Addus HomeCare Conference Call Summary Company Overview - **Company**: Addus HomeCare (NasdaqGS:ADUS) - **Industry**: Home healthcare services, primarily focusing on personal care and hospice services Key Points Industry Dynamics - **Medicaid Dependency**: Approximately 75% of Addus's business is derived from Medicaid, making it sensitive to changes in Medicaid regulations and funding [3][4][5] - **Rate Increases**: Significant rate increases have been observed in key states like Texas and Illinois, which have positively impacted revenue growth [4][5][19] Financial Performance - **Growth Targets**: The company aims for a long-term revenue growth of no less than 10% annually, with 3-5% expected from organic growth and the remainder from acquisitions [5][50] - **Recent Growth**: In the third quarter, personal care services experienced about 6.6% organic growth, with expectations to maintain or exceed the 3-5% range in the upcoming quarters [18][19] Hiring and Labor Market - **Hiring Trends**: Strong hiring trends are noted, with the need for 100-105 hires per business day to support growth, particularly in personal care services [9][10][13] - **Labor Market Conditions**: The labor market is showing positive trends, although challenges remain in specific geographies and skilled roles [13][16] Operational Focus - **Census Growth**: The company is focusing on increasing the census in personal care, which is critical for revenue as they are paid by the hour [10][20] - **Technology Utilization**: The rollout of a caregiver app has improved scheduling and service levels, with over 90% adoption in Illinois [22][28] Hospice Services - **Strong Performance**: Hospice services have seen a 19% increase in discharge growth, driven by improved admissions and patient days [30][31] - **Future Expectations**: Anticipated organic revenue growth for hospice is expected to moderate to mid to upper single digits by mid-2026 [34] Home Health Services - **Complementary Role**: Home health services account for less than 10% of total business but are essential for value-based care integration with personal care and hospice [37][39] - **Regulatory Uncertainty**: The company is navigating uncertainties regarding reimbursement rates, with potential impacts estimated at $3 million if proposed cuts are implemented [56] M&A Strategy - **Acquisition Goals**: The company aims to add over $100 million in acquired revenue annually, focusing on personal care and smaller home health acquisitions [50][58] - **Market Conditions**: Current market conditions are described as slower, with expectations for more opportunities in the upcoming year [51][52] Financial Management - **Expense Management**: The company typically runs SG&A in the 20-21% range, with expectations for improvement as revenue grows [59] - **Capital Deployment**: The primary focus remains on M&A, with share repurchases considered a secondary option [68] Future Outlook - **2026 Projections**: The company is optimistic about growth driven by demographic trends, particularly as the elderly population increases [16][18] - **Legislative Monitoring**: Ongoing monitoring of legislative changes and Medicaid funding is crucial for future planning [41][43] Additional Insights - **Community Engagement**: Local recruitment efforts are emphasized, leveraging community ties to enhance hiring effectiveness [12] - **Technology Adoption**: The app's voluntary use by caregivers is seen as a significant factor in improving operational efficiency and caregiver satisfaction [26][28] This summary encapsulates the key insights and strategic directions discussed during the Addus HomeCare conference call, highlighting the company's focus on growth, operational efficiency, and navigating industry challenges.

