Greenbrook TMS Inc. Q4 2022 Earnings Call

Speaker 1: I.

Speaker 2: Thank you for your patience. Please do not disconnect. Your conference call will begin momentarily. Once again, please continue to stand by. Do not disconnect. Your conference call will begin momentarily. Thank you for your patience. Music

Speaker 1: Can I, I I.

Speaker 1: And extr TR.

Speaker 1: That.

Speaker 1: I.

Speaker 2: Welcome to the Green Book TMS Inc's FY 2022 results conference call-in webcast.

Speaker 2: All lines are currently on mute to prevent any background noise.

Speaker 2: I would like to remind you that this conference call is being recorded today and is also being webcast on the companyís website at www.greenbrookstms.com under the ìInvestorsî section ñ Events. After the speakerís remarks, there will be a question and answer session. Analysts and investors are reminded that any additional questions or comments may be reported

Speaker 2: can be directed to the company at investorrelationsatgreenbrooktms.com. This call contains forward-looking statements which reflect the current expectations or beliefs of the company based on currently available information.

Speaker 2: Forward-looking statements are subject to a number of risks and uncertainties that may cause the actual results of the company to differ materially from those discussed in the forward-looking statements.

Speaker 2: Factors that could cause actual results or events to differ materially from current expectations are discussed in the Risk Factors section of the company's annual report on Form 20-F where the fiscal year ended December 31, 2022 and the company's other materials.

Speaker 2: filed with the Canadian Securities Regulation Authorities and the U.S. Securities and Exchange Commission from time to time, which are available on CDAR, EDGAR and the company's website. Any forward-looking statement speaks only as of the date on which it is made and the company disclaims any intent or obligations.

Speaker 2: to update any forward-looking statements unless required by law. And I would like to turn the meeting over to Mr. Bill Leonard, President and Chief Executive Officer of Greenbrook TMS and Ernst Lobster. Chief Financial Officer, please go ahead.

Speaker 3: Thank you, operator, and thank you to everyone for joining our conference call and webcast today.

Speaker 3: During fiscal year 2022, we added significant operating scale and top line growth to the business. We are now focused on the execution of the recently announced restructuring plan to leverage our scale with the goal of further reducing complexity, streamlining our operating model, and increasing our capacity to meet our needs.

Speaker 3: and drive operational efficiencies to improve our cash flows and ultimately achieve profitability in the future.

Speaker 3: During Q4 2022, we continued the ongoing integration of Success TMS, including the convergence and overlaying of the best-in-breed processes, such as the Success TMS marketing and intake of TMS.

Speaker 3: We were very excited about the record highs in the forward-looking indicators in Q3 2022 going into Q4 2022 from these efforts. Unfortunately, this pipeline did not translate into expected proportionate ramp-up in new patient starts, impacting the expected revenue ramp and cash collections, which ultimately put the stress on the company's liquidity position late in Q4.

Speaker 3: profitably.

Speaker 3: We are very excited about the ongoing rollout of Spravato program, where we have now more than tripled our footprint during fiscal 2022.

Speaker 3: This program supports our long-term business plan of utilizing our existing network of treatment centers to deliver new and innovative treatments to patients suffering from MDD and other mental health disorders.

Speaker 3: We believe our leadership position and nationwide footprint continues to serve as a valuable platform to bring the needed help to patients.

Speaker 3: As at December 31, 2022, the company has expanded its offering servado to 42 TMS centers across the U.S. As previously announced, the company has embarked on a comprehensive restructuring plan aimed at decreasing our footprint by 50 treatment centers.

Speaker 3: and focusing operations to the company's most profitable treatment centers across the United States.

Speaker 3: The purpose of this restructuring plan is to address liquidity concerns and allow us to achieve sufficient cost savings to satisfy operating cash requirements, debt obligations, and remain in compliance with our debt covenants.

Speaker 3: We expect that restructuring plan will streamline patient engagement and deliver care while reducing facility and logistical overhead.

