Okay. Welcome to day 19, I mean, day two of our conference. It's my pleasure to welcome HealthSouth Corporation this morning. HealthSouth is one of the U.S. largest providers of rehabilitation services. The company operates inpatient rehab hospitals, outpatient centers, home health agencies, over 360 centers in about 30 states. It's my pleasure to have the President CEO, Mark Tarr, this morning.
Thank you, and good morning. It's a pleasure to be back here at J.P. Morgan conference again this year. I want to start by introducing some of our management team that are here with me today. First of all, we have Doug Coltharp, our Chief Financial Officer. We have April Anthony, the CEO of our Home Health Encompass. We have Crissy Carlisle, who some of you may know as our Chief IR Officer, and we have Barbara Jacobsmeyer, who is our newly crowned EVP of Operations. It's great to have the team with me here today. I will note that we are an Alabama-based company, therefore, the results of the game last night are still weighing heavily with some of us.
You'll have to ignore the fact that we may not have that same swagger about us that we had this time last year at this very same meeting, as a matter of fact. For those of you that aren't familiar with HealthSouth, we're made up of two business segments. We have one that is a facility-based segment with 123 rehabilitation hospitals, 37 of those hospitals operate as joint venture partnerships with acute care systems. The other segment that we have, Encompass, is obviously home-based, made up of 188 home health locations, 35 hospice locations. Both of the segments enjoy a large percentage of market share. The hospitals are the largest market share. Matter of fact, 28% of the Medicare patients this year receiving inpatient care will receive that in a HealthSouth facility. Our home health locations account for the fourth-largest Medicare home health company.
We have a strong foothold in both of these segments. It's important part of our strategy to create overlap. You can see by the red square in the middle that we reference the 59% of what we call overlap. When we first started our venture with Encompass, we started out with 30% of our inpatient rehab hospitals had overlap with Encompass Home Health. As we've grown out that segment, we've made a real priority to acquire agencies that would create this overlap or otherwise, this 30-mile radius around our rehabilitation hospital. That's a key part of our strategy to create this integrated network that we can work within. Also point out on the map, you can see large concentrations of our locations in the state of Florida, Alabama, Texas, on up into Massachusetts.
We've also posted the 10 development projects that we currently have in the works that will come online in 2017 or 2018. We attribute a large part of our ability to capture the market share that we enjoy to the quality outcomes that we're able to provide to our patients. You can see both of our segments are at leading positions within their categories. On the left-hand side, starting with our IRF quality, we've chosen to show what we consider to be the priority quality metrics, and that is what is the destination of our patients at the time of discharge from the rehab hospital.
Our key focus the last several years have been to make sure that we get our patients back home to the community and not have a reason for readmission to an acute care hospital, or have the need to discharge to a skilled nursing facility at the time of discharge from a hospital. We're proud to show these results, where we're able to achieve a much higher percentage of our patients discharged back to the community than expected according to the database. The database here is compared against what we call the UDS database, which accounts for about 70% of the providers in inpatient rehab submit their data to this database, so it serves as a good comparison. In similar fashion, Encompass in our home health sector looks extremely strong on the quality metrics.
I might note there at the bottom, relative to the third-day readmission rate, they exceed the industry by 170 basis points. Of course, they are compared according to the star ratings of CMS. We're able to achieve that high quality, but we're also very proud of our cost advantage in both of our segments, and we achieve it in very similar ways. I'll draw your attention to the top row, highlighted in blue, and if you go across from left to right, you'll see in the box where it indicates our case mix index of 1.25, indicating a higher acuity than the industry comparison when looking at the other freestanding IRFs that are non-HealthSouth, the 1.23, or the hospital units of 1.18.
Continuing across that row, you'll see that we experience a significant cost advantage when you look at the cost of our treatment per discharge coming in at 12.6 versus a comp of the non-HealthSouth freestanding of 16.6, or the hospital units of 19.8. We're able to achieve those costs, but yet we are still reimbursed lower than the industry norm per discharge at the 19.3 versus the freestanding non-HealthSouth of 20, and then going on down to the 20.5 of the hospital units. The reason that we are reimbursed lower is that we have a very small percentage of our discharge, very low number of our patients actually hit the high-cost outlier threshold. We are able to achieve this efficiency in a number of different ways. One, our productivity of our staffing is exceptional. We do have larger scale.
