TruBridge, Inc. (TBRG)
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Earnings Call: Q2 2022

Aug 2, 2022

Operator

Greetings, and welcome to CPSI second quarter 2022 earnings conference call. At this time, all participants are on a listen-only mode. A question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Dru Anderson. Thank you, Dru. You may begin.

Dru Anderson
SVP of Corporate Communications, CPSI

Good afternoon, and welcome to the CPSI second quarter 2022 earnings conference call. During this call, we may make statements regarding future operating plans, expectations, and performance that constitute forward-looking statements made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. We caution you that any such forward-looking statements only reflect management expectations and predictions based upon currently available information and are not guarantees of future results or performance. Actual results might differ materially from those expressed or implied by such forward-looking statements as a result of known and unknown risks, uncertainties and other factors, including those described in our public releases and reports filed with the Securities and Exchange Commission, including, but not limited to, our most recent annual report on...

We also caution investors that the forward-looking information provided in this call represents our outlook only as of this date, and we undertake no obligation to update or revise any forward-looking statements to reflect events or developments after the date of this call. At this time, I will now turn the call over to Mr. Chris Fowler, President and Chief Executive Officer. Please go ahead, sir.

Chris Fowler
President and CEO, CPSI

Thanks, Dru. Good afternoon, everyone, and thank you for joining us on the call. I'm on my 33rd day in my new role as CEO of CPSI, and I'm thrilled to be with you today to discuss our recent performance and future opportunities. Following my comments, Matt will provide a financial update, after which the two of us, along with David, look forward to taking your questions. As you likely saw in our release this afternoon, we had an excellent second quarter, highlighted by revenue and bookings growth, and most importantly, we remain ahead of pace to achieve our previously stated objective of $80 million in EBITDA in 2024. With TruBridge leading the way and representing almost 60% of total CPSI revenue in the quarter, our journey to transform CPSI into a cloud-based digital platform of healthcare services and solutions continues on course.

Noticeably led by both organic TruBridge growth and outperformance of our recent acquisition, HRG, recurring revenue grew 21% year-over-year and comprised 92% of total CPSI revenue. TruBridge also achieved outstanding bookings results in the quarter with organic year-over-year growth of over 50% and incredibly almost 150% when including TruCode and HRG. We are equally excited about our execution during the quarter of TruBridge cross-sells into the Evident acute care EHR base, which was a near record $7.7 million. TruBridge sales into the large hospital and healthcare system market were also substantially up. Finally, on the bookings highlights, record TruCode bookings were bolstered by a $1.2 million deal in the enterprise hospital and healthcare system segment. We look forward to sharing more details on this contract in the very near future.

Operationally, we also had noteworthy high points during the quarter. Our Get Real Health digital front door solution had a successful go live in the ambulatory environment of Steward Medical Group. Steward is a domestic health system that includes over 450 clinics in 11 states. We're also currently on schedule to roll out our solution to their more than 30 acute care facilities in the first half of the fourth quarter. This implementation showcases our ability to deliver virtual visits, self-registration, appointment scheduling, price transparency and bill pay, patient-provider communications, accessible care records for the patient and their loved ones, and several additional facets of a complete digital front door solution.

While Get Real Health has previously had significant success internationally, this domestic installation creates opportunity for us to go after similar prospects in the U.S., and we are in the process of enabling our sales staff to do just that. Specific to our revenue cycle management and medical record coding services, our hospital and post-acute customers are under considerable pressure from the labor shortage and the rising cost for these skills. While we're not immune to the same challenges, our scale, financial strength, partnerships, leverage of AI, and access to onshore and offshore markets allow us to meet the needs of our client in often compressed time frames. During the quarter, we significantly increased our internal and offshore resources and therefore decreased the lag time from contract execution to service go live.

