American Renal Associates Holdings, Inc. Announces Second Quarter 2018 Results
BEVERLY, Mass.--(BUSINESS WIRE)--Aug 7, 2018--American Renal Associates Holdings, Inc. (NYSE: ARA) (the “Company”), a leading provider of outpatient dialysis services, today announced financial and operating results for the second quarter ended June 30, 2018.
Certain metrics, including those expressed on an adjusted basis, are Non-GAAP financial measures (See “Use of Non-GAAP Financial Measures” and the reconciliation tables further below).
Second Quarter 2018 Highlights (all percentage changes compare Q2 2018 to Q2 2017 unless noted):Net patient service operating revenues increased 16.8% to $217.2 million; Net loss attributable to American Renal Associates Holdings, Inc. was $18.0 million as compared to a net loss of $2.1 million in Q2 2017; Adjusted EBITDA less noncontrolling interests (“Adjusted EBITDA-NCI”) was $31.5 million as compared to $27.4 million in Q2 2017; Adjusted net income attributable to American Renal Associates Holdings, Inc. was $6.9 million, or $0.20 per share, for Q2 2018; Total dialysis treatments increased 5.6%, of which 4.5% was non-acquired growth. Normalized total treatment growth was 6.3% and normalized non-acquired growth was 5.3%; and As of June 30, 2018, the Company operated 233 outpatient dialysis clinics serving approximately 16,000 patients.
Joseph (Joe) Carlucci, Chairman and Chief Executive Officer, said, “We are very pleased with the Company’s second quarter 2018 performance. We executed well with our business development program by opening five de novo clinics and signing three additional new deals during the second quarter of 2018. Our opening schedule continues to be weighted to the second half of 2018, and we continue to have strong visibility into these future openings due to our signed pipeline of 26 clinics as of June 30, 2018. Our normalized treatment growth was 6.3% during the second quarter of 2018, and this rate of growth was essentially in-line with our expectations. As a result of our second half 2018 openings, we continue to expect normalized treatment growth to improve in subsequent quarters of 2018. Our second quarter 2018 revenue growth was favorably impacted by the new CMS coverage policy for Calcimimetics, as well as broader adoption of coverage policies by other payors for these pharmaceuticals. Importantly, on a volume basis, our commercial payor mix remained stable with that of the first quarter of 2018.”
“During the second quarter of 2018, we were able to sustain the more efficient cost structure that was established through our 2017 operating initiatives, while building on that success sequentially from the first quarter of 2018 due to greater progress with the lower-cost erythropoietin stimulating agent (ESA), Mircera, which we introduced as a new alternative for prescribing physicians last year. As we look forward, we continue to believe that our success will be driven by our differentiated physician partnership model, which remains underpinned by our Core Values and validated through strong quality metrics, outstanding patient satisfaction rates and industry-leading physician satisfaction rates,” continued Carlucci.
Financial and operating highlights include:
Revenue: Patient service operating revenues for the second quarter of 2018 were $217.2 million, an increase of 16.8% as compared to $186.0 million for the prior-year period, primarily due to treatment growth and reimbursement of certain pharmaceuticals under the Medicare ESRD PPS Transitional Drug Add-on Payment Adjustment, which became effective on January 1, 2018.
Treatment Volume: Total dialysis treatments for the second quarter of 2018 were 572,929, representing an increase of 5.6% over the second quarter of 2017. Non-acquired treatment growth was 4.5%, and acquired treatment growth was 1.1% for the second quarter of 2018. Normalized for clinic sales, Q2 2018 total treatment growth was 6.3% and non-acquired treatment growth was 5.3% as compared to Q2 2017.
Clinic Activity: As of June 30, 2018, the Company provided services at 233 outpatient dialysis clinics serving 16,018 patients. During the second quarter of 2018, we opened five de novo clinics. As of June 30, 2018, we had 26 signed clinics scheduled to open in the future.
______________________________________________________ * Not Meaningful ** See “Reconciliation of Non-GAAP Financial Measures.”
Operating Expenses: Patient care costs for the second quarter of 2018 were $140.6 million, or 64.7% of patient service operating revenues, as compared to $118.1 million, or 63.5% (or 63.4% excluding the Modification Expense described below) of patient service operating revenues, in the prior-year period. General and administrative expenses were $26.8 million, or 12.3% of patient service operating revenues, as compared to $26.4 million, or 14.2% (or 12.6% excluding the Modification Expense described below) of patient service operating revenues, in the prior-year period. Patient care costs include $0.5 million for the second quarter of 2017 of stock-based compensation related to modification of options at the time of the Company’s initial public offering (the “Modification Expense”). General and administrative expenses include $2.1 million for the second quarter of 2017 of Modification Expense.
Patient care costs for the six months ended June 30, 2018 were $274.3 million, or 66.6% of patient service operating revenues, as compared to $238.4 million, or 65.7% (or 65.1% excluding the Modification Expense, severance expense and gain on sale of assets) of patient service operating revenues, in the prior-year period. Patient care costs include $2.2 million of Modification Expense, $0.1 million of severance costs and $0.5 million gain on sale of assets for the six months ended June 30, 2017. General and administrative expenses during the six months ended June 30, 2018 were $51.8 million, or 12.6% of patient service operating revenues, as compared to $57.6 million, or 15.9% (or 13.0% excluding the Modification Expense and severance expense) of patient service operating revenues, in the prior-year period. General and administrative expenses include $9.5 million of Modification Expense and $0.8 million in severance costs for the six months ended June 30, 2017.
