tenet healthcare Q_2007_Q3_Conference_Call_Final
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Transcript of tenet healthcare Q_2007_Q3_Conference_Call_Final
Q3’07 Earnings Call
November 6, 2007
2
Forward-Looking Statements Certain statements contained in this presentation constitute forward-looking statements. Such forward-looking statements are based on management's current expectations and involve known and unknown risks, uncertainties and other factors that may cause the Company’s actual results to be materially different from those expressed or implied by such forward-looking statements. Such factors include, among others, the following: general economic and business conditions, both nationally and regionally; industry capacity; demographic changes; changes in, or the failure to comply with, laws and governmental regulations; the ability to enter into managed care provider arrangements on acceptable terms; changes in Medicare and Medicaid payments or reimbursement, including those resulting from a shift from traditional reimbursement to managed care plans; liability and other claims asserted against the Company; competition, including the Company’s failure to attract patients to its hospitals; the loss of any significant customers; technological and pharmaceutical improvements that increase the cost of providing, or reduce the demand for, health care; a shortage of raw materials, a breakdown in the distribution process or other factors that may increase the Company’s cost of supplies; changes in business strategy or development plans; the ability to attract and retain qualified personnel, including physicians, nurses and other health care professionals, including the impact on the Company’s labor expenses resulting from a shortage of nurses or other health care professionals; the significant indebtedness of the Company; the availability of suitable acquisition opportunities and the length of time it takes to accomplish acquisitions; the Company's ability to integrate new businesses with its existing operations; and the availability and terms of capital to fund the expansion of the Company's business, including the acquisition of additional facilities. Certain additional risks and uncertainties are discussed in the Company’s filings with the Securities and Exchange Commission, including the Company’s annual report on Form 10-K and quarterly reports on Form 10-Q. Do not rely on any forward-looking statement, as we cannot predict or control many of the factors that ultimately may affect our ability to achieve the results estimated. We make no promise to update any forward-looking statement, whether as a result of changes in underlying factors, new information, future events or otherwise.
Non-GAAP InformationDuring the earnings call and in this presentation, management will be referring to certain financial measures and statistics, including measures such as adjusted EBITDA, which are not calculated in accordance with Generally Accepted Accounting Principles (GAAP). Management recommends that you focus on the GAAP numbers as the best indicator of financial performance. These alternative measures are provided only as a supplement to aid in analysis of the Company.
Reconciliation between non-GAAP measures and related GAAP measures can be found in the press release issued this morning, November 6, 2007, and on the Company’s web site, www.tenethealth.com.
Trevor FetterPresident and CEO
4
Key trends moving in the right direction
AdjustedEBITDA
Volumes
� $177mm – 55% increase versus Q3’06 (same-hospital increase in 54%)
� 7.9 % increase from Q2’07 despite Q3 seasonal pressures
� 0.8% admissions decline (same-hospital) versus 2.2 % decline in Q2’07 (as reported)
� 0.1% admissions increase, excluding Florida and USC (same-hospital)
� 0.6% commercial managed care admissions decline (same-hospital)
� 0.4% commercial managed care admissions increase (same-hospital), excluding USC and Florida
� 1.4% outpatient visits decline (same-hospital)
� 1.0% October 2007 admissions increase despite tough 1.2% Oct’06 comp (as reported)
Revenue
Pricing
� 7.0 % increase in net operating revenue (same-hospital)
� 6.8 % increase in net revenue per adjusted admission (same-hospital)
� 7.4 % increase in net revenue per adjusted patient day (same-hospital)
5
Key trends moving in the right direction (Continued)
Bad Debt
Costs
� 7.2% of revenues – flat to Q3’06
� 36% self-pay collection rate versus 30% in Q3’06
� 4.2% growth in controllable operating expense per adjusted patient day (same-hospital)
Quality� 93.7% CMS Hospital Compare metric in Q2’07 highest to date
� 92.5% for four quarters ended Q2’07
6
Focus on Quality has Positioned Us Well
86.7%87.5%
92.5%
90.4%
77.9%
79.4%
80.9%
82.6%83.8%
86.7%
88.3%89.1%
91.7%
80.2% 80.5%81.5%
82.3%83.3%
84.7%85.9%
75%
77%
79%
81%
83%
85%
87%
89%
91%
93%
95%Q
104-
Q40
4
Q20
4-Q
105
Q30
4-Q
205
Q40
4-Q
305
Q10
5-Q
405
Q20
5-Q
106
Q30
5-Q
206
Q40
5-Q
306
Q10
6-Q
406
Q20
6-Q
107
Q30
6-Q
207
CMS Hospital Compare Data*
Tenet
National Average
* Includes AMI/HF/PN measures only. Data is for 55 hospitals.
