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8-K - 8-K - 21st Century Oncology Holdings, Inc.a12-26695_18k.htm

Exhibit 99.1

 

 

RADIATION THERAPY SERVICES HOLDINGS, INC.

 

Contact:

Bryan J. Carey

Chief Financial Officer

(239) 930-7281

BCarey@rtsx.com

Investors:

Amy Glynn / Nick Laudico

The Ruth Group

646-536-7023 / 7030

aglynn@theruthgroup.com

nlaudico@theruthgroup.com

 

RADIATION THERAPY SERVICES REPORTS THIRD QUARTER 2012

FINANCIAL RESULTS

 

Third Quarter 2012 Financial Highlights:

 

·                  Total company revenues increased 7.2% to $167.5 million

·                  Domestic same practice treatments per day increased 3.6%

·                  International cases increased 7.5%

·                  Pro Forma Adjusted EBITDA of $22.6 million

 

Final Rule Highlights:

 

·                  CMS incorporated updated cost inputs supplied by the industry

·                  IMRT reimbursement reduced by 15% as compared to proposed 40% reduction

·                  CMS indicated it intends to work with Radiation Oncologists to develop episode of care or bundled payments similar to what has been proposed by the Radiation Therapy Alliance

 

FORT MYERS, FL, November 12, 2012 — Radiation Therapy Services Holdings, Inc (“Radiation Therapy” or “the Company”), a leading operator of radiation therapy centers, announced today its financial results for the third quarter and nine months ended September 30, 2012.  The Company reported preliminary third quarter results on November 5, 2012.

 

Dr. Daniel Dosoretz, President and Chief Executive Officer, commented, “As you know, we were very pleased with the outcome of the Final Rule recently published by CMS, as the overall reduction in reimbursement to radiation oncology of 7% was significantly better than what had been proposed in the Preliminary Rule.  This outcome reflects our efforts, along with other providers and advocacy groups, to provide clarity into the true costs associated with providing radiation therapy and to offer CMS alternative solutions for managing healthcare spend in this important area of cancer care.  Going forward, we also believe there is an interest by CMS to work with the industry on bundled or episode of care payment methodologies which will help to ensure appropriate levels of utilization and improved patient care.”

 

“While we expect the rate cuts to have an estimated impact of $20 million on revenues and $16 million on EBITDA for the full year 2013, we expect that we can mitigate a portion of that

 



 

through cost reduction initiatives, improved managed care pricing and growth through expansion and accretive acquisitions. We continue to also focus on expansion opportunities in Latin America, which will also help to offset the rate reductions in the U.S.  As we indicated in our preliminary release of third quarter results, we are experiencing an increasingly challenging operating environment, largely due to meaningful declines in our treatments for prostate cancer.  We believe these declines are resulting from new guidelines published by The United States Preventive Services Task Force that recommend against PSA testing and prostate cancer screening for men with a life expectancy of over 10 years, slowing the rate of men diagnosed and treated. Additionally, we believe an increase in the percentage of patients who, in consultation with their physicians, are choosing not to be actively treated but instead pursuing active surveillance regimens is also affecting treatment volumes. However, we continue to make progress on our integrated cancer care strategy and physician liaison program, which are both helping to drive incremental volume growth and partly offset the declines in prostate.  We strongly believe that these efforts will serve to enhance Radiation Therapy’s leading position as a provider of advanced cancer care, and ensure that our patients continue to receive the highest level of care,” concluded Dr. Dosoretz.

 

Third Quarter 2012 Results

 

Total revenues for the third quarter of 2012 were $167.5 million, an increase of 7.2% compared to $156.3 million in revenues in the same quarter of 2011. The increase in revenue was principally due to the benefit of previously acquired or newly established integrated cancer care practices, the impact of strategic tuck-in acquisitions made in California, North Carolina, Florida and Argentina, the value added services agreement with the North Broward Hospital District and organic growth from Medical Developers.

 

Domestic same practice treatments per day increased 3.6% in the third quarter of 2012, reflecting increased referrals from the Company’s physician liaison program and integrated cancer care model and the impact of the North Broward value added services agreement, offset by volume declines in the treatment of prostate cancer, compared to the third quarter of 2011.  Domestic same practice therapy revenue per treatment decreased 3.0% from the third quarter of 2011, due to reductions in the reimbursement rate announced in the CMS 2012 Physician Fee Schedule, partially offset by continued improvements in managed care pricing.