Enhabit (NYSE: EHAB) 2025 Conference Summary Company Overview - Enhabit operates in the home health and hospice industry, focusing on providing care services to patients in their homes. Key Points Industry Performance - The hospice segment has continued to outperform expectations, reinforcing the effectiveness of strategies implemented over the past few years [2][4] - Home health payer strategies are beginning to yield positive results, particularly in negotiations with various payers [2][4] Financial Performance - The company reported strong performance in 2025, with a focus on reducing leverage and improving free cash flow [2][5] - Hospice revenues increased by 20% in the quarter, driven by admissions and revenue per patient day [29] - The company anticipates low to mid-single-digit growth for home health and mid to high single-digit growth for hospice in the coming years [4] Proposed Rule Impact - The final rule from CMS is expected to be released by the end of November or early December, with expectations that it will be better than the proposed rule [6][8] - The proposed rule includes a potential 6.4% rate cut, which could create a headwind of $35 million to $40 million for the company [9][14] - Clarity on the final rule is critical for the company to strategize effectively and mitigate potential impacts [10][12] Margin and Cost Management - Hospice margins have benefited from increased volume on fixed costs, indicating durable margin profiles [5] - The company is implementing a pilot program to reduce visits per episode from 15 to 13, which could result in significant cost savings without compromising quality [11][39] Payer Relationships - The company has successfully renegotiated contracts with national payers, resulting in low double-digit increases in rates [17] - Most payer agreements are three-year contracts, with a preference for episodic arrangements to manage patient visits effectively [18] Labor Market and Workforce - The clinical workforce situation has improved compared to the pandemic years, with turnover rates returning to pre-pandemic levels [21][55] - Wage trends are stabilizing at a normal increase of 2.5% to 3% [52] Growth Strategy - Enhabit aims to open 10 new locations each year, with a focus on hospice services [37] - The company is prioritizing de novo strategies and expanding its footprint in markets where it already has home health services [34][36] Market Dynamics - The company has not observed significant changes in market dynamics despite the presence of larger competitors like Humana and UnitedHealth [22] - There is ongoing interest in the Medicare Advantage market, with potential stabilization in the transition back to fee-for-service models [23] M&A Opportunities - The company is exploring strategic M&A opportunities, particularly in smaller and medium-sized assets that do not command high multiples [60][61] - Clarity from the final rule is expected to facilitate better alignment between buyer and seller expectations in the market [62][63] Summary Outlook - Enhabit is positioned well for the end of 2025 and the start of 2026, with strong execution in hospice and improving metrics in home health [78][80] - The company is confident in its ability to navigate the proposed rule changes and maintain operational effectiveness [80]

Financial Data and Key Metrics Changes - Total revenue for Q3 2025 was $362.3 million, a 25% increase from $289.8 million in Q3 2024 [4] - Adjusted earnings per share rose to $1.56, up 20% from $1.30 in Q3 2024 [4] - Adjusted EBITDA increased by 31.6% to $45.1 million compared to $34.3 million in Q3 2024 [5][20] - Gross margin percentage improved to 32.2% from 31.8% in Q3 2024 [20] - Adjusted EBITDA margin was 12.5%, compared to 11.8% for the same quarter last year [22] Business Line Data and Key Metrics Changes - Personal care revenues were $275.8 million, accounting for 76.1% of total revenue, with a same-store revenue growth of 6.6% [20] - Hospice care revenues reached $68.9 million, representing 19% of total revenue, with same-store revenue growth of 19% [20][11] - Home health revenues were $17.6 million, or 4.9% of total revenue, with a same-store revenue decrease of 2.8% [20][12] Market Data and Key Metrics Changes - Texas and Illinois announced rate increases for personal care services, effective October 1, 2025, and January 1, 2026, respectively [6][7] - The Texas rate increase is expected to add approximately $17.7 million in annualized revenue [17] - The Illinois rate increase is projected to add about $17.5 million in annualized revenue [17] Company Strategy and Development Direction - The company continues to pursue strategic acquisitions to enhance geographic coverage and density, with recent acquisitions including Del Cielo HomeCare Services [12][19] - Focus on maintaining a strong balance sheet to support acquisition strategies and organic growth [24][25] - The company aims to leverage the increased demand for home-based care as a growth opportunity [15] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism regarding the favorable