Attached files
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| 8-K - FORM 8-K - AMEDISYS INC | d583614d8k.htm |
| EX-99.2 - EX-99.2 - AMEDISYS INC | d583614dex992.htm |
 Investor
Presentation Leading Home Health & Hospice
August 2013
clinical
quality
innovative
care models
better
communities
Exhibit 99.1 |
 Forward-looking Statements
2
www.amedisys.com
NASDAQ: AMED
We encourage everyone to visit the
Investors Section of our website at
www.amedisys.com, where we have
posted additional important
information such as press releases,
profiles concerning our business and
clinical operations and control
processes, and SEC filings.
We intend to use our website to
expedite public access to time-critical
information regarding the Company in
advance of or in lieu of distributing a
press release or a filing with the SEC
disclosing the same information.
This presentation may include forward-looking statements as defined by the Private
Securities Litigation Reform Act of 1995. These forward-looking statements are based
upon current expectations and assumptions about our business that are subject to a
variety of risks and uncertainties that could cause actual results to differ materially
from those described in this presentation. You should not rely on forward-looking
statements as a prediction of future events.
Additional
information
regarding
factors
that
could
cause
actual
results
to
differ
materially from those discussed in any forward-looking statements are described in
reports and registration statements we file with the SEC, including our Annual Report on
Form 10-K and subsequent Quarterly Reports on Form 10-Q and Current Reports on
Form 8-K, copies of which are available on the Amedisys internet website
http://www.amedisys.com
or by contacting the Amedisys Investor Relations department
at (800) 467-2662.
We disclaim any obligation to update any forward-looking statements or any changes in
events, conditions or circumstances upon which any forward-looking statement may be
based except as required by law. |
 Company
Overview 3
•
Founded in 1982, publicly listed 1994
•
503 care centers in 37 states
•
14,700 employees
•
Projected revenue in 2013 of approximately $1.3
billion
•
Largest provider of skilled home health services
•
4
largest hospice business
1
For the quarter ended June 30, 2013
1
th |
 Business
Segments 4
Business
Segment
% of
Revenue
Reimbursement Type
HH -
Medicare
65%
Paid episodically (over a 60-
day episode of care)
HH –
Non-Medicare
15%
Majority paid per visit;
remainder paid episodically
Hospice
20%
Mainly Medicare; paid at a
daily rate
1
Revenue mix based on 2Q13 revenue
15%
20%
65%
HH
-
Medicare
HH
-
-
Medicare
Non
Hospice
Revenue Mix
1 |
 Care
Center
Locations
1
5
Home Health Care Centers (409)
Hospice Care Centers (94)
1
As of June 30, 2013, includes care centers currently held for sale
|
 Estimated
Market
Share
–
Medicare
Revenue
6
13.6%
13.6%
Note: Estimated market share of total 2011 Medicare reimbursement
Home Health
Hospice
1.5%
12.1%
45.2%
7.8%
33.4%
7.9%
56.8%
12.5%
17.1%
5.7%
Amedisys
For Profit
Non-Profit
Public Peers
Hospital-based
Amedisys
For Profit
Non-Profit
Public Peers
Hospital-based |
 7
Home Health/Hospice Medicare Spend
Home Health Source: CBO March 2013 Baseline report (10 year CAGR)
Hospice
Source:
2011
actual
hospice
spending
with
growth
rate
based
on
“Other
Services”
section
of
CBO
March
2013
Baseline
report
(10
year
CAGR)
Population growth estimates provided by Tetrad; CAGR is for 2012-2017 (5 years)
Compound
Annual
Growth
Rates
(CAGR)
Home Health Expenditures = 4.4%
Hospice Expenditures = 5.2%
65+ Population = 3.6%
75+ Population = 2.6%
Hospice
Home Health
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
$30
$25
$20
$15
$10
$5
$-
15
19
19
15
16
20
21
17
17
21
22
19
20
24
21
25
27
22
24
28 |
 Medicare
Reimbursement 8
-1.5%
-2.0%
-2.4%
-5.2%
1.9%
-6.0%
-3.0%
0.0%
3.0%
6.0%
2014 -
Proposed
2013
2012
2011
2010
-2.3%
-4.2%
Home Health
Industry
AMED Specific
•
2014 final rule (rebasing)
•
Sustainable growth rate legislation
(Doc Fix)
•
Co-payment proposals
•
Hospice rebasing (U-shaped
reimbursement)
•
Nursing home reimbursement
1.1%
-1.1%-
2.4%
1.8%
1.4%
-6.0%
-3.0%
0.0%
3.0%
6.0%
2014 -
Final
2013
2012
2011
2010
Hospice
Industry
AMED Specific
Reimbursement Considerations
Reimbursement Considerations |
 Favorable Long
Term Trends •
Compelling demographics
•
Patient preference
•
Low cost of care delivery
•
Increased payor and hospital focus
9
Inpatient
Hospital
LTAC
IRF
SNF
Hospice
Home
Health
Average Cost of Stay
$11,700
$38,664
$17,398
$11,728
$11,321
$5,257
Average Length of Stay
5 days
26 days
13 days
27 days
86 days
120 days
Average Per Diem Cost
$2,388
$1,470
$1,338
$431
$132
$44
Source: MedPAC March 2013 report; hospital information is for inpatient facilities only and is
estimated based on patient discharges |
 Traditional Home
Health and Hospice 10
Current
Business
Dynamics
Issues
•
Fee for service based
•
High volume / low margins
•
“Retail”
relationships
•
Patients with multiple
conditions and physicians
•
Poor coordination /
communication
•
Misaligned incentives
•
Minimal data interchange
•
Regulatory limitations on
services
•
Limited physician
coordination |
 Future
Trends 11
Coordinated Care
Management
•
Aligned incentives
•
Data exchange
•
Communications
•
Care Protocol
•
Outcome focused
•
Value driven
Home
Health
Patient
Home
Hospice
Post-Acute
Facilities
Payors
Physicians
Hospitals
Informal
Care Givers |
 Care Management
Initiatives •
Patient care management
•
Shared service care centers
•
Bundled payment initiatives
•
Next generation operating system
•
Other
–
ACO partnerships
–
Enterprise-level relationships
–
Palliative care and medical home
12 |
 Patient Care
Management 13
•
“Right Care. Right Time. Right Place.”
