Earnings Labs

Encompass Health Corporation (EHC)

Q4 2015 Earnings Call· Wed, Feb 24, 2016

$101.58

+0.62%

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Transcript

Operator

Operator

Good morning, everyone, and welcome to HealthSouth's Fourth Quarter and Full Year 2015 Earnings Conference Call. At this time, I would like to inform all participants that their lines will be in a listen-only mode. After the speakers' remarks, there will be a question-and-answer period. You will be limited to one question and one follow-up question. Today's conference call is being recorded. If you have any objections, you may disconnect at this time. I will now turn the call over to Crissy Carlisle, HealthSouth's Chief Investor Relations Officer.

Crissy Buchanan Carlisle - Chief Investor Relations Officer

Management

Thank you, Jackie, and good morning, everyone. Thank you for joining HealthSouth's fourth quarter 2015 earnings call. With me on the call in Birmingham are Jay Grinney, President and Chief Executive Officer; Doug Coltharp, Chief Financial Officer; Mark Tarr, Chief Operating Officer; Patrick Darby, General Counsel and Corporate Secretary; Andy Price, Chief Accounting Officer; Ed Fay, Treasurer; and Julie Duck, Senior Vice President of Financial Operations. Before we begin, if you do not already have a copy, the fourth quarter earnings release, supplemental slides and related Form 8-K filed with the SEC are available on our website at www.healthsouth.com. On page two of the supplemental slides, you will find the safe harbor statements, which are also set forth in greater detail on the last page of the earnings release. During the call, we will make forward-looking statements which are subject to risk and uncertainties, many of which are beyond our control. Certain risks, uncertainties and other factors that could cause actual results to differ materially from management's projections, forecasts, estimates and expectations are discussed in the company's SEC filings, including the earnings release and related Form 8-K and the Form 10-K for the year ended December 31, 2015, when filed. We encourage you to read them. You are cautioned not to place undue reliance on the estimates, projections, guidance and other forward-looking information presented. Statements made throughout this presentation are based on current estimates of future events and speak only as of today. The company does not undertake a duty to update or correct these forward-looking statements. Our slide presentation and discussion on this call will include certain non-GAAP financial measures. For such measures, reconciliation to the most-directly comparable GAAP measure is available at the end of the slide presentation, at the end of the related press release and is…

Operator

Operator

Our first question comes from the line of Gary Lieberman with Wells Fargo.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Good morning. Thanks for taking the question. I believe in the past you'd given some statistics regarding the percentage of patients discharged from the IRFs going into the Encompass facilities. Do you have those statistics? Jay F. Grinney - President, Chief Executive Officer & Director: I don't have the percent right offhand. I can tell you that in – to give you an idea of what we saw in December of 2015 and comparing that to December of 2014, and you'll recall we purchased Encompass at the end of 2014. In 2014, we had something like 34 discharges coming out of our IRFs and going into an Encompass Home Health agency. In December of 2015, that number was 900.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Okay. Great. So, you're happy with that kind of growth? Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. I mean there's more to go – certainly more to go. But, yes, we're very pleased with the status to-date and we look forward to continued collaboration into 2016 and beyond.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Okay. And there has been a lot of concern by investors about the impact of the BPCI and the CJR on post-acute facilities. Can you talk about anything that you're seeing or your updated thoughts there? Jay F. Grinney - President, Chief Executive Officer & Director: Of course, CJR doesn't start until April 1. We've seen no impact, obviously, from that. First of all, most of the bundles that are in our markets and we pointed that out in the slide, I think, in the JPMorgan presentation and we'll include this in the IRB when we update it. Most of those were lower extremity joint replacement patients. So, most of the Model 2 bundles where the acute care hospital is a convener, they've convened around and bundled around knees and hips, which is, as we all know, the same diagnoses that are bundled under CJR. And so, we think that if there is going to be an impact, it would be in the knees and hips. But as we peel back the onion and as we look at those patients, the vast majority of them have multiple comorbidities and complicating conditions that really require that they be in a facility with 24-hour/seven-day-a-week nursing care, close physician supervision, team initiatives on the therapy side. These are very sick patients. So, the simple knees and hips, we're not getting them today. And so, I don't think that there is any risk that we're going to lose, because we're not going to lose something that we're not getting today. So, right now, we're not seeing any impact. The last comment I would make, Gary, and this is something that reinforced our decision to acquire Encompass and to get into the home health segment, we do believe that the value proposition of a patient requiring post-acute care – and let's take the simple knees and hips out of the equation just for a minute, because, again, we're not seeing them today, we don't think we're going to see them in the future. But let's take the balance of the conditions that we do treat. We believe that the value proposition of a patient being able to stay in an inpatient rehabilitation hospital followed by continuity of care in a high-quality home health environment where that care is integrated and coordinated from literally the moment that the patient is admitted into the acute care hospital, we believe that that value proposition is very powerful. And we think that that will set us up very nicely in a bundled environment, in an ACO environment, in any kind of environment where care needs to be coordinated and the quality of care needs to be first-rate. So, our view is that the bundling and other payment changes that are going on really kind of play into our strong suit.

