Ladies and gentlemen, thank you for standing by. Welcome to the Pediatrix Medical Group Q2 2022 earnings conference call. At this time, your telephone lines are in a listen-only mode. Later, there will be an opportunity for questions and answers with instructions given at that time. If you should require assistance during the call, please press star then zero, and an AT&T specialist will assist you offline. As a reminder, your call today is being recorded. I'll now turn the conference call over to your host, Charles Lynch. Please go ahead. Thank you, Alan, and good morning, everyone. With me this morning are Mark Ordan, our Chief Executive Officer, and Marc Richards, our Chief Financial Officer. I'll quickly read our disclaimer and then turn the call over to Mark. Certain statements and information during this conference call may be deemed to be forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are based on assumptions and assessments made by Pediatrix's management in light of their experience and assessment of historical trends, current conditions, expected future developments, and other factors they believe to be appropriate. Any forward-looking statements made during this call are made as of today, and Pediatrix undertakes no duty to update or revise any such statements, whether as a result of new information, future events, or otherwise. Important factors that could cause actual results, developments, and business decisions to differ materially from forward-looking statements are described in the company's most recent annual report on Form 10-K, its quarterly reports on Form 10-Q, and its current reports on Form 8-K, including the sections entitled Risk Factors. In today's remarks by management, we will be discussing non-GAAP financial metrics. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures can be found in this morning's earnings press release, our quarterly reports on Form 10-Q, and our annual report on Form 10-K, and on our website at www.pediatrix.com. With that, I'll turn the call over to Mark Ordan. Thanks, Charlie. I'll comment this morning on three areas, our results for the quarter and how they play into our outlook for the year, our strategy and our name change to the Pediatrix Medical Group, and some thoughts on the No Surprises Act. We had mixed results in Q2. Patient volumes grew both in hospital-based and office-based services, despite more difficult comps in the Q2 to what we faced in the Q1. However, our revenue was impacted by both payer mix and our ongoing transition to R1 as our RCM partner. As a result, our Adjusted EBITDA for the quarter was slightly below the expectations we shared on our last call with the differential primarily in revenue. We are pleased with our RCM function today, but in retrospect, the speed with which we transitioned from our internal team to R1 gave rise to a revenue impact that set back our Q1 results and to a lesser extent, our Q2 results. I want to stress that this impact I speak of, and which Marc will further detail, is related only to our RCM transition and not to any change in payer relationships or behavior. We are pleased that today, our day-to-day RCM function is substantially improved versus the challenges we faced during this transition. By that, I mean that our front-end activity is moving well, which is significant given that area was meaningfully impacted in the early stages of this transition. This impact should affect 2022 alone, and we see no effect, therefore, beyond this year. We are also still actively working to mitigate the effect on our 2022 P&L. On clinical labor, we reported in Q1 that we had not seen any material change in clinical labor costs, but we're certainly aware of the tough environment around us. In Q2, our clinical salary costs were roughly $3 million above our forecast. While this is much smaller, a much smaller change in cost trend than other providers have discussed, I'm calling it out only given the tough labor environment we're in. We continue to reduce overheads and generate efficiencies in our support services as part of our turnaround strategy. Our G&A expense declined significantly compared to last year and versus our internal projections, and we believe that we will continue to find enhanced operating efficiency without taking away from our dedication to care. We also saved significantly through our Q1 debt refinancing. Interest expense was down more than half year over year, enabling 15% growth in adjusted EPS. Finally, our strong cash flow enabled us to fund the repurchase of $3.3 million of our shares, our CapEx, and one acquisition without changing our debt levels. The confluence of all the factors I've described thus far leads us to expect that $270 million in adjusted EBITDA for 2022 does remain achievable, but we now point to a range of between $260 million and $270 million for the year. I'll turn to our growth and strategy. All of our efforts are focused on women's, children's, and babies' health and on our amazing affiliated clinicians who provide care as well as the research, education, and quality and safety improvements required to be the leaders in their vital fields. On July 1st, we formally changed our name to Pediatrix Medical Group to underscore this complete focus. Our move into a combination of pediatric primary and urgent care will