Q1’08 Earnings Call May 6, 2008
May 21, 2015
Q1’08 Earnings Call
May 6, 2008
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 Company’s quarterly earnings calls and in this presentation, management refers 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 on May 6, 2008, and on the Company’s web site, www.tenethealth.com.
Trevor FetterPresident and
Chief Executive Officer
4
Volume – Admissions Growth (1)
-4%
-2%
0%
2%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2007
Y-o
-Y G
row
th
(1) Same-hospital.
Up 1.0%
2008
5
Key Strategies Proving Effective
Volumes
� Continued growth of active medical staffs
� 2nd consecutive quarter of positive admissions growth (same-hospital)� 1.0% admissions growth (Q1’08 versus Q1’07, same-hospital)� 0.8% admissions growth excluding flu
Bad Debt
Pricing
� Growth in uninsured beginning to moderate� Aggregate uninsured + charity admissions declined 1.2%
� Commercial payers recognizing Tenet’s progress in clinical quality
PhysicianRelations
Costs � Cost initiatives plus operating leverage improved unit costs
CommercialVolumes
� Commercial managed care admissions declined 3.7%� Commercial outpatient visits declined 2.1%
EBITDA � EBITDA margin of 9.9%, up 120 basis points over Q1’07
6
Performance metrics (1) (cont.)
April (2)
Volumes
AdjustedEBITDA
� 3.7% growth in admissions compared to April, ’07 � 0.9% growth in commercial managed care admissions� 2.8% growth in outpatient visits
� $239mm adjusted EBITDA
Y-T-D VolumeGrowth
(through 4/30/08)
� 1.6% admissions growth� 2.6% commercial admissions decline� 1.3% growth in uninsured + charity� 0.1% decline in outpatient visits
(1) Same-hospital(2) April 2008 had one more weekday and one less weekend day than April 2007.
Weekdays generally produce stronger volumes than weekend days.
7
Volume – Admissions Growth (1)
-4%
-2%
0%
2%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 April
YTD
2006 2007
Y-o
-Y G
row
th
(1) Same-hospital.
Up 1.6%
2008
Up 1.0%
8
Adjusted EBITDA (1)
218211
114
153
194
164
177168
239
0
50
100
150
200
250
300
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2007
(1) Same-hospital.
$ in
mill
ions
2008
9
USC Sale
BookValue
Price
� $311 million (3/31/08)
� Sale price = Book value at closing
EBITDA � Approx $25mm in 2007, excluding corporate overhead and unusual or non-recurring items
CapitalExpenditures � Normal annual capital expenditures approx. $10mm
Stephen L. Newman, M.D.Chief Operating Officer
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Physician Relationship Program (“PRP”)
� 13,158 calls logged on 6,764 physicians in Q1’08
� 5.7% admissions increase from these 6,764 physicians:�Best quarterly performance since PRP launch
� 497 PRP calls on unaffiliated physicians
12
Active Physician Staff Continues to Grow
� 178 net additions to active physician staff in Q1’08
� 10.3% net growth in active physician staff since 1/1/07
13
New PRP Enhancements
� Increased numbers of staff becoming involved
� Expanded training curriculum
� Customized education program for hospital-based recruiters
14
Volume Growth
� 1.0% admissions growth
� Aggregate commercial admissions declined by 3.7%
15
TGI – Commercial admissions growth in TGI service lines (1) significantly exceeds total commercial admissions growth
-7%
-6%
-5%
-4%
-3%
-2%
-1%
0%
1%
2%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2007
Y-o
-Y G
row
th
2008
Down1.2%
(1) Data represents commercial admissions growth in 8 service lines which are typically emphasized by TGI: general surgery, major trauma, neonatal, neurological medicine, neurosurgery, open heart, orthopedic surgery,and Cath/EP.