Gary Lieberman - Wells Fargo Securities LLC

Analyst

Great. Thanks very much.

Operator

Operator

Our next question comes from the line of John Ransom with Raymond James. John W. Ransom - Raymond James & Associates, Inc.: Hi. Good morning. Can we just talk for a minute about Reliant? If I look at the purchase price, it was 9.6 times EBITDA when we take out the NOL. And you're talking about EBITDA going down in 2016. So, when do you think that deal will hit your return parameters and how much of a headwind is EBITDA going down at Reliant and CareSouth in your guidance? Thanks. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: So, yeah, John, we've said right from the get-go that it was going to take a step back as we transformed those hospitals to meet the HealthSouth operating model. We think that beginning in 2017, they'll be back on a growth trajectory. When we looked at the markets in which the Reliant hospitals are located, we spent a lot of time looking at the demographics and we got very comfortable that the types of higher-acuity patients that we're accustomed to treating in our HealthSouth IRFs were present in those markets and there was an unmet demand for treating those patients. What we're doing in terms of repositioning the Reliant hospitals will ultimately allow us to run those hospitals at a higher revenue level and at a higher occupancy level, albeit accompanied by a higher expense level. So, their margin structure will mirror the traditional HealthSouth hospitals, but the revenue will be higher. So, we'll see that growth trajectory begin in 2017. And we're very comfortable that it will generate returns that are in line with those that we have previously stated. John W. Ransom - Raymond James & Associates, Inc.: And how much of that – sorry, go…

Operator

Operator

Our next question comes from the line of Sheryl Skolnick with Mizuho Securities. Jay F. Grinney - President, Chief Executive Officer & Director: Good morning, Sheryl.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Thanks. Good morning. Jay, I think everybody who is on this call appreciates to knowing how forthright you've been over so many years in presenting the guidance for the company. But forgive me if I have to go at this question one more time and forgive me if I'm a little frustrated with the lack of a clear answer here. We all, I think, want to believe that your guidance is conservative, because we want to believe that it's a guide-low perform-high HealthSouth that we know and love. Okay. But we need a little help getting there and we need specific numbers to get there. So, maybe you can help us out this way. I had the sense and maybe it's my own fault, but I had the sense that the amount of dilution to EBITDA growth that we're going to see this year from a combined, not separate, but combined CareSouth/Reliant and all the other activities you're doing, including the rate decrease in home health, is a bit more than we thought. So, either please quantify the expected range of that headwind in dollars or tell us, in the absence of those deals, how much you would be forecasting for combined IRF and Encompass EBITDA growth. That would be really helpful. Jay F. Grinney - President, Chief Executive Officer & Director: So, the second part of the question, combined Reliant and CareSouth growth?