•
Centralized support
–
Local clinical decisions
–
Exception reporting
•
Recertification review
–
Attainment of patient goals
–
Physician orders or medication changes
–
Hospitalization during episode
•
Utilization focus
–
Reduce care plan variability
–
Patient outcome driven |
 Shared Service
Model •
All care centers organized into shared service centers
–
40 shared service centers currently operating
–
Completed by the end of 2013
14
Quality Care
Operational
Efficiency
Leadership
•
Clinical resource support
•
Consistency in care delivery/training
•
POD leadership supporting all care centers
•
Improved leadership turnover coverage
CC 1
CC 2
CC 3
CC 4
CC 5
CC 6
CC7
POD
•
Centralized functions (on-call, intake, scheduling)
•
Specialty clinician productivity
•
Scheduling efficiency |
 Bundles
•
CMS Bundled Payment for Care Initiative (BPCI) program
–
Amedisys focused on Model 3 (post-acute)
–
CMS to set target price for relevant services during bundle
–
Awardees share savings and “at risk”
for costs greater than target
•
Amedisys in awardee process in 5 regions
–
Currently
in
Phase
I
--
a
no-risk
reporting
and
ramp-up
period
–
“At Risk”
period starts Oct. 2013 or Jan. 2014
–
Developing partnerships with hospitals/other partners to manage
•
Also focused on ACOs and Model 2 bundles
15 |
 AMS3 Operating
System •
4Q13 Development complete / implementation begins
•
Migrating to .Net platform
Existing platform sun setting
•
Benefits of proprietary system
–
Low incremental spend
–
Ongoing flexibility and customization
•
Enhancements over existing system
–
Greater clinician productivity
–
Superior clinical management engine
–
Care center efficiencies
–
Interoperability
–
Billing efficiencies
–
Expect $10-$15M in net annual savings after fully rolled out
16 |
 Capital
Expenditures 17
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2008
2009
2010
2011
2012
2013
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
3.8%
3.2%
3.0%
4.0%
2.4%
2.4%
28.4
36.4
64.0
44.4
48.3
47.5
Capex
% of Rev
PeopleSoft
IT Security
AMS3 Development |
 Summary
Financial Results 18
(Continuing operations only for quarterly numbers. $ in
millions, except per share data)
2011
(1)
2012
(1)
2Q12
(2)
2Q13
(2)
Adjusted Net Revenue
$ 1,464
$ 1,488
$363
$313
Gross Margin %
46.7%
43.5%
44.2%
43.8%
Adjusted EBITDA
$ 157
$ 103
$27
$19
Adjusted EBITDA Margin
10.7%
6.9%
7.3%
6.1%
Adjusted EPS
$2.29
$1.08
$0.29
$0.17
1.
The financial results for the years 2012 and 2011 are adjusted for certain items incurred in
2012 and 2011 and should be considered non-GAAP financial measures. A
reconciliation
of
these
non-GAAP
financial
measures
is
included
as
Exhibit
99.2
to
our
Form
8-K
filed
with
the
Securities
and
Exchange
Commission
on
March
12,
2013.
2.
The financial results for the three-month period ended June 30, 2013 and June 30, 2012 are
adjusted for certain items totaling $5.1 million and $1.4 million, respectively,
and should be considered a non-GAAP financial measure. A reconciliation of this
non-GAAP financial measure is included as Exhibit 99.2 to our Form 8-K filed with the
Securities and Exchange Commission on July 31, 2013 |
 Home Health
Segment 19
($ in millions, continuing operations for 2Q numbers)
2011
(1)
2012
(1)
2Q12
(2)
2Q13
(2)
Medicare Revenue
$ 1,038
$ 953
$229
$203
Non-Medicare Revenue
$213
$245
$61
$46
Total Revenue
$ 1,251
$ 1,198
$290
$249
Gross Margin %
46.9%
42.3%
43.1%
42.9%
Contribution
$220
$124
$36
$25
Contribution %
17.6%
10.4%
12.6%
10.2%
1.