This investment will enable us to better meet our customers' short and long-term needs as the labor crisis likely continues for the foreseeable future. As stated in previous calls, our existing customer bases have over $400 million of TruBridge revenue opportunity. As such, our ability to satisfy and retain is paramount to our continued growth. The continued adoption of our new cloud-based applications will be central to the success of our retention efforts. With that said, we're very pleased that we are above our goal for both Evident and TruBridge related to retention. I would like to spend some time each quarter on these calls to provide context, updates, and performance against CPSI's strategic vision.

For our next call in early November, I will have completed my first 100 days as CEO, and I look forward to sharing more details and updates to our long-term vision at that time. However, I will call out three important items that are already in focus. First is to identify opportunities for revenue growth acceleration through calculated internal investment in existing products and services and thoughtful M&A. Second, and of course, complementary to the first, is to thoroughly and regularly evaluate our capital allocation strategy to ensure that we fully take advantage of our strong balance sheet and cash flows in order to provide maximum shareholder return. Finally, to aggressively accelerate the work already in progress to build and maintain an always evolving culture of innovation and digital transformation at CPSI.

After 22 years of working at CPSI in various positions, my first month as CEO has been indescribably challenging, rewarding, and enjoyable. In meetings with leaders of our hospital and post-acute customers, it's clear they continue to work daily in the stress of endless regulatory, economic, and competitive pressures, and that they need a partner that can provide a platform of services and solutions for their operations, clinicians, and patients, so that they can solely focus on providing the highest quality of patient care. We will be that partner. In face-to-face conversations across the country with the employees of CPSI, I've been consistently amazed at the talented team members I encounter and their determination to meet and exceed our customers' needs. We're going to invest substantially in our team, both existing and new, by creating and providing opportunities for continuous learning and personal growth.

Needless to say, I'm proud to be at the helm, and I will work enthusiastically alongside them to ensure that our customers and shareholders reap the rewards of our efforts. With that, I'll turn the call over to Matt.

Matt Chambless
CFO, CPSI

Thanks, Chris, and good afternoon, everyone. On today's call, I'll provide a high-level overview of the quarter, including some additional detail on bookings performance and a brief walk through our second quarter financial results. Our growth strategy centers on the harvesting of organic growth opportunities through continued TruBridge expansion, further expanding scale and deepening our offering set through disciplined acquisitions, and enhancing revenue and cash flow stability by embracing the transition to SaaS for our EHR customers. Successful across-the-board execution on all three of these fronts has driven total revenues and recurring revenues to never-before-seen levels for CPSI, while the second quarter's unprecedented TruBridge bookings and strong remaining pipeline indicate this record-setting pace isn't likely to slow anytime soon. While the story around our top line growth is straightforward, the method by which that growth converts to improved profitability metrics is a more nuanced discussion.

Year-over-year EBITDA expansion was constrained during the second quarter by three primary factors, license mix dynamics, intentional investments in sales and marketing efforts, and bad luck in terms of health claim severity. First, headwinds related to license mix materialized in the form of decreased non-recurring revenues as we continue to detach ourselves from these highly volatile, higher margin revenue sources. EHR non-recurring revenues were down $1.4 million from the second quarter of 2021. Second, the past quarter saw significant expansion in our sales and marketing costs, increasing $2.4 million from the second quarter of 2021, excluding the impact of M&A. This includes almost $1 million related to our national client conference held in person this year for the first time since the onset of the pandemic.

This increased investment is necessary to capitalize on the TruBridge growth opportunity and to maintain our recent momentum in bookings. Lastly, the past quarter saw a severe uptick in high-cost employee health claims, causing total health claims costs to nearly double, increasing $2 million from the second quarter of 2021, excluding the impact of M&A. There's no discernible trend or pattern in this flood of high-cost claimants, and we don't expect this level of cost on a normalized go-forward basis. Looking forward on each of these three distinct headwinds, EHR license mix pressures should naturally ease as 2022 comes to a close. Sales and marketing costs should normalize from seasonally high levels in the past quarter, and we don't reasonably expect health claims to continue at this elevated level going forward.