TGI Service lines – commercial admissions only (1)
Total commercial admissions
16
Commercial admissions decline confined to a small number of hospitals
� 3 hospitals responsible for more than half the Q1’08 commercial admissions decline of 1,520 admissions
� April: no loss of aggregate commercial admissions in these 3 hospitals
17
Florida’s volume resurgence continues
� 1.1% aggregate admission growth in Q1’08
� Reducing outmigration
� Regionalizing selected services
� 17.7% growth (14 cases) in commercial open heart procedures
18
April volumes were strong (1)
� 3.7% total admissions growth
� 1.6% Y-T-D admissions growth through April 30
� All 5 regions saw positive growth in April
� 0.9% growth in commercial managed care admissions
� 2.8% growth in outpatient visits
(1) April 2008 versus April 2007. April 2008 had one more weekday and one fewer weekenddays than April 2007. The company typically experiences stronger volumes on week daysthan on weekends.
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Pricing enhancements
� Recently signed commercial contracts made key contribution
� Progress towards closing pricing gap relative to competitors
� Memorandum of understanding with Independence Blue Cross in Philadelphia
� Includes incremental payments for Quality
20
Cost structure continues to improve
� Productivity:� 1.2% improvement in FTEs per adjusted patient day
� 10.7% decline in contract labor expense per adjusted patient day
� 18% reduction in registered nurse turnover
�Supply costs:
� Limited to a 3.9% increase per adjusted patient day
� Much of supply cost increase due to 1.2% increase in orthopedic, neurosurgical and general surgery procedures
Biggs C. PorterChief Financial Officer
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Q1’08 items
Cost ReportSettlements
� $8mm favorable settlement of managed care dispute
� $2mm favorable in Q1’08 versus $12mm favorable in Q1’07
Impairment andRestructuring
Medicaid
� $1mm charge
� $6mm favorable - Georgia Medicaid
Bad Debt
HMODistribution � $6mm favorable
Litigation � $47mm charge
23
Net Revenue (1) -Growth trend remains robust
-4%
-2%
0%
2%
4%
6%
8%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2007
Y-o
-Y G
row
th
(1) Same-hospital.
Up 6.7%
2008
24
Solid pricing gains (1)
� 6.0% growth in net inpatient revenue per admission
� 8.6% growth in net outpatient revenue per visit
� 5.5% increase in net patient revenue per adjusted admission
� Recently signed commercial contracts support pricing trend� Signed contracts cover approximately:
� 84% of commercial rates for 2008
� 68% for 2009
(1) Same-hospital
25
Cost Containment
Controllable Expenses(1) per Adjusted Patient Day
(1) Same-hospital controllable expenses defined as SWB, supplies, and other operating expenses.
2.6
5.1
4.2
4.8
6.56.3
3.6
4.3
5.1
0%
2%
4%
6%
8%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
2006 2007
Y-o
-Y G
row
th
2008
26
Bad Debt
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2Q3Q4Q1
As reported
Compact-adjusted (2) (as reported)
Bad Debt Expense / Net Revenues(excluding unusual charges)
2000 2001 2002 2003 2004 2005 2006 2007
(1) Same-hospital (2) Compact adjustment calculations discontinued beginning in Q1’07.
2008
27
Accounts receivable aging distribution
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
0-90 91-180 over 180
Q1 '07
Q2 '07
Q3 '07
Q4 '07
Q1 '08
28
Medical Office Building (“MOB”) Proposed Sale
� 34 MOBs in package
� Jones Lang LaSalle is Tenet broker
� 2.4 million square feet net rentable space
� MOBs located at 21 of our hospitals
� MOBs located in 7 states
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2008 Outlook Revisions. . . pricing strength offsets slower outpatient
volume growth
no change200 - 300Cash balance at 12/31/08 (2) ($mm)
no change600 - 650Capital expenditures ($mm)
no change400 - 500Adjusted cash flow from operations ($mm)
3.5 – 4.25not providedNet inpatient revenue per admit - growth (1) (%)
4.5 - 5.25not providedNet outpatient revenue per visit – growth (1) (%)
4736Pricing – managed care increment ($mm)
3.43.2Pricing – base line growth (%)
no change775 - 850EBITDA ($mm)
no change3.0 – 3.5Controllable operating expenses PAPD – Growth (1) (%)
no change6.5 - 7.0Bad debt ratio (%)
no change9.3 – 9.4Net revenue ($ bil)
1 - 22 – 3Outpatient visits – growth (1) (%)
no change1 - 2Admissions - growth (1) (%)
Revised(5/6/08)
Prior(2/26/08)
(1) Same-hospital growth from 2007 to 2008(2) Excludes potential proceeds from initiatives to raise $400-600mm, USC sale, and other non-operating items
30
2008 Adjusted EBITDA Outlook Revisions
61(106)16777(116)193Volume (1)
850
2
100
(271)
33
47
273
(56)
(40)
701
EBITDA
850
2
100
(261)
33
36
262
(60)
(40)
701
EBITDA
-(56)-(60) Georgia/ Florida Medicaid
(18)291(18)280Pricing – Base Line Increase (2)
(8,151)8,852(8,151)8,852Prior year
-(40)-(40)Cost Report Adjustments
(8,550)
(86)
100
(261)
(18)
-
Cost
(271)--Costs – Base Line Inflation (5)
9,400
88
-
51
36
Revenue
9,400
88
-
51
47
Revenue
(8,550)
(86)
100
(18)
-
Cost
Total (8)
Other (7)
Cost Reduction Initiatives (6)
Other Initiatives (4)
Managed Care (3)
($ millions)
(1) Annual admissions growth of 1.5 percent, outpatient visit growth of 1.5 percent using 2007’s average pricing with 40 percent margin assumption on incremental revenues.
