specific about it after the second quarter when we update guidance and we have more clarity as the final rule starts to come out.
For the non-wage related aspects, which are almost as equally important in some years, more important than the rate itself, we were pleased to see it was consistent with our expectation that there were not a lot of material regulatory changes which then in turn create, you know, process changes, additional administrative burdens, which, you know, over the past year, a lot of those things had been incorporated in. Pleasantly surprised, but consistent with expectations, given everything else going on in the industry, that it was, you know, everything that was anticipated and will continue to have a minimal disruption by implementing any, you know, minor items that would go final, you know, in August for the October one effective date.
No, thank you. I appreciate your comment, and especially the fact that there were no additional changes is always good, especially with, you know, everything that's going on. You know, on the front, you know, last question on VITAS. You talk about Roto-Rooter. Actually, you gave us these great stats in terms of including increasing your workforce on the Roto-Rooter side. Can you give us some stats on the VITAS side in terms of your net hiring? You mentioned that turnover was still high, but sounds like it was still not where you were expecting or maybe not where it should be.
Can you give us some of the pieces in terms of, you know, is turnover, you know, improving, you know, in recent months, and also, you know, net hiring or any kind of measurements you can provide, on the headcount on the VITAS side? Thank you.
Consistent with how Dave was talking about and Kevin was talking about first quarter performance based upon adjectives from a description perspective, I'll do that as it relates to some of the hiring components since we don't release those aspects publicly. You know, overall, is our net hiring rate and turnover rate performing better than our 2019 levels pre-pandemic? No, it's not. That's what we alluded to inside of our commentary. However, there have been you know, some encouraging signs from a trend perspective inside of the quarter as VITAS, no different than any other healthcare provider, continues to double and triple down with an absolute focus on both recruiting and retention, in particular, our clinical workforce, like we've you know, been consistently talking about for the last few quarters.
There's positive progress, but yet, like everything in hospice, it is a market-specific impact. There's some markets where we're seeing, you know, real positive progress. There's others where we're continuing to flip the proverbial pancake to continue to try to make headway. At the end of the day, that will have the biggest impact on, you know, 2022, 2023, no different than it does for every other hospice provider out there in terms of our ability to continue to attract and retain high-quality clinicians.
I guess you're seeing some improvement. There's like the kinda net headcount on the VITAS side is also improving.
We're seeing positive trends as it relates to it. It's a day-to-day battle not only among, you know, competing with others in the industry, but others outside of home care, in the nursing home segment, in the hospital segment, in the, you know, travel nurse, contract agency segment. We're all searching for similar resources. Like I said, it's, you know, a day in, day out. I'm happy with the level of effort and focus the team has put in, and I promise you will continue to put in as we traverse the rest of 2022.
Okay. Great. Thank you. I guess. My last question, I guess, on the Roto-Rooter side, and I'll go back to the queue. You mentioned the price increases that seems like it, I guess they stuck. They worked, that you implemented early in the year, and then you might consider additional price increases. Assume it's just the inflationary data points and so can you kind of give us a flavor of the magnitude of things in terms of these, you know, price increases that you did and you consider doing? Thank you.
I'll start and just say that we consider Roto-Rooter a premium priced service offering. You know, we look at that market by market very closely, being careful to be premium priced, not overpriced. Again, if inflation continues at its current elevated rates, I mean, we've you know, early in the second half of the year, we will make those calculations and not hesitate to make a price increase if it's indicated. Dave, any other color on that?
No. I mean, part of the issue is the variability. Like compare Baltimore to Cincinnati. They had completely different increases that passed through, and then within each market, we would have a different rate increase for excavation versus, say, drain cleaning. Water restoration, that price increase from Xactimate as well. The reality is it's a hodgepodge, and Baltimore was completely different than Cincinnati. On average, though, we were actually based upon the headline number of 8.5% at the end of March. We got a little room to go for price increases still to catch up to inflation.
Right. It's supply and demand. We said we have many more than several programs where we have more calls than we have people to service them. You can imagine that the classic response to that is, you know, increase prices to bring the two in alignment and the supply and demand. That's the kind of thing. I guess Dave's point is we are not limited to doing that once a year at the beginning of the year.