Our hospitals run larger than the units or the other freestanding. We have invested heavily in technology the past several years with our management systems and management reports that we can provide back to our hospital-based, regional-based, or our corporate-based management team that help us manage our hospitals in a very efficient manner. It's a similar story in our home health sector. If you go to the second column here, you can see where they do receive an average revenue per episode higher than the peer average. They have a higher acuity patient. They take a sicker patient. If you go across to the final column there, you can also see the cost per visit. They too experience a cost advantage coming in at 14.3% less than the peer, in spite of treating a very high acute patient.
The home health group does an excellent job in managing their productivity. They are also the top of class for using their IT system, Homecare Homebase, excuse me, of which April and her team designed. They're able to apply this system in a manner that gives us cost efficiency advantages. One of the focuses that we have in these overlap markets that I referred to earlier is making sure that we coordinate the discharge process as patients discharge from our rehab hospitals into the Encompass home health agencies. It's an opportunity for us to excel on not only the communication side and coordination side, but when you think about patient satisfaction, our ability to work with the patients, work with the families, make sure that their drug regimen and their drug education everything that goes along that is important at that time of discharge is well coordinated.
If we do that, we'll have a successful transition in the home setting and also lower the likelihood for readmission back into acute care hospital. You can see that we have increased this collaboration rate over this past year. When you compare it to Q4 2015, we've increased it up to 28.2%. We believe that this is an area that we'll continue to see an improvement upon. We think a likely near-term goal for us is somewhere between 35% and 40% this next year. I can tell you, we do have best practice markets that are at that 60% level. We'll never be at 100% because there's always the patient choice and there are other factors such as physician preference. We believe that this is an area and a key part of our strategy that we'll be able to excel on in the going future.
One of the notes that Zirbi made is this strong push from this demographic tailwind that we benefit from in both of our segments. As the population ages out, patients get older, they are more likely to have stroke. They're more likely to have conditions and maladies that the types of programs that we have in both our hospitals and our home health agencies have developed to treat this aging population. The average age patient for our hospitals on the Medicare side is 76. The average age patient for the Medicare in our home health side is 77. You can look at any of these graphs and tables here. The first table shows you the Medicare enrollment. It shows you that starting in 2011, the baby boom generation started reaching Medicare eligibility age. You see the CAGR increasing, the trend line increasing from 2%-3%.
Down in the census data down below, keeping in mind I gave you the average age of our patients between the 76 and 77 number, if you go across in those areas, those boxes that we've highlighted, you can see where the actual CAGR is somewhere between 4.5% and 5.5% as these patients age out. The last area I want to draw your attention to on this particular slide is on the right-hand side. You'll see down the home health column, as the patients get older, there's actually an increase in the need for home health coverage for these patients. We believe that this is a significant driver of the future need of our services. These patients are not discretionary in nature.
The vast majority of the conditions we treat are not from elective procedures, that this is really an important part of our strategy that will drive the need for the services we provide as a company. One of the areas that we've put a lot of focus on is our strategy to integrate our two business segments. We believe that in spite of the change in the administration that'll take place very soon, CMS will continue to have its focus on value-based purchasing that as providers, our future lies in the ability to provide high-quality outcomes, in addition, to be able to do that in a very cost-effective manner. I've shared with you the information that we have to show that we are industry-leading in both of those areas.
We also believe that with time, some of the artificial regulatory barriers that limit the types of patients that are seen in certain areas, such as the differences between an IRF or long-term acute care or skilled nursing facility, over time, we believe that CMS is likely to eliminate those silos that exist around those three different areas of care, that what you'll see is more of a site-neutral environment where CMS becomes indifferent to where the patient goes. They will have a payment for the care of the patient. It's up to the provider to make sure that they put the patient in the right area of their facility and provide the right level of care to achieve the outcomes to provide the quality that they're paying for. We believe that we are uniquely positioned to take advantage of that in the future.
Our rehabilitation hospitals are licensed as acute care hospitals. They are a specialty track of acute care hospitals. If you look at the comparisons on our hospitals versus those other siloed areas between the SNFs and the LTCHs, we believe that we're very favorably positioned to, as we refer to here, pivot from the center. It's fairly easy to go down the acuity continuum and treat patients that perhaps are less acute than what we're currently seeing. We also feel that going up the acuity continuum is an area that we're uniquely qualified as well, given the construct of our buildings with our med gases, with our in-house pharmacies, with our nursing staff, many of them are trained in providing critical care nursing. We have full complement of physician medical staff in our hospitals.