help us serve this population much more broadly and effectively. I discussed last quarter the additions to our team under Dr. Jim Swift, our Chief Operating Officer, and we're now fully underway in our growth plans. Between now and the end of 2023, we anticipate we will expand from our current footprint of 21 clinics across 3 markets and 2 states with between 40-50 clinics across 8-10 markets in six states. We expect that this growth will come from a combination of de novo clinic openings and acquisitions. We're also confident that we can fund this growth with internally generated cash flow, and we intend to execute in a fashion that will not dilute our Adjusted EBITDA. On the No Surprises Act, as I mentioned earlier, to date, we haven't seen any notable change in payer behavior. Related to out-of-network cases, we are still waiting for HHS to finalize the tools guiding the details of the arbitration process. That said, we're certainly not sitting idle. Our managed care team, alongside our partners at R1, have built a really robust capability to manage this arbitration process in a thoughtful, data-driven way. Here again, we're much better prepared for this process than we could have been on our own. Before I turn the call to Marc, I want to thank our affiliated clinicians, our operators, and our support teams for all their hard work and dedication to this organization. In my now two years at Pediatrix, I am really awestruck by what our people do for families across the nation. Marc? Thanks, Mark. Good morning, everyone. I'll focus my comments today on our revenue cycle management transition process, then add to Mark's comments on our outlook and financial position. At the top line, the decline in our same unit pricing was measurably less than we reported in Q1 when you exclude the contribution from CARES dollars in both periods. The revenue impact from the RCM-related matters Mark discussed, which we bucket as a component of pricing, was less than half the magnitude of the Q1, or roughly $5 million. Payer mix, which can fluctuate quarter to quarter, represented a headwind in Q2 versus a modest tailwind in Q1. Looking at RCM, our transition to R1 created an increase in accounts receivable and related reserves, which unfavorably affected our revenue in the Q1 and, to a lesser degree, the Q2 of this year. This AR buildup continued beyond March, followed by a significant improvement in cash collections towards the end of the quarter. The impact related to our private pay business, not managed by R1, was negligible for the quarter and is a small component of the $5 million I referenced. All told, you'll see in our press release and in our 10-Q filing this morning that both our gross and net AR declined modestly for the quarter, and DSOs came down by one day compared to March 31st to 58 days. We're certainly pleased with this direction, but DSOs at quarter end are still higher than normal. As of today, we view our RCM activities as bifurcated. As Mark noted, we are now running normal billing and collecting activity related to current patient services. Separately, we're also working the more aged AR and will continue to do so through the remainder of the year. The pace and trajectory of this activity could represent a swing factor within our range of expected EBITDA for the year. For modeling purposes, our 2022 outlook reflects adjusted EBITDA in the H1 of the year of $116.2 million. Additionally, within our outlook, we expect our adjusted EBITDA for the Q3 to increase in the mid-single-digit% range compared to $73 million in the Q3 of 2021. Lastly, we remain in a strong financial position. We generated $82 million in operating cash flow in the Q2, up about $11 million year-over-year, funded $64 million in share repurchases, our normal CapEx, and a small practice acquisition. At quarter end, our total debt of $800 million was effectively unchanged from March 31st, and our leverage based on trailing twelve Adjusted EBITDA was just under 3x. With that, I'll turn the call back over to Mark. Thanks, Marc. We'll now open the call to any questions. Ladies and gentlemen, if you do have a question, please press one then zero on your touch tone phone. You'll hear an indication you've been placed into the queue, and you may remove yourself from queue by repeating the one then zero command. If you happen to be using a speakerphone, we ask you to please pick up your handset and make certain that your phone is unmuted before pressing any buttons. Again, for questions, press one then zero at this time. Our first question will come from Tao Qiu from Stifel, pardon me, Stifel. Go ahead. Hey, good morning. You mentioned that you saw some improvement in collection toward the end of the Q2, and, you know, DSO is down one day, you know, in the Q2, but still pretty much elevated. You know, how fast do you think you can get the number down in the next few quarters? Hey, Tao, it's Marc Richards. How you doing? I mean, that's certainly the goal here in the third and Q4. We'd expect improvement through the Q3 and into the Q4. As you know, historically, our DSO sat right around 50 days, so you know, we still have work to do to shave that down to a normal cycle, Tao. Got it. In terms of pricing, and yeah, could you give us an update on kind of what kind of rate you are seeing, you know, out there