Trailing Four Quarters
7
Q3 2007 Summary
• Q3’07 adjusted EBITDA exceeds Q2’07, despite typical seasonal pressures
• Breadth of factors supported this performance– Commercial volume growth outside USC and Florida– Pricing enhancements– Cost control
• October 2007 admissions increased 1.0%
Note: For reconciliation of net loss to adjusted EBITDA see table #1 in our Q3’07 earnings release.
Stephen L. Newman, M.D.Chief Operating Officer
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Selected key elements of turnaround strategy
1. Effective cost management
2. Targeted Growth Initiative producing volumes increases in commercial managed care
3. Growing active physician staff
4. Florida’s fresh initiatives
5. Turnaround success stories
10
Cost management accelerated in Q3
� Reduced FTEs by 1,275 (year-over-year)
� 2.7% reduction in FTEs outpaces 0.8% admissions decline
� 208 FTE decline from corporate and regional support
� 7.5% of overhead jobs
� 4.2% growth in controllable operating expenses (same-hospital)
� 2.6% increase in supply costs per adjusted patient day (same-hospital)
� Supply costs declined to 17.3 % of net revenues
� 80 basis point decline
11
Commercial managed care volumes grew in service lines targeted by TGI
�Phase One TGI completed in 52 hospitals
�Phase Two TGI currently being implemented
� Targeted service lines evidence commercialvolume growth (1)
� 12.7% increase in commercial neonatal services� 5.5% increase in commercial oncological surgery
admissions� 5.4% increase in commercial open heart surgeries
(1) All growth rates are same-hospital Q3’07 versus Q3’06
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Physician Relationships: Recruiting, redirecting, relocating, and hiring more doctors
� 370 net new physicians added in Q3’07 with active staff privileges (1)
� 3.4% net increase in just Q3’07
� 7.7% net increase Y-T-D September 30, 2007
� 35 newly employed physicians included in Q3’07
� 270 – target for newly employed physicians by year-end 2010
� 590 total target for employed physicians, year-end 2010
� 5,900+ physician visits in Physician Relationship Program (PRP) in Q3’07
� 60% increase in physician visits as compared to 3,700 visits in Q3’06
� 930 of the Q3’07 visits were 1st time visits to existing staff physicians
� 419 of the Q3’07 visits were 1st time visits to new physicians
(1) “Active staff” status generally requires at least 10 admissions per year or 10 outpatient surgeries per year.
13
Florida implementing fresh initiatives
1. Marsha Powers hired to run Florida
2. Consolidated Palm Beach and Miami markets� Coordinate and leverage business development
� Capture economies of scale
3. Reduced patient out-migration
4. Adding new physicians to our Florida medical staffs
5. Accelerated cost reduction efforts� North Ridge Medical Center to be divested
6. New managed care contracts� Eliminate out-of-network situations
� Volume guarantees
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Turnaround Success Stories
� Philadelphia market� 3.3% increase in Q3’07 admissions
� North Shore Medical Center – Miami� 5.8% increase in Q3’07 admissions
� Atlanta Medical Center� 8.5% increase in Q3’07 admissions
� Houston Northwest Medical Center� 8.4% admission growth in Q3’07
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Compelling, tangible evidence of progress
�Solid cost control
� TGI producing growth in targeted commercial managed care volumes
�Adding physicians to active medical staffs
�Signs of progress in Florida
�Growing number of hospital success stories
Biggs C. PorterChief Financial Officer
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Volume – Commercial Managed Care Admissions
-6%
-4%
-2%
0%
2%
Q1 Q2 Q3 Q4 Q1 Q2 Q3
2006 2007
Same Hospital Growth
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Volume - Admissions
-4%
-2%
0%
2%
Q1 Q2 Q3 Q4 Q1 Q2 Q3
Same Hospital Growth
2006 2007
19
Volume - Outpatient Visits
-9%
-7%
-5%
-3%
-1%
1%
Q1 Q2 Q3 Q4 Q1 Q2 Q3
2006 2007
Same Hospital Growth
20
Net Revenue
-4%
-2%
0%
2%
4%
6%
8%
Q1 Q2 Q3 Q4 Q1 Q2 Q3
2006 2007
Same Hospital Growth
21
Solid pricing gains
� 7.8% increase in net inpatient revenue per admission
� 9.7% increase in net outpatient revenue per visit
� Recently signed contracts supported pricing growth
� $32 million favorable swing in Q3’07 cost report adjustments versus Q3’06
� ED scoring and charge increases contributed further support
� Additional commercial contracts expected in Q4’07 should help extend gains in 2008
� Medicaid funding in Florida and Georgia expected to have a $60 million adverse impact in 2008
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Cost Containment
Growth in Controllable Expenses(1)
per Equivalent Patient Day
(1) Total controllable expenses defined as SWB, supplies, and other operating expenses. Same-hospitals excluding Coastal Carolina.
