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Community Health Systems, Inc. (CYH)

Q1 2016 Earnings Call· Tue, May 3, 2016

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Transcript

Operator

Operator

Good morning. My name is Mike and I will be your conference operator today. At this time, I would like to welcome everyone to the Community Health Systems' 2016 First Quarter Conference Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question-and-answer session. I will now turn the call over to Gretchen Hommrich, Director of Investor Relations. You may begin your conference.

Unverified Participant

Management

Thank you, Mike. Good morning and welcome to Community Health Systems' first quarter conference call. Before we begin the call, I would like to read the following disclosure statements. This conference call may contain certain forward-looking statements, including all statements that do not relate solely to historical or current facts. These forward-looking statements are subject to a number of known and unknown risks, which are described in headings such as Risk Factors in our Annual Report on Form 10-K and other reports filed with, or furnished to, the Securities and Exchange Commission. As a consequence, actual results may differ significantly from those expressed in any forward-looking statements in today's discussion. We do not intend to update any of these forward-looking statements. Yesterday afternoon, we issued a press release with our financial statements and definitions and calculations of adjusted EBITDA and adjusted EPS. For those of you listening to the live broadcast of this conference call, a supplemental slide presentation has been posted to our website. We will be referring to those slides during this earnings call. Our results consolidate the results of Community Health Systems in our March 2016 acquisition of an 80% ownership interest in a joint venture with Indiana University Health in La Porte, Indiana. All calculations we will be discussing exclude discontinued operations, loss from early extinguishment of debt, impairment of long-lived assets, expenses incurred related to the company's spin-off of Quorum Health Corporation, expenses related to the HMA legal settlements and related costs, expense from fair value adjustments related to the HMA legal proceedings accounted for at fair value, underlying the CVR agreement and related legal expenses. With that said, I would like to turn the call over to Mr. Wayne Smith, Chairman and Chief Executive Officer. Mr. Smith? Wayne T. Smith - Chairman & Chief…

Operator

Operator

Your first question is from A.J. Rice from UBS.

A.J. Rice - UBS Securities LLC

Analyst

Thanks. Hi, everybody. So just to start out with the stepped up emphasis on restructuring the portfolio, streamlining, looking at ways to deleverage. Maybe can you give us a sense whether you have a deleveraging target, whether this restructuring can be accomplished – I mean, obviously, deleveraging in and of itself may be volume enhancing to the shareholders, but can you pursue this in a way where you're realizing values you think that are at least comparable to where community trades in the market? In other words, the value you can realize on these divestitures. And then, if those things you're identifying today sort of the first step on the longer-term path to restructure the portfolio or do you think this is what you need to do? Wayne T. Smith - Chairman & Chief Executive Officer: Based on what we're trading today, it is not hard to get value, the same value, but I think what we're on track doing is, we had about 200 hospitals. We would like to end up with 140 or 145 or 150 hospitals that are sustainable in markets that have some growth potential. And where we have the ability to add assets to those and enhance the networks or enhance those markets, improve the margins, I think we're on track to do that. As I said earlier, and as you know from our slides and our script, we have about 10 hospitals that we've targeted in addition to the 38 that just left with QHC. We have other hospitals that we think probably may work better if they're not part of our portfolio. It may work better with somebody else. So, this is a process that hopefully we should be in pretty good shape by the end of the year in terms of how…

A.J. Rice - UBS Securities LLC

Analyst

Okay. And maybe just a follow-up question within the – on the comments about the physician practice performance, I know you guys have recruited docs very actively, but is this mostly a legacy HMA issue or is this a broader across the portfolio and what do you sort of – what needs to be done to get back on track, I guess, in terms of just understanding exactly how to get these practices operating where you need to have it? Wayne T. Smith - Chairman & Chief Executive Officer: Let me just make a general comment that we've done a really good job. We recruited in the first quarter, again, 877 physicians. We continue to do a great job in terms of recruiting. What we're doing is like we're doing everything else. We're standardizing and consolidating our practice management so that we enhance and improve productivity in those practices. We didn't recruit a lot of physicians for the HMA hospitals. As you know, we didn't recruit very many physicians prior to the time when we acquired them. So, we did that really fast. This is probably self-inflicted that we didn't do a good enough job in making sure that we had performance improvements, and that we got the kind of performance that we need out of those to be successful. As you know, recruiting physicians is an expensive business. I don't know if you want to add anything to that, Larry. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes, I'll just go back. I think we commented on a previous call about three times more physicians at HMA in 2015 versus 2014, it takes a while to do it. I think we also commented that our productivity of these new physicians is lagging what we've historically done especially the first six months to nine months. We're starting to catch up some of that. I think I commented about a $15 million increase in loss, about $5 million is in Florida. So, clearly, you got a lot of high percentage of that in Florida where we also have some volume issues. But I think we're organized really well about being more productive, spending our expenses better for the practices and also work on revenue enhancement, which are some of the strategies we got underway. Some of our software spending we did that we called out had to do with enhancing some of the physician practices that make them more effective. Wayne T. Smith - Chairman & Chief Executive Officer: And, A.J., just to conclude this discussion about physician practice, we may lose a few physicians along the way. But I would say generally speaking, our physicians have bought into what we're trying to accomplish and are working hard to achieve the goals. And we have a number of things in place in terms of centralized scheduling and things that we are working on that we're implementing which will help a lot as well. So...