(2) Base line pricing increases of 3.4 percent for 2008. These assumptions are before discrete initiatives valued in this analysis, and include certain assumptions on adverse mix change
(3) Price increases in existing contracts and anticipated future increases.(4) Full-year impact of 2007’s ED acuity capture effort and incremental adjustments to chargemaster.(5) Inflation rate of 3.5 percent reflects normal merit increases, union contract adjustments and other items before discrete initiatives valued in this analysis.(6) Full year impact of cost initiatives initiated in 2007.(7) Includes impact of Sierra Providence East Medical Center (El Paso), Coastal Carolina Hospital, physician practices and other non-acute operations.(8) Various risks including volume growth, volume mix, and bad debt create at least $75 million in uncertainties for 2008 performance, hence the adjusted EBITDA
outlook range from $775 mm to $850mm. 2009 uncertainties exceed those identified for 2008. This schedule is not intended to provide a series of spot estimates or line item guidance. Other combinations of line item performance could produce the same, or higher, or lower results.
2008 (2/26/08) 2008 - REVISED
31
Illustrative, sample walk-forward path to$1 billion adjusted EBITDA in 2009
60(91)15161(106)167Volume (1)
1,000
21
29
(286)
-
34
292
-
-
850
EBITDA
850
2
100
(271)
33
47
273
(56)
(40)
701
EBITDA
---(56) Georgia/ Florida Medicaid
(20)312(18)291Pricing – Base Line Increase (2)
(8,500)9,400(8,151)8,852Prior year
---(40)Cost Report Adjustments
(8,550)
(86)
100
(271)
(18)
-
Cost
(286)--Costs – Base Line Inflation (5)
9,400
88
-
51
47
Revenue
9,985
88
-
-
34
Revenue
(8,985)
(67)
29
-
-
Cost
Total (8)
Other (7)
Cost Reduction Initiatives (6)
Other Initiatives (4)
Managed Care (3)
($ millions)
(1) Annual admissions growth of 1.5 percent, outpatient visit growth of 1.5 percent using 2007’s average pricing with 40 percent margin assumption on incremental revenues.
(2) Base line pricing increases of 3.4 percent for 2008. These assumptions are before discrete initiatives valued in this analysis, and include certain assumptions on adverse mix change
(3) Price increases in existing contracts and anticipated future increases.(4) Full-year impact of 2007’s ED acuity capture effort and incremental adjustments to chargemaster.(5) Inflation rate of 3.5 percent reflects normal merit increases, union contract adjustments and other items before discrete initiatives valued in this analysis.(6) Full year impact of cost initiatives initiated in 2007.(7) Includes impact of Sierra Providence East Medical Center (El Paso), Coastal Carolina Hospital, physician practices and other non-acute operations.(8) Various risks including volume growth, volume mix, and bad debt create at least $75 million in uncertainties for 2008 performance, hence the adjusted EBITDA
outlook range from $775 mm to $850mm. 2009 uncertainties exceed those identified for 2008. This schedule is not intended to provide a series of spot estimates or line item guidance. Other combinations of line item performance could produce the same or higher, or lower results.
2008 - REVISED 2009