Pairing our impressive top-line gains with near-term normalization for these cost items, we're well positioned for future growth in adjusted EBITDA. Specifically for the third quarter, we expect to see continued momentum in revenue growth that will translate into EBITDA gains. However, EBITDA expansion will be limited as that revenue growth is expected to come from lower margin service revenues. Although we expect some SG&A costs to alleviate in the third quarter, current expectations around product development labor capitalization will offset much of the reduced SG&A costs. Moving on to the past quarter's results, 88% of the revenue growth over the second quarter of 2021 came from our recent acquisitions of TruCode and HRG. Consolidated adjusted EBITDA decreased to $1.1 million over the same time frame, despite TruCode and HRG contributing a combined $2.8 million increase in adjusted EBITDA.

The second quarter was the first period to include a full quarter's activity from our recent acquisition of HRG, which closed on March 1st of this year. Revenues for HRG totaled $10.8 million for the quarter and $14.6 million since the date of acquisition in early March, with adjusted EBITDA of $1.8 million for the quarter and $2.4 million for the year-to-date. On a pro forma basis, year-to-date revenues of nearly $21 million and adjusted EBITDA of $3 million have HRG outperforming our initial expectations of $40 million of annual revenue and $5.2 million of annual adjusted EBITDA stated in our initial announcement release.

Synergies are also ahead of pace as we've now identified total annual run rate cost synergies of more than $3 million compared to our initial expectations of $2.6 million. Although we'd actioned more than half of those items by the end of the second quarter, we estimate the total expense impact of the second quarter to be less than $300,000. Revenues for TruCode, acquired in May 2021, totaled $3.3 million for the quarter and $6.7 million year-to-date, absent purchase accounting adjustments, converting to adjusted EBITDA of $1.6 million for the quarter and $3.5 million year-to-date. Comparatively, TruCode contributed just $1.6 million of revenues and $0.6 million of adjusted EBITDA to both the quarterly and year-to-date results from a year ago.

Expanding on Chris's earlier comments on bookings, the second quarter saw the continuation of the first quarter's momentum as record TruBridge performance drove total bookings to increase $3.4 million or 17% sequentially, and $7.2 million or 44% above the second quarter of 2021. Specific to TruBridge, bookings increased sequentially by $5.4 million or 53%, propelled by strong cross-sell performance and large client win for TruCode's encoder product. TruCode wins are particularly gratifying as this quarter's bookings, once at full run rate, represent a more than 20% increase in revenues with 50% EBITDA margins. Compared to the second quarter of 2021, elevated cross-sell and TruCode bookings were met with considerable growth in bookings from outside of our EHR base, a target cohort we label as TruBridge's net new market.

TruBridge net new bookings increased to $3.4 million to more than 4 x the same number from a year ago, as the addition of HRG has added considerable talent to our TruBridge sales force. System sales and support bookings decreased $2 million both sequentially and from the second quarter of 2021. The net new decision environment continues to be dominated by SaaS license models, with the second quarter marking the sixth consecutive quarter with a 100% SaaS mix for new hospital EHR contract signings. Turning to the financials, HRG's $10.8 million dollar revenue contribution drove the second quarter to record levels of total and recurring revenues, both increasing 6% sequentially and 21% from the second quarter of 2021.

Organic total revenue growth was 2.5% from the second quarter of 2021, while organic recurring revenue growth was 5% over the same stretch. Recurring revenues made up 92% of total revenues during the past quarter. These top-line improvements were met with the three distinct headwinds that I discussed earlier, resulting in adjusted EBITDA declines of $3 million or 18% sequentially and $1.1 million, or 8% from the second quarter of last year. Non-GAAP net income decreased $3 million or 26% sequentially and $2.2 million or 21% from the second quarter of last year, as increased interest expense and effective tax rates further widened the profitability gaps.

