Susan Nowakowski
Analyst · Susquehanna Financial
Thank you so much, Amy. Good afternoon, everyone, and welcome to AMN Healthcare’s 2011 Full Year and Fourth Quarter Earnings Conference Call.
2011 was a year of continued market recovery, solid execution, and further innovation in the Workforce Solutions that we provide to our clients. For the full year, we grew consolidated revenues by 11% and adjusted EBITDA by 40% on a pro forma basis. Adjusted EBITDA margin for the year was 7.2%, which was a 150 basis point improvement over 2010.
Our growth in operating leverage was driven by several key factors. First, the Travel Nurse division experienced full year pro forma revenue growth of 32% and adjusted EBITDA growth of 71%.
This impressive growth reflects the strength of our MSP client relationships, our recruitment strategies, and the ability to leverage our infrastructure. Of course, none of this is possible without maintaining a very keen focus on the quality of our healthcare professionals that we source and select for our clients.
A second factor was the revenue synergies we enjoyed from our combination with Medfinders, which enabled our team to significantly improve fill rates. Our more powerful integrated sales team led the industry in MSP growth, winning over 20 new MSP clients in 2011 with an estimated 80 million in annualized growth spend under management.
A third factor was the successful integration of the Nurse and Allied brands into 1 platform. This contributed to the improvement in operating margins in this segment of 220 basis points on a pro forma basis.
In addition to solid execution, we have further evolved our suite of Workforce Solutions to provide greater value to our healthcare clients. The pace of change has accelerated in healthcare. And hospital executives are increasingly seeking more sophisticated solutions and partners. The hunger for new and innovative solutions is stronger than we have ever seen. The rapid growth of MSP clients is the best example of this trend. We help these clients to gain more control, visibility, and consistency in the utilization of their clinical labor, while also improving quality and compliance.
Penetration of MSP is strongest is Nurse Staffing, but has also been growing in the Allied Healthcare business over the past year. During the fourth quarter, approximately 1/3 of our Nurse and Allied revenues were generated by MSP clients. This is a significant increase since 2009 when MSP revenues represented only 6% of our Nurse and Allied revenues.
Based on insights from clients, and what most believe to be a natural progression within the industry, we believe that there will be a similar shift towards MSP arrangements in the Locum Tenens market. All signs point to continued growth in MSP penetration. And as the most experienced provider in this phase, AMN is well positioned to capitalize on this trend.
Over the past year, we have also made further advancements in our Workforce Solutions through the growth of our RPO business and other Workforce-related consulting services. In addition, we also continued to grow our EMR staffing business. These consultative Workforce Solutions doubled in size in 2011 and they differentiate us with our clients.
Over the past 2 years, great progress has been made in shifting the perception of our services from what was once a necessary evil to being seen today as an effective way to manage workforce expenses. These higher margin businesses also help us to make progress towards our goal of returning to a 10% adjusted EBITDA margin in the next 3 to 5 years.
Now let’s turn to our current results. We are pleased to report consolidated fourth quarter revenues of $222 million, which was down 3% sequentially and up 8% year-over-year. This was at the upper end of our guidance of $219 to $223. These results exclude our Home Healthcare segment, which were considered discontinued operations.
Fourth quarter Nurse and Allied revenues were $148 million, which were flat sequentially and up 16% year-over-year. This growth was driven mainly by the Travel Nurse business where revenues were flat sequentially and up 26% year-over-year. While we hit our peak volumes for travel nursing in November, we typically see a softening over the holidays due to the fewer travelers on assignment and fewer hours being worked.
For the first quarter of 2012, travel nurse volume is expected to be up over 5% sequentially and in the mid-teens over prior year. The continued growth has been driven by the addition of more MSP clients, increased supply of candidates, improved fill rates, and strong re-book rates.
While volume is up in the fourth quarter, our current open orders are down slightly year-over-year, which we attribute to a weaker flu season and our improved fill rates. Over the past few weeks, we have seen an improvement in new orders and with the number of facilities that have orders open.
The leverage and efficiency inherent in our MSP delivery model has also contributed to our improvement in margins for this business. As an example, the Travel Nurse division fourth quarter operating margin improved by 400 basis points year-over-year, at the same time we continued to grow our MSP client base.
Fourth quarter Travel Nurse average bill rates were up 2% year-over-year. We expect this trend of modest bill rate improvement to continue throughout 2012. In fact, we are expecting the first quarter bill rate to move up closer to 3% year-over-year. However, we will pass along an appropriate amount of this increase as compensation so that we can ensure that we attract the best healthcare professionals for our clients.
We also anticipate continued upward pressure on temporary housing costs. So you should not expect gross margin expansion from these bill rate increases.