in terms of, you know, either Medicaid or commercial rate? I know that some states have increased their Medicaid rate, and I think commercial payers are also more open to higher rate growth to cover inflation. Any commentary you could provide, it would be much appreciated. Thank you. Hey, Tao. It's Charlie. I don't know that we saw anything in the quarter on the Medicaid side to call out. Our general expectation is something in the flattish range, and that's generally how it came through. As Mark Ordan mentioned, excuse me, we're still in effectively business as usual related to managed care renewals and contracting. As I've said in the past, our general view related to overall same unit peer pricing, excluding the impacts of payer mix or as we've seen in the first half of this year, some of the RCM matters, something in the modest range of 1%+, 1%-2%. Digging through some of the impacts to our reported pricing this quarter were in that similar range. Got you. If I may squeeze in one more. Congrats on the rebranding efforts. I remember that during the pandemic, there was a delay, you know, of this initiative due to cost concerns. You know, what kind of G&A impact did this have on the Q2? Any lingering impact in the second half you expect here? It actually had a very modest effect. We had done so much of the work internally. We have a terrific head of marketing and a marketing team, and we had made a lot of the changes, so the incremental expense to formally change the name was negligible, and I think is really gonna have a galvanizing effect on the organization. Got you. Thank you. Thanks, Tao. We'll go next to the line of Brian Tanquilut with Jefferies. Go ahead, please. Hey, good morning, guys. I guess Mark and Marc. But Mark, just on the guidance, maybe without going into quarterly guidance, any color or qualitative comments you can make for us, you know, to consider as we model Q3? Sure. We were going into the quarter thinking that the $270 was the appropriate number, and as I said, $270 is certainly achievable. Because of the, I would say the most major setbacks that we had was from the transition to R1 and the cost, it hit the revenue line item, but I look at it as a cost that was incurred in Q1 and to a lesser extent in Q2, and we'll see how much of that we can recover. We've been working hard, and we have a terrific team doing it to know what that'll shake out to by the end of the year. Payer mix certainly fluctuates by quarter, and in this quarter, it had a negative effect on us. We felt that it's analytically more appropriate to call to a range of 260-270, but we can't say, you know, where in that range it will fall. Again, depending on how we recover from the transition efforts that we described, that will have a major effect on where we end up. Brian, specific to your question on Q3, you know, we expect quarter-over-quarter when looking back to Q3 of 2021, you know, growth quarter-over-quarter in the low single digits. Got it. Okay, that's very helpful. I guess, Mark, since you touched on payer mix, do you think or are you seeing any signs that this is kind of like the broader macro environment starting to show up in the payer mix? I mean, we saw this obviously during the last recession. Just curious what you're seeing maybe ahead of time. No, we haven't. No, we're not seeing that. As a matter of fact, payer mix, and I know from other organizations, same thing, payer mix, can really fluctuate a lot and not because of a pattern. There is no pattern that we see that would indicate any shift, or I would've called it out. All right. Got it. Thank you. We'll go next to the line of Kevin Fischbeck with Bank of America. Go ahead. Oh, great. Thanks. I think you mentioned a $10 million headwind in Q1 and $5 million in Q2 on the R1 transition. Is that $15 million kind of like something that we should think about as potentially coming back in? I guess in your guidance range, is that like how to think about the high and the low end of that range? Are there other factors besides how much of that you're recouping? No, I would think of a component of that loss in the first half of the year is gone. Some of it, of course, is still recoverable, and that's what we're parsing out right now. That uncertainty on mix shift and then is there labor pressure? Like how to think about if we thought at least 270 now being, let's just I'll just say it this way, you're not saying it this way, but at least 270 being at least 260, you know, what other main buckets besides this are we thinking about? Yeah. Labor is a relatively small factor. As I said, I called it out this time because I didn't want people to think that we're not focused on the fact we're in a tough labor environment. We have a different labor mix than other than hospitals do and others do. I think that and other factors make it hit us less. The primary swing factors for 2022 that we see today are a combination of mix and what we can recover in the RCM transition process. Obviously, the other factors we don't forecast what volume's gonna be. You know, we had solid, but you know, a lot of gains in volume just for the quarter. All those things will determine where we are in that range. Okay, there's no change in your volume outlook per se from last quarter. No These other factors. Okay. On the labor side, you have a