All right, great. Well, first off, thank you everyone for joining us today. My name's Joe Noyons. I'm with Three Part Advisors. Up next, we have one of our investor relations clients, U.S. Physical Therapy, which is traded under the symbol USPH on the New York Stock Exchange. USPH has several growth drivers in place, but one that's particularly interesting is our new hospital alliances initiative. That's been worked on this year. I think it's going to meaningfully increase patient volumes and expand margins as we go forward. Presenting on behalf of the company is the Chief Executive Officer, Chris Reading. Chris?
Thanks, Joe. Morning, everyone. Again, my name's Chris Reading. I serve as Chairman and CEO. I've been with the company now 23 years. My background is, one, as a clinician. I had a long career in sports medicine, orthopedic rehabilitation before I got to the company in 2003 as Chief Operating Officer and took over in 2004. We operate around the country in 45 states, just under 800 locations. We're largely orthopedic in nature, musculoskeletal broadly, sprains, strains, fractures, dislocations, post-surgical, anything musculoskeletal, joint replacements, etc . We have a diversified payer mix. Only about a third of our business is Medicare. We're in a, what you would consider a fragmented market from a competitive standpoint. Favorable growth dynamics across the sector. My team has been with me, most of them, several decades. We have a great group of people. We have a great reputation in the market.
Our model is a little bit different than everyone else's. We do have large competitors. They're largely PE-backed, wholly owned entities. We're a group of partnerships, so across our 800 locations, we have about 120 partnerships. Our partnerships range in size from about 80 locations at our largest down to as small as just a few. Our partners have an equity interest in the business along with us. When we buy into an entity, like one that we just recently did just a month or so ago, 10 or 12 clinics in the middle part of the country. Our partners kept a 35% equity interest in that business. We have the balance. We're the managing partner. But our partners run day-to-day operations locally, and we give them ground-up support for all the many things that need to happen to run a healthcare business today.
That's what the footprint looks like across the country. Joe talked about our hospital business, which we're going to spend some time at. We recently entered New York a little more than a year ago, and we have now one of our exciting large partnerships with NYU Langone in New York. We're based in Texas, where I live. I used to work in Virginia, which has become a big state, but we're around the country. We're a few places we're not. California. You'll note a few other places. Usually, that's a combination of reimbursement and regulatory burden in one way, shape, or form. This is a big market. It's a really big market. It's highly fragmented. Most of the people that we compete with, most of the other entities are mom and pop, one to three clinic entities.
There are tens of thousands of those across the country, which make for an interesting backdrop to grow, both on a competitive front and through acquisition. We typically open 25- 30 organic openings a year, and then we may buy anywhere from 30- 70 clinics a year through structured acquisitions where we're paying single digit multiple on trailing 12 months actual EBITDA, not pro forma adjusted forward, made-up EBITDA. It's actual EBITDA. Our partners, one of the other ways that we're different is we distribute cash in our partnership every month. Like clockwork, at a certain day every month, everything that's in the bank gets recorded, and we reconcile everything, and then we distribute to us and to our partner available cash. Every other competitive entity that we deal with, particularly the private equity-backed entities, are so leveraged that there's no equity distributions.
When we're competing with a PE group for an acquisition, it's really a night and day difference in terms of what they get with us, which is a massive amount of embedded support that's been there for more than three decades. Cash flow on a regular basis within the entity that they keep an ownership interest in, and a guaranteed exit at a point of their choosing when they leave the business at the then updated EBITDA on the business times the multiple that we paid up front. Our partners typically stay with us for decades, and that stability gives us the ability to push off and to grow and to scale these businesses. Most people understand that physical therapy is a value driver in the system. We get people out of the hospital, we get people better quicker from surgery with less complications.
We avoid a lot of surgeries in many cases, or unnecessary imaging or other things. Again, it's a value driver. We've talked about the competitive landscape. When we buy into an entity, we help them grow through a number of different ways. Typically, I have a very seasoned commercial contracting team, so our contracts are typically better than what somebody can obtain on their own by themselves in the local market, our payer contracts. We help them add programs and services. We help them open new clinics. We have both resources, technology, and infrastructure designed to help with that. The last thing on here, which is a newer thing, is we help create arrangements, alliances, quasi-partnerships with hospital entities like we have with NYU and with another hospital on the Gulf Coast and with others that we're working on currently. Our partners don't leave.
They stay with us until they retire. We're a very clinician-centric, we're a very patient-centric company. We're here to change lives and impact lives in a meaningful way. We've talked about some of the early differentiators in our company. We cash flow really well. Again, that gives us the ability to make good choices and keep our partners happy and grow and invest and do the things we need to do. These are just some, a list of many of the things that we do for our partners. The way to really think about this is, you guys, if you've either invested or participated in the healthcare system in some way, either as a patient or an investor, you know the complexities around running a healthcare company.