A.J. Rice - UBS Securities LLC

Analyst

All right. Thanks a lot.

Operator

Operator

Your next question is from Brian Tanquilut with Jefferies.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Hey. Good morning, guys. Wayne, just to follow up on A.J.'s question, so as you divest some of these facilities, in the past, you've talked about the need to go deeper in some of the markets that you've shown, the kind of core markets that you guys have identified, so how do you balance that, especially at a time when the payers are consolidating and you probably need to scale up in your key markets? Wayne T. Smith - Chairman & Chief Executive Officer: Yes, we've got 11 markets that we think that we have a very good footprint, we got a huge number of physicians in those markets, outpatient servicing, and we got a lot of opportunity for continued investment in those markets. Then we've got markets like Birmingham, Alabama, where I mentioned earlier Grandview, which is a standalone and it's a great location. It's got great opportunity. It's doing extremely well. We're increasing our market share in that market. So, in addition to that, we will have some other markets around – when you go back and evaluate our markets, and we look at them by either geographics or demographics or payer mix and all the above. We have some very good standalone markets in addition to our network markets. So, the objective here would be as we go forward, not only to use our capital in our network markets, but also in those standalone markets to enhance those markets, to improve and build those markets out as well. So, I think that addresses the issue in terms of managed care because, actually, I don't think we've lost any managed care contracts anytime recently or have been excluded or anything. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes, I think there was one in…

Brian Gil Tanquilut - Jefferies LLC

Analyst

Great. Wayne or Larry, how do you balance that though with the capital requirements of the business especially your focus on de-levering the balance sheet right now? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Well, we brought CapEx spending down. Clearly, we've got a lot of projects after we do a lot of due diligence on what we're going to spend. And I think by reducing the size of the company that allows us to spend our capital wisely. We've completed partly a substantial amount of CapEx projects here recently – on our CapEx, I think we've completed probably $500 million of CapEx projects between 2014 and 2016 that will probably drive this year a good, on a full year basis, probably about $100 million or more of EBITDA benefit. Probably, this year, $40 million, so... Wayne T. Smith - Chairman & Chief Executive Officer: And we've been spending about 5%, and we spent a little around 4% or so in the first quarter. So, we're not talking about a huge reduction, but we are talking about enough that hopefully will make a difference in terms of our cash availability, but we will not make a mistake in terms of capital allocation. When we have an opportunity for growth and improvement, we will continue to use our capital. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: And the other thing, Brian, I don't think – no one picked up, there's no guidance for any additional acquisitions this year.

Brian Gil Tanquilut - Jefferies LLC

Analyst

Got it. And then my follow-up, Larry, just on the guidance, I mean, after the Q1 miss, I know you've turned them low end – on apples-to-apples basis, you turned them low end or the high end of your guidance, but not the low end, so what gives you confidence or how should investors gain confidence on your ability to hit the revised guidance range given the shortfall in Q1? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes, if you sort of walk through the math, if you leave out the HITECH for the first quarter, you're in the mid-2.4, 2.460, you back out what QHC had for the first quarter and what we sell of the investment that's going to go on for QHC and also some of the sales, I think we got about $100 million – we said $50 to $100 million. We sort of got a plan to do about $150 million, but we brought it down on payer mix and volume improvement. I just mentioned that we're fairly up in the payer mix. On managed care, last year, we were up 90 basis points. The big improvement is in the physician practices, which I think we can make an improvement. We lost around about $20 million in the first quarter, and we expect to be $50 million to $60 million improvement for that. So, that's where it is. We got to the supply chain, which was about $10 million – $15 million for the first quarter. We think that's going to be much better than that, continue to contribute. We've got some – the La Porte acquisition was one month and some other acquisitions. We've got some cost reductions from the QH spend going on, and then the HITECH incentives are backed out of the first quarter. It's about $60 million. And then the other expense reductions of $50 million to $75 million, I mean, we've outlined the plan to do it, which gets us somewhere in the midrange of the guidance. It requires a lot of effort, a lot on the physician practices, a lot on the centralization. But I think we've got the game plan to do it, the resources allocated to accomplish it.