Looking deeper at our segments, TruBridge revenues increased 13% sequentially as the inclusion of a full quarter of HRG activity added an incremental $7 million to the top line. Our TruBridge reported amounts include revenues from our Get Real Health and TruCode subsidiaries, and we cautioned on last quarter's earnings call that license timing would cause a slight pullback in both of these high-margin businesses. Combined, Get Real Health and TruCode revenue decreased by $900,000 or 16% from the first quarter. We also cautioned on the last call that hospital patient volumes, which are the primary driver of TruBridge revenues, were likely to pull back from their first quarter record levels. These same-store declines caused revenues from outside of HRG, Get Real Health, and TruCode to decrease by $600,000 or 2%.

Compared to the second quarter of 2021, TruBridge revenues increased by 49% on the backs of the TruCode and HRG acquisitions. Organically, TruBridge revenues grew by 11% over the second quarter of 2021. From a gross margin perspective, the injection of HRG revenues tilted the revenue mix more towards lower margin, service-intensive revenue streams, driving gross margins to decrease to 46% during the past quarter, compared to 50% during the first quarter and 47% during the second quarter of 2021. Next, system sales and support revenues were down 2% sequentially due to continued retention challenges in our post-acute segment. Compared to the second quarter of 2021, revenues decreased $1.8 million or 5% as we continue to advance recurring revenue models in new EHR arrangements, placing significant pressure on non-recurring revenues.

Declining revenues resulted in gross margins decreasing to 50% during the second quarter of 2022, compared to 52% in the previous quarter and 51.5% during the second quarter of 2021. Moving on to operating expenses. Product development costs were flat sequentially, while increased costs associated with our public cloud strategy drove a $600,000 or 10% increase over the second quarter of 2021. Sales and marketing costs increased $1.2 million or 17% sequentially as the resumption of our in-person national client conference introduced nearly $1 million of incremental costs. Compared to the second quarter of 2021, sales and marketing costs increased $2.9 million or 55% as resource expansion and other intentional investments in future growth added to the incremental client conference costs.

General and administrative costs increased $1.7 million from the first quarter, driven mostly by volatility in health claims. Health claims were also the primary culprit in the $3.8 million increase over the second quarter of 2021, with the addition of HRG and other resource expansion causing further G&A burden. Closing out the income statement, our effective tax rate for the quarter increased to 20% compared to 14% in both the first quarter of 2022 and the second quarter of 2021. We continue to expect a full year effective tax rate of around 18%. From a cash flow standpoint, operating cash flows of $7.3 million were down $4.5 million sequentially as net income decreased $5 million.

We're down $12.1 million from the second quarter of 2021's record levels as net receivables expanded $6.3 million, due mostly to one-time integration disruptions, while net receivables contracted by $5.6 million during the second quarter of 2021. This integration driven receivables expansion drove trailing twelve-month operating cash flows as a percentage of adjusted EBITDA to decrease to 60% as of June 30th, 2022, compared to 80% at the end of the first quarter. As the past quarter's temporary disruptions are behind us, we expect that conversion rate to increase going forward.

In conjunction with last quarter's earnings release, we also announced the refinancing of our credit facilities, with the major changes being a $50 million increase in revolver capacity, a step-up in max leverage following an acquisition, transition to SOFR as the benchmark rate, and tweaks to the credit agreement's EBITDA measure to better align with how we report adjusted EBITDA to the investing community. These adjustments were in furtherance of our capital allocation strategy, which prioritizes flexibility to have CPSI optimally positioned to opportunistically deploy capital through a combination of M&A, internal reinvestment, and value-based share repurchases. Our recent acquisitions of TruCode and HRG bring pro forma leverage to roughly 2.1 x EBITDA, well below our target of 2.5 x, ensuring that we remain well-positioned to respond quickly to other opportunities that may arise.