Certain Legal Matters: On August 1, 2018, we executed a Settlement Agreement with affiliates of UnitedHealth Group Incorporated (“United”) to resolve all outstanding litigation between the companies. Pursuant to the Settlement Agreement, the Company will make total settlement payments of $32.0 million in five annual installments. A first installment in the amount of $10.0 million was made on August 1, 2018. In connection with the $32.0 million settlement, the Company recognized the $29.6 million present value of the settlement during the second quarter of 2018, which was included as an expense in Certain legal matters on the Company’s consolidated statement of operations for the three months ended June 30, 2018. The Company also recognized an additional $2.9 million of expense within Certain legal matters during the second quarter of 2018 primarily related to the United matter.
Cash Flow: Cash provided by operating activities for the second quarter of 2018 was $37.5 million as compared to $35.8 million in the prior-year period. Adjusted cash provided by operating activities less distributions to noncontrolling interests (see “Reconciliation of Non-GAAP Financial Measures”) for the second quarter of 2018 was $20.0 million as compared to $17.1 million in the prior-year period. Total capital expenditures for the second quarter of 2018 were $8.6 million as compared to $7.6 million in the prior-year period. Capital expenditures for the three months ended June 30, 2018 included $1.9 million for maintenance and $6.6 million for expansions and new clinic development.
Cash provided by operating activities for the six months ended June 30, 2018 was $58.5 million as compared to $52.4 million in the prior-year period. Adjusted cash provided by operating activities less distributions to noncontrolling interests (see “Reconciliation of Non-GAAP Financial Measures”) for the six months ended June 30, 2018 was $25.1 million as compared to $14.5 million in the prior-year period. Total capital expenditures for the six months ended June 30, 2018 were $18.4 million as compared to $14.1 million in the prior-year period. Capital expenditures for the six months ended June 30, 2018 included $4.9 million for maintenance and $13.5 million for expansions and new clinic development.
Balance Sheet: At June 30, 2018, the Company’s balance sheet included consolidated cash of $69.4 million and consolidated debt of $556.6 million, including the current portion of long-term debt. Excluding clinic-level debt not guaranteed by the Company and clinic-level cash not owned by the Company, Adjusted owned net debt (see “Reconciliation of Non-GAAP Financial Measures”) was $459.6 million at June 30, 2018, as compared to $459.5 million at December 31, 2017. Adjusted owned net debt to last twelve months Adjusted EBITDA-NCI leverage ratio was 4.1x at June 30, 2018, an improvement of 0.3x from December 31, 2017. As of June 30, 2018, net patient accounts receivable was $91.5 million, and days sales outstanding (“DSO”) for the period was 38 days as compared to 40 days as of March 31, 2018.
2018 Outlook for Adjusted EBITDA-NCI:
The Company is reiterating its guidance for 2018 Adjusted EBITDA-NCI to be in a range of $105 million to $111 million.
The expense recognized by the Company during the second quarter of 2018 representing the present value of the settlement with United described above does not affect the Company’s expected 2018 Adjusted EBITDA-NCI guidance because the expenses relating to the United litigation are added back in calculating Adjusted EBITDA-NCI.
The Company is not providing a quantitative reconciliation of our Non-GAAP outlook to the corresponding GAAP information because the GAAP measures that we exclude from our Non-GAAP outlook are not available without unreasonable effort on a forward-looking basis due to their unpredictability, high variability, complexity and low visibility. These excluded GAAP measures include noncontrolling interests, interest expense, income taxes, and other charges. We expect the variability of these charges to have a potentially unpredictable, and potentially significant, impact on our future GAAP financial results.
Please see the “Forward-Looking Statements” section of this release for a discussion of certain risks to our outlook.
American Renal Associates Holdings, Inc. will hold a conference call to discuss this release on Wednesday, August 8, 2018, at 9:00 a.m. Eastern time. Investors will have the opportunity to listen to the conference call by dialing (877) 407-8029, or for international callers (201) 689-8029, or may listen over the Internet by going to the Investor Relations section at www.ir.americanrenal.com. For those who cannot listen to the live broadcast, a replay will be available and can be accessed by dialing (877) 660-6853, or for international callers (201) 612-7415. The conference ID for the live call and the replay is 13680635.
About American Renal Associates
American Renal Associates (“ARA”) is a leading provider of outpatient dialysis services in the United States. As of June 30, 2018, ARA operated 233 dialysis clinic locations in 26 states and the District of Columbia serving approximately 16,000 patients with end stage renal disease. ARA operates principally through a physician partnership model, in which it partners with approximately 400 local nephrologists to develop, own and operate dialysis clinics. ARA’s Core Values emphasize taking good care of patients, providing physicians with clinical autonomy and operational support, hiring and retaining the best possible staff and providing best practices management services. For more information about American Renal Associates, visit www.americanrenal.com.