Brian Gil Tanquilut - Jefferies LLC

Analyst

All right, got it. Thanks.

Operator

Operator

Your next question is from Whit Mayo from Robert Baird. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Hey, thanks. Maybe just one question about the guidance, the $1 billion of revenue that you're selling across these 10 hospitals, does that move to discontinued ops in the second quarter? I'm just trying to reconcile the revenue range. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: No, it does not, Whit. No longer can you move items like that to discontinued and then what will come out, we're going to sell it sometime in the third quarter. So, roughly, three months or four months of that's come out of the guidance. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Okay. That makes sense. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: And that's the 2015 revenue. It might be a little higher or lower by then. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Okay. Maybe we can talk offline about that. But on your – I think you've got some senior notes that are callable, 8% notes callable in November. Can you call those or does your bank agreement require you to pay down the bank debt at this point? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: We're calling the ones due August 2018 senior secured at 5.125% and then I think we announced that on Monday and we're doing that with the proceeds of the spinoff we're allowed to pay that. We have a basket to use when we have sales and it allows us to pay off term loan or unsecured notes on asset sales as long for stay open that basket. But otherwise, we'll be paying off term loans with asset sales. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): What's the size of the basket? Remind me. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: I think it's about $1 billion. We've used a little bit of it, $100 million to $200 million. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Okay. And just one last one and I'll hop back in. But just curious if there's an update on the HMA investigation, potential settlements and just remind us if you have anything reserved at this point. Thanks. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: We've got a reserve on the balance sheet for CVR as $260 million roughly and I think that Wayne said a while ago, there's been no update to that really. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Thanks.

Operator

Operator

Your next question is from Frank Morgan from RBC Capital Markets.

Frank Morgan - RBC Capital Markets LLC

Analyst

Good morning. I was curious if we could talk about those HMA hospitals, the eight in Florida that were about 35% to 40% of the year-over-year EBITDA decline. I guess specifically, are those hospitals where you have competition in the market or are those sole operators and if they are not or if there's competition in those markets, is there any way you can track where volume is going or your splitting position is basically not sending you any business? Wayne T. Smith - Chairman & Chief Executive Officer: yes, that's right. Those eight hospitals are – the problems of those hospitals are one or three or four or five things. Competition in a couple of markets certainly is an issue. HMA got behind the curve, and we didn't move quick enough in terms of doing some things in those markets that we should have, so competition is an issue. One particular market which is well known is that we had a physical plant problem, and we've been able to solve the physical plant problem but unfortunately, it created a lot of issues in that particular market. We've got a couple of markets where there are physician issues. These are not necessarily competition issues. I would say the competition issues are some of which are also physician issues, but these might be issues where the groups that we may had a relationship with that we decided that the relationship wasn't working the way that we thought it should work, and we made some changes there or we decided from a compliance standpoint there might be an issue. So it is a number of different issues, but there's no question about the fact that it's taking this much longer to resolve these issues than we have anticipated. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: It's a mixture of sole providers and some of competition, some of both, Frank.

Frank Morgan - RBC Capital Markets LLC

Analyst

Okay. And then, as you look at the guidance that you now have for the year, does it really contemplate any improvement in those assets or are we thinking kind of steady state until further notice? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: They were down pretty much the first quarter. There's an expected improvement in those over the remainder of the year.

Frank Morgan - RBC Capital Markets LLC

Analyst

Okay. And then, in terms of – I guess that will lead into from a sequential standpoint, the cadence over the balance of the year, is there anything that we should be mindful of as we think about the next several quarters relative to guidance? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Well, the fourth quarter will be the best quarter of the year. You will have this uptick of demand as a result of the deductibles and co-payments, so that'll be the best quarter and then we're coming off of a quarter $633 million, so there'd be some improvement next quarter. But clearly, the fourth quarter will be the best quarter.