Speaker 3: We also expect that restructuring plan will enable Greenbrook to concentrate marketing spend on more effective outreach while continuing to deliver quality care to patients in all of its current core markets.

Speaker 3: As of the date of this press release, the company has realized approximately 17 million in annualized recurring cost reductions through a significant reduction in headcount and by optimizing marketing spend through key learnings from the company's Q4 2022 marketing efforts.

Speaker 3: The company will also continue to reduce recurring corporate, general, and administrative expenses.

Speaker 3: These savings will be fully reflected starting late Q2, 2023, going into Q3, 2023, as the cost related to executing these savings dissipates.

Speaker 3: We believe we will remain on track to achieve the previously announced target of $22 million to $25 million in cost reduction once the restructuring plan is fully implemented.

Speaker 3: And for now, a more detailed review of the company's financial and operating performance, I will turn it over to our CFO , Ernst Luebscher.

Speaker 4: Thank you Bill. As Bill mentioned, revenue for fiscal 2022 increased by 32% to 69.1 million as compared to fiscal 2021 and 50% to 21.1 million for Q4 2022 as compared to Q4 2021. This was driven predominantly by the completion of the Success CMS acquisition.

Speaker 4: are primarily attributable to the geographic distribution of revenue.

Speaker 4: Same region sales growth was 9.7% in fiscal 2022 as our core established region shows resilient performance and continue to grow.

Speaker 4: a regional operating loss of $2.1 million as compared to an entity-wide regional operating income of $0.3 million during fiscal 2021, predominantly due to operating 183 active TMS treatment centers as of December 31, 2022 as compared to 147 active treatment centers as of December 31, 2021.

Speaker 4: entity wide regional operating loss was 0.1 million during Q4 2022 as compared to a small regional operating income during Q4 2021. The increased loss position were primarily as a result of incurring duplicate costs of the combined business subsequent to the acquisition of success DMS arising from additional operating costs.

Speaker 4: arising from additional operating synergies not yet executed and increased marketing spend.

Speaker 4: As Will mentioned, we were very excited about the potential of the significant amount of new leads and the positive trend in forward-looking indicators late in Q3 2022 into Q4 2023, we previously reported. Unfortunately, the pipeline did not translate into new patient starts as ongoing integration initiatives paired with a significant pipeline overwhelmed our team during a significant transition period and resources were spread too thin.

Speaker 4: Despite these challenges and turbulence was caused, we came away with some key learnings, which was the catalyst for the restructuring plan, where we are condensing our footprint, enabling to concentrate marketing spend and other resource for more effective outreach, conversion and treatment.

Speaker 4: Corporate GNA increased by 27% to $26.2 million during fiscal 2022 as compared to fiscal 2021, and by 18% to $5.9 billion during Q4 2022 as compared to Q4 2021. 18 increases were predominantly due to the excess KMS acquisition.

We believe we can reduce corporate G&A costs significantly as part of our restructuring plan. The loss for the period and comprehensive loss during fiscal 2022 was $62.4 million, predominantly due to the impairment loss of $20.7 million recognized, which was necessitated by the Restructuring Plan and current market conditions. Despite these impairment charges, the company believes it can improve its overall performance and performance.

2022 was 2.6 million, including restricted cash, putting pressure on our liquidity position, which we subsequently addressed through additional financing from our supporters, insiders and lenders.

was 2.6 million including restricted cash putting pressure on our liquidity position which we subsequently addressed through additional financing from our supported insiders and lender. Moving on to our co-operating metrics.

As of the end of fiscal 2022, the total treatment centers increased by 23% to 183 from 149 a year ago. As mentioned previously, subsequent to the acquisition of the restructuring plan, we will be operating 133 treatment centers. Due to fiscal 2021, the number of consultations performed increased by 97% to 27,831.

while the number of new patients starts increased by 67% to 279.

and the number of treatments performed increased by 58% to 69,789.

this progress across our existing platform as well as increased marketing spend as I previously mentioned.