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

No. No. How much your EBITDA would have been growing if you hadn't bought Reliant and CareSouth? In other words, what I'm trying to get at... Jay F. Grinney - President, Chief Executive Officer & Director: Yeah.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

...really is, how much is the dilution to your EBITDA guidance this year from those transactions. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Yeah. I think, Sheryl, probably the easiest way to get at that – and part of the reason that we haven't provided that kind of specificity previously is, because, as you know, specifically as it relates to the Reliant transaction, the vast number of those hospitals are in overlap markets. And so, the part of what is going on as well is those were viewed by us as capacity additions in markets in which we were already operating. And we're combining sales and marketing forces and trying to describe which discharges are directly attributable to a former Reliant Hospital versus a HealthSouth hospital, all that gets a little bit murky. Having said that, as an approximation, the EBITDA based on the model transformation and the addition of expenses, the EBITDA run rate for Reliant is expected to take a step back about $2 million to $3 million per quarter during the course of 2016.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Okay. That's the answer. So, it's $8 million to $12 million for the year. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: That's a reasonable estimate.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Okay. And for CareSouth? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: CareSouth, it's a little bit harder to quantify. Again, you got the pricing decrease, which is impacting the overall home health agency. So, it's a smaller number because it's smaller contribution. It might be $1 million a quarter. Again, that's just an estimate.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Okay. So, maybe ask the home health guidance question a little bit differently, and I get it the volumes are terrific and it's the right deal is done and all the rest of that. So, this is no criticism implied, just need data. In understanding the home health business, can you give us an estimate of what the dollar headwind would be for the price cut? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: It's not a static number, because at the same time that you've got a decrease in the Medicare pricing, the patient mix change in the home health business is changing and it's changing at least in part due to the fact that as we increase the number of patients that are flowing from our IRFs to the Encompass platform, you're increasing the percentage of therapy, which has different pricing than some of the nursing component. Jay F. Grinney - President, Chief Executive Officer & Director: You could easily take – on a static basis, you could look at year-to-date or the fourth quarter. And if you assume no change in the case mix and you look at the segment's revenues and you go back to whatever page it is, it shows the mix of the revenue by segment, you can then get a Medicare revenue base and then that would decrease by 1.7%. So, I mean, if you want to quantify, it's easily done. But it's just – it's looking at page 23.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

It's mitigating it by the real world that gets tough. Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. And then – but that just – that's on a static basis. So, you look at the home health is 83% in 2015 Q4, 83% Medicare. And as you saw on page eight, total net operating revenues for the segment in that quarter was $153 million. So, you got 83% of that. They just normalize, say, you're going to extrapolate that times four and then you take 1.7% off of that. You now have a sense of what that revenue is on a static basis. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: And that would be $8 million to $9 million on an annual basis.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Okay. That's great. So, if I do the math then, and some puts and takes here, it looks like ex the dilution, you would probably be looking at the midpoint of the range at about 4% to 5% EBITDA growth? Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. And I think that that's probably – in fact, that is a very fair way to look at it. If you looked at – as we looked at Q4 and if you took out the group health and kind of normalize for a normal run rate on the bad debt, the business was growing just over 4% ex Reliant and ex new store. That was the same-store growth would have been about 4%. And you have additional growth on top of that with the new stores and then obviously with the acquisitions. So, that 4% to 5%, I think, is a very good number.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst

Thank you so much. Now I get it. Jay F. Grinney - President, Chief Executive Officer & Director: Okay.

Operator

Operator

Our next question comes from the line of Whit Mayo with Robert W. Baird. Jay F. Grinney - President, Chief Executive Officer & Director: Hey, Whit. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Hey. Good morning. Just was curious if there's anything new emerging on the supply side, distributor opportunities, pharmacy, GPO, just anything new that you see as an opportunity going forward operationally to perhaps move the needle? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Well, I think, we demonstrated again in Q4 that we made some good progress gaining supply chain efficiencies. I think all of those things are on the table. One of the things that we have been able to do starting in 2015 and will continue into 2016 is to move Encompass into our GPO and there's some efficiencies to be gained there. Obviously, we'll be folding the former Reliant hospitals and CareSouth in, also the – I think the real answer there, Whit, is that we are in a constant process of looking for further opportunities for improvement through the supply chain. There isn't one specific large opportunity that I can point to. It's more about continuously picking up the nickels. Whit Mayo - Robert W. Baird & Co., Inc. (Broker): Makes sense. And Doug, I know you're really enjoying your capital structure now and I think your 7.75% are callable this September, maybe I'm wrong. But does it make sense to revisit that later this year, and just maybe curious, just broader thoughts on rethinking a higher dividend as the year progresses? Thanks. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Well, first on the 7.75%, they became initially callable in September of 2015. And you may recall we called $50 million of…

Operator

Operator

Your next question comes from the line of A.J. Rice with UBS.

