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Community Health Systems, Inc. (CYH)

Q2 2016 Earnings Call· Wed, Aug 3, 2016

$2.88

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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 Second 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 to call over to Mr. Ross Comeaux, Director of Investor Relations. You may begin your conference.

Ross W. Comeaux - Director-Investor Relations, Community Health Systems, Inc.

Management

Thank you, Mike. Good morning and welcome to Community Health Systems' second quarter conference call. Before we begin the call, I'd like to read the following disclosure statement. 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 or 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 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 and April 2016 acquisition of an 80% interest in a 20-bed Physicians' Specialty Hospital in Fayetteville, Arkansas. As a reminder, our results include approximately a month's worth of results from Quorum Health Corporation and our joint venture in Las Vegas that was sold to Universal Health Services. 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, impairment of goodwill, expenses related to the HMA legal settlements and related costs, expense from fair value adjustments related to HMA legal proceedings, accounted for a fair value underlying the CVR agreement, and related legal expenses. With that said, I'd…

Operator

Operator

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

A. J. Rice - UBS Securities LLC

Analyst

Hi, everybody. Larry, just maybe to go through the bridge on page 19 of your slide deck a little more. You have three big swing factors that will make a big difference in your ability to hit the back half of the year outlook: the physician practice improvement expectations of $55 million, the payer mix volume improvement of $50 million, and the expense reduction of $80 million. Can you just give us some sense of how much do you think you've already taken the steps to realize that? What needs to be done to realize some of those gains? Is there other dynamics comparison-wise versus last year or some other aspect that gives you confidence you can – that those numbers are achievable? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yes, I think we said earlier we've made some changes in some of the physician practices that weren't performing quite as well and I think that is something that has been accomplished through the end of the second quarter. You'll get some benefit in the third quarter and the fourth quarter also. I think Wayne referenced a 40% decline in employed physicians, which will help and that's – we pretty well know the number of physicians that'll come on and there's clearly a loss factor of our salaries versus benefit. Of the $55 million, probably 40% is revenue. We've got some new approaches there related to Medicare wellness and also some work with some star rating for managed care and some other features we put in place, that we tested it in certain locations. So based on those tests, we think those are achievable. The expenses relates to the productivity improvements. We've also made some efforts around better collection activity, which will be beneficial. It's not…

Operator

Operator

The next question is from Brian Tanquilit with Jefferies. Your line is open.

Jason Plagman - Jefferies LLC

Analyst

Hey, guys. It's Jason Plagman on for Brian. So on the decline in employed physicians, how much impact will that have on the revenue run rate? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: I don't think that the decline of employed physicians in the second half of the year will be that meaningful. It generally takes 18 to 24 months. One of the things that's created a challenge for us was the large number of physicians that were recruited back in 2015, which we had a challenge. The productivity was slower. We got those to become more productive and I think we've got plenty of physicians out in the marketplace now. And we have to measure how that may affect 2017, but I think that we got enough employed physicians. We got a lot of market share opportunity we can go after. And I don't think anybody wants to employ physicians in all cases to do it. If we need a new service and these employed physicians, that's one we do. But there's a lot of existing physicians there that have plenty of room to continue to grow. Wayne, you want to add anything to that. Wayne T. Smith - Chairman & Chief Executive Officer: No. I think that's covers it enough. Lynn Simon is here in the room and that's the area that she manages. But I think we're on-track with her employee physicians in this all about productivity making sure that we had the most productive physician in the right spots. Lynn, you want to add anything? Okay. Good. Let's go to next question, please.

Operator

Operator

The next question is from Gary Lieberman with Wells Fargo. Your line is open.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Good morning. Thanks for taking the question. I guess, as you think about the trends over the last three or four quarters, where do you feel like you are in achieving some of the improvements that you've set out here to get and how confident do you think you can get them in the rest of the year? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yeah. If you take the bridge, I'm very confident we can do a better job on expenses. This is something we've done over the years. And I think we are pretty focused as a company to do that. I think we reorganized for the physician practices little over year ago and I think we're starting to see some traction on that. The results were a little bit better in the second quarter than they were the first quarter. Thanks to the volume improvements that we've done and physicians brought in a year ago, be beneficial to managed care results, should be there. Over the last couple of years, we have last year or so benefited a fair amount from the Affordable Care Act. Bad debts seem to be relatively stable. (36:11). So that's probably something we've got to keep in mind. I think we got synergies, pretty good synergies, last year. There was some small amount of synergies this quarter. We will continue to get activity. I think if you look at the – main thing we've got to do is do a better job and we're – expenses the last half of the year, and I think we'll continue to work on that. And also get a little bit better. We have got a bit better comps, so from a comp perspective we need to grow our volume, but primarily I think the expenses in some of the physician practices will help us a lot in the second half of the year. And again that second half of the year will set you up nicely for next year, because you will get a full benefit of that for the whole year if we execute correctly on that.