Frank Morgan - RBC Capital Markets LLC

Analyst

Okay. And just one final and I'll hop. Could you provide us with just sort of a pro forma annualized EBITDA run rate of the company today? I know you've given guidance, but just pro forma annualized for the Quorum for these other chain divestitures, the two recent acquisitions you made so that we kind of know what is the actual run rate of the company as this will be going forward and I'll hop? Thank you. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes. We were $633 million for the first quarter and probably if you go back, the last three quarters averaged better than that, it's $661 million for the third quarter, $696 million for the fourth quarter. But looking into first quarter run rate, we made about $56 million – about $18 million of HITECH which brings HITECH $615 million and the Quorum is $56 million. So it reduces it and then the part we're going to reduce roughly $15 million to $18 million from the Las Vegas investment, gets you a quarterly number.

Operator

Operator

And your next question is from Gary Lieberman from Wells Fargo.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Good morning. Thanks for taking the question. I guess when you look in the HMA assets and some of the issues and I guess some of the issues that have progressed, is it more of a factor of lower admissions from physicians that had been there or is it an issue of physicians leaving and not being able to recruit the right physicians? Is there sort of one that's more than the other or is it too difficult to kind of put your finger on it? Wayne T. Smith - Chairman & Chief Executive Officer: Generally speaking, it's all of the above, but having said that, we've done a good job of recruiting. We've done a lot of recruiting in Florida and for these hospitals as well. And a number of physicians did leave. It just is taking a long time to get these physicians up and going that the new ones that were recruited. But, look, it's all of the above. Every possible scenario here has happened in terms of these facilities. But having said that, there's a couple of things here, I think, important to talk about as well. There are a lot of good assets in HMA. We will end up with a lot of very good facilities from HMA when we get through this. As we said, we can kind of point out the ones that are not performing very well. And I think we're on track to get those problems resolved. The other thing that I'm pretty excited about that we haven't really talked about, and we have a slide on slide eight, is our new management group that's working hard now and they're just getting in place. But we have a very good sound group of people that will be operating our divisions now kind of going forward. We have three new Division Presidents. One has only been there for a short period of time. So, I think we're headed the right track in terms of all the things that we're doing. But time will tell. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Clearly, the Florida program which cost us $10 million in this quarter, $10 million in the third quarter and fourth quarter and it will cost us another $10 million next quarter, was not helpful. And I think the challenges of management physicians there as part in the HMA markets has been lower than it has been to the CHS legacy markets because we had to recruit so many.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

And I guess, so is it more of a market issue in the HMA markets or is it more of a facility and structural... Wayne T. Smith - Chairman & Chief Executive Officer: It's all of the above. I mean, we have facility issue. There are some markets that are not going to – that are not great markets. There are some markets that are great markets. There are some facilities that need work, the work hasn't been done on them. You name it. There are a number of those kinds of things. Having said all of that, there are still a lot of very good facilities within HMA that will perform well over the years going forward.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Okay, great. Thanks very much.

Operator

Operator

Your next question is from Chris Rigg from Susquehanna Financial.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Hey, guys. Just wanted to step back here, when we look at certain results over the last three quarters, I guess, is it right to think that a lot of the problems that go back to sort of the third quarter of last year are the same problems that have persisted through the first quarter or have sort of new things kept creeping up over the last nine months or so? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: If you go back to the third quarter, we had a physician salary issue, and a lot of physicians and clearly, we added a few more physicians in the fourth quarter. They're a little bit better, but we were down on physician practice results. We had a drug issue also, and I think our volume results were not as good especially in Florida, with the seasonality that goes on. We had negative admissions, I believe, of about 3% in the fourth quarter and we had about negative adjusted admissions about 1.2%. So, actually, we improved 250 basis points from third quarter into first quarter. But we had another drug issue. We also called out that activity. This quarter, we had some operating expense issues that popped up on our sort of revenue per unit, and our payer mix wasn't as strong as we'd hope it to be. It was still positive, but we were about a 1% revenue for just admission this quarter. Last quarter, we were at 2.5%; a quarter before that, were 2.2%. So, our revenue per unit, which is something we got to continue to work on to get a better revenue per mix. And we anticipate that to get better. So, from that perspective, that got worse in the quarter. I think the expenses were a little bit better managed probably in the fourth quarter than they were in the first quarter. We had a really tough January which we didn't recover from quite as well in the next two months. The managed care utilization, the managed care rates have been pretty good all throughout it.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Got it. Okay. And then just to clarify on the physician practice issues and really the improvement that you're trying to highlight on slide 19. It's still not really clear to me. Is the improvement sort of just an elimination of sort of upfront costs that you've been incurring in recent quarters, or you're actually expecting just the overall productivity to improve and just... W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes. First of all, we're going to recruit less physicians this year than last year, I believe. So there'll be less starts because we had a really good year last year. Two, we're going to improve the productivity, the ones we've got, especially the ones that have been around for a while have not been there. There may be some that – and there'll be some contract changes to make them more interesting in that result. We're going to manage the revenue growth better. We've got four or five initiatives around chronic care management and other activities, star rating on a Medicare Advantage business that we've got underway to try to help that. And also some of the Medicare wellness activities to hopefully get more volume there, and then become more known. And the physicians that we started out with in the third quarter of 2015 have been around now for another six months, they'll be much more productive now than they were then. So that'll be that, plus we'll bring less in. Wayne T. Smith - Chairman & Chief Executive Officer: So, one of the things that we're trying to accomplish in terms of our physician practice improvement is standardization, everything from schedule management and standard hours, online scheduling, all those things and we continue to look at the contracts and all that, as Larry said, in terms of revenue improvement. We're working hard in a number of areas. We're also bringing a lot of technology to our physician practices that we did not have before as we standardize everything from supply and staffing. We're getting much more sophisticated in terms of how we go about managing these practices, including helping the physicians in terms of coding improvements and all the things that physician practices need. So, we've stepped it up quite a bit in terms of our ability to manage practice. We should see the result of that by the end of the year.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Great. Thank you.