reimbursement support from states, which recognizes the value of personal care services [7] - The company anticipates continued growth in hospice and personal care segments, supported by strong hiring trends and rate increases [16][18] - There is caution regarding the home health segment due to potential Medicare payment reductions, but management remains hopeful for improvements [9][41] Other Important Information - The company had cash on hand of approximately $102 million as of September 30, 2025, with net leverage under one times adjusted EBITDA [5][24] - The company is actively working on legislative efforts in various states to advocate for future rate increases [7] Q&A Session Summary Question: Can you provide an update on the Caregiver App rollout in Illinois and New Mexico? - Management noted improvements in fill rates in Illinois and expressed optimism for New Mexico, where the rollout is planned next [28][30] Question: How do you view the hiring trends into 2026 given the strong volume growth? - Management indicated strong hiring momentum with 113 hires per business day, suggesting a positive outlook for organic growth in 2026 [36][39] Question: What is the company's strategy regarding home health and hospice assets? - Management confirmed interest in home health acquisitions that complement personal care and hospice services, while being cautious due to current reimbursement uncertainties [41][42] Question: Can you clarify the impact of overlapping operations in New Mexico and Tennessee on referrals? - Management highlighted the benefits of continuity of care and improved patient outcomes due to the overlap of services [72] Question: What is the outlook for gross margins in Q4 and next year? - Management expects Q4 to be the highest margin quarter, projecting adjusted EBITDA above 13% [54][56] Question: Are there any updates on potential rate increases in New Mexico and Pennsylvania? - Management expressed hope for a rate increase in New Mexico but noted uncertainty regarding Pennsylvania's budget situation [59][60]

Financial Data and Key Metrics Changes - VITAS net revenue was $407.7 million in Q3 2025, an increase of 4.2% compared to the prior year period, driven by a 2.5% increase in days of care and a 4.1% increase in Medicare reimbursement rates [12] - Adjusted EBITDA for VITAS, excluding Medicare cap, totaled $70.4 million, a decline of 3.8% year-over-year, with an adjusted EBITDA margin of 17.0%, down 157 basis points from the prior year [13] - Roto-Rooter revenue increased by 1.1% in Q3 2025 compared to the same period in 2024, with residential plumbing revenue up 8.2% [7][8] Business Line Data and Key Metrics Changes - VITAS admissions totaled 17,714 in Q3 2025, a 5.6% improvement from Q3 2024, with hospital-based admissions at 44.5%, the highest since the pandemic [5][6] - Roto-Rooter branch residential revenue was $150.9 million, an increase of 3.4%, while commercial revenue totaled $55 million, up 2.8% [13][14] - Revenue from independent contractors declined by 4.7% in Q3 2025 compared to the same period in 2024 [14] Market Data and Key Metrics Changes - The average daily census for VITAS was 22,327 patients, an increase of 2.5%, with hospital-directed admissions up 10.4% [17] - The average revenue per patient day for VITAS was $205.08, an increase of 298 basis points year-over-year [12] Company Strategy and Development Direction - The company is focusing on increasing hospital-based admissions to mitigate Medicare cap billing limitations, with expectations of no cap limitations for the Florida program in 2026 [6][16] - Roto-Rooter is implementing operational initiatives to improve margins and stabilize growth, with a focus on managing costs effectively [10][15] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the fourth quarter, anticipating it to be the best quarter for VITAS due to seasonal factors and new rate increases [23][24] - The company is optimistic about returning to a predictable growth trajectory for Roto-Rooter, despite current margin pressures [11][15] Other Important Information - The company expects to open a new location in Pinellas County in early November 2025, which is anticipated to contribute positively to growth [7] - Management reiterated guidance of $22 to $22.30 per share, excluding non-cash expenses and other discrete items [16] Q&A Session Summary Question: Insights on demand and cost trends for Q4 - Management noted that Q4 typically sees higher demand and margins for both VITAS and Roto-Rooter due to seasonal factors [22][24] Question: Thoughts on receivables and cash collections - Management indicated that elevated DSO is primarily a timing issue related to Medicaid payments, not a deterioration in collection efforts [30] Question: Outlook for 2026 margins and growth rates - Management stated that the fourth quarter will inform the strategy for 2026, with expectations of revenue growth in the 8% range and margins around 17.5% to 18% [36][40] Question: Competitive dynamics in Roto-Rooter - Management highlighted improved competitive dynamics, with a shift towards paid leads resulting in better lead generation and potential margin recovery [44][46] Question: Sustainable margins in Roto-Rooter - Management believes that Roto-Rooter can achieve long-term EBITDA margins of 25% to 26%, despite current pressures from marketing costs [54] Question: Clarification on VITAS's Medicare cap liability - Management explained that the strategy of increasing hospital admissions and the current reimbursement environment gives confidence in managing Medicare cap liabilities [66][69]