We're also capable of going in and converting rooms to treat more of what you would see from an ICU-level patient, perhaps a chronic illness that would put a patient on a ventilator from a long-term perspective. We think that we are in a unique position to pivot from the center, given the construct of our buildings and the existing staff that we have in our hospitals currently. 2016 was a really strong year for HealthSouth. We're very proud of our accomplishments, given the objectives that we set out going into the 2016 fiscal year. Among those accomplishments, we put a high priority first on the full integration of Reliant and CareSouth as part of our growth initiatives. These were two large acquisitions we had going into 2015.
We want to make sure that 2016 was a year that we made great advancements on the integration of both of those. The Reliant hospitals are near fully integrated, and we've made great strides in integration of CareSouth Home Health locations that exist primarily in the Southeast and the Mid-Atlantic states. We opened or acquired four new hospitals in 2016. I mentioned earlier that we had 10 new projects that are currently underway. We expanded our existing hospitals by 83 beds, and then we acquired or opened 10 home health locations and eight hospice locations this last year. It was a very strong year in terms of achieving our growth initiatives. We had a number of operational initiatives that we sought out for in 2016. One was to begin to collaborate to a greater degree on our clinical programs between our rehab hospitals and our home health.
We started the process of creating best practices with regard to clinical protocols. I mentioned earlier our focus on creating a process for clinical collaboration that would advance the coordination of our patients as they're discharged from our rehab hospitals into our Encompass Home Health sites. We also started to use some of the data from our EMR in our hospitals that we began investing in some five or six years ago as one of the few post-acute providers to have electronic medical record. Our vendor is Cerner. We're now starting to capture some of the data from that, and in this case, we're starting to apply it to predictive modeling to help identify patients that may be at the risk of acute care transfers so that we can take earlier advanced clinical intervention to prevent those patients from being readmitted.
It was also a year that we continued to participate in alternative payment models, one of which was starting to develop the template and the agreement to participate within the CJR as a collaborator. There's specific language within CJR that allows acute care hospitals, acute care systems to engage with and partner with other providers that would allow the other providers, in a coordinated fashion, to take a risk. That, quite frankly, is something that we're willing to do.
It's something that we think that the fact that we have 37 joint ventured hospitals, we're ideally suited to go out and participate in these mandatory bundles, the CJR particularly, and work collaboratively with the acute care hospitals, coordinating our care up to and involving the acceptance of risk, albeit the way the programs are set up, you're limited 25% of the penalty risk that the acute care hospitals may have on those particular cases. Nonetheless, we put this format in place that we think will ultimately also allow us to go out and coordinate, and it'll be an attractive part of our offerings to Medicare Advantage plans and other commercial plans in the future. It's also a year that we continued to make significant progress on our capital structure. Very proud that we had revised ratings from S&P and Moody's on the outlooks of our debt.
We also increased shareholder distributions. We repurchased $1.7 million of our common stock, as well as raised our dividend from $0.23 to $0.24. All this momentum that we've had in 2016, we think will carry over in 2017 in strong fashion. We'll continue down the growth platform, the opportunity to continue to build out our IRF platform with the 10 hospitals that I mentioned, that'll come online between 2017, 2018. We will continue to expand out our home health platform, prioritizing those opportunities to create those overlap markets. I also want to note that you see here we have marked $50 million to $100 million worth of capital for these acquisitions, which would be twice what we had in 2016. We believe that we can accelerate the potential to go out and acquire these additional home health or hospice locations to expand that network.
We also have operational initiatives that I think are very complementary to what we're trying to do with our strategy. I mentioned earlier the collaborator role. We think that we'll have a number of these collaborator agreements signed by the end of the first half of the year. We want to continue to make strides in enhancing our clinical collaboration with the TeamWorks standardization effort that we've applied in other aspects of our business. We will be applying that this year to the clinical collaboration between our hospitals and our home health locations so that we can standardize this process that we believe will help us achieve that 35%-40% collaboration rate in this next year. Within our guidance, we do have included the outcomes of the two final rules, the one final rule for inpatient segment, as well as the final rule for home health.
The final rule for the inpatient or the IRF sector this year is fairly straightforward. You can see that Medicare implemented a net 1.65% market basket increase. We think that the impact for our hospitals this year will be a total of 1.9% for Medicare pricing. The difference between the two is that we're having a positive swing on the wage index and a disproportionate number of our marketplaces that would put us up from that 1.65% to this 1.9% level. Relative to the additional quality metrics that are required for quality reporting, we believe that we'll be able to accommodate that in our existing systems, many of which we're now able to capture through the use of our EMR. We've had to add a few FTEs at our hospitals to also help to capture some of this quality reporting data.