Operator

Operator

The next question is from Josh Raskin from Barclays.

Joshua Raskin - Barclays Capital, Inc.

Analyst

Hi. Thanks. Just wanted to make sure I understood the moving parts on the guidance. If I think about the change from previous guidance, I'm assuming Quorum is maybe $180 million of EBITDA that is gone. The divestitures, I'm assuming that's $15 million to $20 million, and then Las Vegas maybe $35 million or so. Are there other moving parts? And then, obviously, then there's the core earnings that change as well. But are there other extraneous pieces that I'm missing? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes, on the Quorum, we had an internal budget and then we poured out our internal budget for the first five months and, of course, I think they were – we had an actual in the first quarter also. But it's more like $225 million were thrown out of Quorum. And again, there's a difference between our budget and – our internal budget and what they're going to perform as a separate company, so there are some differences. As it relates to UHS investment, it's probably $35 million or $40 million. They had a really good first quarter. And again, this is our numbers. It may not be Steve's numbers, but $35 million or $40 million going forward. And then about probably $30 million to $35 million or probably $35 million to $40 million off the group of assets unnamed, the 10 hospitals in overall operations that we expect to remove in the third quarter. Said another way, most of the shortfall in the low end of the guidance relates to changes for those assets used in our internal budgets for those facilities.

Joshua Raskin - Barclays Capital, Inc.

Analyst

So, two questions on.... W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: And then on the high end, we did reduce it $50 million and they're at the range from $150 million to $100 million, so high end was $2.7 billion.

Joshua Raskin - Barclays Capital, Inc.

Analyst

So, on the divestitures of $35 million to $40 million, even if you assume a July 1 sale, that implies something in the ballpark of 7% to 8% margin. Is that consistent with what you think of as mid-single-digits? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes.

Joshua Raskin - Barclays Capital, Inc.

Analyst

Okay. And then I'm sorry I just want to make sure that Quorum – so they had previously talked about $270 million of annualized EBITDA and you're saying in an eight-month period, you had $225 million from May 1 through December 31 that you took out. I just want to make sure I got that right. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: That's correct. I think they were $275 million – $265 million, $275 million and I'll let them speak to the exact numbers, but we took out what our budget was and again there are costs that they've got that we don't have and then there's all kinds of different allocations that go on....

Joshua Raskin - Barclays Capital, Inc.

Analyst

Okay. That makes sense. Okay. That makes sense, public company expenses – okay. And then... W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes. They've got an income statement that may be different than our internal budget that we're looking....

Joshua Raskin - Barclays Capital, Inc.