Right. Normally, we do it when low inflation. We'd be crazy to lag by 12 months. When inflation's already in our economic model, you pass through the price increases. Joanna, the reason we actually gave granular numbers on Roto-Rooter is because of the consistency of what I consider strong hiring and retention trends. We can actually use it to predict out how Roto-Rooter is performing. Nick is just reacting to an extremely volatile labor market, where it's hard to discern any trends one way or the other, whether it's with RN, nurse practitioners or home health aides. On the Roto-Rooter side, the reason we spent so much time talking about labor is labor is a critical component of just driving commission revenue and then their commissions.
The fact that we were able to grow labor consistently throughout 2021, the year of the Great Resignation, the fact that we continue to grow labor, both in the skilled and unskilled technician areas throughout the first 4 months of 2022, I think is just a good indicator of the strength of Roto-Rooter, and that's why we got so granular. It's a very predictable trend line at this point throughout the year. Momentum is with Roto-Rooter, both in demand as well as in our ability to service that demand with a growing headcount.
No, definitely the 8% and even the 3% numbers that you gave for Roto-Rooter was, yeah, definitely good to hear that as an indicator for where the business is going. I guess I'll go back to the queue. Thanks so much for answering all these questions.
Thank you.
Thank you. As a reminder, if you would like to ask a question, please press star one on your telephone. To withdraw your question, press the pound key. One moment. Our next question comes from Ben Hendrix of RBC Capital Markets. Please proceed.
Hey, guys. Thanks a lot. Just a quick question here. I noticed that, you know, with about a 4% decline in days of care versus your, ADC, guidance of down 1%, then 1.5%, I know you noted that kind of, decreased hospital admissions, you know, went down pretty significantly, and that looks like it shifted your kind of days of care mix. Trying to get an idea for cadence through the year, how does that develop through the year, kind of in terms of, maybe top-line impact? You know, at what pace would you expect kind of labor inflation to impact cost over the course of the year? Just, really just trying to get an idea of, how you're thinking about cadence.
Thanks.
From a ADC perspective, you're spot on regarding the actual prints. As we think about the entire calendar year, one of the other aspects we included in our comments last quarter for guidance is keep in mind, while we don't provide quarterly guidance, we did provide some directional guidance towards ADC growth accelerating in the second half of the year. A lot of that, you know, you start to see some leading indicators of that, the execution out in the marketplace as we continue to focus on, you know, the community-based segment as well as the broader segment.
You can pick up on that as it relates to the disparity in our admission numbers with, you know, the non-hospital segment having positive both year-over-year comparisons and even more positive sequential Q4 of last year to Q1 as well.
Just one point. I'll just tell you
Internally now, we don't talk about overall admissions. I mean, in fact, other than the fact that investors are used to hearing that from hospice providers, internally, we talk only in terms of from whence they arrive.
That's right. That's exactly right. From Q4 of last year to Q1 of this year, the non-hospital segment admissions sequentially increased a little over about 5.5%. You know, from an ADC perspective, you know, the Omicron variant in the first, you know, in January does have an impact to total days of care inside of the quarter.
You know, we continue to see it as a good, hopefully launching point for the remainder of the calendar year as many of the disruption pieces inside of the pandemic are behind us and we're dealing with more of a regular referral flow and a continual shift of focus, as we look to ensure we are deploying our admission resources to respond to the most appropriate, you know, referrals out there and and go from there to bring on all appropriate and eligible patients that that we respond to. That's from an ADC perspective. Your other question, Ben, right, was pace and cadence as relates to labor, salary, and wage and from an inflationary perspective. You know, we are in line through the first quarter with where we anticipated it.
You know, from a wage and salary standpoint, you know, we have some prudent programs, of course, throughout the course of the year, including, you know, an annual merit cycle that hits in the middle of the year, and all that's incorporated into our guidance. The biggest barometer that we are looking at on a day in and day out basis is really growing our net headcount as it relates to our licensed clinical resources. More and more hoping as we bring those resources in that they're coming in in a full-time capacity versus a part-time capacity or a per diem capacity, which adds a degree of complexity towards, you know, some of that labor management, on a go-forward basis.
Feel good about where we are right now, consistent with our full-year guidance, but time will tell over the next eight months from today.
Thanks a lot, guys. Thank you. At this time, I would like to turn it back to Kevin McNamara for closing remarks.
Well, I will only reiterate a remark that we were gratified with our operating units, and we're certainly generally in line with what we expected when we gave guidance in February and a little above that. Thank everyone for their attention, and we'll be back in three months for the discussion of the second quarter. Thank you.
Thank you. This concludes today's conference call. Thank you for participating, and you may now disconnect.