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 Exchange Act of 1934, as amended. These statements, which have been included in reliance of the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995, involve risks and uncertainties and assumptions relating to our operations, financial condition, business, prospects, growth strategy and liquidity, which may cause our actual results to differ materially from those projected by such forward-looking statements, and the Company cannot give assurances that such statements will prove to be correct. You can identify forward-looking statements because they do not relate strictly to historical or current facts. These statements may include words such as “aim,” “anticipate,” “believe,” “estimate,” “expect,” “forecast,” “outlook,” “potential,” “project,” “projection,” “plan,” “intend,” “seek,” “may,” “could,” “would,” “will,” “should,” “can,” “can have,” “likely,” the negatives thereof and other words and terms of similar meaning in connection with any discussion of the timing or nature of future operating or financial performance or other events.
The forward-looking statements appear in a number of places throughout this press release and include statements regarding our intentions, beliefs or current expectations concerning, among other things, our results of operations, financial condition, liquidity, prospects, growth, strategies and the industry in which we operate. All forward-looking statements are subject to risks and uncertainties, including but not limited to those risks and uncertainties described in “Risk Factors” and “Special Note Regarding Forward-Looking Statements” in our Annual Report on Form 10-K for the year ended December 31, 2017, as updated by our reports on Form 10-Q filed or to be filed with the Securities and Exchange Commission (“SEC”) that may cause actual results to differ materially from those that we expected.
Some of the factors that could cause actual results to differ materially from those expressed or implied by the forward-looking statements include, among others, the following:continuing decline in the number of patients with commercial insurance, including as a result of changes to the healthcare exchanges or changes in regulations or enforcement of regulations regarding the healthcare exchanges and challenges from commercial payors or any regulatory or other changes leading to changes in the ability of patients with commercial insurance coverage to receive charitable premium support; decline in commercial payor reimbursement rates; the ultimate resolution of the Centers for Medicare and Medicaid Services (“CMS”) Interim Final Rule published December 14, 2016 related to dialysis facilities Conditions for Coverage (CMS 3337-IFC), including an issuance of a different but related Final Rule; reduction of government-based payor reimbursement rates or insufficient rate increases or adjustments that do not cover all of our operating costs; our ability to successfully develop de novo clinics, acquire existing clinics and attract new physician partners; our ability to compete effectively in the dialysis services industry; the performance of our joint venture subsidiaries and their ability to make distributions to us; changes to the Medicare end-stage renal disease (“ESRD”) program that could affect reimbursement rates and evaluation criteria, as well as changes in Medicaid or other non-Medicare government programs or payment rates, including the ESRD prospective payment rate system proposed rule for 2019 issued July 11, 2018; federal or state healthcare laws that could adversely affect us; our ability to comply with all of the complex federal, state and local government regulations that apply to our business, including those in connection with federal and state anti-kickback laws and state laws prohibiting the corporate practice of medicine or fee-splitting; heightened federal and state investigations and enforcement efforts; the impact of the litigation by affiliates of UnitedHealth Group, Inc. and the resolution thereof, and the Department of Justice inquiry; changes in the availability and cost of erythropoietin-stimulating agents and other pharmaceuticals used in our business; development of new technologies that could decrease the need for dialysis services or decrease our in-center patient population; our ability to timely and accurately bill for our services and meet payor billing requirements; claims and losses relating to malpractice, professional liability and other matters; the sufficiency of our insurance coverage for those claims and rising insurances costs; and any negative publicity or reputational damage arising from such matters; loss of any members of our senior management; damage to our reputation or our brand and our ability to maintain brand recognition; our ability to maintain relationships with our medical directors and renew our medical director agreements; shortages of qualified skilled clinical personnel, or higher than normal turnover rates; competition and consolidation in the dialysis services industry; deteriorations in economic conditions, particularly in states where we operate a large number of clinics, or disruptions in the financial markets; the participation of our physician partners in material strategic and operating decisions and our ability to favorably resolve any disputes; our ability to honor obligations under the joint venture operating agreements with our physician partners were they to exercise certain put rights and other rights; unauthorized disclosure of personally identifiable, protected health or other sensitive or confidential information; our ability to meet our obligations and comply with restrictions under our substantial level of indebtedness; and, the ability of our principal stockholder, whose interests may conflict with yours, to strongly influence or effectively control our corporate decisions.
The forward-looking statements made in this press release are made only as of the date hereof. Except as required by law, we undertake no obligation to update any forward-looking statement, whether as a result of new information or otherwise. More information about potential factors that could affect our business and financial results is included in our filings with the SEC.
Use of Non-GAAP Financial Measures
In addition to the results prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) provided throughout this press release, the Company has presented the following Non-GAAP financial measures: Adjusted EBITDA, Adjusted EBITDA less noncontrolling interests, Adjusted net income attributable to American Renal Associates Holdings, Inc., Adjusted cash provided by operating activities and Adjusted owned net debt, which exclude various items detailed in the attached “Reconciliation of Non-GAAP Financial Measures.”
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