Analyst

Right. And then just lastly, the $50 million to $100 million of payer mix and volume improvement, I guess I just want to understand a little bit better, what changes payer mix or what improves volumes on a relative basis? Is it just the initiatives you have around physicians or are there any new service lines or is there new properties or wings that are coming on line or things like that? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: There's new contracts, a lot of it in Florida. I think we had six or eight new good-size contracts went in place January 1. We'll get another similar number going in, in the second quarter and third quarter for Florida because we're working to improve the Florida revenue. If you look at the midpoint of our volume growth, it'd be 1.5%; we're at 1.3%. If you sort of consider the flu and Easter offset, leap day, and if we do about 1% volume growth, we're about at 1% – less than 1% revenue growth than we thought for the year, our revenue per unit growth will be somewhere around 2% to 2.5%. Again, we ran that pretty much last year. So, we get the 2.5%. We also had about a 90-basis point increase in our managed care utilization last year. I think it was much smaller than that this quarter, 10 basis points or 20 basis points. And that's basically where $100 million comes from, doing a much better job holding the volume for the rest of the year. And the 1.5% range and being more like a 2% revenue per unit will give us much more revenue than we got off in the first quarter.

Joshua Raskin - Barclays Capital, Inc.

Analyst

Okay. Thanks, guys.

Operator

Operator

We have time for one more caller. The next question is from Kevin Fischbeck from Bank of America.

Kevin Mark Fischbeck - Bank of America Merrill Lynch, Inc.

Analyst

Terrific. Great, thanks. I guess, I wanted to understand a little bit what these divestitures mean from a headwind to next year's perspective because it sounds like maybe there's another $50 million headwind to Quorum from next year, maybe another $20 million, $25 million from Vegas, and maybe another $40 million from these 10 hospitals. Is that kind of the right way to think about that? And then, HITECH, going away, you've probably got $125 million type headwind to next year. Is that the right way to think about that? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Well, you're looking at just EBITDA, Kevin. And, clearly, revenue goes away; EBITDA goes away. Interest expense gets reduced; depreciation gets done. There's a less demand for CapEx. But from an EBITDA perspective, you probably got about $65 million, $70 million probably. Quorum will not be there. You've got probably $15 million to $20 million on Las Vegas, and you got the remaining portion in the first year. But based on where we'll be looking at, you'll have less interest expense for the whole year. You have less depreciation and less needs for CapEx. And actually I'll probably lease these facilities other than the Universal, which I guess we have $35 million cash last year, although we had about $50 million of EBITDA. Probably the 10 hospitals and the other investments are probably not that cash flow positive for us, and so that will help with our cash flow next year.

Kevin Mark Fischbeck - Bank of America Merrill Lynch, Inc.

Analyst

Okay. That's helpful. And I guess as far as the cost-cutting initiatives, I guess maybe two questions. One is, are these cost-cutting initiatives new cost-cutting initiatives in response to a weaker Q1 and that's going to help you kind of not have the Q1 flow through to the rest of business, or is this something that you kind of always had planned based upon what you thought might happen from a portfolio rationalization perspective? And then two, on the physician side, do you get worried at all that if you're cutting back on recruiting, that that's going to impact your volume growth outlook? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes. I'll take the first one. I think what we've got done, we clearly were not pleased with where the first quarter was, and so there are some new cost initiatives to bring costs back down. I think I mentioned the first month for the quarter was not that good and we didn't react fast enough throughout the quarter to get back where we needed to be. So there are some cost initiatives underway that will help some in the second quarter, a lot better in the third quarter and fourth quarter. I think I've mentioned some of the other operating items that we've called out and there were several of them, at least half of those we think will go away on their own. It should be something that repeats itself. As it relates to the physician recruitment activity, Wayne, do you want to... Wayne T. Smith - Chairman & Chief Executive Officer: Yes, Kevin, I think what we're doing is trying to enhance and improve the practices. Hopefully, it will improve volumes instead of creating a problem with volume. So, I don't think we're concerned about losing much volume in terms of the activity that we're – the issues that we have and activity we're doing in terms of correcting some of the productivity, so I think it's a positive, not a negative. It should be going forward. We may lose a few along the way, but I don't think anybody that we lose probably is not a big volume physician anyway. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Kevin, we've done similar things about looking at the employed physicians in the past, and when we've done that, we still were able to grow earnings and volume as a result of it. I think we'll be able to do the same thing here.

Kevin Mark Fischbeck - Bank of America Merrill Lynch, Inc.

Analyst

Okay, great. Thanks.

Operator

Operator

I will now turn the call back over to Mr. Smith for closing comments. Wayne T. Smith - Chairman & Chief Executive Officer: Thank you again for spending time with us this morning. We are focused on the execution of our strategies that we have outlined today and improving our leverage ratios. We want to specifically thank our management team and staff, hospital executive officers, hospital chief financial officers, chief nursing officers, and division operators for their continued focus on operations. Once again, if you have a question, you can always reach us at area code 615-465-7000. Thank you.

Operator

Operator

This concludes today's conference call. You may now disconnect.