Results as reported in our Annual Report on Form 10-K for the year ended December 31,
2012 as filed with the Securities and Exchange Commission on March 12, 2013. 2.
Results as reported in our Quarterly Report on Form 10-Q for the quarter ended June 30,
2013 as filed with the Securities and Exchange Commission on July 31, 2013 |
 20
Home Health Operating Statistics
2011
(1)
2012
(1)
2Q12
(2)
2Q13
(2)
Medicare
Admissions
202,603
200,590
48,023
47,381
Same store admissions growth
(5)%
0%
2%
0%
Recertification rate
44.4%
42.2%
42.6%
36.5%
Revenue per episode
$3,027
$2,874
$2,879
$2,828
Visits per episode
18.7
18.7
19.1
17.6
Non-Medicare
Admissions
73,880
93,016
23,047
18,161
Visits
1,754,255
2,074,446
523,111
378,928
1.
Results as reported in our Annual Report on Form 10-K for the year ended December 31,
2012 as filed with the Securities and Exchange Commission on March 12, 2013.
2.
Results as reported in our Quarterly Report on Form 10-Q for the quarter ended June 30,
2013 as filed with the Securities and Exchange Commission on July 31, 2013. |
 Hospice
Segment 21
($ in millions, continuing operations for 2Q numbers)
2011
(1)
2012
(1)
2Q12
(2)
2Q13
(2)
Total Revenue
$ 218
$ 290
$73
$65
Gross Margin %
46.5%
48.3%
48.5%
47.1%
Contribution
$49
$62
$17
$13
Contribution %
22.6%
21.4%
22.8%
19.7%
Operating Statistics
Total admissions
15,889
19,161
4,797
4,600
Same store revenue growth
19%
13%
22%
(12%)
Average daily census (ADC)
4,197
5,427
5,402
4,939
Average length of stay (ALOS)
88
99
95
99
1.
Results as reported in our Annual Report on Form 10-K for the year ended December 31,
2012 as filed with the Securities and Exchange Commission on March 12, 2013 2.
Results as reported in our Quarterly Report on Form 10-Q for the quarter ended June 30,
2013 as filed with the Securities and Exchange Commission on July 31, 2013. |
 22
Summary Balance Sheet
Assets
Dec. 31, 2012
Jun. 30, 2013
Cash
$ 15
$ 30
Accounts Receivable, Net
169
125
Property and Equipment
157
157
Goodwill
210
209
Other
180
179
Total Assets
$ 731
$ 700
Liabilities
and
Equity
Debt
$ 103
$ 75
Other Liabilities
174
160
Equity
454
465
Total Liabilities and Equity
$ 731
$ 700
Leverage Ratio
1.10x
1.01x
Days Sales Outstanding
42
34
($ in millions) |
 23
Liquidity
1
1.
Availability under revolver of $94 million
2.
1H13
scheduled
debt
repayment
includes
$20M
principal
payment
of
senior
notes
due
in
March
2013,
at
end
of
quarter
$20M
in
senior
notes
remain
outstanding and are due in March 2014
3.
Other cash flows for 2012 include refinancing costs associated with credit agreement signed
on October 26, 2012, retirement of long-term debt and acquisitions.
($ in millions)
2012A
1H13A
2013F
Cash Flow From Operations
$ 69
$66
$ 100-110
Capital Expenditures
48
20
45-50
Scheduled
debt
repayments
2
29
28
36
Cash Flow, Net
(8)
18
14-29
Beginning Cash
48
15
Other
3
(25)
(3)
End Cash
$ 15
$30 |
 24
Guidance
1.
Guidance
based
on
continuing
operations
excluding
the
effects
of
any
one-time
costs
associated
with
our
announced
market
exit
activity
or
corporate
expense initiatives.
2.
Provided as of the date of our form 8-K filed with the Securities and Exchange Commission
on July 31, 2013. 1
2
Calendar Year 2013
Net revenue:
$1.24 -
$1.28 billion
EPS:
$0.45 -
$0.55
Diluted shares:
31.5 million |
 Investment
Rationale •
Favorable demographic trends
•
Positive attributes of home based care
•
IT infrastructure/scalability
•
Clinical quality and innovation
•
Strong liquidity and capital position
•
Market share capture opportunities
25
Efficient Core
Business
Care Mgmt
Solutions |
 Contact
Information Tom Dolan
SVP Finance and Treasurer
Amedisys, Inc.
5959 S. Sherwood Forest Boulevard
Baton Rouge, LA 70816
Office: 225.299.3391
Fax: 225.298.6435
tom.dolan@amedisys.com
26 |