 

Total RVUs per day at same practice domestic freestanding centers, excluding the impact of the Las Vegas capitated contract, decreased 5.0% in the third quarter versus the same period of the prior year principally due to reductions in the reimbursement rate included in the CMS 2012 Physician Fee Schedule.

 

Adjusted earnings before interest, taxes, depreciation, amortization, stock-based compensation and other non-cash and pro forma items (“Pro Forma Adjusted EBITDA”) in the third quarter of 2012 was $22.6 million, or 13.5% of total pro forma revenues, compared to $27.9 million, or 17.7% of total pro forma revenues, in the third quarter of 2011. Pro Forma Adjusted EBITDA margins declined in the current quarter versus the prior year period primarily due to reductions in the Medicare reimbursement rate, the impact of the termination of capitated contracts in Las

 



 

Vegas, NV, the growth and expanded development activity in establishing integrated care practices, and investments made in key personnel. In addition, the Company had one less treatment day in the third quarter as compared to the third quarter of 2011. Together with closures and schedule changes due to Hurricane Isaac, the Company experienced lower revenues despite overall fixed expenses at radiation centers. In addition, certain cost reduction activities have been deferred in order to incorporate actions triggered by the impact of the 2013 physician fee schedule. A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc., determined in accordance with generally accepted accounting principles to Pro Forma Adjusted EBITDA and total revenues, determined in accordance with generally accepted accounting principles, to total pro forma revenues for the quarters ended September 30, 2012 and 2011 is included in the attached supplemental financial information.

 

Income tax expense in the third quarter of 2012 was $1.7 million, compared to an income tax benefit of $11.0 million in the third quarter of 2011.  The net loss for the third quarter of 2012 was $90.5 million, compared to a net loss of $230.3 million in the third quarter of 2011.  The net loss in the third quarter of 2012 and 2011 included impairment charges of $69.9 million and $237.6 million, respectively, attributable to revisions of the Company’s financial forecasts largely as a result of reductions in reimbursement, primarily to write down goodwill, trade name and an investment in a joint venture to their implied fair values, as well as continued depressed economic conditions in the U.S.

 

First Nine Months of 2012 Results

 

Total revenues for the nine months ended September 30, 2012 were $525.2 million, an increase of 10.6% compared to $475.1 million in revenues in the same period of 2011. The increase in revenue was principally due to the benefit of previously acquired or newly established integrated cancer care practices, the impact of strategic tuck-in acquisitions made in California, North Carolina, Florida and Argentina, the value added services agreement with the North Broward Hospital District and organic growth from Medical Developers.

 

Domestic same practice treatments per day increased 3.3% in the first nine months of 2012, due to increased referrals from the Company’s physician liaison program and integrated cancer care model and the impact of the North Broward value added services agreement, offset by volume declines in the treatment of cancer care, compared to the first nine months of 2011.  However, domestic same practice therapy revenue per treatment decreased 3.1% from the first nine months of 2011, due to reductions in the reimbursement rate announced in the CMS 2012 Physician Fee Schedule which were partially offset by improved managed care pricing.

 

Total RVUs per day at same practice domestic freestanding centers, excluding the impact of the Las Vegas capitated contract, decreased 5.1% in the first nine months versus the same period of the prior year principally due to reductions in the reimbursement rate included in the CMS 2012 Physician Fee Schedule.

 

Pro Forma Adjusted EBITDA in the first nine months of 2012 was $81.4 million, or 15.3% of total pro forma revenues, compared to $91.3 million, or 18.6% of total pro forma revenues, in the first nine months of 2011. Pro Forma Adjusted EBITDA margins declined in the current nine

 



 

month period versus the prior year period primarily due to reductions in the Medicare reimbursement rate, the impact of the termination of capitated contracts in Las Vegas, NV, the growth and expanded development in integrated care practices, and investments made in key personnel. In addition, certain cost reduction activities have been deferred in order to incorporate actions triggered by the impact of the 2013 physician fee schedule.  A reconciliation of net loss attributable to Radiation Therapy Services Holdings, Inc., determined in accordance with generally accepted accounting principles to Pro Forma Adjusted EBITDA and total revenues, determined in accordance with generally accepted accounting principles, to total pro forma revenues for the nine-month periods ended September 30, 2012 and 2011 is included in the attached supplemental financial information.