5.1%
4.3%
3.6%
6.3%6.5%
4.8%
4.2%
0%
2%
4%
6%
8%
Q1 Q2 Q3 Q4 Q1 Q2 Q3
2006 2007
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Non-volume Variables (1)
($ in millions)
Reduced Turnover
Denials Management
CDM Reviews
ED Scoring
Reduce Consulting & Overhead Spend
Improved Costing of Medical Devices
Bad Debt Initiatives
DRG Documentation
Staffing Reductions
$60 +$30 +Other Upside Initiatives:
$65 - $85$50Core/Planned Cost Reductions
Annualized2007
(1) These items disclosed as above on June 5, 2007. Items are updated and expanded to add Q4’07 and increased annualized impact on next page.
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Non-volume Variables($ in millions)
150
95
Annualized
20
19
Q3’07
37
11
Q4’07
36
43
YTD
Reduced Turnover
Denials Management
CDM Reviews
ED Scoring
Reduce Consulting & Overhead Spend
Improved Costing of Medical Devices
Bad Debt Initiatives
DRG Documentation
Staffing Reductions
$60 +$30 +Other Upside Initiatives:
$65 - $85$50Core/Planned Cost Reductions
Annualized2007
Prior Estimate Actual Current Estimate
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Bad Debt
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Q1Q2
Q3Q4
Q1Q2
Q3Q4
Q1Q2
Q3Q4
Q1Q2
Q3
Q4Q1
Q2Q3
Q4Q1
Q2Q3
Q4Q1
Q2Q3
Q4Q1
Q2Q3
As reported
Compact-adjusted (1) (as reported)
Bad Debt Expense / Net Revenues (%)(excluding unusual charges)
2000 2001 2002 2003 2004 2005 2006 2007
(1) Compact adjustment calculations discontinued beginning in Q1’07.
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Tenet’s Collection Rates . . . .Have Strengthened in Recent Quarters
Collection Rate
100%
0%
Degree of Insurance
Fully Insured Uninsured
98% - Managed Care (Q2’07’; Q3’07)
60% - Balance-After (Q1’07)
12%-Uninsured (current)
0%-Charity Care
8%-Uninsured (pre-Compact)
97% - Managed Care (Q1’07)
35% - Blended “Self Pay” (Q2’07)
33% - Blended “Self Pay” (Q1’07)
64% - Balance-After (Q2’07; Q3’07)
36% - Blended “Self Pay” (Q3’07)
27
Significantly Reducing “Days to Collection”
N/A
2003
$324M
2006
$289M$357M$482M
Q3 200720052004
A/R Days 1A/R Days 1Managed Care
A/R Greater than 180 days 2
Managed Care A/R Greater than
180 days 2
Reduced MC A/R
by $193M or 40%
$63M
2003
$13M
2006
$20M$28M$40M
Q3 2007
20052004
Medicare A/R Greater than 60
days 2
Medicare A/R Greater than 60
days 2
Across our hospitals, A/R days Managed Care and Medicare aging are all down, releasing significant incremental cash.
Reduced MCR A/R by $43M or 68%
73.9
2003
55.1
2006
53.457.856.3
Q3 2007
20052004
Overall reduction
of 20.5 days or
28%
1 Same store hospital only core acute facilities with prior year cost settlement for all years
2 Same store hospital only core acute facilities plus Rio and Pinecrest Rehab excluding Plaza Specialty, Coastal Carolina, Centennial, Bartlett and Norris Cancer Center for all years; 2003 Managed care data not available – no detail at that level in 2003
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Revenue Cycle Initiatives…Have Led to Improved Collections
• Accelerate communication of patient’s personal responsibility for payment
• Request payment at point of service
• Simplify bills to improve patient understanding
• Provide financial credit to patients from a 3rd
party in a pilot program
29
Cash Flow
� Capex was $179mm
� Adjusted operating cash flow� $82mm YTD
� $93mm in Q3’07
� Q3’07 cash flow impacted by:� $14mm insurance premiums (do not recur in Q4’07)
� $12mm receipt from Philadelphia HMO sale
� $123mm in interest payments� Compared to $82mm in Q4’07
� $43mm net favorable impact from above 3 items Q4’07 compared to Q3’07
� Additional working capital initiatives expected to impact Q4’07
30
2007 Cash Walk Forward ($ in millions)
2 -12Stock Compensation Expense & Other
140 - 190EBITDA (Q4’07)
(24)DOJ Principal Payment
530 - 670Ending Cash (December 31, 2007)
(285) – (235)CapEx (Q4’07)
120 - 150Working Capital Including
– AP build-up and terms
– Normal accruals
– A/R days reduction
(72)Remaining Interest, net
13
(11)
Sale of Facilities and Property
Acquisition Activity
(8)Income Tax Payments
655Beginning Cash (September 30, 2007)
31
Capital Expenditures Per Bed$42,298
$41,627
$34,279
$35,373
$42,695
$46,515
$41,528
$44,217
$36,026
$37,993 $48,055
$38,652
$36,722
$54,249
$45,423
$42,966
$45,876
2002
2003
2004
2005
2006
2007est.