Core Points - The aging population in Japan, particularly those aged 65 and above living alone, has reached 7 million, highlighting a pressing need for caregiving solutions [1] - The Tokyo valley area has emerged as a practical exploration site for ideal caregiving practices, with various stakeholders collaborating to create a unique care system [1][10] Group 1: Aging Population and Care Needs - Japan's elderly population living alone is projected to continue increasing, necessitating urgent attention to caregiving responsibilities [1] - The valley area in Tokyo has become a focal point for innovative caregiving practices, attracting attention from sociologists and journalists [1][10] Group 2: Caregiving Practices in the Valley - The valley is home to numerous medical and caregiving professionals and volunteer organizations that work together to support the elderly [10][22] - The establishment of home care services, such as the "Bokushiku" nursing station, has been pivotal in meeting the growing demand for in-home care [13][21] Group 3: Unique Care Systems - The valley's care system is characterized by a collaborative effort among various participants, including NPOs, volunteers, and local businesses, creating a supportive environment for the elderly [25][26] - The presence of simple lodgings, known as "shack hotels," provides affordable accommodation for those in need of care, with many residents requiring nursing support [18][21] Group 4: Community and Support - The valley has transformed from a "homeless street" to a "welfare street," showcasing the effectiveness of community collaboration in addressing the needs of vulnerable populations [25] - The integration of care services into daily life, such as medication reminders and financial management, reflects a shift in caregiving responsibilities traditionally held by family members [26]

Financial Data and Key Metrics Changes - In Q1 2025, consolidated net revenue was $259.9 million, reflecting a sequential increase of $1.7 million or 0.7% quarter over quarter, but a decrease of $2.5 million or 1% year over year [15] - Consolidated adjusted EBITDA was $26.6 million, an increase of $1.5 million or 6% sequentially, and up $1.3 million or 5.1% year over year, with an overall EBITDA margin of 10.2%, an increase of 60 basis points from the prior year [16] - The leverage ratio improved to 4.4 times, below the covenant of 4.5 times, allowing for better pricing under existing agreements and additional flexibility for acquisitions [22][23] Business Line Data and Key Metrics Changes - Home Health revenue was $200.6 million, a slight increase of $200,000 or 0.1%, with a 3.7% increase in average daily census [16][18] - Hospice revenue reached $59.3 million, reflecting a sequential increase of $1.5 million or 2.6% and a year-over-year increase of $10.1 million or 20.5% [19] - Home Health adjusted EBITDA totaled $38.3 million, reflecting a sequential increase of $2.8 million or 7.9% [18] Market Data and Key Metrics Changes - Non-Medicare admissions increased by 7.4% year over year, driven by payer innovation contracts, with 44% of non-Medicare visits in payer innovation contracts in Q1 2025 [8][9] - Hospice segment admissions grew 8% year over year, with same-store growth of 5.2% [10] - Average daily census in hospice reached 38.09, an improvement of 2.1% sequentially and 12.3% year over year [20] Company Strategy and Development Direction - The company is focusing on payer contract initiatives to drive growth, with a goal to balance admissions and maintain a healthy payer mix [6][26] - A de novo strategy is being implemented, with one new hospice location opened and 13 projects underway [11] - The company is piloting two internally developed apps aimed at improving efficiency and communication [12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ability to build capacity and improve average daily census, with expectations of continued growth through the year [29][42] - The company is monitoring labor market conditions and anticipates a return to normal salary inflation rates of 2% to 3% [28] - Management reaffirmed 2025 guidance based on strong Q1 results and business momentum [23] Other Important Information - The company completed the transition to outsourced coding resources, expected to deliver $1.5 million in cost savings for the remainder of 2025 [12] - Free cash flow generated in Q1 was approximately $17 million, with a 63.5% conversion rate [21] Q&A Session Summary Question: Thoughts on volume growth within the non-Medicare book of business - Management noted that payer innovation contracts contributed significantly to positive growth, with a focus on hiring to improve average daily census and admissions [26] Question: Labor market inflation expectations - Management indicated a return to normal inflation rates of 2% to 3%, with some markets experiencing tighter conditions [28] Question: Hospice ADC growth initiatives - Management highlighted the combination of increased referrals and the establishment of regional admissions departments as key drivers of growth [31] Question: Dynamics behind business per episode trends - The use of the Metalogics Pulse tool has been critical in optimizing visits per episode, focusing on higher acuity patients [33] Question: Capacity and productivity in hospice - Management confirmed that they are monitoring capacity at the branch level and do not anticipate changes in growth trajectory [42] Question: Rate increases and inflation protection in payer contracts - Most contracts are 2-3 years in length, with some having escalators tied to quality metrics, and management is actively renegotiating contracts [46] Question: Research recertification rates - Management acknowledged challenges in research due to the growth of Medicare Advantage and emphasized the focus on growing census as a primary driver [49]

Financial Data and Key Metrics Changes - Total revenue for Q1 2025 was $337.7 million, a 20.3% increase from $280.7 million in Q1 2024 [9] - Adjusted earnings per share rose to $1.42, up 17.4% from $1.21 in Q1 2024 [9] - Adjusted EBITDA increased to $40.6 million, a 25.1% rise from $32.4 million in Q1 2024 [9] - Gross margin percentage improved to 31.9% from 31.4% in Q1 2024 [24] - Adjusted EBITDA margin was 12%, compared to 11.6% in Q1 2024 [25] Business Line Data and Key Metrics Changes - Personal Care segment revenues were $258.3 million, accounting for 76.5% of total revenue, with a 7.4% organic revenue growth [23] - Hospice same store revenue increased by 9.9%, with average daily census rising to 3,515, a 4.6% increase year-over-year [14][21] - Home Health segment revenues were $18 million, representing 5.3% of total revenue, with a 1.3% organic revenue growth [22] Market Data and Key Metrics Changes - Personal Care services received favorable reimbursement support, including a 5.5% rate increase in Illinois effective January 1, 2025 [12] - Same store hours in Personal Care increased by 2% compared to Q1 2024, marking the largest year-over-year volume growth in recent quarters [13] - The company experienced solid caregiver hiring success, with 79 hires per day in Personal Care, up from 78 in Q1 2024 [10] Company Strategy and Development Direction - The company aims for a minimum annual revenue growth of 10%, focusing on acquisitions that complement organic growth [17] - The Gentiva acquisition added approximately $280 million in annualized revenues, significantly expanding market coverage [22] - The company is actively pursuing additional acquisition opportunities to enhance density in existing markets and add clinical services [23][28] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the continued demand for home-based care, viewing it as a growth opportunity [18] - The company anticipates stable gross margins and consistent cash flow conversion in line with historical averages [25][27] - Management noted that the clinical hiring environment remains challenging, but improvements have been observed in the personal care segment [11][67] Other Important Information - The company utilized approximately $2.5 million in ARPA funding during Q1 2025, with $8.8 million remaining [28] - As of March 31, 2025, the company had cash on hand of approximately $97 million and reduced bank debt by $20 million [9][28] Q&A Session Summary Question: Commentary on hospice cap limitations - Management indicated that cap limitations have not been material, with effective management of referral mix [33][34] Question: Impact of weather on personal care services - Management confirmed weather events affected January but noted a rebound in February and March, expecting hours growth to remain in the 2% to 2.5% range [40][41] Question: Hospice revenue growth expectations - Management projected hospice revenue growth in the 5% to 7% range, leaning towards the upper end [44] Question: Margin expansion expectations - Management expects typical margin expansion of 40 to 50 basis points into Q2, with Q1 usually being the low point [50][51] Question: Impact of Medicaid changes - Management stated that potential changes to Medicaid would likely have no direct impact on the company, as its patient base is primarily elderly and disabled [54][56] Question: Performance of Gentiva post-acquisition - Management reported that Gentiva's bottom line performance has exceeded expectations, while top line growth was slightly lighter than anticipated [77] Question: Update on home health services - Management noted stability in Medicare rates and improvements in contracting with Medicare Advantage plans, with discounts narrowing from 40% to 15-20% [106]