 

Income tax expense in the first nine months of 2012 was $3.3 million, compared to an income tax expense benefit of $5.2 million in the first nine months of 2011.  The net loss for the first nine months of 2012 was $117.9 million, compared to a net loss of $238.2 million in the first nine months of 2011. The net loss in the first nine months of 2012 and 2011 included impairment charges of $69.9 million and $237.6 million, respectively, attributable to revisions of the Company’s financial forecasts largely as a result of reductions in reimbursement, primarily to write down goodwill, trade name and an investment in a joint venture to their implied fair values, as well as continued depressed economic conditions in the U.S.

 

Recent Developments

 

On November 1, 2012, CMS published its Final Rule for the 2013 Physician Fee Schedule (PFS), which calls for an overall rate reduction of 7% for radiation oncology, including a 15% reduction in the reimbursement for IMRT treatments and a 20% reduction in the reimbursement for stereotactic radiosurgery treatments.  The rate reductions in the Final Rule were significantly lower than the proposed reductions published in the Preliminary Rule on July 6, 2012.  Radiation Therapy expects these reductions in reimbursement to impact RVUs for Medicare and Medicare-linked revenues by approximately 9.1%, which is expected to impact revenue by approximately $20 million and EBITDA by approximately $16 million.  The Company expects to partly mitigate the impact of the reduction in reimbursement through cost reductions and improved managed care pricing, as well as growth through expansion and accretive acquisitions.

 

Conference Call

 

Management will host a conference call on Tuesday, November 13, 2012 at 2:00 p.m. ET to discuss its financial results. The dial-in numbers are (877) 407-0789 for domestic callers and (201) 689-8562 for international callers.  In addition, a telephonic replay of the call will be available until November 27, 2012.  The replay dial-in numbers are (877) 870-5176 for domestic callers and (858) 384-5517 for international callers.  Please use the conference ID number 403224 to access the replay.

 

A live webcast and webcast replay of the call will also be available from the Investor Relations section on the corporate web site at www.rtsx.com.

 



 

About Radiation Therapy Services Holdings, Inc.

 

Radiation Therapy Services is a leading provider of advanced radiation therapy and other services to cancer patients in the United States and Latin America.  The Company offers a comprehensive range of radiation treatment alternatives, focused on delivering academic quality, cost-effective patient care in a personal and convenient setting. In total, the Company operates 126 treatment centers, including 94 centers located in 15 U.S. states, strategically clustered in 28 local markets. The Company also operates 31 centers located in six countries in Latin America and 1 center located in India.  The Company holds market leading positions in most of its domestic local markets and abroad.

 

Forward-Looking Statements

 

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Act of 1934, as amended.  Statements preceded by, followed by or that otherwise include the words “believes”, “expects”, “anticipates”, “intends”, “projects”, “estimates”, “plans”, “may increase”, “forecast” and similar expressions or future or conditional verbs such as “will”, “should”, “would”, “may” and “could” are generally forward-looking in nature and not historical facts. Forward-looking statements are based on management’s current expectations or beliefs about the Company’s future plans, expectations and objectives, including, but not limited to, the Company’s expected financial results and estimates for 2012 and the effect of CMS's Final Rule for the 2013 Physician Fee Schedule on its results.  These forward-looking statements are not historical facts and are subject to risks and uncertainties that could cause the actual results to differ materially from those projected in these forward-looking statements including, but not limited to reductions in Medicare reimbursement, healthcare reform, decreases in payments by managed care organizations and other commercial payers  and other risk factors that may be described from time to time in the Company’s filings with the Securities and Exchange Commission.  Readers of this release are cautioned not to place undue reliance on forward-looking statements contained herein, which speak only as of the date stated, or if no date is stated, as of the date of this press release. The Company undertakes no obligation to publicly update or revise the forward-looking statements contained herein to reflect changed events or circumstances after the date of this release, unless required by law.