lot of different businesses, you've been expanding different businesses. Would you say the labor is more difficult than any specific part of the business? Not really something I would call out there. I mentioned last time that we have a terrific recruiting arm in the company, so we've done a very good job of keeping pace with turnover. There's no particular area that's driving the increase in costs, and the increase in costs are, you know, relatively modest, but I feel like worth calling out nonetheless. All right, great. Thank you. We'll move next to the line of Pito Chickering with Deutsche Bank. Go ahead, please. Hey, good morning, guys. Thanks for taking my questions here. Sort of on that sort of $50 million of charges sort of in the first half of the year due to R1, my understanding is that was simply the aging of receivables into different buckets, hence the charges. But when you said that part of the Q1 component of $10 million is gone, can you explain sort of why that's gone? I thought you simply didn't get a bill out into a payer, hence it's aged out. I'm a little unclear why it would not be recoverable when the R1s are caught up with the billing. Well- Go ahead. Sorry, Mark. No, the component of that is denials and timely filings. At any point in time, to the extent bills haven't been sent out, at that point in time, it's a timing issue. If those bills are not sent out under the correct timing as dictated by our payer contracts, that money is then lost. That's the component I refer to. That plays into, you know, Pito Chickering, just from based on experience, that is what effectively plays into the buckets of AR and how we will reserve against them as they flow through. Okay, fair enough. And then to follow up on Kevin's question on the sort of salary costs, about $3 million above the forecast, I was under the impression most of your physicians were sort of under multiyear contracts with both fixed and variable components. You always been sort of more insulated from sort of these labor pressures. I guess I'm a little, you know. Can you start walking through where that $3 million sort of came from versus expectations? Because I guess I thought you actually would've been more insulated than this, than that. Yeah, Pito, it's you know keep in mind we've got you know in the thousands of clinical providers across the organization. You know as pleased as we are with our general turnover rates, there is still turnover. It's relatively modest, but there is. You know as we looked at the Q2 and dug into you know those individual practices, et cetera, where there was a you know a financial call-out you know the majority of instances were related to you know that modest level of turnover and open position that hadn't yet been filled and the like, and thus the need for either existing clinicians in that practice to take extra shifts on call over time and the like, you know prior to refilling that position. you know, in each one of those instances, obviously there's been a work plan, and we do think that, you know, there's recapture there with some cost saving. That's the general, you know, tone of how we saw in the quarter. you know, again, as Marc mentioned, you know, roughly $3 million overrun versus our internal forecast is relatively minor. All right. A last question here on pricing. Just can you refresh us on where the out-of-network revenues are today, if they've changed sort of versus year-end? Also on the government versus commercial payer mix. As people sort of think about potential, you know, recession requirements, so where are we today versus where we were in 2008? Thanks so much. If I understand your question correctly, we continue to be overwhelmingly in-network. Less than 5% of our waitlist. We're over 95% in-network, so that hasn't changed at all over the last two years. As I said, we haven't seen any pattern or change in behavior while we wait for clarity from HHS. But I'm not sure that I answered exactly your question. Did I? Yeah. That's for out-of-network. I guess the question is, as people are thinking about, you know, different, you know, recessionary risks here, you know, what's the sort of government commercial mix today, and where was that, you know, in 2008? I don't know if I have stats from 2008 on hand right now. I can speak to what our experience has been over the past four or five years. You know, from an absolute standpoint in terms of the percent of our patient volume as measured by gross charges on either the two sides, government or non-government, which is how we look at it. You know, where we stand today, the government component is very comparable to where it's been over the past couple of years. Actually, you know, even for this quarter is maybe 100 basis points or more lower than where it kinda topped out, call it about four years ago. During that period, you know, as we view it is likely that employment growth through the middle and latter stages of economic expansion prior to the pandemic, you know, had a favorable role for us. Great. Thanks so much, guys. Next, we'll go to the line of Whit Mayo with SVB Securities. Go ahead, please. Thanks. Maybe just to follow up on the payer mix question. I don't know if you've disclosed this, but I was just curious what% of your commercial revenues today are coming from patients on the