We continue to groom our pipeline of potential M&A opportunities that fit our programmatic M&A strategy and feel there's tremendous opportunity to enhance and supplement TruBridge service offerings with reasonably valued roll-ups and tuck-ins. Our largest non-operating uses of capital during the second quarter were internal reinvestments in the form of capitalized software development costs of $4.4 million and $2.6 million of share repurchases. Nearly all of the quarter's share repurchases took place in the final month of the quarter, resulting in minimal impact to our weighted average shares outstanding and related EPS metrics for the quarter.

We'd like to remind investors that the cadence and volume of our repurchases have been and will continue to be influenced by a number of factors, certainly considering value, but also considering capital needs and availability, potential M&A, cost of replacement capital, and other capital allocation alternatives. These alternatives and priorities in capital allocation are ever evolving, so the level of repurchase activity in a given quarter may not reflect our views on the intrinsic value of our stock. To close things out, we're proud of our top-line successes of late and the resiliency of our business to absorb headwinds and achieve strong bottom-line metrics. As we continue to execute on our strategy for top line growth and amplify efficiency through increased automation and offshoring, our view on CPSI's long-term margin trajectory is up and to the right.

With that, we'd like to open the line up for questions.

Operator

Thank you. Ladies and gentlemen, at this time, we will be conducting a question-and-answer session. If you'd like to ask a question, you may press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star key. Our first question comes from the line of Jeff Garro with Piper Sandler. Please proceed with your question.

Jeff Garro
Senior Equity Research Analyst, Piper Sandler

Yeah, good afternoon. Thanks for taking the question. I wanna ask about the drivers of booking success in the TruBridge part of the business. Just curious whether it's a catch-up in decision-making, benefits of the combination with HRG, you know, maybe related to the labor environment, or is there some other key factor that's driving the success there?

David Dye
COO, CPSI

Hey, good afternoon, Jeff. David here. I would say, it's more the latter two. Certainly, Matt mentioned this in his commentary. Certainly it's the acquisition of HRG. We've got some sales talent that came from that, and they were already doing and they continue to do a really good job closing deals, in particular in the enterprise space, which is the larger hospitals and health systems, which we didn't really have a great market into before, and it's much improved with the acquisition of HRG.

It's certainly the fact that there's labor challenges in both the small and community hospital environment and in the larger hospitals and health systems as well. You know, they're calling us on, you know, oftentimes and saying, "Hey, can we have somebody begin with some coding? And we just lost two coders in the next 15 or 30 days," and we're able to meet those needs.

Jeff Garro
Senior Equity Research Analyst, Piper Sandler

Great. That's super helpful. Maybe move on to touch on the three focus items that Chris mentioned and maybe an inference on those. It sounds a little bit like, you know, a greater focus on growth than margin expansion. Curious if you had any thoughts on areas that will need continued investment to capture more of the exciting growth opportunities ahead.

Chris Fowler
President and CEO, CPSI

Yeah. I think that really feeds into the first question, Jeff, as it relates to, you know, the continued interest in the TruBridge services based on, you know, where the market is right now. Obviously, we have been talking over the last several quarters about our initiatives related to offshoring and automation. Those are obviously the two big levers for us to pull to continue to expand margins on the TruBridge side. Right now, we're laser-focused on making sure that we have the capacity to meet the needs, knowing full well that as we continue to execute on the cost-saving side, that we'll balance that out down the road.

You know, to that point, we wanna make sure that we're in a position to serve the customers, and then we'll continue to be focused on the automation and the offshoring.

Jeff Garro
Senior Equity Research Analyst, Piper Sandler

Got it. Makes sense. I'll hop back in the queue.

Chris Fowler
President and CEO, CPSI

Thank you.

Operator

Our next question comes from the line of George Hill with Deutsche Bank. Please proceed with your question.

George Hill
Managing Director and Equity Research Analyst, Deutsche Bank

Yeah, good afternoon, guys. Thanks for taking the question, and I'll say, Chris, congrats on the first 30 days. I guess my first question, Chris, is, you and I guess, talked about kind of an extensive M&A pipeline. I'd be interested if you could talk about kind of which functional segments do you guys think are the most attractive right now, particularly as it relates to servicing the clients that you guys already have from a cross-sell perspective. Then as it relates to the margin weakness, I guess, can you talk about how long you expect the kind of a negative mix trends to persist?

