munity Health Systems(US:CYH)2025-02-19 17:00Financial Data and Key Metrics Changes - For the full year 2024, same store net operating revenues increased by 5.5% and adjusted EBITDA improved by 6% [9][17] - Adjusted EBITDA for the fourth quarter was $428 million, compared to $386 million in the prior year period, with a margin of 13.1%, up from 12.1% [16][17] - Cash flows from operations were $216 million for the fourth quarter, up from $90 million in the fourth quarter of 2023, and $480 million for the full year of 2024, consistent with guidance [19][20] Business Line Data and Key Metrics Changes - Same store admissions increased by 3.2%, adjusted admissions by 2.7%, and surgeries by 1.3% for the full year 2024 [7] - Same store emergency department visits were up 1% and surgeries were up 0.9% in the fourth quarter [16] - Same store ambulatory surgery center cases increased by 14% last year [8] Market Data and Key Metrics Changes - The company completed divestitures in Cleveland, Tennessee, and Statesboro, North Carolina, with plans for additional divestitures expected to generate over $1 billion in total proceeds [10][22] - The net debt to trailing adjusted EBITDA improved to 7.4 times, down from 7.9 times at the end of 2023 [22] Company Strategy and Development Direction - The company is focused on expanding outpatient access, including primary care, specialty practices, and urgent care centers, with significant capital investments [7][15] - The implementation of a new ERP system is expected to drive efficiencies and reduce costs, with estimated savings of $40 million to $60 million in 2025 [23] - The company anticipates further expansion of internally managed hospital-based provider services in 2025 [12] Management's Comments on Operating Environment and Future Outlook - Management noted stabilization in payer downgrades and denials, which had been a troubling trend for healthcare providers [11][17] - The company expects organic growth of $75 million to $100 million in 2025, with net revenue guidance of $12.2 billion to $12.6 billion [23] - Management expressed confidence in the approval of directed payment programs in New Mexico and Tennessee, which could add an incremental $100 million to $125 million to annual EBITDA [24][50] Other Important Information - The company experienced a $10 million impact from a hurricane in Q4, with one hospital still shut down as a result [74] - The company is in discussions for additional strategic divestitures expected to be announced soon [22] Q&A Session Summary Question: Can you help bridge 2024 to 2025 guidance? - Management provided a high-level bridge starting with 2024 EBITDA of $1.54 billion, accounting for reductions from divestitures and adding organic growth to reach the midpoint of 2025 guidance [27][28] Question: What are the strategic moves expected moving forward? - Management highlighted ongoing investments in core portfolio growth, including outpatient and procedural capacity expansions, and noted that there are still investable opportunities in the pipeline [30][33] Question: Can you quantify the continued hurricane impact in Q4? - The hurricane impact was as expected at $10 million, with one hospital shut down for the entire quarter [74]