A.J. Rice - UBS Securities LLC

Analyst · UBS.

Hi, everybody. Thanks. Maybe first, just appreciate the comments around the SW&B that were made with respect to group health cost and the productivity. How about just any comments on what you're seeing with respect to turnover, wage rates for your therapists and your nurses? Mark J. Tarr - Chief Operating Officer & Executive Vice President: Hey, A.J. This is Mark. We don't see any across-the-board widespread pressure on nursing or therapists. We do have markets that are extremely competitive, particularly on the nursing side. So, we remain diligent staying ahead of those competitors, making sure that we have market valued rates for our staff as well as offer other areas that they see as value, such as clinical education and additional certification pay. Jay F. Grinney - President, Chief Executive Officer & Director: And A.J., on the turnover, our nursing turnover hovers right there at the national average. Our therapy turnover is probably 200 basis points to 300 basis points below the national average and has been consistently at those levels for many years.

A.J. Rice - UBS Securities LLC

Analyst · UBS.

Okay. Maybe just – and there maybe something obvious on this, in the 2016 guidance considerations on the inpatient rehab side, one of the comments is managed care and Medicaid increase is expected to moderate in 2016. Is that simply the rate update that you're referring to on the Medicare side and a lack of expansion on the Medicaid or is there something broader? And maybe just comment on payer mix trends and what you're seeing generally. Jay F. Grinney - President, Chief Executive Officer & Director: No. It's a reflection of the number of patients in the categories of Medicaid and exchange or commercial that we saw big increases in 2015. We expect that those categories will continue to grow, but at a moderated level. And so, for example, we saw in 2015 the Medicaid patient increase by 25%. And that was, if you recall, result of a lot of different factors, one of which was the expansion of Medicaid in certain states. So, there were more enrolled, the inclusion of rehabilitation as a covered service, and then, of course, the acquisition of Cardinal Hill in the early part of the year really drove that number. So, if you carved out the Cardinal Hill numbers, it'd be closer to 15% growth in Medicaid. As we go out and as we look at what's happening in Medicaid enrollment in the states where we have a presence, we're not getting anything that would suggest that there is a further expansion to include more individuals in that category. So, we expect that it's going to grow, but we don't expect that it's going to grow at that 15% year-over-year clip.

A.J. Rice - UBS Securities LLC

Analyst · UBS.

Okay. And that's same for managed care. Jay F. Grinney - President, Chief Executive Officer & Director: That's what we're saying.

A.J. Rice - UBS Securities LLC

Analyst · UBS.

And managed care, same. Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. On the exchanges, we also think that – we saw that grow in 2015 around 14%. And based on what the reports are on exchange enrollment, we think that that's going to be probably closer to the 10% range.

A.J. Rice - UBS Securities LLC

Analyst · UBS.

I got you. Okay. That makes sense. Thanks a lot.