On the home health side, it's a little bit more involved. I want to take some time here to cover the impact of the final 2017 rule on this. We will be disproportionately impacted from this rule in a negative way. The types of patients that we treat, in this case, the higher acuity patient, put us at a disproportionate impact from the recalibration, the case mix weights, as well as the conversion of the outlier payments to a cost per unit methodology. We have estimated this will create about a $21 million headwind for 2017. Relative to the quality reporting, much the same as on the IRF side or hospital side, we'll be able to accommodate this within the existing structure and supplement the procedures and processes we currently have in place to capture the quality reporting data.
We offer guidance for 2016 for adjusted EBITDA $785 million-$795 million. For the preliminary guidance on 2017 for adjusted EBITDA would come in at $800 million-$820 million. Try to bridge this to make it clear in terms of the bridging between the 2016 endpoint and the 2017 guidance. As you walk from left to right, you'll see that we had the benefit in 2016 of $4 million of a retroactive indirect medical education, IME, benefit that we actually had from one of the Reliant hospitals that we put forth in 2016 that won't be reoccurring in 2017. Go across, you'll see the growth from operations that we estimate between $32 million and $62 million. The $21 million headwind from the change in the proposed to the final rule for home health. We had the sale of the pediatric home health business.
That was a one-time benefit, but we won't have the ongoing EBITDA in 2017 of $2 million. Those items are outlined at the bottom of this chart. The guidance considerations, for 2017, we talked quite a bit about the pricing impact on both. We put forth an estimated salary increase right at 3%, then we list out a number of the other items as part of the consolidated impact. We are a company with a strong ability to produce free cash flow. You can see here, estimated cash flow of $245 million-$370 million for 2017. I will remind you that we will have a tax impact for that this year. You see our cash flow priorities. We offer our business outlook for the next three years, with the emphasis on adjusted EBITDA CAGR of 5%-8%, 5%-9%, I'm sorry.
Annual discharge growth of 3% and 10%, our final numbers for our salaries and other costs. With that, we'll move to Q&A.
Well, great. Thanks for coming to the HealthSouth breakout. I don't currently cover the company, so I have a few questions. Please don't be shy, and I hope you guys fire away and get the questions you really want answered. Maybe one I would start with is, when you look at the current mix of the business as it exists today, and you look at the development and the acquisition plans that you have, what do you think the company looks like over three to five years, top-line EBITDA growth? What is the profile of HealthSouth?
Doug, do you want to take that?
Yeah. Well, I think that's largely borne out by the business outlook slides that cover a three-year look-forward that Mark referenced at the very end of his presentation. If you look at those slides, what you can see is our anticipation that home health revenues will grow faster than the IRF side. That's really a function of, A, our objective of creating more overlap between the home health business and the IRF. We've got to fill in that 41% of the markets. We won't get to 100%, but our objective is to have complete overlap, and we'll do that predominantly by acquisitions. It's also a function of two other things, at least, and I'm going to ask April to comment on this as well.
One is what we see is the growing demand for home health services and the role it plays in providing a solution to cost-effectiveness across the spectrum into doing things like reducing hospital readmissions. It's also the fact that the rate cut that we talked about, although it impacts it disproportionately, it's been a multi-year rebasing that has taken a financial impact on many of the smaller operators in the business. Recall that the home health industry is one that is highly fragmented. Even today, there remain in excess of 12,000 home health agencies in the U.S., and approximately 95% of those have revenue of less than $5 million. When they see rate cuts or when they see programs like the pre-claim demonstration that is coming forward or the increase in quality reporting requirements, it becomes very difficult for them to compete.
They don't have the resources to be able to deploy to compete effectively, that creates more acquisition candidates for us. Again, over time, we would expect that in terms of the composition of our business, you're going to continue to see solid growth in the IRF business, more rapid growth, meaning that from a revenue and EBITDA perspective, you'll see an increase in percentage from home health. We also have a focus on growing our hospice business as well. It's probably fair to say that up until the last couple of years, our hospice strategy had been one of a little bit, to borrow from retail, of a gift with purchase, which is we had gotten into hospice where we acquired a home health agency that also happened to be in a hospice business.
April and her team wanted to study that business for a period of time to determine if it was one where you could successfully manage it to a reasonable margin and therefore a reasonable return on investment. I think April and her team have made the conclusion that you can do that if you do it in the right way, that we now have as an additional growth objective, ultimately expanding into hospice in as many markets where we currently have a home health agency as we can.