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(in thousands, except share amounts)

 

 

 

September 30,

 

December 31,

 

 

 

2012

 

2011

 

 

 

(unaudited)

 

 

 

ASSETS

 

 

 

 

 

Current assets:

 

 

 

 

 

Cash and cash equivalents

 

$

27,934

 

$

10,177

 

Accounts receivable, net

 

89,414

 

87,094

 

Prepaid expenses

 

7,921

 

5,731

 

Inventories

 

4,755

 

4,308

 

Deferred income taxes

 

3,318

 

2,969

 

Other

 

6,037

 

6,025

 

Total current assets

 

139,379

 

116,304

 

 

 

 

 

 

 

Equity investments in joint ventures

 

496

 

692

 

Property and equipment, net

 

227,449

 

236,411

 

Real estate subject to finance obligation

 

15,395

 

13,719

 

Goodwill

 

498,188

 

556,547

 

Intangible assets, net

 

38,462

 

42,393

 

Other assets

 

44,784

 

32,526

 

Total assets

 

$

964,153

 

$

998,592

 

 

 

 

 

 

 

LIABILITIES AND EQUITY

 

 

 

 

 

 

 

 

 

 

 

Current liabilities:

 

 

 

 

 

Accounts payable

 

$

23,690

 

$

27,748

 

Accrued expenses

 

60,381

 

42,596

 

Income taxes payable

 

2,625

 

5,310

 

Current portion of long-term debt

 

10,972

 

13,945

 

Current portion of finance obligation

 

259

 

161

 

Other current liabilities

 

6,764

 

6,615

 

Total current liabilities

 

104,691

 

96,375

 

Long-term debt, less current portion

 

744,552

 

665,088

 

Finance obligation, less current portion

 

15,994

 

14,105

 

Other long-term liabilities

 

21,785

 

22,659

 

Deferred income taxes

 

9,726

 

10,343

 

Total liabilities

 

896,748

 

808,570

 

 

 

 

 

 

 

Noncontrolling interests - redeemable

 

12,817

 

12,728

 

 

 

 

 

 

 

Commitments and Contingencies

 

 

 

 

 

 

 

 

 

 

 

Equity:

 

 

 

 

 

Common stock, $0.01 par value, 1,025 shares authorized, issued and outstanding

 

 

 

Additional paid-in capital

 

651,799

 

648,703

 

Retained deficit

 

(604,953

)

(483,815

)

Notes receivable from shareholder

 

 

(125

)

Accumulated other comprehensive loss, net of tax

 

(8,960

)

(4,890

)

Total Radiation Therapy Services Holdings, Inc. shareholder’s equity

 

37,886

 

159,873

 

Noncontrolling interests - nonredeemable

 

16,702

 

17,421

 

Total equity

 

54,588

 

177,294

 

Total liabilities and equity

 

$

964,153

 

$

998,592

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS

(in thousands)

(unaudited)

 

 

 

Three Months Ended

 

Nine Months Ended

 

 

 

September 30,

 

September 30,

 

 

 

2012

 

2011

 

2012

 

2011

 

 

 

 

 

 

 

 

 

 

 

Revenues:

 

 

 

 

 

 

 

 

 

Net patient service revenue

 

$

165,385

 

$

154,335

 

$

519,432

 

$

470,305

 

Other revenue

 

2,131

 

1,931

 

5,783

 

4,754

 

Total revenues

 

167,516

 

156,266

 

525,215

 

475,059

 

 

 

 

 

 

 

 

 

 

 

Expenses:

 

 

 

 

 

 

 

 

 

Salaries and benefits

 

87,190

 

77,714

 

276,199

 

238,727

 

Medical supplies

 

15,686

 

12,208

 

47,785

 

37,863

 

Facility rent expense

 

10,119

 

8,374

 

29,634

 

24,508

 

Other operating expenses

 

10,001

 

8,990

 

28,663

 

24,828

 

General and administrative expenses

 

19,076

 

19,209

 

60,059

 

58,514

 

Depreciation and amortization

 

16,697

 

13,629

 

48,140

 

39,082

 

Provision for doubtful accounts

 

5,425

 

4,621

 

15,286

 

12,143

 

Interest expense, net

 

20,027

 

15,454

 

57,182

 

45,261

 

Early extinguishment of debt

 

 

 

4,473

 

 