Operator

Operator

Our next question comes from the line of Josh Raskin with Barclays.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Hi. Thanks. Good morning. Wanted to ask a little bit more broadly, I guess, on – I don't know if you want to call it bundling, but maybe ACOs or even the impact you're seeing in terms of Medicare Advantage growth. And I guess I'm just curious, is there anything that you see just even post-acute when people leave the hospitals, are you seeing a change in that dynamic? I think the market feels as though there has been a pretty rapid change. It doesn't seem like that that's case in the IRF market. But just wanted to see if you guys felt like there was any structural movement that you're seeing once people leave the hospital. Mark J. Tarr - Chief Operating Officer & Executive Vice President: We're not seeing a significant change from what we experienced in the past. And if you look at it from a diagnostic standpoint, it's the orthopedic population that has had the areas that people tend to go more towards either SNF or home health with those orthopedic patients that don't have a lot of comorbidities. So, if anything, we're anecdotally hearing more about patients going straight to home health that don't have the high percentage of comorbidities.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Okay. All right. So, nothing really there. And then, I just want to make sure I got this right in the guidance as well. It sounded like you thought the pressures in 1Q would be a little bit higher in terms of transitions of systems and getting the acquisitions on your platforms. Is there a change in the seasonality? Should we think about the growth rates in the first half differently than the second half? Jay F. Grinney - President, Chief Executive Officer & Director: Let me just back up. What we said is that the impact on the repositioning of Reliant will be felt throughout the year. The staffing impact should be in place by the end of Q2. And then with respect to CareSouth, we said that most of the transition that needs to occur will – all of which will occur in the first half. But there is some seasonality in the numbers, especially in home health. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Yeah. Just two things to note with regard to seasonality, Josh, one of which you've heard us talk about in prior years and one of which may be new to you. The new one related to home health is simply that in the first quarter of every year, Encompass has a system-wide multi-day sales meeting. And it's necessary to reenergize the sales force and get everybody focused on the right things for the coming year. But for that particular quarter, it takes a couple of days of revenue out essentially. The second thing is, as you may recall from our discussion in prior years, the timing of our stock-based long-term incentive plan grants is in the first quarter and that carries a disproportional increase in payroll taxes. So, you'll see some pressure on SWB during the first quarter.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Yeah. I was just trying to isolate any of the unusual ones, not the typical first quarter. Jay F. Grinney - President, Chief Executive Officer & Director: Yes.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

But is it fair to say it'll be a little bit more seasonally weighted to the second half as you get through the staffing changes, et cetera? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Yes.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Okay. And then, just lastly, on the benefit plans, your existing self-funded plan. The $4 million, I just want to understand, the $4.5 million this quarter, was that an incremental increase in your reserves, i.e., you saw further deterioration or is that just the plan is running $4.5 million higher than it did last year, which is the same level of increased cost that you saw in the third quarter? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: It's more in line with your second statement.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Okay. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: And it's really similar to what we saw in the second quarter as well. So, basically, the run rate for the year on a year-over-year basis came up. And as we look at 2016, we think that the new base level that was established in 2015 is the starting point and then we're anticipating a 6% to 10% inflationary rate on top of that.

Joshua Raskin - Barclays Capital, Inc.

Analyst · Barclays.

Okay. Got you. Okay. Thanks, guys.

Operator

Operator

Our next question comes from the line of Kevin Fischbeck with Bank of America Merrill Lynch.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

Hi. Great. Thanks. Wanted to ask about the commentary on the two deals. I guess, I'm not used to hearing from you guys about doing deals that have a lot of investment and actually lower earnings kind of out of the gate. Is that something that normally happens or is there something unusual about these two deals? And prospectively, should we be factoring in something like that happening in every deal you do, there's an upfront investment and then it grows faster afterwards? Jay F. Grinney - President, Chief Executive Officer & Director: I didn't hear all of that. But virtually all of the acquisitions that we've done, the one-offs, have been immediately accretive. When we looked at the Reliant from a strategic standpoint, we were looking at the opportunity to consolidate into some key markets in Texas where we had gaps geographically and a very strong home health presence. And so, the opportunity to acquire these assets was unique. As you know, there aren't a lot of portfolios of rehabilitation facilities. So, we were really trying to position those markets for the long haul. We knew going in that there was going to be some repositioning that would have to take place. I would have to say that we see that as sort of an unusual set of circumstances because, as I said, all of the other acquisitions, we were looking at hospitals that were underperforming and we were taking them on and then immediately seeing improvement as we brought in our operating systems. Here, we're really repositioning them from a clinical capability and from a staffing standpoint to meet some of the new expectations from CMS as it relates to individual therapy and to prepare those hospitals to be better positioned to adhere to all of the quality reporting requirements that CMS has promulgated. So, in that sense, it's a little bit unusual. On the CareSouth, what is occurring there is exactly what has occurred on all of the other Encompass acquisitions, even before our partnership with them. And that is that they would come in and, for a period of time, maybe it'd be a quarter, maybe it would be two quarters, they would recalibrate their operating platform, bring the home care high – home-based platform in, teach those agencies and the employees how to use that, how to use it most efficiently, revamp the sales and marketing. In some instances, they had to change out people in order to get the right folks in from a clinical standpoint in the sales and marketing. So, that part of it, I think, is pretty consistent. So, again, stepping back and answering your question, I think that the Reliant is unusual, because we knew we had to make some significant changes there. But we did that looking at the long term and bringing on capacity to meet the needs of particularly those communities in Texas and then the two new hospitals up there in the Boston metro market.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