Chris Fowler
President and CEO, CPSI

Yeah. I'll take the first one, then I'll let Matt jump in, and get in the ring with us on the margin side. You know, as we think about the M&A, just look back at the last three deals with Get Real Health, TruCode, and HRG, it got a little bit of everything there. If we focus on the last two, and I think we maybe touched on this the last call, the TruCode really points to a nice opportunity for us to cross-sell into our customer base with dollars that they're already spending somewhere else.

It's not that we're introducing something new necessarily, versus that we have found an opportunity for us to provide a service or solution to them more efficiently, through our ability to bring that in. Secondly, with the HRG side, obviously that was a consolidation play, you know, as the services that HRG provided very much overlap with what we do on the TruBridge side. You know, I would say right now, if we're leaning one way or the other, we're probably leaning on that consolidation side.

At the same time, you know, what we've seen with TruCode and the success, the early success in the first year we've seen there, obviously wanna keep our eyes open as we continue to evaluate where those additional drivers are for efficiencies or, you know, potential revenue increase opportunities for our customers that they're not realizing right now. That's really where I would say we're, you know, duly focused on the M&A side. I'll let Matt take the margin question.

Matt Chambless
CFO, CPSI

Yeah. George, you know, we think that the second quarter of this year was really kind of the final time that the HRG related pressure on margins was gonna come through. When we think about it, kind of take a step back, the margin pressure from HRG was really primarily on the gross margin side. When we look at the bottom line, the EBITDA margin impact, you know, we stated in the opening commentary that HRG on about $11 million of revenue did almost $2 million of EBITDA. That's a pretty healthy, you know, margin through to EBITDA. We don't see that really being a drag on EBITDA margins, or at least not that much of a drag going forward.

You know, what really happened to us here in the past quarter were some, you know, more either some anomalies or some intentional investments in places like sales and marketing. You know, the sales and marketing stuff is a little bit more of intentional spend on our end to try to pull forward growth, you know, that we think is reasonably there for TruBridge. Then, you know, just part of doing business and being self-insured on the health insurance side of things, you know, they just kind of claims volatility can bite you from time to time.

Chris Fowler
President and CEO, CPSI

Yeah. I'll add. Sorry, George. I have one more thing going back to the margin opportunity, especially on the gross margin side with HRG specifically. You know, just to remind everybody, while we're still, you know, getting started on the automation and offshoring, HRG was doing none of that. The opportunity, you know, where we're, you know, let's say we're rounding first, headed to second, they were still at home plate. There'll be a bit of a lag there, but we think the upside is pretty good.

Matt Chambless
CFO, CPSI

Yeah. There should be more upside on the HRG EBITDA margin, particularly as we look forward and we capture more of those synergy opportunities actually in the P&L. You know, we mentioned in prepared remarks that, you know, we've kind of upped our estimate of what the potential synergies are from $2.6 million to $3 million. We've decisioned roughly half of those items as of 6/30, but the timing of vendor contract renewals and things like that means that the P&L impact to the second quarter was limited to, you know, somewhere around $300,000. There's a lot of upside there.

George Hill
Managing Director and Equity Research Analyst, Deutsche Bank

Okay. Maybe just a really quick follow-up is like, kind of the benefits issue just sounds like some kind of some real adverse selection on your guys' part, I guess. Do you guys have any visibility to when that sunsets? I guess the flip side question is, would you guys even like, does it even make sense to buy risk on the benefits side given that you guys are a public company, or is that just something you wouldn't even consider?