Fair value adjustment of earn-out liability

 

1,261

 

 

1,261

 

 

Impairment loss

 

69,946

 

237,560

 

69,946

 

237,560

 

Gain on fair value adjustment of previously held equity investment

 

 

 

 

(234

)

Foreign currency transaction loss

 

140

 

35

 

234

 

34

 

Loss (gain) on foreign currency derivative contracts

 

786

 

(232

)

1,006

 

167

 

Total expenses

 

256,354

 

397,562

 

639,868

 

718,453

 

 

 

 

 

 

 

 

 

 

 

Loss before income taxes

 

(88,838

)

(241,296

)

(114,653

)

(243,394

)

Income tax expense (benefit)

 

1,705

 

(10,969

)

3,254

 

(5,208

)

 

 

 

 

 

 

 

 

 

 

Net loss

 

(90,543

)

(230,327

)

(117,907

)

(238,186

)

 

 

 

 

 

 

 

 

 

 

Net income attributable to noncontrolling interests- redeemable and non-redeemable

 

(842

)

(702

)

(3,231

)

(3,209

)

 

 

 

 

 

 

 

 

 

 

Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder

 

(91,385

)

(231,029

)

(121,138

)

(241,395

)

 

 

 

 

 

 

 

 

 

 

Other comprehensive (loss) income:

 

 

 

 

 

 

 

 

 

Unrealized gain (loss) on derivative interest rate swap agreements

 

 

319

 

(333

)

2,419

 

Unrealized loss on foreign currency translation

 

(2,109

)

(457

)

(5,129

)

(808

)

Other comprehensive (loss) income:

 

(2,109

)

(138

)

(5,462

)

1,611

 

 

 

 

 

 

 

 

 

 

 

Comprehensive loss:

 

(92,652

)

(230,465

)

(123,369

)

(236,575

)

Comprehensive income attributable to noncontrolling interests- redeemable and non-redeemable

 

(717

)

(676

)

(2,797

)

(3,147

)

Comprehensive loss attributable to Radiation Therapy Services Holdings, Inc. shareholder

 

$

(93,369

)

$

(231,141

)

$

(126,166

)

$

(239,722

)

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)

(unaudited)

 

 

 

Nine Months Ended

 

 

 

September 30,

 

 

 

2012

 

2011

 

Cash flows from operating activities

 

 

 

 

 

Net loss

 

$

(117,907

)

$

(238,186

)

Adjustments to reconcile net loss to net cash provided by operating activities:

 

 

 

 

 

Depreciation

 

39,310

 

33,708

 

Amortization

 

8,830

 

5,374

 

Deferred rent expense

 

895

 

922

 

Deferred income taxes

 

(1,095

)

(6,299

)

Stock-based compensation

 

3,221

 

1,201

 

Provision for doubtful accounts

 

15,286

 

12,143

 

Loss on the sale/disposal of property and equipment

 

8

 

4

 

Amortization of termination of interest rate swap

 

958

 

 

Write-off of loan costs

 

525

 

 

Early extinguishment of debt

 

4,473

 

 

Termination of derivative interest rate swap agreements

 

(972

)

 

Impairment loss

 

69,946

 

237,560

 

Gain on fair value adjustment of previously held equity investment

 

 

(234

)

Loss on foreign currency transactions

 

17

 

125

 

Loss on foreign currency derivative contracts

 

1,006

 

167

 

Amortization of debt discount

 

608

 

630

 

Amortization of loan costs

 

4,065

 

3,185

 

Equity interest in net loss of joint ventures

 

681

 

863

 

Distribution received from unconsolidated joint ventures

 

9

 

52

 

Changes in operating assets and liabilities:

 

 

 

 

 

Accounts receivable and other current assets

 

(18,852

)

(15,084

)

Income taxes payable

 

(2,541

)

(4,638

)

Inventories

 

(156

)

(1,938

)

Prepaid expenses

 

632

 

2,273

 

Accounts payable and other current liabilities

 

(4,069

)

1,854

 

Accrued deferred compensation

 

1,009

 

 

Accrued expenses / other current liabilities

 

17,229

 

6,833

 

 

 

 

 

 

 

Net cash provided by operating activities

 

23,116

 

40,515

 

 

 

 

 

 