Okay. That's helpful. And I guess, just specifically on Reliant as far as – one of the things you highlight there as growing neurological and, I guess, you do a decent amount of neurological in your core business. But I think MedPAC a few months ago was highlighting neurological as an area that they felt that they were over – that CMS was overpaying for and they were recommending adjustments there. Do you see any risk to that over time? And is that still a good business even if rates do come down? Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. MedPAC wasn't saying that they were overpaying for neurological.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

They were saying that facilities with high neurological had higher margins than industry average? Jay F. Grinney - President, Chief Executive Officer & Director: That's...

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

(56:45). Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. But they – MedPAC never said that they were overpaying for neurological. They were just saying that the higher margin, higher profit hospitals had a higher percent of neurological cases. But I think MedPAC, where they missed, was the fact that if you would also look at the high-margin hospitals, the payments weren't any different than what you get in the low margin. The difference was in the cost structure.

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

Okay. So, you don't – I was connecting the dots of, hey, look, high neuro, high margins, you were probably overpaying. You're saying that there's another reason in there that you're working with MedPAC for them to understand? Jay F. Grinney - President, Chief Executive Officer & Director: Well, we definitely are. In fact, we had a meeting with them two weeks ago helping them. And we actually prepared a report, be happy to get that to you, to anybody, that we submitted to MedPAC that helped to – we think helped them better understand the margin dynamics going on in the IRF industry. It's not a function of pricing, it's a function of cost management. And particularly, many of the low-margin hospitals, IRFs out there, are getting a disproportionate amount of outlier payments, not because their patients are any sicker, but because they're layering up all kinds of costs, transferring all kinds of costs from the acute care hospitals on to these units. Getting higher payments, the margins may be low and really that is as big of a problem as anything. So, we're happy to get that to you. But to answer your basic question, first of all, the premise is not right. They didn't say they're paying too much, but we don't see that as being a risk. I mean, the reality is that's where – that's the kind of patients that are intended to go into inpatient rehabilitation facilities. High acuity...

Kevin Mark Fischbeck - Bank of America Merrill Lynch

Analyst · Bank of America Merrill Lynch.

Okay. Great. Thanks. Jay F. Grinney - President, Chief Executive Officer & Director: Okay.

Operator

Operator

Our next question comes from the line of Sheryl Skolnick with Mizuho Securities.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst · Mizuho Securities.

Thanks. I just wanted to follow-up on a couple of things, if I may. And I really do appreciate you giving me numbers here. That was incredibly helpful. But as we look out in terms of the mix of the business and the home heath business and the rehab business, the positioning for all of these – so this is a post-acute question and this is sort of a bundling question. I got to ask it again. But as we look out and we look at the way you're positioning the business, we look at the presence that you have and then we step back and we look at what's happening in the greater post-acute market where there's all of these methodology changes that are pushing patients out of facility based care and into lower-cost settings. So, I have to ask the question. You're expanding your capacity. You're adding new hospitals. You're adding beds to existing hospitals in addition to doing acquisitions of existing hospitals. How do you get comfortable, because I know you do your work? How do you get comfortable knowing that you're going to need these beds when everybody else is going to be emptying out theirs? Jay F. Grinney - President, Chief Executive Officer & Director: Well. I think, Sheryl, you're right that there is a change going on in the post-acute world out of facilities and into the home. In fact, that's clearly one of the reasons we looked at expanding into home health. What we're seeing, though, in the markets is that the facilities that the patients are leaving are the SNFs, not the inpatient rehabilitation hospitals. There is a built-in demand that is not replaceable going into a SNF. If you look at the kinds of patients that we treat, the kind of medications that they're on, the kind of nursing care that's required, we're licensed as hospitals. And so, we're a logical next step for those patients, those high-acuity, high-comorbidity patients, who no longer qualify for an inpatient acute stay, coming into our hospitals. So, you're absolutely right, we think that our home health segment is going to be the beneficiary of those patients who are going into SNFs, who really should be at home.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst · Mizuho Securities.