Matt Chambless
CFO, CPSI

Yeah. Well, first I'll cover the, you know, self-insured versus, you know, being more fully insured on the health benefit side. You know, given our scale, you know, when we look at the long term, and long term is kind of the view that we have, the prospects of fully ensuring that health claims risk really just doesn't make sense long-term financially. That does subject us to some short-term volatility. You know, and although it's unfortunate for the participants in our health plan that were impacted by these incidents, when we take a look at them, we do have visibility, and these were fairly acute diagnosis that caused this kind of uptick, and it really was just kind of a rash of bad luck. These things do happen from time to time.

The encouraging thing for us from a financial standpoint is none of these claims really appear to have, you know, kind of a long lingering kind of maintenance tail associated with them. We do think that these were kind of a one-time bump in the road.

George Hill
Managing Director and Equity Research Analyst, Deutsche Bank

Okay. Thanks for the call, and I say, hope your teammates are well. Thank you.

Matt Chambless
CFO, CPSI

Thanks, George.

Operator

Our next question comes from the line of Joy Zhang, SVB Securities. Please proceed with your question.

Joy Zhang
VP of Equity Research, SVB Securities

Hi, guys. Thanks for taking my question, and, congrats, on, Chris, again, for your first 30 days. Just following up on the TruBridge bookings question, I'm hoping for more granularity on the composition of the new wins. You mentioned in the prepared remarks there was one enterprise deal, but wondering if you're also seeing an increase in average deal size across the new wins at all, or is that more of a one-off? And any color on how much the new wins is from existing major customers versus new customers should be helpful.

Matt Chambless
CFO, CPSI

Joy, one of the tables that we provide in the earnings release kind of shows the breakout of the of bookings composition, you know, how much was kind of core TruBridge cross-sell versus net new. I believe the enterprise deal that Chris mentioned was on the TruCode side. And again, that's a place where, you know, I particularly get really excited about those bookings because of the margin pull through. You know, $2 million worth of bookings at 50% margins is, you know, that's great news for us.

Joy Zhang
VP of Equity Research, SVB Securities

Got it. That's helpful. I guess, not to be a bummer, but a recession is on the top of mind of a lot of folks, and I recognize that the last recession is kind of impossible comp given the federal safety net that is meaningfully used. With that in mind, what is the incremental downside to your business if we slip into a full-fledged recession?

Matt Chambless
CFO, CPSI

You wanna start on the credit side? Yeah. You know, we'll start with that, you know, taking a look at, you know, capital structure and, you know, the potential there that does impact our thoughts on what our long-term interest rate risks are and what the potential is for, you know, rates to actually settle down from where they are right now. I wouldn't say that it injects more risk on the capital structure side of things just a little bit. It makes things a little bit hairier for us to navigate through as we think about that risk. You know, I'll let David and Chris chime in on what they think operationally.

Chris Fowler
President and CEO, CPSI

Yeah. I'll jump in here, Joy. I would say, you know, in a worst case, you know, as we continue to see TruBridge take more and more of the revenue side of the house, and obviously that's contingent on the volumes that our hospitals are seeing. You could see something that would look sort of similar to COVID, where from a elective services would be the area where I would think that we have the biggest opportunity to see some hit. You know, again, that could also be something that there could be some short-term win to that. You know, you could look at our claims history over the last quarter that people are hurrying up to get the elective services done.

There might be an up and then a down, as it relates to that. You know, we don't have a crystal ball, just like, you know, nobody else does. I would say operationally, that would be the biggest risk to the business. We'll just kinda wait and see.

Joy Zhang
VP of Equity Research, SVB Securities

Super helpful. Thank you.

Operator

There are no further questions in the queue. I'd like to hand the call back to management for closing remarks.

Chris Fowler
President and CEO, CPSI

Yep. Thanks, Doug. Thanks everybody for joining us today. Hope you have a wonderful rest of your Tuesday and a good rest of your week. Thank you all. Bye-bye.

Operator

Ladies and gentlemen, this does conclude today's teleconference. Thank you for your participation. You may disconnect your lines at this time, and have a wonderful day.

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