A lot of things have regulatory burden, or associated complexities that clinical folks, doctors, physical therapists, other clinical type people, they're not trained on necessarily. Think of it this way: the care occurs locally. Everything else that is needed to run that business, we do centrally, and then we oversee all of it, because we're very, very familiar with everything from the care to all these other back office things. What that does is that helps free our partner up and gives them more time to focus on growth, and local mentoring of their team, which enables us to grow people up, to open new clinics and to tuck in acquisitions and to do hospital relationships like the ones that we're going to talk about a little bit. When I had gotten with the company, the company had never done an acquisition. It grew only organically.
The leadership and ownership there didn't believe acquisitions could work. I happened to come from HealthSouth, and so we did lots of acquisitions and were successful with that, even with a slightly different model that wasn't quite as attractive at the time. This model, very attractive. We began to do acquisitions the year that I took over. We've done a little more than 50 now. They've ranged in size from small clinics to very significant acquisitions like the one that we recently did in New York, which now 60 clinics and partnered with NYU Langone . They're all very accretive. They're mostly single-digit multiples. The blended average over time on the multiple, probably across these 50, is somewhere in the seven something range. We trade at significantly more than that. Our partners stay with us, like I said, for decades.
One of the other unique elements of our company is U.S. Physical Therapy, which is a brand that I'm proud of. It's really a public company brand. Locally, we operate under identifiable local brands in these markets. When we acquire a company like the ones that we recently did in Nebraska, we keep their brand, we grow with that brand. U.S. Physical Therapy, become part of the brand. It's not disruptive. We don't lose any people in these transactions, so they're not wildly synergized. In fact, we look to keep everybody intact. It's much more stable. Gives us the ability to push off and begin to grow. Billing collections continues to happen, for the most part, within these brands, unless there's an issue. Sometimes there is.
We have some central billing that we have around the country, regionalized and in Houston, where we can insource things, or we can bring things in over time. That's grown over time. Many of these large partnerships have billing collections within their entities, which we oversee as well. These are pretty common sense things that we bring and create a case for why consolidation makes sense. Again, our revenue mix, about a third of it's federal, most of it's commercial, 10%± is workers' compensation, which is a really good payer for us. Very little is self-pay, and that is not no pay, but true self-pay. Our blended average net reimbursement is just a little under $110 a visit, $107.59, I think, last quarter, and growing. Our visits per clinic per day have grown sequentially over the last 24 months.
I think we're 14 of the last 16 quarters that that's grown, and it's grown on a year-to-year basis, really for the last 23 years. We think we can continue to grow the business and get busier at the same time. Again, this is kind of a standard slide. Clinic growth, visits per clinic per day growth, and visits over time. We have a little bit of a quarterly seasonal progression. First quarter, winter quarter for us, weather, little bit slower, new patient deductibles which have only a temporary impact. Everybody thinks they're not going to use healthcare in the coming year, and then they do, and that kind of goes down out the window pretty quickly. Q2 is usually one of our busiest quarters. Spring comes, people get busy, get outside, get hurt, begin to do things that they haven't done through the winter.
Summer slows down just a little bit for us. People go on vacation and spend time with their families. Kids are out of school. Then football season starts at the end of summer, and we get really busy again. We're busy right through the end of the year. Margins. Beginning in 2020, really with the advent of COVID, but unrelated to COVID, we're part of what's called the Physician Fee Schedule, and this is in reference to Medicare. Within the Physician Fee Schedule, all the other physician types are in there. Think of it as a pie. The way that legislatively things work is that pie has to be budget neutral, and if they give to one group, they have to take from another group.
Back in 2020, there was a big push to pay primary care doctors more in MedPAC, which is the advisory group that advises CMS on payment policy. MedPAC theorized, I think correctly, application was incorrect, but the theory was correct that if they were going to pay the lower reimbursing doctors more to elevate them, they probably needed to take from the guys at the top of the food chain. Those were identified as orthopedic surgeons, interventional pain medicine specialists, and physical medicine rehab docs who do a lot of high-end expensive procedures. These docs are at the highest income level. They said, "Let's take from that group." They did. What they didn't realize, and they didn't even understand at all, was that our physical therapy codes were interspersed among those three other musculoskeletal group codes.
We got hit with what was going to be an 11.5% reduction, which was parceled out over a period of the last few years, which created a bit of a headwind for us, pinched our margins a little bit, in addition to just general inflation. We're coming through that finally. We've got an increase this year. We've got a proposed increase next year, and then we've got a multi-year increase that's expected, correcting some of the mistakes that have been made over the prior years, beginning 2028. We're a little beat up from a. If you've followed our stock at all, most of my career on a multiple of EBITDA, we've been in the north of 20x range. We're probably 14x right now. Stock isn't where we'd like it to be, but we've got some really good things on the forefront in terms of growth.