Right. Jay F. Grinney - President, Chief Executive Officer & Director: In fact, we see that, in our hospitals, we discharge 20%, 30% of our patients to SNF, the vast majority of whom could easily go into a home care setting if they felt more comfortable, if the family member felt more comfortable that they could be cared for in the home. And one of the reasons why we're so excited about partnering with Encompass is, because we believe with Encompass, we are now able to provide that transition, obviating the need for the skilled stay.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst · Mizuho Securities.

Great. Okay. But in the actual new development module, I presume you're looking out at the market demand inclusive of these payment changes and still see a reasonable opportunity to fill those new beds. Jay F. Grinney - President, Chief Executive Officer & Director: Absolutely. And furthermore, if we look all the way out – if we go out the end of our horizon, frankly, we envision a time where we won't be talking about SNF beds, IRF beds, LTAC beds, we'll be talking about post-acute beds. And in that kind of environment, I think that the market will open up for us, because in that kind of environment, if there are no arbitrary designations and CMS is no longer focused on making sure the right post-acute payment goes to the right provider because of bundling, because of ACOs, then the focus is going to be on what facility can provide the best care. The notion that every single patient being discharged from acute care hospital is automatically going to be able to go home is not an accurate assumption. And as our population ages, and we see that most of our Medicare patients are over the age of 75 years. Well, there's this huge cohort, called the baby boomers, as you well know, that are moving into that, we're getting – the Medicare population is growing right now at a faster clip than it's ever grown before and yet the patients who will require inpatient care haven't really started getting into the age where they need that care. But another five years, 10 years, when the newly-minted baby – Medicare population is now 77 years, 78 years, I mean, we don't like to think about it, but inevitably a large number of those are going to have strokes, they're going to have chronic neurological conditions. They're going to find themselves in acute care hospitals with conditions that are going to require hospital-level post-acute care. And that's the niche that our facilities will provide. Now, we may change the name, we may change the level of service, but they're going to need some kind of post-acute care hospital care. And then, the specific reason we got into home health is because we know there are going to be many of those patients who can then go directly home.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst · Mizuho Securities.

Right. Jay F. Grinney - President, Chief Executive Officer & Director: And there are a lot of patients who in that acute care environment coming out and they don't need to come to us. They're the simple knee or hip that are going into a SNF today. Absolutely, tomorrow, they'll be able to go home and we want to be there to provide that care in the home.

Sheryl R. Skolnick - Mizuho Securities USA, Inc.

Analyst · Mizuho Securities.

Great. Thank you so much.

Operator

Operator

Our next question comes from the line of John Ransom from Raymond James. John W. Ransom - Raymond James & Associates, Inc.: Hi. Thanks. Just a real quick follow-up, shifting gears to home health, if you look at your Q4 EBITDA and you peel out CareSouth and compare it to kind of run rate a year ago, including Encompass, how should we think about the organic growth in that business year-over-year? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: In what business? John W. Ransom - Raymond James & Associates, Inc.: Home health. Home health. Jay F. Grinney - President, Chief Executive Officer & Director: Home health ex-CareSouth. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: I think what we've given you, John, there it's – we're not able to give a comp-store figure in 2015, because we didn't own Encompass in 2014. But we've given you some of the volume metrics for those agencies that were owned by Encompass for all of 2014. And I think that's probably the best indication of the current run-rate in the business. And there, you're seeing double-digit increases in the key volume metrics. John W. Ransom - Raymond James & Associates, Inc.: So, if I remember, I think Encompass was running, what, $75 million of EBITDA when you bought it. What were your legacy home health businesses running at the time that you bought it? Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: Pretty de minimis, somewhere in kind of the $4 million to $5 million range. John W. Ransom - Raymond James & Associates, Inc.: Okay. So, if we took out, say, $5 million and we took out a couple of million for CareSouth and compared that $25 million run rate, those two things to $75 million, that would give you an idea of the growth, something like that. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: I don't recall having the $75 million out there. I think there may be some apples-to-oranges going on there, John. It's probably best if we try to reconcile that offline. John W. Ransom - Raymond James & Associates, Inc.: Okay. No problem. It's always dangerous when a SEC guy starts doing math. So, I'll take that under advisement. I'm talking about myself, Doug, not you. Jay F. Grinney - President, Chief Executive Officer & Director: Everything is number one, right? John W. Ransom - Raymond James & Associates, Inc.: I'm talking about myself, not you. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: The other thing is we're comparing a segment number to a stand-alone Encompass numbers. So, I think there's some mapping issues there that we'd be happy to go through with you offline. John W. Ransom - Raymond James & Associates, Inc.: Sure. Sure. Okay. Thank you. Jay F. Grinney - President, Chief Executive Officer & Director: You bet.