We believe that devoting more resources and a focus to our best performing centers through the Restructuring Plan and robust growth of our provider program will be the catalyst for future revenue growth, despite the reduction in centers. Back to you, Bob.

Thanks, Ernst. Despite facing some recent turbulence, we believe mental health remains a key focus in the United States and the unmet demand for treatment remains an all-time high. We continue to offer innovative solutions for this unmet need and our leadership position and nationwide footprint continues to serve as a valuable platform for the future of our country.

to bring that needed help to patients. We are particularly excited about the rollout of Spravato program, where we have more than tripled our footprint during fiscal 2022. We continue to make progress on the restructuring plan and showed a resilient performance in the core regions of the business throughout fiscal 2022. We believe that we are now well positioned to reduce the business cost structure.

to operate profitably.

Before ending, I would like to take a moment to thank our amazing team. We are extremely proud of them as they continue to deliver the highest levels of care. But most importantly, we know that we're making a difference.

We now have treated over 30,000 patients with over 1 million treatments performed. We are having a significant positive impact on the lives of so many people suffering from mental health disorders.

We look forward to keeping you updated on the progress of the company. Thank you for your time today and with that operator, we will now take questions. Thank you, sir. Ladies and gentlemen, if you would like to ask a question.

please press star followed by one on your touch tone phone. You will then hear a three tone prompt acknowledging your request. And if you would like to withdraw from the question queue, please press star followed by two. And if you're using a speakerphone, we do ask that you please lift the handset before pressing any keys.

Please go ahead and press star 1 now if you do have questions.

And your first question will be from Frank Tackenen at Lake Street Capital Market. Please go ahead.

Hey, thanks for taking the questions. I wanted to start with the follow-up related to your comments on learnings from the marketing spend in Q4 of last year. I was hoping you could speak to those a little bit more directly and maybe talk to how you expect the new marketing strategy to manifest itself in the financials in the front.

integrating, we were going through training, expanding our call center, and we just overwhelmed them. And I think a couple of lessons we learned were the fact that take that spend and focus on the centers that are driving the most revenue to our system, that really have the doctors in place, the staff in place that has great ability to close patients.

And so that's what really was the catalyst to kind of look at the footprint, reduce it somewhat, where we're still accessing those patients within that marketplace. But we can derive those patients to particular centers with the resources in place that allows us kind of the capability of kind of providing the care needed. We do expect that to kind of continue with a more streamlined approach to marketing.

continues to be really solid progress there. Can you maybe speak to your expectations around network wide penetration by year end or over the next couple of years that you expect Sravato to get into and maybe as a second part to that, any updated thoughts around a buy in bill within that line item?

Yeah good question. Look we're really pleased with Spravato last year. We ended the year right around 40 plus centers. Those centers ramped up throughout the course of the year so if you looked at the contribution at the end of the year we liked what we saw with them. We would expect that we would expect to kind of shoot for a target.

almost doubling that for 2023, which will add significant revenue to the pipeline with Spervato. As we have said in the past, we've taken a very conservative approach to Spervato in terms of our billing methodology, which is really administer and observe.

We do expect to pilot buy and bill this year at a number of centers to learn from that experience as well. That'll drive a higher contribution to the centers. We don't have a date for that to start, but we are looking forward to a small number of our centers really diving in.

with buy and bill. The key to buy and bill is not only will you generate higher revenue but a higher profit, a higher contribution. More importantly, it does give you access to all the payer plans in place that are covering Spervatto. So I'll have more information for you on our Q1 call, as I believe that's gonna be scheduled out about three weeks from now.

Sure, in terms of, so as we said we target 22 to 25 million in savings and that is that is all all-encompassing so both on the corporate and the direct patient and centric side.

So if you if you look at kind of where we want to be getting, there's obviously variable and non variable cost there. We want to operate direct center and patient care costs at around call it to the 12 million mark was obviously a ramped ramped revenue. But more importantly, we want to generate kind of a 55%

margin after direct center and patient care costs. That's really the target that we're going for. Other regional center support costs, once again, as we mentioned, we've reduced marketing very significantly, which forms part of the restructuring and through the learning.