We'll talk about the hospital thing here in a minute. The other part of our business is the injury prevention business. I started this in 2017. Again, significant part of my background was taking care of injured athletes and taking care of teams. I worked with the Redskins. I took care of all the athletes at the University of Richmond for a number of years as they re-juggled their staff. Lots of high schools. My team took care of the Wizards and the Capitals. I lived in Virginia then. When you take care of a team, you're not just there to wait until somebody gets hurt. You're there to keep the guys either on the floor or on the field healthy and playing.
We took that experience, and we found a very small company based in Denver with some really good people who had started doing the same thing within heavy industry, a company called Briotix. I love their CEO and their COO, really good people. They were looking for an investor at that point in time to help them to grow. They were really small. We believed in the people, and we believed we could help them scale that business. Over time, that's gone from an infinitesimally small business to about $120 million in revenue, a little over $20 million in EBITDA. That continues to grow at an outsized rate. It's now about 15% of our revenue. We're embedded in the nation's largest companies. Almost every large auto manufacturer, we're embedded in at least some of their plants, the exception being GM.
We're in Toyota, we're in Nissan, we're in some of the newer electric car companies, we're in Volkswagen, we're in a lot of different companies. We're in 600 and some and growing Costco warehouses around the country, where we round weekly. We see their high-risk areas. We connect with their employees, separate from management, and just help keep them, from a musculoskeletal standpoint, healthy and working. Doesn't matter to us whether they pulled a hamstring rounding third base at a Sunday church league softball game, or they bent over and they did something at work. We're there to help them be successful and healthy in their work. Those relationships are very long-lived. They're sticky. They grow over time.
We've added companies to this division, a number of companies over the years that have broadened the type of companies we serve and broadened our service offering as well, and it's a significant part of what we do. Margins are very good. We report margins a little bit differently here. Our margins in the injury prevention business really double the margins in the PT business. We report margins on a fully corporate loaded basis in injury prevention. It's just how we did it at the beginning. Growth has been significant over time. We've got a great balance sheet. We redid our banking agreement last year. We now have plenty of access to dry powder. We have about, in total, 200 and, I think last report was $220 million in debt, against an expected EBITDA this year that's north of $100 million. So a good balance sheet overall.
A capital allocation, uniquely as a small healthcare company, we began paying a dividend, I believe it was 2012. So we pay a pretty healthy quarterly dividend, in addition to being able to have enough capital and cash available to grow organically and through acquisitions. We also did a share repurchase, largely in Q1. Given the position of our stock price, we had about a $25 million board authorization. We used that mostly, a little bit in the fourth quarter, very slightly. We were to buy in at $62, $63 a share. We used that whole authorization and got that done in Q1.
We talked about the team. Got a new CFO that will start next week, who comes with a great background, including as a global CFO in one of their healthcare divisions at J&J, and a lot of really good experience, and he will be a great addition to a really solid team. Talk a little bit about our hospital initiative. We started this about a year ago. I got, frankly, tired of meeting with insurance companies who were paying hospitals three to six times what they are paying outpatient providers for theoretically the same physical therapy service delivered in a much less conducive environment to produce the outcomes that we are able to get in a much, much better environment.
And over the course of, for me, 41 years, meeting year after year with insurance executives saying, "Pay us just a little bit more and save yourself anywhere from $180- $300 a visit by moving this business from the hospital to us as an outpatient provider," and getting only apathy and yawns back, decided maybe it is time to join the guys that have it figured out. So earlier this year, we announced a 10-year relationship with NYU Langone. We had just acquired a very significant footprint of facilities, at that time, 40 something, now 60 locations on Long Island and New York. As of this most recent month, we now have all of those facilities rolled under NYU Langone's ambulatory network, which benefits from their contracts. We have long-term agreements in place which give us significant reimbursement lift, give us protection against escalation of employee cost.
We get reimbursed dollar- for- dollar for all of our clinical employees in that arrangement. It is exclusive. They cannot do it with anybody else, and all of our growth will be with them through the next decade plus. They are extremely excited about it. We are very excited about it. It is immediately very impactful to us from a profit standpoint. It does not inhibit our growth.
In fact, it accentuates our growth. They sent five times as many referrals out last year to the wind because they really do not have an outpatient network at all. They did not before they did this with us. They sent five times as many referrals out as we did in the entirety of last year across our network. So we grew our visits last year without NYU by 120,000 in New York. I think we will grow even greater with their support. That is the expectation.
The revenue lift is very significant. The support and the referral opportunity is significant. We've brought on a team of people to work on this around the country. We're working on similar arrangements in significantly penetrated markets where we have significant footprint already around the country, and it's going to be a very, very significant part of our growth as we go forward. Joe, I want to leave time for questions. I think we'll wrap there. Yes, sir, in the back.