 

Cash flows from investing activities

 

 

 

 

 

Purchase of property and equipment

 

(24,179

)

(31,045

)

Acquisition of medical practices

 

(24,057

)

(51,940

)

Proceeds from the sale of property and equipment

 

2,988

 

6

 

(Loans to) repayments from employees

 

(81

)

302

 

Contribution of capital to joint venture entities

 

(497

)

(299

)

Distribution received from joint venture entities

 

 

581

 

Proceeds from the sale of equity interest in a joint venture

 

 

312

 

Payment of foreign currency derivative contracts

 

(543

)

(1,096

)

Premiums on life insurance policies

 

(963

)

 

Change in other assets and other liabilities

 

115

 

479

 

 

 

 

 

 

 

Net cash used in investing activities

 

(47,217

)

(82,700

)

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(in thousands)

(unaudited)

 

 

 

Nine Months Ended

 

 

 

September 30,

 

 

 

2012

 

2011

 

 

 

 

 

 

 

Cash flows from financing activities

 

 

 

 

 

Proceeds from issuance of debt (net of original issue discount of $1.7 million and $625,000, respectively)

 

435,663

 

73,927

 

Principal repayments of debt

 

(376,087

)

(29,811

)

Repayments of finance obligation

 

(81

)

(71

)

Proceeds from equity contribution

 

 

3

 

Payments of notes receivable from shareholder

 

 

50

 

Cash distributions to noncontrolling interest holders - redeemable and non-redeemable

 

(3,196

)

(3,425

)

Consolidation of noncontrolling interest

 

 

38

 

Payments of loan costs

 

(14,437

)

(4,424

)

 

 

 

 

 

 

Net cash provided by financing activities

 

41,862

 

36,287

 

 

 

 

 

 

 

Effect of exchange rate changes on cash and cash equivalents

 

(4

)

(12

)

 

 

 

 

 

 

Net increase (decrease) in cash and cash equivalents

 

17,757

 

(5,910

)

Cash and cash equivalents, beginning of period

 

10,177

 

13,977

 

 

 

 

 

 

 

Cash and cash equivalents, end of period

 

$

27,934

 

$

8,067

 

 

 

 

 

 

 

Supplemental disclosure of noncash transactions

 

 

 

 

 

Recorded finance obligation related to real estate projects

 

$

2,068

 

$

11,288

 

Recorded derecognition of finance obligation related to real estate projects

 

$

 

$

(3,421

)

Recorded noncash consolidation of noncontrolling interest

 

$

 

$

96

 

Recorded capital lease obligations related to the purchase of equipment

 

$

5,618

 

$

598

 

Recorded accounts payable related to acceptance and delivery of medical equipment

 

$

 

$

2,233

 

Recorded issuance of Parent equity units related to the acquisition of medical practices

 

$

 

$

16,250

 

Recorded issuance of senior subordinated notes related to the acquisition of medical practices

 

$

 

$

16,047

 

Recorded earn-out accrual related to the acquisition of medical practices

 

$

 

$

2,340

 

Recorded additional consideration related to the acquisition of medical practices

 

$

 

$

561

 

Recorded noncash dividend declared to noncontrolling interest

 

$

231

 

$

332

 

Recorded property and equipment related to the North Broward Hospital District license agreement

 

$

4,260

 

$

 

Recorded capital lease obligations related to the acquisition of medical practices

 

$

5,746

 

$

 

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

Supplemental Financial Information (Unaudited)

Reconciliation of Total Pro-forma Revenue and Pro-forma Adjusted EBITDA to Net Loss Attributable

to Radiation Therapy Services Holdings, Inc. Shareholder

 

 

 

Three Months Ended

 

Nine Months Ended

 

 

 

September 30,

 

September 30,

 

 

 

2012

 

2011

 

2012

 

2011

 

(in thousands):

 

 

 

 

 

 

 

 

 

Total revenues

 

$

167,516

 

$

156,266

 

$

525,215

 

$

475,059

 

Pro-forma full period effect of acquisitions (a)

 

 

981

 

8,178

 

15,084

 

Total pro-forma revenues

 

$

167,516

 

$

157,247

 

$

533,393

 

$

490,143

 

 

 

 

 

 

 

 

 

 

 