Absolutely. There's not too much to add to Doug's comment there, other than we absolutely believe the market is ripe for further consolidation in both the home health and the hospice area, that as a margin leader and a volume leader in the industry, that we are uniquely positioned to take advantage of some of the stress that's inherently coming from the outside sources, particularly in the reimbursement area, maximize the benefit of that stress for our organization as we grow.
It is worth noting that both of our segments, not only the home health, but inpatient side as well, both of these segments are very fragmented, which present an opportunity for market consolidation. I think it's also one of the reasons that you see from our development pipeline for the hospitals is it's very much dominated by joint venture partnerships, where the acute care hospitals have a rehab unit that is either not run as efficiently as they potentially could, or they see a greater growth opportunity in working with a HealthSouth.
If you were plotting your escape in the last couple of minutes of the presentation, you missed actually two very detailed slides about your three-year outlook.
Yeah.
I apologize for-
No, I'll apologize for that. I got over-enthusiastic about other slides, but I would encourage you to look at our business outlook slides that make up the last three slides of our presentation.
Audience? Anyone? One question I had on the labor cost, the 3% labor cost you're looking at, how does your workforce break down now in terms of PT, RNs, LPNs, home health aides? Can you give us a rough breakdown? Is there any material difference in how the blended 3% works out?
I'll answer to the hospital side and let April Anthony answer to the home health side. On the hospital side, about 60% of our total FTEs involve some nursing component, whether that's RN, LPNs, or nursing assistants. It is nursing-dominated. When we look at our overall salary environment, we have not seen pressures across the board. We have seen certain pressures in selective markets. There's some markets in Texas, the Houston markets, that are high-growth markets. We're very confident in our ability to continue to keep our turnover rate down and our recruitment and retention at a degree that helps us to balance out some of the staffing pressures.
I don't have the exact percentages on the home health breakdown, but better than half of our total field staff is in the nursing disciplines, both RNs and LPNs, certainly, that's our major focus. We have the greatest success in retention with our physical therapy discipline, it's both a smaller portion and a lesser churn portion of our organization. Maintaining therapists has not been as challenging as maintaining nursing has been, we certainly put a lot of our focus as it relates to recruitment and retention on the nursing side to make sure that we can manage through challenging situations there.
Anyone?
In the treatment and home health care area, are there opportunities for telemedicine?
The question's regarding telemedicine in the home health care arena, two different ways to think about that. There's the telemonitoring component. We see that being viable in our space, where we're providing additional monitoring capabilities to particularly high-risk patients, utilizing our nursing force to really coordinate the care of those patients using the monitoring as a trigger. We have found that in some of our acquisitions, that they're utilizing telemonitoring devices. We have rarely found that we've been able to sustain that at scale and really create a differentiated value from those services, we have not deployed telemonitoring broadly as an organization. When you speak more specifically of telemedicine, the more physician-based house call through a device, with our average patient being in their later 70s and 50% of our patients being north of 80, we don't find that to be a terribly effective tool either.
At the moment, that's a very limited use component that occasionally works out, but by no means a standard.
Yes. What about testing the patient at the home instead of drawing blood and sending the blood to the hospital?
Actually completing the lab in the home?
Doing the lab in the home, point of care.
We are not doing any point-of-care lab testing at the moment. We are always drawing the blood and then sending it to the lab.
When you talk about hospice expansion, is that entirely an M&A effort? What kind of synergies are there between the home health and the hospice business?
The hospice growth will come both through M&A as well as through acquisition, as well as through de novo startups. The de novo startups are a bit slow. Ideally, we frankly would prefer to acquire in the hospice arena. There are nearly 5,000 hospices nationwide, there's a pretty ripe field for acquisition. Priority number one is to look at acquisitions. If we can't find an acquisition opportunity in a market that either meets our diligence criteria or is available for purchase, we are not opposed to going the de novo route. We've done a few de novos in the last couple of years on the hospice side, certainly, they can be done. They're just a little bit more laborious and take a bit more time up front. The synergies between home health and hospice, we find those to be significant.
As you heard Mark mention, our strategy is to put home health everywhere that we have IRFs and to put hospice everywhere that we have home health, sort of in that order of priority. We have a significant opportunity with just 35 hospice locations, a significant opportunity to expand our hospice. We absolutely see that the ability to share back-office resources. We believe a dedicated clinical team on the hospice side makes sense, but there's certainly the opportunity to share facilities, share administrative support staff, and share a lot of costs that allow us to have a very low census in hospice and still a nice profit margin on that segment because of those synergies that you simply couldn't do if you were standalone hospice at sub-40 patients. It's hard in many cases to break even.