* 55 core hospitals from 2002 – 2007.
* 2007 capex estimate of $700mm (middle of range of $675 - $725mm) includes approximately $150 million carried over from prior 2006 commitment of $800 million.
Triad
HCA
Tenet
Tenet’s3-year Avg.’05-’07
Tenet’s 3-year ’05-’07 average is $41,528 per bed
Tenet’s 3-year ’05-’07 average is $41,528 per bed
32
2007 Outlook (1)
3.5 – 4.53.0 – 4.07.04.0Revenue (Growth %) (2)
(1.2) – (0.9)(0.5) – 0.5(0.8)(1.4)Admissions (Growth %) (2)
(1.6) – (1.4)0 – 1.0(1.4)(2.1)Outpatient visits (Growth %) (2)
655
179
93
(0.03)
(14)
(9)
177
Q3’07
(66) – (16)(52) – (2)(14)Net Loss (4)
655
440
82
(0.02)
(16)
535
YTD 9/30/07
530 – 670
235 – 285
198 – 278
(0.08) – (0.01)
(58) – (8)
140 – 190
Q4’07
530 – 670
675 – 725
280 – 360
(0.10) – (0.03)
(75) – (25)
675 – 725
2007
Cash (Period End)
Capital Spending
Cash from Ops (3)
EPS (4)
Pretax Income (Loss) (3)
Adjusted EBITDA (3)
($ millions)
(1) In $ millions, except per share amounts.
(2) Same hospital.
(3) Adjusted EBITDA excludes charges/payments for impairment, restructuring and litigation. (4) Excludes the change in the federal income tax valuation allowance and first quarter 2007 FIN 48 tax gain and assumes a
normalized tax rate of 37.5%.
Note: For reconciliation of net loss to adjusted E BITDA see table #3 in our third quarter earnings re lease.
Actual Outlook
33
Summary
�Results could be bumpy but positive trends developing
�Progress on volumes, pricing and costs
� Focused on cash and return on invested capital
�Bad debt expense increase mitigated by aggressive offsetting actions
34
Appendix:Reconciliation of 2007 Outlook net loss to adjusted EBITDA
($ in millions)
$675
(370)
(24)
(1)
280
(380)
(100)
75
(25)
(51)
$(76)
Low
(380)Interest expense, net
330Operating income
(1)Litigation benefit (1)
(370)Depreciation and amortization
$(26)Net loss
$725 Adjusted EBITDA
(24)Impairment of long-lived assets and goodwill and restructuring charges (1)
(50) Loss from continuing operations, before income taxes
75Income tax benefit (2)
25 Income (Loss) from continuing operations
(51)Less: Loss from discontinued operations, net of tax (1)
High
(1) Represents the loss from discontinued operations for the nine months ended September 30, 2007, litigation and related costs and impairment and restructuring charges. Management is not providing a forecast of these items for the remainder of 2007.
(2) Includes a favorable income tax adjustment of $93 million in Q1 2007, required under the new FASB pronouncement FIN 48.
35
2009 EBITDA Walk-Forward - - Assumptions (1)
(1) Walk-forward to $1.0 to $1.1 billion is as discussed on second quarter conference call (8/6/07). Planning cycle for 2008 iscurrently in progress and Outlook is expected to be provided during the year end conference call in late February 2008.(2) Reflects the continuation of 2007 upside initiatives. (3) Assumes variable margin of 40% on increased volume in adjusted admissions(4) Represents significant identified changes absorbing the zero to $100 million provision for risk allowed for in the walk-forward above. There are other risks and opportunities which will be considered in 2008 planning, and which are expected to be net favorable.
NOTE: Refer to Tenet’s 2006 Form 10-K for other ris k factors
(60)Georgia and Florida Medicaid (4)
Risks and opportunities currently projected to be realized:
1,000 – 1,100Implied EBITDA range in 2009 (rounded)
(0 –100)Provision for risk
1051.5% annual volume growth from 2007 base (3)
30+Other upside initiatives (2)
100Hospital/function-specific productivity
15 – 30Length of stay reduction
140 -145Price and cost inflation/market adjustment
700Walk-forward starting point
($mm)