Fourth quarter revenues for local staffing were $24 million, which was up 1% sequentially and 2% year-over-year. Going into the first quarter, we expect revenues from local staffing to be down sequentially due to the seasonal flu clinic business that we experience in the fourth quarter and the lack of any meaningful flu driven census so far in 2012.
Year-over-year revenue growth in local staffing may be stagnant for few quarters as we recently underwent a strategic rationalization of our geographic footprint and we eliminated 8 underperforming offices. These offices were primarily in rural areas and generally had low profitability and less future potential to serve or grow our MSP clients.
Closing these offices will enable us to reallocate resources and better serve existing and future MSP clients in the larger metropolitan areas. As an example, we are in the process of opening a local office in New York City to serve a very large MSP client that we implemented in the fourth quarter, and to serve other clients in the area.
Fourth quarter Allied revenue was $30 million, which was down 3% sequentially and up 2% year-over-year. This sequential decline was due to normal seasonality as clients operate at reduced service levels during the holidays.
Going into the first quarter, we expect a modest sequential improvement driven by volume growth in our therapy business. Although there are certainly some head winds in reimbursement rates for skilled nursing clients, we continue to experience strong demand for therapist overall and we’re focused on growing our therapy supply. We have also experienced recent improvement in our margins, our fill rates, and our re-book rates. Today, approximately 2/3 of our allied business is in the therapy disciplines. And the remainder is in imaging, respiratory, and lab techs.
In our Locum Tenens segment, fourth quarter revenues were $65 million, down 10% sequentially and 7% year-over-year. Although most of this sequential decline was due to normal seasonality, there was also the continued market-driven impact of volume decreases in radiology, surgery, and anesthesia.
Our government division, which supplies all specialties, also experienced greater softness due to funding delays and budget constraints.
Going into the first quarter, overall Lcoums revenues are expected to be relatively flat.
This week, Sean Ebner joined AMN as the new president of our Locum Tenens division. We are very excited to have Sean join the AMN family. He has a proven track record of success in the staffing industry. And his extensive sales leadership, operations, and business development experience make him ideally suited to lead our locum tenens business.
Most recently, Sean led a very successful division, within Technisource, a subsidiary of Randstad. We look forward to the positive impact that Sean will have in growing our top line revenues and our profitability within Locums.
Sean will report directly to Ralph Henderson, whose responsibilities were expanded to cover all of our Temporary Staffing businesses. This reporting structure will help to better capture the cross-selling opportunities that exist across our service lines. Over the years, Ralph has demonstrated a proven track record of industry leading revenue and profitability growth. And we are very pleased to expand his role to President of Healthcare Staffing.
In Physician Permit Placements, fourth quarter revenues were $9 million, up 2% sequentially and flat year-over-year. The physician search market continues to be steady and may be revealing some signs of growth ahead. We are expecting first quarter searches to be up sequentially and year-over-year. We also continue to focus on maintaining marketer and recruitment bench strengths to insure we are able to achieve high fill rates on our active searches.
We have been able to continue also monetize our thought leadership expertise through projects and surveys that leverage our extensive relationship and database of clinicians. A good example of this is a follow-on survey were we are engaged in a partnership with the Physician’s Foundation to complete one of the largest physician surveys ever conducted in the U.S.
On January 30th, we completed the sale of our Home Healthcare business and we used the proceeds to pay down our debt. This divesture enables our leadership team to focus 100% of our attention on our Workforce Solutions, Staffing and Recruitment businesses.
As hospital executives seek to transform their business models, they are more open than ever to implementing innovative solutions to manage their clinical workforce. Our leading position in workforce solutions has more clearly differentiated AMN and the added value that we bring to the clients.
Beyond our success in the MSP space, another confirmation of our reputation as a leader in workforce innovation is our recent recognition as Supplier of the Year by Novation. They are the largest group purchasing organization in the country. This prestigious award was based on our high level of strategic partnership and compliance with their quality standards. This is an example of our differentiated approach to partnering with healthcare organizations.
This type of national recognition and the positive results we are reporting today are made possible by our committed and highly engaged team members and the healthy culture that they create. As a true people business, we are proud to have the most talented, experienced, and passionate team in the industry. I would like to thank everyone for their unique contributions that enable us to serve our clients, our healthcare professionals, and our shareholders. What we are seeing today is the powerful combination of having a highly engaged and capable team coupled with the strategy that puts our client’s needs and goals at the forefront of everything we do.
I will come back to you in our Q&A session along with Ralph and Bob to help answer your questions. But for now, I will turn the call over to our CFO, Brian Scott.