With respect to this relationship with NYU Langone, they're able to bill at a higher rate? Is that understandable?
We're able to bill at their rate. These become their clinics, effectively. They're contracted facilities.
Are you revenue sharing them or how does it work then?
I wouldn't call it a revenue share, but we become a contracted provider. We use our people, our employees, our clinics, what were previously our clinics. They move under their network, get the benefit of their contracted rates, and they pay us a flat per visit rate for every patient, regardless of payer type. We actually get paid more than Medicare pays us, more than Medicare pays them, because Medicare pays everybody the same, site neutrality with Medicare. But the blended average for them is significant. The volume is significant. We'll do probably 700,000 visits this year, this next year, that they wouldn't have done otherwise. And those will all be profitable visits. Our Net Promoter Score's well north of 90. It's mid-90s, actually, and so really happy patients.
And right now only, I don't know what the exact number is, but I'm going to guess that it's less than 10% of our volume comes from NYU. We still get volume from the same places it came from before, but now we have NYU as a potential referral source, and they're very excited about the relationship, and we're excited about the growth opportunities that this affords us. Follow up?
Yeah. With respect to the acquisitions, so you're keeping the billing staff at the local acquisitions you're doing. So what do you bring to the table that helps those individual practices and groups to be more profitable? What is it that you add?
Yeah. So non-hospital related, because the hospitals, they take over the billing collections, and we lose that cost when we do one of these. But in a non-hospital affiliated facility where we have billing collections, maybe historically continuing as a result of an acquisition, we bring very significant experience. We bring new payer contracts. So just like the hospital is able to bring us a contract that gives us rate lift, we're able to bring these small practices contracts that give them rate lift. So that's part of it. Just technology and resources to be able to do things more efficiently so we can scale without having to throw bodies at things. A whole host of additional opportunities, and most importantly, maybe among all of them is we free up the owner's time who weren't probably as good at some of those things as we can be.
It frees up their time to focus on growth and where's the next opportunity and who can I buy in the market and how do I move things forward. That accelerates.
Are these actors that come with your ERP or are they working on some other ERP that they have locally?
Yeah. There's probably seven or eight ERPs, EMRs that run most of the physical therapy companies in the country. We're one of the largest. It's called Raintree. About half the time, they're already on Raintree, and so it's not a big deal, and about half the time, they're on one of the other ones that we're very familiar with. Right out of the gate, we don't change anything. We connect, we backstop all the related pieces, parts that we need to do to make their situation cyber secure and locked down. Then we look to do an orderly transition sometime over the next year or so when things are settled, and people aren't anxious, and we're not forcing change right out of the gate.
Can you just talk about how much physical therapy happens at hospitals?
I wish I could tell you. There's not good macro statistics on it. Bain publishes some things from time to time. I would say in most markets from an outpatient perspective, and there are certainly unique markets, Houston's one of those markets where one of the hospital systems in Houston has a pretty good network of facilities. Most places, hospitals have pretty abysmal outpatient physical therapy network. Now they have to provide inpatient services too, which we don't do, but I can't give you a good stat on it. I'll give you an example. When we went to NYU, and NYU been a fantastic partner. They're extremely good at what they do. But we asked them, we said, "What's your physical therapy network look like?" And they said, "We'll have to get back to you." They weren't sure.
They got back to us in a week, and they said, "We think we have five clinics, and they're not profitable, and we don't even want to talk about them because they'll just slow you down, and you'll be frustrated." Most hospitals, physical therapy is like their 32nd thing to think about. They're not really focused on it. However, if we can bring them a full network of facilities, and the patients that they connect with, and the affinity that exists when a patient's at discharge, the affection they have for their therapist and the brand, it's a real difference-maker. You combine that with what the hospital gets from a reimbursement perspective, it's really significant. Other questions?
The hospital as a network, may be small, may be not very focused on, but they still get an inpatient rate even though it's an outpatient facility or?
It's not an inpatient rate. It's an outpatient rate. Look, this has existed my entire career this way where hospitals are able to command massively higher rates, again, other than from Medicare. It's been that way my whole career, 40+ years. We're now able to deliver to the hospital in these markets significant penetration to help them with their musculoskeletal issues. Keeps orthopedic docs happy and enables them to provide more services to large self-insured companies in their communities and allows them to take risks in some cases, certain musculoskeletal surgeries, joint replacements, and other things. Before, they weren't able to control that. It just kind of went wherever it went.
All right.
Sounds like we're good, Joe. Anything else?
If you have any questions, feel free to reach out to me or anyone on our conference team, and I can help you out. Thank you.
Thank you, guys.