Operator

Operator

The next question is from Joshua Raskin with Barclays. Your line is open.

Joshua Raskin - Barclays Capital, Inc.

Analyst

Hi. Thanks. Good morning. Question on the physician practices again. I sort of hate to harp on this. But in the past, I think you said that the remedy for some of the HMA weakness has been they just didn't do a great job on the physician recruiting side. Now it sounds like you guys are slowing down the physician recruiting because of the short-term losses. I just want to kind of juxtapose how do you get to where you want to be long term? And then you mentioned improved productivity on the existing physicians. And how was that accomplished? Are there compensation schedules that you guys can implement that change the way physicians behave, et cetera? Wayne T. Smith - Chairman & Chief Executive Officer: I might just say that we have talked about this for a good while in terms of the lack of physician recruitment to a number of HMA facilities, particularly in Florida. We recruited pretty hard, as you said, and the numbers were pretty strong last year. When we did that we also brought on a number of physicians that are working their way forward, that we are getting productivity out of and we should continue to see that improve going forward. I think that's what Larry was trying to communicate when he said our adjusted admissions at HMA have gone down from negative 4% to basically flat. Along the way though, there are physicians that are not that productive, so we have been looking and we have a lot of metrics now that we use to determine productivity, centralized scheduling and things that we're putting in place to make sure that we get productivity. So I think we're on the right track and the two – this is what happens oftentimes, when you recruit and then we have other physicians that were in place that we need to work on, but I think what Lynn has done in terms of managing our physician practices has brought a lot of discipline to the area, and I think we're now beginning to see progress from that. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: If you look at the employed physicians that we're bringing in – that we brought in, we clearly had about three times more physicians in 2015 than 2014, and the legacy was relatively flat. Rolling into 2016, the legacy hospitals are slightly above 10% and HMA hospitals are still ahead of a year ago, but we don't need to bring in as much. We had an all-out effort, maybe a little too much of an all-out effort, to bring a lot of physicians in 2015 a record year for us for our internal recruiting efforts. And I think it's appropriate for us now we've got the physicians, to let them mature in the marketplace and get to productivity in the – so it's not as if slowing down is a bad thing. It's probably the right thing to do.

Operator

Operator

The next question is from Ralph Jacoby with Citi. Your line is open.

Ralph Giacobbe - Citigroup Global Markets, Inc.

Analyst

Thanks, good morning. When I look at same-store revenue, it's been in that 1% to 2% range for the last four or five quarters. So I guess how much of this is just having to reaccelerate the topline below that or beyond that low single digit range?. I certainly appreciate cost savings opportunities, but I guess will we see that come through if revenue trends don't accelerate, and maybe help us, what you need from the topline perspective, what's embedded in guidance to just kind of hold the line on margin? Thanks. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yeah, I think we have started out the year, I think it could be somewhere in the neighborhood around 3% same-store revenue growth and we're not there for the first couple of periods. One other thing that is different is we have had much better surgical growth driving some revenue growth in our legacy facilities; a bunch of HMA facilities. So there is lot of effort to try to recapture some of the surgery business, the HMA had once upon a time the big loss. So that's one thing we probably got to do. The second thing from a revenue perspective is continue to do a good job of the managed care penetration, managed care contracting. We've got in some new managed care contracts in Florida in the last three to four months that will be helpful. We're doing a pretty good job of trying to make sure that we grow our managed care revenue payer mix which will help the growth there. I think we also have done a decent job as it relates to looking at our appropriate coding and make sure that's done right. So I think that's an area that we've made some…

Operator

Operator

The next question is from Andrew Schenker with Morgan Stanley. Your line is open. Andrew Schenker - Morgan Stanley & Co. LLC: Hi, thanks, good morning. Just real quick, think about the sale of the 12 hospitals now, I'm just trying to better understand how that compares with the expectations last quarter when you highlight the 10, it seems like you are giving a much better rate for the two extra hospitals, is this just because these two – and what I mean by as – before you were looking for about $ 530 million on $1 billion of revs, now you're thinking about $850 million on $1.45 billion revs so those new hospitals you're getting much better rates for, is this just a more profitable, or is this just you've restructured the portfolio or the offering. It sounds like to maybe find better strategic buyers, so just thinking about what's changed in that package? Thank you. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yeah. The 10 hospitals, there are some of the 10 that are in the 12, but there is not all of the 10 in there, and as we continue to look at which facilities, we had a transaction that we started with a LOI that's not going to go forward. So we have to restructure that. So you've got a different makeup of hospitals, you are correct. The revenue, the price of these is closer than on 60% of revenue versus to the other one was 50%, 53% of revenue. Margins are relative to close on the two and it's just a different makeup of the hospitals, but clearly that the first set of hospitals had a couple of more challenging facilities in there, so now we're not in the 12, but as Wayne said, there are still some other de-leveraging opportunities so the makeup is a little bit differently and as a result the price compared to revenue is a little bit differently. And I think these are all transactions that will help us to deliver and also helped the margin of company going forward. Wayne T. Smith - Chairman & Chief Executive Officer: Yeah. I think that's important thing is that these will definitely after it's de-leverage and our margin should improve and its consistent with our view that we're looking for sustainable markets that we can grow and spend our capital and to enhance our facilities. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Generally, when we describe these transactions, we generally have a pretty good confident level that we've got a letter of intent that's going to generally go forward but we have one letter of intent and the original intent that didn't go forward.