Net loss attributable to Radiation Therapy Services Holdings, Inc. shareholder

 

$

(91,385

)

$

(231,029

)

$

(121,138

)

$

(241,395

)

Income tax epense (benefit)

 

1,705

 

(10,969

)

3,254

 

(5,208

)

Interest expense, net

 

20,027

 

15,454

 

57,182

 

45,261

 

Depreciation and amortization

 

16,697

 

13,629

 

48,140

 

39,082

 

Gain on fair value adjustment of previously held equity investment

 

 

 

 

(234

)

Loss (gain) on foreign currency derivative contracts

 

786

 

(232

)

1,006

 

167

 

Early extinguishment of debt

 

 

 

4,473

 

 

Fair value adjustment of earn-out liability

 

1,261

 

 

1,261

 

 

Impairment loss

 

69,946

 

237,560

 

69,946

 

237,560

 

Management fees (b)

 

244

 

296

 

785

 

914

 

Non-cash expenses (c)

 

715

 

907

 

4,640

 

3,170

 

Sale-lease back adjustments (d)

 

(248

)

(243

)

(737

)

(682

)

Acquisition-related costs (e)

 

571

 

1,291

 

2,316

 

4,288

 

Other expenses (f)

 

644

 

605

 

1,538

 

1,037

 

Litigation settlement (g)

 

952

 

 

2,053

 

938

 

Costs associated with the provision for income taxes (h)

 

 

 

532

 

544

 

Tradename / rebranding initiative (i)

 

206

 

 

523

 

 

Expenses associated with idle / closed treatment facilities (j)

 

494

 

 

1,972

 

 

Pro-forma full period effect of acquisition EBITDA (a)

 

 

593

 

3,686

 

5,840

 

 

 

 

 

 

 

 

 

 

 

Pro-forma Adjusted EBITDA (1)

 

$

22,615

 

$

27,862

 

$

81,432

 

$

91,282

 

 

 

 

 

 

 

 

 

 

 

Pro-forma Adjusted EBITDA as a percentage of total pro-forma revenues

 

13.5

%

17.7

%

15.3

%

18.6

%

 



 


(1) Pro-forma Adjusted EBITDA is defined as income (loss) before interest expense (net of interest income), income taxes, depreciation and amortization, foreign currency derivative contract loss, gain on fair value adjustment of previously held equity investment, early extinguishment of debt, purchase price adjustment, impairment loss, management fees from our sponsor, non-cash expenses including costs relating to stock compensation, amortization of straigh-line rent and amortization of capital expenditures relating to repairs and maintenance, sale-lease back adjustments, acquisition-related costs, other expenses including loss on sale of assets, severance payments related to termination of employess staff reductions, tail premiums on termed physicians, franchise taxes, litigation settlements with physician, costs associated with the provision for income taxes, costs associated with tradename and rebranding initiatives, expenses associated with idle / closed radiation therapy treatment facilities and pro-forma full period effect of acquisition EBITDA.

 

(a) Pro-forma amounts related to adjustments to total revenues and Pro-forma Adjusted EBITDA to reflect the full period effect of our acquisitions completed during 2011 and 2012.  The adjustments reflect the impact to our total revenues and Pro-forma Adjusted EBITDA as if the acquisitions had occurred at the beginning of the year.

 

(b) Management fees are fees paid to our sponsor, Vestar Capital Partners.

 

(c) Non-cash expenses including costs relating to stock compensation, amortization of straight-line rent and amortization of capital expenditures relating to warranty arrangements amortized to repairs and maintenance.

 

(d) Sale-lease back adjustments relates to the adjustment of benefit derived from the classification of operating leases as finance obiligations reflecting a reclassification of interest expense and depreciation and amortization expense as rent expense.

 

(e) Acquisition related costs associated with ASC 805, Business Combinations, including professional fees and due diligence costs relating to the acquisition of physician practices.

 

(f) Other expenses include loss on sale of assets, severance payments related to termination of employee staff reductions, tail premiums paid on terminated physicians and franchise taxes.

 

(g) Litigation settlement relates to costs associated with the termination of physicians during 2011 and 2012.

 

(h) Expenses related to the costs associated with process improvements in the provision for income taxes.