exchanges? I don't know if we've ever had a perfectly clean view on that, Whit, because generally and even going back to the initiation of the exchanges, oftentimes you know we would be submitting a claim to the same carrier whether it was exchange program or not. We've never had a perfectly clear view of ACA volume. That said, you know, in general, any kind of contracts we had that covered that were under the existing contract we have with the payer. They had an exchange program or a normal insurance program, our contracts were comparable. Got it. Well, I guess maybe to ask it a different way. If you look at, go back to 2014, I mean, did you see an uptick in maybe your commercial mix where that could be attributed to exchange patients? I'm just trying to get a sense of sorta how you guys think about that. I think we'd have to get back to you on that. Yeah. Okay. By my recollection, we didn't at the time, but we can track back. I don't remember it being anything that we measured back then. No, that's fair. Just, I'm just trying to, you know, obviously think about, like, if the subsidies go away, you know, what the potential headwind could be if there is a headwind. The other question, UnitedHealthcare has a notice on their website that indicates that you may be out of network in Georgia in 2023. I'm sure you probably can't discuss this, but, you know, maybe there's nothing abnormal about this. I presume this is just ongoing negotiations. I just thought I'd ask if there's anything to talk about there. Really a final question just on the G&A target $250. Are you feeling any better or worse about that? On the first, we wouldn't comment on that. Just normal negotiating processes with all of our payers. We have over 500 contracts, and I'm aware of that, so there's nothing else to read into that. On our G&A targets, we're comfortable with what we've laid out. Okay. Thanks, guys. Appreciate it. We'll go next to Ryan Daniels with William Blair. Hey, guys. This is Jack Flint on for Ryan Daniels. Thanks for taking my question. I just have one quick question. I think all my other questions have really been answered. I know the Brave Care integration wasn't an outright acquisition. But kinda given the inflationary environment and other, you know, current market conditions with rising rates, et cetera, do you have any update on the acquisition pipeline and, you know, possible investments? I guess, you know, just to kinda rephrase this, you know, what's your mindset when it comes to M&A and investments like Brave Care? You know, are you kind of looking at areas to supplement growth on the urgent care side, more technology investments, et cetera? You know, any color you have on that would be appreciated. Well, not to sound too vague, we're excited to grow in any area where it fits our core business and where it's accretive. In many of our subspecialties, we're actively looking at ways to increase our footprint. We'd like to grow in serving NICUs. A lot of my time and Jim Swift's time is spent with our hospital systems and prospective hospital partners to find ways to increase. Certainly in primary and urgent care, you mentioned Brave. We acquired outright NightLight of Orlando and NightLight of Houston. We will look at both de novo growth and also acquisition growth, and we think both of those we can do without undue pressure on using our cash flow. As we mentioned, which I think is very important, we're also able to buy back 3.3 million shares of our stock with all of this without changing our debt levels at all. We are eager to grow when there are opportunities. You know, some of it, the lack of clarity from HHS, you know, probably informs some lag, but we're still active and out there. Perfect. Thanks. As a reminder, ladies and gentlemen, if you do have questions, please take this opportunity now to press one then zero on your touch tone phone. We'll go to the line of A.J. Rice with Credit Suisse. Go ahead. Hi. Thanks. Hello, everybody. A couple things. Obviously, the step-up on the buybacks, I wanted to ask you about that. Is that an opportunistic buy you did in the Q2, or should we begin to think that you're gonna commit more capital to that going forward? Well, I have the classic CEO answer. These are the kind of decisions that we work closely with our board, and we think when we think that that is a strong use of capital, that's where we put our capital. We felt the board felt unanimously that this was a good time to be buying back our shares. I can't comment on future activity. Okay. A lot of back and forth on the R1 transition and the impact it's had on revenues to date. I wondered within the context of that. I'm not 100% clear. Is that something you would characterize as just what can happen when you make a transition like this? Do you feel like R1's dropped the ball? Is there something you did that has resulted in this? Is there any recourse? Do they owe you any kind of concession because this has happened? I said in my comments that, A.J., that we had, in retrospect, moved too abruptly. I'd say we had an RCM team, a big RCM team, and in the move from our RCM team to R1, I'd say with hindsight, which is always handy, we should have retained our team longer to give R1 more time to get up to speed. We did that more abruptly, that's what I mean by more abruptly, than I wish