In our case, we can break even in those hospice locations at about half of that census because of the synergies we can get from existing administrative support capacity and resources on the home health side.
Can you give a more quantitative example of that? I guess, over the next few years as you build that out, I guess without completely spelling it out, what kind of operating leverage you can?
I guess maybe it's incremental margins, the way I view that, or how do you characterize it?
I'm not sure I'm going in the right direction with your question, but I think what we see is the ability to enter a market from the hospice perspective and get to an acceptable margin level sooner. Once you hit sort of a point of economies of scale, once you're north of 50, 60, 70 patients on your hospice census, that overlap and that sharing of expenses mitigates its relative value because you're really getting the greatest value of that at the beginning, where you're not having to double down on facilities and conference rooms and phone systems. Once you realize that, and you get up to a more substantive census level, then we tend to find that that margin expansion is relatively small beyond that initial first 25 or 30 patients.
Just connected to that, what's the right margin long-term to be thinking about? Is it still low 20s%, where you're done?
In the home health space?
Yeah, consolidated.
Consolidated Home Health and Hospice? Do you want get into that, Jeff?
Yeah, I think you can get some of this from the business outlook slides as well. Obviously, 2017 is going to be a difficult year from a margin perspective because of the extent of the rate reduction that we're facing for Medicare home health. That said, on a consolidated basis, we've been a kind of low to mid 20% adjusted EBITDA margin. The higher margin is in the IRF segment. Home health margins have been under pressure for a multi-year period based on the rebasing.
The good news is that we believe that in-home health, once we move beyond 2017, we start to see a more normalized pricing environment, both based on what's included in the Affordable Care Act as it stands today, also based on things like the value-based payment initiative, which will start to redistribute certain Medicare patients to those agencies that are providing or are producing the best outcomes, and we fall into that category. I don't view this as being, in aggregate, a margin expansion story for the near term. I think we'll be working hard to kind of hold margins in.
Just on your payer mix, any kind of changes or shifts worth talking about? I think it's been pretty steady now for a couple of quarters. Related to that, on MA, I know Medicare Fee-For-Service is big, but what's your guys view on the MA plans? I know they make them part of the usual facilities. Do you wish you could get through that more? Is it just not worth it? Just your general thought on MA plans as they continue to grow in popularity.
Overall on our payer mix, I think what you've seen in 2016 is kind of our go-for run rate's been pretty consistent. Relative to MA plans' willingness to use rehabilitation hospitals, we've actually been very successful over the past couple of years in articulating and showing our value proposition, particularly for stroke patients. I think that they realize that working with HealthSouth, an inpatient rehab hospital versus sending the patient to a skilled nursing facility where there might be a likelihood of a return to acute care hospital. I think that they're starting to now realize that looking at the total cost of care from more of an episodic standpoint is more beneficial to them in the long run, and we play right into that.
As Mark mentioned in his presentation, one of the initiatives that we have underway for 2017 is to take some of our initial learnings from CJR and to expand that into a bundled payment program that would be targeted at the Medicare Advantage providers. Now we'll do that in a very limited way initially, but we think that that could be a compelling approach from both our perspective and from the MA plan's perspective at looking at the relationship around these patients differently.
Any other questions?
I have one. Can you talk about BPCI a little bit, what visibility you're having, et cetera? We have a number of companies that follow participating. What we're generally hearing is that we don't know when we're going to get paid, how we're going to get paid, when CMS is going to calculate the savings. A lot of uncertainty around it. Do you guys have any more visibility?
We participate in both segments in BPCI. I would say that we have more experience on the home health front. We have eight hospitals that have participated in the last three years on BPCI, it's been primarily not from a financial exposure, it's been more from an experience opportunity to go in and just see if that platform will roll out on a larger scale, what we would need to make sure that we do as a provider to accommodate that. Overall, we have been very enthusiastic embracing any of the programs that would tie quality with our payment.
Have you seen any financial reconciliation yet or any payments or savings from CMS?
April, you want to comment on that?
Yeah. In the home health side, we have had some interim reconciliations, not yet finalized. You really hate to respond on those because they've still got data coming in. They do give you some interim reporting, but we've not had any.
No actual dollars.
Yeah, done deal, certainly no payments coming through the system yet that are backing those up.
Time for one more. I hope everybody's thinking about lunch.
If not, well, thank you very much for joining us today.
Thank you.
Thank you.