 

(i) Expeses related to the costs associated with the Company’s tradename and rebranding initiatives.

 

(j) Expenses associated with idle / closed radiation therapy treatment facilities.

 

We believe the Pro-forma Adjusted EBITDA provides useful information about our financial performance to investors, lenders, financial analysts and rating agencies since these groups have historically used EBITDA-related measures in the healthcare industry, along with other measures, to estimate the value of a company, to make informed investment decisions, to evaluate a company’s leverage capacity and its ability to meet its debt service requirements.  Pro-forma Adjusted EBITDA eliminates the uneven effect of non-cash depreciation of tangibles assets and amortization of intangible assets, much of which results from acquisitions accounted for under the purchase method of accounting.  Pro-forma Adjusted EBITDA is also used by us to measure individual performance for incentive compensation purposes and as an analytical indicator for purposes of allocating resources to our operating business and assessing their performance, both internally and relative to our peers, as well as to evaluate the performance of our operating management teams, and for purposes in the calculation of debt covenants and related disclosures.

 

Pro-forma Adjusted EBITDA is not intended as a substitute for net income (loss) attributable to Radiation Therapy Services Holdings, Inc. shareholder, operating cash flows or other cash flow data determined in accordance with accounting principles generally accepted in the United States. Due to varying methods of calculation, Pro-forma Adjusted EBITDA as presented may not be comparable to similarly titled measures of other companies.

 



 

RADIATION THERAPY SERVICES HOLDINGS, INC.

KEY OPERATING STATISTICS

(unaudited)

 

 

 

 

Three Months Ended

 

 

 

Nine Months Ended

 

 

 

 

 

September 30,

 

%

 

September 30,

 

%

 

Domestic U.S.

 

2012

 

2011 *

 

Change

 

2012

 

2011 *

 

Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of treatment days

 

63

 

64

 

 

 

191

 

192

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total RVU’s - freestanding centers

 

2,775,821

 

2,885,434

 

-3.8

%

8,677,857

 

9,006,924

 

-3.7

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RVU’s per day - freestanding centers

 

44,061

 

45,085

 

-2.3

%

45,434

 

46,911

 

-3.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in RVU’s per day - freestanding centers - same practice basis

 

-5.0

%

10.7

%

 

 

-5.1

%

9.5

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total treatments - freestanding centers

 

119,167

 

113,346

 

5.1

%

372,488

 

355,176

 

4.9

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatments per day - freestanding centers

 

1,892

 

1,771

 

6.8

%

1,950

 

1,850

 

5.4

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in revenue per treatment - freestanding centers - same practice basis

 

-3.0

%

-0.1

%

 

 

-3.1

%

2.8

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in treatments per day - freestanding centers - same practice basis

 

3.6

%

1.0

%

 

 

3.3

%

-0.2

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of regions at period end (global)

 

9

 

9

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of local markets at period end

 

28

 

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Treatment centers - freestanding (global)

 

121

 

112

 

8.0

%

 

 

 

 

 

 

Treatment centers - hospital / other groups (global)

 

5

 

9

 

-44.4

%

 

 

 

 

 

 

 

 

126

 

121

 

4.1

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days sales outstanding at quarter end

 

39

 

44

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percentage change in freestanding revenues - same practice basis

 

-1.1

%

0.9

%

 

 

-0.5

%

3.2

%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net patient service revenue - professional services only (in thousands)

 

$

48,239

 

$

39,198

 

 

 

$

150,066

 

$

121,732

 

 

 

 


* Excludes the impact of the termination of a capitated contract in Las Vegas, Nevada

 

 

 

Three Months Ended

 

 

 

Nine Months Ended

 

 

 

 

 

September 30,

 

%

 

September 30,

 

%

 

International

 

2012

 

2011

 

Change

 

2012

 

2011 **

 

Change

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of new cases

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2-D cases

 

1,153

 

1,358

 

 

 

3,603

 

4,007

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3-D cases

 

2,262

 

1,748

 

 

 

6,589

 

5,013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMRT / IGRT cases

 

346

 

393

 

 

 

1,125

 

1,024

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

3,761

 

3,499

 

7.5

%

11,317

 

10,044

 

12.7

%

 


** includes full period operating statistics, including period prior to our acquisition on March 1, 2011

 

###