So we were operating at at kind of a between Q3 and Q4, almost a 4 million run rate of of regional marketing spend, we are giving a significant haircut to that. So we're going to be operating on depending on the revenue levels at kind of between a

five and six million cadence there. And once again, we want the regional operating margin, which is really the important metric to be north of 20% going exit run rate in Q4.

Okay, that's good, Connor. Thanks for taking the questions.

Okay, that's good, Kaveri. Thanks for taking the questions. Thank you. Next question.

Next question will be from David Martin at Bloomberg. Please go ahead sir. Good morning Bill and Ernst. You mentioned that you're still accessing patients in the regions where you've closed centers. Does that mean you still got all

And, you know, is it going to cut down on your ability to reach as many patients in that area or do you find them willing to travel further? Yeah, really good question, David. For all markets, we will still be existing except for Delaware and Iowa, and those were very small markets for us. I think Delaware...

And I think you've got to look at it.

in two ways. One is TMS still requires that patients that come on a daily basis. We do believe we have enough centers in play to allow us to access those patients. And with Spravato, we're seeing patients have the ability to travel a little further out because you don't have to be at the center on a daily basis for that period of time of six weeks.

So we feel really good about our current footprint. We basically consolidated some regions, which is one of the lessons we learned with our acquisition of success, and was they had less centers, larger centers. We had more centers, but I think we took the best of both worlds and really kind of consolidated to a number of centers that meets the demand.

provides some cost savings and also allows us to access patients for both TMS and Spivada. Okay, thanks. You've talked in the past about timing to get...

to EBITDA break even. What are your thoughts now? When you say 20% margin exiting 4Q, does that break even for you?

Yeah, that's moving towards breakeven. So I think the key here is to execute the restructuring plan. We we we obviously want to take 22 million of costs out of the business. We anticipate that the restructuring plan will be fully implemented by the end of q Q4 going to Q1 .

And that's kind of the timing that we expect to reach breakeven as well. Okay, last question. You mentioned the steps towards improving the translation to new patient starts. Are you seeing success on that front now? Have you turned that trend around? Yes, for sure. So if you look at

on that front. So revenue is all from a daily perspective. So we've already become more efficient as it relates to that. Okay, does that answer your question?

I'm just wondering like the bottlenecks that you were facing that Yeah, yeah, I think I think that's really in the restructuring plan what we did there is instead of spreading our marketing dollars Which is more costly across the wider geographic Geographic distribution which costs more and more

more inefficient from a convergence standpoint, we've now condensed it. So for example, instead of spreading in Maryland, Delaware, spreading a doctor's time between three locations, we've now condensed two doctors to a certain one location, which gives you more scheduling flexibility to generate better conversions.

Similarly, coordinated time is now focused on leads that is more likely to convert. And then we obviously then have a focus on a higher conversion rate. Similarly, the support resources, like the RCM function, are now not spending time on leads that is unlikely to convert.

where we don't have the appropriate infrastructure in place. And we've already seen kind of that, that yield results going to Q1.

the appropriate infrastructure in place. And we've already seen kind of that yield results going to Q1. Okay, thanks.

Thank you. Once again ladies and gentlemen, if you do have any questions at this time, please press star followed by 1 on your touchtone phone.

And at this time, gentlemen, it appears that we have no further questions registered. Please proceed.

Well, thank you for your time today. We appreciate the opportunity to update you on the company. And as I said earlier in the call, it's a short turnaround. We'll be announcing our Q1 results here in a few weeks. So we look forward to talking to you at that time and showing the progress on the restructuring plan. Thank you again for your time.

Thank you, sir. Ladies and gentlemen, this does indeed conclude the conference call for today. Once again, thank you for attending. At this time, we do ask that you please disconnect two lines.

I think extr TR.

I.

I I.