Operator

Operator

Our next question comes from the line of Toby Wann with Obsidian Research.

Toby Wann - Obsidian Research Group LLC

Analyst · Obsidian Research.

Hey. Thanks for taking the question, guys. Just wanted to touch base quickly with regards to your MAC and continued issues there. And what options really kind of are still on the table for you guys in terms of maybe repositioning existing hospitals to more a geographic-based MAC orientation, et cetera? Can you just kind of provide some color on that? Jay F. Grinney - President, Chief Executive Officer & Director: Yeah. We have repeatedly asked for the opportunity to have our hospital serviced by the MACs that have the contracts for the geographic jurisdiction they're in. And we've been told that that is not possible. I will say, though, Toby, that we have – over the last several months have had several discussions with Cahaba. They've been very productive. And I think that we're learning more about what they're looking at and why. They're learning more about what we do and why. I think some of the fixes are going to be, as we've said before, driven by enhancements to our EMR. And there may be some changes that could occur as this particular MAC or other MACs that we deal with recognize that there may be some inconsistencies in the way they're approaching denials. So, to your specific question, can we move to a geographic-based approach? Thus far, we've been told no. That is something that we continue to raise. And perhaps, at some point, we'll be able to get a more favorable response.

Toby Wann - Obsidian Research Group LLC

Analyst · Obsidian Research.

And is CMS the one that's ultimately making that decision? Jay F. Grinney - President, Chief Executive Officer & Director: Yes. Yeah.

Toby Wann - Obsidian Research Group LLC

Analyst · Obsidian Research.

Okay. Jay F. Grinney - President, Chief Executive Officer & Director: Yes.

Toby Wann - Obsidian Research Group LLC

Analyst · Obsidian Research.

Okay. Thanks for taking the question. Jay F. Grinney - President, Chief Executive Officer & Director: You bet. Douglas E. Coltharp - Chief Financial Officer & Executive Vice President: I just want to circle back on the question that John Ransom had with regard to home health. John, this may not completely answer your question, but if you look at the guidance that we had established at the beginning of 2015, we said that we expected the 2015 adjusted EBITDA contribution from Encompass, not inclusive of the legacy HealthSouth home health agencies, to be $72 million. We then said that we would be folding the HealthSouth agencies in. As I mentioned to you, on a historical basis, those have generated $4 million to $5 million in EBITDA. But as we acknowledged, through the course of 2015, there was some friction combining those in. And then, we had the addition of CareSouth for two months. Still with all of that, we posted $83 million in adjusted EBITDA for the year, so that tells you that there was good core year-over-year growth in the Encompass agencies. And that the $72 million initial estimate represented growth for those agencies over where they were in 2014. So, again, I'm not sure where you got the $75 million, but I think that your initial base was incorrect.

Operator

Operator

And there appear to be no further questions at this time. I'd like to turn the floor back over to Crissy Carlisle for any additional or closing remarks.

Crissy Buchanan Carlisle - Chief Investor Relations Officer

Management

Thank you. If anyone has additional questions, I will be available later today and tomorrow. Please call me at 205-970-5860. Thank you again for joining today's call.

Operator

Operator

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