Operator

Operator

The next question is from Chris Rigg from Susquehanna Financial.

Chris Rigg - Susquehanna Financial Group LLLP

Analyst

Good morning. Larry, thanks for providing the sort of volumes trends in the HMA hospitals over the last few years. Is there anything you can share margin wise there, how the trends have been? And then I guess more importantly, you're seeing diminishing declines in the volume pressure there. Do you think we're near inflection point there or it's still too early to call? Thanks a lot. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: It's 56 or somewhere in the mid-60s of hospitals and so that tells you that the ones that devolve after January 12, have been more challenging and some of those remain challenging. I think we would expect hopefully by the end of the year, we'll be at a point where we don't have to talk about HMA next year. We've owned it a while, we've worked on it. And we're seeing progress, it's a group of 60 some odd hospitals, some do better than others. We had a little bit more challenge in Florida with some other competition there and other stuff. But I'm hopeful that this – we did this to sort of say look, it started out in a pretty difficult environment when you compare it to 2013 and 2012 and all the challenges they've had in 2013 once they went through, including our purchase and the changeover of the Board. And so there has been results and then we will keep working on trying to get the results, we got to also get the revenue growth out of there. The one things that is not heading as fast as you want to is surgeries, so to work on the surgical growth.

Operator

Operator

The next question is from Kevin Fischbeck from Bank of America Merrill Lynch.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst

Hi, Great. Just want to go through, because you are doing a lot of transactions and divestitures. So, I wanted to see if you could help us level set what the core business looks like in 2016. So we can kind of think about what the basis to grow off for 2017, I know in your guidance bridge you exclude EBITDA from divestitures. But I guess, if we took out the EBITDA that actually was included in the numbers, I don't know, I am coming up with something maybe like $130 million. Do you know what that number to take out of 2013 from I guess both the revenue and an EBITDA, so we think about a clean 2016 and the base for 2017 growth? W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yeah, if you take the $2.480 billion, I think what you got to back out is $95 million and then whatever you end up selling, if you sell $1.450 billion at a 5% margin of $70 some odd million roughly if it's a 5% margin, 6% a little bit higher. But I think the known right now is the $95 million that we think we got to back out, as a result of what the bankers and the QHC ended most of the ones we are selling – now keep in mind divestitures stay in the income statement even after you sell them, the income statement you no longer separate it and so it's a little bit more difficult. That's why we went to a same-store. And left out all the stuff we sold, even though it may have owned it for a month or two. But I think the run rate would be somewhere in the neighborhood of $2.480 billion less $95 million plus whatever earnings are of the ones we sell and we will provide as time goes on. But right now 5% is a reasonably good proximity of what the margins are over time.

Operator

Operator

We have time for one more question. The last question is from Matthew Borsch from Goldman Sachs. Tejus Ujjani - Goldman Sachs & Co.: Hi. this is Tejus Ujjani on for Matt. Thanks for taking the question. You called out surgery volume strength of 1.2%. Was hoping you could just break that out in terms of inpatient versus outpatient. And then also any trends in acuity across both. W. Larry Cash - Chief Financial Officer, Director & President-Financial Services: Yeah, the outpatient growth was positive and the inpatient growth was negative so we do not have positive inpatient growth and that's been the way for the past couple of quarters. Lot of it's moving to outpatient especially some in orthopedics. Orthopedics had good outpatient growth and then we also had good growth in neurology, all of which have a pretty high implant cost which has driven from our supplier cost, but our surgical growth has been predominantly outpatient.

Operator

Operator

There are no further questions at this time. I will turn the call back over to the presenters. Wayne T. Smith - Chairman & Chief Executive Officer: Thank you again for spending time with us this morning. We are very focused on our strategies, we've outlined earlier. You will see us improve as we always have done historically. We want to specifically thank our management team, staff, hospital chief executive officers, hospital chief financial officers, and chief nursing officers, and division operators for their continued focus on operations performance. 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.