we had. There's no recourse to R1, and I would say it just collectively didn't go as smoothly as we had hoped. You know, this is the kind of thing that can happen. We have an enormous RCM function, so I think we did it pretty well, but not as well as I wish we had. Having said that, importantly, we're at a point today where we have a very solid RCM function. As I mentioned, in addition to that, we have an arbitration capability that we would never have been able to match on our own. As Marc rightly pointed out, the other side of the RCM effort right now is collecting as much as we can from the earlier months to recover as much as possible. Okay. I think that it was a very good transition, a very good move to transition to R1. We're not disappointed with our decision at all. We're disappointed by the turbulence and by the fact that we believe had we kept people on our team longer, it would have been a better transition and less costly for us. Okay. You did mention with respect to No Surprises Act in your comments that you've geared up your team to be able to deal with any arbitration issues that might result. I just wondered if Is that gearing up for something that may happen, or are you actually seeing more cases go to an arbitration at this point? Or, was your arbitration maybe more? We're overwhelmingly in-network, so we haven't seen an increase in arbitration. The only areas where we're out-of-network and we have had arbitration, we've been very pleased with the results. We know that one of these days, there will be some final ruling and things will settle in and we will need to have a process to settle these in arbitration. It doesn't sound like you're seeing any delay in MCO recontracting, as people are waiting for those final rules to come out. It's just sort of normal course it sounds like, is the way you're describing it. Is that correct? Yeah, that's correct. You know, they would say the latter part of last year, you know, a lot of people were expecting it to be a much tougher environment. Certainly to date, we haven't seen that. All right. Just my last area, just a quick question, is on the push for the pediatric urgent care centers, obviously, you've known some of them for a little while now. Anything developing, either making you more or less optimistic about the economics of that business and the opportunity set? You know, a lot of this during COVID was put in place, and maybe parents were saying, "Hey, I've got a pediatric urgent care center because I wanna keep my kids away from, you know, places where they might catch COVID from adults." Are you seeing any change in the demand profile as we progress through the pandemic? We weren't basing our decision on what we saw at the time was a COVID bump. Like any acquisition, you look not only at what's going on at the moment, but what went on historically. We weren't moving into this because of a COVID froth in earnings. No, we continue to be very pleased with the P&L of these operations and the economic opportunity, and our thinking about it hasn't changed. If there are times when there's an upward blip because of a COVID, which obviously for all reasons, you don't want another COVID, but obviously that's not the driver of our reason to do this. Our reason to do this is as it's always been that we are in our major markets the largest employer of pediatricians. We have an enormous impact on what happens in pediatric care in our markets, and we think that this is a very important step to filling out our ability to help mothers and babies and children. Okay, that's great. Thanks so much. We have a follow-up question from the line of Kevin Fischbeck with Bank of America. Great, thanks. I just wanted to get maybe a little more color about what you mean about the arbitration improvements with R1. What exactly are you guys have in place now that maybe you wouldn't have been able to do before? Well, the arbitration process right now is only where we are out of network, and we're the only place where we're principally out of network is in Texas. I would say that we have the arbitration process, which maybe people don't know, is a case-by-case process. You can imagine how laborious a process like that could be if it ever became significant. You have to have you know a machine in place to handle that and to handle that intelligently. I think we have that today thanks to our partnership with our team, our managed care team and R1. I think that would have been very difficult to build on our own. Okay. I guess, like, do you have a sense about where your pricing is versus kind of the median in network? My assumption is that if you're out of network, almost definitionally, it's because you'd be above the median in-network rate. I guess in that 5%, there might be some risk, but broadly speaking, any way to think about that? No, we don't. It varies payer by payer and contract by contract, so I don't have that. Okay, great. Thanks. Gentlemen, we have no further lines in queue at this time. Great. Well, thank you all, for your understanding, your support, and we look forward to updating you on our progress, as we move forward. Enjoy the rest of your summer. Ladies and gentlemen, that will conclude your conference call for today. Thank you for your participation and for using AT&T Event Conferencing. You may now disconnect.